Avtor/Urednik     Kern, Izidor; Osolnik, Katarina; Tomič, Viktorija; Uršič, Viktor
Naslov     Whipplova bolezen
Prevedeni naslov     Whipple's disease
Tip     članek
Vir     Zdrav Vestn
Vol. in št.     Letnik 78, št. 1
Leto izdaje     2009
Obseg     str. 13-8
Jezik     slo
Abstrakt     Background Whipple’s disease is a chronic, multisystemic disease caused by a microorganism named Tropheryma whipplei. Disease is rare, so it presents a diagnostic problem to clinicians. Long-term treatment with antibiotics is successful. We report two patients with longstanding complaints and accurate histopathological diagnosis further on confirmed by molecular biology test. Methods Both patients presented with malaise, weight loss and laboratory parameters of chronic infection. Since rheumatological, haemathological and infective causes of complaints were ruled out, patients were admitted to our hospital. Histopathological examination in both cases confirmed Whipple’s disease and antibiotic treatment was started. Polymerase chain reaction using specific oligonucleotide primers for 16S rRNA was performed on formalin-fixed, paraffin-embedded tissue samples of both patients and peripheral blood of one patient. Results One patient presented with advanced disease and despite antibiotic treatment he died with signs of pulmonary arterial hypertension. The other patient was diagnosed early in the course of the disease and antibiotic treatment was effective. In tissue samples of both patients we found PAS-positive intracellular bacilli. By PCR method we detected a specific gene segment of Tropheryma whipplei in tissue samples and peripheral blood. Conclusions Presented two cases confirm the rarity of Whipple’s disease and illustrate the variety of nonspecific clinical findings which lead to late diagnosis. Histopathological changes are very specific on PAS staining. Molecular biology test aids in disease confirmation.
Izvleček     Izhodišča Whipplova bolezen je kronična, večsistemska bolezen, ki jo povzroča bacil Tropheryma whipplei. Bolezen je redka, zato jo težko prepoznamo. Dolgotrajno antibiotično zdravljenje je uspešno. V prispevku prikazujemo dva bolnika z večletnimi težavami, zanesljivo histopatološko diagnozo in potrditvijo z molekularnobiološkim testiranjem. Metode Pri obeh bolnikih so izstopali slabo počutje, hujšanje, laboratorijski kazalci kroničnega vnetja. Po izključevanju revmatološkega, hematološkega in infekcijskega vzroka težav sta bila napotena v Bolnišnico Golnik ‐ KOPA. Pri obeh smo s histopatološkim pregledom dokazali Whipplovo bolezen in uvedli antibiotično zdravljenje. V vzorcih tkiva obeh bolnikov, fiksiranih v formalinu in vklopljenih v parafin ter periferne krvi drugega bolnika, smo opravili test verižne reakcije s polimerazo s specifičnimi oligonukleotidnimi začetniki za zaporedje 16S rRNK. Rezultati Pri prvem bolniku je bolezen napredovala in je bolnik kljub antibiotičnemu zdravljenju umrl zaradi pljučne arterijske hipertenzije. Pri drugem je bila bolezen odkrita dovolj zgodaj, da je bilo antibiotično zdravljenje uspešno. V obeh primerih smo v tkivnih vzorcih dokazali PAS-pozitivne intracelularne bacile. V vzorcih tkiva in periferne krvi smo z verižno reakcijo s polimerazo pomnožili del gena 16S rRNK, značilnega za bakterijo Tropheryma whipplei. Zaključki Opisana primera potrjujeta, da je Whipplova bolezen redka. Zaradi pestre, neznačilne klinične slike jo pogosto pozno ali prepozno diagnosticiramo. Histopatološka slika je zelo značilna, ker lahko s PAS dokažemo prisotnost povzročitelja. Molekularnobiološki test zanesljivo potrdi etiologijo bolezni.
Deskriptorji     WHIPPLE'S DISEASE
POLYMERASE CHAIN REACTION
RNA, RIBOSOMAL, 16S
MIDDLE AGE