Gram Positive Bacilli
Bull’s neck is characteristically seen in:
|A||Hamartoma of Lung|
a. In diphtheria, the primary focus of infection was the tonsils or pharynx in 94%, with the nose and larynx the next two most common sites. After an average incubation period of 2-4 days, local signs and symptoms of inflammation develop.
b. Fever is rarely higher than 39ºC. Infection of the anterior nares (more common in infants) causes serosanguinous, purulent, erosive rhinitis with membrane formation. Shallow ulceration of the external nares and upper lip are characteristic.
c. In tonsillar and pharyngeal diphtheria, sore throat is a universal early symptom, but only one half of patients have fever, and fewer have dysphagia, hoarseness, malaise, or headache.
d. Mild pharyngeal injection is followed by unilateral or bilateral tonsillar membrane formation, which extends variably to affect the uvula, soft palate, posterior oropharynx, hypopharynx, and glottic areas.
e. Underlying soft tissue edema and enlarged lymph nodes can cause a "bull-neck" appearance. The degree of local extension correlates directly with profound prostration, bull-neck appearance, and fatality from airway compromise or toxin-mediated complications.
f. The leather-like adherent membrane, extension beyond the faucial area, relative lack of fever, and dysphagia help differentiate diphtheria from exudative pharyngitis due to Streptococcus pyogenes and Epstein-Barr virus.
g. Vincent angina, infective phlebitis and thrombosis of the jugular veins, and mucositis in patients undergoing cancer chemotherapy are usually differentiated by the clinical setting.
h. Infection of the larynx, trachea, and bronchi can be primary or a secondary extension from the pharyngeal infection. Hoarseness, stridor, dyspnea, and "croupy" cough are clues.
i. Differentiation from bacterial epiglottitis, severe viral laryngotracheobronchitis, and staphylococcal or streptococcal tracheitis hinges partially on the relative paucity of other signs and symptoms in the patient with diphtheria and primarily on visualization of the adherent pseudomembrane at the time of laryngo bronchoscopy and intubation.
j. In CT Scan of Lung while investigating a solitary puylm0nary nodule, “bull’s eye” denotes granuloma and “popcorn ball” denotes hamartoma.
k. Diphtheria presents with Bull Neck
l. Glaucoma presents with Buphthalmos – Bull Eye
m. Hepatic candidiasis results from seeding of the liver (usually from a gastrointestinal source) in neutropenic patients. It is most common in patients being treated for acute leukemia and usually develops around the time the neutropenia resolves.