Master the board step 3

Infectious Diseases
Treatment
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TMP/SMX
Actinomyces
Host has a normal immune system. There is a history of facial or dental trauma,
which inoculated these organisms into the cervicofacial area. Actinomyces
is a part of normal mouth flora. Trauma, such as a tooth extraction, can put it
into the facial area, thorax, and abdomen.
Diagnostic Testing
Diagnose with Gram stain and confirm with anaerobic culture. Like
Nocardia, Actinomyces is a branching, filamentous bacteria.
Treatment
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Penicillin
Histoplasmosis
Look for wet areas, such as the Ohio and Mississippi River valleys. This lung
disease that can present as a viral syndrome is also associated with bat droppings
from caves. A physical exam will show palate and oral ulcers and splenomegaly.
The disseminated disease enters the bone marrow and causes pancytopenia.
Anything tuberculosis can do, histoplasmosis can do.
Diagnostic Testing
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Best initial test: Histoplasmosis urine antigen
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Most accurate test: Biopsy with culture is most accurate for both histoplasmosis
and tuberculosis
Treatment
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Acute pulmonary disease is transient and requires no therapy.
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The disseminated disease is treated with amphotericin.
Coccidioidomycosis
This is an acute respiratory illness that occurs in very dry areas like Arizona.
It causes joint pain and erythema nodosum.
Treatment
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Itraconazole
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