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Cat Scratch Disease:
Toxoplasmosis
Bites:
Toxocariasis:
- Clinical diagnosis!
- Think Lymphadenopathy… then fever and constitutional symptoms
- Usually self-limited, can treat with azithromycin x5days
- http://pedemmorsels.com/cat-scratch-disease/
Toxoplasmosis
- Immunocompetent: Vast majority asymptomatic
- Immunocompromised
- Toxoplasmic Encephalitis
- Most common CNS infection in AIDS pt not on ppx
- Toxoplasmic Encephalitis
- CD4+ <100
- Not on appropriate PPx
- Compatible clinical syndrome
- T. gondii IgG Ab positive
- Ring enhancing lesions on imaging
- MRI preferred (more sensitive)
- Tx: Pyrimethamine, Sulfadiazine, Leucovorin x 6 wks
Bites:
- Check vaccination status of patient and animal
- HIGH PRESSURE, COPIOUS irrigation
- Dogs:
- Close bites if <12 hours old, <24 hours on face
- Cats: DO NOT CLOSE (unless terrible cosmetic injury)
- PPx:
- ALL CAT BITES
- Dog bites if:
- >8hours old
- Face, genitals
- Tendon, joints, bone
- Immunocompromised, poor wound healing
- Tx: Augmentin x3-5days
- Bad Pathogens:
- Pasteurella = CAN’T use 1st gen cephalosporins or clindamycin
- Tx: Augmentin, Unasyn, Zosyn
- Capnocytophaga = Bad hombre
- Immunocompromised
- Asplenic
- Hepatic disease
- Tx: IV Zosyn, cephalosporins, carbapenems
- Pasteurella = CAN’T use 1st gen cephalosporins or clindamycin
Toxocariasis:
- Think Children, sandboxes, exposure to feces
- Spectrum of disease: asymptomatic -> organ failure
- 2 flavors:
- Visceral Larva Migrans
- Ocular Larva Migrans: vision loss
- (3rd flavor is Cutaneous Larva Migrans. Caused by Ancylostoma)
- Tx: VLM: Albendazole x5 days, +/- prednisone
