Infectious Diseases in Critical Care Medicine

System PE ID findings Noninfectious mimics Diagnostic features

4. Protozoan—
   malaria,
   toxoplasmosis,
   trypanosomiasis


5. Rickettsia—typhus,
   Q fever, Rocky
   Mountain spotted
   fever


6. Helminths—
   Acanthamoeba,
   Echinococcosis,
   Onchocerciasis,
   Toxocariasis,
   Trichinellosis

Sudden
sensorineural
hearing loss
(i.e., negative
ipsilateral Rinne
test and/or
contralateral
localization on
the Weber test)

1. Viral cochlear/
   vestibular
   labyrinthitis


2. Viral auditory
   nerve neuritis


3. Meningoencephalitis


4. Specific viruses:
   mumps, CMV, EBV,
   rubella, rubeola,
   varicella zoster,
   HSV, parainfluenza
   Lassa fever, HIV


5. Syphilis


6. Scrub typhus


7. Leptospirosis


8. Psittacosis


9. Typhoid fever


10. Scrub

l High-viscosity syndromes:

macroglobulinemia, P-vera

l Small vessel obstruction: sickle

cell anemia, micro-emboli,

Caisson disease

l Diabetes mellitus,

atherosclerosis,

thrombangitis obliterans

l Hypercoagulable states

l Autoimmune disorders—inner

ear autoimmune disease,

relapsing polychondritis, SLE,

polyarteritis nodosa, Cogan’s

syndrome

l Neurologic disorders—MS,

migraine

l Ototoxic drugs

Historical context. Fever

suggests an infection.

Autoimmune disorders

diagnosed by criteria and

serology.

Culture and/or serologic testing

will identify most, but not all,

of the infectious etiologies

Parotid
enlargement and
tenderness

1. Viral parotitis
   (mumps,
   parainfluenza,
   influenza,
   coxsackie virus,
   CMV)


2. Bacterial parotitis

l Bulimia

l Drug induced/iodide parotitis

l Sialolithiasis

l Parotid neoplasms

Fever suggests infection. Pus

emanating from Stenson’s duct

in bacterial parotitis.

Erythema/edema
external auditory
canal

1. Acute otitis
   externa (esp.
   pseudomonal)

l Allergic contact dermatitis

l Eczematous dermatitis

l Psoriasis

l SLE

Historical context. Fever favors

infection.

Inflamed pinna 1. Bacterial
perichondritis

2. Chronic
   granulomatous
   infectious
   process (TB,
   fungal, syphilis,
   leprosy)

l Relapsing polychondritis

l Frost bite

l Irritant contact dermatitis

l Trauma

Distinguished based on the

history. Fever favors an

infectious process. Culture

and/or biopsy if indicated.

Clear nasal
discharge

1. CSF rhinorrhea in
   a patient with
   meningitis and a
   basilar skull/
   cribriform plate
   fracture

l Vasomotor rhinitis

l Allergic rhinitis

l Viral rhinitis

Beta 2 transferrin level is

elevated in CSF and not in

other causes of rhinorrhea.

52 Mishriki