Endocarditis differential diagnosis: Difference between revisions
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{{ | [[Image:Home_logo1.png|right|250px|link=http://www.wikidoc.org/index.php/Endocarditis]] | ||
{{ | {{CMG}} {{AE}} {{Maliha}} | ||
==Overview== | ==Overview== | ||
Endocarditis | Endocarditis must be differentiated from other causes of a [[fever of unknown origin]] ([[FUO]]) such as [[pulmonary embolism]], [[deep vein thrombosis]], [[lymphoma]], [[drug fever]], [[cotton fever]], and disseminated granulomatoses.<ref name="pmid9114175">{{cite journal| author=Hirschmann JV| title=Fever of unknown origin in adults. | journal=Clin Infect Dis | year= 1997 | volume= 24 | issue= 3 | pages= 291-300; quiz 301-2 | pmid=9114175 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9114175 }} </ref> | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Endocarditis must be differentiated from other causes of a fever of unknown origin such as:<ref name="pmid9114175">{{cite journal| author=Hirschmann JV| title=Fever of unknown origin in adults. | journal=Clin Infect Dis | year= 1997 | volume= 24 | issue= 3 | pages= 291-300; quiz 301-2 | pmid=9114175 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9114175 }} </ref> | |||
*[[Lymphoma]] | |||
*[[Pulmonary embolism]] | |||
*[[Deep vein thrombosis]] | |||
*[[Drug fever]] | |||
*[[Cotton fever]] | |||
*Disseminated granulomatoses such as [[tuberculosis]], [[histoplasmosis]], [[coccidioidomycosis]], [[blastomycosis]], and [[sarcoidosis]] | |||
===Drug Fever=== | ===Drug Fever=== | ||
A [[drug fever]] will resolve with discontinuation of the offending agent. There may be elevated [[ | A [[drug fever]] will resolve with discontinuation of the offending agent. There may be elevated urine [[eosinophils]] and a peripheral [[eosinophilia]] as well. | ||
===Cotton Fever=== | ===Cotton Fever=== | ||
The symptoms of cotton fever resemble those of [[sepsis]] and patients may be initially misdiagnosed upon admission to a hospital. However sepsis is a serious medical condition which can lead to death, whereas cotton fever, if left alone, will usually resolve itself spontaneously within 12-24 hours. Symptoms usually appear with 10-20 minutes after injection and in addition to [[fever]] may include [[headache]]s, [[malaise]], [[chills]], [[nausea]] and [[tachycardia]]. The fever itself usually reaches 38.5 - 40.3°C (101 - 105°F) within the first hour.<ref name="pmid2362114">{{cite journal| author=Harrison DW, Walls RM| title="Cotton fever": a benign febrile syndrome in intravenous drug abusers. | journal=J Emerg Med | year= 1990 | volume= 8 | issue= 2 | pages= 135-9 | pmid=2362114 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2362114 }} </ref> | The symptoms of [[cotton fever]] resemble those of [[sepsis]] and patients may be initially misdiagnosed upon admission to a hospital. However sepsis is a serious medical condition which can lead to death, whereas cotton fever, if left alone, will usually resolve itself spontaneously within 12-24 hours. Symptoms usually appear with 10-20 minutes after injection and in addition to [[fever]] may include [[headache]]s, [[malaise]], [[chills]], [[nausea]] and [[tachycardia]]. The fever itself usually reaches 38.5 - 40.3°C (101 - 105°F) within the first hour.<ref name="pmid2362114">{{cite journal| author=Harrison DW, Walls RM| title="Cotton fever": a benign febrile syndrome in intravenous drug abusers. | journal=J Emerg Med | year= 1990 | volume= 8 | issue= 2 | pages= 135-9 | pmid=2362114 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2362114 }} </ref> | ||
'''Table 1; Differentiating psittacosis from other diseases''' | |||
{| class="wikitable" | |||
!Clinical feature | |||
![[Cough]] | |||
![[Sputum]] | |||
![[Dyspnea]] | |||
![[Sore throat]] | |||
![[Headache]] | |||
![[Confusion]] | |||
![[Diarrhea]] | |||
!Chest radiograph changes | |||
!Hyponatremia | |||
![[Leukopenia]] | |||
!Abnormal Liver function tests | |||
!Treatment | |||
|- | |||
!Psittacosis | |||
| ++ | |||
| - | |||
| + | |||
| - | |||
| +++ | |||
| + | |||
|Minimal | |||
| | |||
* No changes seen | |||
| - | |||
| + | |||
| - | |||
|[[Doxycycline]] | |||
|- | |||
![[Chlamydia pneumoniae|''C.pneumoniae'']] pneumonia | |||
| + | |||
| + | |||
| + | |||
| +++ | |||
| ++ | |||
| + | |||
| - | |||
| | |||
* Minimal changes observed | |||
| - | |||
| - | |||
| - | |||
|[[Doxycycline]], [[Azithromycin]] | |||
|- | |||
![[Mycoplasma pneumoniae|''M. pneumoniae'']] pneumonia | |||
| ++ | |||
| ++ | |||
| ++ | |||
| - | |||
| - | |||
| - | |||
| - | |||
| | |||
* Bronchial wall thickening | |||
* Centrilobular nodules | |||
* [[Ground glass opacification on CT|Ground-glass attenuation]] | |||
* [[Consolidation (medicine)|Consolidation]] | |||
| - | |||
| - | |||
| + | |||
|[[Doxycycline]] | |||
|- | |||
![[Legionella pneumophila|''L. Pneumophila'']] infection | |||
| + | |||
| +++ | |||
| +++ | |||
| - | |||
| + | |||
| ++ | |||
| + | |||
|Often Multifocal | |||
| ++ | |||
| + | |||
| ++ | |||
|[[Doxycycline]] | |||
|- | |||
![[Influenza (Flu) (For Patients)|Influenza]] | |||
| ++ | |||
| ++ | |||
| ++ | |||
| ++ | |||
| ++ | |||
| +/- | |||
| +/- | |||
| | |||
* Bi-basal air-space opacities | |||
* Perihilar [[reticular]] and [[Alveolar|alveolar infiltrates]] | |||
| - | |||
| - | |||
| - | |||
|[[zanamivir]], [[oseltamivir]], | |||
|- | |||
![[Endocarditis]] | |||
| ++ | |||
| ++ | |||
| + | |||
| - | |||
| - | |||
| - | |||
| - | |||
| | |||
* Hazy opacities at [[lung]] | |||
bases bilaterally | |||
| - | |||
| +/- | |||
| +/- | |||
|[[Vancomycin]] | |||
|- | |||
![[Coxiella burnetii infection|''Coxiella burnetii'' infection]] | |||
| ++ | |||
| - | |||
| + | |||
| +/- | |||
| - | |||
| +/- | |||
|Minimal | |||
| | |||
* [[Segmental analysis (biology)|Segmental]] or [[Lobar pneumonia|lobar]] opacification | |||
* Occasional [[pleural effusions]] | |||
| - | |||
| +/- | |||
|=/- | |||
|[[Doxycycline]] | |||
|- | |||
![[Leptospirosis]] | |||
| ++ | |||
| + | |||
| ++ | |||
| + | |||
| + | |||
| ++ | |||
| - | |||
| | |||
* Multiple ill-defined [[Nodule (medicine)|nodules]] in both lungs. | |||
| +++ | |||
| | |||
| | |||
|[[Doxycycline]], [[azithromycin]], [[amoxicillin]] | |||
|- | |||
![[Brucellosis]] | |||
| ++ | |||
| - | |||
| + | |||
| - | |||
| ++ | |||
| + | |||
| - | |||
| | |||
* Soft [[Miliary TB|miliary]] mottling | |||
* [[Parenchymal lung disease|Parenchymal nodules]] | |||
* [[Consolidation (medicine)|Consolidation]] | |||
* [[Chronic (medical)|Chronic]] [[diffuse]] changes | |||
* [[Hilar]] or [[Paratracheal lymph nodes|paratracheal]] [[lymphadenopathy]] | |||
* [[Pneumothorax]]. | |||
| -/+ | |||
| +/- | |||
| +/- | |||
|[[Doxycycline]], [[rifampin]] | |||
|} | |||
Key; | |||
+, occurs in some cases | |||
++, occurs in many cases, | |||
+++, occurs frequently | |||
==References== | ==References== | ||
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[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
[[Category:Intensive care medicine]] | [[Category:Intensive care medicine]] | ||
[[Category:Up-To-Date]] | [[Category:Up-To-Date]] |
Latest revision as of 21:12, 3 March 2020
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Maliha Shakil, M.D. [2]
Overview
Endocarditis must be differentiated from other causes of a fever of unknown origin (FUO) such as pulmonary embolism, deep vein thrombosis, lymphoma, drug fever, cotton fever, and disseminated granulomatoses.[1]
Differential Diagnosis
Endocarditis must be differentiated from other causes of a fever of unknown origin such as:[1]
- Lymphoma
- Pulmonary embolism
- Deep vein thrombosis
- Drug fever
- Cotton fever
- Disseminated granulomatoses such as tuberculosis, histoplasmosis, coccidioidomycosis, blastomycosis, and sarcoidosis
Drug Fever
A drug fever will resolve with discontinuation of the offending agent. There may be elevated urine eosinophils and a peripheral eosinophilia as well.
Cotton Fever
The symptoms of cotton fever resemble those of sepsis and patients may be initially misdiagnosed upon admission to a hospital. However sepsis is a serious medical condition which can lead to death, whereas cotton fever, if left alone, will usually resolve itself spontaneously within 12-24 hours. Symptoms usually appear with 10-20 minutes after injection and in addition to fever may include headaches, malaise, chills, nausea and tachycardia. The fever itself usually reaches 38.5 - 40.3°C (101 - 105°F) within the first hour.[2]
Table 1; Differentiating psittacosis from other diseases
Clinical feature | Cough | Sputum | Dyspnea | Sore throat | Headache | Confusion | Diarrhea | Chest radiograph changes | Hyponatremia | Leukopenia | Abnormal Liver function tests | Treatment |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Psittacosis | ++ | - | + | - | +++ | + | Minimal |
|
- | + | - | Doxycycline |
C.pneumoniae pneumonia | + | + | + | +++ | ++ | + | - |
|
- | - | - | Doxycycline, Azithromycin |
M. pneumoniae pneumonia | ++ | ++ | ++ | - | - | - | - |
|
- | - | + | Doxycycline |
L. Pneumophila infection | + | +++ | +++ | - | + | ++ | + | Often Multifocal | ++ | + | ++ | Doxycycline |
Influenza | ++ | ++ | ++ | ++ | ++ | +/- | +/- |
|
- | - | - | zanamivir, oseltamivir, |
Endocarditis | ++ | ++ | + | - | - | - | - |
bases bilaterally |
- | +/- | +/- | Vancomycin |
Coxiella burnetii infection | ++ | - | + | +/- | - | +/- | Minimal |
|
- | +/- | =/- | Doxycycline |
Leptospirosis | ++ | + | ++ | + | + | ++ | - |
|
+++ | Doxycycline, azithromycin, amoxicillin | ||
Brucellosis | ++ | - | + | - | ++ | + | - |
|
-/+ | +/- | +/- | Doxycycline, rifampin |
Key;
+, occurs in some cases
++, occurs in many cases,
+++, occurs frequently
References
- ↑ 1.0 1.1 Hirschmann JV (1997). "Fever of unknown origin in adults". Clin Infect Dis. 24 (3): 291–300, quiz 301-2. PMID 9114175.
- ↑ Harrison DW, Walls RM (1990). ""Cotton fever": a benign febrile syndrome in intravenous drug abusers". J Emerg Med. 8 (2): 135–9. PMID 2362114.