Microsporidiosis differential diagnosis: Difference between revisions

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{{Microsporidiosis}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Microsporidiosis]]
{{CMG}}; {{Ochuko}}
{{CMG}}; {{AE}} {{Ochuko}} {{AY}}


==Overview==
==Overview==
Microsporidiosis should be differentiated from other conditions that cause [[chronic diarrhea]], [[abdominal pain]], [[weight loss]], [[nausea]] and [[vomiting]], [[headache]], [[seizures]] and other manifestations mimicking the infection.
Microsporidiosis should be differentiated from other conditions that cause [[chronic diarrhea]] in [[Immunocompromised|immunocompromised patients]].


==Differentiating Microsporidiosis from other Diseases==
==Differentiating Microsporidiosis from other Diseases==
===Differential Diagnosis===
===Differential Diagnosis===
*[[Bacterial gastroenteritis]]
Microsporidiosis must be differentiated from other diseases that may cause [[chronic diarrhea]], [[weight loss]], and [[abdominal pain]] especially in [[Immunocompromised|immunocompromised patients]].
*[[Cryptosporidiosis]]
{| style="border: 0px; font-size: 120%; margin: 3px; width:1000px;" align="center"
*[[Cytomegalovirus]]
*[[Giardiasis]]
*[[Inflammatory bowel disease]]
*[[isosporiasis|Cystoisosporiasis]]
*[[Tropical sprue]]
*[[Viral gastroenteritis]]


|+
! style="background: #4479BA; color:#FFF;  width: 150px;" | Disease
! style="background: #4479BA; color:#FFF;  width: 200px;" | Prominent clinical findings
! style="background: #4479BA; color:#FFF;  width: 200px;" | Laboratory or radiological findings
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |  [[Giardiasis|Chronic giardiasis]]<ref name="pmid11113253">{{cite journal |vauthors=Thompson RC |title=Giardiasis as a re-emerging infectious disease and its zoonotic potential |journal=Int. J. Parasitol. |volume=30 |issue=12-13 |pages=1259–67 |year=2000 |pmid=11113253 |doi= |url=}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Giardiasis|Chronic giardiasis]] may develop after acute episode of giardiasis or without any acute events.
* Loose foul smelling stools
* [[Flatulence]]
* [[Fatigue]]
* [[Weight loss]]
* [[Steatorrhea]]
* Some patients develop acquired [[lactose intolerance]] (manifested by exacerbation of symptoms following ingestion of dairy products)
| style="padding: 5px 5px; background: #F5F5F5;" |
* Microscopic identification of the organism in the stool
* [[Hypoalbuminaemia]]
* [[Vitamin B12]] and [[Folate deficiency|folate deficiencies]] (as the organism inhabits the [[duodenum]])
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |  [[Cryptosporidiosis]]<ref name="pmid17172373">{{cite journal |vauthors=Sánchez-Vega JT, Tay-Zavala J, Aguilar-Chiu A, Ruiz-Sánchez D, Malagón F, Rodríguez-Covarrubias JA, Ordóñez-Martínez J, Calderón-Romero L |title=Cryptosporidiosis and other intestinal protozoan infections in children less than one year of age in Mexico City |journal=Am. J. Trop. Med. Hyg. |volume=75 |issue=6 |pages=1095–8 |year=2006 |pmid=17172373 |doi= |url=}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Incubation period]] is 7-10 days.
* In [[immunocompetent]] patients:
:* Disease might be asymptomatic or cause [[gastroenteritis]] (but without any biliary involvement)
:* [[Gastroenteritis]] usually resolves spontaneously within 14 days.
* In [[immunocompromised]] patients:
:* Disease is usually more severe and prolonged (especially in severly [[Immunocompromised|immunocomprmised patients]] with [[CD4|CD4 count]] < 100 cells/microL).
:* [[Cryptosporidiosis]] may involve the [[biliary tract]] and the [[liver]].
:* [[Weight loss]]
:* [[RUQ|Abdominal RUQ]] [[tenderness]] might be present if [[biliary]] or [[hepatic]] involvement is present.
| style="padding: 5px 5px; background: #F5F5F5;" |
* Microscopic identification of the [[organism]] in the stool: The [[oocysts]] appear red on staining with modified acid fast staining
* [[PCR]]: Most specific and sensitive diagnostic tool. [[PCR]] is expensive and used in limited cases.
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |  [[Cystoisospora belli|Cystoisosporiasis (isosporiasis)]]<ref name="pmid1889046">{{cite journal |vauthors=Current WL, Garcia LS |title=Cryptosporidiosis |journal=Clin. Microbiol. Rev. |volume=4 |issue=3 |pages=325–58 |year=1991 |pmid=1889046 |pmc=358202 |doi= |url=}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Cystoisospora belli|Cystoisosporiasis]] is usually seen in [[Immunocompromised|immunocompromised patients]].
* [[Incubation period]] can last up to 2 weeks
* [[Watery diarrhea]] that is profuse and foul smelling
* Constitutional symptoms ([[headache]], [[Low-grade fever|low grade fever]], [[myalgia]] and [[malaise]])
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Isospora]] ova or parasites can be visualized on stool microscopic examination.
* [[Endoscopy|Upper GI endoscopy]] may used for excluding other esophageal or gastric disease and obtaining specimens for histopathology.
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | [[Tropical sprue]]<ref name="pmid1091526">{{cite journal |vauthors=Klipstein FA, Schenk EA |title=Enterotoxigenic intestinal bacteria in tropical sprue. II. Effect of the bacteria and their enterotoxins on intestinal structure |journal=Gastroenterology |volume=68 |issue=4 Pt 1 |pages=642–55 |year=1975 |pmid=1091526 |doi= |url=}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
* History of travel to a tropical region (for a period more than a month)
* [[Chronic diarrhea]]
* [[Steatorrhea]]
* Examination may show signs of [[vitamin deficiencies]] (eg [[glossitis]])
| style="padding: 5px 5px; background: #F5F5F5;" |
* [[Megaloblastic anemia]] that might progress into [[pancytopenia]]
* [[Hypoalbuminaemia]]
* [[Vitamin D Deficiency|Vitamin D defeciency]] and [[hypocalcemia]]
|}


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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Latest revision as of 22:43, 29 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ogheneochuko Ajari, MB.BS, MS [2] Ahmed Younes M.B.B.CH [3]

Overview

Microsporidiosis should be differentiated from other conditions that cause chronic diarrhea in immunocompromised patients.

Differentiating Microsporidiosis from other Diseases

Differential Diagnosis

Microsporidiosis must be differentiated from other diseases that may cause chronic diarrhea, weight loss, and abdominal pain especially in immunocompromised patients.

Disease Prominent clinical findings Laboratory or radiological findings
Chronic giardiasis[1]
Cryptosporidiosis[2]
  • Disease might be asymptomatic or cause gastroenteritis (but without any biliary involvement)
  • Gastroenteritis usually resolves spontaneously within 14 days.
  • Microscopic identification of the organism in the stool: The oocysts appear red on staining with modified acid fast staining
  • PCR: Most specific and sensitive diagnostic tool. PCR is expensive and used in limited cases.
Cystoisosporiasis (isosporiasis)[3]
  • Isospora ova or parasites can be visualized on stool microscopic examination.
  • Upper GI endoscopy may used for excluding other esophageal or gastric disease and obtaining specimens for histopathology.
Tropical sprue[4]

References

  1. ↑ Thompson RC (2000). "Giardiasis as a re-emerging infectious disease and its zoonotic potential". Int. J. Parasitol. 30 (12–13): 1259–67. PMID 11113253.
  2. ↑ Sánchez-Vega JT, Tay-Zavala J, Aguilar-Chiu A, Ruiz-Sánchez D, Malagón F, Rodríguez-Covarrubias JA, Ordóñez-Martínez J, Calderón-Romero L (2006). "Cryptosporidiosis and other intestinal protozoan infections in children less than one year of age in Mexico City". Am. J. Trop. Med. Hyg. 75 (6): 1095–8. PMID 17172373.
  3. ↑ Current WL, Garcia LS (1991). "Cryptosporidiosis". Clin. Microbiol. Rev. 4 (3): 325–58. PMC 358202. PMID 1889046.
  4. ↑ Klipstein FA, Schenk EA (1975). "Enterotoxigenic intestinal bacteria in tropical sprue. II. Effect of the bacteria and their enterotoxins on intestinal structure". Gastroenterology. 68 (4 Pt 1): 642–55. PMID 1091526.
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