Schibli A, Weisser M, Bingisser R, Widmer A F, Battegay M
Klinik für Infektiologie & Spitalhygiene, Universitätsspital Basel, Petersgraben 4, 4031, Basel, Schweiz.
Internist (Berl). 2013 Aug;54(8):911-24. doi: 10.1007/s00108-012-3139-x.
The initial assessment of patients with infectious diseases is challenging because of the extremely broad differential diagnosis as well as different host pathogen interactions influenced by a different immune status. The formal initial assessment, including the present and past medical history, thorough physical examination, clinical first impressions as well as routine laboratory analyses, is the basis of every preliminary diagnosis. Specific chief complaints have to be recognized in order to narrow down the differential diagnosis. In cases of life-threatening illnesses, such as septicemia, endocarditis, bacterial meningitis and severe pneumonia, the first diagnostic and therapeutic steps should be performed in a rapid sequence: bacterial blood samples, sputum and/or liquor samples are required and the initial antibiotic therapy has to be chosen empirically as the relevant bacterial spectrum related to the suspected illness must be covered. In less urgent cases it is recommended that a multi-step diagnostic approach be carried out which takes the differential diagnosis into account and prioritizes the probabilities. In the latter situation antibiotic treatment should be delayed to diagnose the infection correctly. Importantly, atypical courses must necessitate careful and critical reassessment of the diagnosis.
对传染病患者进行初步评估具有挑战性，这是因为鉴别诊断范围极广，而且不同的免疫状态会影响宿主与病原体之间的相互作用。正式的初步评估，包括现病史和既往病史、全面的体格检查、临床初步印象以及常规实验室分析，是每项初步诊断的基础。必须识别特定的主要症状，以便缩小鉴别诊断范围。对于危及生命的疾病，如败血症、心内膜炎、细菌性脑膜炎和重症肺炎，应迅速采取一系列诊断和治疗措施：需要采集血样、痰液和/或脑脊液样本，并且必须根据疑似疾病的相关细菌谱经验性地选择初始抗生素治疗方案。在不太紧急的情况下，建议采用多步骤诊断方法，该方法要考虑鉴别诊断并对可能性进行排序。在后一种情况下，应推迟抗生素治疗以正确诊断感染。重要的是，非典型病程必须进行仔细且严格的诊断重新评估。
