0071643192.pdf

INFECTIOUS DISEASE

TREATMENT

■ Mild disease →no treatment.

■ Severe disease or splenectomy →quinine +clindamycin ×10 days.

■ Exchange transfusion if fulminant

COMPLICATIONS

■ Mortality ~6.5% (from acute renal failure, DIC, ARDS)

■ Poorer prognosis if asplenic, elderly, or immunocompromised

Q Fever

■ Coxiella burnetii

■ Transmitted by tick bites, blood transfusions ingestion of raw milk, and

inhalation of dried byproducts of cattle, sheep, or goats

■ Possible bioterrorism agent

SYMPTOMS/EXAM

■ Incubation: 2–6 weeks

■ Flulike symptoms, pneumonia, hepatitis

DIAGNOSIS

■ Acute=clinical

■ Definitive =serologies (positive 2–3 weeks after infection)

TREATMENT

■ Doxycycline, tetracycline, or chloramphenicol

COMPLICATIONS

■ Culture-negative endocarditis, granulomatous hepatitis

PULMONARY FUNGAL INFECTIONS

■ All found in soil (see Table 8.13)

■ Commonly in people who disturb soil (eg, construction workers, dirt

bike riders, farm workers)

■ Coccidiomycosis exhibits increased rates of disseminated disease in

Filipinos, blacks, and Hispanics.

SYMPTOMS/EXAM

■ Frequently asymptomatic

■ Granulomas and hilar adenopathy on CXR

Babesiosis is of greatest

concern in the splenectomized

patient.

Consider Q Fever in the

differential diagnosis of

patients who have significant

exposure to animal

byproducts (eg, abattoirs).

TABLE 8.13. Pulmonary Fungal Infections

DISEASE ORGANISM LOCATION

Coccidioidomycosis Coccidioides immitis SW desert (eg, San Joaquin valley of

central California), Latin America

Histoplasmosis Histoplasma capsulatum Mississippi and Ohio river valleys; birds,

bats, and construction sites

Blastomycosis Blastomyces dermatitides SE central and midwestern states

bordering the Great Lakes