Pneumonic plague differential diagnosis

Template:Pneumonic plague Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Differentiating Pneumonic Plague from other Diseases

Pneumonic plague should be differentiated from the following diseases:

• Inhalational anthrax (Bacillus anthracis)
  • Widened mediastinum and pleural effusions seen on CXR or chest CT.
  • Not true pneumonia; minimal sputum production.
  • Hemoptysis uncommon (if present, suggests diagnosis of plague).

• Tularemia (Francisella tularensis)
  • Clinical course not as rapid or fulminant as in pneumonic plague.

• Mycoplasmal pneumonia (Mycoplasma pneumoniae)
  • Rarely as fulminant as pneumonic plague.

• Pneumonia caused by Chlamydia pneumoniae
  • Rarely as fulminant as pneumonic plague.

• Legionnaires' disease (Legionella pneumophila or other Legionella species)
  • Rarely as fulminant as pneumonic plague.
  • Community outbreaks of Legionnaires' disease often involve exposure to cooling systems.
  • Legionellosis and many other diseases caused by bacterial agents (S aureus, S pneumoniae, H influenzae, K pneumoniae, M catarrhalis) usually occur in persons with underlying pulmonary or other disease or in the elderly.

• Psittacosis (Chlamydia psittaci)
  • Rarely as fulminant as pneumonic plague.
  • Result of bird exposure.

• Other bacterial agents (e.g., Staphyloccocus aureus, Streptococcus pneumoniae, Haemophilus influenzae, Klebsiella pneumoniae, Moraxella catarrhalis)
  • Rarely as fulminant as pneumonic plague.
  • Usually occur in persons with underlying pulmonary or other disease or in the elderly.

• Influenza
  • Influenza generally seasonal (October-March in United States) or involves history of recent cruise ship travel or travel to tropics.

• Hantavirus
  • Exposure to excrement (urine or feces) of mice with Hantavirus.

• RSV
  • RSV usually occurs in children (although may be cause of pneumonia in elderly); tends to be seasonal (winter/spring).

• CMV
  • CMV usually occurs in immunocompromised patients.

• Q fever (Coxiella burnetii)
  • Exposure to infected parturient cats, cattle, sheep, goats.
  • Severe pneumonia not prominent feature.