Listeriosis physical examination: Difference between revisions
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===Neurologic=== | ===Neurologic=== | ||
* Mental status may be altered | * Mental status may be altered | ||
==CNS Infection== | |||
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Because ''L. monocytogenes'' has tropism for the [[brain stem]] and [[meninges]], unlike other causes of [[bacterial meningitis]], ''Listeria'' tends to cause [[parenchymal]] [[brain]] [[infections]]. Therefore, most patients will experience altered consciousness, [[seizures]] and/or movement disorders, and will truly have [[meningoencephalitis]]. | |||
[[Central Nervous System]] [[infection]] is commonly manifested by [[meningoencephalitis]], while [[cerebritis]] is a less common manifestation. "In a study from the Massachusetts General Hospita, with [[CNS]] [[listeriosis]] outside [[neonatal]] period and [[pregnancy]], the most common predisposing factor for developing ''listerial'' [[meningitis]] was [[malignancy]], the second most common factor being [[transplantation]], followed by [[alcoholism]] and [[liver disease]], [[immunosuppression]] and [[steroid]] treatment, [[diabetes mellitus]] and [[HIV]]".<ref>{{Cite book | last1 = Mandell | first1 = Gerald L. | last2 = Bennett | first2 = John E. (John Eugene) | last3 = Dolin | first3 = Raphael. |title = Mandell, Douglas, and Bennett's principles and practice of infectious disease | date = 2010 | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | isbn = 0-443-06839-9 | pages = }}</ref> | |||
====Meningoencephalitis==== | |||
Occurs more frequently in [[neonates]] after 3 days of age, in [[immunocompromised]], and elderly patients. The clinical presentation can range from mild [[fever]] and [[mental status]] changes, to a more aggressive course with [[coma]]. There may also be an encephalic component, which will present with focal [[neurological]] signs, such as [[cranial nerve]] abnormalities, [[ataxia]], and [[hemiplegia]]. | |||
====Cerebritis/ Encephalitis==== | |||
Results from direct hematogenous invasion of [[cerebral]] [[parenchyma]], with or without [[meningeal]] involvement, probably sign of an early localised [[infection]] of the [[parenchyma]], which may eventually progress into [[brain abscess]]. [[Cerebritis]] may occur alongside [[meningitis]] in the same patient. | |||
In these cases, the clinical picture is dominated by ''altered consciousness'' or ''cognitive disfunction'', but may also manifest as<ref>{{Cite book | last1 = Mandell | first1 = Gerald L. | last2 = Bennett | first2 = John E. (John Eugene) | last3 = Dolin | first3 = Raphael. |title = Mandell, Douglas, and Bennett's principles and practice of infectious disease | date = 2010 | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | isbn = 0-443-06839-9 | pages = }}</ref> [[fever]] and [[hemiplegia]]. | |||
====Rhombencephalitis==== | |||
Rare manifestation of [[CNS infection]], which more commonly affects healthy individuals through the ingestion of food contaminated with ''Listeria'', often in [[outbreaks]]. Rhombencephalitis often follows a biphasic course, beginning with [[headache]], [[fever]], [[Nausea]] and [[vomiting]], for the first 4 days. Afterwards, this phase is followed by a period characterized by abut onset of asymmetric [[cranial nerve]] palsies, [[ataxia]], decreased [[consciousness]], [[seizures]], sensory deficits and [[respiratory failure]]. | |||
In this type of the disease, [[mortality]] is high and the survivors tend to experience serious [[sequelae]]. | |||
====Brain abscess==== | |||
Most cases occur in high risk patients. The [[subcortical]] [[abscesses]] tend to be located in the [[thalamus]], [[pons]] and/or [[medulla]], sites which are rarely affected by other [[bacteria]].<ref>{{Cite book | last1 = Mandell | first1 = Gerald L. | last2 = Bennett | first2 = John E. (John Eugene) | last3 = Dolin | first3 = Raphael. |title = Mandell, Douglas, and Bennett's principles and practice of infectious disease | date = 2010 | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | isbn = 0-443-06839-9 | pages = }}</ref>. | |||
====Spinal cord infection==== | |||
Rare cases of [[spinal cord]] involvement have been reported. However, when [[spinal cord]] is affected in the setting of acute [[bacterial meningitis]] of uncertain etiology, ''L. monocytogenes'' should be considered"<ref>{{Cite book | last1 = Mandell | first1 = Gerald L. | last2 = Bennett | first2 = John E. (John Eugene) | last3 = Dolin | first3 = Raphael. |title = Mandell, Douglas, and Bennett's principles and practice of infectious disease | date = 2010 | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | isbn = 0-443-06839-9 | pages = }}</ref>. | |||
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==References== | ==References== | ||
Revision as of 17:02, 23 July 2014
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Listeriosis Microchapters |
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Listeriosis physical examination On the Web |
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American Roentgen Ray Society Images of Listeriosis physical examination |
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Risk calculators and risk factors for Listeriosis physical examination |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]
Overview
Febrile Gastroenteritis
Appearance of the Patient
A patient with listeriosis will likely appear ill, complaining of fever, "body pain" and chills. Depending on the previous health status of the patient, the initial presentation may change, since this is an important factor in the evolution of the disease.
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
Pregnant women with listeriosis often present with flu-like symptoms. Unborn infants sustain the most severe complications, such as fetal death, stillbirth or meningitis.[1]
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
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