Brucellosis differential diagnosis: Difference between revisions
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==Overview== | ==Overview== | ||
[[Brucellosis]] must be differentiated from [[ | [[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 [[ | [[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="pmid1593042322">{{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="pmid754636422">{{cite journal|year=1995|title=Brucellosis: current epidemiology, diagnosis, and management.|url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7546364|journal=Curr Clin Top Infect Dis|volume=15|issue=|pages=115-28|doi=|pmc=|pmid=7546364|author=Young EJ}}</ref><ref name="enf22">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</ref> | ||
A detailed clinical history which includes recent travel history, recent camping or hunting, consumption of unpasteurized milk or raw meat 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 raw meat products, and occupational history should be obtained, in order to differentiate [[brucellosis]] from other diseases. | ||
{| class="wikitable" | {| class="wikitable" | ||
!Differential diagnosis of Brucellosis | !Differential diagnosis of Brucellosis | ||
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|[[Brucellosis]] | |[[Brucellosis]] | ||
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|[[Lymphocytosis|Relative lymphocytosis]] | |[[Lymphocytosis|Relative lymphocytosis]] | ||
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|[[Typhoid fever]] | |[[Typhoid fever]] | ||
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|Decreased [[hemoglobin]] | |Decreased [[hemoglobin]] | ||
|Incremental increase in temperature initially and than sustained [[fever]] as high as 40°C (104°F) | |Incremental increase in temperature initially and than sustained [[fever]] as high as 40°C (104°F) | ||
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|[[Malaria]] | |[[Malaria]] | ||
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|Microcytosis, | |Microcytosis, | ||
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|[[Tuberculosis]] | |[[Tuberculosis]] | ||
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|Mild normocytic [[anemia]], [[hyponatremia]], and | |Mild normocytic [[anemia]], [[hyponatremia]], and | ||
[[hypercalcemia]] | [[hypercalcemia]] | ||
|[[Night sweats]], constant fatigue | |[[Night sweats]], constant [[fatigue]] | ||
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|[[Lymphoma]] | |[[Lymphoma]] | ||
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|Increase [[ESR]], increased [[LDH]] | |Increase [[ESR]], increased [[LDH]] | ||
|[[Night sweats]], constant fatigue | |[[Night sweats]], constant fatigue | ||
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|[[Mumps]] | |[[Mumps]] | ||
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|[[Lymphocytosis|Relative lymphocytosis]], serum [[amylase]] elevated | |[[Lymphocytosis|Relative lymphocytosis]], serum [[amylase]] elevated | ||
|[[Parotid gland|Parotid]] swelling/tenderness | |[[Parotid gland|Parotid]] swelling/tenderness | ||
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|[[Rheumatoid arthritis]] | |[[Rheumatoid arthritis]] | ||
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|[[ESR]] and [[CRP]] elevated, positive [[rheumatoid factor]] | |[[ESR]] and [[CRP]] elevated, positive [[rheumatoid factor]] | ||
|Morning stiffness | |Morning [[stiffness]] | ||
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|[[SLE]] | |[[SLE]] | ||
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|[[ESR]] and [[CRP]] elevated, positive [[ANA]] | |[[ESR]] and [[CRP]] elevated, positive [[ANA]] | ||
|[[Fatigue]] | |[[Fatigue]] | ||
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|[[Human Immunodeficiency Virus|HIV]] | |[[Human Immunodeficiency Virus|HIV]] | ||
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|Constant fatigue | |Constant fatigue | ||
Revision as of 14:34, 4 April 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Danitza Lukac Vishal Devarkonda, M.B.B.S[2]
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 raw meat products, and occupational history should be obtained, in order to differentiate brucellosis from other diseases.
| Differential diagnosis of Brucellosis | Symptoms | Signs | Diagnosis | Additional Findings | ||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Fever | Rash | Diarrhea | Abdominal pain | Weight loss | Painful lymphadenopathy | Hepatosplenomegaly | Arthritis | Lab Findings | ||
| Brucellosis | + | + | - | + | + | + | + | + | Relative lymphocytosis |
Night sweats, often with characteristic smell, likened to wet hay |
| Typhoid fever | + | + | - | + | - | - | + | + | Decreased hemoglobin | Incremental increase in temperature initially and than sustained fever as high as 40°C (104°F) |
| Malaria | + | - | + | + | - | - | + | + | Microcytosis,
elevated LDH |
"Tertian" fever: paroxysms occur every second day |
| Tuberculosis | + | + | - | + | + | + | - | + | Mild normocytic anemia, hyponatremia, and | Night sweats, constant fatigue |
| Lymphoma | + | - | - | + | + | - | + | - | Increase ESR, increased LDH | Night sweats, constant fatigue |
| Mumps | + | - | - | - | - | + | - | - | Relative lymphocytosis, serum amylase elevated | Parotid swelling/tenderness |
| Rheumatoid arthritis | - | + | - | - | - | - | - | + | ESR and CRP elevated, positive rheumatoid factor | Morning stiffness |
| SLE | - | + | - | + | + | - | - | + | ESR and CRP elevated, positive ANA | Fatigue |
| HIV | - | - | - | + | + | + | - | + | Constant fatigue | |
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.
- ↑ 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