Psittacosis differential diagnosis

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

Overview

Psittacosis must be differentiated from other diseases that cause atypical pneumonia, febrile illness without localizing signs and extrapulmonary manifestations such as gastroenteritis, hepatitis, meningitis, or encephalitis. The three main diseases to differentiate psittacosis from are Chlamydia pneumoniae, Mycoplasma pneumoniae, and Legionella infection as they tend to have similar clinical manifestations which can only be differentiated by taking appropriate histories and laboratpory investigations. There are other conditions to watch out for which may also present similar to psittacosis.

Differentiating Psittacosis from other Disease

Psittacosis can be differentiated in 3 categories based on the manifestations of the patient. For the patient with atypical pneumonia, other conditions to consider include;

• Chlamydia pneumoniae,
• Mycoplasma pneumoniae, and
• Legionella infection

For the patient who presents with febrile illness without localizing signs, the following should also be considered;

• Influenza
• Endocarditis
• Septicemia
• Vasculitis
• Coxiella burnetii infection
• Leptospirosis
• Brucellosis

Table 1; (Showing the differentials between C psittaci, C pneumonia, M pneumonia, and L pneumophila)

Clinical feature	C.psittaci	C.pneumoniae	M pneumoniae	L pneumophila
Cough	++	+	++	+
Sputum	-	+	++	+++
Dyspnea	+	+	++	+++
Sore throat	-	++	-	-
Headache	+++	+	-	+
Confusion	+	-	-	++
Diarrhea	-	-	-	+
Chest radiograph changes	Minimal	Minimal	Disparity	Often multifocal
Hyponatremia	-	-	-	++
Leukopenia	-	-	-	+
Abnormal Liver function tests	+	-	+	++
Response to doxycycline	Rapid- afebrile within 48 hours	Prompt	Prompt	Improved but still unwell

Key;

+, occurs in some cases

++, occurs in many cases,

+++, occurs frequently

For the patient who presents with febrile illness without localizing signs, the following should also be considered;

• Influenza,
• Endocarditis,
• Septicemia,
• Vasculitis,
• Coxiella burnetii infection,
• Leptospirosis, and
• Brucellosis

References

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