THE WASHINGTON MANUAL™ I n fectio us Diseases Su bspecial ty C o n su l t SECO ND EDI TI ON Edito rs Nigar Kirman i, MD Pro fesso r o f Medicine Divisio n o f I nfectio us Diseases Departmento f I nternal Medicine Washingto n University Scho o l o f Medicine St Louis, Misso uri Keith F W o el tje, MD , Ph D Pro fesso r o f Medicine Divisio n o f I nfectio us Diseases Departmento f I nternal Medicine Washingto n University Scho o l o f Medicine St Louis, Misso uri Hil ary M B abco ck, MD AssistantPro fesso r o f Medicine Divisio n o f I nfectio us Diseases Departmento f I nternal Medicine Washingto n University Scho o l o f Medicine St Louis, Misso uri Series Edito rs Th o mas M D e Fer, MD Pro fesso r o f Medicine Washingto n University Scho o l o f Medicine St Louis, Misso uri Kath erin e E Hen derso n , MD AssistantPro fesso r o f Clinical Medicine Departmento f Medicine Washingto n University Scho o l o f Medicine Barnes-J ewish Ho spital St Louis, Misso uri Senior Acquisitions Editor: Sonya Seigafuse Senior Product Manager: Kerry Barrett Vendor Manager: Alicia Jackson Senior Marketing Manager: Kimberly Schonberger Senior Manufacturing Manager: Benjamin Rivera Editorial Coordinator: Katie Sharp Design Coordinator: Stephen Druding Production Service: Integra Software Services Pvt Ltd © 2013 by Department of Medicine, Washington University School of Medicine Printed in China All rights reserved This book is protected by copyright No part of this book may be reproduced in any form by any means, including photocopying, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews Materials appearing in this book prepared by individuals as part of their official duties as U.S government employees are not covered by the above-mentioned copyright Library of Congress Cataloging-in-Publication Data The Washington manual infectious diseases subspecialty consult —2nd ed / editors, Nigar Kirmani, Keith F Woeltje, Hilary M Babcock p ; cm — (Washington manual subspecialty consult series) Infectious diseases subspecialty consult Includes bibliographical references and index ISBN 978-1-4511-1364-8 — ISBN 1-4511-1364-1 I Kirmani, Nigar II Woeltje, Keith F III Babcock, Hilary IV Washington University (Saint Louis, Mo.) School of Medicine V Title: Infectious diseases subspecialty consult VI Series: Washington manual subspecialty consult series [DNLM: Communicable Diseases—Handbooks Diagnosis, Differential—Handbooks Patient Care Planning—Handbooks WC 39] 616.9—dc23 2012025731 The Washington Manual™ is an intent-to-use mark belonging to Washington University in St Louis to which international legal protection applies The mark is used in this publication by LWW under license from Washington University Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication Application of the information in a particular situation remains the professional responsibility of the practitioner The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with current recommendations and practice at the time of publication However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions This is particularly important when the recommended agent is a new or infrequently employed drug Some drugs and medical devices presented in the publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use in their clinical practice To purchase additional copies of this book, call our customer service department at (800) 638-3030 or fax orders to (301) 223-2320 International customers should call (301) 223-2300 Visit Lippincott Williams & Wilkins on the Internet: at LWW.com Lippincott Williams & Wilkins customer service representatives are available from 8:30 am to pm, EST 10 5 Contributing Authors Hil ary M Babco ck, MD AssistantPro fesso r o f Medicine Divisio n o f I nfectio us Diseases Departmento f I nternal Medicine Washingto n University Scho o l o f Medicine St Louis, Misso uri Tho mas C Bail ey, MD Pro fesso r o f Medicine Divisio n o f I nfectio us Diseases Departmento f I nternal Medicine Washingto n University Scho o l o f Medicine St Louis, Misso uri Erik R Dubberke, MD AssistantPro fesso r o f Medicine Divisio n o f I nfectio us Diseases Departmento f I nternal Medicine Washingto n University Scho o l o f Medicine St Louis, Misso uri Michael J Durkin , MD I nstructo r in Medicine Divisio n o f I nfectio us Diseases Departmento f I nternal Medicine Washingto n University Scho o l o f Medicine St Louis, Misso uri Jessica R Grubb, MD AssistantPro fesso r o f Medicine Divisio n o f I nfectio us Diseases Departmento f I nternal Medicine Washingto n University Scho o l o f Medicine St Louis, Misso uri José E Hagan , MD Clinical Fello w Divisio n o f I nfectio us Diseases Departmento f I nternal Medicine Washingto n University Scho o l o f Medicine St Louis, Misso uri Zhuo l in Han , MD Clinical Fello w Divisio n o f I nfectio us Diseases Departmento f I nternal Medicine Washingto n University Scho o l o f Medicine St Louis, Misso uri Jeffrey P Hen derso n , MD AssistantPro fesso r o f Medicine Divisio n o f I nfectio us Diseases Departmento f I nternal Medicine Washingto n University Scho o l o f Medicine St Louis, Misso uri Hito shi Ho n da, MD Clinical Fello w Divisio n o f I nfectio us Diseases Departmento f I nternal Medicine Washingto n University Scho o l o f Medicine St Louis, Misso uri Cyn thia John so n , MD Clinical Fello w Divisio n o f I nfectio us Diseases Departmento f I nternal Medicine Washingto n University Scho o l o f Medicine St Louis, Misso uri Amel ia M Kasper, MD Resident Divisio n o f I nfectio us Diseases Departmento f I nternal Medicine Washingto n University Scho o l o f Medicine St Louis, Misso uri Nigar Kirman i, MD Pro fesso r o f Medicine Divisio n o f I nfectio us Diseases Departmento f I nternal Medicine Washingto n University Scho o l o f Medicine St Louis, Misso uri Ro byn S Kl ein , MD Asso ciate Pro fesso r o f Medicine Divisio n o f I nfectio us Diseases Departmento f I nternal Medicine Washingto n University Scho o l o f Medicine St Louis, Misso uri F Matthew Kuhl man n , MD I nstructo r o f Medicine Divisio n o f I nfectio us Diseases Departmento f I nternal Medicine Washingto n University Scho o l o f Medicine St Louis, Misso uri Michael A Lan e, MD AssistantPro fesso r o f Medicine Divisio n o f I nfectio us Diseases Departmento f I nternal Medicine Washingto n University Scho o l o f Medicine St Louis, Misso uri Steven J Lawren ce, MD AssistantPro fesso r o f Medicine Divisio n o f I nfectio us Diseases Departmento f I nternal Medicine Washingto n University Scho o l o f Medicine St Louis, Misso uri Susan a Lazarte, MD Clinical Fello w Divisio n o f I nfectio us Diseases Departmento f I nternal Medicine Washingto n University Scho o l o f Medicine St Louis, Misso uri Stephen Y Lian g, MD Clinical Fello w Divisio n o f I nfectio us Diseases Departmento f I nternal Medicine Washingto n University Scho o l o f Medicine St Louis, Misso uri Luis A Marco s, MD Clinical Fello w Divisio n o f I nfectio us Diseases Departmento f I nternal Medicine Washingto n University Scho o l o f Medicine St Louis, Misso uri Jon as Marschal l , MD AssistantPro fesso r o f Medicine Divisio n o f I nfectio us Diseases Departmento f I nternal Medicine Washingto n University Scho o l o f Medicine St Louis, Misso uri Jay R McDo n al d, MD AssistantPro fesso r o f Medicine Divisio n o f I nfectio us Diseases Departmento f I nternal Medicine Washingto n University Scho o l o f Medicine St Louis, Misso uri Dian a Nurutdin o va, MD I nstructo r in Medicine Divisio n o f I nfectio us Diseases Departmento f I nternal Medicine Washingto n University Scho o l o f Medicine St Louis, Misso uri Rachel Presti, MD AssistantPro fesso r o f Medicine Divisio n o f I nfectio us Diseases Departmento f I nternal Medicine Washingto n University Scho o l o f Medicine St Louis, Misso uri Hil ary Ren o , MD I nstructo r in Medicine Divisio n o f I nfectio us Diseases Departmento f I nternal Medicine Washingto n University Scho o l o f Medicine St Louis, Misso uri David J Riddl e, MD I nstructo r in Medicine Divisio n o f I nfectio us Diseases Departmento f I nternal Medicine Washingto n University Scho o l o f Medicine St Louis, Misso uri David J Ritchie, PharmD Clinical Pharmacist, I nfectio us Diseases Barnes-J ewish Ho spital Pro fesso r o f Pharmacy Practice St Louis Co llege o f Pharmacy St Louis, Misso uri Carl o s San to s, MD AssistantPro fesso r o f Medicine Divisio n o f I nfectio us Diseases Departmento f I nternal Medicine Washingto n University Scho o l o f Medicine St Louis, Misso uri Mo l l y F Sariko n da, MD 10 Jones criteria L Leishmaniasis clinical presentation diagnosis epidemiology pathophysiology treatment Leptospirosis clinical presentation diagnosis treatment Lung abscess causes clinical presentation complications diagnostic procedures imaging treatment Lyme disease clinical presentation diagnosis epidemiology special considerations treatment Lymphogranuloma venereum (LGV) clinical presentation diagnosis treatment M Malaria clinical presentation diagnosis epidemiology etiology pathophysiology prevention 607 risk factors treatment Mediastinitis clinical presentation definition epidemiology etiology pathophysiology treatment acute mediastinitis chronic mediastinitis Lemierre Syndrome Meningitis acute clinical presentation diagnosis etiology pathophysiology prevention prognosis/outcome risk factors treatment chronic clinical presentation complications definition diagnosis etiology pathophysiology prognosis/outcome risk factors treatment Microsporidiosis diagnosis etiology treatment Molluscum contagiosum diagnosis treatment 608 Mucopurulent cervicitis Mucorales clinical presentation diagnosis mucormycosis treatment types of infection Mycobacterium avium complex (MAC) clinical presentation diagnosis occurrence treatment Mycobacterium tuberculosis clinical presentation diagnosis treatment latent tuberculosis primary tuberculosis Myocarditis diagnosis etiology treatment N Necrotizing fasciitis clinical presentation definition diagnosis epidemiology etiology outcome/prognosis pathophysiology risk factors treatment Neutropenic fever diagnosis occurrence treatment Nongonococcal arthritis See Arthritis 609 Nongonococcal urethritis See Urethritis, nongonococcal Non-neutropenic fever O Opportunistic infections associated with HIV bacterial infections diarrhea by protozoal infections fungal infections Human Herpesvirus disease malignancies in HIV-infected patients protozoal infections viral infections Oral candidiasis See Candidiasis Oral cavity infections herpangina herpetic gingivostomatitis oral candidiasis See Candidiasis salivary gland infections Osteomyelitis contiguous clinical presentation complications diagnostic testing differential diagnosis epidemiology etiology monitoring/follow-up outcome/prognosis risk factors special considerations treatment with diabetes clinical presentation complications diagnostic testing differential diagnosis monitoring/follow-up outcome/prognosis prevention 610 risk factors special considerations treatment hematogenous Osteomyelitis clinical presentation complications diagnostic testing differential diagnosis epidemiology etiology monitoring/follow-up outcome/prognosis risk factors special considerations treatment with peripheral vascular disease clinical presentation complications diagnostic testing differential diagnosis monitoring/follow-up outcome/prognosis prevention risk factors special considerations treatment P Paracoccidioidomycosis clinical presentation diagnosis P brasiliensis treatment Paragonimiasis clinical presentation diagnosis epidemiology pathophysiology 611 treatment Parasitic infections Pediculosis diagnosis Pediculus or Phthirus treatment Pelvic inflammatory disease clinical presentation diagnosis treatment Penicilliosis clinical presentation diagnosis Penicillium marneffei treatment Pericarditis diagnosis etiology treatment Peritonitis chronic ambulatory peritoneal dialysis diagnosis occurrence treatment primary clinical presentation diagnostic testing etiology treatment secondary clinical presentation diagnostic testing treatment Pharyngitis, acute Centor Diagnostic Criteria clinical presentation complications diagnostic testing etiology 612 treatment Plague diagnosis treatment Pneumocystis pneumonia (PCP) clinical presentation diagnosis etiology treatment Pneumonia CAP See Community-acquired pneumonia (CAP) diagnosis nosocomial associated conditions clinical presentation diagnostic procedures differential diagnosis epidemiology etiology health care–associated pneumonia imaging pathophysiology risk factors treatment occurrence PCP See Pneumocystis pneumonia (PCP) treatment Pneumonia Severity Index (PORT score) Polyomavirus infections BK virus infection diagnosis treatment Posttransplant lymphoproliferative disorder (PTLD) Progressive multifocal leukoencephalopathy (PML) diagnosis occurrence treatment Progressive outer retinal necrosis (PORN) Prosthetic joint infections 613 clinical presentation complications diagnostic testing differential diagnosis infection rates monitoring/follow-up outcome/prognosis risk factors special considerations treatment Protozoal infections amebiasis American trypanosomiasis babesiosis diarrhea caused by giardiasis leishmaniasis malaria Toxoplasma gondii toxoplasmosis Pyelonephritis diagnosis treatment Pyogenic liver abscess clinical presentation diagnostic testing treatment Pyomyositis clinical presentation complications diagnosis etiology treatment Q Q fever clinical presentation diagnosis etiology 614 treatment R Rabies diagnosis treatment Respiratory infections acute bronchitis acute epiglottitis acute pharyngitis community-acquired pneumonia influenza lung abscess nosocomial pneumonias rhinosinusitis tuberculosis Respiratory syncytial virus diagnosis treatment Respiratory virus infections Rhinosinusitis clinical presentation complications diagnostic testing pathophysiology treatment Rocky mountain spotted fever (RMSF) clinical presentation diagnosis treatment S Salivary gland infections clinical presentation diagnostic testing occurrence treatment Scabies diagnosis 615 etiology treatment Schistosomiasis clinical presentation diagnosis epidemiology pathophysiology treatment Sepsis definitions diagnosis etiology outcome/prognosis pathophysiology treatment antimicrobial therapy other therapies Septic bursitis See Bursitis, septic Sexually transmitted infections (STI) ectoparasites genital warts Sexually transmitted infections (STI) gonorrhea molluscum contagiosum mucopurulent cervicitis nongonococcal urethritis painful genital ulcer diseases painless genital ulcer diseases pelvic inflammatory disease vulvovaginitis and vaginosis Skin and soft tissue infections abscesses, furuncles, and carbuncles antibiotic dosing cellulitis and erysipelas clostridial myonecrosis impetigo necrotizing fasciitis pyomyositis surgical site infections 616 toxic shock syndrome unusual organisms Solid organ transplantation (SOT) Spontaneous bacterial peritonitis (SBP) See Peritonitis Sporotrichosis clinical presentation diagnosis S schenckii treatment Stomach infections H pylori gastritis Strongyloidiasis clinical presentation diagnosis epidemiology pathophysiology prevention risk factors treatment Surgical site infections (SSI) classification clinical presentation definition diagnosis epidemiology etiology outcome/prognosis pathophysiology risk factors treatment Syphilis clinical presentation diagnosis treatment Treponema pallidum T Tick-borne illnesses tick-borne relapsing fever 617 tick paralysis Toxic shock syndrome (TSS) classification clinical presentation definition diagnosis epidemiology etiology outcome/prognosis pathophysiology risk factors staphylococcal streptococcal treatment Toxocariasis clinical presentation diagnosis epidemiology pathophysiology treatment Toxoplasma gondii clinical presentation diagnosis occurrence treatment Toxoplasmosis clinical presentation diagnosis epidemiology pathophysiology prevention treatment Traveler’s diarrhea diagnosis treatment Trichomoniasis Trypanosomiasis African American 618 clinical presentation complications diagnosis epidemiology monitoring/follow-up pathophysiology phases prevention treatment Tuberculosis clinical presentation diagnostic criteria differential diagnosis epidemiology laboratories testing pathophysiology risk factors and associated conditions treatment antituberculosis therapy side effects culture-negative tuberculosis tuberculin skin test interpretation Tularemia clinical presentation diagnosis transmission treatment Typhoid fever See Enteric fever (typhoid fever) U Urethritis, nongonococcal Urinary tract infections (UTI) acute bacterial prostatitis asymptomatic bacteriuria catheter-associated chronic bacterial prostatitis complicated diabetes anatomic abnormalities renal transplant risk factors 619 epididymitis and orchitis funguria in men diagnosis etiology occurrence risk factors treatment pyelonephritis in women, uncomplicated cystitis V Varicella zoster virus (VZV) complications after HSCT diagnosis occurrence treatment complications with SOT diagnosis treatment diagnosis special considerations treatment Viral infections cytomegalovirus hepatitis B hepatitis C human papillomavirus infection PML varicella-zoster virus Vulvovaginitis and vaginosis diagnosis treatment Z Zoonotic infections and ectoparasites animal and human bite wounds anthrax babesiosis 620 bartonellosis brucellosis human ehrlichiosis leptospirosis Lyme disease pediculosis plague Q fever rabies rocky mountain spotted fever scabies tick-borne illnesses tularemia Zoster ophthalmicus 621 [...]... Chairman of Medicine Codirector of the Infectious Disease Division Washington University School of Medicine 12 Preface e are delighted to introduce the long-awaited second edition of The Washington Manual ™ Infectious Diseases Subspecialty Consult The chapters have been contributed primarily by faculty and fellows from the Infectious Diseases Division in the Department of Internal Medicine at the Washington. .. Blanchard, Chief of the Division of Medical Education in the Department of Medicine at Washington University School of Medicine, for his advice and guidance I believe this Subspecialty Manual will meet its desired goal of providing practical knowledge that can be directly applied at the bedside and in outpatient settings to improve patient care I Victoria J Fraser, MD Dr J William Campbell Professor Interim... complements the Washington Manual of Medical Therapeutics by providing more in-depth coverage of infectious diseases We have focused on providing easy-to-follow guidance for the diagnosis and treatment of infectious diseases likely to be seen by medical house officers and hospitalists Diseases are organized primarily by organ system to facilitate generating a useful differential diagnosis based on a patient’s... Past medical and surgical history Specific details should be summarized in the HPI, with additional information supplemented in the body of the consultation note Review detailed histories of immunosuppression due to illness or medications Details of surgeries and surgical findings related to infections should be summarized Pertinent vaccination history can be summarized Medications Review histories of. .. University Scho o l o f Medicine St Louis, Misso uri Keith F Wo el tje, MD, PhD Pro fesso r o f Medicine Divisio n o f I nfectio us Diseases Departmento f I nternal Medicine Washingto n University Scho o l o f Medicine St Louis, Misso uri 11 Chairman’s Note t is a pleasure to present the new edition of The Washington Manual Subspecialty Consult Series: Infectious Diseases Subspecialty Consult This pocket-size... School of Medicine in St Louis Infectious disease is an exciting field in constant evolution Even since the release of the first edition of this manual, there have been new diseases, new diagnostic methods, and new treatment challenges with the development of multipledrug–resistant organisms There continues to be a need for specialists in this field Infectious disease specialists treat patients of all... patient care and education is unsurpassed, and their efforts and skill in compiling this manual are evident in the quality of the final product In particular, I would like to acknowledge our editors, Drs Nigar Kirmani, Keith Woeltje, and Hilary Babcock, and the series editors, Drs Tom De Fer and Katherine Henderson, who have worked tirelessly to produce another outstanding edition of this manual I would... significant diagnoses Four general categories of infectious disease consults Diagnostic dilemmas are by far the most challenging consultation; they are classified as consults where a diagnosis remains elusive Types of consults include evaluations for fever of unknown origin and other seemingly mysterious illnesses Thorough evaluation and history describing details of the patient’s potential exposures is... a minimum of 2 to 3) should be obtained from a febrile patient within the first 24 hours of presentation when endocarditis, bacteremia, or catheter-associated bloodstream infection is suspected Each culture should consist of 20 to 30 mL of blood drawn from a single site at a single time point In the case of catheter-associated bloodstream infection, at 27 least one culture should be obtained through... character or volume of surgical drain output or wound drainage) Hardware and foreign material inserted during the surgery should be documented The possibility of drug fever should be examined through a chronology of all medications (e.g., antibiotics, anesthetics) received during and after surgery Chest radiography, urinalysis, and urine culture are suggested for the evaluation of fever presenting ... Codirector of the Infectious Disease Division Washington University School of Medicine 12 Preface e are delighted to introduce the long-awaited second edition of The Washington Manual ™ Infectious Diseases. .. Division of Medical Education in the Department of Medicine at Washington University School of Medicine, for his advice and guidance I believe this Subspecialty Manual will meet its desired goal of. .. Library of Congress Cataloging-in-Publication Data The Washington manual infectious diseases subspecialty consult 2nd ed / editors, Nigar Kirmani, Keith F Woeltje, Hilary M Babcock p ; cm — (Washington