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Differential Diagnosis

In the early stage of the disease, strongyloidiasis may clinically and radiographically mimic the duodenitis and jejunitis seen with peptic ulcer disease, giardiasis, or an adjacent inflammatory process such as cholecystitis or pancreatitis. In the second stage of the disease, giardiasis, hookworm disease, sprue, diffuse lymphoma of the small bowel, and a number of other diseases associated with malabsorption may be considered in the differential diagnosis. In the third or late paralytic stage, the plain film examination may suggest severe reflex ileus or even a partial mechanical small bowel obstruction. The findings on small bowel series at this stage may at times suggest tuberculosis, Crohn's disease, or other severe inflammatory process involving the small bowel and occasionally the colon. A high small bowel obstruction will also have to be differentiated in some patients.

In the chest, the larval stage of strongyloidiasis may present a pattern indistinguishable from Löffler's syndrome, with patchy areas of pneumonitis similar to the appearance seen in the larval phase of other parasitic diseases, such as ascariasis, schistosomiasis, and paragonimiasis. Disseminated strongyloidiasis may resemble tropical pulmonary eosinophilia with increased eosinophil count, pulmonary infiltrates, and serum cross-reactivity with filarial antigens. The pulmonary edema pattern seen in AIDS or other immunosuppressed individuals with hyperinfection strongyloidiasis may be indistinguishable from pulmonary edema or generalized infection of the lung caused by a variety of other opportunistic organisms particularly prevalent in patients with altered immunological status.

Finally, larva currens must be distinguished clinically from cutaneous larval migrans, the latter being of longer duration and also more widespread and not just perianal in distribution.

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Copyright: Palmer and Reeder