Bacteria 7D: Spirochetes- Treponema, Borrelia, Leptospira (Treatment)

Bacteria 7D: Spirochetes- Treponema, Borrelia, Leptospira (Treatment)


for the fourth tier in this module we’re
going to zip through these antibiotics and see how our cases are doing did we
keep them all alive by our clinical traces you’ll just have to wait and find
out as mentioned briefly in the last tier
syphilis may require different treatments based on the stage of disease
in industrialized nations it’s extremely rare to see anything but primary
syphilis this is why you’re probably safe to remember that this is one of the
few bugs still susceptible to good old penicillin after all this time we can’t
seem to rid the world of this pathogen but at least it hasn’t grown resistance
to our antibiotics yet a shot in the butt and you’re good to go though there
are other oral beta-lactams that can be used as well of course the dreaded
penicillin allergy questions can throw a wrench in your plans if this is the case
the next line of treatment is often doxycycline though this bug is usually
susceptible to many genres for an OB/GYN rotation and the shelf exams if you have
to take those for each specialty it is also important to know that doxycycline
is contraindicated in newborns sense congenital syphilis is also very bad for
a baby we have to do something the best step is to desensitize the allergic
mother slowly to penicillin the details are beyond the scope of this class and
usually beyond the scope of step one material but might come up during rounds
lastly if you are in Doctors Without Borders or perhaps have a recent
immigrant patient and happen to run into tertiary syphilis
remember the intramuscular injections and oral medications are not sufficient
they will not cross the blood-brain barrier if the medication does not get
to the brain where the micro currently is then it can’t kill it
luckily intravenous penicillin is able to cross more readily okay
all of these exceptions to the general rule could be a bit confusing to sum up
penicillin is first choice on most questions unless the patient’s allergic
if the allergy is in pregnancy it’s best to desensitize the mother to the
allergen if in a non-pregnant patient over ten years old doxycycline is the
best penicillin is also still effective in tertiary syphilis but it has to be IV
penicillin as Lyme disease may go undiagnosed it can be difficult to treat
treatment is also said to not be needed if the tick was there for less than 24
hours sure I know I started my stopwatch every time I get bit by a tick and then
just leave it there overnight despite the bacteria being fairly
susceptible to doxycycline like many tick-borne diseases some
patients report feeling symptomatic for weeks after treatment it is not uncommon
for individuals to have a post-infection reaction this and the fact that current
lab medicine is unable to determine from a past infection in a current infection
has led to the misnomer of chronic Lyme disease doxycycline is not recommended
for anyone under 10 years old so in the pediatric population you would use
amoxicillin with lepto we are pretty much in the same boat doxycycline is
usually recommended for treatment except for the pediatric population if the
child has a severe penicillin allergy then we might want to consider using
doxycycline despite the contra-indications we’ll
cover more contra-indications and side effects in the next module we come back
to Mr. Drussen our 26 year old male with substance use disorder to see that his
arm is decreased in size and redness compared to yesterday we look over his
lab results and his blood cultures came back positive for methicillin-sensitive
staphylococcus aureus sonography was negative for a subdermal abscess and
echo was negative for heart vegetations as well so we didn’t need to do an
incision to drain an abscess and we won’t need to keep him on weeks of
antibiotics for a potential endocarditis he lucked out this time now may
be a proper time to switch him to an antibiotic with a lower side-effect
profile and that is more appropriate for his non resistant strain a beta-lactam
would likely suffice from this point on and may be taken orally case 2 we speak
to Mr. Wiley two days later he states that his respiratory issues have begun
to resolve and was curious what the cause ended up being as suspected his Legionella antigen came back positive in the
future perhaps we should recommend he say out of the motels with older AC
units luckily he is already on the correct antibiotic for empiric treatment
had his symptoms progressed or stayed the same we might want to consider a
resistant strain since this doesn’t appear to be the case we’ll tell him to
call back if anything changes with miss Hall we follow up a few weeks later the
chancres will last a few weeks with or without treatment and it could take some
time to make sure that the bug has been flushed from the system she states that
she had a very energized conversation with her ex but she has not been
sexually active since her last physical on exam the chancres appear to be
healing and some have gone away completely
she also reports no current complaints or symptoms with syphilis a follow-up is
not always required resistance antibiotics has not been a major concern
which does not hold true for other STD causing bacteria if she was still
showing any signs or symptoms it would be worth considering co-infection for
one of these other books well I hope you enjoyed this brief foray into clinical
cases reading about a patient and study material can be quite boring and
difficult to link to actual diseases following these patients over the course
of a disease or treatment even digitally can help add experiential learning to
the mix this finally ends our fourth module long exploration of gram-negative
rods try to go over any notes flashcards and other study materials so these
categories of microbes don’t get intermingled too much as we reach the
end of the course the last few modules will be on some odd bacterium that don’t
fit clearly into gram-positive or gram negative groups if you recall how the
gram stain actually works you might be able to guess just why these future
microbes are so different the next module will cover Mycobacterium

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