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DIFFERENTIAL DIAGNOSIS OF PNEUMONIA Appendicitis Pulmonic tuberculosis Bronchial Cancer Aspiration of Foreign Bodies Infarction-Pneumonia following Pulmonary Embolism Sarcoidosis Exogenous Allergic Alveolitis Atelectasis Pulmonary Hemorrhage Acute Respiratory Distress Syndrome due to other Causes Differential diagnosis of persistent cough in children DIFFERENTIAL DIAGNOSIS OF PNEUMONIA 1. Appendicitis 2. Acute Tuberculosis 3. Bronchial Cancer 4. Aspiration of foreign Bodies 5. Infarction Pneumonia after Lung-Embolism 6. Sarcoidosis 7. Exogenous allergic Alveolitis 8. Atelectasis 9. Pulmonary Hemorrhage 10. Acute Respiratory Distress Syndrome due to other Causes In this book we can only offer a limited amount of homeopathically useful symptoms and disease description of the following diseases, which we came across during our work on the topic of pneumonia. For extensive information see explicit sources. Ed. Appendicitis glt2,2023 Strange as it may seem, appendicitis and pneumonia are sometimes mistaken for each other in the beginning of the disease (for a day or two). This is true of right-sided pneumonia more particularly. Both may show signs of chill, rise of temperature, and increased respiration. But the appendicitis case will have rigidity of the rectus muscle and possibly develop localized tenderness. The pneumonia case will develop the physical signs in the lungs. Pulmonic tuberculosis Kroegel kroe1,2014: Tuberculosis is an infectious disease caused by pathogens of the Mycobacterium tuberculosis complex. It is usually a clinically inapparent, acute or chronic systemic disease, which manifests itself preferably in the lungs, but also in other organs (lymphatic system, pleura, bones, urogenital tract, CNS, gastrointestinal tract). The Mycobacteria reach the pulmonary alveoli, preferably the apical lung sections (upper lobes), where they induce a local immune reaction (primary complex). In most cases, this primary tuberculosis is asymptomatic, self-limiting and stays undiagnosed. Fever and flu-like symptoms occur in about 5% of cases. If the Mycobacteria are not completely eliminated by the initial immune response, they slowly multiply in macrophages, while specific cellular immunity develops over the course of 3 - 9 weeks (= conversion of the tuberculin test result). Primary infection of tuberculosis can be difficult to distinguish by clinical symptoms. Frequently, pleuritic pain and arthralgia occur in addition to cough and fever. Correct diagnosis requires microbiological detection of Mycobacterium tuberculosis. Past medical history and social history may be helpful. Physical examination is nonspecific; peripheral lymphadenopathy (cervical, axillary, supraclavicular) may be detectable. Auscultation is usually unremarkable; moist accessory sounds occur with a tuberculous infiltration; rarely, a cavernous whoop can be heard. [It is more frequent in infants after taking cold with recurrent attacks of fever with sub-febrile temperature (remittent fever), profuse perspiration, quick emaciation, involvement of apices of the lungs and formation of caverns.] bwax,1902 [Take care: In miliary tuberculosis we also find rusty sputum - like in lobar pneumonia - but without fibrine.] gccx,1902 Bronchial Cancer Rarely, the differential diagnosis of pneumonia may also involve lung carcinoma. Cough, hemoptysis, fever, dyspnea, chest pain may exist in one as well as in the other disease. Ed. At the onset of clinical signs the symptoms of bronchial carcinoma and broncho-pneumonia can be clinically quite similar. Persistent or recurrent cough with subfebrile condition and weakness are warning symptoms if they persist for more than three months and no disease process is recognized by the patient or by the treating physician. glt2 [The clinical symptoms of lung carcinoma are multifaceted and can develop firstly from the tumor itself, secondly from its metastases, and thirdly from paraneoplastic syndromes. Whether the tumor causes symptoms and the nature of these symptoms depends primarily on its location in the bronchial system and on the metastatic pattern. There is no specific symptomatology that allows early diagnose of bronchial carcinoma. In some cases, metastatic symptoms or paraneoplastic lesions may be the first manifestation of bronchial carcinoma. In about 15% of patients with bronchial carcinoma there are no symptoms at all. The general tumor symptoms include, in particular, a decrease in body weight, inappetence, fever, sweating and anemia.] kroe1,2014 Aspiration of Foreign Bodies Inhalation of a foreign body into the larynx and respiratory tract. Symptoms include sudden onset of respiratory distress associated with coughing, gagging, or stridor. Unilateral wheezing suggests partial obstruction of the main or distal bronchi. Major causes of foreign body aspiration are altered mental status from alcohol or sedative use; seizure; neurologic disorders; trauma associated with a decreased level of consciousness; dental procedures; advanced or young age [in nurslings most often due to vomiting, in infants more often due to foreign bodies! glt1,Lentze]; disorders associated with dysphagia and impaired cough reflex (esp. when needing help from others to eat and drink, eg. people in nursery homes and people with multiple handicaps), and bronchoscopy esp. when bioptic probes are taken. Diagnosis: Case-history, X-Ray (first investigation to order), and Chest-CT-scan. A flexible bronchoscopy confirms suspected cases of foreign body aspiration and can be used to attempt removal of the foreign body. Rigid bronchoscopy is performed if flexible bronchoscopy fails. [In aspiration pneumonia there is established a catarrhal or fibrinous inflammation in the terminal bronchioles and air vessels as the result of irritants that find their way down the bronchial tubes.] bwax,1902 [The most common pulmonary disease leading to ARDS is pneumonia, especially aspiration pneumonia.] mur1,2016 Infarction-Pneumonia following Pulmonary Embolism See at thromb-embolic complications. Sarcoidosis Sarcoidosis is a disease characterized by the growth of tiny collections of inflammatory cells (granulomas) in any part of your body - most commonly in the lungs and lymph nodes (esp. bilateral hilar lymphadenopathy). But it can also affect the liver, spleen, eyes, skin, joints, heart, and other organs. The cause of sarcoidosis is unknown, but experts think it results from the body's immune system responding to an unknown substance. Not-infectious parts of Proprionibacteria or Mycobacteria are possible antigens, but this is still under discussion. Some research suggests that infectious agents, chemicals, dust, and a potentially abnormal reaction to the body's own proteins (self-proteins) could be responsible for the formation of granulomas in people who are genetically predisposed. Transbronchial biopsy leads to accurate diagnosis. Signs and symptoms of sarcoidosis vary depending on which organs are affected. Sarcoidosis sometimes develops gradually and produces symptoms that last for years. In other cases, symptoms appear suddenly and then disappear just as quickly. An acute, specific manifestation is called "Löfgren-Syndrom". Many people with sarcoidosis have no symptoms, so the disease may be discovered only when a chest X-ray is done for another reason. General symptoms include: fatigue, swollen lymph-nodes, weight loss, pain, and joint effusion, eg. swollen ankles. Lung symptoms include: persistent dry cough, shortness of breath, wheezing, and chest pain. Skin symptoms include: a rash of red or reddish-purple bumps, usually located on the shins or ankles, which may be warm and tender to the touch; disfiguring sores (lesions) on the nose, cheeks and ears; areas of skin that are darker or lighter in color; growths under the skin (nodules), particularly around scars or tattoos. Possible eye symptoms are blurred vision, eye pain, burning, itching or dry eyes, severe redness, and sensitivity to light. Cardiac sarcoidosis can show itself by chest pain, shortness of breath (dyspnea), fainting (syncope), fatigue, irregular heartbeats (arrhythmias), rapid or fluttering heart beats (palpitations), swelling caused by excess fluid (edema). Sarcoidosis can also affect calcium metabolism, the nervous system, the liver and spleen, muscles, bones and joints, the kidneys, lymph nodes, or any other organ. There is no (orthodox) cure for sarcoidosis and therapy usually comprises administering glucocorticoids or other immunosuppressants. Most people do very well though, with no treatment at all or only modest treatment. In some cases, sarcoidosis goes away on its own. In other cases, sarcoidosis can last for years and may cause organ damage. Exogenous Allergic Alveolitis This is an allergic disease of the lung parenchyma and bronchioles caused by repeated inhalation of and sensitization to alveolar organic antigen. In case of persistence of the antigen, progressive pulmonary fibrosis may develop. kroe1,2014 Causations: More than 300 antigens have been identified as capable of causing hypersensitivity pneumonitis, although eight of them account for approximately 75% of cases. (esp. bird-excrements, hay dust containing thermophilic actinomycetes (causes "Farmer's Lung"), microbes in humidifiers, certain chemicals like polyurethic acid, etc.). Antigens are usually classified by type and occupational affiliation; a farmer's lung caused by the inhalation of hay dust containing thermophilic actinomycetes is a classic example of this pathology. Therefore a finding out the patient's work situation/history is very helpful for diagnosis. A significant similarity is observed between pneumonitis of hypersensitivity and chronic bronchitis in farmers. Farmers generally develop chronic bronchitis much more often than other people, independently from smoking, and associated with inhalation of thermophilic actinomycetes. The clinical manifestations of this condition and the results of diagnostic studies are similar to those for pneumonitis of hypersensitivity. Symptoms: The acute form of progression with massive, intermittent antigen inhalation leads to flu-like symptoms with fever, chills, fatigue, pain in the limbs, dyspnea at rest, and cough 4 to a maximum of 12 hours after exposure. After a few days, the symptoms subside without therapy. In the chronic form, the symptoms are uncharacteristic: exertional dyspnea, dry cough, and a chronic feeling of illness with loss of appetite, weight loss, and lassitude. Diagnosis Diagnosis is established by analyzing the history, by physical examination, pulmonary function testing, the results of radiation studies (HRCT), bronchoalveolar lavage and histological examination of the biopsy material. Also a check for specific suspected antibodies (precipitins) can be beneficial, but this scan can show positive results also in exposed but not diseased individuals. Precipitins are not elevated in 10-20% of EAA patients. Orthodox treatment: Short-term treatment with glucocorticoids is prescribed. It is also necessary for the patient to cease contact with the antigen. Atelectasis Ed. See at complications Pulmonary Hemorrhage See this at the chapter for Pulmonary hemorrhage in the chapter Complications (p XX). Acute Respiratory Distress Syndrome due to other Causes See this at the chapter for Pulmonary hemorrhage in the chapter Complications (p XX). Differential diagnosis of persistent cough in children glt1,2023 Galic glt1,2023: o Serous otitis or sinusitis (due to cough-receptors in involved mucous membranes), Cough longer than 10 days, coryza and/or swallowing after cough aggravated mornings and evenings; recommended examinations: illumination of sinuses, examination of the eardrums, possible diagnostic: acoustic impedance test o Spasmodic cough including post-infectious Whooping cough, even if the general condition is overall good; spasmodic cough in attacks, otherwise no symptoms; no striking features on auscultation and in blood-examination; no fever; main differential diagnosis is asthma. Mind: If the child had received pertussis-vaccination, whooping cough is often ruled out too quickly! Persistent infection with Mycoplasma or Chlamydia-bacteria for weeks is also a cause to be considered. Persistence of bacteria or hyper-reactivity - typically aggravated by physical exertion. o Cigarette smoking at home o Rumination in neglected children - regurgitation with gastroesophageal reflux can also excite coughing o Foreign bodies in the airways (has to be explicitly asked for!) o Asthma o Peak expiratory flow (PEF)-protocol is possible from the age of 5 to 7 - Decline of 15%-20% in attacks gives evidence for the disease. o PEF-decline on physical exertion with dyspnea o PEF-incline after administration of sympathomimetic bronchodilators o BronchitisBronchitis in children is almost always due to viral infection and therefore administration of antibiotics is useless. The danger of bacterial super-infection is low (cp. Rebhandl, Mader et.al. 2005) ◄ COMPLICATIONS IN PNEUMONIA | ▲ | ANATOMICAL AND PHYSIOLOGICAL SPECIFICATIONS IN CHILDREN ► |