Filariasis differential diagnosis: Difference between revisions

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* [[Rhonchi]] may be present in patients with Pulmonary tropical eosinophilia syndrome.
* [[Rhonchi]] may be present in patients with Pulmonary tropical eosinophilia syndrome.
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'''Preparing Blood Smears'''  
'''Preparing Blood Smears'''
 
* Thick Smears  
Thick Smears  
# Thick smears consist of a thick layer of dehemoglobinized (lysed) [[Red blood cell|red blood cells]] (RBCs).
 
# Thick smears allow a more efficient detection of parasites (increased sensitivity).  
Thick smears consist of a thick layer of dehemoglobinized (lysed) [[Red blood cell|red blood cells]] (RBCs).Thick smears allow a more efficient detection of parasites (increased sensitivity).  
* Thin Smears consist of [[blood]] spread in a layer such that the thickness decrease.
 
Thin Smears  
Thin smears consist of [[blood]] spread in a layer such that the thickness decrease.
 
'''By the ultrasound''', the following findings can be observed:
'''By the ultrasound''', the following findings can be observed:
* Dilated lymphatic channels
* Dilated lymphatic channels
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* History of untreated varicose veins
* History of untreated varicose veins
* Painful bilateral lower limb swelling increase with standing and decreased by rest and leg elevation
* Painful bilateral lower limb swelling increase with standing and decreased by rest and leg elevation.
|Chronic
|Chronic
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
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* Skin change distribution correlate with varicose veins sites in the medial side of ankle and leg
* Skin change distribution correlate with varicose veins sites in the medial side of ankle and leg
* Reduction of swelling with limb elevation.
* Reduction of swelling with limb elevation.
|[[Duplex ultrasound]] will demonstrate typical findings of venous valvular insufficiency
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* [[Duplex ultrasound]] will demonstrate typical findings of venous valvular insufficiency
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|[[Deep venous thrombosis|Acute deep venous thrombosis]]
|[[Deep venous thrombosis|Acute deep venous thrombosis]]
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* Negative '''Semmer sign''' to differentiate from liphedema;<ref name="pmid23939641">{{cite journal| author=Trayes KP, Studdiford JS, Pickle S, Tully AS| title=Edema: diagnosis and management. | journal=Am Fam Physician | year= 2013 | volume= 88 | issue= 2 | pages= 102-10 | pmid=23939641 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23939641  }}</ref>
* Negative '''Semmer sign''' to differentiate from liphedema;<ref name="pmid23939641">{{cite journal| author=Trayes KP, Studdiford JS, Pickle S, Tully AS| title=Edema: diagnosis and management. | journal=Am Fam Physician | year= 2013 | volume= 88 | issue= 2 | pages= 102-10 | pmid=23939641 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23939641  }}</ref>
* (pinching) the skin on the upper surface of the toes. If it t is possible to grasp a thin fold of tissue the it is negative result. In a positive result, it is only possible to grasp a lump of tissue.
* Pinching the skin on the upper surface of the toes. If it is possible to grasp a thin fold of tissue the it is negative result. In a positive result, it is only possible to grasp a lump of tissue.


|MRI offers strong qualitative and quantitative parameters in the diagnosis of lipedema <ref name="pmid9412843">{{cite journal| author=Dimakakos PB, Stefanopoulos T, Antoniades P, Antoniou A, Gouliamos A, Rizos D| title=MRI and ultrasonographic findings in the investigation of lymphedema and lipedema. | journal=Int Surg | year= 1997 | volume= 82 | issue= 4 | pages= 411-6 | pmid=9412843 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9412843  }}</ref>
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* MRI offers strong qualitative and quantitative parameters in the diagnosis of lipedema <ref name="pmid9412843">{{cite journal| author=Dimakakos PB, Stefanopoulos T, Antoniades P, Antoniou A, Gouliamos A, Rizos D| title=MRI and ultrasonographic findings in the investigation of lymphedema and lipedema. | journal=Int Surg | year= 1997 | volume= 82 | issue= 4 | pages= 411-6 | pmid=9412843 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9412843  }}</ref>
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|[[Myxedema]]
|[[Myxedema]]
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| -
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* Tenderness,hotness and may be flactuation if abscess formed
* Tenderness,hotness and may be flactuation if abscess formed.
* Lymphangitis in nearby lymph nodes.
* Lymphangitis in nearby lymph nodes.
* Toxemia and fever in severe cases.
* Toxemia and fever in severe cases.
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|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
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|According to the primary cause ( Echo- LFT- RFT)
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* According to the primary cause ( Echo- LFT- RFT)
|}
|}


==References==
==References==
{{reflist|2}}
{{reflist|2}}

Revision as of 17:02, 24 July 2017

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

Overview

Lymphatic filariasis must be differentiated from other causes of lower limb edema, such as chronic venous insufficiency, acute deep venous thrombosis, lipedema, myxedema, cellulitis and causes of generalized edema. Hydrocele sholud be differentiated from other causes of testicular masses. Breast lymphedema must be differentiated from breast cancer.

Differentiating filariasis from other diseases

Lymphatic filariasis must be differentiated from other causes of lower limb edema like chronic venous insufficiency, acute deep venous thrombosis, lipedema, myxedema, cellulitis and causes of generalized edema.

Diseases Symptoms Signs Gold standard Investigation to diagnose
History Onset Pain Fever Laterality Scrotal swelling Symptoms of primary disease
Lymphatic filariasis
  • History of living in endemic area or travelling to it
 Chronic + + Bilateral + -

Preparing Blood Smears

  • Thick Smears
  1. Thick smears consist of a thick layer of dehemoglobinized (lysed) red blood cells (RBCs).
  2. Thick smears allow a more efficient detection of parasites (increased sensitivity).
  • Thin Smears consist of blood spread in a layer such that the thickness decrease.

By the ultrasound, the following findings can be observed:

  • Dilated lymphatic channels
  • Living worms tend to be in motion which called "filarial dance" sign.
Chronic venous insufficiency
  • History of untreated varicose veins
  • Painful bilateral lower limb swelling increase with standing and decreased by rest and leg elevation.
 Chronic + - Bilateral +

(If congenial)

-
  • Typical varicose veins
  • Skin change distribution correlate with varicose veins sites in the medial side of ankle and leg
  • Reduction of swelling with limb elevation.
Acute deep venous thrombosis
  • History of prolonged recumbency
  • Classic symptoms of DVT include acute unilateral swelling, pain, and erythema
 Acute + - Unilateral - May be associated with primary disease mandates recumbency for long duration
  • Dilated superficial veins
  • Difference in calf diameter were twice as likely to have DVT(most impotant sign )[1]
  • Calf pain on passive dorsiflexion of the foot Homan's sign) isn't realiable sign.
Lipedema Family history especially in women; X-linked dominant or autosomal dominant condition[2] Abnormal deposition of fat and edema and easy bruising. Chronic + - Bilateral - -
  • Tender with palpation
  • Negative Semmer sign to differentiate from liphedema;[3]
  • Pinching the skin on the upper surface of the toes. If it is possible to grasp a thin fold of tissue the it is negative result. In a positive result, it is only possible to grasp a lump of tissue.
  • MRI offers strong qualitative and quantitative parameters in the diagnosis of lipedema [4]
Myxedema
  • History of untreated hypothyroidism
  • Infiltration of the skin with glycosaminoglycans with associated water retention
 Chronic + - Bilateral - +

(hypothyroidism )

  • Pretibial myxedema
  • Thyroid function tests.
(Cellulitis-erysipelas-skin abscess)
  • Acute painful swelling and may be fever
 Acute + + Unilateral - -
  • Tenderness,hotness and may be flactuation if abscess formed.
  • Lymphangitis in nearby lymph nodes.
  • Toxemia and fever in severe cases.
  • Cellulitis involves the deeper dermis erysipelas involves the upper dermis.[5]
  • Usually it doesn't need any laboratory tests to diagnose.[6]
  • Blood cultures are warranted for patients in the following circumstances:[7]
  1. Systemic toxicity
  2. Extensive skin or soft tissue involvement
  3. Underlying comorbidities
  4. persistent cellulitis
Other causes of generalized edema
  • History of chronic general condition(cardiac-liver-renal)
 Chronic - - Bilateral - +
  • According to the primary cause ( Echo- LFT- RFT)

References

  1. ↑ Goodacre S, Sutton AJ, Sampson FC (2005). "Meta-analysis: The value of clinical assessment in the diagnosis of deep venous thrombosis". Ann Intern Med. 143 (2): 129–39. PMID 16027455. Review in: ACP J Club. 2006 Mar-Apr;144(2):46-7 Review in: Evid Based Med. 2006 Apr;11(2):56
  2. ↑ Child AH, Gordon KD, Sharpe P, Brice G, Ostergaard P, Jeffery S; et al. (2010). "Lipedema: an inherited condition". Am J Med Genet A. 152A (4): 970–6. doi:10.1002/ajmg.a.33313. PMID 20358611.
  3. ↑ Trayes KP, Studdiford JS, Pickle S, Tully AS (2013). "Edema: diagnosis and management". Am Fam Physician. 88 (2): 102–10. PMID 23939641.
  4. ↑ Dimakakos PB, Stefanopoulos T, Antoniades P, Antoniou A, Gouliamos A, Rizos D (1997). "MRI and ultrasonographic findings in the investigation of lymphedema and lipedema". Int Surg. 82 (4): 411–6. PMID 9412843.
  5. ↑ Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL; et al. (2014). "Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America". Clin Infect Dis. 59 (2): 147–59. doi:10.1093/cid/ciu296. PMID 24947530.
  6. ↑ Raff AB, Kroshinsky D (2016). "Cellulitis: A Review". JAMA. 316 (3): 325–37. doi:10.1001/jama.2016.8825. PMID 27434444.
  7. ↑ Woo PC, Lum PN, Wong SS, Cheng VC, Yuen KY (2000). "Cellulitis complicating lymphoedema". Eur J Clin Microbiol Infect Dis. 19 (4): 294–7. PMID 10834819.
  8. ↑ Leppard BJ, Seal DV, Colman G, Hallas G (1985). "The value of bacteriology and serology in the diagnosis of cellulitis and erysipelas". Br J Dermatol. 112 (5): 559–67. PMID 4005155.
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