Differential diagnosis for a respiratory disease outbreak: Clinical information

Other associated syndromes or Predominant Respiratory Most common chest x-ray Unique laboratory or pathology Vaccine available in Infection control Pathogen features (respiratory and non- Syndrome findings findings U.S. precautions respiratory) Pneumonia, Conjunctivitis, Keratoconjunctivitis, Standard, Upper respiratory* Diarrhea, Rhinorrhea, Adenovirus Patchy infiltrates Smudge cells (pathology) No Droplet, Bronchiolitis, Croup, Hemorrhagic cystitis, Contact Pharyngitis Disseminated disease Dyspnea associated with Bacteremia, Meningitis, Mediastinal widening, Anthrax Vaccine Bacillus anthracis mediastinal changes, Gastrointestinal bleeding, Cutaneous Bloody pleural effusion Standard Large pleural effusions Adsorbed (AVA) Pneumonia lesions Usually lobar or segmental Febrile illness**, Cutaneous lesions, Blastomyces consolidation; Pneumonia Hemoptysis, Weight loss Granulomatous lesions No Standard dermatitidis Chronic form mimics Chest pain tuberculosis or sarcoid DTaP or TDaP (other Apnea in infants, Rhinorrhea, Prolonged cough, Pulmonary consolidations in combinations: DTaP- Bordetella pertussis Conjunctival involvement, Leukolymphocytosis Droplet Pneumonia ~20-25% cases Hib, DTaP-Hepatis B- Encephalopathy and seizures Inactivated polio) Chlamydia Usually lobar consolidation; Pneumonia, Cough, Febrile illness**, Headache, Mononuclear infiltrates, (Chlamydophila) Chest radiograph often worse No Standard Pharyngitis Hepatosplenomegaly Intracytoplasmic inclusions psittaci than clinical appearance Chlamydia Pneumonia, Cough, (Chlamydophila) Encephalitis, Sinusitis Patchy infiltrates Inclusion bodies (pathology) No Standard Pharyngitis pneumoniae Unilateral infiltrates with adenopathy, Pulmonary Weight loss, Arthralgias, Headache, Neutrophilia and eosinophilia; Coccidioides immitis Pneumonia, Cough nodules or cavities, Diffuse No Standard Rash, Erythema nodosum Granulomatous lesions (pathology) reticulonodular disease in immunocompromised Standard (all), Contact Acute Respiratory Distress Syndrome Upper respiratory*, Progressive infiltrates (HKU1, NL63, 0299E, Coronavirus (ARDS), Gastrointestinal involvement N/A No Pneumonia (SARS-HCoV) (SARS-HCoV) OC43, SARS-HCoV) (SARS-HCoV) Airborne (SARS-HCoV) Febrile illness**, Headache, Sweats, Variable appearance; Coxiella burnetti Pneumonia Hepatitis, Endocarditis (subacute), May be rapidly progressive; Transaminitis Yes Standard Miscarriage Effusions in ~35% patients Indolent skin ulcer, Regional Pneumonia often missed on Pneumonia, lymphadenopathy, ARDS, Abdominal chest radiograph; Variable Francisella tularensis N/A No Standard Pharyngitis pain, Diarrhea, Vomiting, Painful findings including adenopathy purulent conjunctivitis and effusions Group A Pharyngitis, Skin infections, Toxic shock syndrome, Elevated Antistreptolysin O Antibody Lobar consolidation No Droplet Streptococcus Pneumonia Necrotizing fasciitis, Bacteremia (ASO) titer

Haemophilus Meningitis, Bacteremia, Pneumonia Patchy or lobar infiltrates N/A Hib Droplet influenzae Septic arthritis, Otitis media Thrombocytopenia, Asymmetric interstitial Hantaviruses, New Pneumonia, Myalgias, Arthralgias, Nausea, Leukocytosis, Atypical lymphocytosis, infiltrates, Pulmonary edema, No Standard World ARDS-like syndrome Diarrhea, Cardiogenic shock Immunoblasts, Pleural effusions Hemoconcentration Chest pain, Headache, Arthralgias, Hilar adenopathy; Patchy Weight loss, Hepatosplenomegaly, infiltrates more common in Histoplasma Pneumonia Erythema multiforme/Erythema lower lobes; Granulomatous lesions (pathology) No Standard capsulatum nodosum, Pericarditis, Chronic form mimics Ocular choroiditis tuberculosis

* Upper respiratory=nasal congestion, rhinorrhea, sore throat or bronchitis ** Febrile illness=fever, myalgias, arthralgias, fatigue 1 of 2 Updated: Mar 2008 Differential diagnosis for a respiratory disease outbreak: Clinical information

Other associated syndromes or Predominant Respiratory Most common chest x-ray Unique laboratory or pathology Vaccine available in Infection control Pathogen features (respiratory and non- Syndrome findings findings U.S. precautions respiratory) Pneumonia, Bronchiolitis, Diffuse interstitial infiltrates, Human Upper respiratory*, Rhinorrhea Hyperinflation, N/A No Standard and Contact metapneumovirus Pharyngitis Atelectasis Febrile illness**, Myalgias, Croup, Seasonal influenza: Bronchiolitis, Otitis Media, Sinusitis, Inactivated split virus Standard and Droplet; Myositis, Myocarditis, Upper respiratory*, (IM), Avian and Swine Influenza viruses Rhabdomyolysis, Variable N/A Cough, Pneumonia Live attenuated influenza: Standard, Encephalopathy/Encephalitis, (intranasal) Contact, Droplet, Reye Syndrome, Exacerbation of Airborne chronic diseasesia

Pneumonia Febrile illness**, Interstitial infiltrates, Multilobar Hyponatremia; Acute fibropurulent Legionella spp. (Legionnaires' disease), Diarrhea, infiltrates; pneumonitis in alveoli and bronchi No Standard Cough (Pontiac fever) Weakness Pleural effusions (pathology)

Positive tuberculin skin test (TST) or interferon gamma release assay Bacille Calmette- (IGRA) (does not distinguish disease Guerin (BCG); from latent infection); Lymphadenitis, Pleuritis, Hemopytsis, Infiltrates with hilar adenopathy, May be difficult to Mycobacterium Prolonged cough, Caseating or non-caseating Meningitis, Weight loss, Osteomyelitis, Cavitary lesions, obtain as not Airborne tuberculosis Pneumonia granulomas (pathology); Positive Pericarditis, Genitourinary disease Miliary pattern routinely used in smear for acid-fast bacilli; Diagnosis U.S.; confirmed by isolation of M. Limited efficacy tuberculosis from body fluid or tissue; Anemia uncommon Erythema multiforme, Pneumonia, Stevens-Johnson syndrome, Cold agglutinins; Diffuse alveolar, Mycoplasma Pharyngitis, Raynaud's phenomenon, Variable hyaline membranes, pulmonary No Droplet pneumoniae Upper respiratory* Meningoencephalitis, Bullous infarctions (pathology) myringitis Parainfluenza virus Pneumonia, Bronchiolitis, Febrile illness** Undescribed N/A No Standard and Contact type 1-4 Upper respiratory*, Croup

Respiratory syncytial Pneumonia, Bronchiolitis, Otitis media, Rhinorrhea, Diffuse interstitial infiltrates; N/A No Standard and Contact virus (RSV) Upper respiratory* Sinusitis, Croup, Wheezing Hyperinflation; Atelectasis

Upper respiratory*, Rhinorrhea, Asthma exacerbations, Rhinovirus Pneumonia Chronic Obstructive Pulmonary Undescribed N/A No Contact (high-risk groups) Disease (COPD) Conjugate Streptococcus Sinusitis, Meningitis Leukocytosis, Pneumonia Segmental or lobar pneumonia (infant/children), Standard pneumoniae Bacteremia, Otitis Media Sputum may show gram-positive cocci Polysaccharide Sputum initially scant becoming blood- tinged and purulent with gram- Yersinia pestis Bubonic (fever and lymphadenopathy), Bronchopneumonia with patchy negative bacilli; Characteristic (secondary to bubonic Pneumonia Sepsis, Lymphadenopathy, No Droplet bilateral infiltrates morphology with Wayson or Wright- plague) Meningitis, Chest pain, Hemoptysis Giemsa stain; Leukocytosis; Gram- negative bacteremia Sputum usually frothy, blood-tinged, Sepsis, Dense lobar pneumonia which purulent with gram-negative bacilli; Yersinia pestis Disseminated Intravascular is usually unilateral with Characteristic morphology with (primary pneumonic Pneumonia No Droplet Coagulation (DIC), Chest pain, naturally occurring disease; Wayson or Wright-Giemsa stain; plague) Hemoptysis Hilar lymphadenopathy Leukocytosis, Gram-negative bacteremia

* Upper respiratory=nasal congestion, rhinorrhea, sore throat or bronchitis ** Febrile illness=fever, myalgias, arthralgias, fatigue 2 of 2 Updated: Mar 2008