Legionellosis differential diagnosis: Difference between revisions

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__NOTOC__
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{{Legionellosis}}
 
{{CMG}}
{{CMG}} [[Ogechukwu Hannah Nnabude, MD]]


==Overview==
==Overview==
Legionellosis must be differentiated from other causes of [[fever]], [[dyspnea]], [[cough]], and [[sputum]] production, such as [[bacterial pneumonia]], [[viral pneumonia]], and other causes of [[atypical pneumonia]].
[[Legionnaires' disease]] must be differentiated from other causes of [[fever]], [[dyspnea]], [[cough]], and [[sputum]] production, such as [[bacterial pneumonia]], [[viral pneumonia]], and other causes of [[atypical pneumonia]].


==Differential Diagnosis==
==Differential Diagnosis==
{{ddx0|Legionnaires' disease}}{{ddx1|[[Acute interstitial pneumonia]]}}
[[Legionnaires' disease]] must be differentiated from other causes of [[fever]], [[dyspnea]], [[cough]], and [[sputum]] production, such as [[bacterial pneumonia]], [[viral pneumonia]], and other causes of [[atypical pneumonia]].<ref name="pmid23422417">{{cite journal |vauthors=Irfan M, Farooqi J, Hasan R |title=Community-acquired pneumonia |journal=Curr Opin Pulm Med |volume=19 |issue=3 |pages=198–208 |year=2013 |pmid=23422417 |doi=10.1097/MCP.0b013e32835f1d12 |url=}}</ref>
{{ddx1|[[Mycoplasma pneumonia]]}}
{{ddx1|Pneumococcal [[pneumonia]]}}
{{ddx1|Pneumocystis carinii [[pneumonia]]}}
{{ddx1|[[Pulmonary embolism]]}}
{{ddx1|Streptococcal [[pneumonia]]}}
{{ddx1|Viral [[pneumonia]]}}


----
{|
 
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Disease
{{ddx|Legionnaires' disease}}
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Clinical manifestation
 
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab findings
=====Clinical manifestations=====
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging findings
* [[Adult respiratory distress syndrome]]
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Chest X-ray
* [[Breath sounds|Bronchial breath sounds]]
|-
* [[Dry cough]]
! align="center" style="background:#DCDCDC;" |[[Legionnaires' disease]] <ref name="pmid26231463">{{cite journal| author=Cunha BA, Burillo A, Bouza E| title=Legionnaires' disease. | journal=Lancet | year= 2016 | volume= 387 | issue= 10016 | pages= 376-385 | pmid=26231463 | doi=10.1016/S0140-6736(15)60078-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26231463  }} </ref> <ref name="pmid28159178">{{cite journal| author=Cunha BA, Cunha CB| title=Legionnaire's Disease: A Clinical Diagnostic Approach. | journal=Infect Dis Clin North Am | year= 2017 | volume= 31 | issue= 1 | pages= 81-93 | pmid=28159178 | doi=10.1016/j.idc.2016.10.007 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28159178  }} </ref> <ref name="pmid28159171">{{cite journal| author=Chahin A, Opal SM| title=Severe Pneumonia Caused by Legionella pneumophila: Differential Diagnosis and Therapeutic Considerations. | journal=Infect Dis Clin North Am | year= 2017 | volume= 31 | issue= 1 | pages= 111-121 | pmid=28159171 | doi=10.1016/j.idc.2016.10.009 | pmc=7135102 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28159171  }} </ref>
* [[Fever|High grade fever]]
| align="left" style="background:#F5F5F5;" |
* [[Dyspnea|Progressive dyspnea]]
*[[Dry cough]]
 
*[[Fever|High grade fever]]
=====Laboratory abnormalities=====
*[[Breath sounds|Bronchial breath sounds]]
* Legionella urinary antigen positive
*[[Asthenia]]
* [[Leukocytosis]] with relative [[lymphopenia]]
*[[Dyspnea|Progressive dyspnea]]
* [[Hyponatremia]]
*[[diarrhea]]
* [[Hypophosphatemia]]
*[[Seizures]] and other neurological findings
 
*[[nausea]], and [[vomiting]]
=====Radiographic features=====
*[[Adult respiratory distress syndrome]]
* [[Alveoli|Alveolar consolidation]] on chest radiograph
| align="left" style="background:#F5F5F5;" |
* [[Consolidation (medicine)|Lobar consolidation]] on chest radiograph
*Legionella urinary antigen positive
 
*[[Leukocytosis]] with relative [[lymphopenia]]
----
*[[Hyponatremia]]
 
*[[Hypophosphatemia]]
{{ddx|Acute interstitial pneumonia}}
| align="left" style="background:#F5F5F5;" |
 
*[[Alveoli|Alveolar consolidation]] on chest radiograph
=====Clinical manifestations=====
*[[Consolidation (medicine)|Lobar consolidation]] on chest radiograph
* [[Dry cough]]
| align="center" style="background:#F5F5F5;" |
* [[Dyspnea|Progressive dyspnea]]
[[File:Legionella pneumonie Chest Xray.jpg|thumb|Chest X-ray of a patient with Legionnaires disease courtesy Hellerhoff]]
 
=====Laboratory abnormalities=====
* Nonspecific
 
=====Radiographic features=====
* Disseminated [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
* Interstitial infiltrate on chest radiograph
* Increased uptake on gallium scan
 
-----
 
{{ddx|Mycoplasma pneumonia}}
 
=====Clinical manifestations=====
* [[Dry cough]]
* [[Pleuritic chest pain]]
* Bronchial [[breath sounds]]
* [[Inflamed]], opaque, hypomobile [[tympanic membrane]]
 
=====Laboratory abnormalities=====
* [[Lymphocytosis]]
* [[Cold agglutinins]] positive
 
=====Radiographic features=====
* [[Alveolar]] [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
* Interstitial infiltrate on [[chest radiograph]]
* Lobar [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
 
----
 
{{ddx|Pneumococcal pneumonia}}
 
=====Clinical manifestations=====
* [[Fever|High grade fever]]
* [[Hemoptysis]]
* [[Rales|Fine rales]]
* [[Pleuritic chest pain]]
* Increased [[breath sounds]]
* Bronchial b[[Breath sounds|reath sounds]]
* Dullness on chest percussion
* [[Sputum|Purulent sputum]]
* [[Shallow respiration]]
* Pectoriloquy
* Increased [[tactile fremitus]]
* [[Productive cough]]
* [[Egophony]]
 
=====Laboratory abnormalities=====
* [[Gram positive bacteria|Gram positive]] [[diplococci]] on sputum Gram stain
* [[Pleural effusion]] ([[exudative]])
* Respiratory alkalosis
 
=====Radiographic features=====
* Parenchymal hyperlucency on [[chest radiograph]]
* Increased uptake on [[gallium scan]]
* Unilateral diaphragm elevation on [[chest radiograph]]
* Alveolar [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
* Lobar [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
 
----
 
{{ddx|Pneumocystis carinii pneumonia}}
 
=====Clinical manifestations=====
* [[Immunosuppressive]] state
* [[Subcutaneous emphysema]]
* [[Cough|Hacking cough]]
* [[Dyspnea|Progressive dyspnea]]
 
=====Laboratory abnormalities=====
* [[Respiratory alkalosis]]
* Serum beta-D-glucan elevation
 
=====Radiographic features=====
* [[Alveolar]] [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
* Lobar [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
* Interstitial infiltrate on [[chest radiograph]]
* [[Pneumomediastinum]] on [[chest radiograph]]
 
----
 
{{ddx|Pulmonary embolism}}
 
=====Clinical manifestations=====
* Calf [[pain]] or [[swelling]]
* Decreased [[pulse pressure]]
* [[Dyspnea]]
* [[Hemoptysis]]
* [[Hyperventilation]]
* [[Immobility]]
* Increased pulmonic component of heart sound
* [[Pleuritic chest pain]]
* Prior [[Deep vein thrombosis|DVT]]
* [[Pulmonary hypertension]]
* Right ventricular heave
* [[Right-to-left shunt]]
* [[Substernal chest pain]]
* [[Tachypnea]]
* [[Thrombophlebitis]]
* [[Venous stasis]]
* [[Bone fracture]]
 
=====Laboratory abnormalities=====
* [[D-dimer]] elevation
* [[Hypocapnia]]
* [[Hypoxia]]
* [[Pleural effusion]] (exudative or bloody)
* [[Atrial fibrillation]] on ECG
* [[Right axis deviation]] on ECG
* Right ventricular overload on ECG
 
=====Radiographic features=====
* Normal [[chest radiograph]]
* [[Atelectasis]] on [[chest radiograph]]
* Lobar consolidation on [[chest radiograph]]
* Prominent [[pulmonary artery]] on [[chest radiograph]]
* [[Hampton's hump]] on [[chest radiograph]]
* Right ventricular enlargement on [[echocardiography]]
* [[Thrombus]] on echocardiography
* Segmental [[perfusion]] defect on lung scan
* [[V/Q scan|V/Q]] mismatch on lung scan
 
----
 
{{ddx|Streptococcal pneumonia}}
 
=====Clinical manifestations=====
* Pectoriloquy
* Bronchial [[breath sounds]]
* [[Erythema nodosum]]
* Purulent [[sputum]]
* [[Shallow respiration]]
* Increased [[tactile fremitus]]
* [[Pleuritic chest pain]]
* [[Egophony]]
 
=====Laboratory abnormalities=====
* [[Gram-positive cocci]] in chains on sputum [[Gram stain]]
* [[Respiratory alkalosis]]
* [[Pleural effusion]] (exudative)
 
=====Radiographic features=====
* Alveolar consolidation on chest radiograph
* Lobar consolidation on chest radiograph
* [[Empyema]] on chest radiograph
* Increased uptake on [[gallium scan]]
 
----
 
{{ddx|Viral pneumonia}}
 
=====Clinical manifestations=====
* [[Pleuritic chest pain]]
* [[Breath sounds|Bronchial breath sounds]]
* Recent [[influenza]]
* Fine [[rales]]
* [[Breath sounds|Bronchovesicular breath sounds]]
 
=====Laboratory abnormalities=====
* [[Lymphocytosis]]
* [[Respiratory alkalosis]]
 
=====Radiographic features=====
* Lobar [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
* Interstitial infiltrate on [[chest radiograph]]
 
==Differentiating legionellosis from other causes of atypical pneumonia==
 
Legionellosis must be differentiated from other diseases that cause [[atypical pneumonia]] such as Q fever and mycoplasma pneumonia
{| class="wikitable"
!Disease
!Prominent clinical features
!Lab findings
!Chest X-ray
|-
|-
|Q fever
! align="center" style="background:#DCDCDC;" |[[Q fever]] <ref name="pmid15182283">{{cite journal| author=Okimoto N, Asaoka N, Osaki K, Kurihara T, Yamato K, Sunagawa T | display-authors=etal| title=Clinical features of Q fever pneumonia. | journal=Respirology | year= 2004 | volume= 9 | issue= 2 | pages= 278-82 | pmid=15182283 | doi=10.1111/j.1440-1843.2004.00586.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15182283  }} </ref> <ref name="pmid9743171">{{cite journal| author=Caron F, Meurice JC, Ingrand P, Bourgoin A, Masson P, Roblot P | display-authors=etal| title=Acute Q fever pneumonia: a review of 80 hospitalized patients. | journal=Chest | year= 1998 | volume= 114 | issue= 3 | pages= 808-13 | pmid=9743171 | doi=10.1378/chest.114.3.808 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9743171  }} </ref>
|
| align="left" style="background:#F5F5F5;" |
* Q fever is characterized by abrupt onset of [[fever]], [[myalgia]], [[headache]], and other constitutional symptoms.
*[[Fever]]
* [[Cough]] is the most prominent respiratory symptom and it is usually dry.<ref name="pmid23422417">{{cite journal |vauthors=Irfan M, Farooqi J, Hasan R |title=Community-acquired pneumonia |journal=Curr Opin Pulm Med |volume=19 |issue=3 |pages=198–208 |year=2013 |pmid=23422417 |doi=10.1097/MCP.0b013e32835f1d12 |url=}}</ref>
*Dry [[cough]]
* [[Cough]] is associated with [[dyspnea]] and [[pleuritic chest pain]].
*[[Dyspnea]]
|
*[[Pleuritic chest pain]]
* [[Antibody]] detection using [[Immunofluorescence|indirect immunofluorescence]] (IIF) is the preferred method for diagnosis.
*[[myalgia]]
* [[Polymerase chain reaction|PCR]] can be used if IIF is negative, or very early once disease is suspected.
*[[headache]]
* [[Coxiella burnetii|''C. burnetii'']] does not grow on ordinary blood cultures, but can be cultivated on special media such as embryonated eggs or cell culture.
| align="left" style="background:#F5F5F5;" |
* A two-to-three fold increase in [[Aspartate transaminase|AST]] and [[ALT]] is seen in most patients.
*[[Antibody]] detection using [[Immunofluorescence|indirect immunofluorescence]] (IIF)
|
*[[Polymerase chain reaction|PCR]]
[[Image:Q fever.gif|center|300px|thumb|Q fever pneumonia - - Case courtesy of Royal Melbourne Hospital Respiratory, Radiopaedia.org, rID 21993 ]]
*[[Coxiella burnetii|''C. burnetii'']] cultivated on special media such as embryonated eggs or cell culture
*A two-to-three fold increase in [[Aspartate transaminase|AST]] and [[ALT]]
| align="left" style="background:#F5F5F5;" |
Multiple soft infiltrative shadows on CXR
| align="center" style="background:#F5F5F5;" |
[[Image:Q fever.gif|center|300px|thumb|Q fever pneumonia - Case courtesy of Royal Melbourne Hospital Respiratory, Radiopaedia.org, rID 21993 ]]
|-
|-
|[[mycoplasma pneumonia|''Mycoplasma'' pneumonia]]
! align="center" style="background:#DCDCDC;" |[[mycoplasma pneumonia|''Mycoplasma'' pneumonia]] <ref name="pmid27148202">{{cite journal| author=Parrott GL, Kinjo T, Fujita J| title=A Compendium for Mycoplasma pneumoniae. | journal=Front Microbiol | year= 2016 | volume= 7 | issue=  | pages= 513 | pmid=27148202 | doi=10.3389/fmicb.2016.00513 | pmc=4828434 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27148202  }} </ref> <ref name="pmid29264006">{{cite journal| author=Saraya T| title=Mycoplasma pneumoniae infection: Basics. | journal=J Gen Fam Med | year= 2017 | volume= 18 | issue= 3 | pages= 118-125 | pmid=29264006 | doi=10.1002/jgf2.15 | pmc=5689399 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29264006  }} </ref>
|
| align="left" style="background:#F5F5F5;" |
* [[mycoplasma pneumonia|''Mycoplasma'' pneumonia]] can be [[asymptomatic]].
*[[Dry cough]]
* [[Headache]], [[Nausea and vomiting|nausea]], and [[malaise]] usually precede the onset of symptoms.<ref name="pmid23422417">{{cite journal |vauthors=Irfan M, Farooqi J, Hasan R |title=Community-acquired pneumonia |journal=Curr Opin Pulm Med |volume=19 |issue=3 |pages=198–208 |year=2013 |pmid=23422417 |doi=10.1097/MCP.0b013e32835f1d12 |url=}}</ref>
*[[Fever]]
* [[Cough]] is intractable and nonproductive.
*[[Pharyngitis]]
|
*[[Nausea and vomiting]]
* Postitve [[Coombs test]]
*[[Sinus congestion]]
* [[Leukocytosis]]
*[[Pleuritic chest pain]]
* [[Thrombocytosis]]
*[[Inflamed]], opaque, hypomobile [[tympanic membrane]]
|
| align="left" style="background:#F5F5F5;" |
*[[Lymphocytosis]]
*[[Cold agglutinins]] positive
*Positive [[CoNombs test]]
*[[Leukocytosis]]
*[[Thrombocytosis]]
| align="left" style="background:#F5F5F5;" |
*[[Alveolar]] [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
*Interstitial infiltrate on [[chest radiograph]]
*Lobar [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
| align="center" style="background:#F5F5F5;" |
[[Image:Atypical-pneumonia-mycoplasma - Case courtesy of Dr Alborz Jahangiri, Radiopaedia.org, rID 45781.jpg|center|300px|thumb|Mycoplasma pneumonia - Case courtesy of Dr Alborz Jahangiri, Radiopaedia.org, rID 45781]]
[[Image:Atypical-pneumonia-mycoplasma - Case courtesy of Dr Alborz Jahangiri, Radiopaedia.org, rID 45781.jpg|center|300px|thumb|Mycoplasma pneumonia - Case courtesy of Dr Alborz Jahangiri, Radiopaedia.org, rID 45781]]
|-
|-
|[[Legionellosis]]
! align="center" style="background:#DCDCDC;" |[[Chlamydia pneumonia]]
|
| align="left" style="background:#F5F5F5;" |
* [[Legionellosis]] is characterized by cough that is slightly productive.<ref name="pmid23422417">{{cite journal |vauthors=Irfan M, Farooqi J, Hasan R |title=Community-acquired pneumonia |journal=Curr Opin Pulm Med |volume=19 |issue=3 |pages=198–208 |year=2013 |pmid=23422417 |doi=10.1097/MCP.0b013e32835f1d12 |url=}}</ref>
*Associated with [[upper respiratory tract]] symptoms
* Constitutional symptoms such as [[chills]], [[myalgia]], and [[arthralgia]].
*Associated with extrapulmonary maifestations such as:
* Gastrointestinal symptoms such as [[diarrhea]], [[nausea]], and [[vomiting]].
**[[Meningitis]]
|
**[[Guillain-Barre syndrome]]
* Labs are nonspecific for diagnosing [[legionellosis]]  
| align="left" style="background:#F5F5F5;" |
* [[Renal dysfunction|Renal]] and [[hepatic dysfunction]]  
*Normal WBC count
* [[Thrombocytopenia]] and [[leukocytosis]]  
*Positive [[Antibody|antichlamydial antibody]]
* [[Hyponatremia]]  
| align="left" style="background:#F5F5F5;" |
|
| align="center" style="background:#F5F5F5;" |
[[Image:Legionella-pneumonia - Case courtesy of Dr Henry Knipe, Radiopaedia.org, rID 31816.jpg|center|300px|thumb|Legionella pneumonia - Case courtesy of Dr Henry Knipe, Radiopaedia.org, rID 31816 ]]
[[Image:Chlamydia-pneumonia - Case courtesy of Dr Andrew Dixon, Radiopaedia.org, rID 14567.jpg|center|300px|thumb|Chlamydia-pneumonia - Case courtesy of Dr Andrew Dixon, Radiopaedia.org, rID 14567]]
|-
! align="center" style="background:#DCDCDC;" |[[Acute interstitial pneumonia]]
| align="left" style="background:#F5F5F5;" |
*[[Dry cough]]
*[[Dyspnea|Progressive dyspnea]]
| align="left" style="background:#F5F5F5;" |
*Nonspecific
| align="left" style="background:#F5F5F5;" |
*Disseminated [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
*Interstitial infiltrate on chest radiograph
*Increased uptake on gallium scan
| align="center" style="background:#F5F5F5;" |
[[File:Acute Interstitial Pneumonitis Chest Xray - Case Courtesy of Dr Salam, Radiopaedia, rID 45404.jpeg|thumb|Acute Interstitial Pneumonitis Chest X-ray - Case Courtesy of Dr Salam, Radiopaedia, rID 45404]]
|-
! align="center" style="background:#DCDCDC;" |[[Pneumococcal pneumonia]]
| align="left" style="background:#F5F5F5;" |
*[[Fever|High grade fever]]
*[[Hemoptysis]]
*[[Rales|Fine rales]]
*[[Pleuritic chest pain]]
*Increased [[breath sounds]]
*Bronchial b[[Breath sounds|reath sounds]]
*Dullness on chest percussion
*[[Sputum|Purulent sputum]]
*[[Shallow respiration]]
*Pectoriloquy
*Increased [[tactile fremitus]]
*[[Productive cough]]
*[[Egophony]]
| align="left" style="background:#F5F5F5;" |
*[[Gram positive bacteria|Gram positive]] [[diplococci]] on sputum Gram stain
*[[Pleural effusion]] ([[exudative]])
*Respiratory alkalosis
| align="left" style="background:#F5F5F5;" |
*Parenchymal hyperlucency on [[chest radiograph]]
*Increased uptake on [[gallium scan]]
*Unilateral diaphragm elevation on [[chest radiograph]]
*Alveolar [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
*Lobar [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
| align="center" style="background:#F5F5F5;" |
[[File:Pneumococcal Pneumonia Chest Xray..jpg|thumb|Chest X-ray of a patient with pneumococcal pneumonia - case courtesy Dr Jack Ren,  Radiopaedia.org, rID 29090]]
|-
! align="center" style="background:#DCDCDC;" |[[Pneumocystis carinii pneumonia]]
| align="left" style="background:#F5F5F5;" |
*[[Immunosuppressive]] state
*[[Subcutaneous emphysema]]
*[[Cough|Hacking cough]]
*[[Dyspnea|Progressive dyspnea]]
| align="left" style="background:#F5F5F5;" |
*[[Respiratory alkalosis]]
*Serum beta-D-glucan elevation
| align="left" style="background:#F5F5F5;" |
*[[Alveolar]] [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
*Lobar [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
*Interstitial infiltrate on [[chest radiograph]]
*[[Pneumomediastinum]] on [[chest radiograph]]
| align="center" style="background:#F5F5F5;" |
[[File:Acute Interstitial Pneumonitis Chest Xray - Case Courtesy of Dr Salam, Radiopaedia, rID 45404.jpeg|thumb|Pneumocystis Jiroverci Chest Xray - Case Courtesy of Dr Behrang Amini, Radiopaedia, rID 1901]]
|-
! align="center" style="background:#DCDCDC;" |[[Pulmonary embolism]]
| align="left" style="background:#F5F5F5;" |
*Calf [[pain]] or [[swelling]]
*Decreased [[pulse pressure]]
*[[Dyspnea]]
*[[Hemoptysis]]
*[[Hyperventilation]]
*[[Immobility]]
*Increased pulmonic component of heart sound
*[[Pleuritic chest pain]]
*Prior [[Deep vein thrombosis|DVT]]
*[[Pulmonary hypertension]]
*Right ventricular heave
*[[Right-to-left shunt]]
*[[Substernal chest pain]]
*[[Tachypnea]]
*[[Thrombophlebitis]]
*[[Venous stasis]]
*[[Bone fracture]]
| align="left" style="background:#F5F5F5;" |
*[[D-dimer]] elevation
*[[Hypocapnia]]
*[[Hypoxia]]
*[[Pleural effusion]] (exudative or bloody)
*[[Atrial fibrillation]] on ECG
*[[Right axis deviation]] on ECG
*Right ventricular overload on ECG
| align="left" style="background:#F5F5F5;" |
*Normal [[chest radiograph]]
*[[Atelectasis]] on [[chest radiograph]]
*Lobar consolidation on [[chest radiograph]]
*Prominent [[pulmonary artery]] on [[chest radiograph]]
*[[Hampton's hump]] on [[chest radiograph]]
*Right ventricular enlargement on [[echocardiography]]
*[[Thrombus]] on echocardiography
*Segmental [[perfusion]] defect on lung scan
*[[V/Q scan|V/Q]] mismatch on lung scan
| align="center" style="background:#F5F5F5;" |
[[File:Hampton Hump.PNG|thumb|Hampton Hump in a patient with pulmonary embolism courtesy of Hellerhoff]]
|-
|-
|[[Chlamydia pneumonia]]
! align="center" style="background:#DCDCDC;" |[[Viral pneumonia]]
|
| align="left" style="background:#F5F5F5;" |
* There are no specific clinical features of [[chlamydia pneumonia]].
*[[Pleuritic chest pain]]
* Symptoms appear gradually.
*[[Breath sounds|Bronchial breath sounds]]
* [[Chlamydia infection]] is usually associated with [[upper respiratory tract]] symptoms ([[pharyngitis]], [[sinusitis]], etc).
*Recent [[influenza]]
* It might be associated with extrapulmonary maifestations such as [[meningitis]] and [[Guillain-Barre syndrome]].<ref name="pmid23422417">{{cite journal |vauthors=Irfan M, Farooqi J, Hasan R |title=Community-acquired pneumonia |journal=Curr Opin Pulm Med |volume=19 |issue=3 |pages=198–208 |year=2013 |pmid=23422417 |doi=10.1097/MCP.0b013e32835f1d12 |url=}}</ref>
*Fine [[rales]]
|
*[[Breath sounds|Bronchovesicular breath sounds]]
* [[Chlamydia pneumonia]] is usually associated with normal [[WBC|WBC count.]]
| align="left" style="background:#F5F5F5;" |
* Diagnosed with the presence of [[Antibody|antichlamydial antibody]] (through [[complement fixation]] or direct immunofluoroscence) or direct antigen detection.
*[[Lymphocytosis]]
|
*[[Respiratory alkalosis]]
[[Image:Chlamydia-pneumonia - Case courtesy of Dr Andrew Dixon, Radiopaedia.org, rID 14567.jpg|center|300px|thumb|Chlamydia-pneumonia - Case courtesy of Dr Andrew Dixon, Radiopaedia.org, rID 14567]]
| align="left" style="background:#F5F5F5;" |
*Lobar [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
*Interstitial infiltrate on [[chest radiograph]]
| align="center" style="background:#F5F5F5;" |
|}
|}


==References==
==References==

Latest revision as of 20:58, 28 July 2022


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Ogechukwu Hannah Nnabude, MD

Overview

Legionnaires' disease must be differentiated from other causes of fever, dyspnea, cough, and sputum production, such as bacterial pneumonia, viral pneumonia, and other causes of atypical pneumonia.

Differential Diagnosis

Legionnaires' disease must be differentiated from other causes of fever, dyspnea, cough, and sputum production, such as bacterial pneumonia, viral pneumonia, and other causes of atypical pneumonia.[1]

Disease Clinical manifestation Lab findings Imaging findings Chest X-ray
Legionnaires' disease [2] [3] [4]
Chest X-ray of a patient with Legionnaires disease courtesy Hellerhoff
Q fever [5] [6]

Multiple soft infiltrative shadows on CXR

Q fever pneumonia - Case courtesy of Royal Melbourne Hospital Respiratory, Radiopaedia.org, rID 21993
Mycoplasma pneumonia [7] [8]
Mycoplasma pneumonia - Case courtesy of Dr Alborz Jahangiri, Radiopaedia.org, rID 45781
Chlamydia pneumonia
Chlamydia-pneumonia - Case courtesy of Dr Andrew Dixon, Radiopaedia.org, rID 14567
Acute interstitial pneumonia
  • Nonspecific
Acute Interstitial Pneumonitis Chest X-ray - Case Courtesy of Dr Salam, Radiopaedia, rID 45404
Pneumococcal pneumonia
Chest X-ray of a patient with pneumococcal pneumonia - case courtesy Dr Jack Ren,  Radiopaedia.org, rID 29090
Pneumocystis carinii pneumonia
Pneumocystis Jiroverci Chest Xray - Case Courtesy of Dr Behrang Amini, Radiopaedia, rID 1901
Pulmonary embolism
Hampton Hump in a patient with pulmonary embolism courtesy of Hellerhoff
Viral pneumonia


References

  1. ↑ Irfan M, Farooqi J, Hasan R (2013). "Community-acquired pneumonia". Curr Opin Pulm Med. 19 (3): 198–208. doi:10.1097/MCP.0b013e32835f1d12. PMID 23422417.
  2. ↑ Cunha BA, Burillo A, Bouza E (2016). "Legionnaires' disease". Lancet. 387 (10016): 376–385. doi:10.1016/S0140-6736(15)60078-2. PMID 26231463.
  3. ↑ Cunha BA, Cunha CB (2017). "Legionnaire's Disease: A Clinical Diagnostic Approach". Infect Dis Clin North Am. 31 (1): 81–93. doi:10.1016/j.idc.2016.10.007. PMID 28159178.
  4. ↑ Chahin A, Opal SM (2017). "Severe Pneumonia Caused by Legionella pneumophila: Differential Diagnosis and Therapeutic Considerations". Infect Dis Clin North Am. 31 (1): 111–121. doi:10.1016/j.idc.2016.10.009. PMC 7135102 Check |pmc= value (help). PMID 28159171.
  5. ↑ Okimoto N, Asaoka N, Osaki K, Kurihara T, Yamato K, Sunagawa T; et al. (2004). "Clinical features of Q fever pneumonia". Respirology. 9 (2): 278–82. doi:10.1111/j.1440-1843.2004.00586.x. PMID 15182283.
  6. ↑ Caron F, Meurice JC, Ingrand P, Bourgoin A, Masson P, Roblot P; et al. (1998). "Acute Q fever pneumonia: a review of 80 hospitalized patients". Chest. 114 (3): 808–13. doi:10.1378/chest.114.3.808. PMID 9743171.
  7. ↑ Parrott GL, Kinjo T, Fujita J (2016). "A Compendium for Mycoplasma pneumoniae". Front Microbiol. 7: 513. doi:10.3389/fmicb.2016.00513. PMC 4828434. PMID 27148202.
  8. ↑ Saraya T (2017). "Mycoplasma pneumoniae infection: Basics". J Gen Fam Med. 18 (3): 118–125. doi:10.1002/jgf2.15. PMC 5689399. PMID 29264006.
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