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]] 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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! Diseases
! Diseases


! colspan="4" |Symptoms
! colspan="7" |Symptoms


! Signs
! rowspan="2" | Signs


! Investigations
! rowspan="2" | Gold standard Investigation to diagnose
|-
|-
!
!
!
!History
!
!Onset
!
!Pain
!
!Fever
!
!Laterality
!
!Scrotal swelling
!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
* asymptomatic or symptomatic.
|[[Chronic (medical)|Chronic]]
* Symptoms include:
|<nowiki>+</nowiki>
 
| +
* [[Elephantiasis]] (frequently in the lower extremities)
|[[Bilateral]]
* [[Hydrocele|Scrotal swelling]]
| +
* Nocturnal [[cough]]
|<nowiki>-</nowiki>
* [[Fever]]
* [[Malaise]]
* [[Headache]]
* [[Chills]]
|
|
|
|
|
* [[Hepatomegaly]]
* [[Hepatomegaly]]
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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[edit | edit source] ====
* [[Blood film|Thick blood film]]  
If you are using [[venous blood]], [[Blood smear|blood smears]] should be prepared as soon as possible after collection (delay can result in changes in parasite [[Morphology|morpholo]]
 
===== Thick Smears[edit | edit source] =====
Thick smears consist of a thick layer of dehemoglobinized (lysed) [[Red blood cell|red blood cells]] (RBCs). The blood elements (including parasites, if any) are more concentrated (app. 30×) than in an equal area of a thin smear. Thus, thick smears allow a more efficient detection of parasites (increased sensitivity). However, they do not permit an optimal review of parasite morphology. For example, they are often not adequate for species identification of malaria parasites: if the thick smear is positive for [[Plasmodium|malaria parasites]], the thin smear should be used for species identification.


Prepare at least 2 smears per patient! Place a small drop of [[blood]] in the center of the pre-cleaned, labeled slide. Using the corner of another slide or an applicator stick, spread the drop in a circular pattern until it is the size of a dime (1.5 cm2). A thick smear of proper density is one which, if placed (wet) over newsprint, allows you to barely read the words. Lay the slides flat and allow the smears to dry thoroughly (protect from dust and insects!). Insufficiently dried smears (and/or smears that are too thick) can detach from the slides during staining. The risk is increased in smears made with anticoagulated blood. At room temperature, drying can take several hours; 30 minutes is the minimum; in the latter case, handle the [[Blood smear|smear]] very delicately during staining. You can accelerate the drying by using a fan or hair dryer (use cool setting). Protect thick smears from hot environments to prevent heat-fixing the smear. Do not fix thick smears with [[methanol]] or [[heat]]. If there will be a delay in staining smears, dip the thick smear briefly in water to hemolyse the [[RBC|RBCs]].
* [[Blood film|Thin blood film]]


Examination of skin snips will identify microfilariae of Onchocerca volvulus and Mansonella streptocerca. Skin snips can be obtained using a corneal-scleral punch, or more simply a [[scalpel]] and [[needle]]. The sample must be allowed to incubate for 30 minutes to 2 hours in saline or [[culture medium]], and then examined for microfilariae that would have migrated from the [[tissue]] to the liquid phase of the specimen.
* [[Ultrasound]]:
** "filarial dance" sign


===== Thin Smears[edit | edit source] =====
Thin smears consist of [[blood]] spread in a layer such that the thickness decreases progressively toward the feathered edge. In the feathered edge, the [[Cell|cells]]<nowiki/>should be in a monolayer, not touching one another. Prepare at least 2 smears per patient!  Place a small drop of [[blood]] on the pre-cleaned, labeled slide, near its frosted end. Bring another slide at a 30-45° angle up to the drop, allowing the drop to spread along the contact line of the 2 slides. Quickly push the upper (spreader) slide toward the unfrosted end of the lower slide. Make sure that the smears have a good feathered edge. This is achieved by using the correct amount of blood and spreading technique. Allow the thin smears to dry. (They dry much faster than the thick smears, and are less subject to detachment because they will be fixed.) Fix the smears by dipping them in absolute [[methanol]].
|-
|-


| Chronic venous insufficiency
| [[Chronic venous insufficiency]]


|
|
* 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 (medical)|Chronic]]
|
|<nowiki>+</nowiki>
| -
|[[Bilateral]]
| +
 
(If congenial)
| -
|
|
* Typical [[varicose veins]]
* [[Skin]] change distribution correlate with [[varicose veins]] sites in the medial side of [[ankle]] and [[leg]]
* Reduction of [[swelling]] with limb elevation
|
|
* Typical varicose veins
* [[Duplex ultrasound]]
* Skin change distribution correlate with varicose veins sites in the medial side of ankle and leg
* Reduction of swelling with limb elevation.
|Duplex ultrasound will demonstrate typical findings of venous valvular insufficiency
|-
|-
|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 (medicine)|Acute]]
| +
| -
|Unilateral
| -
|May be associated with primary disease mandates recumbency for long duration
|
|
* Dilated [[superficial veins]]
* 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
|
|
|
* [[Compression ultrasonography]] with [[Doppler ultrasound|doppler]]
|
* [[D-dimer]]
* Compression ultrasonography (CUS) with Doppler is the diagnostic test of choice
* D-dimer is used for unprobable cases
|-
|-
|Lipedema
|[[Lipedema]]
|Patients may complain of pain,swelling and easy bruising.<ref name="pmid22301856">{{cite journal| author=Herbst KL| title=Rare adipose disorders (RADs) masquerading as obesity. | journal=Acta Pharmacol Sin | year= 2012 | volume= 33 | issue= 2 | pages= 155-72 | pmid=22301856 | doi=10.1038/aps.2011.153 | pmc=4010336 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22301856  }}</ref>
|
|
* 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
| +
| -
|Bilateral
| -
|<nowiki>-</nowiki>
|
|
|
|
* 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
* Tenderness with palpation
* Tenderness with palpation
* 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<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
* Infiltration of the skin with glycosaminoglycans with associated water retention
* Chronic painful nonpitting swelling
|
|
|
|
* History of untreated [[hypothyroidism]]
* Infiltration of the skin with [[Glycosaminoglycan|glycosaminoglycans]] with associated water retention
|Chronic
| +
| -
|Bilateral
| -
| +
([[hypothyroidism]] )
|
|
* [[Pretibial myxedema]]
|
|
* [[Thyroid function tests|Thyroid function tests.]]
|-
|-
|Cellulitis
|([[Cellulitis]]-[[Erysipelas|erysipelas-]]<nowiki/>skin abscess)
|Acute painful swelling and may be fever
|
|
* Acute painful [[swelling]]
* [[Fever]]
|Acute
| +
| +
|Unilateral
| -
| -
|
|
* [[Tenderness]], hotness, and may be fluctuation if [[abscess]] formed
* [[Lymphangitis]] in nearby [[Lymph node|lymph nodes]]
* [[Toxemia]] and [[fever]] in severe cases
* [[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>
|
|
|Tenderness,hotness and may be flactuation if abscess formed
* 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]]
 
* 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>
|-
|-
|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
| -
| -
|Bilateral
| -
|<nowiki>+</nowiki>
|
|
|
|
|-
* Echocardiogram
| colspan="7" |
* [[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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