Q fever differential diagnosis: Difference between revisions

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{{CMG}};{{AE}}{{AY}}
{{CMG}};{{AE}}{{AY}}
==Overview==
==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==
==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"
{| class="wikitable"
!Disease
!Disease
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|Q fever
|Q fever
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* 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 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]].
* [[Cough]] is associated with [[dyspnea]] and [[pleuritic chest pain]].
|
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* [[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.
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[[Image:Q fever.gif|center|300px|thumb|Q fever pneumonia - - Case courtesy of Royal Melbourne Hospital Respiratory, Radiopaedia.org, rID 21993 ]]
[[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]]
|
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* [[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.
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* Postitve [[Coombs test|Coomb’s test]]
* Postitve [[Coombs test]]
* [[Leukocytosis]]
* [[Leukocytosis]]
* [[Thrombocytosis]]
* [[Thrombocytosis]]
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|[[Legionellosis]]
|[[Legionellosis]]
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* [[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]].
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* Labs are non specific for diagnosing [[legionella pneumonia]]  
* Labs are nonspecific for diagnosing [[legionellosis]]  
* [[Renal dysfunction|Renal]] and [[hepatic dysfunction]]  
* [[Renal dysfunction|Renal]] and [[hepatic dysfunction]]  
* [[Thrombocytopenia]] and [[leukocytosis]]  
* [[Thrombocytopenia]] and [[leukocytosis]]  
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|[[Chlamydia pneumonia]]
|[[Chlamydia pneumonia]]
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* There are no specific clinical features for chlamydia pneumonia.
* There are no specific clinical features of [[chlamydia pneumonia]].
* Symptoms appear gradually.
* 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>
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* [[Chlamydia pneumonia]] is usually associated with normal [[WBC|WBC count.]]
* [[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.
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[[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]]
[[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]]
|}
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'''Table 1; Differentiating psittacosis from other diseases'''
'''Table 1: Differentiating [[psittacosis]] from other diseases'''


{| class="wikitable"
{| class="wikitable"
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* [[Chronic (medical)|Chronic]] [[diffuse]] changes
* [[Chronic (medical)|Chronic]] [[diffuse]] changes
* [[Hilar]] or [[Paratracheal lymph nodes|paratracheal]] [[lymphadenopathy]]
* [[Hilar]] or [[Paratracheal lymph nodes|paratracheal]] [[lymphadenopathy]]
* [[Pneumothorax]].
* [[Pneumothorax]]
| -/+
| -/+
| +/-
| +/-

Revision as of 18:31, 3 August 2017

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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
  • 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 - 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

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

References

  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.


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