Case 5 – infection with ricketsia conorii (spp israelensis) – intracellular bacteria

Question 1

General info - no need to memorize

Answer 1

A 28-year-old veterinarian presents with fever, headache, and rash on the palms.
Blood cultures are negative.

Question 2

The presumptive diagnosis is?

Answer 2

Israeli spotted fever

Question 3

Israeli spotted fever - characteristics - 4

Answer 3

• found all over Mediterranean – 2-3 cases in Rambam per year
• aggressive
• passes from dogs with tick as vector
• does not grow on regular culture! ∴ diag is serologic (but takes a week to dev Abs)

Question 4

Israeli spotted fever - symptoms - 4

Answer 4

Leukopenia(not leukocytosis!)
cytopenia,
renal failure,
palmar rash

Question 5

Treatment for intracellular bacteria - 2

Answer 5

Doxycycline – 1st line

Macrolides

Question 6

Doxycycline - side effects - 4

Answer 6

vaginitis,
teeth coloring (children < 8 years),
harsh esophagitis,
drug-induced lupus

Question 7

Macrolides - types - 3

Answer 7

Erythromycin, Azithromycin, Clarythromycin

Question 8

Azithromycin - pros - 5

Answer 8

good for intracellular bacs and various STDs and resp

infs, long t1/2, and few SEs

Question 9

Azithromycin - cons - 1

Answer 9

but causes cardiac deaths dt QT prolongation (in patients w/ preexisting conditions)