Clinical presentation and diagnosis Physical Examination

Findings on physical examination, along with the clinical presentation, can help to provide the anatomic location of the infection. Once the anatomic site is identified, the most probable pathogens associated with disease can be determined based on likely endogenous or exogenous flora. Fever often accompanies infection and is defined as a rise in body temperature above the normal 37°C (98.6°F). Oral and axillary temperatures may underestimate core temperature by at least 0.6°C (1°F), whereas rectal temperatures best approximate core temperatures. Fever is a host response to bacterial toxins. However, bacterial infections are not the sole cause of fever. Fever also may be caused by other infections (e.g., fungal or viral), medications (e.g., penicillins, cephalosporins, salicylates, and phenytoin), trauma, or other medical conditions (e.g., autoimmune disease, malignancy, pulmonary embolism, and hyperthyroidism). Some patients with infections may present with hypothermia (e.g., patients with overwhelming infection). Elderly patients may be afebrile, as may those with localized infections (e.g., urinary tract infection).6 For others, fever may be the only indication of infection. For example, neutropenic patients may not have the ability to mount normal immune responses to infection (e.g., infiltrate on chest x-ray, pyuria on urinalysis, and erythema or induration around catheter site), and the only finding may be fever.

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