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