Dyspnea, Weakness, Diaphoresis In A 77 Yo Man

Front 1

Possible causes of fever and hypotension

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pneumonia, infective endocarditis, infectious diarrhea, bacteremia, tickborne illness

Front 2

Possible causes of pneumonia without an infiltrate

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Legionella pneumophila, Pneumocystis jiroveci, HIV Infection

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Criteria for infective endocarditis

Back 3

Bacteremia, acute valvulitis, peripheral emboli, immunologic vascular phenomenon, valvular vegetations, fever

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Frequent causes of infectious diarrhea

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Clostridium difficile, Escherichia coli, campylobacter, shigella, salmonella, yersinia, Listeria monocytogenes,

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Sources of community-acquired gram-negative bacteremia in the elderly (age, >70 years)

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include the urinary tract (the most likely source), as well as the gastrointestinal tract, respiratory tract, and skin and soft tissues.

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Viral causes of myocarditis

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Influenza, West Nile virus, and enteroviral infections

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Babesiosis

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fever and weakness, no lymphadenopathy; thrombocytopenia is common, azotemia occurs in approximately 20% of patients. Elevated aminotransferase levels have been reported, usually in the context of elevated alkaline phosphatase and bilirubin levels.The most important hallmark of infection with this intraerythrocytic parasite is hemolysis.

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Ehrlichiosis

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commonly present in May through July with fever, malaise, and headache; dyspnea and diarrhea can occur, and renal dysfunction is possible. In most cases, leukopenia, thrombocytopenia, and elevated aminotransferase levels are noted. The illness can range in seriousness from mild to fatal, with more severe disease reported in the elderly. Morulae of bacteria are seen in less than 10% of cases on a Wright–Giemsa stain of a buffy-coat smear. Ehrlichia is most commonly found in the south central states of Missouri, Oklahoma, Tennessee, and Arkansas,

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Anaplasma phagocytophilum

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a gram-negative coccobacillus, is the cause of human granulocytotropic anaplasmosis, formerly known as human granulocytic ehrlichiosis. It is transmitted most commonly in May and June by the deer tick and other ixodes species and has an incubation period of 1 week or less;

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Anaplasma phagocytophilum

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Older people, such as our patient, have higher infection rates than younger people and are at risk for more serious illness. The overall mortality rate is 10%.

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Anaplasma phagocytophilum

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typically presents acutely with fever and malaise, Headache is also common, Diarrhea can occur,azotemia is present in 70% of cases. thrombocytopenia and elevated aminotransferase and lactate dehydrogenase levels, leukopenia (either neutropenia or lymphopenia), the diagnosis of anaplasmosis can be made by the identification of morulae in leukocytes on a peripheral-blood smear

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Anaplasma phagocytophilum

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Treat with doxycycline