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-long-term penicillin
-surgical drainage may be necessary
Actinomycosis pearl
poor dental hygiene with clinical symptoms necessitates consideration of actinomycosis
Anthrax (Bacillus anthracis)
-postexposure prophylaxis is oral doxycycline or oral ciprofloxacin
-confirmed disease is oral or IV ciprofloxacin or oral doxycycline
-mortality rate high despite proper therapy, especially in pulmonary disease
Anthrax pearl
rare infectious disease in which patient "dies sterile" --all organisms are eliminated, but the toxicity is lethal
Bacillary Dysentery (Shigellosis)
-supportive care
-Bactrim and ciprofloxacin are drugs of choice, although resistance is increasing
Bacillary Dysentery (Shigellosis) pearl
the first organism associated with reactive arthritis
Botulism (Clostridium botulinum)
-removal of unabsorbed toxic from gut
-specific antitoxin
-vigilant support, including attention to respiratory function
Botulism (Clostridium botulinum) pearl
In IV drug users w/ cranial nerve findings, this picture is classic for wound botulism caused by black tar heroin
Brucellosis (Brucella species)
-rifampin and doxycycline required for 21 days
Brucellosis (Brucella species) pearl
dilution of previously negative serum samples is ordered to exclude a prozone effect; dramatically high titers are falsely negative unless diluted
Campylobacter Enteritis (Campylobacter jujuni)
-erythromycin or ciprofloxacin will shorten duration of illness by 1 days
-disease is self-limted but can be severe
Campylobacter Enteritis (Campylobacter jujuni) pearl
The most commonly isolated pathogen in dysentery
Cat-Scratch Disease (Bartonella henseiae)
-nonspecific; exlusion of similar diseases most important
-erythromycin in immunocompromised patients
Cat-Scratch Disease pearl
The involved cat usually a kitten from an animal shelter; though asymptomatic, these animals have enormous organism burdens
Chancroid (Haemophilus ducreyi)
-azithromcyin, ceftriaxone, erythromycin, or ciprofloxacin
-Rapid plasma reagin (RPR) for all, HIV when appropriate
Chancroid pearl
tender inguinal lymphadenopathy in overweight pateints may not be nodes; an incarcerated fermoral hernia may be the problem
Cholera (Vibrio cholerae)
-vaccination preventative for travelers to endemic areas but rarely indicated
-rapid replacement of fluid and electrolytes, especially potassium
-Cola beverages inhibit cAMP reduce diarrhea, for use in areas where standard volume repletion is unavailable
-tetracycline and many other antibiotics may shorten duration of Vibrio excretion
Cholera pearl
A markedly elevated hematocrit from severe dehydration may lead to hyperviscosity and secondary venous thrombosis
Clostridial Myconecrosis (Gas Gangrene)
-immediate surgical debridement and exposure of infected areas
-IV penicillin w/ clindamycin
-tetanus prophylaxis
-hyperbaric oxygen of uncertain benefit
Clostrial Myconecrosis pearl
In a patient severely symptomatic and extremely toxic w/ clinical picture, a relatively low-grade fever is virtually diagnostic of clostridial gas gangrene
Diphtheria (Corynebacterium diphtheriae)
-active immunization
-diphtheria antitoxin
-penicillin or erythromycin
-corticosteroids in selected pts with severe laryngeal involvement, myocarditis, or neuropathy
-exposures of susceptible individuals call for a booster toxoid, active immunization, antibiotics, and daily throat inspections
Diphtheria pearl
hyperesthetic shallow skin ulcers in homeless patients suggest the diagnosis of cutaneous diphtheria
Enteric Fever (Typhoid Fever)
-active immunization helpful during epidemics for travelers
-ciprofloxacin or 2nd-generation cephalosporin pending susceptibility
-cholecystectomy may be necessary in relapsed cases
-complications in one-third of untreated patients include intestinal hemorrhage or perforation, cholecystitis, nephritis, and meningitis
Enteric Fever pearl
The development of tachycardia and leukocytosis in a pt with typhoid fever is considered to be ileal perforation until proven otherwise

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