Legionellosis differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{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==
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]].<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>
[[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>


{|
{|
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! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Chest X-ray
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Chest X-ray
|-
|-
! align="center" style="background:#DCDCDC;" |[[Legionellosis]]
! 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;" |
**[[Adult respiratory distress syndrome]]
*[[Dry cough]]
**[[Breath sounds|Bronchial breath sounds]]
*[[Fever|High grade fever]]
**[[Dry cough]]
*[[Breath sounds|Bronchial breath sounds]]
**[[Fever|High grade fever]]
*[[Asthenia]]
**[[Dyspnea|Progressive dyspnea]]
*[[Dyspnea|Progressive dyspnea]]
**[[diarrhea]]
*[[diarrhea]]
**[[nausea]], and [[vomiting]]
*[[Seizures]] and other neurological findings
|
*[[nausea]], and [[vomiting]]
*[[Adult respiratory distress syndrome]]
| align="left" style="background:#F5F5F5;" |
*Legionella urinary antigen positive
*Legionella urinary antigen positive
*[[Leukocytosis]] with relative [[lymphopenia]]
*[[Leukocytosis]] with relative [[lymphopenia]]
*[[Hyponatremia]]
*[[Hyponatremia]]
*[[Hypophosphatemia]]
*[[Hypophosphatemia]]
|
| align="left" style="background:#F5F5F5;" |
*[[Alveoli|Alveolar consolidation]] on chest radiograph
*[[Alveoli|Alveolar consolidation]] on chest radiograph
*[[Consolidation (medicine)|Lobar 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]]
|-
|-
! align="center" style="background:#DCDCDC;" |Q fever
! 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;" |
* Abrupt onset of [[fever]], [[myalgia]], [[headache]], and other constitutional symptoms.
*[[Fever]]
* [[Cough]] is the most prominent respiratory symptom and it is usually dry.<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>
*Dry [[cough]]
* [[Cough]] is associated with [[dyspnea]] and [[pleuritic chest pain]].
*[[Dyspnea]]
|
*[[Pleuritic chest pain]]
* [[Antibody]] detection using [[Immunofluorescence|indirect immunofluorescence]] (IIF) is the preferred method for diagnosis.
*[[myalgia]]
* [[Polymerase chain reaction|PCR]] can be used if IIF is negative, or very early once disease is suspected.
*[[headache]]
* [[Coxiella burnetii|''C. burnetii'']] does not grow on ordinary blood cultures, but can be cultivated on special media such as embryonated eggs or cell culture.
| align="left" style="background:#F5F5F5;" |
* A two-to-three fold increase in [[Aspartate transaminase|AST]] and [[ALT]] is seen in most patients.
*[[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
[[Image:Q fever.gif|center|300px|thumb|Q fever pneumonia - - Case courtesy of Royal Melbourne Hospital Respiratory, Radiopaedia.org, rID 21993 ]]
*A two-to-three fold increase in [[Aspartate transaminase|AST]] and [[ALT]]
| 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 ]]
|-
|-
! align="center" style="background:#DCDCDC;" |[[mycoplasma pneumonia|''Mycoplasma'' 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]]
*[[Dry cough]]
*[[Fever]]
*[[Pharyngitis]]
*[[Nausea and vomiting]]
*[[Sinus congestion]]
*[[Pleuritic chest pain]]
*[[Pleuritic chest pain]]
*Bronchial [[breath sounds]]
*[[Inflamed]], opaque, hypomobile [[tympanic membrane]]
*[[Inflamed]], opaque, hypomobile [[tympanic membrane]]
|
| align="left" style="background:#F5F5F5;" |
**[[Lymphocytosis]]
*[[Lymphocytosis]]
**[[Cold agglutinins]] positivePostitve [[Coombs test]]
*[[Cold agglutinins]] positive
* [[Leukocytosis]]
*Positive [[CoNombs test]]
* [[Thrombocytosis]]
*[[Leukocytosis]]
|
*[[Thrombocytosis]]
| align="left" style="background:#F5F5F5;" |
*[[Alveolar]] [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
*[[Alveolar]] [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
*Interstitial infiltrate on [[chest radiograph]]
*Interstitial infiltrate on [[chest radiograph]]
*Lobar [[Consolidation (medicine)|consolidation]] 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]]
[[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]]
|-
|-
! align="center" style="background:#DCDCDC;" |[[Chlamydia pneumonia]]
! align="center" style="background:#DCDCDC;" |[[Chlamydia pneumonia]]
|
| align="left" style="background:#F5F5F5;" |
* There are no specific clinical features of [[chlamydia pneumonia]].
*Associated with [[upper respiratory tract]] symptoms
* Symptoms appear gradually.
*Associated with extrapulmonary maifestations such as:
* [[Chlamydia infection]] is usually associated with [[upper respiratory tract]] symptoms ([[pharyngitis]], [[sinusitis]], etc).
**[[Meningitis]]
* It might be associated with extrapulmonary maifestations such as [[meningitis]] and [[Guillain-Barre syndrome]].<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>
**[[Guillain-Barre syndrome]]
|
| align="left" style="background:#F5F5F5;" |
* [[Chlamydia pneumonia]] is usually associated with normal [[WBC|WBC count.]]
*Normal WBC count
* Diagnosed with the presence of [[Antibody|antichlamydial antibody]] (through [[complement fixation]] or direct immunofluoroscence) or direct antigen detection.
*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]]
[[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]]
|-
|-
! align="center" style="background:#DCDCDC;" |Acute interstitial pneumonia
! align="center" style="background:#DCDCDC;" |[[Acute interstitial pneumonia]]
|
| align="left" style="background:#F5F5F5;" |
*[[Dry cough]]
*[[Dry cough]]
*[[Dyspnea|Progressive dyspnea]]
*[[Dyspnea|Progressive dyspnea]]
|
| align="left" style="background:#F5F5F5;" |
*Nonspecific
*Nonspecific
|
| align="left" style="background:#F5F5F5;" |
*Disseminated [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
*Disseminated [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
*Interstitial infiltrate on chest radiograph
*Interstitial infiltrate on chest radiograph
*Increased uptake on gallium scan
*Increased uptake on gallium scan
|
| 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]]
|-
|-
! align="center" style="background:#DCDCDC;" |Pneumococcal pneumonia
! align="center" style="background:#DCDCDC;" |[[Pneumococcal pneumonia]]
|
| align="left" style="background:#F5F5F5;" |
*[[Fever|High grade fever]]
*[[Fever|High grade fever]]
*[[Hemoptysis]]
*[[Hemoptysis]]
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*[[Productive cough]]
*[[Productive cough]]
*[[Egophony]]
*[[Egophony]]
|
| align="left" style="background:#F5F5F5;" |
*[[Gram positive bacteria|Gram positive]] [[diplococci]] on sputum Gram stain
*[[Gram positive bacteria|Gram positive]] [[diplococci]] on sputum Gram stain
*[[Pleural effusion]] ([[exudative]])
*[[Pleural effusion]] ([[exudative]])
*Respiratory alkalosis
*Respiratory alkalosis
|
| align="left" style="background:#F5F5F5;" |
*Parenchymal hyperlucency on [[chest radiograph]]
*Parenchymal hyperlucency on [[chest radiograph]]
*Increased uptake on [[gallium scan]]
*Increased uptake on [[gallium scan]]
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*Alveolar [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
*Alveolar [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
*Lobar [[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]]
|-
|-
! align="center" style="background:#DCDCDC;" |Pneumocystis carinii pneumonia
! align="center" style="background:#DCDCDC;" |[[Pneumocystis carinii pneumonia]]
|
| align="left" style="background:#F5F5F5;" |
*[[Immunosuppressive]] state
*[[Immunosuppressive]] state
*[[Subcutaneous emphysema]]
*[[Subcutaneous emphysema]]
*[[Cough|Hacking cough]]
*[[Cough|Hacking cough]]
*[[Dyspnea|Progressive dyspnea]]
*[[Dyspnea|Progressive dyspnea]]
|
| align="left" style="background:#F5F5F5;" |
*[[Respiratory alkalosis]]
*[[Respiratory alkalosis]]
*Serum beta-D-glucan elevation
*Serum beta-D-glucan elevation
|
| align="left" style="background:#F5F5F5;" |
*[[Alveolar]] [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
*[[Alveolar]] [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
*Lobar [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
*Lobar [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
*Interstitial infiltrate on [[chest radiograph]]
*Interstitial infiltrate on [[chest radiograph]]
*[[Pneumomediastinum]] on [[chest radiograph]]
*[[Pneumomediastinum]] on [[chest radiograph]]
|
| 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]]
|-
|-
! align="center" style="background:#DCDCDC;" |Pulmonary embolism
! align="center" style="background:#DCDCDC;" |[[Pulmonary embolism]]
|
| align="left" style="background:#F5F5F5;" |
*Calf [[pain]] or [[swelling]]
*Calf [[pain]] or [[swelling]]
*Decreased [[pulse pressure]]
*Decreased [[pulse pressure]]
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*[[Venous stasis]]
*[[Venous stasis]]
*[[Bone fracture]]
*[[Bone fracture]]
|
| align="left" style="background:#F5F5F5;" |
*[[D-dimer]] elevation
*[[D-dimer]] elevation
*[[Hypocapnia]]
*[[Hypocapnia]]
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*[[Right axis deviation]] on ECG
*[[Right axis deviation]] on ECG
*Right ventricular overload on ECG
*Right ventricular overload on ECG
|
| align="left" style="background:#F5F5F5;" |
*Normal [[chest radiograph]]
*Normal [[chest radiograph]]
*[[Atelectasis]] on [[chest radiograph]]
*[[Atelectasis]] on [[chest radiograph]]
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*Segmental [[perfusion]] defect on lung scan
*Segmental [[perfusion]] defect on lung scan
*[[V/Q scan|V/Q]] mismatch 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]]
|-
|-
! align="center" style="background:#DCDCDC;" |Streptococcal pneumonia
! align="center" style="background:#DCDCDC;" |[[Viral pneumonia]]
|
| align="left" style="background:#F5F5F5;" |
*Pectoriloquy
*Bronchial [[breath sounds]]
*[[Erythema nodosum]]
*Purulent [[sputum]]
*[[Shallow respiration]]
*Increased [[tactile fremitus]]
*[[Pleuritic chest pain]]
*[[Egophony]]
|
*[[Gram-positive cocci]] in chains on sputum [[Gram stain]]
*[[Respiratory alkalosis]]
*[[Pleural effusion]] (exudative)
|
*Alveolar consolidation on chest radiograph
*Lobar consolidation on chest radiograph
*[[Empyema]] on chest radiograph
*Increased uptake on [[gallium scan]]
|
|-
! align="center" style="background:#DCDCDC;" |Viral pneumonia
|
*[[Pleuritic chest pain]]
*[[Pleuritic chest pain]]
*[[Breath sounds|Bronchial breath sounds]]
*[[Breath sounds|Bronchial breath sounds]]
Line 202: Line 196:
*Fine [[rales]]
*Fine [[rales]]
*[[Breath sounds|Bronchovesicular breath sounds]]
*[[Breath sounds|Bronchovesicular breath sounds]]
|
| align="left" style="background:#F5F5F5;" |
*[[Lymphocytosis]]
*[[Lymphocytosis]]
*[[Respiratory alkalosis]]
*[[Respiratory alkalosis]]
|
| align="left" style="background:#F5F5F5;" |
*Lobar [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
*Lobar [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
*Interstitial infiltrate on [[chest radiograph]]
*Interstitial infiltrate on [[chest radiograph]]
|
| align="center" style="background:#F5F5F5;" |
|}
|}


==References==
==References==

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.
  2. Cunha BA, Burillo A, Bouza E (2016). "Legionnaires' disease". Lancet. 387 (10016): 376–385. doi:10.1016/S0140-6736(15)60078-2. PMID 26231463.
  3. Cunha BA, Cunha CB (2017). "Legionnaire's Disease: A Clinical Diagnostic Approach". Infect Dis Clin North Am. 31 (1): 81–93. doi:10.1016/j.idc.2016.10.007. PMID 28159178.
  4. Chahin A, Opal SM (2017). "Severe Pneumonia Caused by Legionella pneumophila: Differential Diagnosis and Therapeutic Considerations". Infect Dis Clin North Am. 31 (1): 111–121. doi:10.1016/j.idc.2016.10.009. PMC 7135102 Check |pmc= value (help). PMID 28159171.
  5. Okimoto N, Asaoka N, Osaki K, Kurihara T, Yamato K, Sunagawa T; et al. (2004). "Clinical features of Q fever pneumonia". Respirology. 9 (2): 278–82. doi:10.1111/j.1440-1843.2004.00586.x. PMID 15182283.
  6. Caron F, Meurice JC, Ingrand P, Bourgoin A, Masson P, Roblot P; et al. (1998). "Acute Q fever pneumonia: a review of 80 hospitalized patients". Chest. 114 (3): 808–13. doi:10.1378/chest.114.3.808. PMID 9743171.
  7. Parrott GL, Kinjo T, Fujita J (2016). "A Compendium for Mycoplasma pneumoniae". Front Microbiol. 7: 513. doi:10.3389/fmicb.2016.00513. PMC 4828434. PMID 27148202.
  8. Saraya T (2017). "Mycoplasma pneumoniae infection: Basics". J Gen Fam Med. 18 (3): 118–125. doi:10.1002/jgf2.15. PMC 5689399. PMID 29264006.