Infectious Diseases in Critical Care Medicine

System PE ID findings Noninfectious mimics Diagnostic features

Chest wall
tenderness

1. Epidemic
   pleurodynia


2. Septic arthritis of
   the sternoclavicular,
   sternomanubrial, or
   costoclavicular joint


3. Necrotizing fasciitis

l Tietze syndrome

l Chest trauma

l Intercostal/mammary

thrombophlebitis (Mondor

disease)

l SAPHO syndrome

l Relapsing polychondritis

Fever favors infection. Tender

chest wall thrombosed vein

in Mondor disease. Imaging

in SAPHO.

Chest wall mass 1. “Pointing”
empyema

2. TB of a rib


3. Actinomycosis


4. Nocardiosis


5. Aspergillosis

l Neoplasm, malignant or

benign

The skin over a “pointing”

empyema is warm. Chest X

Ray, culture, and biopsy.

Chest dullness to
percussion

1. Lobar pneumonia
   with or without
   empyema

l Atelectasis

l Pleural effusion

l Pleural thickening

Fever favors infection. Imaging.

Wheezing 1. Lower respiratory
tract infection (esp.
with RSV, human
metapneumovirus)

2. Chronic pneumonia


3. PIE (Strongyloides
   stercoralis,
   hookworm,Ascaris
   lumbricoides,or
   Schistosoma
   japonicum)


4. Tropical pulmonary
   eosinophilia


5. Allergic bronchopul-
   monary aspergillosis

l Asthma/COPD

l CHF

l Endobronchial tumors

l Sarcoidosis

l Cystic fibrosis

l Pulmonary embolism

l Lymphangioleiomyomatosis

l Acute chest syndrome sickle

cell disease

l Drug-induced bronchospasm

l Bronchiectasis

l Bronchiolitis obliterans

l Hypersensitivity pneumonitis

Culture, serology for infections.

Imaging (X Ray, CT scan).

Peripheral smear in SS

disease. Occasionally,

biopsy (bronchiolitis,

hypersensitivity

pneumonitis).

Late inspiratory
crackles (rales)

1. Pneumonia l Atelectasis
   l CHF
   l Pulmonary fibrosis
   l Sarcoidosis
   l Collagen vascular disorders
   (SLE, Wegener’s granulomatosis,
   scleroderma, others)

Culture, sputum Gram stain,

serologic testing (ANA,

cANCA, Scl-70). Rarely,

lung biopsy. Elevated JVP,

S 3 gallop, edema in CHF.

Pleural friction rub 1. Viral pleurisy

2. Pneumonia


3. Tuberculous
   pleuritis

l Pulmonary embolism/infarction

l Sickle cell chest syndrome

l Asbestosis/mesothelioma

l Postpericardiotomy syndrome

l SLE

l Post thoracotomy

l Drug-induced pleuritis

Imaging (X Ray, CT).

Peripheral smear in SS

disease. Pleural biopsy

for TB.

Amphoric breath
sounds

1. Lung abscess


2. Tubercular cavity


3. Fungal pulmonary
   cavity

l Cyst, bleb, or bulla of any

etiology communicating with

a bronchus (i.e., COPD,

cavitary cancer, etc.)

l Open pneumothorax

Imaging (X Ray, CT). Sputum

culture for TB.

Tender, inflamed
superficial vein

1. Septic thrombophle-
   bitis

l Trousseau syndrome

l Thromboangiitis obliterans

l Chemical phlebitis

Fever> 1028 F and positive

blood cultures in septic

thrombophlebitis

Palpable arterial
aneurysm

1. Mycotic aneurysm l Polyarteritis nodosa
   l Traumatic aneurysm
   l Neurofibromatosis

Fever, positive blood cultures in

mycotic aneurysm. Multiorgan

involvement, ANCA positivity

in PAN. Cutaneous

neurofibromas in NF.

(Continued)

Physical Exam Clues to Infectious Diseases and Their Mimics in Critical Care 57