Investigations

1st investigations to order

FBC

Test
Result
Test

Anaemia is present in 85% of patients with classic Whipple's disease.[11]​​[49]​

Result

low haemoglobin

serum albumin

Test
Result
Test

Hypoalbuminaemia is present in 91% of patients with classic Whipple's disease.[11][14]

Result

low

serum CRP

Test
Result
Test

Non-specific test. Usually elevated in cases of Whipple's disease.

Result

elevated

serum ESR

Test
Result
Test

Non-specific test. Usually elevated in cases of Whipple's disease.

Result

elevated

upper GI endoscopy

Test
Result
Test

Upper GI endoscopy with biopsy is the preferred first diagnostic test.[50][52] To avoid sampling errors, at least 5 biopsies should be taken from various sites of the duodenum.

Result

duodenal mucosa may appear macroscopically pale yellow with clumsy and dilated villi and ectatic lymph vessels

Periodic acid-Schiff (PAS) staining of duodenal biopsies

Test
Result
Test

Diastase-resistant, Ziehl-Neelsen-negative, PAS-positive macrophages is the classic diagnostic marker. Morphological changes in PAS-positive macrophages indicate successful therapy.[75]

Result

PAS-positive macrophages

PCR

Test
Result
Test

Detects T whipplei DNA. PCR from duodenal tissue is a poor diagnostic criterion, because carriers can be healthy. PCR from sterile samples (e.g., lymph node, cerebrospinal fluid, synovial fluid) is more indicative for Whipple's disease, but should be assisted by histology whenever possible.

Result

positive for Tropheryma whipplei DNA

Tropheryma whipplei-specific immunohistochemistry

Test
Result
Test

Anti-T whipplei-positive macrophages are a diagnostic marker for Whipple's disease and are more sensitive than PAS-staining. Carried out on sampled tissue. Available at specialised centres only.

Result

detection of T whipplei antigens

Emerging tests

electron microscopy

Test
Result
Test

Non-specific visualisation of T whipplei within tissues. Carried out on sampled tissue.

Result

visualisation of bacteria

culture

Test
Result
Test

Extremely cumbersome and time consuming. Growth takes several weeks to months. Only available in specialised centres.

Result

positive for Tropheryma whipplei

serology

Test
Result
Test

Antibody pattern against T whipplei proteins of healthy people and Whipple's disease patients can be distinguished. Serology has not been established as a diagnostic tool.

Result

antibodies against Tropheryma whipplei

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