Blastomycosis differential diagnosis: Difference between revisions

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Afghanistan
Afghanistan
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* Maculopapular rash
* Maculopapular rash

Revision as of 20:53, 2 March 2017

Blastomycosis Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: ; Vidit Bhargava, M.B.B.S [2] Aditya Ganti M.B.B.S. [3]

Overview

Blastomycosis have overlapping signs & symptoms with that of other fungal and bacterial disorders. A detailed History, Physical examination and serological tests helps us to pin-point the diagnosis. All this disorders can be often misinterpreted as community acquired pneumonia as they all present with similar complaints such as fever, productive cough, chest pain and shortness of breath. The following table elaborates differentiating features between blastomycosis from other fungal disorders.

Fungal

Pathogen Disease Geographic distribution High risk Groups Differentiating features Microscopic findings
Physical exam Laboratory findings
Fungal Histoplasmosis Mississippi and Ohio River valleys
  • Cave dwellers
  • Soil that contains bird or bat dropping[1]
  • Palate and oral ulcers
  • Spleenomegaly
  • Pancytopenia
  • Urine antigen testing
Yeast are typically smaller, with narrow-based budding, found intracellularly within macrophages
Coccidioidomycosis Southwestern US region Opportunistic infection seen in AIDS
  • Rash on upper body or legs[2]
  • Night sweats
Serologic tests( enzyme immune assay )more sensitive Characteristic spherule appearance
Paracoccidioidomycosis[3] Central and South america Opportunistic infection seen in AIDS
  • Lymphadenopathy
  • Hepatosplenomegaly
  • Bone marrow dysfunction
  • Elevated liver enzymes
Smaller fungi with thin cell walls, forming mariner wheel appearance, circumferentially surrounding the parent cell.( Captain wheel appearance )
Sporotrichosis Ubiquitous Gardeners [4]
  • Person’s hand or the arm
  • Lymphadenitis (nodular)
+ Sporotrichin skin test Finger or cigar shaped yeast.
Aspergillosis[5] Ubiquitous
  • Cystic fibrosis or asthma. tuberculosis.
  • Immunocomprimised
  • Wheezing
  • Stuffiness, runny nose
  • Hemoptysis
  • Weight loss
Cell wall detection using galactomannan antigen detection, Beta-D-glucan detection test. Septated hyphae with acute angle branching
Bacterial Anthrax Ubiquitous Live stock handlers
  • Painless skin ulcer with a black center [6]
  • Bloody diarrhea
NonmotileGram-positiveaerobic or facultatively anaerobicendospore-forming, rod-shaped bacterium
Legionella Ubiquitous Chronic lung disease

Building water systems

  • Diarrhea
  • Confusion
  • + Urine Antigen
  • Hyponatreimia[7]
Gram negative bacterium
Tuberculosis Asia,Africa Ill contact individuals
  • Night sweats
  • Hemoptysis
Aerobicnon-encapsulatednon-motileacid-fast bacillus
Listeriosis Ubiquitous Pregnant women [8]

Adults > 65

Immunocomprimised.

  • pregnancy can lead to miscarriage, stillbirth, premature delivery,
  • Non-pregnant : headache, stiff neck, confusion, loss of balance, and convulsions
flagellated, catalase-positive, facultative intracellularanaerobicnonsporulatingGram-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 thrombocyotopenia.
Gram-negative bacteria,non-motile, encapsulated coccobacilli.
Scrub typhus Asia-Pacific region

Australia

Afghanistan

Hikers[9]
  • Maculopapular rash
  • Indirect immunofluorescence
Gram-negative α-proteobacterium  intracellular parasite
Leptospirosis Temperate, tropical climates. People who work with animals,
  • Jaundice
  • Red eyes
  • kidney failure
  • Antibodies labelled with fluorescent markers positive for leptospires.
  • Microscopic agglutination test +
Spiral-shaped bacteria with hooked ends on dark-field.
Cat scratch fever Ubiquitous cat licking a person's open wound, or bites or scratches a person
  • Lymphadenopathy
  • papule or pustule at the infected site
  • enzymatic immunoassay positive for antibody to B henselae
  • lymphocytosis
Gram-negative bacteria. facultative intracellular parasites
Viral Chickenpox
  • Pregnant women.
  • Infants born at less than 28 weeks gestation
  • Immunocompromised persons
  • Spots appearing in two or three waves
Whole infected cell (wc) ELISA for IgG.
Coxsackie A virus Children attending day care[10] Painful blisters in the mouth, palms and on the feet.

Rash, appears after episode of high fever.

Clinically diagnosed
Others Primary lung cancer Age >65
  • Weight loss
  • H/o smoking
  • Hemoptysis
CT guided bronchoscopy + for malignant cells

Bacterial

Viral

Chronic and disseminated disease

Chronic blastomycosis may be initially confused with a malignancy or tuberculosis. While spread to other areas may be confused with malignancy as well. Skin lesions are often misdiagnosed as pyoderma gangreosum or keratoacanthoma. Therefore, a high index of suspicion is needed on the part of physician to diagnose blastomycosis

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. Marques SA (2013). "Paracoccidioidomycosis: epidemiological, clinical, diagnostic and treatment up-dating". An Bras Dermatol. 88 (5): 700–11. doi:10.1590/abd1806-4841.20132463. PMC 3798345. PMID 24173174.
  4. Mahajan VK (2014). "Sporotrichosis: an overview and therapeutic options". Dermatol Res Pract. 2014: 272376. doi:10.1155/2014/272376. PMC 4295339. PMID 25614735.
  5. 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.
  6. 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.
  7. Schuetz P, Haubitz S, Christ-Crain M, Albrich WC, Zimmerli W, Mueller B (2013). "Hyponatremia and anti-diuretic hormone in Legionnaires' disease". BMC Infect. Dis. 13: 585. doi:10.1186/1471-2334-13-585. PMC 3880094. PMID 24330484.
  8. 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.
  9. Zhou YH, Xia FQ, Van Poucke S, Zheng MH (2016). "Successful Treatment of Scrub Typhus-Associated Hemophagocytic Lymphohistiocytosis With Chloramphenicol: Report of 3 Pediatric Cases and Literature Review". Medicine (Baltimore). 95 (8): e2928. doi:10.1097/MD.0000000000002928. PMC 4779037. PMID 26937940.
  10. 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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