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+++, occurs frequently
+++, occurs frequently
Legionellosis must be differentiated from other diseases that cause [[atypical pneumonia]] such as Q fever and mycoplasma pneumonia
{| class="wikitable"
!Disease
!Prominent clinical features
!Lab findings
!Chest X-ray
|-
|Q fever
|
* Q fever is characterized by abrupt onset of [[fever]], [[myalgia]], [[headache]], and other constitutional symptoms.
* [[Cough]] is the most prominent respiratory symptom and it is usually dry.<ref name="pmid23422417">{{cite journal |vauthors=Irfan M, Farooqi J, Hasan R |title=Community-acquired pneumonia |journal=Curr Opin Pulm Med |volume=19 |issue=3 |pages=198–208 |year=2013 |pmid=23422417 |doi=10.1097/MCP.0b013e32835f1d12 |url=}}</ref>
* [[Cough]] is associated with [[dyspnea]] and [[pleuritic chest pain]].
|
* [[Antibody]] detection using [[Immunofluorescence|indirect immunofluorescence]] (IIF) is the preferred method for diagnosis.
* [[Polymerase chain reaction|PCR]] can be used if IIF is negative, or very early once disease is suspected.
* [[Coxiella burnetii|''C. burnetii'']] does not grow on ordinary blood cultures, but can be cultivated on special media such as embryonated eggs or cell culture.
* A two-to-three fold increase in [[Aspartate transaminase|AST]] and [[ALT]] is seen in most patients.
|
[[Image:Q fever.gif|center|300px|thumb|Q fever pneumonia - - Case courtesy of Royal Melbourne Hospital Respiratory, Radiopaedia.org, rID 21993 ]]
|-
|[[mycoplasma pneumonia|''Mycoplasma'' pneumonia]]
|
* [[mycoplasma pneumonia|''Mycoplasma'' pneumonia]] can be [[asymptomatic]].
* [[Headache]], [[Nausea and vomiting|nausea]], and [[malaise]] usually precede the onset of symptoms.<ref name="pmid23422417">{{cite journal |vauthors=Irfan M, Farooqi J, Hasan R |title=Community-acquired pneumonia |journal=Curr Opin Pulm Med |volume=19 |issue=3 |pages=198–208 |year=2013 |pmid=23422417 |doi=10.1097/MCP.0b013e32835f1d12 |url=}}</ref>
* [[Cough]] is intractable and nonproductive.
|
* Postitve [[Coombs test]]
* [[Leukocytosis]]
* [[Thrombocytosis]]
|
[[Image:Atypical-pneumonia-mycoplasma - Case courtesy of Dr Alborz Jahangiri, Radiopaedia.org, rID 45781.jpg|center|300px|thumb|Mycoplasma pneumonia - Case courtesy of Dr Alborz Jahangiri, Radiopaedia.org, rID 45781]]
|-
|[[Legionellosis]]
|
* [[Legionellosis]] is characterized by cough that is slightly productive.<ref name="pmid23422417">{{cite journal |vauthors=Irfan M, Farooqi J, Hasan R |title=Community-acquired pneumonia |journal=Curr Opin Pulm Med |volume=19 |issue=3 |pages=198–208 |year=2013 |pmid=23422417 |doi=10.1097/MCP.0b013e32835f1d12 |url=}}</ref>
* Constitutional symptoms such as [[chills]], [[myalgia]], and [[arthralgia]].
* Gastrointestinal symptoms such as [[diarrhea]], [[nausea]], and [[vomiting]].
|
* Labs are nonspecific for diagnosing [[legionellosis]]
* [[Renal dysfunction|Renal]] and [[hepatic dysfunction]]
* [[Thrombocytopenia]] and [[leukocytosis]]
* [[Hyponatremia]]
|
[[Image:Legionella-pneumonia - Case courtesy of Dr Henry Knipe, Radiopaedia.org, rID 31816.jpg|center|300px|thumb|Legionella pneumonia - Case courtesy of Dr Henry Knipe, Radiopaedia.org, rID 31816 ]]
|-
|[[Chlamydia pneumonia]]
|
* There are no specific clinical features of [[chlamydia pneumonia]].
* Symptoms appear gradually.
* [[Chlamydia infection]] is usually associated with [[upper respiratory tract]] symptoms ([[pharyngitis]], [[sinusitis]], etc).
* It might be associated with extrapulmonary maifestations such as [[meningitis]] and [[Guillain-Barre syndrome]].<ref name="pmid23422417">{{cite journal |vauthors=Irfan M, Farooqi J, Hasan R |title=Community-acquired pneumonia |journal=Curr Opin Pulm Med |volume=19 |issue=3 |pages=198–208 |year=2013 |pmid=23422417 |doi=10.1097/MCP.0b013e32835f1d12 |url=}}</ref>
|
* [[Chlamydia pneumonia]] is usually associated with normal [[WBC|WBC count.]]
* Diagnosed with the presence of [[Antibody|antichlamydial antibody]] (through [[complement fixation]] or direct immunofluoroscence) or direct antigen detection.
|
[[Image:Chlamydia-pneumonia - Case courtesy of Dr Andrew Dixon, Radiopaedia.org, rID 14567.jpg|center|300px|thumb|Chlamydia-pneumonia - Case courtesy of Dr Andrew Dixon, Radiopaedia.org, rID 14567]]
|}


==References==
==References==

Revision as of 15:28, 29 August 2017

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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

The following conditions must be considered in the differential diagnosis of Legionnaires' disease: DDx [1][2][3][4][5][6][7]


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


Template:WikiDoc Sources

Clinical manifestations
Laboratory abnormalities
Radiographic features


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


Template:WikiDoc Sources

Clinical manifestations
Laboratory abnormalities
  • Nonspecific
Radiographic features


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


Template:WikiDoc Sources

Clinical manifestations
Laboratory abnormalities
Radiographic features


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


Template:WikiDoc Sources

Clinical manifestations
Laboratory abnormalities
Radiographic features


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


Template:WikiDoc Sources

Clinical manifestations
Laboratory abnormalities
Radiographic features


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


Template:WikiDoc Sources

Clinical manifestations
Laboratory abnormalities
Radiographic features


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


Template:WikiDoc Sources

Clinical manifestations
Laboratory abnormalities
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


Template:WikiDoc Sources

Clinical manifestations
Laboratory abnormalities
Radiographic features


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
  • No changes seen
 - + - Doxycycline
C.pneumoniae pneumonia + + + +++ ++ + -
  • Minimal changes observed
 - - - Doxycycline, Azithromycin
M. pneumoniae pneumonia ++ ++ ++ - - - - - - + Doxycycline
L. Pneumophila infection + +++ +++ - + ++ + Often Multifocal ++ + ++ Doxycycline
Influenza ++ ++ ++ ++ ++ +/- +/- - - - zanamivir, oseltamivir,
Endocarditis ++ ++ + - - - -
  • Hazy opacities at lung

bases bilaterally

- +/- +/- Vancomycin
Coxiella burnetii infection ++ - + +/- - +/- Minimal - +/- =/- Doxycycline
Leptospirosis ++ + ++ + + ++ -
  • Multiple ill-defined nodules in both lungs.
 +++ Doxycycline, azithromycin, amoxicillin
Brucellosis ++ - + - ++ + - -/+ +/- +/- Doxycycline, rifampin

Key;

+, occurs in some cases

++, occurs in many cases,

+++, occurs frequently

Legionellosis must be differentiated from other diseases that cause atypical pneumonia such as Q fever and mycoplasma pneumonia

Disease Prominent clinical features Lab findings Chest X-ray
Q fever
  • Antibody detection using indirect immunofluorescence (IIF) is the preferred method for diagnosis.
  • PCR can be used if IIF is negative, or very early once disease is suspected.
  • C. burnetii does not grow on ordinary blood cultures, but can be cultivated on special media such as embryonated eggs or cell culture.
  • A two-to-three fold increase in AST and ALT is seen in most patients.
Q fever pneumonia - - Case courtesy of Royal Melbourne Hospital Respiratory, Radiopaedia.org, rID 21993
Mycoplasma pneumonia
Mycoplasma pneumonia - Case courtesy of Dr Alborz Jahangiri, Radiopaedia.org, rID 45781
Legionellosis
Legionella pneumonia - Case courtesy of Dr Henry Knipe, Radiopaedia.org, rID 31816
Chlamydia pneumonia
Chlamydia-pneumonia - Case courtesy of Dr Andrew Dixon, Radiopaedia.org, rID 14567

References

  1. ↑ 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.
  2. ↑ Siegenthaler, Walter (2007). Differential diagnosis in internal medicine: from symptom to diagnosis. Stuttgart New York: Thieme. ISBN 978-1588905512.
  3. ↑ Mesko, Dusan (2002). Differential diagnosis by laboratory medicine: a quick reference for physicians. Berlin New York: Springer-Verlag. ISBN 978-3540430575.
  4. ↑ Reeder and Felson's gamuts in radiology: comprehensive lists of roentgen differential diagnosis. Place of publication not identified: Springer. 2014. ISBN 978-1475781229.
  5. ↑ Burgener, Francis (2008). Differential diagnosis in conventional radiology. Stuttgart New York: Thieme. ISBN 978-1588902757.
  6. ↑ Gattuso, Paolo (2015). Differential diagnosis in surgical pathology. Philadelphia, PA: Saunders/Elsevier. ISBN 978-1455770137.
  7. ↑ "DXplain".
  8. ↑ 8.0 8.1 8.2 8.3 Irfan M, Farooqi J, Hasan R (2013). "Community-acquired pneumonia". Curr Opin Pulm Med. 19 (3): 198–208. doi:10.1097/MCP.0b013e32835f1d12. PMID 23422417.
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