Yersinia pestis infection differential diagnosis: Difference between revisions

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{{Yersinia pestis infection}}
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==Overview==
==Overview==
The differential diagnosis for yersina pestis infection depends on the clinical syndrome of the plague (bubonic plague, septicimic plague, pneumonic plague, or pharyngeal plague).  Bubonic plague should be differenciated from other causes of [[lymphadenopathy]] such as streptococcal or staphylococcal [[lymphadenitis]], [[infectious mononucleosis]], [[cat-scratch fever]], and [[tularemia]].
The differential diagnosis for ''yersina pestis'' infection is dependent on the clinical syndrome (bubonic plague, septicimic plague, pneumonic plague, or pharyngeal plague).  Bubonic plague should be differentiated from other causes of [[lymphadenopathy]], such as [[streptococcus|streptococcal]] or [[staphylococcus|staphylococcal]] [[lymphadenitis]], [[infectious mononucleosis]], [[cat-scratch fever]], and [[tularemia]]. Septicemic plague should be differentiated from non-specific [[sepsis]] syndrome and [[gram negative]] sepsis.  The differential diagnosis for pneumonic plague includes infections that cause [[community-acquired pneumonia]], such as [[pneumococcus|pneumococcal]] or [[streptococcus|streptococcal]] pneumonia, [[virus|viral]] pneumonia, [[hemophilus influenzae]], and [[anthrax]].<ref name=WHObook>Plague Manual: Epidemiology, Distribution, Surveillance. World Health Organization. Communicable Disease Surveillance and Response and Control. WHO/CDS/CSR/EDC/99.2 </ref>


Septicemic plague should be differnciated from non-specific [[sepsis]] syndrome and [[gram negative]] sepsis.  The differential diagnosis for pneumonic plague includes infections that cause [[community-acquired pneumonia]] such as [[pneumococcus|pneumococcal]] or [[streptococcus|streptococcal]] pneumonia, [[virus|viral]] pneumonia, [[hemophilus influenzae]], and [[anthrax]].<ref name=WHObook>Plague Manual: Epidemiology, Distribution, Surveillance. World Health Organization. Communicable Disease Surveillance and Response
==Differential Diagnosis==
and Control. WHO/CDS/CSR/EDC/99.2 </ref>
===Bubonic Plague===


Conditions that also cause [[lymphadenopathy]]:<ref name=WHObook>Plague Manual: Epidemiology, Distribution, Surveillance World Health Organization Communicable Disease Surveillance and Response
and Control WHO/CDS/CSR/EDC/992 </ref>
*[[Streptococcal]] or [[staphylococcal]] [[adenitis]] (''[[Staphylococcus aureus]]'', ''Staphylococcus pyogenes'')
**Purulent or inflamed [[lesion]] often noted [[distal]] to involved [[nodes]] (ie, [[pustule]], infected traumatic lesion)
**Involved nodes more likely to be fluctuant
**Associated ascending [[lymphangitis]] or [[cellulitis]] may be present (generally not seen with plague)


==Differential Diagnosis==
===Bubonic Plague===
Conditions that cause [[lymphadenopathy]]:<ref name=WHObook>Plague Manual: Epidemiology, Distribution, Surveillance. World Health Organization. Communicable Disease Surveillance and Response
and Control. WHO/CDS/CSR/EDC/99.2 </ref>
* Streptococcal or staphylococcal [[lymphadenitis]]
* [[Infectious mononucleosis]]
* [[Infectious mononucleosis]]
* [[Cat-scratch fever]]
 
*[[Tularemia]] (''[[Francisella tularensis]]'')
**[[Ulcer]] or [[pustule]] often present distal to involved nodes
**Clinical course rarely as fulminant as in plague
**Systemic toxicity uncommon
 
*[[Cat scratch fever]] (''[[Bartonella henselae]]'')
**History of contact with cats; usually history of cat scratch
**Indolent clinical course; progresses over weeks
**Primary lesion at site of scratch often present (small [[papule]], [[vesicle]])
**Systemic toxicity not present
 
*[[Mycobacterial infection]], including [[scrofula]] (''[[Mycobacterium tuberculosis]]'' and other Mycobacterium species)
**With scrofula, [[adenitis]] occurs in [[cervical]] region
**Usually painless
**Indolent clinical course
**[[Infections]] with species other than M tuberculosis more likely to occur in [[immunocompromised]] patients
 
* [[Lymphatic filariasis]]
* [[Lymphatic filariasis]]
* Tick [[typhus]]
* [[Tick typhus]]
* [[Tularemia]]


Conditions that cause intra-abdominal [[lymphadenopathy]]:<ref name=WHObook>Plague Manual: Epidemiology, Distribution, Surveillance. World Health Organization. Communicable Disease Surveillance and Response
Conditions that also cause intra-abdominal [[lymphadenopathy]]:<ref name=WHObook>Plague Manual: Epidemiology, Distribution, Surveillance World Health Organization Communicable Disease Surveillance and Response
and Control. WHO/CDS/CSR/EDC/99.2 </ref>
and Control WHO/CDS/CSR/EDC/992 </ref>
* [[Appendicitis]]
* [[Appendicitis]]
* [[Acute cholecystitis]]
* [[Acute cholecystitis]]
* [[Enterocolitis]]
* [[Enterocolitis]]


Condition that causes inguinal [[lymphadenopathy]]:<ref name=WHObook>Plague Manual: Epidemiology, Distribution, Surveillance. World Health Organization. Communicable Disease Surveillance and Response
Condition that also causes inguinal [[lymphadenopathy]]:<ref name=WHObook>Plague Manual: Epidemiology, Distribution, Surveillance World Health Organization Communicable Disease Surveillance and Response
and Control. WHO/CDS/CSR/EDC/99.2 </ref>
and Control WHO/CDS/CSR/EDC/992 </ref>
* [[Inguinal hernia]]
*[[Lymphogranuloma venereum]] (''[[Chlamydia trachomatis]]'')
**[[Adenitis]] occurs in the [[inguinal]] region
**History of [[sexual]] exposure 10-30 days previously
**Suppuration, fistula tracts common
**Although LGV [[buboes]] may be somewhat [[tender]], exquisite tenderness usually absent
**Although patients may appear ill ([[headache]], [[fever]], [[myalgias]]), systemic [[toxicity]] not present
 
*[[Chancroid]] (''[[Haemophilus ducreyi]]'')
**Adenitis occurs in the inguinal region
**Ulcerative lesion present
**Systemic symptoms uncommon; toxicity does not occur
 
*Primary [[genital herpes]]
**Herpes lesions present in genital area
**Adenitis occurs in the inguinal region
**Although patients may be ill (fever, headache), severe systemic toxicity not present
 
*Primary or secondary [[syphilis]] (''[[Treponema pallidum]]'')
**Enlarged [[lymph nodes]] in the inguinal region
**Lymph nodes generally painless
**[[Chancre]] may be noted with primary syphilis
 
*Strangulated inguinal [[hernias]]
**Evidence of bowel involvement


===Septicemic Plague===
===Septicemic Plague===
Conditions that manifest similarly:
* Non-specific [[sepsis]] syndrome
* Non-specific [[sepsis]] syndrome
* [[Gram negative]] sepsis<ref name=WHObook>Plague Manual: Epidemiology, Distribution, Surveillance. World Health Organization. Communicable Disease Surveillance and Response
* [[Gram negative]] sepsis<ref name=WHObook>Plague Manual: Epidemiology, Distribution, Surveillance World Health Organization Communicable Disease Surveillance and Response
and Control. WHO/CDS/CSR/EDC/99.2 </ref>
and Control WHO/CDS/CSR/EDC/992 </ref>


===Pneumonic Plague===
===Pneumonic Plague===
Infections that cause [[community-acquired pneumonia]]:<ref name=WHObook>Plague Manual: Epidemiology, Distribution, Surveillance. World Health Organization. Communicable Disease Surveillance and Response
Pneumonic plague should be differentiated from the following diseases:
and Control. WHO/CDS/CSR/EDC/99.2 </ref>
 
* [[Pneumococcus]]
*Inhalational [[anthrax]] (''Bacillus anthracis'')
* [[Streptococcus]]
**Widened [[mediastinum]] and [[pleural effusions]] seen on CXR or chest CT
* [[Haemophilus influenzae]]
**Not true [[pneumonia]]; minimal [[sputum]] production
* [[Anthrax]]
**[[Hemoptysis]] uncommon (if present, suggests diagnosis of plague)
* [[Tularaemia]]
 
* [[Legionella]]
*[[Tularemia]] (''Francisella tularensis'')
* [[Pneumophila]]
**Clinical course not as rapid or fulminant as in pneumonic plague
 
*[[Mycoplasmal pneumonia]] (''Mycoplasma pneumoniae'')
**Rarely as [[fulminant]] as pneumonic plague
 
*[[Pneumonia]] caused by ''Chlamydia pneumoniae''
**Rarely as fulminant as pneumonic plague
 
*[[Legionnaires' disease]] (''Legionella pneumophila'' or other Legionella  species)
**Rarely as fulminant as pneumonic plague
**Community outbreaks of Legionnaires' disease often involve exposure to cooling systems
**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
 
*[[Psittacosis]] (''Chlamydia psittaci'')
**Rarely as fulminant as pneumonic plague
**Result of bird exposure
 
*Other bacterial agents (eg, ''Staphyloccocus aureus'', ''Streptococcus pneumoniae'', ''Haemophilus influenzae'', ''Klebsiella pneumoniae'', ''Moraxella catarrhalis'')
**Rarely as fulminant as pneumonic plague
**Usually occur in persons with underlying pulmonary or other disease or in the elderly
 
*[[Influenza]]
**Influenza generally seasonal (October-March in United States) or involves history of recent cruise ship travel or travel to tropics
 
*[[Hantavirus]]
**Exposure to excrement (urine or feces) of mice with Hantavirus
 
*[[RSV]]
**RSV usually occurs in children (although may be cause of pneumonia in elderly); tends to be seasonal (winter/spring)
 
*[[CMV]]
**CMV usually occurs in immunocompromised patients
 
*[[Q fever]] (''Coxiella burnetii'')
**Exposure to infected parturient cats, cattle, sheep, goats
**Severe pneumonia not prominent feature
 
* [[Leptospirosis]]
* [[Leptospirosis]]
* [[Hantavirus pulmonary syndrome]]
* [[Hantavirus pulmonary syndrome]]
* [[Influenza]]
 
* [[Virus]]es
* [[Virus|viral]] pneumonia


==References==
==References==
{{reflist|2}}
{{reflist|2}}
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Latest revision as of 00:46, 30 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2]; Alison Leibowitz [3]

Overview

The differential diagnosis for yersina pestis infection is dependent on the clinical syndrome (bubonic plague, septicimic plague, pneumonic plague, or pharyngeal plague). Bubonic plague should be differentiated from other causes of lymphadenopathy, such as streptococcal or staphylococcal lymphadenitis, infectious mononucleosis, cat-scratch fever, and tularemia. Septicemic plague should be differentiated from non-specific sepsis syndrome and gram negative sepsis. The differential diagnosis for pneumonic plague includes infections that cause community-acquired pneumonia, such as pneumococcal or streptococcal pneumonia, viral pneumonia, hemophilus influenzae, and anthrax.[1]

Differential Diagnosis

Bubonic Plague

Conditions that also cause lymphadenopathy:[1]

  • Cat scratch fever (Bartonella henselae)
    • History of contact with cats; usually history of cat scratch
    • Indolent clinical course; progresses over weeks
    • Primary lesion at site of scratch often present (small papule, vesicle)
    • Systemic toxicity not present

Conditions that also cause intra-abdominal lymphadenopathy:[1]

Condition that also causes inguinal lymphadenopathy:[1]

  • Chancroid (Haemophilus ducreyi)
    • Adenitis occurs in the inguinal region
    • Ulcerative lesion present
    • Systemic symptoms uncommon; toxicity does not occur
  • Primary genital herpes
    • Herpes lesions present in genital area
    • Adenitis occurs in the inguinal region
    • Although patients may be ill (fever, headache), severe systemic toxicity not present
  • Strangulated inguinal hernias
    • Evidence of bowel involvement

Septicemic Plague

Conditions that manifest similarly:

Pneumonic Plague

Pneumonic plague should be differentiated from the following diseases:

  • Tularemia (Francisella tularensis)
    • Clinical course not as rapid or fulminant as in pneumonic plague
  • Pneumonia caused by Chlamydia pneumoniae
    • Rarely as fulminant as pneumonic plague
  • Legionnaires' disease (Legionella pneumophila or other Legionella species)
    • Rarely as fulminant as pneumonic plague
    • Community outbreaks of Legionnaires' disease often involve exposure to cooling systems
    • 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
  • Psittacosis (Chlamydia psittaci)
    • Rarely as fulminant as pneumonic plague
    • Result of bird exposure
  • Other bacterial agents (eg, Staphyloccocus aureus, Streptococcus pneumoniae, Haemophilus influenzae, Klebsiella pneumoniae, Moraxella catarrhalis)
    • Rarely as fulminant as pneumonic plague
    • Usually occur in persons with underlying pulmonary or other disease or in the elderly
  • Influenza
    • Influenza generally seasonal (October-March in United States) or involves history of recent cruise ship travel or travel to tropics
  • Hantavirus
    • Exposure to excrement (urine or feces) of mice with Hantavirus
  • RSV
    • RSV usually occurs in children (although may be cause of pneumonia in elderly); tends to be seasonal (winter/spring)
  • CMV
    • CMV usually occurs in immunocompromised patients
  • Q fever (Coxiella burnetii)
    • Exposure to infected parturient cats, cattle, sheep, goats
    • Severe pneumonia not prominent feature

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 Plague Manual: Epidemiology, Distribution, Surveillance. World Health Organization. Communicable Disease Surveillance and Response and Control. WHO/CDS/CSR/EDC/99.2

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