Essential Infectious Disease Topics for Primary Care (eBook)

Preface 6
Table of Contents 8
Contributors 10
Part I 13
Chapter 1 14
Clinical Guidelines 14
Overview and Epidemiology 14
Likely Pathogens in CAP 15
Chest Radiography 15
Other Diagnostic Testing 15
Specific Pathogen Testing 16
S. pneumoniae 16
Legionella Species 16
C. pneumoniae 17
Viral Pneumonia 17
Site of Treatment Decision 18
Empiric Therapy 18
Specific Antibacterial Agents 20
Macrolides 20
Ketolides 20
Amoxicillin 21
Amoxicillin-Clavulanate 21
Cephalosporins 21
Doxycycline 21
Fluoroquinolones 21
Clindamycin 22
Discharge Criteria 22
Special Populations and Circumstances 22
Pneumonia in Elderly Persons 22
Pneumonia in the Context of Bioterrorism 23
Update on Performance Indicators 24
Prevention 24
Influenza 24
Pneumococcal Vaccine 24
Selected Reading 25
Chapter 2 26
Pharyngitis 26
Introduction 26
Pathophysiology 27
Clinical Presentation 27
History 27
Physical Exam 27
Clinical Guidelines 28
Laboratory Evaluation 28
Differential Diagnosis 29
Treatment 30
Complications 31
Suggestions for Evaluation and Management 33
References 34
Chapter 3 36
Treatment and Management of Acute Otitis Media 36
Epidemiology and Risk Factors 36
Bacteriology and Vaccine Effects 37
Diagnosis of AOM 37
Treatment of Otitis Media 38
Observation Versus Immediate Treatment for AOM 38
Antibiotic Treatment of Otitis Media 39
Tympanostomy Tubes, Tympanostomy, and Adenoidectomy 41
Summary and Recommendations 41
References 42
Chapter 4 44
Management of Chronic Obstructive Pulmonary Disease Exacerbations and Acute Bronchitis 44
Chronic Obstructive Pulmonary Disease 44
Pathogenesis 44
Risk Factors 44
Diagnosis 45
Inpatient Versus Outpatient Management 46
Management 47
Supplemental Oxygen 47
Bronchodilator Therapy 47
Corticosteroid Therapy 47
Antibiotics 48
Noninvasive Positive Pressure Ventilation 49
Invasive Ventilation 49
Other Beneficial Treatments 51
Discharge Planning 51
Acute Bronchitis 51
Evaluation 52
Etiology 52
Management 52
References 53
Chapter 5 56
Latent Tuberculosis Infection 56
Introduction 56
Pathophysiology 57
Risk of Active TB 57
Screening for TB 58
Diagnosis of Active TB 58
Testing For TB 59
Positive Test Criterion 60
Other Diagnostic Tests 61
Chest Radiograph 61
Acid-Fast Bacilli Testing 62
Sputum Examination for AFB 62
Sputum Culture 62
Rapid Sputum Testing 63
Testing in Children 63
Treatment of LTBI 63
Special Considerations 66
References 66
Chapter 6 68
Acute Sinusitis 68
Introduction 68
Pathophysiology 68
Epidemiology 69
Clinical Presentation and Differential Diagnosis 69
Diagnosis 70
Treatment 72
Duration 73
Other Treatments 73
Nasal Steroids 74
Summary 74
Suggested Reading 75
Part II 76
Chapter 7 78
Gastroenteritis 78
Introduction 78
Pathophysiology 78
Clinical Presentation 90
History 90
Physical Exam 91
Laboratory Tests 92
Differential Diagnosis 92
Treatment 93
Conclusions 95
Suggested Reading 95
Chapter 8 96
Hepatitis 96
Introduction 96
Hepatitis A 96
Introduction 96
Pathophysiology 96
Clinical Presentation (History and Physical Exam) 97
Laboratory Investigations 97
Differential Diagnosis and Differentiating Features 98
Treatment 99
Expected Outcomes and Complications 99
Prevention and Screening 99
Hepatitis B 100
Introduction 100
Pathophysiology 100
Clinical Presentation (History and Physical Exam) 101
Laboratory Investigations 101
Differential Diagnosis 101
Treatment 103
Expected Outcomes and Complications 103
Prevention 103
Hepatitis C 104
Introduction 104
Pathophysiology 105
Clinical Presentation (History and Physical Exam) 105
Laboratory Investigations 105
Differential Diagnosis and Differentiating Features-See Hepatitis A and B 107
Treatment 107
Expected Outcomes and Complication 107
Prevention 108
Hepatitis D 108
Introduction 108
Pathophysiology 109
Clinical Presentation (History, Physical Exam, and Laboratory Investigations) 109
Treatment 110
Expected Outcomes and Complications 110
Prevention 110
Hepatitis E 111
Introduction 111
Pathophysiology 111
Clinical Presentation (History, Physical Exam, and Laboratory Investigations) 111
Treatment 111
Expected Outcomes and Complications 111
Prevention 112
References 112
Part III 114
Chapter 9 116
Sexually Transmitted Diseases 116
Partner Management 116
Special Populations 117
Adolescents 117
Men Who Have Sex with Men 117
Detection of HIV Infection:Screening and Diagnostic Testing 117
Diseases Characterized by Genital Ulcers 118
Management of Patients Who Have Genital Ulcers 118
Chancroid 118
Diagnosis 118
Treatment 118
Genital HSV Infections 119
Diagnosis 119
Treatment 119
Severe Disease 121
Special Situations 121
Granuloma Inguinale (Donovanosis) 122
Recommended Regimen 122
Alternative Regimens 122
Special Considerations 123
Lymphogranuloma Venereum 123
Treatment 124
Special Considerations 124
Syphilis 124
General Principles 124
Background 124
Serologic Testing 125
Treatment 125
Management of Sex Partners 125
Primary and Secondary Syphilis 126
Recommended Regimen for Adults 126
Other Management Considerations 126
Follow-Up 126
Special Considerations 126
Latent Syphilis 127
Treatment 127
Tertiary Syphilis 129
Recommended Regimen 129
Other Management Considerations 129
Special Considerations 129
Neurosyphilis 130
Treatment 130
Follow-Up 130
Special Considerations 131
Syphilis in HIV-Infected Persons 131
Diagnostic Considerations 131
Treatment 131
Primary and Secondary Syphilis in HIV-Infected Persons 131
Treatment 131
Other Management Considerations 132
Special Considerations 132
Latent Syphilis in HIV-Infected Persons 132
Diagnostic Considerations 132
Treatment 133
Special Considerations 133
Syphilis During Pregnancy 133
Diagnostic Considerations 133
Treatment 133
Recommended Regimen 134
Other Management Considerations 134
Follow-Up 134
Special Considerations 134
Diseases Characterized by Urethritis and Cervicitis 135
Management of Male Patients Who Have Urethritis 135
Etiology 135
Confirmed Urethritis 135
Management of Patients Who Have Nongonococcal Urethritis Diagnosis 136
Treatment 136
Recommended Regimens 136
Alternative Regimens 136
Follow-Up for Patients Who Have Urethritis 136
Recurrent and Persistent Urethritis 137
Recommended Regimens 137
Management of Patients Who Have Cervicitis 137
Etiology 137
Diagnosis 138
Treatment 138
Recommended Regimens for Presumptive Treatment 138
Management of Sex Partners 138
Special Considerations 139
HIV Infection 139
Chlamydial Infections 139
Chlamydial Infections in Adolescents and Adults 139
Diagnostic Considerations 139
Treatmen 139
Recommended Regimens 140
Alternative Regimens 140
Follow-Up 140
Management of Sex Partners 140
Special Considerations 141
Recommended Regimens 141
Alternative Regimens 141
Gonococcal Infections 142
Gonococcal Infections in Adolescents and Adults 142
Diagnostic Considerations 142
Dual Therapy for Gonococcal and Chlamydial Infections 142
Quinolone-Resistant N. gonorrhoeae 142
Uncomplicated Gonococcal Infections of the Cervix, Urethra, and Rectum 143
Recommended Regimens 143
Alternative Regimens 144
Uncomplicated Gonococcal Infections of the Pharynx 144
Recommended Regimens 144
Follow-Up 144
Management of Sex Partners 144
Special Considerations 145
Gonococcal Conjunctivitis 146
Recommended Regimen 146
Disseminated Gonococcal Infection 146
Treatment 146
Gonococcal Meningitis and Endocarditis 147
Recommended Regimen 147
Diseases Characterized by Vaginal Discharge 147
Management of Patients Who Have Vaginal Infections 147
Bacterial Vaginosis 148
Diagnostic Considerations 148
Treatment 148
Recommended Regimens 149
Alternative Regimens 149
Management of Sex Partners 150
Special Considerations 150
Allergy or Intolerance to the Recommended Therapy 150
Pregnancy 150
HIV Infection 151
Trichomoniasis 151
Recommended Regimens 152
Alternative Regimen 152
Follow-Up 152
Management of Sex Partners 152
Special Considerations 152
Vulvovaginal Candidiasis 153
Uncomplicated VVC 153
Complicated VVC 155
Severe VVC 156
Nonalbicans VVC 156
Compromised Host 156
Pregnancy 156
HIV Infection 156
Pelvic Inflammatory Disease 156
Diagnostic Considerations 157
Treatment 158
Parenteral Treatment 158
Oral Treatment 159
Follow-Up 160
Management of Sex Partners 161
Prevention 161
Special Considerations 161
Epididymitis 161
Diagnostic Considerations 162
Treatment 162
Management of Sex Partners 163
Special Considerations 163
HPV Infection 163
HPV Tests 163
Treatment 163
Genital Warts 164
Treatment 164
Counseling Genital HPV Infection 166
Management of Sex Partners 166
Special Considerations 167
Cervical Cancer Screening for Women Who Attend STD Clinics or Have a History of STDs 167
Vaccine Preventable STDs 167
Hepatitis A 167
Diagnosis 168
Treatment 168
Prevention 168
Preexposure Immunization 168
Prevaccination Serologic Testing for Susceptibility 168
Postvaccination Serologic Testing 168
Postexposure Prophylaxis 169
Hepatitis B 169
Diagnosis 169
Treatment 169
Prevention 169
Postexposure Prophylaxis 170
Hepatitis C 171
Proctitis, Proctocolitis, and Enteritis 171
Treatment 171
Ectoparasitic Infections 172
Pediculosis Pubis 172
Recommended Regimens 172
Alternative Regimens 172
Other Management Considerations 172
Follow-Up 173
Special Considerations 173
Scabies 173
Recommended Regimen 173
Alternative Regimens 173
Other Management Considerations 173
Crusted Scabies 173
Follow-Up 174
Management of Sex Partners and Household Contacts 174
Management of Outbreaks in Communities, Nursing Homes, and Other Institutional Settings 174
Special Considerations 174
Sexual Assault and STDs 174
Adults and Adolescents 174
Evaluation for Sexually Transmitted Infections Initial Examination 175
Follow-Up Examinations 175
Prophylaxis 175
Recommended Regimens 176
Risk for Acquiring HIV Infection 176
Bibliography 177
Chapter 10 178
Human Immunodeficiency Virus 178
Introduction 178
Pathophysiology 179
Clinical Presentation 179
OIs and Treatment 179
Differential Diagnosis 183
HIV Testing and Laboratory Studies 183
Treatment of HIV Infection 184
Development of Resistance and Treatment Failure 189
Pregnancy in the HIV-Positive Patient 190
Care of Infants and HIV-Positive Children 192
Postexposure Prophylaxis 192
Special Situations 196
Resources for Consultation 196
Bibliography 196
Part IV 198
Chapter 11 200
Cellulitis and Skin Infections Associated with Bites 200
Introduction 200
Cellulitis and Erysipelas 200
Pathophysiology 200
Bacteriology 201
Clinical Appearance and Differential Diagnosis 203
Invasive SSTI 203
Necrotizing Fasciitis 203
Pyomyositis 204
Noninfectious Conditions with Similar Appearance 204
Contact Dermatitis, Fixed Drug Reaction, Insect Bites, and Stings 205
Stasis Dermatitis 205
Wells Syndrome 205
Sweets Syndrome 205
Superficial Thrombophlebitis 205
Deep Venous Thrombosis 205
Acute Gouty Arthritis 205
Carcinoma Erysipelatoides 206
Diagnostic Studies 206
Treatment 206
Prevention of Recurrence 208
Skin Infections Associated with Bites 208
Dog and Cat Bites 209
Dog Bites 209
Cat Bite 209
Bacteriology 209
Initial Wound Management 209
Antibiotics 210
Immunization 210
Human Bites 211
Bacteriology 211
Wound Management and Antibiotics 211
References and Further Reading 212
Chapter 12 214
Diabetic Foot Infections 214
Introduction 214
Pathophysiology 214
Clinical Presentation 215
History 216
Physical Exam 216
Laboratory Investigations and Tests 217
Differential Diagnosis 219
Treatment 219
Expected Outcomes 222
Bibliography 222
Chapter 13 224
Osteomyelitis 224
Introduction 224
Pathophysiology 224
Acute Osteomyelitis 225
Chronic Osteomyelitis 226
Diagnosis 226
Laboratory Tests 227
Radiology 228
Treatment 229
Surgical Therapy 229
Medical Therapy 230
Hyperbaric Oxygen Therapy 231
Follow-Up 231
Prognosis 232
Prevention 232
Conclusion 233
References 233
Chapter 14 236
Septic Arthritis and Infectious Bursitis 236
Introduction 236
Background 236
Pathogenesis 237
Presentation 238
Diagnosis 239
Bacteriology 241
Treatment 242
Conclusion 244
References 244
Chapter 15 246
Lyme Disease Prevention, Diagnosis, and Treatment 246
Prevention and Prophylaxis 246
Diagnosis 247
Treatment of Early Lyme Disease 248
Lyme Meningitis and Other Manifestations of Early Neurologic Lyme Disease 248
Treatment of Late Lyme Disease 250
Post-Lyme Disease Syndromes 250
Summary and Recommendations 250
References 250
Part V 252
Chapter 16 254
Infective Endocarditis 254
Introduction 254
Pathophysiology 254
Clinical Presentation 256
Treatment 258
Complications 259
Antibiotic Prophylaxis 260
References 262
Suggested Reading 262
Chapter 17 264
Meningitis 264
Introduction 264
Pathophysiology 264
Clinical Presentation 265
Differential Diagnosis 266
Treatment 267
Outcome and Complications 268
Additional Information 269
Suggested Reading 269
Chapter 18 270
Urinary Tract Infections 270
Introduction 270
Pathophysiology 270
Clinical Presentation 272
History 272
Women 273
Men 273
Children 273
Physical Examination 274
Women 274
Men 274
Children 275
Diagnosis 275
Pregnant Women 277
Men 277
Children 277
Treatment 278
Asymptomatic Bacteriuria 278
Uncomplicated UTI 281
Complicated UTI 282
Pregnant Women 282
Men 283
Children 283
Follow-Up 284
References 284
Chapter 19 286
Adult Immunizations 286
Introduction 286
Hepatitis B 286
Hepatitis A 288
Measles, Mumps, and Rubella 289
Varicella and Zoster 290
Varicella 290
Zoster 291
Human Papillomaviruses 291
Pneumococcal Vaccine 292
Influenza Vaccine 293
Tetanus, Diphtheria, and Pertussis 294
Meningococcal Vaccine 296
Conclusion 297
References 297
Chapter 20 300
Clinical Ethics and Infectious Disease in Family Medicine 300
Introduction 300
Doesn’t the Law Resolve Most Bioethical Issues? 301
Won’t Professional Oaths and Codes Solve Ethical Issues? 301
A Framework:Case Analysis in Clinical Ethics 301
Case 1:No Harm in Asking 303
Step 1:Information Collection 303
Step 2:Ethical Evaluation 303
Step 3:Initiate Ethical Approach 305
Step 4:Review and Evaluate 305
Case 2:What We Don’t Know Can Hurt Us 306
Step 1:Information Collection 307
Step 2:Ethical Evaluation 308
Step 3:Initiate Ethical Approach 309
Step 4:Review and Evaluate Ethics 310
Summary 310
References 310
Index 312