Brucellosis differential diagnosis: Difference between revisions

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!✔/✘
!✔/✘
!✘
!✘
 
{| class="wikitable"
 
!Differentiating diagnosis of Brucellosis
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center class="wikitable" style="border: 2; background: none;"
! colspan="5" |Symptoms
! colspan="2" rowspan="2" style="border: 1; background: 1;" | Classification of acute abdomen based on etiology
! colspan="3" |Signs
! colspan="1" rowspan="2" |Presentation
! colspan="2" |Diagnosis
! colspan="4" rowspan="1" | Symptoms
!Additional Findings
! colspan="3" rowspan="1" | Signs
! colspan="2" rowspan="1" | Diagnosis
! colspan="1" rowspan="2" | Additional Findings
|-
|-
! colspan="1" rowspan="1"| Fever || Abdominal Pain || Diarrhea || Constipation
! colspan="1" rowspan="1"| Guarding || Rebound Tenderness || Bowel sounds
! colspan="1" rowspan="1"| Lab Findings || Imaging Findings
|-
! colspan="1" rowspan="8" | Common causes of Peritonitis
! colspan="1" | Primary Peritonitis
| colspan="1" rowspan="1" | Spontateous Bacterial Peritonitis
|✔
|Diffuse
|✘
|✘
|✘
|✘
|Diminished
|'''Ascitic fluid''' PMN
>250cells/mm<small>³</small>
'''Culture''': Positive for single organism
|
|
|Fever
|Rash
|Diarrhea
|Abdominal pain
|Weight loss
|Painful lymphadenopathy
|Hepatosplenomegaly
|Arthritis
|Lab Findings
|Imaging Findings
|
|
|-
|-
! colspan="1" rowspan="7" | Secondary Peritonitis
|[[Brucellosis]]
| colspan="1" rowspan="1" | Perforated gastric and duodenal ulcer || ✔
||  Diffuse
|| ✘
||✘
|✔
|✔
|✔
|✘
|Glucose
< 50mg/dl
Ascitic fluid LDH > serum LDH
Total Protein
> 1g/dl
|
|
|
|
|-
| colspan="1" rowspan="1" |  Acute Cholangitis || ✔
|| RUQ
|| ✘
|| ✘
|✘
|✘
|N
|Increased LFT
|
|
|
|
|-
|✔
| colspan="1" rowspan="1" | Acute Cholecystitis || ✔
|| RUQ
||  ✘
|| ✘
|✘
|✘
|N
|
|
|✔
|
|
|
|-
| colspan="1" rowspan="1" |  Acute Pancreatitis || ✔
|| Diffuse
||  ✔
|| ✘
|✘
|✘
|N
|Increased Amylase / Lipase
|
|
|
|
|-
|-
| colspan="1" rowspan="1" | Acute Appendicitis || ✔
|[[Typhoid fever]]
|| RLQ
|| ✘
|| ✘
|✘
|✔
|✔
|N
|
|
|
|
|-
| colspan="1" rowspan="1" | Acute Diverticulitis || ✔
|| LLQ
|| ✔/✘
|| ✔/✘
|✘
|✘
|N
|
|
|
|
|
|
|-
| colspan="1" rowspan="1" | Acute Salphingitis || ✔
|| LLQ/ RLQ
|| ✘
|| ✘
|✔/✘
|✔/✘
|N
|
|
|
|
|
|-
! colspan="2" rowspan="4" | Hollow Viscous Obstruction
| colspan="1" rowspan="1" |Small Intestine obstruction
|✘
|Diffuse
|✘
|✔✔
|✘
|✘
|Absent
|
|
|
|
|
|
|-
|-
|Volvulus
|[[Malaria]]
|✔
|
|
|LLQ
|
|
|
|
|
|
|
|
|✔
|
|
|
|
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|
|
|-
|-
|Biliary Colic
|[[Tuberculosis]]
|✔
|
|
|RUQ
|
|
|
|
|✔
|
|
|
|
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|
|
|-
|-
|Renal Colic
|[[Lymphoma]]
|✔
|
|
|Flank Pain
|
|
|
|
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|
|
|
|
|
|-
! rowspan="4" |Vascular Disorders
! rowspan="2" |Ischemic causes
|Mesentric Ischemia
|
|Periumbilical
|
|
|
|
|
|Increased AG Acidosis
|
|
|
|
|-
|-
|Acute Ischemic Colitis
|Mumps
|
|✔
|✘
|
|
|
|
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|
|
|-
|-
! rowspan="2" |Hemorrhagic causes
|Rheumatoid arthritis
|Ruptured Abdominal Aortic Aneurysm
|✘
|
|✔
|Diffuse
|
|
|
|
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|
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|
|
|✔
|
|
|
|
|
|
|-
|-
|Intraabdominal or Retroperitoneal Hemorrhage
|SLE
|
|✘
|Diffuse
|✔
|
|
|
|
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|
|✔
|
|
|
|
|
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|-
|-
! rowspan="3" |Gynaecological Causes
|[[Human Immunodeficiency Virus|HIV]]
! rowspan="2" |Ovarian Cyst Complications
|✘
|Torsion of the Cyst
|✘
|
|
|RLQ / LLQ
|
|
|✔
|
|
|
|
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|-
|Cyst Rupture
|
|RLQ / LLQ
|
|
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|
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|-
!Pregnancy
|Ruptured Ectopic Pregnancy
|
|RLQ / LLQ
|
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|
|Positive Urine beta HCG
|
|
|-
|}
{| class="wikitable"
! colspan="11" |Differentiating Brucellosis from other diseases
|-
|Disease
|History of consumption of unpasteurized milk or daily products
|History of recent weight loss
|Situated in endemic area or travel to endemic area
|IV abuse or
multiple sexual partners
|Fever
|Rash
|Painless lymphadenopathy
|Painful Lymphadenopathy
|White patches on the tonsil and back of throat
|Keys distinguishing features
|-
|[[Brucellosis]]
|✔
|✖
|✔
|✖
|✔
|✔
|✖
|✔
|✖
|
|-
|[[Typhoid fever]]
|✖
|✖
|✔
|✖
|✔
|✔
|✖
|✔
|✖
|
* Step ladder fever
* Rash which is salmon-colored and blanching
|-
|[[Malaria]]
|✖
|✖
|✔
|✖
|✔
|✖
|✖
|✔
|✖
|
* Paroxysms of spike in fever
* Chills
* Sweating
|-
|[[Tuberculosis]]
|✖
|✔
|✔
|✖
|✔
|✖
|✖
|✔
|✖
|
* Night sweats
* Weight loss
* Fatigue
|-
|[[Lymphoma]]
|✖
|✔
|✔
|✖
|✔
|✔
|✔
|✖
|✖
|
* Insidious in nature
* Painless lymphadenopathy
|-
|[[Epstein Barr virus|Epstein-Barr virus]]
|✖
|✖
|✖
|✖
|✔
|✔
|✖
|✔
|✔
|Posterior cervical lymphadenopathy
|-
|[[Toxoplasma]]
|✖
|✖
|✖
|✖
|✔
|✔
|✔
|✖
|✖
|Immunocompromised
|-
|[[Cytomegalovirus causes|Cytomegalovirus]]
|✖
|✖
|✖
|✖
|✔
|✔
|✖
|✔
|✖
|History of Blood transfusion
|-
|[[Human Immunodeficiency Virus|HIV]]
|✖
|✔
|✔
|✔
|✔
|✔
|✔
|✔
|✖
|History of  highest risk of contracting disease include contaminated blood transfusions, childbirth, needle sharing, and receptive anal intercourse.
|}
|}
==Reference==
==Reference==
{{reflist|2}}
{{reflist|2}}

Revision as of 18:33, 21 February 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Danitza Lukac Vishal Devarkonda, M.B.B.S[2]

Overview

Brucellosis must be differentiated from Typhoid fever, Malaria, Tuberculosis, Lymphoma, Dengue, Leptospirosis, Rheumatic disease, Epstein-barr virus, Toxoplasmosis, Cytomegalovirus, and HIV.

Differentiating Brucellosis from other Diseases

Brucellosis must be differentiated from Typhoid fever, Malaria, Tuberculosis, Lymphoma, Dengue, Leptospirosis, Rheumatic disease, Epstein-barr virus, Toxoplasmosis, Cytomegalovirus, and HIV.[1][2][3][4]

A detailed clinical history which includes recent travel history, recent camping or hunting, consumption of unpasteurized milk or raw meat products, and occupational history should be obtained, in order to differentiate Brucellosis from other diseases. ✔ !✔/✘ !✔/✘ !✘

Differentiating diagnosis of Brucellosis Symptoms Signs Diagnosis Additional Findings
Fever Rash Diarrhea Abdominal pain Weight loss Painful lymphadenopathy Hepatosplenomegaly Arthritis Lab Findings Imaging Findings
Brucellosis ✔ ✔ ✔
Typhoid fever ✔
Malaria ✔ ✔
Tuberculosis ✔ ✔
Lymphoma ✔
Mumps ✔ ✘
Rheumatoid arthritis ✘ ✔ ✔
SLE ✘ ✔ ✔
HIV ✘ ✘ ✔

Reference

  1. ↑ Pappas G, Akritidis N, Bosilkovski M, Tsianos E (2005). "Brucellosis". N Engl J Med. 352 (22): 2325–36. doi:10.1056/NEJMra050570. PMID 15930423.
  2. ↑ Brucellosis "Dennis Kasper, Anthony Fauci, Stephen Hauser, Dan Longo, J. Larry Jameson, Joseph Loscalzo"Harrison's Principles of Internal Medicine, 19e Accessed on January,2017
  3. ↑ Young EJ (1995). "Brucellosis: current epidemiology, diagnosis, and management". Curr Clin Top Infect Dis. 15: 115–28. PMID 7546364.
  4. ↑ Enfermedades infecciosas: Brucelosis -Diagnóstico de Brucelosis,Guia para el Equipo de Salud. Ministerio de Salud-Argentina. http://www.msal.gob.ar/images/stories/bes/graficos/0000000304cnt-guia-medica-brucelosis.pdf. Accessed on February 2, 2016
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