¿Cómo diferenciarla de otras infecciones? Parte II

Differential Diagnosis for Gastrointestinal Anthrax
Diagnosis	Distinguishing Features
Abdominal Subtypea
Typhoid fever (Salmonella typhi)	—Ascites usually not present —Other clinical features may be similar
Intestinal tularemia (Francisella tularensis)	—Illness often less severe than that seen with gastrointestinal anthrax —Ascites not present —Less likely to resemble acute abdomen —Fever may be less prominent
Bacillary dysentery (Shigella dysenteriae)	—Ascites usually not present —Other clinical features may be similar
Acute bacterial gastroenteritis caused by other agents (eg, Campylobacter jejuni, Shiga toxin–producing Escherichia coli, Yersinia enterocolitica)	—Illness often less severe than that seen with gastrointestinal anthrax —Ascites not present —Less likely to resemble acute abdomen —Fever may be less prominent —Hemolytic uremic syndrome may occur with infection caused by Shiga toxin–producing E coli
Bacterial peritonitis	—Gastrointestinal symptoms (nausea, vomiting, gastrointestinal bleeding, diarrhea) not prominent features —Tends to occur in persons with underlying medical conditions (eg, alcoholism, other liver disease)
Acute abdomen (eg, appendicitis)b	—Anthrax generally begins with vague systemic symptoms rather than abdominal pain —Ascites is relatively common with gastrointestinal anthrax and less common with appendicitis and similar conditions
Oropharyngeal Subtype
Diphtheria (Corynebacterium diphtheriae)	—Primarily occurs in nonimmune children under 15 yr of age —Pharyngeal membrane is prominent feature; ulcerative or necrotic lesions generally not present —Removal of pharyngeal membrane often causes bleeding of submucosa
Pharyngeal tularemia (Francisella tularensis)	—Neck swelling usually absent —Exudative pharyngitis common; ulcerative lesions may occur
Streptococcal pharyngitis (Streptococcus pyogenes)	—Exudative pharyngitis most prominent feature; necrotic ulcers generally absent —Neck edema usually absent, although cervical lymphadenopathy may be prominent
Infectious mononucleosis	—Most common in young adults —Splenomegaly commonly occurs —Neck edema usually absent, although cervical lymphadenopathy may be prominent
Enteroviral vesicular pharyngitis (coxsackievirus)	—Small vesicles noted on soft palate, uvula, or anterior tonsillar pillars —Generally occurs in children —Neck edema usually absent
Acute herpetic pharyngitis (herpes simplex virus)	—Vesicles, shallow ulcers may be noted, but lesions usually not necrotic —Neck edema usually absent, although cervical lymphadenopathy may be prominent
Anaerobic pharyngitis (Vincent's angina)	—Purulent exudate covers posterior pharynx —Tonsillar abscesses may occur —Neck edema usually absent
Yersinia enterocolitica pharyngitis	—Exudative pharyngitis most prominent feature —Neck edema usually absent —Cervical adenopathy, abdominal pain may occur
aDixon 1999. bKanafani 2003.

Differential Diagnosis for Anthrax Meningitis
Diagnosis	Distinguishing Features
Subarachnoid hemorrhage	—Fever not usually prominent feature —Can be distinguished by CT without contrasta
Bacterial meningitis from other causes	—Meningitis not usually hemorrhagic as seen with anthrax meningitis —CSF Gram stain may be useful in diagnosis
Aseptic meningitis	—Meningitis not hemorrhagic —CSF does not show characteristic gram-positive bacilli —CSF usually demonstrates lymphocytosis
Encephalitis	—CSF findings may be variable, depending on etiology —CSF Gram stain may be useful in diagnosis
Abbreviations: CSF, cerebrospinal fluid; CT, computed tomography. aDixon 1999.

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: 30 septiembre 2015].