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INTRODUCTION

APPROACH TO THE PATIENT Infectious Disease Emergencies

  • Acutely ill febrile pts require emergent attention and must be appropriately evaluated and treated at presentation to improve outcome. A quick assessment of general appearance provides a subjective sense of whether the pt is septic or toxic.

  • History: Although presenting symptoms are frequently nonspecific, the physician should elicit the following elements of a directed history to help identify risk factors for particular infections:

    • – Onset and duration of symptoms, changes in severity or rate of progression over time

    • – Host factors (e.g., alcoholism, IV drug use) and comorbid conditions (e.g., asplenia, diabetes, HIV infection)

    • – Potential nidus for invasive infection (e.g., recent URI or influenza, trauma, burn, surgery, foreign body)

    • – Exposure history (e.g., travel, pets, diet, medication use, vaccination history, sick contacts, menstruation history, sexual contacts)

  • Physical examination: A complete physical examination should be performed, with particular attention to general appearance, vital signs, skin and soft tissue exam, and neurologic evaluation (including mental status).

  • Diagnostic workup: should be initiated rapidly, preferably before antibiotics are given

    • – Bloodwork: cultures, CBC with differential, electrolytes, BUN, creatinine, LFTs, blood smear examination (for parasitic or tick-borne diseases), buffy coat

    • – CSF cultures if meningitis is possible. If focal neurologic signs, papilledema, or abnormal mental status is noted, administer antibiotics after blood culture samples are obtained, perform brain imaging, and then consider LP.

    • – CT or MRI to evaluate focal abscesses; cultures of wounds or scraping of skin lesions as indicated

    • – No diagnostic procedure should delay treatment for more than minutes.

  • Treatment: Empirical antibiotic therapy (Table 26-1) is critical.

    • – Adjunctive therapy (e.g., glucocorticoids or IV immunoglobulin) may reduce morbidity and mortality rates for specific conditions. Dexamethasone for bacterial meningitis must be given before or with the first dose of antibiotic.

TABLE 26-1COMMON INFECTIOUS DISEASE EMERGENCIES

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