bacterial infections pfn: somcml03

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Slide 1JSOMTC, SWMG(A)

Bacterial InfectionsPFN: SOMCML03

Hours: 2.5


Terminal Learning Objective

Action: Communicate knowledge of “Bacterial Infections”

Condition: Given a lecture in a classroom environment

Standard: Receive a minimum score of 75% on the written exam IAW course standards


References

Pathophysiology for the Health Professions, 4th Edition

Merck Manual, 19th Edition

Current Medical Diagnosis & Treatment,

51st Edition

Special Operations Forces Medical Handbook, 2nd Edition

Sanford’s Guide to Antimicrobial Therapy, 44th Edition

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Reason

The regions that SOF personnel deploy to are among the most disease‐ridden places on the planet. Preventative measures combined with maintaining a high index of suspicion will result in more combat ready forces on the battlefield accomplishing the mission.


Agenda

Identify Group A B‐hemolytic Streptococcusand the diseases it can cause

Communicate the etiology, signs and symptoms, the Jones Criteria, diagnostic tests, and management of rheumatic fever

Communicate the etiology, signs and symptoms, diagnostic tests, and management of bacterial meningitis


Agenda

Communicate the etiology, signs and symptoms, diagnostic tests, and management of the three forms of anthrax, to include: pneumonic, G.I., and cutaneous forms

Communicate the etiology, signs and symptoms, diagnostic tests, and management of brucellosis

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Agenda

Communicate the etiology, signs and symptoms, diagnostic tests, and management of tularemia

Communicate the etiology, signs and symptoms, diagnostic tests, and management of typhoid

Communicate the etiology, signs and symptoms, diagnostic tests, and management of cholera


Agenda

Communicate the etiology, signs and symptoms, diagnostic tests, and management of the three forms of plague

Communicate the etiology, signs and symptoms, diagnostic tests, and management of the four kinds of tetanus, to include: generalized, neonatal, local, and cephalic tetanus


Agenda

Communicate the etiology, signs and symptoms, diagnostic tests, and management of Clostridium perfringensinfections

Communicate the etiology, signs and symptoms, diagnostic tests, and management of Bartonella bacterial diseases, to include: Cat Scratch Disease, Trench Fever, and Oroya Fever

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Identify Group A Beta‐hemolytic Streptococcus and the Diseases it

Can Cause


A Look at Gram‐positive Cocci


Streptococcal Infections

Group A Beta‐hemolytic Streptococcus‐GABS

Streptococcal pharyngitis

Impetigo

Necrotizing fasciitis

Indirect sequelae

Scarlet fever

Rheumatic fever

Glomerulonephritis

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Strep Pharyngitis


The Etiology, Signs and Symptoms, the Jones Criteria, Diagnostic Tests, and Management of Rheumatic

Fever


Rheumatic Fever

Acute inflammatory complication of GABS infection

Characterized by:

Chorea (involuntary writhing movements)

Carditis

Arthritis

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Rheumatic Fever

Acute Rheumatic Fever (ARF) ‐ Typically occurs approximately 19 days after untreated streptococcal pharyngitis


Rheumatic Fever

Etiology ‐ GABS


Rheumatic Fever

Group A Beta‐hemolytic strep

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Subjective: Symptoms

Fever, malaise, wt. loss

Migratory arthralgias (polyarthritis)

Rash, erythema marginatum

Sub Q nodules (involving extensor surfaces)

Chorea

Carditis: palpitations, chest pain, SOB, lethargy, fatigue

Rheumatic Fever


Rheumatic Fever

History

Have you had a sore throat in the last few weeks?

Have you taken your temperature or do you feel hot?

Have you felt sick for a long time?


Objective: Signs

Fever (102 F)

Rash (erythema marginatum)

Short, abrupt, non‐purposeful movements (often disappear during sleep)

Grimacing

Bibasilar rales, aortic insufficiency or mitral regurgition murmurs, S3 gallop

Rheumatic Fever

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Rheumatic Fever

Erythema Marginatum


Rheumatic Fever

Laboratory findings

ESR >120 mm/h

WBC 12,000 – 20,000

ECG – prolonged PR interval

CXR may show cardiomegaly

ASO titer


Diagnosis requires the following:

Two major criteria or

One major and two minor criteria

Jones Criteria (Rheumatic Fever)

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Major criteria

Polyarthritis

Chorea

Carditis

Erythema Migrans

Sub Q nodules

Evidence of recent GABS (+ culture)

Minor criteria

Arthralgia

Fever

Elevated ESR

Prolonged PR interval

Jones Criteria (Rheumatic Fever)


Rheumatic Fever

Differential diagnosis

Polyarthritis:

• Gonococcal arthritis

• Subacute bacterial endocarditis

• Lyme disease

• Reiter’s syndrome

Carditis:

• Viral myocarditis

• Pericarditis


Management

New recommendation (2012) by Infectious Disease Society of America to only treat pharyngitis patients with a positive test for GABS

Rapid Strep to become part of MES

Primary: Benzathine Penicillin or oral PCN VK

Alternate: Clindamycin or Azithromycin

ASA or NSAID

Rheumatic Fever

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Patient education

Relapsing condition

• Prophylaxis treatment before procedures

Bedrest until afebrile

Diet regular

Medications: expect tinnitus with high dose aspirin

Rheumatic Fever


Rheumatic Fever

Complication of untreated strep throat

Presentation: young patient (5 – 20 y/o)

Most common clinical manifestations

Poly arthritis (painful migratory arthritis)

Chorea (spastic involuntary movements)

Carditis (rubs/murmurs/gallop)

Jones criteria used for diagnosis


The Etiology, Signs and Symptoms, Diagnostic Tests, and Management

of Bacterial Meningitis

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Caused byGram‐negative Aerobic Cocci


Meningococcal Meningitis(Neisseria Meningitidis)


Meningococcal Meningitis

Types

Neisseria meningiditis ‐ most common etiology for large, periodic epidemics

Strep. pneumoniae ‐ most often cause of community acquired infection

H. influenza ‐ decreased incidence with childhood vaccination programs

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Characteristics

High fever, headache, and stiff neck

Infection has rapid onset / progression

Prompt diagnosis and treatment critical towards reduction of morbidity




Symptoms

Initial

• High fever

• Headache

• Stiff neck

•Malaise

• Photophobia

• Arthralgias/myalgias

Advanced

• Delirium

• Nausea / vomiting

• Skin rash

• Dizziness

• Seizures

• Coma

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History

How fast did your symptoms progress?

Have you been exposed to others who have been ill or had meningitis?

Have you had meningitis in the past?

Does it hurt to bend your neck or touch your chin to your chest?

Vaccinations against meningitis?

Travel to “meningitis belt”?

Recently done “The Haj”?



Objective: Signs

Fever to 104oF or 40oC

Cervical meningismus

Prostration

Toxic appearance



Hemorrhagic petechial skin lesions

Possible papilledema due to increased ICP

Eponyms / classic signs

Meningeal signs

Brudzinsky sign

Kernig’s sign

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Meningococcal Meningitis Brudzinsky ‐ flexion of head / neck onto chest causes increase of pain of nuchal or spinal regions / patient will tend to flex the leg / knee

Kernig's ‐ extension of leg / knee with patient in supine position – this movement is limited by spasm of hamstring which also causes pain


Lab: WBC Count ‐ Leukocytosis

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Lab: Gram‐negative Cocci



CSF analysis

Bacterial form ‐ elev WBC (over 10000) PML* predom., decreased glucose, increased protein

Viral form ‐ WBC decreased (below 1000 ), less than 50% PML’s, nl glucose, nl protein



Assessment ‐ DDX

Rickettsial infection

Dengue

Leptospirosis

Cerebral malaria

Malignancy

Severe viral or bacterial sepsis

Subdural/epidural hematoma

Stroke

Toxin (e.g., drugs, ETOH, etc.)

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Plan (Empiric Treatment)

Availability of certain procedures may be limited in the field

Begin antibiotics as soon as possible

Empiric choices: penicillin or ampicillin

Ceftriaxone (Rocephin) or cefotaxime (3rd generation cephalosporin)

Plus vancomycin in adults to cover possibility of penicillin resistant Strep. pneumoniae



Plan (cont.)

Evacuate immediately

Airway support/oxygen (intubate as needed)

Fluid hydration with IV NS or LR

Control fever with Tylenol

Consider steroids (Decadron)

Respiratory isolation x 24h

Intimate contacts: prophylaxis



Prevention

Isolation

Medications

• Ciprofloxacin 500mg PO single dose

• Ceftriaxone 250 mg IM single dose

Vaccine

Elimination of carrier

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Treatment

High index of suspicion

High fever, headache, stiff neck

Rapid progression of symptoms (hours)

Administration of broad‐spectrum antibiotics should not await the results of diagnostic tests



of the Three Forms of Anthrax


Caused by Gram‐positive Bacilli

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Anthrax


Anthrax

Characteristics

Acute bacterial (spore‐forming bacillus) infection

Transmission

• Break in skin / mucus membrane

• Inhalation (pneumonic form)

• Ingestion

Inhalation form uniformly fatal w/o treatment

Cutaneous form approx 10% fatal w/o treatment


Anthrax

Subjective (Symptoms)

Cutaneous• Pruritic papule

• Ulcer

• Vesicle / pustule

• Painless eschar

• Non‐blanching petechiae

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Anthrax


Anthrax


Anthrax

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Anthrax

Subjective (continued)

Pulmonary (bio‐weapon)

• Fever

• URI‐like cough and chest discomfort

• 36‐48 h after infection, stridor; respiratory distress

• Shock and death


Anthrax

History

Is anybody else in your unit sick with the same symptoms?

Have you handled animal carcasses or local products made from hide or wool?

Did you have a rash that turned into a painless sore?


Anthrax

Objective (Signs)

Inspection: papule with vesicles forms an ulcer; non‐tender ulcer with black eschar

• Rapid respiratory rate, neck and chest edema

Auscultation: rhonchi or rales; hypotension

Palpation: regional adenopathy

Percussion: localized dullness (pulmonary)

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Anthrax

Lab / x‐ray

Gram stain ‐ gram positive rods / boxcar shape

Blood culture

Sputum culture

X‐ray: mediastinal widening and lymph node enlargements


Anthrax

Lab / X‐ray


Anthrax

DDx

Staphylococcal boil

Orf

Scrub typhus

Spider bite

Tularemia

Influenza

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Anthrax

Plan (Treatment)

Cutaneous‐ 80% self‐limiting

• Ciprofloxacin 500 mg PO bid x 60d or

• Doxycycline 100 mg PO bid x 60d

Pulmonary‐Begin antibiotics as soon as possible:

• Ciprofloxacin 400mg IV q12h x 7‐10d

Prophylaxis – Empiric (presumed exposure)

• Ciprofloxacin 500 mg po bid x 60d or

• Doxycycline 100 mg PO bid x 60d

• Both reduced to 30d for vaccinated personnel


Anthrax

Considerations

Inhalation form = poor prognosis even with appropriate therapy

Cutaneous form = almost always responds to timely antimicrobial therapy


Anthrax

Highly infectious disease of animals

Spores resist destruction and remain viable in soil for decades

Several forms of transmission

Cutaneous is the most common (occupational)

Pulmonary anthrax is often fatal (Bio‐weapon)

Ciprofloxacin (Doxy is alternate)

Vaccine is available*

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of Brucellosis


Brucellosis (Malta or Undulant Fever)


Brucellosis


Fever– prolonged, unpredictable

Relative bradycardia

Flu‐like symptoms

Profuse malodorous sweating

Chronic (wks‐months): fever, wt. loss, arthralgias, myalgias

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Brucellosis

History

Have you had any raw milk or cheese?

Have you come in contact with cattle, goats, buffalo, camels, reindeer, caribou, yaks, coyotes, deer or swine?

Do any of your joints hurt?


Objective (Signs)

Temperatures to 104o F

Palpation: generalized adenopathy

Chronic: hepatomegaly; splenomegaly

Brucellosis


Brucellosis

Assessment

Travel history, animal exposure, and consuming unpasteurized milk products

DDX

Enteric fever

TB (non pulmonary)

Non‐falciparummalaria

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Brucellosis

Plan (Treatment)

Primary: doxycycline with gentamicin (danger of renal insufficiency)

Alternate: doxycycline and rifampin

High incidence of relapse with single agent


Brucellosis

Patient education

Avoid untreated milk; boil milk first

Avoid doxycycline in children who are < 8, excessive sun light exposure

Take doxy with food to avoid nausea

Do not take doxy with high‐calcium food*

Do not lay down for less than 1 hr after taking**


Brucellosis

Systemic febrile illness

Fever, headache, chills and body aches

Positive history of exposure to infected animals or animal products (raw milk)

Combination therapy

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of Tularemia


Tularemia

Acute disease with several forms

Transmitted by ticks and deer flies or contact with infected animal (skinning rabbits)

Characterized by local ulcerative lesion and regional lymphadenopathy

The pneumonic form is potential bio‐weapon



Fever

Nausea and vomiting

Severe prostration

Tularemia

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Tularemia

History

Have you recently had a tick exposure?

Have you been hunting and skinned/dressed/ate any small wild animals?

How long have you felt feverish? (Can last 1 month)


Tularemia

Objective (Signs)

Inspection: Fever to 104o F; relative bradycardia; papule; exudative pharyngitis; conjunctivitis; eyelid edema

Rash: Maculopapular, ulcer

Auscultate: Rales

Palpate: Swollen localized lymphadenopathy


Tularemia

Oculoglandular

Ulcer of Tularemia

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Tularemia

Cervical lymphadenitis


DDX

Meningococcal infection


Cat‐scratch disease

Syphilis

Lymphogranuloma

Plague

Anthrax

Tularemia


Plan (Treatment)

Primary: streptomycin / gentamicin

Alternative(s): doxycycline / ciprofloxacin

Tularemia

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Francisella tularensis is a small non‐sporulating, aerobic bacillus that can enter the body by ingestion, inoculation, inhalation, or contamination

A history of exposure to rabbits or ticks

Localized ulcer and swollen lymph nodes

Pneumonic form is potential bio‐weapon

Tularemia



of Typhoid


Typhoid Fever

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Typhoid Fever

Typhoid fever – Salmonella typhi

Illness common in developing countries with poor sanitation

Incubation 1‐3 weeks after exposure


Typhoid Fever


Flu‐like symptoms

Rash – transient rose‐colored (rose spots)

Constipation / diarrhea (pea soup)

Abdominal discomfort (intestinal perforation)


History

How long have you felt feverish?

Have you noticed any red to pink spots on your abdomen or chest?

Have you recently traveled in a developing country?

What do you BMs look like*?

Typhoid Fever

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Typhoid Fever

Objective (Signs)

Stepladder temperatures

Relative bradycardia

Rose spots (2‐3 mm) pink to red papules on chest / abdomen that fade with pressure

Abdominal distension

Bloody diarrhea

Splenomegaly / hepatomegaly


Typhoid Fever

Rose Spots


Typhoid Fever

Laboratory

WBC count is lowered

Fecal leukocytes

Anemia

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Typhoid Fever

DDX

Non‐typhoidal salmonella

TB

Hepatitis

Leptospirosis

Malaria

Amebic liver abscess

Brucellosis


Plan (Treatment)

Primary: ciprofloxacin

• Avoid in pre‐pubertal children

Alternative: ceftriaxone (Rocephin)

• Azithromicin

Steroids for delirium or shock (dexamethasone)

Typhoid Fever


Patient education

Use tepid baths to bring down temperature

Vigorous oral rehydration

Avoid laxatives, salicylates

Immunize

Preventive medicine

Typhoid Fever

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Typhoid Fever

Step‐ladder fever, prostration, rose‐colored rash, and abdominal pain

Transmitted in feces of asymptomatic carriers or the urine / stool of those with active disease

Diarrhea with bleeding (positive Guaiac test)

Vaccine is available


Typhoid Fever

Typhoid Mary (1869‐1938)

Asymptomatic carrier

Cook in NYC

Associated with 53 cases of Typhoid, including 3 deaths

Changed name to continue cooking

Quarantined last 23 years of her life and died of pneumonia there



of Cholera

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Cholera


Cholera

Acute infection

Vibrio cholerae

Involving the entire small bowel

Profuse watery diarrhea, vomiting, muscular cramps

Dehydration, oliguria, and collapse

Possible death w/o rehydration


Cholera

Symptoms and signs

Incubation 1‐3 days

Can be mild to fulminant diarrhea

Rice‐water stools

Vomiting

Hypovolemia

Oliguria and anuria

Circulatory collapse

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DX

Confirmed ‐ isolation of Vibrio cholerae

DDX:

Shigellosis dysentary

Typhoid fever

Amebic dysentary

Pseudomembranous colitis

Cholera


Treatment Correct hypovolemia

•Oral Rehydration Solution (ORS)

• Intravenous (LR)

Medications:• Cipro

• Doxy

• Tmp‐smx (e.g., Bactrim or Septra)

• Erythro

Cholera


Profuse watery diarrhea ‐ (rice water), 1L/h

Potential for epidemics – spread by contamination of water and food

Aggressive rehydration therapy (primary treatment)

Antibiotics

Vaccines not very effective, and generally not recommended

Cholera

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of the Three Forms of Plague


Plague


Plague Bubonic Plague, Pestis, Black Death

A highly fatal illness – transmitted by a bite from a rodent flea or by contact with infected wild rodents

The bubonic form (95% of cases)

The pneumonic form and septicemic form are rapidly toxic and nearly always fatal*

Plague

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Causative organism ‐ Yersinia pestis, Gram‐negative rod

Reservoir ‐ primarily wild rodents (rats, chipmunks, and some other mammals)

Vector ‐ infected flea

Pneumonic plague vector ‐ man to man via infected droplets from pulmonary lesions of Yersinia pestis

Endemic to all continents, except Australia

Plague


Plague

Bubonic

Pneumonic

Septicemia


Bubonic plague

Most common form

> 50% mortality in untreated patients, < 5% mortality in treated patients

Incubation period ‐ varies from hours to 12 days, but usually 2‐5 days

Plague

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Pneumonic plague

Incubation period 2 to 3 days

Untreated patients die within 48 hours of symptoms

Immediate treatment

Plague


Septicemic plague

Usually occurs with bubonic plague

May be fatal before the manifestations of bubonic plague occur

Incubation period ‐ a few hours to days

Plague


History

Do you have tender lymph nodes?

Can you see or recall a flea bite near the bubo?

Have you been handling rodents lately?

How long have symptoms been present?

Plague

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Plague

Signs and symptoms

High fever with sudden onset

Chills

Severe headache

Tachycardia


Bubonic Plague

Bubonic plague

Enlarged lymph nodes (buboes)

• Extremely tender

• Inguinal, axillary nodes most common

Meningeal signs may be seen


Plague

Bubonic Plague

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Septicemic plague

Secondary to bubonic or pneumonic plague

Abdominal pain

Nausea and vomiting

Signs of bleeding‐ purpura or DIC

Hypertension

Shock

Plague


Plague

Septicemic Plague


Pneumonic plague

Dyspnea

Painless cough

Hemoptysis

Untreated, fatal within 48 hours

Plague

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Plague

Pneumonic Plague


Laboratory

Gram’s stain of bubo or sputum

•Gram‐negative coccobacillus with a bipolar (safety pin) appearance

CXR: diffuse pneumonitis

• Increased markings throughout lung fields

Plague


Plague

Bipolar or “safety pin” appearance

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Plague Dx

Based on recovery of the organisms from blood, bubo, sputum, or lymph

DDX:

Tularemia


Acute lymphadenitis

Dengue

Typhus

Hantavirus


Plague

Plan

Treatment:

• Primary: gentamicin IV (adjust to kidney function)

• Alternative: doxycycline

• Note: if meningitis develops, use ciprofloxacin or choramphenicol

Patient education: Plague is a quarantinabledisease subject to World Health Organization regulations (report to higher!)


Plague

Antibiotic management

Start immediately if suspected

DOC ‐ gentamycin 2mg/kg IV loading dose then 1.7mg/kg q8h

• Streptomycin 30 mg/kg q.d. IM or IV in 2 divided doses for 10 days

• Doxycycline 100 mg bid PO or IV

• Tetracycline 25mg/kg day in 4 divided doses for 7 to 10 days

•Will not be tested on dosing!

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Plague

Prevention

Rodent and flea control

Vaccine• No vaccine currently in US

Post‐exposure prophylaxis: Doxycycline

Do not perform I&D of suppurative nodes


Plague

Sudden onset high fever

History positive contact with rodents / fleas

Buboes

Vaccine only known to be effective against bubonic form

Potential bioweapon

Quarantine



of the Four Kinds of Tetanus

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Caused By Anaerobic, Spore‐forming, Gram‐positive Bacilli


Tetanus

Caused by the toxin produce by Clostridium tetani bacteria (spores in the soil)

Causes acute central nervous system intoxication introduced into the body:

Open wounds, burns, frostbite, needles

Unclean cutting/dressing of the umbilical cord

Crush injuries

Incubation: varies


Tetanus

Signs and symptoms

Neonatal cases: weakness, irritability, trouble nursing, unable to suck

Trismus (lockjaw)

Painful muscle spasms (to mild stimuli)

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Tetanus

50% of all cases are neonatal


Tetanus

History

Have you received a tetanus immunization?

• If so, when was the last one?

Have you recently had a potentially contaminated wound?

Does loud noise/laughing/people touching you/gusts of air trigger painful muscle spasms?


Objective (Signs)

Fever

Tetanic muscle spasms (stimulus induced)

Trismus (lockjaw)

Opisthotonos (arched back spasm)

Respiratory muscle spasm

Tetanus

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Tetanus

Opisthotonos (arched back spasm)


Tetanus

Trismus (lockjaw)


Tetanus

DX

Diagnosis based on history and physical findings; Gram stain will show drumstick‐looking bacilli

DDX

Meningoencephalitis

Strychnine poisoning

Hypocalcemia tetany

Generalized seizures

Rabies

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Tetanus

Plan (Treatment)

Maintain airway

Tetanus (human) immune globulin (TIG)

Tetanus immunization (Td vs. TD vs. DTP)

Narcotic analgesia

Diazepam

Antibiotics

Debridement

Evacuate to hospital ‐ bedrest


Tetanus

Patient education

Bedrest in a non‐stimulating environment

Sedation to keep the patient calm

Maintain current tetanus immunization


Tetanus

Disease is caused by the toxin; not the bacteria

Neonatal cases > 50% , umbilical stump

Lockjaw , and painful muscle spasms

Control spasms with anti‐toxin (TIG)

Supportive care

Prevention – vaccine

Recovery from tetanus illness does not confer (give) immunity

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The Etiology, Signs and Symptoms, Diagnostic Tests, and Management of Clostridium Perfringens Infections


Clostridial Wound Infections

Clinical manifestations

Clostridial cellulitis ‐ invades already dead tissue

Clostridial myositis ‐ intermediate stage

Myonecrosis (gas gangrene) ‐ rapidly fatal



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50







DX

Gram stain

Tx

HBO*

Surgery

ABX

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The Etiology, Signs and Symptoms, Diagnostic Tests, and Management of Bartonella Bacterial Diseases


Caused byGram‐negative Bacilli


Bartonella Infections

Cat‐scratch disease (or fever)

Trench fever

Oroya fever

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Cat‐scratch Fever

A bacterial disease caused by Bartonella henselae

From a scratch or bite by a cat or kitten

Causes lymphadenitis and variable fever > 101o F

Infection self‐resolves in 2‐6 months


Disease is found in all parts of the world

Infected animals do not become sick

Papule at inoculation site

Lymph glands nearby become swollen/tender

Low fever, headache, anorexia

Cat‐scratch Fever


Cat‐scratch Fever

History

Do you have any swollen or sore lymph nodes?

History of cat contact in 90% of cases

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Objective (Signs)

Variable fever: >101o F is accompanied by crusted papule or pustule at inoculation site

Later: tender, fluctuant, regional lymphadenopathy develops, (3 mo)

12% have splenomegaly

Cat‐scratch Fever


Cat‐scratch Disease


Cat‐scratch Disease

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DDX

Cutaneous plague

Tularemia

Cat‐scratch Fever


Cat‐scratch Fever

Plan (Treatment)

Azithromycin ‐ 500 mg PO day 01, then 250 mg PO days 2‐5

Doxy is alternate ‐ 100 mg PO bid x 5 days

Analgesics

Warm soaks and heating pads on sore areas

Relieve pain in fluctuant lymph node with needle aspiration, avoid incision and drainage


Trench Fever

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Trench Fever

Headache

Fever: episodic fever (relapses up to 10 years)

Severe back / leg pains

Transient rash (maculopapular)


Trench Fever

History

Have you been around anyone with lice or poor body hygiene?


Trench Fever

Objective (Signs)

Fever (up to 105oF) lasting 4‐5 days, recurs in paroxysms for 3‐6 weeks

Pain and tenderness, especially in shins

56


Trench Fever

DDX

Various chronic febrile illnesses of the tropics: malaria, tuberculosis, brucellosis


Treatment

Doxycycline 100 mg po bid x 15 days

Aspirin prn

Trench Fever


Oroya Fever (Bartonellosis)

57


Oroya Fever

Historical

Disease confirmed in 1885 by medical student named Daniel Carrion

He injected himself with blood from a verruga peruana lesion…and subsequently died

The disease was then sometimes referred to as “Carrions Disease”


Oroya Fever


Fever, which can persist up to 6 weeks

Pallor; weakness; chills; muscle / joint pain

Raised skin lesions


History

Have you traveled in the past month to Peru, Ecuador or Colombia?

Oroya Fever

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Objective (Signs)

Fever (up to 105o F)

Severe anemia

Skin lesions, verruga peruana

Oroya Fever


Oroya Fever

Verruga Peruana


Oroya Fever

DDX

Kaposi’s sarcoma (KS)

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Oroya Fever

Plan (Treatment)

Oroya fever: doxycycline

Verruga peruana: rifampin


Bartonellosis

Cat‐scratch disease – lymphadenopathy, fever

Trench fever – prolonged or recurrent fever

Oroya fever – acute febrile hemolytic anemia, skin lesions


60


Terminal Learning Objective

Action: Communicate knowledge of “Bacterial Infections”

Condition: Given a lecture in a classroom environment

Standard: Receive a minimum score of 75% on the written exam IAW course standards


Agenda

Identify Group A B‐Hemolytic Streptococcusand the diseases it can cause

Communicate the etiology, signs and symptoms, the Jones Criteria, diagnostic tests, and management of rheumatic fever

Communicate the etiology, signs and symptoms, diagnostic tests, and management of bacterial meningitis


Agenda

Communicate the etiology, signs and symptoms, diagnostic tests, and management of the three forms of anthrax, to include: pneumonic, G.I., and cutaneous forms

Communicate the etiology, signs and symptoms, diagnostic tests, and management of brucellosis

61


Agenda

Communicate the etiology, signs and symptoms, diagnostic tests, and management of tularemia

Communicate the etiology, signs and symptoms, diagnostic tests, and management of typhoid

Communicate the etiology, signs and symptoms, diagnostic tests, and management of cholera


Agenda

Communicate the etiology, signs and symptoms, diagnostic tests, and management of the three forms of plague

Communicate the etiology, signs and symptoms, diagnostic tests, and management of the four kinds of tetanus, to include: generalized, neonatal, local, and cephalic tetanus


Agenda

Communicate the etiology, signs and symptoms, diagnostic tests, and management of Clostridium perfringensinfections

Communicate the etiology, signs and symptoms, diagnostic tests, and management of Bartonella bacterial diseases, to include: Cat Scratch Disease, Trench Fever, and Oroya Fever

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Reason

The regions that SOF personnel deploy to are among the most disease ridden‐places on the planet. Preventative measures combined with maintaining a high index of suspicion will result in more combat ready forces on the battlefield accomplishing the mission.


Break

bacterial infections pfn: somcml03

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