Listeriosis physical examination: Difference between revisions

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Latest revision as of 22:31, 29 July 2020

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
Infection in pregnancy
Sepsis of unknown origin
Meningoencephalitis
Encephalitis
Rhombencephalitis
Brain abscess
Spinal cord infection
Endocarditis

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
Neurologic	Motor and sensory focal neurologic signs
Abdominal	Abdominal tenderness
Abdominal	Abdominal distention

Sepsis of Unknown Origin

Organ System	Findings
Vital Signs	Fever
	Tachycardia
	Tachypnea
	Hypotension
	Weak peripheral pulses
Skin	Pallor
Skin	Cyanosis
HEENT	Dry mucous membranes
	Lymphadenopathy
	Papilledema on fundoscopic exam
Neurologic	Altered mental status
Neurologic	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	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

@@ Line 4: / Line 4: @@
 ==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:
+* [[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==
-===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==
+{| class="wikitable" style="border: 2; background: none;"
-Pregnant women with [[listeriosis]] often present with [[flu]]-like [[symptoms]]. Unborn infants sustain the most severe [[complications]], such as [[fetal death]], [[stillbirth]] or [[meningitis]].<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==
-===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
-==CNS Infection==
-===Meningoencephalitis===
-===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
-===Neurologic===
-* [[Mental status]] may be altered
-* [[Seizures]] may be present
-* [[Focal neurologic signs]] may be present
-===Cerebritis/ Encephalitis===
-===Rhombencephalitis===
-===Brain abscess===
-===Spinal cord infection===
-<!--
- 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====
+{| class="wikitable" style="border: 2; background: none;"
-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>.
+! colspan="1" rowspan="1" style="border: 1; background: 1;" |Organ System
+! colspan="1" rowspan="1" |Findings
+|-
+! rowspan="5" style="border: 1; background: none;" |Vital Signs
+|[[Fever]]
+|-
+|[[Tachycardia]]
+|-
+|[[Tachypnea]]
+|-
+|[[Hypotension]]
+|-
+|Weak peripheral [[pulses]]
+|-
+! rowspan="2" style="border: 1; background: none;" |Skin
+|[[Pallor]]
+|-
+|[[Cyanosis]]
+|-
+! rowspan="3" style="border: 1; background: none;" |'''HEENT'''
+|Dry [[mucous membranes]]
+|-
+|[[Lymphadenopathy]]
+|-
+|[[Papilledema]] on fundoscopic exam
+|-
+! rowspan="2" style="border: 1; background: none;" |Neurologic
+|[[Altered mental status]]
+|-
+|[[Focal neurologic signs|Motor and sensory focal neurologic signs]]
+|-
+! rowspan="1" style="border: 1; background: none;" |Abdominal
+|[[Abdominal tenderness]]
+|}
--->
+==Central Nervous System Infection==
+{| class="wikitable" style="border: 2; background: none;"
+! colspan="1" rowspan="1" style="border: 1; background: 1;" |Organ System
+! colspan="1" rowspan="1" |Findings
+|-
+! rowspan="5" style="border: 1; background: none;" |Vital Signs
+|[[Fever]]
+|-
+|[[Tachycardia]]
+|-
+|[[Tachypnea]]
+|-
+|[[Hypotension]]
+|-
+|Weak peripheral [[pulses]]
+|-
+! rowspan="2" style="border: 1; background: none;" |Skin
+|[[Pallor]]
+|-
+|[[Skin rash]]
+|-
+! rowspan="3" style="border: 1; background: none;" |'''HEENT'''
+|Bulging [[fontanelles]] may be present ([[neonates]])
+|-
+|[[Papilledema]] on [[Fundoscopy|fundoscopic exam]]
+|-
+|[[Neck stiffness]] may be present (typically absent in [[neonates]])
+|-
+! rowspan="6" style="border: 1; background: none;" |Neurologic
+|[[Altered mental status]]
+|-
+|[[Focal neurologic signs|Motor and sensory focal neurologic signs]]
+|-
+|[[Autonomic dysfunction]] may be present
+|-
+|[[Hemiparesis]] may be present
+|-
+|[[Ataxia]] may be present
+|-
+|[[Dystonia]] may be present
+|}
 ==References==
 {{Reflist|2}}
-[[Category:Bacterial diseases]]
+{{WH}}
+{{WS}}
+[[Category:Emergency mdicine]]
 [[Category:Disease]]
+[[Category:Up-To-Date]]
 [[Category:Infectious disease]]
+[[Category:Neurology]]
-{{WH}}
+[[Category:Gastroenterology]]
-{{WS}}