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Clinical approach 

Clinical approach

Clinical approach

Christopher J. Ellis


August 28, 2014: This chapter has been re-evaluated and remains up-to-date. No changes have been necessary.


Chapter reviewed, minor editorial amendments.

Updated on 31 May 2012. The previous version of this content can be found here.
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date: 30 March 2017

Infection is most often suspected when patients present with pyrexia and is certainly the most common cause of this presentation, whether in hospitalized patients or those in the community. The other principal causes of fever are primary inflammatory conditions and malignancy, but infections are likely to be most rapidly progressive and acutely life-threatening and hence must be the physician’s first concern.

The clinical approach to patients with likely infection begins with a focused history, leading on to a clinical examination which assesses the extent of the physiological derangement and looks for a focus of infection. Standard physiological measures define likely sepsis (see Chapter 7.1.2), which is the commonest reason for their sudden derangement in hospitalized patients. Investigations should be phased and must not delay the start of potentially life-saving treatment, the response to which must be carefully followed, especially when treatment has to be started before a complete or certain diagnosis is possible, and compared with the likely speed of response for the putative condition being treated. There is increasing evidence that delays in initiating appropriate therapy, especially antimicrobial medication and circulatory support, increase mortality.

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