Bubonic plague differential diagnosis

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Overview

Differential diagnosis

The differential diagnosis of the plague can be broken down into three different categories based on the form of the disease.

Bubonic plague

  • Tularemia (Francisella tularensis)
    • Ulcer or pustule often present distal to involved nodes.
    • Clinical course rarely as fulminant as in plague.
    • Systemic toxicity uncommon.
  • Cat scratch fever (Bartonella henselae)
    • History of contact with cats; usually history of cat scratch.
    • Indolent clinical course; progresses over weeks.
    • Primary lesion at site of scratch often present (small papule, vesicle).
    • Systemic toxicity not present.
  • Chancroid (Hemophilus ducreyi)
    • Adenitis occurs in the inguinal region.
    • Ulcerative lesion present.
    • Systemic symptoms uncommon; toxicity does not occur.
  • Primary genital herpes
    • Herpes lesions present in genital area.
    • Adenitis occurs in the inguinal region.
    • Although patients may be ill (fever, headache), severe systemic toxicity not present.
  • Primary or secondary syphilis (Treponema pallidum)
    • Enlarged lymph nodes in the inguinal region.
    • Lymph nodes generally painless.
    • Chancre may be noted with primary syphilis.
  • Strangulated inguinal hernias
    • Evidence of bowel involvement.

Pneumonic plague

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

Septicemic plague

  • Meningococcemia
    • More likely to have evidence of meningitis (but not always present).
  • Septicemia caused by other Gram-negative bacteria.
    • Underlying illness usually present.

Chest X Ray

Some other infectious diseases can be differentiated by looking at chest x ray images. For example, SARS, Hantavirus syndrome, and Anthrax all need to be ruled out because they do present with some similar Symptoms. An example of a chest x ray for Hantavirus and Anthrax is shown.

This chest x ray image is of a patient with Hantavirus syndrome

This chest x ray image is of a patient with Anthrax

References