Which physical signs can localize the source of infection in sepsis/septic shock?

Updated: Oct 07, 2020
  • Author: Andre Kalil, MD, MPH; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
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Answer

In septic shock, it is important to identify any potential source of infection. This is particularly important in cases where a site of infection can be removed or drained, as in certain intra-abdominal infections, soft-tissue abscesses and fasciitis, or perirectal abscesses. The following physical signs help localize the source of an infection:

  • Central nervous system (CNS) infection – Profound depression in mental status and signs of meningismus (neck stiffness)

  • Head and neck infections – Inflamed or swollen tympanic membranes, sinus tenderness, nasal congestion or exudate, pharyngeal erythema and exudates, inspiratory stridor, and cervical lymphadenopathy

  • Chest and pulmonary infections – Dullness on percussion, bronchial breath sounds, localized rales, or any evidence of consolidation

  • Cardiac infections – Any new murmur, especially in patients with a history of injection or IV drug use

  • Abdominal and GI infections – Abdominal distention, localized tenderness, guarding or rebound tenderness, and rectal tenderness or swelling

  • Pelvic and GU infections – Costovertebral angle tenderness, pelvic tenderness, pain on cervical motion, adnexal tenderness or masses, and cervical discharge

  • Bone and soft-tissue infections – Focal erythema, edema, tenderness, crepitus in necrotizing infections, fluctuance, pain with joint range of motion, and joint effusions and associated warmth or erythema

  • Skin infections – Petechiae, purpura, erythema, ulceration, bullous formation, and fluctuance


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