Chagas disease differentiating chagas disease from other diseases: Difference between revisions

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==Differentiating Chagas disease from other Diseases==
==Differentiating Chagas disease from other Diseases==
Chagas disease should be differentiated from the following diseases:
Chagas disease is more common among [[Immunocompromised|immunocompromised patients]] who are at high risk for other [[fungal]], [[bacterial]], and [[viral infections]]. It should be differentiated from the following diseases:
{| class="wikitable"
{| class="wikitable"
!Disease
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Disease
!Differentiating signs and symptoms
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Differentiating signs and symptoms
!Differentiating tests
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Differentiating tests
|-
|-
|[[Lymphoma|CNS lymphoma]]
|[[Lymphoma|CNS lymphoma]]<ref name="pmid20212226">{{cite journal |vauthors=Gerstner ER, Batchelor TT |title=Primary central nervous system lymphoma |journal=Arch. Neurol. |volume=67 |issue=3 |pages=291–7 |year=2010 |pmid=20212226 |doi=10.1001/archneurol.2010.3 |url=}}</ref>
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* [[Immunocompetent]] individual
* Patient is [[immunocompetent]]
* Focal symptoms indicative of a mass lesion
* Focal symptoms indicative of a mass [[lesion]]
* [[Seizure]]
* [[Seizure]]
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*Single solitary ring enhacning lesion on CT or MRI
*Single solitary ring enhancing [[lesion]] on [[CT]] or [[MRI]]
|-
|-
|Disseminated tuberculosis
|[[Disseminated tuberculosis]]<ref name="pmid21740673">{{cite journal |vauthors=von Reyn CF, Kimambo S, Mtei L, Arbeit RD, Maro I, Bakari M, Matee M, Lahey T, Adams LV, Black W, Mackenzie T, Lyimo J, Tvaroha S, Waddell R, Kreiswirth B, Horsburgh CR, Pallangyo K |title=Disseminated tuberculosis in human immunodeficiency virus infection: ineffective immunity, polyclonal disease and high mortality |journal=Int. J. Tuberc. Lung Dis. |volume=15 |issue=8 |pages=1087–92 |year=2011 |pmid=21740673 |doi=10.5588/ijtld.10.0517 |url=}}</ref>
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* Prior history of residence in an endemic area.
* Prior history of residence in an [[Endemic (epidemiology)|endemic]] area
* Chronic [[cough]], [[weight loss]], [[hemoptysis]]
* Chronic [[cough]], [[weight loss]], [[hemoptysis]]
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* [[PCR]] of [[CSF]] for [[tuberculosis]]
* [[PCR]] of [[CSF]] for [[tuberculosis]]
* Mycobacterial culture of CSF
* Mycobacterial culture of [[CSF]]
* Brain biopsy for [[acid-fast bacilli]] staining
* [[Brain]] biopsy for [[acid-fast bacilli]] staining
* Culture and acid stain positive for [[acid-fast bacilli]]
* Culture and acid stain positive for [[acid-fast bacilli]]
* CXR shows cavitations.
* CXR shows [[Cavitation|cavitations]]
|-
|-
|[[Aspergillosis]]
|[[Aspergillosis]]<ref name="pmid10194462">{{cite journal |vauthors=Latgé JP |title=Aspergillus fumigatus and aspergillosis |journal=Clin. Microbiol. Rev. |volume=12 |issue=2 |pages=310–50 |year=1999 |pmid=10194462 |pmc=88920 |doi= |url=}}</ref>
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* Pulmonary lesions in addition to CNS lesions.
* [[Pulmonary]] [[lesions]] in addition to [[CNS]] [[lesions]]
* Symptoms may include [[cough]], [[chest pain]], and [[hemoptysis]].
* Symptoms may include [[cough]], [[chest pain]], and [[hemoptysis]]
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*CSF fungal culture, galactomannan.
*[[CSF]] fungal culture, [[galactomannan]]
|-
|-
|[[Cryptococcosis]]
|[[Cryptococcosis]]
Line 43: Line 43:
*Symptoms include [[cough]], [[chest pain]], and [[hemoptysis]]
*Symptoms include [[cough]], [[chest pain]], and [[hemoptysis]]
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*[[Cryptococcal antigen]] from [[CSF]] and serum
*[[Cryptococcal infection|Cryptococcal]] [[antigen]] from [[CSF]] and [[serum]]
*CSF fungal culture
*[[CSF]] fungal culture
|-
|-
|[[Chagas disease]]
|[[Chagas disease]]<ref name="pmid20399979">{{cite journal |vauthors=Rassi A, Rassi A, Marin-Neto JA |title=Chagas disease |journal=Lancet |volume=375 |issue=9723 |pages=1388–402 |year=2010 |pmid=20399979 |doi=10.1016/S0140-6736(10)60061-X |url=}}</ref>
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*History of residence in Central and South America
*History of residence in Central or  South America
*Acute infection is rarely symptomatic,
*Acute infection is rarely symptomatic
*[[Encephalitis]] or focal brain lesions
*[[Encephalitis]] or focal [[brain]] [[lesions]]
*[[Myocarditis]]
*[[Myocarditis]]
*Chronic infections in [[immunocompromised]] patients develops into [[encephalitis]] with necrotic brain lesions causing mass effect.
*[[Chronic]] [[infections]] in [[immunocompromised]] patients develop into [[encephalitis]] with [[necrotic]] [[brain]] lesions causing a [[mass effect]]
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*Trypanosoma cruzi in blood, tissue or CSF, PCR of tissue or body fluids, serologic tests.
*[[Trypanosoma cruzi]] in [[blood]], [[Tissue (biology)|tissue]], or [[CSF]], [[PCR]] of [[Tissue (biology)|tissue]] or [[body fluids]], and [[Serological testing|serologic tests]]
|-
|-
|[[Cytomegalovirus infection|CMV infection]]
|[[Cytomegalovirus infection|CMV infection]]<ref name="pmid11215290">{{cite journal |vauthors=Emery VC |title=Investigation of CMV disease in immunocompromised patients |journal=J. Clin. Pathol. |volume=54 |issue=2 |pages=84–8 |year=2001 |pmid=11215290 |pmc=1731357 |doi= |url=}}</ref>
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*Most common CNS opportunistic infection in AIDS patients
*Most common [[CNS]] [[opportunistic infection]] in [[AIDS]] patients
*Presents with [[encephalitis]], [[retinitis]], progressive [[myelitis]] or [[polyradiculitis]].
*Presents with [[encephalitis]], [[retinitis]], progressive [[myelitis]], or [[polyradiculitis]]
*In disseminated disease, it involves both [[liver]] and [[renal organs]].
*In [[disseminated disease]], it involves both the [[liver]] and kidneys
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*Brain CT/MRI/biopsy: location of lesions are usually near the [[brain stem]] or [[periventricular]] areas.
*[[Brain]] [[CT]]/[[MRI]]/[[biopsy]]: location of [[lesions]] is usually near the [[brain stem]] or periventricular areas
*[[PCR]] of CSF with detectable virus is diagnostic.
*[[PCR]] of [[CSF]] with detectable [[virus]] is diagnostic
*Brain biopsy with + staining for [[CMV]] or evidence of owl's eyes is also diagnostic, but it is rarely performed, because of the location of brain lesions.
*[[Brain biopsy]] with + [[staining]] for [[CMV]] or evidence of owl's eyes is also diagnostic, but it is rarely performed because of the location of [[brain]] lesions
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|-
|[[HSV|HSV infection]]
|[[HSV|HSV infection]]<ref name="pmid1919640">{{cite journal |vauthors=Bustamante CI, Wade JC |title=Herpes simplex virus infection in the immunocompromised cancer patient |journal=J. Clin. Oncol. |volume=9 |issue=10 |pages=1903–15 |year=1991 |pmid=1919640 |doi=10.1200/JCO.1991.9.10.1903 |url=}}</ref>
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*[[Seizures]], [[headache]], [[confusion]] and/or [[urinary retention]] can be seen in disseminated disease, which usually affects only [[immunocompromised]] or acute infections
*[[Seizures]], [[headache]], [[confusion]] and/or [[urinary retention]] can be seen in [[disseminated disease]], which usually affects only the [[immunocompromised]] or acute [[infections]]
*In pregnant women it may be associated with concurrent genital/oral lesions; can be spread to the neonate during acute infection in the mother, or via viral shedding in the birth canal.
*In [[pregnant]] women, it may be associated with concurrent [[genital]]/[[oral]] [[lesions]]; can be spread to the [[neonate]] during acute infection in the mother, or via [[viral shedding]] in the [[birth canal]]
*Neonatal HSV can range from localized skin infections to encephalitis, pneumonitis, and disseminated disease.
*[[Neonatal]] [[Herpes simplex virus|HSV]] can range from localized [[Skin and soft-tissue infections|skin infections]] to [[encephalitis]], [[pneumonitis]], and [[disseminated disease]]
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*Brain CT/MRI/biopsy: location of lesions is usually the medial [[temporal lobe]] or the orbital surface of the [[frontal lobe]].
*[[Brain]] [[CT]]/[[MRI]]/[[biopsy]]: location of [[lesions]] is usually the [[medial]] [[temporal lobe]] or the [[Orbital cavity|orbital]] surface of the [[frontal lobe]].
*[[PCR]] of [[CSF]] with detectable virus is diagnostic.
*[[PCR]] of [[CSF]] with detectable [[virus]] is diagnostic
|-
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|Varicella Zoster infection
|[[Chickenpox|Varicella Zoster infection]]<ref name="pmid15864101">{{cite journal |vauthors=Hambleton S |title=Chickenpox |journal=Curr. Opin. Infect. Dis. |volume=18 |issue=3 |pages=235–40 |year=2005 |pmid=15864101 |doi= |url=}}</ref>
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*Multifocal involvement has subacute course, usually only in immunosuppressed, with headache, fever, focal deficits, and seizures.  
*Multifocal involvement has subacute course, usually only in [[immunosuppressed]], with [[headache]], [[fever]], focal deficits, and [[seizures]].  
*Unifocal involvement is more typically seen in immunocompetent hosts, occurring after contralateral cranial nerve herpes zoster, with mental status changes, TIAs, and stroke.
*Unifocal involvement is more typically seen in [[immunocompetent]] hosts, occurring after [[contralateral]] [[cranial nerve]] [[herpes zoster]], with [[Altered mental status|mental status changes]], [[TIA|TIAs]], and [[stroke]]
*Disseminated [[varicella zoster virus]] can occur in adults during primary infection, presenting with [[pneumonitis]] and/or [[hepatitis]].
*[[Disseminated disease|Disseminated]] [[varicella zoster virus]] can occur in adults during primary [[infection]], presenting with [[pneumonitis]] and/or [[hepatitis]]
*Disease is a [[vasculopathy]], with [[hemorrhage]] and [[stroke]].
*Disease is a [[Vasculitis|vasculopathy]] with [[hemorrhage]] and [[stroke]]
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|
*[[PCR]] of [[CSF]] with detectable virus is diagnostic.
*[[PCR]] of [[CSF]] with detectable [[virus]] is diagnostic
|-
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|[[Brain abscess]]
|[[Brain abscess]]<ref name="pmid24174804">{{cite journal |vauthors=Alvis Miranda H, Castellar-Leones SM, Elzain MA, Moscote-Salazar LR |title=Brain abscess: Current management |journal=J Neurosci Rural Pract |volume=4 |issue=Suppl 1 |pages=S67–81 |year=2013 |pmid=24174804 |pmc=3808066 |doi=10.4103/0976-3147.116472 |url=}}</ref><ref name="pmid25360205">{{cite journal |vauthors=Patel K, Clifford DB |title=Bacterial brain abscess |journal=Neurohospitalist |volume=4 |issue=4 |pages=196–204 |year=2014 |pmid=25360205 |pmc=4212419 |doi=10.1177/1941874414540684 |url=}}</ref>
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*Associated with [[sinusitis]] (abutting the sinuses) or with [[bacteremia]].
*Associated with [[sinusitis]] (abutting the sinuses) or with [[bacteremia]]
*Signs and symptoms includes [[fever]] and necrotizing brain lesions with mass effect
*Signs and symptoms includes [[fever]] and [[necrotizing]] [[brain]] [[lesions]] with [[mass effect]]
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*CSF culture or culture of brain abscess.
*[[CSF]] culture or culture of [[brain abscess]]
|-
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|[[Progressive multifocal leukoencephalopathy]]
|[[Progressive multifocal leukoencephalopathy]]<ref name="pmid20298966">{{cite journal |vauthors=Tan CS, Koralnik IJ |title=Progressive multifocal leukoencephalopathy and other disorders caused by JC virus: clinical features and pathogenesis |journal=Lancet Neurol |volume=9 |issue=4 |pages=425–37 |year=2010 |pmid=20298966 |pmc=2880524 |doi=10.1016/S1474-4422(10)70040-5 |url=}}</ref>
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*Symptoms are often more insidious in onset and progress over months. Symptoms include progressive weakness, poor coordination, with gradual slowing of mental function. Only seen in the immunosuppressed. Rarely associated with fever or other systemic symptoms.
*Symptoms are often more insidious in onset and progress over months. Symptoms include progressive [[weakness]], poor [[coordination]], with gradual slowing of [[mental]] function. Only seen in the [[immunosuppressed]]. Rarely associated with [[fever]] or other systemic symptoms


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*PCR of CSF for JC virus.
*[[Polymerase chain reaction|PCR]] of [[CSF]] for [[JC virus]]
*Biopsy reveals white matter lesions and not well-circumscribed lesions.
*[[Biopsy]] reveals [[white matter]] [[lesions]] and not well-circumscribed [[lesions]].
|}
|}


Revision as of 15:57, 14 August 2017

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

Overview

Chagas disease must be differentiated from other diseases the cause cardiomyopathy, hepatosplenomegaly, or esophageal/colonic dysfunction, such as electrophysiological cardiac diseases, GI hypomotility disorders, and malignancies.

Differentiating Chagas disease from other Diseases

Chagas disease is more common among immunocompromised patients who are at high risk for other fungal, bacterial, and viral infections. It should be differentiated from the following diseases:

Disease Differentiating signs and symptoms Differentiating tests
CNS lymphoma[1]
Disseminated tuberculosis[2]
Aspergillosis[3]
Cryptococcosis
Chagas disease[4]
CMV infection[5]
HSV infection[6]
Varicella Zoster infection[7]
Brain abscess[8][9]
Progressive multifocal leukoencephalopathy[10]
  • Symptoms are often more insidious in onset and progress over months. Symptoms include progressive weakness, poor coordination, with gradual slowing of mental function. Only seen in the immunosuppressed. Rarely associated with fever or other systemic symptoms

Chagas disease should also be differentiated from the following diseases:

References

  1. ↑ Gerstner ER, Batchelor TT (2010). "Primary central nervous system lymphoma". Arch. Neurol. 67 (3): 291–7. doi:10.1001/archneurol.2010.3. PMID 20212226.
  2. ↑ von Reyn CF, Kimambo S, Mtei L, Arbeit RD, Maro I, Bakari M, Matee M, Lahey T, Adams LV, Black W, Mackenzie T, Lyimo J, Tvaroha S, Waddell R, Kreiswirth B, Horsburgh CR, Pallangyo K (2011). "Disseminated tuberculosis in human immunodeficiency virus infection: ineffective immunity, polyclonal disease and high mortality". Int. J. Tuberc. Lung Dis. 15 (8): 1087–92. doi:10.5588/ijtld.10.0517. PMID 21740673.
  3. ↑ Latgé JP (1999). "Aspergillus fumigatus and aspergillosis". Clin. Microbiol. Rev. 12 (2): 310–50. PMC 88920. PMID 10194462.
  4. ↑ Rassi A, Rassi A, Marin-Neto JA (2010). "Chagas disease". Lancet. 375 (9723): 1388–402. doi:10.1016/S0140-6736(10)60061-X. PMID 20399979.
  5. ↑ Emery VC (2001). "Investigation of CMV disease in immunocompromised patients". J. Clin. Pathol. 54 (2): 84–8. PMC 1731357. PMID 11215290.
  6. ↑ Bustamante CI, Wade JC (1991). "Herpes simplex virus infection in the immunocompromised cancer patient". J. Clin. Oncol. 9 (10): 1903–15. doi:10.1200/JCO.1991.9.10.1903. PMID 1919640.
  7. ↑ Hambleton S (2005). "Chickenpox". Curr. Opin. Infect. Dis. 18 (3): 235–40. PMID 15864101.
  8. ↑ Alvis Miranda H, Castellar-Leones SM, Elzain MA, Moscote-Salazar LR (2013). "Brain abscess: Current management". J Neurosci Rural Pract. 4 (Suppl 1): S67–81. doi:10.4103/0976-3147.116472. PMC 3808066. PMID 24174804.
  9. ↑ Patel K, Clifford DB (2014). "Bacterial brain abscess". Neurohospitalist. 4 (4): 196–204. doi:10.1177/1941874414540684. PMC 4212419. PMID 25360205.
  10. ↑ Tan CS, Koralnik IJ (2010). "Progressive multifocal leukoencephalopathy and other disorders caused by JC virus: clinical features and pathogenesis". Lancet Neurol. 9 (4): 425–37. doi:10.1016/S1474-4422(10)70040-5. PMC 2880524. PMID 20298966.

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