Enterobiasis differential diagnosis: Difference between revisions

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Revision as of 15:05, 26 June 2017

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 diseases causing pruritis ani and the nematode infections.

Differentiating Enterobiasis from other diseases

Enterobiasis should be differentiated from various other causes of anal pruritus and from other nematode infections.

Differentiating Enterobiasis from other causes of Anal Pruritis

The table below summarizes other major causes of pruritus ani (anal pruritus).^[1]^[2]^[3]

Causes		Suggestive findings	Diagnostic approach	Treatment
Skin infections	Bacterial	Skin edema, erythema, and warmth. Pruritus, pain, and discharge from the lesions.	Physical examination reveals local inflammatory findings Culture/sensitivity of discharge	Topical or oral antibiotics
	Candidal	Erythematous skin plaques and erosions with peripheral scaling. Pruritus on the skin plaques.	KOH preparation of skin scrapings	Topical antifungals
	Scabies	Erythematous papules with hemorrhagic crustings. Pruritus, pain, and bleeding from papules.	Identification of eggs on skin scrapings	Topical permethrin Oral ivermectin
	HPV (Condylomata acuminata)	Soft papules/plaques in the anogenital area. Pruritus, pain, and bleeding from papules.	Physical examination Shave biopsy of the lesion	Topical trichloroacetic acid Topical imiquimod Cryotherapy or surgical resection
Other skin diseases	Atopic dermatitis	Scaly, erythematous, pruritic and skin lesions.	Physical examination	Topical emollients Topical steroids
	Seborrheic dermatitis	Erythematous, yellow, oily plaques Mild pruritus	Physical examination	Topical emollients Topical steroids Topical ketoconazole
	Contact dermatitis	Erythematous, pruritic skin lesion	Physical examination	Avoid irritants Topical steroids
	Lichen planus	Pruritic, purple, polygonal plaques or papules.	Physical examination Punch/shave biopsy	Topical steroids Phototherapy
	Lichen sclerosus	Vulvular/anal pruritis and thinning of the skin.	Physical examination Punch/shave biopsy	Topical steroids
	Perianal carcinoma (Bowen disease or Paget's disease)	Rectal bleeding Perianal pruritus Eczematous plaque Rectal mass	Physical examination Sigmoidoscopy/colonoscopy CT/PET scan	Surgery
Anorectal Disorders	Inflammatory bowel disease	Abdominal pain Diarrhea (secretory, mucoid,or bloody) Weight loss Perianal pruritis	Physical examination Antinuclear antibodies Sigmoidoscopy/colonoscopy	Sulfasalazine, mesalamine Oral steroids Antibiotics (e.g, metronidiazole) Azathioprine, 6-mercaptopurine Infliximab, adalimumab
	Hemorrhoids (internal or external)	Bright red blood on toilet paper/stool Pain with defecation Painful lump in the anal area Perianal pruritis	Physical examination Anoscopy/sigmoidoscopy	Psyllium, methylcellulose. Surgery
	Anal fissure	Bright red blood on toilet paper/stool Pain with defecation Perianal pruritus Anal tears	Physical examination reveals anal lacerations.	Topical anesthetics Psyllium, methylcellulose
Hygiene Related problems	Excessive sweating and Poor cleaning	Wearing tight undergarments or synthetic clothes.	Exclusion of medical causes	Use of cotton undergarments. Frequently changing undergarments.
	Meticulous cleansing of anal area	Inappropriate cleaning practices	Exclusion of medical causes	Patient education and change of practice.
	Skin irritants	Use of ointments, soaps, and sanitary wipes.	Exclusion of medical causes	Avoidance of the irritant use.

Differentiating Enterobiasis from other nematode infections

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

Differentiating Enterobiasis from other Nematode infections^[4]^[5]
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^[6]	Free in the lumen of cecum, appendix, adjacent colon	Albendazole Mebendazole Pyrantel pamoate Ivermectin Levamisole Piperazine

References

↑ Siddiqi S, Vijay V, Ward M, Mahendran R, Warren S (2008). "Pruritus ani". Ann R Coll Surg Engl. 90 (6): 457–63. doi:10.1308/003588408X317940. PMC 2647235. PMID 18765023.
↑ Fleshman, James (2007). The ASCRS textbook of colon and rectal surgery. New York, NY: Springer. ISBN 978-0-387-36374-5.
↑ [+https://www.fascrs.org/patients/disease-condition/pruritis-ani-expanded-version "Pruritis Ani Expanded Version | ASCRS"] Check |url= value (help).
↑ 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.

Template:WH Template:WS

[pmid18765023-1] Siddiqi S, Vijay V, Ward M, Mahendran R, Warren S (2008). "Pruritus ani". Ann R Coll Surg Engl. 90 (6): 457–63. doi:10.1308/003588408X317940. PMC 2647235. PMID 18765023.

[ASCRS_textbook-2] Fleshman, James (2007). The ASCRS textbook of colon and rectal surgery. New York, NY: Springer. ISBN 978-0-387-36374-5.

[urlPruritis_Ani_Expanded_Version_|_ASCRS-3] [+https://www.fascrs.org/patients/disease-condition/pruritis-ani-expanded-version "Pruritis Ani Expanded Version | ASCRS"] Check |url= value (help).

[Principles_and_Practice-4] 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.

[Murray_and_Nadel's_Textbook_of_Respiratory_Medicine-5] 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.

[pmid21879805-6] 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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@@ Line 7: / Line 7: @@
 ==Differentiating Enterobiasis from other diseases==
+Enterobiasis should be differentiated from various other causes of anal pruritus and from other nematode infections.
+===Differentiating Enterobiasis from other causes of Anal Pruritis===
 The table below summarizes other major causes of pruritus ani (anal pruritus).<ref name="pmid18765023">{{cite journal |vauthors=Siddiqi S, Vijay V, Ward M, Mahendran R, Warren S |title=Pruritus ani |journal=Ann R Coll Surg Engl |volume=90 |issue=6 |pages=457–63 |year=2008 |pmid=18765023 |pmc=2647235 |doi=10.1308/003588408X317940 |url=}}</ref><ref name="ASCRS textbook">{{cite book | last = Fleshman | first = James | title = The ASCRS textbook of colon and rectal surgery | publisher = Springer | location = New York, NY | year = 2007 | isbn = 978-0-387-36374-5 }}</ref><ref name="urlPruritis Ani Expanded Version | ASCRS">{{cite web |url=+https://www.fascrs.org/patients/disease-condition/pruritis-ani-expanded-version |title=Pruritis Ani Expanded Version &#124; ASCRS |format= |work= |accessdate=}}</ref>
 <br>
@@ Line 202: / Line 204: @@
 |}
+===Differentiating Enterobiasis from other nematode infections===
 The table below summarizes the findings that differentiate enterobiasis from other [[nematode]] infections.
 {| class="wikitable"