A problem that occurs during or after a trip does not necessarily need to have a causal connection with that trip.
- African trypanosomiasis
. Oedema on the face can occur in West African trypanosomiasis.
- Chagas’ disease. Unilateral swelling of the eyelids (Romaña sign) occurs in South American trypanosomiasis.
- Trichinosis. Periorbital oedema in a febrile patient with eosinophilia and muscle pains, should lead one to suspect infection with Trichinella spiralis.
- Sparganosis, an infection caused by Spirometra (tapeworm) larvae. Infection is transmitted by drinking water in which infected Cyclops copepods are found, by eating infected snakes or by local application of an infected frog to the skin. There is a risk of eye complications. Diagnosis is made by excision biopsy.
- Calabar oedema on the the face is very unusual in Loa loa infection.
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Other cosmopolitan causes:
- Erysipelas of the face is usually clinically obvious. Other signs of infection will be present. Herpes zoster can initially resemble erysipelas.
- Quincke's oedema: an allergic reaction can be localised on the face. The tongue sometimes swells up and severe dyspnoea can occur. Not to be confused with halzoun (reaction to Linguatula serrata, a pentastomid).
- Nephrotic syndrome: Numerous causes, some of which are tropical (e.g. P. malariae). Here facial oedema will occur early on. This is usually more obvious after lying on the back for a short time.
- Osteomyelitis of the skull (Pott's puffy tumour) results in a painful, localised oedema. Associated sinusitis or subdural empyema should be looked for.
- Vena cava superior syndrome can likewise cause facial oedema.
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- Calabar swellings occur
repeatedly during infection with Loa loa filariae. The most frequent is the localisation on the wrists, hands or forearms. They are moderately painful and feel warm. Tests for microfilariae must be performed but symptomatic patients are sometimes amicrofilaraemic. A subconjunctival eye passage of an adult worm is pathognomonic.
- Leprosy. Upgrading reactions in leprosy can occasionally strongly resemble cellulitis. The swelling frequently occurs on sites of already existing leprosy lesions. The administration of rifampicin diminishes the efficacy of steroids. Type II reactions can be very severe.
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Other cosmopolitan causes:
- Cellulitis and erysipelas (streptococci, staphylococci) are usually clinically clearly recognizable. Cutaneous erythema and local pain are sometimes caused by a deep-lying abscess (e.g. pyomyositis) or infection focus (e.g. osteomyelitis). An underlying malignant process (e.g. fibrosarcoma) can occasionally mimic a deep abscess.
- Erysipeloid is a rare disease. It is caused by Erysipelothrix rusiopathiae, a Gram-positive rod shaped bacterium. This organism can cause cutaneous lesions resembling erysipelas (hence the name). The disease usually occurs in individuals who have contact with pigs or fish.
- Phlebitis and deep venous thrombosis in a limb can cause a unilateral oedema. This is not uncommon after long-distance flights. Oedema secondary to paralysis (non-functional muscle pump) does not pose any diagnostic problems.
- Urticaria do not usually pose any diagnostic problem, though identification of the aetiology can certainly sometimes be very difficult or even impossible. Anisakiasis is not an uncommon cause of urticaria.
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In chronic lymphatic obstruction the skin exhibits increasing fibrosis. The tissue is found to be non-pitting upon physical examination. In the longer term there is a risk of developing a haemangiolymphosarcoma (Stewart-Treves’ syndrome).
- Lymphatic filariosis: An important cause of lymph oedema is infection with Wuchereria bancrofti or with Brugia malayi. Non-pitting lymphoedema of a limb can occur unilaterally. In Brugia infections the lymphoedema is usually restricted to the foot, lower leg (calf), forearm and genitals. Microfilariae will be detectable in a certain percentage of patients (nocturnal blood-taking), but antigen-detection has now superceded the search for W. bancrofti microfilariae. Onchocerciasis can occasionally result in lymphoedema. The microfilariae will be searched for in the skin.
- Podoconiosis: This is a disease that can be confused with bancroftosis. The disease arises from damage to the lymph ducts by mineral particles penetrating through the skin. Podoconiosis can occur in people who walk barefoot over long periods in areas with a specific mineral composition of the soil.
- Various infections: Leprosy, tuberculosis, chromomycosis and lymphogranuloma venereum can likewise cause lymphoedema. This can lead to elephantiasis. Recurrent erysipelas with lymphangitis with destruction of the lymphatics, with or without thrombophlebitis, can cause lymphoedema.
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Non-infectious cosmopolitan causes:
- Surgical intervention with resection of lymph nodes or tumoural invasion of the lymph nodes can cause lymphoedema.
- Lymphoedema can be primary and hereditary (Milroy disease). There is hypoplasia or aplasie of the lymphatics.
- In lipoedema there is no true oedema. It is a chronic disease (fat accumulation), the aetiology of which is unclear.
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Cosmopolitan aetiology or exotic causes should be looked for. Myxoedema, heart-, liver- and kidney failure, nephrosis, hypoalbuminaemia in kwashiorkor and protein-loosing enteropathy can cause generalised oedema (examples: beriberi, Schistosoma mansoni, Plasmodium malariae, severe infection with Strongyloides stercoralis or S. fulleborni etc.). Infections with Capillaria philipinensis and S. fulleborni can lead to severe protein loss in the intestines.
