|
|
(21 intermediate revisions by 4 users not shown) |
Line 4: |
Line 4: |
|
| |
|
| ==Overview== | | ==Overview== |
| The findings on the [[physical examination]] depend on the clinical manifestation of listeriosis (febrile [[gastroenteritis]], [[sepsis]], infection in pregnancy, or [[central nervous system]] infection). Common findings may include [[fever]], [[tachycardia]], [[pallor]]. Signs of [[neurological]] involvement may range from [[altered mental state]], to [[paralysis]], [[respiratory failure]], and [[coma]]. | | The findings on the [[physical examination]] depend on the clinical manifestation of listeriosis. Common findings include [[fever]], [[tachycardia]], [[pallor]], and [[abdominal tenderness]]. Signs of [[neurological]] involvement may include [[altered mental state]], [[paralysis]], [[respiratory failure]], and [[coma]]. |
| | |
| | ==Physical Examination== |
| | The findings on the [[physical examination]] depend on the clinical manifestation of listeriosis. Click on the links below for the exact clinical manifestation you are lookig for: |
| | * [[Listeriosis physical examination#Febrile Gastroenteritis|Febrile gastroenteritis]] |
| | * [[Listeriosis physical examination#Infection in Pregnancy|Infection in pregnancy]] |
| | * [[Listeriosis physical examination#Sepsis of Unknown Origin|Sepsis of unknown origin]] |
| | * [[Listeriosis physical examination#Meningoencephalitis|Meningoencephalitis]] |
| | * [[Listeriosis physical examination#Encephalitis|Encephalitis]] |
| | * [[Listeriosis physical examination#Rhombencephalitis|Rhombencephalitis]] |
| | * [[Listeriosis physical examination#Brain Abscess|Brain abscess]] |
| | * [[Listeriosis physical examination#Spinal Cord Infection|Spinal cord infection]] |
| | * [[Listeriosis physical examination#Endocarditis|Endocarditis]] |
|
| |
|
| ==Febrile Gastroenteritis== | | ==Febrile Gastroenteritis== |
| ===Appearance of the Patient===
| |
| A patient with [[listeriosis]] may be ill-looking.
| |
| ===Vitals===
| |
| ====Temperature====
| |
| *A [[fever]] is often present
| |
| ====Pulse====
| |
| =====Rate=====
| |
| *[[Tachycardia]] may be present
| |
| =====Strength=====
| |
| *The pulse may be weak
| |
| ====Blood Pressure====
| |
| *[[Hypotension]] may be present
| |
| ====Respiratory Rate====
| |
| *[[Tachypnea]] may be present
| |
| ===Skin===
| |
| * [[Pallor]] may be present
| |
| ===Throat===
| |
| * [[Mucous membranes]] may be dehydrated
| |
| ===Abdomen===
| |
| *[[Abdominal distention]] may be present
| |
| *[[Abdominal tenderness]] may be present
| |
|
| |
|
| ==Infection in Pregnancy== | | {| class="wikitable" style="border: 2; background: none;" |
| Pregnant women with [[listeriosis]] often present with [[flu]]-like [[symptoms]].<ref name=WHO>{{cite web | title = Risk assessment of Listeria monocytogenes in ready-to-eat foods | url = http://whqlibdoc.who.int/publications/2004/9241562625_part1.pdf }}</ref>
| | ! colspan="1" rowspan="1" style="border: 1; background: 1;" |Organ System |
| | ! colspan="1" rowspan="1" |Findings |
| | |- |
| | ! rowspan="1" style="border: 1; background: none;" |General Appearance |
| | |Patient is ill-looking |
| | |- |
| | ! rowspan="4" style="border: 1; background: none;" |Vital Signs |
| | |[[Fever]] |
| | |- |
| | |[[Tachycardia]] |
| | |- |
| | |[[Tachypnea]] |
| | |- |
| | |[[Hypotension]] |
| | |- |
| | ! style="border: 1; background: none;" |Skin |
| | |[[Pallor]] |
| | |- |
| | ! style="border: 1; background: none;" |'''HEENT''' |
| | |Dry [[mucous membranes]] |
| | |- |
| | ! rowspan="2" style="border: 1; background: none;" |Neurologic |
| | |[[Altered mental status]] |
| | |- |
| | |[[Focal neurologic signs|Motor and sensory focal neurologic signs]] |
| | |- |
| | ! rowspan="2" style="border: 1; background: none;" |Abdominal |
| | |[[Abdominal tenderness]] |
| | |- |
| | |[[Abdominal distention]] |
| | |} |
|
| |
|
| ==Sepsis of Unknown Origin== | | ==Sepsis of Unknown Origin== |
| ===Vitals===
| |
| ====Temperature====
| |
| *A [[fever]] is often present
| |
| *[[Hypothermia]] may be present
| |
| ====Pulse====
| |
| =====Rate=====
| |
| *[[Tachycardia]] is often present
| |
| =====Strength=====
| |
| *Peripheral pulses may be weak
| |
| ====Blood Pressure====
| |
| *[[Hypotension]] may be present
| |
| ====Respiratory Rate====
| |
| *[[Tachypnea]] may be present
| |
| ===Skin===
| |
| *[[Cyanosis]] may be present
| |
| * [[Pallor]] may be present
| |
| ===Throat===
| |
| *Mucous membranes may be dehydrated
| |
| ===Neck===
| |
| *[[Lymph nodes]] may be present
| |
| ===Abdomen===
| |
| *[[Abdominal tenderness]] may be present
| |
| ===Extremities===
| |
| *[[Cyanosis]] may be present
| |
| ===Neurologic===
| |
| * Mental status may be altered
| |
|
| |
| ==Meningoencephalitis==
| |
| ===Appearance of the Patient===
| |
| A patient with [[meningoencephalitis]] may have a wide range of presentations. These may range from mild focal neurologic signs to [[coma]].
| |
| ===Vitals===
| |
| ====Temperature====
| |
| *A [[fever]] is often present
| |
| ====Pulse====
| |
| =====Rate=====
| |
| *[[Tachycardia]] may be present
| |
| =====Strength=====
| |
| *The pulse may be weak
| |
| ====Blood Pressure====
| |
| *[[Hypotension]] may be present
| |
| ====Respiratory Rate====
| |
| *[[Tachypnea]] may be present
| |
| ===Skin===
| |
| * [[Pallor]] may be present
| |
| * [[Skin rash]] may be present
| |
| ===Head===
| |
| * Bulging fontanelles may be present (neonates)
| |
|
| |
| ===Neck===
| |
| * [[Neck stiffness]] may be present
| |
| ===Neurologic===
| |
| * [[Mental status]] may be altered
| |
| * [[Coma]] may be present
| |
| * [[Seizures]] may be present
| |
| * [[Focal neurologic signs]] may be present
| |
|
| |
| ==Encephalitis==
| |
| ===Appearance of the Patient===
| |
| A patient with [[encephalitis]] may have a wide range of presentations. These may range from personality changes, mild focal neurologic signs, to [[coma]].
| |
| ===Vitals===
| |
| ====Temperature====
| |
| *A [[fever]] is often present
| |
| ====Pulse====
| |
| =====Rate=====
| |
| *[[Tachycardia]] may be present
| |
| =====Strength=====
| |
| *The pulse may be weak
| |
| ====Blood Pressure====
| |
| *[[Hypotension]] may be present
| |
| ====Respiratory Rate====
| |
| *[[Tachypnea]] may be present
| |
| ===Skin===
| |
| * [[Pallor]] may be present
| |
| * [[Skin rash]] may be present
| |
| ===Head===
| |
| * Bulging fontanelles may be present (neonates)
| |
| ===Neck===
| |
| * [[Neck stiffness]] may be present
| |
| ===Throat===
| |
| * Mucosal [[rash]] may be present
| |
| ===Neurologic===
| |
| * [[Mental status]] may be altered
| |
| * [[Coma]] may be present
| |
| * [[Seizures]] may be present
| |
| * [[Focal neurologic signs]] may be present
| |
| * [[Autonomic dysfunction]] may be present
| |
| * [[Hemiparesis]] may be present
| |
| * [[Ataxia]] may be present
| |
| * [[Dystonia]] may be present
| |
|
| |
| ==Rhombencephalitis==
| |
| ===Appearance of the Patient===
| |
| Commonly in previously healthy patients.
| |
| The disease usually progresses in two phases:
| |
| * Initial phase - patient may be febrile with nausea and vomiting
| |
| * Second phase - there is usually cranial nerve palsies, tremor, ataxia and altered consciousness
| |
| ===Vitals===
| |
| ====Temperature====
| |
| *A [[fever]] is often present
| |
| ====Pulse====
| |
| =====Rate=====
| |
| *[[Tachycardia]] may be present
| |
| =====Strength=====
| |
| *The pulse may be weak
| |
| ====Blood Pressure====
| |
| *[[Hypotension]] may be present
| |
| ====Respiratory Rate====
| |
| *[[Tachypnea]] may be present
| |
| ===Skin===
| |
| * [[Pallor]] may be present
| |
| * [[Skin rash]] may be present
| |
| ===Head===
| |
| * Bulging fontanelles may be present (neonates)
| |
| ===Neck===
| |
| * [[Neck stiffness]] may be present
| |
| ===Lungs===
| |
| [[Respiratory failure]] is present in half of the patients
| |
| ===Throat===
| |
| * Mucosal [[rash]] may be present
| |
| ===Neurologic===
| |
| * [[Mental status]] may be altered
| |
| * [[Coma]] may be present
| |
| * [[Seizures]] may be present
| |
| * [[Focal neurologic signs]] may be present
| |
| * [[Autonomic dysfunction]] may be present
| |
| * [[Hemiparesis]] may be present
| |
| * [[Ataxia]] may be present
| |
| * [[Dystonia]] may be present
| |
| * Tremor may be present
| |
|
| |
| ==Brain Abscess==
| |
| ===Appearance of the Patient===
| |
| Patients often complain of [[headache]], [[drowsiness]], [[confusion]], [[speech difficulties]] and [[fever]] with a rapidly progressive course. These manifestations are a combination of increased [[intracranial pressure]] (due to a space-occupying lesion), infection, and focal neurologic brain tissue damage.
| |
| ===Vitals===
| |
| ====Temperature====
| |
| *A [[fever]] may be present
| |
| ====Pulse====
| |
| =====Rate=====
| |
| *[[Tachycardia]] may be present
| |
| =====Strength=====
| |
| *The pulse may be weak
| |
| ====Blood Pressure====
| |
| *[[Hypotension]] may be present
| |
| ====Respiratory Rate====
| |
| *[[Tachypnea]] may be present
| |
| ===Skin===
| |
| * [[Pallor]] may be present
| |
| * [[Skin rash]] may be present
| |
| ===Head===
| |
| * Bulging fontanelles may be present (neonates)
| |
| ===Eyes===
| |
| * [[Papilledema]] may be present
| |
| ===Neck===
| |
| * [[Neck stiffness]] may be present
| |
| ===Lungs===
| |
| [[Respiratory failure]] is present in half of the patients
| |
| ===Throat===
| |
| * Mucosal [[rash]] may be present
| |
| ===Neurologic===
| |
| * [[Mental status]] may be altered
| |
| * [[Coma]] may be present
| |
| * [[Speech difficulties]] may be present
| |
| * [[Seizures]] may be present
| |
| * [[Focal neurologic signs]] may be present
| |
| * [[Autonomic dysfunction]] may be present
| |
| * [[Hemiparesis]] may be present
| |
| * [[Ataxia]] may be present
| |
| * [[Dystonia]] may be present
| |
| * Tremor may be present
| |
|
| |
|
| ==Spinal Cord Infection== | | {| class="wikitable" style="border: 2; background: none;" |
| ===Vitals=== | | ! colspan="1" rowspan="1" style="border: 1; background: 1;" |Organ System |
| ====Temperature==== | | ! colspan="1" rowspan="1" |Findings |
| *A [[fever]] may be present
| | |- |
| ====Pulse====
| | ! rowspan="5" style="border: 1; background: none;" |Vital Signs |
| =====Rate===== | | |[[Fever]] |
| *[[Tachycardia]] may be present
| | |- |
| =====Strength=====
| | |[[Tachycardia]] |
| *The pulse may be weak
| | |- |
| ====Blood Pressure====
| | |[[Tachypnea]] |
| *[[Hypotension]] may be present
| | |- |
| ====Respiratory Rate====
| | |[[Hypotension]] |
| *[[Tachypnea]] may be present
| | |- |
| ===Skin===
| | |Weak peripheral [[pulses]] |
| * [[Pallor]] may be present
| | |- |
| * [[Skin rash]] may be present
| | ! rowspan="2" style="border: 1; background: none;" |Skin |
| ===Head===
| | |[[Pallor]] |
| * Bulging fontanelles may be present (neonates)
| | |- |
| ===Eyes=== | | |[[Cyanosis]] |
| * [[Papilledema]] may be present
| | |- |
| ===Neck===
| | ! rowspan="3" style="border: 1; background: none;" |'''HEENT''' |
| * [[Neck stiffness]] may be present
| | |Dry [[mucous membranes]] |
| ===Lungs=== | | |- |
| [[Respiratory failure]] is present in half of the patients | | |[[Lymphadenopathy]] |
| ===Throat===
| | |- |
| * Mucosal [[rash]] may be present
| | |[[Papilledema]] on fundoscopic exam |
| ===Abdomen===
| | |- |
| * [[Bladder]] dysfunction may be present
| | ! rowspan="2" style="border: 1; background: none;" |Neurologic |
| * [[Bowel]] dysfunction may be present
| | |[[Altered mental status]] |
| ===Extremities=== | | |- |
| * Decreased strength may be present
| | |[[Focal neurologic signs|Motor and sensory focal neurologic signs]] |
| ===Neurologic===
| | |- |
| * [[Mental status]] may be altered
| | ! rowspan="1" style="border: 1; background: none;" |Abdominal |
| * [[Coma]] may be present
| | |[[Abdominal tenderness]] |
| * [[Seizures]] may be present
| | |} |
| * [[Focal neurologic signs]] may be present
| |
| * [[Autonomic dysfunction]] may be present
| |
| * [[Hemiparesis]] may be present
| |
| * [[Ataxia]] may be present
| |
| * [[Dystonia]] may be present
| |
| * [[Tremor]] may be present
| |
|
| |
|
| ==Endocarditis== | | ==Central Nervous System Infection== |
| ===Vitals=== | | {| class="wikitable" style="border: 2; background: none;" |
| ====Temperature==== | | ! colspan="1" rowspan="1" style="border: 1; background: 1;" |Organ System |
| *A [[fever]] may be present
| | ! colspan="1" rowspan="1" |Findings |
| ====Pulse====
| | |- |
| * Wide [[pulse pressure]] may be present due to [[aortic insufficiency]]
| | ! rowspan="5" style="border: 1; background: none;" |Vital Signs |
| =====Rate=====
| | |[[Fever]] |
| *[[Tachycardia]] may be present
| | |- |
| =====Strength=====
| | |[[Tachycardia]] |
| *The pulse may be weak
| | |- |
| ====Blood Pressure====
| | |[[Tachypnea]] |
| *[[Hypotension]] may be present
| | |- |
| ====Respiratory Rate====
| | |[[Hypotension]] |
| *[[Tachypnea]] may be present
| | |- |
| ===Skin=== | | |Weak peripheral [[pulses]] |
| * [[Pallor]] may be present
| | |- |
| * [[Skin rash]] may be present
| | ! rowspan="2" style="border: 1; background: none;" |Skin |
| *[[Petechiae]] are present in 10-40% of patients
| | |[[Pallor]] |
| *[[Splinter hemorrhages]] are present in 5-15% of patients
| | |- |
| *[[Osler's nodes]] are present in 7-10% of patients
| | |[[Skin rash]] |
| *[[Janeway lesion]]s are present in 6-10% of patients
| | |- |
| ===Head===
| | ! rowspan="3" style="border: 1; background: none;" |'''HEENT''' |
| * Bulging fontanelles may be present (neonates)
| | |Bulging [[fontanelles]] may be present ([[neonates]]) |
| ===Eyes===
| | |- |
| * [[Papilledema]] may be present
| | |[[Papilledema]] on [[Fundoscopy|fundoscopic exam]] |
| *[[Conjunctival hemorrhage]] may be present
| | |- |
| *[[Roth's spot]]s in the [[retina]] may be present
| | |[[Neck stiffness]] may be present (typically absent in [[neonates]]) |
| ===Neck===
| | |- |
| * [[Neck stiffness]] may be present
| | ! rowspan="6" style="border: 1; background: none;" |Neurologic |
| ===Heart===
| | |[[Altered mental status]] |
| *[[Murmur|Heart Murmur]](s) are present in 80-85% of patients, including that of [[aortic insufficiency]], [[tricuspid regurgitation]] and [[mitral regurgitation]]
| | |- |
| ===Lungs===
| | |[[Focal neurologic signs|Motor and sensory focal neurologic signs]] |
| * [[Respiratory failure]] is present in half of the patients
| | |- |
| * [[Rales]] may be present
| | |[[Autonomic dysfunction]] may be present |
| ===Throat=== | | |- |
| * Mucosal [[rash]] may be present
| | |[[Hemiparesis]] may be present |
| * Patients in whom there is new acute onset of [[aortic regurgitation]], bobbing of the [[uvula]] may be present
| | |- |
| ===Abdomen===
| | |[[Ataxia]] may be present |
| * [[Abdominal pain]] may be present due to [[mesenteric]] [[embolization]] or [[ileus]], both of which may manifest as [[reduced bowel sounds]]
| | |- |
| * [[Splenomegaly]] may be present in 15-30% patients
| | |[[Dystonia]] may be present |
| * [[Left upper quadrant pain]] (LUQ pain) may be present, as a result of a [[splenic infarct]] from embolization
| | |} |
| * [[Flank pain]] may be present as a result of an [[embolus to the kidney]]
| |
| * [[Bladder]] dysfunction may be present
| |
| * [[Bowel]] dysfunction may be present
| |
| ===Extremities===
| |
| * [[Janeway lesion]]s may be present
| |
| * [[Gangrene]] of fingers may be present
| |
| * [[Splinter haemorrhage]]s may be present
| |
| * [[Osler's node]]s may be present
| |
| ===Neurologic===
| |
| * [[Septic emboli]] may result in [[stroke]] and focal neurologic findings
| |
| * [[Mental status]] may be altered
| |
| * [[Seizures]] may be present
| |
| * [[Focal neurologic signs]] may be present
| |
| * [[Autonomic dysfunction]] may be present
| |
| * [[Hemiparesis]] may be present
| |
| * [[Tremor]] may be present
| |
|
| |
|
| ==References== | | ==References== |
| {{Reflist|2}} | | {{Reflist|2}} |
|
| |
|
| [[Category:Bacterial diseases]] | | {{WH}} |
| | {{WS}} |
| | |
| | [[Category:Emergency mdicine]] |
| [[Category:Disease]] | | [[Category:Disease]] |
| | [[Category:Up-To-Date]] |
| [[Category:Infectious disease]] | | [[Category:Infectious disease]] |
| | | [[Category:Neurology]] |
| {{WH}}
| | [[Category:Gastroenterology]] |
| {{WS}}
| |