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Texas Border Infections (Dr. Horseman)
Terms in this set (92)
Murine typhus is ____ to southern Texas and California.
Murine typhus is usually caused by which two organisms?
Rickettsia felis (occasionally)
What are the two most common vectors of murine typhus?
Cat flea (more common in S. Texas/California)
The clinical infection of murine typhus is characterized by _____.
Most cases of murine typhus present as _____.
What characteristics are associated with the clinical presentation of murine typhus?
- Sever HA
- Maculopapular (more common) or petechiae (less common) rash
- Mild leukopenia or normal WBC
- Mild to moderate increase in LFTs
What is the preferred method of diagnosis of murine typhus?
Serology (indirect fluorescent antibody)
______ test is often used for screening of murine typhus but it is insensitive and obsolete.
Febrile agglutinin (Weil-Felix)
If you had a ____ infection recently, it would react in the febrile agglutinin (Weil-Felix) test as well.
What antibiotic treatment can be used in murine typhus?
Doxycycline 3-7 days
Rocky Mountain Spotted Fever is caused by ______.
RMSF is a ____ borne illness.
Which ticks can transmit RMSF?
American dog tick
Rocky Mountain wood tick
Brown dog tick
Clinical infection with RMSF is characterized by _____.
What characteristics are associated with the clinical presentation of RMSF?
- Fever >102F
- Myalgias and sever HA
- Petechial rash (LATE stage)
- Pulmonary edema, ARDS
- Normal WBC with bandemia
- Elevated LFTs
What is the usual method of diagnosing RMSF?
What type of rash is common in the early stage of RMSF?
What type of rash is common in the late stage of RMSF?
What antibiotic treatment can be used to treat RMSF?
Doxycycline (usually 7 days)
Which are the novel modes of transmission of West Nile Virus?
- Transfused blood
- Transplanted organs
- Breast milk
- Transplacental transmission
- Percutaneous occupational exposure
- Conjunctival exposure (?)
- Dialysis (?)
Most cases of West Nile Virus are transmitted via _____.
Which species of mosquito is responsible for West Nile Virus?
What are the clinical syndromes associated with West Nile Virus?
- Asymptomatic (subclinical infection)
- West Nile Fever
- West Nile Neuroinvasive Disease
- Acute Flaccid Paralysis (West Nile Poliomyelitis)
What is the most common form of West Nile Neuroinvasive Disease?
West Nile Encephalopathy
What are the risk factors for severe disease of West Nile Virus?
- Age >60 years old
- Diabete mellitus
- Cancer history
- Chronic renal disease
- Chronic alcohol abuse
Treatment for West Nile Virus is _____.
Dengue fever virus is a _____ virus of the genus ____.
How many serotypes of dengue fever virus are there?
Dengue fever virus is transmitted via Aedes mosquitos, usually the _____.
Like WNV, most dengue fever infections are _____.
What are the symptoms of a dengue fever infection?
- Musculoskeletal and lumbar back pain
- Thrombocytopenia (Dengue hemorrhagic fever/DHF)
- Shock with plasma leakage (Dengue Shock Syndrome/DSS)
What is the treatment for dengue fever infection?
(IGIV was not proven to be beneficial)
Antibodies to dengue fever virus may cross react with ____.
_____ is the best "treatment" of dengue fever infection.
What is used to prevent dengue fever infection?
Tetravalent dengue vaccine (investigational)
Transmission of rabies is through the ____ and _____ of an infected host.
T/F: Transmission of rabies has commonly been documented as contamination though the mucous membranes, aerosol transmission and corneal/organ transplants?
False; these routes of transmission have rarely been documented
The rabies virus spreads ____ through ____ to the CNS and eventually to the salivary glands.
____ percent of patients will become symptomatic within 90 days of exposure to the rabies virus.
More than 90% of all animals cases of rabies reported to the CDC annually occur in _____.
____ are the most frequently reported rabid wildlife species nationally.
Which wildlife animals are most frequently reported has having rabies?
Raccoons > Skunks > Bats > Foxes
Rabies should be considered in patients with signs or symptoms of ____ or ____.
Signs and symptoms of rabies include:
- Autonomic instability (including hypersalivation)
- Agitation, confusion, hallucinations
- Ascending Flaccid Paralysis
- Symmetric Quadriparesis
- Meningeal sings
What is the mortality rate for previously unvaccinated patients with rabies?
What is the "Milwaukee Protocol"
Regimen given to initial unvaccinated survivor of rabies
- Ketamine-Medazolam-induced coma
Routine management of patients with rabies should be ____.
What is the post-exposure prophylaxis for a patient not previously vaccinated for rabies?
- Wound cleaning
- Human Rabies Immune Globulin
- Vaccine (on days 0, 3, 7, and 14)
What is the post-exposure prophylaxis for a patient previously vaccinated against rabies?
- Wound cleaning
- Vaccine (only on days 0 and 3)
NO human rabies immune globulin
Which are the clinically important Vibrios?
- V. vulnificans
- V. parahaemolyticus
- V. alginolyticus
- Toxigenic and nontoxigenic (non-O1) strains of V. cholerae
Which serogroups of V. cholerae are "toxigenic"?
O1, O75, O139, O141
Toxigenic strains of V. cholerae produce ____.
Cholera toxin produces ______ illness characterized by _____.
Watery stools (rice water stools)
What is the treatment for toxigenic V. cholerae?
Intense rehydration with oral rehydration solution or IV fluids
What kinds of illnesses can non-toxigenic strains of vibrio cause?
- Primary sepsis
- Wound/Skin and soft-tissue infection
What are the risk factors for severe or life-treatening vibrio infections?
- Immunosuppression (chemotherapy or HIV)
- Iron storage diseases (hemochromatosis)
What are possible reasons for the low number of cases of serious infections of Vibrio infections?
- Not all cases are reported to the CDC
- Not all members of each risk group are equally at risk
- Not all isolates of V. vulnificans are clinical or pathogenic strains
- Combinations of the above
What is the treatment non-toxigenic Vibrios?
CDC Recommends (severe V. vulnificans):
- Ceftazidime + Doxycycline OR
- Cefotaxime + Doxycycline
When taking a patient history what questions should you ask to help narrow a diagnosis of a Vibrio infection?
- Have you been in saltwater?
- Have you handled or eaten raw seafood, especially raw oysters?
- Have you handled live fish, shellfish or other marine animals?
What is the etiologic agent of Lyme Disease?
What is the usual vector of Lyme Disease?
Ixodes or deer tick
Which ticks (according to the CDC) are not known to transmit Lyme Disease?
- Lone star ticks
- American dog tick
- Rocky Mountain wood tick
- Brown dog tick
How many stages are associated with the clinical presentation of Lyme Disease?
What are the characteristics of the earliest stage of Lyme Disease?
Red, expanding rash called erythema migrans (EM)
What are the characteristics of the late stage of Lyme Disease?
- Cranial Nerve palsies
- Chronic neuropathy
- Chronic fatigue syndrome
Usually an intermittent monoarticular process involving the knee, ankle, or wrist (in decreasing frequency). Occasionally polyarticular
What is the antimicrobial treatment for Lyme Disease?
Doxycycline 100 mg PO BID X 28 days without signs of neurologic disease
What is the treatment for recurrent arthritis associated with Lyme Disease?
Ceftriaxone X 14-21 days
What is STARI?
Southern Tick-Associated Rash Illness
STARI is transmitted by the _____.
Lone Star Tick (tick borne illness)
The etiologic agent of STARI is unknown but may be caused by ______.
The initial rash of STARI resembles ______.
Rash typically appears within _____ (time period) of a Lone Star Tick Bite.
Treatment of choice for STARI appears to be ____, but the alternative is ____ (? maybe)
Many times STARI is treated the same as _____ due to difficulty differentiating these illnesses.
What is the causative agent of Q Fever?
How is Q Fever usually transmitted?
By inhaling contaminated aerosols
Up to 50% of cases of Q Fever are ______.
What are the characteristics of clinical illness of Q Fever?
- High fevers (up to 104-105 F)
- Severe headache
- General malaise
- Chills and/or diaphoresis
- Non-productive cough
What complications are associated with Q fever?
- Endocarditis (chronic complication)
What is diagnostic of Q Fever?
A single specimen with IgM antibody (seen as early as 10-14 days after infection)
What is the treatment of choice for Q Fever?
Doxycycline 100 mg q12h X 5-7 days
For Endocarditis: Doxycycline 100 mg PO BID + hydrochloroquine 600 mg PO daily for at least 18 months
Brucellosis is usually caused by: (4)
Brucella suis (In Texas)
What is the usual route of transmission of Brucellosis?
Ingestion of unpasteurized dairy products
What are the symptoms of brucellosis?
- Back pain
Untreated cases of brucellosis for a long period of time are associated with ______.
Undulant fever pattern
What is the preferred treatment for brucellosis?
Doxycycline (X 6 weeks) + Gentimicin IM (X 7 days)
Alternative: Doxycicline + Rifampin (both PO for 6 weeks)
Tularemia is caused by ________ (organism).
What is the gram stain and morphology or Francisella tularensis?
Gram Neg. Coccobacilli
How may Francisella tularensis be acquired?
- Mammal, tick or fly bites
- Skinning infected animals
- Contamination of food or water
- Inhalation of aerosolized F. tularensis
Early symptoms of tularemia include:
- Abrupt onset of fever
What is the preferred treatment for tularemia?
Gentimicin (IV X 7-14 days) EXCEPT for cases of meningitis
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