Legionellosis differential diagnosis: Difference between revisions

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! align="center" style="background:#DCDCDC;" |[[Legionellosis]]
! align="center" style="background:#DCDCDC;" |[[Legionellosis]]
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*[[Adult respiratory distress syndrome]]
*[[Adult respiratory distress syndrome]]
*[[Breath sounds|Bronchial breath sounds]]
*[[Breath sounds|Bronchial breath sounds]]
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*[[diarrhea]]
*[[diarrhea]]
*[[nausea]], and [[vomiting]]
*[[nausea]], and [[vomiting]]
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*Legionella urinary antigen positive
*Legionella urinary antigen positive
*[[Leukocytosis]] with relative [[lymphopenia]]
*[[Leukocytosis]] with relative [[lymphopenia]]
*[[Hyponatremia]]
*[[Hyponatremia]]
*[[Hypophosphatemia]]
*[[Hypophosphatemia]]
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*[[Alveoli|Alveolar consolidation]] on chest radiograph
*[[Alveoli|Alveolar consolidation]] on chest radiograph
*[[Consolidation (medicine)|Lobar consolidation]] on chest radiograph
*[[Consolidation (medicine)|Lobar consolidation]] on chest radiograph
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! align="center" style="background:#DCDCDC;" |Q fever
! align="center" style="background:#DCDCDC;" |Q fever
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* Abrupt onset of [[fever]], [[myalgia]], [[headache]], and other constitutional symptoms
*Abrupt onset of [[fever]], [[myalgia]], [[headache]], and other constitutional symptoms
* Dry [[cough]]
*Dry [[cough]]
* [[Dyspnea]]
*[[Dyspnea]]
* [[Pleuritic chest pain]]
*[[Pleuritic chest pain]]
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* [[Antibody]] detection using [[Immunofluorescence|indirect immunofluorescence]] (IIF)
*[[Antibody]] detection using [[Immunofluorescence|indirect immunofluorescence]] (IIF)
* [[Polymerase chain reaction|PCR]]
*[[Polymerase chain reaction|PCR]]
* [[Coxiella burnetii|''C. burnetii'']] cultivated on special media such as embryonated eggs or cell culture
*[[Coxiella burnetii|''C. burnetii'']] cultivated on special media such as embryonated eggs or cell culture
* A two-to-three fold increase in [[Aspartate transaminase|AST]] and [[ALT]]
*A two-to-three fold increase in [[Aspartate transaminase|AST]] and [[ALT]]
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[[Image:Q fever.gif|center|300px|thumb|Q fever pneumonia - Case courtesy of Royal Melbourne Hospital Respiratory, Radiopaedia.org, rID 21993 ]]
[[Image:Q fever.gif|center|300px|thumb|Q fever pneumonia - Case courtesy of Royal Melbourne Hospital Respiratory, Radiopaedia.org, rID 21993 ]]
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! align="center" style="background:#DCDCDC;" |[[mycoplasma pneumonia|''Mycoplasma'' pneumonia]]
! align="center" style="background:#DCDCDC;" |[[mycoplasma pneumonia|''Mycoplasma'' pneumonia]]
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*[[Dry cough]]
*[[Dry cough]]
*[[Pleuritic chest pain]]
*[[Pleuritic chest pain]]
*Bronchial [[breath sounds]]
*Bronchial [[breath sounds]]
*[[Inflamed]], opaque, hypomobile [[tympanic membrane]]
*[[Inflamed]], opaque, hypomobile [[tympanic membrane]]
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*[[Lymphocytosis]]
*[[Lymphocytosis]]
*[[Cold agglutinins]] positive
*[[Cold agglutinins]] positive
* Positive [[Coombs test]]
*Positive [[Coombs test]]
* [[Leukocytosis]]
*[[Leukocytosis]]
* [[Thrombocytosis]]
*[[Thrombocytosis]]
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*[[Alveolar]] [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
*[[Alveolar]] [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
*Interstitial infiltrate on [[chest radiograph]]
*Interstitial infiltrate on [[chest radiograph]]
*Lobar [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
*Lobar [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
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[[Image:Atypical-pneumonia-mycoplasma - Case courtesy of Dr Alborz Jahangiri, Radiopaedia.org, rID 45781.jpg|center|300px|thumb|Mycoplasma pneumonia - Case courtesy of Dr Alborz Jahangiri, Radiopaedia.org, rID 45781]]
[[Image:Atypical-pneumonia-mycoplasma - Case courtesy of Dr Alborz Jahangiri, Radiopaedia.org, rID 45781.jpg|center|300px|thumb|Mycoplasma pneumonia - Case courtesy of Dr Alborz Jahangiri, Radiopaedia.org, rID 45781]]
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! align="center" style="background:#DCDCDC;" |[[Chlamydia pneumonia]]
! align="center" style="background:#DCDCDC;" |[[Chlamydia pneumonia]]
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* No specific clinical features of [[chlamydia pneumonia]].
*No specific clinical features of [[chlamydia pneumonia]].
* Gradual symptoms
*Gradual symptoms
* Associated with [[upper respiratory tract]] symptoms
*Associated with [[upper respiratory tract]] symptoms
* Associated with extrapulmonary maifestations such as:
*Associated with extrapulmonary maifestations such as:
**[[Meningitis]]  
**[[Meningitis]]
**[[Guillain-Barre syndrome]]
**[[Guillain-Barre syndrome]]
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* Normal WBC count
*Normal WBC count
* Positive [[Antibody|antichlamydial antibody]]
*Positive [[Antibody|antichlamydial antibody]]
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[[Image:Chlamydia-pneumonia - Case courtesy of Dr Andrew Dixon, Radiopaedia.org, rID 14567.jpg|center|300px|thumb|Chlamydia-pneumonia - Case courtesy of Dr Andrew Dixon, Radiopaedia.org, rID 14567]]
[[Image:Chlamydia-pneumonia - Case courtesy of Dr Andrew Dixon, Radiopaedia.org, rID 14567.jpg|center|300px|thumb|Chlamydia-pneumonia - Case courtesy of Dr Andrew Dixon, Radiopaedia.org, rID 14567]]
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! align="center" style="background:#DCDCDC;" |Acute interstitial pneumonia
! align="center" style="background:#DCDCDC;" |Acute interstitial pneumonia
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*[[Dry cough]]
*[[Dry cough]]
*[[Dyspnea|Progressive dyspnea]]
*[[Dyspnea|Progressive dyspnea]]
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*Nonspecific
*Nonspecific
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*Disseminated [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
*Disseminated [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
*Interstitial infiltrate on chest radiograph
*Interstitial infiltrate on chest radiograph
*Increased uptake on gallium scan
*Increased uptake on gallium scan
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! align="center" style="background:#DCDCDC;" |Pneumococcal pneumonia
! align="center" style="background:#DCDCDC;" |Pneumococcal pneumonia
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*[[Fever|High grade fever]]
*[[Fever|High grade fever]]
*[[Hemoptysis]]
*[[Hemoptysis]]
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*[[Productive cough]]
*[[Productive cough]]
*[[Egophony]]
*[[Egophony]]
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*[[Gram positive bacteria|Gram positive]] [[diplococci]] on sputum Gram stain
*[[Gram positive bacteria|Gram positive]] [[diplococci]] on sputum Gram stain
*[[Pleural effusion]] ([[exudative]])
*[[Pleural effusion]] ([[exudative]])
*Respiratory alkalosis
*Respiratory alkalosis
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*Parenchymal hyperlucency on [[chest radiograph]]
*Parenchymal hyperlucency on [[chest radiograph]]
*Increased uptake on [[gallium scan]]
*Increased uptake on [[gallium scan]]
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*Alveolar [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
*Alveolar [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
*Lobar [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
*Lobar [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
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! align="center" style="background:#DCDCDC;" |Pneumocystis carinii pneumonia
! align="center" style="background:#DCDCDC;" |Pneumocystis carinii pneumonia
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*[[Immunosuppressive]] state
*[[Immunosuppressive]] state
*[[Subcutaneous emphysema]]
*[[Subcutaneous emphysema]]
*[[Cough|Hacking cough]]
*[[Cough|Hacking cough]]
*[[Dyspnea|Progressive dyspnea]]
*[[Dyspnea|Progressive dyspnea]]
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*[[Respiratory alkalosis]]
*[[Respiratory alkalosis]]
*Serum beta-D-glucan elevation
*Serum beta-D-glucan elevation
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*[[Alveolar]] [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
*[[Alveolar]] [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
*Lobar [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
*Lobar [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
*Interstitial infiltrate on [[chest radiograph]]
*Interstitial infiltrate on [[chest radiograph]]
*[[Pneumomediastinum]] on [[chest radiograph]]
*[[Pneumomediastinum]] on [[chest radiograph]]
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! align="center" style="background:#DCDCDC;" |Pulmonary embolism
! align="center" style="background:#DCDCDC;" |Pulmonary embolism
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*Calf [[pain]] or [[swelling]]
*Calf [[pain]] or [[swelling]]
*Decreased [[pulse pressure]]
*Decreased [[pulse pressure]]
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*[[Venous stasis]]
*[[Venous stasis]]
*[[Bone fracture]]
*[[Bone fracture]]
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*[[D-dimer]] elevation
*[[D-dimer]] elevation
*[[Hypocapnia]]
*[[Hypocapnia]]
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*[[Right axis deviation]] on ECG
*[[Right axis deviation]] on ECG
*Right ventricular overload on ECG
*Right ventricular overload on ECG
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*Normal [[chest radiograph]]
*Normal [[chest radiograph]]
*[[Atelectasis]] on [[chest radiograph]]
*[[Atelectasis]] on [[chest radiograph]]
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*Segmental [[perfusion]] defect on lung scan
*Segmental [[perfusion]] defect on lung scan
*[[V/Q scan|V/Q]] mismatch on lung scan
*[[V/Q scan|V/Q]] mismatch on lung scan
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! align="center" style="background:#DCDCDC;" |Streptococcal pneumonia
! align="center" style="background:#DCDCDC;" |Streptococcal pneumonia
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*Pectoriloquy
*Pectoriloquy
*Bronchial [[breath sounds]]
*Bronchial [[breath sounds]]
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*[[Pleuritic chest pain]]
*[[Pleuritic chest pain]]
*[[Egophony]]
*[[Egophony]]
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*[[Gram-positive cocci]] in chains on sputum [[Gram stain]]
*[[Gram-positive cocci]] in chains on sputum [[Gram stain]]
*[[Respiratory alkalosis]]
*[[Respiratory alkalosis]]
*[[Pleural effusion]] (exudative)
*[[Pleural effusion]] (exudative)
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*Alveolar consolidation on chest radiograph
*Alveolar consolidation on chest radiograph
*Lobar consolidation on chest radiograph
*Lobar consolidation on chest radiograph
*[[Empyema]] on chest radiograph
*[[Empyema]] on chest radiograph
*Increased uptake on [[gallium scan]]
*Increased uptake on [[gallium scan]]
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! align="center" style="background:#DCDCDC;" |Viral pneumonia
! align="center" style="background:#DCDCDC;" |Viral pneumonia
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*[[Pleuritic chest pain]]
*[[Pleuritic chest pain]]
*[[Breath sounds|Bronchial breath sounds]]
*[[Breath sounds|Bronchial breath sounds]]
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*Fine [[rales]]
*Fine [[rales]]
*[[Breath sounds|Bronchovesicular breath sounds]]
*[[Breath sounds|Bronchovesicular breath sounds]]
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*[[Lymphocytosis]]
*[[Lymphocytosis]]
*[[Respiratory alkalosis]]
*[[Respiratory alkalosis]]
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*Lobar [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
*Lobar [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
*Interstitial infiltrate on [[chest radiograph]]
*Interstitial infiltrate on [[chest radiograph]]
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[[File:Hampton Hump.PNG|thumb|Hampton Hump in a patient with pulmonary embolism]]


==References==
==References==

Revision as of 06:25, 4 May 2022

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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 pneumonia, viral pneumonia, and other causes of atypical pneumonia.

Differential Diagnosis

Legionellosis must be differentiated from other causes of fever, dyspnea, cough, and sputum production, such as bacterial pneumonia, viral pneumonia, and other causes of atypical pneumonia.[1]

Disease Clinical manifestation Lab findings Imaging findings Chest X-ray
Legionellosis
Q fever
Q fever pneumonia - Case courtesy of Royal Melbourne Hospital Respiratory, Radiopaedia.org, rID 21993
Mycoplasma pneumonia
Mycoplasma pneumonia - Case courtesy of Dr Alborz Jahangiri, Radiopaedia.org, rID 45781
Chlamydia pneumonia
Chlamydia-pneumonia - Case courtesy of Dr Andrew Dixon, Radiopaedia.org, rID 14567
Acute interstitial pneumonia
  • Nonspecific
Pneumococcal pneumonia
Pneumocystis carinii pneumonia
Pulmonary embolism
Streptococcal pneumonia
  • Alveolar consolidation on chest radiograph
  • Lobar consolidation on chest radiograph
  • Empyema on chest radiograph
  • Increased uptake on gallium scan
Viral pneumonia
Hampton Hump in a patient with pulmonary embolism

References

  1. Irfan M, Farooqi J, Hasan R (2013). "Community-acquired pneumonia". Curr Opin Pulm Med. 19 (3): 198–208. doi:10.1097/MCP.0b013e32835f1d12. PMID 23422417.