Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • fever/sweats
  • cough
  • septic shock
  • non-healing skin sore/ulcer or abscess
  • regional lymphadenitis/parotitis
  • bacteraemia without evident clinical focus
  • lower motor neuron cranial nerve palsies (especially cranial nerves VII and VIII)
  • flaccid paraparesis

Other diagnostic factors

  • shortness of breath
  • abdominal pain/diarrhoea
  • dysuria
  • urinary retention
  • altered conscious state
  • mycotic pseudo-aneurysms

Risk factors

  • occupational/recreational environmental exposure
  • diabetes
  • hazardous alcohol use
  • chronic renal disease
  • malignancy and immunosuppressive therapy
  • thalassaemia
  • cystic fibrosis and other chronic lung disease
  • bioterrorism

Diagnostic investigations

1st investigations to order

  • blood culture
  • sputum culture
  • urine culture
  • culture of pus/swab from skin lesion, abscess, lymphadenitis, drained internal abscess (e.g., liver abscess)
  • CXR
  • CT abdomen and pelvis ± CT chest
  • abdominal/pelvis ultrasound
Full details

Investigations to consider

  • throat swab in/on Ashdown's selective broth/agar
  • rectal swab in/on Ashdown's selective broth/agar
  • CSF culture
  • CSF microscopy, protein and glucose
Full details

Emerging tests

  • rapid antigen detection test
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Professor in Medicine

Northern Territory Medical Program

Royal Darwin Hospital

Head of Tropical and Emerging Infectious Diseases

Menzies School of Health Research

Charles Darwin University

Darwin

Australia

Disclosures

BJC is the author of several references cited in this monograph.

David A.B. Dance

Senior Clinical Research Fellow/Consultant Microbiologist

Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit

Vientiane

Laos

Centre for Tropical Medicine and Global Health

University of Oxford

Oxford

Honorary Professor

Faculty of Infectious and Tropical Diseases

London School of Hygiene and Tropical Medicine

London

UK

Disclosures

DABD is the author of several references cited in this monograph.

Peer reviewers VIEW ALL

Director of Microbiology

Townsville Hospital

Townsville

Australia

Disclosures

RN declares that he has no competing interests.

Professor of Medicine

Faculty of Medicine

Khon Kaen University

Khon Kaen

Thailand

Disclosures

PC declares that he has no competing interests.

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