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Answers to the Chapter Exercises – 462

Index – 473

© Springer International Publishing AG, part of Springer Nature 2019 J. Domachowske (ed.), Introduction to Clinical Infectious Diseases, https://doi.org/10.1007/978-3-319-91080-2 462 Answers to the Chapter Exercises

Answers to the Chapter Exercises

Chapter 1 Chapter 4 vv1. Staphylococcus aureus, methicillin resistant or MRSA Matching: vv2. Mycobacterium marinum Answer Key: 1E, 2D, 3E, 4F, 5A vv3. Aeromonas hydrophilia, Chapter 5 vv4. False vv1. a. This patient scores 1 using the Centor criteria: vv5. True age 15–44 years (0 point), no (0 point), absence of tender cervical (0 vv6. False point), (0 point), and tonsillar (1 point). Under the current recommendations, no vv7. True further diagnostic evaluation is needed, and no antibiotics are warranted since there is a low vv8. True likelihood of GAS . Answer D would be appropriate for patients with 2 or more points. Empiric treatment with antibiotics is no longer Chapter 2 recommended. vv1. E vv2. c. It is important to differentiate between critical and stable patients. This patient presents with several vv2. C concerning features including respiratory difficulty, positioning, and drooling. Suspicion for airway vv3. A compromise secondary to an infection of the oropharynx, retropharynx, or should be vv4. G high. In critical patients, the ABCs are always first line of treatment: A for airway, B for breathing, and C for vv5. B circulation. Everything else waits until the patient has been stabilized. Although a CT scan would likely be a vv6. H very appropriate test in a patient like this, sending a critical patient to the CT scanner, which often does vv7. D not have the same resources as an emergency department or intensive care unit, places the patient vv8. F at serious risk should they decompensate en route. Many patients with serious of the , parapharyngeal spaces, or epiglottis would also not Chapter 3 tolerate lying flat. vv1. B. Provide supportive care vv3. c. Oral candidiasis typically does not affect healthy adults, so an immunocompromising condition vv2. C. Staphylococcus aureus should be suspected in this patient. Her history of intravenous drug use puts her at higher risk of vv3. B. Epstein Barr specific anti-IgM against viral contracting several blood-borne illnesses, including capsid antigen HIV. HIV testing is appropriate in the management of this patient. Antibiotics are not indicated for the vv4. A. henselae treatment of candidiasis. Thrush is a clinical ­diagnosis that does not need laboratory culture vv5. D. Redness, swelling, heat, and pain confirmation. 463 Answers to the Chapter Exercises vv4. a, b, c. The management of small, minimally Chapter 7 symptomatic peritonsillar and other deep space abscesses is evolving and remains somewhat Matching: controversial. No single approach to treatment has proven to be superior to any other. Many of these Answer Key: 1C, 2B, 3A, 4E, 5D cases will resolve with antibiotic treatment and supportive care; however some ultimately will Multiple choice: require drainage. In making the decision about how to manage such patients, the provider must weigh vvB is the best answer. Mist is not indicated as there is no the risks of performing a procedure versus the risks demonstrated clinical benefit. is caused by ­es, of not draining a potential abscess. The only choice so antibiotics are not indicated. If a child is found to have listed that would not be appropriate for this patient croup due to virus, treatment with the antivi­ral would be to take her to the operating room for medication, oseltamivir, can be considered. incision and drainage under general anesthesia because her symptoms are mild and the collection Practical Examples: is small. vvD. . This is the best answer for this clinical scenario. The child presents with classic bronchiolitis Chapter 6 including a prodrome with upper respiratory symptoms followed by the onset of tachypnea and retractions. He is vv1. mildly hypoxemic in room air and has prominent nasal flaring with intercostal retractions and wheezing. A. vv2. False – pertussis occurs in all age groups. Respiratory syncytial virus, this is the most common viral pathogen causing bronchiolitis worldwide. D. Manage­ment vv3. Young infant population under 4 months of age. of bronchiolitis is generally supportive with the provision of oxygen as needed and fluids. A trial of albuterol can be vv4. The clinical definition of pertussis disease is a cough considered since a subset of infants and young children may greater than or equal to 14 days and one or more of benefit, although evidence does not support its routine use. the following symptoms: paroxysmal cough, inspiratory whoop, or post-tussive vomiting. Chapter 8 vv5. False – Neither natural pertussis infection nor immunization produces lifelong immunity. Repea­ Matching: ted vaccination with pertussis-containing vaccines is needed to protect a person against pertussis. Answer Key: 1I, 2F, 3G, 4J, 5A, 6H, 7B, 8D, 9C, 10E vv6. True – The disease consists of three stages: The catarrhal stage which may last as long as 10 to 14 Chapter 9 days, the paroxysmal stage which may last as long as 42 days, and the convalescent stage which may last vv1. for as long as 56 days. vv2. vv7. True vv3. vv8. Test of choice for diagnosis in all age groups is pertussis real-time polymerase chain reaction (PCR) Chapter 10 assays. The most reliable results are obtained within the first 3 to 4 weeks of the cough illness. vv1. A vv9. The antibiotics that are effective in the treatment or vv2. B chemoprophylaxis of pertussis are the azalides (azithromycin), macrolides (erythromycin, clarithro- mycin), and trimethoprim-sulfamethoxazole Chapter 11 (TMP-SMX). Matching: vv10. True Answer Key: 1d, 2b, 3f, 4a, 5h, 6g, 7c, 8e 464 Answers to the Chapter Exercises vv1. c Case 3: vv2. a—Late gadolinium enhancement in a patchy vvD sub-epicardial pattern is consistent with myocarditis Case 4a: vv3. c vvC

Chapter 12 Case 4b: vv1. A vvB vv2. A Chapter 16 vv3. A vv1. b vv4. True vv2. d vv5. False vv3. b

Chapter 13 vv4. a vv1. C vv5. d vv2. A Chapter 17 vv3. D vv1. c vv4. B vv2. a vv5. C vv3. False Chapter 14 vv4. a, b, d vv1. C. vv2. B. Use of transcatheter arterial embolization procedures Chapter 18 vv3. C. Including intravitreal antibiotics in the treatment vv1. b regimen vv2. e vv4. A. Percutaneous drainage vv3. b Chapter 15 Chapter 19 Matching: vv1. A-iv; B-vi; C-ii; D-i; E-v; F-iii Answer Key: 1E, 2D, 3A, 4B, 5C vv2. D Case 1: vv3. C vvC

Case 2: vv4. B vvA vv5. E 465 Answers to the Chapter Exercises

Chapter 20 vvA complete blood count with differential can be helpful. If an invasive procedure is planned, a coagulation screen vv1. 1G; 2E; 3B; 4A,D; 5F; 6D; 7C,D,E,F,G can be obtained. vv2. D Other blood studies that may be helpful include blood cultures. vv3. 1D,F; 2E; 3B; 4C A lumbar puncture to obtain cerebrospinal fluid will help determine if her illness is meningitis or not. vv4. C 55 What is included in your differential diagnosis? How does this change if the patient is 3 months old? How would this change if the patient is 70 years old taking anticoagulation due to a history of atrial Chapter 21 fibrillation? vv1. B. Guillan Barré syndrome vvThe differential diagnosis for can be broad. Bacterial meningitis and aseptic meningitis are consider- vv2. D. Spasticity. If Spasticity develops, it is a late (and ations. Migraine headache is also a consideration. not acute/early) manifestation of acute transverse may cause headache, but may not cause myelitis. photophobia. Also, intracranial processes such as venous sinus thrombosis can lead to headache. There are vv3. D. Unknown. Although many of the AFM cases were numerous other causes for headache in the adolescent preceded by mild respiratory illness due to girl—the list provided is not exhaustive. EV-D68, extensive testing has not identified EV-D68 or other pathogens in the CSF. Despite the A 3-month-old infant would not be able to verbalize strong association, causality remains in doubt. the presence of a headache. Instead, she may present as a fussy or intractably crying infant. Colic is a non-life threatening condition which includes prolonged crying. Chapter 22 Other, more serious problems should be evaluated— including the possibility of meningitis, otitis, or other ??1. A 17-year-old girl presents with a diffuse headache serious infections. Noninfectious causes of irritability in and photophobia. The onset has been gradual over the infant can include corneal abrasions, intussusception, the last few days, but is getting worse. testicular torsion, and hair tourniquets around fingers, toes, or genitals. Again, this is not an exhaustive list of 55 What additional information would you like to potential causes of irritability in the infant, but history obtain? and a careful examination can lead to a diagnosis. The elderly adult has a different set of risk factors, vvA thorough history can help direct diagnostic testing. including vascular disease and bleeding risk. Other risks Symptoms such as , recent illness, location of the may be identified on review of medical history. For the headache, palliative and provocative factors, and patient on anticoagulation, hemorrhagic stroke or rup- associated symptoms should be asked. These factors can tured intracranial aneurysm should be considered. direct a differential diagnosis for headache, and if needed, for infectious causes of headache. ??2. A lumbar puncture is performed. Initial results are below: Social history should be obtained. Elements include history of sexual activity, new sexual partners, new living 55 Nucleated cell count: 15 cells/mm3, 75% lympho- environment (such as a dormitory or barracks), outdoor cytes, 25% neutrophils. The CSF is described as exposures to mosquitoes and ticks, travel history, and ill clear, with no red blood cells noted. contacts. 55 Total protein 55 g/dl, glucose 60 g/dl A complete review of systems can help uncover asso- 55Which diagnosis is more likely with these lab ciated symptoms which may be important in diagnosing results? How would this be different if the patient the patient. were 3 weeks old? 6 weeks old? A careful physical examination should be performed, including evaluating for signs of meningismus and look- vvFor the 17-year-old, this is consistent with pleocytosis ing for characteristic rashes. and suggests meningitis. The nucleated cell count 55 What laboratory studies would you like to obtain? differential suggests a viral etiology. 466 Answers to the Chapter Exercises

For the 3-week-old infant, these values fall within HIV itself can cause an aseptic meningitis, particularly normal limits. However, if the child was 6 weeks old (just during acute conversion. Hosts with HIV and low CD4 cell 3 weeks older!), the findings would be concerning for a counts are at risk for Cryptococcus meningitis, JC virus, meningitis. and central nervous system toxoplasmosis. Patients with 55 How would your differential diagnosis change if the AIDS are also at risk for CMV reactivation disease. patient was a recent immigrant to the United States, 3 and the cell count showed 115 cells/mm , with 90% Chapter 23 monocytes? Case 1 vvThis child has a different epidemiologic risk profile than if the patient had never traveled. Additionally, since the vv1. C differential has a monocytic predominance, there should be consideration of other pathogens. These include vv2. A-D tuberculosis and fungi. vv3. B (if black-and-white image, both A or B could be correct.) ??3. A Gram stain shows no organisms. Bacterial cultures reveal no growth. vv4. B

55 What additional tests would help diagnose the Case 2 17-year-old girl? vv5. D vvPolymerase chain reaction could be ordered to diagnose and herpes simplex virus, two of the most vv6. C common causes of aseptic meningitis. Other tests, such as HIV testing, could reveal an underlying cause for other Case 3 illnesses, such as Cryptococcus meningitis or HIV-related aseptic meningitis. vv7. A

55 What tests would you order if the patient were an vv8. B (if black-and-white image, A or B could be correct.) infant? vv9. D vvInfants are at risk for herpes simplex virus infection in the first weeks of life. They can also be prone to other viral infections like enterovirus and parechovirus. A review of Chapter 24 the delivery record including maternal labs can direct diagnostic testing, which may include PCR against vv1. Headache specific pathogens. vv2. Age (newborns) 55 What tests would you order if the patient spent time outdoors and reported mosquito or tick bites? vv3. In the vertebral bodies (vertebral osteomyelitis) vvWith this epidemiologic exposure, consideration should vv4. S. aureus be given to West Nile and other arboviruses, as well as Lyme and other tick-borne illness. West Nile and arbovi- vv5. The frontal sinuses ruses are primarily diagnosed with antibody assays on CSF or serum. Lyme may be diagnosed with an antibody assay confirmed by Western blot. Lyme may also be diagnosed with PCR on the CSF, although a negative PCR does not Chapter 25 exclude Lyme disease. vv1. c 55 What additional considerations would you have if the vv2. , mumps, varicella, rotavirus, influenza, polio, patient was infected with HIV? rabies vvDepending on the degree of immunosuppression, v3. 1D, 2E, 3A, 4B, 5C patients with HIV could be at risk for many infections. v 467 Answers to the Chapter Exercises

Chapter 26 vvAnswer. Tetanus is a medical emergency requiring hospital admission. Eradication of C. tetani, neutralization of tetanus Tetanus toxins, and supportive care remain the cornerstone in the management and care of patients with tetanus. ??1. Identify the different risk factors associated in the transmission and exposure to tetanus infection. Diphtheria

??1. Describe the pseudomembrane and the “Bull neck” vvAnswer. . Table 26.1 lists the various ways tetanus infection gets into your body and clinical history signs associated with the clinical presentation of increasing index of suspicion for tetanus which includes diphtheria. burns, crush injuries, injuries with dead tissues, intrave- nous drug use, minor surgical procedures or rectal/ vvAnswer. Pseudomembrane is a local inflammatory vaginal instrumentation, puncture wounds from a nail or reaction induced by bacteria that is dense and adherent recent needle injection, and wounds contaminated with in the superficial layer of the skin or respiratory mucosa feces, dirt, saliva. due to diphtheria toxin that triggers the production of a necrotic, coagulated mass of fibrin, leukocytes, dead ??2. Name the various symptoms and clinical respiratory epithelial cells and bacteria. presentation of tetanus. “Bull neck” is a sign of severe disease associated with vvAnswer. . Table 26.2 lists the various signs and symp- diphtheria due to extensive neck swelling with cervical toms associated with tetanus which includes difficulty lymphadenitis. swallowing, fever and sweating, headache, jaw cramp- ing, labile blood pressure and , painful ??2. Identify the different end organs affected by the muscle stiffness of the body, and sudden involuntary diphtheria toxin. muscle tightening or muscle spasms.

vvAnswer. . Table 26.6 lists the different clinical forms of diphtheria which identify the different end organs ini- . Table 26.3 enumerates the overlapping clinical forms of tetanus which includes cephalic tetanus, gener- tially affected by the diphtheria toxin as follows, alized tetanus, localized tetanus, and neonatal tetanus. respiratory diphtheria (nasal, laryngeal, pharyngeal, and tonsillar) and cutaneous diphtheria. ??3. Ask the director of the Microbiology Lab if they have photo micrographs on file of the C. tetani bacteria ??3. Correspond with the Microbiology Laboratory showing its characteristic terminal spore. The regarding which appropriate specimens to collect Centers for Disease Control and Prevention’s website from patients with a clinical diagnosis of diphtheria. has a repository of pictures depicting the terminal vvAnswer. Learning experience may vary with local spore of C. tetani. microbiology unit. vvAnswer. Learning experience may vary with local A swab specimen from beneath the pseudomembrane is microbiology unit. the most valuable specimen, but positive results can also be obtained from nasopharyngeal swab samples. Direct exam- ??4. Describe the overlapping clinical forms of tetanus ination of swab samples using a Gram stain (. Fig. 26.8) has and list the differential diagnoses for tetanus. limited utility, but swab samples can be analyzed with Neisser or Loeffler methylene blue stains with positive sam- vvAnswer. . Table 26.3 enumerates the overlapping clinical ples demonstrating metachromatic granules. For optimum forms of tetanus which includes cephalic tetanus, general- visualization of these characteristic granules, the bacterium ized tetanus, localized tetanus, and neonatal tetanus. should be grown on Loeffler culture medium before stain- ing. PCR-­based direct specimen detection systems for the Tetanus is a clinical diagnosis; however, there are diphtheria tox gene have been described. several differential diagnoses that need to be ruled out which includes adverse drug reactions (phenothiazine ??4. Describe the different clinical forms of diphtheria reaction, strychnine poisoning), hypocalcemic tetany, and list the differential diagnosis of diphtheria. meningitis, encephalitis, seizures, rabies, and conver-

sion disorder. vvAnswer. . Table 26.6 lists the different clinical forms of diphtheria which includes respiratory diphtheria (nasal, ??5. Discuss the cornerstone of management and laryngeal, pharyngeal, and tonsillar) and cutaneous complications of patients with tetanus. diphtheria. 468 Answers to the Chapter Exercises

There are other disease processes that may be associ- vvAnswer. . Table 26.15 lists the various clinical presenta-

ated with membranous , and . Table 26.9 lists tions of classic botulism and infant botulism. the differential diagnosis which includes other microbio- logic agents (Arcanobacterium hemolyticum, Borellia vin- Classic botulism may present with blurred vision, dip- centi) associated with Vincent’s angina or necrotizing lopia (double vision), drooping eyelids, dry mouth, dys- gingivitis, Candida albicans, influenza asso- arthria (slurred or slow speech), dysphagia (difficulty ciated with , Staphylococcus aureus, Streptococcus swallowing), dysphonia (hoarse voice), muscle , pyogenes (Group A Streptococcus), Toxoplasma spp., if not treated may progress to descending paralysis (adenovirus, infectious mononucleosis due to involving respiratory muscles, arms, and legs. EBV, herpes simplex virus) as well as use of medications Infant botulism may present with lethargy, constipa- like antineoplastic agents like methotrexate that may cause tion, feed poorly, poor muscle tone, or with weak cry. formation of pharyngeal membrane and long-term use of corticosteroid (e.g., prednisolone) may cause oral thrush. ??3. Correspond with the Microbiology Laboratory regarding which culture and bioassays are available ??5. Discuss the cornerstone of management and locally and which appropriate specimens to collect complications of patients with the clinical diagnosis from patients with a clinical suspicion for botulism. of diphtheria. vvAnswer. Learning experience may vary with local vvAnswer. Antitoxin and antimicrobial regimen remains microbiology unit. the cornerstone in the care and management of patients with provisional clinical diagnosis of diphtheria. Most hospital laboratories are not properly equipped to process specimens from patients suspected of having Respiratory diphtheria may progress to severe and botulism. Before collecting any specimens the medical

life-­threatening complications as listed in . Table 26.8 care provider should call their state health department’s which includes cranial and peripheral neuropathies, or CDC’s emergency 24-h telephone number (770-488- myocarditis with associated heart block, renal 7100) so that appropriate action can be taken to establish Insufficiency, toxic circulatory collapse, and upper airway the diagnosis, initiate therapy, and investigate the case. obstruction due to extensive membrane formation or cer- Laboratory confirmation of foodborne botulism is the vical edema (Bull-neck). Some patients with pharyngeal detection of botulinum toxin in serum, stool, or patient's diphtheria may have nasal speech due to palatal palsy. food, or the isolation of Clostridium botulinum from stool. This case definition is also used for adult and child Botulism non-foodborne cases. For wound botulism, laboratory confirmation entails detection of botulinum toxin in ??1. Identify the different risk factors associated with the serum, or isolation of Clostridium botulinum from the development of botulism. wound. Bioassays for botulinum toxin are currently the most important laboratory tests for diagnosis of botu- vvAnswer. . Table 26.13 lists the different kinds of botulism lism. Currently, the only reliable assay is the mouse bioas- and the different factors associated with their develop- say together with neutralization of mouse toxicity with ment. Foodborne botulism occurs after eating foods type-­specific antitoxins.

(improperly canned, fermented, or preserved homemade . Table 26.16 summarizes the list of specimens for foods) contaminated with botulinum toxin. Infant botulism diagnostic assay in cases of botulism. occurs if spores of the bacteria get into the infant’s intestine, germinate, and produce botulinum toxin. ??4. Describe the different clinical forms of botulism. Wound botulism occurs if spores of the bacteria get into

the wound (after traumatic injury, surgery, or intravenous vvAnswer. . Table 26.13 lists the different clinical forms of drug use), germinate, and produce botulinum toxin. Adult botulism. Foodborne botulism occurs after eating foods intestinal toxemia is a rare kind of botulism due to spores (improperly canned, fermented, or preserved homemade of the microorganism getting into adult’s intestine, foods) contaminated with botulinum toxin. Infant germinate, and produce toxin similar to infant botulism. botulism occurs if spores of the bacteria get into the Those with medical conditions involving the digestive infant’s intestine, germinate, and produce botulinum tract may be at risk. Iatrogenic botulism occurs if excessive toxin. Wound botulism occurs if spores of the bacteria get botulinum toxin is injected for cosmetic reasons (for into the wound (after traumatic injury, surgery, or wrinkles) or medical reasons (for migraine ). intravenous drug use), germinate, and produce botuli- num toxin. Adult intestinal toxemia is a rare kind of ??2. Differentiate the various symptoms and clinical botulism due to spores of the microorganism getting presentation of classic botulism versus infant into adult’s intestine, germinate, and produce toxin botulism. similar to infant botulism. Those with medical conditions 469 Answers to the Chapter Exercises

involving the digestive tract may be at risk. Iatrogenic methicillin-resistant Staphylococcus aureus. Methicillin botulism occurs if excessive botulinum toxin is injected is not a treatment option for methicillin-­susceptible S. for cosmetic reasons (for wrinkles) or medical reasons aureus because it has not been manufactured for use (for migraine headaches). in clinical medicine for many years. Antibiotic suscepti- bility testing of S. aureus does not actually include ??5. Discuss the different treatment regimens in methicillin, yet the terms methicillin-­susceptible S. managing patients with botulism as well as the aureus (MSSA) and methicillin-resistant S. aureus associated complications. (MRSA) are widely used. vvAnswer. Botulism is a medical emergency and any Antibiotic susceptibility testing is performed using the patients with clinical suspicion for botulism should be related beta lactamase penicillin, oxacillin, so the more accu- managed urgently with antitoxin. Laboratory confirma- rate terminology would be oxacillin-susceptible or resistant-­ tion of the diagnosis for botulisms should not preclude susceptible S. aureus (OSSA or ORSA). While more accurate, administration of antitoxin. Equine botulinum antitoxin and almost synonymous with MSSA and MRSA, use of the may be obtained from the Centers for Disease Control terms OSSA and ORSA has never gained traction. and Prevention (CDC) through the state health depart- All oxacillin susceptible isolates of S. aureus are also sus- ment which can significantly prevent worsening of ceptible to methicillin, nafcillin, and cefazolin (a first-­ botulism and may shorten its presentation if given early. generation cephalosporin), so laboratory testing for each one Equine-derived heptavalent botulinum antitoxin (BAT) is individually is unnecessary. Antibiotic treatment for the the treatment of choice for pediatric and adult botulism patient under discussion should be switched from vancomy- which is available from the CDC. BAT contains antitoxin cin to nafcillin, oxacillin, or cefazolin. against all seven botulinum types A-G. BAT stops toxemia and ends further uptake of botulinum toxin. The CDC vv3. Treatment should continue for 10–14 days from the Emergency Operations Center may be contacted for time of the first negative blood culture. botulism consultation and information regarding antitoxin. vv4. Persistent bacteremia despite the use of antibiotics that should be effective indicates the presence of an ongoing Human-derived antitoxin or intravenous Human source, such as an abscess. Search for complications and Botulism Immune Globulin (BIG-IV or Baby BIG) is the metastatic foci of infection such as endocarditis, septic antitoxin of choice for infant botulism. Baby BIG is thrombophlebitis, osteomyelitis, pyomyositis. licensed for infant botulism due to C. botulinum toxin type A or B and is available through the California State Case 2

Health Department (7 www.­infantbotulism.­org; 510- 231-7600). Baby BIG has been reported to significantly vv1. As part of his fever evaluation, blood cultures should decrease the number of days of intensive care unit stay as be collected from a peripheral vein and from his well as total length of hospitalization. catheter. He has fever and neutropenia so broad

. Table 26.17 summarizes the different treatment spectrum, empiric intravenous antibiotics are regimens for botulisms. necessary. The boy is treated empirically with Recovery from botulism takes several weeks to vancomycin and cefepime. months. Complications include and shortness of breath for years and even death in 5% of patients. vv2. Most coagulase negative staphylococci, including Mortality is associated from consequences of long-term Staphylococcus epidermidis, are resistant to ­methicillin, paralysis or with . so treatment with vancomycin is typically needed. Occasionally one will encounter a penicillin- or oxacillin- susceptible isolate. In those instances, it is not only Chapter 29 appropriate, but it is preferred that the more narrow spectrum penicillin be used instead of vancomycin. Case 1 For the patient under discussion, the isolate is resistant to vv1. The internal jugular central venous catheter is penicillin and oxacillin. In an attempt to salvage, rather than promptly removed, and she is treated with intrave- remove the device, his treatment included both intravenous nous vancomycin. vancomycin and vancomycin lock therapy for 10–14 days. The salvage effort was successful. vv2. Vancomycin would be effective, but its use should be reserved for the treatment of infections caused by vv3. The catheter would need to be removed. 470 Answers to the Chapter Exercises

Case 3 dal anti-inflammatory drugs, steroid injections, or even a joint aspiration just to remove fluid may all vv1. He is at high risk for fungal infection. Blood cultures help with joint pain and inflammation. are positive for Candida albicans. vv2. New guidelines and recommendations in the field of vv2. The PICC should be removed immediately. The Lyme disease apply to this patient. Firstly, oral antifungal treatment of choice for invasive candidia- doxycycline is now considered as an option for Lyme sis in this population is intravenous amphotericin B meningitis, without signs of encephalitis. Treatment deoxycholate. outcomes are identical to patients treated with intravenous ceftriaxone. Further to that, the duration vv3. A lumbar puncture should be done to evaluate for of therapy is no longer thought to be required to be meningeal involvement. In addition, ultrasonogra- 28 days, but that 14 days may be sufficient. Lastly, phy of the abdomen, an echocardiogram, and a doxycycline no longer has a concern for dental careful ophthalmologic examination should be staining in children under the age of 8 years. As such, performed to identify metastatic foci of infection. it would not be unreasonable to offer a 14-day course of oral doxycycline in this 5-year-old patient. However, parents or practitioners may feel uncomfortable with Chapter 30 this option, due to the dramatic change in practice. IV ceftriaxone does have a long track record of success in vv1. A treating Lyme meningitis. The risks of having a percutaneous line placed include thrombosis, line vv2. C breakage, bleeding, or infection and should be placed against the benefits of once-daily reliable dosing. vv3. B Risks from a percutaneous line appear to increase with time, so a 14-day course might be an appropriate vv4. D plan. Conversely, young active children may not safely tolerate such IV access for a prolonged period. Amoxicillin should be discussed as part of the Chapter 32 exercise, as it would normally be recommended in this age group, but learners should be aware that vv1. This clinical scenario is common and can be difficult amoxicillin has not been studied in the context of to clarify. Repeat infection with Borrelia burgdorferi is treating Lyme meningitis, and cannot at this time be well-documented, and positive serology is unfortu- recommended for this indication. It should be noted nately not protective. Because of this, serologic also that oral doxycycline does itself carry risks of testing for Lyme disease is likely to be unreliable in photosensitivity reactions and esophagitis or gastritis, this patient with a relatively recent history of Lyme which can adversely affect adherence to therapy. arthritis, and so joint-fluid aspiration for PCR might be appropriate to test for a new infection. Because the vv3. There are multiple explanations for the continued symptoms were absent for several months, it is fevers in this child, but of all of them, Lyme disease unlikely to be treatment-resistant arthritis due to may be the least likely. He was appropriately treated persistent autoantibodies. It may be another Lyme with amoxicillin for erythema migrans, and so infection, or it may be a different diagnosis entirely. persistent fevers would strongly suggest an alterna- Testing for other causes of arthritis, such as septic tive explanation. Such explanations would include arthritis, post-streptococcal arthritis, rheumatoid other tick-borne infections such as anaplasma or arthritis, or assessing for a simple traumatic injury Babesia, neither of which would be treated by the might be appropriate. Anticipatory guidance should amoxicillin that he had received, or non-tick-borne include an explanation that after treatment for Lyme infections. Epstein-Barr virus and Cat-scratch disease disease, the organism appears to be eradicated and (caused by ) are common causes of does not persist, and that serology is often unhelpful persistent febrile illness in young children. While all of after a proven case of Lyme disease in diagnosing these can be diagnosed with serology or PCR, such future infections. In the situation where arthritis testing may not provide rapid results (with the symptoms do persist after treatment for Lyme disease, exception perhaps of the Monospot test for EBV, it should be discussed that the symptoms are not due which is relatively insensitive at this age). Microscopic to persistent infection, but rather an immune examination of the blood smear might reveal morulae response in the joint capsule that should improve of , or the “Maltese Cross” intra-erythro- with time. Symptomatic management with nonsteroi- cytic parasites of Babesia, but requires an experienced 471 Answers to the Chapter Exercises

laboratory worker. Basic blood work might reveal tolerated. ELISA/antibody testing would be a better evidence for these infections: Anaplasma is associated option given chronic Chaga’s disease when the with a leukopenia and thrombocytopenia, and parasite is far less detectable in the peripheral blood hyponatremia. Babesia infection may demonstrate as compared to acute Chaga’s disease. An abdominal anemia. EBV infection may show elevated liver CT is out of scope for the patient’s complaints. enzyme levels, lactate dehydrogenase, and atypical lymphocytes. If anaplasmosis is suspected, treatment vv2. c. The answer is c. There is currently no available with doxycycline is reasonable before serologic or vaccine to prevent infection with T. cruzi due to PCR testing confirms the diagnosis. parasite antigenic shift and mimicry. The parasite is transmitted by the Triatomine vector to the host through the feces not the saliva. Chapter 34 vv1. 3 Chapter 37 vv2. 3 vv1. b. This patient likely has leptospirosis and needs to receive rapid treatment. Furthermore, his cough vv3. 5 suggests pulmonary involvement and CXR should be evaluated for pulmonary hemorrhage. vv4. 4 vv2. c. Conjunctival suffusion, particularly given the vv5. 4 patient’s history and localized to his calf, is indicative of leptospirosis. Begin treatment on oral amoxicillin after taking blood samples to be sent to Chapter 35 the CDC. Make patient aware of complications to look out for, and tell him to report to the emergency vv1. C room if he develops severe symptoms. vv2. E Chapter 38 vv3. A vv1. A vv4. B vv2. C vv5. D vv6. B Chapter 39 vv7. A vv1. A, C, and D are all appropriate answers. Any patient with past travel to or emigration from an endemic vv8. B country presenting with unexplained neurological pathology (most often seizures, but can include vv9. D meningitis, CN palsies, and ocular deficits especially in NPNCC) should have neurocysticercosis included vv10. A in their differential (A and C). D is a correct answer because the patient likely emigrated to the United States and has the classic presentation of neurocysti- Chapter 36 cercosis. Although it is possible that this patient may have neurocysticercosis, it is extremely unlikely due vv1. b. The answer is b. The next best step would be to to her brief travel history to a very well-developed obtain a peripheral blood smear to evaluate for any tourist hub and her non-NCC specific symptoms. trypomastigotes, and confirm the diagnosis of acute Chaga’s disease. After confirmation one would begin vv2. E is the correct response. Humans can acquire the treatment regimen with Benznidazole. Nifurtimox neurocysticercosis by ways of autoinoculation is also a possible pharmacological intervention but (fecal-oral) or by ingestion of the eggs from a person studies have shown that benznidazole is better with taeniasis through poor hand-hygiene. Human 472 Answers to the Chapter Exercises

ingestion of undercooked pork may cause taeniasis see oral ulcers here as well. Lastly, primary can pres- if the pork is infected with cysticerci, but not ent with a painless chancre (which can occur anywhere on neurocysticercosis. A patient with any type of the body, including the oropharynx), and secondary syphilis cysticercosis cannot transmit the parasite unless they can present with pharyngitis, lymphadenopathy, and a rash also have taeniasis: cysticercosis in humans is an although systemic symptoms like fever, fatigue, and myalgia accidental infection that ends the life cycle of the are somewhat less common. HIV acute seroconversion can parasite. mirror a number of other diagnoses, and thus it is important to keep this in your differential diagnosis. Down vvQuestion 2 – Answer C vv1. proglottid In early HIV, there is a period of intense and rapid viral repli- vv2. human cation which results in high viral loads that can be above 100,000 viral copies/ml. During this period there is also vv3. cysticercus infection of CD4+ T cells, with their total numbers remaining normal or decreasing transiently. Of the available options, vv4. taeniaisis only choice C reflects the normal CD4+ T-cell count and high HIV viral load typically seen during acute HIV infection. Across vvQuestion 3 – Answer A vv5. neurocysticercosis When ART was first introduced for treatment of HIV, the vv6. oncosphere ideal time to start therapy was unknown. Significant improvement was noted in patients who had CD4+ T-cell vv7. seizures counts less than 350 cells/mm3; however, it was unclear if patients with preserved CD4+ T-cell counts would benefit from treatment. Additionally, toxicities were prevalent with Chapter 41 all of the early treatment options. Although the patient in the vignette has a CD4+ T-cell count that is within the nor- vvQuestion 1 - Answer: D mal range, he would benefit from starting therapy as soon as possible. Treatment is predicted to reduce his risk for Although it is possible that the patient has any of the avail- disease progression and reduce his HIV reservoir. able answer choices, when evaluating the patient’s presenta- Additionally, the risk for transmission to his partner is sig- tion and pertinent history, option D is the best choice. When nificantly reduced once his viremia is suppressed. PrEP considering acute HIV seroconversion, painful oral ulcers should also be considered for his partner. can help distinguish this diagnosis from the rest of the dif- ferential diagnoses. Infectious mononucleosis can present vvQuestion 4 – Answer B with fever, pharyngitis, , lymphadenopathy, and a maculopapular rash, but oral ulcers would be atypical. While new or recurrent symptoms, including fever, cough, Hodgkin’s lymphoma can present in young adults with fever, and worsening findings on chest imaging, should prompt an weight loss, night sweats, pruritus, and lymphadenopathy, assessment for all possible causes, this patient is likely to have but pharyngitis, oral ulcers, and a rash would make this immune reconstitution inflammatory syndrome. Her symp- option less likely. Streptococcal pharyngitis can present with toms improved after starting therapy for tuberculosis and fever, tonsillar , pharyngitis, a rash, and tender HIV but recurred about 4 weeks later. ­cervical lymphadenopathy; however, it would be atypical to 473 A

Index

Acute histoplasmosis 99 Alcoholic hepatitis 136 A Acute HIV infection 28, 421, 426 Allergic bronchopulmonary aspergillosis Acute inflammatory demyelinating (ABPA) 96 Abscess 4, 5, 8 ­polyradiculopathy (AIDP) 231 Alopecia 403 –– See also specific abscess Acute (AOM) 39, 40 Amanita phalloides 136 Acellular pertussis vaccines 69 – complications 43 Amatoxin 136 Achalasia 386 – – diagnosis of 41 Amblyomma sp. Actinomycosis 31 – – differential diagnosis of 41 – A. aureolatum 356 Acute bacterial endocarditis 110 – – – follow–up 43 – A. cajennense 356 Acute bacterial lymphadenitis 30 – – – microbiologic causes 40 – A. imitator 356 Acute bacterial rhinosinusitis (ABRS) 44 – – –– treatment 41–43 Aminotransferases 136 –– complications of 47 Acute respiratory viral infections 26 Amoebic dysentery 148 –– diagnosis 45, 46 Acute retroviral syndrome 426 Amoxicillin 10, 176, 177 –– differential diagnosis 47 Acute rheumatic fever (ARF) 64 Ampicillin 10, 176, 177 –– microbiologic causes of 45 –– clinical manifestations 127 Animal bite wounds 5, 8 –– treatment 47 – diagnosis 130 Anogenital cutaneous HPV infections 184 Acute febrile syndrome 136 – – ASO titers 129 Anogenital warts 183, 184, 186, 187 Acute flaccid myelitis (AFM) – –– echocardiography 129 Antibiotic prophylaxis 129 –– cause 233 –– serologic testing 128–129 Antibiotic therapy 42 –– definition 229 –– epidemiology 126 Antiemetics 164 –– diagnosis of 231 –– historical perspective 126 Antigen detection tests 446, 447 –– enterovirus D68 231 –– incidence 127 Antiviral therapy 30 –– poliovirus infection 231 –– Jones’ major diagnostic criteria Apnea 60, 92, 93 –– VZV-associated acute flaccid myelitis 232 – articular manifestations 128 Appendicitis 149, 153 Acute flaccid paralysis (AFP) – –– carditis 128 Aquatic injuries and exposures, wound –– cause 233 –– chorea 127, 128 infections 4, 11, 12 –– definition 228 –– erythema marginatum 128 Arboviruses 240, 271, 272, 276–277 –– diagnostic evaluation 230 –– subcutaneous nodules 128 Arcanobacterium haemolyticum 20 –– etiologies 230 –– minor diagnostic criteria 127 Arterial catheters 316 –– Guillain-Barré syndrome 231 –– pathogenesis 126–127 Arterial embolization 149 –– polioviruses 230 – 127 Aseptic meningitis Acute gastroenteritis (AGE) – –– treatment –– arboviruses 240 –– clinical evaluation –– antibiotics 129 –– bacterial meningitis –– dehydration assessment 160, 161 –– aspirin 129 –– Borrelia burgdorferi 239–241 –– hospitalization 161 –– glucocorticoids 129, 130 –– CSF evaluation 236–238 –– indications for medical visit 160 –– IgIV 129 –– diagnosis 237 –– clinical presentation 160 –– NSAIDs 129 –– incidence 236 –– complications 160 –– vaccine 129, 130 –– suppurative bacterial meningitis 236 –– definition 158 Acute salpingitis with adhesions 207 –– treatment 243 –– diagnosis Acute tonsillopharyngitis 19 –– causes of 240–242 –– blood culture 161 Acute transverse myelitis (ATM) –– cerebrospinal fluid analysis 236, 237 –– microbiologic testing 161 –– clinical findings 228 –– enterovirus 238, 239, 243 –– multiplex molecular assays 162 –– clinical manifestation 233 –– HSV infection 239, 242 –– PCR assays 162 –– CSF evaluation 229 –– initial evaluation stages 236 –– stool testing 161 –– definition 228 –– pathogen-specific serologic tests 237 –– differential diagnosis 162 –– diagnostic criteria 228–230 –– PCR-based tests 237 –– epidemiology 158, 159 –– differential diagnosis 232 –– symptoms 236 –– etiology 159, 160, 166 –– incidence 228 Aspartate aminotransferase (AST) 136, 137 –– hospitalization 161 –– MRI 229, 230 exacerbation 72 –– inflammatory diarrhea 158 –– prevalence 228 Atypical 88, 93 –– invasive organisms 158 –– treatment 232 –– bilateral diffuse interstitial infiltrates –– noninflammatory/secretory diarrhea 158 –– varicella-zoster virus-associated ATM 228 characteristic of 89 –– prevention Adenovirus 76, 120, 136–138, 143 –– causes of 89 –– hand hygiene 164, 165 Adult intestinal toxemia 296 –– diagnosis of 88, 89 –– proper sanitation 164 Advisory Committee on Immunization Practices –– differential diagnosis of 89 –– rotavirus vaccine 166 (ACIP) 139 –– etiologies of –– treatment 166 Aedes aegypti 376–378, 380, 381 –– Bordetella pertussis 91, 92 –– antidiarrheal and antimotility agents 164 Aeromonas species 12 –– Chlamydophila pneumoniae 90 –– antimicrobial therapy 164, 165 362 –– Chlamydophila psittaci 90 –– antinausea and antiemetic drug 164 AIDS, see Human immunodeficiency virus (HIV) –– 91 –– early refeeding 163, 164 Alanine aminotransferase (ALT) 136, –– Mycoplasma pneumoniae 89, 90 –– objectives 162 137, 140 –– treatment options for 90 –– ORS 163 Alcohol use 136, 140 Azithromycin 71, 93 –– probiotics 164 474 Index

Bacterial pharyngitis 64 –– development 260 B Bacterial sepsis –– diagnosis 260, 261 Babesia in thin blood film 446, 456 –– qSOFA criteria 313 –– Peptostreptococcus species 261 Bacteremia 441 –– signs and symptoms 310 –– 262 – SIRS criteria 312 – risk factors 260 –– continuous bacteremia 312 – – – SOFA score 313 – S. aureus 261 –– definition 310 – – – treatment 313 – treatment 261 –– laboratory studies 310–312 – – Bacterial septic arthritis 352 BRAT diet 164 –– neonates 312 Bacterial sinusitis 44–47 Bronchiolitis 81 –– risk factors 312 Bacterial skin and skin structure infections 4, 6 – differential diagnosis 77 –– signs and symptoms 310 – – aquatic injuries and exposures, wound – definitions 82 –– Streptococcus pneumoniae 310 – – infections 11, 12 – outbreaks of 82 –– treatment 313 – Bacteria –– bite wound infections 8, 10, 11 –– oxygen saturation 82 – cellulitis 4, 5, 8 – pathophysiology of 82 –– oxygen 451 – – – definitions 4 – prevention 83 –– specimen collection and transport 440, 441 – – – immunodeficiency, clinical clues to 12, 13 – prognosis of 84 –– and yeast – – – eczema 13 – risk factors 83 –– colony types 453 – – – intravenous drug use 13 – signs and symptoms 82 –– hemolysis 453 – – – type 2 diabetes mellitus 13 – treatment and management 83 –– molecular identification 453, 454 – – – wound infection 13 Bronchoalveolar lavage (BAL) 99 –– phenotypic identification 453 – Bacterial cellulitis 5 –– less common pathogens in 12 Broth microdilution 460 Bacterial enteritis 159 –– skin abscess 5, 7 Budding yeast 444 Bacterial meningitis –– 8 Bull neck 290 Bacterial 80 –– beyond early infancy 250 – clinical features 80 –– Borrelia burgdorferi 239–241 – – differential diagnoses 80 –– causes 247 – C –– management 80 –– 247 Candida albicans 58, 173, 204, 336, 338 –– organisms 80 –– clinical presentation 249 Candidal vulvovaginitis 337 Bacterial vaginosis (BV) 203, 204 –– complications 246 Candidiasis Bartonella henselae 30, 138, 242, 277, 278 –– CSF evaluation 236, 237 –– Candida albicans 336 Baylisascaris procyonis 270 –– definition 246 –– candidal vulvovaginitis 337 Benznidazole 389 –– diagnosis 237, 255, 256 –– chronic mucocutaneous candidiasis 337 Beta-lactam antibiotic therapy 113 –– diagnostic studies 246, 247 –– diaper dermatitis 337 Bilateral subconjunctival hemorrhages 71 –– differential diagnosis 246, 247, 251, 252 –– esophageal candidiasis 337 BioFire FilmArray® Respiratory Pathogen 449 –– discharge criteria 253, 254 –– gram-positive ovoid organisms 336 Bite wound infections 4, 8–11 –– E. coli 247 –– invasive candidiasis 338 Blastomyces dermatitidis 98 –– Enterobacter species 247 –– beyond the neonatal period 340 Blastomycosis 98, 99 –– follow-up 253, 254 –– neonatal invasive candidiasis 338–340 Bleeding 13 –– Hib meningitis 247 –– risk factors 338 Bordetella pertussis 68, 69, 72, 91, 92 –– incidence 236 –– oropharyngeal infection 336–337 Borrelia sp. –– intrapartum intravenous antibiotics 247 –– risk factors 336 –– B. burgdorferi 239, 240, 242, 278, 344 –– intravenous antibiotics 246 –– treatment 336 –– B. lonestari 347 –– laboratory testing Capnocytophaga canimorsus 10 Botfly larva 442 –– blood cultures 250 Carbuncle 5–7 Botulism 287 –– cerebrospinal fluid findings 250, 251 Cardiac murmurs 110–112, 114, 115 –– antigenic serotypes 295 –– Listeria monocytogenes 247 Carditis 128, 348 –– Centers for Disease Control and –– long-term complications 253 Carotid sheath 55, 56 Prevention 297 –– mortality rates 253 Caspofungin 103 –– clinical presentation 296 –– 247, 248 Cat scratch lymphadenitis 30, 31, 278 –– Clostridium botulinum 294 –– neonatal meningitis 247, 254, 255 Catheter-related bloodstream infections (CRBSIs) –– complications 297 –– neuroimaging 251 –– central venous catheter 321, 322 –– cranial nerve palsies 294 –– in newborns and young infants 249–250 –– clinical indications 319 –– diagnosis 296–298 –– pathogenesis of 248 –– clinical presentation 317 –– foodborne 294, 296 –– PCV7 247 –– definition 316 –– iatrogenic botulism 294, 296 –– predisposing conditions 248, 249 –– diagnosis of 318, 319 –– incubation period 296 –– prevention of 254 –– etiologies of 318, 319 –– infant 294, 296 –– prognosis 253 –– Gram-positive cocci 322 –– mechanism of botulinum toxin 295 –– risk factors 247, 248 –– incidence of 316 –– treatment 297 –– Streptococcus agalactiae 247 –– methicillin-susceptible Staphylococcus –– wound 294, 296 –– Streptococcus pneumoniae 247, 248 aureus 321 362 –– supportive care 251 –– microbiologic indications 319 Brain abscess –– suppurative bacterial meningitis 236 –– PICC 321, 322 –– anatomic location of 260 –– treatment 243, 256 –– prevention of 321 –– antibiotic therapy 261, 262 –– adjunctive treatment 253 –– risk factors 317, 318 –– causes of 261 –– antibiotic therapy 252, 255 –– subcutaneous port device 321 –– clinical manifestations 260 –– beyond newborn period 252, 253 –– treatment 319–321 –– definition 260 –– in newborns and young infants 252 –– types of 317 475 B–D Index

Cefazolin 176 Cirrhosis 136 –– media 450 Ceftriaxone 176, 177 Clarithromycin 71 –– of viruses 452 Cellular immunity 96 Classical broth macrodilution (tube dilution) 458 Cutaneous HPV infection 184 Cellular-immune dysfunction 418 Clinical dehydration scale (CDS) 161, 166 Cutaneous pustule 8 Cellulitis 4, 5, 8, 61 Clinical laboratory improvement amendments Cysticercosis 410, 412 Centers for Disease Control and Prevention (CLIA)-waived tests 204, 206 Cysticercus 410, 413 (CDC) 206 Clostridium difficile-associated diarrhea Cystitis 172 Central line-associated bloodstream infection (CDAD) 164 Cytokine storm 378 (CLABSI) 316 Clostridium sp. Cytomegalovirus (CMV) infection 32, 143, 215, Central nervous system-dominated anicteric –– C. botulinum 294 217, 221, 223, 275, 447, 456 leptospirosis 396 –– C. perfringens 149 Cytopathic effect (CPE) 455 Cephalexin 176, 177 –– C. tetani 286 Cephalic tetanus 288 Coalescent mastoiditis 48 Cephalosporin 11 Coccidioidal infection 103 D Cepheid GeneXpert® MTB/RIF real-time PCR assay Coccidioidomycosis 98 Danger space 56, 64 cartridge 449 48 Dasypus novemcinctus, nine-banded armadillo 403 Cerebral malaria 368 Community-acquired pneumonia (CAP) 88 Deep neck space infections 60–63 Cervical cancer screening 185, 186 Computed tomography 33, 55, 61–64, 139, 176, –– bacterial causes 59 Cervical intraepithelial neoplasia (CIN) 185 237, 251, 272, 340 –– complications of 64 Cervical lymphadenitis 26 Condyloma acuminata 184, 187 –– imaging 63 Cervical necrotizing fasciitis (CNF) 62 Condyloma acuminatum 182 Dehydration 160–163 Chagas disease Congenital/perinatal infections Dengue fever –– acute phase 386 –– anti-infective regimen 223 –– cytokine storm 378 –– antiparasitic medication 388, 389 –– blueberry muffin rash 224 –– DENV 378 –– cardiac and intestinal treatment 389 –– chorioretinitis 220 –– diagnosis 380 –– chronic phase 386 –– clinical findings 223 –– epidemiology 377, 378 –– clinical case study 389 –– CMV infection 215, 217, 221, 223 –– history 377 –– clinical features 387, 388 –– definition 214 –– incubation period 378 –– indeterminate phase 386 –– fluorescein-tagged anti-cytomegalovirus –– risk factors 379 –– life cycle of T. cruzi 386, 387 antibody 221 –– symptoms 379 –– prevalence 386 –– HSV infection 215, 219, 220 –– treatment 380, 381 –– public health efforts, Ecuador 389, 390 –– late-onset manifestations 220 –– vaccination 381 –– signs and symptoms 386 –– maternal toxoplasmosis 215 –– viremia 378 – transmission 386 –– microcephaly/blueberry muffin rash 219 – Dengue virus 144 Chagoma 386, 388 –– neurodevelopmental problems 214 Dermacentor sp. Chemosis 48 –– parvovirus B19 218 –– D. andersoni 356 Chickenpox 22, 23 –– rubella 217 –– D. variabilis 356 Chikungunya virus 380, 381 –– serologic tests 221 Dermis 4 Childhood febrile exanthems 18 –– syphilis 215, 219, 221 Diagnostic microbiology –– erythema infectiosum 20, 21 –– T. pallidum-specific test 221 –– blood cultures 441 –– hand foot and mouth disease 21, 22 –– thrombocytopenia 223 –– diagnostic testing 440 –– matching pathogen 23 –– TORCH 214 –– direct microorganism detection 442, 443, 445, – measles and rubeola 18, 19 –– toxoplasmosis 215, 217, 218, 220 – 446, 448 –– roseola, roseola infantum, exanthem subitum, –– varicella infection 217, 218 –– specimen collection and transport 440–442 HHV6 infection 21 –– vertical transmission Diagnostic virology 451 – rubella and German measles 20 –– anti-infective treatments 222, 223 – Diaper dermatitis 337 – scarlet fever 19, 20 –– clinical manifestations 215, 216 – Diarrhea, see Acute gastroenteritis (AGE) – varicella, chickenpox 22, 23 –– definition 214 – Diffusion susceptibility tests 458 Chlamydia 200, 204, 206–208 –– diagnostic laboratory testing 220–221 Dilated cardiomyopathy (DCM) 118–121, 123, Chlamydia trachomatis 206, 207 –– pathogens 214–215 386, 389 Chlamydophila sp. –– Zika virus 219, 221 Dimorphic fungi 102, 103 – C. pneumoniae 90 Continuous bacteremia 312 – Diphtheria –– C. psittaci 90 Conventional and shell vial cell culture 452 –– antitoxin and antimicrobial regimen 292, 293 Chloramphenicol 360 Corynebacterium diphtheriae 290 –– bull neck 289, 290 Chorea 128 Cough 78, 81, 89 –– causes 291 Chorioretinitis 220 Councilman bodies 378 –– Centers for Disease Control and Chronic granulomatous disease (CGD) 12, 30, Coxsackie A16 58 Prevention 292, 293 148–150, 153 Cranial nerve palsies 294 –– clinical forms 291 Chronic HIV infection 426, 427 Crimean-Congo hemorrhagic fever virus 144 –– clinical presentations 292 Chronic Lyme disease (CLD) 351, 352 Croup, see Laryngotracheitis –– complications 292 Chronic mucocutaneous candidiasis 337 Cryoglobulinemia 141 –– Corynebacterium diphtheriae 290 Chronic otitis media with effusion (COME) 39 Cryptococcus meningitis 242 –– diagnosis 291, 292 Chronic recurrent multifocal osteomyelitis Cryptosporidium parvum 160 –– differential diagnoses 292, 293 (CRMO) 328, 329, 331 Culture –– mechanism of diphtheria toxin 290, 291 Chronic sinusitis 44 –– aerobic and anaerobic blood culture 451 –– membranous pharyngitis 289 Chronic suppurative otitis media (CSOM) 39, 42 –– of bacteria and fungi 448, 449, 451 –– treatment 293 Ciprofloxacin 177 –– of blood 451 –– ulcer/cutaneous diphtheria 289, 290 476 Index

Dipstick urinalyses 175 143, 148, 152, 153 –– specimen processing 100 Direct microorganism detection 443, 445–448 –– gastroenteritis 159 –– symptomatic and disseminated dimorphic –– hematoxylin and eosin stain 446 –– urinary tract infections 173–177 fungal infection 98 –– wet mount 442 Esophageal candidiasis 337 –– T-lymphocyte function 96 Direct polymerase chain reaction 31 Exanthem subitum 21 –– transmission of 96 Disk diffusion 458 Exotic animal bite wound infections 9–10 –– treatment, by dimorphic fungi 102, 103 Disproportional STI 200 Expedited partner therapy (EPT) 195, 197, 200, 207 –– triazoles 100 Dyspareunia 200, 202–204, 206–208, 337 Extracorporeal membrane oxygenation –– tumor necrosis factor antagonists 98 Dysphonia 76, 294, 296 (ECMO) 121 Furuncle 6 Extraneural cysticercosis 410 Fusarium sp. 454 Extraparenchymal neurocysticercosis 410, 412 –– F. macroconidia 454 Extrapulmonary symptoms 93 –– F. solani 97 E Fusobacterium necrophorum 148 Early HIV infection 426 Early refeeding 163, 164 Eastern equine encephalitis (EEE) virus 276 F G Ebola virus 144 Facial cellulitis 4 Galactomannan (GM) during replication 99 Echinococcus protoscolices (hydatid sand) 443 Facial erysipelas 7 Generalized tetanus 288 Eczema 4, 13 Faget’s sign 379 Genital chlamydia infections 210 8 Febrile exanthems of childhood 18 Gentamicin 113, 177 Elementary bodies (EB) 90 –– erythema infectiosum 20, 21 German measles 20 Elevated liver enzymes 136, 143, 144 –– hand foot and mouth disease 21, 22 Gianotti-Crosti syndrome 137, 139 Endophthalmitis 150, 151, 154 –– matching pathogen 23 Giardia cysts and Cryptosporidium oocytes 447 Enhanced urinalysis 175 –– measles and rubeola 18, 19 Giardia lamblia 158, 160 Entamoeba histolytica 144, 148, 152, 153, 455 –– roseola, roseola infantum, exanthem subitum, Glandular 27 173 HHV6 infection 21 Glucose-6-phosphate dehydrogenase (G6PD) Enterococcus species 173 –– rubella and German measles 20 deficiency 368 Enterovirus family 58, 70, 120, 228, 230–232, –– scarlet fever 19, 20 Gonococcal Isolate Surveillance Project (GISP) 208 238–239, 270–272, 275, 276 –– varicella, chickenpox 22, 23 200, 207–209 Enzyme-linked immunosorbent assay Fever 46, 76, 77 Granulomatous amebic meningoencephalitis (ELISA) 152, 379, 396 Fitz-Hugh-Curtis syndrome 200, 208 278, 279 Epidemic 362, 363 Flesh-eating strep 304 Group A streptococcus (GAS) 59, 60 Epidermis 4 Fluoroquinolones 177 Guillain-Barré syndrome 231 Epidermodysplasia verruciformis 184 Folliculitis 6 Epididymitis Foodborne botulism 294, 296 –– antibiotic therapy 195 27 –– color Doppler ultrasonography 193 Friable cervix 200 H –– diagnosis 196, 197 Fulminant hepatitis 141 HACEK group organisms 111 –– diagnostic laboratory testing 194 Fungal hyphae 443, 446 40, 247 –– expedited partner therapy 195 Hand foot and mouth disease 21, 22 –– pathogens 193 –– adverse effects 103 Hansen’s disease (HD), see Leprosy –– physical examination 193 –– amphotericin B 103 HBV e-antigen (HBeAg) 139, 140, 144, 145 –– risk factors 193 –– antifungal therapies 101–103 HBV surface antigen (HBsAg) 139–141, 144, 145 –– symptoms 193 –– antigen and antibody-based assays 99 Head and neck –– testicular torsion 193 –– calcified lung lesions 99 –– cavities of 54 –– treatment 196, 197 –– case studies 104 –– spaces of 54, 56 Epididymo-orchitis 192, 194–196 –– clinical evaluation 98 –– structures of 56 Epiglottitis 76, 80 –– definitive diagnosis 100 Hematogenous seeding 148, 149 –– airway management, endotracheal intubation –– diagnosis 98 Hemophagocytic lymphohistiocytosis 380 for 81 –– drug interactions 103 Hepatitis –– antibiotics 81 –– echinocandins 100, 103 –– cytomegalovirus (CMV) infection 143 Epitrochlear lymph nodes 27 –– epidemiology 96 –– diagnostic evaluation 137, 138 Epstein-Barr virus (EBV) infection 32, 57, 352 –– fungal staining and histopathology 100 –– EBV (see Epstein-Barr Virus (EBV) infection) –– heterophile antibody test 142 –– fungal-specific DNA 100 –– etiology 136, 137 –– incubation period 142 –– geography 97 –– HAV –– mode of transmission 142 –– Grocott methenamine silver stain 97 –– anti-HAV IgM 139 –– PCR test 143 –– hematologic malignancies 97 –– incubation period 139 –– serologic testing 142 –– hepatic cytochrome P450 enzymes 103 –– passive/active immunization 139 –– signs and symptoms 142 –– laboratory diagnosis 99 –– risk factors 138 –– treatment 143 –– lactophenol cotton blue preparation 97 –– source of transmission 138 Erysipelas 6 –– MALDI-TOF 100 –– HBV Erythema chronicum migrans (ECM) 347, 348, –– molecular testing 99 –– case study 144 351, 353 –– patient specimen 99 –– coinfection 140 Erythema infectiosum 20, 21 –– polyenes 100 –– description 139 Erythema marginatum 128 –– polymerase chain reaction 100 –– geographic location 139 Erythema nodosum leprosum (ENL) 406 –– primary/secondary immune deficiency 96 –– HBcAb 139 Erythromycin 71 –– rifampin 103 –– HBeAg 139, 140 Eschar 360 –– salvage therapies 102 –– HBsAg 139, 140 477 D–H Index

–– incubation period 139 –– initial evaluation 428 –– global epidemiology 418 –– prevention 141 –– integrase inhibitors 430 –– highly active antiretroviral therapy 426 –– risk factors 139 –– laboratory testing 428 –– HIV vaccines 433 –– serologic markers 139, 140 –– life cycle 433 –– initial evaluation 428 –– treatment 140 –– malignancies 433 –– integrase inhibitors 430 –– HCV –– management 426 –– laboratory testing 428, 429 –– antibody testing 141 –– medical male circumcision 433 –– life cycle 433 –– antiviral treatment 141 –– medication formulations 431 –– malignancies 433 –– coinfection 142 –– memory loss 428 –– management 426 –– cryoglobulinemia 141 –– metabolic and endocrine changes 433 –– medical male circumcision 433 –– extrahepatic manifestation 141, 145 –– natural history 426 –– medication formulations 431 –– incubation period 141 –– neurologic manifestations 433 –– memory loss 428 –– NAAT 141 –– neurologic signs and symptoms 428 –– metabolic and endocrine changes 433 –– risk factors 141 –– non-nucleoside reverse transcriptase –– natural history 426 –– SVR 141, 142 inhibitors 430 –– neurologic manifestations 433 –– transmission route 145 –– nucleoside reverse transcriptase inhibitors 430 –– neurologic signs and symptoms 428 –– herbal supplements 136 –– opportunistic infections 426 –– non-nucleoside reverse transcriptase –– HEV 145 –– patient preference 431 inhibitors 430 –– history 136 –– perinatal transmission 428 –– nucleoside reverse transcriptase inhibitors 430 –– neonates 137, 143 –– pharyngeal erythema 434 –– opportunistic infections 426 –– physical examination 136, 137 –– physical examination 428 –– patient preference 431 –– risk factors 136 –– postexposure prophylaxis 433 –– perinatal transmission 428 –– signs and symptoms 136 –– pre-exposure prophylaxis 433 –– pharyngeal erythema 434 –– in traveler –– prevention 433 –– physical examination 428 –– E. histolytica 144 –– prophylaxis 426 –– postexposure prophylaxis 433 –– HEV 144 –– protease inhibitors 430 –– pre-exposure prophylaxis 433 Hepatitis B immunoglobulin (HBIG) 141 –– rapid antigen test 434 –– prevention 433 Hepatitis E virus (HEV) 144 –– rectal pain 428 –– prophylaxis 426 Hepatocellular carcinoma (HCC) 138–140, 142 –– replication 420, 421 –– protease inhibitors 430 Hepatosplenic candidiasis 148, 149 –– retrovirus 421 –– rapid antigen test 434 Herpangina 58 –– risk factors 421, 422 –– rectal pain 428 Herpes simplex virus (HSV) infection 58, 215, 219, –– sexual transmission 433 –– replication 420, 421 220, 239, 242, 273, 274 –– tenofovir plus emtricitabine 433 –– retrovirus 421 Herpes simplex virus CPE 456 –– transmission modes 420 –– risk factors 421, 422 Heterophile antibody test 142 –– transmission risk estimates 421 –– sexual transmission 433 Histoplasma capsulatum 33, 98 –– US epidemiology 419 –– tenofovir plus emtricitabine 433 Histoplasmosis 98 –– virology 419–421 –– transmission modes 420 Human immunodeficiency virus (HIV) –– zidovudine 428 –– transmission risk estimates 421 –– acute retroviral syndrome 426 Honeymoon cystitis 172 –– US epidemiology 419 –– AIDS-defining condition 427 Human bite wound infections 8–11 –– virology 419–421 –– antibiotics 431 Human diploid fibroblast monolayer 453 –– zidovudine 428 –– antiretroviral therapy 428, 430 Human herpes virus (HHV) 21, 120, 275, 432 Human papillomaviruses (HPV) –– ARV medications 421 Human immunodeficiency virus (HIV) 32, 58 –– anogenital cutaneous HPV infections 184 –– blood transfusions 418 –– acute retroviral syndrome 426 –– cervical cancer screening 185, 186 –– cardiopulmonary examination 428 –– antibiotics 431 –– colposcopy/anoscopy 184, 185 –– case studies 434 –– antiretroviral therapy 428, 430 –– cutaneous warts 184 –– CD4+ T-lymphocytes 419 –– ARV medications 421 –– direct sexual contact 183 –– cellular immunodeficiency 433 –– blood transfusions 418 –– DNA-based screening assays 185 –– for children 431 –– cardiopulmonary examination 428 –– epidermodysplasia verruciformis 184 –– complications 431–433 –– case studies 434 –– incidence 183 –– contaminated blood products 418 –– CD4+ T-lymphocytes 419 –– mRNA-based screening test 185 –– controllers 427 –– cellular immunodeficiency 433 –– natural history of 183 –– dermatologic examination 428 –– for children 431 –– nonsexual modes of transmission 183 –– diagnosis 426, 429 –– complications 431–433 –– oncogenic potential 184 –– diarrheal illness 428 –– contaminated blood products 418 –– pap smear test 185 –– direct injection 421 –– dermatologic examination 428 –– papanicolaou cytology screening 185 –– disease progression –– diagnosis 426 –– prevalence, cervical HPV 183 –– antiretroviral therapy 427 –– diarrheal illness 428 –– recurrent juvenile respiratory –– CD4+ T-cell count 427 –– direct injection 421 papillomatosis 184 –– chronic 426, 427 –– disease progression –– structure 182 –– early HIV infection 426 –– antiretroviral therapy 427 –– types 182, 188 –– long-term non-progressors 427 –– CD4+ T-cell count 427 –– vaccines –– fusion and entry inhibitors 430 –– chronic 426, 427 –– acceptance and hesistancy 186–187 –– gastrointestinal examination 428 –– early HIV infection 426 –– male/female age 186 –– genome 421 –– long-term non-progressors 427 –– prevalence 186 –– global epidemiology 418 –– fusion and entry inhibitors 430 –– side effects 186 –– highly active antiretroviral therapy 426 –– gastrointestinal examination 428 –– types 186 –– HIV vaccines 433 –– genome 421 –– vertical transmission 183 478 Index

Huntington’s disease 128 Intravenous drug use (IVDU) 136, 137, 141 –– bilateral bulbar and palpebral conjunctival Hyalohyphomycete hyphae 446 Invasive/semi-invasive pulmonary fungal suffusions 396 Hyperreactive malarial splenomegaly 372 disease 96 –– biphasic infection 394–397 Hypoglycorrhachia 268 Ixodes scapularis 344, 346 –– clinical presentations 396 Hypopharyngeal cavity 54 –– complications 394 Hypovolemia/dehydration 160 –– conjunctival suffusion 396, 397 J –– diagnostic test 396 –– differential diagnosis 397 Janeway lesions 110, 113 –– empiric antibiotic treatment 396 Jarisch-Herxheimer phenomenon 398 I –– epidemiology 395 Juvenile recurrent respiratory papillomatosis 182 Iatrogenic botulism 296 –– fetal loss 394 Immune globulin intravenous (IgIV) 123, 131, –– hematogenous seeding 398 278, 305–307 –– immune phase 394, 396 Immune reconstitution inflammatory syndrome K –– intensive care monitoring and supportive (IRIS) 431, 432 Kava (Piper methysticum) 136 care 398 Immunodeficiency, clinical clues to 12, 13 Kikuchi-Fujimoto disease 242 –– intravenous benzylpenicillin 398 – eczema 13 – Kissing disease, see Epstein-Barr virus (EBV) –– Jarisch-Herxheimer reaction 398 – intravenous drug use 13 – infection –– oral doxycycline 398 – type 2 diabetes mellitus 13 – Klebsiella pneumoniae 80, 148, 150, 151, 153 –– laboratory findings 396 –– wound infection 13 –– leptospiremic phase 394, 396 Impetigo 6, 7 –– nonspecific febrile illness 394 In vitro antimicrobial susceptibility testing –– physical examination 396 –– bacteria L –– prevalence 395 –– anaerobic bacteria 459 La Crosse virus 277 –– risk factors 395 –– beta-lactamase testing 459 Lactose intolerance 160 –– transmission 394 –– dilution and diffusion 458 Lactose-fermenting and nonlactose-fermenting –– treatment 398 –– elliptical zones of inhibition 459 colonies 450 Leukocyte esterase (LE) 175 –– gradient diffusion 459 Lichen planus 137 –– isolates, characteristics 457 –– clinical feature of 76 Liebermeister’s rule 379 –– laboratory testing 456 –– differential diagnosis 77 Listeria monocytogenes 143 –– Mueller-Hinton agar plate 457, 458 Laryngotracheitis (croup) 76, 78 Liver abscess –– mycobacteria 459 Laryngotracheobronchitis (LTB) 76 –– anaerobic bacteria 148, 149 –– susceptibility testing 457 –– clinical features 79 –– clinical manifestations 150 –– test interpretations 458 –– diagnosis 78 –– complications 150 –– broth microdilution 460 –– differential diagnosis 79 –– definition 148 –– genetic resistance markers 460 –– management 78 –– diagnosis –– patient management 456 Legionella pneumophila 89–91, 379, 447 –– bacteremia/fungemia 151 –– of yeasts 460 Legionnaires’ disease 93 –– computer tomography 150 Incision and drainage (I&D) procedure 4, 6, 8, 13 Lemierre’s syndrome 64, 148 –– laboratory findings 151 Indeterminate leprosy 403 Lepromatous (multibacillary) leprosy 403, 404 –– magnetic resonance imaging 151 Infant botulism 294, 296 Leprosy –– single abscess 151 Infective endocarditis –– acid-fast bacilli 403 –– ultrasonography 150 –– blood cultures 112 –– antibiotics 406 –– incidence 148, 154 –– clinical manifestations 110, 111 –– classifications 405 –– pathogenesis 149–150 –– definition 110 –– dermatologic manifestations 403 –– pathogens 153 –– diagnosis 114 –– diagnosis 403 –– polymicrobial bacterial infection 148 –– echocardiography 112 –– differential diagnosis 404, 406 –– predisposing risk factors 153 –– gram-positive organisms 110 –– disease surveillance 406 –– risk factors 149 –– incidence 110 –– epidemiology 402 –– travelers 152 –– modified Duke criteria for diagnosis –– features 406 –– treatment –– clinical criteria 112 –– human to human transmission 402 –– antibiotic treatment 152 –– major criteria 113 –– hypopigmented/erythematous skin –– antifungal therapy 152 –– minor criteria 113 lesions 403 –– cephalosporin 152 –– pathological criteria 112 –– multiple skin lesions 404 –– empiric therapy 152 –– pathogens 110–112 –– Mycobacterium leprae 402 –– percutaneous needle drainage 152 –– prevention 114 –– nerve enlargement 403 –– piperacillin and tazobactam 154 –– risk factors 111 –– signs 403 –– for rupture 154 –– surgical intervention 115 –– slit-skin smear test 403 Localized tetanus 288 –– perivalvular extension 114 –– social and cultural history 402 Lockjaw 286 –– valvular dysfunction 114 –– transmission 402 Long-term central venous catheters (CVCs) 316 –– vegetation 114 –– treatment 405 Ludwig’s angina 62 –– symptoms 114, 115 –– type 1 reactions 406 Lumbar puncture 246 –– TEE 115 –– type 2 reactions 406 Lyme disease Inflammatory diarrhea 158 –– World Health Organization 402 –– amoxicillin 351 Influenza viruses 76 –– zoonotic transmission 402, 403 –– bacterial septic arthritis 352 Interferon gamma release assays (IGRAs) 29 Leptospiremia 394 –– Borrelia burgdorferi 344 Internal transcribed spacer (ITS) region Leptospirosis –– Borrelia lonestari 347 sequencing for fungi 454 –– abnormal laboratory findings 398 –– carditis 348 479 H–N Index

–– CLD 351, 352 –– severe anemia 368 Microimmunofluorescence (MIF) technique 90 –– clinical diagnosis 347 –– severity 368, 373 Microscopic agglutination test (MAT) 396 –– complications 348, 351 –– signs 370 Milrinone 121, 122 –– diagnosis 351 –– symptoms 368 Minimum inhibitory concentration (MIC) 458 –– doxycycline 352 –– transmission 366 Molds and eukaryotic parasites 454 –– EBV infection 352 –– treatment 369 Molecular assays 442 –– enzyme immunoassay screening tests 347 –– World Health Organization 366 Monoarticular arthritis 349 –– epidemiology 344–346 Male reproductive system 192 Mononucleosis-like syndrome 426 –– erythema chronicum migrans 347, 348, 351, 353 Marseilles fever 362 Monovalent attenuated human rotavirus 166 –– intravenous ceftriaxone 353 Masticator space 56 Morbilliform 19 –– laboratory diagnosis 349, 350 Mastoiditis Mucopurulent cervicitis (MPC) 200, 206–208 –– monoarticular arthritis 349 –– acute 48, 50 Mucorales 97 –– neurologic manifestations 348 –– coalescent 48 Mucormycete hyphae 446 –– oral doxycycline 353 –– complications of 50 Multifocal bacterial osteomyelitis 328 –– PTLDS 351 –– definitions 48 Mumps 192, 194, 196 –– serologic testing 344, 352 –– development, risk factors for 48 363 –– symptoms 344, 348 –– diagnosis of 49 Muscle and soft tissue cysticercosis 410 –– treatment of 350 –– differential diagnosis 49 Mycobacterium –– Western blots 347 –– microbiologic causes of 48, 49 –– auramine acid-fast stain 445 Lyme meningitis 239–241 –– pathophysiology 48 –– Kinyoun acid-fast stain 445 Lymph nodes 26 –– subacute/masked 48 –– M. marinum 12 Lymphadenitis 26 –– treatment of 49 –– M. tuberculosis 31, 193, 196, 242 –– diagnostic imaging 30 Matrix-assisted laser desorption-ionization time-of- Mycobacterium avium complex (MAC) 432 –– actinomycosis 31 flight mass spectrometry (MALDI-TOF MS) 453 Mycoplasma pneumoniae 89, 90, 278 –– acute bacterial lymphadenitis 30 Maxillary sinuses 45 Myocarditis –– acute infection with human Measles 18, 19 –– diagnosis 118 immunodeficiency virus 32 Mediterranean spotted fever 362 –– cardiac catheterization 119 –– cat scratch lymphadenitis 30, 31 Meningismus 236, 246 –– cardiac MRI 119 –– Epstein–Barr virus and cytomegalovirus 32 Meningitis 246 –– challenges 118 –– fungal causes 33 Meningoencephalitis 236 –– chest radiograph 118 –– general treatment considerations 30 –– arboviruses 276 –– complete blood count 119 –– Mycobacterium tuberculosis 31 –– Bartonella Henselae 277, 278 –– comprehensive metabolic panel 119 –– Nocardia species 32 –– Baylisascaris procyonis 270 –– echocardiogram 121, 122 –– NTM 31, 32 –– Borrelia burgdorferi 278 –– electrocardiogram 118, 119 –– Toxoplasma gondii 33 –– causes of 279 –– physical examination 118 –– direct diagnostic tests 28, 29 –– chronic enteroviral meningoencephalitis 279 –– troponin 119 –– indirect diagnostic tests 29 –– clinical evaluation 268 –– winter season 118 –– medical history 26, 27 –– clinical symptom 279 –– differential diagnosis 119, 120 –– microbiologic causes 27 –– CMV encephalitis 275 –– noninvasive test 123 –– physical examination, approach to 28 –– CSF analysis 270 –– outcomes 121 Lymphadenopathy 26 –– definition 268 –– pathogens causing 120 Lymphangitis 4 –– diagnostic testing 270–272 –– physical examination 123 Lymphatic system 26 –– Eastern equine encephalitis virus 276 –– recovery 122 Lysis centrifugation 451 –– EBV infection 275 –– symptoms 121 –– etiologies 268, 269 –– treatment 120–121 –– granulomatous amebic meningoencephalitis –– troponin 123 278, 279 M –– herpes B virus 275 Malaria –– herpes simplex viruses 273, 274 –– antigen-based tests 369 –– HHV6 275 N –– artemether-lumefantrine 370 –– intravenous acyclovir 268 Nasal secretions 46 –– case studies 370–372 –– La Crosse virus 277 Nasopharyngeal cavity 54 –– climate changes 366 –– Mycoplasma pneumoniae 278 Nasopharyngeal swab PCR testing 93 –– clinical presentation 368 –– neuroimaging 272 National Hansen’s Disease Program (NHDP) 406 –– diagnostic testing 368–370 –– PAM 278 Nebulized racemic epinephrine 79 –– differential diagnosis 368, 370 –– picornaviruses 275–276 Necrotizing soft tissue infection 6 –– disease severity 368 –– signs and symptoms 269 Needle aspiration 29–31, 62 –– drug resistance 373 –– SLE virus 276, 277 Neisseria sp. –– failed prophylaxis 368 –– treatment 268, 270, 279 –– N. gonorrhoeae 208 –– Giemsa-stained thin blood smear 370–372 –– VZV 274, 275 –– N. meningitidis 247, 248, 250 –– histidine-rich protein II test 369 –– West Nile virus 276 –– N. weaver 10 –– host factors 368 Mesenteric lymphadenitis 28 Neonatal invasive candidiasis –– life cycle 367 Methicillin-resistant Staphylococcus aureus –– clinical manifestations 338, 339 –– malaria prophylaxis 368 (MRSA) 4–6, 8, 11, 12, 30, 329, 331, 450 –– diagnosis 339 –– P. falciparum 368 Methicillin-sensitive Staphylococcus aureus –– incidence of 338 –– PCR-based tests 369 (MSSA) 4–6, 8, 13, 329, 331 –– risk factors 338 –– physical examination 369–370 Metronidazole 152 –– sites of infections 338 –– serologic tests 369 Microfilaria 442 –– treatment 339, 340 480 Index

Neonatal meningitis 247 –– therapeutic monitoring 332 Penile discharge 196, 197 Neonatal tetanus 288 –– treatment of 331, 332 Pentavalent bovine-human reassortant Neurocysticercosis Otalgia 44 vaccine 166 –– antiepileptic medication 413 Otitis 39 Periapical lucency 63 –– antiparasitic therapy 413 –– AOM 40 Perihepatitis 208 –– autoinoculation 412 –– complications 43 Period of intoxication 379 –– autopsies 411 –– diagnosis of 41 Peripherally inserted central catheters (PICC) 316 –– case studies 412, 413 –– differential diagnosis of 41 Peritonsillar abscesses (PTAs) 61, 62 –– clinical features 410 –– follow–up 43 Peritonsillar space 54 –– cysticidal antiparasitic drugs 413 –– treatment 41–43 Pertussis 68, 92 –– definition 410 –– definitions 39 –– antibiotics 71 –– differential diagnosis 411 –– otitis externa 39, 40 –– antimicrobial therapy 70 –– extraparenchymal 410 –– risk factors 40 –– component 69 –– neuroimaging findings 412 Otitis externa (OE) 39 –– definitions 68, 69 –– neurologic and neuropsychiatric symptoms Otitis media with effusion (OME) 39, 44 –– diagnosis 69, 70 412 Otorrhea 39 –– differential diagnosis 70 –– parenchymal 410 –– immunization 71 –– seizures 411 –– prevention 71 –– Taenia solium 410 P –– stages of 68 –– treatment 413 P. vivax parasitemia 371 –– symptoms of 68 Nifurtimox 389 Pancarditis 128 Pharyngitis 54 Nikolsky sign 302 Papanicolaou cytology screening 185 –– causes of 57 Nitrofurantoin 176, 177 Parainfluenza 2 culture confirmation, –– bacteria 59, 60 Nocardia species 32, 272, 445 immunofluorescence 457 –– deep neck space infections 60–63 Nonamplified probe assays 448 Parameningeal infections –– fungi 58 Noninvasive aspergillosis 98 –– brain abscess –– parasites 58 Nonmenstrual vaginal bleeding 207 –– anatomic location of 260 –– viruses 57, 58 Non-oncogenic and oncogenic human –– antibiotic therapy 261, 262 –– complications of 64 papillomavirus (HPV) serotypes 432 –– causes of 261 –– deep neck space infections 63 Non-purulent cellulitis 5 –– clinical manifestations 260 –– definitions Nontuberculous mycobacteria (NTM) lymphad- –– definition 260 –– head and neck, cavities of 54 enitis 12, 27, 29, 31, 32 –– development 260 –– head and neck, spaces of 54, 56 Norovirus 159, 162, 165, 166 –– diagnosis 260, 261 –– head and neck, structures of 56 Nucleic acid amplification tests (NAAT) 141, 194, –– Peptostreptococcus species 261 –– infectious causes of 56 196, 197, 200, 203, 442, 448 –– Pseudomonas aeruginosa 262 –– intravenous broad-spectrum antibiotics 56 Nucleic acid sequencing 454, 460 –– risk factors 260 –– majority of 56 –– S. aureus 261 –– symptoms 56 –– treatment 261 Physiologic leukorrhea 200, 202, 203 O –– predisposing risk factors 260 Picornaviruses 275–276 Oncosphere 410 –– spinal epidural abscess 260, 262–264 Pinworm eggs 442 Opisthotonus 286 –– subdural empyema Plantar warts 184 Opportunistic infection prophylaxis based on –– clinical signs and symptoms 264 Plasmodium sp. 456 CD4+ T-cell counts 431 –– definition 260, 264 –– P. falciparum 366, 368–371, 373, 374 Opportunistic infections (OIs) 431 –– development 264 –– P. ovale 366–369, 371–374 Opportunistic infections in AIDS 432, 433 –– diagnosis 264, 265 –– P. vivax 366, 368, 369, 371–373 Oral candidiasis 58 –– microbiology of 265 Pneumococcal conjugate vaccine (PCV7) 247 Oral cavity 54 –– treatment of 265 Pneumococcal meningitis 253 Oral rehydration 160–162 –– symptoms 260 Pneumonia 88, 93 Oral rehydration solution (ORS) 163 Paranasal sinus infection 264 Polymerase chain reaction (PCR) 396 Oral rehydration therapy (ORT) 163 Parapharyngeal abscesses 61 Polymerase chain reaction (PCR) testing 138 Orchitis 195–196 Parapharyngeal infections 56–57 Pontiac fever 93 360, 363 Parapharyngeal space 55 Positive hemadsorption test 457 Oropharyngeal cavity 54 Parasite exams of stool 454 Post-streptococcal glomerulonephritis (PSGN) 64 Oropharyngeal infection 336–337 Parasites 441, 442 Posttreatment Lyme disease syndrome Osler nodes 110, 113 Parechovirus meningoencephalitis 275, 276 (PTLDS) 351 Osteomyelitis Parenchymal neurocysticercosis 410, 411 Pott’s puffy tumor 264 –– antibiotic therapy 334 Parenteral antimalarial medication 368 Prehn’s sign 193, 195, 196 –– definition 328 Parinaud’s oculoglandular syndrome 27 Prerenal azotemia 358 –– diagnosis 333, 334 Parotitis 192, 196 Prevertebral space 56 –– differential diagnosis 329 Parrot fever 91 Primary amoebic meningoencephalitis (PAM) 278 –– incidence 328 Parvovirus B19 120, 218 Probiotics 164 –– laboratory evaluation 330 Pasteurella sp. Proglottid 410 –– long-term sequelae 332 –– P. canis 8 Prophylaxis 129, 130 –– multifocal bacterial osteomyelitis 328 –– P. multocida 8, 10, 27 Prostatitis 196 –– pathogens 329 Pelvic inflammatory disease (PID) 200, 202, 207 Proteus species 173 –– radiologic imaging 330, 331 Penicillin-binding protein assay, Protozoan speciation 455 –– risk factors 329, 330 immunochromatography 458 Pseudomonas aeruginosa 173, 177, 262, 454, 459 –– symptoms 328 Penile condyloma acuminata 185 Psittacosis 91, 93 481 N–S Index

Pulmonary artery catheters 316 Rotavirus vaccine 158, 159, 166 Signal amplification assays 448 Pulmonary aspergillosis 97, 100 Roth spots 110, 113 Sinusitis 44 Pure neural leprosy (PNL) 403 RSV bronchiolitis 83 –– acute bacterial rhinosinusitis Purified protein derivative (PPD) 12, 29, 32 Rubella 20, 217 –– complications of 47 Purulent cellulitis 4, 5 Rubeola 18, 19 –– diagnosis 45, 46 Pyelonephritis 172, 173, 176–178 –– differential diagnosis 47 Pylephlebitis 148, 149, 153 –– microbiologic causes of 45 Pyogenic liver abscess 148, 149 S –– treatment 47 Sabethes chloropterus 377 –– anatomy and pathophysiology 45 Safety-net antibiotic prescriptions (SNAP) 41 –– definitions 44, 45 R St. Louis encephalitis (SLE) virus 276, 277 –– risk factors 45 Radiofrequency ablation (RFA) 148, 149 Salmonella species 148, 149, 153 16S ribosomal DNA sequencing for Recurrent acute bacterial rhinosinusitis Scarlet fever 18–20 bacteria 454 (RABR) 44 Schistosoma hematobium egg 455 Skin abscess 5, 7 Recurrent AOM 39 Scrotal pain Spinal epidural abscess Recurrent juvenile respiratory papillomatosis 184 –– clinical presentation 197 –– clinical stages 262 Respiratory distress 77, 80, 84, 89 –– diagnosis 197 –– contiguous spread 262 Respiratory syncytial virus (RSV) 78, 82 –– epididymitis –– definition 260 Respiratory viruses 78 –– antibiotic therapy 195 –– diagnosis 262–264 62 –– color Doppler ultrasonography 193 –– hematogenous seeding 262 Retropharyngeal abscesses (RPAs) 61 –– diagnostic laboratory testing 194 –– risk factors 262 Retropharyngeal space 55 –– expedited partner therapy 195 –– S. aureus 263 Rheumatic heart disease (RHD) 126–129 –– pathogens 193, 194 –– symptom 262 Rhipicephalus sanguineus 356 –– physical examination 193 –– treatment 263, 264 Rhomboencephalitis 268 –– risk factors 193 Splenomegaly 110, 114 Ribavirin 380 –– symptoms 193 Sputum 443 Rickettsia sp. –– testicular torsion 193 Squamous intraepithelial lesions 182 –– R. australis 362 –– treatment 196, 197 Sridor 78 –– R. japonica 362 –– orchitis 194–196 Staphylococcal carbuncle 7 –– R. parkeri 360, 362 –– prostatitis 194, 196 Staphylococcus sp. –– R. prowazekii 360 363 –– S. aureus 59, 111, 113–115, 173, 302, 459 –– R. rickettsiae 356 Secretory diarrhea 158 –– S. lugdunensis 111 –– R. sibirica 362 Sepsis 310 –– S. saprophyticus 173 –– R. typhi 360 Sepsis-related organ failure assessment (SOFA) Strawberry cervix 205 360 score 310, 313 Strep throat 19 Rickettsioses Septic arthritis Streptococcal pharyngitis 60, 126–130 –– African tick bite fever 362 –– ankle 328 Streptococcal toxic shock syndrome 303 –– common infections 360, 361 –– definition 328 Streptococcus sp. –– 362, 363 –– diagnosis 328 –– S. agalactiae 30, 41, 143, 247 –– murine typhus 363 –– differential diagnosis 329 –– S. mitis 115 –– 360, 362 –– elbow joints 328 –– S. pneumoniae 40, 247, 248, 310 –– rickettsialpox 360 –– of hip joint 328 –– S. pyogenes 8, 19, 59, 126, 127, 129, 302 –– RMSF (see Rocky Mountain spotted fever –– incidence 328 Stridor 79, 81 (RMSF)) –– knee joint 328 Subacute bacterial endocarditis (SBE) 110 –– scrub typhus 363 –– laboratory evaluation 330 Subacute bacterial rhinosinusitis (SBRS) 44 –– spotted fever 360, 362 –– long-term sequelae 332 Subacute sclerosing panencephalitis (SSPE) 19 –– typhus 360 –– pathogens 329 Subacute/masked mastoiditis 48 Risus sardonicus 286 –– radiologic imaging 330, 331 Subcutaneous nodules 128 Rocky mountain spotted fever (RMSF) –– risk factors 329, 330, 333 Subcutaneous tissue 4 –– CNS symptoms 358 –– surgical intervention 333 Subdural empyema –– differential diagnosis 359 –– synovial fluid analysis 328 –– clinical signs and symptoms 264 –– early symptoms 358 –– therapeutic monitoring 332 –– definition 260, 264 –– epidemiology 356–357 –– treatment of 331, 332 –– development 264 –– fulminant course 358 Serum sickness-like reaction 137 –– diagnosis 264, 265 –– history 356 Sexual history 202 –– microbiology of 265 –– incidence 357 Sexually transmitted infection (STI) 200 –– treatment of 265 –– laboratory diagnosis 358, 359 –– asymptomatic 208 Sublingual spaces 55, 56 –– pathogenesis 357, 358 –– diagnostic testing 200 Submandibular spaces 55, 56 –– prerenal azotemia 358 –– empiric treatment 209 Superficial pustule 7 –– prevention 360 –– male patient (see Scrotal pain) Sustained virologic response (SVR) 141, 142 –– 358 –– prevalence 201 Swollen glands 26 –– rash 358 –– prevention 209 Sydenham’s chorea 127–130 –– renal failure 358 –– screening 209 Symptomatic trichomoniasis 205 –– Rickettsia rickettsiae 356 –– strategic approaches 200 Syndrome of inappropriate antidiuretic hormone –– treatment 359, 360 –– wet mount microscopy 202 (SIADH) 251 Romaña’s sign 386, 388, 390 Shell vial monolayers 453, 455 Syphilis 215, 219, 221 Roseola 21 Short-term central venous catheters (CVCs) 316 Systemic inflammatory response syndrome Roseola infantum 21 Shou-Wu Pian (Polygonum multiflorum) 136 (SIRS) 4, 310 482 Index

Trypanosoma cruzi 386–390 –– laboratory testing 202 T Trypomastigote 386 –– medications 202 Tachypnea 88 Tuberculoid leprosy 403 –– noninfectious etiologies 200 Taenia egg 455 Tuberculous meningitis 242 –– optimal approach 201 Taenia solium 59, 410 Tympanic membrane (TM) 39 –– patient counselling 208 Taeniasis 410, 412 Type 2 diabetes mellitus 13 –– physical examination 209 Tapeworms (cestodes) 410–413 –– societal and anatomic factors 200 Target amplification assays 448 –– treatment 201 Tdap vaccine 72 U –– whiff test 203 Testicular appendix torsion 194, 195 Ulcer/cutaneous diphtheria 289, 290 Vancomycin 114, 152, 253 Testicular torsion 193–195, 197 Ultrasonography 5, 30, 63, 137, 140, 142, 150, Varicella-zoster virus (VZV) 22, 23, 137, 217, 218, Tetanus 151, 176, 193 274, 275 Ventricular assist device (VAD) 121 –– clinical forms 288 Uncontrolled HIV 427 Verruca plana 184 –– clinical history 286, 287 Urease 173 Verruca vulgaris 184 –– Clostridium tetani 286–288 Urethritis 173 Vesicoureteral reflux (VUR) 178 –– complications 288 Urinary tract infections (UTIs) Vibrio vulnificus 11–13 –– differential diagnoses 288 –– antibiotics 176–178 Viral bronchiolitis 82 –– fecal contamination 286 –– bacterial uropathogens 173 Viral capsid antigen (VCA) 142 –– incubation period 288 –– clinical presentation Viral gastroenteritis 158, 160, 162 –– intravenous metronidazole 288 –– dysuria/painful urination 174 Viral myocarditis, see Infectious myocarditis –– opisthotonic posturing 286 –– fever 174 Viral pharyngitis 57 –– putative mechanism 287 –– foul smelling urine 174 Viremia 378, 379, 381 –– spasm of muscles 286 –– secondary enuresis 174 Virus replication 426 –– spore contamination 286 –– sexual child abuse 174 Viruses, specimen collection and transport 441 –– symptoms 286, 288 –– computed tomography 176 Virus-induced host cell changes 455 –– tetanospasmin 286 –– constipation 174 Voiding cystourethrogram (VCUG) 178 –– treatment 288, 289 –– cystitis 172 Thrombocytopenia 379 –– diagnosis Vomiting 158, 160–164, 166 Tonsillitis 60 –– bladder catheterization 175 Vomito negro (black vomit) 379 Tonsillopharyngitis 57, 59 –– dipstick urinalyses 175 Vulvovaginal Candidiasis (VVC) 204, 205 TORCH 214, 219 –– hemoglobin 175 Totally implantable venous access device 316 –– leukocyte esterase 175 Toxic shock syndrome (TSS) –– microscopy on urinary sediment 175 W –– clinical manifestations 302–304 –– nitrites 175 Wait-and-see prescription (WASP) 41 –– diagnosis 302 –– urine collection 174, 175, 178 Waldeyer’s tonsillar ring 56 –– differential diagnosis 304–305 –– urine culture 176 Walking pneumonia 93 –– epidemiology of 304 –– epidemiology 172 Weil disease 394, 396, 397 –– pathogenesis of 302–303 –– fungal infections 173, 174 West Nile virus (WNV) 276, 376, 380, 381 –– risk factors 302 –– microbial virulence 174 Wheezing 82 –– S. aureus 302 –– pyelonephritis 172, 178 Whole-cell vaccines 69 –– signs and symptoms 302 –– renal ultrasonography 176 Wolbachia-infected mosquitoes 381 –– S. pyogenes 302 –– spermicides 174 Wound botulism 294, 296 –– streptococcal toxic shock syndrome 303 –– treatment 176–177 –– superantigen 302 –– urethritis 173 –– treatment –– viral pathogens 174 Y –– clindamycin 305 –– voiding cystourethrogram procedure 178 Yeast histopathology 100 –– IgIV 305, 306 Urine antigen testing 93 (YF) 144 –– limb amputation 305 Urine dipsticks 175 –– diagnosis 379 –– oxacillin/nafcillin 305 Urogenital flora 176 –– history 376, 377 –– parenteral antimicrobial therapy 305 Urosepsis 172 –– incidence 377 –– vancomycin 305 US Advisory Committee on Immunization – incubation period 379 Toxic synovitis 329 Practices (ACIP) 186 – – sylvatic/jungle cycle 377 Toxoplasma gondii 33, 58 – – symptoms 379 Toxoplasmosis 215, 217, 218, 220 – – treatment 380 Tracheitis 76 V – –– urban cycle 377 Trans-arterial chemoembolization Vaccines 69 –– vaccination 380 (TACE) 148, 149 Vaginal discharge 201 –– viral pathogenesis 378 Traumatic lumbar puncture 251 – in adolescent females 200 – Yersinia sp. Triatomine insect 386, 387, 389, 390 –– antibiotic treatment 210 –– Y. enterocolitica 159 Trichomonads 205 –– behavioral factors 200 –– Y. pestis 27 Trichomonas vaginalis (TV) 205 –– causes 200, 201, 203 Trichomoniasis 203, 205, 206 –– developmental factors 200 Trimethoprim-sulfamethoxazole 32, 176, 177 –– diagnostic testing 202, 209 Trismus 62 –– differential diagnosis 200 Z Troponin 118, 119, 123 –– etiology 202–206, 209 Zika virus 219, 221, 376, 379–381