Intestinal Flukes Differential Diagnoses

Updated: Jul 14, 2016
  • Author: Joseph Adrian L Buensalido, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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DDx

Diagnostic Considerations

Differential diagnoses of trematode eggs in feces include other trematodes, such as liver flukes or lung flukes (see below [32] and see Table 1).

Intestinal flukes

  • Frequently asymptomatic

  • Mild infection - Mild diarrhea, abdominal pain

  • Severe infection - Malabsorption, intestinal obstruction, eosinophilia may be present

Liver flukes (opisthorchiasis, clonorchiasis)

  • Frequently asymptomatic

  • Acute infection - Serum sickness–like illness (similar to Katayama fever with high fever, eosinophilia, tender hepatomegaly, rash)

  • Advanced stage - May be complicated by recurrent cholangitis, jaundice, associated with cholangiocarcinoma

Liver flukes (fascioliasis)

  • Acute infection - High fever, right-upper-quadrant pain, hepatomegaly, eosinophilia, urticaria

  • Chronic stage - Frequently asymptomatic, biliary obstructive symptoms, eosinophilia

  • Ectopic infection - Visceral larva migrans–like, aberrant sites (eg, lungs, heart, brain, skin)

Lung flukes (paragonimiasis)

  • Acute infection - Diarrhea and pain, eosinophilia, fever, cough, dyspnea, chest pain

  • Pulmonary stage (after approximately 6 mo) - Chronic bronchitis symptoms progressing to pleurisy, hemoptysis, eosinophilia, pulmonary infiltrates with cysts, with or without thin-walled cavities and pleural effusions

  • Cerebrospinal infection - Brain or spinal cord invasion with 1-10 cysts, meningoencephalitis or paraplegia in symptomatic infections (acute infections)

  • Abdominal infection - Invasion into liver, spleen, or peritoneum

  • Migratory subcutaneous infection - Firm, slightly mobile, tender cysts similar to trematode larva migrans

Differential Diagnoses