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==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==
===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}}

Latest revision as of 22:31, 29 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]

Overview

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:

Febrile Gastroenteritis

Organ System Findings
General Appearance Patient is ill-looking
Vital Signs Fever
Tachycardia
Tachypnea
Hypotension
Skin Pallor
HEENT Dry mucous membranes
Neurologic Altered mental status
Motor and sensory focal neurologic signs
Abdominal Abdominal tenderness
Abdominal distention

Sepsis of Unknown Origin

Organ System Findings
Vital Signs Fever
Tachycardia
Tachypnea
Hypotension
Weak peripheral pulses
Skin Pallor
Cyanosis
HEENT Dry mucous membranes
Lymphadenopathy
Papilledema on fundoscopic exam
Neurologic Altered mental status
Motor and sensory focal neurologic signs
Abdominal Abdominal tenderness

Central Nervous System Infection

Organ System Findings
Vital Signs Fever
Tachycardia
Tachypnea
Hypotension
Weak peripheral pulses
Skin Pallor
Skin rash
HEENT Bulging fontanelles may be present (neonates)
Papilledema on fundoscopic exam
Neck stiffness may be present (typically absent in neonates)
Neurologic Altered mental status
Motor and sensory focal neurologic signs
Autonomic dysfunction may be present
Hemiparesis may be present
Ataxia may be present
Dystonia may be present

References

Template:WH Template:WS

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