Infectious Diseases in Critical Care Medicine

System PE ID findings Noninfectious mimics Diagnostic features

Peripheral
neuropathy
(stocking
sensory deficit
with or without
weakness)

1. HIV


2. Leprosy


3. CMV


4. M. pneumoniae


5. Lyme disease


6. Hepatitis B, C


7. VZV


8. Parvovirus


9. Neuroborreliosis


10. Neurosyphilis


11. Trypanosomiasis


12. Botulism


13. Diphtheria


14. Tropheryma
    whipplei

l Diabetes mellitus

l Alcohol abuse

l Drugs

l Vasculitis

l Myxedema

l Renal failure

l Rheumatoid arthritis

l Sarcoidosis

l Monoclonal gammopathy/

amyloidosis

l Acromegaly

l Multifocal CIDP

l Porphyria

l Hereditary (i.e., Charcot-

Marie-Tooth)

l Vitamin B deficiency

l Heavy metal poisoning

Clinical setting. Culture,

serology, and imaging to

distinguish the various

possibilities.

Brachial
plexopathy

1. Parvovirus B19


2. EBV
   mononucleosis


3. HIV


4. Lyme disease

l Pancoast tumor

l Trauma/compression

l Parsonage–Turner syndrome

l Post irradiation

l Tumor infiltration

l Paraneoplastic

Clinical setting. Culture,

serology, and imaging to

distinguish the various

possibilities.

Lumbosacral
plexopathy
(a) T12 to L4—
decreased
flexion,
adduction, and
eversion of
thigh. Absent
patellar reflex
(b) L5 to S3—hip
extension,
abduction, and
internal rotation
of thigh, flexion
of leg, and all
movements of
foot. Absent
Achilles reflex
(c) Entire
plexus—variable
weakness of hip
girdle, thigh and
foot muscles

1. CMV (in AIDS)


2. Herpes zoster


3. C. pneumoniae

l Trauma/parturition

l Retroperitoneal hemorrhage

l Neoplastic

l Diabetic

l Vasculitic (RA, SLE, PAN)

Clinical setting. Culture,

serology, and imaging to

distinguish the various

possibilities.

Paraplegia/paresis
with a sensory
level

1. Spinal epidural
   abscess


2. Tuberculous
   adhesive
   arachnoiditis


3. Transverse myelitis
   (mycoplasma, TB,
   Lyme disease,
   syphilis, viral,
   HTLV-1)

l Arachnoiditis due to epidural

drug injection, hemorrhage

or postsurgical

l Arachnoiditis due to seeding

of a CNS or metastatic

cancer

l Transverse myelitis (MS,

autoimmune/vasculitis, drugs,

Devic’s syndrome)

Significant spinal pain suggests

epidural abscess.

Blood and CSF culture/

serology.

Imaging and serologic testing

for vasculitis.

(Continued)

Physical Exam Clues to Infectious Diseases and Their Mimics in Critical Care 63