is an antibiotic useful for the treatment of middle ear infections, endocarditis, meningitis, pneumonia, bone and joint infections, intra-abdominal infections, skin infections, urinary tract infections, gonorrhea, and pelvic inflammatory disease. It is also sometimes used before surgery and following a bite wound to try to prevent infection. Ceftriaxone can be given by injection into a vein or into a muscle.
Many conditions increase the risk of pneumococcal infections, including smoking, alcoholism, diabetes mellitus, liver cirrhosis, congestive heart failure, splenectomy, chronic obstructive pulmonary disease, and primary humoral immunodeficiencies. However, the highest incidence of pneumococcal infection occurs in people with acquired immunodeficiencies, such as patients with solid cancer, hematologic malignancies, and AIDS. Recurrent episodes of pneumococcal pneumonia are one of the clinical criteria for the diagnosis of AIDS.
The presence of a cochlear implant may predispose patients to otitis or meningitis caused by Streptococcus pneumoniae.
People aged 65 or older (both PCV 13 and PPSV 23 vaccines - see below details for timing)
People with CSF leak (both PCV 13 and PPSV 23 vaccines - see below details for timing)
Immunocompromised patients* (both PCV 13 and PPSV 23 vaccines - see below details for timing)
People with chronic illness** (only PPSV23 - see below details for timing)
Smokers and people living in special environments (only PPSV23 - see below details for timing)
PCV13: Only a single dose of PCV13 is recommended over the entire lifetime of an adult.
PPSV23: This vaccine is given at least twice to patients as long as the first dose was given to the patient before turning 65 years old. The second dose is given no sooner than 5 years after the first dose. Previously unimmunized 65 year old or older patients should only receive one dose of PPSV23 in their remaining life time; the dose should be given as soon as possible.
Partly immunized patients - missing PCV13: In patients who have only received PPSV23 and have indications for both vaccines, PCV 13 should be given no sooner than 1 year after the last PPSV23.
Partly immunized patients - missing PPSV23: In patients, who have received PCV13 and who have indications for both vaccines, PPSV 23 should be given no sooner than 6-12 months after the PCV13 vaccination.
Unimmunized patients requiring both PCV13 and PPSV23: In patients with indications for both vaccines, PCV 13 should be given first and PPSV23 should be given no sooner than 6 to 12 months after the PCV13 vaccination.
* Immunocompromised patients: those with splenic dysfunction or asplenia, hematologic malignancy, multiple myeloma, renal failure, organ transplants, HIV infection.
** People with chronic illness: cardiovascular (eg, congestive heart failure and cardiomyopathies) and pulmonary diseases (including COPD and emphysema but not asthma), diabetes mellitus, alcoholism, and chronic liver failure.
Norwegian or crusted scabies is a rare, massive infestation caused by Sarcoptes scabiei of the hominis variety that occurs in immunosuppressed patients, including those with post-transplant, leukemia, HIV infection, human T-cell Lymphotropic virus type 1 infection, leprosy, or diabetes. A parasitic infestation with Norwegian scabies is easily missed because its symptoms are psoriasis-like. Norwegian scabies usually evolves into crusted and hyperkeratotic plaques or nodules that are more prominent in the limbs.
The diagnosis of crusted scabies is based on clinical suspicion and identification of mites, eggs, or feces in a skin scrapping.
Although topical scabicides can be effective, the treatment of choice is single or multiple doses of oral ivermectin.
Mefloquine, atovaquone/proguanil, and doxycycline can all be used to prevent chloroquine-resistant malaria.
All of them are effective and deciding to choose one over the other depends on recognizing contraindications and adverse events, likelihood of patient compliance (mefloquine is given weekly, the other 2 are given daily) and cost (atovaquone/proguanil is the most expensive drug, doxycycline the cheapest).
Mefloquine is contraindicated in patients with psychiatric disorders because it can trigger mood swings, anxiety, paranoid ideation, and other neuropsychiatric manifestations. Gastrointestinal symptoms are a more common adverse event.
Atovaquone/proguanil has an excellent record of safety. It is contraindicated in patients with chronic kidney disease. It can cause gastrointestinal upset, insomnia, headache, rash, and mouth ulcers.
immunoassay in stool
The patient's presentation is consistent with giardiasis. Although Giardia trophozoites and cysts may be identified in stool samples, the fecal elimination of the organisms is intermittent and multiple samples may be required to confirm a diagnosis. Instead, fecal immunoassays are the diagnostic method of choice given their high sensitivity and specificity rates.
Giardiasis usually presents as chronic diarrhea that does not respond to conventional antibiotics. Flatulence, steatorrhea, abdominal cramps, and foul-smelling stools are common symptoms.
The patient has multiple, and frequently missed, risk factors for giardiasis, including travel to an endemic country, close contact with children, and being a man who has sex with other men.
A stool culture will be negative. A fecal fat excretion test might be abnormal, but it will not confirm the diagnosis. Polymerase chain reaction can be used to detect G lamblia, but this test is currently only used in experimental settings.
The Spread of the Diseases. Diseases brought to America during the Columbian Exchange include smallpox, chicken pox, typhus, typhoid, measles, cholera, influenza, scarlet fever, diphtheria, whooping cough, and bubonic plague. 75%-90%
followed by Klebsiella and Proteus.
Patients may present with symptoms of cystitis, including incontinence, dysuria, frequency, urgency, suprapubic pain, and malodorous urine.
They also might present with symptoms of pyelonephritis, including abdominal, back, or flank pain, malaise, fever, nausea, vomiting, and, occasionally, diarrhea.
typically presents with 1-3 days of significant rhinorrhea, followed by the development of cough and audible wheezing. In patients with mild illness, this is the extent of the disease, but some infants go on to develop bronchiolitis, which consists of worsening cough and wheezing, retractions, tachypnea, and air hunger.
Children ages 6 weeks to 7 months, and those who were born prematurely or have chronic lung disease, are most susceptible to severe illness (lower respiratory tract infection with lung compromise), although nearly all children exposed to RSV develop at least mild symptoms of upper respiratory tract infection.
vary in size (usually 1-5 mm) and are skin-colored, smooth, discrete, dome-shaped, pearly papules. Typically, a plug of "cheesy" material is expressed from a central umbilication. These papules are usually found on the eyelids, thighs, neck, face, and axillae, although they can occur anywhere on the body. Normal human blood has a significant excess oxygen transport capability, only used in cases of great physical exertion. Provided blood volume is maintained by volume expanders, a rested patient can safely tolerate very low haemoglobin levels, less than 1/3 that of a healthy person.
The body automatically detects the lower hemoglobin level, and compensatory mechanisms start up. The heart pumps more blood with each beat. Since the lost blood was replaced with a suitable fluid, the now diluted blood flows more easily, even in the small vessels. As a result of chemical changes, more oxygen is released to the tissues. These adaptations are so effective that if only half of the red blood cells remain, oxygen delivery may still be about 75 percent of normal. A patient at rest uses only 25 percent of the oxygen available in his blood. In extreme cases, patients have survived with a haemoglobin level of 2 g/dl, about 1/7 the norm, although levels this low are very dangerous.
With enough blood loss, ultimately red blood cell levels drop too low for adequate tissue oxygenation, even if volume expanders maintain circulatory volume. In these situations, the only alternatives are blood transfusions, packed red blood cells, or oxygen therapeutics (if available). However in some circumstances, hyperbaric oxygen therapy can maintain adequate tissue oxygenation even if red blood cell levels are below normal life-sustaining levels.
Symptoms of babesiosis are similar to those of Lyme disease but babesiosis more often starts with a high fever and chills.
As the infection progresses, patients may develop fatigue, headache, drenching sweats, muscle aches, chest pain, hip pain and shortness of breath ("air hunger").
Babesiosis is often so mild it is not noticed but can be life-threatening to people with no spleen, the elderly, and people with weak immune systems.
Complications include very low blood pressure, liver problems, severe hemolytic anemia (a breakdown of red blood cells), and kidney failure.
A fungus ball in the lungs may cause no symptoms and may be discovered only with a chest X-ray, or it may cause repeated coughing up of blood, chest pain, and occasionally severe, even fatal, bleeding. A rapidly invasive Aspergillus infection in the lungs often causes cough, fever, chest pain, and difficulty breathing.
Poorly controlled aspergillosis can disseminate through the blood stream to cause widespread organ damage.
Symptoms include fever, chills, shock, delirium, seizures and blood clots. The person may develop kidney failure, liver failure (causing jaundice), and breathing difficulties. Death can occur quickly.
In older children, the rate of asymptomatic infection is high.
However, in infants with an immature immunologic system, disseminated disease may occur.
The clinical picture is variable depending on the immunologic status. At the onset of the infection, clinical manifestations are nonspecific (headache, fever, cough, and nausea). Usually, these symptoms are self-limited and improve without treatment.
Patients who develop disseminated disease (the very young, very old, and immunocompromised) present with prolonged fever, malaise, cough, and weight loss.
Hepatosplenomegaly is frequent in infants.
Findings on chest x-ray may be normal in 40% to 50% of patients with disseminated disease or may show lobar or diffuse infiltrates, cavitations, hilar adenopathy, or any combination of these.
Frequently, the clinical presentation is misdiagnosed as tuberculosis. Skin tests, serologic reaction, and specific cultures are used for diagnosis confirmation.
Treatment indications and regimens are similar to those for adults, except that amphotericin B deoxycholate is usually well tolerated in children.
Aspergillosis is caused by a mold found on decaying vegetation and in soil. The principal route of transmission is inhalation. Aspergillosis can manifest with invasive, chronic, or allergic symptoms, depending on the patient.
Children with asthma or cystic fibrosis may present with allergic bronchopulmonary aspergillosis. The condition is usually treated with steroids and antifungal medication.
Invasive aspergillosis normally appears in immunocompromised patients with neutropenia and can involve pulmonary, sinus, cerebral, cutaneous, cardiac, and orbital sites.
Aspergillomas, or fungal balls, can grow in cavities or cysts in patients with lung disease. Allergic sinusitis occurs in children with nasal polyps or chronic sinusitis.