Differential diagnosis for a repiratory disesae outbreak ...

Differential diagnosis for a respiratory disease outbreak: Clinical information

Pathogen

Adenovirus

Bacillus anthracis

Blastomyces dermatitidis

Bordetella pertussis

Chlamydia (Chlamydophila) psittaci Chlamydia (Chlamydophila) pneumoniae

Coccidioides immitis

Coronavirus

Coxiella burnetti

Francisella tularensis

Group A Streptococcus Haemophilus influenzae Hantaviruses, New World

Histoplasma capsulatum

Predominant Respiratory Syndrome

Pneumonia, Upper respiratory* Bronchiolitis, Croup,

Pharyngitis

Dyspnea associated with mediastinal changes, Pneumonia

Pneumonia

Other associated syndromes or features (respiratory and non-

respiratory)

Conjunctivitis, Keratoconjunctivitis, Diarrhea, Rhinorrhea, Hemorrhagic cystitis, Disseminated disease

Bacteremia, Meningitis, Gastrointestinal bleeding, Cutaneous

lesions

Febrile illness**, Cutaneous lesions, Hemoptysis, Weight loss Chest pain

Most common chest x-ray findings

Patchy infiltrates

Mediastinal widening, Large pleural effusions Usually lobar or segmental

consolidation; Chronic form mimics tuberculosis or sarcoid

Prolonged cough, Pneumonia

Apnea in infants, Rhinorrhea, Conjunctival involvement,

Encephalopathy and seizures

Pulmonary consolidations in ~20-25% cases

Pneumonia, Cough, Pharyngitis

Pneumonia, Cough, Pharyngitis

Febrile illness**, Headache, Hepatosplenomegaly

Encephalitis, Sinusitis

Usually lobar consolidation; Chest radiograph often worse

than clinical appearance

Patchy infiltrates

Unique laboratory or pathology findings

Vaccine available in U.S.

Smudge cells (pathology)

No

Bloody pleural effusion

Anthrax Vaccine Adsorbed (AVA)

Infection control precautions

Standard, Droplet, Contact

Standard

Granulomatous lesions

No

Standard

Leukolymphocytosis

Mononuclear infiltrates, Intracytoplasmic inclusions Inclusion bodies (pathology)

DTaP or TDaP (other combinations: DTaPHib, DTaP-Hepatis B-

Inactivated polio)

No

No

Droplet Standard Standard

Pneumonia, Cough

Weight loss, Arthralgias, Headache, Rash, Erythema nodosum

Upper respiratory*, Pneumonia (SARS-HCoV)

Acute Respiratory Distress Syndrome (ARDS), Gastrointestinal involvement

(SARS-HCoV)

Unilateral infiltrates with adenopathy, Pulmonary nodules or cavities, Diffuse reticulonodular disease in immunocompromised

Progressive infiltrates (SARS-HCoV)

Neutrophilia and eosinophilia; Granulomatous lesions (pathology)

N/A

No

Standard

Standard (all), Contact

No

(HKU1, NL63, 0299E, OC43, SARS-HCoV)

Airborne (SARS-HCoV)

Pneumonia

Febrile illness**, Headache, Sweats, Hepatitis, Endocarditis (subacute),

Miscarriage

Variable appearance; May be rapidly progressive; Effusions in ~35% patients

Transaminitis

Yes

Standard

Indolent skin ulcer, Regional

Pneumonia often missed on

Pneumonia, Pharyngitis

lymphadenopathy, ARDS, Abdominal chest radiograph; Variable pain, Diarrhea, Vomiting, Painful findings including adenopathy

N/A

purulent conjunctivitis

and effusions

No

Standard

Pharyngitis, Pneumonia

Skin infections, Toxic shock syndrome, Necrotizing fasciitis, Bacteremia

Lobar consolidation

Elevated Antistreptolysin O Antibody (ASO) titer

No

Droplet

Pneumonia

Meningitis, Bacteremia, Septic arthritis, Otitis media

Patchy or lobar infiltrates

N/A

Hib

Pneumonia, ARDS-like syndrome

Myalgias, Arthralgias, Nausea, Diarrhea, Cardiogenic shock

Asymmetric interstitial infiltrates, Pulmonary edema,

Pleural effusions

Thrombocytopenia, Leukocytosis, Atypical lymphocytosis,

Immunoblasts, Hemoconcentration

No

Chest pain, Headache, Arthralgias,

Hilar adenopathy; Patchy

Weight loss, Hepatosplenomegaly,

infiltrates more common in

Pneumonia

Erythema multiforme/Erythema

lower lobes;

Granulomatous lesions (pathology)

No

nodosum, Pericarditis,

Chronic form mimics

Ocular choroiditis

tuberculosis

Droplet Standard Standard

* Upper respiratory=nasal congestion, rhinorrhea, sore throat or bronchitis ** Febrile illness=fever, myalgias, arthralgias, fatigue

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Updated: Mar 2008

Differential diagnosis for a respiratory disease outbreak: Clinical information

Pathogen Human metapneumovirus

Influenza viruses

Legionella spp.

Mycobacterium tuberculosis

Mycoplasma pneumoniae Parainfluenza virus type 1-4

Predominant Respiratory Syndrome

Pneumonia, Bronchiolitis, Upper respiratory*, Pharyngitis

Upper respiratory*, Cough, Pneumonia

Other associated syndromes or features (respiratory and non-

respiratory)

Rhinorrhea

Febrile illness**, Myalgias, Croup, Bronchiolitis, Otitis Media, Sinusitis,

Myositis, Myocarditis, Rhabdomyolysis,

Encephalopathy/Encephalitis, Reye Syndrome, Exacerbation of

chronic diseasesia

Most common chest x-ray findings

Diffuse interstitial infiltrates, Hyperinflation, Atelectasis

Variable

Unique laboratory or pathology findings

Vaccine available in U.S.

Infection control precautions

N/A

No

Standard and Contact

Seasonal influenza:

Inactivated split virus Standard and Droplet;

N/A

(IM), Live attenuated

Avian and Swine influenza: Standard,

(intranasal)

Contact, Droplet,

Airborne

Pneumonia (Legionnaires' disease), Cough (Pontiac fever)

Febrile illness**, Diarrhea, Weakness

Interstitial infiltrates, Multilobar Hyponatremia; Acute fibropurulent

infiltrates;

pneumonitis in alveoli and bronchi

No

Pleural effusions

(pathology)

Standard

Prolonged cough, Pneumonia

Pneumonia, Pharyngitis, Upper respiratory*

Positive tuberculin skin test (TST) or

interferon gamma release assay

(IGRA) (does not distinguish disease

Lymphadenitis, Pleuritis, Hemopytsis, Infiltrates with hilar adenopathy,

Meningitis, Weight loss, Osteomyelitis,

Cavitary lesions,

Pericarditis, Genitourinary disease

Miliary pattern

from latent infection); Caseating or non-caseating granulomas (pathology); Positive smear for acid-fast bacilli; Diagnosis

confirmed by isolation of M.

tuberculosis from body fluid or tissue;

Anemia uncommon

Erythema multiforme, Stevens-Johnson syndrome,

Raynaud's phenomenon, Meningoencephalitis, Bullous

myringitis

Variable

Cold agglutinins; Diffuse alveolar, hyaline membranes, pulmonary

infarctions (pathology)

Bacille CalmetteGuerin (BCG);

May be difficult to obtain as not

routinely used in U.S.;

Limited efficacy

No

Airborne Droplet

Pneumonia, Bronchiolitis, Upper respiratory*, Croup

Febrile illness**

Undescribed

N/A

No

Standard and Contact

Respiratory syncytial virus (RSV)

Rhinovirus

Streptococcus pneumoniae

Yersinia pestis (secondary to bubonic plague)

Yersinia pestis (primary pneumonic plague)

Pneumonia, Bronchiolitis, Upper respiratory*

Otitis media, Rhinorrhea, Sinusitis, Croup, Wheezing

Diffuse interstitial infiltrates; Hyperinflation; Atelectasis

N/A

Upper respiratory*,

Rhinorrhea, Asthma exacerbations,

Pneumonia

Chronic Obstructive Pulmonary

Undescribed

N/A

(high-risk groups)

Disease (COPD)

Pneumonia

Sinusitis, Meningitis Bacteremia, Otitis Media

Segmental or lobar pneumonia

Leukocytosis, Sputum may show gram-positive cocci

Pneumonia Pneumonia

Sputum initially scant becoming blood-

Bubonic (fever and lymphadenopathy), Sepsis, Lymphadenopathy,

Meningitis, Chest pain, Hemoptysis

Bronchopneumonia with patchy bilateral infiltrates

tinged and purulent with gramnegative bacilli; Characteristic morphology with Wayson or WrightGiemsa stain; Leukocytosis; Gram-

negative bacteremia

Sputum usually frothy, blood-tinged,

Sepsis,

Dense lobar pneumonia which purulent with gram-negative bacilli;

Disseminated Intravascular

is usually unilateral with

Characteristic morphology with

Coagulation (DIC), Chest pain,

naturally occurring disease;

Wayson or Wright-Giemsa stain;

Hemoptysis

Hilar lymphadenopathy

Leukocytosis, Gram-negative

bacteremia

No No Conjugate (infant/children), Polysaccharide

No

No

Standard and Contact Contact Standard Droplet

Droplet

* Upper respiratory=nasal congestion, rhinorrhea, sore throat or bronchitis ** Febrile illness=fever, myalgias, arthralgias, fatigue

2 of 2

Updated: Mar 2008

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