0071643192.pdf

INFECTIOUS DISEASE

■ Leptospiruric/immune phase (1 month)

■ Aseptic meningitis

■ Weil syndrome (10%)

■ Progresses to severe, life-threatening jaundice

■ ARF, hemorrhage, ARDS

■ Mortality = ~5%

DIFFERENTIAL

Meningitis, dengue, malaria, viral hepatitis, typhus.

DIAGNOSIS

■ Clinical in acute phase

■ ↑WBC,↑bilirubin (relatively mild increase Alk-phos and transaminases)

■ CSF=aseptic meningitis

■ Blood and urine cultures

■ Serology (ELISA)

TABLE 8.18. Geographically Limited Causes of Acute Fever

NAME VECTOR ORGANISM/DISTRIBUTION SYMPTOMS/EXAM DIAGNOSIS/TREATMENT

Schistosomiasis Penetration of S. mansoni(Africa, Acute: Severe fever, HA, cough, O&P

skin by fresh Caribbean, S. America, urticaria, hypereosinophilia

water cercariae Middle East) (Katayama fever)

(eg, while S. japonicum Chronic: Dermatitis, Serologic testing

swimming) (China, SE Asia) hematochezia, hepatic Praziquantel

S. mekongi cirrhosis,S. hematobium

(Cambodia, Laos) hematuria

S. hematobium

(Africa, Middle East)

Chagas disease Reduviid Trypanosoma cruzi Acute: Unilateral periophthalmic Blood smear or

(American (kissing) bug (South and Central cellulitis (Romaña’s sign) xenodiagnosis

trypanosomiasis) America) Chronic: Cardiomyopathy Nifurtimox

megaesophagus, megacolon

West African Glossina Trypanosoma brucei Posterior cervical LAD Increased serum IgM

trypanosomiasis (tsetse) fly gambiense(West and (Winterbottom sign), pruritis, Pentamidine or

(sleeping Central Africa) personality changes, with slow Melarsoprol

sickness) progression to coma

East African Glossina Trypanosoma brucei High fever, rash, leading rapidly Increased serum IgM

trypanosomiasis (tsetse) fly rhodesiense(East and to encephalitis and coma Suramin or

(sleeping Southeast Africa) Melarsoprol

sickness)

Visceral Sandflies L. donovani, infantum, Hepatosplenomegaly, anemia, Sodium

leishmaniasis (Phlebotomus chagasi (South Asia, cachexia, grayish skin coloration stibogluconate

(Kala-Azar) sp.) Middle East)

LAD =lymphadenopathy.