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Pneumococcal Polysaccharide Vaccine (PPV) recommendations:
- - All patients 65 years or older
- - Patients >2yo with high risk conditions (diabetes, heart disease, chronic liver disease, chronic pulmonary disease, congenital immunodeficiency, leukemia, lymphoma, generalized malignancy, CSF leaks, renal failure, asplenia, HIV, hemodialysis, receiving clotting factor concentrates, taking alkylating agents, high dose steroid treatment)
Patients who receive the vaccine before 65yo need to be re-vaccinated when they are 65yo & 5 or more years have lapsed since the first immunization.
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Cause of Celiac Sprue:
Tropheryma whippelii
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Most common causes of Otitis externa:
- Pseudomonas aeruginosa
- Staphylococcus aureus
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Amebiasis causative agent:
Entamoeba histolytica
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Characteristics of Entamoeba histolytica infection:
Crampy abdominal pain, fever, loose stools mixed with blood and mucus.
More likely to infect long term travelers such as Peace Corps volunteers.
If left untreated may progress to liver abscess --> rupture presents as RUQ pain and fever.
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Entamoeba histolytica diagnosis & treatment:
Dx: stool - cysts & antigen, serum - serology
Tx: Metronidazole + Iodoquinol or Paromomycin
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Causes of diarrhea with blood & mucus:
Entamoeba histolytica
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Causes of bloody diarrhea:
- Escherichia coli, hemorrhagic
- Camphylobacter jejuni
- Shigella
- Salmonella
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Causative organism of Travler's Diarrhea:
Clinical features:
enterotoxigenic Escherichia coli
several days of nonbloody diarrhea with nausea, vomiting, and low-grade fever
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Causes of nonbloody diarrhea:
- Escherichia coli, enterotoxigenic
- Giardia
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Prophylaxis in AIDS pts:
- CD4 < 200 - PCP (give TMP-SMX or dapsone if sulfa allergy)
- CD4 < 100 - Toxoplasmosis (TMP-SMX or dapsone), MAC (azithromycin or clarithromycin)
- CD4 < 50
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