Rick. cases Flashcards
African American male presents a week after camping. He has a maculopapular rash on his palms and soles. He also has a fever and headache. His medical record lists a G6PD deficiency. What are you concerned about with this patient and how do you test it?
R. Rickettsii: rocky mountain spotted fever
Triad: HA, Fever, maculopapular rash from peripheral to core. G6PD deficient patients are at higher risk for the disease which is transmitted by ticks, usually in the summertime. African American males are more likely to die from this disease if left untreated. Test by conducting Immunofluoersence or PCR of blood/skin.
A woman presents after a cruise through the Mediterranean sea, where she visited the African and European continents, as well as turkey. She has fever, headache, and myalgias. You note an ulceration on her arm with a black center. She is a diabetic who admits to drinking daily. What is the bug, and what are her risk factors?
R. Connari, Fievre Boutonnesse/ Mediterranean spotted fever
Located in the med, Africa and middle east. A south African form exists as well. Individuals who are diabetic or alcoholics tend to have difficult comorbidities. It presents with a Tache Noir– ulceration at the site of tick bite. May have lymphadenopathy.
A homeless individual is brought to the ER with an acute fever. Upon exam, he has a Vesicular rash on his arms. Whats the bug?
R. Akari
The only spotted fever with a Vesicular rash, it is commonly found in individuals who are homeless and in urban locations. It is transferred by Mites from their natural reservoir in mice.
You are volunteering at a refugee camp in a cold environment. Multiple people present around the same time with fever x 3-5 days, then a maculopapular rash on their trunks. There are flying squirrels like, everywhere…
Typhus Prowazekii: epidemic typhus
a spotted fever that is common in war, famine, places where a lot of people are close together. Spread by Lice. Their natural reservoirs are humans and flying squirrels.. This rash is the opposite of rocky mountain– it starts in the trunk and heads to the periphery. This disease can become latent for years, redeveloping as “Brill Zinsser”, or it can cause death in 40% of patients… 2-3 month recovery time.
Serum testing.
Elderly woman presents with maculopapular rash on trunk and extremities. She has also had a fever, cough and headache. She owns two cats which are outdoor and do not have flea collars. What could be causing her symptoms?
Typhus Murine: endemic typhus
This bug is transferred from cats, possums and rats via flea bites. The maculopapular rash is unique because it is on the trunk and peripheral at the same time. It could possibly be a Petechial rash instead. Usually far more mild than epidemic typhus, and self-limiting. However, the elderly may require more intensive treatment.
Serum testing.
A man in Australia is brought to the clinic with fever, headache, an ulcerated bite on his leg, local lympahednopathy and loss of hearing. What are you worried about?
Scrub Typhi: orienta tsutsu.
Commonly found in japan, china, Australia.
It is transferred by mites/ chiggers in locations with a lot of “scrub” vegetation. Will cause hearing loss, lymphadenopathy, and possible trunkal rash. May present with possible delirium and agitation.
Usually resolves in two weeks.
A local cattle rancher presents with fever x 2 weeks, then went away without intervention. Now, he has splinter hemorrhages on his fingernails, and ossler nodes on his hands which make you think he has endocarditis. He has no visible rash. What could be the problem?
Coxiella burnetti: Q fever
No rash, ever. Infects macrophages, causing fever. Eventually it may cause endocarditis, osteomyelitis. It is a very hardy organism, surviving outside of a cell in the environment. It’s vector is usually farm animals and their fluids/ waste.
Individual presents to a clinic in Texas with maculopapular rash, headache, fever, and nuchal rigidity. He was camping last week. He has increased liver enzymes, leukopenia, thrombocytopenia. There is Morulae on a peripheral blood smear. What could he have?
Ehrlechia Chaffeensis: Human Monocytic Erhlechi
Spread by the Lone Star Tick from White Tailed Deer. It is unique compared to Anaplasmosis because it has CNS involvement, a possible rash, and is spread by a different type of tick.
Individual presents in Maine with a fever, headache and sudden Bell’s Palsy. No rash is seen. He has increased liver enzymes, leukopenia, thrombocytopenia. There is Morulae on a peripheral blood smear. He was camping last week.
Anaplasmosis: Human Granulocytic Anaplasmosis.
This bug is unique because it usually has no rash, no CNS involvement, and effects men more than women. It is carried by the same tick as Babe. and Lyme.
