Whipple Disease — SCE Infectious Diseases MCQ

Correct answer: C — Occult CNS infection and late neurological relapse can occur, so use a CNS-active induction followed by prolonged maintenance after reassessment

The best answer is “Occult CNS infection and late neurological relapse can occur, so use a CNS-active induction followed by prolonged maintenance after reassessment”. Subclinical CNS involvement is recognised in classic Whipple disease, making CNS-active induction important even without a neurological presentation. “The organism is resistant to every oral antimicrobial” is less appropriate because it conflicts with the decisive clinical feature or cited guidance. “CNS penetration is needed only when meningism is present” is less appropriate because it conflicts with the decisive clinical feature or cited guidance. “Two weeks of topical therapy eradicates intestinal carriage” is less appropriate because it conflicts with the decisive clinical feature or cited guidance. “Surgery is required because antibiotics cannot reach macrophages” is less appropriate because it conflicts with the decisive clinical feature or cited guidance.

Reference: European clinical guideline on Whipple disease: https://pubmed.ncbi.nlm.nih.gov/23418877/