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A right lower quadrant abdominal wall abscess and enteric fistula are observed and confirmed by the presence of enteral contrast in the abdominal wall.

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Table 1. Infectious and Noninfectious Causes of Fever ^[12]

System	Infectious Causes	Noninfectious Causes
Central nervous	Meningitis, encephalitis	Posterior fossa syndrome, central fever, seizures, cerebral infraction, hemorrhage, cerebrovascular accident
Cardiovascular	Central line, infected pacemaker, endocarditis, sternal osteomyelitis, viral pericarditis, myocardial/perivalvular abscess	Myocardial infarction, balloon pump syndrome, Dressler syndrome
Pulmonary	Ventilator-associated pneumonia, mediastinitis, tracheobronchitis, empyema	Pulmonary emboli, ARDS, atelectasis (without pneumonia), cryptogenic organizing pneumonia, bronchogenic carcinoma without postobstructive pneumonia, systemic lupus erythematosus, pneumonitis, vasculitis
Gastrointestinal	Intra-abdominal abscess, cholangitis, cholecystitis, viral hepatitis, peritonitis, diarrhea (Clostridium difficile)	Pancreatitis, acalculous cholecystitis, ischemia of the bowel/colon, bleeding, cirrhosis, irritable bowel syndrome
Urinary tract	Catheter-associated bacteremia, urosepsis, pyelonephritis, cystitis	Allergic interstitial nephritis
Skin/soft tissue	Decubitus ulcers, cellulitis, wound infection	Vascular ulcers
Bone/joint	Chronic osteomyelitis, septic arthritis	Acute gout
Other	Transient bacteremia, sinusitis	Adrenal insufficiency, phlebitis/thrombophlebitis, neoplastic fever, alcohol/drug withdrawal, delirium tremens, drug fever, fat emboli, deep venous thrombosis, postoperative fever (48 h), fever after transfusion

Table 2. Clinical Conditions Associated With Sepsis

System	Associated With Sepsis	Not Typically Associated With Sepsis
GI tract	Liver Gallbladder Colon Abscess Intestinal obstruction Instrumentation	Esophagitis Gastritis Pancreatitis (may have multiorgan dysfunction but not infectious in origin) Small bowel disorders GI bleeding
GU tract	Pyelonephritis Intra- or perinephric abscess Renal calculi Urinary tract obstruction Acute prostatitis/abscess Renal insufficiency Instrumentation in patients with bacteriuria	Urethritis Cystitis Cervicitis Vaginitis Catheter-associated bacteriuria (in otherwise healthy hosts without genitourinary tract disease)
Pelvis	Peritonitis Abscess
Upper respiratory tract	Deep neck space infection Abscess	Pharyngitis Sinusitis Bronchitis Otitis
Lower respiratory tract	Community-acquired pneumonia (with asplenia) Empyema Lung abscess	Community-acquired pneumonia (in otherwise healthy host)
Intravascular	IV line sepsis Infected prosthetic device Acute bacterial endocarditis
Cardiovascular	Acute bacterial endocarditis Myocardial/perivalvular ring abscess	Subacute bacterial endocarditis
CNS	Bacterial meningitis	Aseptic meningitis
Skin/soft-tissue	Necrotizing fasciitis	Osteomyelitis Uncomplicated wound infections
CNS = central nervous system; GI = gastrointestinal; GU = genitourinary; IV = intravenous. Adapted from: Cunha BA, Shea KW. Fever in the intensive care unit. Infect Dis Clin North Am. Mar 1996;10(1):185-209.^[39]

System

Associated With Sepsis

Not Typically Associated With Sepsis

GI tract

Liver

Gallbladder

Colon

Abscess

Intestinal obstruction

Instrumentation

Esophagitis

Gastritis

Pancreatitis (may have multiorgan dysfunction but not infectious in origin)

Small bowel disorders

GI bleeding

GU tract

Pyelonephritis

Intra- or perinephric abscess

Renal calculi

Urinary tract obstruction

Acute prostatitis/abscess

Renal insufficiency

Instrumentation in patients with bacteriuria

Urethritis

Cystitis

Cervicitis

Vaginitis

Catheter-associated bacteriuria (in otherwise healthy hosts without genitourinary tract disease)

Pelvis

Peritonitis

Abscess

Upper respiratory tract

Deep neck space infection

Abscess

Pharyngitis

Sinusitis

Bronchitis

Otitis

Lower respiratory tract

Community-acquired pneumonia (with asplenia)

Empyema

Lung abscess

Community-acquired pneumonia (in otherwise healthy host)

Intravascular

IV line sepsis

Infected prosthetic device

Acute bacterial endocarditis

Cardiovascular

Acute bacterial endocarditis

Myocardial/perivalvular ring abscess

Subacute bacterial endocarditis

CNS

Bacterial meningitis

Aseptic meningitis

Skin/soft-tissue

Necrotizing fasciitis

Osteomyelitis

Uncomplicated wound infections

CNS = central nervous system; GI = gastrointestinal; GU = genitourinary; IV = intravenous. Adapted from: Cunha BA, Shea KW. Fever in the intensive care unit. Infect Dis Clin North Am. Mar 1996;10(1):185-209.^[39]

Table 3. Noninfectious Conditions Mimicking Clinical and Hemodynamic Parameters of Sepsis

Clinical Presentations Mimicking Sepsis	Hemodynamic Parameters Mimicking Sepsis
Myocardial infarction	Spinal cord injury
Pancreatitis	Adrenal insufficiency
Diabetic ketoacidosis	Acute pancreatitis
Systemic lupus erythematosus flare with abdominal crisis	Hemorrhage
Ventricular pseudoaneurysm	Pulmonary embolism
Massive aspiration/atelectasis	Anaphylaxis
Systemic vasculitis
Hypovolemia (eg, due to diuretics, dehydration)

Table 4. Characteristics of Pseudosepsis and Sepsis

Parameters	Pseudosepsis	Sepsis
Microbiologic	No definite source PLUS ≥1 abnormalities Negative blood cultures excluding contaminants	Proper identification/process/source PLUS ≥1 microbiologic abnormalities Positive buffy coat smear result OR several positive blood culture results with a pathogenic organism
Hemodynamic	⇓ PVR ⇑ CO	⇓ PVR ⇑ CO Left ventricular dilatation
Laboratory	⇑ WBC count (with left shift) Normal platelet count ⇑ FSP ⇑ Lactate ⇑ D-dimers ⇑ PT/PTT ⇓ Albumin ⇓ Fibrinogen ⇓ Globulins	⇑ WBC count (with left shift) ⇓ Platelets ⇑ FSP ⇑ Lactate ⇑ D-dimers ⇑ PT/PTT ⇓ Albumin
Clinical	≤102°F ± Tachycardia ± Respiratory alkalosis ± Hypotension	≥102°F OR Hypothermia ± Mental status changes ± Hypotension
CO = cardiac output; FSP = fibrin split products; GI = gastrointestinal; GU = genitourinary; PT/PTT = prothrombin time/partial thromboplastin time; PVR = peripheral vascular resistance; WBC = white blood cell.

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Author

Amber Mahmood Bokhari, MBBS Fellow in Infectious Disease, SSM Health St Louis University Hospital

Amber Mahmood Bokhari, MBBS is a member of the following medical societies: American Medical Association, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Coauthor(s)

Nirav Patel, MD Assistant Professor of Internal Medicine, Division of Infectious Diseases, Allergy and Immunology, and Division of Pulmonary, Critical Care, and Sleep Medicine, St Louis University School of Medicine; Chief Medical Officer, Director of Antibiotic Stewardship, Infection Control Officer, St Louis University Hospital

Nirav Patel, MD is a member of the following medical societies: American Medical Association, Infectious Diseases Society of America, Infectious Diseases Society of St Louis, Missouri State Medical Association, Society for Healthcare Epidemiology of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Thomas E Herchline, MD Professor of Medicine, Wright State University, Boonshoft School of Medicine; Medical Consultant, Public Health, Dayton and Montgomery County (Ohio) Tuberculosis Clinic

Thomas E Herchline, MD is a member of the following medical societies: Alpha Omega Alpha, Infectious Diseases Society of America, Infectious Diseases Society of Ohio

Disclosure: Nothing to disclose.

Chief Editor

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America; Fellow of the Royal College of Physicians, London

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Additional Contributors

Burke A Cunha, MD Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Acknowledgements

Pranatharthi Haran Chandrasekar, MBBS, MD Professor, Department of Internal Medicine, Director of Infectious Disease Fellowship, Harper Hospital, Wayne State University School of Medicine

Pranatharthi Haran Chandrasekar, MBBS, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Thomas M Kerkering, MD Chief of Infectious Diseases, Virginia Tech Carilion School of Medicine

Thomas M Kerkering, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Public Health Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Medical Society of Virginia, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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