Endocarditis differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Endocarditis}}
[[Image:Home_logo1.png|right|250px|link=http://www.wikidoc.org/index.php/Endocarditis]]
{{CMG}}
{{CMG}} {{AE}} {{Maliha}}


==Overview==
==Overview==
Endocarditis often presents as an unexplained fever and must be distinguished from other causes of a [[fever of unknown origin]] ([[FUO]]).  
Endocarditis must be differentiated from other causes of a [[fever of unknown origin]] ([[FUO]]) such as [[pulmonary embolism]], [[deep vein thrombosis]], [[lymphoma]], [[drug fever]], [[cotton fever]], and disseminated granulomatoses.<ref name="pmid9114175">{{cite journal| author=Hirschmann JV| title=Fever of unknown origin in adults. | journal=Clin Infect Dis | year= 1997 | volume= 24 | issue= 3 | pages= 291-300; quiz 301-2 | pmid=9114175 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9114175  }} </ref>


==Differential Diagnosis==
==Differential Diagnosis==
Causes of a fever of unknown origin which endocarditis must be differentiated from include a [[drug fever]], [[cotton fever]], [[lymphoma]], [[pulmonary embolism]], and [[deep vein thrombosis]]. Disseminated granulomatoses such as [[Tuberculosis]], [[Histoplasmosis]], [[Coccidioidomycosis]], [[Blastomycosis]] and [[Sarcoidosis]] can also cause a FUO.  [[Blood cultures]] and echocardiography are critical in differentiating endocarditis from these other syndromes.
Endocarditis must be differentiated from other causes of a fever of unknown origin such as:<ref name="pmid9114175">{{cite journal| author=Hirschmann JV| title=Fever of unknown origin in adults. | journal=Clin Infect Dis | year= 1997 | volume= 24 | issue= 3 | pages= 291-300; quiz 301-2 | pmid=9114175 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9114175  }} </ref>
*[[Lymphoma]]  
*[[Pulmonary embolism]]
*[[Deep vein thrombosis]]
*[[Drug fever]]  
*[[Cotton fever]]   
*Disseminated granulomatoses such as [[tuberculosis]], [[histoplasmosis]], [[coccidioidomycosis]], [[blastomycosis]], and [[sarcoidosis]]


===Drug Fever===
===Drug Fever===
A [[drug fever]] will resolve with discontinuation of the offending agent.  There may be elevated [[urine eosinophils]] and a peripheral [[eosinophilia]] as well.
A [[drug fever]] will resolve with discontinuation of the offending agent.  There may be elevated urine [[eosinophils]] and a peripheral [[eosinophilia]] as well.


===Cotton Fever===
===Cotton Fever===
The symptoms of cotton fever resemble those of [[sepsis]] and patients may be initially misdiagnosed upon admission to a hospital. However sepsis is a serious medical condition which can lead to death, whereas cotton fever, if left alone, will usually resolve itself spontaneously within 12-24 hours. Symptoms usually appear with 10-20 minutes after injection and in addition to [[fever]] may include [[headache]]s, [[malaise]], [[chills]], [[nausea]] and [[tachycardia]]. The fever itself usually reaches 38.5 - 40.3°C (101 - 105°F) within the first hour.<ref name="pmid2362114">{{cite journal| author=Harrison DW, Walls RM| title="Cotton fever": a benign febrile syndrome in intravenous drug abusers. | journal=J Emerg Med | year= 1990 | volume= 8 | issue= 2 | pages= 135-9 | pmid=2362114 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2362114  }} </ref>
The symptoms of [[cotton fever]] resemble those of [[sepsis]] and patients may be initially misdiagnosed upon admission to a hospital. However sepsis is a serious medical condition which can lead to death, whereas cotton fever, if left alone, will usually resolve itself spontaneously within 12-24 hours. Symptoms usually appear with 10-20 minutes after injection and in addition to [[fever]] may include [[headache]]s, [[malaise]], [[chills]], [[nausea]] and [[tachycardia]]. The fever itself usually reaches 38.5 - 40.3°C (101 - 105°F) within the first hour.<ref name="pmid2362114">{{cite journal| author=Harrison DW, Walls RM| title="Cotton fever": a benign febrile syndrome in intravenous drug abusers. | journal=J Emerg Med | year= 1990 | volume= 8 | issue= 2 | pages= 135-9 | pmid=2362114 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2362114  }} </ref>
 
 
'''Table 1; Differentiating psittacosis from other diseases'''
 
{| class="wikitable"
!Clinical feature
![[Cough]]
![[Sputum]]
![[Dyspnea]]
![[Sore throat]]
![[Headache]]
![[Confusion]]
![[Diarrhea]]
!Chest radiograph changes
!Hyponatremia
![[Leukopenia]]
!Abnormal Liver function tests
!Treatment
|-
!Psittacosis
| ++
| -
| +
| -
| +++
| +
|Minimal
|
* No changes seen
| -
| +
| -
|[[Doxycycline]]
|-
![[Chlamydia pneumoniae|''C.pneumoniae'']] pneumonia
| +
| +
| +
| +++
| ++
| +
| -
|
* Minimal changes observed
| -
| -
| -
|[[Doxycycline]], [[Azithromycin]]
|-
![[Mycoplasma pneumoniae|''M. pneumoniae'']] pneumonia
| ++
| ++
| ++
| -
| -
| -
| -
|
* Bronchial wall thickening
* Centrilobular nodules
* [[Ground glass opacification on CT|Ground-glass attenuation]]
* [[Consolidation (medicine)|Consolidation]]
| -
| -
| +
|[[Doxycycline]]
|-
![[Legionella pneumophila|''L. Pneumophila'']] infection
| +
| +++
| +++
| -
| +
| ++
| +
|Often Multifocal
| ++
| +
| ++
|[[Doxycycline]]
|-
![[Influenza (Flu) (For Patients)|Influenza]]
| ++
| ++
| ++
| ++
| ++
| +/-
| +/-
|
* Bi-basal air-space opacities
* Perihilar [[reticular]] and [[Alveolar|alveolar infiltrates]]
| -
| -
| -
|[[zanamivir]], [[oseltamivir]],
|-
![[Endocarditis]]
| ++
| ++
| +
| -
| -
| -
| -
|
* Hazy opacities at [[lung]]
bases bilaterally
| -
| +/-
| +/-
|[[Vancomycin]]
|-
![[Coxiella burnetii infection|''Coxiella burnetii'' infection]]
| ++
| -
| +
| +/-
| -
| +/-
|Minimal
|
* [[Segmental analysis (biology)|Segmental]] or [[Lobar pneumonia|lobar]] opacification
* Occasional [[pleural effusions]]
| -
| +/-
|=/-
|[[Doxycycline]]
|-
![[Leptospirosis]]
| ++
| +
| ++
| +
| +
| ++
| -
|
* Multiple  ill-defined  [[Nodule (medicine)|nodules]]  in  both  lungs.
| +++
|
|
|[[Doxycycline]], [[azithromycin]], [[amoxicillin]]
|-
![[Brucellosis]]
| ++
| -
| +
| -
| ++
| +
| -
|
* Soft [[Miliary TB|miliary]] mottling
* [[Parenchymal lung disease|Parenchymal nodules]]
* [[Consolidation (medicine)|Consolidation]]
* [[Chronic (medical)|Chronic]] [[diffuse]] changes
* [[Hilar]] or [[Paratracheal lymph nodes|paratracheal]] [[lymphadenopathy]]
* [[Pneumothorax]].
| -/+
| +/-
| +/-
|[[Doxycycline]], [[rifampin]]
|}
 
Key;
 
+, occurs in some cases
 
++, occurs in many cases,
 
+++, occurs frequently
 


==References==
==References==
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[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Infectious disease]]
 
[[Category:Intensive care medicine]]
[[Category:Intensive care medicine]]
[[Category:Up-To-Date]]
[[Category:Up-To-Date]]

Latest revision as of 21:12, 3 March 2020

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

Overview

Endocarditis must be differentiated from other causes of a fever of unknown origin (FUO) such as pulmonary embolism, deep vein thrombosis, lymphoma, drug fever, cotton fever, and disseminated granulomatoses.[1]

Differential Diagnosis

Endocarditis must be differentiated from other causes of a fever of unknown origin such as:[1]

Drug Fever

A drug fever will resolve with discontinuation of the offending agent. There may be elevated urine eosinophils and a peripheral eosinophilia as well.

Cotton Fever

The symptoms of cotton fever resemble those of sepsis and patients may be initially misdiagnosed upon admission to a hospital. However sepsis is a serious medical condition which can lead to death, whereas cotton fever, if left alone, will usually resolve itself spontaneously within 12-24 hours. Symptoms usually appear with 10-20 minutes after injection and in addition to fever may include headaches, malaise, chills, nausea and tachycardia. The fever itself usually reaches 38.5 - 40.3°C (101 - 105°F) within the first hour.[2]


Table 1; Differentiating psittacosis from other diseases

Clinical feature Cough Sputum Dyspnea Sore throat Headache Confusion Diarrhea Chest radiograph changes Hyponatremia Leukopenia Abnormal Liver function tests Treatment
Psittacosis ++ - + - +++ + Minimal
  • No changes seen
 - + - Doxycycline
C.pneumoniae pneumonia + + + +++ ++ + -
  • Minimal changes observed
 - - - Doxycycline, Azithromycin
M. pneumoniae pneumonia ++ ++ ++ - - - - - - + Doxycycline
L. Pneumophila infection + +++ +++ - + ++ + Often Multifocal ++ + ++ Doxycycline
Influenza ++ ++ ++ ++ ++ +/- +/- - - - zanamivir, oseltamivir,
Endocarditis ++ ++ + - - - -
  • Hazy opacities at lung

bases bilaterally

- +/- +/- Vancomycin
Coxiella burnetii infection ++ - + +/- - +/- Minimal - +/- =/- Doxycycline
Leptospirosis ++ + ++ + + ++ -
  • Multiple ill-defined nodules in both lungs.
 +++ Doxycycline, azithromycin, amoxicillin
Brucellosis ++ - + - ++ + - -/+ +/- +/- Doxycycline, rifampin

Key;

+, occurs in some cases

++, occurs in many cases,

+++, occurs frequently


References

  1. ↑ 1.0 1.1 Hirschmann JV (1997). "Fever of unknown origin in adults". Clin Infect Dis. 24 (3): 291–300, quiz 301-2. PMID 9114175.
  2. ↑ Harrison DW, Walls RM (1990). ""Cotton fever": a benign febrile syndrome in intravenous drug abusers". J Emerg Med. 8 (2): 135–9. PMID 2362114.

Template:WH Template:WS

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