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 diseases causing pruritis ani such as seborrheic dermatitis, atopic dermatitis, contact dermatitis, skin infections, anal fissure and the nematode infections like ascariasis, ancylostomiasis, and strongyloidiasis.

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).

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 strongyloidiasis from other Nematode infections Infection Nematode Transmission Direct Person-Person Transmission Duration of Infection Pulmonary Manifestation Location of Adult worm(s) Treatment 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 Albendazole Mebendazole Pyrantel pamoate Ivermectin Levamisole Piperazine Strongyloidiasis 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 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 Albendazole Mebendazole Ascariasis 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 air in the lumen of the small bowel (primarily jejunum) Albendazole Mebendazole Pyrantel pamoate Ivermectin Levamisole Piperazine Hookworm infection 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 References