Physical Exam Clues to Infectious Diseases and Their Mimics in Critical Care

Under the best of circumstances, the physical examination (PE) of an ICU patient is quite challenging. To make matters more difficult, many physical findings are neither specific nor sensitive. What have been touted as “pathognomonic” findings are rarely, if ever, so. The astute physician must always consider that a given physical examination finding may be due to more than one disease entity. Premature closure and availability bias can further trip up the unwary clinician. As with various clinical syndromes, physical examination findings in infected patients can be mimicked by a variety of infectious and noninfectious diseases. The table that follows lists many of the physical examination findings one may encounter in the infected ICU patient along with their noninfectious mimics and hints to help distinguish them apart.