Tuberculosis differential diagnosis: Difference between revisions
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*Positive for [[P-ANCA]] | *Positive for [[P-ANCA]] | ||
*Biopsy of the tissue | *Biopsy of the affected tissue shows necrotizing [[granulomas]] <ref name="pmid10377211">{{cite journal |vauthors=Langford CA, Hoffman GS |title=Rare diseases.3: Wegener's granulomatosis |journal=Thorax |volume=54 |issue=7 |pages=629–37 |year=1999 |pmid=10377211 |pmc=1745525 |doi= |url=}}</ref> | ||
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*Elderly females of 40-50 age group | *Elderly females of 40-50 age group | ||
*Manifestation of [[rheumatoid arthritis]] | *Manifestation of [[rheumatoid arthritis]] | ||
*Presents with other systemic symptoms including symmetric [[arthritis]] of the small joints of the hands and feet | *Presents with other systemic symptoms including symmetric [[arthritis]] of the small joints of the hands and feet and morning stiffness are common manifestations. | ||
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*Pulmonary nodules with cavitation are | *Pulmonary nodules with cavitation are present in the upper lobe ([[Caplan syndrome]]) on Xray. | ||
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*Positive for both [[rheumatoid factor]] and anti-cyclic citrullinated peptide [[Antibody|antibody.]] | *Positive for both [[rheumatoid factor]] and anti-cyclic citrullinated peptide [[Antibody|antibody.]] | ||
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*Additional findings on CT include [[fibrosis]] (honeycomb, linear, or associated with bronchial distortion), pleural thickening, and ground-glass opacities.<ref name="pmid2748828">{{cite journal |vauthors=Brauner MW, Grenier P, Mompoint D, Lenoir S, de Crémoux H |title=Pulmonary sarcoidosis: evaluation with high-resolution CT |journal=Radiology |volume=172 |issue=2 |pages=467–71 |year=1989 |pmid=2748828 |doi=10.1148/radiology.172.2.2748828 |url=}}</ref> | *Additional findings on CT include [[fibrosis]] (honeycomb, linear, or associated with bronchial distortion), pleural thickening, and ground-glass opacities.<ref name="pmid2748828">{{cite journal |vauthors=Brauner MW, Grenier P, Mompoint D, Lenoir S, de Crémoux H |title=Pulmonary sarcoidosis: evaluation with high-resolution CT |journal=Radiology |volume=172 |issue=2 |pages=467–71 |year=1989 |pmid=2748828 |doi=10.1148/radiology.172.2.2748828 |url=}}</ref> | ||
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*Biopsy of lung | *Biopsy of lung reveals non-[[caseating]] [[granuloma]] | ||
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*Rare condition and mimics [[asthma]], [[pneumonia]] and [[emphysema]] | *Rare condition and mimics [[asthma]], [[pneumonia]] and [[emphysema]] | ||
*It is | *It is due to [[drug]] or [[toxin]] exposure, [[autoimmune diseases]], [[viral infections]], or [[radiation injury]] | ||
* | *Individuals working in industries are at high risk | ||
*Presents with [[Fever|feve]]<nowiki/>r, [[cough]], [[wheezing]] and [[shortness of breath]] over weeks to months,<ref name="pmid2805873">{{cite journal |vauthors=Cordier JF, Loire R, Brune J |title=Idiopathic bronchiolitis obliterans organizing pneumonia. Definition of characteristic clinical profiles in a series of 16 patients |journal=Chest |volume=96 |issue=5 |pages=999–1004 |year=1989 |pmid=2805873 |doi= |url=}}</ref> | *Presents with [[Fever|feve]]<nowiki/>r, [[cough]], [[wheezing]] and [[shortness of breath]] over weeks to months,<ref name="pmid2805873">{{cite journal |vauthors=Cordier JF, Loire R, Brune J |title=Idiopathic bronchiolitis obliterans organizing pneumonia. Definition of characteristic clinical profiles in a series of 16 patients |journal=Chest |volume=96 |issue=5 |pages=999–1004 |year=1989 |pmid=2805873 |doi= |url=}}</ref> | ||
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*[[Langerhans cell histiocytosis|Langerhans]] cell [[Langerhans cell histiocytosis|Histiocytosis]]<ref name="pmid22429393">{{cite journal |vauthors=Suri HS, Yi ES, Nowakowski GS, Vassallo R |title=Pulmonary langerhans cell histiocytosis |journal=Orphanet J Rare Dis |volume=7 |issue= |pages=16 |year=2012 |pmid=22429393 |pmc=3342091 |doi=10.1186/1750-1172-7-16 |url=}}</ref> | *[[Langerhans cell histiocytosis|Langerhans]] cell [[Langerhans cell histiocytosis|Histiocytosis]]<ref name="pmid22429393">{{cite journal |vauthors=Suri HS, Yi ES, Nowakowski GS, Vassallo R |title=Pulmonary langerhans cell histiocytosis |journal=Orphanet J Rare Dis |volume=7 |issue= |pages=16 |year=2012 |pmid=22429393 |pmc=3342091 |doi=10.1186/1750-1172-7-16 |url=}}</ref> | ||
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*Exclusively | *Exclusively occurs in smokers, with a peak age of onset 20-40 years. | ||
*Clinical presentation | *Clinical presentation is variable, but symptoms generally include months of dry [[cough]], [[fever]], [[night sweats]] and [[weight loss]]. | ||
*Skin is involved in 80% of the cases, scaly [[erythematous rash]] is typical. | *Skin is involved in 80% of the cases, scaly [[erythematous rash]] is typical. | ||
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|Neurocysticercosis | |Neurocysticercosis | ||
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*Presenting symptoms | *Presenting symptoms vary based on the site of the cysticerci. | ||
*[[Parenchymal]] neurocysticercosis causes all the symptoms and signs of [[Space occupying lesion|space occupying lesions]]. | *[[Parenchymal]] neurocysticercosis causes all the symptoms and signs of [[Space occupying lesion|space occupying lesions]]. | ||
*Extraparenchymal neurocysticercosis causes manifestations of [[increased intracranial pressure]] if cysts are present in the [[subarachnoid space]] or in the [[ventricles]], | *Extraparenchymal neurocysticercosis causes manifestations of [[increased intracranial pressure]] if cysts are present in the [[subarachnoid space]] or in the [[ventricles]], the clinical picture of [[spinal cord compression]] if present in the spinal cord or causes eye disease if cysts are present in the [[orbit]]. | ||
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|[[Brain abscess]] | |[[Brain abscess]] | ||
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*[[Headaches]] are the most common symptom. | *[[Headaches]] are the most common symptom. Often, [[headaches]] occur on the same side of the [[Abscesses|abscess]] and tend to be severe (unresponsive to [[analgesics]]). | ||
*[[Fever]] is not a reliable sign.<ref name="pmid25075836">{{cite journal |vauthors=Brouwer MC, Tunkel AR, McKhann GM, van de Beek D |title=Brain abscess |journal=N. Engl. J. Med. |volume=371 |issue=5 |pages=447–56 |year=2014 |pmid=25075836 |doi=10.1056/NEJMra1301635 |url=}}</ref> | *[[Fever]] is not a reliable sign.<ref name="pmid25075836">{{cite journal |vauthors=Brouwer MC, Tunkel AR, McKhann GM, van de Beek D |title=Brain abscess |journal=N. Engl. J. Med. |volume=371 |issue=5 |pages=447–56 |year=2014 |pmid=25075836 |doi=10.1056/NEJMra1301635 |url=}}</ref> | ||
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*Culture from the CT-guided aspirated lesion helps in identifying the causative agent. | *Culture from the CT-guided aspirated lesion helps in identifying the causative agent. | ||
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*[[Contrast enhanced CT]] | *[[Contrast enhanced CT]] is useful for a rapid assessment of the size and number of the [[abscesses]]. | ||
*[[MRI|MRI:]] [[Diffusion-weighted imaging|Diffusion-weighted imaging (DWI)]] [[MRI]] can differentiate [[brain abscesses]] from [[Brain cyst|cystic brain lesions]] with [[Sensitivity|sensitivit]]<nowiki/>y and [[specificity]] of 96%.<ref name="urlBrain Abscess — NEJM">{{cite web |url=http://www.nejm.org/doi/full/10.1056/NEJMra1301635 |title=Brain Abscess — NEJM |format= |work= |accessdate=}}</ref> | *[[MRI|MRI:]] [[Diffusion-weighted imaging|Diffusion-weighted imaging (DWI)]] [[MRI]] can differentiate [[brain abscesses]] from [[Brain cyst|cystic brain lesions]] with [[Sensitivity|sensitivit]]<nowiki/>y and [[specificity]] of 96%.<ref name="urlBrain Abscess — NEJM">{{cite web |url=http://www.nejm.org/doi/full/10.1056/NEJMra1301635 |title=Brain Abscess — NEJM |format= |work= |accessdate=}}</ref> | ||
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*Most common presenting symptom is [[Headache|dull aching headache]]. | *Most common presenting symptom is [[Headache|dull aching headache]]. | ||
* | *Often, it is associated with other symptoms of [[Increased intracranial pressure|increased intracranial pressure (ICP)]] as [[Seizure|seizures]], [[Visual disturbance|visual disturbances]], [[Nausea and vomiting|nausea, and vomiting]].<ref name="urlPrimary Brain Tumors in Adults - American Family Physician">{{cite web |url=http://www.aafp.org/afp/2008/0515/p1423.html |title=Primary Brain Tumors in Adults - American Family Physician |format= |work= |accessdate=}}</ref> | ||
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*[[CT]]: [[Contrast enhanced CT|Contrast-enhanced CT]] scan shows a ring enhancing lesion surrounded by an area of hypodensity ([[cerebritis]]) and the resulting [[mass effect]]. | *[[CT]]: [[Contrast enhanced CT|Contrast-enhanced CT]] scan shows a ring enhancing lesion surrounded by an area of hypodensity ([[cerebritis]]) and the resulting [[mass effect]]. | ||
*[[MRI]]: Better than [[CT]] scan in assessing the site and size of the [[tuberculoma]]. Gadolinium-enhanced MRI | *[[MRI]]: Better than [[CT]] scan in assessing the site and size of the [[tuberculoma]]. Gadolinium-enhanced MRI reveals a ring-enhancing lesion between 1-5 cm in size (In NCC, the wall is thicker, [[Calcification|calcifications]] are eccentric and the diameter is less than 2 cm) | ||
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|Neurosarcoidosis | |Neurosarcoidosis | ||
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*70% of the patients present with the neurological symptoms rather than the presentation of systemic disease. Common presentations | *70% of the patients present with the neurological symptoms rather than the presentation of systemic disease. Common presentations include:<ref name="urlNeurosarcoidosis">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3975794/ |title=Neurosarcoidosis |format= |work= |accessdate=}}</ref> | ||
#Cranial nerve neuropathies: [[Facial palsy]] is the most common presentation. | #[[Cranial nerve]] [[neuropathies]]: [[Facial palsy]] is the most common presentation. | ||
#[[Meningeal]] involvement: diffuse [[Meningitis|meningeal inflammation]] can | #[[Meningeal]] involvement: diffuse [[Meningitis|meningeal inflammation]] can result in diffuse [[Polyneuropathy|basilar polyneuropathy]] in 40% of the patients. with [[neurosarcoidosis]]. | ||
#Inflammatory [[spinal cord]] disease: Inflammatory span | #[[Inflammatory]] [[spinal cord]] disease: Inflammatory span is often more than 3 spinal cord segments that help to distinguish it from [[Multiple sclerosis|Multiple Sclerosis]]. | ||
#[[Peripheral neuropathy]]: [[Polyneuropathy|Asymmetric polyneuropathy]] or [[mononeuritis multiplex]]. It may also manifest as [[Guillain-Barré syndrome|Guillain-Barré syndrome (GBS)]] like presentation. | #[[Peripheral neuropathy]]: [[Polyneuropathy|Asymmetric polyneuropathy]] or [[mononeuritis multiplex]]. It may also manifest as [[Guillain-Barré syndrome|Guillain-Barré syndrome (GBS)]] like presentation. | ||
#[[Hypothalamic pituitary adrenal axis|HPO axis]] involvement: may present as [[diabetes insipidus]]. More than 50% of the cases have | #[[Hypothalamic pituitary adrenal axis|HPO axis]] involvement: may present as [[diabetes insipidus]]. More than 50% of the cases do not have any radiological signs. | ||
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Pulmonary tuberculosis must be | [[Pulmonary tuberculosis]] must be distinguished from other cavitary lung lesions. | ||
==Differential Diagnosis== | ==Differential Diagnosis== |
Revision as of 05:12, 28 March 2021
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mashal Awais, M.D.[2]; Alejandro Lemor, M.D. [3]
Overview
Pulmonary tuberculosis should be distinguished from other diseases that cause cough, hemoptysis, fever, night sweat, and weight loss such as: bacterial pneumonia, atypical pneumonia, brucellosis, bronchogenic carcinoma, sarcoidosis, and Hodgkin lymphoma.
Differential Diagnosis
Pulmonary Tuberculosis
Disease | Findings |
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Bacterial pneumonia | Sudden onset of symptoms, such as high fever, cough, purulent sputum, chest pain, leukocytosis, chest X-ray shows consolidation. |
Bronchogenic carcinoma | may be asymptomatic, usually at older ages (> 50 years old), cough, hemoptysis, weight loss |
Brucellosis | Fever, anorexia, night sweats, malaise,back pain , headache, and depression. History of exposure to infected animal |
Hodgkin lymphoma | Fever, night sweats, pruritus, painless adenopathy, mediastinal mass |
Mycoplasmal pneumonia | Gradual onset of dry cough, headache, malaise, sore throat. Diffuse bilateral infiltrates on chest X-ray. |
Sarcoidosis | Non-caseating granulomas in lungs and other organs, bilateral hilar lymphadenopathy, mostly in African American females. |
Adapted from Mandell, Douglas, and Bennett's principles and practice of infectious diseases 2010 [1] |
Extra-Pulmonary Tuberculosis
Extra-Pulmonary Location | Differential Diagnosis |
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Tuberculous Lymphadenitis | Lymphoma, squamous cell carcinoma, papillary thyroid cancer, pyogenic infection |
Skeletal Tuberculosis | Multiple myeloma, bone metastasis, spinal cord abscess, osteoporosis |
Tuberculous Arthrits | Bacterial septic arthritis, pseudogout |
Central Nervous System Tuberculosis | Bacterial meningitis, viral meningitis, encephalitis |
Tuberculosis Peritonitis | Bacterial peritonitis, chronic peritoneal dialysis |
Adapted from Asian Spine J. Feb 2014; 8(1): 97–111[2]; Handbook of Clinical Neurology[3]; Circulation Dec 2005 vol.112 no.23 3608-3616[4]; Am J Trop Med Hyg 2013 vol. 88 no. 1 54-64[5] Clin Infect Dis.(2011)53(6):555-562.[6] |
Causes of
lung cavities |
Differentiating Features | Differentiating radiological findings | Diagnosis
confirmation |
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Disease | Prominent clinical features | Lab findings | Radiological findings |
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Neurocysticercosis |
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Brain abscess |
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Brain tumors |
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Brain tuberculoma |
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Neurosarcoidosis |
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Pulmonary tuberculosis must be distinguished from other cavitary lung lesions.
Differential Diagnosis
Pulmonary tuberculosis must be differentiated from other cavitary lung lesions.
Causes of
lung cavities |
Differentiating Features | Differentiating radiological findings | Diagnosis
confirmation |
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References
- ↑ Mandell, Gerald (2010). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 0443068399.
- ↑ Moon, Myung-Sang (2014). "Tuberculosis of Spine: Current Views in Diagnosis and Management". Asian Spine Journal. 8 (1): 97. doi:10.4184/asj.2014.8.1.97. ISSN 1976-1902.
- ↑ Garcia-Monco, Juan Carlos (2014). "Tuberculosis". 121: 1485–1499. doi:10.1016/B978-0-7020-4088-7.00100-0. ISSN 0072-9752.
- ↑ Mayosi, B. M. (2005). "Tuberculous Pericarditis". Circulation. 112 (23): 3608–3616. doi:10.1161/CIRCULATIONAHA.105.543066. ISSN 0009-7322.
- ↑ Daher, E. D. F.; da Silva Junior, G. B.; Barros, E. J. G. (2013). "Renal Tuberculosis in the Modern Era". American Journal of Tropical Medicine and Hygiene. 88 (1): 54–64. doi:10.4269/ajtmh.2013.12-0413. ISSN 0002-9637.
- ↑ Fontanilla, J.-M.; Barnes, A.; von Reyn, C. F. (2011). "Current Diagnosis and Management of Peripheral Tuberculous Lymphadenitis". Clinical Infectious Diseases. 53 (6): 555–562. doi:10.1093/cid/cir454. ISSN 1058-4838.
- ↑ 7.0 7.1 7.2 7.3 Chaudhuri MR (1973). "Primary pulmonary cavitating carcinomas". Thorax. 28 (3): 354–66. PMC 470041. PMID 4353362.
- ↑ 8.0 8.1 Mouroux J, Padovani B, Elkaïm D, Richelme H (1996). "Should cavitated bronchopulmonary cancers be considered a separate entity?". Ann. Thorac. Surg. 61 (2): 530–2. doi:10.1016/0003-4975(95)00973-6. PMID 8572761.
- ↑ 9.0 9.1 Onn A, Choe DH, Herbst RS, Correa AM, Munden RF, Truong MT, Vaporciyan AA, Isobe T, Gilcrease MZ, Marom EM (2005). "Tumor cavitation in stage I non-small cell lung cancer: epidermal growth factor receptor expression and prediction of poor outcome". Radiology. 237 (1): 342–7. doi:10.1148/radiol.2371041650. PMID 16183941.
- ↑ 10.0 10.1 10.2 10.3 Langford CA, Hoffman GS (1999). "Rare diseases.3: Wegener's granulomatosis". Thorax. 54 (7): 629–37. PMC 1745525. PMID 10377211.
- ↑ 11.0 11.1 Lee KS, Kim TS, Fujimoto K, Moriya H, Watanabe H, Tateishi U, Ashizawa K, Johkoh T, Kim EA, Kwon OJ (2003). "Thoracic manifestation of Wegener's granulomatosis: CT findings in 30 patients". Eur Radiol. 13 (1): 43–51. doi:10.1007/s00330-002-1422-2. PMID 12541109.
- ↑ 12.0 12.1 Baughman RP, Teirstein AS, Judson MA, Rossman MD, Yeager H, Bresnitz EA, DePalo L, Hunninghake G, Iannuzzi MC, Johns CJ, McLennan G, Moller DR, Newman LS, Rabin DL, Rose C, Rybicki B, Weinberger SE, Terrin ML, Knatterud GL, Cherniak R (2001). "Clinical characteristics of patients in a case control study of sarcoidosis". Am. J. Respir. Crit. Care Med. 164 (10 Pt 1): 1885–9. doi:10.1164/ajrccm.164.10.2104046. PMID 11734441.
- ↑ 13.0 13.1 Brauner MW, Grenier P, Mompoint D, Lenoir S, de Crémoux H (1989). "Pulmonary sarcoidosis: evaluation with high-resolution CT". Radiology. 172 (2): 467–71. doi:10.1148/radiology.172.2.2748828. PMID 2748828.
- ↑ 14.0 14.1 Murphy J, Schnyder P, Herold C, Flower C (1998). "Bronchiolitis obliterans organising pneumonia simulating bronchial carcinoma". Eur Radiol. 8 (7): 1165–9. doi:10.1007/s003300050527. PMID 9724431.
- ↑ 15.0 15.1 15.2 15.3 Al-Ghanem S, Al-Jahdali H, Bamefleh H, Khan AN (2008). "Bronchiolitis obliterans organizing pneumonia: pathogenesis, clinical features, imaging and therapy review". Ann Thorac Med. 3 (2): 67–75. doi:10.4103/1817-1737.39641. PMC 2700454. PMID 19561910.
- ↑ 16.0 16.1 Cordier JF, Loire R, Brune J (1989). "Idiopathic bronchiolitis obliterans organizing pneumonia. Definition of characteristic clinical profiles in a series of 16 patients". Chest. 96 (5): 999–1004. PMID 2805873.
- ↑ 17.0 17.1 Lee KS, Kullnig P, Hartman TE, Müller NL (1994). "Cryptogenic organizing pneumonia: CT findings in 43 patients". AJR Am J Roentgenol. 162 (3): 543–6. doi:10.2214/ajr.162.3.8109493. PMID 8109493.
- ↑ 18.0 18.1 Suri HS, Yi ES, Nowakowski GS, Vassallo R (2012). "Pulmonary langerhans cell histiocytosis". Orphanet J Rare Dis. 7: 16. doi:10.1186/1750-1172-7-16. PMC 3342091. PMID 22429393.
- ↑ 19.0 19.1 Moore AD, Godwin JD, Müller NL, Naidich DP, Hammar SP, Buschman DL, Takasugi JE, de Carvalho CR (1989). "Pulmonary histiocytosis X: comparison of radiographic and CT findings". Radiology. 172 (1): 249–54. doi:10.1148/radiology.172.1.2787035. PMID 2787035.
- ↑ Brouwer MC, Tunkel AR, McKhann GM, van de Beek D (2014). "Brain abscess". N. Engl. J. Med. 371 (5): 447–56. doi:10.1056/NEJMra1301635. PMID 25075836.
- ↑ "Brain Abscess — NEJM".
- ↑ 22.0 22.1 "Primary Brain Tumors in Adults - American Family Physician".
- ↑ "The Journal of Association of Chest Physicians - Tuberculoma of the brain - A diagnostic dilemma: Magnetic resonance spectroscopy a new ray of hope : Download PDF".
- ↑ 24.0 24.1 "Neurosarcoidosis".