Acute HIV infection
- Largely asymptomatic, but up to 50-60% of patients have mono-like syndromes
- CUMC rapid HIV screen -- antigen detection -- still need to consider sending HIV PCR
Posted 12/14/16 09:42:19 AM by Matthew Cummings
Severe febrile illness in returning traveler
- Fever with hemorrhagic syndrome: viral hemorrhagic fever (including dengue), meningococcal disease, leptospirosis, rickettsial disease
- Fever with pulmonary infiltrates: typical viral/bacterial pathogens, novel influenza, coronaviruses, schistosomiasis, leptospirosis, hantavirus
Posted 12/14/16 09:44:12 AM by Matthew Cummings
- Systemic infection caused by Burkholderia pseudomallei (GNR)
- Endemic in SE Asia
- Presents with undifferentiated sepsis, PNA, skin ulcerations
Posted 12/14/16 09:46:29 AM by Matthew Cummings
- Pathogenic spirochetes of the genus Leptospira (21 species), largely endemic to tropics
- Human infection: exposure to environmental sources, such as animal urine, contaminated water or soil, or infected animal tissue.
- Occupational exposure (subsistence farming) and living in rodent-infested, flood-prone urban slums.
- Biphasic illness
- Initial flu-like prodome followed by...
- Thrombocytopenia, leukocytosis w/ left shift
- Jaundice and renal failure ("Weil's disease")
- Pulmonary hemorrhage, ARDS
- Physical exam pearl: Conjunctival suffusion in ~50% of cases --> swelling of the conjunctiva is seen along the corners of the eye +/- frank conjunctivitis
- Rx: IV Penicillin, Doxycycline, Ceftriaxone/Cefotaxime --> Typically 5-7 days
- Jarisch-Herxheimer reaction --> Acute inflammatory response to clearance of spirochetes from the circulation (also in syphilis)
- Usually more of an issue w/ ocular/CNS disease -- consider steroids
Posted 12/14/16 09:50:48 AM by Matthew Cummings
Created by Christopher Kelly
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