182 - Rickettsial Diseases

Question 1

Rocky/Mediterranean spotted fever is caused by a __ born G(_), with a similar presentation in the first _ days.

Answer 1

5

Question 2

The symptoms in the first 5 days include: 5

Answer 2

fever
headache
myalgia
vomiting
cough

Question 3

3 days after infection _% of patients will develop __ and 6 days after- __

Answer 3

50
purpura
petechiae

Question 4

__ involvement is very specific and appear after _ days in _% of patients

Answer 4

palms
5
40

Question 5

The bitten area may develop into __

Answer 5

Tache noire

Question 6

Pulmonal- non cardiogenic- __ may develop

Answer 6

edema

Question 7

Hypo__ and hypo__ together with pre-renal azotemia are possible clinical complications in spotted fever

Answer 7

tension

volemia

Question 8

Cardiac involvement with __ are possible clinical complications in spotted fever

Answer 8

arrhythmia

Question 9

__ and __ are are possible CNS clinical complications in spotted fever

Answer 9

meningitis

encephalitis

Question 10

__ and __ involvement with enzyme/bilirubin increase are possible clinical complications in spotted fever

Answer 10

renal failure

hepatic

Question 11

Anemia and __ occur in up to __% in spotted fever.

Answer 11

myositis

30

Question 12

Untreated Rocky fever may __ within - days if left untreated. __ and __ patients are in higher risk.

Answer 12

die
8-15
black
G6PD

Question 13

only 3% of patients will have the typical triad in the first 3 days:

Answer 13

rash
fever
exposure to tick

Question 14

Serological tests will become positive only - days after exposure

Answer 14

7-10

Question 15

A good diagnostic tool is an __ biopsy of _ or _

Answer 15

immunohistologic
skin
PCR

Question 16

What are the lab results we may see in spotted fever? 4

Answer 16

elevated CRP
elevated CPK
hypoalbuminemia
hyponatremia

Question 17

What is the correct ABx for spotted fever?

Answer 17

doxycycline IV/PO- ASAP

Question 18

What is the correct ABx for pregnant patients with spotted fever?

Answer 18

chloramphenicol

Question 19

How long should you treat a spotted fever patient with ABx?

Answer 19

until the patient is fever free > _ days

Question 20

Which pathogen causes Q fever?

Answer 20

coxiella Brunetti

Question 21

What is the main vector for C. Brunetti?

Answer 21

cattle- via aerosol (during parturition)

unpasteurized mike

Question 22

Incubation of Q fever may last - days

Answer 22

3-30

Question 23

Q fever will initially have non specific flu like symptoms: 6

Answer 23

prolonged fever+ chills
lethargy
headache
sweating
nausea + vomiting 
diarrhea

Question 24

Which patients are more exposed to IE due to Q fever? 3

Answer 24

immunocompromised
valvular disease
CRF

Question 25

Which imaging test is the most suitable for diagnosing IE in patients with Q fever

Answer 25

TEE

Question 26

What is the main diagnostic tool for Q fever?

Answer 26

serological tests

Question 27

IgG >: for antigen phase I may suggest __ disease. In __ disease phase II is higher.

Answer 27

1:800
chronic
acute

Question 28

What is the recommended ABx for treating acute Q fever?

Answer 28

doxycycline / quinolone

if pregnant - resprim (TMP/SMX)

Question 29

What is the recommended ABx for treating chronic Q fever?

Answer 29

doxycycline + hydroxychloroquine - 18 months
or
rifampin + doxycycline/ciprofloxacin for 3 years