Cryptococcosis physical examination: Difference between revisions
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==Overview== | ==Overview== | ||
Physical examination findings in patients with [[Cryptococcal Meningitis|cryptococcal meningitis]] include [[fever]], [[nystagmus]], [[papilledema]] and [[cranial nerve]] deficits. [[Cutaneous]] [[cryptococcal infection]] will demonstrate [[erythematous]] [[papules]], [[pustules]], [[nodules]], and [[ulcers]]. [[Rales]] can be heard on [[auscultation]] in [[pulmonary]] [[cryptococcus infection]]. | Physical examination findings in patients with [[Cryptococcal Meningitis|cryptococcal meningitis]] include [[fever]], [[nystagmus]], [[papilledema]], and [[cranial nerve]] deficits. [[Cutaneous]] [[cryptococcal infection]] will demonstrate [[erythematous]] [[papules]], [[pustules]], [[nodules]], and [[ulcers]]. [[Rales]] can be heard on [[auscultation]] in [[pulmonary]] [[cryptococcus infection]]. | ||
==Physical Examination== | ==Physical Examination== | ||
| Line 17: | Line 17: | ||
====HEENT==== | ====HEENT==== | ||
*[[Nystagmus]] may be present | *[[Nystagmus]] may be present | ||
*Extra-ocular movements may be abnormal | *Extra-ocular movements may be abnormal | ||
*[[Eye examination|Ophthalmoscopic exam]] may be abnormal with signs consistent with [[papilledema]] | *[[Eye examination|Ophthalmoscopic exam]] may be abnormal with signs consistent with [[papilledema]]. Ophthalmoscopic exam may indicate [[increased intracranial pressure]]<ref name="pmid8250075">{{cite journal |vauthors=Kestelyn P, Taelman H, Bogaerts J, Kagame A, Abdel Aziz M, Batungwanayo J, Stevens AM, Van de Perre P |title=Ophthalmic manifestations of infections with Cryptococcus neoformans in patients with the acquired immunodeficiency syndrome |journal=Am. J. Ophthalmol. |volume=116 |issue=6 |pages=721–7 |year=1993 |pmid=8250075 |doi= |url=}}</ref> | ||
====[[Neck]]==== | ====[[Neck]]==== | ||
*[[Neck stiffness]] is strongly suggestive of [[meningitis]] | *[[Neck stiffness]] is strongly suggestive of [[meningitis]] | ||
====Skin==== | ====Skin==== | ||
[[Erythematous]] [[papules]], [[pustules]] and [[ulcers]] may be present on examination. | [[Erythematous]] [[papules]], [[pustules]], and [[ulcers]] may be present on examination<ref name="pmid12964709">{{cite journal |vauthors=Christianson JC, Engber W, Andes D |title=Primary cutaneous cryptococcosis in immunocompetent and immunocompromised hosts |journal=Med. Mycol. |volume=41 |issue=3 |pages=177–88 |year=2003 |pmid=12964709 |doi= |url=}}</ref> | ||
====Heart==== | ====Heart==== | ||
*Decreased [[heart rate]] indicates [[increased intracranial pressure]] | *Decreased [[heart rate]] indicates [[increased intracranial pressure]]<ref name="pmid15805143">{{cite journal |vauthors=Kalmar AF, Van Aken J, Caemaert J, Mortier EP, Struys MM |title=Value of Cushing reflex as warning sign for brain ischaemia during neuroendoscopy |journal=Br J Anaesth |volume=94 |issue=6 |pages=791–9 |year=2005 |pmid=15805143 |doi=10.1093/bja/aei121 |url=}}</ref> | ||
==== | ====Neuromuscular==== | ||
*[[Muscular strength]] is usually intact, but focal deficits might be present | *[[Muscular strength]] is usually intact, but focal deficits might be present | ||
*[[Sensation]] is usually intact, but focal deficits might be present | *[[Sensation]] is usually intact, but focal deficits might be present | ||
*[[Reflexes|Hyperactive reflexes]] may be present | *[[Reflexes|Hyperactive reflexes]] may be present | ||
*Deficits in [[cranial nerves]] might be present: decreased [[Visual acuity|vision acuity]], [[Muscles of facial expression|facial muscle]] [[Muscle weakness|weakness]], decreased [[hearing]] ([[CN VIII]]), and [[diplopia]] | *Deficits in [[cranial nerves]] might be present: decreased [[Visual acuity|vision acuity]], [[Muscles of facial expression|facial muscle]] [[Muscle weakness|weakness]], decreased [[hearing]] ([[CN VIII]]), and [[diplopia]]<ref name="pmid2690522">{{cite journal |vauthors=Fassbinder W |title=[Responsibilities of the internist in kidney transplantation] |language=German |journal=Verh Dtsch Ges Inn Med |volume=95 |issue= |pages=515–26 |year=1989 |pmid=2690522 |doi= |url=}}</ref> | ||
*[[Gait]] instability may be present | *[[Gait]] instability may be present | ||
=====Special tests===== | =====Special tests===== | ||
Following are the special tests for [[meningitis]]. Positive tests provide a strong suspicion for [[meningeal irritation]]:<ref name="pmid12060874">{{cite journal| author=Thomas KE, Hasbun R, Jekel J, Quagliarello VJ| title=The diagnostic accuracy of Kernig's sign, Brudzinski's sign, and nuchal rigidity in adults with suspected meningitis. | journal=Clin Infect Dis | year= 2002 | volume= 35 | issue= 1 | pages= 46-52 | pmid=12060874 | doi=10.1086/340979 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12060874 }} </ref> | Following are the special tests for [[meningitis]]. Positive tests provide a strong suspicion for [[meningeal irritation]]:<ref name="pmid12060874">{{cite journal| author=Thomas KE, Hasbun R, Jekel J, Quagliarello VJ| title=The diagnostic accuracy of Kernig's sign, Brudzinski's sign, and nuchal rigidity in adults with suspected meningitis. | journal=Clin Infect Dis | year= 2002 | volume= 35 | issue= 1 | pages= 46-52 | pmid=12060874 | doi=10.1086/340979 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12060874 }} </ref> | ||
*[[Kernig's sign]] | *[[Kernig's sign]]<ref name="pmid12060874">{{cite journal |vauthors=Thomas KE, Hasbun R, Jekel J, Quagliarello VJ |title=The diagnostic accuracy of Kernig's sign, Brudzinski's sign, and nuchal rigidity in adults with suspected meningitis |journal=Clin. Infect. Dis. |volume=35 |issue=1 |pages=46–52 |year=2002 |pmid=12060874 |doi=10.1086/340979 |url=}}</ref> | ||
:*Postive [[Kernig's sign | :*Postive [[Kernig's sign]] indicates [[meningitis]]. | ||
*[[Brudzinski's sign]] | *[[Brudzinski's sign]]<ref name="pmid12060874"></ref> | ||
:*Positive [[Brudzinski's | :*Positive [[Brudzinski's sign]] may suggest [[meningitis]] | ||
*It should be noted that [[Kernig's sign]] and [[ | *It should be noted that [[Kernig's sign]] and [[Brudzinski's sign]] are not typically present in [[fungal meningitis]] | ||
*Jolt accentuation:<ref name="pmid2071396">{{cite journal| author=Uchihara T, Tsukagoshi H| title=Jolt accentuation of headache: the most sensitive sign of CSF pleocytosis. | journal=Headache | year= 1991 | volume= 31 | issue= 3 | pages= 167-71 | pmid=2071396 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2071396 }} </ref> | *Jolt accentuation:<ref name="pmid2071396">{{cite journal| author=Uchihara T, Tsukagoshi H| title=Jolt accentuation of headache: the most sensitive sign of CSF pleocytosis. | journal=Headache | year= 1991 | volume= 31 | issue= 3 | pages= 167-71 | pmid=2071396 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2071396 }} </ref> | ||
:*Exacerbation of [[headache]] by moving head in horizontal direction two to three times | :*Exacerbation of [[headache]] by moving head in horizontal direction two to three times indicates a positive test | ||
===Gallery=== | ===Gallery=== | ||
<gallery> | <gallery> | ||
Image: Cryptococcosis05.jpeg| Skin lesion in a case of a disseminated fungal infection, cryptococcosis, caused by a member of the fungal genus | Image: Cryptococcosis05.jpeg| Skin lesion in a case of a disseminated fungal infection, cryptococcosis, caused by a member of the fungal genus ''Cryptococcus''. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL> | ||
</gallery> | </gallery> | ||
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[[Category:Fungal diseases]] | [[Category:Fungal diseases]] | ||
[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Emergency medicine]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Infectious disease]] | |||
[[Category:Pulmonology]] | |||
[[Category:Neurology]] | |||
[[Category:Dermatology]] | |||
Latest revision as of 21:10, 29 July 2020
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aravind Kuchkuntla, M.B.B.S[2]
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Overview
Physical examination findings in patients with cryptococcal meningitis include fever, nystagmus, papilledema, and cranial nerve deficits. Cutaneous cryptococcal infection will demonstrate erythematous papules, pustules, nodules, and ulcers. Rales can be heard on auscultation in pulmonary cryptococcus infection.
Physical Examination
General appearance of patient
- Patient may be in distress
- Altered mental status
Vitals
- A low grade fever is often present
HEENT
- Nystagmus may be present
- Extra-ocular movements may be abnormal
- Ophthalmoscopic exam may be abnormal with signs consistent with papilledema. Ophthalmoscopic exam may indicate increased intracranial pressure[1]
Neck
- Neck stiffness is strongly suggestive of meningitis
Skin
Erythematous papules, pustules, and ulcers may be present on examination[2]
Heart
- Decreased heart rate indicates increased intracranial pressure[3]
Neuromuscular
- Muscular strength is usually intact, but focal deficits might be present
- Sensation is usually intact, but focal deficits might be present
- Hyperactive reflexes may be present
- Deficits in cranial nerves might be present: decreased vision acuity, facial muscle weakness, decreased hearing (CN VIII), and diplopia[4]
- Gait instability may be present
Special tests
Following are the special tests for meningitis. Positive tests provide a strong suspicion for meningeal irritation:[5]
- Postive Kernig's sign indicates meningitis.
- Positive Brudzinski's sign may suggest meningitis
- It should be noted that Kernig's sign and Brudzinski's sign are not typically present in fungal meningitis
- Jolt accentuation:[6]
- Exacerbation of headache by moving head in horizontal direction two to three times indicates a positive test
Gallery
-
![Skin lesion in a case of a disseminated fungal infection, cryptococcosis, caused by a member of the fungal genus Cryptococcus. From Public Health Image Library (PHIL). [7]](/images/f/f3/Cryptococcosis05.jpeg)
Skin lesion in a case of a disseminated fungal infection, cryptococcosis, caused by a member of the fungal genus Cryptococcus. From Public Health Image Library (PHIL). [7]
![Skin lesion in a case of a disseminated fungal infection, cryptococcosis, caused by a member of the fungal genus Cryptococcus. From Public Health Image Library (PHIL). [7]](/index.php/File:Cryptococcosis05.jpeg)
References
- ↑ Kestelyn P, Taelman H, Bogaerts J, Kagame A, Abdel Aziz M, Batungwanayo J, Stevens AM, Van de Perre P (1993). "Ophthalmic manifestations of infections with Cryptococcus neoformans in patients with the acquired immunodeficiency syndrome". Am. J. Ophthalmol. 116 (6): 721–7. PMID 8250075.
- ↑ Christianson JC, Engber W, Andes D (2003). "Primary cutaneous cryptococcosis in immunocompetent and immunocompromised hosts". Med. Mycol. 41 (3): 177–88. PMID 12964709.
- ↑ Kalmar AF, Van Aken J, Caemaert J, Mortier EP, Struys MM (2005). "Value of Cushing reflex as warning sign for brain ischaemia during neuroendoscopy". Br J Anaesth. 94 (6): 791–9. doi:10.1093/bja/aei121. PMID 15805143.
- ↑ Fassbinder W (1989). "[Responsibilities of the internist in kidney transplantation]". Verh Dtsch Ges Inn Med (in German). 95: 515–26. PMID 2690522.
- ↑ 5.0 5.1 5.2 Thomas KE, Hasbun R, Jekel J, Quagliarello VJ (2002). "The diagnostic accuracy of Kernig's sign, Brudzinski's sign, and nuchal rigidity in adults with suspected meningitis". Clin Infect Dis. 35 (1): 46–52. doi:10.1086/340979. PMID 12060874.
- ↑ Uchihara T, Tsukagoshi H (1991). "Jolt accentuation of headache: the most sensitive sign of CSF pleocytosis". Headache. 31 (3): 167–71. PMID 2071396.
- ↑ "Public Health Image Library (PHIL)".