Infectious Diseases in Critical Care Medicine

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System PE ID findings Noninfectious mimics Diagnostic features


Right parasternal
or suprasternal
pulsation



  1. Mycotic or luetic
    ascending aortic
    aneurysm


l Noninfectious ascending
aortic aneurysm
l Tortuous carotid artery
l Dissecting aneurysm of the
ascending aorta
l Right-sided aortic arch

Fever, positive blood cultures
in mycotic aneurysm. RPR in
luetic aneurysm.
Echocardiography in other
diagnoses.

Pericardial friction
rub



  1. Acute viral or
    bacterial
    pericarditis


l Collagen vascular diseases
(esp. SLE)
l Postpericardiotomy/MI
syndrome
l Uremia
l Pericardial metastases

Clinical context for post-
pericardiotomy syndrome.
Serologic testing, BUN/
creatinine,
echocardiography.

Apical pan-systolic
murmur



  1. Mitral regurgitation
    in acute rheumatic
    fever

  2. Mitral regurgitation
    in bacterial
    endocarditis


l Mitral regurgitation due to
other causes—mitral valve
prolapse, papillary muscle
dysfunction/rupture,
endocarditis, severe
LV dilation.

Jones criteria in ARF.
Echocardiography in other
diagnoses.

Apical diastolic
rumbling murmur



  1. Relative mitral
    stenosis in acute
    rheumatic fever
    (Carey Coombs
    murmur)


l Mitral stenosis—late effect
of rheumatic fever or
degenerative valvular disease
l Austin Flint murmur

Jones criteria in ARF.
Echocardiography in other
diagnoses.

Basilar diastolic
blowing murmur
(LSB)



  1. Aortic regurgitation
    in endocarditis


l Aortic regurgitation due to
hypertension, rheumatic heart
disease, aortoannular ectasia,
aortic dissection
l Pulmonic insufficiency

Blood cultures and IE stigmata
for IE. Echocardiography for
other diagnoses.

Pan-systolic
murmur LLSB



  1. Tricuspid
    regurgitation in
    endocarditis

  2. Tricuspid
    regurgitation in
    rheumatic fever


l Tricuspid regurgitation in
Ebstein anomaly, prolapse,
carcinoid, papillary muscle
dysfunction, connective
tissue disorders (Marfan),
RA, radiation injury

Blood cultures and IE stigmata
for IE. Jones criteria for ARF.
Echocardiography for other
diagnoses.

Jaundice 1. Viral hepatitides
(A, B, E, EBV,
CMV)



  1. Ascending
    cholangitis

  2. Sepsis-associated
    cholestasis

  3. Leptospirosis

  4. Malaria

  5. Hemorrhagic
    fevers

  6. Relapsing fever


l Alcoholic liver disease
l Biliary tract obstruction
(stone, tumor, stricture)
l Drug induced
l Hemolytic anemia
l Cancer (primary or metastatic
to liver)
l Hepatic vein thrombosis
l Ischemic hepatitis

Clinical context. Serologic
testing. Culture. Peripheral
smear (hemolytic anemia,
malaria). US for CBD
obstruction, tumors/hepatic
vein thrombosis.

Doughy abdomen 1. Tubercular
peritonitis


l Peritoneal metastases
l Recent significant weight loss
l Peritoneal mesothelioma

Imaging (CT, US). Peritoneal/
ascites culture or biopsy.

Right lower
quadrant
tenderness



  1. Acute salpingitis
    with a tuboovarian
    abscess

  2. Bacterial ileocecitis
    (Yersinia
    enterocolitica,
    Campylobacter
    jejuni,Salmonella
    enteritidis)


l Acute appendicitis
l Cecitis/typhlitis
l Regional enteritis
l Diverticulitis
l Epiploic appendagitis
l Impaction of a stone in the right
ureter
l Meckel’s diverticulitis
l Ovarian cyst

Stool culture, specific serology
in enteric infections. CT
scanning/US for
noninfectious etiologies.

58 Mishriki

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