DOCSLIB.ORG

Case of a 58 Year Old Woman with a Skin Ulcer, Fever, and Lymphadenopathy

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Case of a 58 Year Old Woman with a Skin Ulcer, Fever, and Lymphadenopathy Case of a 58 year old woman with a skin ulcer, fever, and lymphadenopathy Ming Fung, Ella Park, Jane Lee Case Presentation Patient Symptoms: - Skin ulcer - Temperatures over 40°C - Headache - Chills - Myalgias - Malaise - Cervical lymphadenopathy Case Presentation Patient Symptoms: Cervical lymphadenopathy Final Symptoms - In no distress - Temperature of 38.0°C - Ulcer at the hairline - Left cervical lymphadenopathy - Systolic murmur Case Background: Lifestyle - Monogamous life with her husband - Wooded area in Coastal New England - Frequent exposure to the outdoor environment - Owns a pet dog - Does not smoke or use illicit drugs Case Background: Medical History - Medication: - Acetaminophen - Clindamycin - Cesarean section Diagnosis Differential Diagnosis Approach ● Fast Thinking Diagnosis ● Slow Thinking diagnosis ● Final diagnosis Diagnosis Fast Thinking process: ● Lived in forested area of New England ● Ulcerated skin lesion ● Lymphadenopathy ● Fever ● Possible exposure to animal vectors Diagnosis Slow Thinking process: ● Heart murmur ● Endocarditis? ○ (most common cause: infection associated with oral surgery) ● Glomerulonephritis ● Rareness Diagnosis What could explain ulcerated skin lesions and lymphadenopathy? Bubonic plague - Endemic southwestern U.S.A - Incubation period 2-8 days Patient perspective: - Traveled months before symptoms -No septic shock Diagnosis ● Rickettsialpox - Poxlike lesion with central eschar - Papulovesicular rash on appendages Patient perspective: - No rash - Typically transmitted by mites - Commonly reported by in urban areas Diagnosis ● Cutaneous anthrax (Anthrax infection) - Associated with bioterrorism Patient perspective: - No reported bioterrorism activity - No international travel/exposure to places where disease is endemic Lab Results: Serological Test - Test: - F.tularensis Antibodies must be present in a higher titer than 1:80 after 14 days - Patient: - First few days: Negative results - After 4 weeks: 1:640 titer Final Diagnosis ● Rule out other possible diseases/infections ● Positive Serological test Unanimous Conclusive diagnosis: Ulceroglandular Tularemia Treatment Medications ● Acetaminophen (inflammation) ● Streptomycin (3 days) ● Vancomycin (3 days) ● Ciprofloxacin (11 days) ○ enthesopathy ● Doxycycline (3 days) F. tularensis ● Transmission: ○ Contact with infected animals ○ Arthropod bites ○ Consumption of contaminated meat Symptoms of Tularemia ● Suppuration (pus formation) of lymph nodes ● Abscesses (pustules) ● Facial cellulitis (bacterial skin infection) ● Chronic otitis (ear infection) ● Meningitis (CNS inflammation) ● Acute encephalitis (Brain inflammation) ● Lymphangitis of upper limb (inflammation of lymph vessels) Prevention ● Similar to Lyme ● Avoid tick bites ○ Treated clothing ○ Repellent Thank you Questions? Citations ● Baggett MV, Gonzalez RG, Bhattacharyya RP, Mahowald MA. Case 4-2016. New ○ England Journal of Medicine [Internet] 2016 [cited 2019 Jan 15];374(6):573–81. Available from: Case 4-2016. A 58-year-old woman with a skin ulcer, fever, and lymphadenopathy. ● Maurin M, Pelloux I, Brion JP, Bano J-ND, Picard A. Human Tularemia in France, 2006-2010. ○ Clinical Infectious Diseases [Internet] 2011 [cited 2019 Jan 15];53(10). Available from: https://academic.oup.com/cid/article/53/10/e133/332757.
Load more

Recommended publications
  • Healthcare Providers* Report Immediately by Phone!
    Effective July 2008 COMMUNICABLE AND OTHER INFECTIOUS DISEASES REPORTABLE IN MASSACHUSETTS BY HEALTHCARE PROVIDERS* *The list of reportable diseases is not limited to those designated below and includes only those which are primarily reportable by clinical providers. A full list of reportable diseases in Massachusetts is detailed in 105 CMR 300.100. REPORT IMMEDIATELY BY PHONE! This includes both suspect and confirmed cases. All cases should be reported to your local board of health; if unavailable, call the Massachusetts Department of Public Health: Telephone: (617) 983-6800 Confidential Fax: (617) 983-6813 • REPORT PROMPTLY (WITHIN 1-2 BUSINESS DAYS). This includes both suspect and confirmed cases. All cases should be reported to your local board of health; if unavailable, call the Massachusetts Department of Public Health: Telephone: (617) 983-6800 Confidential Fax: (617) 983-6813 • Anaplasmosis • Leptospirosis Anthrax • Lyme disease Any case of an unusual illness thought to have Measles public health implications • Melioidosis Any cluster/outbreak of illness, including but not Meningitis, bacterial, community acquired limited to foodborne illness • Meningitis, viral (aseptic), and other infectious Botulism (non-bacterial) Brucellosis Meningococcal disease, invasive • Chagas disease (Neisseria meningitidis) • Creutzfeldt-Jakob disease (CJD) and variant CJD Monkeypox or other orthopox virus Diphtheria • Mumps • Ehrlichiosis • Pertussis • Encephalitis, any cause Plague • Food poisoning and toxicity (includes poisoning
    [Show full text]
  • WO 2014/134709 Al 12 September 2014 (12.09.2014) P O P C T
    (12) INTERNATIONAL APPLICATION PUBLISHED UNDER THE PATENT COOPERATION TREATY (PCT) (19) World Intellectual Property Organization International Bureau (10) International Publication Number (43) International Publication Date WO 2014/134709 Al 12 September 2014 (12.09.2014) P O P C T (51) International Patent Classification: (81) Designated States (unless otherwise indicated, for every A61K 31/05 (2006.01) A61P 31/02 (2006.01) kind of national protection available): AE, AG, AL, AM, AO, AT, AU, AZ, BA, BB, BG, BH, BN, BR, BW, BY, (21) International Application Number: BZ, CA, CH, CL, CN, CO, CR, CU, CZ, DE, DK, DM, PCT/CA20 14/000 174 DO, DZ, EC, EE, EG, ES, FI, GB, GD, GE, GH, GM, GT, (22) International Filing Date: HN, HR, HU, ID, IL, IN, IR, IS, JP, KE, KG, KN, KP, KR, 4 March 2014 (04.03.2014) KZ, LA, LC, LK, LR, LS, LT, LU, LY, MA, MD, ME, MG, MK, MN, MW, MX, MY, MZ, NA, NG, NI, NO, NZ, (25) Filing Language: English OM, PA, PE, PG, PH, PL, PT, QA, RO, RS, RU, RW, SA, (26) Publication Language: English SC, SD, SE, SG, SK, SL, SM, ST, SV, SY, TH, TJ, TM, TN, TR, TT, TZ, UA, UG, US, UZ, VC, VN, ZA, ZM, (30) Priority Data: ZW. 13/790,91 1 8 March 2013 (08.03.2013) US (84) Designated States (unless otherwise indicated, for every (71) Applicant: LABORATOIRE M2 [CA/CA]; 4005-A, rue kind of regional protection available): ARIPO (BW, GH, de la Garlock, Sherbrooke, Quebec J1L 1W9 (CA). GM, KE, LR, LS, MW, MZ, NA, RW, SD, SL, SZ, TZ, UG, ZM, ZW), Eurasian (AM, AZ, BY, KG, KZ, RU, TJ, (72) Inventors: LEMIRE, Gaetan; 6505, rue de la fougere, TM), European (AL, AT, BE, BG, CH, CY, CZ, DE, DK, Sherbrooke, Quebec JIN 3W3 (CA).
    [Show full text]
  • Medical Management of Biological Casualties Handbook
    USAMRIID’s MEDICAL MANAGEMENT OF BIOLOGICAL CASUALTIES HANDBOOK Sixth Edition April 2005 U.S. ARMY MEDICAL RESEARCH INSTITUTE OF INFECTIOUS DISEASES FORT DETRICK FREDERICK, MARYLAND Emergency Response Numbers National Response Center: 1-800-424-8802 or (for chem/bio hazards & terrorist events) 1-202-267-2675 National Domestic Preparedness Office: 1-202-324-9025 (for civilian use) Domestic Preparedness Chem/Bio Helpline: 1-410-436-4484 or (Edgewood Ops Center – for military use) DSN 584-4484 USAMRIID’s Emergency Response Line: 1-888-872-7443 CDC'S Emergency Response Line: 1-770-488-7100 Handbook Download Site An Adobe Acrobat Reader (pdf file) version of this handbook can be downloaded from the internet at the following url: http://www.usamriid.army.mil USAMRIID’s MEDICAL MANAGEMENT OF BIOLOGICAL CASUALTIES HANDBOOK Sixth Edition April 2005 Lead Editor Lt Col Jon B. Woods, MC, USAF Contributing Editors CAPT Robert G. Darling, MC, USN LTC Zygmunt F. Dembek, MS, USAR Lt Col Bridget K. Carr, MSC, USAF COL Ted J. Cieslak, MC, USA LCDR James V. Lawler, MC, USN MAJ Anthony C. Littrell, MC, USA LTC Mark G. Kortepeter, MC, USA LTC Nelson W. Rebert, MS, USA LTC Scott A. Stanek, MC, USA COL James W. Martin, MC, USA Comments and suggestions are appreciated and should be addressed to: Operational Medicine Department Attn: MCMR-UIM-O U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID) Fort Detrick, Maryland 21702-5011 PREFACE TO THE SIXTH EDITION The Medical Management of Biological Casualties Handbook, which has become affectionately known as the "Blue Book," has been enormously successful - far beyond our expectations.
    [Show full text]
  • Rickettsialpox-A Newly Recognized Rickettsial Disease V
    Public Health Reports Vol. 62 * MAY 30, 1947 * No. 22 Printed With the Approval of the Bureau of the Budget as Required by Rule 42 of the Joint-Committee on Printing RICKETTSIALPOX-A NEWLY RECOGNIZED RICKETTSIAL DISEASE V. RECOVERY OF RICKETTSIA AKARI FROM A HOUSE MOUSE (MUS MUSCULUS)1 By ROBERT J. HUEBNER, Senior Assistant Surgeon, WILLIAm L. JELLISON, Parasitologist, CHARLES ARMSTRONG, Medical Director, United States Public Health Service Ricketttia akari, the causative agent of rickettsialpox, was isolated from the blood of persons ill with this disease (1) and from rodent mites Allodermanyssus sanguineus Hirst inhabiting the domicile of ill per- sons (2). This paper describes the isolation of R. akari from a house mouse (Mus musculus) trapped on the same premises-a housing development in the citr of New York where more than 100 cases of rickettsialpox have occurred (3), (4), (5), (6). Approximately 60 house mice were trapped in the basements of this housing development where rodent harborage existed in store rooms and in incinerator ashpits. Engorged mites were occasionally found attached to the mice, the usual site of attachment being the rump. Mites were frequently found inside the box traps after the captured mice were removed. Early attempts to isolate the etiological agent of rickettisalpox from these mice were complicated by the presence of choriomeningitis among them. Twelve successive suspensions of mouse tissue, repre- senting 16 house mice, inoculated intracerebrally into laboratory mice (Swiss strain) and intraperitoneally into guinea pigs resulted in the production of a highly lethal disease in both species which was identified immunologically as choriomeningitis.
    [Show full text]
  • Specialised Services for Infectious Diseases (Adult)
    B07/S/a 2013/14 NHS STANDARD CONTRACT FOR SPECIALISED SERVICES FOR INFECTIOUS DISEASES (ADULT) SECTION B PART 1 - SERVICE SPECIFICATIONS Service Specification B07/S/a No. Service Specialised Services for Infectious Diseases (Adult) Commissioner Lead Provider Lead Period 12 months Date of Review 1. Population Needs 1.1 National/local context and evidence base Incidence and prevalence rates for infectious diseases (ID) are heavily influenced by ethnicity, migration, dispersal, and local factors. In general the burden of infection is greater in urban areas. National surveillance of various infections is undertaken for various diseases including: human immunodeficiency virus (HIV), hepatitis, tuberculosis (TB), sexually transmitted infections, meningo-encephalitis and imported infections. Infectious diseases services are provided by multidisciplinary teams including ID consultants and clinical microbiologists as well as clinicians from many other organ- based and syndrome based specialities. Specialised ID services are currently provided in around 20-25 specialist ID centres in England, including Cutaneous Infections at Kings College Hospital NHS Foundation Trust. Specialist ID centres deal with less common or more serious cases of ID dependent on the specialist diagnostic facilities and clinical expertise available in individual units. These facilities are serviced by teams of doctors with specialist training in ID and microbiology, with support from their colleagues in nursing, radiology and pharmacology. The multidisciplinary ID team co-ordinates a rapid and effective evaluation of the infection and its risk of transmission and provides appropriate diagnostic and medical management on a 24 hour basis. Admissions to the specialised infectious disease services are equivalent to 1 NHS England B07/S/a © NHS Commissioning Board, 2013 The NHS Commissioning Board is now known as NHS England approximately 500 admissions per million population or approximately 25,000 admissions in England per annum.
    [Show full text]
  • “Epidemiology of Rickettsial Infections”
    6/19/2019 I have got 45 min…… First 15 min… •A travel medicine physician… •Evolution of epidemiology of rickettsial diseases in brief “Epidemiology of rickettsial •Expanded knowledge of rickettsioses vs travel medicine infections” •Determinants of Current epidemiology of Rickettsialinfections •Role of returning traveller in rickettsial diseaseepidemiology Ranjan Premaratna •Current epidemiology vs travel health physician Faculty of Medicine, University of Kelaniya Next 30 min… SRI LANKA •Clinical cases 12 Human Travel & People travel… Human activity Regionally and internationally Increased risk of contact between Bugs travel humans and bugs Deforestation Regionally and internationally Habitat fragmentation Echo tourism 34 This man.. a returning traveler.. down Change in global epidemiology with fever.. What can this be??? • This is the greatest challenge faced by an infectious disease / travel medicine physician • compared to a physician attending to a well streamlined management plan of a non-communicable disease……... 56 1 6/19/2019 Rickettsial diseases • A travel medicine physician… • Represent some of the oldest and most recently recognizedinfectious • Evolution of epidemiology of rickettsial diseases in brief diseases • Expanded knowledge of rickettsioses vs travel medicine • Determinants of Current epidemiology of Rickettsialinfections • Athens plague described during 5th century BC……? Epidemic typhus • Role of returning traveller in rickettsial diseaseepidemiology • Current epidemiology vs travel health physician • Clinical cases 78 In 1916.......... By 1970s-1980s four endemic rickettsioses; a single agent unique to a given geography !!! • R. prowazekii was identified as the etiological agent of epidemic typhus • Rocky Mountain spotted fever • Mediterranean spotted fever • North Asian tick typhus • Queensland tick typhus Walker DH, Fishbein DB. Epidemiology of rickettsial diseases. Eur J Epidemiol 1991 910 Family Rickettsiaceae Transitional group between SFG and TG Genera Rickettsia • R.
    [Show full text]
  • WILDLIFE DISEASES and HUMANS Robert G
    University of Nebraska - Lincoln DigitalCommons@University of Nebraska - Lincoln The aH ndbook: Prevention and Control of Wildlife Wildlife Damage Management, Internet Center for Damage 11-29-1994 WILDLIFE DISEASES AND HUMANS Robert G. McLean Chief, Vertebrate Ecology Section, Medical Entomology & Ecology Branch, Division of Vector-borne Infectious, Diseases National Center for Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado McLean, Robert G., "WILDLIFE DISEASES AND HUMANS" (1994). The Handbook: Prevention and Control of Wildlife Damage. Paper 38. http://digitalcommons.unl.edu/icwdmhandbook/38 This Article is brought to you for free and open access by the Wildlife Damage Management, Internet Center for at DigitalCommons@University of Nebraska - Lincoln. It has been accepted for inclusion in The aH ndbook: Prevention and Control of Wildlife Damage by an authorized administrator of DigitalCommons@University of Nebraska - Lincoln. Robert G. McLean Chief, Vertebrate Ecology Section Medical Entomology & Ecology Branch WILDLIFE DISEASES Division of Vector-borne Infectious Diseases National Center for Infectious Diseases AND HUMANS Centers for Disease Control and Prevention Fort Collins, Colorado 80522 INTRODUCTION GENERAL PRECAUTIONS Precautions against acquiring fungal diseases, especially histoplasmosis, Diseases of wildlife can cause signifi- Use extreme caution when approach- should be taken when working in cant illness and death to individual ing or handling a wild animal that high-risk sites that contain contami- animals and can significantly affect looks sick or abnormal to guard nated soil or accumulations of animal wildlife populations. Wildlife species against those diseases contracted feces; for example, under large bird can also serve as natural hosts for cer- directly from wildlife.
    [Show full text]
  • Treatment of Biological Warfare Agent Casualties
    ARMY FM 8-284 NAVY NAVMED P-5042 AIR FORCE AFMAN (I) 44-156 MARINE CORPS MCRP 4-11.1C FIELD MANUAL TREATMENT OF BIOLOGICAL WARFARE AGENT CASUALTIES HEADQUARTERS, DEPARTMENTS OF THE ARMY, THE NAVY, AND THE AIR FORCE, AND COMMANDANT, MARINE CORPS DISTRIBUTION RESTRICTION: Approved for public release; distribution is unlimited. 17 July 2000 FM 8-284 NAVMED P-5042 AFMAN (I) 44-156 MCRP 4-11.1C FIELD MANUAL HEADQUARTERS NO. 8-284 DEPARTMENTS OF THE ARMY, NAVMED P-5042 THE NAVY, AND THE AIR FORCE, AIR FORCE MANUAL (INTERSERVICE) AND COMMANDANT, MARINE CORPS NO. 44-156 Washington, DC 17 July 2000 MARINE CORPS MCRP 4-11.1C TREATMENT OF BIOLOGICAL WARFARE AGENT CASUALTIES TABLE OF CONTENTS Page PREFACE ........................................................................................... vii CHAPTER 1. INTRODUCTION 1-1. The Threat of Biological Warfare Agents Against United States Forces and Civilian Populations ................................................. 1-1 1-2. Modes of Delivery .................................................................... 1-1 1-3. Employment of Biological Warfare Agents ...................................... 1-2 1-4. Classification of Biological Warfare Agents ..................................... 1-3 1-5. Portals of Entry ....................................................................... 1-3 1-6. Environmental Detection ............................................................ 1-4 1-7. Diagnosis ............................................................................... 1-5 1-8. Specimen Collection
    [Show full text]
  • NYS DOH STD Reporting Form
    To order more copies of this form call the Provider Access Line: 1-866-NYC-DOH1 NYC Department of Health & Mental Hygiene Universal Reporting Form PHA No. Form PD-16 (9/09) Mail completed form to: NYC Dept. of Health & Mental Hygiene; 125 Worth Street, Room 315, CN-6; New York, NY 10013 • Or report online: www.nyc.gov/nycmed P Patient Last Name First Name Middle Name DATE OF REPORT A T Patient AKA: Last Name AKA: First Name M.I . I ____ / ____ / ____ E Date of Birth Age Country of Birth Soc.Sec.No. N T ____ / ____ / ________ If patient is a child, Guardian Last Name Guardian First Name M.I. Ⅺ Homeless I Borough: Manhattan N Patient Home Address Apt. No. Zip Code Bronx F Unknown Brooklyn O Home Telephone Number Medical Record Number ( _______ ) ________ – _____________ Queens R Unknown M Staten Island Other Telephone Number Medicaid Number Ⅺ NYC, borough unknown A Unknown ( _______ ) ________ – _____________ Unknown T Ⅺ I Sex Race (Check all that apply) Ethnicity Hispanic Please report non-NYC Not NYC (Specify City/State) Male Transexual Asian White American Indian/Alaska Native Unknown (Check one) Non-Hispanic residents to the appropriate ________________, _____ O N Female Unknown Black Other race Native Hawaiian/Pacific Islander Unknown health jurisdiction Ⅺ Unknown Admitted to hospital? Admission Date Is patient alive? If no, date of death Unknown Is patient pregnant? If yes, due date Yes No ____ / ____ / ________ Unknown Yes No Yes No Unknown Discharge Date Unknown ____ / ____ / ________ Unknown Unknown
    [Show full text]
  • Tropical Fevers: Part A. Viral, Bacterial, and Fungal
    5A.1 CHAPTER 5 Tropical Fevers: Part A. Viral, bacterial, and fungal John Frean and Lucille Blumberg 1. INTRODUCTION Pyrexial illness is a presentation of many diseases particularly associated with tropical environments, but one should remember that many common infections, such as influenza and tuberculosis, also occur in the tropics or may be acquired en route to and from exotic locales. Febrile patients may also have chronic or recurrent medical problems that are unrelated to their tropical exposure, including non-infectious disease e.g. autoimmune or malignant conditions. In approaching a pyrexial patient, therefore, a general medical history should aim to elicit the presence of any underlying conditions, particularly those associated with increased risk of infections such as diabetes, neoplastic conditions, HIV infection, splenectomy, and pregnancy. The history of the current illness will determine the duration (acute or chronic) and pattern, if any, of fever; signs and symptoms which may be important in suggesting possible aetiologies are headache and other central nervous system involvement; myalgia and arthralgia; photophobia and conjunctivitis; skin rashes and localised lesions; lymphadenopathy, hepatomegaly, and splenomegaly; jaundice, and anaemia. The geographic and travel history, both recent and past, is of course of vital importance. The onset of illness in relation to known incubation periods and time of possible exposure can help to include or eliminate various infectious diseases (see Table 1). The areas visited and the nature of the travel may also be helpful in suggesting the likely exposures, e.g. business travel confined to city hotels has a different risk profile compared to river-rafting adventures.
    [Show full text]
  • Integrated Pest Management for Rodent Control a Rodent Control Plan Protects Your Reputation, Saves Money and Time
    Integrated Pest Management for Rodent Control A rodent control plan protects your reputation, saves money and time. So, why do so many commercial kitchen managers and owners take a wait-and-see approach? Reactive Rodent Control in Restaurants and Commercial Kitchens It’s estimated that Rodent related issues are a leading cause of why restaurants fail health inspections. It has been reported that one in four restaurants in the USA use rodenticides on an rat-borne diseases as needed basis1, and only 53% have a proactive plan with Pest Management have killed more Professionals (PMPs) that visit more than once a month to manage and control humans in the last rodents1. And, more than 70% of restaurants and commercial kitchens are not engaged with and do not provide basic information or direction to PMPs about 10 centuries than the rodent activity2. It is no secret rodents cause significant health and property casualties of all wars damage, yet many food handling establishments would rather be reactive when and revolutions controlling rodents. Consider the business reputation and loss of customers if someone were to post a video of a rodent sighting on social media. The viral spread combined. of the video may cost the restaurant or commercial kitchen substantial revenue source: www.fws.gov/pacificislands/publications/ taking months, if not, years to recover. The business reputation may even suffer Ratsfactsheet.pdf irreparable damage. This scenario can be avoided if a proactive rodent control plan is put in place. below: Diseases Rodents Carry To keep your facility rodent free, routine inspection is a key component of a proactive Rodents have been reported to harbor and spread as many as 200 human integrated pest management program.
    [Show full text]
  • Report for the Hemodialysis Vascular Access: Standardized Fistula Rate
    ESRD Quality Measure Development, Maintenance, and Support Contract Number HHSM-500-2013-13017I Report for the Hemodialysis Vascular Access: Standardized Fistula Rate (SFR) NQF #2977 Submitted to CMS by the University of Michigan Kidney Epidemiology and Cost Center June 21, 2017 Produced by UM-KECC Submitted: 6.21.2017 1 ESRD Quality Measure Development, Maintenance, and Support Contract Number HHSM-500-2013-13017I Table of Contents Introduction .................................................................................................................................................. 3 Methods ........................................................................................................................................................ 3 Overview ................................................................................................................................................... 3 Data Sources ............................................................................................................................................. 4 Outcome Definition .................................................................................................................................. 4 Denominator Definition ............................................................................................................................ 5 Risk Adjustment ........................................................................................................................................ 5 Choosing Adjustment Factors
    [Show full text]