Whipworm infection differential diagnosis: Difference between revisions
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[[Trichuris trichiura]] must be differentiated from other [[nematode]] infections such as [[ascariasis]], [[Hookworm|hook worm infection]] and [[Strongyloides stercoralis]] that can present with [[diarrhea]] and [[abdominal pain]]. | [[Trichuris trichiura]] must be differentiated from other [[nematode]] infections such as [[ascariasis]], [[Hookworm|hook worm infection]] and [[Strongyloides stercoralis]] that can present with [[diarrhea]] and [[abdominal pain]]. | ||
{| class="wikitable" | {| class="wikitable" | ||
! colspan="7" |Differentiating | ! colspan="7" |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> | ||
|- | |- | ||
|Nematode | ! style="background:#4479BA; color: #FFFFFF;" |Nematode | ||
|Transmission | ! style="background:#4479BA; color: #FFFFFF;" |Transmission | ||
|Direct Person-Person Transmission | ! style="background:#4479BA; color: #FFFFFF;" |Direct Person-Person Transmission | ||
|Duration of Infection | ! style="background:#4479BA; color: #FFFFFF;" |Duration of Infection | ||
|Pulmonary Manifestation | ! style="background:#4479BA; color: #FFFFFF;" |Pulmonary Manifestation | ||
|Location of Adult worm(s) | ! style="background:#4479BA; color: #FFFFFF;" |Location of Adult worm(s) | ||
|Treatment | ! style="background:#4479BA; color: #FFFFFF;" |Treatment | ||
|- | |- | ||
|[[Ascaris lumbricoides]] | | style="background:#DCDCDC;" align="center" |[[Trichuris trichiura]] | ||
|Ingestion of infective ova | ([[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" |[[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" |[[Ascaris lumbricoides]] | |||
|Ingestion of infective [[ova]] | |||
|No | |No | ||
|1-2 years | |1-2 years | ||
| | | | ||
* [[Löffler's syndrome]] (usually about 9-12 days after exposure to ova) | * [[Löffler's syndrome]] (usually about 9-12 days after exposure to [[ova]]) | ||
* [[Cough]] | * [[Cough]] | ||
* Substernal discomfort | * [[Substernal pain|Substernal]] discomfort | ||
* [[Crackles]] | * [[Crackles]] | ||
* [[Wheezing]] | * [[Wheezing]] | ||
* Transient opacities | * Transient [[Opacity|opacities]] | ||
|Free in the lumen of the small bowel | |Free air in the [[lumen]] of the [[small bowel]] | ||
(primarily jejunum) | (primarily [[jejunum]]) | ||
| | | | ||
* [[Albendazole]] | * [[Albendazole]] | ||
| Line 45: | Line 73: | ||
* [[Piperazine]] | * [[Piperazine]] | ||
|- | |- | ||
| | | style="background:#DCDCDC;" align="center" |[[Hookworm]] | ||
([[Necator americanus]] and [[Ancylostoma duodenale]]) | |||
| | |[[Skin]] penetration by filariform larvae | ||
|Skin penetration by filariform larvae | |||
|No | |No | ||
| | | | ||
* 3-5 years (Necator) | * 3-5 years ([[Necator americanus|Necator]]) | ||
* 1 year (Ancylostoma) | * 1 year ([[Ancylostoma]]) | ||
| | | | ||
* [[Löffler's syndrome]] | * [[Löffler's syndrome]] | ||
* Transient opacities | * Transient opacities | ||
|Attached to the mucosa of mid-upper portion of the [[small bowel]] | |Attached to the [[mucosa]] of mid-upper portion of the [[small bowel]] | ||
| | | | ||
* [[Albendazole]] | * [[Albendazole]] | ||
| Line 76: | Line 93: | ||
* [[Pyrantel pamoate]] | * [[Pyrantel pamoate]] | ||
|- | |- | ||
|[[ | | style="background:#DCDCDC;" align="center" |[[Enterobius vermicularis]] | ||
| | ([[pinworm]]) | ||
|Ingestion of infective [[ova]] | |||
|Yes | |Yes | ||
| | | | ||
* | * 1-month | ||
| | | | ||
* | * Extraintestinal migration is very rare | ||
|Free air in the lumen of [[cecum]], [[appendix]], adjacent [[colon]] | |||
|Free in the lumen of [[cecum]], [[appendix]], adjacent [[colon]] | |||
| | | | ||
* [[Albendazole]] | * [[Albendazole]] | ||
| Line 103: | Line 109: | ||
* [[Levamisole]] | * [[Levamisole]] | ||
* [[Piperazine]] | * [[Piperazine]] | ||
|} | |||
The table below summarizes the findings that differentiate Strongyloidiasis from peptic ulcer disease, Intussusception and bile duct stone: | |||
{| class="wikitable" | |||
!Disease | |||
!Common findings | |||
!Differentiating features | |||
!Laboratory findings | |||
|- | |||
|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 testing positive | |||
* H. pylori on histology | |||
* Negative stool exam and serology | |||
|- | |||
|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 | |||
|- | |||
|Bile duct stone | |||
| | |||
* 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 | |||
|} | |} | ||
Revision as of 18:25, 24 July 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aravind Kuchkuntla, M.B.B.S[2]
Overview
Trichuris trichiura must be differentiated from other nematode infections such as ascariasis, hook worm infection and Strongyloides stercoralis that can present with diarrhea and abdominal pain.
Differential Diagnosis
Trichuris trichiura must be differentiated from other nematode infections such as ascariasis, hook worm infection and Strongyloides stercoralis that can present with diarrhea and abdominal pain.
| Differentiating Strongyloidiasis from other Nematode infections[1][2][3] | ||||||
|---|---|---|---|---|---|---|
| Nematode | Transmission | Direct Person-Person Transmission | Duration of Infection | Pulmonary Manifestation | Location of Adult worm(s) | Treatment |
| Trichuris trichiura
(whipworm) |
Ingestion of infective ova | No | 1-3 years |
|
Anchored in the superficial mucosa of cecum and colon | |
| Strongyloides stercoralis | Filariform larvae penetrate skin or bowel mucosa | Yes |
|
|
Embedded in the mucosa of the duodenum, jejunum | |
| Ascaris lumbricoides | Ingestion of infective ova | No | 1-2 years |
|
Free air in the lumen of the small bowel
(primarily jejunum) |
|
| Hookworm | Skin penetration by filariform larvae | No |
|
|
Attached to the mucosa of mid-upper portion of the small bowel | |
| Enterobius vermicularis
(pinworm) |
Ingestion of infective ova | Yes |
|
|
Free air in the lumen of cecum, appendix, adjacent colon | |
The table below summarizes the findings that differentiate Strongyloidiasis from peptic ulcer disease, Intussusception and bile duct stone:
| Disease | Common findings | Differentiating features | Laboratory findings |
|---|---|---|---|
| Peptic ulcer disease |
|
|
|
| Intussusception |
|
|
|
| Bile duct stone |
|
|
|
References
- ↑ 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.
- ↑ 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.
- ↑ 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.