Whipple's disease other diagnostic studies

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Bhagyashree Deshmankar M.B.B.S.[2]; Sadaf Sharfaei M.D.[3]

Endoscopy and small bowel biopsy may be helpful in the diagnosis of Whipple’s disease. Diagnostic findings of Whipple’s disease include, PAS positive inclusions in macrophages of lamina propria. Other diagnostic studies for Whipple’s disease include electron microscopy which demonstrate bacteria, immunofluorescent assay to detect antibodies against Tropheryma whipplei and PCR, which demonstrates 16S rRNA gene of Tropheryma whipplei.

• Endoscopy of the intestine may show:^{[1][2][3][4][5][6][7][8][9][10][11][12]}
  • Thick circular folds
  • Erosions
  • Erythematous mucosa
  • Multiple whitish yellow small plaques 
• Small bowel biopsy may be helpful in the diagnosis of Whipple’s disease. Findings diagnostic of Whipple’s disease include:
  • PAS positive inclusions in macrophages of lamina propria
  • All the organs affected by disease may demonstrate PAS positive macrophages like heart, lungs, CNS, eyes, liver, spleen, joints, and bone marrow.
• Other diagnostic studies for Whipple’s disease which confirm the diagnosis include:
  • Electron microscopy, which demonstrates:
    • Typical trilamellar membrane of Tropheryma whipplei which consists of:
      • Plasma membrane
      • Thin homogeneous wall
      • Plasma membrane–like structure 
    • Gram positive cell wall structure
  • PCR of affected tissue, which demonstrates:
    • 16S rRNA gene of Tropheryma whipplei
  • Serum immunofluorescent assay, which demonstrates:
    • Antibodies against Tropheryma whipplei

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