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Information should be obtained whether a condition that can reduce the function of the patient's immune system is present because such conditions predispose to infections with certain microorganisms.
For example, a history of splenectomy usually due to splenic rupture as a result of trauma carries a higher risk of infection with encapsulated microorganisms such as Streptococcus pneumoniae. An underlying malignancy, chemotherapy, other immunosuppressive medications such as prednisone or azathioprine , or neutropenia, or AIDS acquired immunodeficiency syndrome due to HIV virus infection also place the patient at increased risk of infection and often with less common causal microorganisms opportunistic infection.
There are also other conditions from the medical history which are important because they may predispose to specific infections, e. It is also important to consider if iatrogenic predisposing factors or causes of infection are present e. Physical examination of the patient with fever General appearance: Does the patient appear toxic, in a severe condition, or does he or she look relatively well?
Vital signs: Oral and rectal temperature should be taken. Examination of the skin and inspection of the patient Check for an area of focal erythema suggesting an infection of the skin or focal edema and erythema at sites of intravenous catheters, if any.
In febrile patients with any type of catheter e. Inspect the skin for rashes in some cases the specific appearance of the rash may suggest the diagnosis.
Pustules can be found in staphylococcal disease and gonococcemia. Pustules are small circumscribed elevations of the skin containing pus and having an inflamed base.
Purpuric rash of meningococcemia bacteremia caused by fulminant infection by Neisseria Meningitidis in a 15 year old girl. The girl was succesfully treated with intravenous ceftriaxone.
Rapid recovery following fulminant meningococcemia complicated by myocarditis in a year-old Nepalese girl: a case report. International medical case reports journal. Percuss the teeth for tenderness suggesting an abscess.
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