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Med-Challenger EM Career
Comprehensive Review and Assessment for
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Issue: October 15, 2006
Case: Mammalian Bite Wounds
Taken from
Med-Challenger EM Career
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Question:
A young girl presents with new onset of a persistent
high fever and one or two tender, inflamed nodes in the left
neck or axilla. A few weeks earlier, a 0.5 cm crusted red papule
had appeared on her left forearm at the site of a cat scratch
3-10 days earlier. The most likely treatment is _____.
Answer Options:
- Bartonella serology, needle aspiration, and azithromycin
- PPD placement, chest radiograph, and empiric treatment with isoniazid,
rifampin, and pyrazinamide
- CBC, excision, Warthin-Starry stain, AFB stain, and possible referral to
oncology
- excision, AFB culture, clarithromycin plus clofazimine, and possibly
ethambutol
- incision and drainage, aerobic and anaerobic cultures, and cephalexin
Answer:
A
Remediation:
The organism is
Bartonella henselae. A maculopapular rash occurs in
5-10%. Unusual presentations can include encephalopathy with
normal or near-normal CSF, pneumonia, or adenopathy with
conjunctivitis (oculoglandular form). It can also mimic Kaposi's
sarcoma in AIDS patients. CSD has also been reported to follow
injuries from fishhooks, thorns, splinters, monkeys, and dogs.
Most cases in immunocompetent patients are self-limited.
Antibiotics are indicated if the patient is seriously
immunocompromised (e.g. AIDS) Azithromycin is the current first
line choice, if treated. Needle aspiration of suppurative nodes
can give rapid relief. Incision and drainage should be avoided.
Biopsy is seldom needed; serology and PCR testing of sera or
aspirated material from fluctuant nodes is available.
Antibiotics may be used for cases with encephalitis or other
serious manifestations, though efficacy has not been proven.
Other possible agents include an IV aminoglycoside or oral
ciprofloxacin, doxycycline, or erythromycin.
About the Image(s):
Image 1:
Axillary Adenopathy of Cat-Scratch Disease
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