Hantavirus infection differential diagnosis: Difference between revisions

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{| class="wikitable"
! rowspan="2" |Pathogen
! rowspan="2" |Disease
! rowspan="2" |Geographic distribution
! rowspan="2" |High risk Groups
! colspan="2" |Differentiating features
! rowspan="2" |Microscopic findings
|-
!Physical exam
!Laboratory findings
|-
| rowspan="5" |Fungal
|[[Histoplasmosis]]
|Mississippi and Ohio River valleys
|
* Cave dwellers
* Soil that contains bird or bat dropping<ref name=cdc3>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.</ref>
|
* [[Palate]] and [[oral]] [[ulcers]] 
* [[Splenomegaly]]
|
* [[Pancytopenia]]
* [[Urine]] [[antigen]] testing
|[[Yeast]] are typically smaller, with narrow-based [[budding]], found [[Intracellular|intracellularly]] within [[macrophages]]
|-
|[[Coccidioidomycosis]]
|Southwestern US region
|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>
* [[Night sweats]]
|Serologic tests ([[enzyme]] [[immune]] [[assay]]) more sensitive
|Characteristic spherule appearance
|-
|[[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
|Opportunistic [[infection]] seen in [[HIV AIDS|AIDS]]
|
* [[Lymphadenopathy]]
* [[Hepatosplenomegaly]]
* [[Bone marrow]] dysfunction
|
* Elevated [[liver]] [[enzymes]]
* [[Hyperbilirubinemia]]
* [[Hypoalbuminemia]]
|[[Fungi|Smaller fungi]] with thin [[cell]] walls, forming mariner wheel appearance,  circumferentially surrounding the parent cell. (Captain wheel appearance)
|-
|[[Sporotrichosis]]
|Ubiquitous
|Gardeners <ref name="pmid25614735">{{cite journal |vauthors=Mahajan VK |title=Sporotrichosis: an overview and therapeutic options |journal=Dermatol Res Pract |volume=2014 |issue= |pages=272376 |year=2014 |pmid=25614735 |pmc=4295339 |doi=10.1155/2014/272376 |url=}}</ref>
|
* Extremities 
* [[Lymphadenitis]] (nodular)
|'''+''' Sporotrichin skin test
|Finger or cigar shaped  [[yeast]].
|-
|[[Aspergillosis]]<ref name="pmid20375786">{{cite journal |vauthors=Sherif R, Segal BH |title=Pulmonary aspergillosis: clinical presentation, diagnostic tests, management and complications |journal=Curr Opin Pulm Med |volume=16 |issue=3 |pages=242–50 |year=2010 |pmid=20375786 |pmc=3326383 |doi=10.1097/MCP.0b013e328337d6de |url=}}</ref>
|Ubiquitous
|
* [[Cystic fibrosis]] or [[Asthma|asthma.]] [[tuberculosis]].
* [[Immunocompromised]]
|
* [[Wheezing]]
* Stuffiness, [[runny nose]]
* [[Hemoptysis]]
* [[Weight loss]]
|Cell wall detection using [[galactomannan]] antigen detection, Beta-D-glucan detection test.
|[[Hyphae|Septated hyphae]] with acute angle branching
|-
| rowspan="8" |Bacterial
|[[Anthrax]]
|Ubiquitous
|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>
* [[Bloody diarrhea]]
|
* [[Thrombocytopenia]]
* [[Hyponatremia]]
* '''↑''' [[BUN]]
* [[Hypoalbuminemia]]
* ↑ [[Troponin]].
|[[Motility|Nonmotile]], [[Gram-positive]], [[aerobic]] or facultatively [[anaerobic]], [[endospore]]-forming, [[rod]]-shaped [[bacterium]]
|-
|[[Legionella]]
|Ubiquitous
|Chronic [[lung]] disease
Building water systems
|
* [[Diarrhea]]
* [[Confusion]]
|
* '''+''' [[Urine]] [[antigen]]
* [[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]]
|-
|[[Tuberculosis]]
|Asia,Africa
|Ill contact individuals
|
* [[Night sweats]]
* [[Hemoptysis]]
|
* [[Hypercalcemia]]
* Elevated [[alkaline phosphatase]] levels
* [[fluorescence microscopy]] ([[Auramine-rhodamine stain|auramine-rhodamine staining]])+ for baccilli.
|[[Aerobic]], [[Capsule|non-encapsulated]], [[Motility|non-motile]], [[acid-fast]] [[bacillus]]
|-
|[[Listeriosis]]
|Ubiquitous
|[[Pregnant]] women <ref name="pmid21517700">{{cite journal |vauthors=Lamont RF, Sobel J, Mazaki-Tovi S, Kusanovic JP, Vaisbuch E, Kim SK, Uldbjerg N, Romero R |title=Listeriosis in human pregnancy: a systematic review |journal=J Perinat Med |volume=39 |issue=3 |pages=227–36 |year=2011 |pmid=21517700 |pmc=3593057 |doi=10.1515/JPM.2011.035 |url=}}</ref>
Adults > 65 
[[Immunocompromised]].
|
* [[Pregnancy]] can lead to miscarriage, stillbirth, premature delivery
* Non-pregnant : [[headache]], [[stiff neck]], [[confusion]], loss of balance, and [[convulsions]]
|
* Elevated titers of [[listeriolysin O]]
* [[CSF]] analysis :[[Pleocytosis]] [[lymphocytes]]            ↑[[CSF]] [[protein]]          '''↓''' [[CSF]] [[glucose]]
|[[Flagellate|flagellated]], [[Catalase|catalase-positive]], facultative [[intracellular]], [[Anaerobe|anaerobic]], [[Spore|nonsporulating]], [[Gram-positive]] [[bacillus]]
|-
|[[Brucellosis]]
|
Mexico, South and Central America
|People who take unpasteurized dairy products
|
* [[Arthritis]]
* [[Testicular]] and [[scrotal swelling]]
* [[Endocarditis]]
|
* [[Antibody]] production against[[lipopolysaccharide]] and bacterial antigens
* Relative [[lymphocytosis]] and [[thrombocytopenia]].
|[[Gram-negative bacteria]],[[Motile|non-motile]], [[Encapsulated organisms|encapsulated]] [[Coccobacilli|coccobacilli.]]
|-
|[[Scrub typhus]]
|Asia-Pacific region
Australia
Afghanistan
|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>
|
* [[Maculopapular rash]]
|
* Indirect immunofluorescence
* '''+''' [[Weil-Felix test]]
|a [[gram-negative]] α-[[Proteobacteria|proteobacterium]]  [[intracellular]] [[Parasites|parasite]]
|-
|[[Leptospirosis]]
|Temperate,  tropical climates.
|People who work with animals
|
* [[Jaundice]]
* [[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>
|
* [[Antibodies]] labelled with fluorescent markers positive for leptospires.
* Microscopic [[Agglutination|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<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>
|
* [[Lymphadenopathy]]
* [[Papule]] or [[Pustules|pustule]] at the [[infected]] site
|
* Enzymatic immunoassay positive for  antibody to B henselae
* [[Lymphocytosis]]
|[[Gram-negative]] [[Bacterium|bacteria]]. [[Facultative aerobic|facultative]] intracellular parasites
|-
| rowspan="2" |Viral
|[[Chickenpox]]
|      '''−'''
|
* 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>
* [[Immunocompromised]] persons
|
* [[Conjunctival]] and [[catarrhal]] symptoms
* Spots appearing in two or three waves
|Whole infected cell (wc) [[ELISA]] for IgG.
|                    '''−'''
|-
|[[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>
|Painful [[Blister|blisters]] in the mouth, palms and on  the feet.
[[Rash]], appears after episode of [[high fever]].
|Clinically diagnosed
|                    '''−'''
|-
|Others
|[[Lung cancer|Primary lung cancer]]
|      '''−'''
|Age >65
|
* [[Weight loss]]
* H/o smoking
* [[Hemoptysis]]
|CT guided [[bronchoscopy]] + for [[malignant]] [[cells]]
|                      '''−'''
|}


==References==
==References==

Revision as of 19:36, 7 July 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Differentiating Hantavirus infection from other Diseases

Disease Incubation period Vector Symptoms Physical signs Lab findings Other findings Treatment
Fever Cough Rash Joint pain Myalgia Diarrhea Common hemorrhagic symptoms Characterestic physical finding Icterus Plasma Creatine kinase Confirmatory test
Leptospirosis 2 to 30 days Rodents

Domestic animals

Fever last for 4-7 days, remission for 1-2 days and then relapse + Present over legs Hemorrhagic rash + +

(Severe myalgia is characteristic of leptospirosis typically localized to the calf and lumbar areas)

+ Conjunctival hemorrhage,

Hemoptysis

Conjunctival suffusion + Elevated Microscopic agglutination test of urine History of exposure to soil or water

contaminated by infected rodents

Recent history travel to tropical, sub tropical areas or humid areas

NSAIDs
Dengue 4 to 10 days Aedes mosquito Fever last for 1-2 days,

remission for 1-2 days and then relapse for 1-2 days (Biphasic fever pattern)

- Over legs and trunk

pruritic rash May be hemorrhagic

+ + - Upper gastrointestinal bleeding Painful lymphadenopathy - Normal Serology showing positive IgM or IgG Recent travel to South America, Africa, Southeast Asia Supportive care

Avoid aspirin and other NSAIDs

Malaria Female Anopheles Fever present daily or on alternate day or every 3 days depending on Plasmodium sps. - No rash - + - Bloody urine Hepatosplenomegaly + Normal Giemsa stained thick and thin blood smears Recent travel to South America, Africa, Southeast Asia Anti malarial regimen
Ebola 2 to 21 days. No vector

Human to human transmission

Air born disease

+ + Maculopapular

non-pruritic rash with erythema

Centripetal distribution

+ + +

May be bloody in the early phase

Epistaxis

Mucosal bleeding

Sudden onset of high fever with conjunctival injection and early gastrointestinal symptoms - Normal RT-PCR Recent visit to endemic area especially African countries Isolation of the patient,

supportive therapy

Influenza 1-4 days No vector

Air born disease

+ + +/- + + + - Fever and upper respiratory symptoms - Normal Viral culture or PCR Health care workers

Patients with co-morbid conditions

Symptomatic treatment

Oseltamivir or zanamivir

Yellow fever 3 to 6 days Aedes or Haemagogus species mosquitoes + + - - + - Conjunctival hemorrhage,

Hemoptysis

Relative bradycardia

(Faget's sign)

+ Normal RT-PCR,

Nucleic acid amplification test,

Immuno-histochemical staining

Recent travel to  Africa, South and Central America, and the Caribbean.

Tropical rain forests of south America

Symptomatic treatment,

Anti-inflammatory drugs

Typhoid fever 6 to 30 days No vector

Air born disease

+ - Blanching erythematous 

maculopapularlesions on the lower chest and abdomen

+ + + Intestinal bleeding Rose spots - Normal Blood or stool culture showing salmonella typhi sps. Residence in endemic area

Recent travel to endemic area

Fluoroquinolones,

Third generation cephalosporins,

Azithromycin

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]
 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 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

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 −

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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