Legionellosis differential diagnosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Differentiating Legionellosis from other Diseases
Legionnaires' disease should be differentiated from the following diseases:
- Congestive heart failure
- Interstitial pneumonia
- Mycoplasma pneumonia
- Pneumococcal pneumonia
- Pneumocystis jirovecii pneumonia
- Pulmonary embolism
- Streptococcal pneumonia
- Viral pneumonia
Differentiating Legionellosis from other Diseases
Radiologically, Legionella pneumonia may resemble bacterial community-acquired pneumonia and certain zoonotic atypical pathogens, particularly Coxiella burnetii, Chlamydophila psittaci, and adenovirus. On chest radiograph, Legionella pneumonia often manifests as patchy or fluffy alveolar infiltrates central or peripheral in location that progresses to involve adjacent lobes and the contralateral side, without cavitation or hilar adenopathy.[1]
Mycoplasma pneumoniae
The distinctive features that serve to differentiate Legionnaires' disease from M. pneumoniae include relative bradycardia, mildly elevated transaminase levels, transient hypophosphatemia, increased ferritin levels, and microscopic hematuria.
Q fever
Q fever usually follows a subacute course, as with most cases of Legionnaires' disease. Relative bradycardia and other extra pulmonary symptoms in Q fever may overlap with Legionnaires' disease. The distinctive finding in Q fever is the presence of splenomegaly.
Adenovirus
Adenoviral pneumonia often presents with focal infiltratea mimicking Legionnaires' disease, Q fever, psittacosis, or typical bacterial CAPs. As with Legionnaires' disease, adenoviral CAP may be accompanied by a mild increase of transaminase and CPK levels. However, relative bradycardia, increased ferritin levels, hypophosphatemia, and microscopic hematuria are not commonly observed adenoviral CAP.