Brucellosis differential diagnosis: Difference between revisions

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|Constant fatigue  
|Constant fatigue  
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'''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


==Reference==
==Reference==

Revision as of 14:47, 27 July 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Danitza Lukac Vishal Devarkonda, M.B.B.S[2]

Overview

Brucellosis must be differentiated from typhoid fever, malaria, tuberculosis, lymphoma, dengue, leptospirosis, rheumatic disease, epstein-barr virus, toxoplasmosis, cytomegalovirus, and HIV.

Differentiating Brucellosis from other Diseases

Brucellosis must be differentiated from typhoid fever, malaria, tuberculosis, lymphoma, Dengue, Leptospirosis, Rheumatic disease, epstein-barr virus, Toxoplasmosis, cytomegalovirus, and HIV.[1][2][3][4]

A detailed clinical history which includes recent travel history, recent camping or hunting, consumption of unpasteurized milk or raw meat products, and occupational history should be obtained, in order to differentiate brucellosis from other diseases.

Differential diagnosis of Brucellosis Symptoms Signs Diagnosis Additional Findings
Fever Rash Diarrhea Abdominal pain Weight loss Painful lymphadenopathy Hepatosplenomegaly Arthritis Lab Findings
Brucellosis + + - + + + + + Relative lymphocytosis

Night sweats, often with characteristic smell, likened to wet hay

Typhoid fever + + - + - - + + Decreased hemoglobin Incremental increase in temperature initially and than sustained fever as high as 40°C (104°F)
Malaria + - + + - - + + Microcytosis,

elevated LDH

"Tertian" fever: paroxysms occur every second day
Tuberculosis + + - + + + - + Mild normocytic anemia, hyponatremia, and

hypercalcemia

Night sweats, constant fatigue
Lymphoma + - - + + - + - Increase ESR, increased LDH Night sweats, constant fatigue
Mumps + - - - - + - - Relative lymphocytosis, serum amylase elevated Parotid swelling/tenderness
Rheumatoid arthritis - + - - - - - + ESR and CRP elevated, positive rheumatoid factor Morning stiffness
SLE - + - + + - - + ESR and CRP elevated, positive ANA Fatigue
HIV - - - + + + - + Constant fatigue

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

Reference

  1. ↑ Pappas G, Akritidis N, Bosilkovski M, Tsianos E (2005). "Brucellosis". N Engl J Med. 352 (22): 2325–36. doi:10.1056/NEJMra050570. PMID 15930423.
  2. ↑ Brucellosis "Dennis Kasper, Anthony Fauci, Stephen Hauser, Dan Longo, J. Larry Jameson, Joseph Loscalzo"Harrison's Principles of Internal Medicine, 19e Accessed on January,2017
  3. ↑ Young EJ (1995). "Brucellosis: current epidemiology, diagnosis, and management". Curr Clin Top Infect Dis. 15: 115–28. PMID 7546364.
  4. ↑ Enfermedades infecciosas: Brucelosis -Diagnóstico de Brucelosis,Guia para el Equipo de Salud. Ministerio de Salud-Argentina. http://www.msal.gob.ar/images/stories/bes/graficos/0000000304cnt-guia-medica-brucelosis.pdf. Accessed on February 2, 2016
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