Q fever differential diagnosis: Difference between revisions

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Revision as of 18:31, 3 August 2017

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Ahmed Younes M.B.B.CH [2]

Overview

Q fever must be differentiated from other diseases that cause atypical pneumonia such as Mycoplasma pneumonia and legionellosis.

Differentiating Q fever from other diseases

Q fever must be differentiated from other diseases that cause atypical pneumonia such as Mycoplasma pneumonia and legionellosis.

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.^[1] Cough is associated with dyspnea and pleuritic chest pain.	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 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 can be asymptomatic. Headache, nausea, and malaise usually precede the onset of symptoms.^[1] Cough is intractable and nonproductive.	Postitve Coombs test Leukocytosis Thrombocytosis	Mycoplasma pneumonia - Case courtesy of Dr Alborz Jahangiri, Radiopaedia.org, rID 45781
Legionellosis	Legionellosis is characterized by cough that is slightly productive.^[1] Constitutional symptoms such as chills, myalgia, and arthralgia. Gastrointestinal symptoms such as diarrhea, nausea and vomiting.	Labs are nonspecific for diagnosing legionellosis Renal and hepatic dysfunction Thrombocytopenia and leukocytosis Hyponatremia	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.^[1]	Chlamydia pneumonia is usually associated with normal WBC count. Diagnosed with the presence of antichlamydial antibody (through complement fixation or direct immunofluoroscence) or direct antigen detection.	Chlamydia-pneumonia - Case courtesy of Dr Andrew Dixon, Radiopaedia.org, rID 14567

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	++	++	++	-	-	-	-	Bronchial wall thickening Centrilobular nodules Ground-glass attenuation Consolidation	-	-	+	Doxycycline
L. Pneumophila infection	+	+++	+++	-	+	++	+	Often Multifocal	++	+	++	Doxycycline
Influenza	++	++	++	++	++	+/-	+/-	Bi-basal air-space opacities Perihilar reticular and alveolar infiltrates	-	-	-	zanamivir, oseltamivir,
Endocarditis	++	++	+	-	-	-	-	Hazy opacities at lung bases bilaterally	-	+/-	+/-	Vancomycin
Coxiella burnetii infection	++	-	+	+/-	-	+/-	Minimal	Segmental or lobar opacification Occasional pleural effusions	-	+/-	=/-	Doxycycline
Leptospirosis	++	+	++	+	+	++	-	Multiple ill-defined nodules in both lungs.	+++			Doxycycline, azithromycin, amoxicillin
Brucellosis	++	-	+	-	++	+	-	Soft miliary mottling Parenchymal nodules Consolidation Chronic diffuse changes Hilar or paratracheal lymphadenopathy Pneumothorax	-/+	+/-	+/-	Doxycycline, rifampin

Key;

+, occurs in some cases

++, occurs in many cases,

+++, occurs frequently

References

↑ ^1.0 ^1.1 ^1.2 ^1.3 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.

Template:WikiDoc Sources

[pmid23422417-1] 1.0 ^1.1 ^1.2 ^1.3 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.

[1]

@@ Line 3: / Line 3: @@
 {{CMG}};{{AE}}{{AY}}
 ==Overview==
-Q fever must be differentiated from other diseases that cause [[atypical pneumonia]]  such as [[mycoplasma pneumonia]] and [[legionella pneumonia]].
+Q fever must be differentiated from other diseases that cause [[atypical pneumonia]] such as [[mycoplasma pneumonia|''Mycoplasma'' pneumonia]] and [[legionellosis]].
 ==Differentiating Q fever from other diseases==
-Q fever must be differentiated from other diseases that cause [[atypical pneumonia]]  such as [[mycoplasma pneumonia|''mycoplasma pneumonia'']] and [[legionella pneumonia|''legionella pneumonia'']].
+Q fever must be differentiated from other diseases that cause [[atypical pneumonia]] such as [[mycoplasma pneumonia|''Mycoplasma'' pneumonia]] and [[legionellosis]].
 {| class="wikitable"
 !Disease
@@ Line 14: / Line 14: @@
 |Q fever
 |
-* Q fever is characterized by abrupt onset of [[fever]], [[myalgia]], [[headache]] and other constitutional symptoms.
+* 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.
+* [[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.
+* [[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 as embryonated eggs or cell culture.
+* [[Coxiella burnetii|''C. burnetii'']] does not grow on ordinary blood cultures, but can be cultivated on special media as embryonated eggs or cell culture.
-* Two to three fold increase in [[Aspartate transaminase|AST]] and [[ALT]] is seen in most of the patients.
+* 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
+* [[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>
+* [[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]] which is intractable and nonproductive
+* [[Cough]] is intractable and nonproductive.
 |
-* Postitve [[Coombs test|Coomb’s test]]
+* Postitve [[Coombs test]]
 * [[Leukocytosis]]
 * [[Thrombocytosis]]
@@ Line 39: / Line 39: @@
 |[[Legionellosis]]
 |
-* [[Legionella pneumophila|Legionella pneumonia]] 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>
+* [[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, arthralgia
+* Constitutional symptoms such as [[chills]], [[myalgia]], and [[arthralgia]].
-* Gastrointestinal symptoms such as diarrhea, nausea and vomiting.
+* Gastrointestinal symptoms such as [[diarrhea]], [[nausea]] and [[vomiting]].
 |
-* Labs are non specific for diagnosing [[legionella pneumonia]]
+* Labs are nonspecific for diagnosing [[legionellosis]]
 * [[Renal dysfunction|Renal]] and [[hepatic dysfunction]]
 * [[Thrombocytopenia]] and [[leukocytosis]]
@@ Line 52: / Line 52: @@
 |[[Chlamydia pneumonia]]
 |
-* There are no specific clinical features for 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).
+* [[Chlamydia infection]] is usually associated with [[upper respiratory tract]] symptoms ([[pharyngitis]], [[sinusitis]], etc).
-* It might be associated with extrapulmonary manifestaions 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>
+* 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.]]
-* It's diagnosed with the presence of [[Antibody|antichlamydial antibody]] (through complement fixation or direct immunofluoroscence) or direct antigen detection.
+* 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]]
 |}
-'''Table 1; Differentiating psittacosis from other diseases'''
+'''Table 1: Differentiating [[psittacosis]] from other diseases'''
 {| class="wikitable"
@@ Line 219: / Line 219: @@
 * [[Chronic (medical)|Chronic]] [[diffuse]] changes
 * [[Hilar]] or [[Paratracheal lymph nodes|paratracheal]] [[lymphadenopathy]]
-* [[Pneumothorax]].
+* [[Pneumothorax]]
 | -/+
 | +/-

Q fever differential diagnosis: Difference between revisions

Revision as of 18:31, 3 August 2017

Overview

Differentiating Q fever from other diseases

References

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