Psittacosis differential diagnosis

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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, 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

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;

• Chlamydia pneumoniae
• Mycoplasma pneumoniae
• Legionella infection

For the patient who presents with febrile illness without localizing signs, the following should also be considered;

• Influenza
• Endocarditis
• Septicemia
• Vasculitis
• Coxiella burnetii infection
• Leptospirosis
• Brucellosis

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	++	++	++	-	-	-	-	Bronchial wall thickening Centrilobular nodules Ground-glass attenuation Consolidation	-	-	+	Doxycycline
L. Pneumophilla	+	+++	+++	-	+	++	+	Often Multifocal	++	+	++	Doxycycline
Influenza	++	++	++	++	++	+/-	+/-	Bi-basal air-space opacities Perihilar reticular and alveolar infiltrates	-	-	-	zanamivir, oseltamivir,
Endocarditis	++	++	+	-	-	-	-	Hazy opacities at lung bases bilaterally	-	+/-	+/-	Vancomycin
Coxiella burnetii infection	++	-	+	+/-	-	+/-	Minimal	Segmental or lobar opacification Occasional pleural effusions	-	+/-	=/-	Doxyxycline
Leptospirosis	++	+	++	+	+	++	-	Multiple ill-defined nodules in both lungs.	+++			Doxycycline, azithromycin, amoxicillin
Brucellosis	++	-	+	-	++	+	-	Soft miliary mottling Parenchymal nodules Consolidation Chronic diffuse changes Hilar or paratracheal lymphadenopathy Pneumothorax.	-/+	+/-	+/-	Doxycycline, rifampin

Key;

+, occurs in some cases

++, occurs in many cases,

+++, occurs frequently

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