Differentiating (disease name) from other diseases page

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Charmaine Patel, M.D. [2]

Introduction to the Differentiating (Disease Name) From Other Diseases Page

  • This chapter covers the process that is traditionally known as "differential diagnosis".
  • The page name should be "Differentiating (disease name) from other diseases", with only the first letter of the title capitalized.
  • Goal: To provide information on a systematic method of differentiating a given disease from other diseases that may present similarly.
  • For an example of a microchapter on differentiating disease, click here.
  • Search the disease database (http://diseasesdatabase.com/content.asp) to assure the content for this page is complete.
  • As with all microchapter pages linking to the main page, at the top of the edit box put {{CMG}}, your name template, and the microchapter navigation template you created at the beginning.
  • Remember to create links within Wikidoc by placing [[square brackets]] around key words which you want to link to other pages. Make sure you make your links as specific as possible. For example if a sentence contained the phrase anterior spinal artery syndrome, the link should be to anterior spinal artery syndrome not anterior or artery or syndrome. For more information on how to create links click here.
  • Remember to follow the same format and capitalization of letters as outlined in the template below.
  • You should include the name of the disease in the first sentence of every subsection.

Overview

  • The overview section should include the disease name in the first sentence.
  • The goal is to summarize the page several sentences, usually stating the categories that the disease is classified by.
  • This section can be the same as the differentiating disease section in the overview page.

Template

  • First Sentence:
[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
OR
[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].
OR
[Disease name] must be differentiated from other causes of [symptom/sign], such as [Differential 1], [Differential 2], and [Differential 3].
  • Examples:
Example 1: Hepatitis C must be differentiated from other diseases that cause hepatic injury and abnormal liver function tests, such as other viral hepatitides (Hepatitis A, Hepatitis B, and Hepatitis E), alcoholic liver disease, non-alcoholic steatohepatitis, drug-induced liver injury, autoimmune hepatitis, and hepatocellular carcinoma.
Example 2: Colorectal cancer must be differentiated from other diseases that cause unexplained weight loss, unexplained loss of appetite, abdominal discomfort, nausea, vomiting, diarrhea, anemia, and fatigue, such as irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), hemorrhoids, anal fissures, and diverticular disease.
Example 3: Colorectal cancer must be differentiated from Irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), hemorrhoids, anal fissures, and diverticular disease.
Example 4: Pericarditis must be differentiated from other causes of chest pain, such as myocardial infarction, aortic dissection, and pulmonary embolism.

Preferred Template Statements

  • [Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
  • [Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].

IF the disease has multiple subtypes and the subtypes do not have the same differential diagnoses:

  • As [disease name] manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtype. [Subtype name 1] must be differentiated from other diseases that cause [clinical feature 1], such as [differential dx1] and [differential dx2]. In contrast, [subtype name 2] must be differentiated from other diseases that cause [clinical feature 2], such as [differential dx3] and [differential dx4].

Differentiating (Disease name) from other Diseases

  • In this section you will outline the conditions or diseases that may often be confused with the disease you are describing.
  • You can list the diseases, include major clinical features of each differential diagnosis including major symptoms, physical exam findings, and provide a brief description of how each disease is different from the one you are describing, as seen here.
  • You can differentiate physical examination characteristics from those of similar diseases.
  • You can also provide guidance on the distinguishing characteristics of the physical exam findings, the laboratory findings, and other diagnostic modalities.
  • A table may be helpful. It should be preceded by the following sentence:

The table below summarizes the findings that differentiate ______ dz from other conditions that may cause ____ (major symptoms) and _____ (major signs):

  • If you want to have some abbreviations, you should describe them before starting the table. You can find an example here.
  • The use of the following symbols may be helpful within a table:
    • ↑ and ↓ ,to signify elevations and reductions in quantitative findings.
    • + , ++, or +++ to signify varying levels of quantitative findings, - if there is a null value, and Nl if the desired value is within normal limits.
  • The following table may be used as a general template for differentiating diseases from one another:
Diseases Laboratory Findings Physical Examination History and Symptoms Other Findings
Lab Test 1 Lab Test 2 Lab Test 3 Lab Test 4 Physical Finding 1 Physical Finding 2 Physical Finding 3 Physical Finding 4 Finding 1 Finding 2 Finding 3 Finding 4
Differential Diagnosis 1 +
Differential Diagnosis 2 -
Differential Diagnosis 3
Differential Diagnosis 4
Differential Diagnosis 5
  • This table must include the cardinal manifestations of differential diagnosis and the list of diseases must be prioritize based on mortality rate and prevalences of the diseases. For example, if you want to write a differential diagnosis table for heat stroke, sepsis, malignant hyperthermia, neuroleptic malignant syndrome, and serotonin syndrome first, you need to mention the cardinal manifestations for these conditions as, hyperthermia and altered mental status. Second, prioritize your list based on disease mortality or prevalence then, create the table. You can find the example here.
Differential Diagnosis Similar Features Differentiating Features
Differential 1
  • On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
  • On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Differential 2
  • On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
  • On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Differential 3
  • On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
  • On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Differential 4
  • On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
  • On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].
Differential 5
  • On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] also observed in [disease name].
  • On [physical exam; history; diagnostic test; imaging], [Differential 1] {has; demonstrates} [feature 1], [feature 2], [feature 3] that distinguish it from [disease name].

Examples:

The following tables may be used as examples of different table styles for differentiating disease:

Example 1

The table below summarizes the different findings between Pericarditis and Myocardial infarction:

Characteristic/Parameter Pericarditis Myocardial infarction
Pain description Sharp, pleuritic, retro-sternal (under the sternum) or left precordial (left chest) pain. Crushing, pressure-like, heavy pain. Described as "elephant on the chest".
Radiation Pain radiates to the trapezius ridge (to the lowest portion of the scapula on the back) or no radiation. Pain radiates to the jaw, or the left or arm, or does not radiate.
Exertion Does not change the pain Can increase the pain
Position Pain is worse supine or upon inspiration (breathing in) Not positional
Onset/duration Sudden pain, that lasts for hours or sometimes days before a patient comes to the ER Sudden or chronically worsening pain that can come and go in paroxysms or it can last for hours before the patient decides to come to the ER

Example 2

The table below summarizes the findings that differentiate Shigellosis from other conditions that cause fever and hemorrhage:

Disease Findings
EHEC May present with fever, chills vomiting, diarrhea, generalized pain or malaise, and gastointestinal bleeding that follow an incubation period of 3-7 days. Unlike E. coli, Shigella cannot ferment lactose or decarboxylate lysine.[1]
Ebola Presents with fever, chills vomiting, diarrhea, generalized pain or malaise, and sometimes internal and external bleeding, that follow an incubation period of 2-21 days.
Typhoid fever Presents with fever, headache, rash, gastrointestinal symptoms, with lymphadenopathy, relative bradycardia, cough and leucopenia and sometimes sore throat. Blood and stool culture can confirm the presence of the causative bacteria.
Malaria Presents with acute fever, headache and sometimes diarrhea (children). A blood smears must be examined for malaria parasites. The presence of parasites does not exclude a concurrent viral infection. An antimalarial should be prescribed as an empiric therapy.
Lassa fever Disease onset is usually gradual, with fever, sore throat, cough, pharyngitis, and facial edema in the later stages. Inflammation and exudation of the pharynx and conjunctiva are common.
Yellow fever and other Flaviviridae Present with hemorrhagic complications. Epidemiological investigation may reveal a pattern of disease transmission by an insect vector. Virus isolation and serological investigation serves to distinguish these viruses. Confirmed history of previous yellow fever vaccination will rule out yellow fever.
Others Viral hepatitis, leptospirosis, rheumatic fever, typhus, and mononucleosis can produce signs and symptoms that may be confused with Ebola in the early stages of infection.

Example 3
Stroke, must be differentiated from other diseases that may cause, altered mental status, motor and or somatosensory deficits. The table below, summarizes the differential diagnosis for stroke.

Diseases Symptoms Physical Examination Past medical history Diagnostic tests Other Findings
Headache LOC Motor weakness Abnormal sensory Motor Deficit Sensory deficit Speech difficulty Gait abnormality Cranial nerves CT /MRI CSF Findings Gold standard test
Brain tumor[2] + - - - + + + - + Weight loss, fatigue + Cancer cells[3] MRI Cachexia, gradual progression of symptoms
Hemorrhagic stroke + + + + + + + + - Hypertension + - CT scan without contrast[4][5] Neck stiffness
Subdural hemorrhage + + + + + - - - + Trauma, fall + Xanthochromia[6] CT scan without contrast[4][5] Confusion, dizziness, nausea, vomiting
Neurosyphilis[7][8] + - + + + + - + - STIs + Leukocytes and protein CSF VDRL-specifc

CSF FTA-Ab -sensitive[9]

Blindness, confusion, depression,

Abnormal gait

Complex or atypical migraine + - + + - - + - - Family history of migraine - - Clinical assesment Presence of aura, nausea, vomiting
Hypertensive encephalopathy + + - - - - + + - Hypertension + - Clinical assesment Delirium, cortical blindness, cerebral edema, seizure
Wernicke’s encephalopathy - + - - - + + + + History of alcohal abuse - - Clinical assesment and lab findings Ophthalmoplegia, confusion
CNS abscess + + - - + + + - - History of drug abuse, endocarditis, immunosupression + leukocytes, glucose and protien MRI is more sensitive and specific High grade fever, fatigue,nausea, vomiting
Drug toxicity - + - + + + - + - - - - Drug screen test Lithium, Sedatives, phenytoin, carbamazepine
Conversion disorder + + + + + + + + History of emotional stress - - Diagnosis of exclusion Tremors, blindness, difficulty swallowing
Metabolic disturbances (electrolyte imbalance, hypoglycemia) - + + + + + - - + - - Hypoglycemia, hypo and hypernatremia, hypo and hyperkalemia Depends on the cause Confusion, seizure, palpitations, sweating, dizziness, hypoglycemia
Meningitis or encephalitis + - - - - + + - - History of fever and malaise - Leukocytes,

Protein

↓ Glucose

CSF analysis[10] Fever, neck

rigidity

Multiple sclerosis exacerbation - - + + - + + + + History of relapses and remissions + CSF IgG levels

(monoclonal bands)

Clinical assesment and MRI [11] Blurry vision, urinary incontinence, fatigue
Seizure + + - - + + - - + Previous history of seizures - Mass lesion Clinical assesment and EEG [12] Confusion, apathy, irritability,

References

  • References should be cited for the material that you have put on your page. Type in {{reflist|2}}.This will generate your references in small font, in two columns, with links to the original article and abstract.
  • For information on how to add references into your page, click here
  1. Hale, TL; Keusch, GT (1996). "Shigella. In: Baron S, editor. Medical Microbiology. 4th edition.". Galveston (TX): University of Texas Medical Branch at Galveston. Retrieved 4 April 2015. 
  2. Morgenstern LB, Frankowski RF (1999). "Brain tumor masquerading as stroke.". J Neurooncol. 44 (1): 47–52. PMID 10582668. 
  3. Weston CL, Glantz MJ, Connor JR (2011). "Detection of cancer cells in the cerebrospinal fluid: current methods and future directions.". Fluids Barriers CNS. 8 (1): 14. PMC 3059292Freely accessible. PMID 21371327. doi:10.1186/2045-8118-8-14. 
  4. 4.0 4.1 Birenbaum D, Bancroft LW, Felsberg GJ (2011). "Imaging in acute stroke.". West J Emerg Med. 12 (1): 67–76. PMC 3088377Freely accessible. PMID 21694755. 
  5. 5.0 5.1 DeLaPaz RL, Wippold FJ, Cornelius RS, Amin-Hanjani S, Angtuaco EJ, Broderick DF; et al. (2011). "ACR Appropriateness Criteria® on cerebrovascular disease.". J Am Coll Radiol. 8 (8): 532–8. PMID 21807345. doi:10.1016/j.jacr.2011.05.010. 
  6. Lee MC, Heaney LM, Jacobson RL, Klassen AC (1975). "Cerebrospinal fluid in cerebral hemorrhage and infarction.". Stroke. 6 (6): 638–41. PMID 1198628. 
  7. Liu LL, Zheng WH, Tong ML, Liu GL, Zhang HL, Fu ZG; et al. (2012). "Ischemic stroke as a primary symptom of neurosyphilis among HIV-negative emergency patients.". J Neurol Sci. 317 (1-2): 35–9. PMID 22482824. doi:10.1016/j.jns.2012.03.003. 
  8. Berger JR, Dean D (2014). "Neurosyphilis". Handb Clin Neurol. 121: 1461–72. PMID 24365430. doi:10.1016/B978-0-7020-4088-7.00098-5. 
  9. Ho EL, Marra CM (2012). "Treponemal tests for neurosyphilis--less accurate than what we thought?". Sex Transm Dis. 39 (4): 298–9. PMC 3746559Freely accessible. PMID 22421697. doi:10.1097/OLQ.0b013e31824ee574. 
  10. Carbonnelle E (2009). "[Laboratory diagnosis of bacterial meningitis: usefulness of various tests for the determination of the etiological agent].". Med Mal Infect. 39 (7-8): 581–605. PMID 19398286. doi:10.1016/j.medmal.2009.02.017. 
  11. Giang DW, Grow VM, Mooney C, Mushlin AI, Goodman AD, Mattson DH; et al. (1994). "Clinical diagnosis of multiple sclerosis. The impact of magnetic resonance imaging and ancillary testing. Rochester-Toronto Magnetic Resonance Study Group.". Arch Neurol. 51 (1): 61–6. PMID 8274111. 
  12. Manford M (2001). "Assessment and investigation of possible epileptic seizures.". J Neurol Neurosurg Psychiatry. 70 Suppl 2: II3–8. PMC 1765557Freely accessible. PMID 11385043. 



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