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DOC for a pt w/ travel hx (back from the tropics), who has flu-like symptoms; splenomegaly; lab: CBC: anemia, thrombocytopenia, hypoglycemia. Blood smear: enlarged RBCs and Schuffner dots. Mefloquine + Primaquine Which drug is contraindicated in specific Tx of liver form of malaria in pts w/ G6PD deficiency? Primaquine DOC for a pt w/ travel hx (back from the tropics), who has flu-like symptoms (fever > 103oF), seizure, hyperparasitemia (>2.5% of RBC), pulmonary edema, or renal failure, or severe anemia? Quinidine and Doxycycline Cause of malaria-like illness in an immunosuppressed pt w/o travel hx; lab: blood smear has cross-over rings in the RBCs? Babesia spp. A pt from S. America has a week-long fever, anorexia, lymphadenopathy, mild hepatosplenomegaly, and myocarditis; a nodular lesion on the arm. Blood smear should reveal motile species of what? Trypanosoma cruzi Cause of a chronic-stage systemic dz w/ cardiomyopathy, megaesophagus, megacolon, and weight loss in a pt from S. America, who does not respond to nifurtimox. Trypanosoma cruzi Cause of protracted fever and Crohn's, celiac dz, ocular problems, and lymphadenopathy; duodenal biopsy demonstrating foamy macrophages in lamina propria? Tropheryma whipplei Clinical Dx of painless papule (on arms, face, or chest), then vesicles/bullae, then black eschar + edema evolving over 3-5d associated with animal exposure is Cutaeneous anthrax Cutaneous anthrax can be treated in 7-10 days with Ciprofloxacin Animal exposure or biowarfare-associated fever, chills, sweats, GI sx, cough, malaise, chest pain, but no coryza (first 3-4d); then sepsis; CXR: wide mediastinum and bloody pleural effusion. Blood culture should yield: Bacillus anthracis Inhalation anthrax is treated with Fluoroquinolone > Doxycycline Need to treat inhalation anthrax 60-100 days because Spores persist in vivo 30 days PxPr to prevent inhalation anthrax via aerosolized spores from powder particle size < 10 microns requires Cipro for 60 days Species of Clostridium that causes afebrile, systemic toxic diseases in infants (honey), and in adults foodborne (meat, canned vegetables), wound (injected), iatrogenic (cosmetic) is C. botulinum Many pts w/ flaccid paralysis; unusual Clostrium botulium types (not A, B or E), common geography without common food source are clues to Bioterrorism Aerobic small slender gram-negative rod, erroneously identified as Pseudomonas sp., which causes glanders in horses and rarely humans; may be used in bioterrorism is Burkholderia mallei Small, pleomorphic, aerobic Gram-neg rod that causes pathophysiology: 1) bite/abrasion (acquired from tick exposure or contact with rabbits) → nodule/ulcer → node → sepsis, or 2) inhalation (bioterrorism) → acute fever, dry cough. CXR: infiltrates + hilar adenopathy, is Francisella turlarensis Hx of acute fever, myalgias, remorrhagic rash, conjunctivitis, pharyngitis, headache, diarrhea, and thrombocytopenia in bioterrorism indicates Viral hemorrhagic fever (e.g., Marburg, Ebola) Aerobic, Gram-neg bipolar rod, which causes pathophysiology of (a) painful lymphadenitis, fever, chills, headache (after exposure to rodents, rabbits or fleas) (b) sepsis; (c) pneumonic (post bubo or epidemic): severe, often with hemoptysis and dyspnea, is Yersinia pestis Hx of sudden fever ≥ 39°C , homogeneous vesiculo- pustular rash (unlike common viral exanthems) in multiple pts is caused by Variolla major virus (small pox)