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Rocky Mountain Spotted Fever
- A tick borne disease
- Rickettsia rickettsii
- Causes small vessel vasculitis
- Can cause serious damage to internal organs, can be lethal
- My be found throughout the Western Hemisphere
Clinical Presentation
- Initial symptoms
- High Fever
- Nausea / vomiting
- Severe headache
- Muscle pain
- Later signs and symptoms
- Maculopapular rash, occurs 2-5 days after fever, beginning on the wrists and ankles and then spreads to trunk
- Petechial rash
- Abdominal pain
- Joint pain
- Injected Conjunctiva
- Hypotension
- Restlessness
- Insomnia
- Delirium
Physical Exam Findings
- Maculopapular rash several days after the fever. Begins on wrists and ankles then spreads to hands, feet, arms, legs and then trunk.
- Severe cases
- Jaundice
- Hepatosplenomegaly
- Acute respiratory distress
Diagnosis
- Serum blood tests – low platelet count, low blood sodium concentration, or elevated liver enzyme levels
- Biopsy of rash
- PCR
Treatment
- Prevention
- Long sleeves, high socks
- Bug repellent including DEET
- Medications
- Doxycycline is the first line treatment in anyone older than 8 and not pregnant. Amoxicillin may be used in those cases but is not as effective.
- Chloramphenicol – 2nd line
Salmonellosis
- Salmonella enterica – Gram negative rod
- Ingestion of contaminated food or water
- Gastroenteritis (most common)
- incubation is 8-48hrs
- course is 3-5 days
- Typhoid 5-14 days
Clinical Presentation
- Gastroenteritis (most common)
- Crampy abdominal pain
- Fever
- Nausea / vomiting
- Bloody diarrhea
- Enteric Fever (typhoid)
- Prodrome
- General malaise
- Cough
- Fever
- Abdominal pain / distention
- Constipation / Diarrhea – Pea soup stool
- High fever
- Elevated heart rate
- Abdominal tenderness
- Pink papular rash on trunk
- Delirium
- Hypovolemic shock
- Prodrome
Diagnosis
- Stool analysis/ Fecalysis
- Blood culture
- Urine culture
Treatment
- Replacement of fluids and electrolytes!
- Gastritis
- Self limiting
- Bactrim or cipro may be used
- Enteric fever
- Fluoroquinolones – ciprofloxacin
- Third generation cephalosporin – ceftriaxone
Shigellosis
- Shigella – Gram negative, facultative anaerobe, rod
- Mode of transmission: fecal-oral route
- This is often found in day care centers, nursing homes, refugee camps, and other places where conditions are crowded and sanitation is poor
- Patients with HLA-B27 may develop reactive arthritis
Signs and Symptoms
- Abdominal discomfort
- Abdominal cramps
- Diarrhea
- Presence of blood, pus, or mucus in stools
- Fever
- Rectal tenesmus
Diagnosis
- Stool analysis for RBC’s and WBC’s
- Stool culture
- Sigmoidoscopy
Treatment
- Fluids and electrolytes!
- Medications
- Bactrim
- Cipro
- Ampicillin
Tetanus
- Clostridium tetani – Gram positive, obligate anaerobe, rod
- Neurotoxin which causes uncontrollable muscle spasms
- Wound contamination – puncture wounds
Signs and Symptoms
- Pain and spasticity at the site of inoculation
- Jaw stiffness (frequent early sign)
- Trismus – lockjaw; spasms and stiffness along the jaw muscles (later sign)
- Stiffness of the neck muscles
- Difficulty swallowing
- Stiffness of the abdominal muscles
- Painful body spasms lasting for several minutes
- Spasm of the respiratory muscles
Diagnosis
- Clinical diagnosis
- Normal cerebrospinal fluid
Treatment
- Prevention
- Vaccination with a booster every 10 years
- Wound debridement
- Metronidazole or penicillin
- Tetanus immunoglobulin IM
- Antitoxic binds free neurotoxin
- Diazepam or Magnesium to help control muscle spasms
- Supportive care
- Intubation
