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 and the nematode infections.

Differentiating Enterobiasis from other diseases

Causes Suggestive findings Diagnostic approach Treatment 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, etc. 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, methycellulose. 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. Skin disorders Atopic dermatitis Erythematous, pruritic, scaly 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 sclerosis 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. 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 cleansing practices. Exclusion of medical causes. Patient education and change of practice. Skin irritants Use of ointments, soaps, sanitary wipes. Exclusion of medical causes. Avoidance of the irritant use. 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