Filariasis differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Filariasis}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Filariasis]]
{{CMG}}{{AE}}{{MAD}}
{{CMG}}{{AE}}{{MAD}}


__NOTOC__
{{Filariasis}}
__NOTOC__
=Overview=
=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.
Lymphatic filariasis must be differentiated from other causes of [[Edema|lower limb edema]], such as [[chronic venous insufficiency]], [[Deep vein thrombosis|acute deep venous thrombosis]], [[lipedema]], [[myxedema]], [[cellulitis]] and causes of [[generalized edema]].


==Differentiating filariasis from other diseases==
==Differentiating filariasis from other diseases==
Lymphatic filariasis must be differentiated from other causes of lower limb edema:
Lymphatic filariasis must be differentiated from other causes of [[lower limb]] [[edema]] like [[chronic venous insufficiency]], acute [[Deep vein thrombosis|deep venous thrombosis]], [[lipedema]], [[myxedema]], [[cellulitis]] and causes of [[generalized edema]].
{| class="wikitable"
{| class="wikitable"


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! colspan="7" |Symptoms
! colspan="7" |Symptoms


! Signs
! rowspan="2" | Signs


! rowspan="2" | Gold standard Investigation to diagnose
! rowspan="2" | Gold standard Investigation to diagnose
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!Scrotal swelling
!Scrotal swelling
!Symptoms of primary disease
!Symptoms of primary disease
!
|-
|-


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|
|
* History of living in endemic area or travelling to it
* History of living in [[endemic]] area or travelling to it
|Chronic
|[[Chronic (medical)|Chronic]]
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
| +
| +
|Bilateral
|[[Bilateral]]
| +
| +
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
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* [[Lymphangitis]]
* [[Lymphangitis]]
* [[Hydrocele]]
* [[Hydrocele]]
* Scrotal elephantiasis
* Scrotal [[elephantiasis]]
* [[Lymphadenopathy|Lymphadenopathies]]
* [[Lymphadenopathy|Lymphadenopathies]]
* [[Rhonchi]] may be present in patients with Pulmonary tropical eosinophilia syndrome
* [[Rhonchi]] may be present in patients with [[Pulmonary]] tropical [[eosinophilia]] syndrome
|
|
'''Preparing Blood Smears'''
* [[Blood film|Thick blood film]]


Thick Smears
* [[Blood film|Thin blood film]]


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).
* [[Ultrasound]]:
 
** "filarial dance" sign
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:
* Dilated lymphatic channels
* Living worms tend to be in motion which called "filarial dance" sign.


|-
|-
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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]] that increases with standing and decreases by rest and [[leg]] elevation
|Chronic
|[[Chronic (medical)|Chronic]]
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
| -
| -
|Bilateral
|[[Bilateral]]
| +
| +


(If congenial , Venous insufficiency un testicular veins may form scrotal swelling)
(If congenial)
| -
| -
|
|
* Typical varicose veins
* Typical [[varicose veins]]
* 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
|
* [[Duplex ultrasound]]  
|-
|-
|[[Deep venous thrombosis|Acute deep venous thrombosis]]
|[[Deep venous thrombosis|Acute deep venous thrombosis]]
|
|
* History of prolonged recumbency
* History of prolonged recumbency
* Classic symptoms of DVT include acute unilateral swelling, pain, and erythema   
* Classic symptoms of [[DVT]] include acute unilateral [[swelling]], [[pain]], and [[erythema]]  
|Acute
|[[Acute (medicine)|Acute]]
| +
| +
| -
| -
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|May be associated with primary disease mandates recumbency for long duration
|May be associated with primary disease mandates recumbency for long duration
|
|
* Dilated superficial veins
* Dilated [[superficial veins]]
* Difference in calf diameter were twice as likely to have DVT(most impotant sign )<ref name="pmid16027455">{{cite journal| author=Goodacre S, Sutton AJ, Sampson FC| title=Meta-analysis: The value of clinical assessment in the diagnosis of deep venous thrombosis. | journal=Ann Intern Med | year= 2005 | volume= 143 | issue= 2 | pages= 129-39 | pmid=16027455 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16027455  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16539361 Review in: ACP J Club. 2006 Mar-Apr;144(2):46-7]  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17213086 Review in: Evid Based Med. 2006 Apr;11(2):56]</ref>
* Difference in [[Calf muscle|calf]] diameter is twice as likely to have [[DVT]](most impotant sign )<ref name="pmid16027455">{{cite journal| author=Goodacre S, Sutton AJ, Sampson FC| title=Meta-analysis: The value of clinical assessment in the diagnosis of deep venous thrombosis. | journal=Ann Intern Med | year= 2005 | volume= 143 | issue= 2 | pages= 129-39 | pmid=16027455 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16027455  }}  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16539361 Review in: ACP J Club. 2006 Mar-Apr;144(2):46-7]  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17213086 Review in: Evid Based Med. 2006 Apr;11(2):56]</ref>
* Calf pain on passive dorsiflexion of the foot Homan's sign) isn't realiable sign.
* Calf pain on passive [[dorsiflexion]] of the [[foot]] ([[Homan's sign]]) isn't realiable sign


|
|
* [[Compression ultrasonography]] (CUS) with Doppler is the diagnostic test of choice
* [[Compression ultrasonography]] with [[Doppler ultrasound|doppler]]
* [[D-dimer]] level is used for unprobable cases
* [[D-dimer]]
|-
|-
|[[Lipedema]]
|[[Lipedema]]
|Family history especially in women; X-linked dominant or autosomal dominant condition<ref name="pmid20358611">{{cite journal| author=Child AH, Gordon KD, Sharpe P, Brice G, Ostergaard P, Jeffery S et al.| title=Lipedema: an inherited condition. | journal=Am J Med Genet A | year= 2010 | volume= 152A | issue= 4 | pages= 970-6 | pmid=20358611 | doi=10.1002/ajmg.a.33313 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20358611  }}</ref> Abnormal deposition of fat and edema and '''easy bruising'''.
|
* Family history especially in women; [[X-linked dominant]] or [[autosomal dominant]] condition<ref name="pmid20358611">{{cite journal| author=Child AH, Gordon KD, Sharpe P, Brice G, Ostergaard P, Jeffery S et al.| title=Lipedema: an inherited condition. | journal=Am J Med Genet A | year= 2010 | volume= 152A | issue= 4 | pages= 970-6 | pmid=20358611 | doi=10.1002/ajmg.a.33313 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20358611  }}</ref>  
* Abnormal deposition of fat and [[edema]] and [[easy bruising]]
|Chronic
|Chronic
| +
| +
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| -
| -
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|Tender with palpation
|
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>
* Tenderness with palpation


(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.
* Negative Semmer sign<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>


|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>
|
* MRI<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>
|-
|-
|[[Myxedema]]
|[[Myxedema]]
|
|
* History of untreated hypothyroidism
* History of untreated [[hypothyroidism]]
* Infiltration of the skin with [[Glycosaminoglycan|glycosaminoglycans]] with associated water retention
* Infiltration of the skin with [[Glycosaminoglycan|glycosaminoglycans]] with associated water retention
|Chronic
|Chronic
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([[hypothyroidism]] )
([[hypothyroidism]] )
|
|
* [[Pretibial myxedema]]
|
|
* [[Thyroid function tests|Thyroid function tests.]]
|-
|-
|([[Cellulitis]]-[[Erysipelas|erysipelas-]]<nowiki/>skin abcess)
|([[Cellulitis]]-[[Erysipelas|erysipelas-]]<nowiki/>skin abscess)
|Acute painful swelling and may be fever
|
* Acute painful [[swelling]]
* [[Fever]]
|Acute
|Acute
| +
| +
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| -
| -
|
|
* Tenderness,hotness and may be flactuation if abscess formed
* [[Tenderness]], hotness, and may be fluctuation if [[abscess]] formed
* Lymphangitis in nearby lymph nodes.
* [[Lymphangitis]] in nearby [[Lymph node|lymph nodes]]
* Toxemia and fever in severe cases.
* [[Toxemia]] and [[fever]] in severe cases
* Cellulitis involves the deeper dermis erysipelas involves the upper dermis.<ref name="pmid24947530">{{cite journal| author=Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL et al.| title=Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. | journal=Clin Infect Dis | year= 2014 | volume= 59 | issue= 2 | pages= 147-59 | pmid=24947530 | doi=10.1093/cid/ciu296 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24947530  }}</ref>
* [[Cellulitis]] involves the deeper [[dermis]] and [[erysipelas]] involves the upper dermis<ref name="pmid24947530">{{cite journal| author=Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL et al.| title=Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. | journal=Clin Infect Dis | year= 2014 | volume= 59 | issue= 2 | pages= 147-59 | pmid=24947530 | doi=10.1093/cid/ciu296 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24947530  }}</ref>
|
|
* Usually it doesn't need any laboratory tests to diagnose.<ref name="pmid27434444">{{cite journal| author=Raff AB, Kroshinsky D| title=Cellulitis: A Review. | journal=JAMA | year= 2016 | volume= 316 | issue= 3 | pages= 325-37 | pmid=27434444 | doi=10.1001/jama.2016.8825 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27434444  }}</ref>
* Diagnosis is clinical<ref name="pmid27434444">{{cite journal| author=Raff AB, Kroshinsky D| title=Cellulitis: A Review. | journal=JAMA | year= 2016 | volume= 316 | issue= 3 | pages= 325-37 | pmid=27434444 | doi=10.1001/jama.2016.8825 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27434444  }}</ref>
* Blood cultures are warranted for patients in the following circumstances:<ref name="pmid10834819">{{cite journal| author=Woo PC, Lum PN, Wong SS, Cheng VC, Yuen KY| title=Cellulitis complicating lymphoedema. | journal=Eur J Clin Microbiol Infect Dis | year= 2000 | volume= 19 | issue= 4 | pages= 294-7 | pmid=10834819 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10834819  }}</ref>
* [[Blood cultures]]
# Systemic toxicity
 
# Extensive skin or soft tissue involvement
* Serologic ''testing for [[beta-hemolytic streptococci]]''<ref name="pmid4005155">{{cite journal| author=Leppard BJ, Seal DV, Colman G, Hallas G| title=The value of bacteriology and serology in the diagnosis of cellulitis and erysipelas. | journal=Br J Dermatol | year= 1985 | volume= 112 | issue= 5 | pages= 559-67 | pmid=4005155 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4005155  }}</ref>
# Underlying comorbidities
# persistent cellulitis
* ''In patients with recurrent cellulitis, serologic testing for [[beta-hemolytic streptococci]] is a good diagnostic tool.''<ref name="pmid4005155">{{cite journal| author=Leppard BJ, Seal DV, Colman G, Hallas G| title=The value of bacteriology and serology in the diagnosis of cellulitis and erysipelas. | journal=Br J Dermatol | year= 1985 | volume= 112 | issue= 5 | pages= 559-67 | pmid=4005155 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4005155  }}</ref>
|-
|-
|Other causes of generalized edema
|Other causes of [[generalized edema]]
|History of chronic general condition(cardiac-liver-renal)
|
* History of chronic general condition (cardiac-liver-renal)
|Chronic
|Chronic
| -
| -
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|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|
|
|According to the primary cause ( Echo- LFT- RFT)
|
|-
* Echocardiogram
| colspan="10" |
* [[LFTs|LFT]]
* RFT
|}
|}


==References==
==References==
{{reflist|2}}
{{reflist|2}}
[[Category:Emergency mdicine]]
[[Category:Disease]]
[[Category:Up-To-Date]]
[[Category:Infectious disease]]
[[Category:Vascular medicine]]
[[Category:Urology]]
[[Category:Gastroenterology]]

Latest revision as of 21:45, 29 July 2020

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.

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 + -
Chronic venous insufficiency Chronic + - Bilateral +

(If congenial)

-
Acute deep venous thrombosis Acute + - Unilateral - May be associated with primary disease mandates recumbency for long duration
Lipedema Chronic + - Bilateral - -
  • Tenderness with palpation
  • Negative Semmer sign[3]
Myxedema Chronic + - Bilateral - +

(hypothyroidism )

(Cellulitis-erysipelas-skin abscess) Acute + + Unilateral - -
Other causes of generalized edema
  • History of chronic general condition (cardiac-liver-renal)
 Chronic - - Bilateral - +
  • Echocardiogram
  • 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. ↑ 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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