Whipple's disease differential diagnosis: Difference between revisions
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*[[Clonorchiasis]] | *[[Clonorchiasis]] | ||
*[[Parkinson's disease]] | *[[Parkinson's disease]] | ||
'''The table below summarizes the findings that differentiate fatty causes of chronic diarrhea'''<ref name="pmid8694025">{{cite journal| author=Hertzler SR, Savaiano DA| title=Colonic adaptation to daily lactose feeding in lactose maldigesters reduces lactose intolerance. | journal=Am J Clin Nutr | year= 1996 | volume= 64 | issue= 2 | pages= 232-6 | pmid=8694025 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8694025 }} </ref><ref name="pmid9414969">{{cite journal| author=Briet F, Pochart P, Marteau P, Flourie B, Arrigoni E, Rambaud JC| title=Improved clinical tolerance to chronic lactose ingestion in subjects with lactose intolerance: a placebo effect? | journal=Gut | year= 1997 | volume= 41 | issue= 5 | pages= 632-5 | pmid=9414969 | doi= | pmc=1891556 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9414969 }} </ref><ref name="pmid15391722">{{cite journal| author=BLACK-SCHAFFER B| title=The tinctoral demonstration of a glycoprotein in Whipple's disease. | journal=Proc Soc Exp Biol Med | year= 1949 | volume= 72 | issue= 1 | pages= 225-7 | pmid=15391722 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15391722 }} </ref> | |||
{| class="wikitable" | |||
! rowspan="2" |Cause | |||
! colspan="2" |Osmotic gap | |||
! rowspan="2" |History | |||
! rowspan="2" |Physical exam | |||
! rowspan="2" |Gold standard | |||
! rowspan="2" |Treatment | |||
|- | |||
!< 50 | |||
mOsm | |||
per kg | |||
!> 50 | |||
mOsm | |||
per kg* | |||
|- | |||
|[[lactose intolerance]] | |||
| - | |||
| + | |||
| | |||
* [[Bloating|Bloating,]] | |||
* [[Flatulence]] | |||
* [[Abdominal pain]], and/or [[chronic diarrhea]] | |||
* after ingestion of [[lactose]] | |||
| | |||
* [[Abdominal]] [[tenderness ]]when palpated in severe [[disease]] | |||
* [[Fever]] | |||
* [[Hypotension]] | |||
* [[Tachycardia]] | |||
* [[Nausea and vomiting]] | |||
|[[Hydrogen Breath Test|Lactose breath hydrogen test]] | |||
|Restriction of [[lactose]] and maintain [[calcium]] and [[vitamin D]] intake. | |||
|- | |||
|[[Celiac sprue]] | |||
| - | |||
| + | |||
| | |||
* [[Diarrhea]] with bulky, [[Steatorrhea|foul-smelling stools]] | |||
* [[Growth failure]] in children, | |||
* [[Weight loss|Weight loss,]] | |||
* [[Anemia]], | |||
* [[Neurologic diseases|Neurologic disorders]] | |||
* [[Osteopenia]] | |||
| | |||
* [[Neuropsychiatric|Neuropsychiatric disease]] | |||
* [[Dermatitis herpetiformis]] | |||
* [[Arthritis]] | |||
* [[Iron deficiency]] | |||
* [[Metabolic]] bone disease | |||
* [[Hyposplenism]] | |||
* [[Kidney disease]] | |||
* [[Idiopathic pulmonary hemosiderosis]] | |||
|[[Immunoglobulin A]] ([[IgA]]) [[Tissue transglutaminase|anti-tissue transglutaminase]] (TTG) antibody followed by upper [[endoscopy]] with [[biopsy]]. | |||
|Dietary counseling, elimination of [[gluten]] in the diet. | |||
|- | |||
|[[Whipple's disease|Whipple disease]] | |||
| - | |||
| + | |||
| | |||
* [[Arthralgias]] | |||
* [[Weight loss]] | |||
* [[Diarrhea]] | |||
* [[Abdominal pain]] | |||
| | |||
* [[Leukocytopenia]] | |||
* [[Thrombocytopenia]] | |||
* [[Skin hyperpigmentation]] | |||
|Upper [[endoscopy]] with [[biopsies]] of the [[small intestine]] for ''[[Tropheryma whipplei|T. whipplei]]'' testing ([[histology]] with [[Periodic acid-Schiff stain|PAS staining]], [[polymerase chain reaction]] [[[PCR]]] testing, and [[immunohistochemistry]]) | |||
|[[Doxycycline]] and [[hydroxychloroquine]] are [[bactericidal]] | |||
|} | |||
==References== | ==References== | ||
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Overview
Whipple's disease must be differentiated from celiac disease, chronic diarrhea, clonorchiasis, and Parkinson's disease.
Differentiating Whipple's disease from other Diseases
The following diseases have presentations similar to that of Whipple's disease.
The table below summarizes the findings that differentiate fatty causes of chronic diarrhea[1][2][3]
| Cause | Osmotic gap | History | Physical exam | Gold standard | Treatment | |
|---|---|---|---|---|---|---|
| < 50
mOsm per kg |
> 50
mOsm per kg* | |||||
| lactose intolerance | - | + |
|
|
Lactose breath hydrogen test | Restriction of lactose and maintain calcium and vitamin D intake. |
| Celiac sprue | - | + |
|
Immunoglobulin A (IgA) anti-tissue transglutaminase (TTG) antibody followed by upper endoscopy with biopsy. | Dietary counseling, elimination of gluten in the diet. | |
| Whipple disease | - | + | Upper endoscopy with biopsies of the small intestine for T. whipplei testing (histology with PAS staining, polymerase chain reaction [[[PCR]]] testing, and immunohistochemistry) | Doxycycline and hydroxychloroquine are bactericidal | ||
References
- ↑ Hertzler SR, Savaiano DA (1996). "Colonic adaptation to daily lactose feeding in lactose maldigesters reduces lactose intolerance". Am J Clin Nutr. 64 (2): 232–6. PMID 8694025.
- ↑ Briet F, Pochart P, Marteau P, Flourie B, Arrigoni E, Rambaud JC (1997). "Improved clinical tolerance to chronic lactose ingestion in subjects with lactose intolerance: a placebo effect?". Gut. 41 (5): 632–5. PMC 1891556. PMID 9414969.
- ↑ BLACK-SCHAFFER B (1949). "The tinctoral demonstration of a glycoprotein in Whipple's disease". Proc Soc Exp Biol Med. 72 (1): 225–7. PMID 15391722.