| Symptom/Sign |
Definition |
| >arthralgia |
Joint pain; |
| >fatigue |
Tiredness; Lassitude; |
| >fever |
In hospitalized patients, common conditions with fever usually <102 F:
Acute cholecystitis; MI; Phlebitis; PE; Viral hepatitis; Wound infections; Cystitis;
Conditions with fever >102 F:
Cholangitis; Pericarditis; Suppurative thrombophlebitis; Septic PE; Nonviral hepatitis; Deep abscesses; Bowel infarction; Pyelonephritis;
Abbreviations: MI = myocardial infarction; PE = pulmonary emboli; [ID, p. 62] |
| >fever, biphasic |
Fever pattern in which the initial fever breaks and then returns again; [ID, p. 55] |
| >myalgia |
Aches and pains in the muscles; |
| >relative bradycardia |
Slow heart rate; A relative bradycardia (relative to fever) is defined as <140 for 105, <130 for 104, <120 for 103, < 110 for 102, and <100 for 101 degrees Fahrenheit. [ID, p. 56] Relative bradycardia in acute pneumonia suggests viral infection or infection by mycoplasma, chlamydia, Legionella, or tularemia. [PPID, p. 896] |
| E dysphagia |
Difficulty swallowing caused by either local injury (mouth, throat, and esophagus) or central nervous system disease; |
| E epistaxis |
Nosebleed; "Most epistaxes occur secondary to local trauma (including nose blowing and picking) and drying of the nasal mucous membrane." [Merck Manual, p. 827] |
| E nasal ulcers |
Sores in the nose; |
| E pharyngitis |
Sore throat; |
| E rhinitis |
Runny nose, rhinorrhea; Common colds are caused by rhinoviruses (20%) and other viruses (coronoaviruses, influenza, parinfluenza, RSV, and certain enteroviruses. The cause of about 1/2 of all common colds is unknown. [CCDM, p. 516] |
| E stomatitis |
Inflammation of the mouth or sores in the mouth; 20-30% of adults have recurrent aphthous ulcers (cause unknown); Rare viral causes of stomatitis are Epstein-Barr, influenza, CMV, and HIV; Acute necrotizing ulcerative gingivitis is caused by fusospirochetal bacteria; [Merck Manual, p. 815-8] Rare causes of stomatitis are granuloma inguinale, chancroid, diphtheria, Crimean-Congo hemorrhagic fever, asd aspergillosis. [GIDEON] |
| G abdominal mass |
An enlarged organ, cyst, tumor, or abscess in the abdominal cavity; |
| G abdominal pain |
|
| G blood in stool |
Bloody diarrhea; Hematochezia (red blood in stool from intestinal bleeding); Melena (black stool from digested blood); |
| G constipation |
|
| G diarrhea |
|
| G fecal leukocytes |
Pus in stool; Inflammatory diarrhea; In community-acquired diarrhea, fecal leukocytes are suggestive of C. jejuni, C. difficile, Salmonella, or Shigella; [ABX Guide, p. 91] Detected by Gram stain or, more reliably, by lactoferrin; [PPID, p. 242] In inflammatory diarrhea, the fecal lactoferrin latex agglurination titer is 1:50 or higher. [PPID, p. 1345] |
| G hematemesis |
Blood in vomitus; |
| G hepatomegaly |
Liver enlargement; Causes of fever and hepatomegaly include: amebic liver abscess, babesiosis, Bartonella species infection, brucellosis, Chagas' disease, clonorchiasis, echinococcosis, fascioliasis, histoplasmosis, malaria, mononucleosis, viral hepatitis, opisthorchiasis, psittacosis, relapsing fever, Rocky Mountain spotted fever, schistosomiasis, syphilis, toxocariasis, tuberculosis, tularemia, typhoid fever, typhus, visceral leishmaniasis. [ID, p. 62, Table 5.12] Hepatomegaly is present in about 85% of patients with acute viral hepatitis. [PPID, p. 1580] |
| G jaundice |
Yellow color of skin and sclerae (white part of the eyes) due to elevated bilirubin; Icterus; Increased bilirubin is caused by liver disease, bile duct obstruction, or hemolytic anemia. |
| G liver function test, abnormal |
An abnormal laboratory test, usually referring to elevated liver enzymes in the blood due to liver injury; Other causes of granulomatous hepatitis are coccidioidomycosis, blastomycosis, cryptococcosis, aspergillosis, mucormycosis, nocardiosis, toxocariasis, influenza B, and Whipple's disease. [Cecil, p. 1128-35] AIDS-related cholangitis is most likely related to infection with cytomegalovirus, Cryptosporidium, or Microsporidia. [Merck Manual, p. 246] |
| G nausea, vomiting |
|
| H anemia |
Decreased red blood cells or decreased hemoglobin; Rare infectious causes of anemia are Brazilian purpuric fever, Gas gangrene, Cytomegalovirus, Fascioliasis, Microsporidiosis, Osteomyelitis, Urinary Schistosomiasis, Septicemia, Shigellosis, Smallpox, Toxic shock syndrome, Epidemic typhus, Scrub typhus, and Yersiniosis; [GIDEON] |
| H eosinophilia |
Infections that may cause eosinophilia include hookworm, filariasis, schistosomiasis, echinococossis, coccidioidomycosis, brucellosis, cat-scratch fever, and mycobacterial disease. [Merck Manual, p. 1094] The most common causes of eosinophilia in a returning traveler are schistosomiasis and strongyloidiasis. Serology tests are available for these two diseases. A normal eosinophil count is <350/mm3. Massive eosinophilia (>5000/mm3) may be seen in strongyloidiasis, tropical pulmonary eosinophilia (filariasis), visceral larva migrans, and trichinellosis. [PPID, p. 4026] See Table 98-4 for causes of eosinophilia with abdominal pain and/or diarrhea. [PPID, p. 1407] |
| H hemoglobinuria |
Hemoglobin in urine; "Intravascular hemolysis is uncommon; it results in hemoglobinuria when the Hb released into plasma exceeds the Hb-binding capacity of plasma-binding proteins (eg, haptoglobin, a globulin normally present in concentrations of about 1.0 g/L in plasma)." [Merck Manual, p. 1046] Urine reagent strips detect heme peroxidase activity in hemoglobin or myoglobin. Free hemoglobin causes pink serum; myoglobin causes clear serum; [Wallach, p. 96-101] Acute rhabdomyolysis with myoglobinuria is associated with the weakness observed in many systemic infections, e.g., influenza, adenovirus, SARS, Mycoplasma pneumoniae, Legionella pneumophila, HIV, Epstein-Barr, measles, varicella, dengue, parvovirus B19, West Nile virus, bacterial sepsis, leptospirosis, brucellosis, and rickettsial infections.[PPID, p. 1321] Other causes of hemolytic anemia are bacterial endocarditis, miliary TB, mononucleosis, pssitacosis, and Clostridium welchii (puerperal infections); [DXplain] |
| H hypergammaglobulinemia |
In the evaluation of splenomegaly, hypergammaglobulinemia (increased gamma globulin in the blood) suggests: 1.) a chronic infection such as malaria, kala-azar, brucellosis, or TB; 2.) hepatic cirrhosis; 3.) sarcoidosis; or 4.) collagen vascular diseases. [Merck Manual, p. 1091] "Polyclonal gammopathy is characteristic of HIV, African trypanosomiasis, kala-azar, and non-acute malaria." [ID, p. 161] One of the causes of polyclonal gammopathy with hyperproteinemia is chronic infection, including TB, osteomyelitis, SBE, mononucleosis, malaria, leishmaniasis, and trypanosomiasis. [Wallach, p. 78] Other diseases associated with hypergammaglobulinemia are infective endocarditis, ascariasis, babesiosis, Q fever, and angiostrongyliasis. [DXplain] |
| H leukocytosis |
Increased white blood cells; normal white blood cell count equals 4,500-10,000 per microliter; Patients with meningococcemia may have a normal WBC count, but increased bands and other immature WBCs referred to as a left shift. [Wilson, p. 68] Leucocytosis (neutrophilia) in acute fever: sepsis, abscess, amebiasis (usually), leptospirosis (usually), Still's disease, and lymphoma (uncommon); [Cohen, p. 685] WBC counts are typically low in viral hemorrhaghic fevers early in the course, but may be elevated later. [Cohen, p. 1249] Leukocytosis is a normal response to a bacterial or fungal infection. [PPID, p. 998] Elevated lymphocyte counts are common in viral infections, e.g., mononucleosis and hepatitis, and also in pertussis. [Cecil, p. 1262-3] |
| H leukopenia |
Decreased white blood cells; normal white blood cell count equals 4,500-10,000 per microliter; Neutropenia = <500 cells/mm3 or <1000 cells/mm3 with predicted decline to <500 cells/m3; [ABX Guide, p. 62] Common in many viral infections, e.g., rubella and influenza, and in severe sepsis; In returned travelers, it accompanies malaria, typhoid, brucellosis, rickettsial diseases, and visceral leishmaniasis. [Cohen, p. 685] Leukopenia is common in patients with typhoid fever, Rocky Mountain spotted fever, Colorado tick fever, and ehrlichiosis. [PPID, p. 1000] |
| H lymphadenopathy |
Enlargement of lymph nodes, either regional or generalized and either acute or chronic; Ulceroglandular and oculoglandular are two types of regional lymphadenopathy associated with a skin entry wound or conjunctivitis, respectively. [PPID, p. 1209] See "entry wound with lymph nodes," "lymphadenitis, acute," "oculoglandular syndrome," and "nodular lymphangitis." Causes of chronic lymphadenopathy include syphilis, HIV, TB, histoplasma, cryptococcosis, lymphoma, sarcoid, cat scratch disease (localized), and metastatic cancer (localized). Stony hard lymph nodes suggest cancer or actinomycosis. Rubbery lymph nodes suggest lymphoma. [ABX Guide] "Pain and tenderness typically distinguish lympadenitis from lymphadenopathy." [Merck Manual, p. 984] Lymphadenopathy is very common in childhood; it is benign in about 80% of cases. [Cohen, p. 172] |
| H splenomegaly |
Enlargement of the spleen; Causes of fever and splenomegaly include: Babesiosis, Brucellosis, Chagas disease, Histoplasmosis, Malaria, Mononucleosis, Psittacosis, Relapsing fever, Rocky Mountain spotted fever, Schistosomiasis, Subacute bacterial endocarditis, Syphilis, Toxocariasis, Tuberculosis, Tularemia, Typhoid fever, Typhus, Visceral leishmaniasis. [ID, p. 62, Table 5.12] Causes of mild splenomegaly include sepsis, hepatitis, and lepromatous leprosy and erythema nodosum leprosum. Mild splenomegaly is present in about 5% of cases of acute hepatitis. [Cohen, p. 1095, 411] Splenomegaly is present in about 15% of cases of acute viral hepatitis. [PPID, p. 1580] |
| H thrombocytopenia |
Low platelet count; Signs of severe thrombocytopenia include petechiae, ecchymoses at sites of minor trauma, and mucosal bleeding. [Merck Manual, p. 1065] Acute thrombocytopenia, but not chronic thrombocytopenia, is associated with sepsis and is short-lived. Drugs are the most common cause of thrombocytopenia in the hospital. Infections associated with thrombocytopenia include measles, rubella, dengue, hemorrhagic fevers, EBV, CMV, varicella, mumps, HIV, TSS, trypanosomiasis, malaria, ehrlichiosis, typhus, and Rocky Mountain spotted fever. [ID, p. 160] |
| N delirium |
"A state of temporary mental confusion and clouded consciousness resulting from high fever, intoxication, or shock and characterized by anxiety, tremors, hallucinations, delusions, and incoherence" [American Heritage Dictionary] Delirium is a sign of high fever, especially in children and elderly patients. [Cohen, p. 679] Infectious causes include encephalitis, meningitis, pneumonia, sepsis, and pyelonephriitis. [Merck Manual, p. 1810] |
| N headache |
Head pain; Cephalgia; |
| N opisthotonos |
Abnormal rigidity and arching of the back most commonly seen in cases of meningitis, especially in infants; Opisthotonos also occurs in cases of strychnine poisoning, rabies, and tetanus. |
| N paresthesia |
Tingling or numbness; |
| N seizure |
Convulsion; Febrile seizures occur in children less than 6 years of age (especially 6-18 months) with fever >38 deg C (100.4 deg F); [Merck Manual, p. 2374] |
| N stiff neck |
A stiff neck with flexion indicates meningeal irritation from subarachnoid hemorrhage or an infectious process such as meningitis. [Merck Manual, p. 1844] Meningismus; |
| N weakness |
Not fatigue, but weakness of the muscles; reduced strength; Weakness of specific muscles is a focal neurological sign seen in encephalitis and other CNS infections. Acute rhabdomyolysis with myoglobinuria is associated with the weakness observed in many systemic infections, e.g., influenza, adenovirus, SARS, Mycoplasma pneumoniae, Legionella pneumophila, HIV, Epstein-Barr, measles, varicella, dengue, parvovirus B19, West Nile virus, bacterial sepsis, leptospirosis, brucellosis, and rickettsial infections.[PPID, p. 1321] Urine reagent strips detect heme peroxidase activity in hemoglobin or myoglobin. Free hemoglobin causes pink serum; myoglobin causes clear serum; [Wallach, p. 96-101] |
| O conjunctivitis, acute |
Inflammation or infection of the conjunctiva of the eyes; pink eye; |
| O oculoglandular syndrome |
Parinaud's oculoglandular syndrome; A unilateral conjunctival ulcer or conjunctivitis associated with swelling of the preauricular lymph node; Cat-scratch disease is the most common cause in the US. [ID, p. 1245; Guerrant, p. 1005; PPID, p. 1326, 1536] |
| R chest pain |
Chest pain, made worse by breathing (pleuritic), or otherwise; |
| R cough |
|
| R dyspnea, acute |
Shortness of breath, acute; Acute dyspnea is an uncomfortable sensation of difficulty breathing or shortness of breath that develops during a brief period of time, i.e., seconds to hours. |
| R hemoptysis |
Coughing up blood; Causes of hemoptysis in developing countries include tuberculosis, mycoses, echinococcosis, paragonimiasis, amoebiasis, leptospirosis, and melioidosis. [Guerrant, p. 987] |
| R sputum production |
Coughing up phlegm; |
| R wheezing |
A symptom and a physical finding, wheezing is the result of airway narrowing. [Merck Manual, p. 363] |
| S entry wound with lymph nodes |
An infectious agent enters through the skin and provokes regional lymphadenopathy as in ulceroglandular tularemia; |
| S lymphadenitis, acute |
Tender, inflamed lymph nodes; may be associated with lymphangitis and have a tendency to suppurate (drain pus) or form buboes, e.g., in cat-scratch disease, tularemia, and plague; [PPID, p. 1328] Campylobacter jejuni, Yersinia enterocolitica, and Salmonella enteritidis can cause mesenteric lymphadenitis and pseudoappendicitis. [PPID, p. 2797] "Pain and tenderness typically distinguish lympadenitis from lymphadenopathy." [Merck Manual, p. 984] |
| S lymphangitis |
Acute infammation of lymph vessels, most commonly caused by Streptococcal cellulitis; [Merck Manual, p. 985] Group A Streptococci and S. aureus are common causes. Rare causes are Pasteurella multocida, nocardia, atypical mycobacteria, Sporothrix schenckii, and filariasis. [ABX Guide] Strept lymphangitis is common. Occasional causes are S. aureus, P. multocida, and S. schenckii; Other causes are rare or very rare. [PPID, p. 1331] |
| S nodular lymphangitis |
Cutaneous inoculation, usually of an extremity, followed by the development of nodules in the draining lymphatics that may ulcerate or drain. Sporothrix schenckii, Nocardia brasiliensis, Mycobacterium, and Leishmania brasiliensis are the most important causes in the U.S. [Am Fam Physician 2001;63:326-32] "Rope-like lymphangitis" has been described in11 patients infected with Rickettsia sibirica subsp mongolotimonae, one of the 14 members of the spotted fever rickettsioses. [Cohen, p. 1809] |
| S papules or plaques |
Papule: a raised, swollen area of the skin < 10 mm in diameter; Plaque: a raised skin lesion or confluent papules > 10 mm in diameter; [Merck Manual, p. 932] |
| S petechiae and ecchymoses |
Tiny (< 3 mm) nonblanchable foci of extravasated blood in the skin with larger areas being called ecchymoses or purpura; Caused by thrombocytopenia or platelet dysfunction; [Merck Manual, p. 933; PPID, p. 796] Staphlococcus aureus, adenovirus, congenital cytomegalovirus, and rubella virus infections may cause petechial purpuric eruptions. [Cohen, p. 156] Diffuse petechial lesions may occur in critically ill patients and are associated with peripheral gangrene, consumptive coagulopathy, and shock. [PPID, p. 796] Purpura fulminans is a manifestation of DIC and a complication of Group A streptococci, N. meningitidis, S. aureus, and pneumococcus infections. [PPID, p. 1290] |
| S pustule |
Pustules are elevated, superficial lesions containing pus. Pustules are seen in folliculitis, acne, chloracne, pustular psoriasis, anthrax, and orf. Pustules may occur from bacterial or fungal skin infections and have been described after chronic antimony poisoning. [Merck Manual, p. 933; Ladou, p. 407] |
| S rash (exanthem) |
A skin eruption caused by an infectious disease; an exanthema; 1% to 8% of patients taking antibiotics have a cutaneous reaction. Consider a drug reaction in patients with a maculopapular rash, expecially when palmoplantar involvement. [PPID p. 792] Other causes of a macular or papular rash are adenovirus, cytomegalovirus, and disseminated fungal infections (Blastomyces dermatitidis, Candida spp., Coccidioides immitis, Cryptococcus neoformans, Fusarium spp., and Histoplasma capsulatum). [Cohen, p. 156] |
| S rash on palms |
Rash on palms of hands and soles of feet; 1% to 8% of patients taking antibiotics have a cutaneous reaction. Consider a drug reaction in patients with a maculopapular rash, expecially when palmoplantar involvement. [PPID p. 792] |
| S skin lesion, circinate |
Circular or ring-shaped; Erythema migrans is a red papule that slowly expands and typically reaches a diameter of at least 5 cm. The enlarging papule often clears centrally to create a annular (shaped like a ring) rash at the site of the tick bite. It is the first sign of Lyme disease in about 90% of cases. [CCDM, p. 315] In differential diagnosis, consider cellulitis and allergic reaction to tick saliva. [Harrison's Practice] Ring-like rashes occur in other diseases, e.g., ringworm and the concentric rings (target lesions) of erythema multiforme. Other circular rashes are cellulitis, erysipeloid, erysipelas, and erythrasma. |
| S skin or subcutaneous nodule |
A firm or hard mass under the skin; |
| S skin vesicles |
Vesicular eruption; Small blisters; Vesiculobullous dermatoses |
| S ulcer of skin |
Injury to the top layers of the skin to produce a crater or "open sore"; |
| S urticaria |
Hives; Itchy red papules that are transient; the papules may be localized or widespread; See "Differential Diagnosis of Pruritic and Urticarial Skin Lesions." [Guerrant, p. 959-61] |
| S warty growth of the skin |
Warty or verrucous growth of the skin caused by an infection; papillomata; |
| S skin lesion, linear or serpiginous |
A serpiginous or snake-like rash is seen in cutaneous larva migrans. [White, p. 5] |
| U hematuria |
Blood in the urine; Normal urine may contain as many as a few red blood cells (RBCs) per high-powered field (hpf) when examined under the microscope. Greater than 3 RBCs/hpf is abnormal. After "very strenuous exercise," 18% of subjects have microscopic hematuria. [Wallach, p. 94] |
| U pyuria |
Pus in urine; |
| X cystic or cavitary lesions |
See Table 16.3 in Sullivan, p. 213. See "Differential Diagnosis of a Cavitary Lesion on Chest Radiograph." [ID, p. 544] |
| X hilar lymphadenopathy |
Enlargement of lymph nodes in the mediastinum is one of the many causes of mediastinal masses; [Merck Manual, p. 490] The most common causes of mediastinal lymphadenopathy are sarcoidosis, tuberculosis, fungal infection, histoplasmosis, and Cryptococcus (in AIDS patients); Anthrax causes necrotic, edematous hilar and mediastinal lymph nodes; [PPID, p. 1326] See "mediastinal widening." |
| X lung infiltrates |
Abnormal pulmonary density visible on chest x-ray caused by infection (pneumonia) or chemical irritant (pneumonitis); varies from minimal "fluffy" fluid densities to frank consolidation; |
| X mediastinal widening |
Enlargement of the mediastinum (an anatomical compartment located in the chest cavity between the lungs); "A widened mediastinum on chest radiograph in a previously healthy patient with evidence of overwhelming flu-like illness is essentially pathognomonic of advanced inhalational anthrax and should prompt immediate action. [Inglesby TV et al. Anthrax as a Biological Weapon. JAMA.1999;281:1735-1745] The main causes of mediastinitis are esophageal perforation, infection of head and neck, infection from other sites, and cardiothoracic surgery. Unusual causes are anthrax, brucellosis, actinomycosis, paragonimiasis, and Streptococcus pneumoniae. [PPID, p. 1173] Rare causes of mediastinistis are amoebic abscess, aspergillosis, candidiasis, nocardiosis, invasive fungi, bacterial pericarditis, and bacterial pneumonia. [GIDEON] See "hilar lymphadenopathy." |
| X pleural effusions |
Collection of fluid in the pleural space (between the lungs and chest wall); See Table 16.3 in Sullivan, p. 213. Tropical infectious diseases that cause pleural effusions include tuberculosis, paragonimiasis, cryptococcosis, toxocariasis, echinococcosis, amebiasis, sparganosis, and gnathostomiasis. [Guerrant, p. 987] |
| *acute renal failure |
"Acute renal failure (ARF) is defined as a precipitous and significant (>50%) decrease in glomerular filtration rate (GFR) over a period of hours to days, with an accompanying accumulation of nitrogenous wastes in the body." [eMedicine, 2004] |
| *ARDS |
Acute respiratory distress syndrome (ARDS) is characterized by 1.) severe hypoxemia, 2.) bilateral pulmonary infiltrates, and 3.) absence of heart failure. Causes include direct injury (pulmonary infections, inhalation of corrosive gases, lung contusion) or indirect injury (narcotic overdose, burns, shock, trauma, sepsis). [5MCC-2006; Harrison, p. 649-51] |
| *arthritis |
Causes of acute arthritis include: N. gonorrhea, S aureus, streptococci, B. burgdorferi, H. influenza, P. multocida, S. moniliformis, S. minus, Salmonella, parvovirus B19, hepatitis B, hepatitis C, rubella, varicella, mumps, adenoviruses, coxsackie viruses, and EBV. Causes of chronic arthritis include M. tuberculosis, C. immitis, H. capsulatum, C. neoformans, B. dermatitidis, S. schenckii, and Brucella sp. [Merck Manual, p. 312-17] Causes of Reiter's syndrome (reactive arthritis) include Chlamydia trachomatis, Salmonella, Shigella, Yersinia, Campylobacter, and HIV infections. [PPID, p. 1491-2] Causes of parasitic arthritis include Echinococcus granulosus and Schistosomiasis. [Harrison's Practice] |
| *bleeding tendency |
Bleeding into the skin, mouth, nose, and gastrointestinal tract; Bleeding diathesis; In most viral hemorrhagic fevers, the etiology of the bleeding is multifactorial and includes liver injury, consumptive coagulopathy, and marrow dysfunction. [USAMRIID, p. 149] |
| *blindness |
Permanent and severe loss of vision from infection of the eye or brain (cortical blindness); |
| *bowel obstruction |
Blockage of intestines; |
| *brain abscess or lesion |
Bacteria isolated from brain abscesses are usually anaerobic. [Merck Manual, p. 1850] S. pneumoniae, H. influenzae, L. monocytogenes, and Salmonella spp. are rarely isolated. Fungal causes mainly in the immunosuppressed include Candida spp., Aspergillus spp., mucormycosis, and Scedosporium spp. Causes of fungal meningitis can also cause abscesses (cryptococcosis, blastomycosis, histoplsamosis, and coccioidomycosis). Parasitic causes include Toxoplasma gondii, Trypanosoma cruzi, Entamoeba histolytica, Schistosoma spp., Paragoniumus spp. and Taenia solium. [PPID, p. 1265-6] Rare causes of cerebral mass or cyst: Angiostrongyliasis, Chromomycosis, Herpes simplex encephalitis, Nontuberculous mycobacteria, and Urinary schistosomiasis; [GIDEON] |
| *cirrhosis |
Chronic liver disease with fibrosis and portal hypertension; |
| *cranial neuropathy |
"Neuropathy refers to injury to one or more nerves at any level along their pathways and is termed cranial or peripheral based on the nerve involved." [ID, p. 1365] Occurs infrequently in cases of viral encephalitis unless accompanied by brain stem infection. [PPID, p. 1246] In acute bacterial meningitis, cranial nerve palsies are caused by meningeal inflammation or increased CSF pressure. [Cohen, p. 213] The following rarely cause cranial nerve palsies: Adenovirus infection; Arenaviral hemorrhagic fever (S. America); Arthropod-borne viral arthritis and rash; Coccidioidomycosis, Colorado tick fever; Ehrlichiosis; Influenza; Kawasaki disease; Kyasanur Forest disease; Leishmaniasis; Measles; Nocardiosis; Paracoccidioidomycosis; Parvovirus B19 infection; Respiratory syncytial virus infection; Rift Valley fever; Rocky Mountanin spotted fever; Rubella; Schistosomiasis - japonicum; Typhus -epidemic; Typhus - scrub; [GIDEON] |
| *encephalitis |
Inflammation of the brain; |
| *endocarditis |
Inflammation of the tissue lining the heart's cavity and valves; Fungal causes include Candida, Aspergillus, Histoplasma, Blastomyces, Coccidiodes, Cryptococcus, Scedosporium prolificans, and Mucor; [PPID, p. 1085] |
| *epididymo-orchitis |
Inflammation of epididymis and testis; C. trachomatis and N. gonorrhea are the most likely pathogens in younger males and E. coli, S. aureus, and M. tuberculosis in older males. [Lexi-ID, p. 131] |
| *erythema nodosum |
Cause not determined in up to 60% of cases; Bacterial causes include streptococcus, tuberculosis, leprosy, Yersinia enterocolitica, tularemia, Campylobacter, salmonella, shigella, and gonorrhea. Fungal causes include dermatophytes, coccidioidomycosis, histoplasmosis, and blastomycosis. Other causes include sarcoidosis, drugs, pregnancy, inflammatory bowel disease, mononucleosis, lymphogranuloma venereum, and malignancies. [5MCC-2004; Merck Manual, p. 975; ID, p. 61] Other known causes are infections by hepatitis B, herpes simplex, HIV, measles, parvovirus B19, varicella, diphtheria, Q fever, chancroid, M. marinum, N. meningitidis, syphilis, sporotrichosis, ascariasis, giardiasis, toxoplasmosis, and filariasis. [PPID, p. 796] Other causes are leptospirosis, inflammatory dermatophyte infections, and upper respiratory tract viruses. [Cohen, p. 157] |
| *glomerulonephritis |
Inflammation of kidneys involving capillaries of the renal glomeruli; Glomerulonephritis in malaria and subacute endocarditis are probably secondary to Type III or immune-complex mediated hypersensitivity. [Cohen, p. 25] |
| *meningitis |
Meningitis is inflammation of the meninges, the membranes that cover the brain and spinal cord. Causes of chronic meningitis include TB, cryptococcosis, coccidioidomycosis, histoplasmosis, blastomycosis, syphilis, brucellosis, toxoplasmosis, and Lyme disease. |
| *myocarditis |
Inflammation of the myocardium, the heart muscle; See 64 infectious causes of myocarditis; [PPID, Table 81-1] |
| *osteomyelitis |
Hematogenous osteomyelitis follows bacteremia and usually affects the spine and the metaphyses of long bones. The most common causes of hematogenous osteomyelitis are Staphlococcus aureus, Haemophilus influenza, and in infants, Group B streptococci. Patients with sickle cell disease are susceptible to Salmonella osteomyelitis. [ID, p. 1225-6] |
| *pancreatitis |
Inflammation of the pancreas; Cause is usually noninfectious (alcohol, gallstones, medications, triglycerides, post-ERCP). Infectious causes include viruses (mumps, coxsackie virus, CMV, varicella-zoster, HSV, HIV, and hepatitis B), bacteria (mycoplasma, mycobacteria, Legionella, Leptospira, and salmonella), Fungi (Cryptococcus when HIV infected, PCP, and aspergillus), and parasites (toxoplasma, cryptosporidia, and ascaris). [ABX Guide] AIDS patients are at risk due to infections (CMV, Cryptosporidium, and Mycobacterium avium complex) and drugs (didanosine, pentamidine, and trimethoprim-sulfamethoxazole). [Harrison's Practice] Pancreatic Infection without Acute Pancreatitis: Aspergillus, M. tuberculosis, M. avium, Actinomyces, Nocardia asteroides, Cryptococcus neoformans, Coccidioides immitis, Paracoccidioides brasiliensis, Histoplasma capsulatum, Candida spp., Zygomycetes, Pneumocystis jirovecii, Leishmania donovani, Entamoeba histolytica, Strongyloides stercoralis, Schistosoma haematobium, Paragonimus westermani, Clonorchis sinensis, Echinococcus granulosus; [PPID, p. 959] |
| *paralysis |
"Impairment or loss of esp. the motor function of the nerves;" [The Oxford Dictionary and Thesaurus. New York: Berkley Books, 1997] Palsy; |
| *parotitis |
Acute infection and enlargement of one or both parotid glands; Mumps parotitis is usually bilateral. S. aureus is the most common etiology in suppurative infections. Other possible causes are coxsackievirus, influenza virus, parainfluenza virus 1 and 3, LCM, CMV, and HIV. TB, actinomycosis, and HIV can cause chronic parotitis. [ID, p. 427] Silaloadenitis; |
| *pericarditis |
Inflammation of the pericardium, the membrane that encloses the heart; See "Causes of Acute Pericarditis." [ID, p. 590] See Table 81-3 in PPID and 46.3 in Cohen. |
| *peripheral neuropathy |
Inflammatory or toxic neuropathy that impairs nerve function (sensory and/or motor); "Neuropathy refers to injury to one or more nerves at any level along their pathways and is termed cranial or peripheral based on the nerve involved." [ID, p. 1365] |
| *pneumonia |
Infection of the lungs; |
| *sepsis |
Sepsis is an inflammatory response that includes fever, tachycardia, and leukocytosis caused by a microbial infection. Septicemia is simply the presence of microbes in the blood. [Harrison, p. 129-30] Infections by bacteria, viruses, rickettsiae, mycobacteria, fungi, and parasites may be complicated by sepsis. Severe sepsis is associated with "organ dysfunction, perfusion abnormalities, and hypotension." [ID, p. 561] In 3000 ICU patients in Europe, the causative organism was identified in only 60% of cases with severe sepsis; Gram positive bacteria caused 40%, Gram negatives caused 38%, and fungi (mainly Candida spp.) caused 17% of cases. [Cohen, p. 480] |
| *shock |
Cardiovascular collapse; Circulatory collapse |
| *stupor and coma |
Unconsciousness; Comatose; |
| *transverse myelitis |
Transverse myelitis is an acute inflammatory spinal cord disorder across the width of the spinal cord. It may follow vaccinations or viral infections (Epstein-Barr, echovirus, rubella, rubeola, mumps, hepatitis A, influenza, and varicella-zoster). It is also associated with vasculitis and use of amphetamines or heroin. It is linked to syphilis, tuberculosis, Lyme disease, cat-scratch disease, brucellosis, leptospirosis, Mycoplasma infection, B virus infection, psittacosis, and relapsing fever. AIDS patients are at increased risk for myelitis caused by cytomegalovirus and Toxoplasma gondii. Schistosomiasis and listeriosis can cause infectious myelitis. S. aureus, tuberculomas, and brucella granulomas can cause spinal cord abscesses. Echinococcus cysts may cause secondary myelitis. Symptoms of transverse myelitis include neck or back pain, ascending weakness, numbness of the lower extremities, and difficulty voiding with progression to paralysis, urinary retention, constipation, and loss of bowel control. [Merck Manual, p. 1910-11; ID, p. 1332-73; Harrison's 15th ed. 2001; p.2430-1; Cohen, p. 224; National Institute of Neurological Disorders and Stroke website] Myelitis may occur with or without encephalitis; Chronic myelitis is often caused by retroviruses (HTLVs and HIVs); Transverse myelitis refers to myelitis of both halves of the spinal cord; [Cohen, p. 223] |
| *uveitis |
Uveitis is inflammation of the iris, ciliary body, or choroid. Uveitis may be associated with retinitis and optic neuritis. [Merck Manual, p. 912] "Uveitis" is a nonspecific term referring to intraocular inflammation. Uveitis is caused by infections, immune disorders, and isolated eye conditions. The cause is unknown in about 25% of cases. Infectious causes include: 1.) Viruses: HIV, herpes simplex, herpes zoster, cytomegalovirus; 2.) Bacteria: tuberculosis, leprosy, syphilis, leptospirosis, brucellosis, Lyme disease, Whipple disease; 3.) Parasitic: toxoplasmosis, acanthamebiasis, toxocariasis, cysticercosis, onchocerciasis, 4.) Fungal: histoplasmosis, coccidioidomycosis, sporotrichosis, blastomycosis, cryptococcosis; 5.) Immune-mediated: Kawasaki disease, Reiter syndrome; Anterior uveitis: iritis, iridocyclitis; Intermediate uveitis: cyclitis, pars planitis; Posterior uveitis: choroiditis, chorioretinitis; [5MCC] Anterior uveitis includes iritis and iridocyclitis. Posterior uveitis includes choroiditis and retinitis or both (chorioretinitis).[PPID, p. 1561] |
| *weight loss |
Weight loss secondary to chronic disease; Abnormal weight loss; Cachexia and wasting are severe forms of weight loss. |
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