Microvillous inclusion disease
| Microvillous inclusion disease | |
|---|---|
| Classification and external resources | |
| OMIM | 251850 |
| DiseasesDB | 32409 |
| eMedicine | ped/461 |
Microvillous inclusion disease, also known as Davidson's disease, congenital microvillous atrophy and, less specifically, microvillous atrophy, is a rare genetic disorder of the small intestine that is inherited in an autosomal recessive pattern.[1][2]
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[edit] Presentation
It is characterized by chronic, intractable diarrhea in new-born infants, starting in the first few days of life.[3] This results in metabolic acidosis and severe dehydration. Pregnancy and birth are usually normal.
[edit] Prognosis
It is nearly always fatal unless, like short bowel syndrome patients, treated with parenteral nutrition or an intestinal transplant.[3] The patient is often classified as being in "intestinal failure" and treated with the cohort of patients known as "short bowel syndrome" patients.
[edit] Pathophysiology
It is caused by a congenital lack of apical microvilli in the epithelial cells of the small intestine.[4]
[edit] Diagnosis
Prenatal screening in utero is currently offered by several medical centers since the gene(s) involved in the disease were recently discovered to be MYO5B;[5][6] Diagnosis is typically made by biopsy of the small intestine.[1]
[edit] Biopsy
The appearance of microvillous inclusion disease on light microscopy is similar to celiac sprue; however, it usually lacks the intraepithelial lymphocytic infiltration characteristic of celiac sprue and stains positive for carcinoembryonic antigen (CEA).[2] The definitive diagnosis is dependent on electron microscopy.[7]
[edit] Differential diagnosis
The differential diagnosis of chronic and intractable diarrhea is:[8]
- Intestinal epithelial dysplasia
- Syndromatic diarrhea
- Immunoinflammatory enteropathy
[edit] Genetic prevalence
Microvillous inclusion disease is thought to be extremely rare; only, approximately, two dozen cases have been identified in the medical literature.[9]
One patient, a teenage female living in Arizona, suddenly began to grow microvilli after thirteen years of TPN (Total Parenteral Nutrition) and Lipid dependancy. She now enjoys a typical teenage diet and is seen regularly by her Gastroenterologist.
One patient from the UK was documented to achieve nutritional independence at age 3.[10]
On 26 June 2009 a six year old girl diagnosed with microvillous inclusion disease became the third person in the UK to die of swine flu.[11]
[edit] History
Microvillous inclusion disease was first described in 1978 by Davidson et al.[12] It was originally described as familial enteropathy.
[edit] References
- ^ a b Chehade, Mirna; Sicherer, Scott H (2005). "Infantile food protein-induced enterocolitis syndrome". In David, Timothy J. Recent Advances in Paediatrics 22. London: Royal Society of Medicine Press. pp. 140. ISBN 1853155721. http://books.google.com/?id=gyujuv2pOhcC&pg=PA140&vq=%22microvillous+atrophy%22&dq=%22microvillous+atrophy%22
- ^ a b Mills SE, Carter D, Greenson JK, Oberman HA, Reuter V, Stoler MH. Sternberg's Diagnostic Surgical Pathology. 4th Ed. Lippincott Williams & Wilkins. Copyright 2004. ISBN 978-0-7817-4051-7.
- ^ a b Salvatore, S.; Hauser, B.; Vandenplas, Y. (2007). "Chronic enteropathy and feeding". In Cooke, Richard J.; Vandenplas, Yvan; Wahn, Ulrich. Nutrition Support for Infants and Children at Risk. Basel, Switzerland; New York: Karger. pp. 123. ISBN 3805581947. http://books.google.com/?id=5TxMbNABKOAC&pg=PA123&vq=%22microvillous+inclusion+disease&dq=%22microvillous+inclusion+disease%22
- ^ Arpin, M.; Crepaldi, T.; Louvard, D. (1999). "Cross-talk between Apical and Basolateral Domains of Epithelial Cells Regulates Microvillus Assembly". In Birchmeier, Walter; Birchmeier, Carmen. Epithelial Morphogenesis in Development and Disease. Amsterdam: Harwood Academic. pp. 104. ISBN 9057024195. http://books.google.com/?id=gemrGZ596Q8C&pg=PA104&vq=%22microvillous+atrophy%22&dq=%22microvillous+atrophy%22
- ^ Mueller T; Hess, MW; Schiefermeier, N; Pfaller, K; Ebner, HL; Heinz-Erian, P; Ponstingl, H; Partsch, J et al (2008). "MYO5B mutations cause microvillus inclusion disease and disrupt epithelial cell polarity". Nat Genet 40 (10): 1163–5. doi:10.1038/ng.225. PMID 18724368.
- ^ Szperl A, Golachowska M, Rings E, IJzendoorn S, et al (2011). "Functional characterization of mutations in the myosin Vb gene associated with microvillus inclusion disease.". J Ped Gastroenterol Nutr 52: 307–13. PMID 21206382.
- ^ Kennea N, Norbury R, Anderson G, Tekay A (2001). "Congenital microvillous inclusion disease presenting as antenatal bowel obstruction". Ultrasound Obstet Gynecol 17 (2): 172–4. doi:10.1046/j.1469-0705.2001.00211.x. PMID 11251929.
- ^ Ruemmele FM (2007). "Chronic enteropathy: molecular basis". Nestle Nutr Workshop Ser Pediatr Program 59: 73–85; discussion 85–8. doi:10.1159/000098514. PMID 17245092.
- ^ Online 'Mendelian Inheritance in Man' (OMIM) Microvillous atrophy -251850
- ^ Croft NM; Howatson, AG; Ling, SC; Nairn, L; Evans, TJ; Weaver, LT (2000). "Microvillous inclusion disease: An evolving Condition". J Pediatr Gastroenterol Nutr 32 (2): 185–189. PMID 10941974.
- ^ "Swine flu girl 'had tough life'". BBC News. 30 June 2009. http://news.bbc.co.uk/1/hi/england/west_midlands/8126095.stm. Retrieved 12 May 2010.
- ^ Davidson GP, Cutz E, Hamilton JR, Gall DG (1978). "Familial enteropathy: a syndrome of protracted diarrhea from birth, failure to thrive, and hypoplastic villus atrophy". Gastroenterology 75 (5): 783–90. PMID 100367.
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