Tests

1st tests to order

CBC

Test
Result
Test

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

Result

low hemoglobin

serum albumin

Test
Result
Test

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

Result

low

serum CRP

Test
Result
Test

Nonspecific test. Usually elevated in cases of Whipple disease.

Result

elevated

serum ESR

Test
Result
Test

Nonspecific test. Usually elevated in cases of Whipple 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 with 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. Morphologic changes in PAS-positive macrophages indicate successful therapy.[75]

Result

PAS-positive macrophages

PCR

Test
Result
Test

Detects T whipplei DNA. Positive PCR from duodenal tissue is a poor diagnostic criterion, because carriers can be healthy. PCR from sterile samples (e.g., lymph node, CSF, synovial fluid) is more indicative for Whipple 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 disease and are more sensitive than PAS-staining. Carried out on sampled tissue. Available at specialized centers only.

Result

detection of T whipplei antigens

Emerging tests

electron microscopy

Test
Result
Test

Nonspecific visualization of T whipplei within tissues. Carried out on sampled tissue.

Result

visualization of bacteria

culture

Test
Result
Test

Extremely cumbersome and time consuming. Growth takes several weeks to months. Only available in specialized centers.

Result

positive for T whipplei

serology

Test
Result
Test

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

Result

antibodies against T whipplei

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