Tags: Leptospirosis

Rocky Mountain Spotted Fever

Essentials of Diagnosis • Key symptoms and signs: abrupt onset of high fevers, headaches, myalgias, malaise, and a flu-like illness 3-12 days after tick bite; rash (80-90% of patients, initially maculopapular, then petechial, classically involving the palms and soles). • Predisposing factors: tick exposure (April through September), pet owners, animal handlers, and outdoor activities. • Commonest geographic location of infection: rural. • Confirmatory serology via IFA. • PCR with blood or skin biopsy: sensitive and specific but not widely available. General Considerations RMSF is caused by Rickettsia rickettsii and is an acute tick-borne illness occurring during seasonal tick activity. The disease is characterized by acute onset of fever, headache, and a …

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Ehrlichia Infection (Ehrlichiosis)

Essentials of Diagnosis • Key symptoms and signs: abrupt onset of high fever, headache, myalgias, chills 8-9 days after tick bite; rash (36% of human monocytic ehrlichiosis [HME] patients; only 2% of human granulocytic ehrlichiosis [HGE] patients); central nervous system involvement (20-25% of patients). • Predisposing factors: tick and rural exposure (April through September). • Presentation: most present as flu-like illness. • Key laboratory features: thrombocytopenia, leukopenia, and elevated liver transaminases. • Diagnosis: confirmed by a fourfold or greater rise in titers with an IFA. General Considerations Human ehrlichiosis was first recognized in the United States in 1986 as a life threatening tick-borne illness similar to Rocky Mountain spotted fever (RMSF), …

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Borrelia & Leptospira Species

 BORRELIA SPECIES RELAPSING FEVER Essentials of Diagnosis • The most common presentation is fever with rash, headache, shaking chills, myalgias, arthralgias, and — during the acute phase — hepatosplenomegaly. • Louse-borne relapsing fever (LBRF) is epidemic, caused by B. recurrentis, and characterized by one or two relapses. • Tick-borne relapsing fever (TBRF) is endemic, caused by several Borrelia species, and characterized by multiple clinical relapses. • Organisms can be visualized in blood smears of febrile patients, unlike other spirochetal pathogens, using dark-field microscopy or Giemsa or Wright stains. • Helical (3-10 spirals) spirochetes, 8-30 um × 0.3 um, motile (flagella). • Weil-Felix reaction: Proteus OX-K agglutinin titers are elevated (this is …

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Treponema Pallidum

Essentials of Diagnosis • Spiral, motile, coil-shaped, elongated (0.10 um × 5-20 um) spirochete. • No reliable method for sustained in vitro cultivation. • Direct detection with darkfield microscopy or immunofluorescent antibody in early syphilis. • Nontreponemal antibody tests (rapid plasma reagin, Venereal Disease Research Laboratory [VDRL]) for screening, treatment follow-up. • Treponema-specific antibody tests (fluorescent treponemal antibody test, microhemagglutination-T pallidum test) for confirmation. • Cerebrospinal fluid (CSF) lymphocytosis, elevated CSF protein, or reactive CSF VDRL test suggests neurosyphilis. • PCR, DNA probes, and immunoblotting techniques promising in congenital syphilis, early syphilis, or neurosyphilis. • All patients with T pallidum infection should be tested for HIV coinfection and vice versa. General …

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Streptococcal Toxic Shock Syndrome

In the late 1980s, invasive GAS infections occurred in North America and Europe in previously healthy individuals of all ages. This illness is associated with bacteremia, deep soft-tissue infection, shock, multi-organ failure, and death in 30% of cases. StrepTSS occurs sporadically, although minor epidemics have been reported. Most patients present with a viral-like prodrome, history of minor trauma, recent surgery, or varicella infection. The prodrome may be caused by a viral illness that predisposed to strepTSS, or these vague early symptoms may be related to the evolving infection. In cases associated with necrotizing fasciitis, the infection may begin deep in the soft tissue at a site of minor trauma that frequently …

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Staphylococci

STAPHYLOCOCCUS AUREUS Essentials of Diagnosis • Large gram-positive cocci (0.7-1.5 um in size). • Colonies surrounded by zone of hemolysis on blood agar. • Colonies pigmented pale yellow to deep orange macroscopically. • Cluster in grapelike bunches microscopically. • Biochemically differentiated from streptococci by presence of the enzyme catalase. • Biochemically differentiated from other staphylococci by presence of the enzyme coagulase. • Analysis of chromosomal DNA can identify clonal isolates (useful in epidemiologic studies). General Considerations A. Epidemiology. Staphylococcus aureus colonizes the human skin, vagina, nasopharynx, and gastrointestinal tract. Colonization occurs shortly after birth and may be either transient or persistent. Published studies differ widely in estimates of the prevalence of …

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Toxic Shock Syndrome

The toxic shock syndrome (TSS) is a heterogeneous complex of symptoms attributed to TSST-1 toxin-producing S aureus. Two variants have been described: menstruation-associated and nonmenstrual disease. Cases of menstruation-associated disease are correlated with the use of superabsorbent tampons. Diaphragm contraception, parturition, indwelling foreign bodies, and recent surgery predispose to nonmenstrual disease. Clinical Findings A. Signs and Symptoms. Myalgias, headache, malaise, watery diarrhea, and confusion (in the face of a normal neurologic exam) are early symptoms of TSS, typically preceding the rash by 2-3 days. Erythroderma is initially seen on the palms and soles, progressing to a confluent generalized rash. Hypotension and fever are invariably present at this stage. Multisystem organ failure …

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Buy Vibramycin (Doxycycline) Without Prescription 100mg

Doxycycline Calcium, Doxycycline Hyclate, Doxycycline Monohydrate: Dosage and Administration • Reconstitution and Administration Doxycycline calcium, doxycycline hyclate, and doxycycline monohydrate are administered orally. When oral therapy is not feasible, doxycycline hyclate may be administered by slow IV infusion; however, oral therapy should replace IV therapy as soon as possible. If doxycycline is given IV, the risk of thrombophlebitis should be considered. • Oral Administration To reduce the risk of esophageal irritation and ulceration, capsules or tablets containing doxycycline hyclate and capsules containing doxycycline monohydrate should be administered with adequate amounts of fluid and probably should not be given at bedtime or to patients with esophageal obstruction or compression. It has been …

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Tetracyclines General Statement: Cautions

• GI Effects The most frequent adverse reactions to tetracyclines are dose-related GI effects including nausea, vomiting, diarrhea, bulky loose stools, anorexia, flatulence, abdominal discomfort, and epigastric burning and distress. Stomatitis, glossitis, dysphagia, sore throat, hoarseness, black hairy tongue, pancreatitis, and inflammatory lesions in the anogenital region with candidal overgrowth have also been reported occasionally. GI effects occur most frequently when tetracyclines are administered orally, but may also occur when the drugs are administered IM or IV. In clinical trials in which combined therapy with tetracycline hydrochloride, metronidazole, and bismuth subsalicylate was used for the treatment of H. pylori infection and associated duodenal ulcer, adverse effects generally were related to the …

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Tetracyclines General Statement: Uses

Tetracyclines are used principally in the treatment of infections caused by susceptible Rickettsia, Chlamydia, Mycoplasma, and a variety of uncommon gram-negative and gram-positive bacteria. Because of the development of resistance, tetracyclines are rarely used for the treatment of infections caused by common gram-negative or gram-positive bacteria unless other appropriate anti-infectives are contraindicated or are ineffective and in vitro susceptibility tests indicate that the causative organisms are susceptible to the drugs. Generally, given a susceptible organism, the currently available tetracyclines are all equally effective when administered in appropriate dosages. Because minocycline and, to a lesser extent, doxycycline penetrate most body tissues and fluids better than do other currently available tetracyclines, some clinicians …

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