Differential Diagnosis
- Single most likely diagnosis
- Strongyloides stercoralis: This parasitic infection is strongly suggested by the combination of pulmonary symptoms (cough), eosinophilia (15%), and the patient's habit of working barefoot, which increases the risk of skin penetration by the parasite. The lifecycle of Strongyloides involves autoinfection and can lead to a wide range of symptoms including gastrointestinal and pulmonary issues, fitting the described symptoms.
- Other Likely diagnoses
- Hookworm infection: Hookworms can cause pulmonary symptoms during their migratory phase, eosinophilia, and are commonly acquired through skin contact with contaminated soil, which aligns with working barefoot. However, the primary symptom of hookworm infection is usually iron-deficiency anemia due to chronic blood loss.
- Ascaris lumbricoides: While primarily causing gastrointestinal symptoms, Ascaris can lead to pulmonary symptoms (Löffler's syndrome) during its larval migration phase, accompanied by eosinophilia. Infection occurs through ingestion of eggs, not typically through skin contact, making it less likely given the context.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Paragonimus westermani (Lung Fluke): Although less common and typically acquired through ingestion of undercooked crustaceans, Paragonimus infection can cause pulmonary symptoms and eosinophilia. It's crucial to consider this diagnosis due to its potential severity and the need for specific treatment.
- Schistosomiasis: Certain species of Schistosoma can cause pulmonary symptoms, especially during the acute phase of infection. Schistosomiasis is acquired through skin contact with contaminated water, which might not directly relate to working barefoot but is a critical diagnosis to consider due to its potential for severe morbidity.
- Rare diagnoses
- Anisakiasis: Typically acquired through ingestion of undercooked or raw fish, Anisakiasis can cause gastrointestinal and, less commonly, pulmonary symptoms if the larvae migrate to the lungs. It's an unlikely diagnosis given the context but could be considered in a differential diagnosis due to its potential for severe allergic reactions and eosinophilia.
- Capillaria philippinensis: This intestinal parasite can cause severe gastrointestinal symptoms and is associated with eosinophilia. While rare and typically acquired through ingestion of contaminated food or water, it's a diagnosis to consider in cases with unexplained gastrointestinal and pulmonary symptoms.