**2.4 Cardiac**

Infectious pericarditis, myocarditis, and endocarditis as causes of sepsis can be easily missed in the emergency department due to their often subtle and variable presentations. Acute infectious pericarditis describes infection of the fibrous tissue encasing the heart and the base of the aorta and vena cava. Echoviruses and coxsackie A and B viruses account for nearly 90% of cases of infective pericarditis, with bacterial, parasitic, and fungal organisms accounting for the minority of cases [23]. The most common bacterial pathogens implicated in infective pericarditis are *Streptococcus pneumoniae* and *Staphylococcus auresus* [23]. The diagnosis of acute pericarditis is based on the presence of characteristic chest pain and electrocardiographic abnormalities [23]. Auscultation of a friction rub is helpful but is poorly sensitive for the diagnosis [24]. Infective myocarditis describes infection of the myocardial tissue, with coxsackie B being the most common cause. Other common causes include influenza virus, adenovirus, hepatitis C virus, parvovirus

**23**

*Evaluation and Treatment of Elevated Temperature in the Emergency Department*

ischemia or hemorrhage, septic emboli, and metastatic infection.

affect the decision to start empiric antibiotics early in these patients.

unavailable, CT myelography can also be used [35].

Infections of the spinal column are an important diagnostic consideration in all patients presenting to the ED with back pain. Potential sources of infection in the spinal column include vertebral osteomyelitis, discitis, and epidural abscess. These infections are commonly missed, as there is remarkable variability in patient presentation and fever is seen in only half of these patients [33–35] Neurologic deficits likewise may or may not be present [33–35]. Risk factors for infections of the spinal column include immunocompromise, recent instrumentation, spinal implants, and use of intravenous drugs [35]. Magnetic resonance imaging (MRI) is the preferred imaging study in patients with suspected spinal column infection [35]. If MRI is

Causes of intraabdominal sepsis include abdominal and pelvic abscesses, pelvic inflammatory disease, spontaneous bacterial peritonitis, cholecystitis or

B-19, and cytomegalovirus [23]. Infectious myocarditis should be considered in patients presenting with chest pain and signs of heart failure, especially when there is concurrent fever. Finally, the presence of a new murmur in an acutely ill patient should raise suspicion for infective endocarditis (IE), infection of endocardial lining of the heart valves. Important risk factors for endocarditis include intravenous drug use, prosthetic valves, indwelling intravascular devices, and immunocompromise [25]. IE presents remarkably variably and symptoms depend on the stage of disease. Fever is the most common symptom of IE; other findings concerning for endocarditis include stigmata of peripheral thromboembolism such as Osler nodes, Janeway lesions, Roth spots, or splinter hemorrhages [25]. Patients with IE may also present initially with complications of endocarditis, which include cerebrovascular

Meningitis is an infection of the meningeal lining of the central nervous system by bacteria, viruses, or fungi, with bacterial causes accounting the highest global burden [26]. Encephalitis describes infection of the cerebral parenchyma with a pathogen. *Streptococcus pneumonia,* group B streptococci, and *Neisseria meningitidis* are the most common causes of bacterial meningitis, with *Listeria monocytogenes* also being common in children, immunocompromised individuals, and adults greater than 50 years of age [26, 27]. Common viral causes of meningitis and encephalitis include herpesviruses, enteroviruses, and cytomegalovirus [28]. Fever, altered mental status, and nuchal rigidity are the classically described triad of meningitis, but the majority of patients in clinical practice only manifest one or two of these symptoms [26]. Lumbar puncture with cerebrospinal fluid (CSF) analysis is the diagnostic test of choice for meningitis. CT imaging should precede lumbar puncture in patients whose symptoms may be secondary to mass effect, such as those with immunocompromise, new seizure, papilledema, focal neurologic deficit, or altered mental status [26, 28, 29] Importantly, diagnostic studies should not delay the administration of antimicrobials in patients with suspected meningitis or encephalitis. Administration of antimicrobials prior to lumbar puncture has been shown to have minimal effect on chemistry and cytology findings studies of CSF but may lead to a falsely negative Gram stain or culture [30–32]. This should not

*DOI: http://dx.doi.org/10.5772/intechopen.94899*

**2.5 Meningitis and encephalitis**

**2.6 Spinal column infections**

**2.7 Intraabdominal infections**

*Evaluation and Treatment of Elevated Temperature in the Emergency Department DOI: http://dx.doi.org/10.5772/intechopen.94899*

B-19, and cytomegalovirus [23]. Infectious myocarditis should be considered in patients presenting with chest pain and signs of heart failure, especially when there is concurrent fever. Finally, the presence of a new murmur in an acutely ill patient should raise suspicion for infective endocarditis (IE), infection of endocardial lining of the heart valves. Important risk factors for endocarditis include intravenous drug use, prosthetic valves, indwelling intravascular devices, and immunocompromise [25]. IE presents remarkably variably and symptoms depend on the stage of disease. Fever is the most common symptom of IE; other findings concerning for endocarditis include stigmata of peripheral thromboembolism such as Osler nodes, Janeway lesions, Roth spots, or splinter hemorrhages [25]. Patients with IE may also present initially with complications of endocarditis, which include cerebrovascular ischemia or hemorrhage, septic emboli, and metastatic infection.
