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| ==Overview==
| | #Redirect [[Yersinia pestis infection differential diagnosis]] |
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| ==Differential diagnosis==
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| The differential diagnosis of the plague can be broken down into three different categories based on the form of the disease.
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| ===Bubonic plague===
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| *[[Streptococcal]] or [[staphylococcal]] [[adenitis]] (Staphylococcal aureus, Staphylococcal pyogenes)
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| **Purulent or inflamed [[lesion]] often noted [[distal]] to involved [[nodes]] (i.e., [[pustule]], infected traumatic lesion).
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| **Involved nodes more likely to be fluctuant.
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| **Associated ascending [[lymphangitis]] or [[cellulitis]] may be present (generally not seen with plague).
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| *[[Tularemia]] (Francisella tularensis)
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| **[[Ulcer]] or [[pustule]] often present distal to involved nodes.
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| **Clinical course rarely as fulminant as in plague.
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| **Systemic toxicity uncommon.
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| *[[Cat scratch fever]] (Bartonella henselae)
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| **History of contact with cats; usually history of cat scratch.
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| **Indolent clinical course; progresses over weeks.
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| **Primary lesion at site of scratch often present (small [[papule]], [[vesicle]]).
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| **Systemic toxicity not present.
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| *[[Mycobacterial infection]], including [[scrofula]] (Mycobacterium tuberculosis and other Mycobacterium species)
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| **With scrofula, [[adenitis]] occurs in [[cervical]] region.
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| **Usually [[painless]].
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| **Indolent clinical course.
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| **[[Infections]] with species other than M. tuberculosis. more likely to occur in [[immunocompromised]] patients.
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| *[[Lymphogranuloma venereum]] (Chlamydia trachomatis)
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| **[[Adenitis]] occurs in the [[inguinal]] region.
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| **History of [[sexual]] exposure 10-30 days previously.
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| **Suppuration, fistula tracts common.
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| **Although LGV [[buboes]] may be somewhat [[tender]], exquisite tenderness usually absent.
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| **Although patients may appear ill ([[headache]], [[fever]], [[myalgias]]), systemic [[toxicity]] not present.
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| *[[Chancroid]] (Hemophilus ducreyi)
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| **Adenitis occurs in the inguinal region.
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| **Ulcerative lesion present.
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| **Systemic symptoms uncommon; toxicity does not occur.
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| *Primary [[genital herpes]]
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| **Herpes lesions present in genital area.
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| **Adenitis occurs in the inguinal region.
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| **Although patients may be ill (fever, headache), severe systemic toxicity not present.
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| *Primary or secondary [[syphilis]] (Treponema pallidum)
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| **Enlarged [[lymph nodes]] in the inguinal region.
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| **Lymph nodes generally painless.
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| **[[Chancre]] may be noted with primary syphilis.
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| *Strangulated inguinal [[hernias]]
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| **Evidence of bowel involvement.
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| ===Pneumonic plague===
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| *Inhalational [[anthrax]] (Bacillus anthracis)
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| **Widened [[mediastinum]] and [[pleural effusions]] seen on CXR or chest CT.
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| **Not true [[pneumonia]]; minimal [[sputum]] production.
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| **[[Hemoptysis]] uncommon (if present, suggests diagnosis of plague).
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| *[[Tularemia]] (Francisella tularensis)
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| **Clinical course not as rapid or fulminant as in pneumonic plague.
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| *Mycoplasmal pneumonia (Mycoplasma pneumoniae)
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| **Rarely as [[fulminant]] as pneumonic plague.
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| *Pneumonia caused by Chlamydia pneumoniae
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| **Rarely as fulminant as pneumonic plague.
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| *[[Legionnaires' disease]] (Legionella pneumophila or other Legionella species)
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| **Rarely as fulminant as pneumonic plague.
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| **Community outbreaks of Legionnaires' disease often involve exposure to cooling systems.
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| **Legionellosis and many other diseases caused by bacterial agents (S aureus, S pneumoniae, H influenzae, K pneumoniae, M catarrhalis) usually occur in persons with underlying pulmonary or other disease or in the elderly.
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| *Psittacosis (Chlamydia psittaci)
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| **Rarely as fulminant as pneumonic plague.
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| **Result of bird exposure.
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| *Other bacterial agents (e.g., Staphyloccocus aureus, Streptococcus pneumoniae, Haemophilus influenzae, Klebsiella pneumoniae, Moraxella catarrhalis)
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| **Rarely as fulminant as pneumonic plague.
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| **Usually occur in persons with underlying pulmonary or other disease or in the elderly.
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| *[[Influenza]]
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| **Influenza generally seasonal (October-March in United States) or involves history of recent cruise ship travel or travel to tropics.
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| *[[Hantavirus]]
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| **Exposure to excrement (urine or feces) of mice with hantavirus.
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| *[[RSV]]
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| **RSV usually occurs in children (although may be cause of pneumonia in elderly); tends to be seasonal (winter/spring).
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| *[[CMV]]
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| **CMV usually occurs in immunocompromised patients.
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| *[[Q fever]] (Coxiella burnetii)
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| **Exposure to infected parturient cats, cattle, sheep, goats.
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| **Severe pneumonia not prominent feature.
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| ===Septicemic plague===
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| *[[Meningococcemia]]
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| **More likely to have evidence of meningitis (but not always present).
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| *[[Septicemia]] caused by other Gram-negative bacteria.
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| **Underlying illness usually present.
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| ==Chest X Ray==
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| Some other infectious diseases can be differentiated by looking at chest x ray images. For example, [[SARS]], [[Hantavirus]] syndrome, and [[Anthrax]] all need to be ruled out because they do present with some similar [[Bubonic plague symptoms|Symptoms]]. An example of a chest x ray for Hantavirus and Anthrax is shown.
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| [[Image:Chest hantavirus.jpg|400 px|This chest x ray image is of a patient with Hantavirus syndrome]]
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| [[Image:Chest anthrax.jpg|This chest x ray image is of a patient with Anthrax]]
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| ==References==
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| {{Reflist|2}}
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