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[3 cases of Whipple's disease. Clinical, biological, histological and therapeutic remarks. Electronic microscope study of the jejunal mucosa. Demonstration of the bacterial origin of the disease. Isolation and identification of the causative organism]
Anaerobic corynebacteria have been known since 1897, when Roux first described Corynebacterium pyogenes. Roux, a veterinary doctor practicing in the Ile-de-France, observed an enzootic disease of purulent abscesses affecting cattle (hence its incorrect name of C. pyogenes bovis). Roux isolated the germ which caused the disease and studied it at the Pasteur Institute. In 1908 and 1909, in Metchnikoff’s laboratory at the Pasteur Institute, Jungano was studying fecal microflora and discovered three species of corynebacteria: Corynebacterium liquefaciens, Corynebacterium diphtheroides, and Corynebacterium granulosum.
Kardiospasmus beruht auf einer Störung der parasympathischen und sympathischen Innervation des Osophagus: Normalerweise verursacht Vagusreizung eine Kontraktion der oberen Ösophagusanteile, während der Kardiaanteil erschlafft. Sympathicusreizung führt zu Tonussteigerung der Muskulatur der Kardia und Kardiaverschluß. Sympathicusdurchtrennung verursacht meist rlbnusnachlaß der Kardia und wird daher therapeutisch bei Kardiospasmus angewandt. Sympathicusdurchschneidung führt aber bei Kardiospasmus in einer Reihe von Fällen nicht zum Erfolg. Dis Ursachen des Kardiospasmus können nicht einfach auf ein Überwiegen der sympathischen Tiber die parasympathische Innervation bezogen werden. Tierexperimentelle Untersuchungen2 ergaben, daß der durch Vagusausschaltung erzeugte Kardiospasmus scheinbar paradoxerweise durch Atropin behoben werden kann, und daß auf der anderen Seite ein bestehender Kardiospasmus durch Adrenalin beseitigt werden kann. Man nimmt daher an, daß die im Syympathicus verlaufenden Kardiospasmus erzeugenden Fasern cholinergischer Natur, die im Vagus verlaufenden Fasern. die die Kardia öffnen, dagegen adrenergischer Natur sind (also umgekehrt wie sonst). Aus histologischen Untersuchungen der Osophaguswand von Kranken mit Kardiospasmus wird neuerdings auf primäre degenerative Veränderungen in den Auerbacnsehen Plexus geschlossen.Erkrankung der Vagusendigungen wäre danach die eigentliche Ursache des Osophagusspasmus. Die idiopathischen Formen von Kardiospasmus müssen von den Spasmen des Ösophagus auf reflektorischer Grundlage getrennt werden. Letztere entstehen durch Reizung afferenter vegetativer Fasern aus anderen Abdominalorganen (z. B. Magen- und Gallenblasenerkrankungen).
A 75-year-old woman was treated successfully for endophthalmitis due to a Coryneform bacterium contracted from a contaminated corneal graft. We were able to study the involved eye histologically when the patient died unexpectedly 5 1/2 weeks after treatment. The vitreous contained a moderate number of macrophages filled with PAS-positive particles. Ultrastructurally, the PAS-positive particles corresponded to degenerating bacterial cell walls. The striking resemblance of the macrophages in this case to macrophages in Whipple's disease is intriguing because Corynebacterium has been the most frequently implicated bacterial genus in the pathogenesis of Whipple's disease.
A 36 year old white man was diagnosed as having Whipple's disease after a prolonged illness of lethargy, night sweats, and weight loss associated with lymphadenopathy and splenomegaly. Biopsy specimen of an inguinal lymph node confirmed the presence of periodic acid Schiff positive macrophages and culture gave a pure growth of Corynebacterium jeikeium. Twelve hours after the introduction of oral co-trimoxazole and streptomycin the patient's condition deteriorated. He became confused, feverish, and developed florid retinal vasculitis with associated visual impairment. Both the systemic symptoms and the retinal vasculitis responded to treatment with corticosteroids and his vision returned to normal. We think this was a Jarisch-Herxheimer reaction not previously described in Whipple's disease and advise inspection of the fundi of such patients before starting treatment.
A 75-year-old woman was treated successfully for endophthalmitis due to a coryneform bacterium contracted from a contaminated corneal graft. We were able to study the involved eye histologically when the patient died unexpectedly 5 1/2 weeks after treatment. The vitreous contained a moderate number of macrophages filled with PAS-positive particles. Ultrastructurally, the PAS-positive particles corresponded to degenerating bacterial cell walls. The striking resemblance of the macrophages in this case to macrophages in Whipple's disease is intriguing because Corynebacterium has been the most frequently implicated bacterial genus in the pathogenesis of Whipple's disease.
The capacity of newly transformed cells of Bacillus subtilis to synthesize deoxyribonucleic acid (DNA), ribonucleic acid (RNA), and protein has been determined by following the kinetics of suicide after their exposure to tritiated precursors of each of these macromolecules. Competent cells, whether transformed or not, are heterogeneous with respect to DNA synthesis. About 40 to 50% are latent in DNA synthesis. This latency may persist for 2.5 to 3 hr since transformants are resistant to thymineless death for this period after DNA addition. The remainder of the transformants synthesize DNA at one-half the rate of the cells of the total population. Synthesis of stable RNA does not occur at an appreciable rate in newly transformed cells. Newly transformed cells, however, do synthesize protein extensively, as demonstrated by the lethality of incorporated tritiated amino acids. Either chloramphenicol or actinomycin D treatment during the time of exposure to the tritiated amino acid prevented the suicide of transformants.
A 50 year old man lost 50 lb, passed bulky stools, and complained of joint pain. He was pigmented and had large nodes. PAS dye stained granules in mesenteric and axillary nodes and macrophages in the jejunal mucosa. Antibiotic treatment resulted in remission of symptoms.
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