Infectious Diseases in Critical Care Medicine

System PE ID findings Noninfectious mimics Diagnostic features

Uvular swelling Acute infectious
uvulitis (streptococcal,
Hemophilus influenzae)

l Angioedema—hereditary or

acquired (i.e., ACE inhibitors)

l Inhalation injuries or exposures

(i.e., marijuana, cocaine,

Ecballium elaterium)

l Trauma

l Post anesthesia and deep

sedation (with and without

endotracheal intubation)

l Obstructive sleep apnea

l Heavy chain disease

Fever and/or cellulitis of the

surrounding tissues should

prompt a search for

infection. Acute infectious

uvulitis may be associated

with epiglottitis.

Smooth,
erythematous
tongue

1. Infectious glossitis
   due to type b
   H. influenzae


2. Atrophic thrush

l Vitamin B complex deficiency

l Nontropical sprue

l Pernicious anemia

l Iron deficiency

l Alcoholism

l Amyloidosis

l Regional enteritis

Culture will be positive in

bacterial/fungal glossitis.

Blanching of half of
the tongue

1. Bacterial
   endocarditis
   emboli

l Giant cell arteritis

l Air embolism (Liebermeister

sign)

Fever> 1028 F favors

endocarditis. Air embolism

with petechial rash,

confusion.

Buccal/gingival
violaceous
papule/nodule

1. Kaposi sarcoma


2. Bacillary
   angiomatosis

l Venous lake or varicosity

l Pyogenic granuloma

l Scurvy

l Hemangioma

Biopsy will distinguish the

entities.

Preauricular
lymphadenopathy/
mass

1. Parinaud’s
   oculoglandular
   syndrome (TB, cat
   scratch disease,
   syphilis, tularemia,
   Chlamydia
   trachomatis,
   adenovirus,
   Bartonella)


2. Toxoplasmosis


3. Acute parotitis


4. Actinomycosis


5. Infection of the
   scalp, face, ear


6. Orbital adnexal
   infection

l Metastatic cancer

l Branchial cleft cyst

l Preauricular sinus

l Parotid tumor

l Lymphoma

Culture/serology/biopsy.

CT scanning, if needed.

Submental/
submandibular
lymphadenopathy

1. Oral, buccal,
   dental infections
   (sialadenitis,
   diphtheria, primary
   HSV gingivo-
   stomatitis,
   gonorrhea,
   syphilis, etc.)


2. Parinaud’s
   oculoglandular
   conjunctivitis.

l Metastatic cancer Culture or biopsy. CT scanning,

if needed.

Anterior cervical
lymphadenopathy

1. Oropharyngeal
   infections


2. Toxoplasmosis


3. Mycobacterial infec-
   tions


4. HIV

l Metastatic cancer

l Kikuchi–Fujimoto disease

l Sarcoidosis

l Lymphoma

Culture/serology/biopsy.

CT scanning, if needed.

54 Mishriki