Hantavirus infection differential diagnosis: Difference between revisions

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__NOTOC__
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{{Hantavirus pulmonary syndrome}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Hantavirus_infection]]
{{CMG}}; {{AE}} {{ADG}}


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==Overview==
Hemorrhagic fever caused by hantavirus can be differentiated from other disease  such as [[dengue]], [[malaria]] and [[Ebola]]. The hantavirus cardiopulmonary syndrome can be differentiated from other diseases like [[histoplasmosis]], [[coccidioidomycosis]], [[brucellosis]], [[tuberculosis]] and [[aspergillosis]].
 
==Differentiating Hantavirus infection from other Diseases==
Hemorrhagic fever caused by hantavirus can be differentiated from other disease  such as [[dengue]], [[malaria]] and [[Ebola]]. The hantavirus cardiopulmonary syndrome can be differentiated from other diseases like [[histoplasmosis]], [[coccidioidomycosis]], [[brucellosis]], [[tuberculosis]] and [[aspergillosis]].
 
===Differentiating Hantavirus infection from other causes of Hemorrhagic fever===
<small>
{| class="wikitable"
! rowspan="2" |Disease
! rowspan="2" |Incubation period
! rowspan="2" |Vector
! colspan="7" |Symptoms
! colspan="2" |Physical signs
! colspan="2" |Lab findings
! rowspan="2" |Other findings
! rowspan="2" |Treatment
|-
!Fever
!Cough
!Rash
!Joint pain
!Myalgia
!Diarrhea
!Common hemorrhagic symptoms
!Characterestic physical finding
!Icterus
!Plasma Creatine kinase
!Confirmatory test
|-
![[Leptospirosis]]
| align="center" |2 to 30 days
| align="center" |Rodents
 
Domestic animals
| align="center" |[[Fever]] last for 4-7 days, remission for 1-2 days and then relapse
| align="center" | +
| align="center" |Present over legs [[Hemorrhagic]] [[rash]]
| align="center" | +
| align="center" | +
(Severe [[myalgia]] is characteristic of leptospirosis typically localized to the [[Calf muscle|calf]] and [[lumbar]] areas)
| align="center" | +
| align="center" |[[Conjunctival hemorrhage]],
[[Hemoptysis]]
| align="center" |[[Conjunctival hemorrhage|Conjunctival suffusion]]
| align="center" | +
| align="center" |Elevated
| align="center" |[[Agglutination|Microscopic agglutination test]] of urine
| align="center" |History of exposure to soil or water
contaminated by [[infected]] rodents
 
Recent history travel to tropical,
sub tropical areas or humid areas
| align="center" |[[NSAIDs]]
|-
!'''[[Dengue fever|Dengue]]'''
| align="center" |4 to 10 days
| align="center" |''[[Aedes]]'' [[Aedes|mosquito]]
| align="center" |[[Fever]] last for 1-2 days,
remission for 1-2 days and then relapse for 1-2 days
(Biphasic [[fever]] pattern)
| align="center" | -
| align="center" |Over legs and [[trunk]]
 
pruritic [[rash]] May be [[hemorrhagic]]
| align="center" | +
| align="center" | +
| align="center" | -
| align="center" |[[Upper gastrointestinal bleeding]]
| align="center" |[[Lymphadenopathy|Painful lymphadenopathy]]
| align="center" | -
| align="center" |Normal
| align="center" |Serology showing positive [[IgM]] or [[IgG]]
| align="center" |Recent travel to South America, Africa, Southeast Asia
| align="center" |Supportive care
Avoid aspirin and other [[NSAIDs]]
|-
!'''[[Malaria]]'''
| align="center" |
* ''[[Plasmodium falciparum]]: 9-14 days''
* ''[[Plasmodium vivax]]: 12-18 days''
* ''[[Plasmodium ovale]]: 18-40 days''
| align="center" |[[Anopheles|Female Anopheles]]
| align="center" |[[Fever]] present daily or on alternate day or every 3 days depending on [[Plasmodium|Plasmodium sps]].
| align="center" | -
| align="center" |No rash
| align="center" | -
| align="center" | +
| align="center" | -
| align="center" |[[Hematuria|Bloody urine]]
| align="center" |[[Hepatosplenomegaly]]
| align="center" | +
| align="center" |Normal
| align="center" |[[Giemsa stain|Giemsa]] stained thick and thin [[blood]] smears
| align="center" |Recent travel to South America, Africa, Southeast Asia
| align="center" |[[Antimalarial medication|Anti malarial regimen]]
|-
!'''[[Ebola]]'''
| align="center" |2 to 21 days.
| align="center" |No vector
 
Human to human transmission
 
[[Airborne transmission|Air born disease]]
| align="center" | +
| align="center" | +
| align="center" |[[Maculopapular]]
non-pruritic [[rash]] with [[erythema]]
 
Centripetal distribution
| align="center" | +
| align="center" | +
| align="center" | +
 
May be bloody in the early phase
| align="center" |[[Epistaxis]]
 
[[Mucosal bleeding]]
| align="center" |Sudden onset of high [[fever]] with [[conjunctival injection]] and early [[gastrointestinal]] symptoms
| align="center" | -
| align="center" |Normal
| align="center" |[[RT-PCR]]
| align="center" |Recent visit to endemic area especially African countries
| align="center" |Isolation of the patient,
 
supportive therapy
|-
!'''[[Influenza]]'''
| align="center" |1-4 days
| align="center" |No vector
 
[[Airborne transmission|Air born disease]]
| align="center" | +
| align="center" | +
| align="center" | +/-
| align="center" | +
| align="center" | +
| align="center" | +
| align="center" | -
| align="center" |[[Fever]] and upper [[respiratory]] symptoms
| align="center" | -
| align="center" |Normal
| align="center" |[[Viral culture]] or [[PCR]]
| align="center" |Health care workers
Patients with co-morbid conditions
| align="center" |Symptomatic treatment
 
[[Oseltamivir]] or [[zanamivir]]
|-
!'''[[Yellow fever]]'''
| align="center" |3 to 6 days
| align="center" |[[Aedes]] or [[Aedes|Haemagogus]] species mosquitoes
| align="center" | +
| align="center" | +
| align="center" | -
| align="center" | -
| align="center" | +
| align="center" | -
| align="center" |[[Conjunctival hemorrhage]],
 
[[Hemoptysis]]
| align="center" |Relative [[bradycardia]]
([[Faget's sign]])
| align="center" | +
| align="center" |Normal
| align="center" |[[RT-PCR]],
 
[[Nucleic acid amplification technique|Nucleic acid amplification test]],
 
[[Immunohistochemical staining|Immuno-histochemical staining]]
| align="center" |Recent travel to  Africa, South and Central America, and the Caribbean.
 
Tropical rain forests of south America
| align="center" |Symptomatic treatment,
 
[[Anti inflammatory medications|Anti-inflammatory drugs]]
|-
!'''[[Typhoid fever]]'''
| align="center" |6 to 30 days
| align="center" |No vector
 
[[Airborne transmission|Air born disease]]
| align="center" | +
| align="center" | -
| align="center" |Blanching [[erythematous]] 
[[maculopapular]][[lesions]] on the
lower chest and abdomen
| align="center" | +
| align="center" | +
| align="center" | +
| align="center" |[[Intestinal bleeding]]
| align="center" |[[Rose spots]]
| align="center" | -
| align="center" |Normal
| align="center" |[[Blood]] or [[stool]] [[Culture medium|culture]] showing ''[[Salmonella typhi|salmonella typhi sps]].''
| align="center" |Residence in [[endemic]] area
 
Recent travel to [[endemic]] area
| align="center" |[[Fluoroquinolones]],
 
[[Cephalosporin|Third generation cephalosporins]],
 
[[Azithromycin]]
|}
</small>
 
 
===Differentiating Hantavirus infection on the basis of Cardiopulmonary involvement===
The hantavirus cardiopulmonary syndrome can be differentiated from other diseases like [[histoplasmosis]], [[coccidioidomycosis]], [[brucellosis]], [[tuberculosis]] and [[aspergillosis]].
 
{| class="wikitable"
! rowspan="2" |Disease
! rowspan="2" |Geographic distribution
! rowspan="2" |High risk Groups
! colspan="2" |Differentiating features
! rowspan="2" |Microscopic findings
|-
!Physical exam
!Laboratory findings
|-
|[[Histoplasmosis]]
|Mississippi and Ohio River valleys
|
* Cave dwellers
 
* Soil that contains bird or bat dropping<ref name="cdc3">Information for Healthcare Professionals about Histoplasmosis. Centers for Disease Control and Prevention. 2015. Available at: http://www.cdc.gov/fungal/diseases/histoplasmosis/health-professionals.html. Accessed February 2, 2016.</ref>
|
* [[Palate]] and [[oral]] [[ulcers]]  
* [[Splenomegaly]]
|
* [[Pancytopenia]]
 
* [[Urine]] [[antigen]] testing
|[[Yeast]] are typically smaller, with narrow-based [[budding]], found [[Intracellular|intracellularly]] within [[macrophages]]
|-
|[[Coccidioidomycosis]]
|Southwestern US region
|Opportunistic infection seen in [[HIV AIDS|AIDS]]
|
* [[Rash]] on upper body or legs<ref name="pmid23843703">{{cite journal |vauthors=Brown J, Benedict K, Park BJ, Thompson GR |title=Coccidioidomycosis: epidemiology |journal=Clin Epidemiol |volume=5 |issue= |pages=185–97 |year=2013 |pmid=23843703 |pmc=3702223 |doi=10.2147/CLEP.S34434 |url=}}</ref>
* [[Night sweats]]
|Serologic tests ([[enzyme]] [[immune]] [[assay]]) more sensitive
|Characteristic spherule appearance
|-
|[[Aspergillosis]]<ref name="pmid20375786">{{cite journal |vauthors=Sherif R, Segal BH |title=Pulmonary aspergillosis: clinical presentation, diagnostic tests, management and complications |journal=Curr Opin Pulm Med |volume=16 |issue=3 |pages=242–50 |year=2010 |pmid=20375786 |pmc=3326383 |doi=10.1097/MCP.0b013e328337d6de |url=}}</ref>
|Ubiquitous
|
* [[Cystic fibrosis]] or [[Asthma|asthma.]] [[tuberculosis]].
 
* [[Immunocompromised]]
|
* [[Wheezing]]
 
* Stuffiness, [[runny nose]]
* [[Hemoptysis]]
* [[Weight loss]]
|Cell wall detection using [[galactomannan]] antigen detection, Beta-D-glucan detection test.
|[[Hyphae|Septated hyphae]] with acute angle branching
|-
|[[Anthrax]]
|Ubiquitous
|Live stock handlers
|
* Painless [[skin]] [[ulcer]] with a black center <ref name="pmid22527064">{{cite journal |vauthors=Hicks CW, Sweeney DA, Cui X, Li Y, Eichacker PQ |title=An overview of anthrax infection including the recently identified form of disease in injection drug users |journal=Intensive Care Med |volume=38 |issue=7 |pages=1092–104 |year=2012 |pmid=22527064 |pmc=3523299 |doi=10.1007/s00134-012-2541-0 |url=}}</ref>
* [[Bloody diarrhea]]
|
* [[Thrombocytopenia]]
 
* [[Hyponatremia]]
 
* '''↑''' [[BUN]]
 
* [[Hypoalbuminemia]]
 
* ↑ [[Troponin]].
|[[Motility|Nonmotile]], [[Gram-positive]], [[aerobic]] or facultatively [[anaerobic]], [[endospore]]-forming, [[rod]]-shaped [[bacterium]]
|-
|[[Tuberculosis]]
|Asia,Africa
|Ill contact individuals
|
* [[Night sweats]]
* [[Hemoptysis]]
|
* [[Hypercalcemia]]
* Elevated [[alkaline phosphatase]] levels
* [[fluorescence microscopy]] ([[Auramine-rhodamine stain|auramine-rhodamine staining]])+ for baccilli.
|[[Aerobic]], [[Capsule|non-encapsulated]], [[Motility|non-motile]], [[acid-fast]] [[bacillus]]
|-
|[[Listeriosis]]
|Ubiquitous
|[[Pregnant]] women <ref name="pmid21517700">{{cite journal |vauthors=Lamont RF, Sobel J, Mazaki-Tovi S, Kusanovic JP, Vaisbuch E, Kim SK, Uldbjerg N, Romero R |title=Listeriosis in human pregnancy: a systematic review |journal=J Perinat Med |volume=39 |issue=3 |pages=227–36 |year=2011 |pmid=21517700 |pmc=3593057 |doi=10.1515/JPM.2011.035 |url=}}</ref>
Adults > 65  
 
[[Immunocompromised]].
|
* [[Pregnancy]] can lead to miscarriage, stillbirth, premature delivery
* Non-pregnant : [[headache]], [[stiff neck]], [[confusion]], loss of balance, and [[convulsions]]
|
* Elevated titers of [[listeriolysin O]]
 
* [[CSF]] analysis :[[Pleocytosis]] [[lymphocytes]]            ↑[[CSF]] [[protein]]          '''↓''' [[CSF]] [[glucose]]
|[[Flagellate|flagellated]], [[Catalase|catalase-positive]], facultative [[intracellular]], [[Anaerobe|anaerobic]], [[Spore|nonsporulating]], [[Gram-positive]] [[bacillus]]
|-
|[[Brucellosis]]
|
Mexico, South and Central America
|People who take unpasteurized dairy products
|
* [[Arthritis]]
* [[Testicular]] and [[scrotal swelling]]
* [[Endocarditis]]
|
* [[Antibody]] production against[[lipopolysaccharide]] and bacterial antigens
* Relative [[lymphocytosis]] and [[thrombocytopenia]].
|[[Gram-negative bacteria]],[[Motile|non-motile]], [[Encapsulated organisms|encapsulated]] [[Coccobacilli|coccobacilli.]]
|-
|[[Coxsackie A virus]]
|      '''−'''
|Children attending day care<ref name="pmid23017893">{{cite journal |vauthors=Flett K, Youngster I, Huang J, McAdam A, Sandora TJ, Rennick M, Smole S, Rogers SL, Nix WA, Oberste MS, Gellis S, Ahmed AA |title=Hand, foot, and mouth disease caused by coxsackievirus a6 |journal=Emerging Infect. Dis. |volume=18 |issue=10 |pages=1702–4 |year=2012 |pmid=23017893 |pmc=3471644 |doi=10.3201/eid1810.120813 |url=}}</ref>
|Painful [[Blister|blisters]] in the mouth, palms and on the feet.
[[Rash]], appears after episode of [[high fever]].  
|Clinically diagnosed
|                    '''−'''
|}


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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Latest revision as of 21:57, 29 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

Hemorrhagic fever caused by hantavirus can be differentiated from other disease such as dengue, malaria and Ebola. The hantavirus cardiopulmonary syndrome can be differentiated from other diseases like histoplasmosis, coccidioidomycosis, brucellosis, tuberculosis and aspergillosis.

Differentiating Hantavirus infection from other Diseases

Hemorrhagic fever caused by hantavirus can be differentiated from other disease such as dengue, malaria and Ebola. The hantavirus cardiopulmonary syndrome can be differentiated from other diseases like histoplasmosis, coccidioidomycosis, brucellosis, tuberculosis and aspergillosis.

Differentiating Hantavirus infection from other causes of Hemorrhagic fever

Disease Incubation period Vector Symptoms Physical signs Lab findings Other findings Treatment
Fever Cough Rash Joint pain Myalgia Diarrhea Common hemorrhagic symptoms Characterestic physical finding Icterus Plasma Creatine kinase Confirmatory test
Leptospirosis 2 to 30 days Rodents

Domestic animals

Fever last for 4-7 days, remission for 1-2 days and then relapse + Present over legs Hemorrhagic rash + +

(Severe myalgia is characteristic of leptospirosis typically localized to the calf and lumbar areas)

+ Conjunctival hemorrhage,

Hemoptysis

Conjunctival suffusion + Elevated Microscopic agglutination test of urine History of exposure to soil or water

contaminated by infected rodents

Recent history travel to tropical, sub tropical areas or humid areas

NSAIDs
Dengue 4 to 10 days Aedes mosquito Fever last for 1-2 days,

remission for 1-2 days and then relapse for 1-2 days (Biphasic fever pattern)

- Over legs and trunk

pruritic rash May be hemorrhagic

+ + - Upper gastrointestinal bleeding Painful lymphadenopathy - Normal Serology showing positive IgM or IgG Recent travel to South America, Africa, Southeast Asia Supportive care

Avoid aspirin and other NSAIDs

Malaria Female Anopheles Fever present daily or on alternate day or every 3 days depending on Plasmodium sps. - No rash - + - Bloody urine Hepatosplenomegaly + Normal Giemsa stained thick and thin blood smears Recent travel to South America, Africa, Southeast Asia Anti malarial regimen
Ebola 2 to 21 days. No vector

Human to human transmission

Air born disease

+ + Maculopapular

non-pruritic rash with erythema

Centripetal distribution

+ + +

May be bloody in the early phase

Epistaxis

Mucosal bleeding

Sudden onset of high fever with conjunctival injection and early gastrointestinal symptoms - Normal RT-PCR Recent visit to endemic area especially African countries Isolation of the patient,

supportive therapy

Influenza 1-4 days No vector

Air born disease

+ + +/- + + + - Fever and upper respiratory symptoms - Normal Viral culture or PCR Health care workers

Patients with co-morbid conditions

Symptomatic treatment

Oseltamivir or zanamivir

Yellow fever 3 to 6 days Aedes or Haemagogus species mosquitoes + + - - + - Conjunctival hemorrhage,

Hemoptysis

Relative bradycardia

(Faget's sign)

+ Normal RT-PCR,

Nucleic acid amplification test,

Immuno-histochemical staining

Recent travel to  Africa, South and Central America, and the Caribbean.

Tropical rain forests of south America

Symptomatic treatment,

Anti-inflammatory drugs

Typhoid fever 6 to 30 days No vector

Air born disease

+ - Blanching erythematous 

maculopapularlesions on the lower chest and abdomen

+ + + Intestinal bleeding Rose spots - Normal Blood or stool culture showing salmonella typhi sps. Residence in endemic area

Recent travel to endemic area

Fluoroquinolones,

Third generation cephalosporins,

Azithromycin


Differentiating Hantavirus infection on the basis of Cardiopulmonary involvement

The hantavirus cardiopulmonary syndrome can be differentiated from other diseases like histoplasmosis, coccidioidomycosis, brucellosis, tuberculosis and aspergillosis.

Disease Geographic distribution High risk Groups Differentiating features Microscopic findings
Physical exam Laboratory findings
Histoplasmosis Mississippi and Ohio River valleys
  • Cave dwellers
  • Soil that contains bird or bat dropping[1]
Yeast are typically smaller, with narrow-based budding, found intracellularly within macrophages
Coccidioidomycosis Southwestern US region Opportunistic infection seen in AIDS Serologic tests (enzyme immune assay) more sensitive Characteristic spherule appearance
Aspergillosis[3] Ubiquitous Cell wall detection using galactomannan antigen detection, Beta-D-glucan detection test. Septated hyphae with acute angle branching
Anthrax Ubiquitous Live stock handlers Nonmotile, Gram-positive, aerobic or facultatively anaerobic, endospore-forming, rod-shaped bacterium
Tuberculosis Asia,Africa Ill contact individuals Aerobic, non-encapsulated, non-motile, acid-fast bacillus
Listeriosis Ubiquitous Pregnant women [5]

Adults > 65

Immunocompromised.

flagellated, catalase-positive, facultative intracellular, anaerobic, nonsporulating, Gram-positive bacillus
Brucellosis

Mexico, South and Central America

People who take unpasteurized dairy products Gram-negative bacteria,non-motile, encapsulated coccobacilli.
Coxsackie A virus Children attending day care[6] Painful blisters in the mouth, palms and on the feet.

Rash, appears after episode of high fever.

Clinically diagnosed

References

  1. Information for Healthcare Professionals about Histoplasmosis. Centers for Disease Control and Prevention. 2015. Available at: http://www.cdc.gov/fungal/diseases/histoplasmosis/health-professionals.html. Accessed February 2, 2016.
  2. Brown J, Benedict K, Park BJ, Thompson GR (2013). "Coccidioidomycosis: epidemiology". Clin Epidemiol. 5: 185–97. doi:10.2147/CLEP.S34434. PMC 3702223. PMID 23843703.
  3. Sherif R, Segal BH (2010). "Pulmonary aspergillosis: clinical presentation, diagnostic tests, management and complications". Curr Opin Pulm Med. 16 (3): 242–50. doi:10.1097/MCP.0b013e328337d6de. PMC 3326383. PMID 20375786.
  4. Hicks CW, Sweeney DA, Cui X, Li Y, Eichacker PQ (2012). "An overview of anthrax infection including the recently identified form of disease in injection drug users". Intensive Care Med. 38 (7): 1092–104. doi:10.1007/s00134-012-2541-0. PMC 3523299. PMID 22527064.
  5. Lamont RF, Sobel J, Mazaki-Tovi S, Kusanovic JP, Vaisbuch E, Kim SK, Uldbjerg N, Romero R (2011). "Listeriosis in human pregnancy: a systematic review". J Perinat Med. 39 (3): 227–36. doi:10.1515/JPM.2011.035. PMC 3593057. PMID 21517700.
  6. Flett K, Youngster I, Huang J, McAdam A, Sandora TJ, Rennick M, Smole S, Rogers SL, Nix WA, Oberste MS, Gellis S, Ahmed AA (2012). "Hand, foot, and mouth disease caused by coxsackievirus a6". Emerging Infect. Dis. 18 (10): 1702–4. doi:10.3201/eid1810.120813. PMC 3471644. PMID 23017893.

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