Ascariasis differential diagnosis: Difference between revisions

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{{Ascariasis}}
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==Overview==
Ascariasis can mimic other worm infections, and also gastrointestinal pathologies like [[peptic ulcer disease]], [[intussusception]] in children, [[bile duct]] stone, etc.<ref name="pmid2260195">{{cite journal| author=Hamed AD, Akinola O| title=Intestinal ascariasis in the differential diagnosis of peptic ulcer disease. | journal=Trop Geogr Med | year= 1990 | volume= 42 | issue= 1 | pages= 37-40 | pmid=2260195 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2260195  }} </ref><ref name="pmid23078449">{{cite journal| author=Goel A, Lakshmi CP, Pottakkat B| title=Biliary ascariasis: mimicker of retained bile duct stone. | journal=Dig Endosc | year= 2012 | volume= 24 | issue= 6 | pages= 480 | pmid=23078449 | doi=10.1111/j.1443-1661.2012.01338.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23078449  }} </ref>
==Differential Diagnosis==
* Differential diagnosis of intestinal ascariasis
# [[Peptic ulcer disease]]<ref name="pmid2260195">{{cite journal| author=Hamed AD, Akinola O| title=Intestinal ascariasis in the differential diagnosis of peptic ulcer disease. | journal=Trop Geogr Med | year= 1990 | volume= 42 | issue= 1 | pages= 37-40 | pmid=2260195 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2260195  }} </ref>
# [[Intestinal obstruction]] from [[Ascaris lumbricoides]] can mimic [[intussusception]]<ref name="pmid3979231">{{cite journal| author=Katz Y, Varsano D, Siegal B, Bar-Yochai A| title=Intestinal obstruction due to Ascaris lumbricoides mimicking intussusception. | journal=Dis Colon Rectum | year= 1985 | volume= 28 | issue= 4 | pages= 267-9 | pmid=3979231 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3979231  }} </ref>
* Differential diagnosis of biliary ascariasis
# [[Gallbladder cancer]]<ref name="pmid25308610">{{cite journal| author=Kong F, Xi H, Bai Y, Li Z| title=Ascaris infestation of biliary tree mimicking gallbladder cancer. | journal=Dig Liver Dis | year= 2015 | volume= 47 | issue= 2 | pages= e3 | pmid=25308610 | doi=10.1016/j.dld.2014.09.012 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25308610  }} </ref>
# Retained [[bile duct]] stone<ref name="pmid23078449">{{cite journal| author=Goel A, Lakshmi CP, Pottakkat B| title=Biliary ascariasis: mimicker of retained bile duct stone. | journal=Dig Endosc | year= 2012 | volume= 24 | issue= 6 | pages= 480 | pmid=23078449 | doi=10.1111/j.1443-1661.2012.01338.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23078449 }} </ref>
* Other worm infections can sometimes have clinical presentations similar to that of [[Ascaris lumbricoides]]
The table below summarizes the findings that differentiate  from other nematode infections:
{| class="wikitable"
! colspan="8" |Differentiating ascariasis 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" |[[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" |[[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]], [[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" |[[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]]
|}
 
==References==
==References==
{{reflist|2}}
{{reflist|2}}
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Latest revision as of 20:28, 29 July 2020

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

Overview

Ascariasis can mimic other worm infections, and also gastrointestinal pathologies like peptic ulcer disease, intussusception in children, bile duct stone, etc.[1][2]

Differential Diagnosis

  • Differential diagnosis of intestinal ascariasis
  1. Peptic ulcer disease[1]
  2. Intestinal obstruction from Ascaris lumbricoides can mimic intussusception[3]
  • Differential diagnosis of biliary ascariasis
  1. Gallbladder cancer[4]
  2. Retained bile duct stone[2]
  • Other worm infections can sometimes have clinical presentations similar to that of Ascaris lumbricoides

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

Differentiating ascariasis from other Nematode infections[5][6][7]
Infection Nematode Transmission Direct Person-Person Transmission Duration of Infection Pulmonary Manifestation Location of Adult worm(s) Treatment
Ascariasis Ascaris lumbricoides Ingestion of infective ova No 1-2 years Free air in the lumen of the small bowel

(primarily jejunum)

Strongyloidiasis Strongyloides stercoralis Filariform larvae penetrate skin or bowel mucosa Yes
  • Lifetime of the host
 Embedded in the mucosa of the duodenum, 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
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

References

  1. ↑ 1.0 1.1 Hamed AD, Akinola O (1990). "Intestinal ascariasis in the differential diagnosis of peptic ulcer disease". Trop Geogr Med. 42 (1): 37–40. PMID 2260195.
  2. ↑ 2.0 2.1 Goel A, Lakshmi CP, Pottakkat B (2012). "Biliary ascariasis: mimicker of retained bile duct stone". Dig Endosc. 24 (6): 480. doi:10.1111/j.1443-1661.2012.01338.x. PMID 23078449.
  3. ↑ Katz Y, Varsano D, Siegal B, Bar-Yochai A (1985). "Intestinal obstruction due to Ascaris lumbricoides mimicking intussusception". Dis Colon Rectum. 28 (4): 267–9. PMID 3979231.
  4. ↑ Kong F, Xi H, Bai Y, Li Z (2015). "Ascaris infestation of biliary tree mimicking gallbladder cancer". Dig Liver Dis. 47 (2): e3. doi:10.1016/j.dld.2014.09.012. PMID 25308610.
  5. ↑ 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.
  6. ↑ 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.
  7. ↑ 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.


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