Blastomycosis differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Blastomycosis}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Blastomycosis]]
{{CMG}}; {{AE}}; {{VB}} {{ADG}}
{{CMG}}; {{AE}}; {{VB}} {{ADG}}


==Overview==
==Overview==
Blastomycosis have overlapping signs & symptoms with that of other fungal and bacterial disorders. A detailed History, Physical examination and serological tests helps us to pin-point the diagnosis. All this disorders can be often misinterpreted as community acquired pneumonia as they all present with similar complaints such as fever, productive cough, chest pain and shortness of breath. The following table elaborates differentiating features between blastomycosis  from other fungal disorders.
Blastomycosis has overlapping signs & symptoms with that of other [[fungal]] and [[bacterial]] disorders. A detailed history, physical examination, and serological tests help us to pinpoint the diagnosis. All these disorders can be often misinterpreted as [[Community-acquired pneumonia|community acquired pneumonia]] as they all present with similar complaints such as [[fever]], [[productive cough]], [[chest pain]] and [[shortness of breath]].  


====Fungal====
====Fungal====
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* [[Aspergillosis]]
* [[Aspergillosis]]
* [[Pneumocystis pneumonia]]
* [[Pneumocystis pneumonia]]
* [[Sporotrichosis]]
* [[Sporotrichosis]]  
 
The following table elaborates differentiating features between Blastomycosis  from other fungal disorders:
{| class="wikitable"
{| class="wikitable"
! rowspan="2" |Pathogen
! rowspan="2" |Pathogen
Line 30: Line 30:
* Cave dwellers
* Cave dwellers


* Soil that contains bird or bat dropping
* Soil that contains bird or bat dropping<ref name=cdc3>Information for Healthcare Professionals about Histoplasmosis. Centers for Disease Control and Prevention. 2015. Available at: http://www.cdc.gov/fungal/diseases/histoplasmosis/health-professionals.html. Accessed February 2, 2016.</ref>
|
* [[Palate]] and [[oral]] [[ulcers]] 
* [[Splenomegaly]]
|
|
* Palate and oral ulcers 
* [[Pancytopenia]]
* Spleenomegaly
 
|Pancytopenia
* [[Urine]] [[antigen]] testing
Urine antigen testing
|[[Yeast]] are typically smaller, with narrow-based [[budding]], found [[Intracellular|intracellularly]] within [[macrophages]]
|Yeast are typically smaller, with narrow-based budding, found intracellularly within macrophages
|-
|-
|[[Coccidioidomycosis]]
|[[Coccidioidomycosis]]
|Southwestern US region
|Southwestern US region
|Opportunistic infection seen in AIDS
|Opportunistic infection seen in [[HIV AIDS|AIDS]]
|
|
* Rash on upper body or legs
* [[Rash]] on upper body or legs<ref name="pmid23843703">{{cite journal |vauthors=Brown J, Benedict K, Park BJ, Thompson GR |title=Coccidioidomycosis: epidemiology |journal=Clin Epidemiol |volume=5 |issue= |pages=185–97 |year=2013 |pmid=23843703 |pmc=3702223 |doi=10.2147/CLEP.S34434 |url=}}</ref>
* Night sweats
* [[Night sweats]]
|Serologic tests( enzyme immune assay )more sensitive  
|Serologic tests ([[enzyme]] [[immune]] [[assay]]) more sensitive  
|Characteristic spherule appearance  
|Characteristic spherule appearance  
|-
|-
|[[Paracoccidioidomycosis]]
|[[Paracoccidioidomycosis]]<ref name="pmid24173174">{{cite journal |vauthors=Marques SA |title=Paracoccidioidomycosis: epidemiological, clinical, diagnostic and treatment up-dating |journal=An Bras Dermatol |volume=88 |issue=5 |pages=700–11 |year=2013 |pmid=24173174 |pmc=3798345 |doi=10.1590/abd1806-4841.20132463 |url=}}</ref>
|Central and South america
|Central and South america
|Opportunistic infection seen in AIDS
|Opportunistic [[infection]] seen in [[HIV AIDS|AIDS]]
|
|
* Lymphadenopathy
* [[Lymphadenopathy]]
* Hepatosplenomegaly
* [[Hepatosplenomegaly]]
* Bone marrow dysfunction  
* [[Bone marrow]] dysfunction  
|Elevated liver enzymes
|
* Elevated [[liver]] [[enzymes]]


[[Hyperbilirubinemia]]
* [[Hyperbilirubinemia]]


[[Hypoalbuminemia]]
* [[Hypoalbuminemia]]
|Smaller fungi with thin cell walls, forming  mariner wheel appearance,  circumferentially surrounding the parent cell.( Captain wheel appearance )
|[[Fungi|Smaller fungi]] with thin [[cell]] walls, forming mariner wheel appearance,  circumferentially surrounding the parent cell. (Captain wheel appearance)
|-
|-
|[[Sporotrichosis]]
|[[Sporotrichosis]]
|Ubiquitous
|Ubiquitous
|Gardeners  
|Gardeners <ref name="pmid25614735">{{cite journal |vauthors=Mahajan VK |title=Sporotrichosis: an overview and therapeutic options |journal=Dermatol Res Pract |volume=2014 |issue= |pages=272376 |year=2014 |pmid=25614735 |pmc=4295339 |doi=10.1155/2014/272376 |url=}}</ref>
|
|
* Person’s hand or the arm
* Extremities 
* Lymphadenitis (nodular)
* [[Lymphadenitis]] (nodular)
|Sporotrichin skin test
|'''+''' Sporotrichin skin test
|Finger or cigar shaped  yeast.
|Finger or cigar shaped  [[yeast]].
|-
|-
|[[Aspergillosis]]
|[[Aspergillosis]]<ref name="pmid20375786">{{cite journal |vauthors=Sherif R, Segal BH |title=Pulmonary aspergillosis: clinical presentation, diagnostic tests, management and complications |journal=Curr Opin Pulm Med |volume=16 |issue=3 |pages=242–50 |year=2010 |pmid=20375786 |pmc=3326383 |doi=10.1097/MCP.0b013e328337d6de |url=}}</ref>
|Ubiquitous
|Ubiquitous
|
|
* Cystic fibrosis or asthma. tuberculosis.
* [[Cystic fibrosis]] or [[Asthma|asthma.]] [[tuberculosis]].


* Immunocomprimised
* [[Immunocompromised]]
|
|
* Wheezing
* [[Wheezing]]


* Stuffiness, runny nose
* Stuffiness, [[runny nose]]
* Hemoptysis  
* [[Hemoptysis]]
* Weight loss
* [[Weight loss]]
|Cell wall detection using galactomannan antigen detection, Beta-D-glucan detection test.
|Cell wall detection using [[galactomannan]] antigen detection, Beta-D-glucan detection test.
|Septated hyphae with acute angle branching
|[[Hyphae|Septated hyphae]] with acute angle branching
|-
|-
| rowspan="8" |Bacterial
| rowspan="8" |Bacterial
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|Live stock handlers
|Live stock handlers
|
|
* Painless skin ulcer with a black center 
* Painless [[skin]] [[ulcer]] with a black center <ref name="pmid22527064">{{cite journal |vauthors=Hicks CW, Sweeney DA, Cui X, Li Y, Eichacker PQ |title=An overview of anthrax infection including the recently identified form of disease in injection drug users |journal=Intensive Care Med |volume=38 |issue=7 |pages=1092–104 |year=2012 |pmid=22527064 |pmc=3523299 |doi=10.1007/s00134-012-2541-0 |url=}}</ref>
* Bloody diarrhea
* [[Bloody diarrhea]]
|[[thrombocytopenia]],
|
[[hyponatremia]],
* [[Thrombocytopenia]]
 
* [[Hyponatremia]]
 
* '''↑''' [[BUN]]


[[BUN]],
* [[Hypoalbuminemia]]


[[hypoalbuminemia]], [[troponin]].
* ↑ [[Troponin]].
|[[Motility|Nonmotile]], [[Gram-positive]], [[aerobic]] or facultatively [[anaerobic]], [[endospore]]-forming, [[rod]]-shaped [[bacterium]]
|[[Motility|Nonmotile]], [[Gram-positive]], [[aerobic]] or facultatively [[anaerobic]], [[endospore]]-forming, [[rod]]-shaped [[bacterium]]
|-
|-
|[[Legionella]]
|[[Legionella]]
|Ubiquitous
|Ubiquitous
|Chronic lung disease
|Chronic [[lung]] disease
Building water systems
Building water systems
|
|
* Diarrhea
* [[Diarrhea]]
* Confusion
* [[Confusion]]
|Urine Antigen +
|
Hyponatreimia
* '''+''' [[Urine]] [[antigen]]
|[[Gram negative]] [[bacterium]]
 
* [[Hyponatremia]]<ref name="pmid24330484">{{cite journal |vauthors=Schuetz P, Haubitz S, Christ-Crain M, Albrich WC, Zimmerli W, Mueller B |title=Hyponatremia and anti-diuretic hormone in Legionnaires' disease |journal=BMC Infect. Dis. |volume=13 |issue= |pages=585 |year=2013 |pmid=24330484 |pmc=3880094 |doi=10.1186/1471-2334-13-585 |url=}}</ref>
|[[Gram negative]] [[bacterium]]
|-
|-
|[[Tuberculosis]]
|[[Tuberculosis]]
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|Ill contact individuals
|Ill contact individuals
|
|
* Night sweats
* [[Night sweats]]
* Hemoptysis
* [[Hemoptysis]]
|
|
|Acid fast bacteria
* [[Hypercalcemia]]
* Elevated [[alkaline phosphatase]] levels
* [[fluorescence microscopy]] ([[Auramine-rhodamine stain|auramine-rhodamine staining]])+ for baccilli.
|[[Aerobic]], [[Capsule|non-encapsulated]], [[Motility|non-motile]], [[acid-fast]] [[bacillus]]
|-
|-
|[[Listeriosis]]
|[[Listeriosis]]
|Ubiquitous
|Ubiquitous
|Pregnant women  
|[[Pregnant]] women <ref name="pmid21517700">{{cite journal |vauthors=Lamont RF, Sobel J, Mazaki-Tovi S, Kusanovic JP, Vaisbuch E, Kim SK, Uldbjerg N, Romero R |title=Listeriosis in human pregnancy: a systematic review |journal=J Perinat Med |volume=39 |issue=3 |pages=227–36 |year=2011 |pmid=21517700 |pmc=3593057 |doi=10.1515/JPM.2011.035 |url=}}</ref>
Adults > 65   
Adults > 65   


Immunocomprimised.
[[Immunocompromised]].
|
|
* pregnancy can lead to miscarriage, stillbirth, premature delivery,
* [[Pregnancy]] can lead to miscarriage, stillbirth, premature delivery
* Non-pregnant : headache, stiff neck, confusion, loss of balance, and convulsions
* Non-pregnant : [[headache]], [[stiff neck]], [[confusion]], loss of balance, and [[convulsions]]
|
|
|flagellated, catalase-positive, facultative [[intracellular]], [[Anaerobe|anaerobic]], [[Spore|nonsporulating]], [[Gram-positive]] [[bacillus]]
* Elevated titers of [[listeriolysin O]]
 
* [[CSF]] analysis :[[Pleocytosis]] [[lymphocytes]]            ↑[[CSF]] [[protein]]          '''↓''' [[CSF]] [[glucose]]
|[[Flagellate|flagellated]], [[Catalase|catalase-positive]], facultative [[intracellular]], [[Anaerobe|anaerobic]], [[Spore|nonsporulating]], [[Gram-positive]] [[bacillus]]
|-
|-
|[[Brucellosis]]
|[[Brucellosis]]
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|People who take unpasteurized dairy products
|People who take unpasteurized dairy products
|
|
* Arthritis
* [[Arthritis]]
* Testicular and scrotal swelling
* [[Testicular]] and [[scrotal swelling]]
* Endocarditis
* [[Endocarditis]]
|
|
|Gram-negative bacteria,non-motile, encapsulated coccobacilli.
* [[Antibody]] production against[[lipopolysaccharide]] and bacterial antigens
* Relative [[lymphocytosis]] and [[thrombocytopenia]].
|[[Gram-negative bacteria]],[[Motile|non-motile]], [[Encapsulated organisms|encapsulated]] [[Coccobacilli|coccobacilli.]]
|-
|-
|[[Scrub typhus]]
|[[Scrub typhus]]
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Afghanistan
Afghanistan
|Hikers
|Hikers<ref name="pmid26937940">{{cite journal |vauthors=Zhou YH, Xia FQ, Van Poucke S, Zheng MH |title=Successful Treatment of Scrub Typhus-Associated Hemophagocytic Lymphohistiocytosis With Chloramphenicol: Report of 3 Pediatric Cases and Literature Review |journal=Medicine (Baltimore) |volume=95 |issue=8 |pages=e2928 |year=2016 |pmid=26937940 |pmc=4779037 |doi=10.1097/MD.0000000000002928 |url=}}</ref>
|
|
* Maculopapular rash
* [[Maculopapular rash]]
|
|
|a [[Gram-negative]] α-proteobacterium  intracellular parasite
* Indirect immunofluorescence
 
* '''+''' [[Weil-Felix test]]
|a [[gram-negative]] α-[[Proteobacteria|proteobacterium]]  [[intracellular]] [[Parasites|parasite]]
|-
|-
|[[Leptospirosis]]
|[[Leptospirosis]]
|Temperate,  tropical climates.
|Temperate,  tropical climates.
|People who work with animals,
|People who work with animals
|
|
* Jaundice
* [[Jaundice]]


* Red eyes
* [[Red eyes]]
* kidney failure
* [[Kidney failure]]<ref name="pmid27059657">{{cite journal |vauthors=Iroh Tam PY, Obaro SK, Storch G |title=Challenges in the Etiology and Diagnosis of Acute Febrile Illness in Children in Low- and Middle-Income Countries |journal=J Pediatric Infect Dis Soc |volume=5 |issue=2 |pages=190–205 |year=2016 |pmid=27059657 |doi=10.1093/jpids/piw016 |url=}}</ref>
|
|
|Spiral-shaped bacteria with hooked ends on dark-field.
* [[Antibodies]] labelled with fluorescent markers positive for leptospires.
 
* Microscopic [[Agglutination|agglutination test]] '''+'''
|Spiral-shaped [[bacteria]] with hooked ends on dark-field.
|-
|-
|[[Cat scratch fever]]
|[[Cat scratch fever]]
|Ubiquitous
|Ubiquitous
|cat licking a person's open wound, or bites or scratches a person
|Cat licking a person's open [[wound]], or [[bites]] or scratches a person<ref name="pmid17442105">{{cite journal |vauthors=Gouriet F, Lepidi H, Habib G, Collart F, Raoult D |title=From cat scratch disease to endocarditis, the possible natural history of Bartonella henselae infection |journal=BMC Infect. Dis. |volume=7 |issue= |pages=30 |year=2007 |pmid=17442105 |pmc=1868026 |doi=10.1186/1471-2334-7-30 |url=}}</ref>
|
* [[Lymphadenopathy]]
 
* [[Papule]] or [[Pustules|pustule]] at the [[infected]] site
|
* Enzymatic immunoassay positive for  antibody to B henselae
* [[Lymphocytosis]]
|[[Gram-negative]] [[Bacterium|bacteria]]. [[Facultative aerobic|facultative]] intracellular parasites
|-
| rowspan="2" |Viral
|[[Chickenpox]]
|      '''−'''
|
* Pregnant women.
* Infants born at less than 28 weeks gestation<ref name="pmid27563537">{{cite journal |vauthors=De Paschale M, Clerici P |title=Microbiology laboratory and the management of mother-child varicella-zoster virus infection |journal=World J Virol |volume=5 |issue=3 |pages=97–124 |year=2016 |pmid=27563537 |pmc=4981827 |doi=10.5501/wjv.v5.i3.97 |url=}}</ref>
* [[Immunocompromised]] persons
|
|
* Lymphadenopathy
* [[Conjunctival]] and [[catarrhal]] symptoms


* papule or pustule at the infected site
* Spots appearing in two or three waves
|Whole infected cell (wc) [[ELISA]] for IgG.
|                    '''−'''
|-
|[[Coxsackie A virus]]
|      '''−'''
|Children attending day care<ref name="pmid23017893">{{cite journal |vauthors=Flett K, Youngster I, Huang J, McAdam A, Sandora TJ, Rennick M, Smole S, Rogers SL, Nix WA, Oberste MS, Gellis S, Ahmed AA |title=Hand, foot, and mouth disease caused by coxsackievirus a6 |journal=Emerging Infect. Dis. |volume=18 |issue=10 |pages=1702–4 |year=2012 |pmid=23017893 |pmc=3471644 |doi=10.3201/eid1810.120813 |url=}}</ref>
|Painful [[Blister|blisters]] in the mouth, palms and on  the feet.
[[Rash]], appears after episode of [[high fever]].
|Clinically diagnosed
|                    '''−'''
|-
|Others
|[[Lung cancer|Primary lung cancer]]
|      '''−'''
|Age >65
|
|
|[[Gram-negative]] [[Bacterium|bacteria]]. facultative intracellular parasites
* [[Weight loss]]
 
* H/o smoking
* [[Hemoptysis]]
|CT guided [[bronchoscopy]] + for [[malignant]] [[cells]]
|                      '''−'''
|}
|}


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* [[Influenza]]
* [[Influenza]]
* [[Parainfluenza]]
* [[Parainfluenza]]
* [[HIV -1/-2]]
* [[HIV]] -1/-2
* [[Coxsackie B virus]]
* [[Coxsackie A virus]]
* [[Hepatits]]
* [[Hepatits A|Hepatits]]
* [[Cytomegalovirus]]
* [[Cytomegalovirus]]
* [[Eastern equine encephalitis virus]]
* [[Eastern equine encephalitis virus]]
* [[Venezuelan equine encephalitis]]
* [[Venezuelan equine encephalitis]]
* [[Coronavirus]]
* [[Coronavirus]]
* [[California Encephalitis virus]]
* California [[encephalitis]] virus
 
==Chronic and disseminated disease==
Chronic blastomycosis may be initially confused with a malignancy or tuberculosis. While spread to other areas may be confused with malignancy as well. Skin lesions are often misdiagnosed as pyoderma gangreosum or keratoacanthoma. Therefore, a high index of suspicion is needed on the part of physician to diagnose blastomycosis


==References==
==References==


{{Reflist|2}}
{{Reflist|2}}
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Latest revision as of 20:37, 29 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: ; Vidit Bhargava, M.B.B.S [2] Aditya Ganti M.B.B.S. [3]

Overview

Blastomycosis has overlapping signs & symptoms with that of other fungal and bacterial disorders. A detailed history, physical examination, and serological tests help us to pinpoint the diagnosis. All these disorders can be often misinterpreted as community acquired pneumonia as they all present with similar complaints such as fever, productive cough, chest pain and shortness of breath.

Fungal

The following table elaborates differentiating features between Blastomycosis from other fungal disorders:

Pathogen Disease Geographic distribution High risk Groups Differentiating features Microscopic findings
Physical exam Laboratory findings
Fungal Histoplasmosis Mississippi and Ohio River valleys
  • Cave dwellers
  • Soil that contains bird or bat dropping[1]
 Yeast are typically smaller, with narrow-based budding, found intracellularly within macrophages
Coccidioidomycosis Southwestern US region Opportunistic infection seen in AIDS Serologic tests (enzyme immune assay) more sensitive Characteristic spherule appearance
Paracoccidioidomycosis[3] Central and South america Opportunistic infection seen in AIDS Smaller fungi with thin cell walls, forming mariner wheel appearance, circumferentially surrounding the parent cell. (Captain wheel appearance)
Sporotrichosis Ubiquitous Gardeners [4] + Sporotrichin skin test Finger or cigar shaped yeast.
Aspergillosis[5] Ubiquitous Cell wall detection using galactomannan antigen detection, Beta-D-glucan detection test. Septated hyphae with acute angle branching
Bacterial Anthrax Ubiquitous Live stock handlers Nonmotile, Gram-positive, aerobic or facultatively anaerobic, endospore-forming, rod-shaped bacterium
Legionella Ubiquitous Chronic lung disease

Building water systems

Gram negative bacterium
Tuberculosis Asia,Africa Ill contact individuals Aerobic, non-encapsulated, non-motile, acid-fast bacillus
Listeriosis Ubiquitous Pregnant women [8]

Adults > 65

Immunocompromised.

flagellated, catalase-positive, facultative intracellular, anaerobic, nonsporulating, Gram-positive bacillus
Brucellosis

Mexico, South and Central America

People who take unpasteurized dairy products Gram-negative bacteria,non-motile, encapsulated coccobacilli.
Scrub typhus Asia-Pacific region

Australia

Afghanistan

Hikers[9]
  • Indirect immunofluorescence
 a gram-negative α-proteobacterium intracellular parasite
Leptospirosis Temperate, tropical climates. People who work with animals
  • Antibodies labelled with fluorescent markers positive for leptospires.
 Spiral-shaped bacteria with hooked ends on dark-field.
Cat scratch fever Ubiquitous Cat licking a person's open wound, or bites or scratches a person[11]
  • Enzymatic immunoassay positive for antibody to B henselae
  • Lymphocytosis
 Gram-negative bacteria. facultative intracellular parasites
Viral Chickenpox −
  • Spots appearing in two or three waves
 Whole infected cell (wc) ELISA for IgG. −
Coxsackie A virus − Children attending day care[13] Painful blisters in the mouth, palms and on the feet.

Rash, appears after episode of high fever.

Clinically diagnosed −
Others Primary lung cancer − Age >65 CT guided bronchoscopy + for malignant cells −

Bacterial

Viral

References

  1. ↑ Information for Healthcare Professionals about Histoplasmosis. Centers for Disease Control and Prevention. 2015. Available at: http://www.cdc.gov/fungal/diseases/histoplasmosis/health-professionals.html. Accessed February 2, 2016.
  2. ↑ Brown J, Benedict K, Park BJ, Thompson GR (2013). "Coccidioidomycosis: epidemiology". Clin Epidemiol. 5: 185–97. doi:10.2147/CLEP.S34434. PMC 3702223. PMID 23843703.
  3. ↑ Marques SA (2013). "Paracoccidioidomycosis: epidemiological, clinical, diagnostic and treatment up-dating". An Bras Dermatol. 88 (5): 700–11. doi:10.1590/abd1806-4841.20132463. PMC 3798345. PMID 24173174.
  4. ↑ Mahajan VK (2014). "Sporotrichosis: an overview and therapeutic options". Dermatol Res Pract. 2014: 272376. doi:10.1155/2014/272376. PMC 4295339. PMID 25614735.
  5. ↑ Sherif R, Segal BH (2010). "Pulmonary aspergillosis: clinical presentation, diagnostic tests, management and complications". Curr Opin Pulm Med. 16 (3): 242–50. doi:10.1097/MCP.0b013e328337d6de. PMC 3326383. PMID 20375786.
  6. ↑ Hicks CW, Sweeney DA, Cui X, Li Y, Eichacker PQ (2012). "An overview of anthrax infection including the recently identified form of disease in injection drug users". Intensive Care Med. 38 (7): 1092–104. doi:10.1007/s00134-012-2541-0. PMC 3523299. PMID 22527064.
  7. ↑ Schuetz P, Haubitz S, Christ-Crain M, Albrich WC, Zimmerli W, Mueller B (2013). "Hyponatremia and anti-diuretic hormone in Legionnaires' disease". BMC Infect. Dis. 13: 585. doi:10.1186/1471-2334-13-585. PMC 3880094. PMID 24330484.
  8. ↑ Lamont RF, Sobel J, Mazaki-Tovi S, Kusanovic JP, Vaisbuch E, Kim SK, Uldbjerg N, Romero R (2011). "Listeriosis in human pregnancy: a systematic review". J Perinat Med. 39 (3): 227–36. doi:10.1515/JPM.2011.035. PMC 3593057. PMID 21517700.
  9. ↑ Zhou YH, Xia FQ, Van Poucke S, Zheng MH (2016). "Successful Treatment of Scrub Typhus-Associated Hemophagocytic Lymphohistiocytosis With Chloramphenicol: Report of 3 Pediatric Cases and Literature Review". Medicine (Baltimore). 95 (8): e2928. doi:10.1097/MD.0000000000002928. PMC 4779037. PMID 26937940.
  10. ↑ Iroh Tam PY, Obaro SK, Storch G (2016). "Challenges in the Etiology and Diagnosis of Acute Febrile Illness in Children in Low- and Middle-Income Countries". J Pediatric Infect Dis Soc. 5 (2): 190–205. doi:10.1093/jpids/piw016. PMID 27059657.
  11. ↑ Gouriet F, Lepidi H, Habib G, Collart F, Raoult D (2007). "From cat scratch disease to endocarditis, the possible natural history of Bartonella henselae infection". BMC Infect. Dis. 7: 30. doi:10.1186/1471-2334-7-30. PMC 1868026. PMID 17442105.
  12. ↑ De Paschale M, Clerici P (2016). "Microbiology laboratory and the management of mother-child varicella-zoster virus infection". World J Virol. 5 (3): 97–124. doi:10.5501/wjv.v5.i3.97. PMC 4981827. PMID 27563537.
  13. ↑ Flett K, Youngster I, Huang J, McAdam A, Sandora TJ, Rennick M, Smole S, Rogers SL, Nix WA, Oberste MS, Gellis S, Ahmed AA (2012). "Hand, foot, and mouth disease caused by coxsackievirus a6". Emerging Infect. Dis. 18 (10): 1702–4. doi:10.3201/eid1810.120813. PMC 3471644. PMID 23017893.

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