Blood And Lymph - Dugan - Zoonotic Infections 1

Front 1

Whats the biggest clue a pt is infected with Brucella?

Back 1

They have had contact with animals or have eaten something unpasteurized because its an animal STD

esp Milk, Urine, Placental tissues

Front 2

A 24 y/o female pt is preggo when you learn she recently contracted brucella from the goats and sheep on a farm she works on. Biopsy of placenta and featal tissues is positive for Erythritol, a growth factor. You note lesions on her pubic area. What should you do?

1. nothing, baby is fine
2. treat pt with Doxycycline and Streptomycin

Back 2

Treat pt. b/c Brucella can cause placentitis and abortion!

Front 3

Young boy recently consumed raw goat and sheeps milk from his family's dairy farm where he repeatedly helps his father deliver the goat and sheep babies. He presents with fever that peaks in the afternoon and falls as he sleeps. He has generalized weakness, and on physical exam you note hepatosplenomegaly and lymphadenopathy. Dx? and Tx?

Back 3

Brucella = Doxycyclin and streptomycin (or gentamicin for prolonged pd. of time)

Note: Goat and sheep can cause the most serious Brucella infections. Contact with Milk, Urine or placental tissues

Front 4

Lab results come back with Febile agglutinins (O side chain antigens) and positive Brucella IgM and IgG. Small gram neg rods. What are you likely to find on PE?

Back 4

lesions in genital area


Pt will have: fever, generalized malaise, may have fever that peaks in afternoon,

Front 5

Like Leishmania, the Brucella organisms live in what cells in our body?

Back 5

Macrophages

Front 6

How does Brucella resist our immune system and spread/multiply?

Back 6

Brucella lives in macrophages (like Leishmania and Francisella) and thus evades killing by macrophages

Front 7

Where can Brucella form granulomatous nodules in a pt?

Back 7

Lymphatics, Liver, spleen, bone marrow

Front 8

Young boy recently consumed raw goat and sheeps milk from his family's dairy farm where he repeatedly helps his father deliver the goat and sheep babies. He presents with fever that peaks in the afternoon and falls as he sleeps. He has generalized weakness, and on physical exam you note hepatosplenomegaly and lymphadenopathy. What do you tell the family to avoid future infections of this type?

Back 8

Avoid contact with infected animals and their products which will be hard for them since they're FARMERS so whtever just treat them with Doxy and Streptomicin (or genta for a long time)

Don't drink raw milk.

Front 9

Whats one way you can differnetiate Brucella from Fanciscella tularensis?

Back 9

Brucella = pt in contact with or comsumes raw material from sheet, goat, cow, swine (ie FARM animals)

Farncisella tularensis = pt in contact with rodent, rabbit, beaver, musckrat etc. (ie NOT FARM ANIMALS) and transmitted via arthropod vectors ie flies and mosquitos

Front 10

Where does Brucella, Franscicella tularensis, and Leishmania all reside in our cells?

Back 10

Macrophages (due to lipid-rich capsule) and thus evade immune system

Front 11

A meat trapper, hunter and owner of the local meat market came down with Ulcers on his left hand and upon PE you note cervical lympnadenopathy (swollen lymph nodes). Pt thinks he has the flu. Whats your Dx and TX?

Back 11

Dx = Francisella tularesis and Tx = streptomycin or gentamicin

Front 12

A meat trapper, hunter and owner of the local meat market came down with Ulcers on his left hand and upon PE you note cervical lympnadenopathy (swollen lymph nodes). Pt thinks he has the flu. What will you likely see when you get the lab values back?

Back 12

febrile agglutinins (=same as Brucella, but Abs for each will be specific to each illness) = Francisella Abs (but ONLY 4 weeks after symptoms onset

Or ELISA which demonstrates Ab response

Front 13

A meat trapper, hunter and owner of the local meat market came down with Ulcers on his left hand and upon PE you note cervical lympnadenopathy (swollen lymph nodes). Pt thinks he has the flu. Symptoms have been present for 2 weeks. What will you likely see when you get the lab values back?

Back 13

WON'T See febrile agglutinins = Abs specific for Francisella b/c these only show up 4 weeks after Symptom onset

Culture of Ulcer = Gram neg rod (like Brucella = small gran neg rod) (culture requires chocolate agar enriched with with cysteine and glucose)

Front 14

A meat trapper, hunter and owner of the local meat market came down with Ulcers on his left hand and upon PE you note cervical lympnadenopathy (swollen lymph nodes). Pt thinks he has the flu. What do you tell him so he doesn't get this again?

Back 14

Educate him to avoid sick or dead animals
Use insect repellent
Drink clean water and STOP eating all your steak MEGA RARE YOU ZOMBIE

Front 15

If the pts has been vacationing or visited the Martha's vineyard region or Nantucket region,what disease should you be thinking?

Back 15

Francisella is endemic to Martha's Vineyard and Nantucket. Poor rich white people.

(or should I say, poor rich white people's butlers, b/c lets face it those pple don't touch dead animals like rabbit, rodents, beaver or musckrat etc...so they're BUTLERS come down with lymphadenopathy, ulcers, flu-symptoms)