{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,2,15]],"date-time":"2024-02-15T07:10:17Z","timestamp":1707981017979},"reference-count":53,"publisher":"Akademiai Kiado Zrt.","issue":"26","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2007,7,1]]},"abstract":"<jats:p>A Whipple-k\u00f3r bakteri\u00e1lis fert\u0151z\u00e9s okozta, ritk\u00e1n el\u0151fordul\u00f3, sz\u00e1mos szerv \u00e9rintetts\u00e9g\u00e9vel, \u00edgy v\u00e1ltozatos klinikummal t\u00e1rsul\u00f3, alattomos kezdet\u0171, relapsusokkal k\u00eds\u00e9rt id\u00fclt lefoly\u00e1s\u00fa, kezel\u00e9s n\u00e9lk\u00fcl fat\u00e1lis gyullad\u00e1sos betegs\u00e9g. A k\u00f3rk\u00e9p gyan\u00faj\u00e1t a jellegzetes (de nem specifikus) t\u00fcneti tri\u00e1sz (fogy\u00e1s, kr\u00f3nikus hasmen\u00e9s, arthralgia) megjelen\u00e9se sugallhatja. Elh\u00faz\u00f3d\u00f3, intermitt\u00e1l\u00f3 jelleg\u0171 l\u00e1z \u00e9s lymphadenopathia t\u00e1rsul\u00e1sakor fenn\u00e1ll\u00e1s\u00e1nak k\u00fcl\u00f6n\u00f6sen nagy a val\u00f3sz\u00edn\u0171s\u00e9ge. A Whipple-k\u00f3r vonatkoz\u00e1s\u00e1ban meghat\u00e1roz\u00f3 jelent\u0151s\u00e9g\u0171 volt az egyedi tulajdons\u00e1gokkal b\u00edr\u00f3 k\u00f3rokoz\u00f3, a<jats:italic>Tropheryma whipplei<\/jats:italic>felismer\u00e9se. A bakteri\u00e1lis fert\u0151z\u00e9s v\u00e9lhet\u0151en gyakori, betegs\u00e9g viszont csak a hajlamos\u00edt\u00f3 immunol\u00f3giai t\u00e9nyez\u0151(k) megl\u00e9te eset\u00e9n alakul ki. Tekintettel az alapvet\u0151en a macrophagokban perziszt\u00e1l\u00f3 \u00e9s szaporod\u00f3 bakt\u00e9riumokra, f\u0151k\u00e9nt a mononuclearis-phagocyta rendszer k\u00f3ros funkci\u00f3ja t\u00e9telezhet\u0151 fel. (A Whipple-k\u00f3r els\u0151sorban macrophag betegs\u00e9gk\u00e9nt \u00e9rtelmezhet\u0151.) A klinikai k\u00e9p soksz\u00edn\u0171. B\u00e1r a Whipple-k\u00f3rt eredetileg a gastrointestinalis rendszer megbeteged\u00e9s\u00e9nek v\u00e9lt\u00e9k, ma sziszt\u00e9m\u00e1s betegs\u00e9gnek tekintik. A fert\u0151z\u00e9s gyan\u00fajakor az els\u0151k\u00e9nt v\u00e1lasztand\u00f3 vizsg\u00e1lat a gasztroszk\u00f3pia: jellegzetes esetben a postbulbaris duodenum \u00e9s a jejunum ter\u00fclet\u00e9n az erythemas, erod\u00e1lt, s\u00e9r\u00fcl\u00e9keny ny\u00e1lkah\u00e1rty\u00e1n sz\u00e9tsz\u00f3rt halv\u00e1nys\u00e1rg\u00e1s plaque-ok mutatkoznak. A sz\u00f6vettani mint\u00e1kban el\u0151t\u00e9rben \u00e1ll a kifejezett macrophag infiltr\u00e1ci\u00f3 (a bakt\u00e9rium intracellul\u00e1ris inv\u00e1zi\u00f3j\u00e1val). A betegs\u00e9g igazol\u00e1s\u00e1nak klasszikus eszk\u00f6ze a v\u00e9konyb\u00e9l-biopszi\u00e1s mint\u00e1k PAS-fest\u00e9se, valamint a k\u00f3rokoz\u00f3 PCR-ral t\u00f6rt\u00e9n\u0151 igazol\u00e1sa. A megfelel\u0151 antibiotikum kiv\u00e1laszt\u00e1sa \u00e9s a ter\u00e1pia id\u0151tartama napjainkban is nagyr\u00e9szt empirikus.<\/jats:p>","DOI":"10.1556\/oh.2007.28144","type":"journal-article","created":{"date-parts":[[2007,6,22]],"date-time":"2007-06-22T23:50:03Z","timestamp":1182556203000},"page":"1225-1230","source":"Crossref","is-referenced-by-count":1,"title":["Whipple\u2019s disease: current problems"],"prefix":"10.1556","volume":"148","author":[{"given":"Gy\u00f6rgyi","family":"M\u0171zes","sequence":"first","affiliation":[{"name":"1 Semmelweis Egyetem, \u00c1ltal\u00e1nos Orvostudom\u00e1nyi Kar II. Belgy\u00f3gy\u00e1szati Klinika Budapest Szentkir\u00e1lyi u. 46. 1088"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hajnal","family":"Sz\u00e9kely","sequence":"additional","affiliation":[{"name":"1 Semmelweis Egyetem, \u00c1ltal\u00e1nos Orvostudom\u00e1nyi Kar II. Belgy\u00f3gy\u00e1szati Klinika Budapest Szentkir\u00e1lyi u. 46. 1088"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zsolt","family":"Tulassay","sequence":"additional","affiliation":[{"name":"1 Semmelweis Egyetem, \u00c1ltal\u00e1nos Orvostudom\u00e1nyi Kar II. Belgy\u00f3gy\u00e1szati Klinika Budapest Szentkir\u00e1lyi u. 46. 1088"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"425","reference":[{"key":"atypb1","first-page":"221","volume":"46","year":"1895","journal-title":"Trans. Pathol. Soc. London"},{"key":"atypb2","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1097\/00004836-199106000-00010","volume":"13","year":"1991","journal-title":"J. Clin. Gastroenterol."},{"key":"atypb3","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1309\/8YGR-FE7L-39LL-L37C","volume":"118","year":"2002","journal-title":"Am. J. Clin. 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