Infectious Diseases in Critical Care Medicine

System PE ID findings Noninfectious mimics Diagnostic features

Cerebellar ataxia 1. Lyme disease

2. Brain abscess


3. Toxoplasma
   encephalitis


4. Listeria
   monocytogenes
   meningitis


5. CNS syphilis


6. Tick borne
   encephalitis


7. Viral encephalitis
   (Japanese, St.
   Louis, West Nile,
   entero-viral,
   Varicella
   meningitis,
   Venezuelan
   equine, CMV)


8. Rickettsia
   (Rickettsiarickettsii,
   Coxiellaburnetti)


9. JC virus (including
   PML)


10. Cerebral malaria


11. Neurotoxic
    shellfish
    poisoning


12. Subacute
    progressive
    disseminated
    histoplasmosis


13. West African
    trypanosomiasis


14. Whipple’s disease


15. Primary amoebic
    meningoencephalitis


16. Hendra virus


17. Francisella
    Tularensis

l CNS tumors

l Drugs

l Multiple sclerosis

l Miller Fisher syndrome

l Ataxia-telengiectasia syndrome

l Friedrich’s ataxia

l Spinocerebellar ataxia

l Celiac disease

l Posterior circulation ischemia/

stroke

l Alcoholic cerebellar disease

l Idiopathic cerebellar

degeneration

l Paraneoplastic syndrome

l MELAS

l Vitamin E deficiency

l Dominant periodic ataxia

l Olivopontocerebellar atrophy

l Paraneoplastic disorder

l Vitamin E deficiency

l Exposure to toxins (lead,

anticonvulsants, salicylates,

aminoglycosides, sedatives)

l Autoimmune disorders (SLE,

Sjogren’s)

Fever favors an infectious

etiology. Chronicity suggests

hereditary syndrome.

Culture (including CSF),

serology, imaging to

distinguish among the other

etiologies.

Descending
paralysis with
absent MSRs

Botulism

Bulbar poliomyelitis

l Miller–Fisher syndrome Fever and asymmetry suggest

polio. Ataxia and diffuse

areflexia seen in Miller–

Fisher syndrome

Abbreviations: ACE, angiotensin converting enzyme; AFB, acid fast bacillus; AIDS, autoimmune deficiency
syndrome; ANA, antinuclear antibody; ARF, acute rheumatic fever; cANCA, cytoplasmic staining antineutrophil
cytoplasmic antibody; CBD, common bile duct; CHF, congestive heart failure; CK, creatine kinase; CMV,
cytomegalovirus; CN, cranial nerve; CNS, central nervous system; COPD, chronic obstructive pulmonary disease;
CPPD, calcium pyrophosphate dehydrate; CSF, cerebrospinal fluid; CT, computed tomography; DISH, diffuse
idiopathic skeletal hyperostosis; EBV, Epstein-Barr virus; GBM, glomerular basement membrane; GI, gastroin-
testinal; GU, genitourinary; HIV, human immunodeficiency virus; HTLV, human T cell lymphotropic virus; IE,
infectious endocarditis; IVDA, intravenous drug abuse; JC, Jakob Creutzfeldt; JRA, juvenile rheumatoid arthritis;
JVP, jugular venous pressure; LGV, lymphogranuloma venereum; LV, left ventricle; MCP, metacarpophalangeal;
MELAS, mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke; MI, myocardial infarction; MRI,
magnetic resonance imaging; MS, multiple sclerosis; NF, neurofibromatosis; NMS, neuroleptic malignant
syndrome; PAN, polyarteritis nodosa; PIE, pulmonary infiltrate with eosinophilia; PML, progressive multifocal
leukoencephalopathy; P-vera, polycythemia vera; RA, rheumatoid arthritis; RPR, rapid plasma reagent; RSV,
respiratory syncytial virus; SAPHO, synovitis, acne, pustulosis, hyperostosis, osteitis syndrome; SBE, subacute
bacterial endocarditis; SLE, systemic lupus erythematosus; SS, sickle cell disease; STDs, sexually transmitted
diseases; TB, tuberculosis; TIA, transient ischemic attack; TSH, thyroid stimulating hormone; TUGSE, traumatic
ulcerative granuloma with stromal eosinophilia; US, ultrasound; VZV, varicella zoster virus.

64 Mishriki