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56-532: Whipple's disease is significantly more common in men, with 87% of patients diagnosed being male. When recognized and treated, Whipple's disease can usually be cured with long-term antibiotic therapy, but if the disease is left undiagnosed or untreated, it can ultimately be fatal. The most common symptoms are diarrhea , abdominal pain , weight loss , and joint pains .The joint pains may be due to migratory nondeforming arthritis, which may occur many years before any digestive-tract symptoms develop; they tend to involve

112-429: A polymerase chain reaction -based assay is also available, which can be confirmatory if performed on blood, vitreous fluid, synovial fluid, heart valves, or cerebrospinal fluid . PCR of saliva, gastric or intestinal fluid, and stool specimens is highly sensitive, but not specific enough, indicating that healthy individuals can also harbor the causative bacterium without the manifestation of Whipple's disease, but that

168-424: A concurrent decreased number of lymphocytes and plasma cells , per high power field view of the biopsy. Diagnosis is made by biopsy , usually by duodenal endoscopy , which reveals PAS -positive macrophages in the lamina propria containing non acid-fast , Gram-positive bacilli. Immunohistochemical staining for antibodies against T. whipplei has been used to detect the organism in a variety of tissues, and

224-657: A defense mechanism". The following types of diarrhea may indicate further investigation is needed: A severity score is used to aid diagnosis in children. When diarrhea lasts for more than four weeks a number of further tests may be recommended including: A 2019 guideline recommended that testing for ova and parasites was only needed in people who are at high risk though they recommend routine testing for giardia . Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were not recommended. Worldwide in 2004, approximately 2.5 billion cases of diarrhea occurred, which resulted in 1.5 million deaths among children under

280-470: A few cases such as those who have bloody diarrhea and a high fever, those with severe diarrhea following travelling , and those who grow specific bacteria or parasites in their stool. Loperamide may help decrease the number of bowel movements but is not recommended in those with severe disease. About 1.7 to 5 billion cases of diarrhea occur per year. It is most common in developing countries , where young children get diarrhea on average three times

336-689: A frequent cause. In the elderly, particularly those who have been treated with antibiotics for unrelated infections, a toxin produced by Clostridioides difficile often causes severe diarrhea. Parasites, particularly protozoa e.g., Cryptosporidium spp., Giardia spp., Entamoeba histolytica , Blastocystis spp., Cyclospora cayetanensis , are frequently the cause of diarrhea that involves chronic infection. The broad-spectrum antiparasitic agent nitazoxanide has shown efficacy against many diarrhea-causing parasites. Other infectious agents, such as parasites or bacterial toxins, may exacerbate symptoms. In sanitary living conditions where there

392-413: A high glucose content are more absorbable and less likely to cause diarrhea. Sugar alcohols such as sorbitol (often found in sugar-free foods) are difficult for the body to absorb and, in large amounts, may lead to osmotic diarrhea. In most of these cases, osmotic diarrhea stops when the offending agent (e.g., milk or sorbitol) is stopped. Exudative diarrhea occurs with the presence of blood and pus in

448-435: A liquid, or "loose", bowel movement. Acute diarrhea is most commonly due to viral gastroenteritis with rotavirus , which accounts for 40% of cases in children under five. In travelers , however, bacterial infections predominate. Various toxins such as mushroom poisoning and drugs can also cause acute diarrhea. Chronic diarrhea can be the part of the presentations of a number of chronic medical conditions affecting

504-451: A negative PCR is most likely indicative of a healthy individual. Treatment is with penicillin , ampicillin , tetracycline , or co-trimoxazole for one to two years. Any treatment lasting less than a year has a relapse rate around 40%. Expert opinion as of 2007 is that Whipple's disease should be treated with doxycycline with hydroxychloroquine for 12 to 18 months. Hydroxychloroquine increases antibiotic and bactericides activity against

560-709: A paper in the now-defunct Bulletin of Johns Hopkins Hospital . The patient was a 36-year-old medical missionary. Whipple referred to the disease as "intestinal lipodystrophy ". It was long presumed to be an infectious disease, but the causative organism was only fully identified in 1992. In 2003, doctors from Johns Hopkins Hospital , together with the French microbiologist Didier Raoult applied novel diagnostic methods to stored tissue samples from Whipple's original patient, and demonstrated T. whipplei in these tissues. Diarrhea Diarrhea ( American English ), also spelled diarrhoea or diarrhœa ( British English ),

616-464: A population, especially in the absence of water filtration or purification. Human feces contains a variety of potentially harmful human pathogens . Proper nutrition is important for health and functioning, including the prevention of infectious diarrhea. It is especially important to young children who do not have a fully developed immune system. Zinc deficiency , a condition often found in children in developing countries can, even in mild cases, have

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672-512: A ratio between 2:1 and 3:1 of male to female patients. In the United States and some other countries, it occurs predominantly in those of Caucasian ethnicity , suggesting a possible genetic predisposition in that population. T. whipplei appears to be an environmental organism that is commonly present in the gastrointestinal tract, but remains asymptomatic. Several lines of evidence suggest that some defect—inherited or acquired—in immunity

728-414: A result, if it is stopped, there might be a delay in recovery. They cite in support of this argument research published in 1973 that found that treating Shigella with the anti-diarrhea drug (Co-phenotrope, Lomotil ) caused people to stay feverish twice as long as those not so treated. The researchers indeed themselves observed that: "Lomotil may be contraindicated in shigellosis. Diarrhea may represent

784-435: A series of tests of intelligence. Diarrhea can cause electrolyte imbalances , kidney impairment , dehydration , and defective immune system responses. When oral drugs are administered, the efficiency of the drug is to produce a therapeutic effect and the lack of this effect may be due to the medication travelling too quickly through the digestive system, limiting the time that it can be absorbed. Clinicians try to treat

840-438: A significant impact on the development and proper functioning of the human immune system. Indeed, this relationship between zinc deficiency and reduced immune functioning corresponds with an increased severity of infectious diarrhea. Children who have lowered levels of zinc have a greater number of instances of diarrhea, severe diarrhea, and diarrhea associated with fever. Similarly, vitamin A deficiency can cause an increase in

896-806: A week over the previous three months. Symptoms of diarrhea-predominant IBS can be managed through a combination of dietary changes, soluble fiber supplements and medications such as loperamide or codeine . About 30% of patients with diarrhea-predominant IBS have bile acid malabsorption diagnosed with an abnormal SeHCAT test. Diarrhea can be caused by other diseases and conditions, namely: Over 700 medications, such as penicillin , are known to cause diarrhea. The classes of medications that are known to cause diarrhea are laxatives, antacids, heartburn medications, antibiotics, anti-neoplastic drugs, anti-inflammatories as well as many dietary supplements. According to two researchers, Nesse and Williams , diarrhea may function as an evolved expulsion defense mechanism. As

952-484: A year. Total deaths from diarrhea are estimated at 1.53 million in 2019—down from 2.9 million in 1990. In 2012, it was the second most common cause of deaths in children younger than five (0.76 million or 11%). Frequent episodes of diarrhea are also a common cause of malnutrition and the most common cause in those younger than five years of age. Other long term problems that can result include stunted growth and poor intellectual development. The word diarrhea

1008-430: Is isotonic with plasma even during fasting. It continues even when there is no oral food intake. Osmotic diarrhea occurs when too much water is drawn into the bowels. If a person drinks solutions with excessive sugar or excessive salt, these can draw water from the body into the bowel and cause osmotic diarrhea. Osmotic diarrhea can also result from maldigestion (e.g., pancreatic disease or coeliac disease ) in which

1064-646: Is a symptom of, among others, Shigella , Entamoeba histolytica , and Salmonella . Diarrheal disease may have a negative impact on both physical fitness and mental development. "Early childhood malnutrition resulting from any cause reduces physical fitness and work productivity in adults", and diarrhea is a primary cause of childhood malnutrition. Further, evidence suggests that diarrheal disease has significant impacts on mental development and health; it has been shown that, even when controlling for helminth infection and early breastfeeding, children who had experienced severe diarrhea had significantly lower scores on

1120-479: Is ample food and a supply of clean water, an otherwise healthy person usually recovers from viral infections in a few days. However, for ill or malnourished individuals, diarrhea can lead to severe dehydration and can become life-threatening. Open defecation is a leading cause of infectious diarrhea leading to death. Poverty is a good indicator of the rate of infectious diarrhea in a population. This association does not stem from poverty itself, but rather from

1176-442: Is an increase in the active secretion, or there is an inhibition of absorption. There is little to no structural damage. The most common cause of this type of diarrhea is a cholera toxin that stimulates the secretion of anions , especially chloride ions (Cl ). Therefore, to maintain a charge balance in the gastrointestinal tract , sodium (Na ) is carried with it, along with water. In this type of diarrhea intestinal fluid secretion

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1232-535: Is an infection of the intestines due to a virus , bacterium , or parasite —a condition also known as gastroenteritis . These infections are often acquired from food or water that has been contaminated by feces , or directly from another person who is infected. The three types of diarrhea are: short duration watery diarrhea, short duration bloody diarrhea, and persistent diarrhea (lasting more than two weeks, which can be either watery or bloody). The short duration watery diarrhea may be due to cholera , although this

1288-584: Is best known in humans, it affects many other species, notably among primates . The cecal appendix , when present, appears to afford some protection against diarrhea to young primates. Numerous studies have shown that improvements in drinking water and sanitation ( WASH ) lead to decreased risks of diarrhoea. Such improvements might include for example use of water filters, provision of high-quality piped water and sewer connections. In institutions, communities, and households, interventions that promote hand washing with soap lead to significant reductions in

1344-539: Is defined by the World Health Organization as having three or more loose or liquid stools per day, or as having more stools than is normal for that person. Acute diarrhea is defined as an abnormally frequent discharge of semisolid or fluid fecal matter from the bowel, lasting less than 14 days, by World Gastroenterology Organization . Acute diarrhea that is watery may be known as AWD (Acute Watery Diarrhoea.) Secretory diarrhea means that there

1400-674: Is from the Ancient Greek διάρροια from διά dia "through" and ῥέω rheo "flow". Diarrhea is the spelling in American English , whereas diarrhoea is the spelling in British English . Slang terms for the condition include "the runs", "the squirts" (or "squits" in Britain ) and "the trots". The word is often pronounced as / ˌ d aɪ ə ˈ r iː ə / DY -ə- REE -ə . Diarrhea

1456-437: Is rare in the developed world. If blood is present, it is also known as dysentery . A number of non-infectious causes can result in diarrhea. These include lactose intolerance , irritable bowel syndrome , non-celiac gluten sensitivity , celiac disease , inflammatory bowel disease such as ulcerative colitis , hyperthyroidism , bile acid diarrhea , and a number of medications. In most cases, stool cultures to confirm

1512-402: Is required for it to become pathogenic. The possible immunological defect may be specific for T. whipplei , since the disease is not associated with a substantially increased risk of other infections. The disease is usually diagnosed in middle age (median 49 years). Studies from Germany have shown that age at diagnosis has been rising since the 1960s. Whipple described the disease in 1907 in

1568-517: Is similar to the diseases caused by MAC bacteria. The disease is common in farmers and those exposed to soil and animals, suggesting that the infection is acquired from these sources. Individuals who are most susceptible to the disease are those with decreased ability to perform intracellular degradation of ingested pathogens or particles, particularly within macrophages. Several studies indicate that defective T-lymphocyte (particularly TH1 population) function may be an important predisposing factor for

1624-554: Is the condition of having at least three loose, liquid, or watery bowel movements in a day. It often lasts for a few days and can result in dehydration due to fluid loss. Signs of dehydration often begin with loss of the normal stretchiness of the skin and irritable behaviour. This can progress to decreased urination , loss of skin color , a fast heart rate , and a decrease in responsiveness as it becomes more severe. Loose but non-watery stools in babies who are exclusively breastfed , however, are normal. The most common cause

1680-473: Is the most common cause in children under five years old. Adenovirus types 40 and 41, and astroviruses cause a significant number of infections. Shiga-toxin producing Escherichia coli , such as E coli o157:h7 , are the most common cause of infectious bloody diarrhea in the United States. Campylobacter spp. are a common cause of bacterial diarrhea, but infections by Salmonella spp., Shigella spp. and some strains of Escherichia coli are also

1736-610: The age of five. Greater than half of these were in Africa and South Asia. This is down from a death rate of 4.5 million in 1980 for gastroenteritis. Diarrhea remains the second leading cause of infant mortality (16%) after pneumonia (17%) in this age group. The majority of such cases occur in the developing world, with over half of the recorded cases of childhood diarrhea occurring in Africa and Asia , with 696 million and 1.2 billion cases, respectively, compared to only 480 million in

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1792-419: The bloodstream via the intestinal tract in the small intestine. Prior to defecation, the large intestine reabsorbs the water and other digestive solvents in the waste product in order to maintain proper hydration and overall equilibrium. Diarrhea occurs when the large intestine is prevented, for any number of reasons, from sufficiently absorbing the water or other digestive fluids from fecal matter, resulting in

1848-455: The conditions under which impoverished people live. The absence of certain resources compromises the ability of the poor to defend themselves against infectious diarrhea. "Poverty is associated with poor housing, crowding, dirt floors, lack of access to clean water or to sanitary disposal of fecal waste ( sanitation ), cohabitation with domestic animals that may carry human pathogens, and a lack of refrigerated storage for food, all of which increase

1904-637: The diarrheas by reducing the dosage of medication, changing the dosing schedule, discontinuation of the drug, and rehydration. The interventions to control the diarrhea are not often effective. Diarrhea can have a profound effect on the quality of life because fecal incontinence is one of the leading factors for placing older adults in long term care facilities (nursing homes). In the latter stages of human digestion, ingested materials are inundated with water and digestive fluids such as gastric acid , bile , and digestive enzymes in order to break them down into their nutrient components, which are then absorbed into

1960-461: The disease. In particular, circulating cells which are CD11b (also known as integrin alpha) expressive are reduced in susceptible individuals. CD11b has a vital role in activation of macrophages to destroy intracellularly ingested T. whipplei bacteria. Common clinical signs and symptoms of Whipple's disease include diarrhea, steatorrhea, abdominal pain, weight loss, migratory arthropathy, fever, and neurological symptoms. Weight loss and diarrhea are

2016-469: The exact cause are not required. Diarrhea can be prevented by improved sanitation , clean drinking water , and hand washing with soap. Breastfeeding for at least six months and vaccination against rotavirus is also recommended. Oral rehydration solution (ORS)—clean water with modest amounts of salts and sugar —is the treatment of choice. Zinc tablets are also recommended. These treatments have been estimated to have saved 50 million children in

2072-504: The frequency of diarrhea   ... Poverty also restricts the ability to provide age-appropriate, nutritionally balanced diets or to modify diets when diarrhea develops so as to mitigate and repair nutrient losses. The impact is exacerbated by the lack of adequate, available, and affordable medical care." One of the most common causes of infectious diarrhea is a lack of clean water. Often, improper fecal disposal leads to contamination of groundwater. This can lead to widespread infection among

2128-404: The heart is unable to pump fluid through the body. Of those affected by Whipple's disease, 10–40% have problems related to the involvement of the brain ; the symptoms relate to the part of the brain that is affected. The most common problems are dementia , memory loss , confusion , and decreased level of consciousness . Eye-movement disturbances and myorhythmia (rapidly repetitive movements of

2184-608: The incidence of diarrhea. The same applies to preventing open defecation at a community-wide level and providing access to improved sanitation . This includes use of toilets and implementation of the entire sanitation chain connected to the toilets (collection, transport, disposal or reuse of human excreta ). There is limited evidence that safe disposal of child or adult feces can prevent diarrheal disease. Mesenteric lymph nodes The superior mesenteric lymph nodes may be divided into three principal groups: The mesenteric lymph nodes or mesenteric glands are one of

2240-429: The intestine. Common causes include ulcerative colitis , Crohn's disease , microscopic colitis , celiac disease , irritable bowel syndrome , and bile acid malabsorption . There are many causes of infectious diarrhea, which include viruses , bacteria and parasites. Infectious diarrhea is frequently referred to as gastroenteritis . Norovirus is the most common cause of viral diarrhea in adults, but rotavirus

2296-431: The large joints, but can occur in any pattern and tend not to damage the joint surface to the point that the joint becomes deformed. Fever and chills occur in a small proportion of people. In its more advanced form, malabsorption (insufficient absorption of nutrients from the diet) leads to wasting and the enlargement of lymph nodes in the abdomen. Neurological symptoms (discussed below) are more common in those with

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2352-566: The most common symptoms that lead to identification of the process, but may be preceded by chronic, unexplained, relapsing episodes of nondestructive seronegative arthritis, often of large joints. Endoscopy of the duodenum and jejunum can reveal pale yellow shaggy mucosa with erythematous eroded patches in patients with classic intestinal Whipple's disease, and small bowel X-rays may show some thickened folds. Other pathological findings may include enlarged mesenteric lymph nodes , hypercellularity of lamina propria with "foamy macrophages", and

2408-561: The muscles) of the face, together referred to as oculomasticatory myorhythmia, are highly characteristic for Whipple's disease. Weakness and poor coordination of part of the body, headaches , seizures , and a number of more uncommon neurological features are present in some cases. T. whipplei is one of the Actinomycetes , and is a distant relative of the Mycobacterium avium complex , explaining in part why Whipple's disease

2464-575: The nutrients are left in the lumen to pull in water. Or it can be caused by osmotic laxatives (which work to alleviate constipation by drawing water into the bowels). In healthy individuals, too much magnesium , vitamin C or undigested lactose can produce osmotic diarrhea and distention of the bowel. A person who has lactose intolerance can have difficulty absorbing lactose after an extraordinarily high intake of dairy products. In persons who have fructose malabsorption , excess fructose intake can also cause diarrhea. High-fructose foods that also have

2520-417: The other types of diarrhea can be found in this type of diarrhea. It can be caused by bacterial infections, viral infections, parasitic infections, or autoimmune problems such as inflammatory bowel diseases. It can also be caused by tuberculosis, colon cancer, and enteritis. If there is blood visible in the stools, it is also known as dysentery . The blood is a trace of an invasion of bowel tissue. Dysentery

2576-403: The past 25 years. When people have diarrhea it is recommended that they continue to eat healthy food, and babies continue to be breastfed. If commercial ORS is not available, homemade solutions may be used. In those with severe dehydration, intravenous fluids may be required. Most cases, however, can be managed well with fluids by mouth. Antibiotics , while rarely used, may be recommended in

2632-512: The potential for increased risk of disease contraction. Malabsorption is the inability to absorb food fully, mostly from disorders in the small bowel, but also due to maldigestion from diseases of the pancreas . Causes include: The two overlapping types here are of unknown origin: Another possible cause of diarrhea is irritable bowel syndrome (IBS), which usually presents with abdominal discomfort relieved by defecation and unusual stool (diarrhea or constipation ) for at least three days

2688-437: The replication of the bacteria in acidic vacuoles of macrophages by increasing the macrophage intraphagosomal pH. Sulfonamides ( sulfadiazine or sulfamethoxazole ) may be added for treatment of neurological symptoms. The disease is regarded as extremely rare, with an incidence (new number of cases per year) of one case per million people. The patients are predominantly male, with various studies and sources typically reporting

2744-751: The rest of the world. Infectious diarrhea resulted in about 0.7 million deaths in children under five years old in 2011 and 250 million lost school days. In the Americas, diarrheal disease accounts for a total of 10% of deaths among children aged 1–59 months while in South East Asia, it accounts for 31.3% of deaths. It is estimated that around 21% of child mortalities in developing countries are due to diarrheal disease. The World Health Organization has reported that "deaths due to diarrhoeal diseases have dropped by 45%, from sixth leading cause of death in 2000 to thirteenth in 2021." Even though diarrhea

2800-399: The severe form of the abdominal disease. Chronic malabsorptive diarrhea leads to the poor absorption of fat, causing steatorrhea (fatty, offensive-smelling stool), flatulence, and abdominal distension. Protein-losing enteropathy may also occur, causing depletion of albumin , a blood protein, which may lead to peripheral edema caused by the lowered oncotic pressures . Hyperpigmentation of

2856-432: The severity of diarrheal episodes. However, there is some discrepancy when it comes to the impact of vitamin A deficiency on the rate of disease. While some argue that a relationship does not exist between the rate of disease and vitamin A status, others suggest an increase in the rate associated with deficiency. Given that estimates suggest 127 million preschool children worldwide are vitamin A deficient, this population has

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2912-446: The skin occurs in almost half; some also have skin nodules. Various eye problems, such as uveitis , may occur; this is typically associated with deteriorating vision and pain in the affected eye. Endocarditis (infection of the heart valve ) has been reported in a small number of cases, sometimes in people with no other symptoms of Whipple's disease; this is typically noticed as breathlessness and leg swelling due to fluid accumulation as

2968-415: The stool. This occurs with inflammatory bowel diseases , such as Crohn's disease or ulcerative colitis , and other severe infections such as E. coli or other forms of food poisoning. Inflammatory diarrhea occurs when there is damage to the mucosal lining or brush border, which leads to a passive loss of protein-rich fluids and a decreased ability to absorb these lost fluids. Features of all three of

3024-403: The three principal groups of superior mesenteric lymph nodes and lie between the layers of the mesentery . They number from one hundred to one hundred and fifty, and are sited as two main groups: The ileocolic lymph nodes , from ten to twenty in number, form a chain around the ileocolic artery , but tend to subdivide into two groups, one near the duodenum and the other on the lower part of

3080-505: The trunk of the right colic artery and others are found in relation to the trunk and branches of the middle colic artery . The superior mesenteric glands receive lymph from the jejunum , ileum , cecum , vermiform process , and the ascending and transverse parts of the colon; lymph drains into the preaortic glands . [REDACTED] This article incorporates text in the public domain from page 709 of the 20th edition of Gray's Anatomy (1918) This article related to

3136-404: The trunk of the artery. Where the vessel divides into its terminal branches the chain is broken up into several groups: The mesocolic lymph nodes are numerous, and lie between the layers of the transverse mesocolon , in close relation to the transverse colon; they are best developed in the neighborhood of the right and left colic flexures . One or two small glands are occasionally seen along

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