Filariasis differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Filariasis}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Filariasis]]
{{CMG}}{{AE}}{{MAD}}
{{CMG}}{{AE}}{{MAD}}


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* History of living in endemic area or travelling to it
* History of living in [[endemic]] area or travelling to it
|Chronic
|[[Chronic (medical)|Chronic]]
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
| +
| +
|Bilateral
|[[Bilateral]]
| +
| +
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
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* Scrotal [[elephantiasis]]
* Scrotal [[elephantiasis]]
* [[Lymphadenopathy|Lymphadenopathies]]
* [[Lymphadenopathy|Lymphadenopathies]]
* [[Rhonchi]] may be present in patients with Pulmonary tropical eosinophilia syndrome.
* [[Rhonchi]] may be present in patients with [[Pulmonary]] tropical [[eosinophilia]] syndrome
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'''Preparing blood smears'''
* [[Blood film|Thick blood film]]
* Thick smears
 
# Thick smears consist of a thick layer of dehemoglobinized (lysed) [[Red blood cell|red blood cells]] (RBCs). 
* [[Blood film|Thin blood film]]
# Thick smears allow a more efficient detection of parasites (increased sensitivity).
 
* Thin smears consist of [[blood]] spread in a layer such that the thickness decrease.
* [[Ultrasound]]:
'''By the ultrasound''', the following findings can be observed:
** "filarial dance" sign
* Dilated lymphatic channels
* Living worms tend to be in motion which called "filarial dance" sign.


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* History of untreated [[varicose veins]]
* History of untreated [[varicose veins]]
* Painful bilateral [[lower limb]] [[swelling]] that increases with standing and decreases by rest and [[leg]] elevation.
* Painful bilateral [[lower limb]] [[swelling]] that increases with standing and decreases by rest and [[leg]] elevation
|Chronic
|[[Chronic (medical)|Chronic]]
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
| -
| -
|Bilateral
|[[Bilateral]]
| +
| +


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| -
| -
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* Typical varicose veins
* Typical [[varicose veins]]
* [[Skin]] change distribution correlate with varicose veins sites in the medial side of [[ankle]] and [[leg]]
* [[Skin]] change distribution correlate with [[varicose veins]] sites in the medial side of [[ankle]] and [[leg]]
* Reduction of [[swelling]] with limb elevation.
* Reduction of [[swelling]] with limb elevation
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* [[Duplex ultrasound]] will demonstrate typical findings of [[Venous insufficiency|venous valvular insufficiency]]
* [[Duplex ultrasound]]  
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|[[Deep venous thrombosis|Acute deep venous thrombosis]]
|[[Deep venous thrombosis|Acute deep venous thrombosis]]
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* History of prolonged recumbency
* History of prolonged recumbency
* Classic symptoms of [[DVT]] include acute unilateral [[swelling]], [[pain]], and [[erythema]]   
* Classic symptoms of [[DVT]] include acute unilateral [[swelling]], [[pain]], and [[erythema]]   
|Acute
|[[Acute (medicine)|Acute]]
| +
| +
| -
| -
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* Dilated [[superficial veins]]
* Dilated [[superficial veins]]
* Difference in [[Calf muscle|calf]] diameter is twice as likely to have [[DVT]](most impotant sign )<ref name="pmid16027455">{{cite journal| author=Goodacre S, Sutton AJ, Sampson FC| title=Meta-analysis: The value of clinical assessment in the diagnosis of deep venous thrombosis. | journal=Ann Intern Med | year= 2005 | volume= 143 | issue= 2 | pages= 129-39 | pmid=16027455 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16027455  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16539361 Review in: ACP J Club. 2006 Mar-Apr;144(2):46-7]  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17213086 Review in: Evid Based Med. 2006 Apr;11(2):56]</ref>
* Difference in [[Calf muscle|calf]] diameter is twice as likely to have [[DVT]](most impotant sign )<ref name="pmid16027455">{{cite journal| author=Goodacre S, Sutton AJ, Sampson FC| title=Meta-analysis: The value of clinical assessment in the diagnosis of deep venous thrombosis. | journal=Ann Intern Med | year= 2005 | volume= 143 | issue= 2 | pages= 129-39 | pmid=16027455 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16027455  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16539361 Review in: ACP J Club. 2006 Mar-Apr;144(2):46-7]  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17213086 Review in: Evid Based Med. 2006 Apr;11(2):56]</ref>
* Calf pain on passive [[dorsiflexion]] of the [[foot]] ([[Homan's sign]]) isn't realiable sign.
* Calf pain on passive [[dorsiflexion]] of the [[foot]] ([[Homan's sign]]) isn't realiable sign


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* [[Compression ultrasonography]] (CUS) with [[Doppler ultrasound|doppler]] is the diagnostic test of choice
* [[Compression ultrasonography]] with [[Doppler ultrasound|doppler]]  
* [[D-dimer]] level is used for unprobable cases
* [[D-dimer]]
|-
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|[[Lipedema]]
|[[Lipedema]]
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* Family history especially in women; [[X-linked dominant]] or [[autosomal dominant]] condition.<ref name="pmid20358611">{{cite journal| author=Child AH, Gordon KD, Sharpe P, Brice G, Ostergaard P, Jeffery S et al.| title=Lipedema: an inherited condition. | journal=Am J Med Genet A | year= 2010 | volume= 152A | issue= 4 | pages= 970-6 | pmid=20358611 | doi=10.1002/ajmg.a.33313 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20358611  }}</ref>  
* Family history especially in women; [[X-linked dominant]] or [[autosomal dominant]] condition<ref name="pmid20358611">{{cite journal| author=Child AH, Gordon KD, Sharpe P, Brice G, Ostergaard P, Jeffery S et al.| title=Lipedema: an inherited condition. | journal=Am J Med Genet A | year= 2010 | volume= 152A | issue= 4 | pages= 970-6 | pmid=20358611 | doi=10.1002/ajmg.a.33313 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20358611  }}</ref>  
* Abnormal deposition of fat and [[edema]] and [[easy bruising]].
* Abnormal deposition of fat and [[edema]] and [[easy bruising]]
|Chronic
|Chronic
| +
| +
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|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
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* Tender with palpation
* Tenderness with palpation


* Negative '''Semmer sign''' to differentiate from lymphedema.<ref name="pmid23939641">{{cite journal| author=Trayes KP, Studdiford JS, Pickle S, Tully AS| title=Edema: diagnosis and management. | journal=Am Fam Physician | year= 2013 | volume= 88 | issue= 2 | pages= 102-10 | pmid=23939641 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23939641  }}</ref>
* Negative Semmer sign<ref name="pmid23939641">{{cite journal| author=Trayes KP, Studdiford JS, Pickle S, Tully AS| title=Edema: diagnosis and management. | journal=Am Fam Physician | year= 2013 | volume= 88 | issue= 2 | pages= 102-10 | pmid=23939641 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23939641  }}</ref>
* Pinching the [[skin]] on the upper surface of the [[toes]]. If it is possible to grasp a thin fold of [[tissue]] then it is negative result.
* In a positive result, it is only possible to grasp a [[lump]] of [[tissue]].


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* MRI offers strong qualitative and quantitative parameters in the diagnosis of [[lipedema]] <ref name="pmid9412843">{{cite journal| author=Dimakakos PB, Stefanopoulos T, Antoniades P, Antoniou A, Gouliamos A, Rizos D| title=MRI and ultrasonographic findings in the investigation of lymphedema and lipedema. | journal=Int Surg | year= 1997 | volume= 82 | issue= 4 | pages= 411-6 | pmid=9412843 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9412843  }}</ref>
* MRI<ref name="pmid9412843">{{cite journal| author=Dimakakos PB, Stefanopoulos T, Antoniades P, Antoniou A, Gouliamos A, Rizos D| title=MRI and ultrasonographic findings in the investigation of lymphedema and lipedema. | journal=Int Surg | year= 1997 | volume= 82 | issue= 4 | pages= 411-6 | pmid=9412843 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9412843  }}</ref>
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|[[Myxedema]]
|[[Myxedema]]
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* History of untreated [[hypothyroidism]].
* History of untreated [[hypothyroidism]]
* Infiltration of the skin with [[Glycosaminoglycan|glycosaminoglycans]] with associated water retention.
* Infiltration of the skin with [[Glycosaminoglycan|glycosaminoglycans]] with associated water retention
|Chronic
|Chronic
| +
| +
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* [[Thyroid function tests|Thyroid function tests.]]
* [[Thyroid function tests|Thyroid function tests.]]
|-
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|([[Cellulitis]]-[[Erysipelas|erysipelas-]]<nowiki/>[[skin abscess]])
|([[Cellulitis]]-[[Erysipelas|erysipelas-]]<nowiki/>skin abscess)
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* Acute painful [[swelling]]  
* Acute painful [[swelling]]  
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| -
| -
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* [[Tenderness]], hotness, and may be fluctuation if [[abscess]] formed.
* [[Tenderness]], hotness, and may be fluctuation if [[abscess]] formed
* [[Lymphangitis]] in nearby [[Lymph node|lymph nodes]].
* [[Lymphangitis]] in nearby [[Lymph node|lymph nodes]]
* [[Toxemia]] and [[fever]] in severe cases.
* [[Toxemia]] and [[fever]] in severe cases
* [[Cellulitis]] involves the deeper [[dermis]] and [[erysipelas]] involves the upper dermis.<ref name="pmid24947530">{{cite journal| author=Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL et al.| title=Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. | journal=Clin Infect Dis | year= 2014 | volume= 59 | issue= 2 | pages= 147-59 | pmid=24947530 | doi=10.1093/cid/ciu296 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24947530  }}</ref>
* [[Cellulitis]] involves the deeper [[dermis]] and [[erysipelas]] involves the upper dermis<ref name="pmid24947530">{{cite journal| author=Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL et al.| title=Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. | journal=Clin Infect Dis | year= 2014 | volume= 59 | issue= 2 | pages= 147-59 | pmid=24947530 | doi=10.1093/cid/ciu296 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24947530  }}</ref>
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* Usually it doesn't need any laboratory tests to diagnose.<ref name="pmid27434444">{{cite journal| author=Raff AB, Kroshinsky D| title=Cellulitis: A Review. | journal=JAMA | year= 2016 | volume= 316 | issue= 3 | pages= 325-37 | pmid=27434444 | doi=10.1001/jama.2016.8825 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27434444  }}</ref>
* Diagnosis is clinical<ref name="pmid27434444">{{cite journal| author=Raff AB, Kroshinsky D| title=Cellulitis: A Review. | journal=JAMA | year= 2016 | volume= 316 | issue= 3 | pages= 325-37 | pmid=27434444 | doi=10.1001/jama.2016.8825 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27434444  }}</ref>
* [[Blood cultures]] are warranted for patients in the following circumstances:<ref name="pmid10834819">{{cite journal| author=Woo PC, Lum PN, Wong SS, Cheng VC, Yuen KY| title=Cellulitis complicating lymphoedema. | journal=Eur J Clin Microbiol Infect Dis | year= 2000 | volume= 19 | issue= 4 | pages= 294-7 | pmid=10834819 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10834819  }}</ref>
* [[Blood cultures]]
# [[Toxicity|Systemic toxicity]]
 
# Extensive [[skin]] or [[soft tissue]] involvement
* Serologic ''testing for [[beta-hemolytic streptococci]]''<ref name="pmid4005155">{{cite journal| author=Leppard BJ, Seal DV, Colman G, Hallas G| title=The value of bacteriology and serology in the diagnosis of cellulitis and erysipelas. | journal=Br J Dermatol | year= 1985 | volume= 112 | issue= 5 | pages= 559-67 | pmid=4005155 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4005155  }}</ref>
# Underlying [[comorbidities]]
# persistent [[cellulitis]]
* In patients with recurrent [[cellulitis]], serologic ''testing for [[beta-hemolytic streptococci]]'' is a good diagnostic tool''.''<ref name="pmid4005155">{{cite journal| author=Leppard BJ, Seal DV, Colman G, Hallas G| title=The value of bacteriology and serology in the diagnosis of cellulitis and erysipelas. | journal=Br J Dermatol | year= 1985 | volume= 112 | issue= 5 | pages= 559-67 | pmid=4005155 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4005155  }}</ref>
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|Other causes of [[generalized edema]]
|Other causes of [[generalized edema]]
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* According to the primary cause ( Echo- [[LFTs]]- RFT)
* Echocardiogram
* [[LFTs|LFT]]
* RFT
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==References==
==References==
{{reflist|2}}
{{reflist|2}}
[[Category:Emergency mdicine]]
[[Category:Disease]]
[[Category:Up-To-Date]]
[[Category:Infectious disease]]
[[Category:Vascular medicine]]
[[Category:Urology]]
[[Category:Gastroenterology]]

Latest revision as of 21:45, 29 July 2020

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

Overview

Lymphatic filariasis must be differentiated from other causes of lower limb edema, such as chronic venous insufficiency, acute deep venous thrombosis, lipedema, myxedema, cellulitis and causes of generalized edema.

Differentiating filariasis from other diseases

Lymphatic filariasis must be differentiated from other causes of lower limb edema like chronic venous insufficiency, acute deep venous thrombosis, lipedema, myxedema, cellulitis and causes of generalized edema.

Diseases Symptoms Signs Gold standard Investigation to diagnose
History Onset Pain Fever Laterality Scrotal swelling Symptoms of primary disease
Lymphatic filariasis
  • History of living in endemic area or travelling to it
 Chronic + + Bilateral + -
Chronic venous insufficiency Chronic + - Bilateral +

(If congenial)

-
Acute deep venous thrombosis Acute + - Unilateral - May be associated with primary disease mandates recumbency for long duration
Lipedema Chronic + - Bilateral - -
  • Tenderness with palpation
  • Negative Semmer sign[3]
Myxedema Chronic + - Bilateral - +

(hypothyroidism )

(Cellulitis-erysipelas-skin abscess) Acute + + Unilateral - -
Other causes of generalized edema
  • History of chronic general condition (cardiac-liver-renal)
 Chronic - - Bilateral - +
  • Echocardiogram
  • LFT
  • RFT

References

  1. ↑ Goodacre S, Sutton AJ, Sampson FC (2005). "Meta-analysis: The value of clinical assessment in the diagnosis of deep venous thrombosis". Ann Intern Med. 143 (2): 129–39. PMID 16027455. Review in: ACP J Club. 2006 Mar-Apr;144(2):46-7 Review in: Evid Based Med. 2006 Apr;11(2):56
  2. ↑ Child AH, Gordon KD, Sharpe P, Brice G, Ostergaard P, Jeffery S; et al. (2010). "Lipedema: an inherited condition". Am J Med Genet A. 152A (4): 970–6. doi:10.1002/ajmg.a.33313. PMID 20358611.
  3. ↑ Trayes KP, Studdiford JS, Pickle S, Tully AS (2013). "Edema: diagnosis and management". Am Fam Physician. 88 (2): 102–10. PMID 23939641.
  4. ↑ Dimakakos PB, Stefanopoulos T, Antoniades P, Antoniou A, Gouliamos A, Rizos D (1997). "MRI and ultrasonographic findings in the investigation of lymphedema and lipedema". Int Surg. 82 (4): 411–6. PMID 9412843.
  5. ↑ Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL; et al. (2014). "Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America". Clin Infect Dis. 59 (2): 147–59. doi:10.1093/cid/ciu296. PMID 24947530.
  6. ↑ Raff AB, Kroshinsky D (2016). "Cellulitis: A Review". JAMA. 316 (3): 325–37. doi:10.1001/jama.2016.8825. PMID 27434444.
  7. ↑ Leppard BJ, Seal DV, Colman G, Hallas G (1985). "The value of bacteriology and serology in the diagnosis of cellulitis and erysipelas". Br J Dermatol. 112 (5): 559–67. PMID 4005155.
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