¿Cómo diferenciarla de otras infecciones? Parte I

Los diagnósticos diferenciales de Carbunco dependen del síndrome clínico (cutáneo, pulmonar, gastrointestinal o meníngeo). Otros diagnósticos se definen en las siguientes tablas, señalando algunas características que ayudan a diferenciarlos.

Differential Diagnosis for Cutaneous Anthrax
(Note: Two key features that distinguish cutaneous anthrax from other conditions in differential diagnosis are painlessness of the lesion and the relatively large extent of associated edema.) B megaterium, B pumilus, B cereus cutaneous infections may resemble cutaneous anthrax (Duncan 2011).
Diagnosisa-c	Distinguishing Features
Ecthyma gangrenosum	—Usually in neutropenic patients with Pseudomonas aeruginosa bacteremia —Edema usually not present
Ulceroglandular tularemia (Francisella tularensis)	—Clinical course usually indolent; disease often self-limited —Systemic toxicity uncommon
Bubonic plague (Yersinia pestis)	—Systemic toxicity common —Extremely tender regional lymphadenopathy present —Ulceration and eschar formation usually absent
Staphylococcal or streptococcal cellulitis	—May be history of trauma or preexisting lesion at site of infection —Eschar formation does not occur —Usually painful
Necrotizing soft tissue infections (particularly Group A Streptococcus and Clostridium species)	—Severe systemic toxicity often present —Early in course, pain usually more severe than clinical findings would indicate
Bite of brown recluse spider (Loxosceles reclusa)d	—Brown recluse spiders prefer warm temperatures and are not native to northern half of United States —Spiders tend to hide in barns, woodpiles, and similar places —Bite usually causes painful blister that progresses to necrosis (unlike anthrax, which is painless) —Edema generally absent
Rickettsialpox (Rickettsia akari)	—Initial presentation involves painless papule that forms black eschar —Generalized maculopapular rash appears 2-3 days later
Scrub typhus (Orientia tsutsugamushi; formerly Rickettsia tsutsugamushi)	—Zoonotic infection from chigger bites; occurs in endemic areas (Asia and Western Pacific) —Often associated with generalized maculopapular rash
Orf (orf virus, a parapox virus)	—Occurs in farm workers —Characterized by pustule that progresses to weeping nodule —Eschar formation does not occur —Edema usually absent
Necrotic herpes simplex infection	—More likely to occur in immunocompromised host
aDixon 1999. bSwartz 2001. cBell 2002. dNelson 2002.

Differential Diagnosis for Inhalational Anthrax
(Note: Features that distinguish inhalational anthrax from other conditions in differential diagnosis include presence of widened mediastinum and pleural effusions on chest radiograph or CT scan with minimal evidence of pneumonia.)
Diagnosisa,b	Distinguishing Features
Pneumonic plague (Yersinia pestis)	—Hemoptysis relatively common with pneumonic plague, but rare with inhalational anthrax
Tularemia (Francisella tularensis)	—Clinical course usually indolent, lasting weeks —Less likely to be fulminant
Community-acquired bacterial pneumonia —Mycoplasmal pneumonia (Mycoplasma pneumoniae) —Pneumonia caused by Chlamydia pneumoniae —Legionnaires' disease (Legionella pneumophila or other Legionella species) —Psittacosis (Chlamydia psittaci) —Other bacterial agents (eg, Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, Klebsiella pneumoniae, Moraxella catarrhalis)	—Rarely as fulminant as inhalational anthrax —Legionellosis and many other bacterial agents (S aureus, S pneumoniae, H influenzae, K pneumoniae, M catarrhalis) usually occur in persons with underlying pulmonary or other disease or in elderly —Bird exposure with psittacosis —Gram stain of sputum may be useful —Community outbreaks caused by other etiologic agents not likely to be as explosive as pneumonic plague outbreak —Outbreaks of S pneumoniae usually institutional —Community outbreaks of Legionnaires' disease often involve exposure to cooling towers
Viral pneumonia —Influenza —Hantavirus —RSV —CMV	—Influenza generally seasonal (October-March in United States) or involves history of recent cruise ship travel or travel to tropics —Exposure to mice infected with hantavirus or their urine or feces —RSV usually occurs in children (although may be cause of pneumonia in elderly); tends to be seasonal (winter/spring) —CMV usually occurs in immunocompromised patients
—Q fever (Coxiella burnetii)	—Exposure to infected parturient cats, cattle, sheep, goats —Severe pneumonia not prominent feature
Abbreviations: CMV, cytomegalovirus; CT, computed tomography; RSV, respiratory syncytial virus. aDixon 1999. bBell 2002.

Tomado de:
Cidrap.umn.edu. 1. CIDRAP - Center for Infectious Disease Research and Policy. [Online]. Disponible en: http://www.cidrap.umn.edu/infectious-disease-topics/anthrax [Consultado: 20 septiembre 2015].