Listeriosis physical examination
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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 (febrile gastroenteritis, sepsis, infection in pregnancy, or central nervous system infection). Common findings include fever, tachycardia, pallor. Signs of neurological involvement may range from altered mental state, to 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
Appearance of the Patient
A patient with listeriosis may be ill-looking.
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.[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
Meningoencephalitis
Appearance of the Patient
A patient with meningoencephalitis may have a wide range of presentations. These may range from mild focal neurologic signs to coma.
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
Head
- Bulging fontanelles may be present (neonates)
Neck
- Neck stiffness may be present
Neurologic
- Mental status may be altered
- Coma may be present
- Seizures may be present
- Focal neurologic signs may be present
Encephalitis
Appearance of the Patient
A patient with encephalitis may have a wide range of presentations. These may range from personality changes, mild focal neurologic signs, to coma.
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
Head
- Bulging fontanelles may be present (neonates)
Neck
- Neck stiffness may be present
Throat
- Mucosal rash may be present
Neurologic
- Mental status may be altered
- Coma may be present
- Seizures may be present
- Focal neurologic signs may be present
- Autonomic dysfunction may be present
- Hemiparesis may be present
- Ataxia may be present
- Dystonia may be present
Rhombencephalitis
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
Head
- Bulging fontanelles may be present (neonates)
Neck
- Neck stiffness may be present
Lungs
Respiratory failure is present in half of the patients
Throat
- Mucosal rash may be present
Neurologic
- Mental status may be altered
- Coma may be present
- Seizures may be present
- Focal neurologic signs may be present
- Autonomic dysfunction may be present
- Hemiparesis may be present
- Ataxia may be present
- Dystonia may be present
- Tremor may be present
Brain Abscess
Appearance of the Patient
Patients often complain of headache, drowsiness, confusion, speech difficulties and fever with a rapidly progressive course. These manifestations are a combination of increased intracranial pressure (due to a space-occupying lesion), infection, and focal neurologic brain tissue damage.
Vitals
Temperature
- A fever may be 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
Head
- Bulging fontanelles may be present (neonates)
Eyes
- Papilledema may be present
Neck
- Neck stiffness may be present
Lungs
Respiratory failure is present in half of the patients
Throat
- Mucosal rash may be present
Neurologic
- Mental status may be altered
- Coma may be present
- Speech difficulties may be present
- Seizures may be present
- Focal neurologic signs may be present
- Autonomic dysfunction may be present
- Hemiparesis may be present
- Ataxia may be present
- Dystonia may be present
- Tremor may be present
Spinal Cord Infection
Vitals
Temperature
- A fever may be 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
Head
- Bulging fontanelles may be present (neonates)
Eyes
- Papilledema may be present
Neck
- Neck stiffness may be present
Lungs
Respiratory failure is present in half of the patients
Throat
- Mucosal rash may be present
Abdomen
Extremities
- Decreased strength may be present
Neurologic
- Mental status may be altered
- Coma may be present
- Seizures may be present
- Focal neurologic signs may be present
- Autonomic dysfunction may be present
- Hemiparesis may be present
- Ataxia may be present
- Dystonia may be present
- Tremor may be present
Endocarditis
Vitals
Temperature
- A fever may be present
Pulse
- Wide pulse pressure may be present due to aortic insufficiency
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
- Skin rash may be present
- Petechiae are present in 10-40% of patients
- Splinter hemorrhages are present in 5-15% of patients
- Osler's nodes are present in 7-10% of patients
- Janeway lesions are present in 6-10% of patients
Head
- Bulging fontanelles may be present (neonates)
Eyes
- Papilledema may be present
- Conjunctival hemorrhage may be present
- Roth's spots in the retina may be present
Neck
- Neck stiffness may be present
Heart
- Heart Murmur(s) are present in 80-85% of patients, including that of aortic insufficiency, tricuspid regurgitation and mitral regurgitation
Lungs
- Respiratory failure is present in half of the patients
- Rales may be present
Throat
- Mucosal rash may be present
- Patients in whom there is new acute onset of aortic regurgitation, bobbing of the uvula may be present
Abdomen
- Abdominal pain may be present due to mesenteric embolization or ileus, both of which may manifest as reduced bowel sounds
- Splenomegaly may be present in 15-30% patients
- Left upper quadrant pain (LUQ pain) may be present, as a result of a splenic infarct from embolization
- Flank pain may be present as a result of an embolus to the kidney
- Bladder dysfunction may be present
- Bowel dysfunction may be present
Extremities
- Janeway lesions may be present
- Gangrene of fingers may be present
- Splinter haemorrhages may be present
- Osler's nodes may be present
Neurologic
- Septic emboli may result in stroke and focal neurologic findings
- Mental status may be altered
- Seizures may be present
- Focal neurologic signs may be present
- Autonomic dysfunction may be present
- Hemiparesis may be present
- Tremor may be present