eMedicine Specialties > Pediatrics: General Medicine > Pulmonology

Afebrile Pneumonia Syndrome: Differential Diagnoses & Workup

Author: Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Coauthor(s): Judith R Grisi, BS, PAC, Physician Assistant, Monmouth Ocean Pulmonary Medicine, CentraState Medical Center
Contributor Information and Disclosures

Updated: Jan 7, 2009

Differential Diagnoses

Actinomycosis
Hydrocarbon Inhalation Injury
Airway Foreign Body
Hypereosinophilic Syndrome
Alveolar Proteinosis
Hypersensitivity Pneumonitis
Aspiration Syndromes
Inhalation Injury
Asthma
Loffler Syndrome
Atelectasis, Pulmonary
Measles
Atypical Mycobacterial Infection
Mycoplasma Infections
Bronchiectasis
Parainfluenza Virus Infections
Bronchiolitis
Passive Smoking and Lung Disease
Bronchitis, Acute and Chronic
Pertussis
Bronchopulmonary Dysplasia
Pneumonia
Children's Interstitial Lung Disease (ChILD)
Primary Ciliary Dyskinesia
Chlamydial Infections
Respiratory Failure
Cold Agglutinin Disease
Respiratory Syncytial Virus Infection
Congenital Pneumonia
Rhinovirus Infection
Cystic Fibrosis
Right Middle Lobe Syndrome
Cytomegalovirus Infection
Status Asthmaticus
Goodpasture Syndrome
Tuberculosis
Histiocytosis

Workup

Laboratory Studies

In patients with afebrile pneumonia syndrome (APS), the CBC count may reveal a mild eosinophilia, with or without mild leukocytosis. Serum immunoglobulin levels are typically moderately elevated.

  • C trachomatis
    • Tissue culture isolation of the organism from nasopharyngeal specimens is the most useful test. If conjunctivitis is present, conjunctival specimens are also helpful.
    • Nonculture techniques include direct fluorescent antibody (DFA) tests and enzyme-linked immunoassays (EIAs).
    • Polymerase chain reaction (PCR), ligase chain reaction (LCR), and other nucleic acid probe techniques are routinely becoming more available.
    • Serology is useful but takes longer than the above-named tests.
  • CMV
    • Cell culture of urine, respiratory secretions, or blood buffy coat (including the shell-vial centrifugation technique) is the definitive test.
    • PCR and nucleic acid hybridization are becoming more readily available.
    • Serology is often useful, although it takes longer than more direct methods.
  • U urealyticum
    • The organism can be cultured from respiratory secretions.
    • PCR and serology are not routinely available.
  • Other
    • RSV, parainfluenza virus, and adenovirus can be cultured from respiratory secretions, although DFA and EIA are more rapid and more readily available.
    • P jiroveci is diagnosed using DFA on secretions or biopsy material from the lungs.
    • Detection of the agents listed is not conclusive evidence of causation because all agents may colonize infants without producing disease.

Imaging Studies

Chest radiographs may reveal the following:6

  • Air trapping
  • Bronchial wall thickening
  • Diffuse interstitial infiltrates (which may be out of proportion to the clinical condition, especially in infants with C trachomatis infection)
  • Atelectasis
  • Reticulonodular or miliary pattern (rare)

Other Tests

  • Results of infant pulmonary function testing (when available) are frequently abnormal in both the acute phase of infection and the long term.

Procedures

  • Bronchoalveolar lavage with or without transbronchial biopsy may provide specimens for diagnosis if the clinical severity warrants.

Histologic Findings

  • Special stains of biopsy material may reveal evidence of particular etiologies. More commonly, direct or indirect fluorescent antibody staining helps identify viral antigens in respiratory secretions (RSV, adenovirus, and parainfluenza).

More on Afebrile Pneumonia Syndrome

Overview: Afebrile Pneumonia Syndrome
Differential Diagnoses & Workup: Afebrile Pneumonia Syndrome
Treatment & Medication: Afebrile Pneumonia Syndrome
Follow-up: Afebrile Pneumonia Syndrome
References
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References

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Further Reading

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Keywords

afebrile pneumonia syndrome, APS, adenovirus, atypical pneumonia, bronchiolitis, Chlamydia trachomatis, chlamydial pneumonitis, conjunctivitis, croup, cytomegalovirus, CMV, human bocavirus, human metapneumovirus, infantile pneumonitis, interstitial pneumonia, laryngotracheobronchitis, newborn infection, nonbacterial pneumonia, obstructive airway disease, parainfluenza virus, pharyngitis, Pneumocystis jiroveci, pneumonia, pneumonitis, respiratory syncytial virus, RSV, rhinorrhea, RTI, tachypnea, upper respiratory tract infection, URI, Ureaplasma urealyticum, viral pneumonia

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Contributor Information and Disclosures

Author

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Consulting; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching; sanofi pasteur Grant/research funds Unrestricted research grant; sanofi pasteur  Consulting; sanofi pasteur Honoraria Speaking and teaching; Tap Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching

Coauthor(s)

Judith R Grisi, BS, PAC, Physician Assistant, Monmouth Ocean Pulmonary Medicine, CentraState Medical Center
Disclosure: Nothing to disclose.

Medical Editor

Susanna A McColley, MD, Director of Cystic Fibrosis Center; Head, Division of Pulmonary Medicine; Associate Professor, Department of Pediatrics, Children's Memorial Medical Center of Chicago, Northwestern University
Susanna A McColley, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Sleep Disorders Association, and American Thoracic Society
Disclosure: Genentech Honoraria Speaking and teaching; Genentech Consulting fee Consulting; Novartis Consulting fee Consulting; Altus Consulting fee Consulting; Axcan Scandi Consulting fee Consulting; Boston Scientific Consulting fee Consulting

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Heidi Connolly, MD, Associate Professor of Pediatrics and Psychiatry, University of Rochester; Director, Pediatric Sleep Medicine Services, Strong Sleep Disorders Center
Heidi Connolly, MD is a member of the following medical societies: American Academy of Pediatrics, American Thoracic Society, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

CME Editor

Mary E Cataletto, MD, Associate Director, Division of Pediatric Pulmonology, Winthrop University Hospital; Professor of Clinical Pediatrics, State University of New York at Stony Brook; Director of Children's Sleep Services, Winthrop University Hospital
Mary E Cataletto, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Chest Physicians
Disclosure: Shering Plough Pharmaceuticals Honoraria Consulting

Chief Editor

Michael R Bye, MD, Professor of Clinical Pediatrics, Division of Pulmonary Medicine, Columbia University College of Physicians and Surgeons; Attending Physician, Pediatric Pulmonary Medicine, Columbia University Medical Center
Michael R Bye, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, and American Thoracic Society
Disclosure: Merck Honoraria Speaking and teaching

 
 
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