Bacterial pneumonia differential diagnosis: Difference between revisions

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{{Bacterial pneumonia}}
{{Bacterial pneumonia}}
==Overview==
==Overview==
Bacterial Pneumonia has various subclassifications, all with distinct underlying causes. Prevalent organisms have been mentioned below.
==Differentiating Bacterial Pneumonia from other Diseases==
==Differentiating Bacterial Pneumonia from other Diseases==


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|+'''Differential Diagnosis of Pneumonia by Infectious Agent'''
|+'''Differential Diagnosis of Pneumonia by Infectious Agent'''
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Disease}}
! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Disease}}
! style="background: #4479BA; width: 500px;" | {{fontcolor|#FFF|Findings}}
! style="background: #4479BA; width: 500px;" |{{fontcolor|#FFF|Findings}}
! style="background: #4479BA; width: 500px;" | {{fontcolor|#FFF|Common Organisms}}
! style="background: #4479BA; width: 500px;" |{{fontcolor|#FFF|Common Organisms}}
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Typical Bacterial
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Typical Bacterial
| style="padding: 5px 5px; background: #F5F5F5;" |  
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" | [[S. pneumoniae]], [[H. influenzae]], [[S. aureus]], [[Klebsiella pneumoniae]], [[anaerobes]], [[group A streptococci]], [[Moraxella catarrhalis]].
| style="padding: 5px 5px; background: #F5F5F5;" |[[S. pneumoniae]], [[H. influenzae]], [[S. aureus]], [[Klebsiella pneumoniae]], [[anaerobes]], [[group A streptococci]], [[Moraxella catarrhalis]].
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Atypical Bacterial
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Atypical Bacterial
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" | [[Mycoplasma pneumoniae]], [[Legionella]] spp, [[Chlamydophila pneumoniae]], and C. psittaci.
| style="padding: 5px 5px; background: #F5F5F5;" |[[Mycoplasma pneumoniae]], [[Legionella]] spp, [[Chlamydophila pneumoniae]], and C. psittaci.
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Viral
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Viral
| style="padding: 5px 5px; background: #F5F5F5;" |  
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" | Influenza virus, Parainfluenza virus, Adenovirus, Rhinovirus, RSV, SARS, MERS-CoV,  
| style="padding: 5px 5px; background: #F5F5F5;" |Influenza virus, Parainfluenza virus, Adenovirus, Rhinovirus, RSV, SARS, MERS-CoV,
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Fungi
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Fungi
| style="padding: 5px 5px; background: #F5F5F5;" |  
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" | Cryptococcus spp, Pneumocystis jirovecii,  Histoplasma capsulatum, Coccidioides spp, Aspergillus spp
| style="padding: 5px 5px; background: #F5F5F5;" |Cryptococcus spp, Pneumocystis jirovecii,  Histoplasma capsulatum, Coccidioides spp, Aspergillus spp
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | Parasite
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |Parasite
| style="padding: 5px 5px; background: #F5F5F5;" |  
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |  
| style="padding: 5px 5px; background: #F5F5F5;" |
|}
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{| style="border: 0px; font-size: 90%; margin: 3px; width: 700px;" align=center
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|+'''Differential Diagnosis of Pneumonia''' <ref name="pmid1458569">{{cite journal| author=Schiele F, Muller J, Colinet E, Siest G, Arzoglou P, Brettschneider H et al.| title=Interlaboratory study of the IFCC method for alanine aminotransferase performed with use of a partly purified reference material. | journal=Clin Chem | year= 1992 | volume= 38 | issue= 12 | pages= 2365-71 | pmid=1458569 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1458569  }} </ref><ref name="pmid11113658">{{cite journal| author=Castro-Guardiola A, Armengou-Arxé A, Viejo-Rodríguez A, Peñarroja-Matutano G, Garcia-Bragado F| title=Differential diagnosis between community-acquired pneumonia and non-pneumonia diseases of the chest in the emergency ward. | journal=Eur J Intern Med | year= 2000 | volume= 11 | issue= 6 | pages= 334-339 | pmid=11113658 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11113658  }} </ref><ref name="Ahnsjö1935">{{cite journal|last1=Ahnsjö|first1=Sven|title=Contribution to the Differential Diagnosis of Pneumonia in Childhood|journal=Acta Paediatrica|volume=17|issue=3|year=1935|pages=439–446|issn=0803-5253|doi=10.1111/j.1651-2227.1935.tb07697.x}}</ref>
|+'''Differential Diagnosis of Pneumonia''' <ref name="pmid1458569">{{cite journal| author=Schiele F, Muller J, Colinet E, Siest G, Arzoglou P, Brettschneider H et al.| title=Interlaboratory study of the IFCC method for alanine aminotransferase performed with use of a partly purified reference material. | journal=Clin Chem | year= 1992 | volume= 38 | issue= 12 | pages= 2365-71 | pmid=1458569 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1458569  }} </ref><ref name="pmid11113658">{{cite journal| author=Castro-Guardiola A, Armengou-Arxé A, Viejo-Rodríguez A, Peñarroja-Matutano G, Garcia-Bragado F| title=Differential diagnosis between community-acquired pneumonia and non-pneumonia diseases of the chest in the emergency ward. | journal=Eur J Intern Med | year= 2000 | volume= 11 | issue= 6 | pages= 334-339 | pmid=11113658 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11113658  }} </ref><ref name="Ahnsjö1935">{{cite journal|last1=Ahnsjö|first1=Sven|title=Contribution to the Differential Diagnosis of Pneumonia in Childhood|journal=Acta Paediatrica|volume=17|issue=3|year=1935|pages=439–446|issn=0803-5253|doi=10.1111/j.1651-2227.1935.tb07697.x}}</ref>


! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Disease}}
! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Disease}}
! style="background: #4479BA; width: 500px;" | {{fontcolor|#FFF|Findings}}
! style="background: #4479BA; width: 500px;" |{{fontcolor|#FFF|Findings}}
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | [[Acute bronchitis]]
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Acute bronchitis]]
| style="padding: 5px 5px; background: #F5F5F5;" | No infiltrates seen on the chest X-ray.
| style="padding: 5px 5px; background: #F5F5F5;" |No infiltrates seen on the chest X-ray.
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | [[Asthma]]
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Asthma]]
| style="padding: 5px 5px; background: #F5F5F5;" | Past medical history, no infiltrates seen on chest X-ray.
| style="padding: 5px 5px; background: #F5F5F5;" |Past medical history, no infiltrates seen on chest X-ray.
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | [[Bronchiolitis obliterans]]  
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Bronchiolitis obliterans]]
| style="padding: 5px 5px; background: #F5F5F5;" | Should be suspected in patients with pneumonia who do not respond to antibiotics treatment.
| style="padding: 5px 5px; background: #F5F5F5;" |Should be suspected in patients with pneumonia who do not respond to antibiotics treatment.
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | [[Congestive heart failure]]  
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Congestive heart failure]]
| style="padding: 5px 5px; background: #F5F5F5;" | Bilateral [[pulmonary edema]], shortness of breath.
| style="padding: 5px 5px; background: #F5F5F5;" |Bilateral [[pulmonary edema]], shortness of breath.
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | [[COPD]]
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[COPD]]
| style="padding: 5px 5px; background: #F5F5F5;" | Past medical history, no infiltrates on chest X-ray, fever is uncommon.
| style="padding: 5px 5px; background: #F5F5F5;" |Past medical history, no infiltrates on chest X-ray, fever is uncommon.
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | [[Empyema]]
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Empyema]]
| style="padding: 5px 5px; background: #F5F5F5;" | CXR showing features of [[pleural effusion]], inflammatory markers on [[thoracocentesis]].  
| style="padding: 5px 5px; background: #F5F5F5;" |CXR showing features of [[pleural effusion]], inflammatory markers on [[thoracocentesis]].
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | [[Endocarditis]]
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Endocarditis]]
| style="padding: 5px 5px; background: #F5F5F5;" | Finding of septic [[pulmonary emboli]]
| style="padding: 5px 5px; background: #F5F5F5;" |Finding of septic [[pulmonary emboli]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | [[Gastroesophageal reflux disease]] (GERD)
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Gastroesophageal reflux disease]] (GERD)
| style="padding: 5px 5px; background: #F5F5F5;" | Normal chest X-ray, symptoms are worse during night and associated with meals.
| style="padding: 5px 5px; background: #F5F5F5;" |Normal chest X-ray, symptoms are worse during night and associated with meals.
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Lung abscess]]  
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Lung abscess]]
| style="padding: 5px 5px; background: #F5F5F5;" | Chest X-ray shows signs of [[lung abscess]].
| style="padding: 5px 5px; background: #F5F5F5;" |Chest X-ray shows signs of [[lung abscess]].
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | [[Lung cancer]]  
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Lung cancer]]
| style="padding: 5px 5px; background: #F5F5F5;" | Weight loss, clear sputum.  CT scan and biopsy are helpful in ruling out malignancy.
| style="padding: 5px 5px; background: #F5F5F5;" |Weight loss, clear sputum.  CT scan and biopsy are helpful in ruling out malignancy.
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Pertussis]]
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Pertussis]]
| style="padding: 5px 5px; background: #F5F5F5;" | Productive cough for weeks, nasopharyngeal aspirate aids in diagnosis.
| style="padding: 5px 5px; background: #F5F5F5;" |Productive cough for weeks, nasopharyngeal aspirate aids in diagnosis.
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | [[Pulmonary embolus]]
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Pulmonary embolus]]
| style="padding: 5px 5px; background: #F5F5F5;" | A high degree of suspicion should be kept for [[pulmonary embolus]]. Chest X-ray may be normal.
| style="padding: 5px 5px; background: #F5F5F5;" |A high degree of suspicion should be kept for [[pulmonary embolus]]. Chest X-ray may be normal.
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Sinusitis]]
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Sinusitis]]
| style="padding: 5px 5px; background: #F5F5F5;" | Sinus tenderness, post nasal drip.
| style="padding: 5px 5px; background: #F5F5F5;" |Sinus tenderness, post nasal drip.
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" | [[Vasculitis]]
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |[[Vasculitis]]
| style="padding: 5px 5px; background: #F5F5F5;" | Systemic manifestations of [[collagen vascular disease]] may be seen.
| style="padding: 5px 5px; background: #F5F5F5;" |Systemic manifestations of [[collagen vascular disease]] may be seen.


|}
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Revision as of 07:06, 28 December 2021

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Overview

Bacterial Pneumonia has various subclassifications, all with distinct underlying causes. Prevalent organisms have been mentioned below.

Differentiating Bacterial Pneumonia from other Diseases

Differential Diagnosis of Pneumonia by Infectious Agent
Disease Findings Common Organisms
Typical Bacterial S. pneumoniae, H. influenzae, S. aureus, Klebsiella pneumoniae, anaerobes, group A streptococci, Moraxella catarrhalis.
Atypical Bacterial Mycoplasma pneumoniae, Legionella spp, Chlamydophila pneumoniae, and C. psittaci.
Viral Influenza virus, Parainfluenza virus, Adenovirus, Rhinovirus, RSV, SARS, MERS-CoV,
Fungi Cryptococcus spp, Pneumocystis jirovecii, Histoplasma capsulatum, Coccidioides spp, Aspergillus spp
Parasite


Differential Diagnosis of Pneumonia [1][2][3]
Disease Findings
Acute bronchitis No infiltrates seen on the chest X-ray.
Asthma Past medical history, no infiltrates seen on chest X-ray.
Bronchiolitis obliterans Should be suspected in patients with pneumonia who do not respond to antibiotics treatment.
Congestive heart failure Bilateral pulmonary edema, shortness of breath.
COPD Past medical history, no infiltrates on chest X-ray, fever is uncommon.
Empyema CXR showing features of pleural effusion, inflammatory markers on thoracocentesis.
Endocarditis Finding of septic pulmonary emboli
Gastroesophageal reflux disease (GERD) Normal chest X-ray, symptoms are worse during night and associated with meals.
Lung abscess Chest X-ray shows signs of lung abscess.
Lung cancer Weight loss, clear sputum. CT scan and biopsy are helpful in ruling out malignancy.
Pertussis Productive cough for weeks, nasopharyngeal aspirate aids in diagnosis.
Pulmonary embolus A high degree of suspicion should be kept for pulmonary embolus. Chest X-ray may be normal.
Sinusitis Sinus tenderness, post nasal drip.
Vasculitis Systemic manifestations of collagen vascular disease may be seen.

References

  1. Schiele F, Muller J, Colinet E, Siest G, Arzoglou P, Brettschneider H; et al. (1992). "Interlaboratory study of the IFCC method for alanine aminotransferase performed with use of a partly purified reference material". Clin Chem. 38 (12): 2365–71. PMID 1458569.
  2. Castro-Guardiola A, Armengou-Arxé A, Viejo-Rodríguez A, Peñarroja-Matutano G, Garcia-Bragado F (2000). "Differential diagnosis between community-acquired pneumonia and non-pneumonia diseases of the chest in the emergency ward". Eur J Intern Med. 11 (6): 334–339. PMID 11113658.
  3. Ahnsjö, Sven (1935). "Contribution to the Differential Diagnosis of Pneumonia in Childhood". Acta Paediatrica. 17 (3): 439–446. doi:10.1111/j.1651-2227.1935.tb07697.x. ISSN 0803-5253.

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