Misdiagnosis disease

Shortness of breath, cough, and wheeze are common symptoms of respiratory diseases (Table 3.2). These shared symptoms make misdiagnosis by physicians common if the diagnosis is based solely on reported symptoms. Medical tests help to distinguish the respiratory diseases from each other (Table 3.3). Other pitfalls in medical diagnosis include diagnosing common diseases (such as asthma, emphysema, and chronic bronchitis) instead of the actual rarer diseases (such as BO) and not considering occupational exposures as the cause. 

Symptoms of poisoning may affect all or only few individuals in a particular population. Symptoms may be divided into early, late, and delayed early symptoms occur a few hours after toxin ingestion, late symptoms up to several days after, and delayed symptoms affect patients after some weeks, or even months. The most dangerous situation involves delayed, subacute symptoms that do not affect all individuals in an analyzed population. In such a cases, a relationship between consumed food and disease symptoms is practically impossible to confirm and may lead to a misdiagnosis. 

Preventing misdiagnosis of stroke is increasingly important in the acute stage of the disease when thrombolytic or interventional therapies with potential adverse effects are considered. Misdiagnosis may have serious consequences A misdiagnosed patient may be subject to unjustified thrombolytic therapy and encounter an elevated bleeding risk. Or, another serious nonvascular disorder maybe misclassified as stroke and treatment options maybe missed. 

Sigal, L.H. Lyme Disease Controversy Social and Financial Costs of Misdiagnosis and Mismanagement. Archives of Internal Medicine (July 22,1996) 1493-1500. 

Atypical lymphocytes are found in the peripheral blood and T-cell areas of lymph nodes (paracortex) and may cause misdiagnosis as Hodgkin s disease histologically (therefore, don t biopsy a lymph node ). 

The use of LDH and CPK levels alone can also lead to a misdiagnosis because these enzymes are produced by many tissues. How can a cUnidan diagnose heart disease with confidence when the elevated serum enzyme levels could indicate coexisting disease in another tissue The physidan is able to make such a decision because of the presence of isoenzymes, which provide diagnostic accuracy because they reveal the tissue of origin. 

Vidaud D, Assouline B, Lecoz P, Cadranel JF, Chappuis P. Misdiagnosis revealed by genetic linkage analysis in a family with Wilson disease. Neurology 1996 46 1485-1486 Walker JM, Tsivkovskii R, Lutsenko S. MetaUochaperone Atoxl transfers copper to the NH2-ter-minal domain of the Wilson s disease protein and regulates its catalytic activity. J Biol Chem 2002 277 27953-27959... 

The symptoms of acute intoxication may be very similar to that of other diseases (Box 5.3), may often lead to a misdiagnosis and, at times, death. On the other hand, some metabolic disorders can predispose a neonate to frequent neonatal period complications such as infections like E. coli sepsis in children with galactosemia or hematological complications such as central nervous system hemorrhage in hyperammonemia or thrombocytopeiua due to bone marrow suppresion in some aminoacidurias [2,7],... 

Fraction of false positive responses, e.g., misdiagnosis of a disease state when none exists. This fraction should be a very small number, i.e., a low failure rate. 

Skin Five patients who were initially thought to be having a flare of cutaneous chronic graft-versus-host disease were actually exhibiting phototoxicity due to voriconazole [74% A high index of suspicion of this adverse reaction after bone marrow transplantation is needed to prevent misdiagnosis and avoid immunosuppressive therapy. 

Fireman E, Haimsky E, Noiderfer M, et al. Misdiagnosis of sarcoidosis in patients with chronic berylhum disease. Sarcoidosis Vase Diffuse Lung Dis 2003 20(2) 144-148. 

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