EM Infectious 6 - Pearls

Question 1

Most common cause of skin and soft tissue infection presenting to the ED

Answer 1

Community-acquired MRSA

Question 2

Rose gardener’s disease

Answer 2

SPOROTRICHOSIS
- caused by fungus Sporothrix schenkii
- endemic in Central and South America and Africa

• m/c type: lymphocutaneous
  » characterized by an initial painless nodule or papule at the site of inoculation that later develops subcutaneous nodules with clear skip areas along lymphatic channels

Question 3

most cases of extracutaneous sporotrichosis involve what organ system

Answer 3

skeletal system
- an indolent form of monoarticular athritis is the most common symptom

Multiarticular arhtritis is usually only seen in patients with immunocompromise

Question 4

tx of sporotrichosis

Answer 4

Itraconazole (100 to 200 mg daily for 2-4 weeks after all lesions have resolved

IV amphotericin B is effective, but adverse reactions limit its use to disseminated forms of the disease

Question 5

most important cause of chronic skin ulceration in the world

Answer 5

Cutaneous leishmaniasis
- spread by sandflies
- in Latin America, Africa, Middle East, Asia

• common presentation: small papule slowly enlarging and forming a painless shallow skin ulcer with a noticeable rolled edge like a volcano, with a raised edge and central crater, often with a scab

Question 6

treatment of cutaneous leishmaniasis

Answer 6

Many forms are self-limiting
Lesions can be treated with heat application or paromomycin topical ointment

More serious forms can be treated with liposomal amphotericin B or sodium stibogluconate

Question 7

most common cause of CNS infection globally

Answer 7

NEUROCYSTICERCOSIS
- also the leading cause of adult-onset seizures worldwide
- endemic in Mexico, Latin America, sub-Saharan Africa, India, and East Asia

MOI: inadvertent ingestion of eggs from contaminated food or soil

Question 8

Noncontrast CT in neurocysticercosis

Answer 8

would show calcifications of inactive disease and can reveal mass effect or hydrocephalus

Question 9

treatment in neurocysticercosis

Answer 9

mainstay: albendazole or praziquantel
steroids in those with encephalitis, hydrocephalus, or vasculitis to avoid inflammation as cysts involute

Question 10

“meningitis belt”

Answer 10

Meningococcal meningitis (caused by Neisseria meningitidis) occurs with regularity in sub-Saharan Africa along the “meningitis belt” running from Senegal to Ethiopia.

Pilgrims attending the Hajj in Saudi Arabia are also at risk of Neisseria meningitis