Microsporidiosis differential diagnosis: Difference between revisions

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{{Microsporidiosis}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Microsporidiosis]]
{{CMG}}; {{Ochuko}};{{AE}}{{AY}}
{{CMG}}; {{AE}} {{Ochuko}} {{AY}}


==Overview==
==Overview==
Microsporidiosis should be differentiated from other conditions that cause [[chronic diarrhea]] in immunocompromised patients.
Microsporidiosis should be differentiated from other conditions that cause [[chronic diarrhea]] in [[Immunocompromised|immunocompromised patients]].


==Differentiating Microsporidiosis from other Diseases==
==Differentiating Microsporidiosis from other Diseases==
===Differential Diagnosis===
===Differential Diagnosis===
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Microsporidiosis must be differentiated from other diseases that may cause [[chronic diarrhea]], [[weight loss]], and [[abdominal pain]] especially in [[Immunocompromised|immunocompromised patients]].
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! style="background: #4479BA; color:#FFF;  width: 150px;" | Disease
! style="background: #4479BA; color:#FFF;  width: 150px;" | Disease
! style="background: #4479BA; color:#FFF;  width: 200px;" | History
! style="background: #4479BA; color:#FFF;  width: 200px;" | Prominent clinical findings
! style="background: #4479BA; color:#FFF;  width: 200px;" | Physical examination
! style="background: #4479BA; color:#FFF;  width: 200px;" | Laboratory or radiological findings
! style="background: #4479BA; color:#FFF;  width: 200px;" | Laboratory or radiological findings
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| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |  Acute viral nasopharyngitis<ref name="pmid12517470">{{cite journal |vauthors=Heikkinen T, Järvinen A |title=The common cold |journal=Lancet |volume=361 |issue=9351 |pages=51–9 |year=2003 |pmid=12517470 |doi=10.1016/S0140-6736(03)12162-9 |url=}}</ref>
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |  [[Giardiasis|Chronic giardiasis]]<ref name="pmid11113253">{{cite journal |vauthors=Thompson RC |title=Giardiasis as a re-emerging infectious disease and its zoonotic potential |journal=Int. J. Parasitol. |volume=30 |issue=12-13 |pages=1259–67 |year=2000 |pmid=11113253 |doi= |url=}}</ref>
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* Symptoms start with [[sore throat]]
* [[Giardiasis|Chronic giardiasis]] may develop after acute episode of giardiasis or without any acute events.
* [[Nasal congestion]] and [[runny nose]]
* Loose foul smelling stools
* [[Cough]] that may persist after the resolution of the other symptoms
* [[Flatulence]]
* [[Fever]] is not common
* [[Fatigue]]
* [[Weight loss]]
* [[Steatorrhea]]
* Some patients develop acquired [[lactose intolerance]] (manifested by exacerbation of symptoms following ingestion of dairy products)
 
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* [[Nasal mucosa]] is [[congested]] and [[Hyperaemia|hyperemic]]
* Microscopic identification of the organism in the stool
* [[Pharynx]] is typically normal
* [[Hypoalbuminaemia]]
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* [[Vitamin B12]] and [[Folate deficiency|folate deficiencies]] (as the organism inhabits the [[duodenum]])
* Diagnosis is usually clinical and lab tests are rarely needed
 
* The virus can be [[Culture medium|cultured]] on human lung cells but results take time
* [[PCR]] is rapid and accurate test but done only in [[immunocompromised]] patients when the [[virus]] strain needs to be known
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |  Allergic rhinitis<ref name="pmid20232579">{{cite journal |vauthors=Pawankar R, Bunnag C, Chen Y, Fukuda T, Kim YY, Le LT, Huong le TT, O'Hehir RE, Ohta K, Vichyanond P, Wang DY, Zhong N, Khaltaev N, Bousquet J |title=Allergic rhinitis and its impact on asthma update (ARIA 2008)--western and Asian-Pacific perspective |journal=Asian Pac. J. Allergy Immunol. |volume=27 |issue=4 |pages=237–43 |year=2009 |pmid=20232579 |doi= |url=}}</ref>
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |  [[Cryptosporidiosis]]<ref name="pmid17172373">{{cite journal |vauthors=Sánchez-Vega JT, Tay-Zavala J, Aguilar-Chiu A, Ruiz-Sánchez D, Malagón F, Rodríguez-Covarrubias JA, Ordóñez-Martínez J, Calderón-Romero L |title=Cryptosporidiosis and other intestinal protozoan infections in children less than one year of age in Mexico City |journal=Am. J. Trop. Med. Hyg. |volume=75 |issue=6 |pages=1095–8 |year=2006 |pmid=17172373 |doi= |url=}}</ref>
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* Characterized by repeated paroxysms of [[rhinorrhea]], [[sneezing]] and [[cough]].
* [[Incubation period]] is 7-10 days.
* Symptoms may be related to a specific season of the year, hence the name “seasonal allergies”.
* In [[immunocompetent]] patients:
:* Disease might be asymptomatic or cause [[gastroenteritis]] (but without any biliary involvement)
:* [[Gastroenteritis]] usually resolves spontaneously within 14 days.
* In [[immunocompromised]] patients:
:* Disease is usually more severe and prolonged (especially in severly [[Immunocompromised|immunocomprmised patients]] with [[CD4|CD4 count]] < 100 cells/microL).
:* [[Cryptosporidiosis]] may involve the [[biliary tract]] and the [[liver]].
:* [[Weight loss]]
:* [[RUQ|Abdominal RUQ]] [[tenderness]] might be present if [[biliary]] or [[hepatic]] involvement is present.
 
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* [[Rhinorrhea]] fluid is usually clear and watery.
* Microscopic identification of the [[organism]] in the stool: The [[oocysts]] appear red on staining with modified acid fast staining
* Examination of the nose reveals a crease below the [[nasal bridge]] from repeated pulling of the nose secondary to irritation.
* [[PCR]]: Most specific and sensitive diagnostic tool. [[PCR]] is expensive and used in limited cases.
* [[Edema]] in the area below the eye if associated [[conjunctivitis]] is present.<ref name="pmid11449200">{{cite journal |vauthors=Skoner DP |title=Allergic rhinitis: definition, epidemiology, pathophysiology, detection, and diagnosis |journal=J. Allergy Clin. Immunol. |volume=108 |issue=1 Suppl |pages=S2–8 |year=2001 |pmid=11449200 |doi= |url=}}</ref>
 
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* Skin testing using intradermal prick skin tests to determine the specific [[allergens]] causing [[allergic rhinitis]].
* Serum immune assays to determine [[IgE|IgE levels]] in the [[serum]].
|-
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| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |  Acute sinusitis<ref name="pmid9347786">{{cite journal |vauthors=Low DE, Desrosiers M, McSherry J, Garber G, Williams JW, Remy H, Fenton RS, Forte V, Balter M, Rotstein C, Craft C, Dubois J, Harding G, Schloss M, Miller M, McIvor RA, Davidson RJ |title=A practical guide for the diagnosis and treatment of acute sinusitis |journal=CMAJ |volume=156 Suppl 6 |issue= |pages=S1–14 |year=1997 |pmid=9347786 |doi= |url=}}</ref>
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |  [[Cystoisospora belli|Cystoisosporiasis (isosporiasis)]]<ref name="pmid1889046">{{cite journal |vauthors=Current WL, Garcia LS |title=Cryptosporidiosis |journal=Clin. Microbiol. Rev. |volume=4 |issue=3 |pages=325–58 |year=1991 |pmid=1889046 |pmc=358202 |doi= |url=}}</ref>
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* Presents with symptoms similar to [[URTI|URTIs]] ([[sneezing]], [[cough]] and [[runny nose]])
* [[Cystoisospora belli|Cystoisosporiasis]] is usually seen in [[Immunocompromised|immunocompromised patients]].
* Symptoms last for a longer time (about 10 days) with the peak of symptoms between 4th and 6th days.
* [[Incubation period]] can last up to 2 weeks
* Usually, [[acute sinusitis]] is not associated with [[fever]]<ref name="pmid7242607">{{cite journal |vauthors= |title=Acute maxillary sinusitis |journal=N. Engl. J. Med. |volume=305 |issue=4 |pages=226–7 |year=1981 |pmid=7242607 |doi=10.1056/NEJM198107233050419 |url=}}</ref>
* [[Watery diarrhea]] that is profuse and foul smelling
* Constitutional symptoms ([[headache]], [[Low-grade fever|low grade fever]], [[myalgia]] and [[malaise]])
 
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* Inspection may show [[erythema]] and [[edema]] over the involved [[sinus]]
* [[Isospora]] ova or parasites can be visualized on stool microscopic examination.
* Palpation of [[sinuses]] shows [[tenderness]] on palpation
* [[Endoscopy|Upper GI endoscopy]] may used for excluding other esophageal or gastric disease and obtaining specimens for histopathology.
* [[Transillumination]] of the sinuses may show opacity.
 
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* [[X ray]] and [[CT]] may show air fluid level or bubbles in the affected sinus.
* [[Culture medium|Culture]] of the nasal secretions is of limited use in [[acute sinusitis]] as nasal secretions may be contaminated by [[Flora|nasal flora]].
|-
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| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | Infectious mononucleosis<ref name="pmid4864269">{{cite journal |vauthors=Niederman JC, McCollum RW, Henle G, Henle W |title=Infectious mononucleosis. Clinical manifestations in relation to EB virus antibodies |journal=JAMA |volume=203 |issue=3 |pages=205–9 |year=1968 |pmid=4864269 |doi= |url=}}</ref>
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | [[Tropical sprue]]<ref name="pmid1091526">{{cite journal |vauthors=Klipstein FA, Schenk EA |title=Enterotoxigenic intestinal bacteria in tropical sprue. II. Effect of the bacteria and their enterotoxins on intestinal structure |journal=Gastroenterology |volume=68 |issue=4 Pt 1 |pages=642–55 |year=1975 |pmid=1091526 |doi= |url=}}</ref>
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* Symptoms of [[pharyngitis]]: [[sore throat]] and [[Dysphagia|difficult swallowing]]
* History of travel to a tropical region (for a period more than a month)
* [[Fever]]
* [[Chronic diarrhea]]
* [[Fatigue]]
* [[Steatorrhea]]
* [[Lymphadenopathy]] especially in the posterior cervical region
* Examination may show signs of [[vitamin deficiencies]] (eg [[glossitis]])
 
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* Abdominal examination reveals [[splenomegaly]]
* [[Megaloblastic anemia]] that might progress into [[pancytopenia]]
* [[Maculopapular rash]] may be present
* [[Hypoalbuminaemia]]
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* [[Vitamin D Deficiency|Vitamin D defeciency]] and [[hypocalcemia]]
* Positive monospot test
 
* Elevated [[liver enzymes]]
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|}


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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Latest revision as of 22:43, 29 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ogheneochuko Ajari, MB.BS, MS [2] Ahmed Younes M.B.B.CH [3]

Overview

Microsporidiosis should be differentiated from other conditions that cause chronic diarrhea in immunocompromised patients.

Differentiating Microsporidiosis from other Diseases

Differential Diagnosis

Microsporidiosis must be differentiated from other diseases that may cause chronic diarrhea, weight loss, and abdominal pain especially in immunocompromised patients.

Disease Prominent clinical findings Laboratory or radiological findings
Chronic giardiasis[1]
Cryptosporidiosis[2]
  • Disease might be asymptomatic or cause gastroenteritis (but without any biliary involvement)
  • Gastroenteritis usually resolves spontaneously within 14 days.
  • Microscopic identification of the organism in the stool: The oocysts appear red on staining with modified acid fast staining
  • PCR: Most specific and sensitive diagnostic tool. PCR is expensive and used in limited cases.
Cystoisosporiasis (isosporiasis)[3]
  • Isospora ova or parasites can be visualized on stool microscopic examination.
  • Upper GI endoscopy may used for excluding other esophageal or gastric disease and obtaining specimens for histopathology.
Tropical sprue[4]

References

  1. ↑ Thompson RC (2000). "Giardiasis as a re-emerging infectious disease and its zoonotic potential". Int. J. Parasitol. 30 (12–13): 1259–67. PMID 11113253.
  2. ↑ Sánchez-Vega JT, Tay-Zavala J, Aguilar-Chiu A, Ruiz-Sánchez D, Malagón F, Rodríguez-Covarrubias JA, Ordóñez-Martínez J, Calderón-Romero L (2006). "Cryptosporidiosis and other intestinal protozoan infections in children less than one year of age in Mexico City". Am. J. Trop. Med. Hyg. 75 (6): 1095–8. PMID 17172373.
  3. ↑ Current WL, Garcia LS (1991). "Cryptosporidiosis". Clin. Microbiol. Rev. 4 (3): 325–58. PMC 358202. PMID 1889046.
  4. ↑ Klipstein FA, Schenk EA (1975). "Enterotoxigenic intestinal bacteria in tropical sprue. II. Effect of the bacteria and their enterotoxins on intestinal structure". Gastroenterology. 68 (4 Pt 1): 642–55. PMID 1091526.
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