Bacterial pneumonia differential diagnosis
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Arooj Naz, M.B.B.S
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Overview
Symptoms related to pulmonary diseases may overlap, and so, it is important to differentiate bacterial causes from other diseases. This can be done with the assistance of laboratory examinations such as chest x-ray findings, throat cultures, and sensitivity bacterial cultures. Some pulmonary diseases that must be differentiated include bronchitis, bronchiolitis obliterans, empyema, lung abscess, and pulmonary carcinomas. Other diseases to be ruled out include bacterial endocarditis, especially in patients with an underlying history of intravenous drug abuse, GERD, and sinusitis.
Differentiating Bacterial Pneumonia from other Diseases
| Disease | Common Organisms |
|---|---|
| Typical Bacterial | S. pneumoniae, H. influenzae, S. aureus, Klebsiella pneumoniae, anaerobes, group A streptococci, Moraxella catarrhalis |
| Atypical Bacterial | Mycoplasma pneumoniae, Legionella spp, Chlamydophila pneumoniae, and C. psittaci |
| Viral | Influenza virus, Parainfluenza virus, Adenovirus, Rhinovirus, RSV, SARS, MERS-CoV |
| Fungi | Cryptococcus spp, Pneumocystis jirovecii, Histoplasma capsulatum, Coccidioides spp, Aspergillus spp |
| Parasite |
| Disease | Findings |
|---|---|
| Acute bronchitis | No infiltrates seen on the chest X-ray |
| Asthma | Past medical history, no infiltrates seen on chest X-ray |
| Bronchiolitis obliterans | Should be suspected in patients with pneumonia who do not respond to antibiotics treatment |
| Congestive heart failure | Bilateral pulmonary edema, shortness of breath |
| COPD | Past medical history, no infiltrates on chest X-ray, fever is uncommon |
| Empyema | CXR showing features of pleural effusion, inflammatory markers on thoracocentesis |
| Endocarditis | Finding of septic pulmonary emboli |
| Gastroesophageal reflux disease (GERD) | Normal chest X-ray, symptoms are worse during night and associated with meals |
| Lung abscess | Chest X-ray shows signs of lung abscess |
| Lung cancer | Weight loss and clear sputum. CT scan and biopsy are helpful in ruling out malignancy |
| Pertussis | Productive cough for weeks, nasopharyngeal aspirate aids in diagnosis |
| Pulmonary embolus | A high degree of suspicion should be kept for pulmonary embolus. Chest X-ray may be normal |
| Sinusitis | Sinus tenderness, post nasal drip |
| Vasculitis | Systemic manifestations of collagen vascular disease may be seen |
References
- ↑ Schiele F, Muller J, Colinet E, Siest G, Arzoglou P, Brettschneider H; et al. (1992). "Interlaboratory study of the IFCC method for alanine aminotransferase performed with use of a partly purified reference material". Clin Chem. 38 (12): 2365–71. PMID 1458569.
- ↑ Castro-Guardiola A, Armengou-Arxé A, Viejo-Rodríguez A, Peñarroja-Matutano G, Garcia-Bragado F (2000). "Differential diagnosis between community-acquired pneumonia and non-pneumonia diseases of the chest in the emergency ward". Eur J Intern Med. 11 (6): 334–339. PMID 11113658.
- ↑ Ahnsjö, Sven (1935). "Contribution to the Differential Diagnosis of Pneumonia in Childhood". Acta Paediatrica. 17 (3): 439–446. doi:10.1111/j.1651-2227.1935.tb07697.x. ISSN 0803-5253.