Specifically they may not mount a fever or white blood cell response. Localizing symptoms may be absent, and the patient may not have the ability to manifest adenopathy. In addition to usual sites, consider sinuses, candidal sepsis, etc., to be source of fever. Look hard for illness in the ill-appearing patient even in the absence of fever or localizing symptoms. Treat any infection aggressively because patients who are immunosuppressed secondary to steroids can get ill rapidly.
Diabetics are a greater risk of listeriosis, osteomyelitis, infection in a prosthetic joint, etc.
Because of neuropathy, the diabetic patient may present with a relatively advanced infection. Neutropenia and neutropenic fever. Need to start empiric antibiotics quickly if work-up does not reveal a specific source. Can add aminoglycoside to these as well for the sicker patient. It is not known if this will translate into better survival rates.