5-86
regurgitation
Palpation Sub-acute (8-20 days): Hepatomegaly 5%, splenomegaly, rare neurologic findings: sensory loss,
cranial nerve palsies, cerebellar signs
Using Advanced Tools: CXR may show pneumonitis (diffuse inflammation), 1/3 have pleural effusions.
Assessment:
Differential Diagnosis
Influenza - febrile respiratory infection of relatively short duration.
Salmonella - febrile illness with gastrointestinal symptoms which can persist for weeks, food/water borne.
Malaria - recurrent fever; blood smears show parasite.
Hepatitis - often less prominent fever; jaundice may be present; more prominent anorexia, malaise and fatigue
Atypical pneumonia - can mimic Q fever pneumonia; ask about relevant exposure history to lead to Q fever
diagnosis
Other diagnoses to consider include brucellosis, psittacosis, typhus
Plan:
Treatment
Primary: Acute infection: Doxycycline 100 mg po bid until afebrile for 5 days
Chronic infection: Ciprofloxacin 750 mg po bid and rifampin 300 mg po bid
Patient Education
Prevention and Hygiene: Drink pasteurized milk. Burn or bury highly infectious Coxiella-contaminated tissue.
Zoonotic Disease Considerations
Principal Animal Hosts: Sheep, cattle, goats, occasionally cats
Clinical Disease in Animals: Usually subclinical; anorexia, abortion.
Spriochetal Infections
ID: Leptospirosis
COL Naomi Aronson, MC, USAIntroduction: Leptospirosis is usually transmitted by contact with the urine of infected wild or domestic
animals worldwide. Humans contract leptospirosis through contact with water, food or soil containing urine
from these animals. Leptospira microorganisms cause illness after skin/mucous membrane exposure or
ingestion of fresh water contaminated by the urine or tissues of infected animals. This may happens by
consuming contaminated food or water or through skin contact, especially with mucous membranes or broken
skin. Person to person transmission is unknown. Leptospirosis infection has an incubation period of 2-20
days. Severe leptospirosis is called Weil’s disease.
Subjective: Symptoms
Fevers to 104°F which defervesce; then recurrent fever, chills, headache, conjunctival suffusion, uveitis (red,
painful eye), photophobia (can last for months), jaundice, rash, myalgias; 10% of cases develop severe
symptoms (Weil’s disease), with jaundice, hemorrhage (skin/GI/pulmonary), renal failure, aseptic meningitis.
Focused History: Have you had a fever that resolved after one week then recurred? (typical pattern) Have
you recently waded, swam or bathed in freshwater? (typical exposure in endemic area) Do your calves or
back and neck muscles ache or feel stiff? (typical myalgias).
Objective: Signs
Using Basic Tools:
Inspection: Fever to 104°F; often biphasic (first episode lasts 3-9 days, then 3 days without fever, then
recurs); day 3: conjunctival and palatal erythema; jaundice, petechiae and cutaneous hemorrhage in severe