Zoonoses

Question 1

Hawaii (though WW)

kidney, liver, lung involvement

exposure to damp soil or water

late summer/early fall

Answer 1

lepto

Question 2

image = conjunctival suffusion

AND/OR

calf and/or lumbar muscle tenderness

AND/OR

severe renal and hepatic dysfunction (total bili >> mild AST/ALT elevation)

Answer 2

consider lepto

Question 3

Dx lepto

Answer 3

via microscopic agglutination test (MAT) - exposing serum samples w/ lepto Ags - detection of agglutination under dark field

• 4-fold rise in acute/convalescent sera
• _>_1:800 w/ sx = dx
• _>_1:200 suggests recent or current infection

Question 4

tx lepto

Answer 4

Severe: IV PCN G (CRO has = efficacy)

Mild: PO doxy or amox

Question 5

RF/Buzz words for lepto

Answer 5

recreational: freshwater swimming, canoeing

natural calamities: flooding, increased rainfall

occupational or household exposure to rodents

Question 6

Medically important spirochete infections

Answer 6

SwiRLL

• Syphilis
• Relapsing fever (Borrelia recurrentis)
• Leptospirosis (leptospira)
• Lyme disease

Question 7

persons w/ HIV (CD4<200) or other immunosuppressed persons

neovascular proliferation - cutaneous nodules/masses (usually red/purple) that bleed profusely when incised

nodules in liver, spleen, bone, brain, GI tract

Answer 7

B henselae (also quintana) = bacillary angiomatosis

***Can look like KS in HIV pts

Question 8

malodourous perspiration

Answer 8

brucella

Question 9

anterosuperior step-like erosion of a (usually lumbar) vertebra

Answer 9

think of brucellosis

Question 10

round pneumonia (coin-sized pulmonary infiltrate)

in the right epi setting

Answer 10

consider coxiella (Q fever)

Question 11

painless, nonpurulent papule → vesicle → black eschar

significant induration

nonpitting edema >> size of wound

Answer 11

cutaneous anthrax

edema d/t edema factor produced by bacteria

Question 12

prominent migratory arthritis/arthralgia + diffuse morbilliform/petechial rash (can involve palms/soles)

rodent exposure

Answer 12

rate-bite fever (specifically streptobacillus moniliformis)

Question 13

rodent exposure

Asia

development of ulcer at inoculation site a/w regional LAD

ulcer becomes eschar

no arthritis/arthralgia

Answer 13

rat-bite fever (streptobacillus minus)

Question 14

a/w exposure to sheep, goats, cattle, camels

papule → vesicle → granulomatous nodule over 4-6wks

(usually on finger)

Answer 14

Org

self-resolves

Question 15

horses

Answer 15

rhodococcus

Question 16

sacroiliitis

Answer 16

brucellosis

Question 17

fever + jaundice

Answer 17

lepto

Question 18

tender LN

Answer 18

bartonella

tularemia

plague

Question 19

CN IE

• homeless:
• animal exposure:

Answer 19

• homeless: B quintana
• animal exp: Coxeilla

Question 20

slaughterhouses, bets, parturient cats, sheep handlers, living downwind of sheep/cattle farms

Answer 20

Q fever

Question 21

handling overseas animal hair, hides

Answer 21

anthrax

Question 22

animal urine on intact skin: hiker, farmer, forestry, vet, swimming, rafting

Answer 22

lepto

Question 23

eating unpasteurized cheese from overseas (including goat cheese)

Answer 23

brucellosis

Question 24

wild game or their ticks: handling, cleaning

muskrats, beavers, rabbits, squirrels

Answer 24

tularemia

Question 25

flea bites from rodents or outdoor cats in contact w/ wild rodents

Answer 25

Y pestis

Question 26

Acute PNA, fever, HA, HSM chronic IE **granulomatous hepatitis - doughnut granulomas** exposure to cows, sheep, goats, cats, etc

Answer 26

**Q fever** TX: doxy or levo or azithro. Chronic: doxy + hydroxychloroquine

Question 27

dx and tx of brucellosis

Answer 27

* _DX_: BCx, serology * _TX_: doxy + rifampin or strep/gent (TMP/SMX in pregnancy, young children)

Question 28

* _Acute/indolent_: fever, myalgias, HSM/LAD * _Late_: liver, epidymo-orchitis, endocarditis, meningitis, bone = asymmetric sacroiliitis, tenosynovitis * **malorodous perspiration** * _exposures_: non-USA dairy/meet (Greece, Turkey common), slaughterhouse worker, meat packer, vet

Answer 28

brucellosis

Question 29

* fever, myalgia, HA (**late - aseptic meningitis**), **conjunctival suffusion** * severe: jaundice, azotemia, pulm hemorrhage * liver damage, leukocytosis * exposed intact skin to animal urine in water: vegetarians, farmers, loggers, triathletes, rafting

Answer 29

**leptospirosis (a spirochete)** ## Footnote _TX_: doxy (outpt). IV PCN (inpt) - beware of Jarisch-Herxheimer reaction

Question 30

zoonotic endemic disease in Madagascar Sept-April

Answer 30

plague (Y pestis)

Question 31

Dx and Tx

Answer 31

Y pestis * GN coccobacillus * **safety-pin appearance** * _Tx_: streptomycin \>\> doxy, cipro

Question 32

* sepsis, PNA (hematogenous or aerosol) * fever, nausea, swollen/painful LN * crowded conditions * NM, CA, AZ, CO * rodent flea bites or prairie dogs

Answer 32

Y pestis

Question 33

Tx of tularemia

Answer 33

gentamycin (severe), FQ (mild) ppx (bioterrorism): doxy

Question 34

Skin: pruritic papule on skin --\> small vesicles around an ulcer +/- pain edema exposure to animal hides (goat, sheep)

Answer 34

**cutaneous anthrax** ## Footnote aerobic, encapsulated, sporulating GP bacillus tx w/ PCN

Question 35

Dx and tx of Bartonella IE

Answer 35

* usually culture-negative * IgG\>1:800 highly suggestive * PCR * _TX_: gent + doxy x6wks

Question 36

* SM, F, arthropathy/arthritis * leg pains * rash * severe weakness * thrombocytopenia * BSI, IE (usually culture negative) * advanced HIV, homeless, EtOH * crowded, unsanitary conditions

Answer 36

B quintana ("trench fever" in WW1)

Question 37

* F, C, HSM * CT: hypodense center +/- contrast enh rim * U/S, MRI: masses * Blood filled spaces * Warthin Starry stain - numerous bacilli

Answer 37

peliosis 2/2 B henselae

Question 38

pt w/ advanced stage HIV

Answer 38

bartonella osteo

Question 39

syndromes of bartonella in HIV pts

Answer 39

* bacillary angiomatosis * bacillary peliosis * osteomyelitis (lytic) * chronic BSI/IE

Question 40

bacteremia/IE in homeless trench fever

Answer 40

B quintana

Question 41

* _acute_: fever + anemia * _later_: hemangioma-like nodules in skin/MM * Andes, Peru * sand fly bite

Answer 41

**Oroya fever --\> verruga peruana** d/t B bacilliformis

Question 42

Syndromes caused by B henselae

Answer 42

* CSD * peliosis * bacillary angiomatosis (HIV)

Question 43

tx of CSD

Answer 43

lots resolve on their own tx = azithromycin (a bit better than no RX)

Question 44

Answer 44

**CSD LAD** * stellate abscess - necrotic area w/ neutrophils surrounded by palisaiding histiocytes * Warthin Starry silver stain

Question 45

Answer 45

CSD ## Footnote stellate retinitis, uveitis \*pic shows lipid exudates forming **macular star**

Question 46

stellate abscess (on bx) Warthin Starry stain +

Answer 46

bartonella henselae

Question 47

Infections a/w purulent inguinal LN

Answer 47

* bartonella henselae * tick-borne tularemia ("glandular") * chancroid - w/ painful genital ulcer * S aureus * LGV (C trachomatis L1-3) - genital lesion usually inapparent (NOT in syphilis or granuloma inguinale)

Question 48

* several days HA, F/C, cough, myalgias * generalized LAD * generalized vesiculopustular rash - progressed in uniform manner (most prominent = trunk, palms, soles) * new pet prairie dog was ill

Answer 48

Monkeypox

Question 49

seals/whales (whaler) also pork

Answer 49

Erysipelothrix rhusiopathiae

Question 50

rodents

Answer 50

* leptospira * monkeypox * salmonella * spirillum minus * streptobacillus moniliformis * Y pestis

Question 51

rabbits

Answer 51

tularemia

Question 52

leeches

Answer 52

aeromonas hydrophila

Question 53

farm animals

Answer 53

* B anthracis * brucella * coxiella * campy * E coli * Erysipelothris * Hep E * leptospira * salmonella

Question 54

dogs

Answer 54

* campy * capnocytophaga * leptospira * pasteurella multocida * staph intermedius/pseudintermedius

Question 55

fish

Answer 55

* E rhusiopathiae * M marinum * Strep iniae * vibrio

Question 56

cats

Answer 56

* bartonella henselae * pasteruella multocida