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Most common vector borne illness in US?
Transmitted by?
Ixodes ticks (ticks must be in place around 24 hours to transmit spirochetes)
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Lyme Disease Diagnosis
ELISA, confirmed by Western Blot
-Serology may be negative in early disease
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Lyme Disease Tx:
EM, isolated CN palsies, 1st and 2nd degree AV block
Doxycyclin PO
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Lyme Disease Tx:
Meningitis, High degree AV block
IV ceftriaxone 2g x 2-3 wks
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Lyme Disease Tx:
Chronic arthirtis
- PO therapy 1-2 wks
- IV regiments 2-4 wks
- Must use IV if neurologic disease w/ arthritis
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Lyme Disease Tx:
Pregnant
Amoxil
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Lyme Disease Tx:
Pregnant and PCN allergic
Cefuroxime or erythromycin
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Tick Bite Prophylaxis: Engorged tick resembling Ixodes sp, exposure to endemic areas, tick in place >48 hrs
Give doxycycline 200 mg x 1 dose
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Best method for preventing lyme disease
Avoid vector exposure
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Post- Lyme Disease Syndrome
- Sx's like Fibromyalgia and Chronic fatigue syndrome
- Nonspecific complaints (headache, fatigue, arthralgias)
What do you do? Do no retreat pt tha thas been correctly treated
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HME (Human Monocytic Ehrlichosis)
Transmitted by?
Lonestar Tick
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Anaplasmosis (formerly HGE) transmitted by
Ixodes tick
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Lab findings in ehrlichiosis and anaplasmosis
Leukopenia, thrombocytopenia, elevated transaminases
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Diagnostic test for Ehrlichiosis and Anaplasmosis
Serum Ab titers, blood smear (morulae)
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Ehrlichiosis/Anaplasmosis Tx:
Doxycycine 100 BID x 7-10 days
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Babesiosis:
Transmitted by?
Ixodes tick
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Babesiosis:
Symptoms
Fever, chills, NS, myalgias of gradual onset
Can be severe in splenectomized pt
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Diagnostic test for babesiosis?
Periopheral blood smear
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Babesiosis Tx:
- Clindamycin/quinine x 7 days
- Atovaquone/azythromcin x 7 days
- Exchange tarnsfusions for severely ill pt
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Ixodes ticks transmit:
Lyme Disease
Anaplasmosis
Babesiosis
- Doxy, IV Ceftriaxone
- Doxy
- Quinine/ Clindamycin
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Ring form in RBC
Babesiosis
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Morula in WBC
Ehrlichiosis/Anaplasmosis
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Leptospirosis tx:
Doxy or PCN
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Severe form of Leptospirosis
Weil Syndrome- renal and hepatic failure, pulmonary infiltrates, hypotension
Tx- PCN
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Tularemia (Ulceroglandular, associated w/ draining lymph nodes)
Tx: Streptomycin
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Anthrax Tx?
Cipro or doxy
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Bioterrorism: CXR= lobar pneumonia
Tularemia
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Bioterrorism: CXR= hilar/mediastinal
Anthrax
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Bioterrorism: Gram neg coccobacillia, alveolar pneumonia
Yersinia pestis
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Similar to chicken pox, but all lesions same stage (papular)
Small pox/vaccinia
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Positive PPD (TST): >5 mm positive for
- HIV+
- Immunosuppressed
- Recent contact of active case
- CXR w/ old TB
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Positive PPD: >10 mm
HCW, substance abusers
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Positive PPD: >15 mm
No risk factors
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Tx: Latent TB infxn
9 months INH
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Endocarditis Tx
Blood culture first then antibiotics
(TEE better than TTE)
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Endocarditis: Indications for surgery (6)
- CHF
- Valvular abscess
- Exxtension of infxn (3o Heart Block)
- Embolic events
- Fungal endocarditis
- Not responding or rx to tx
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Painless genital ulcer
Syphilis
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Single large painful
- Chancroid
- H. ducreyi (gram neg. coccobacilli- school of fish on CX)
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Painless, Donovan bodies on Bx
Tx 3 wks of bactrim or doxy or azithro
Klebsiella granuloma
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Urethritis or cervicitis: Tx
Ceftriaxone plus doxy
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Bacterial vaginosis: KOH + fishy odor
Tx?
Flagyl x7 days
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Trichomonas: Tx
Flagyl x1, tx partner
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PCP: Tx
- TMP/SMX
- Steroids when PaO2 <70 or A-a gradient >35
- Bronchoscopy for definitive diagnosis
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Cryptococcal meningitis
Amp B + Flucytosine
Followed by diflucan
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Toxoplasmosis
Treat empirically for 2 wks w/ pyrimethamine _ sulfadiazene _ folinic acid, if it doesn't resolve, biopsy it...likely CNS lymphoma
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HIV: mass effect
CNS lymphoma
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HIV: White matter changes
PML
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HCW with HIV + needle sick
PPX w/ 3 active HAART
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When to start HAART
- Any detectable viral load
- HIV+ pregant female (no efavirez)
- HIVAN (HIV associated nephropathy)
- Coinfection w/ Hep B
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HIV pt w/ central line loses vision in one eye
Candidal endophthalmitis
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Sea water exposure, comma shape rods on gram stain
Vibrio vulnificus
tx. doxycycline
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Sore throat + ampicillin= rash
Mononucleosis
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Influenza ppx
Oselatmivir
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Bacterial meningitis tx
Vanc, rocephin +/-amp
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Aseptic encephalitis w/ temporal lobe abnormalities on imaging - Check CNS for HSV PCR
Start acyclovir empirically
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Fishtank granuloma
Mycobacterium marinum
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