Infectious Diseases in Critical Care Medicine

System PE ID findings Noninfectious mimics Diagnostic features

Scrotal swelling/
tenderness

1. Epididymo-orchitis


2. Pyocele

l Testicular cancer

l Testicular torsion

l Polyarteritis nodosa

Color Doppler US shows

impaired blood flow in

torsion and an

inhomogeneous collection in

a pyocele.

Epididymal
beading

1. Genitourinary
   tuberculosis

l Epididymal cysts in

polycystic kidney disease

l Young’s syndrome

Upper and lower GU tract

scarring in TB. Imaging.

Nuchal rigidity,
meningismus

1. Infectious
   meningitis
   (bacterial, viral)

l Noninfectious meningitis

(drug induced, SLE,

Behcet’s syndrome,

Sjogren’s syndrome,

sarcoidosis)

l Leptomeningeal metastases

l Primary CNS angiitis

l Degenerative cervical spine

disease

Fever> 1028 F suggests

infection. CSF culture/

Serology. Imaging.

Chorea 1. Acute rheumatic
fever
(Sydenham’s
chorea)

2. HIV


3. Creutzfeldt–Jakob
   disease

l CNS ischemic/hemorrhage

l Neurologic disorders

(Huntington’s chorea, neuro-

acanthocytosis)

l SLE

l Drugs (l-dopa, lithium,

methadone, lamotrigine)

l Toxins

l Paraneoplastic

l Antiphospholipid syndrome

l Metabolic—hyper-thyroidism,

hyperglycemia, hypocalcemia

l Other—P vera, basal ganglia

calcification, senile

Fever suggests infection but

does not exclude CNS

lesions, SLE,

hyperthyroidism. Serology,

routine blood work, and

imaging for other

possibilities.

Cranial nerve
palsies (isolated
or in various
combinations)

1. Suppurative
   intracranial
   thrombophlebitis—
   CN II, IV, V, VI, VII


2. Acute bacterial
   meningitis—III, IV,
   VI, VII


3. Rhinocerebral
   Mucormycosis—
   II through VII, IX,
   and X


4. Lyme disease—
   primarily CN VII
   (at times
   bilateral). Less
   common II, III,
   the sensory
   portion of V, VI,
   and the acoustic
   portion of VIII


5. Acute HIV
   meningitis—V,
   VII, and VIII


6. Malignant otitis
   externa—VII, less
   commonly X, X, XII


7. Orbital cellulitis—
   III, IV, VI; V1

l Nerve infarction (i.e., diabetic)

l Supratentorial mass with

herniation

l Migraine

l Aneurysm

l Subarachnoid hemorrhage

l Sarcoidosis

l Meningeal carcinomatosis/

lymphoma

l Tolosa–Hunt

l Neurologic syndromes—

Weber’s, Benedikt’s,

Nothnagel’s)

l Neoplasms (pituitary,

meningioma)

l Trauma

l Pseudotumor cerebri

l Multiple sclerosis

l Ciguatera fish poisoning

Clinical setting. Culture,

serology, and imaging to

distinguish the various

possibilities.

(Continued)

Physical Exam Clues to Infectious Diseases and Their Mimics in Critical Care 61