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==Overview==
==Overview==
Legionellosis must be differentiated from other causes of fever, dyspnea, cough, and sputum production, such as bacterial pnuemonia, viral pneumonia, other causes of atypical pnuemonia, and congestive heart failure.
Legionellosis must be differentiated from other causes of fever, dyspnea, cough, and sputum production, such as bacterial pnuemonia, viral pneumonia, and other causes of atypical pnuemonia.


==Differentiating Legionellosis from other Diseases==
==Differential Diagnosis==
Legionellosis should be differentiated from the following diseases:
{{ddx0|Legionnaires' disease}}
{{ddx1|Acute interstitial pneumonia}}
{{ddx1|Mycoplasma pneumonia}}
{{ddx1|Pneumococcal pneumonia}}
{{ddx1|Pneumocystis carinii pneumonia}}
{{ddx1|Pulmonary embolism}}
{{ddx1|Streptococcal pneumonia}}
{{ddx1|Viral pneumonia}}


* [[Congestive heart failure]]
----
* [[Interstitial pneumonia]]
* [[Mycoplasma pneumonia]]
* [[Pneumococcal pneumonia]]
* [[Pneumocystis jirovecii pneumonia]]
* [[Pulmonary embolism]]
* [[Streptococcal]] [[pneumonia]]
* [[Viral pneumonia]]
* [[Q fever]]


{{ddx|Legionnaires' disease}}
=====Clinical manifestations=====
* High grade fever
* Dry cough
* Progressive dyspnea
* Bronchial breath sounds
* Adult respiratory distress syndrome
=====Laboratory abnormalities=====
* Legionella urinary antigen positive
* Alveolar consolidation on chest radiograph
* Lobar consolidation on chest radiograph
----
{{ddx|Acute interstitial pneumonia}}
=====Clinical manifestations=====
* Dry cough
* Progressive dyspnea
* Adult respiratory distress syndrome
=====Laboratory abnormalities=====
* Disseminated consolidation on chest radiograph
* Interstitial infiltrate on chest radiograph
* Increased uptake on Gallium scan
-----
{{ddx|Mycoplasma pneumonia}}
=====Clinical manifestations=====
* Dry cough
* Pleuritic chest pain
* Inflammed, opaque, hypomobile tympanic membrane
* Bronchial breath sounds
=====Laboratory abnormalities=====
* Lymphocytosis
* Cold agglutinins positive
* Alveolar consolidation on chest radiograph
* Interstitial infiltrate on chest radiograph
* Lobar consolidation on chest radiograph
----
{{ddx|Pneumococcal pneumonia}}
=====Clinical manifestations=====
* Hemoptysis
* Fine rales
* Pleuritic chest pain
* Increased breath sounds
* Bronchial breath sounds
* Dullness on chest percussion
* Purulent sputum
* Shallow respiration
* Pectoriloquy
* Increased tactile fremitus
* Productive cough
* Egophony
* High grade fever
=====Laboratory abnormalities=====
* Pleural effusion (exudative)
* Respiratory alkalosis
* Parenchymal hyperlucency on chest radiograph
* Increased uptake on Gallium scan
* Unilateral diaphragm elevation on chest radiograph
* Alveolar consolidation on chest radiograph
* Lobar consolidation on chest radiograph
* Gram positive diplococci on sputum Gram stain
----
{{ddx|Pneumocystis carinii pneumonia}}
=====Clinical manifestations=====
* Immunosuppressive state
* Mediastinal emphysema
* Subcutaneous emphysema
* Hacking cough
* Progressive dyspnea
=====Laboratory abnormalities=====
* Respiratory alkalosis
* Serum beta-D-glucan elevated
* Alveolar consolidation on chest radiograph
* Lobar consolidation on chest radiograph
* Interstitial infiltrate on chest radiograph
----
{{ddx|Pulmonary embolism}}
=====Clinical manifestations=====
* Calf pain / swelling
* Decreased pulse pressure
* Dyspnea with normal chest X-ray
* Hemoptysis
* Hyperventilation
* Immobility
* Increased pulmonic component of heart sound
* Pleuritic chest pain
* Prior DVT
* Pulmonary hypertension
* Right ventricular heave
* Right ventricular hypertrophy
* Right-to-left shunt
* Substernal chest pain
* Tachypnea
* Thrombophlebitis
* Unilateral lower extremity edema
* Venous stasis
=====Laboratory abnormalities=====
* Atrial fibrillation
* Bone fracture
* Atelectasis on chest radiograph
* Lobar consolidation on chest radiograph
* Prominent pulmonary artery on chest radiograph
* Hampton's hump on chest radiograph
* D-dimer elevated
* Right ventricular enlargement on echocardiography
* Thrombus on echocardiography
* Hypocapnia
* Hypoxia
* Segmental perfusion defect on lung scan
* V/Q mismatch on lung scan
* Pleural effusion (exudative / bloody)
* RVH on ECG
* Right axis deviation on ECG
----
{{ddx|Streptococcal pneumonia}}
=====Clinical manifestations=====
* Pectoriloquy
* Bronchial breath sounds
* Empyema
* Erythema nodosum
* Purulent sputum
* Shallow respiration
* Increased tactile fremitus 
* Pleuritic chest pain
* Egophony
=====Laboratory abnormalities=====
* Respiratory alkalosis
* Pleural effusion (exudative)
* Increased uptake on Gallium scan
* Gram-positive cocci in chains on sputum Gram stain
* Alveolar consolidation on chest radiograph
* Lobar consolidation on chest radiograph
----
{{ddx|Viral pneumonia}}
=====Clinical manifestations=====
* Pleuritic chest pain
* Bronchial breath sounds
* Influenza
* Fine rales
* Bronchovesicular breath sounds
=====Laboratory abnormalities=====
* Lymphocytosis
* Respiratory alkalosis
* Lobar consolidation on chest radiograph
* Interstitial infiltrate on chest radiograph
==References==
==References==
{{reflist|2}}
{{reflist|2}}

Revision as of 06:49, 9 August 2015

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

Overview

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

Differential Diagnosis

The following conditions must be considered in the differential diagnosis of Legionnaires' disease: DDx [1][2][3][4][5][6][7]
  • Acute interstitial pneumonia DDx
  • Mycoplasma pneumonia DDx
  • Pneumococcal pneumonia DDx
  • Pneumocystis carinii pneumonia DDx
  • Pulmonary embolism DDx
  • Streptococcal pneumonia DDx
  • Viral pneumonia DDx


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2] Mahshid Mir, M.D. [3]

Differential Diagnosis
DDx Alphabetic Order
A B
C D
E F
G H
I J
K L
M N
O P
Q R
S T
U V
W X
Y Z


Template:WikiDoc Sources

Clinical manifestations
  • High grade fever
  • Dry cough
  • Progressive dyspnea
  • Bronchial breath sounds
  • Adult respiratory distress syndrome
Laboratory abnormalities
  • Legionella urinary antigen positive
  • Alveolar consolidation on chest radiograph
  • Lobar consolidation on chest radiograph


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [4] Mahshid Mir, M.D. [5]

Differential Diagnosis
DDx Alphabetic Order
A B
C D
E F
G H
I J
K L
M N
O P
Q R
S T
U V
W X
Y Z


Template:WikiDoc Sources

Clinical manifestations
  • Dry cough
  • Progressive dyspnea
  • Adult respiratory distress syndrome
Laboratory abnormalities
  • Disseminated consolidation on chest radiograph
  • Interstitial infiltrate on chest radiograph
  • Increased uptake on Gallium scan


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [6] Mahshid Mir, M.D. [7]

Differential Diagnosis
DDx Alphabetic Order
A B
C D
E F
G H
I J
K L
M N
O P
Q R
S T
U V
W X
Y Z


Template:WikiDoc Sources

Clinical manifestations
  • Dry cough
  • Pleuritic chest pain
  • Inflammed, opaque, hypomobile tympanic membrane
  • Bronchial breath sounds
Laboratory abnormalities
  • Lymphocytosis
  • Cold agglutinins positive
  • Alveolar consolidation on chest radiograph
  • Interstitial infiltrate on chest radiograph
  • Lobar consolidation on chest radiograph


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [8] Mahshid Mir, M.D. [9]

Differential Diagnosis
DDx Alphabetic Order
A B
C D
E F
G H
I J
K L
M N
O P
Q R
S T
U V
W X
Y Z


Template:WikiDoc Sources

Clinical manifestations
  • Hemoptysis
  • Fine rales
  • Pleuritic chest pain
  • Increased breath sounds
  • Bronchial breath sounds
  • Dullness on chest percussion
  • Purulent sputum
  • Shallow respiration
  • Pectoriloquy
  • Increased tactile fremitus
  • Productive cough
  • Egophony
  • High grade fever
Laboratory abnormalities
  • Pleural effusion (exudative)
  • Respiratory alkalosis
  • Parenchymal hyperlucency on chest radiograph
  • Increased uptake on Gallium scan
  • Unilateral diaphragm elevation on chest radiograph
  • Alveolar consolidation on chest radiograph
  • Lobar consolidation on chest radiograph
  • Gram positive diplococci on sputum Gram stain


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [10] Mahshid Mir, M.D. [11]

Differential Diagnosis
DDx Alphabetic Order
A B
C D
E F
G H
I J
K L
M N
O P
Q R
S T
U V
W X
Y Z


Template:WikiDoc Sources

Clinical manifestations
  • Immunosuppressive state
  • Mediastinal emphysema
  • Subcutaneous emphysema
  • Hacking cough
  • Progressive dyspnea
Laboratory abnormalities
  • Respiratory alkalosis
  • Serum beta-D-glucan elevated
  • Alveolar consolidation on chest radiograph
  • Lobar consolidation on chest radiograph
  • Interstitial infiltrate on chest radiograph


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [12] Mahshid Mir, M.D. [13]

Differential Diagnosis
DDx Alphabetic Order
A B
C D
E F
G H
I J
K L
M N
O P
Q R
S T
U V
W X
Y Z


Template:WikiDoc Sources

Clinical manifestations
  • Calf pain / swelling
  • Decreased pulse pressure
  • Dyspnea with normal chest X-ray
  • Hemoptysis
  • Hyperventilation
  • Immobility
  • Increased pulmonic component of heart sound
  • Pleuritic chest pain
  • Prior DVT
  • Pulmonary hypertension
  • Right ventricular heave
  • Right ventricular hypertrophy
  • Right-to-left shunt
  • Substernal chest pain
  • Tachypnea
  • Thrombophlebitis
  • Unilateral lower extremity edema
  • Venous stasis
Laboratory abnormalities
  • Atrial fibrillation
  • Bone fracture
  • Atelectasis on chest radiograph
  • Lobar consolidation on chest radiograph
  • Prominent pulmonary artery on chest radiograph
  • Hampton's hump on chest radiograph
  • D-dimer elevated
  • Right ventricular enlargement on echocardiography
  • Thrombus on echocardiography
  • Hypocapnia
  • Hypoxia
  • Segmental perfusion defect on lung scan
  • V/Q mismatch on lung scan
  • Pleural effusion (exudative / bloody)
  • RVH on ECG
  • Right axis deviation on ECG


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [14] Mahshid Mir, M.D. [15]

Differential Diagnosis
DDx Alphabetic Order
A B
C D
E F
G H
I J
K L
M N
O P
Q R
S T
U V
W X
Y Z


Template:WikiDoc Sources

Clinical manifestations
  • Pectoriloquy
  • Bronchial breath sounds
  • Empyema
  • Erythema nodosum
  • Purulent sputum
  • Shallow respiration
  • Increased tactile fremitus
  • Pleuritic chest pain
  • Egophony
Laboratory abnormalities
  • Respiratory alkalosis
  • Pleural effusion (exudative)
  • Increased uptake on Gallium scan
  • Gram-positive cocci in chains on sputum Gram stain
  • Alveolar consolidation on chest radiograph
  • Lobar consolidation on chest radiograph


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [16] Mahshid Mir, M.D. [17]

Differential Diagnosis
DDx Alphabetic Order
A B
C D
E F
G H
I J
K L
M N
O P
Q R
S T
U V
W X
Y Z


Template:WikiDoc Sources

Clinical manifestations
  • Pleuritic chest pain
  • Bronchial breath sounds
  • Influenza
  • Fine rales
  • Bronchovesicular breath sounds
Laboratory abnormalities
  • Lymphocytosis
  • Respiratory alkalosis
  • Lobar consolidation on chest radiograph
  • Interstitial infiltrate on chest radiograph

References

  1. ↑ Ferri, Fred (2011). Ferri's differential diagnosis: a practical guide to the differential diagnosis of symptoms, signs, and clinical disorders. Philadelphia, PA: Elsevier/Mosby. ISBN 978-0323076999.
  2. ↑ Siegenthaler, Walter (2007). Differential diagnosis in internal medicine: from symptom to diagnosis. Stuttgart New York: Thieme. ISBN 978-1588905512.
  3. ↑ Mesko, Dusan (2002). Differential diagnosis by laboratory medicine: a quick reference for physicians. Berlin New York: Springer-Verlag. ISBN 978-3540430575.
  4. ↑ Reeder and Felson's gamuts in radiology: comprehensive lists of roentgen differential diagnosis. Place of publication not identified: Springer. 2014. ISBN 978-1475781229.
  5. ↑ Burgener, Francis (2008). Differential diagnosis in conventional radiology. Stuttgart New York: Thieme. ISBN 978-1588902757.
  6. ↑ Gattuso, Paolo (2015). Differential diagnosis in surgical pathology. Philadelphia, PA: Saunders/Elsevier. ISBN 978-1455770137.
  7. ↑ "DXplain".

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