Legionellosis differential diagnosis: Difference between revisions

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__NOTOC__
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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==
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;" |
| align="left" style="background:#F5F5F5;" |
*[[Adult respiratory distress syndrome]]
*[[Breath sounds|Bronchial breath sounds]]
*[[Dry cough]]
*[[Dry cough]]
*[[Fever|High grade fever]]
*[[Fever|High grade fever]]
*[[Breath sounds|Bronchial breath sounds]]
*[[Asthenia]]
*[[Dyspnea|Progressive dyspnea]]
*[[Dyspnea|Progressive dyspnea]]
*[[diarrhea]]
*[[diarrhea]]
*[[Seizures]] and other neurological findings
*[[nausea]], and [[vomiting]]
*[[nausea]], and [[vomiting]]
*[[Adult respiratory distress syndrome]]
| align="left" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
*Legionella urinary antigen positive
*Legionella urinary antigen positive
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*[[Consolidation (medicine)|Lobar consolidation]] on chest radiograph
*[[Consolidation (medicine)|Lobar consolidation]] on chest radiograph
| align="center" style="background:#F5F5F5;" |
| 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;" |
| align="left" style="background:#F5F5F5;" |
*Abrupt onset of [[fever]], [[myalgia]], [[headache]], and other constitutional symptoms
*[[Fever]]
*Dry [[cough]]
*Dry [[cough]]
*[[Dyspnea]]
*[[Dyspnea]]
*[[Pleuritic chest pain]]
*[[Pleuritic chest pain]]
*[[myalgia]]
*[[headache]]
| align="left" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
*[[Antibody]] detection using [[Immunofluorescence|indirect immunofluorescence]] (IIF)
*[[Antibody]] detection using [[Immunofluorescence|indirect immunofluorescence]] (IIF)
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*A two-to-three fold increase in [[Aspartate transaminase|AST]] and [[ALT]]
*A two-to-three fold increase in [[Aspartate transaminase|AST]] and [[ALT]]
| align="left" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
Multiple soft infiltrative shadows on CXR
| align="center" style="background:#F5F5F5;" |
| 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 ]]
[[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;" |
| 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;" |
| align="left" style="background:#F5F5F5;" |
*[[Lymphocytosis]]
*[[Lymphocytosis]]
*[[Cold agglutinins]] positive
*[[Cold agglutinins]] positive
*Positive [[Coombs test]]
*Positive [[CoNombs test]]
*[[Leukocytosis]]
*[[Leukocytosis]]
*[[Thrombocytosis]]
*[[Thrombocytosis]]
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! align="center" style="background:#DCDCDC;" |[[Chlamydia pneumonia]]
! align="center" style="background:#DCDCDC;" |[[Chlamydia pneumonia]]
| align="left" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
*No specific clinical features of [[chlamydia pneumonia]].
*Gradual symptoms
*Associated with [[upper respiratory tract]] symptoms
*Associated with [[upper respiratory tract]] symptoms
*Associated with extrapulmonary maifestations such as:
*Associated with extrapulmonary maifestations such as:
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[[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;" |
| align="left" style="background:#F5F5F5;" |
*[[Dry cough]]
*[[Dry cough]]
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*Increased uptake on gallium scan
*Increased uptake on gallium scan
| align="center" style="background:#F5F5F5;" |
| 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;" |
| align="left" style="background:#F5F5F5;" |
*[[Fever|High grade fever]]
*[[Fever|High grade fever]]
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*Lobar [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
*Lobar [[Consolidation (medicine)|consolidation]] on [[chest radiograph]]
| align="center" style="background:#F5F5F5;" |
| 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;" |
| align="left" style="background:#F5F5F5;" |
*[[Immunosuppressive]] state
*[[Immunosuppressive]] state
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*[[Pneumomediastinum]] on [[chest radiograph]]
*[[Pneumomediastinum]] on [[chest radiograph]]
| align="center" style="background:#F5F5F5;" |
| 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;" |
| align="left" style="background:#F5F5F5;" |
*Calf [[pain]] or [[swelling]]
*Calf [[pain]] or [[swelling]]
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*[[V/Q scan|V/Q]] mismatch on lung scan
*[[V/Q scan|V/Q]] mismatch on lung scan
| align="center" style="background:#F5F5F5;" |
| align="center" style="background:#F5F5F5;" |
[[File:Hampton Hump.PNG|thumb|Hampton Hump in a patient with pulmonary embolism]]
[[File:Hampton Hump.PNG|thumb|Hampton Hump in a patient with pulmonary embolism courtesy of Hellerhoff]]
|-
! align="center" style="background:#DCDCDC;" |Streptococcal pneumonia
| align="left" style="background:#F5F5F5;" |
*Pectoriloquy
*Bronchial [[breath sounds]]
*[[Erythema nodosum]]
*Purulent [[sputum]]
*[[Shallow respiration]]
*Increased [[tactile fremitus]]
*[[Pleuritic chest pain]]
*[[Egophony]]
| align="left" style="background:#F5F5F5;" |
*[[Gram-positive cocci]] in chains on sputum [[Gram stain]]
*[[Respiratory alkalosis]]
*[[Pleural effusion]] (exudative)
| align="left" style="background:#F5F5F5;" |
*Alveolar consolidation on chest radiograph
*Lobar consolidation on chest radiograph
*[[Empyema]] on chest radiograph
*Increased uptake on [[gallium scan]]
| align="center" style="background:#F5F5F5;" |
|-
|-
! align="center" style="background:#DCDCDC;" |Viral pneumonia
! align="center" style="background:#DCDCDC;" |[[Viral pneumonia]]
| align="left" style="background:#F5F5F5;" |
| align="left" style="background:#F5F5F5;" |
*[[Pleuritic chest pain]]
*[[Pleuritic chest pain]]

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.