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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* [[Blood film|Thin blood film]]
* [[Blood film|Thin blood film]]


* [[Ultrasound]]
* [[Ultrasound]]:
** Dilated [[Lymphatic drainage|lymphatic channels]]
** "filarial dance" sign
** Living worms tend to be in motion which called "filarial dance" sign


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* 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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* [[Compression ultrasonography]] (CUS) with [[Doppler ultrasound|doppler]]  
* [[Compression ultrasonography]] with [[Doppler ultrasound|doppler]]  
* [[D-dimer]] level
* [[D-dimer]]
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|[[Lipedema]]
|[[Lipedema]]
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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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* 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>
* 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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