Psittacosis differential diagnosis: Difference between revisions

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{{CMG}}; {{AE}} {{ADI}}{{DAMI}}
{{CMG}}; {{AE}} {{ADI}}{{DAMI}}
==Overview==
==Overview==
Psittacosis must be differentiated from other diseases that cause [[atypical pneumonia]]<ref name="pmid3343952">{{cite journal| author=Yung AP, Grayson ML| title=Psittacosis--a review of 135 cases. | journal=Med J Aust | year= 1988 | volume= 148 | issue= 5 | pages= 228-33 | pmid=3343952 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3343952  }} </ref>, 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.
Psittacosis must be differentiated from other diseases that cause [[atypical pneumonia|atypical pneumonia,]]<ref name="pmid3343952">{{cite journal| author=Yung AP, Grayson ML| title=Psittacosis--a review of 135 cases. | journal=Med J Aust | year= 1988 | volume= 148 | issue= 5 | pages= 228-33 | pmid=3343952 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3343952  }} </ref> [[Febrile|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 [[History & Symptoms|histories]] and [[Laboratory|laboratory investigations]]. There are other conditions to watch out for which may also present similar to psittacosis.


==Differentiating Psittacosis from other Disease<ref name="pmid3343952">{{cite journal| author=Yung AP, Grayson ML| title=Psittacosis--a review of 135 cases. | journal=Med J Aust | year= 1988 | volume= 148 | issue= 5 | pages= 228-33 | pmid=3343952 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3343952  }} </ref>==
==Differentiating Psittacosis from other Disease<ref name="pmid3343952">{{cite journal| author=Yung AP, Grayson ML| title=Psittacosis--a review of 135 cases. | journal=Med J Aust | year= 1988 | volume= 148 | issue= 5 | pages= 228-33 | pmid=3343952 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3343952  }} </ref>==
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;
The following [[diseases]] must be differentiated from [[psittacosis]] based on the presentation of [[cough]], [[fever]], [[myalgia]], and [[shortness of breath]].
*[[Chlamydia pneumoniae|Chlamydia pneumoniae]]  
*[[Chlamydia pneumoniae|Chlamydia pneumoniae]]  
*[[Mycoplasma pneumoniae]]  
*[[Mycoplasma pneumoniae]]  
*[[Legionella infection]]
*[[Legionella infection]]


For the patient who presents with febrile illness without localizing signs, the following should also be considered;
*[[Influenza (Flu) (For Patients)|Influenza]]
*[[Influenza (Flu) (For Patients)|Influenza]]
*[[Endocarditis]]  
*[[Endocarditis]]  
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*[[Brucellosis]]  
*[[Brucellosis]]  


'''Table 1; Differentiating C.psittaci from other diseases.'''
'''Table 1; Differentiating C.psittaci from other diseases'''
{| class="wikitable"
{| class="wikitable"
!Clinical feature
!Clinical feature
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!Treatment
!Treatment
|-
|-
|C.psittaci
|[[Chlamydia psittaci|C.psittaci]]
| ++
| ++
| -
| -
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| +
| +
| -
| -
|Doxycycline
|[[Doxycycline]]
|-
|-
|C.pneumoniae
|[[Chlamydia pneumoniae|C.pneumoniae]]
| +
| +
| +
| +
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| -
| -
| -
| -
|Doxycycline, Azithromycin
|[[Doxycycline]], [[Azithromycin]]
|-
|-
|M pneumoniae
|[[Mycoplasma pneumoniae|M. pneumoniae]]
| ++
| ++
| ++
| ++
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* Bronchial wall thickening
* Bronchial wall thickening
* Centrilobular nodules  
* Centrilobular nodules  
* Ground-glass attenuation  
* [[Ground glass opacification on CT|Ground-glass attenuation]]
* Consolidation  
* [[Consolidation (medicine)|Consolidation]]
| -
| -
| -
| -
| +
| +
|Doxycycline
|[[Doxycycline]]
|-
|-
|L. Pneumophilla
|[[Legionella pneumophila|L. Pneumophila]]
| +
| +
| +++
| +++
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| +
| +
| ++
| ++
|Doxycycline
|[[Doxycycline]]
|-
|-
|[[Influenza (Flu) (For Patients)|Influenza]]
|[[Influenza (Flu) (For Patients)|Influenza]]
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|
|
* Bi-basal air-space opacities
* Bi-basal air-space opacities
* Perihilar reticular and alveolar infiltrates
* Perihilar [[reticular]] and [[Alveolar|alveolar infiltrates]]
| -
| -
| -
| -
| -
| -
|zanamivir, oseltamivir,
|[[zanamivir]], [[oseltamivir]],
|-
|-
|[[Endocarditis]]
|[[Endocarditis]]
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| -
| -
|
|
* Hazy opacities at lung
* Hazy opacities at [[lung]]
bases bilaterally
bases bilaterally
| -
| -
| +/-
| +/-
| +/-
| +/-
|Vancomycin
|[[Vancomycin]]
|-
|-
|[[Coxiella burnetii infection]]
|[[Coxiella burnetii infection]]
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|Minimal
|Minimal
|
|
* Segmental or lobar opacification
* [[Segmental analysis (biology)|Segmental]] or [[Lobar pneumonia|lobar]] opacification
* Occasional pleural effusions
* Occasional [[pleural effusions]]
| -
| -
| +/-
| +/-
|=/-
|=/-
|Doxyxycline
|[[Doxycycline]]
|-
|-
|[[Leptospirosis]]
|[[Leptospirosis]]
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| -
| -
|
|
* Multiple  ill-defined  nodules  in  both  lungs.
* Multiple  ill-defined  [[Nodule (medicine)|nodules]] in  both  lungs.
| +++
| +++
|
|
|
|
|Doxycycline, azithromycin, amoxicillin
|[[Doxycycline]], [[azithromycin]], [[amoxicillin]]
|-
|-
|[[Brucellosis]]
|[[Brucellosis]]
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| -
| -
|
|
* Soft miliary mottling
* Soft [[Miliary TB|miliary]] mottling
* Parenchymal nodules
* [[Parenchymal lung disease|Parenchymal nodules]]
* Consolidation
* [[Consolidation (medicine)|Consolidation]]
* Chronic diffuse changes
* [[Chronic (medical)|Chronic]] [[diffuse]] changes
* Hilar or paratracheal lymphadenopathy
* [[Hilar]] or [[Paratracheal lymph nodes|paratracheal]] [[lymphadenopathy]]
* Pneumothorax.
* [[Pneumothorax]].
| -/+
| -/+
| +/-
| +/-
| +/-
| +/-
|Doxycycline, rifampin
|[[Doxycycline]], [[rifampin]]
|}
|}
Key;
Key;

Revision as of 21:12, 24 July 2017

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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]Omodamola Aje B.Sc, M.D. [3]

Overview

Psittacosis must be differentiated from other diseases that cause atypical pneumonia,[1] 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[1]

The following diseases must be differentiated from psittacosis based on the presentation of cough, fever, myalgia, and shortness of breath.

Table 1; Differentiating C.psittaci from other diseases

Clinical feature Cough Sputum Dyspnea Sore throat Headache Confusion Diarrhea Chest radiograph changes Hyponatremia Leukopenia Abnormal Liver function tests Treatment
C.psittaci ++ - + - +++ + Minimal
  • No changes seen
 - + - Doxycycline
C.pneumoniae + + + +++ ++ + -
  • Minimal changes observed
 - - - Doxycycline, Azithromycin
M. pneumoniae ++ ++ ++ - - - - - - + Doxycycline
L. Pneumophila + +++ +++ - + ++ + Often Multifocal ++ + ++ Doxycycline
Influenza ++ ++ ++ ++ ++ +/- +/- - - - zanamivir, oseltamivir,
Endocarditis ++ ++ + - - - -
  • Hazy opacities at lung

bases bilaterally

- +/- +/- Vancomycin
Coxiella burnetii infection ++ - + +/- - +/- Minimal - +/- =/- Doxycycline
Leptospirosis ++ + ++ + + ++ -
  • Multiple ill-defined nodules in both lungs.
 +++ Doxycycline, azithromycin, amoxicillin
Brucellosis ++ - + - ++ + - -/+ +/- +/- Doxycycline, rifampin

Key;

+, occurs in some cases

++, occurs in many cases,

+++, occurs frequently

References

  1. ↑ 1.0 1.1 Yung AP, Grayson ML (1988). "Psittacosis--a review of 135 cases". Med J Aust. 148 (5): 228–33. PMID 3343952.
  2. ↑ Raoult D, Marrie T (1995). "Q fever". Clin Infect Dis. 20 (3): 489–95, quiz 496. PMID 7756465.


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