Blastomycosis differential diagnosis: Difference between revisions

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==Overview==
==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 these disorders can be often misinterpreted as [[Community-acquired pneumonia|community acquired pneumonia]] as they all present with similar complaints such as [[fever]], [[productive cough]], [[chest pain]] and [[shortness of breath]].  
Blastomycosis has overlapping signs & symptoms with that of other fungal and bacterial disorders. A detailed history, physical examination, and serological tests help us to pinpoint the diagnosis. All these disorders can be often misinterpreted as [[Community-acquired pneumonia|community acquired pneumonia]] as they all present with similar complaints such as [[fever]], [[productive cough]], [[chest pain]] and [[shortness of breath]].  


====Fungal====
====Fungal====
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* [[Hypoalbuminemia]]
* [[Hypoalbuminemia]]
|[[Fungi|Smaller fungi]] with thin cell walls, forming mariner wheel appearance,  circumferentially surrounding the parent cell.( Captain wheel appearance )
|[[Fungi|Smaller fungi]] with thin cell walls, forming mariner wheel appearance,  circumferentially surrounding the parent cell.( Captain wheel appearance )
|-
|-
|[[Sporotrichosis]]
|[[Sporotrichosis]]
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|Ubiquitous
|Ubiquitous
|
|
* [[Cystic fibrosis]] or [[Asthma|asthma.]] [[tuberculosis]].
* [[Cystic fibrosis]] or [[Asthma|asthma.]] [[tuberculosis]].


* [[Immunocompromised]]  
* [[Immunocompromised]]  
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|Live stock handlers
|Live stock handlers
|
|
* 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]]
|
|
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* ↑ [[Troponin]].
* ↑ [[Troponin]].
|[[Motility|Nonmotile]], [[Gram-positive]], [[aerobic]] or facultatively [[anaerobic]], [[endospore]]-forming, [[rod]]-shaped [[bacterium]]
|[[Motility|Nonmotile]], [[Gram-positive]], [[aerobic]] or facultatively [[anaerobic]], [[endospore]]-forming, [[rod]]-shaped [[bacterium]]
|-
|-
|[[Legionella]]
|[[Legionella]]
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* [[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>
* [[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]]
|-
|-
|[[Tuberculosis]]
|[[Tuberculosis]]
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|
|
* [[Hypercalcemia]]
* [[Hypercalcemia]]
* Elevated [[alkaline phosphatase]] levels
* Elevated [[alkaline phosphatase]] levels
* [[fluorescence microscopy]] ([[Auramine-rhodamine stain|auramine-rhodamine staining]])+ for baccilli.
* [[fluorescence microscopy]] ([[Auramine-rhodamine stain|auramine-rhodamine staining]])+ for baccilli.
|[[Aerobic]], [[Capsule|non-encapsulated]], [[Motility|non-motile]], [[acid-fast]] [[bacillus]]
|[[Aerobic]], [[Capsule|non-encapsulated]], [[Motility|non-motile]], [[acid-fast]] [[bacillus]]
|-
|-
|[[Listeriosis]]
|[[Listeriosis]]
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* 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]]


* [[CSF]] analysis :[[Pleocytosis]] [[lymphocytes]]           ↑[[CSF]] [[protein]]          '''↓''' [[CSF]] [[glucose]] 
* [[CSF]] analysis :[[Pleocytosis]] [[lymphocytes]]           ↑[[CSF]] [[protein]]         '''↓''' [[CSF]] [[glucose]]  
|[[Flagellate|flagellated]], [[Catalase|catalase-positive]], facultative [[intracellular]], [[Anaerobe|anaerobic]], [[Spore|nonsporulating]], [[Gram-positive]] [[bacillus]]
|[[Flagellate|flagellated]], [[Catalase|catalase-positive]], facultative [[intracellular]], [[Anaerobe|anaerobic]], [[Spore|nonsporulating]], [[Gram-positive]] [[bacillus]]
|-
|-
|[[Brucellosis]]
|[[Brucellosis]]
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* '''+''' [[Weil-Felix test]]  
* '''+''' [[Weil-Felix test]]  
|a [[Gram-negative]] α-[[Proteobacteria|proteobacterium]]  [[intracellular]] parasite
|a [[Gram-negative]] α-[[Proteobacteria|proteobacterium]] [[intracellular]] parasite
|-
|-
|[[Leptospirosis]]
|[[Leptospirosis]]
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* Microscopic [[Agglutination|agglutination test]] '''+'''
* Microscopic [[Agglutination|agglutination test]] '''+'''
|Spiral-shaped bacteria with hooked ends on dark-field.
|Spiral-shaped bacteria with hooked ends on dark-field.
|-
|-
|[[Cat scratch fever]]
|[[Cat scratch fever]]
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* [[Lymphadenopathy]]
* [[Lymphadenopathy]]


* [[Papule]] or [[Pustules|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 aerobic|facultative]] intracellular parasites
|[[Gram-negative]] [[Bacterium|bacteria]]. [[Facultative aerobic|facultative]] intracellular parasites
|-
|-
| rowspan="2" |Viral
| rowspan="2" |Viral
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* [[Immunocompromised]] persons
* [[Immunocompromised]] persons
|
|
* [[conjunctival]] and [[catarrhal]] symptoms
* [[conjunctival]] and [[catarrhal]] symptoms


* 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.
|                    '''−'''
|                    '''−'''
|-
|-
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|      '''−'''
|      '''−'''
|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

Revision as of 19:56, 29 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 has overlapping signs & symptoms with that of other fungal and bacterial disorders. A detailed history, physical examination, and serological tests help us to pinpoint the diagnosis. All these 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.

Fungal

The following table elaborates differentiating features between Blastomycosis from other fungal disorders:

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.
 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

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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