Ua ʻike anei ʻoe i ka maʻi ʻo Whipple? E kamaʻilio kākou e pili ana i kēia maʻi laha ʻole ma nā ʻōlelo maʻalahi!

Ke manaʻo nei ʻoe i kekahi manawa ua nāwaliwali loa kou kino, loaʻa iā ʻoe nā pilikia ʻōpū, loaʻa iā ʻoe ka ʻeha o nā hono, akā ʻaʻole hiki iā ʻoe ke loaʻa ke kumu no ia mea? Malia paha he maʻi kēia i lohe ʻole ʻia e ka poʻe he nui, akā he mea nui e ʻike. I kēia lā e kamaʻilio mākou e pili ana i kekahi maʻi laha ʻole, akā inā mālama pono ʻia, hiki ke ho'ōla ʻia. ʻO ia ka Maʻi ʻo Whipple.

He aha ka maʻi o Whipple?

I ka ʻōlelo maʻalahi, ʻo ka maʻi Whipple kahi maʻi bacteria kakaʻikahi e kū mai ana i loko o kou ʻōpū liʻiliʻi . Hoʻokumu ʻia kēia e ka meaʻai āu e ʻai ai ʻaʻole i hoʻoheheʻe pono ʻia a ʻaʻole i komo ʻia nā meaolaola e pono ai i loko o kou kino (ua kapa ʻia kēia he "malabsorption"). E noʻonoʻo e pili ana i ia mea, ʻai mākou i ka meaʻai e loaʻa ai ka ikehu a me ka meaʻai no ko mākou kino. No laila, inā ʻaʻole i komo pono ʻia, hiki ke loaʻa nā pilikia he nui. Hiki mai kēia maʻi ke komo kahi bacteria i kapa ʻia ʻo "Tropheryma whipplei" i loko o ke kino. Loaʻa pinepine kēia bacteria i ka lepo, ʻo ia hoʻi, i ka lepo. Akā ʻo ka nūhou maikaʻi , me nā "antibiotics" kūpono, hiki ke hoʻopau ʻia kēia bacteria mai ke kino, e hōʻemi ana i nā hōʻailona, ​​a hoʻōla loa ʻia .

Pehea ka maʻamau o ka maʻi ʻo Whipple?

Eia ka mea nui. ʻOiai he nui nā bacteria e hoʻoulu ai i kēia maʻi ((Tropheryma whipplei)) i ke kaiapuni, ʻoi aku hoʻi i ka lepo, he maʻi laha ʻole loa ka maʻi Whipple . Wahi a nā kānaka noiʻi lapaʻau, ʻoiai ma kahi ʻāina e like me ʻAmelika, ua manaʻo ʻia he ʻeiwa mau kānaka mai ka miliona e loaʻa iā ia. ʻO ke ʻano kēia, ʻaʻole nā ​​​​mea a pau i pili i kēia bacteria e loaʻa i kēia maʻi. ʻAʻole ʻike ʻia ke kumu pololei.

He aha nā hōʻailona o ka maʻi ʻo Whipple?

ʻAʻole ʻike koke ʻia nā hōʻailona o ka maʻi Whipple. Hoʻomohala mālie lākou ma kekahi mau pae .

Nā hōʻailona o ka pae mua (Prodromal Phase)

Hoʻomaka ia me ka ʻeha nui o nā hono . Hiki i kēia ʻeha ke hele mai a hele aku. Hoʻopilikia nui ia i kou mau hono nui - kou mau kuʻekuʻe wāwae, kuʻekuʻe lima, nā pūhaka, nā kuli, a me nā poʻohiwi . I kekahi manawa kapa nā kauka i kēia pae mua ʻo ka "prodromal phase." Hiki i kēia ke mau no ʻehiku a ʻewalu paha mau makahiki , a laila hoʻomaka nā hōʻailona ʻē aʻe e ʻike ʻia. E noʻonoʻo i ka paʻakikī o ka loaʻa ʻana o ka ʻeha o nā hono no nā makahiki me ka loaʻa ʻole o ke kumu.

Nā hōʻailona ma hope

Ma hope o kekahi manawa, hiki ke ʻike ʻia nā hōʻailona like ʻole:

• ʻEha ʻōpū: ʻAʻole wale ka ʻeha ʻōpū maʻamau, hiki ke lilo i ʻeha e ʻoi aku ka ʻino ma hope o ka ʻai ʻana a i ʻole e mau ana.
• Ka maʻi kahe (ʻōpala wai): Nā ʻōpala wai e kū mai ana i nā manawa he nui i ka lā. Hiki i kēia ke hoʻoulu i ka maloʻo nui a me ka nalowale ʻana o nā meaʻai mai ke kino.
• Pehu (Edema): E ʻike paha ʻoe i ka pehu ʻana, ʻoiai ma nā wāwae a me nā kuʻekuʻe wāwae. Inā manaʻo ʻia he dimple ke kaomi ʻoe me kou manamana lima, he edema paha ia.
• Luhi pinepine:ʻAʻole pili i ka nui o kāu hiamoe ʻana, ua like kou kino me ke ola ʻole a ʻaʻole ʻoe makemake e hana i kekahi mea.
• Fiva: Manaʻo wela me ke kumu ʻole.
• ʻOle ke ʻano o ka ʻili: ʻO kekahi mau wahi, ʻoi aku hoʻi nā mea i hōʻike ʻia i ka lā, e lilo paha i ʻeleʻele ma mua o ka maʻamau.
• Nā kīpē lymph pehu: Nā puʻupuʻu liʻiliʻi ma nā wahi e like me ka ʻāʻī, nā armpits, a me ka ʻūhā.
• ʻO ka pohō kaumaha i wehewehe ʻole ʻia: ʻO ka pohō kaumaha me ka ʻole o ka ʻai ʻana a i ʻole ka hoʻoikaika kino ʻana.

Nā pilikia o ka ʻōnaehana nerve waena

Ma waena o 20% a me 40% o ka poʻe me ka maʻi Whipple e loaʻa nā pilikia o ka ʻōnaehana nerve waena . He ʻano koʻikoʻi kēia. Hiki i nā hōʻailona ke komo pū me:

• Nā pilikia kaulike: Manaʻo ʻoe he kūpaʻa ʻole ʻoe i ka wā e hele ana a ʻaʻole hiki ke kū pololei.
• Huikau: Nalowale ka ʻike i kou wahi, ka manawa, a me nā poʻe āu i ʻike ai.
• Paʻakikī ke ale ʻana: Manaʻo e like me ʻoe e ʻū ana i ka wā e ale ai i ka meaʻai a mea inu paha.
• Poho ka hoʻomanaʻo: Ka poina ʻana i nā hanana i hala koke aku nei.
• Nā loli o ke ʻano: Manaʻo e like me ʻoe ʻaʻole like me ke kanaka ma mua, huhū koke, a hoʻonāukiuki.
• Nā ʻūlū: Ka nalowale koke o ka ʻike a me nā ʻūlū.
• Nā pilikia o ka ʻōlelo: Ka hūpō o nā huaʻōlelo, ka hiki ʻole ke ʻōlelo maopopo.

He aha ke kumu o ka maʻi ʻo Whipple?

Wahi a nā kauka, ua hoʻokumu ʻia ka maʻi e kahi ʻano bacteria kikoʻī (Tropheryma whipplei) i loaʻa ma ka lepo . ʻO kēlā me kēia mea i hōʻike ʻia i kēia bacteria e pilikia ana i ka maʻi. Eia naʻe, e like me kā mākou i ʻōlelo ai ma mua, he mea kakaikahi loa ka maʻi Whipple. No laila, ʻaʻole maopopo ke kumu e loaʻa ai i kekahi poʻe wale nō .

Eia nō naʻe, ua ʻike ʻia e nā noiʻi e hiki i nā mea aʻe ke hoʻonui i ka pilikia o ka hoʻomohala ʻana i ka maʻi :

• Makahiki: Ua hōʻike ʻia ka maʻi Whipple e hoʻopilikia pinepine i ka poʻe ma waena o 65-84 mau makahiki , akā hiki ke loaʻa i ka poʻe ʻōpio ma mua o kēlā.
• Ka ʻike ʻia ʻana i ka lepo a i ʻole ka mahi holoholona: Hōʻike ka noiʻi ʻana he ʻoi aku ka nui o ka pilikia o ka poʻe e hana ana me ka lepo a i ʻole ka mahi holoholona i ka loaʻa ʻana o kēia maʻi. ʻOi aku ka nui o ka pilikia o ka poʻe e mahiʻai ana, e māla ana, a e hana pū ana paha me nā holoholona. Hiki paha iā ʻoe ke ʻike ʻia i kēia bacteria ke kanu ʻoe i kahi mea liʻiliʻi i loko o kou māla home.
• Nā hoʻololi hoʻoilina:Aia kahi pilina ma waena o ka maʻi ʻo Whipple a me ke kumu e hana ai i ka protein `(IFR4)`. Kōkua kēia protein i nā ʻōnaehana pale o ko mākou kino, e like me `(nā pūnaewele B)` a me `(nā pūnaewele T)`, e ulu. Ua ʻike ʻia hoʻi ua pili ia i kahi mutation i loko o ka gene `(HLA-B27)`. He ʻoi aku ka hohonu o kēia mau mea, akā i ka ʻōlelo maʻalahi, hiki i kekahi mau loli i loko o kā mākou mau genes ke hoʻoholo iā mākou i kēia.
• ʻŌnaehana pale kino nāwaliwali: Inā loaʻa iā ʻoe kahi maʻi e hoʻopilikia ai i kāu ʻōnaehana pale kino (e like me ka HIV), a inā ʻoe e lawe i nā immunosuppressants (hāʻawi ʻia kēia mau mea no kekahi mau maʻi, i kekahi manawa no nā mea e like me ka arthritis, a ma hope o kahi hoʻoili kino), ʻoi aku ka nui o kou pilikia o ka hoʻomohala ʻana i kēia maʻi.

He aha nā pilikia e hiki mai ana mai ka maʻi ʻo Whipple?

E like me kā mākou i ʻōlelo ai ma mua, ʻo ka maʻi Whipple ke kumu o ka hiki ʻole o ke kino ke omo pono i nā momona, nā kalapona, nā huaora, a me nā meaola ʻē aʻe mai ka meaʻai e hele ana ma kou ʻōpū liʻiliʻi. He maʻi holomua ia e lilo i mea ʻino i ka hala ʻana o ka manawa . ʻO ke ʻano kēia, inā ʻaʻole mālama ʻia, hiki ke ulu mai nā pilikia olakino hou a koʻikoʻi.

Hiki ke loaʻa nā pilikia e like me kēia:

• Anemia (helu haʻahaʻa o nā ʻula koko ʻulaʻula): Hiki i kēia ke hana i ka luhi mau, nāwaliwali, a me ka mae.
• Dementia (nalowale o ka hoʻomanaʻo a me ka hana noʻonoʻo): Hiki ke hana kēia inā pili ka ʻōnaehana nerve.
• ʻŌhumu puʻuwai: Hiki ke lohe ʻia kēia ke nānā ke kauka iā ʻoe me kahi stethoscope.
• ʻO ka myorhythmia Oculomasticatory: He hōʻailona kikoʻī loa kēia, kahi e neʻe like ai nā maka a me ka ʻāwae .
• ʻO ka effusion Pleural: Hiki i kēia ke pilikia i ka hanu ʻana.
• Uveitis: Hiki i nā hōʻailona ke komo pū me ka ʻulaʻula, ka ʻeha, a me ka ʻike maka pōwehiwehi.

ʻO ka mea nui loa, inā pili ka maʻi Whipple i kou ʻōnaehana nerve waena, hiki ke make. No laila he mea nui e ʻike koke i ke kauka inā loaʻa iā ʻoe nā hōʻailona.

Pehea e ʻike ai nā kauka i ka maʻi o Whipple?

Ke hele ʻoe e ʻike i ke kauka, e hāʻawi mua ʻo ia iā ʻoe i kahi hoʻokolokolo kino . A laila, e nīnau lākou e pili ana i kou mōʻaukala olakino , me nā pilikia olakino o kēia manawa a i ʻole ma mua. Hiki iā lākou ke nīnau e pili ana i nā lāʻau lapaʻau āu e lawe ai a inā paha ua loaʻa i kekahi o kou ʻohana kekahi o kēia mau kūlana. Eia kekahi, hiki iā lākou ke hana i kēia mau hoʻokolohua:

• Helu Koko Piha (CBC) : Nānā kēia i ke kūlana o nā hunaola koko o ke kino, inā he anemia, a inā he mau hōʻailona o ka maʻi.
• ʻO ka endoscopy luna o ka ʻōpū liʻiliʻiMa kēia, ua hoʻokomo ʻia kahi ʻōmole me kahi kāmela liʻiliʻi ma ka waha a nānā ʻia i loko o ka ʻōpū liʻiliʻi. Ma kēia ʻano, hiki ke nānā ʻia nā loli ma laila, nā hōʻailona o ka maʻi. E hoʻomoe ʻia ʻoe ma mua o ka hana ʻana i kēia, no laila ʻaʻole ʻoe e ʻeha.
• Hoʻāʻo Polymerase Chain Reaction (PCR) : He hoʻāʻo kūikawā kēia e hiki ke kōkua i ka hoʻoholo ʻana inā loaʻa ka bacteria (T. whipplei). Hiki ke hana ʻia ma kahi ʻāpana ʻiʻo i lawe ʻia mai kahi biopsy a i ʻole ma kahi wai kino ʻē aʻe.
• ʻO ka biopsy ʻōpū liʻiliʻi : I ka wā o ka endoscopy, lawe ʻia kahi ʻāpana liʻiliʻi o ka ʻiʻo mai ka ʻōpū liʻiliʻi a nānā ʻia ma lalo o kahi microscope. Hoʻohana pinepine ʻia kēia e hōʻoia i ka maʻi Whipple. Hiki iā ia ke nānā i nā loli kikoʻī i loko o ka ʻiʻo ʻōpū i hoʻokumu ʻia e ka bacteria.

Pehea e mālama ʻia ai ka maʻi ʻo Whipple?

He manawa pōkole ka lōʻihi e hoʻopau loa ai i nā bacteria e hoʻoulu ai i ka maʻi Whipple mai ke kino. No laila, he lōʻihi iki ka lāʻau lapaʻau. Akā inā ʻoe e hoʻomanawanui, hiki iā ʻoe ke loaʻa nā hopena maikaʻi.

Eia nā mea nui i hana ʻia ma ke ʻano he lāʻau lapaʻau:

• Nā lāʻau antibiotic : Hoʻomaka ka lāʻau lapaʻau me nā lāʻau antibiotic intravenous (IV) no ʻelua a ʻehā pule . Hana pinepine ʻia kēia ma ka haukapila. Ma hope o kēlā, pono ʻoe e lawe i nā lāʻau antibiotic waha no ka liʻiliʻi o nā mahina 12 e hiki mai ana . I kekahi manawa, pono paha ʻoe e lawe iā lākou no ka lōʻihi, a hiki i ʻelua mau makahiki. He mea nui loa ka lawe ʻana i ka lāʻau lapaʻau e like me ke kuhikuhi a kāu kauka.
• Hoʻololi wai : Inā ua maloʻo ʻoe ma muli o ka maʻi diarrhea, hiki ke hāʻawi ʻia iā ʻoe nā wai IV e kōkua i ka hoʻōki ʻana. A i ʻole, e ʻōlelo ʻia paha ʻoe e inu i nā mea inu electrolyte (e like me Jeevani) e pani i nā wai a me nā paʻakai i nalowale.
• Nā wikamina a me nā mea hoʻohui meaʻai : Hiki i kāu kauka ke ʻōlelo aku iā ʻoe e lawe i nā mea hoʻohui e hoʻopiha hou i nā wikamina (e like me ka wikamina D, B12, a me ka hao) a me nā meaʻai i hiki ʻole i kou ʻōpū ke omo pono. He mea maʻamau ka loaʻa ʻana o nā hemahema meaʻai i kēia maʻi.

Aia kekahi mau hopena ʻaoʻao o ka lāʻau lapaʻau?

ʻAe, hiki ke loaʻa kekahi mau hopena ʻaoʻao, ʻoiai me nā antibiotics. Akā, ʻaʻole hiki kēia i nā kānaka a pau, a inā paha e hana lākou, ʻaʻole ia he mea koʻikoʻi.

• Ka maʻi ʻōpū (ʻeha ʻōpū)
• Pōʻino
• Ka luaʻi a me ka luaʻi
• ʻŌhū ʻili
• Nā maʻi hū (ʻoi aku hoʻi i loko o ka vagina i nā wahine)

Inā hana ʻia kekahi mea e like me kēia, he mea nui e haʻi i kāu kauka . Hiki paha iā lākou ke hoʻololi i ka lāʻau lapaʻau a hāʻawi paha iā ʻoe i kahi mea ʻē aʻe e hōʻemi ai i nā hopena ʻaoʻao.

He aha ka mea e ʻike ai kekahi me ka maʻi ʻo Whipple?

E like me nā kānaka he nui, ʻo ʻoe pū kekahiKe hoʻomaka ʻoe i ka lāʻau lapaʻau, e hoʻomaka koke ʻoe e ʻike i ka hōʻoluʻolu. E emi mālie ana ka ʻeha o ka ʻōpū a me nā ʻeha hui. Eia nō naʻe, hiki ke hala a ʻelua mau makahiki no ka ho'ōla piha ʻana o kou ʻōpū liʻiliʻi. No laila, he mea nui e hoʻomanawanui i ka lāʻau lapaʻau.

I ka hapa nui o ka manawa , ua ho'ōla loa ʻia ka maʻi ʻo Whipple me ka lāʻau lapaʻau . Eia nō naʻe, i kekahi manawa hiki i ka maʻi ke hoʻi hou ma hope o ka pau ʻana o ka lāʻau lapaʻau. ʻO ia ke kumu e hoʻomau ai nā kauka e nānā iā ʻoe.

E noi aku kāu kauka iā ʻoe e hele mai no nā hoʻokolohua hahai maʻamau no kahi manawa lōʻihi. Eia kekahi laʻana, e noi ʻia paha ʻoe e hana i kahi endoscopy luna:

• I kēlā me kēia ʻeono mahina no ka makahiki mua o ka mālama ʻana.
• Hoʻokahi manawa i ka makahiki no nā makahiki ʻekolu e hiki mai ana .
• A laila hoʻokahi manawa i kēlā me kēia ʻekolu makahiki no ke koena o kou ola .

Hana ʻia kēia e nānā inā ua hoʻi hou mai ka maʻi. No laila, mai poina i nā kipa ʻana e like me ka ʻōlelo a ke kauka.

Hiki ke pale ʻia ka maʻi ʻo Whipple?

He mea paʻakikī iki kēlā e ʻōlelo. No ka mea, aia nā bacteria e hoʻoulu ai i ka maʻi ʻo Whipple ma nā wahi āpau o ko kākou kaiapuni, ʻoi aku hoʻi ma ka lepo . Eia naʻe, ʻaʻole nā ​​​​mea āpau i pili iā ia e loaʻa i ka maʻi ʻo Whipple.

Eia nō naʻe, ʻoi aku ka nui o ka pilikia o ka poʻe me nā ʻōnaehana pale kino nāwaliwali a i ʻole ka poʻe e lawe ana i nā immunosuppressants i ka loaʻa ʻana o ka maʻi. Inā ʻo ʻoe kekahi o kēia poʻe, he manaʻo maikaʻi e komo i nā mīkina lima i nā manawa a pau e hana ai ʻoe me ka lepo a i ʻole ka lepo, a e holoi pono i kou mau lima ma hope o ka hana . E makaʻala loa inā ʻoe e mahi ana i ka māla a i ʻole e hana pū ana me nā holoholona.

Pehea wau e mālama ai iaʻu iho?

ʻO ka mea nui loa, ʻo ia ka lawe ʻana i nā lāʻau antibiotic e like me ke kuhikuhi a ke kauka, no ka manawa piha . Mai poina i hoʻokahi lā, a lawe i ka lāʻau lapaʻau no ka manawa piha i kuhikuhi ʻia e ke kauka. Pono ka hapa nui o ka poʻe e lawe i nā lāʻau antibiotic no hoʻokahi makahiki ma hope o ka hōʻoia ʻia ʻana. Pono paha kekahi poʻe e lawe i nā lāʻau antibiotic no ke koena o ko lākou ola. Na ke kauka ia e hoʻoholo.

Ke loaʻa iā ʻoe ka maʻi ʻo Whipple, e nele ana paha kou kino i nā meaʻai koʻikoʻi he nui . ʻOiai inā loaʻa iā ʻoe ka hōʻoluʻolu mai ka lāʻau lapaʻau, he manaʻo maikaʻi nō naʻe e kūkākūkā me kahi meaʻai meaʻai e pili ana i nā mea āu e ʻai ai a inu ai . E kōkua kēia iā ʻoe e loaʻa ka meaʻai kūpono a mālama i ke kaumaha olakino.

Āhea wau e ʻike hou ai i ke kauka?

Inā hoʻomau ʻoe i nā hōʻailona o ka maʻi Whipple ma hope o kou hoʻomaka ʻana i ka lāʻau lapaʻau, a inā hoʻi hou nā hōʻailona ma hope koke iho o ka pau ʻana o ka lāʻau lapaʻau (no ka laʻana, inā ʻeha kou ʻōpū a ʻeha paha kou hono), e ʻike pono i kāu kauka. Mai hoʻokaʻulua. ʻO ke ʻano paha kēia ua hoʻi mai ka maʻi, a i ʻole he pilikia ʻē aʻe paha.

No ke aha i kapa ʻia ai kēia maʻi ʻo "ka maʻi Whipples"?

He mea maikaʻi kēia e ʻike. Ua kapa ʻia ka maʻi a me nā bacteria e hoʻoulu ai ma hope o George H. Whipple, he pathologist nāna i wehewehe mua i nā hōʻailona i ka makahiki 1907. ʻAʻole a hiki i 80 mau makahiki ma hope mai ua ʻike nā kānaka noiʻi i ka bacteria nāna i hoʻoulu. Ua kapa lākou i ka bacteria ʻo Tropheryma whipplei. ʻO ka inoa he hui pū ʻana o ʻelua mau huaʻōlelo Helene, ʻo "trophe" ʻo ia hoʻi ka meaʻai a me "eryma" ʻo ia hoʻi ke ālai ʻia . ʻO ia hoʻi, ke kumu ia o ka malabsorption . ʻAʻole anei he inoa kūpono?

Aia nā bacteria ma nā wahi a puni mākou (a i loko o ko mākou kino). ʻO ka maʻamau, ʻaʻole hoʻopilikia mai nā bacteria a mākou e hālāwai ai i kēlā me kēia lā iā mākou. Akā, ʻokoʻa iki kēia maʻi bacteria laha ʻole, ʻo ka maʻi Whipple. Hoʻokumu ʻia ia e kahi bacteria maʻamau i loaʻa i ka lepo i kapa ʻia ʻo Tropheryma whipplei.

Hiki iā ʻoe ke pili i kēia bacteria (T. whipplei) ma ka hana a i ʻole i ka wā e mahi ana. Eia naʻe, ʻaʻole nā ​​​​mea a pau i pili iā ia e loaʻa i ka maʻi Whipple. ʻO ka mea pōmaikaʻi, hiki ke ho'ōla pinepine ʻia ke ʻano inā ʻike mua ʻia a mālama pono ʻia.

ʻO nā mea nui loa e pono ai ʻoe e hoʻomanaʻo

He maʻi bacteria ka maʻi Whipple, akā hiki ke ho'ōla ʻia inā mālama pono ʻia .

• Inā hoʻomau nā hōʻailona e like me ka ʻeha o nā hono, ka ʻeha o ka ʻōpū, ka maʻi kahe, a me ka pohō kaumaha , e ʻike pono i ke kauka. Mai hoʻowahāwahā i kēia mau mea.
• ʻO ka lāʻau lapaʻau e pili ana i ka lawe ʻana i nā lāʻau antibiotic no ka manawa lōʻihi . He mea nui loa ia e hahai pololei iā lākou.
• Inā ʻoe e hana ana me ka lepo, ʻoiai inā he nāwaliwali kou ʻōnaehana pale kino, e holoi pono i kou mau lima a e hoʻohana i nā mīkina lima .
• ʻOiai ma hope o ka ho'ōla ʻia ʻana o ka maʻi, he mea nui e hele i nā hoʻokolohua maʻamau ('follow-up') e like me ke kauoha a ke kauka.

Mai makaʻu i kēia maʻi. He mea nui e ʻike ʻia a e ʻimi i ka ʻōlelo aʻoaʻo lapaʻau. ʻAʻole ʻoe hoʻokahi, a aia nā kauka e hiki ke kōkua iā ʻoe me kekahi pilikia. Inā he kānalua kāu, mai kānalua e kamaʻilio me ke kauka.

ʻO ka maʻi Whipple, ka maʻi bacteria, ka ʻōpū liʻiliʻi, ka malabsorption, Tropheryma whipplei, ka ʻeha o nā hono