Tularemia differential diagnosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ilan Dock, B.S.
Overview
General symptoms reported within the early stages tularemia often resemble those of other tick-borne diseases. These symptoms include fever, chills, headache, and other non-specific flu like symptoms. Later stages of tularemia may include pneumonic clinical manifestations and ulcers in the epidermal tissue.[1]
Differentiating Tularemia from other Tick-borne diseases
The following table differentiates between variations of tularemia and their associated manifestations. [1]
| Clinical Manifestation | Transmission |
|---|---|
| Ulceroglandular | Skin ulcer forms as the site of infection as well as general flu like symptoms and swelling of regional lymph glands. |
| Glandular | Resemble clinical manifestations of Ulceroglandular infection without the presence of a skin ulcer. |
| Oculoglandular | Irritation and inflammation of the eye with swelling of lymph glands. |
| Pneumonic and Typhoidal | Most dangerous form of tularemia. Characterized by cough, chest pain, and breathing difficulties. May also include all general flu like symptoms, without localization symptoms. |
The following table differentiates between general symptoms associated with tularemia and other similarly presenting, tick borne diseases.
| Disease | Organism | Vector | Symptoms | |
|---|---|---|---|---|
| Bacterial Infection | ||||
| Borreliosis (Lyme Disease) [2] | Borrelia burgdorferi sensu lato complex and B. mayonii | I. scapularis, I. pacificus, I. ricinus, and I. persulcatus | Erythema migrans, flu-like illness(fatigue, fever), Lyme arthritis, neuroborreliosis, and carditis. | |
| Relapsing Fever [3] | Tick-borne relapsing fever (TBRF): | Borrelia duttoni, Borrelia hermsii, and Borrelia parkerii | Ornithodoros species | Consistently documented high fevers, flu-like illness, headaches, muscular soreness or joint pain, altered mental status, painful urination, rash, and rigors. |
| Louse-borne relapsing fever (LBRF) : | Borrelia recurrentis | Pediculus humanus | ||
| Typhus (Rickettsia) | ||||
| Rocky Mountain Spotted Fever | Rickettsia rickettsii | Dermacentor variabilis, Dermacentor andersoni | Fever, altered mental status, myalgia, rash, and headaches. | |
| Helvetica Spotted Fever [4] | Rickettsia helvetica | Ixodes ricinus | Rash: spotted, red dots. Respiratory symptoms (dyspnea, cough), muscle pain, and headaches. | |
| Ehrlichiosis (Anaplasmosis) [5] | Ehrlichia chaffeensis, Ehrlichia ewingii | Amblyomma americanum, Ixodes scapularis | Fever, headache, chills, malaise, muscle pain, nausea, confusion, conjunctivitis, or rash (60% in children and 30% in adults). | |
| Tularemia [6] | Francisella tularensis | Dermacentor andersoni, Dermacentor variabilis | Ulceroglandular, glandular, oculoglandular, oroglandular, pneumonic, typhoidal. | |
| Viral Infection | ||||
| Tick-borne meningoencephalitis [7] | TBEV virus | Ixodes scapularis, I. ricinus, I. persulcatus | Early Phase: Non-specific symptoms including fever, malaise, anorexia, muscle pains, headaches, nausea, and vomiting. Second Phase: Meningitis symptoms, headache, stiff neck, encephalitis, drowsiness, sensory disturbances, and potential paralysis. | |
| Colorado Tick Fever [8] | CTF virus | Dermacentor andersoni | Common symptoms include fever, chills, headache, body aches, and lethargy. Other symptoms associated with the disease include sore throat, abdominal pain, vomiting, and a skin rash. A biphasic fever is a hallmark of Colorado Tick Fever and presents in nearly 50% of infected patients. | |
| Crimean-Congo Hemorrhagic Fever | CCHF virus | Hyalomma marginatum, Rhipicephalus bursa | Initially infected patients will likely feel a few of the following symptoms: headache, high fever, back and joint pain, stomach pain, vomiting, flushed face, red throat petechiae of the palate, and potentially changes in mood as well as sensory perception. | |
| Protozoan Infection | ||||
| Babesiosis [9] | Babesia microti, Babesia divergens, Babesia equi | Ixodes scapularis, I. pacificus | Non-specific flu-like symptoms. | |
References
- ↑ 1.0 1.1 Centers for Disease Control and Prevention, Signs and Symptoms of Tularemia. http://www.cdc.gov/tularemia/signssymptoms/index.html Accessed March 1, 2016
- ↑ Lyme Disease Information for HealthCare Professionals. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/lyme/healthcare/index.html Accessed on December 30, 2015
- ↑ Relapsing Fever Information. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/relapsing-fever/ Accessed on December 30, 2015
- ↑ Rocky Mountain Spotted Fever Information. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/rmsf/ Accessed on December 30, 2015
- ↑ Disease index General Information (2015). http://www.cdc.gov/parasites/babesiosis/health_professionals/index.html Accessed on December 30, 2015
- ↑ Rocky Mountain Spotted Fever Information. Centers for Disease Control and Prevention (2015). \http://www.cdc.gov/tularemia/index.html Accessed on December 30, 2015
- ↑ General Disease Information (TBE). Centers for Disease Control and Prevention (2015). http://www.cdc.gov/vhf/tbe/ Accessed on December 30, 2015
- ↑ General Tick Deisease Information. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/coloradotickfever/index.html Accessed on December 30, 2015
- ↑ Babesiosis. Centers for Disease Control and Prevention (2015). http://www.cdc.gov/parasites/babesiosis/disease.htmlAccessed December 8, 2015.