Filariasis differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]

Filariasis Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Filariasis from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
X Ray
CT Scan
MRI
Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Filariasis differential diagnosis On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
slides
Images
American Roentgen Ray Society Images of Filariasis differential diagnosis All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Filariasis differential diagnosis
on Filariasis differential diagnosis
Filariasis differential diagnosis in the news
Blogs on Filariasis differential diagnosis
Directions to Hospitals Treating Filariasis
Risk calculators and risk factors for Filariasis differential diagnosis

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.

Differentiating filariasis from other diseases

Diseases	Symptoms				Signs	Investigations
Lymphatic filariasis	History of living in endemic area or travelling to it. asymptomatic or symptomatic. Symptoms include: Elephantiasis (frequently in the lower extremities) Scrotal swelling Nocturnal cough Fever Malaise Headache Chills				Hepatomegaly Lymphedema Elephantiasis Lymphangitis Hydrocele Scrotal elephantiasis Lymphadenopathies Rhonchi may be present in patients with Pulmonary tropical eosinophilia syndrome	Preparing Blood Smears[edit | edit source] If you are using venous blood, blood smears should be prepared as soon as possible after collection (delay can result in changes in parasite morpholo Thick Smears[edit | edit source] Thick smears consist of a thick layer of dehemoglobinized (lysed) 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 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 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 RBCs. 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. 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 cellsshould 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	History of untreated varicose veins Painful bilateral lower limb swelling increase with standing and decreased by rest and leg elevation				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.	Duplex ultrasound will demonstrate typical findings of venous valvular insufficiency
Acute deep venous thrombosis	History of prolonged recumbency Classic symptoms of DVT include acute unilateral swelling, pain, and erythema					Compression ultrasonography (CUS) with Doppler is the diagnostic test of choice D-dimer is used for unprobable cases
Lipedema	Patients may complain of pain,swelling and easy bruising.				Family history especially in women; X-linked dominant or autosomal dominant condition Abnormal deposition of fat and edema Tenderness with palpation
Myxedema	History of untreated hypothyroidism Infiltration of the skin with glycosaminoglycans with associated water retention Chronic painful nonpitting swelling
Cellulitis	Acute painful swelling and may be fever				Tenderness,hotness and may be flactuation if abscess formed
Other causes of generalized edema	History of chronic general condition(cardiac-liver-renal)