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The key to diagnosis is considering T. whipplei infection. PCR-based testing of tissue specimens rather than body fluids generally has a higher diagnostic yield. Histologic examination of intestinal biopsy samples remains an important diagnostic procedure, although it is less sensitive than PCR.

Treatment: Whipple's Disease

Although the optimal regimen and duration are not known (and likely depend on the site of infection), ceftriaxone (2 g IV q24h) or meropenem (1 g IV q8h) for 2 weeks followed by TMP-SMX (160/800 mg PO bid) for 3-12 months appears to be efficacious. For CNS or cardiac infection, ceftriaxone (2 g IV q12h) or meropenem (2 g IV q8h) for 2 weeks followed by oral doxycycline or minocycline plus hydroxychloroquine or chloroquine for 1 year seems prudent.

For a more detailed discussion, see Filice GA: Nocardiosis, Chap. 199, p. 1084; and Russo TA: Actinomycosis and Whipple's Disease, Chap. 200, p. 1088, in HPIM-19.

Outline

Section 7. Infectious Diseases