Enterobiasis differential diagnosis

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

Overview

Enterobiasis must be differentiated from other nematode infections.

Differentiating Enterobiasis from other diseases

Disease History Physial exam Diagnostic studies Treatment Anorectal Disorders Inflammatory bowel disease CNS dysfunction (disorientation, headache, irrational behavior, irritability, emotional instability, confusion, coma, or seizure) Electrolyte disturbances, increased CK, AST, and ALT Relevant history of excessive exercise and lack of water access Hemorrhoids(internal or external) Altered mental status Thrombocytopenia, leukocytosis, leukopenia, elevated Cr Anal fissure Generalized muscle rigidity Hypercarbia (PaCO2) >65 mmHg, hyperkalemia History of receiving anaesthetic agent Infections Bacterial Change in mental status Electrolyte disturbances, increased CK, LDH, ALP, AST, and ALT, leukocytosis, myoglobinuria. Relevant history of recent use of anti-psychotics Candidal Mental status changes (anxiety, agitated delirium, restlessness, and disorientation) Elevated CK, LDH, ALP, AST, and ALT History of recent use of SSRIs, SNRIs , or MAOIs. Scabies Mental status changes (anxiety, agitated delirium, restlessness, and disorientation) Elevated CK, LDH, ALP, AST, and ALT History of recent use of SSRIs, SNRIs , or MAOIs. Viral Mental status changes (anxiety, agitated delirium, restlessness, and disorientation) Elevated CK, LDH, ALP, AST, and ALT History of recent use of SSRIs, SNRIs , or MAOIs. Skin disorders Atopic dermatitis Mental status changes (anxiety, agitated delirium, restlessness, and disorientation) Elevated CK, LDH, ALP, AST, and ALT History of recent use of SSRIs, SNRIs , or MAOIs. Seborrheic dermatitis Mental status changes (anxiety, agitated delirium, restlessness, and disorientation) Elevated CK, LDH, ALP, AST, and ALT History of recent use of SSRIs, SNRIs , or MAOIs. Contact dermatitis Mental status changes (anxiety, agitated delirium, restlessness, and disorientation) Elevated CK, LDH, ALP, AST, and ALT History of recent use of SSRIs, SNRIs , or MAOIs. Lichen planus Mental status changes (anxiety, agitated delirium, restlessness, and disorientation) Elevated CK, LDH, ALP, AST, and ALT History of recent use of SSRIs, SNRIs , or MAOIs. Lichen sclerosis Mental status changes (anxiety, agitated delirium, restlessness, and disorientation) Elevated CK, LDH, ALP, AST, and ALT History of recent use of SSRIs, SNRIs , or MAOIs. Perianal carcinoma (Bowen disease) Mental status changes (anxiety, agitated delirium, restlessness, and disorientation) Elevated CK, LDH, ALP, AST, and ALT History of recent use of SSRIs, SNRIs , or MAOIs. Hygiene Related problems Excessive sweating and Poor cleaning Mental status changes (anxiety, agitated delirium, restlessness, and disorientation) Elevated CK, LDH, ALP, AST, and ALT History of recent use of SSRIs, SNRIs , or MAOIs. Meticulous cleansing of anal area Mental status changes (anxiety, agitated delirium, restlessness, and disorientation) Elevated CK, LDH, ALP, AST, and ALT History of recent use of SSRIs, SNRIs , or MAOIs. Skin irritants Mental status changes (anxiety, agitated delirium, restlessness, and disorientation) Elevated CK, LDH, ALP, AST, and ALT History of recent use of SSRIs, SNRIs , or MAOIs. The table below summarizes the findings that differentiate enterobiasis from other nematode infections. Differentiating Enterobiasis from other Nematode infections Nematode Transmission Direct Person-Person Transmission Duration of Infection Pulmonary Manifestation Location of Adult worm(s) Treatment Ascaris lumbricoides Ingestion of infective ova No 1-2 years Löffler's syndrome (usually about 9-12 days after exposure to ova) Cough Substernal discomfort Crackles Wheezing Transient opacities Free in the lumen of the small bowel (primarily jejunum) Albendazole Mebendazole Pyrantel pamoate Ivermectin Levamisole Piperazine 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 Hookworm (Necator americanus and Ancylostoma duodenale) Skin penetration by filariform larvae No 3-5 years (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 Strongyloides stercoralis Filariform larvae penetrates 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 Enterobius vermicularis (pinworm) Ingestion of infective ova Yes 1 month Extraintestinal migration is very rare Free in the lumen of cecum, appendix, adjacent colon Albendazole Mebendazole Pyrantel pamoate Ivermectin Levamisole Piperazine References