Brucellosis differential diagnosis: Difference between revisions
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==Overview== | ==Overview== | ||
Brucellosis must be differentiated from Typhoid fever, Malaria, Tuberculosis, Lymphoma, Dengue, Leptospirosis, Rheumatic disease, Epstein-barr virus, Toxoplasmosis, Cytomegalovirus, and HIV. | [[Brucellosis]] must be differentiated from [[Typhoid fever]], [[Malaria]], [[Tuberculosis]], [[Lymphoma]], [[Dengue fever|Dengue]], [[Leptospirosis]], [[Rheumatology|Rheumatic disease]], [[Epstein-barr virus]], [[Toxoplasmosis]], [[Cytomegalovirus]], and [[Human Immunodeficiency Virus|HIV]]. | ||
==Differentiating Brucellosis from other Diseases== | ==Differentiating Brucellosis from other Diseases== | ||
Brucellosis must be differentiated from Typhoid fever, Malaria, Tuberculosis, Lymphoma, Dengue, Leptospirosis, Rheumatic disease, Epstein-barr virus, Toxoplasmosis, Cytomegalovirus, and HIV.<ref name="pmid15930423">{{cite journal| author=Pappas G, Akritidis N, Bosilkovski M, Tsianos E| title=Brucellosis. | journal=N Engl J Med | year= 2005 | volume= 352 | issue= 22 | pages= 2325-36 | pmid=15930423 | doi=10.1056/NEJMra050570 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15930423 }}</ref><ref>Brucellosis "Dennis Kasper, Anthony Fauci, Stephen Hauser, Dan Longo, J. Larry Jameson, Joseph Loscalzo"Harrison's Principles of Internal Medicine, 19e Accessed on January,2017</ref><ref name="pmid7546364">{{cite journal| author=Young EJ| title=Brucellosis: current epidemiology, diagnosis, and management. | journal=Curr Clin Top Infect Dis | year= 1995 | volume= 15 | issue= | pages= 115-28 | pmid=7546364 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7546364 }}</ref> | [[Brucellosis]] must be differentiated from [[Typhoid fever]], [[Malaria]], [[Tuberculosis]], Lymphoma, [[Dengue]], [[Leptospirosis]], [[Rheumatic disease]], [[Epstein Barr virus|Epstein-barr virus]], [[Toxoplasmosis]], [[Cytomegalovirus causes|Cytomegalovirus]], and [[Human Immunodeficiency Virus|HIV]].<ref name="pmid15930423">{{cite journal| author=Pappas G, Akritidis N, Bosilkovski M, Tsianos E| title=Brucellosis. | journal=N Engl J Med | year= 2005 | volume= 352 | issue= 22 | pages= 2325-36 | pmid=15930423 | doi=10.1056/NEJMra050570 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15930423 }}</ref><ref>Brucellosis "Dennis Kasper, Anthony Fauci, Stephen Hauser, Dan Longo, J. Larry Jameson, Joseph Loscalzo"Harrison's Principles of Internal Medicine, 19e Accessed on January,2017</ref><ref name="pmid7546364">{{cite journal| author=Young EJ| title=Brucellosis: current epidemiology, diagnosis, and management. | journal=Curr Clin Top Infect Dis | year= 1995 | volume= 15 | issue= | pages= 115-28 | pmid=7546364 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7546364 }}</ref><ref name="enf" /> | ||
A detailed clinical history which includes recent travel history, recent camping or hunting, consumption of unpasteurized milk or dairy products and occupational history should be obtained, in order to differentiate | A detailed clinical history which includes recent travel history, recent camping or hunting, consumption of unpasteurized milk or dairy products, and occupational history should be obtained, in order to differentiate [[Brucellosis]] from other diseases. | ||
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! style="width: 120px;background: #4479BA" |{{fontcolor|#FFF| Distinguishing Clinical Features}} | ! style="width: 120px;background: #4479BA" |{{fontcolor|#FFF| Distinguishing Clinical Features}} | ||
|- | |- | ||
| style="width: 120px;font-weight: bold;background: #DCDCDC" | Typhoid fever | | style="width: 120px;font-weight: bold;background: #DCDCDC" | [[Typhoid fever]] | ||
| style="background: #F5F5F5; text-align:center" | High persistent fevers (104-105°F), particularly vespertine + constipation + relative bradycardia | | style="background: #F5F5F5; text-align:center" | High persistent fevers (104-105°F), particularly vespertine + constipation + relative bradycardia | ||
|- | |- | ||
| style="width: 120px;font-weight: bold;background: #DCDCDC" | Malaria | | style="width: 120px;font-weight: bold;background: #DCDCDC" | [[Malaria]] | ||
| style="background: #F5F5F5; text-align:center" | Intermittent fever + chills + sweating + anorexia + nausea + cephalalgia + myalgia + normal CBC or thrombocytopenia and/or hemolytic anemia + hyperbilirubinemia + normal or mild elevated erythrocyte sedimentation rate + hepatosplenomegaly | | style="background: #F5F5F5; text-align:center" | Intermittent fever + chills + sweating + anorexia + nausea + cephalalgia + myalgia + normal CBC or thrombocytopenia and/or hemolytic anemia + hyperbilirubinemia + normal or mild elevated erythrocyte sedimentation rate + hepatosplenomegaly | ||
|- | |- | ||
| style="width: 120px;font-weight: bold;background: #DCDCDC" | Tuberculosis | | style="width: 120px;font-weight: bold;background: #DCDCDC" | [[Tuberculosis]] | ||
| style="background: #F5F5F5; bold; text-align:center" | Night sweats + weight loss + dry or productive cough. | | style="background: #F5F5F5; bold; text-align:center" | Night sweats + weight loss + dry or productive cough. | ||
|- | |- | ||
| style="width: 120px;font-weight: bold;background: #DCDCDC" | Lymphoma | | style="width: 120px;font-weight: bold;background: #DCDCDC" | [[Lymphoma]] | ||
| style="background: #F5F5F5; text-align:center" | Painless superficial lymphadenopathy (cervical, supraclavicular, axillary or inguinal) + fever + night sweats + asthenia + weight loss + generalized pruritus | | style="background: #F5F5F5; text-align:center" | Painless superficial lymphadenopathy (cervical, supraclavicular, axillary or inguinal) + fever + night sweats + asthenia + weight loss + generalized pruritus | ||
|- | |- | ||
| style="width: 120px;font-weight: bold;background: #DCDCDC" | Dengue | | style="width: 120px;font-weight: bold;background: #DCDCDC" | [[Dengue]] | ||
| style="background: #F5F5F5; text-align:center" | Fever + cephalalgia + retro orbital pain + myalgias + abdominal pain + arthralgia + cutaneous eruption + hemorrhagic manifestations | | style="background: #F5F5F5; text-align:center" | Fever + cephalalgia + retro orbital pain + myalgias + abdominal pain + arthralgia + cutaneous eruption + hemorrhagic manifestations | ||
|- | |- | ||
| style="width: 120px;font-weight: bold;background: #DCDCDC" | Leptospirosis | | style="width: 120px;font-weight: bold;background: #DCDCDC" | [[Leptospirosis]] | ||
| style="background: #F5F5F5; text-align:center" | Jaundice with no hepatosplenomegaly + leukocytosis + neutrophilia + elevated erythrocyte sedimentation rate | | style="background: #F5F5F5; text-align:center" | Jaundice with no hepatosplenomegaly + leukocytosis + neutrophilia + elevated erythrocyte sedimentation rate | ||
|- | |- | ||
| style="width: 120px;font-weight: bold;background: #DCDCDC" |Rheumatic Diseases | | style="width: 120px;font-weight: bold;background: #DCDCDC" |[[Rheumatic Diseases]] | ||
| style="background: #F5F5F5; text-align:center" | Protracted fever + weight loss + polyadenopathy + cough + thoracic pain + hemoptysis + dysphonia + weakness + ocular lesions. | | style="background: #F5F5F5; text-align:center" | Protracted fever + weight loss + polyadenopathy + cough + thoracic pain + hemoptysis + dysphonia + weakness + ocular lesions. | ||
|- | |- | ||
|style="width: 120px;font-weight: bold;background: #DCDCDC" |Epstein-Barr virus | |style="width: 120px;font-weight: bold;background: #DCDCDC" |[[Epstein Barr virus|Epstein-Barr virus]] | ||
|style="background: #F5F5F5; text-align:center"|Low-grade fever nearly all cases+Sore throat(white patches on tongue and back of tongue)+Muscle weakness+fatigue+tender lymphadenopathy, particularly involving the posterior cervical lymph nodes. | |style="background: #F5F5F5; text-align:center"|Low-grade fever nearly all cases+Sore throat(white patches on tongue and back of tongue)+Muscle weakness+fatigue+tender lymphadenopathy, particularly involving the posterior cervical lymph nodes. | ||
|- | |- | ||
|style="width: 120px;font-weight: bold;background: #DCDCDC" |Toxoplasma | |style="width: 120px;font-weight: bold;background: #DCDCDC" |[[Toxoplasma]] | ||
|style="background: #F5F5F5; text-align:center"|Flu like sypmtoms+swollen lymph nodes+muscle aches and pain that last for a month or more | |style="background: #F5F5F5; text-align:center"|Flu like sypmtoms+swollen lymph nodes+muscle aches and pain that last for a month or more | ||
|- | |- | ||
|style="width: 120px;font-weight: bold;background: #DCDCDC" |Cytomegalovirus | |style="width: 120px;font-weight: bold;background: #DCDCDC" |[[Cytomegalovirus causes|Cytomegalovirus]] | ||
|style="background: #F5F5F5; text-align:center"|Enlarged lymph nodes, especially in the neck+fever+fatigue+loss of appetite+malaise+muscle aches+rash+sore throat | |style="background: #F5F5F5; text-align:center"|Enlarged lymph nodes, especially in the neck+fever+fatigue+loss of appetite+malaise+muscle aches+rash+sore throat | ||
|- | |- | ||
|style="width: 120px;font-weight: bold;background: #DCDCDC" |HIV | |style="width: 120px;font-weight: bold;background: #DCDCDC" |[[Human Immunodeficiency Virus|HIV]] | ||
|style="background: #F5F5F5; text-align:center"|Acute retro-viral syndrome presents with flu-like symptoms with fever+ lymphadenopathy+ rash+ fatigue+ myalgia+ arthritic pain+ headache | |style="background: #F5F5F5; text-align:center"|Acute retro-viral syndrome presents with flu-like symptoms with fever+ lymphadenopathy+ rash+ fatigue+ myalgia+ arthritic pain+ headache | ||
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Revision as of 16:19, 9 January 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Danitza Lukac
Overview
Brucellosis must be differentiated from Typhoid fever, Malaria, Tuberculosis, Lymphoma, Dengue, Leptospirosis, Rheumatic disease, Epstein-barr virus, Toxoplasmosis, Cytomegalovirus, and HIV.
Differentiating Brucellosis from other Diseases
Brucellosis must be differentiated from Typhoid fever, Malaria, Tuberculosis, Lymphoma, Dengue, Leptospirosis, Rheumatic disease, Epstein-barr virus, Toxoplasmosis, Cytomegalovirus, and HIV.[1][2][3][4]
A detailed clinical history which includes recent travel history, recent camping or hunting, consumption of unpasteurized milk or dairy products, and occupational history should be obtained, in order to differentiate Brucellosis from other diseases.
| Differential Diagnosis | Distinguishing Clinical Features |
|---|---|
| Typhoid fever | High persistent fevers (104-105°F), particularly vespertine + constipation + relative bradycardia |
| Malaria | Intermittent fever + chills + sweating + anorexia + nausea + cephalalgia + myalgia + normal CBC or thrombocytopenia and/or hemolytic anemia + hyperbilirubinemia + normal or mild elevated erythrocyte sedimentation rate + hepatosplenomegaly |
| Tuberculosis | Night sweats + weight loss + dry or productive cough. |
| Lymphoma | Painless superficial lymphadenopathy (cervical, supraclavicular, axillary or inguinal) + fever + night sweats + asthenia + weight loss + generalized pruritus |
| Dengue | Fever + cephalalgia + retro orbital pain + myalgias + abdominal pain + arthralgia + cutaneous eruption + hemorrhagic manifestations |
| Leptospirosis | Jaundice with no hepatosplenomegaly + leukocytosis + neutrophilia + elevated erythrocyte sedimentation rate |
| Rheumatic Diseases | Protracted fever + weight loss + polyadenopathy + cough + thoracic pain + hemoptysis + dysphonia + weakness + ocular lesions. |
| Epstein-Barr virus | Low-grade fever nearly all cases+Sore throat(white patches on tongue and back of tongue)+Muscle weakness+fatigue+tender lymphadenopathy, particularly involving the posterior cervical lymph nodes. |
| Toxoplasma | Flu like sypmtoms+swollen lymph nodes+muscle aches and pain that last for a month or more |
| Cytomegalovirus | Enlarged lymph nodes, especially in the neck+fever+fatigue+loss of appetite+malaise+muscle aches+rash+sore throat |
| HIV | Acute retro-viral syndrome presents with flu-like symptoms with fever+ lymphadenopathy+ rash+ fatigue+ myalgia+ arthritic pain+ headache |
Reference
- ↑ Pappas G, Akritidis N, Bosilkovski M, Tsianos E (2005). "Brucellosis". N Engl J Med. 352 (22): 2325–36. doi:10.1056/NEJMra050570. PMID 15930423.
- ↑ Brucellosis "Dennis Kasper, Anthony Fauci, Stephen Hauser, Dan Longo, J. Larry Jameson, Joseph Loscalzo"Harrison's Principles of Internal Medicine, 19e Accessed on January,2017
- ↑ Young EJ (1995). "Brucellosis: current epidemiology, diagnosis, and management". Curr Clin Top Infect Dis. 15: 115–28. PMID 7546364.
- ↑ 4.0 4.1 Enfermedades infecciosas: Brucelosis -Diagnóstico de Brucelosis,Guia para el Equipo de Salud. Ministerio de Salud-Argentina. http://www.msal.gob.ar/images/stories/bes/graficos/0000000304cnt-guia-medica-brucelosis.pdf. Accessed on February 2, 2016