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