Viral syndrome

Background

• Among the most common illnesses encountered in ED
• Majority trivial, some may be life-threatening
• Depending on the type of virus: may be transmitted via direct contact, droplet, fecal-oral, saliva, sexual contact, venereal, or vertical transmission.

Clinical Features

• Generalized viral features
  • Myalgia
  • Arthralgia
  • Fever
  • Lymphadenopathy
  • Rash
• Specific viral syndromes
  • Gastroenteritis
  • Encephalitis
  • Hepatitis
  • Meningitis
  • Pneumonia
  • URI

Differential Diagnosis

Viral infections

• Adenovirus
• Acute Bronchitis
• Arbovirus
• CMV
• Coronavirus
• Coxsackievirus
  • Hand-foot-and-mouth disease
• Herpesvirus
  • Herpangina
• HIV (Acute Retroviral Syndrome)
• Infectious mononucleosis (EBV)
• Influenza virus
• Laryngitis
• Rhinovirus
• Varicella

Fever

Infectious

• Critical
  • Sepsis
  • PNA with respiratory failure
  • Peritonitis
  • Meningitis
  • Cavernous Sinus Thrombosis
  • Necrotizing Fasciitis
• Emergent
  • PNA
  • Peritonsillar Abscess
  • Retropharyngeal Abscess
  • Epiglottitis
  • Endocarditis
  • Pericarditis
  • Appendicitis
  • Cholecystitis
  • Diverticulitis
  • Intra-abdominal abscess
  • Pyelonephritis
  • Tubo-ovarian abscess
  • Encephalitis
  • Brain abscess
  • Cellulitis
  • Abscess
  • Malaria
• Non-emergent
  • Viral syndrome
  • Otitis Media
  • Sinusitis
  • Pharyngitis
  • Influenza
  • TB
  • UTI
  • Epididymitis
  • Prostatitis

Non-infectious

• Critical
  • AMI
  • PE
  • Intracranial Hemorrhage
  • CVA
  • NMS
  • Thyroid Storm
  • Acute Adrenal Insufficiency
  • Transfusion Rx
  • Pulmonary Edema
  • Heat Stroke
  • Malignant hyperthermia
• Emergent
  • CHF
  • Dehydration
  • Recent Seizure
  • Sickle Cell Dz
  • Transplant rejection
  • Pancreatitis
  • DVT
  • Serotonin Syndrome
• Non-emergent
  • Drug fever (except as in NMS and Serotonin Syndrome)
  • Malignancy
  • Gout
  • Sarcoidosis
  • Crohn's Disease
  • Postmyocardiotomy syndrome
  • Sweet's syndrome

Diagnosis

• Clinical diagnosis
• Serology testing may be indicated to diagnose or rule-out life-threatening causes

Management

• Symptomatic management
• Exclude other causes if serious presentation
  • Consider empiric acyclovir and antibiotics until HSV and bacterial causes ruled out.

References

• Takhar SS, Moran GJ. Disseminated Viral Infections. In: Tintinalli JE, Stapczynski J, Ma O, Cline DM, Cydulka RK, Meckler GD, T. eds. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. New York, NY: McGraw-Hill; 2011.