Infectious Diseases in Critical Care Medicine

System PE ID findings Noninfectious mimics Diagnostic features

3. Amebic colitis


4. Tuberculous
   colitis


5. Actinomycosis


6. Mycobacterium
   avium-intracellulare
   (in AIDS)


7. Angiostrongylus
   costaricensis


8. Balantidium coli


9. Ascariasis

l Ectopic pregnancy

l Cecal adenocarcinoma

l Carcinoid

Obturator sign 1. Appendicitis

2. Pelvic abscess

l Pelvic fracture

l Obturator muscle spasm/

dysfunction

Fever and leukocytosis in

appendicitis/pelvic abscess.

Psoas sign 1. Appendicitis

2. Psoas abscess

l Psoas hematoma

l Iliopsoas bursitis

Fever and leukocytosis in

appendicitis/psoas abscess.

CT scanning in psoas

hematoma.

Tender
hepatomegaly

1. Acute viral
   hepatitis


2. Hepatic abscess
   (pyogenic, amebic,
   Toxoplasma)


3. Typhoid


4. Disseminated
   candidiasis


5. Echinococcosis


6. Acute
   schistosomiasis


7. Fascioliasis


8. Clonorchiasis


9. Hepatic capillariasis

l Acute alcoholic hepatitis

l Drug-induced hepatitis

l Right-sided heart failure/

constrictive pericarditis

l Hepatic sickle cell crisis

l Budd–Chiari syndrome

Clinical context. There may be

a friction rub over a hepatic

abscess. Serology,

ultrasonography, culture to

distinguish the various

etiologies.

Splenomegaly 1. Acute infections
(e.g., EBV, CMV,
hepatitis, SBE,
psittacosis, cat
scratch disease)

2. Chronic infections
   (e.g., miliary TB,
   malaria,
   schistosomiasis,
   AIDS brucellosis,
   visceral
   leishmaniasis,
   syphilis,
   toxoplasmosis)

Congestive—cirrhosis, portal

hypertension, CHF, compression

or thrombosisof portal or splenic

vein

l Neoplasms—lymphoproliferative

disorders, myeloproliferative

disorders

l Inflammatory—sarcoidosis,

amyloidosis

l Connective tissue diseases—

SLE, RA

l Hemolytic anemias

l Storage diseases (e.g.,

Gaucher’s, Niemann–Pick,

etc.)

Based on the clinical context,

blood and other appropriate

cultures, serological testing,

review of peripheral smear

and, rarely, splenic biopsy.

Prostatic nodule 1. Tuberculosis l Cancer
l Leiomyoma

In TB, the seminal vesicle and

vas deferens are also

involved.

Carpo-metacarpal
ulnar deviation

1. Jaccoud’s arthritis
   in recurrent
   polyarthritis of
   rheumatic fever

l Rheumatoid arthritis

l SLE

l Ulnar impaction syndrome

l Chronic hemiplegia

Initially, the deviation in

Jaccoud’s arthritis is

passively reducible. MCP

synovitis, swan neck, and

boutonniere deformities in

RA. Imaging.

(Continued)

Physical Exam Clues to Infectious Diseases and Their Mimics in Critical Care 59