Infectious Disease

Bacterial:
Amoxicillin is used for treatment of pregnant \ lactating patients with early-localized Lyme
disease as alternative to doxycycline which is contraindicated here.

Empiric antibiotic therapy with either ceftazidime or cefepime should be started in

febrile neutropenic patients, which is emergency case occurred in bone marrow failure
patient and as the result of neutropenia many infections occurred .most of them is
pseudomonas infections..So ceftazedime is given...if fever persist in spite of antibiotic,
amphotricin should be given because fungal infection suspected.
Endocarditis:
Petechiae :
Splinter hemorrhage:
Janway lesion:
Osler nodes:
Roth spot :

vasculitis and emboli

vasculitis and emboli
emboli
vasculitis
vasculitis

subacute and acute.

subacute and acute.
acute
subacute
aubacute

Cervicofacial actinomycosis classically presents as slowly progressive, non-tender,

indurated mass, which evolves into multiple abscesses, fistulae, and draining sinus tracts
with sulfur granules, which appear yellow. Treatment is high dose penicillin or Erythromycin
for 6-12 weeks followed by surgical debridement. the antibiotic treatment reduce the
necrotic tissue. Actinomyces abscess resemble with TB abscess, so Acid Fast stain should
be done to rule out TB and Nocardia.
Pseudomonas aeruginosa is the most frequent cause for malignant otitis externa.
Diabetes mellitus and other immunosuppressive conditions predispose to the development
of malignant otitis externa
Intermittent catheterization is an effective measure to reduce the risk of UTI in patients with
neurogenic bladder
After 43-72 hours of parenteral therapy for uncomplicated pyelonephritis, the patient can be
usually switched to an oral agent. Oral therapy is more convenient and less expensive; if the
results of antibiotic susceptibilily testing are known, the appropriate antibiotic can be easity
chosen ;if you start with IV ceftriaxon in the first 2 days, you can change to oral therapy.
Intravenous cetoteten, ampicillinlsulbactam, or the combination of clindamycin and a
fluoroquinolone is the appropriate empirical treatment for limb-threatening infections in
diabetics, whereas mild, or non-limb-threatening, infections can be treated with oral antibiotics
like cephalosporin, clindamycin, amoxicillin/clavulanate and fluoroquinolones
Gonorrhea is a common organism, which causes sexually transmitted disease .It is also a
common cause of pharyngitis, generally acquired from oral sex.

Transesophageal echocardioqraplry (TEE) is used to see valvular vegetations, which is an

important finding in infective endocarditis. TEE needs to be done in this patient but starting
antibiotics after drawing blood for culture is more urgent required. Positive blood cultures
and TEE evidence of valvular vegetations satisfy Dukes major criteria for the Dx of IE.
S.Epidermidis is the most frequent cause of IE in patients with prosthetic valves.
Urethral cultures have higher yield (> 80% ) than synovial ( <40%) or blood culture( always
negative ) in cases of suspected gonococcal purulent arthritis.

In a patient from the Orient who presents with a hypopigmented patch of insensate skin,
leprosy should be suspected. With progressive peripheral nerve damage, muscle atrophy
is common causing crippling deformities of the hands. The most common sites affected are
the face, ears, wrists, buttocks, knees and eyebrows. The diagnosis is made by
demonstration of acid-fast bacilli in skin biopsies.
Drug of choice for early syphilis is benzathine penicillin G and a single IM injection is
required. For those patients who are allergic to penicillin, doxycycline or tetracycline
is given for 14 days. For patients with neurosyphilis, IV aqueous crystalline penicillin is the
treatment of choice and IM procaine penicillin is a good alternative

Viral:
Always suspect RUBELLA when a patient with maculopapular rash (started in the face and
spread to the body) proceeded by occipital or posterior cervical lymphadenopathy, fever and
headache. Arthritis may develop in females
CMV pneumonitis :should be considered in differential diagnosis of any post BMT patient with
dyspnea, cough and fever . The radiological evidence includes multifocal diffuse patchy
infiltrates on X-ray and ground glass attenuation, parenchymal opacification or multiple small
nodules on high resolution CT scan. The median time of development of CMV pneumonitis
after BMT is about 45 days with the range of two weeks to over two years.
Hematological abnormalities seen in infectious mononucleosis include hemolytic anemia,
thrombocytopenia, disseminated intravascular coagulation (DIC) and thrombotic
thrombocytopenic purpura / hemolytic uremic syndrome (TIPIHUS)

Fungal:
Mucormycosis requires aggressive surgical debridement plus earty systemic
chemotherapy with amphotericin B.

Invasive pulmonary disease presents with fever, cough, dyspnea or hemoptysis. Chest x-ray
may show cavitary lesion. CT scan shows pulmonary nodules with halo sign or lesions with air
crescent.

Treatment of disseminated Histoplasmosis in HIV patients is IV amphotericin B followed

by lifelong treatment with itraconazole. Initial treatment with IV amphotericin B
decreases the fungal load and lifelong treatment with itraconazole prevents relapse (even if
culture negative ,do not stop itraconazole).

Parasitological:
Albendazole or mebendazole is the first line of treatment for E.vermicularis infection. Pyrantel
palmate is an alternative.
Babesiosis is a tick borne illness occurs in persons aged greater than 40, splenectomized, or
immunocompromised individuals .Parasite enters RBCs and causes hemolysis. Babesiosis
should be suspected in any patient from an endemic area who presents with a tick bite. Clinical
picture varies from asymptomatic infection to hemolytic anemia associated with jaundice,
hemoglobinuria, renal failure and death Unlike other tick bome illnesses, rash is not a feature of
Babesiosis, except severe infection resulting in thrombocytopenia, which may cause secondary
petechial or purpuric rash .intravascular hemolysis. anemia, thrombocytopenia, mild leukopenia,
atypical lymphocytosis, elevated ESR, abnormal liver function tests, and decreased serum
complement levels However, a definitive diagnosis of babesiosis can be made from a blood
smear The two widely used drug regimens are quinine-clindamycin and atovaquone
azithromycin
Ehrlichiosis is a tick bome illness and it is called spotless Rocky Mountain spotted Fever
Clinical features include fever, malaise, headache, nausea or vomiting Labs. show leukopenia
and thrombocytopenia
Babesia hemolysis anemia Ehrlichiosis no hemolysis anemia.

AIDS:
Odynophagia:
The best initial step is to begin with 1-2 weeks empiric treatment with fluconazol. if no response
the NS is endoscopy and biopsy: the ulcerative esophagitis will be either HSV or CMV (the most
common). The herpes simplex virus (HSV) esophagitis ulcers are usually multiple, well
circumscribed and have a "volcano" (small and deep) like appearance, whereas the ulcers
seen in CMV infection tend to be large, shallow and superficial land and presence of
intracellular inclusions are diagnostic of CMV esophagitis.

HIV patients are at a high risk for tuberculosis and require prophylactic treatment to prevent
an active disease. PPD is done to verify this. Positive PPD test (Skin induration of greater

than5 mm with PPD testing) with normal CXR and without TB symptoms in HIV patients
requires prophylaxis with isoniazid for 9 months (thats meaning inactive TB)
Whenever a health care worker is exposed to HIV, baseline HIV testing should be
performed immediately and postexposure prophylaxis with combination of 2 or 3
antiretroviral drugs should be started witout any delay. Testing for HIV should be performed
immediately as baseline studies and should be repeated at 6 wks, 3 mo and 6 mo .
In a HIV patient, bilateral interstitial pneumonia is most likely due to PCP. For moderate to
severe PCP in individuals with AIDS, the use of adjunctive corticosteroids has decreased
mortality. Prednisolone is used in combination with TMP-SMX when PaO2 is less than 70
mmHg in patients of PCP
Azithromycin or clarithromycin is the drug of choice for MAC prophylaxis in HIV patients
with CD4 cell count below 50/microL. Oral Ganciclovir may be effective for the prophylaxis
against CMV infection in HIV patients with CD4 cell count below 50-microL, however it is not
currently recommended for this purpose.(KAPALN says: valgancyclovir for PX).

ANTIBIOTIC:
Pseudomonas: ceftazedime ,cefipem(the only cefalosporines affect
it),pipracillin+gentamycin.

STD:
Lymphogranuloma venereum (LGV): Chlamydia trachomatis serotypes L1, L2 and L3.The
disease starts 1 to 4 weeks after initial contact and manifests with generalized malaise,
headaches and fever. A papule appears and subsequently transforms into an ulcer, typically
located in the vulvovaqinal region. The ulcer is painless and the disease may go unnoticed until
inguinal adenitis develops about a month later. In women, however, the lymphadenopathy
involves more commonty the deep nodes around the rectum and anus .If untreated at this
stage, LGV progresses into a severe and chronic disease causing ulceration, proctocolitis,
rectal stricture, rectovaginal fistulas and elephantiasis.
Granuloma inguinale (GI) is a distinct condition that presents similarly but is due to Donovania
granulomatis. Unlike LGV, the ulcer and lymphadenopathy of granuloma inguinale present at
the same time. Moreover, the ulcer of Granuloma inguinale has irregular borders and is
characterized by a beefy red granular base.