Infectious Diseases in Critical Care Medicine

System PE ID findings Noninfectious mimics Diagnostic features

Trepopnea 1. Infectious pleuritis
(affected side
down)

l Left-sided CHF

l Unilateral extensive lung

disease or post

pneumonectomy

l Swyer–James syndrome

l Endobronchial mass with

ball-valve effect

Fever in infective pleuritis.

Chest X Ray or echo-

cardiography in others.

Subcutaneous
nodules

1. Acute rheumatic
   fever


2. Nocardiosis


3. Sporotrichosis


4. Mycobacterial infec-
   tions


5. Rochalimaea
   henselae


6. Dirofilaria immitis


7. Cutaneous
   leishmaniasis


8. Onchocerciasis

l Rheumatoid arthritis

l SLE

l Tophaceous gout

l Sarcoidosis

l Granuloma annulare

Jones criteria in ARF. Fever

> 1028 F suggests, but does

not prove, infection.

Appropriate cultures and

serologies. Synovitis and

joint changes in RA. Biopsy

for others.

Tender violaceous
acral papules

1. Osler’s nodes l Cholesterol emboli Murmur, fever, positive blood
   cultures in endocarditis.
   Livedo reticularis in
   cholesterol emboli.

Ptosis, miosis,
possible hidrosis
(i.e., Horner’s
syndrome)

1. Chronic apical
   pneumonia
   (staphylococcal,
   fungal,Aspergillus,
   Pasteurella)


2. Tuberculosis


3. Hydatid cyst of the
   thoracic outlet


4. Mycotic thoracic
   aortic aneurysm


5. Thoracic hydatid
   cyst


6. Basal meningitis

l Central lesions—Wallenberg

syndrome, TIA/stroke, brain

tumors, MS

l Preganglionic lesions—thoracic

tumors, phrenic nerve

syndrome, thyroid enlargement,

DISH, neck trauma, carotid

dissection, Arnold–Chiari

malformation, Syringomyelia

l Postganglionic lesions—skull

fracture, cluster headaches,

migraines, or middle ear

infections

Fever suggests infection. Blood

cultures/serologic testing.

Imaging (chest X Ray, CT/MRI

brain/spinal cord)

Optic papillitis 1. Bacterial—esp.
Brucellosis,
endocarditis,
Leptospirosis,
Lyme disease,
Mycoplasma
pneumoniae,
syphilis,
tuberculosis

2. Fungal—Candidiasis
   Coccidioidomycosis,
   Mucormycosis,
   Cryptococcosis


3. Viral—acquired
   immune deficiency
   syndrome, varicella
   zoster virus, Equine
   encephalitis,
   hepatitis A, B, C,
   EBV, influenza,
   measles, mumps,
   poliomyelitis, yellow
   fever, West Nile
   virus

l Idiopathic

l Nonarteritic anterior ischemic

optic neuropathy

l Demyelinating/degenerative

diseases—adreno-

leukodystrophy,

hereditary ataxia, MS,

neuromyelitis optica

l Drugs/vaccines/toxins

Inflammatory/autoimmune-

Henoch–Scho ̈nlein, polyarteritis

nodosa, sarcoidosis, Wegener

granulomatosis, Behc ̧et disease,

progressive systemic sclerosis,

RA, SLE, giant cell arteritis,

Takayasu syndrome

l Buerger disease

(thromboangiitis obliterans)

l Multiple myeloma

Distinguished by CSF findings

including culture and

serology. MRI and CT

scanning for demyelinating

and degenerative CNS

disorders. Clinical criteria

and serologic testing for

autoimmune disorders

(Continued)

Physical Exam Clues to Infectious Diseases and Their Mimics in Critical Care 51