Microsporidiosis differential diagnosis: Difference between revisions

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==Differentiating Microsporidiosis from other Diseases==
==Differentiating Microsporidiosis from other Diseases==
===Differential Diagnosis===
===Differential Diagnosis===
Microspordiosis must be differentiated from other diseases that is causing chronic diarrhea, weight loss and abdominal pain especially in immunocompromised patients.
Microspordiosis must be differentiated from other diseases that is causing [[chronic diarrhea]], [[weight loss]] and [[abdominal pain]] especially in [[Immunocompromised|immunocompromised patients]].
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! 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" |  Chronic giardiasis
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |  [[Giardiasis|Chronic giardiasis]]
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* Chronic giardiasis may develop after a bout of acute giardiasis or without any acute events.
* [[Giardiasis|Chronic giardiasis]] may develop after a bout of acute giardiasis or without any acute events.
* Loose foul smelling stools
* Loose foul smelling stools
* Flatuelence
* [[Flatulence]]
* Fatigue
* [[Fatigue]]
* Weight loss
* [[Weight loss]]
* Steatorrhea
* [[Steatorrhea]]
* Some patients develop acquired lactose intolerance (manifested by exacerbation of symptoms following ingestion of dairy products)
* Some patients develop acquired [[lactose intolerance]] (manifested by exacerbation of symptoms following ingestion of dairy products)


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* Microscopic identification of the organism in the stool
* Microscopic identification of the organism in the stool
* Hypoalbuminaemia
* [[Hypoalbuminaemia]]
* Vitamin B12 and folate deficiencies (as the organism inhabits the duodenum)
* [[Vitamin B12]] and [[Folate deficiency|folate deficiencies]] (as the organism inhabits the [[duodenum]])


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| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |  Cryptosporidiosis
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |  [[Cryptosporidiosis]]
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* Incubation period is 7-10 days.
* [[Incubation period]] is 7-10 days.
* In immunocompetent patients:
* In [[immunocompetent]] patients:
:* Disease might be asymptomatic or cause gastroenteritis (but without any biliary involvement)
:* Disease might be asymptomatic or cause [[gastroenteritis]] (but without any biliary involvement)
:* Gastroenteritis usually resolves spontaneously within 14 days.
:* [[Gastroenteritis]] usually resolves spontaneously within 14 days.
* In immunocompromised patients:
* In [[immunocompromised]] patients:
:* Disease is usually more severe and prolonged (especially in severly immunocomprmised patients with CD4 count < 100 cells/microL).
:* Disease is usually more severe and prolonged (especially in severly [[Immunocompromised|immunocomprmised patients]] with [[CD4|CD4 count]] < 100 cells/microL).
:* Cryptosporidiasis may involve the biliary tract and the liver.
:* [[Cryptosporidiosis]] may involve the [[biliary tract]] and the [[liver]].
:* Weight loss
:* [[Weight loss]]
:* Abdominal RUQ tenderness might be present if biliary or hepatic involvement is present.
:* [[RUQ|Abdominal RUQ]] [[tenderness]] might be present if [[biliary]] or [[hepatic]] involvement is present.


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* Microscopic identification of the organism in the stool: The oocysts appear red on staining with modified acid fast staining
* Microscopic identification of the [[organism]] in the stool: The [[oocysts]] appear red on staining with modified acid fast staining
* PCR: is the most specific and sensitive diagnostic tool. PCR is expensive and used in limited cases.
* [[PCR]]: is the most specific and sensitive diagnostic tool. [[PCR]] is expensive and used in limited cases.


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| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |  Cystoisosporiasis (isosporiasis)
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |  [[Cystoisospora belli|Cystoisosporiasis (isosporiasis)]]
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* Cystoisosporiasis is usually seen in immunocompromised patients.
* [[Cystoisospora belli|Cystoisosporiasis]] is usually seen in [[Immunocompromised|immunocompromised patients]].
* Incubation period can last up to 2 weeks
* [[Incubation period]] can last up to 2 weeks
* Watery diarrhea that is profuse and foul smelling
* [[Watery diarrhea]] that is profuse and foul smelling
* Constitutional symptoms (headache, low grade fever, myalgia and malaise)
* Constitutional symptoms ([[headache]], [[Low-grade fever|low grade fever]], [[myalgia]] and [[malaise]])


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* Isospora ova or parasites can be visualized on stool microscopic examination.
* [[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.
* [[Endoscopy|Upper GI endoscopy]] may used for excluding other esophageal or gastric disease and obtaining specimens for histopathology.


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| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | Tropical sprue
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" | [[Tropical sprue]]
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* History of travel to a tropical region (for a period more than a month)
* History of travel to a tropical region (for a period more than a month)
* Chronic diarrhea
* [[Chronic diarrhea]]
* Steatorrhea
* [[Steatorrhea]]
* Examination may show signs of vitamin deficiencies (eg glossitis)
* Examination may show signs of [[vitamin deficiencies]] (eg [[glossitis]])


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* Megaloblastic anemia that might progress into pancytopenia
* [[Megaloblastic anemia]] that might progress into [[pancytopenia]]
* Hypoalbuminaemia
* [[Hypoalbuminaemia]]
* Vitamin D defeciency and hypocalcemia
* [[Vitamin D Deficiency|Vitamin D defeciency]] and [[hypocalcemia]]


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Revision as of 16:18, 1 July 2017

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

Microspordiosis must be differentiated from other diseases that is causing chronic diarrhea, weight loss and abdominal pain especially in immunocompromised patients.

Disease Prominent clinical findings Laboratory or radiological findings
Chronic giardiasis
Cryptosporidiosis
  • 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: is the most specific and sensitive diagnostic tool. PCR is expensive and used in limited cases.
Cystoisosporiasis (isosporiasis)
  • 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

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