Bacterial Zoonotic Infections
Coxiella, Bartonella ...
414
Description

Bacterial Zoonotic Infections

Coxiella, Bartonella quintana, and Brucella are important causes of culture-negative endocarditis.

Cat scratch disease (Bartonella henslae):

 • Epi: Worldwide 

 • Transmission: Cat bite/scratch, fleas

 • Symptoms: Fever, LAD 1-3 wks, neuro, ocular

 • Abnl Labs: ↑ESR/CRP, ↑AST/ALT

 • Diag Tests: PCR 1-3d; Ab 1-2wks; histology

 • Treatment: Regimens vary

Leptospirosis (Leptospira spp.):

 • Epi: Worldwide; tropics > temperate 

 • Transmission: Water contaminated by animal urine/sewage, esp. after floods

 • Symptoms: Fever, HA, myalgia, jaundice, rash, conjunctival suffusion

 • Abnl Labs: ↑Bili, ↑AST/ALT, anemia, AKI, hypoNa, ↑CK

 • Diag Tests: Serology if 3-5d sxs 

 • Treatment: Outpt doxy 100 bid x7d; inpt PCN G, doxy, or CTX

Q fever (Coxiella burnetii):

 • Epi: Worldwide (not New Zealand) 

 • Transmission: Aerosolized ungulate fluid

 • Symptoms: Fever, HA, myalgia, PNA, endocarditis

 • Abnl Labs: ↑AST/ALT, ↑Bili, ↓Plt, ↑CK

 • Diag Tests: PCR if <7d sxs, serology if ≥7d

 • Treatment: Doxy 100 bid x14d

Brucellosis (Brucella spp):

 • Epi: Worldwide 

 • Transmission: Dairy products, ungulate contact, lab exposure

 • Symptoms: Undulant fever, arthritis (SI joint, spine), endocarditis

 • Abnl Labs: ↑AST/ALT, ↓WBC with relative ↑lymp

 • Diag Tests: Serology if 7-1d sxs 

 • Treatment: Doxy 100 bid x 6 wks + gentamicin or rifampin

Tularemia (Francisella tularensis):

 • Epi: N America, Europe > Asia 

 • Transmission: Arthropod bite, animal contact (rabbit), food/water, airborne

 • Symptoms: Regional LAD; 6 syndromes: PNA, glandular, etc.

 • Abnl Labs: Nonspecific;↑ESR/CRP; normal WBC, LFTs, Cr; ↓Plt

 • Diag Tests: Serology if sxs ≥2wks; cx cysteine+ media; gram stain

 • Treatment: Streptomycin 7-10d; cipro or doxy 10-21d if mild dz



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Account created for the MGH Internal Medicine Housestaff Manual "White Book" - https://stk10.github.io/MGH-Docs/WhiteBook-2019-2020.pdf
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