Blastomycosis differential diagnosis: Difference between revisions

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* Palate and oral ulcers   
* Palate and oral ulcers   
* Spleenomegaly
* [[Splenomegaly]]
|
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* Pancytopenia
* [[Pancytopenia]]


* Urine antigen testing
* Urine antigen testing
|Yeast are typically smaller, with narrow-based budding, found intracellularly within macrophages
|Yeast are typically smaller, with narrow-based budding, found [[Intracellular|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<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>
* [[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  
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|[[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>
|[[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  
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* Person’s hand or the arm  
* Person’s hand or the arm  
* Lymphadenitis (nodular)
* [[Lymphadenitis]] (nodular)
|'''+''' Sporotrichin skin test
|'''+''' Sporotrichin skin test
|Finger or cigar shaped  yeast.
|Finger or cigar shaped  yeast.
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|Ubiquitous
|Ubiquitous
|
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* 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
|Septated hyphae with acute angle branching
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* 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>
* 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]]
* [[Thrombocytopenia]]
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Building water systems
Building water systems
|
|
* Diarrhea
* [[Diarrhea]]
* Confusion
* [[Confusion]]
|
|
* '''+''' Urine Antigen
* '''+''' Urine Antigen


* Hyponatreimia<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>
* [[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]]
|[[Gram negative]] [[bacterium]]
|-
|-
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|Ill contact individuals
|Ill contact individuals
|
|
* Night sweats
* [[Night sweats]]
* Hemoptysis
* [[Hemoptysis]]
|
|
* [[Hypercalcemia]]
* [[Hypercalcemia]]
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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]]
|
|
* Elevated titers of [[listeriolysin O]]
* Elevated titers of [[listeriolysin O]]
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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]]
|
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* Antibody production against lipopolysaccharide and  bacterial antigens
* Antibody production against lipopolysaccharide and  bacterial antigens
* Relative lymphocytosis and thrombocyotopenia.
* Relative [[lymphocytosis]] and [[thrombocytopenia]].
|Gram-negative bacteria,non-motile, encapsulated coccobacilli.
|[[Gram-negative bacteria]],[[Motile|non-motile]], [[Encapsulated organisms|encapsulated]] [[Coccobacilli|coccobacilli.]]
|-
|-
|[[Scrub typhus]]
|[[Scrub typhus]]
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|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>
|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>
|
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* Maculopapular rash
* [[Maculopapular rash]]
|
|
* Indirect immunofluorescence
* Indirect immunofluorescence


* '''+''' [[Weil-Felix test]]  
* '''+''' [[Weil-Felix test]]  
|a [[Gram-negative]] α-proteobacterium  intracellular parasite
|a [[Gram-negative]] α-[[Proteobacteria|proteobacterium]]  [[intracellular]] parasite
|-
|-
|[[Leptospirosis]]
|[[Leptospirosis]]
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|People who work with animals
|People who work with animals
|
|
* Jaundice
* [[Jaundice]]


* Red eyes
* [[Red eyes]]
* 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>
* [[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>
|
|
* Antibodies labelled with fluorescent markers positive for leptospires.
* Antibodies labelled with fluorescent markers positive for leptospires.
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|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>
|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>
|
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* Lymphadenopathy
* [[Lymphadenopathy]]


* papule or pustule at the infected site
* [[Papule]] or [[Pustules|pustule]] at the infected site
|
|
* enzymatic immunoassay positive for  antibody to B henselae
* enzymatic immunoassay positive for  antibody to B henselae
* [[lymphocytosis]]
* [[lymphocytosis]]
|[[Gram-negative]] [[Bacterium|bacteria]]. facultative intracellular parasites
|[[Gram-negative]] [[Bacterium|bacteria]]. [[Facultative aerobic|facultative]] intracellular parasites
|-
|-
| rowspan="2" |Viral
| rowspan="2" |Viral
|Chickenpox
|Chickenpox
|
|       '''−'''
|
|
* Pregnant women.
* 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>
* 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
* [[Immunocompromised]] persons
|
|
* [[conjunctival]] and [[catarrhal]] symptoms
* [[conjunctival]] and [[catarrhal]] symptoms
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* Spots appearing in two or three waves
* Spots appearing in two or three waves
|Whole infected cell (wc) [[ELISA]] for IgG.
|Whole infected cell (wc) [[ELISA]] for IgG.
|
|                   '''−'''
|-
|-
|[[Coxsackie A virus]]
|[[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>
|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.
|Painful [[Blister|blisters]] in the mouth, palms and on  the feet.
Rash, appears after episode of high fever.  
[[Rash]], appears after episode of [[high fever]].  
|Clinically diagnosed
|Clinically diagnosed
|
|                     '''−'''
|-
|-
|Others
|Others
|Primary lung cancer
|Primary lung cancer
|
|       '''−'''
|Age >65
|Age >65
|
|
* Weight loss
* [[Weight loss]]


* H/o smoking
* H/o smoking
* Hemoptysis
* [[Hemoptysis]]
|CT guided bronchoscopy + for malignant cells
|CT guided bronchoscopy + for malignant cells
|
|                     '''−'''
|}
|}


Revision as of 15:16, 6 March 2017

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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 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.

Fungal

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]
  • Urine antigen testing
 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
  • Elevated liver enzymes
 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

  • + Urine Antigen
 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.
  • Microscopic agglutination test +
 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

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

  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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