Bubonic plague sudden onset of fever headache chills

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Bubonic Plague Sudden onset of fever, headache, chills, and weakness Swollen, tender and painful lymph nodes Septicemic Plague Fever, chills, extreme weakness, abdominal pain, shock, and possibly bleeding into the skin and other organs Skin and other tissues may turn black and die, especially on fingers, toes, and the nose Septicemic plague can occur as the first symptom of plague, or may develop from untreated bubonic plague 14
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Bubonic Plague Consider in patients with clinical signs and recent travel or living in western US Can lead to septicemic plague and/or pneumonic plague if left untreated IV gentamicin and fluoroquinolones are typically first-line treatments Duration of treatment is 10 to 14 days, or until 2 days after fever subsides. Oral therapy may be substituted once the patient improves. 15
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16 Plague Types
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Sarcoptes Scabiei Scabies “the itch”; contagious, parasitic skin infection Mites Burrow up to 1cm in the stratum corneum and deposit eggs Infestation sites Interdigital spaces of fingers and surfaces of wrists External male genitalia Buttocks Anterior axillary folds Infection characterized by inflammation and intense itching Requires prescription therapy 17
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Sarcoptes Scabei Rash and pruritus may last up to 2 weeks after treatment Treat fellow household members and close contacts All persons should be treated at the same time to avoid reinfestation All bedding, clothing, towels, etc. used over 3 days before treatment need to be decontaminated 18
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Therapeutic Treatment Permethrin 5% cream applied from neck down and wash off after 8-14 hours Ivermectin 200mg/kg oral dose once Not FDA approved but widely used and literature supported Use when topical therapy impractical or difficult Crotamiton 10% cream or lotion; requires second application 24 hours later Sulfur ointment safe in children less than 2 months old Second line: Lindane 1% lotion or cream Increasing resistance Contraindications in pregnant women, children, infants, and elderly Potentially neurotoxic Single 60 ml application from neck down, leave on 8-12 hours, then rinse off Hydrocortisone may be used topically for pruritus 19
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Bedbugs Hide and deposit eggs on objects during the day and bite at night Increased infestation in the US due to worldwide travel Hotels Bites Exposed areas of skin such as arms, neck, etc. Clusters of twos and threes, straight line Irritation at the site Dermal hemorrhage 20
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Bedbugs Treatment is typically supportive Local antiseptic or antibiotic creams for secondary infections Corticosteroid creams and oral antihistamines for allergic reactions 21
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22
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Ticks Attach mouthparts into the skin If removal doesn’t include mouthpart intense itching and nodules requiring surgical excision can occur Can remain up to 10 days before falling off Itching papules disappear within 1 week Removal Use tweezers Do not use heating methods, nail polish, or petrolatum 23
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Ticks: Systemic Diseases Certain species transmit systemic diseases
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