Legionellosis differential diagnosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Legionellosis must be differentiated from other causes of fever, dyspnea, cough, and sputum production, such as bacterial pnuemonia, viral pneumonia, and other causes of atypical pneumonia.
Differential Diagnosis
The following conditions must be considered in the differential diagnosis of Legionnaires' disease:
DDx [1][2][3][4][5][6][7]- Acute interstitial pneumonia
[[#Findings suggestive of Acute interstitial pneumonia: Return to Top|DDx]] - Mycoplasma pneumonia
[[#Findings suggestive of Mycoplasma pneumonia: Return to Top|DDx]] - Pulmonary embolism
[[#Findings suggestive of Pulmonary embolism: Return to Top|DDx]]
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2] Mahshid Mir, M.D. [3]
| Differential Diagnosis | |
|---|---|
| DDx Alphabetic Order | |
| A | B |
| C | D |
| E | F |
| G | H |
| I | J |
| K | L |
| M | N |
| O | P |
| Q | R |
| S | T |
| U | V |
| W | X |
| Y | Z |
Clinical manifestations
- Adult respiratory distress syndrome
- Bronchial breath sounds
- Dry cough
- High grade fever
- Progressive dyspnea
Laboratory abnormalities
- Legionella urinary antigen positive
- Leukocytosis with relative lymphopenia
- Hyponatremia
- Hypophosphatemia
Radiographic features
- Alveolar consolidation on chest radiograph
- Lobar consolidation on chest radiograph
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [4] Mahshid Mir, M.D. [5]
| Differential Diagnosis | |
|---|---|
| DDx Alphabetic Order | |
| A | B |
| C | D |
| E | F |
| G | H |
| I | J |
| K | L |
| M | N |
| O | P |
| Q | R |
| S | T |
| U | V |
| W | X |
| Y | Z |
Clinical manifestations
Laboratory abnormalities
- Nonspecific
Radiographic features
- Disseminated consolidation on chest radiograph
- Interstitial infiltrate on chest radiograph
- Increased uptake on gallium scan
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [6] Mahshid Mir, M.D. [7]
| Differential Diagnosis | |
|---|---|
| DDx Alphabetic Order | |
| A | B |
| C | D |
| E | F |
| G | H |
| I | J |
| K | L |
| M | N |
| O | P |
| Q | R |
| S | T |
| U | V |
| W | X |
| Y | Z |
Clinical manifestations
- Dry cough
- Pleuritic chest pain
- Bronchial breath sounds
- Inflamed, opaque, hypomobile tympanic membrane
Laboratory abnormalities
- Lymphocytosis
- Cold agglutinins positive
Radiographic features
- Alveolar consolidation on chest radiograph
- Interstitial infiltrate on chest radiograph
- Lobar consolidation on chest radiograph
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [8] Mahshid Mir, M.D. [9]
| Differential Diagnosis | |
|---|---|
| DDx Alphabetic Order | |
| A | B |
| C | D |
| E | F |
| G | H |
| I | J |
| K | L |
| M | N |
| O | P |
| Q | R |
| S | T |
| U | V |
| W | X |
| Y | Z |
Clinical manifestations
- High grade fever
- Hemoptysis
- Fine rales
- Pleuritic chest pain
- Increased breath sounds
- Bronchial breath sounds
- Dullness on chest percussion
- Purulent sputum
- Shallow respiration
- Pectoriloquy
- Increased tactile fremitus
- Productive cough
- Egophony
Laboratory abnormalities
- Gram positive diplococci on sputum Gram stain
- Pleural effusion (exudative)
- Respiratory alkalosis
Radiographic features
- Parenchymal hyperlucency on chest radiograph
- Increased uptake on gallium scan
- Unilateral diaphragm elevation on chest radiograph
- Alveolar consolidation on chest radiograph
- Lobar consolidation on chest radiograph
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [10] Mahshid Mir, M.D. [11]
| Differential Diagnosis | |
|---|---|
| DDx Alphabetic Order | |
| A | B |
| C | D |
| E | F |
| G | H |
| I | J |
| K | L |
| M | N |
| O | P |
| Q | R |
| S | T |
| U | V |
| W | X |
| Y | Z |
Clinical manifestations
- Immunosuppressive state
- Subcutaneous emphysema
- Hacking cough
- Progressive dyspnea
Laboratory abnormalities
- Respiratory alkalosis
- Serum beta-D-glucan elevation
Radiographic features
- Alveolar consolidation on chest radiograph
- Lobar consolidation on chest radiograph
- Interstitial infiltrate on chest radiograph
- Pneumomediastinum on chest radiograph
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [12] Mahshid Mir, M.D. [13]
| Differential Diagnosis | |
|---|---|
| DDx Alphabetic Order | |
| A | B |
| C | D |
| E | F |
| G | H |
| I | J |
| K | L |
| M | N |
| O | P |
| Q | R |
| S | T |
| U | V |
| W | X |
| Y | Z |
Clinical manifestations
- Calf pain or swelling
- Decreased pulse pressure
- Dyspnea
- Hemoptysis
- Hyperventilation
- Immobility
- Increased pulmonic component of heart sound
- Pleuritic chest pain
- Prior DVT
- Pulmonary hypertension
- Right ventricular heave
- Right-to-left shunt
- Substernal chest pain
- Tachypnea
- Thrombophlebitis
- Venous stasis
- Bone fracture
Laboratory abnormalities
- D-dimer elevation
- Hypocapnia
- Hypoxia
- Pleural effusion (exudative or bloody)
- Atrial fibrillation on ECG
- Right axis deviation on ECG
- Right ventricular overload on ECG
Radiographic features
- Normal chest radiograph
- Atelectasis on chest radiograph
- Lobar consolidation on chest radiograph
- Prominent pulmonary artery on chest radiograph
- Hampton's hump on chest radiograph
- Right ventricular enlargement on echocardiography
- Thrombus on echocardiography
- Segmental perfusion defect on lung scan
- V/Q mismatch on lung scan
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [14] Mahshid Mir, M.D. [15]
| Differential Diagnosis | |
|---|---|
| DDx Alphabetic Order | |
| A | B |
| C | D |
| E | F |
| G | H |
| I | J |
| K | L |
| M | N |
| O | P |
| Q | R |
| S | T |
| U | V |
| W | X |
| Y | Z |
Clinical manifestations
- Pectoriloquy
- Bronchial breath sounds
- Erythema nodosum
- Purulent sputum
- Shallow respiration
- Increased tactile fremitus
- Pleuritic chest pain
- Egophony
Laboratory abnormalities
- Gram-positive cocci in chains on sputum Gram stain
- Respiratory alkalosis
- Pleural effusion (exudative)
Radiographic features
- Alveolar consolidation on chest radiograph
- Lobar consolidation on chest radiograph
- Empyema on chest radiograph
- Increased uptake on gallium scan
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [16] Mahshid Mir, M.D. [17]
| Differential Diagnosis | |
|---|---|
| DDx Alphabetic Order | |
| A | B |
| C | D |
| E | F |
| G | H |
| I | J |
| K | L |
| M | N |
| O | P |
| Q | R |
| S | T |
| U | V |
| W | X |
| Y | Z |
Clinical manifestations
- Pleuritic chest pain
- Bronchial breath sounds
- Recent influenza
- Fine rales
- Bronchovesicular breath sounds
Laboratory abnormalities
Radiographic features
- Lobar consolidation on chest radiograph
- Interstitial infiltrate on chest radiograph
References
- ↑ Ferri, Fred (2011). Ferri's differential diagnosis: a practical guide to the differential diagnosis of symptoms, signs, and clinical disorders. Philadelphia, PA: Elsevier/Mosby. ISBN 978-0323076999.
- ↑ Siegenthaler, Walter (2007). Differential diagnosis in internal medicine: from symptom to diagnosis. Stuttgart New York: Thieme. ISBN 978-1588905512.
- ↑ Mesko, Dusan (2002). Differential diagnosis by laboratory medicine: a quick reference for physicians. Berlin New York: Springer-Verlag. ISBN 978-3540430575.
- ↑ Reeder and Felson's gamuts in radiology: comprehensive lists of roentgen differential diagnosis. Place of publication not identified: Springer. 2014. ISBN 978-1475781229.
- ↑ Burgener, Francis (2008). Differential diagnosis in conventional radiology. Stuttgart New York: Thieme. ISBN 978-1588902757.
- ↑ Gattuso, Paolo (2015). Differential diagnosis in surgical pathology. Philadelphia, PA: Saunders/Elsevier. ISBN 978-1455770137.
- ↑ "DXplain".