Strongyloidiasis differential diagnosis: Difference between revisions

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{{Strongyloidiasis}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Strongyloidiasis]]
{{CMG}}; {{AE}} {{ADG}}, {{MMF}}
==Overview==
Strongyloidiasis can mimic other [[worm]] [[infections]] like ''[[Ascaris lumbricoides]]'', ''[[Trichuris trichiura]]'', [[Hookworm Infection|hookworm infections]] (''[[Necator americanus]]'' and ''[[Ancylostoma duodenale]]''), ''[[Enterobius vermicularis]]'' ([[pinworm]]) and gastrointestinal pathologies such as [[peptic ulcer disease]], [[intussusception]] in children, and [[Choledocholithiasis|bile duct stone]].<ref name="Principles and Practice">Durand, Marlene (2015). "Chapter 288:Intestinal Nematodes (Roundworms)". Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases Updated Edition, Eighth Edition. Elsevier. pp. 3199–3207. ISBN 978-1-4557-4801-3.</ref><ref name="Murray and Nadel's Textbook of Respiratory Medicine">{{cite book |last1=Kim |first1=Kami |last2=Weiss |first2=Louis |last3=Tanowitz |first3=Herbert |title=Murray and Nadel's Textbook of Respiratory Medicine Sixth Edition |publisher=Elsevier |date=2016 |pages=682-698 |chapter=Chapter 39:Parasitic Infections |isbn=978-1-4557-3383-5}}</ref><ref name="pmid25121962">{{cite journal |vauthors=Puthiyakunnon S, Boddu S, Li Y, Zhou X, Wang C, Li J, Chen X |title=Strongyloidiasis--an insight into its global prevalence and management |journal=PLoS Negl Trop Dis |volume=8 |issue=8 |pages=e3018 |year=2014 |pmid=25121962 |pmc=4133206 |doi=10.1371/journal.pntd.0003018 |url=}}</ref>


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==Differentiating Strongyloidiasis from other diseases==
The table below summarizes the findings that differentiate [[strongyloidiasis]] from other [[Nematode|nematod]]<nowiki/>e infections:
{| class="wikitable"
! colspan="8" |Differentiating strongyloidiasis from other Nematode infections<ref name="Principles and Practice">Durand, Marlene (2015). "Chapter 288:Intestinal Nematodes (Roundworms)". Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases Updated Edition, Eighth Edition. Elsevier. pp. 3199–3207. ISBN 978-1-4557-4801-3.</ref><ref name="Murray and Nadel's Textbook of Respiratory Medicine">{{cite book |last1=Kim |first1=Kami |last2=Weiss |first2=Louis |last3=Tanowitz |first3=Herbert |title=Murray and Nadel's Textbook of Respiratory Medicine Sixth Edition |publisher=Elsevier |date=2016 |pages=682-698 |chapter=Chapter 39:Parasitic Infections |isbn=978-1-4557-3383-5}}</ref><ref name="pmid21879805">{{cite journal| author=Serpytis M, Seinin D| title=Fatal case of ectopic enterobiasis: Enterobius vermicularis in the kidneys. | journal=Scand J Urol Nephrol | year= 2012 | volume= 46 | issue= 1 | pages= 70-2 | pmid=21879805 | doi=10.3109/00365599.2011.609834 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21879805 }} </ref>
|-
! style="background:#4479BA; color: #FFFFFF;" |Infection
! style="background:#4479BA; color: #FFFFFF;" |Nematode
! style="background:#4479BA; color: #FFFFFF;" |Transmission
! style="background:#4479BA; color: #FFFFFF;" |Direct Person-Person Transmission
! style="background:#4479BA; color: #FFFFFF;" |Duration of Infection
! style="background:#4479BA; color: #FFFFFF;" |Pulmonary Manifestation
! style="background:#4479BA; color: #FFFFFF;" |Location of Adult worm(s)
! style="background:#4479BA; color: #FFFFFF;" |Treatment
|-
| style="background:#DCDCDC;" align="center" |[[Strongyloidiasis]]
| style="background:#DCDCDC;" align="center" |[[Strongyloides stercoralis]]
|Filariform larvae penetrate [[skin]] or [[bowel]] [[mucosa]]
|Yes
|
* Lifetime of the host
|
* [[Löffler's syndrome]]
* Chronic [[cough]]
* [[Pneumonia]] or [[sepsis]] in hyperinfection
|Embedded in the mucosa of the [[duodenum]]  and [[jejunum]]
|
* [[Ivermectin]]
* [[Albendazole]]
* [[Thiabendazole]]
|-
| style="background:#DCDCDC;" align="center" |[[Trichuriasis]]
| style="background:#DCDCDC;" align="center" |[[Trichuris trichiura]]
([[whipworm]])
|Ingestion of infective [[ova]]
|No
|1-3 years
|
* No [[pulmonary]] migration, therefore, no pulmonary manifestation
|Anchored in the superficial [[mucosa]] of [[cecum]] and [[colon]]
|
* [[Albendazole]]
 
* [[Mebendazole]]
|-
| style="background:#DCDCDC;" align="center" |[[Ascariasis]]
| style="background:#DCDCDC;" align="center" |[[Ascaris lumbricoides]]
|Ingestion of infective [[ova]]
|No
|1-2 years
|
* [[Löffler's syndrome]] (usually about 9-12 days after exposure to [[ova]])
* [[Cough]]
* [[Substernal pain|Substernal]] discomfort
* [[Crackles]]
* [[Wheezing]]
* Transient [[Opacity|opacities]]
|Free air in the [[lumen]] of the [[small bowel]]
(primarily [[jejunum]])
|
* [[Albendazole]]
 
* [[Mebendazole]]
 
* [[Pyrantel pamoate]]
 
* [[Ivermectin]]
 
* [[Levamisole]]
 
* [[Piperazine]]
|-
| style="background:#DCDCDC;" align="center" |[[Hookworm Infection|Hookworm infection]]
| style="background:#DCDCDC;" align="center" |[[Necator americanus]] and [[Ancylostoma duodenale]]
|[[Skin]] penetration by filariform larvae
|No
|
* 3-5 years (''[[Necator americanus|Necator]]'')
* 1 year (''[[Ancylostoma]]'')
|
* [[Löffler's syndrome]]
* Transient opacities
|Attached to the [[mucosa]] of mid-upper portion of the [[small bowel]]
|
* [[Albendazole]]
 
* [[Mebendazole]]
 
* [[Levamisole]]
 
* [[Pyrantel pamoate]]
|-
| style="background:#DCDCDC;" align="center" |[[Enterobiasis]]
| style="background:#DCDCDC;" align="center" |[[Enterobius vermicularis]]
([[pinworm]])
|Ingestion of infective [[ova]]
|Yes
|
* 1-month
|
* Extraintestinal migration is very rare
|Free air in the lumen of [[cecum]], [[appendix]], adjacent [[colon]]
|
* [[Albendazole]]
* [[Mebendazole]]
* [[Pyrantel pamoate]]
* [[Ivermectin]]
* [[Levamisole]]
* [[Piperazine]]
|}
*Strongyloidiasis, when it involves the [[gastrointestinal tract]], presents with [[abdominal pain]] and must be differentiated from other [[Gastrointestinal tract|GI]] disorders like [[Peptic ulcer|peptic ulcer disease]], [[intussusception]], and [[Gall stones|bile duct stone]].
*The table below summarizes the findings that differentiate strongyloidiasis from [[peptic ulcer disease]], [[intussusception]], and [[Gall stones|bile duct stone]]:
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Disease
!Common findings
!Differentiating features
!Laboratory findings
|- style="background: #DCDCDC; padding: 5px; text-align: center;"
|[[Peptic ulcer disease]]
|
* [[Abdominal pain]]
* [[Bloating]] and abdominal fullness
* [[Nausea]], and lots of [[vomiting]]
* [[Loss of appetite]] and [[weight loss]]
* [[Hematemesis]]
|
* Epigastric with severity relating to mealtimes
* Waterbrash (rush of saliva after an episode of regurgitation to dilute the acid in [[esophagus]])
|
* Rapid [[Urease|urease testing]] positive
* ''[[Helicobacter pylori|H. pylori]]'' on histology
* Negative stool exam and serology
|- style="background: #DCDCDC; padding: 5px; text-align: center;"
|[[Intussusception]]
|
* [[Abdominal pain]] that is colicky and intermittent
|
* Currant jelly stools
* Most cases occur in children ages 6 months - 2 years
|
* [[Ultrasound]] findings include the target and pseudokidney signs
|- style="background: #DCDCDC; padding: 5px; text-align: center;"
|[[Gall stones|Bile duct stone]]
|
* [[Abdominal pain|Acute abdominal pain]]
* [[Nausea and vomiting]]
|
* Pain is usually located in the upper right abdominal area radiates to shoulders
* [[Jaundice]]
|
*[[Bilirubin]]
*Abnormal [[liver function tests]]
*Elevation of pancreatic enzymes
|}
 
'''The table below summarizes the findings that differentiate intestinal strongyloidiasis from other conditions that may cause [[abdominal pain]] and [[diarrhea]]'''<ref name="pmid23552316">{{cite journal |vauthors=Báez-Vallecillo L, Stewart BD, Kott MM, Bhattacharjee M |title=Strongyloides hyperinfection as a mimic of inflammatory bowel disease |journal=Am. J. Gastroenterol. |volume=108 |issue=4 |pages=622–3 |year=2013 |pmid=23552316 |doi=10.1038/ajg.2012.456 |url=}}</ref><ref name="pmid19624088">{{cite journal |vauthors=Taneja N, Khurana S, Dubey ML, Malla N, Bhasin DK, Chatterjee S, Sharma M |title=Concomitant intestinal parasitism and non-cholera vibrio infection |journal=Trop Gastroenterol |volume=30 |issue=1 |pages=42–3 |year=2009 |pmid=19624088 |doi= |url=}}</ref><ref name="pmid16734908">{{cite journal |vauthors=Vadlamudi RS, Chi DS, Krishnaswamy G |title=Intestinal strongyloidiasis and hyperinfection syndrome |journal=Clin Mol Allergy |volume=4 |issue= |pages=8 |year=2006 |pmid=16734908 |pmc=1538622 |doi=10.1186/1476-7961-4-8 |url=}}</ref>
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="3" |
! rowspan="3" |History
! colspan="4" |Symptoms
! colspan="3" |Diagnosis
|-- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" |Abdominal pain
! colspan="2" |Diarrhea
! rowspan="2" |Peritoneal Signs
! rowspan="2" |Stool examination
! rowspan="2" |Laboratory Findings
! rowspan="2" |Gold standard
|-- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Dysentry
!Watery
|- style="background: #DCDCDC; padding: 5px; text-align: center;"
|Intestinal strongyloidiasis
|Travel to the
endemic areas
| '''+'''
| -
| '''+'''
| -
|Eggs
|[[Eosinophilia]]
|[[Stool examination|Stool exam]]
|- style="background: #DCDCDC; padding: 5px; text-align: center;"
|Intestinal infections
|Antibiotic use
| '''+'''
| '''+'''
| -
| '''+'''
| -
|[[Leukocytosis]]
|[[Blood culture]]
|- style="background: #DCDCDC; padding: 5px; text-align: center;"
|[[Inflammatory bowel disease]]
|Exacerbations
| '''+'''
| '''+'''
| -
| '''+'''
|Occult blood
|[[Leukocytosis]]
|[[Biopsy]]
|- style="background: #DCDCDC; padding: 5px; text-align: center;"
|[[Irritable bowel syndrome]] 
|Altered bowel habits
| -
|
| '''+'''
| -
| -
| -
|Clinical diagnosis
|- style="background: #DCDCDC; padding: 5px; text-align: center;"
|[[Peritonitis]] and [[Sepsis|abdominal sepsis]]
|Surgery
Diverticular disease
 
Inflammatory bowel disease,
 
Obstruction
| '''+'''
| -
| -
| '''+'''
| -
|[[Leukocytosis]]
|[[Complete blood count|CBC]],[[Blood culture]]
|- style="background: #DCDCDC; padding: 5px; text-align: center;"
|[[Cholera]] 
|Poor sanitation
Contaminated water supply
| -
| -
| '''+'''
| -
| -
|[[Leukocytosis]]
|Clinical diagnosis
|- style="background: #DCDCDC; padding: 5px; text-align: center;"
|[[Diverticulitis]]
|[[Constipation]]
| '''+'''
| '''+'''
| -
| '''+'''
|[[Occult blood]]
|[[Leukocytosis]]
|CT
|}
'''The table below summarizes the findings that differentiate pulmonary strongyloidiasis from other conditions that may cause [[cough]][[Wheezing|, wheezing]], [[dyspnea]] and [[hemoptysis]]'''<ref name="pmid20111672">{{cite journal |vauthors=Mokhlesi B, Shulzhenko O, Garimella PS, Kuma L, Monti C |title=Pulmonary Strongyloidiasis: The Varied Clinical Presentations |journal=Clin Pulm Med |volume=11 |issue=1 |pages=6–13 |year=2004 |pmid=20111672 |pmc=2812430 |doi=10.1097/01.cpm.0000107609.50629.69 |url=}}</ref>
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="3" |Disease
! rowspan="3" |History
! colspan="7" |Symptoms
! colspan="2" |Diagnosis
|-- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! colspan="2" |Cough
! rowspan="2" |Dyspnea
! rowspan="2" |Hoarsness
! rowspan="2" |Hemoptysis
! rowspan="2" |Wheezing
! rowspan="2" |Hypoxia
! rowspan="2" |Laboratory Findings
! rowspan="2" |Imaging
|-- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Productive
!Dry
|- style="background: #DCDCDC; padding: 5px; text-align: center;"
|[[Pulmonary strongyloidiasis]]
|Travel to the
endemic areas
| -
| '''+'''
| '''+'''
| +/-
| '''+'''
| +/-
| -
|[[Eosinophilia]]
|Segmental or lobar opacities
 
[[Pleural effusion]]
 
[[Cavitation]]<nowiki/>s and [[abscesses]]
|- style="background: #DCDCDC; padding: 5px; text-align: center;"
|[[Chronic obstructive pulmonary disease]]
|Smoking
| '''+'''
|<nowiki>-</nowiki>
|'''+'''
|'''+'''
|<nowiki>-</nowiki>
| '''+'''
| '''+'''
|<nowiki>-</nowiki>
|Hyperinflation
|- style="background: #DCDCDC; padding: 5px; text-align: center;"
|[[Acute respiratory distress syndrome]]
|Surgery
[[Infection]] or [[sepsis]]
 
Acute medical illness
 
Trauma
|<nowiki>-</nowiki>
|'''+'''
|'''+'''
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
| '''+'''
|'''+'''
|
|Diffuse infiltrates
|- style="background: #DCDCDC; padding: 5px; text-align: center;"
|[[Asthma]]
|Family history
Previous exacerbations
| -
| '''+'''
|'''+'''
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|'''+'''
|'''+'''
|Mild [[eosinophilia]]
|
|- style="background: #DCDCDC; padding: 5px; text-align: center;"
|[[Pneumonia]]
|Ill contact
| '''+'''
|
|'''+'''
|<nowiki>-</nowiki>
|'''+'''
|<nowiki>-</nowiki>
|'''+'''
|[[Leukocytosis]]
|Consolidation
|}


==References==
==References==


{{Reflist|2}}
{{Reflist|2}}
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{{WS}}


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Latest revision as of 00:19, 30 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2], Furqan M M. M.B.B.S[3]

Overview

Strongyloidiasis can mimic other worm infections like Ascaris lumbricoides, Trichuris trichiura, hookworm infections (Necator americanus and Ancylostoma duodenale), Enterobius vermicularis (pinworm) and gastrointestinal pathologies such as peptic ulcer disease, intussusception in children, and bile duct stone.[1][2][3]

Differentiating Strongyloidiasis from other diseases

The table below summarizes the findings that differentiate strongyloidiasis from other nematode infections:

Differentiating strongyloidiasis from other Nematode infections[1][2][4]
Infection Nematode Transmission Direct Person-Person Transmission Duration of Infection Pulmonary Manifestation Location of Adult worm(s) Treatment
Strongyloidiasis Strongyloides stercoralis Filariform larvae penetrate skin or bowel mucosa Yes
  • Lifetime of the host
 Embedded in the mucosa of the duodenum and jejunum
Trichuriasis Trichuris trichiura

(whipworm)

Ingestion of infective ova No 1-3 years
  • No pulmonary migration, therefore, no pulmonary manifestation
 Anchored in the superficial mucosa of cecum and colon
Ascariasis Ascaris lumbricoides Ingestion of infective ova No 1-2 years Free air in the lumen of the small bowel

(primarily jejunum)

Hookworm infection Necator americanus and Ancylostoma duodenale Skin penetration by filariform larvae No Attached to the mucosa of mid-upper portion of the small bowel
Enterobiasis Enterobius vermicularis

(pinworm)

Ingestion of infective ova Yes
  • 1-month
  • Extraintestinal migration is very rare
 Free air in the lumen of cecum, appendix, adjacent colon
Disease Common findings Differentiating features Laboratory findings
Peptic ulcer disease
  • Epigastric with severity relating to mealtimes
  • Waterbrash (rush of saliva after an episode of regurgitation to dilute the acid in esophagus)
Intussusception
  • Currant jelly stools
  • Most cases occur in children ages 6 months - 2 years
  • Ultrasound findings include the target and pseudokidney signs
Bile duct stone
  • Pain is usually located in the upper right abdominal area radiates to shoulders
  • Jaundice

The table below summarizes the findings that differentiate intestinal strongyloidiasis from other conditions that may cause abdominal pain and diarrhea[5][6][7]

History Symptoms Diagnosis
Abdominal pain Diarrhea Peritoneal Signs Stool examination Laboratory Findings Gold standard
Dysentry Watery
Intestinal strongyloidiasis Travel to the

endemic areas

+ - + - Eggs Eosinophilia Stool exam
Intestinal infections Antibiotic use + + - + - Leukocytosis Blood culture
Inflammatory bowel disease Exacerbations + + - + Occult blood Leukocytosis Biopsy
Irritable bowel syndrome  Altered bowel habits - + - - - Clinical diagnosis
Peritonitis and abdominal sepsis Surgery

Diverticular disease

Inflammatory bowel disease,

Obstruction

+ - - + - Leukocytosis CBC,Blood culture
Cholera  Poor sanitation

Contaminated water supply

- - + - - Leukocytosis Clinical diagnosis
Diverticulitis Constipation + + - + Occult blood Leukocytosis CT

The table below summarizes the findings that differentiate pulmonary strongyloidiasis from other conditions that may cause cough, wheezing, dyspnea and hemoptysis[8]

Disease History Symptoms Diagnosis
Cough Dyspnea Hoarsness Hemoptysis Wheezing Hypoxia Laboratory Findings Imaging
Productive Dry
Pulmonary strongyloidiasis Travel to the

endemic areas

- + + +/- + +/- - Eosinophilia Segmental or lobar opacities

Pleural effusion

Cavitations and abscesses

Chronic obstructive pulmonary disease Smoking + - + + - + + - Hyperinflation
Acute respiratory distress syndrome Surgery

Infection or sepsis

Acute medical illness

Trauma

- + + - - + + Diffuse infiltrates
Asthma Family history

Previous exacerbations

- + + - - + + Mild eosinophilia
Pneumonia Ill contact + + - + - + Leukocytosis Consolidation

References

  1. ↑ 1.0 1.1 Durand, Marlene (2015). "Chapter 288:Intestinal Nematodes (Roundworms)". Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases Updated Edition, Eighth Edition. Elsevier. pp. 3199–3207. ISBN 978-1-4557-4801-3.
  2. ↑ 2.0 2.1 Kim, Kami; Weiss, Louis; Tanowitz, Herbert (2016). "Chapter 39:Parasitic Infections". Murray and Nadel's Textbook of Respiratory Medicine Sixth Edition. Elsevier. pp. 682–698. ISBN 978-1-4557-3383-5.
  3. ↑ Puthiyakunnon S, Boddu S, Li Y, Zhou X, Wang C, Li J, Chen X (2014). "Strongyloidiasis--an insight into its global prevalence and management". PLoS Negl Trop Dis. 8 (8): e3018. doi:10.1371/journal.pntd.0003018. PMC 4133206. PMID 25121962.
  4. ↑ Serpytis M, Seinin D (2012). "Fatal case of ectopic enterobiasis: Enterobius vermicularis in the kidneys". Scand J Urol Nephrol. 46 (1): 70–2. doi:10.3109/00365599.2011.609834. PMID 21879805.
  5. ↑ Báez-Vallecillo L, Stewart BD, Kott MM, Bhattacharjee M (2013). "Strongyloides hyperinfection as a mimic of inflammatory bowel disease". Am. J. Gastroenterol. 108 (4): 622–3. doi:10.1038/ajg.2012.456. PMID 23552316.
  6. ↑ Taneja N, Khurana S, Dubey ML, Malla N, Bhasin DK, Chatterjee S, Sharma M (2009). "Concomitant intestinal parasitism and non-cholera vibrio infection". Trop Gastroenterol. 30 (1): 42–3. PMID 19624088.
  7. ↑ Vadlamudi RS, Chi DS, Krishnaswamy G (2006). "Intestinal strongyloidiasis and hyperinfection syndrome". Clin Mol Allergy. 4: 8. doi:10.1186/1476-7961-4-8. PMC 1538622. PMID 16734908.
  8. ↑ Mokhlesi B, Shulzhenko O, Garimella PS, Kuma L, Monti C (2004). "Pulmonary Strongyloidiasis: The Varied Clinical Presentations". Clin Pulm Med. 11 (1): 6–13. doi:10.1097/01.cpm.0000107609.50629.69. PMC 2812430. PMID 20111672.

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