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 will depend on the form of the disease in each patient, namely febrile gastroenteritis, sepsis of unknown origin, infection in pregnancy or CNS infection. However, common findings may include: fever, tachycardia, pallor and different stages of neurologic affection, which may range from altered mental state, to paralysis, respiratory failure and coma.

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

Pregnant women with listeriosis often present with flu-like symptoms. Unborn infants sustain the most severe complications, such as fetal death, stillbirth or meningitis.

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

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

• Pallor may be present
• Skin rash may be present

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

• Pallor may be present
• Skin rash may be present

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

Appearance of the Patient

Commonly in previously healthy patients. The disease usually progresses in two phases:

• Initial phase - patient may be febrile with nausea and vomiting
• Second phase - there is usually cranial nerve palsies, tremor, ataxia and altered consciousness

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
• Skin rash may be present

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

• Pallor may be present
• Skin rash may be present

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

• Pallor may be present
• Skin rash may be present

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

• Bladder dysfunction may be present
• Bowel dysfunction may be present

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