Chickenpox differential diagnosis: Difference between revisions

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__NOTOC__
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{{Chickenpox}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Chickenpox]]
{{CMG}}; {{AE}} {{MJM}} {{JS}}
{{CMG}}; {{AE}} {{MJM}} {{JS}} {{ARK}}


==Overview==
==Overview==
There are many active considerations that need to be ruled out to diagnose chickenpox. The one exception to this is smallpox. Smallpox would be a major concern in the case of biological warfare.
[[Chickenpox]] must be differentiated from various [[rash]]-causing conditions like [[Coxsackievirus]], [[Stevens-Johnson syndrome]] ([[Stevens-Johnson syndrome|SJS]]), [[measles]], [[rubella]], [[Rocky Mountain spotted fever|Rocky mountain spotted fever]] and [[syphilis]].


==Differentiating Chickenpox from other Diseases==
==Differentiating Chickenpox from other Diseases==
Different [[rash]]-like conditions can be confused with [[chickenpox]] and are thus included in its differential diagnosis. The various conditions that should be differentiated from [[chickenpox]] include:<ref name="pmid25250996">{{cite journal| author=Hartman-Adams H, Banvard C, Juckett G| title=Impetigo: diagnosis and treatment. | journal=Am Fam Physician | year= 2014 | volume= 90 | issue= 4 | pages= 229-35 | pmid=25250996 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25250996  }} </ref><ref name="pmid27265069">{{cite journal| author=Mehta N, Chen KK, Kroumpouzos G| title=Skin disease in pregnancy: The approach of the obstetric medicine physician. | journal=Clin Dermatol | year= 2016 | volume= 34 | issue= 3 | pages= 320-6 | pmid=27265069 | doi=10.1016/j.clindermatol.2016.02.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27265069  }} </ref><ref name="MooreSeward2006">{{cite journal|last1=Moore|first1=Zack S|last2=Seward|first2=Jane F|last3=Lane|first3=J Michael|title=Smallpox|journal=The Lancet|volume=367|issue=9508|year=2006|pages=425–435|issn=01406736|doi=10.1016/S0140-6736(06)68143-9}}</ref><ref name="pmid26612370">{{cite journal| author=Ibrahim F, Khan T, Pujalte GG| title=Bacterial Skin Infections. | journal=Prim Care | year= 2015 | volume= 42 | issue= 4 | pages= 485-99 | pmid=26612370 | doi=10.1016/j.pop.2015.08.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26612370  }} </ref><ref name="pmid26566601">{{cite journal| author=Ramoni S, Boneschi V, Cusini M| title=Syphilis as "the great imitator": a case of impetiginoid syphiloderm. | journal=Int J Dermatol | year= 2016 | volume= 55 | issue= 3 | pages= e162-3 | pmid=26566601 | doi=10.1111/ijd.13072 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26566601  }} </ref><ref name="pmid25855021">{{cite journal| author=Kimura U, Yokoyama K, Hiruma M, Kano R, Takamori K, Suga Y| title=Tinea faciei caused by Trichophyton mentagrophytes (molecular type Arthroderma benhamiae ) mimics impetigo : a case report and literature review of cases in Japan. | journal=Med Mycol J | year= 2015 | volume= 56 | issue= 1 | pages= E1-5 | pmid=25855021 | doi=10.3314/mmj.56.E1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25855021  }} </ref><ref name="pmid23176858">{{cite journal| author=CEDEF| title=[Item 87--Mucocutaneous bacterial infections]. | journal=Ann Dermatol Venereol | year= 2012 | volume= 139 | issue= 11 Suppl | pages= A32-9 | pmid=23176858 | doi=10.1016/j.annder.2012.01.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23176858  }} </ref>
Chickenpox must be differentiated from other diseases presenting with diffuse papulovesicular rash in a [[febrile]] patient. The various conditions that should be differentiated from [[chickenpox]] include:<ref name="pmid25250996">{{cite journal| author=Hartman-Adams H, Banvard C, Juckett G| title=Impetigo: diagnosis and treatment. | journal=Am Fam Physician | year= 2014 | volume= 90 | issue= 4 | pages= 229-35 | pmid=25250996 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25250996  }} </ref><ref name="pmid27265069">{{cite journal| author=Mehta N, Chen KK, Kroumpouzos G| title=Skin disease in pregnancy: The approach of the obstetric medicine physician. | journal=Clin Dermatol | year= 2016 | volume= 34 | issue= 3 | pages= 320-6 | pmid=27265069 | doi=10.1016/j.clindermatol.2016.02.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27265069  }} </ref><ref name="MooreSeward2006">{{cite journal|last1=Moore|first1=Zack S|last2=Seward|first2=Jane F|last3=Lane|first3=J Michael|title=Smallpox|journal=The Lancet|volume=367|issue=9508|year=2006|pages=425–435|issn=01406736|doi=10.1016/S0140-6736(06)68143-9}}</ref><ref name="pmid26612370">{{cite journal| author=Ibrahim F, Khan T, Pujalte GG| title=Bacterial Skin Infections. | journal=Prim Care | year= 2015 | volume= 42 | issue= 4 | pages= 485-99 | pmid=26612370 | doi=10.1016/j.pop.2015.08.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26612370  }} </ref><ref name="pmid26566601">{{cite journal| author=Ramoni S, Boneschi V, Cusini M| title=Syphilis as "the great imitator": a case of impetiginoid syphiloderm. | journal=Int J Dermatol | year= 2016 | volume= 55 | issue= 3 | pages= e162-3 | pmid=26566601 | doi=10.1111/ijd.13072 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26566601  }} </ref><ref name="pmid25855021">{{cite journal| author=Kimura U, Yokoyama K, Hiruma M, Kano R, Takamori K, Suga Y| title=Tinea faciei caused by Trichophyton mentagrophytes (molecular type Arthroderma benhamiae ) mimics impetigo : a case report and literature review of cases in Japan. | journal=Med Mycol J | year= 2015 | volume= 56 | issue= 1 | pages= E1-5 | pmid=25855021 | doi=10.3314/mmj.56.E1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25855021  }} </ref><ref name="pmid23176858">{{cite journal| author=CEDEF| title=[Item 87--Mucocutaneous bacterial infections]. | journal=Ann Dermatol Venereol | year= 2012 | volume= 139 | issue= 11 Suppl | pages= A32-9 | pmid=23176858 | doi=10.1016/j.annder.2012.01.002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23176858  }} </ref>


=== Common conditions to be differentiated from chickenpox: ===
{| class="wikitable"
{| class="wikitable"
! style="width: 200px; background: #4479BA; text-align: center;"| {{fontcolor|#FFF|Disease}}
! style="width: 200px; background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Common Conditions}}
! style="width: 200px; background: #4479BA; text-align: center;"| {{fontcolor|#FFF|Features}}
! style="width: 200px; background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Features}}
|-
|-
| style="background: #DCDCDC; padding: 5px;"|[[Impetigo]] 
| style="background: #DCDCDC; padding: 5px;" |[[Coxsackievirus]]
|
|
*It commonly presents with pimple-like lesions surrounded by [[erythematous]] [[skin]]. Lesions are [[pustules]], filled with [[pus]], which then break down over 4-6 days and form a thick crust. It's often associated with insect bites, cuts, and other forms of [[trauma]] to the [[skin]].
* The most commonly caused disease is the [[Coxsackie A]] disease, presenting as [[hand-foot-mouth disease]]. It may be [[asymptomatic]] or cause mild [[symptoms]]. There may be [[fever]] and painful [[blisters]] in the mouth ([[herpangina]]), on the palms and fingers of the hand, or on the soles of the feet. There can also be [[blisters]] in the [[throat]] or above the [[tonsils]]. Adults can also be affected. The [[rash]], which can appear several days after [[Fever|high temperature]] and painful [[sore throat]], can be [[itchy]] and painful, especially on the hands/fingers and bottom of feet.
|-
|-
| style="background: #DCDCDC; padding: 5px;"|[[Insect bite]]s
| style="background: #DCDCDC; padding: 5px;" |[[Stevens-Johnson syndrome]]  
|
|
* The insect injects [[formic acid]], which can cause an immediate [[skin]] reaction often resulting in a [[rash]] and swelling in the injured area, often with formation of [[vesicles]].
* The [[symptoms]] may include [[fever]], [[sore throat]]  and [[fatigue]]. Commonly presents as [[ulcers]] and other lesions in the [[mucous membranes]], almost always in the [[mouth]] and [[lips]] but also in the [[genital]] and [[Anal|anal regions]]. The lesions in the [[mouth]] are extremely painful and reduce the patient's ability to eat or drink. [[Conjunctivitis]] of the [[Eye|eyes]] occurs in about 30% of children. A [[rash]] measuring about an inch across, may arise on the face, [[trunk]], arms and legs, and soles of the feet, but usually not on the [[scalp]].
|-
|-
| style="background: #DCDCDC; padding: 5px;"|[[Kawasaki disease]]  
| style="background: #DCDCDC; padding: 5px;" |[[Kawasaki disease]]  
|
|
* Commonly presents with high and persistent [[fever]], red [[mucous membranes]] in mouth, "[[strawberry tongue]]", [[swollen lymph nodes]] and [[skin rash]] in early disease, with peeling off of the [[skin]] of the [[hands]], [[feet]] and [[genital area]].
* Commonly presents with high and persistent [[fever]], red [[mucous membranes]] in mouth, "[[strawberry tongue]]", [[swollen lymph nodes]] and [[skin rash]] in early disease, with peeling of the [[skin]] of [[hands]], [[feet]] and [[genital area]].
|-
|-
| style="background: #DCDCDC; padding: 5px;"|[[Measles]]  
| style="background: #DCDCDC; padding: 5px;" |[[Measles]]  
|
|
* Commonly presents with high [[fever]], [[coryza]] and [[conjunctivitis]], with observation of [[oral mucosa|oral mucosal]] lesions ([[Koplik's spots]]), followed by widespread [[skin rash]].
* [[Prodrome]] of high [[fever]], [[cough]], [[coryza]] and [[conjunctivitis]], with [[oral mucosa|oral mucosal]] lesions ([[Koplik's spots]]), followed by widespread [[skin rash]].
|-
|-
| style="background: #DCDCDC; padding: 5px;"|[[Monkeypox]]
| style="background: #DCDCDC; padding: 5px;" |[[Syphilis]]
|It commonly presents with gneralized systemic [[symptoms]] such as [[malaise]], [[fatigue]], [[headache]] and [[fever]]. [[Skin]] eruptions may be subtle and [[asymptomatic]] It is classically described as:
* Non-pruritic bilateral symmetrical [[mucocutaneous]] [[rash]]
* Non-tender regional [[lymphadenopathy]]
* Condylomata lata 
* Patchy [[alopecia]]
|-
| style="background: #DCDCDC; padding: 5px;" |[[Rubella]]
|
* Commonly presents with a facial [[rash]] which then spreads to the [[trunk]] and [[limbs]], fading after 3 days, low grade [[fever]], swollen [[glands]], [[joint pain]]s, [[headache]] and [[conjunctivitis]]. The [[rash]] disappears after a few days with no staining or peeling of the [[skin]]. [[Forchheimer's sign]] occurs in 20% of cases, and is characterized by small, red [[papules]] on the area of the [[soft palate]].
|-
| style="background: #DCDCDC; padding: 5px;" |[[Cytomegalovirus]]
|
|
* The presentation is similar to [[smallpox]], although it is often a milder form, with [[fever]], [[headache]], [[myalgia]], [[back pain]], [[swollen lymph nodes]], a general feeling of discomfort, and exhaustion. Within 1 to 3 days (sometimes longer) after the appearance of [[fever]], the patient develops a papular [[rash]], often first on the face. The lesions usually develop through several stages before crusting and falling off.
* The common [[symptoms]] include [[sore throat]], swollen [[lymph nodes]], [[fever]], [[headache]], [[fatigue]], [[weakness]], [[muscle pain]] and [[loss of appetite]].
|-
|-
| style="background: #DCDCDC; padding: 5px;"|[[Rubella]]
| style="background: #DCDCDC; padding: 5px;" |[[Meningococcemia]]  
|
|
* Commonly presents with a facial [[rash]] which then spreads to the [[trunk]] and [[limbs]], fading after 3 days, low grade [[fever]], swollen [[glands]], [[joint pain]]s, [[headache]] and [[conjunctivitis]]. The [[rash]] disappears after a few days with no staining or peeling of the [[skin]]. ''[[Forchheimer's sign]]'' occurs in 20% of cases, and is characterized by small, red [[papules]] on the area of the [[soft palate]].
* It commonly presents with [[rash]], [[petechiae]], [[headache]], [[confusion]], and [[stiff neck]], high [[fever]], [[Mental status examination|mental status]] changes, [[nausea]] and [[vomiting]].
|-
|-
| style="background: #DCDCDC; padding: 5px;"|Atypical [[measles]]
| style="background: #DCDCDC; padding: 5px;" |[[Meningitis]]  
|
|
* The symptoms commonly begin about 7-14 days after infection and present as [[fever]], [[cough]], [[coryza]] and [[conjunctivitis]]. Observation of [[Koplik's spots]] is also a characteristic finding in measles.
* It commonly presents with [[headache]], [[nuchal rigidity]], [[fever]], [[petechiae]] and [[altered mental status]].
|-
|-
| style="background: #DCDCDC; padding: 5px;"|[[Coxsackievirus]]
| style="background: #DCDCDC; padding: 5px;" |[[Rocky Mountain spotted fever]]  
|
|
* The most commonly caused disease is the [[Coxsackie A]] disease, presenting as ''hand, foot and mouth disease''. It may be [[asymptomatic]] or cause mild [[symptoms]], or it may produce [[fever]] and painful [[blisters]] in the mouth ([[herpangina]]), on the palms and fingers of the hand, or on the soles of the feet. There can also be [[blisters]] in the [[throat]]  or above the [[tonsils]]. Adults can also be affected. The [[rash]], which can appear several days after high temperature and painful sore throat, can be itchy and painful, especially on the hands/fingers and bottom of feet.
* The [[symptoms]] may include [[maculopapular rash]], [[petechial rash]], [[abdominal pain]] and [[joint pain]].
|-
|-
| style="background: #DCDCDC; padding: 5px;"|[[Acne]]
| style="background: #DCDCDC; padding: 5px;" |[[Molluscum contagiosum]]
|
|
* It is typical of teenagers, usually appears on the [[face]] and upper neck, but the [[chest]], [[human back|back]] and [[shoulder]]s may have [[acne]] as well. The upper [[arm]]s can also have [[acne]], but lesions found there are often [[keratosis pilaris]], not [[acne]]. The typical [[acne]] lesions are [[comedones]] and [[inflammatory]] [[papules]], [[pustules]], and [[nodules]]. Some of the large [[nodules]] were previously called "[[cyst]]s"
* The lesions are commonly flesh-colored, dome-shaped and pearly in appearance. They are often 1-5 millimeters in diameter, with an umblicated center. Generally not painful, but they may itch or become irritated. Picking or scratching the lesions may lead to further [[infection]] or scarring. In about 10% of the cases, [[eczema]] develops around the lesions. They may occasionally be complicated by secondary [[bacterial infections]].
|-
|-
| style="background: #DCDCDC; padding: 5px;"|[[Syphilis]]  
| style="background: #DCDCDC; padding: 5px;" |[[Mononucleosis]]
|It commonly presents with gneralized systemic [[symptoms]] such as [[malaise]], [[fatigue]], [[headache]] and [[fever]]. [[Skin]] eruptions may be subtle and [[asymptomatic]] It is classically described as:
|
* Non-pruritic bilateral symmetrical mucocutaneous [[rash]]
* Common [[symptoms]] include low-grade [[fever]] without [[chills]], [[sore throat]], white patches on [[tonsils]] and back of the throat, [[muscle weakness]] and sometime extreme [[fatigue]], tender [[lymphadenopathy]], [[petechial hemorrhage]] and [[skin rash]]
* Non-tender regional [[lymphadenopathy]]
|}
* Condylomata lata and  
 
* Patchy [[alopecia]].
=== Less common conditions to be differentiated from chickenpox: ===
{| class="wikitable"
! style="width: 200px; background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Less Common Diseases}}
! style="width: 200px; background: #4479BA; text-align: center;" | {{fontcolor|#FFF|Features}}
|-
|-
| style="background: #DCDCDC; padding: 5px;"|[[Molluscum contagiosum]]
| style="background: #DCDCDC; padding: 5px;" |Atypical [[measles]]
|
|
* The lesions are commonly flesh-colored, dome-shaped, and pearly in appearance. They are often 1-5 millimeters in diameter, with a dimpled center. Generally not painful, but they may itch or become irritated. Picking or scratching the lesions may lead to further [[infection]] or scarring. In about 10% of the cases, [[eczema]] develops around the lesions. They may occasionally be complicated by secondary [[bacterial infections]].
* The symptoms commonly begin about 7-14 days after [[infection]] and present as [[fever]], [[cough]], [[coryza]] and [[conjunctivitis]]. Observation of [[Koplik's spots]] is also a characteristic finding in [[measles]].
|-
|-
| style="background: #DCDCDC; padding: 5px;"|[[Mononucleosis]]
| style="background: #DCDCDC; padding: 5px;" |[[Parvovirus B19]]
|
|
* Common [[symptoms]] include low-grade [[fever]] without [[chills]], [[sore throat]], white patches on [[tonsils]] and back of the throat, [[muscle weakness]] and sometime extreme [[fatigue]], tender [[lymphadenopathy]], [[petechial hemorrhage]] and [[skin rash]].
*The [[rash]] of fifth disease is typically described as "[[Parvovirus|slapped cheeks]]", with [[erythema]] across the cheeks and sparing the [[nasolabial folds]], forehead, and mouth.
|-
|-
| style="background: #DCDCDC; padding: 5px;"|Toxic [[erythema]]  
| style="background: #DCDCDC; padding: 5px;" |[[Rickettsialpox|Rickettsial pox]]
|
|
* It is a common [[rash]] in infants, with clustered and [[vesicular]] appearance.
* The first [[symptom]] is commonly a bump formed by a mite-bite, eventually resulting in a black, crusty [[scab]]. Many of the [[symptoms]] are [[flu]]-like including [[fever]], [[chills]], [[weakness]] and [[muscle pain]] but the most distinctive [[symptom]] is the [[rash]] that breaks out, with a generalized distribution.
|-
|-
| style="background: #DCDCDC; padding: 5px;"|[[Rat-bite fever]]  
| style="background: #DCDCDC; padding: 5px;" |Toxic [[erythema]]  
|
|
* It commonly presents with [[fever]], [[chills]], open sore at the site of the bite and [[rash]], which may show red or purple plaques.
* It is a common [[rash]] in [[infants]], with clustered and [[vesicular]] appearance.
|-
|-
| style="background: #DCDCDC; padding: 5px;"|[[Parvovirus B19]]
| style="background: #DCDCDC; padding: 5px;" |[[Monkeypox]]
|
|
*The [[rash]] of fifth disease is typically described as "slapped cheeks," with [[erythema]] across the cheeks and sparing the nasolabial folds, forehead, and mouth.
* The presentation is similar to [[smallpox]], although it is often a milder form, with [[fever]], [[headache]], [[myalgia]], [[back pain]], [[swollen lymph nodes]], a general feeling of discomfort, and exhaustion. Within 1 to 3 days (sometimes longer) after the appearance of [[fever]], the patient develops a papular [[rash]], often first on the face. The lesions usually develop through several stages before crusting and falling off.
|-
|-
| style="background: #DCDCDC; padding: 5px;"|[[Cytomegalovirus]]
| style="background: #DCDCDC; padding: 5px;" |[[Rat-bite fever]]  
|
|
* The common [[symptoms]] include [[sore throat]], swollen [[lymph nodes]], [[fever]], [[headache]], [[fatigue]], [[weakness]], [[muscle pain]]  and [[loss of appetite]].
* It commonly presents with [[fever]], [[chills]], open sore at the site of the bite and [[rash]], which may show red or purple [[Plaque|plaques]].
|-
|-
| style="background: #DCDCDC; padding: 5px;"|[[Scarlet fever]]  
| style="background: #DCDCDC; padding: 5px;" |[[Scarlet fever]]  
|
|
* It commonly includes [[fever]], punctate red [[macules]] on the hard and soft [[palate]] and [[uvula]] ([[Forchheimer's spots]]), bright red [[tongue]] with a "strawberry" appearance, [[sore throat]] and [[headache]] and [[lymphadenopathy]].
* It commonly includes [[fever]], punctate red [[macules]] on the hard and soft [[palate]] and [[uvula]] ([[Forchheimer's spots]]), bright red [[tongue]] with a "strawberry" appearance, [[sore throat]] and [[headache]] and [[lymphadenopathy]].
|}
===Differentiating chickenpox infection in [[immunocompromised]] host===
[[Varicella Zoster Virus|Varicella Zoster virus]] infection is common among [[immunocompromised]] patients who are at high risk for other [[fungal]], [[bacterial]], and [[viral]] infections. It should be differentiated from the following diseases, which may present as [[confusion]], [[fever]] and [[headache]] in [[immunocompromised]] patients:
{| class="wikitable"
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Disease
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Differentiating signs and symptoms
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Differentiating tests
|-
|[[Lymphoma|CNS lymphoma]]<ref name="pmid20212226">{{cite journal |vauthors=Gerstner ER, Batchelor TT |title=Primary central nervous system lymphoma |journal=Arch. Neurol. |volume=67 |issue=3 |pages=291–7 |year=2010 |pmid=20212226 |doi=10.1001/archneurol.2010.3 |url=}}</ref>
|
* Patient is [[immunocompetent]]
* Focal [[symptoms]] indicative of a mass [[lesion]]
* [[Seizure]]
|
*Single solitary ring enhancing [[lesion]] on [[CT]] or [[MRI]]
|-
|[[Disseminated tuberculosis]]<ref name="pmid21740673">{{cite journal |vauthors=von Reyn CF, Kimambo S, Mtei L, Arbeit RD, Maro I, Bakari M, Matee M, Lahey T, Adams LV, Black W, Mackenzie T, Lyimo J, Tvaroha S, Waddell R, Kreiswirth B, Horsburgh CR, Pallangyo K |title=Disseminated tuberculosis in human immunodeficiency virus infection: ineffective immunity, polyclonal disease and high mortality |journal=Int. J. Tuberc. Lung Dis. |volume=15 |issue=8 |pages=1087–92 |year=2011 |pmid=21740673 |doi=10.5588/ijtld.10.0517 |url=}}</ref>
|
* Prior history of residence in an [[Endemic (epidemiology)|endemic]] area
* Chronic [[cough]], [[weight loss]], [[hemoptysis]]
|
* [[PCR]] of [[CSF]] for [[tuberculosis]]
* [[Mycobacterial]] [[Culture media|culture]] of [[CSF]]
* [[Brain]] biopsy for [[acid-fast bacilli]] staining
* [[Culture medium|Culture]] and acid stain positive for [[acid-fast bacilli]]
* [[Chest X-ray|CXR]] shows [[Cavitation|cavitations]]
|-
|-
| style="background: #DCDCDC; padding: 5px;"|[[Rocky Mountain spotted fever]]  
|[[Aspergillosis]]<ref name="pmid10194462">{{cite journal |vauthors=Latgé JP |title=Aspergillus fumigatus and aspergillosis |journal=Clin. Microbiol. Rev. |volume=12 |issue=2 |pages=310–50 |year=1999 |pmid=10194462 |pmc=88920 |doi= |url=}}</ref>
|
* [[Pulmonary]] [[lesions]] in addition to [[CNS]] [[lesions]]
* [[Symptoms]] may include [[cough]], [[chest pain]], and [[hemoptysis]]
|
|
* The [[symptoms]] may include [[maculopapular rash]], [[petechial rash]], [[abdominal pain]] and [[joint pain]].
*[[CSF]] [[fungal]] [[Culture medium|culture]], [[galactomannan]]
|-
|-
| style="background: #DCDCDC; padding: 5px;"|[[Stevens-Johnson syndrome]]  
|[[Cryptococcosis]]
|
*[[Symptoms]] include [[cough]], [[chest pain]], and [[hemoptysis]]
|
|
* The [[symptoms]] may include [[fever]], [[sore throat]] and [[fatigue]]. Commonly presents [[ulcers]] and other lesions in the [[mucous membranes]], almost always in the [[mouth]] and lips but also in the genital and anal regions. Those in the mouth are usually extremely painful and reduce the patient's ability to eat or drink. [[Conjunctivitis]] of the eyes occurs in about 30% of children. A [[rash]] of round lesions about an inch across, may arise on the face, trunk, arms and legs, and soles of the feet, but usually not on the scalp.
*[[Cryptococcal infection|Cryptococcal]] [[antigen]] from [[CSF]] and [[serum]]
*[[CSF]] [[fungal]] [[Culture medium|culture]]
|-
|-
| style="background: #DCDCDC; padding: 5px;"|[[Varicella-zoster virus]]  
|[[Chagas disease]]<ref name="pmid20399979">{{cite journal |vauthors=Rassi A, Rassi A, Marin-Neto JA |title=Chagas disease |journal=Lancet |volume=375 |issue=9723 |pages=1388–402 |year=2010 |pmid=20399979 |doi=10.1016/S0140-6736(10)60061-X |url=}}</ref>
|
*History of residence in Central or South America
*Acute infection is rarely symptomatic
*[[Encephalitis]] or focal [[brain]] [[lesions]]
*[[Myocarditis]]
*[[Chronic]] [[infections]] in [[immunocompromised]] patients develop into [[encephalitis]] with [[necrotic]] [[brain]] lesions causing a [[mass effect]]
|
|
* It commonly starts as a painful [[rash]] on one side of the face or body. The [[rash]] forms blisters that typically scab over in 7-10 days and clears up within 2-4 weeks.
*[[Trypanosoma cruzi]] in [[blood]], [[Tissue (biology)|tissue]], or [[CSF]], [[PCR]] of [[Tissue (biology)|tissue]] or [[body fluids]], and [[Serological testing|serologic tests]]
|-
|-
| style="background: #DCDCDC; padding: 5px;"|[[Chickenpox]]  
|[[Cytomegalovirus infection|CMV infection]]<ref name="pmid11215290">{{cite journal |vauthors=Emery VC |title=Investigation of CMV disease in immunocompromised patients |journal=J. Clin. Pathol. |volume=54 |issue=2 |pages=84–8 |year=2001 |pmid=11215290 |pmc=1731357 |doi= |url=}}</ref>
|
*Most common [[CNS]] [[opportunistic infection]] in [[AIDS]] patients
*Presents with [[encephalitis]], [[retinitis]], progressive [[myelitis]], or [[polyradiculitis]]
*In [[disseminated disease]], it involves both the [[liver]] and [[kidneys]]
|
|
* It commonly starts with [[conjunctival]] and catarrhal [[symptoms]] and then characteristic spots appearing in two or three waves, mainly on the body and head, rather than the hands, becoming itchy raw pox (small open sores which heal mostly without scarring). Touching the fluid from a [[chickenpox]] blister can also spread the disease.
*[[Brain]] [[CT]]/[[MRI]]/[[biopsy]]: location of [[lesions]] is usually near the [[brain stem]] or periventricular areas
*[[PCR]] of [[CSF]] with detectable [[virus]] is diagnostic
*[[Brain biopsy]] with + [[staining]] for [[CMV]] or evidence of owl's eyes is also diagnostic, but it is rarely performed because of the location of [[brain]] lesions
|-
|-
| style="background: #DCDCDC; padding: 5px;"|[[Meningococcemia]]  
|[[HSV|HSV infection]]<ref name="pmid1919640">{{cite journal |vauthors=Bustamante CI, Wade JC |title=Herpes simplex virus infection in the immunocompromised cancer patient |journal=J. Clin. Oncol. |volume=9 |issue=10 |pages=1903–15 |year=1991 |pmid=1919640 |doi=10.1200/JCO.1991.9.10.1903 |url=}}</ref>
|
*[[Seizures]], [[headache]], [[confusion]] and/or [[urinary retention]] can be seen in [[disseminated disease]], which usually affects only the [[immunocompromised]] or acute [[infections]]
*In [[pregnant]] women, it may be associated with concurrent [[genital]]/[[oral]] [[lesions]]; can be spread to the [[neonate]] during acute infection in the mother, or via [[viral shedding]] in the [[birth canal]]
*[[Neonatal]] [[Herpes simplex virus|HSV]] can range from localized [[Skin and soft-tissue infections|skin infections]] to [[encephalitis]], [[pneumonitis]], and [[disseminated disease]]
|
|
* It commonly presents with [[rash]], [[petechiae]], [[headache]], [[confusion]], and [[stiff neck]], high [[fever]], mental status changes, [[nausea]] and [[vomiting]].
*[[Brain]] [[CT]]/[[MRI]]/[[biopsy]]: location of [[lesions]] is usually the [[medial]] [[temporal lobe]] or the [[Orbital cavity|orbital]] surface of the [[frontal lobe]].
*[[PCR]] of [[CSF]] with detectable [[virus]] is diagnostic
|-
|-
| style="background: #DCDCDC; padding: 5px;"|[[Rickettsialpox|Rickettsial pox]]
|[[Chickenpox|Varicella Zoster infection]]<ref name="pmid15864101">{{cite journal |vauthors=Hambleton S |title=Chickenpox |journal=Curr. Opin. Infect. Dis. |volume=18 |issue=3 |pages=235–40 |year=2005 |pmid=15864101 |doi= |url=}}</ref>
|
*Multifocal involvement has subacute course, usually only in [[immunosuppressed]], with [[headache]], [[fever]], focal deficits, and [[seizures]]
*Unifocal involvement is more typically seen in [[immunocompetent]] hosts, occurring after [[contralateral]] [[cranial nerve]] [[herpes zoster]], with [[Altered mental status|mental status changes]], [[TIA|TIAs]], and [[stroke]]
*[[Disseminated disease|Disseminated]] [[varicella zoster virus]] can occur in adults during primary [[infection]], presenting with [[pneumonitis]] and/or [[hepatitis]]
*Disease is a [[Vasculitis|vasculopathy]] with [[hemorrhage]] and [[stroke]]
|
|
* The first [[symptom]] is commonly a bump formed by a mite-bite, eventually resulting in a black, crusty scab. Many of the [[symptoms]] are [[flu]]-like including [[fever]], [[chills]], [[weakness]] and [[muscle pain]] but the most distinctive [[symptom]] is the [[rash]] that breaks out, spanning the person's entire body.
*[[PCR]] of [[CSF]] with detectable [[virus]] is diagnostic
|-
|-
| style="background: #DCDCDC; padding: 5px;"|[[Meningitis]]
|[[Brain abscess]]<ref name="pmid24174804">{{cite journal |vauthors=Alvis Miranda H, Castellar-Leones SM, Elzain MA, Moscote-Salazar LR |title=Brain abscess: Current management |journal=J Neurosci Rural Pract |volume=4 |issue=Suppl 1 |pages=S67–81 |year=2013 |pmid=24174804 |pmc=3808066 |doi=10.4103/0976-3147.116472 |url=}}</ref><ref name="pmid25360205">{{cite journal |vauthors=Patel K, Clifford DB |title=Bacterial brain abscess |journal=Neurohospitalist |volume=4 |issue=4 |pages=196–204 |year=2014 |pmid=25360205 |pmc=4212419 |doi=10.1177/1941874414540684 |url=}}</ref>
|
|
* It commonly presents with [[headache]], [[nuchal rigidity]], [[fever]], [[petechiae]] and [[altered mental status]].
*Associated with [[sinusitis]] (abutting the sinuses) or with [[bacteremia]]
*Signs and [[symptoms]] includes [[fever]] and [[necrotizing]] [[brain]] [[lesions]] with [[mass effect]]
|
*[[CSF]] [[Culture medium|culture]] or [[Culture media|culture]] of [[brain abscess]]
|-
|[[Progressive multifocal leukoencephalopathy]]<ref name="pmid20298966">{{cite journal |vauthors=Tan CS, Koralnik IJ |title=Progressive multifocal leukoencephalopathy and other disorders caused by JC virus: clinical features and pathogenesis |journal=Lancet Neurol |volume=9 |issue=4 |pages=425–37 |year=2010 |pmid=20298966 |pmc=2880524 |doi=10.1016/S1474-4422(10)70040-5 |url=}}</ref>
|
*[[Symptoms]] are often more insidious in onset and progress over months. [[Symptoms]] include progressive [[weakness]], poor [[coordination]], with gradual slowing of [[mental]] function. Only seen in the [[immunosuppressed]]. Rarely associated with [[fever]] or other systemic [[symptoms]]
 
|
*[[Polymerase chain reaction|PCR]] of [[CSF]] for [[JC virus]]
*[[Biopsy]] reveals [[white matter]] [[lesions]] and not well-circumscribed [[lesions]].
|}
|}


 
=== '''Oral lesions to be differentiated from chicken pox:''' ===
 
Oral lesions caused by chickenpox must be differentiated from other diseases presenting with pain and [[Blisters|blistering]] within the mouth ([[gingivostomatitis]] and [[glossitis]]). The differentials include:<small><div style="width: 70%;">
 
 
 
 
 
 
 
 
'''The following table is a list of differential diagnosis oral lesions presenting similar to chicken pox:'''
 
 
 
 
<small><div style="width: 70%;">
{| class="wikitable"
{| class="wikitable"
!Disease
!Disease
Line 148: Line 216:
*[[Sores]] in the [[mouth]]
*[[Sores]] in the [[mouth]]
*[[Rash]] with [[blisters]]
*[[Rash]] with [[blisters]]
*[[Aches]]
*[[Myalgia]]
|
|
*[[Pregnancy]]
*[[Pregnancy]]
Line 158: Line 226:
*[[Tzanck test]]
*[[Tzanck test]]
|
|
*[[Oral cavity]]
*[[Mucuos membrane]]
*[[Skin]]
*[[Skin]]
|
|
Line 166: Line 234:
|[[Chickenpox|Chicken pox]]
|[[Chickenpox|Chicken pox]]
|
|
*[[Conjunctival symptoms]]
*Conjunctival symptoms:
*[[Catarrhal symptoms]]  
:*[[Conjunctival injection]]
:*Cloudy cornea
*Catarrhal symptoms:
:*[[Rhinorrhea]]
:*[[Coughing]]
:*[[Sneezing]]
*Characteristic [[spots]] on the trunk appearing in two or three waves
*Characteristic [[spots]] on the trunk appearing in two or three waves
*[[Itching]]
*[[Itching]]
Line 243: Line 316:
*Oral Cavity
*Oral Cavity
|
|
*Characteristic enanthem- Punctate [[macule]] which evolve over a period of 24 hours to 2-4mm erythematous papules which vesiculate, and then centrally ulcerate.
*Characteristic exanthem- Punctate [[macule]] which evolve over a period of 24 hours to 2-4mm erythematous papules which vesiculate, and then centrally ulcerate.
*The lesions are usually small in number, and evolve rapidly. The lesions are seen more commonly on the [[soft palate]] and [[uvula]]. The lesions can also be seen on the [[tonsils]], posterior pharyngeal wall and the [[buccal mucosa]].
*The lesions are usually small in number, and evolve rapidly. The lesions are seen more commonly on the [[soft palate]] and [[uvula]]. The lesions can also be seen on the [[tonsils]], posterior pharyngeal wall and the [[buccal mucosa]].
|
|
[[File:Herpangina3.jpg|center|400x400px|alt=Erythema, vesicles and ulcerating lesions in herpangina|Erythema, vesicles and ulcerating lesions in herpangina]]
[[File:Herpangina3.jpg|center|400x400px|alt=Erythema, vesicles and ulcerating lesions in herpangina|Erythema, vesicles and ulcerating lesions in herpangina]]
|-
|-
|Primary herpetic gingivoestomatitis<ref name="KolokotronisDoumas2006">{{cite journal|last1=Kolokotronis|first1=A.|last2=Doumas|first2=S.|title=Herpes simplex virus infection, with particular reference to the progression and complications of primary herpetic gingivostomatitis|journal=Clinical Microbiology and Infection|volume=12|issue=3|year=2006|pages=202–211|issn=1198743X|doi=10.1111/j.1469-0691.2005.01336.x}}</ref>
|Primary herpetic [[gingivostomatitis]]<ref name="KolokotronisDoumas2006">{{cite journal|last1=Kolokotronis|first1=A.|last2=Doumas|first2=S.|title=Herpes simplex virus infection, with particular reference to the progression and complications of primary herpetic gingivostomatitis|journal=Clinical Microbiology and Infection|volume=12|issue=3|year=2006|pages=202–211|issn=1198743X|doi=10.1111/j.1469-0691.2005.01336.x}}</ref>
|
|
*Pin-head [[vesicles]] rupture to form painful irregular ulcerations covered by yellow-grey membrane
*Pin-head [[vesicles]] rupture to form painful irregular ulcerations covered by yellow-grey membrane
Line 291: Line 364:
|[[File:Human tongue infected with oral candidiasis--By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=11717223.jpg|thumb|Tongue infected with oral candidiasis - By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=11717223.jpg|400x400px]]
|[[File:Human tongue infected with oral candidiasis--By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=11717223.jpg|thumb|Tongue infected with oral candidiasis - By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=11717223.jpg|400x400px]]
|}
|}
</div>


</div>
{| class="wikitable"
!Disease
!Presentation
!Risk Factors
!Diagnosis
!Affected Organ Systems
!Important features
!Picture
|-
! colspan="3" |Diseases predominantly affecting the oral cavity
!
!
!
!
|-
|[[Oral candidiasis|Oral Candidiasis]]
|
* [[Dysphagia]] or [[odynophagia]]
* White patches on the mouth and tongue
|
*[[Newborn]] babies
 
*Denture users
 
*Poorly controlled [[diabetes]]
 
*As a side effect of medication, most commonly having taken [[antibiotic]]s. Inhaled [[corticosteroids]] for the treatment of lung conditions (e.g, [[asthma]] or [[COPD]]) may also result in oral candidiasis which may be reduced by regularly rinsing the mouth with water after taking the medication.
 
*People with poor [[nutrition]], specifically [[vitamin A]], [[Iron deficiency anemia|iron]] and [[Folate deficiency|folate deficiencies]].
 
*People with an [[immune deficiency]] (e.g. as a result of [[AIDS]]/[[HIV]] or [[chemotherapy]] treatment).
 
*Women undergoing hormonal changes, like [[pregnancy]] or those on [[birth control pills]].
 
*[[Organ transplantation]] patients
|
* Clinical diagnosis
* Confirmatory tests rarely needed
|'''Localized candidiasis'''
* [[Oral candidiasis|Oral]] and [[Esophageal candidiasis|esophageal candidasis]]
* [[Candida vulvovaginitis]]
* [[Chronic mucocutaneous candidiasis]]
 
'''Invasive candidasis'''
* [[Candidiasis|Candidaemia]]
* [[Endocarditis|Candida endocarditis]]
* [[Osteoarthritis|Candida osteoarticular disease]]
|
* [[Osteoarthritis|Oral candidiaisis is]] a benign self limiting disease unless accompanied by [[immunosuppression]].
|[[File:Human tongue infected with oral candidiasis--By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=11717223.jpg|thumb|Tongue infected with oral candidiasis - By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=11717223.jpg|400x400px]]
|-
|[[Herpes simplex|Herpes simplex oral lesions]]
|
* [[Fever]] 
* [[Sore throat]]
* Painful [[ulcer]]s
|
* Stress
* Recent [[URTI]]
* Female sex
|
* Physical examination
* [[Viral culture]]
* [[Tzanck smear]]
|
* Orofacial Infection
* [[Herpes simplex anogenital infection|Anogenital Infection]]
* [[Herpes simplex ocular infection|Ocular Infection]]
* [[Herpes simplex encephalitis|Herpes Encephalitis]]
* [[Herpes simplex neonatorum|Neonatal Herpes]]
* [[Herpetic whitlow|Herpetic Whitlow]]
* [[Herpes gladiatorum|Herpes Gladiatorum]]
|
* The symptoms of primary [[HSV]] infection generally resolve within two weeks
|[[File:Herpesinfection - By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=19051042.jpg|thumb|Oral herpes simplex infection - By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=19051042.jpg|400x400px]]
|-
|[[Aphthous ulcer|Aphthous ulcers]]
|
* Painful, red spot or bump that develops into an open [[ulcer]]
|
* Being a female
* Between the ages of 10-40
* Family history of [[Aphthous ulcer|aphthous ulcers]]
|
* Physical examination
* Diagnosis of exclusion
|
* Oral cavity
|
* Self-limiting , [[Pain]] decreases in 7 to 10 days, with complete healing in 1 to 3 weeks
|[[File:Afta foto - By Ebarruda - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=7903358.jpg|thumb|Apthous ulcer on the lower surface of the tongue - By Ebarruda - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=7903358|400x400px]]
|-
|[[Squamous cell carcinoma]]
|
*Non healing [[ulcer]], [[nodule]], indurated plaque or mass
*May involve [[skin]], [[lips]], inside the [[mouth]], [[throat]] or [[esophagus]]
|
* Chronic sun or [[Ultraviolet|UV exposure]]
* Fair [[skin]]
* [[Elderly]] age (>45 yrs)
* [[Male sex]]
* [[Smoking]]
|
*[[Physical exam]]
*[[Biopsy]]
|
*[[Oral Cavity]]
**Floor of [[mouth]]
**Lateral [[tongue]]
*[[Throat]]
*[[Esophagus]]
|
*[[Malignant]]
*Can spread to [[TMJ]]
*Some times associated with [[leukoplakia]]
|[[File:PLoS oral cancer.png|thumb|400x400px| |Squamous cell carcinoma - By Luca Pastore, Maria Luisa Fiorella, Raffaele Fiorella, Lorenzo Lo Muzio - http://www.plosmedicine.org/article/showImageLarge.action?uri=info%3Adoi%2F10.1371%2Fjournal.pmed.0050212.g001, CC BY 2.5, https://commons.wikimedia.org/w/index.php?curid=15252632]]
|-
|[[Leukoplakia]]
|
*White leathery spots on the [[mucous membranes]] of the [[tongue]] and inside of the [[mouth]]
*Lateral borders of [[tongue]]
|
*Atypical [[Tobacco]] use
*Chronic [[irritation]]
*[[Immunodeficiency]]
*[[Bloodroot]] ([[Sanguinarine|sanguinaria]])
|
*[[Physical exam]]
*Diagnosis of exclusion
*[[Biopsy]]
|
*[[Vulva|Vulvar]] lesions occur independent of oral lesions
|
*Associated with [[HIV]]
*Persistant white spots
*[[Benign]] but can progress to [[carcinoma]] after almost 10 years
*Oral proliferative [[Leukoplakia|verrucous leukoplakia]] is an aggressive sub type with multiple lesions and higher conversion to [[warts]] or [[carcinoma]]<ref>{{Cite journal
| author = [[Ann M. Gillenwater]], [[Nadarajah Vigneswaran]], [[Hanadi Fatani]], [[Pierre Saintigny]] & [[Adel K. El-Naggar]]
| title = Proliferative verrucous leukoplakia (PVL): a review of an elusive pathologic entity!
| journal = [[Advances in anatomic pathology]]
| volume = 20
| issue = 6
| pages = 416–423
| year = 2013
| month = November
| doi = 10.1097/PAP.0b013e3182a92df1
| pmid = 24113312
}}</ref>
|[[File:Oral hairy leukoplakia (EBV, in HIV)a.jpg|thumb|400x300px|Leukoplakia - By Aitor III - Own work, Public Domain, https://commons.wikimedia.org/w/index.php?curid=9873087]]
|-
|[[Melanoma]]
|
*A lesion with [[ABCD]]
**[[Asymmetry]]
**Border irregularity
**Color variation
**[[Diamete]]r changes
*[[Bleeding]] from the lesion
|
*[[Ultraviolet|UV radiations]]
*[[Genetic predisposition]]
*[[Old age]]
*[[Male gender]]
*Family or personal history of [[melanoma]]
*Multiple benign or atypical [[Nevus|nevi]]
|
*[[ABCD]] characteristics
*[[Bleeding]] or [[ulceration]] may show [[malignancy]]
*Serum [[LDH]] may be elevated in case of [[malignancy]]
*[[Biopsy]]
|
*Can [[metastasize]]
*All [[UV radiation]] or sun exposed areas can be effected independently
*1-2 to hundreds of [[granules]]
|
*[[Neural crest cell]] derivative
*Development begins with disruption of [[nevus]] growth control
*Progression involves [[MAPK/ERK pathway]]
*[[RAS|N-RAS]] or [[BRAF]] [[oncogene]] also involved
|[[File:Palate malign melanoma 01.jpg|thumb|400x400px|Oral melanoma - By Emmanouil K Symvoulakis, Dionysios E Kyrmizakis, Emmanouil I Drivas, Anastassios V Koutsopoulos, Stylianos G Malandrakis, Charalambos E Skoulakis and John G Bizakis - Symvoulakis et al. Head & Face Medicine 2006 2:7 doi:10.1186/1746-160X-2-7 (Open Access), [1], CC BY-SA 2.0, https://commons.wikimedia.org/w/index.php?curid=9839811]]
|-
|[[Fordyce spots]]
|
*Rice-like [[granules]] or [[spots]]
*Small, [[painless]], [[raised]], [[pale]], red or white
*1 to 3 mm in [[diameter]]
|
*Greasy skin types
*Some [[Rheumatic|rheumatic disorders]]
*[[Hereditary nonpolyposis colorectal cancer]]
**Lower [[gingiva]] (gums)
**[[Vestibular system|Vestibular mucosa]]
|
*[[Physical exam]]
*Small [[keratin]]-filled [[pseudocysts]]
*May be seen on [[incidental]] [[mucosal]] [[biopsy]]
**[[Biopsy]] not done for them primarily
|
*[[Oral cavity]]
**[[Vermillion border|Vermilion border]] of the lips
**[[Oral mucosa]] of the upper lip
*[[Buccal mucosa]] in the commissural region often bilaterally
*[[Genitals]]
|
*[[Benign neoplasms]] with [[sebaceous]] features
*Visible [[sebaceous glands]]
*No surrounding [[mucosal]] change
*Several adjacent [[glands]] may coalesce into a larger cauliflower-like cluster
|[[File:Fospot.jpg|thumb|400x400px|Fordyce spots - Por Perene - Obra do próprio, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=19772899]]
|-
|[[Burning mouth syndrome]]
|
*Burning or [[tingling]] on the [[lips]], [[tongue]], or entire [[mouth]]
|
*[[Nutritional deficiencies]]
*Chronic [[anxiety]] or [[depression]]
*[[Diabetes type 2]]
*[[Menopause]]
*[[Oral thrush]] or [[dry mouth]], or damaged [[nerves]] transmitting taste
*[[Female gender ]]
*[[Menopause]]
|
*[[Presentation]]
*[[Physical exam]]
|
*[[Oral cavity]]
|
*Pain typically is low in the morning and builds up over the day
*Low dosages of [[benzodiazepines]], [[tricyclic antidepressants]] or [[anticonvulsants]] may be effective
|
|-
|[[Torus palatinus]]
|
*Bony growth on midline of the [[hard palate]]
*[[Nodular]] mass covered with normal [[mucosa]]
|
*[[Genetic predisposition]]
**[[Autosomal dominant]]
|
*[[Physical exam]]
*Types
**[[Torus palatinus|Flat tori]]
**[[Torus palatinus|Spindle tori]]
**[[Torus palatinus|Nodular tori]]
**[[Torus palatinus|Lobular tori]]
|
*[[Hard palate]]
|
*More common in [[Asian]] and Inuit populations
*Twice more common in [[females]]
*Repeated [[trauma]] can cause [[bleeding]]
*[[Surgery]] may be required in symptomatic
|[[File:06-06-06palataltoria.jpg|thumb|Torus palatinus|400x400px|Torus palatinus - By Photo taken by dozenist, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=846591]]
|-
| colspan="4" |'''Diseases involving oral cavity and other organ systems'''
|
|
|
|-
|[[Behçet's disease|Behcet's disease]]
|
*Painful [[mouth sores]]
*[[Acne]] like skin lesions
*Headache, [[fever]], poor [[balance]], [[disorientation]]
*[[Abdominal pain]], [[diarrhea]] or [[bleeding]]
*[[Uveitis]]
*Joint [[swelling]] and joint [[pain]]
*Genital [[sores]] wit [[pain]] and [[scaring]]
*[[Aneurysms]]
|
*Over active [[immune system]]
|
*[[Physical examination]]
|
*[[Mouth]]
*[[Genitals]]
*[[GIT]]
*[[Eye]]
*[[Joints]]
*[[Skin]]
*[[Vascular system]]
*[[Brain]]
|
*[[Outbreaks]] of exaggerated [[inflammation]]
*Affects smaller [[blood vessels]]
|[[File:Behcets disease.jpg|thumb|400x400px|Behcet's disease - By Ahmet Altiner MD, Rajni Mandal MD - http://dermatology.cdlib.org/1611/articles/18_2009-10-20/2.jpg, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=17863021]]
|-
|[[Crohn's disease]]
|
*Chronic, episodic [[diarrhea]] or [[constipation]]
*[[Abdominal pain]]
*[[Vomiting]]
*[[Weight loss]] or [[weight gain]]
|
*[[Smoking]]
*[[Whites]] and [[European]] [[Jews]]
*[[Hormonal contraception]]
*Diets high in microparticles, sweet, fatty or refined foods
*Industrialized country
|
*Typical [[history]] and [[symptoms]]
*[[Skip lesions]] on [[biopsy]]
*[[Anti saccharomyces cerevisiae antibodies|Anti-Saccharomyces cerevisiae antibodies (ASCA)]]
*[[Anti-neutrophil cytoplasmic antibodies]] ([[ANCA]])
|
*[[Eyes]]
*[[Joints]]
*[[Skin]]
|
*May lead to
**[[Obstruction]]s
**[[Abscess]]es
**Free [[perforation]]
**[[Hemorrhage]]
|
|-
|[[Agranulocytosis]]
|
*[[Fever]] or [[chills]]
*Frequent [[infections]]
*Unusual [[redness]], [[pain]], or [[swelling]] around a wound
*Mouth [[ulcers]]
*[[Abdominal pain]]
*[[Burning sensation when urinating]]
*[[Sore throat]]
|
*[[Medications]]<ref name="PMID17142169">{{cite journal |author=Andrès E, Zimmer J, Affenberger S, Federici L, Alt M, Maloisel F. |title=Idiosyncratic drug-induced agranulocytosis: Update of an old disorder. |journal=Eur J Intern Med. |volume=17|issue=8 |pages=529-35 |year=2006|pmid 17142169|doi=|url=https://www.ncbi.nlm.nih.gov/pubmed/17142169}}</ref>
*[[List of chemotherapeutic agents#Cytotoxic Chemotherapy|Cytotoxic chemotherapy]]
*[[Hematological malignancy|Hematologic malignancies]]
*[[Autoimmune disorders]]
|
*[[Neutropenia]] <100 cells per micro litre
*[[Eosinopenia]]
*[[Basopenia]]
|
*[[Oral cavity]]
*[[Skin]]
*[[GIT]]
*[[Urinary system]]
*[[Conjunctiva]]
|
*[[Immunocompromised|Immunocompromization]]
*Types
**[[Drug-induced]]
**[[Malignant]]
**[[Autoimmune]]
|
|-
|[[Syphilis]]<ref> title="By Internet Archive Book Images [No restrictions], via Wikimedia Commons" href="https://commons.wikimedia.org/wiki/File:A_manual_of_syphilis_and_the_venereal_diseases%2C_(1900)_(14595882378).jpg"</ref>
|
*[[Chancre]]
*Regional [[lymphadenopathy]]
|
*[[Multiple sexual partners]]
*Illicit [[drug use]]
*[[Unprotected sex]]
*[[Homosexual men|Men who have sex with men]]
*Residence in highly prevalent areas
*[[Human Immunodeficiency Virus (HIV)|HIV]] infection
*Presence of other [[STI]]s
*Previous history of [[Sexually transmitted disease|STIs]]
*[[Intravenous drug use]]
|
*[[Darkfield microscope|Darkfield microscopy]]
*Non [[Treponema|treponemal]] tests like [[VDRL]] and [[RPR test]])
*[[Treponema|Treponemal]] tests[[FTA-ABS|FTA-ABS tests]], (TP-PA) assay, [[Enzyme linked immunosorbent assay (ELISA)|enzyme immunoassays]], and [[Chemiluminescence|chemiluminescence immunoassays]])
|
*[[Oral cavity]]
*[[Penis]]
*[[Cervix]]
*[[Labia]]
*[[Anal canal]]
*[[Rectum ]]
*[[CNS]]
*[[Cardiovascular|CVS]]
|
*[[Primary syphilis]]
**[[Chancre]]
*[[Secondary syphilis]]
**[[Condyloma latum|Condylomata lata]]
*[[Latent syphilis]]
**[[Asymptomatic]]
*[[Tertiary syphilis]]
**[[Gumma|Gummas]]
**[[Neurosyphilis]]
|[[File:Hutchinson teeth congenital syphilis PHIL 2385.rsh.jpg|thumb|400x400px|oral syphilis - By CDC/Susan Lindsley - http://phil.cdc.gov/phil_images/20021114/34/PHIL_2385_lores.jpg, Public Domain, https://commons.wikimedia.org/w/index.php?curid=2134349]]
|-
|[[Coxsackie virus]]
|
*[[Fever]]
*[[Sores]] in the [[mouth]]
*[[Rash]] with [[blisters]]
*[[Aches]]
|
*[[Pregnancy]]
*[[immunodeficiency]]
|
*[[History]] and [[Physical exam]]
*[[Swabbing|Throat swabs]]
*Swabs from the lesion
*[[Tzanck test]]
|
*[[Oral cavity]]
*[[Skin]]
|
*Symptomatic treatment
|[[File:Hand foot mouth disease 07a.jpg|thumb|400x400px|Coxsackie virus stomatitis - Adapted from Dermatology Atlas.<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref>]]
|-
|[[Chickenpox|Chicken pox]]
|
*[[Conjunctival]] symptoms
*[[Catarrhal]] symptoms
*Characteristic [[spots]] on the trunk appearing in two or three waves
*[[Itching]]
|
*[[Pregnancy]]
*[[Premature infants]] born to susceptible mothers
*All [[infants]] born at less than 28 weeks [[gestation]] or who weigh =1000 grams
*[[Immunocompromised]]
|
*[[History]] and [[physical exam]]
*[[PCR]] to detect [[VZV]] in [[skin lesions]] ([[vesicles]], [[scabs]], [[Maculopapular|maculopapular lesions]])
|
*[[Oral cavity]]
*[[Skin]]
|
*[[Sodium bicarbonate]] in baths or [[antihistamines]] for [[itching]]
*[[Paracetamol]] ([[acetaminophen]]) for [[fever]]
*[[Prednisolone]] is [[contraindicated]]
|[[File:Herpangina2016.jpg|thumb|400x400px|Chickenpox - By James Heilman, MD - Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=52872565]]
|-
|[[Measles]]
|
*[[Fever]]
*[[Rash]]
*[[Cough]]
*[[Coryza]] (runny nose)
*[[Conjunctivitis]] (pink eye)
*[[Malaise]]
*[[Koplick spots]] in mouth
|
*Unvaccinated individuals<ref name="pmid11135778">{{cite journal| author=Feikin DR, Lezotte DC, Hamman RF, Salmon DA, Chen RT, Hoffman RE| title=Individual and community risks of measles and pertussis associated with personal exemptions to immunization. | journal=JAMA | year= 2000 | volume= 284 | issue= 24 | pages= 3145-50 | pmid=11135778 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11135778  }} </ref><ref name="pmid9009400">{{cite journal| author=Ratnam S, West R, Gadag V, Williams B, Oates E| title=Immunity against measles in school-aged children: implications for measles revaccination strategies. | journal=Can J Public Health | year= 1996 | volume= 87 | issue= 6 | pages= 407-10 | pmid=9009400 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9009400  }} </ref>
*Crowded and/or unsanitary conditions
*Traveling to less developed and developing countries
*Immunocompromized
*Winter and [[spring]] seasons
*Born after 1956 and never fully vaccinated
*Health care workers
|
*[[History]] and [[examination]]
*[[PCR]] for [[Measles]]-specific [[IgM|IgM antibody]]
*[[PCR]] for [[Measles]] [[RNA]]
|
*[[Oral cavity]]
*[[Skin]]
*[[Respiratory tract]]
*[[Eyes]]
*[[Throat]]
|
*Caused by [[Morbillivirus]]
*Primary site of infection is the [[respiratory epithelium]] of the [[nasopharynx]]
*Transmitted in [[respiratory secretions]], via [[aerosol droplets]] containing [[Virus|virus particles]]
|[[File:Koplik spots, measles 6111 lores.jpg|thumb|400x400px|Koplick spots (Measles) - By CDC - http://phil.cdc.gov/PHIL_Images/20040908/4f54ee8f0e5f49f58aaa30c1bc6413ba/6111_lores.jpg, Public Domain, https://commons.wikimedia.org/w/index.php?curid=824483]]
|}


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


[[Category:Viral diseases]]
[[Category:Disease]]
[[Category:Up-To-Date]]
[[Category:Dermatology]]
[[Category:Pediatrics]]
[[Category:Pediatrics]]
[[Category:Poxviruses]]
[[Category:Emergency medicine]]
[[Category:Infectious disease]]
[[Category:Infectious disease]]
[[Category:Overview complete]]
[[Category:Pulmonology]]
[[Category:primary care]]
 
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Latest revision as of 20:53, 29 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Michael Maddaleni, B.S. João André Alves Silva, M.D. [2] Aravind Reddy Kothagadi M.B.B.S[3]

Overview

Chickenpox must be differentiated from various rash-causing conditions like Coxsackievirus, Stevens-Johnson syndrome (SJS), measles, rubella, Rocky mountain spotted fever and syphilis.

Differentiating Chickenpox from other Diseases

Chickenpox must be differentiated from other diseases presenting with diffuse papulovesicular rash in a febrile patient. The various conditions that should be differentiated from chickenpox include:[1][2][3][4][5][6][7]

Common conditions to be differentiated from chickenpox:

Common Conditions Features
Coxsackievirus
Stevens-Johnson syndrome
Kawasaki disease
Measles
Syphilis It commonly presents with gneralized systemic symptoms such as malaise, fatigue, headache and fever. Skin eruptions may be subtle and asymptomatic It is classically described as:
Rubella
Cytomegalovirus
Meningococcemia
Meningitis
Rocky Mountain spotted fever
Molluscum contagiosum
  • The lesions are commonly flesh-colored, dome-shaped and pearly in appearance. They are often 1-5 millimeters in diameter, with an umblicated center. Generally not painful, but they may itch or become irritated. Picking or scratching the lesions may lead to further infection or scarring. In about 10% of the cases, eczema develops around the lesions. They may occasionally be complicated by secondary bacterial infections.
Mononucleosis

Less common conditions to be differentiated from chickenpox:

Less Common Diseases Features
Atypical measles
Parvovirus B19
Rickettsial pox
Toxic erythema
Monkeypox
  • The presentation is similar to smallpox, although it is often a milder form, with fever, headache, myalgia, back pain, swollen lymph nodes, a general feeling of discomfort, and exhaustion. Within 1 to 3 days (sometimes longer) after the appearance of fever, the patient develops a papular rash, often first on the face. The lesions usually develop through several stages before crusting and falling off.
Rat-bite fever
  • It commonly presents with fever, chills, open sore at the site of the bite and rash, which may show red or purple plaques.
Scarlet fever

Differentiating chickenpox infection in immunocompromised host

Varicella Zoster virus infection is common among immunocompromised patients who are at high risk for other fungal, bacterial, and viral infections. It should be differentiated from the following diseases, which may present as confusion, fever and headache in immunocompromised patients:

Disease Differentiating signs and symptoms Differentiating tests
CNS lymphoma[8]
Disseminated tuberculosis[9]
Aspergillosis[10]
Cryptococcosis
Chagas disease[11]
CMV infection[12]
HSV infection[13]
Varicella Zoster infection[14]
Brain abscess[15][16]
Progressive multifocal leukoencephalopathy[17]

Oral lesions to be differentiated from chicken pox:

Oral lesions caused by chickenpox must be differentiated from other diseases presenting with pain and blistering within the mouth (gingivostomatitis and glossitis). The differentials include:

Disease Presentation Risk Factors Diagnosis Affected Organ Systems Important features Picture
Coxsackie virus
  • Symptomatic treatment
Hand-foot-and-mouth disease
Chicken pox
  • Conjunctival symptoms:
  • Catarrhal symptoms:
  • Characteristic spots on the trunk appearing in two or three waves
  • Itching
Chickenpox
Measles Koplick spots (Measles)
Herpangina
  • Attendance at a kindergarten/child care center
  • Contact with herpangina cases
  • Residence in rural areas
  • Overcrowding
  • Poor hygiene
  • Low socioeconomic status
  • Skin
  • Oral Cavity
  • Characteristic exanthem- Punctate macule which evolve over a period of 24 hours to 2-4mm erythematous papules which vesiculate, and then centrally ulcerate.
  • The lesions are usually small in number, and evolve rapidly. The lesions are seen more commonly on the soft palate and uvula. The lesions can also be seen on the tonsils, posterior pharyngeal wall and the buccal mucosa.
Erythema, vesicles and ulcerating lesions in herpangina
Erythema, vesicles and ulcerating lesions in herpangina
Primary herpetic gingivostomatitis[20]
  • Oral cavity
  • Mucous membranes
  • Ulcers are common on lips, gums, throat, front of tongue, inside of the cheeks and roof of the mouth
  • Treatment is with antiviral agents such as Valacyclovir and Famciclovir

Oral Candidiasis
  • Clinical diagnosis
  • Confirmatory tests rarely needed
Localized candidiasis

Invasive candidasis

Tongue infected with oral candidiasis - By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=11717223.jpg


Disease Presentation Risk Factors Diagnosis Affected Organ Systems Important features Picture
Diseases predominantly affecting the oral cavity
Oral Candidiasis
  • Denture users
  • As a side effect of medication, most commonly having taken antibiotics. Inhaled corticosteroids for the treatment of lung conditions (e.g, asthma or COPD) may also result in oral candidiasis which may be reduced by regularly rinsing the mouth with water after taking the medication.
  • Clinical diagnosis
  • Confirmatory tests rarely needed
Localized candidiasis

Invasive candidasis

Tongue infected with oral candidiasis - By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=11717223.jpg
Herpes simplex oral lesions
  • Stress
  • Recent URTI
  • Female sex
  • The symptoms of primary HSV infection generally resolve within two weeks
Oral herpes simplex infection - By James Heilman, MD - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=19051042.jpg
Aphthous ulcers
  • Painful, red spot or bump that develops into an open ulcer
  • Physical examination
  • Diagnosis of exclusion
  • Oral cavity
  • Self-limiting , Pain decreases in 7 to 10 days, with complete healing in 1 to 3 weeks
Apthous ulcer on the lower surface of the tongue - By Ebarruda - Own work, CC BY-SA 3.0, httpscommons.wikimedia.orgwindex.phpcurid=7903358
Squamous cell carcinoma
Squamous cell carcinoma - By Luca Pastore, Maria Luisa Fiorella, Raffaele Fiorella, Lorenzo Lo Muzio - http://www.plosmedicine.org/article/showImageLarge.action?uri=info%3Adoi%2F10.1371%2Fjournal.pmed.0050212.g001, CC BY 2.5, https://commons.wikimedia.org/w/index.php?curid=15252632
Leukoplakia
  • Vulvar lesions occur independent of oral lesions
Leukoplakia - By Aitor III - Own work, Public Domain, https://commons.wikimedia.org/w/index.php?curid=9873087
Melanoma
Oral melanoma - By Emmanouil K Symvoulakis, Dionysios E Kyrmizakis, Emmanouil I Drivas, Anastassios V Koutsopoulos, Stylianos G Malandrakis, Charalambos E Skoulakis and John G Bizakis - Symvoulakis et al. Head & Face Medicine 2006 2:7 doi:10.1186/1746-160X-2-7 (Open Access), [1], CC BY-SA 2.0, https://commons.wikimedia.org/w/index.php?curid=9839811
Fordyce spots
Fordyce spots - Por Perene - Obra do próprio, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=19772899
Burning mouth syndrome
Torus palatinus
Torus palatinus - By Photo taken by dozenist, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=846591
Diseases involving oral cavity and other organ systems
Behcet's disease
Behcet's disease - By Ahmet Altiner MD, Rajni Mandal MD - http://dermatology.cdlib.org/1611/articles/18_2009-10-20/2.jpg, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=17863021
Crohn's disease
Agranulocytosis
Syphilis[24]
oral syphilis - By CDC/Susan Lindsley - http://phil.cdc.gov/phil_images/20021114/34/PHIL_2385_lores.jpg, Public Domain, https://commons.wikimedia.org/w/index.php?curid=2134349
Coxsackie virus
  • Symptomatic treatment
Coxsackie virus stomatitis - Adapted from Dermatology Atlas.[25]
Chicken pox
Chickenpox - By James Heilman, MD - Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=52872565
Measles
  • Unvaccinated individuals[18][19]
  • Crowded and/or unsanitary conditions
  • Traveling to less developed and developing countries
  • Immunocompromized
  • Winter and spring seasons
  • Born after 1956 and never fully vaccinated
  • Health care workers
Koplick spots (Measles) - By CDC - http://phil.cdc.gov/PHIL_Images/20040908/4f54ee8f0e5f49f58aaa30c1bc6413ba/6111_lores.jpg, Public Domain, https://commons.wikimedia.org/w/index.php?curid=824483

References

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  24. title="By Internet Archive Book Images [No restrictions], via Wikimedia Commons" href="https://commons.wikimedia.org/wiki/File:A_manual_of_syphilis_and_the_venereal_diseases%2C_(1900)_(14595882378).jpg"
  25. "Dermatology Atlas".