Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- leg pain
- cellulitis
- diarrhoea
- abdominal cramps
- ear pain
- eye pain, redness
Other diagnostic factors
- fever
- altered mental status
- nausea
- vomiting
- hypotension
Risk factors
- exposure to brackish or marine waters
- handling and/or cleaning seafood
- ingestion of raw or undercooked shellfish
- underlying hepatic disease (cirrhosis, hepatitis B or C, haemochromatosis)
- current corticosteroid use or other immunosuppression (HIV, chemotherapy, solid organ transplantation)
Diagnostic investigations
1st investigations to order
- full blood count
- platelet count
- basic metabolic panel
- blood lactate
- blood culture
- wound swab for Gram stain
- wound swab for culture
- stool culture
- ear canal swab for culture
- conjunctival swab, corneal scraping, or chamber aspirates for culture
Treatment algorithm
sepsis or severe systemic infection
localised skin/soft-tissue infection alone
gastroenteritis
superficial inoculation infections
Contributors
Authors
Michael Sands, MD, MPH & TM, FIDSA

Professor of Medicine
College of Medicine
University of Florida
Jacksonville
FL
Disclosures
MS declares that he has no competing interests.
Carmen Isache, MD

Associate Professor of Medicine
College of Medicine
University of Florida
Jacksonville
FL
Disclosures
CI declares that she has no competing interests.
Peer reviewers
Christopher Huston, MD
Assistant Professor of Medicine
Division of Infectious Diseases
University of Vermont College of Medicine
Burlington
VT
Disclosures
CH declares that he has no competing interests.
Franz Allerberger, MD, MPH
Professor of Clinical Microbiology
Austrian Agency for Health and Food Safety (AGES)
Vienna
Austria
Disclosures
FA declares that he has no competing interests.
Differentials
- Sepsis
- Gangrene
- Infectious diarrhoea
More DifferentialsGuidelines
- Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021
- Vibrio species causing vibriosis
More GuidelinesPatient leaflets
Diarrhoea in adults
Diarrhoea in children
More Patient leafletsLog in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer