Non-Polio enterovirus infections differential diagnosis: Difference between revisions

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{{Non-Polio enterovirus infections}}
{{Non-Polio enterovirus infections}}
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==Overview==
The [[differential]] [[diagnoses]] of non-polio [[enterovirus]] [[infections]] spans [[diseases]] affecting the [[respiratory]], [[gastrointestinal]] and [[central nervous systems]]:
* [[Influenza]]
*[[Adenovirus]]
*[[Upper respiratory tract infections]] ([[pharyngitis]], [[sinusitis]])
*[[Allergic rhinitis]]
*[[Meningitis]]
*[[Gastroenteritis]]
 
==Differential [[diagnoses]]==
===Differential [[diagnoses]] for [[rhinovirus]]===
{| class="wikitable"
|+
![[Disease]]
![[Clinical]] Findings
![[Para-clinical]] findings
![[Gold standard]]
!Additional findings
|-
|'''[[Influenza]]''' <ref name="pmid29083802">{{cite journal| author=| title=StatPearls | journal= | year= 2022 | volume=  | issue=  | pages=  | pmid=29083802 | doi= | pmc= | url= }}</ref>
|[[Cough]], [[fever]], [[sore throat]], [[headache]], [[myalgia]], [[runny nose]], [[congested]] [[eyes]]
|[[Chest X-ray]] may show signs of concomitant [[bacterial]] [[pneumonia]]
|[[Immunofluorescent]] direct and indirect [[antibody]] staining for detection of [[viral antigen]], real-time [[PCR]] test, [[cell culture]] of upper or lower [[respiratory tract]] specimens
|[[Frontal]] or [[retro-orbital]] [[headache]], [[photophobia]], [[ocular pain]], [[shortness of breath]], [[tachycardia]], [[hypotension]] and need for [[ventilation]] in severe cases
|-
|'''[[Adenovirus infection]]''' <ref name="pmid27486739">{{cite journal| author=Lynch JP, Kajon AE| title=Adenovirus: Epidemiology, Global Spread of Novel Serotypes, and Advances in Treatment and Prevention. | journal=Semin Respir Crit Care Med | year= 2016 | volume= 37 | issue= 4 | pages= 586-602 | pmid=27486739 | doi=10.1055/s-0036-1584923 | pmc=7171713 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27486739  }}</ref>
|[[Fever]], [[pharyngitis]], [[coryza]], watery eyes
|[[Cervical]] [[adenopathy]], [[pharyngoconjunctivitis]], [[tonsillitis]]
|[[Viral culture]], [[PCR]], [[viral antigen]] assay, [[serology]]
|[[Dyspnea]], gross [[bloody urine]]
|-
|'''[[Bacterial]] [[pharyngitis]], [[sinusitis]]'''<ref name="pmid23958368">{{cite journal| author=Grief SN| title=Upper respiratory infections. | journal=Prim Care | year= 2013 | volume= 40 | issue= 3 | pages= 757-70 | pmid=23958368 | doi=10.1016/j.pop.2013.06.004 | pmc=7127764 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23958368 }}</ref>
|[[Purulent]] [[nasal]] [[discharge]], [[maxillary]] tooth or facial [[pain]], worsening after initial improvement ([[fever]], [[headache]], increase in [[nasal]] [[discharge]])
|[[Unilateral]] [[maxillary sinus]] [[tenderness]], [[pharyngeal erythema]] and [[swelling]], [[tonsillar exudates]], [[edematous]] [[uvula]], [[palatine]] [[petechiae]], anterior [[cervical lymphadenopathy]]
|[[Nasal endoscopy]] or [[antral puncture]] and culture of [[secretions]], [[Centor]] criteria
|Ear [[pain]]/pressure/fullness, [[sore throat]], [[halitosis]], [[cough]], [[fatigue]], [[rheumatic fever]], [[peritonsillar abscess]], [[post-streptococcal glomerulonephritis]] and [[scarlet fever]]
|-
|'''[[Allergic rhinitis]]'''
|[[Sneezing]], [[rhinorrhoea]], watery eyes, [[postnasal drip]], [[chronic nasal congestion]] and obstruction<ref name="pmid26075169">{{cite journal| author=Varshney J, Varshney H| title=Allergic Rhinitis: an Overview. | journal=Indian J Otolaryngol Head Neck Surg | year= 2015 | volume= 67 | issue= 2 | pages= 143-9 | pmid=26075169 | doi=10.1007/s12070-015-0828-5 | pmc=4460099 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26075169  }}</ref>, triggers like [[pollen]], [[animal dander]], [[flooring/upholstery]], [[molds]], [[humidity]], perfumes and/or tobacco smoke<ref name="pmid22166009">{{cite journal| author=Small P, Kim H| title=Allergic rhinitis. | journal=Allergy Asthma Clin Immunol | year= 2011 | volume= 7 Suppl 1 | issue= Suppl 1 | pages= S3 | pmid=22166009 | doi=10.1186/1710-1492-7-S1-S3 | pmc=3245436 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22166009  }}</ref>
|Mouth breathing, frequent sniffling/throat clearing, transverse supra-tip nasal crease and dark circles under the eyes. Swelling of the nasal mucosa and thin,clear secretions on anterior rhinoscopy<ref name="pmid221660092">{{cite journal| author=Small P, Kim H| title=Allergic rhinitis. | journal=Allergy Asthma Clin Immunol | year= 2011 | volume= 7 Suppl 1 | issue= Suppl 1 | pages= S3 | pmid=22166009 | doi=10.1186/1710-1492-7-S1-S3 | pmc=3245436 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22166009  }}</ref>
|[[Serum]] testing for [[allergen-specific]] [[IgE]] or [[allergy]] skin testing<ref name="pmid25629743">{{cite journal| author=Wheatley LM, Togias A| title=Clinical practice. Allergic rhinitis. | journal=N Engl J Med | year= 2015 | volume= 372 | issue= 5 | pages= 456-63 | pmid=25629743 | doi=10.1056/NEJMcp1412282 | pmc=4324099 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25629743  }}</ref>
|Bluish hue of [[inferior turbinates]], cobblestoning of the [[nasal mucosa]], [[nasal polyps]], [[eustachian tube]] dysfunction, [[allergic dermatitis]], [[aspirin]] sensitivity, tender sinuses<ref name="pmid221660093">{{cite journal| author=Small P, Kim H| title=Allergic rhinitis. | journal=Allergy Asthma Clin Immunol | year= 2011 | volume= 7 Suppl 1 | issue= Suppl 1 | pages= S3 | pmid=22166009 | doi=10.1186/1710-1492-7-S1-S3 | pmc=3245436 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22166009  }}</ref>
|}
===Differential [[diagnoses]] of [[non-rhinovirus]] [[non-polio]] [[enterovirus]] [[infections]]===
 
{| class="wikitable"
|+
!'''Disease'''
!'''Clinical findings'''
!Para-clinical findings
!Gold standard
!Additional findings
|-
|'''[[Meningitis]]'''<ref name="pmid29083833">{{cite journal| author=| title=StatPearls | journal= | year= 2022 | volume= | issue= | pages=  | pmid=29083833 | doi= | pmc= | url= }}</ref>
|[[Fever]], [[neck pain]], [[stiffness]], [[photophobia]], altered mental status, [[neurological]] deficits, [[seizures]], [[Brudzinski]] and [[Kernig]] signs of [[meningeal]] [[irritation]],
|[[Cerebrospinal fluid]] analysis reveals elevated [[opening pressures]], increased [[White cell count]] and [[protein]].[[Glucose]] is typically normal in [[viral]] and [[fungal]] [[meningitis]]. [[CT]] head for signs of [[raised intracranial pressure]] and/or [[brain herniation]] before [[lumbar puncture]]
|Analysis of [[cerebrospinal fluid]] ([[CSF]]) including [[cultures]], [[serology]] and [[microscopy]]
|[[Headache]], [[dizziness]], [[confusion]], [[delirium]], [[irritability]], [[nausea/vomiting]], [[petechiae]]/[[purpura]] in [[meningococcal]] [[meningitis]], [[cranial nerve]] abnormalities; [[hypothermia]], decreased oral intake, [[irritability]] and [[bulging fontanelle]] in infants
 
|-
|'''[[Gastroenteritis]]'''<ref name="pmid23958366">{{cite journal| author=Graves NS| title=Acute gastroenteritis. | journal=Prim Care | year= 2013 | volume= 40 | issue= 3 | pages= 727-41 | pmid=23958366 | doi=10.1016/j.pop.2013.05.006 | pmc=7119329 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23958366  }}</ref>
|[[Malaise]], [[anorexia]], [[abdominal pain]] and [[cramping]], [[watery diarrhea]], [[nausea and vomiting]], [[low-grade fever]], signs of [[dehydration]] (dry [[mucous membranes]], [[tachycardia]], [[orthostatic blood pressure]],
|[[Sorbitol]] [[McConkey]] [[agar]] for [[E.coli]] O157:H7
|Mostly [[clinical]] [[diagnosis]]; [[stool]] for [[ova]], [[parasites]] and [[cultures]], [[fecal]] [[leukocytes]] and [[occult blood]], [[toxin]] [[assays]]
|[[Colitis]], [[bloody diarrhea]], [[tenesmus]], [[hemolytic uremic syndrome]], [[reactive arthritis]], [[Guillain-Barre syndrome]]
|}


== References ==
== References ==
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[[Category:Disease]]
[[Category:Disease]]
[[Category:Infectious disease]]
 
[[Category:Needs content]]
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[[Category:Viruses]]
[[Category:Viruses]]

Latest revision as of 17:50, 6 February 2023

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sujaya Chattopadhyay, M.D.[2]

Overview

The differential diagnoses of non-polio enterovirus infections spans diseases affecting the respiratory, gastrointestinal and central nervous systems:

Differential diagnoses

Differential diagnoses for rhinovirus

Disease Clinical Findings Para-clinical findings Gold standard Additional findings
Influenza [1] Cough, fever, sore throat, headache, myalgia, runny nose, congested eyes Chest X-ray may show signs of concomitant bacterial pneumonia Immunofluorescent direct and indirect antibody staining for detection of viral antigen, real-time PCR test, cell culture of upper or lower respiratory tract specimens Frontal or retro-orbital headache, photophobia, ocular pain, shortness of breath, tachycardia, hypotension and need for ventilation in severe cases
Adenovirus infection [2] Fever, pharyngitis, coryza, watery eyes Cervical adenopathy, pharyngoconjunctivitis, tonsillitis Viral culture, PCR, viral antigen assay, serology Dyspnea, gross bloody urine
Bacterial pharyngitis, sinusitis[3] Purulent nasal discharge, maxillary tooth or facial pain, worsening after initial improvement (fever, headache, increase in nasal discharge) Unilateral maxillary sinus tenderness, pharyngeal erythema and swelling, tonsillar exudates, edematous uvula, palatine petechiae, anterior cervical lymphadenopathy Nasal endoscopy or antral puncture and culture of secretions, Centor criteria Ear pain/pressure/fullness, sore throat, halitosis, cough, fatigue, rheumatic fever, peritonsillar abscess, post-streptococcal glomerulonephritis and scarlet fever
Allergic rhinitis Sneezing, rhinorrhoea, watery eyes, postnasal drip, chronic nasal congestion and obstruction[4], triggers like pollen, animal dander, flooring/upholstery, molds, humidity, perfumes and/or tobacco smoke[5] Mouth breathing, frequent sniffling/throat clearing, transverse supra-tip nasal crease and dark circles under the eyes. Swelling of the nasal mucosa and thin,clear secretions on anterior rhinoscopy[6] Serum testing for allergen-specific IgE or allergy skin testing[7] Bluish hue of inferior turbinates, cobblestoning of the nasal mucosa, nasal polyps, eustachian tube dysfunction, allergic dermatitis, aspirin sensitivity, tender sinuses[8]

Differential diagnoses of non-rhinovirus non-polio enterovirus infections

Disease Clinical findings Para-clinical findings Gold standard Additional findings
Meningitis[9] Fever, neck pain, stiffness, photophobia, altered mental status, neurological deficits, seizures, Brudzinski and Kernig signs of meningeal irritation, Cerebrospinal fluid analysis reveals elevated opening pressures, increased White cell count and protein.Glucose is typically normal in viral and fungal meningitis. CT head for signs of raised intracranial pressure and/or brain herniation before lumbar puncture Analysis of cerebrospinal fluid (CSF) including cultures, serology and microscopy Headache, dizziness, confusion, delirium, irritability, nausea/vomiting, petechiae/purpura in meningococcal meningitis, cranial nerve abnormalities; hypothermia, decreased oral intake, irritability and bulging fontanelle in infants
Gastroenteritis[10] Malaise, anorexia, abdominal pain and cramping, watery diarrhea, nausea and vomiting, low-grade fever, signs of dehydration (dry mucous membranes, tachycardia, orthostatic blood pressure, Sorbitol McConkey agar for E.coli O157:H7 Mostly clinical diagnosis; stool for ova, parasites and cultures, fecal leukocytes and occult blood, toxin assays Colitis, bloody diarrhea, tenesmus, hemolytic uremic syndrome, reactive arthritis, Guillain-Barre syndrome

References

  1. ↑ "StatPearls". 2022. PMID 29083802.
  2. ↑ Lynch JP, Kajon AE (2016). "Adenovirus: Epidemiology, Global Spread of Novel Serotypes, and Advances in Treatment and Prevention". Semin Respir Crit Care Med. 37 (4): 586–602. doi:10.1055/s-0036-1584923. PMC 7171713 Check |pmc= value (help). PMID 27486739.
  3. ↑ Grief SN (2013). "Upper respiratory infections". Prim Care. 40 (3): 757–70. doi:10.1016/j.pop.2013.06.004. PMC 7127764 Check |pmc= value (help). PMID 23958368.
  4. ↑ Varshney J, Varshney H (2015). "Allergic Rhinitis: an Overview". Indian J Otolaryngol Head Neck Surg. 67 (2): 143–9. doi:10.1007/s12070-015-0828-5. PMC 4460099. PMID 26075169.
  5. ↑ Small P, Kim H (2011). "Allergic rhinitis". Allergy Asthma Clin Immunol. 7 Suppl 1 (Suppl 1): S3. doi:10.1186/1710-1492-7-S1-S3. PMC 3245436. PMID 22166009.
  6. ↑ Small P, Kim H (2011). "Allergic rhinitis". Allergy Asthma Clin Immunol. 7 Suppl 1 (Suppl 1): S3. doi:10.1186/1710-1492-7-S1-S3. PMC 3245436. PMID 22166009.
  7. ↑ Wheatley LM, Togias A (2015). "Clinical practice. Allergic rhinitis". N Engl J Med. 372 (5): 456–63. doi:10.1056/NEJMcp1412282. PMC 4324099. PMID 25629743.
  8. ↑ Small P, Kim H (2011). "Allergic rhinitis". Allergy Asthma Clin Immunol. 7 Suppl 1 (Suppl 1): S3. doi:10.1186/1710-1492-7-S1-S3. PMC 3245436. PMID 22166009.
  9. ↑ "StatPearls". 2022. PMID 29083833.
  10. ↑ Graves NS (2013). "Acute gastroenteritis". Prim Care. 40 (3): 727–41. doi:10.1016/j.pop.2013.05.006. PMC 7119329 Check |pmc= value (help). PMID 23958366.


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