Infectious Diseases in Critical Care Medicine

System PE ID findings Noninfectious mimics Diagnostic features

Charcot joint 1. Syphilis

2. Leprosy

l Diabetes

l Alcoholism

l Trauma

l Amyloidosis

l Pernicious anemia

l Syringomyelia, spina bifida,

myelomeningocele

l MS

l Charcot-Marie-Tooth disease

l Connective disorders (RA,

scleroderma)

l Cauda equine lesions

Clinical context. Serology,

imaging, biopsy/culture.

Mono or pauci-
articular arthritis

1. Bacterial septic
   arthritis


2. Lyme disease


3. Viruses (parvovirus
   B19, hepatitis B,
   rubella, mumps,
   adenovirus,
   coxsackie,
   retroviruses, EBV,
   Chikungunya)

l Gout

l Pseudogout

l Other crystalline arthritides

l Lofgren’s syndrome (peri-arthritis

of the ankles)

l Plant thorn synovitis

l Synovial metastases

l Charcot joint

Arthrocentesis with microscopy

(including polarized lens)

and culture. Serology,

imaging.

Sternoclavicular
inflammation/
tenderness

1. Septic arthritis/
   osteomyelitis
   (esp. in IVDA)

l Trauma/fracture

l Inflammatory arthritis (RA,

ankylosis spondylitis,

psoriatic)

l Gout

l Friedrich’s syndrome

Blood and joint fluid culture/

microscopy. Imaging.

Acute sacroiliac
tenderness

1. Septic arthritis/
   osteomyelitis
   (IVDA, indwelling
   catheter)

l Reactive arthritis

l Trauma/fracture

l Crystalline arthritides

Blood and joint fluid culture/

microscopy. Imaging.

Chronic sacroiliac
tenderness

1. Brucella arthritis


2. Tubercular arthritis

l Spondyloarthropathies

(i.e., ankylosing spondylitis,

inflammatory bowel disease,

psoriatic arthritis)

Imaging. Serology, joint fluid

culture.

Tenderness/
inflammation
symphysis pubis

1. Osteomyelitis of
   the symphysis
   pubis

l Osteitis pubis (sterile)

l CPPD disease

Blood/bone culture. Imaging.

Muscle swelling/
tenderness

1. Pyomyositis


2. Necrotizing fasciitis


3. Trichinosis


4. Infected hematoma

l Bland hematoma

l Muscle infarction

Culture, imaging. Occasional

muscle biopsy (trichinosis)

Penile ulcer 1. Syphilis

2. Herpes simplex


3. Chancroid


4. Lymphogranuloma
   venereum


5. Donovanosis


6. Histoplasma


7. Tularemia


8. Leishmaniasis


9. Amebiasis

l Behc ̧et disease, Crohn’s

disease, Lichen planus

l Cancer

Extreme tenderness suggests

herpes, chancroid. Groove

sign in LGV. Bilateral

lymphadenopathy in syphilis,

herpes. Culture, serology, or

biopsy.

Perineal/scrotal
purpura

1. Early Fournier’s
   gangrene

l Blue scrotum sign of Bryant

seen in retroperitoneal

hemorrhage

Recent GU surgery/

manipulation fever,

prostration in Fournier’s

gangrene.

60 Mishriki