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Depending on the seriousness of the disease, treatment may also include fluid and electrolyte replacement. Electrolytes are salts and other substances in body fluid that the heart and brain need to function properly. Extra iron, folate, vitamin D, calcium, and magnesium may also be given to help compensate for the vitamins and minerals the body cannot absorb on its own.
Individuals who are being treated for Whipple disease should be closely monitored by a health care provider because signs of the disease can return after therapy has been finished. Full recovery of the small intestine may take up to 2 years, but the symptoms usually disappear in less time. Because relapse is common even after successful treatment, the health care team may continue to monitor the patient for many years.
Whipple disease bacillus can affect the periaqueductal gray matter, making noncommunicating hydrocephalus (secondary to aqueductal stenosis - an obstruction of the cerebral aqueduct) more likely in patients with advanced Whipple disease affecting the central nervous system. Patients with aqueductal stenosis represent a neurosurgical emergency and a ventriculoperitoneal shunt should be placed in an urgent manner.
In progressive Whipple disease affecting the central nervous system with progressive, communicating hydrocephalus, it is possible to limit or reverse some of the cognitive and motor deficits by shunting. This is especially important as the reported reversal of other central nervous system symptoms and signs remains limited and requires several weeks to months despite otherwise efficient antibiotic treatment.