Legionellosis differential diagnosis: Difference between revisions

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{{Legionellosis}}
 
{{CMG}}
{{CMG}} [[Ogechukwu Hannah Nnabude, MD]]


==Overview==
==Overview==
Legionellosis must be differentiated from other causes of [[fever]], [[dyspnea]], [[cough]], and [[sputum]] production, such as [[bacterial pneumonia]], [[viral pneumonia]], and other causes of [[atypical pneumonia]].
[[Legionnaires' disease]] must be differentiated from other causes of [[fever]], [[dyspnea]], [[cough]], and [[sputum]] production, such as [[bacterial pneumonia]], [[viral pneumonia]], and other causes of [[atypical pneumonia]].


==Differential Diagnosis==
==Differential Diagnosis==
{{ddx0|Legionnaires' disease}}{{ddx1|[[Acute interstitial pneumonia]]}}
[[Legionnaires' disease]] must be differentiated from other causes of [[fever]], [[dyspnea]], [[cough]], and [[sputum]] production, such as [[bacterial pneumonia]], [[viral pneumonia]], and other causes of [[atypical pneumonia]].<ref name="pmid23422417">{{cite journal |vauthors=Irfan M, Farooqi J, Hasan R |title=Community-acquired pneumonia |journal=Curr Opin Pulm Med |volume=19 |issue=3 |pages=198–208 |year=2013 |pmid=23422417 |doi=10.1097/MCP.0b013e32835f1d12 |url=}}</ref>
{{ddx1|[[Mycoplasma pneumonia]]}}
{{ddx1|Pneumococcal [[pneumonia]]}}
{{ddx1|Pneumocystis carinii [[pneumonia]]}}
{{ddx1|[[Pulmonary embolism]]}}
{{ddx1|Streptococcal [[pneumonia]]}}
{{ddx1|Viral [[pneumonia]]}}
 
----
 
{{ddx|Legionnaires' disease}}
 
=====Clinical manifestations=====
* [[Adult respiratory distress syndrome]]
* [[Breath sounds|Bronchial breath sounds]]
* [[Dry cough]]
* [[Fever|High grade fever]]
* [[Dyspnea|Progressive dyspnea]]
 
=====Laboratory abnormalities=====
* Legionella urinary antigen positive
* [[Leukocytosis]] with relative [[lymphopenia]]
* [[Hyponatremia]]
* [[Hypophosphatemia]]
 
=====Radiographic features=====
* [[Alveoli|Alveolar consolidation]] on chest radiograph
* [[Consolidation (medicine)|Lobar consolidation]] on chest radiograph
 
----
 
{{ddx|Acute interstitial pneumonia}}
 
=====Clinical manifestations=====
* [[Dry cough]]
* [[Dyspnea|Progressive dyspnea]]
 
=====Laboratory abnormalities=====
* Nonspecific
 
=====Radiographic features=====
* Disseminated [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
* Interstitial infiltrate on chest radiograph
* Increased uptake on gallium scan
 
-----
 
{{ddx|Mycoplasma pneumonia}}
 
=====Clinical manifestations=====
* [[Dry cough]]
* [[Pleuritic chest pain]]
* Bronchial [[breath sounds]]
* [[Inflamed]], opaque, hypomobile [[tympanic membrane]]
 
=====Laboratory abnormalities=====
* [[Lymphocytosis]]
* [[Cold agglutinins]] positive
 
=====Radiographic features=====
* [[Alveolar]] [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
* Interstitial infiltrate on [[chest radiograph]]
* Lobar [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
 
----
 
{{ddx|Pneumococcal pneumonia}}
 
=====Clinical manifestations=====
* [[Fever|High grade fever]]
* [[Hemoptysis]]
* [[Rales|Fine rales]]
* [[Pleuritic chest pain]]
* Increased [[breath sounds]]
* Bronchial b[[Breath sounds|reath sounds]]
* Dullness on chest percussion
* [[Sputum|Purulent sputum]]
* [[Shallow respiration]]
* Pectoriloquy
* Increased [[tactile fremitus]]
* [[Productive cough]]
* [[Egophony]]
 
=====Laboratory abnormalities=====
* [[Gram positive bacteria|Gram positive]] [[diplococci]] on sputum Gram stain
* [[Pleural effusion]] ([[exudative]])
* Respiratory alkalosis
 
=====Radiographic features=====
* Parenchymal hyperlucency on [[chest radiograph]]
* Increased uptake on [[gallium scan]]
* Unilateral diaphragm elevation on [[chest radiograph]]
* Alveolar [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
* Lobar [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
 
----
 
{{ddx|Pneumocystis carinii pneumonia}}
 
=====Clinical manifestations=====
* [[Immunosuppressive]] state
* [[Subcutaneous emphysema]]
* [[Cough|Hacking cough]]
* [[Dyspnea|Progressive dyspnea]]
 
=====Laboratory abnormalities=====
* [[Respiratory alkalosis]]
* Serum beta-D-glucan elevation
 
=====Radiographic features=====
* [[Alveolar]] [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
* Lobar [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
* Interstitial infiltrate on [[chest radiograph]]
* [[Pneumomediastinum]] on [[chest radiograph]]
 
----
 
{{ddx|Pulmonary embolism}}
 
=====Clinical manifestations=====
* Calf [[pain]] or [[swelling]]
* Decreased [[pulse pressure]]
* [[Dyspnea]]
* [[Hemoptysis]]
* [[Hyperventilation]]
* [[Immobility]]
* Increased pulmonic component of heart sound
* [[Pleuritic chest pain]]
* Prior [[Deep vein thrombosis|DVT]]
* [[Pulmonary hypertension]]
* Right ventricular heave
* [[Right-to-left shunt]]
* [[Substernal chest pain]]
* [[Tachypnea]]
* [[Thrombophlebitis]]
* [[Venous stasis]]
* [[Bone fracture]]
 
=====Laboratory abnormalities=====
* [[D-dimer]] elevation
* [[Hypocapnia]]
* [[Hypoxia]]
* [[Pleural effusion]] (exudative or bloody)
* [[Atrial fibrillation]] on ECG
* [[Right axis deviation]] on ECG
* Right ventricular overload on ECG
 
=====Radiographic features=====
* Normal [[chest radiograph]]
* [[Atelectasis]] on [[chest radiograph]]
* Lobar consolidation on [[chest radiograph]]
* Prominent [[pulmonary artery]] on [[chest radiograph]]
* [[Hampton's hump]] on [[chest radiograph]]
* Right ventricular enlargement on [[echocardiography]]
* [[Thrombus]] on echocardiography
* Segmental [[perfusion]] defect on lung scan
* [[V/Q scan|V/Q]] mismatch on lung scan
 
----
 
{{ddx|Streptococcal pneumonia}}


=====Clinical manifestations=====
{|
* Pectoriloquy
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Disease
* Bronchial [[breath sounds]]
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Clinical manifestation
* [[Erythema nodosum]]
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab findings
* Purulent [[sputum]]
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging findings
* [[Shallow respiration]]
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Chest X-ray
* Increased [[tactile fremitus]]
* [[Pleuritic chest pain]]
* [[Egophony]]
 
=====Laboratory abnormalities=====
* [[Gram-positive cocci]] in chains on sputum [[Gram stain]]
* [[Respiratory alkalosis]]
* [[Pleural effusion]] (exudative)
 
=====Radiographic features=====
* Alveolar consolidation on chest radiograph
* Lobar consolidation on chest radiograph
* [[Empyema]] on chest radiograph
* Increased uptake on [[gallium scan]]
 
----
 
{{ddx|Viral pneumonia}}
 
=====Clinical manifestations=====
* [[Pleuritic chest pain]]
* [[Breath sounds|Bronchial breath sounds]]
* Recent [[influenza]]
* Fine [[rales]]
* [[Breath sounds|Bronchovesicular breath sounds]]
 
=====Laboratory abnormalities=====
* [[Lymphocytosis]]
* [[Respiratory alkalosis]]
 
=====Radiographic features=====
* Lobar [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
* Interstitial infiltrate on [[chest radiograph]]
 
 
'''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
! align="center" style="background:#DCDCDC;" |[[Legionnaires' disease]] <ref name="pmid26231463">{{cite journal| author=Cunha BA, Burillo A, Bouza E| title=Legionnaires' disease. | journal=Lancet | year= 2016 | volume= 387 | issue= 10016 | pages= 376-385 | pmid=26231463 | doi=10.1016/S0140-6736(15)60078-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26231463  }} </ref> <ref name="pmid28159178">{{cite journal| author=Cunha BA, Cunha CB| title=Legionnaire's Disease: A Clinical Diagnostic Approach. | journal=Infect Dis Clin North Am | year= 2017 | volume= 31 | issue= 1 | pages= 81-93 | pmid=28159178 | doi=10.1016/j.idc.2016.10.007 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28159178  }} </ref> <ref name="pmid28159171">{{cite journal| author=Chahin A, Opal SM| title=Severe Pneumonia Caused by Legionella pneumophila: Differential Diagnosis and Therapeutic Considerations. | journal=Infect Dis Clin North Am | year= 2017 | volume= 31 | issue= 1 | pages= 111-121 | pmid=28159171 | doi=10.1016/j.idc.2016.10.009 | pmc=7135102 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28159171  }} </ref>
| ++
| align="left" style="background:#F5F5F5;" |
| -
*[[Dry cough]]
| +
*[[Fever|High grade fever]]
| -
*[[Breath sounds|Bronchial breath sounds]]
| +++
*[[Asthenia]]
| +
*[[Dyspnea|Progressive dyspnea]]
|Minimal
*[[diarrhea]]
|
*[[Seizures]] and other neurological findings
* No changes seen
*[[nausea]], and [[vomiting]]
| -
*[[Adult respiratory distress syndrome]]
| +
| align="left" style="background:#F5F5F5;" |
| -
*Legionella urinary antigen positive
|[[Doxycycline]]
*[[Leukocytosis]] with relative [[lymphopenia]]
*[[Hyponatremia]]
*[[Hypophosphatemia]]
| align="left" style="background:#F5F5F5;" |
*[[Alveoli|Alveolar consolidation]] on chest radiograph
*[[Consolidation (medicine)|Lobar consolidation]] on chest radiograph
| align="center" style="background:#F5F5F5;" |
[[File:Legionella pneumonie Chest Xray.jpg|thumb|Chest X-ray of a patient with Legionnaires disease courtesy Hellerhoff]]
|-
|-
|[[Chlamydia pneumoniae|''C.pneumoniae'']] pneumonia
! align="center" style="background:#DCDCDC;" |[[Q fever]] <ref name="pmid15182283">{{cite journal| author=Okimoto N, Asaoka N, Osaki K, Kurihara T, Yamato K, Sunagawa T | display-authors=etal| title=Clinical features of Q fever pneumonia. | journal=Respirology | year= 2004 | volume= 9 | issue= 2 | pages= 278-82 | pmid=15182283 | doi=10.1111/j.1440-1843.2004.00586.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15182283  }} </ref> <ref name="pmid9743171">{{cite journal| author=Caron F, Meurice JC, Ingrand P, Bourgoin A, Masson P, Roblot P | display-authors=etal| title=Acute Q fever pneumonia: a review of 80 hospitalized patients. | journal=Chest | year= 1998 | volume= 114 | issue= 3 | pages= 808-13 | pmid=9743171 | doi=10.1378/chest.114.3.808 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9743171  }} </ref>
| +
| align="left" style="background:#F5F5F5;" |
| +
*[[Fever]]
| +
*Dry [[cough]]
| +++
*[[Dyspnea]]
| ++
*[[Pleuritic chest pain]]
| +
*[[myalgia]]
| -
*[[headache]]
|
| align="left" style="background:#F5F5F5;" |
* Minimal changes observed
*[[Antibody]] detection using [[Immunofluorescence|indirect immunofluorescence]] (IIF)
| -
*[[Polymerase chain reaction|PCR]]
| -
*[[Coxiella burnetii|''C. burnetii'']] cultivated on special media such as embryonated eggs or cell culture
| -
*A two-to-three fold increase in [[Aspartate transaminase|AST]] and [[ALT]]
|[[Doxycycline]], [[Azithromycin]]
| align="left" style="background:#F5F5F5;" |
Multiple soft infiltrative shadows on CXR
| align="center" style="background:#F5F5F5;" |
[[Image:Q fever.gif|center|300px|thumb|Q fever pneumonia - Case courtesy of Royal Melbourne Hospital Respiratory, Radiopaedia.org, rID 21993 ]]
|-
|-
|[[Mycoplasma pneumoniae|''M. pneumoniae'']] pneumonia
! align="center" style="background:#DCDCDC;" |[[mycoplasma pneumonia|''Mycoplasma'' pneumonia]] <ref name="pmid27148202">{{cite journal| author=Parrott GL, Kinjo T, Fujita J| title=A Compendium for Mycoplasma pneumoniae. | journal=Front Microbiol | year= 2016 | volume= 7 | issue=  | pages= 513 | pmid=27148202 | doi=10.3389/fmicb.2016.00513 | pmc=4828434 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27148202  }} </ref> <ref name="pmid29264006">{{cite journal| author=Saraya T| title=Mycoplasma pneumoniae infection: Basics. | journal=J Gen Fam Med | year= 2017 | volume= 18 | issue= 3 | pages= 118-125 | pmid=29264006 | doi=10.1002/jgf2.15 | pmc=5689399 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29264006  }} </ref>
| ++
| align="left" style="background:#F5F5F5;" |
| ++
*[[Dry cough]]
| ++
*[[Fever]]
| -
*[[Pharyngitis]]
| -
*[[Nausea and vomiting]]
| -
*[[Sinus congestion]]
| -
*[[Pleuritic chest pain]]
|
*[[Inflamed]], opaque, hypomobile [[tympanic membrane]]
* Bronchial wall thickening
| align="left" style="background:#F5F5F5;" |
* Centrilobular nodules
*[[Lymphocytosis]]
* [[Ground glass opacification on CT|Ground-glass attenuation]]  
*[[Cold agglutinins]] positive
* [[Consolidation (medicine)|Consolidation]]  
*Positive [[CoNombs test]]
| -
*[[Leukocytosis]]
| -
*[[Thrombocytosis]]
| +
| align="left" style="background:#F5F5F5;" |
|[[Doxycycline]]
*[[Alveolar]] [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
*Interstitial infiltrate on [[chest radiograph]]
*Lobar [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
| align="center" style="background:#F5F5F5;" |
[[Image:Atypical-pneumonia-mycoplasma - Case courtesy of Dr Alborz Jahangiri, Radiopaedia.org, rID 45781.jpg|center|300px|thumb|Mycoplasma pneumonia - Case courtesy of Dr Alborz Jahangiri, Radiopaedia.org, rID 45781]]
|-
|-
|[[Legionella pneumophila|''L. Pneumophila'']] infection
! align="center" style="background:#DCDCDC;" |[[Chlamydia pneumonia]]
| +
| align="left" style="background:#F5F5F5;" |
| +++
*Associated with [[upper respiratory tract]] symptoms
| +++
*Associated with extrapulmonary maifestations such as:
| -
**[[Meningitis]]
| +
**[[Guillain-Barre syndrome]]
| ++
| align="left" style="background:#F5F5F5;" |
| +
*Normal WBC count
|Often Multifocal
*Positive [[Antibody|antichlamydial antibody]]
| ++
| align="left" style="background:#F5F5F5;" |
| +
| align="center" style="background:#F5F5F5;" |
| ++
[[Image:Chlamydia-pneumonia - Case courtesy of Dr Andrew Dixon, Radiopaedia.org, rID 14567.jpg|center|300px|thumb|Chlamydia-pneumonia - Case courtesy of Dr Andrew Dixon, Radiopaedia.org, rID 14567]]
|[[Doxycycline]]
|-
|-
|[[Influenza (Flu) (For Patients)|Influenza]]
! align="center" style="background:#DCDCDC;" |[[Acute interstitial pneumonia]]
| ++
| align="left" style="background:#F5F5F5;" |
| ++
*[[Dry cough]]
| ++
*[[Dyspnea|Progressive dyspnea]]
| ++
| align="left" style="background:#F5F5F5;" |
| ++
*Nonspecific
| +/-
| align="left" style="background:#F5F5F5;" |
| +/-
*Disseminated [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
|
*Interstitial infiltrate on chest radiograph
* Bi-basal air-space opacities
*Increased uptake on gallium scan
* Perihilar [[reticular]] and [[Alveolar|alveolar infiltrates]]
| align="center" style="background:#F5F5F5;" |
| -
[[File:Acute Interstitial Pneumonitis Chest Xray - Case Courtesy of Dr Salam, Radiopaedia, rID 45404.jpeg|thumb|Acute Interstitial Pneumonitis Chest X-ray - Case Courtesy of Dr Salam, Radiopaedia, rID 45404]]
| -
| -
|[[zanamivir]], [[oseltamivir]],
|-
|-
|[[Endocarditis]]
! align="center" style="background:#DCDCDC;" |[[Pneumococcal pneumonia]]
| ++
| align="left" style="background:#F5F5F5;" |
| ++
*[[Fever|High grade fever]]
| +
*[[Hemoptysis]]
| -
*[[Rales|Fine rales]]
| -
*[[Pleuritic chest pain]]
| -
*Increased [[breath sounds]]
| -
*Bronchial b[[Breath sounds|reath sounds]]
|
*Dullness on chest percussion
* Hazy opacities at [[lung]]
*[[Sputum|Purulent sputum]]
bases bilaterally
*[[Shallow respiration]]
| -
*Pectoriloquy
| +/-
*Increased [[tactile fremitus]]
| +/-
*[[Productive cough]]
|[[Vancomycin]]
*[[Egophony]]
| align="left" style="background:#F5F5F5;" |
*[[Gram positive bacteria|Gram positive]] [[diplococci]] on sputum Gram stain
*[[Pleural effusion]] ([[exudative]])
*Respiratory alkalosis
| align="left" style="background:#F5F5F5;" |
*Parenchymal hyperlucency on [[chest radiograph]]
*Increased uptake on [[gallium scan]]
*Unilateral diaphragm elevation on [[chest radiograph]]
*Alveolar [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
*Lobar [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
| align="center" style="background:#F5F5F5;" |
[[File:Pneumococcal Pneumonia Chest Xray..jpg|thumb|Chest X-ray of a patient with pneumococcal pneumonia - case courtesy Dr Jack Ren,  Radiopaedia.org, rID 29090]]
|-
|-
|[[Coxiella burnetii infection|''Coxiella burnetii'' infection]]
! align="center" style="background:#DCDCDC;" |[[Pneumocystis carinii pneumonia]]
| ++
| align="left" style="background:#F5F5F5;" |
| -
*[[Immunosuppressive]] state
| +
*[[Subcutaneous emphysema]]
| +/-
*[[Cough|Hacking cough]]
| -
*[[Dyspnea|Progressive dyspnea]]
| +/-
| align="left" style="background:#F5F5F5;" |
|Minimal
*[[Respiratory alkalosis]]
|
*Serum beta-D-glucan elevation
* [[Segmental analysis (biology)|Segmental]] or [[Lobar pneumonia|lobar]] opacification
| align="left" style="background:#F5F5F5;" |
* Occasional [[pleural effusions]]
*[[Alveolar]] [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
| -
*Lobar [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
| +/-
*Interstitial infiltrate on [[chest radiograph]]
|=/-
*[[Pneumomediastinum]] on [[chest radiograph]]
|[[Doxycycline]]
| align="center" style="background:#F5F5F5;" |
[[File:Acute Interstitial Pneumonitis Chest Xray - Case Courtesy of Dr Salam, Radiopaedia, rID 45404.jpeg|thumb|Pneumocystis Jiroverci Chest Xray - Case Courtesy of Dr Behrang Amini, Radiopaedia, rID 1901]]
|-
|-
|[[Leptospirosis]]
! align="center" style="background:#DCDCDC;" |[[Pulmonary embolism]]
| ++
| align="left" style="background:#F5F5F5;" |
| +
*Calf [[pain]] or [[swelling]]
| ++
*Decreased [[pulse pressure]]
| +
*[[Dyspnea]]
| +
*[[Hemoptysis]]
| ++
*[[Hyperventilation]]
| -
*[[Immobility]]
|
*Increased pulmonic component of heart sound
* Multiple  ill-defined  [[Nodule (medicine)|nodules]] in  both  lungs.
*[[Pleuritic chest pain]]
| +++
*Prior [[Deep vein thrombosis|DVT]]
|
*[[Pulmonary hypertension]]
|
*Right ventricular heave
|[[Doxycycline]], [[azithromycin]], [[amoxicillin]]
*[[Right-to-left shunt]]
*[[Substernal chest pain]]
*[[Tachypnea]]
*[[Thrombophlebitis]]
*[[Venous stasis]]
*[[Bone fracture]]
| align="left" style="background:#F5F5F5;" |
*[[D-dimer]] elevation
*[[Hypocapnia]]
*[[Hypoxia]]
*[[Pleural effusion]] (exudative or bloody)
*[[Atrial fibrillation]] on ECG
*[[Right axis deviation]] on ECG
*Right ventricular overload on ECG
| align="left" style="background:#F5F5F5;" |
*Normal [[chest radiograph]]
*[[Atelectasis]] on [[chest radiograph]]
*Lobar consolidation on [[chest radiograph]]
*Prominent [[pulmonary artery]] on [[chest radiograph]]
*[[Hampton's hump]] on [[chest radiograph]]
*Right ventricular enlargement on [[echocardiography]]
*[[Thrombus]] on echocardiography
*Segmental [[perfusion]] defect on lung scan
*[[V/Q scan|V/Q]] mismatch on lung scan
| align="center" style="background:#F5F5F5;" |
[[File:Hampton Hump.PNG|thumb|Hampton Hump in a patient with pulmonary embolism courtesy of Hellerhoff]]
|-
|-
|[[Brucellosis]]
! align="center" style="background:#DCDCDC;" |[[Viral pneumonia]]
| ++
| align="left" style="background:#F5F5F5;" |
| -
*[[Pleuritic chest pain]]
| +
*[[Breath sounds|Bronchial breath sounds]]
| -
*Recent [[influenza]]
| ++
*Fine [[rales]]
| +
*[[Breath sounds|Bronchovesicular breath sounds]]
| -
| align="left" style="background:#F5F5F5;" |
|
*[[Lymphocytosis]]
* Soft [[Miliary TB|miliary]] mottling
*[[Respiratory alkalosis]]
* [[Parenchymal lung disease|Parenchymal nodules]]
| align="left" style="background:#F5F5F5;" |
* [[Consolidation (medicine)|Consolidation]]
*Lobar [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
* [[Chronic (medical)|Chronic]] [[diffuse]] changes
*Interstitial infiltrate on [[chest radiograph]]
* [[Hilar]] or [[Paratracheal lymph nodes|paratracheal]] [[lymphadenopathy]]
| align="center" style="background:#F5F5F5;" |
* [[Pneumothorax]].
| -/+
| +/-
| +/-
|[[Doxycycline]], [[rifampin]]
|}
|}


Key;
+, occurs in some cases
++, occurs in many cases,
+++, occurs frequently


==References==
==References==
{{reflist|2}}
{{reflist|2}}


[[Category:Infectious disease]]
[[Category:Pulmonology]]
[[Category:Pulmonology]]
[[Category:Disease]]
[[Category:Disease]]
[[Category:Bacterial diseases]]
[[Category:Bacterial diseases]]

Latest revision as of 20:58, 28 July 2022


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Ogechukwu Hannah Nnabude, MD

Overview

Legionnaires' disease must be differentiated from other causes of fever, dyspnea, cough, and sputum production, such as bacterial pneumonia, viral pneumonia, and other causes of atypical pneumonia.

Differential Diagnosis

Legionnaires' disease must be differentiated from other causes of fever, dyspnea, cough, and sputum production, such as bacterial pneumonia, viral pneumonia, and other causes of atypical pneumonia.[1]

Disease Clinical manifestation Lab findings Imaging findings Chest X-ray
Legionnaires' disease [2] [3] [4]
Chest X-ray of a patient with Legionnaires disease courtesy Hellerhoff
Q fever [5] [6]

Multiple soft infiltrative shadows on CXR

Q fever pneumonia - Case courtesy of Royal Melbourne Hospital Respiratory, Radiopaedia.org, rID 21993
Mycoplasma pneumonia [7] [8]
Mycoplasma pneumonia - Case courtesy of Dr Alborz Jahangiri, Radiopaedia.org, rID 45781
Chlamydia pneumonia
Chlamydia-pneumonia - Case courtesy of Dr Andrew Dixon, Radiopaedia.org, rID 14567
Acute interstitial pneumonia
  • Nonspecific
Acute Interstitial Pneumonitis Chest X-ray - Case Courtesy of Dr Salam, Radiopaedia, rID 45404
Pneumococcal pneumonia
Chest X-ray of a patient with pneumococcal pneumonia - case courtesy Dr Jack Ren,  Radiopaedia.org, rID 29090
Pneumocystis carinii pneumonia
Pneumocystis Jiroverci Chest Xray - Case Courtesy of Dr Behrang Amini, Radiopaedia, rID 1901
Pulmonary embolism
Hampton Hump in a patient with pulmonary embolism courtesy of Hellerhoff
Viral pneumonia


References

  1. Irfan M, Farooqi J, Hasan R (2013). "Community-acquired pneumonia". Curr Opin Pulm Med. 19 (3): 198–208. doi:10.1097/MCP.0b013e32835f1d12. PMID 23422417.
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