CHAPTER 14: BACTERIAL INFECTIONS Flashcards
1
Q
painful, erythematous nodule with a pale center located on the finger- tips.
Seen in bacterial endocarditis
mnemonic: Ouchey Fingers
A
OSLER NODES
2
Q
nontender, angular hemorrhagic lesion of the soles and palms
seen in subacute bacterial endocariditis
A
janeway lesions
3
Q
type of impetigo that occurs characteristically in newborns, although it may occur at any age.
common sites are the FACE and HANDS
majority are caused by phage types 71 or 55 coagulase-positive S. aureus or a related group 2 phage type.
maybe and early manifestation of HIV infection
A
Bullous impetigo
4
Q
bullos impetigo begins between the _____ and ____ days of life with the appearance of bullae, which may appear on any part of the body.
A
he fourth and tenth days of life
5
Q
acute glomerulonephritis is associated with ______ infection
A
Group A B-hemolytic streptocccal skin infection ( impetigo)
6
Q
treatment of Group A B-hemolytic streptocccal skin infection ( impetigo)
A
application of mupirocin oint- ment to the anterior nares twice daily or
by a 10-day course of rifampin, 600 mg/day, combined with dicloxacillin (for MSSA) or TMP-SMX (for MRSA).
7
Q
is a superficial folliculitis with thin-walled pustules at the follicle orifices. Susceptible locations are the extremities and scalp, although it is also seen on the face, especially periorally.
S. aureus- MCC
A
Bockhart impetigo
8
Q
also known as “barber’s itch”
s a perifollicular, chronic, pustular staphylococcal
infection of the bearded region characterized by inflammatory papules and pustules, and a tendency to recurrence
A
Sycosis vulgaris or Sycosis barbae
9
Q
is an acute, round, tender, circumscribed, perifollicular staphylococcal abscess that generally ends in central suppuration
A
furuncle, or boil,
10
Q
merely two or more confluent furuncles, with separate heads.
A
carbuncle
11
Q
The proximate cause of furunculosis is either contagion or autoinoculation from a carrier focus, usually in ______.
A
nose or groin
12
Q
Treatment for acutely inflamed furuncle
A
incision should be strictly avoided, and warm compresses and oral antibiotics are administered.
A penicillinase-resistant penicil- lin or first-generation cephalosporin should be given orally in a dose of 1–2 g/day, according to the severity of the case.
13
Q
Methicillin-resistant and even vancomycin-resistant strains of furunculosis occur and, if suspected, are treated with
A
trimethoprim- sulfamethoxazole double strength twice daily, clindamycin 300 to 450 mg three times daily, or doxycycline or minocycline 100 mg two times daily.
Mupi- rocin ointment applied to the anterior nares daily for 5 days and bleach baths may help prevent recurrence.
14
Q
when should incision with drainage is indicated in furunculosis?
A
When the furuncle has become localized and shows definite fluctuation.
The cavity should be packed with iodoform or petrolatum gauze.
15
Q
in furunculosis , Indications for antibiotics in addition to drainage are
A
Indications for antibiotics in addition to drainage are high fever, lesion larger than 5 cm or located in a critical location or difficult-to-drain area, multiple furuncles, or signs and symptoms persisting after drainage.
16
Q
is an inflammatory reaction involving the folds of the skin surrounding the fingernail.
It is characterized by acute or chronic purulent, tender, and painful sw
A
Paronychia
17
Q
The primary predisposing factor of pyogenic paronychia is
A
sepa- ration of the eponychium from the nail plate.
18
Q
Treatment of pyogenic paronychia
A
- protect and effort to keep fingernails dry
- Acutely inflamed pyogenic abscesses should be incised and drained.
- penicillin / cephalosporin
- TMP-SMX for MRSA
- for C. albican infetion: miconazole + topical cortisocteroid cream
19
Q
Staphylococcus aureus abscess formation within the deep, large, striated muscles usually presents with fever and muscle pain. It is typically hematogenous in origin.
A
Pyomyositis
20
Q
most frequent muscle site of Pyomyositis in tropic is ___; in HIV infected px is ____
A
pyomyosistis in tropics: Thigh
HIV infected px: deltoid
21
Q
is a febrile, rapidly evolving, desquamative infectious disease in which the skin exfoliates in sheets.
Skin does NOT separate at the dermoepidermal junc- tion, as in toxic (drug-induced) epidermal necrolysis (TEN), but WITHIN the granular layer.
A
Staphylococcal scalded skin syndrome (SSSS)
22
Q
mcc causative agent of SSSS
A
Group 2 S. aureus, usually phage types 71 or 55,
23
Q
Treatment of choice od SSSS
A
penicillinase-resistant penicillin such as dicloxacillin com- bined with fluid therapy and general supportive measure
24
Q
is an acute, febrile, multisystem illness, with one of its major diagnostic criteria being a wide- spread macular erythematous eruption. It is usually caused by toxin-producing strains of S. aureus, most of which were ini- tially isolated from the cervical mucosa in menstruating young women.
A
Toxic shock syndrome (TSS)
25
what is the streptococcal strain causing TSS?
The streptococci are usually of M-types 1 and 3, with 80% of the isolates producing pyrogenic exotoxin A.
26
what is the biologic marker of TSS, that is an indicator of severe bacterial infection?
procalcitonin
27
treatment of TSS
systemic antibiotics: Vancomycin + nafcillin ,
fluid tx to trea shock and drainage of S. aureus infected site.
28
is an ulcerative staphylococcal or streptococcal pyo- derma, almost always of the shins or dorsal feet.
The disease begins with a vesicle or vesicopustule, which enlarges and in a few days becomes thickly crusted. When the crust is removed, there is a superficial, saucer-shaped ulcer with a raw base and elevated edges
Ecthyma
29
Treatment of ecthyma
1. cleansing with soap and water + application of mupirocin, retapamulin, or bacitracin ointment, twice daily.
2. Oral dicloxacillin or a first-generation cephalosporin
30
Cephalocaudal cutaneous eruption: begins on the neck, then spreads to the trunk and finally the extremities
WHITE strawberry tongue appearance: tongue has a white coating through which reddened, hypertrophied papillae project.
pastia line: There is accentuation over the skinfolds, and a linear petechial eruption
+ GAS,
+ inc ASO titer after strep pharyngeal infection
Scarlet fever
31
Also once known as St. Anthony’s fire and ignis sacer,
A streptococcal infection of the skin involving the superficial dermal lymphatics.
It is characterized by local redness, heat, swelling, and a highly characteristic raised, indurated border, preceeded prodromal symptoms of malaise for several hours, chills, high fever, headache, vomiting, and joint pains and inc PMN leukocytosis of 20,000 cells/ mm3 or more.
Erysipelas
32
Erysipelas is caused by ___ organism
β-hemolytic group A streptococcal
33
treatment of erysipelas
1. Systemic penicillin
2. ice bags and cold compresse
3. IV antibiotics
34
is a suppurative inflammation involving the subcu- taneous tissue.
Mild local erythema and tenderness, malaise, and chilly sensations or a sudden chill and fever may be present at the onset. The erythema rapidly becomes intense and spreads. The area becomes infiltrated and pits on pressure.
Cellulitis
35
tx of cellulitis
Initial empiric therapy with dicloxacillin or cephalexin for 5 days will usually suffice.
36
tx of Necrotizing fasciitis
Early surgical debridement is an essential component of suc- cessful therapy.
ppro- priate IV antibiotics, and supportive care.
37
The most definitive confirmatory test of Necrotizing fasciitis
MRI
38
characterized by tense superficial blisters occurring on a tender erythematous base over the volar fat pad of the phalanx of a finger or thumb or occasion- ally a toe.
caused by Group A β-hemolytic streptococci or S. aureus
Blistering distal dactylitis
39
appears as a spreading, patchy ery- thema that migrates peripherally and often forms polycyclic configurations.
It is usually part of the early phase of the rheumatic fever, coexisting with carditis but usually preceding the arthritis.
Erythema marginatum
40
JONES Criteria: ( Major signs)
1. erythema marginatum
2. subcu- taneous nodules
3. carditis
4. polyarthritis
5. (sydenham) chorea
41
is the major cause of bacterial sepsis and meningitis in neonates. It may cause orbital cellulitis or facial erysipelas in these patients.
Streptococcus agalactiae
42
Cellulitis of the hands may be caused by the fish pathogen.
Treatment : penicillin
Streptococcus iniae infections
43
an acute infectious disease characterized by a rapidly necrosing, painless eschar with associated edema and suppurative regional adenitis
Anthrax
43
an acute infectious disease characterized by a rapidly necrosing, painless eschar with associated edema and suppurative regional adenitis
Anthrax
43
an acute infectious disease characterized by a rapidly necrosing, painless eschar with associated edema and suppurative regional adenitis
Anthrax
44
what is woolsorter’s disease?
woolsorter’s disease is an inhalational form of Anthrax.
45
what is woolsorter’s disease?
woolsorter’s disease is an inhalational form of Anthrax.
46
a large, square- ended, rod-shaped gram-positive organism that occurs singly or in pairs in smears from the blood or in material from the local lesion, or in long chains on artificial media, where it tends to form spores.
Bacillus anthracis
47
hree virulence factors of Bacillus anthracis
1. a polyglutamate acid capsule inhibiting phagocytosis; 2. an edema toxin, composed of edema factor and a transport protein termed protective antigen;
3. and lethal toxin, composed of lethal factor plus protective antigen.
48
tx of Anthrax
1. Ciprofloxacin (500 mg) or doxycycline (100 mg), twice daily for 60 days, are curative in the cutaneous form when there are no systemic symptoms, lesions are not on the head or neck and are without significant edema, and the patient is not a child younger than 2 years.
2. Agressive IV Ciprofloxacin or doxycycline for severe cases.
3. vaccine is available
49
is a gram-positive bacillus with rounded ends that may be isolated from soil, water, animals, and asymptomatic individuals.
produce meningitis or encephalitis with monocytosis.
Risk factors include alcoholism, advanced age, pregnancy, and immunosuppression.
Listeria monocytogenes
50
tx of Listeriosis
Ampicillin + gentamicin is the antibiotic of choice, and TMP-SMX is an effective alternate.
51
disease causing ulceration that is punched out and has hard, rolled, elevated edges with a pale- blue tinge (Fig. 14-24). Often, the lesion is covered with a leathery, grayish membrane.
Corynebacterium diphtheriae infection
52
Treatment of Corynebacterium diphtheriae infection
1. intramuscular (IM) injections of diph- theria antitoxin, 20,000–40,000 U, after a conjunctival test has been performed to rule out hypersensitivity to horse serum.
( One drop of antitoxin diluted 1 : 10 is placed in one eye and 1 drop of saline in the other eye. If after 30 min there is no reac- tion, 20,000–40,000 U of antitoxin is given.)
2. Erythromycin, 2 g/ day, is the drug of choice,
3. In severe cases, IV penicillin G, 600,000 U/day for 14 days, is indicated.
4. Rifampin, 600 mg/ day for 7 days, will eliminate the carrier state.
53
characterized by sharply delineated, dry, brown, slightly scaling patches occurring in the intertriginous areas, especially the axillae (Fig. 14-25), the genitocrural crease, and the webs between the fourth and fifth toes and less often the third and fourth toes
Erythrasma
54
causative agent of Erythrasma
diphtheroid Corynebacterium minutissimum
| This non-spore-forming, rod-shaped, gram- positive organism may occasion
55
diagnostic medium for erythrasma.
**Wood’s light**
The affected areas show a coral-red fluorescence, which results from the **coproporphyrin III.**
56
tx of Erythrasma
1. Topical erythromycin solution or topical clindamycin is easily applied and rapidly effective.
2. Oral erythromycin (250 mg four times daily for 1 week), clarithromycin (single 1-g dose), and topical miconazole are equally effective.
57
a bacterial infection of the plantar stratum corneum, the thick, weight-bearing portions of the soles become gradually covered with shallow, asymptomatic, dis- crete round pits 1–3 mm in diameter, some of which become confluent, forming furrows
pitted keratolysis
58
mcc of pitted keratolysis
Kytococcus sedentarius
| It produces two serine proteases that can degrade keratin.
59
tx for pitted keratolysis
1. Topical erythromycin or clindamycin is curative in pitted keratolysis.
2. Miconazole or clotrimazole cream and Whitfield ointment are effective alternatives.
3. Both 5% benzoyl peroxide gel and a 10–20% solution of aluminum chloride may be used.
4. Botulinum toxin helps if there is associated hyperhidrosis.
60
gas gangrene is cause by
Clostridium spp.
61
a **postoperative** progressive bacterial synergetic gangrene. It usually follows drainage of peritoneal abscess, lung abscess, or chronic empyema.
Chronic undermining burrowing ulcers (Meleney gangrene)
62
3 zones of Chronic undermining burrowing ulcers (Meleney gangrene):
After 1 or 2 weeks, the wound markings or **retention suture holes **assume a carbunculoid appearance, finally differentiating into three skin zones:
1. outer, bright red;
2. middle, dusky purple;
3. and inner, gangrenous with a central area of granulation tissue.
63
essential organism causing Chronic undermining burrowing ulcers (Meleney gangrene)
microaerophilic, nonhemolytic streptococcus (peptostrepto- coccus) in the spreading periphery of the lesion, associated with Staphylococcus aureus or Enterobacteriaceae in the zone of gangrene.
64
ecthyma gangrenosum is caused by
Pseudomonas aeruginosa.
65
tx for Meleney gangrene.
1. Wide excision and grafting are primary therapy for Meleney gangrene.
2. Antimicrobial agents, penicillin, and an aminogly- coside should be given as adjunctive therapy.
66
is a gangrenous infection of the penis, scrotum, or perineum that may be caused by infection with group A streptococci or with mixed enteric bacilli and anaer- obes.
Fournier syndrome / Fournier gangrene of the penis or scrotum
67
are anaerobic, gram-positive, filamentous bacteria that colonize the mouth, colon, and urogenital track. Infections are seen most often in the cervicofacial area but also on the abdominal region, thoracic area, or pelvis
Actinomyces
68
MCC in Diabetic and immunosuppressed patients and alcoholics with poor dental hygiene
lumpy jaw.
Man- dibular infection is seen four times
HX: Eosinophilic clubs composed of immunoglobulin are seen at the periphery of the granule (Splendore-Hoeppli phenom- enon)
dx: crushed granule in brain-heart infusion blood agar (incubated at 37C). ; direct microscopy
Actinomycosis
69
tx of Actinomycosis
Penicillin G in large doses, 10–20 MU/day for 1 month, fol- lowed by 4–6 g/day of oral penicillin for another 2 months
Other effective medications have been ampicillin, erythromycin, tetracyclines, ceftriaxone, and clindamycin.
Surgical incision, drainage, and excision of devitalized tissue are important.
70
____ is usually responsible for the dissemi- nated form of nocardiosis;
____is the most common cause of primary cutaneous disease.
Nocardia asteroides- dessiminated
Nocardia brasiliensis- primary cutaneous disease
71
describe Nocardia spp.
Nocardia are gram-positive, partially acid-fast, aerobic, fila- mentous bacteria. Some are branched, but filaments tend to be shorter and more fragmentary than those of Actinomyces.
Sabouraud dextrose agar, without antibacterial additives, there are creamy or moist, white colo- nies, which later become chalky and orange colored.
72
DOC for nocardia infection
cutaneous nocardial infection: TMP-SMX, 4 tablets twice daily for 6–12 weeks.
N. asteroides: Minocycline
N. brasiliensis: amoxicillin-clavulanate
Amikacin and imipenem are effec- tively used in combination with a variety of antibiotics for disseminated infection.
73
Recommended treatment for Ecthyma grangrenosum
immediate institution of IV antipseudomonal penicillin.
+ granulocyte- macrophage colony-stimulating factor to stimulate both pro- liferation and differentiation of myeloid precursors is an adjunct in a patient with myelodysplasia or treatment-induced neutropenia.
74
characterized by onycholysis of the distal portion of the nail and a striking greenish discoloration in the separated areas.
caused by P. aeruginosa
Green nail syndrome
75
tx for Green nail syndrome
Soaking the affected finger in a 1% acetic acid solution BID.
Trimming the onycholytic nail plate + application of Neosporin solution BID
76
characterized by pruritic follicular, maculopapular, vesicular, or pustular lesions occurring within 1–4 days after bathing in a hot tub, whirlpool, or public swim- ming pool (Fig. 14-33).
Pseudomonas aeruginosa folliculitis (hot tub folliculitis)
77
tx for Pseudomonas aeruginosa folliculitis (hot tub folliculitis)
involutes usually within 7–14 days without therapy
third-generation oral cephalosporin or a fluoroquinolone such as ciprofloxacin or ofloxacin may be useful
78
tx for external otitis caused by P. aeruginosa
Cortisporin otic solution or suspension, or 2% acetic acid compresses with topical cortico- steroids, will help clear this infection.
Antifungal solutions (e.g., ciclopiroxolamine) combined with corticosteroid solutions are effective in otomy- cosis.
79
**granuloma in GUT, skin and subcutaneous tissue in immunocomp px.**
caused by S. aureus, P. aeruginosa and E. coli
Hx:foamy eosinophilic** Hansemann macrophages** contain calcified, concentrically laminated, intra- cytoplasmic bodies (**Michaelis-Gutmann).**
Tx: fluoroquinolone such as ciprofloxacin or ofloxacin
MALACOPLAKIA (MALAKOPLAKIA)
80
organsism that causes Chancroid ( soft chancre)
Haemophilus ducreyi (the Ducrey bacillus).
| a gram-negative bacillus
81
inguinal adenitis
suppurative bubo
painful chancre
dx: culture in selective medium con- taining **vancomycin**, and cultures are done in a water-saturated environment with 1–5% CO2, at a temperature of 33°C.
Haemophilus ducreyi (the Ducrey bacillus) chancroid.
82
The treatment of choice for chancroid
DOC: azithromycin, 1 g orally in a single dose.
Erythromycin, 500 mg 4x a day for 7 days;
ceftriaxone, 250 mg IM SD ; and
ciprofloxacin ( CI in pregnant and < 17 yo), 500 mg BID x 3 days, are also recommended treatments.
if w/ pus: repeated aspiration ( not incision)
83
organism causing donovanosis
Granuloma inguinale/ donovanosis is caused by the gram-negative bacte- rium Klebsiella granulomatis.
84
stain MC used in rapid dx and demonstration of donovian bodies
wright or giemsa stain
85
tx for donovanosis
Oral TMP-SMX (1 double-strength tablet) or doxycycline (100 mg) twice daily for a minimum of 3 weeks is the recom- mended regimen.
Alternative regimens are oral ciprofloxacin, 750 mg twice daily; erythromycin base, 500 mg four times daily; and azithromycin, 1 g once weekly, all for at least 3 weeks.
The addition of an IV aminoglycoside such as gentamicin, 1 mg/kg every 8 h, should be considered if lesions do no respond within the first few days and in HIV-infected patients.
86
causative organism of Gonococcemia
Neisseria gonorrhoeae.
87
The treatment of choice for disseminated gonococcal infec- tion
ceftriaxone, 1 g/day intravenously + azithromycin 1 g PO for min. of 1 wk
88
presents with fever, chills, hypoten- sion, and meningitis. Half to two thirds of patients develop a petechial eruption, most frequently on the trunk and lower extremities, which may progress to ecchymoses, bullous hemorrhagic lesions, and ischemic necrosis
Acute meningococcemia
89
causative agent of Meningococcemia
fastidious gram-negative diplococcus Neisseria meningitidis.
90
most important viruence and serotyping factor of Neisseria meningitidis causing meninggococcemia
polysaccharide capsule
| The human nasopharynx is the only known reservoir,
91
tx of Meningococcemia
Treatment is with IV ceftriaxone, 2 g four times daily, or penicillin G, 300,000 U/kg/day up to 24 MU/day for 7 days.
Dexamethasone, cefotaxime, chloramphenicol, and TMP-SMX are alternatives. One dose of ciprofloxacin, 500 mg, is given after the initial course of antibiotics to clear nasal carriage
Rifampin, 10 mg/kg every 12 h for 2 days, is an alternative prophylactic therapy for children.
A polyvalent vaccine is effective against groups A, C, Y, and W-135 and is recommended for high-risk groups.
92
Treatment of Vibrio vulnificus infection
Doxycycline together with ceftriaxone is the treatment of choice.
93
typhoid fever is caused by ______ are acquired from ingestion of contaminated food or water.
Salmonella typhi
94
After an incubation period of 1–2 weeks, there is usually an acute onset of fever, chills, headache, constipation, and bron- chitis.
After 7–10 days of fever and diarrhea, skin lesions,rose-colored macules or papules (“rose spots”) 2–5 mm in diameter, appear on the anterior trunk, between the umbilicus and nipples.
Typhoid fever (Salmonella typhi)
95
how to dx typhoid fever
confirmed by culturing the organism from blood, stool, skin, or bone marrow.
96
tx for typhoid fever
ciprofloxacin or ceftriaxone.
97
are small, gram-negative rods that cause bacillary dysentery, an acute diarrheal illness.
person-to-person transmission; from contaminated food and water.
Small, blanchable, erythematous macules on the extremities, as well as petechial or morbilliform eruptions, may occur.
cutaneous form of STD
tx : fluoroquinolone
Shigellae (SHIGELLOSIS)
98
may occur in patients with skin injury and exposure to this organism.
associated with ship- ping fever in cattle and septicemia in lambs and newborn pigs.
The open sites become inflamed, lymphangitis and fever develop, and axillary lymph nodes become enlarged. Diagno- sis is based on demonstration of the bacteria on culture.
Primary cutaneous (ulceroglandular) Pasteurella haemolytica (Mannheimia haemolytica) infection
99
is a small, nonmotile, gram-negative, bipolar-staining bacterium.
injuries from cat/ dog bite and scratches
After animal trauma, erythema, swelling, pain, and tenderness develop within a few hours of the bite, with a gray-colored serous or sanguinopurulent drainage from the puncture wounds
Pasteurella multocida infection
| tx: systemic Penicillin G, cleaning of wound and tetanus prophylaxis.
100
organsism causes cat- scratch disease.
Hallmark: (regional and unilateral ) Lymphadenopathy, appears 1 or 2 weeks after the primary lesions or 10–50 days (average 17) after inoculation.
tx: resolved spontaneously
if severe: azithromycin
Bartonella henselae
101
Trench fever is caused by ______, which is spread from person to person by the body louse.
fever lasting 1 wk, then recurs q5days
Bartonella quintana
102
organism causing plague
Yersinia pestis
103
carrier / vector of Y. pestis causing plague
infected rodent fleas or wild rodents.
Xenopsylla cheopis (Orien- tal rat flea) has traditionally been considered the vector in human outbreaks,
Diamanus montanus, Thrassis bacchi, and Opisocrostis hirsutus are species of fleas on wild animals responsible for spreading sylvatic plague in the United States.
104
MOA of plague
Transmission occurs through contact with infected rodent fleas or rodents, pneu- monic spread, or infected exudates.
105
tx of Y. pestis infection
gentamicin and streptomycin IV .
Other effective drugs include chloramphenicol, the tetracy- clines, and ciprofloxacin.
106
what are the 2 forms of rat-bite fever?
1. sodoku,” caused by Spirillum minor;
2. septicemia, caused by Streptobacillus moniliformis, otherwise known as epidemic arthritic erythema or Haverhill fever.
107
organism causing tularemia or Ohara's disease or deer fly fever
Francisella tularensis, a short, non- motile, non-spore-forming, gram-negative coccobacillus.
108
carrier organism of tularemia
tick, Derma- centor andersoni or Amblyomma americanum,
and of a deer fly, Chrysops discalis,
109
MOA of tularemia
han- dling of wild rabbits and the bite of deer flies or ticks.
110
definite dx of tularemia
A definite diagnosis is made by staining smears obtained from the exudate with specific fluorescent antibody.
F. tular- ensis can be cultured only on special media containing cystine glucose blood agar or other selective media.
111
main histologic feature of tularemia is
granu- loma;
the tissue reaction consists primarily of a massing of endothelial cells and the formation of giant cells.
112
TOC of tularemia
Streptomycin IV
alternative:
Gentamicin
ciprofloxacin
doxycycline
113
also known as undulant fever
Workers in the meatpacking industry are mainly at risk; however, veterinarians, pet owners, and travelers who consume unpasteurized milk or cheese may also contract the disease.
dx: biopsy may reveal noncaseating granulomas; culture of blood, bone marrow, or granulomas
confirmatory dx:
by a rising serum enzyme-linked immunosorbent assay (ELISA) or agglutination titer, PCR
tx: doxycycline and strepto- mycin in combination for 6 weeks.
Brucellosis
114
Q fever is caused by
Coxiella burnetii
115
Louse-borne EPIDEMIC typhus, caused by
Rickettsia prowazekii
116
cat, or rat flea-borne ENDEMIC typhus, caused by
Rick- ettsia typhi;
117
scrub typhus, a mite-borne infection caused by
Rickettsia tsutsugamushi,
118
Rocky Mountain spotted fever, caused by
Rickettsia rickettsii
At 1–2 weeks after the tick bite, chills, fever, and weakness occur. An eruption appears, but unlike typhus, it begins on the ankles, wrists, and forehead rather than the trunk. The initial lesions are small, red macules, which blanch on pressure and rapidly become papular in untreated patients. Spread to the trunk occurs over 6–18 h, and the lesions become petechial and hemorrhagic over 2–4 days
119
carrier of R. rickettsii. causing Rocky Mountain spotted fever
wood tick (Dermacentor andersoni),
the dog tick (D. variabilis and R. sanguineus in Arizona),
and the Lone Star tick (Amblyomma americanum).
120
___ aka Weil’s disease, pretibial fever, and “Fort Bragg fever.”
Leptospirosis
( Leptospira interrogans)
. . .
After an incubation period of 8–12 days, Weil’s disease (icteric leptospirosis) starts with an abrupt onset of chills, followed by high fever, intense jaundice, petechiae, and purpura on both skin and mucous membranes, and renal disease, manifested by proteinuria, hematuria, and azotemia. Death may occur in 5–10% of patients as a result of renal failure, vascular collapse, or hem- orrhage. Leukocytosis of 15,000–30,000 cells/mm3 and lym- phocytosis in CSF are usually present.
121
diagnostic tools of Leptospirosis
darkfield microscopy during the first week of illness finding the spirochetes
blood cultures, guinea pig inoculation, and the demonstration of rising antibodies during the second week of the disease.
The microagglutination sero- logic test is the TEST OF CHOICE
122
Treatment of Leptospirosis
Treatment with tetracyclines and penicillin shortens the disease duration if given early.
Doxycycline, 100 mg/day for 1 week, is effective in mild disease; however, IV penicillin is necessary in severely affected patients. A dose of 200 mg once weekly may help prevent infection while visiting a hyperen- demic area.
123
cause of Lyme disease
Borrelia burgdorferi
124
MOT of Lyme disease.
transmitted to humans by various members of the family of hard ticks, Ixodidae.
125
Diagnosing early Lyme disease depends on recognition of the skin eruption called ___
erythema migrans
(most sensi- tive evidence of early infection.)
126
treatment of choice of Lyme disease.
adults: doxy- cycline, 100 mg twice daily for 3 weeks.
Amoxicillin, 500 mg twice daily for 21 days, or
cefuroxime axetil, 500 mg twice daily for 21 days, is also effective.
Children under age 9 and Pregnant women : amoxicillin, 20 mg/kg/day in divided doses.
disseminated disease: parenteral penicillin G or ceftriaxone is used.
Immunodeficient patients: IV peni- cillin or ceftriaxone,
127
is an important cause of acute respiratory disease in children and young adults.
Mycoplasma pneumoniae (Eaton agent)
- are distinct from true bacteria in that they lack a cell wall and differ from viruses in that they grow on cell-free media.
128
is an STD caused by microorganisms of the Chlamydia trachomatis group and char- acterized by suppurative inguinal adenitis with matted lymph nodes, inguinal bubo with secondary ulceration, and constitu- tional symptoms.
Lymphogranuloma venereum (LGV)
129
e recommended treatment of LGV
The recommended treatment of LGV is doxycycline, 100 mg twice daily for 3 weeks.
An alternative is erythromycin, 500 mg four times daily for 21 days.
Sexual partners within the prior 30 days should also be treated.
130
mc manifestation of gonorrhea in men
urethritis
131
what bacterial infection causes opthalmia neonatorum
gonorrhea
132
triad of desimminated gonococcal infection (DGI)
1. dermatitis
2. migratory arthritis
3. tenosynovitis
