Legionellosis differential diagnosis: Difference between revisions
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* Lobar [[Consolidation (medicine)|consolidation]] on [[chest radiograph]] | * Lobar [[Consolidation (medicine)|consolidation]] on [[chest radiograph]] | ||
* Interstitial infiltrate on [[chest radiograph]] | * Interstitial infiltrate on [[chest radiograph]] | ||
'''Table 1; Differentiating psittacosis from other diseases''' | |||
{| class="wikitable" | |||
!Clinical feature | |||
![[Cough]] | |||
![[Sputum]] | |||
![[Dyspnea]] | |||
![[Sore throat]] | |||
![[Headache]] | |||
![[Confusion]] | |||
![[Diarrhea]] | |||
!Chest radiograph changes | |||
!Hyponatremia | |||
![[Leukopenia]] | |||
!Abnormal Liver function tests | |||
!Treatment | |||
|- | |||
|Psittacosis | |||
| ++ | |||
| - | |||
| + | |||
| - | |||
| +++ | |||
| + | |||
|Minimal | |||
| | |||
* No changes seen | |||
| - | |||
| + | |||
| - | |||
|[[Doxycycline]] | |||
|- | |||
|[[Chlamydia pneumoniae|''C.pneumoniae'']] pneumonia | |||
| + | |||
| + | |||
| + | |||
| +++ | |||
| ++ | |||
| + | |||
| - | |||
| | |||
* Minimal changes observed | |||
| - | |||
| - | |||
| - | |||
|[[Doxycycline]], [[Azithromycin]] | |||
|- | |||
|[[Mycoplasma pneumoniae|''M. pneumoniae'']] pneumonia | |||
| ++ | |||
| ++ | |||
| ++ | |||
| - | |||
| - | |||
| - | |||
| - | |||
| | |||
* Bronchial wall thickening | |||
* Centrilobular nodules | |||
* [[Ground glass opacification on CT|Ground-glass attenuation]] | |||
* [[Consolidation (medicine)|Consolidation]] | |||
| - | |||
| - | |||
| + | |||
|[[Doxycycline]] | |||
|- | |||
|[[Legionella pneumophila|''L. Pneumophila'']] infection | |||
| + | |||
| +++ | |||
| +++ | |||
| - | |||
| + | |||
| ++ | |||
| + | |||
|Often Multifocal | |||
| ++ | |||
| + | |||
| ++ | |||
|[[Doxycycline]] | |||
|- | |||
|[[Influenza (Flu) (For Patients)|Influenza]] | |||
| ++ | |||
| ++ | |||
| ++ | |||
| ++ | |||
| ++ | |||
| +/- | |||
| +/- | |||
| | |||
* Bi-basal air-space opacities | |||
* Perihilar [[reticular]] and [[Alveolar|alveolar infiltrates]] | |||
| - | |||
| - | |||
| - | |||
|[[zanamivir]], [[oseltamivir]], | |||
|- | |||
|[[Endocarditis]] | |||
| ++ | |||
| ++ | |||
| + | |||
| - | |||
| - | |||
| - | |||
| - | |||
| | |||
* Hazy opacities at [[lung]] | |||
bases bilaterally | |||
| - | |||
| +/- | |||
| +/- | |||
|[[Vancomycin]] | |||
|- | |||
|[[Coxiella burnetii infection|''Coxiella burnetii'' infection]] | |||
| ++ | |||
| - | |||
| + | |||
| +/- | |||
| - | |||
| +/- | |||
|Minimal | |||
| | |||
* [[Segmental analysis (biology)|Segmental]] or [[Lobar pneumonia|lobar]] opacification | |||
* Occasional [[pleural effusions]] | |||
| - | |||
| +/- | |||
|=/- | |||
|[[Doxycycline]] | |||
|- | |||
|[[Leptospirosis]] | |||
| ++ | |||
| + | |||
| ++ | |||
| + | |||
| + | |||
| ++ | |||
| - | |||
| | |||
* Multiple ill-defined [[Nodule (medicine)|nodules]] in both lungs. | |||
| +++ | |||
| | |||
| | |||
|[[Doxycycline]], [[azithromycin]], [[amoxicillin]] | |||
|- | |||
|[[Brucellosis]] | |||
| ++ | |||
| - | |||
| + | |||
| - | |||
| ++ | |||
| + | |||
| - | |||
| | |||
* Soft [[Miliary TB|miliary]] mottling | |||
* [[Parenchymal lung disease|Parenchymal nodules]] | |||
* [[Consolidation (medicine)|Consolidation]] | |||
* [[Chronic (medical)|Chronic]] [[diffuse]] changes | |||
* [[Hilar]] or [[Paratracheal lymph nodes|paratracheal]] [[lymphadenopathy]] | |||
* [[Pneumothorax]]. | |||
| -/+ | |||
| +/- | |||
| +/- | |||
|[[Doxycycline]], [[rifampin]] | |||
|} | |||
Key; | |||
+, occurs in some cases | |||
++, occurs in many cases, | |||
+++, occurs frequently | |||
==References== | ==References== |
Revision as of 14:41, 27 July 2017
Legionellosis Microchapters |
Diagnosis |
---|
Treatment |
Case Studies |
Legionellosis differential diagnosis On the Web |
American Roentgen Ray Society Images of Legionellosis differential diagnosis |
Risk calculators and risk factors for Legionellosis differential diagnosis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Legionellosis must be differentiated from other causes of fever, dyspnea, cough, and sputum production, such as bacterial pneumonia, viral pneumonia, and other causes of atypical pneumonia.
Differential Diagnosis
DDx
[1][2][3][4][5][6][7]- Acute interstitial pneumonia
[[#Findings suggestive of Acute interstitial pneumonia: Return to Top|DDx]]
- Mycoplasma pneumonia
[[#Findings suggestive of Mycoplasma pneumonia: Return to Top|DDx]]
- Pulmonary embolism
[[#Findings suggestive of Pulmonary embolism: Return to Top|DDx]]
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2] Mahshid Mir, M.D. [3]
Differential Diagnosis | |
---|---|
DDx Alphabetic Order | |
A | B |
C | D |
E | F |
G | H |
I | J |
K | L |
M | N |
O | P |
Q | R |
S | T |
U | V |
W | X |
Y | Z |
Clinical manifestations
- Adult respiratory distress syndrome
- Bronchial breath sounds
- Dry cough
- High grade fever
- Progressive dyspnea
Laboratory abnormalities
- Legionella urinary antigen positive
- Leukocytosis with relative lymphopenia
- Hyponatremia
- Hypophosphatemia
Radiographic features
- Alveolar consolidation on chest radiograph
- Lobar consolidation on chest radiograph
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [4] Mahshid Mir, M.D. [5]
Differential Diagnosis | |
---|---|
DDx Alphabetic Order | |
A | B |
C | D |
E | F |
G | H |
I | J |
K | L |
M | N |
O | P |
Q | R |
S | T |
U | V |
W | X |
Y | Z |
Clinical manifestations
Laboratory abnormalities
- Nonspecific
Radiographic features
- Disseminated consolidation on chest radiograph
- Interstitial infiltrate on chest radiograph
- Increased uptake on gallium scan
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [6] Mahshid Mir, M.D. [7]
Differential Diagnosis | |
---|---|
DDx Alphabetic Order | |
A | B |
C | D |
E | F |
G | H |
I | J |
K | L |
M | N |
O | P |
Q | R |
S | T |
U | V |
W | X |
Y | Z |
Clinical manifestations
- Dry cough
- Pleuritic chest pain
- Bronchial breath sounds
- Inflamed, opaque, hypomobile tympanic membrane
Laboratory abnormalities
- Lymphocytosis
- Cold agglutinins positive
Radiographic features
- Alveolar consolidation on chest radiograph
- Interstitial infiltrate on chest radiograph
- Lobar consolidation on chest radiograph
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [8] Mahshid Mir, M.D. [9]
Differential Diagnosis | |
---|---|
DDx Alphabetic Order | |
A | B |
C | D |
E | F |
G | H |
I | J |
K | L |
M | N |
O | P |
Q | R |
S | T |
U | V |
W | X |
Y | Z |
Clinical manifestations
- High grade fever
- Hemoptysis
- Fine rales
- Pleuritic chest pain
- Increased breath sounds
- Bronchial breath sounds
- Dullness on chest percussion
- Purulent sputum
- Shallow respiration
- Pectoriloquy
- Increased tactile fremitus
- Productive cough
- Egophony
Laboratory abnormalities
- Gram positive diplococci on sputum Gram stain
- Pleural effusion (exudative)
- Respiratory alkalosis
Radiographic features
- Parenchymal hyperlucency on chest radiograph
- Increased uptake on gallium scan
- Unilateral diaphragm elevation on chest radiograph
- Alveolar consolidation on chest radiograph
- Lobar consolidation on chest radiograph
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [10] Mahshid Mir, M.D. [11]
Differential Diagnosis | |
---|---|
DDx Alphabetic Order | |
A | B |
C | D |
E | F |
G | H |
I | J |
K | L |
M | N |
O | P |
Q | R |
S | T |
U | V |
W | X |
Y | Z |
Clinical manifestations
Laboratory abnormalities
- Respiratory alkalosis
- Serum beta-D-glucan elevation
Radiographic features
- Alveolar consolidation on chest radiograph
- Lobar consolidation on chest radiograph
- Interstitial infiltrate on chest radiograph
- Pneumomediastinum on chest radiograph
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [12] Mahshid Mir, M.D. [13]
Differential Diagnosis | |
---|---|
DDx Alphabetic Order | |
A | B |
C | D |
E | F |
G | H |
I | J |
K | L |
M | N |
O | P |
Q | R |
S | T |
U | V |
W | X |
Y | Z |
Clinical manifestations
- Calf pain or swelling
- Decreased pulse pressure
- Dyspnea
- Hemoptysis
- Hyperventilation
- Immobility
- Increased pulmonic component of heart sound
- Pleuritic chest pain
- Prior DVT
- Pulmonary hypertension
- Right ventricular heave
- Right-to-left shunt
- Substernal chest pain
- Tachypnea
- Thrombophlebitis
- Venous stasis
- Bone fracture
Laboratory abnormalities
- D-dimer elevation
- Hypocapnia
- Hypoxia
- Pleural effusion (exudative or bloody)
- Atrial fibrillation on ECG
- Right axis deviation on ECG
- Right ventricular overload on ECG
Radiographic features
- Normal chest radiograph
- Atelectasis on chest radiograph
- Lobar consolidation on chest radiograph
- Prominent pulmonary artery on chest radiograph
- Hampton's hump on chest radiograph
- Right ventricular enlargement on echocardiography
- Thrombus on echocardiography
- Segmental perfusion defect on lung scan
- V/Q mismatch on lung scan
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [14] Mahshid Mir, M.D. [15]
Differential Diagnosis | |
---|---|
DDx Alphabetic Order | |
A | B |
C | D |
E | F |
G | H |
I | J |
K | L |
M | N |
O | P |
Q | R |
S | T |
U | V |
W | X |
Y | Z |
Clinical manifestations
- Pectoriloquy
- Bronchial breath sounds
- Erythema nodosum
- Purulent sputum
- Shallow respiration
- Increased tactile fremitus
- Pleuritic chest pain
- Egophony
Laboratory abnormalities
- Gram-positive cocci in chains on sputum Gram stain
- Respiratory alkalosis
- Pleural effusion (exudative)
Radiographic features
- Alveolar consolidation on chest radiograph
- Lobar consolidation on chest radiograph
- Empyema on chest radiograph
- Increased uptake on gallium scan
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [16] Mahshid Mir, M.D. [17]
Differential Diagnosis | |
---|---|
DDx Alphabetic Order | |
A | B |
C | D |
E | F |
G | H |
I | J |
K | L |
M | N |
O | P |
Q | R |
S | T |
U | V |
W | X |
Y | Z |
Clinical manifestations
- Pleuritic chest pain
- Bronchial breath sounds
- Recent influenza
- Fine rales
- Bronchovesicular breath sounds
Laboratory abnormalities
Radiographic features
- Lobar consolidation on chest radiograph
- Interstitial infiltrate on chest radiograph
Table 1; Differentiating psittacosis from other diseases
Clinical feature | Cough | Sputum | Dyspnea | Sore throat | Headache | Confusion | Diarrhea | Chest radiograph changes | Hyponatremia | Leukopenia | Abnormal Liver function tests | Treatment |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Psittacosis | ++ | - | + | - | +++ | + | Minimal |
|
- | + | - | Doxycycline |
C.pneumoniae pneumonia | + | + | + | +++ | ++ | + | - |
|
- | - | - | Doxycycline, Azithromycin |
M. pneumoniae pneumonia | ++ | ++ | ++ | - | - | - | - |
|
- | - | + | Doxycycline |
L. Pneumophila infection | + | +++ | +++ | - | + | ++ | + | Often Multifocal | ++ | + | ++ | Doxycycline |
Influenza | ++ | ++ | ++ | ++ | ++ | +/- | +/- |
|
- | - | - | zanamivir, oseltamivir, |
Endocarditis | ++ | ++ | + | - | - | - | - |
bases bilaterally |
- | +/- | +/- | Vancomycin |
Coxiella burnetii infection | ++ | - | + | +/- | - | +/- | Minimal |
|
- | +/- | =/- | Doxycycline |
Leptospirosis | ++ | + | ++ | + | + | ++ | - |
|
+++ | Doxycycline, azithromycin, amoxicillin | ||
Brucellosis | ++ | - | + | - | ++ | + | - |
|
-/+ | +/- | +/- | Doxycycline, rifampin |
Key;
+, occurs in some cases
++, occurs in many cases,
+++, occurs frequently
References
- ↑ Ferri, Fred (2011). Ferri's differential diagnosis: a practical guide to the differential diagnosis of symptoms, signs, and clinical disorders. Philadelphia, PA: Elsevier/Mosby. ISBN 978-0323076999.
- ↑ Siegenthaler, Walter (2007). Differential diagnosis in internal medicine: from symptom to diagnosis. Stuttgart New York: Thieme. ISBN 978-1588905512.
- ↑ Mesko, Dusan (2002). Differential diagnosis by laboratory medicine: a quick reference for physicians. Berlin New York: Springer-Verlag. ISBN 978-3540430575.
- ↑ Reeder and Felson's gamuts in radiology: comprehensive lists of roentgen differential diagnosis. Place of publication not identified: Springer. 2014. ISBN 978-1475781229.
- ↑ Burgener, Francis (2008). Differential diagnosis in conventional radiology. Stuttgart New York: Thieme. ISBN 978-1588902757.
- ↑ Gattuso, Paolo (2015). Differential diagnosis in surgical pathology. Philadelphia, PA: Saunders/Elsevier. ISBN 978-1455770137.
- ↑ "DXplain".