Abstract
Many infectious disease issues are managed in the urgent care setting. This chapter highlights tuberculosis, Lyme disease, rabies, and measles.
Keywords
Lyme, measles, purified protein derivative (PPD), rabies, tuberculosis
Tuberculosis (TB)
1
How does TB spread from one person to another?
TB, which is caused by Mycobacterium tuberculosis, is spread via respiratory droplets from one person to another. It is not spread by contact.
2
How does latent TB differ from active TB?
Latent TB occurs when patients are infected with TB but do not become ill, and they exhibit no symptoms. Patients with latent TB are not contagious and therefore are not at risk for transmission to others.
3
What clinical symptoms would a patient with active TB exhibit?
Cough (lasting several weeks), chest pain, night sweats, weakness, weight loss, fever, chills.
4
What past medical/social history in a patient would increase your suspicion for TB?
HIV, drug/alcohol abuse, prior TB infection, immunosuppression, homelessness, incarceration, recent immigration or travel from high-risk area.
5
What constitutes a positive TB purified protein derivative (PPD) test?
See Table 11.1 .
| Induration | |||
|---|---|---|---|
| >5 mm | >10 mm | >15 mm | |
| Positive Test in a Patient with |
|
|
|
6
Would you recommend any treatment for patients with latent TB?
Yes. Treatment of latent TB is recommended, as there is a risk of progression of latent to active TB.
7
Is there a vaccination for TB?
Yes, many countries with large numbers of TB patients give bacille Calmette-Guérin (BCG); however, in the United States it is not routinely administered secondary to the low risk. Note that patients who have had BCG may create a false-positive reaction.
8
How should I interpret a PPD test in a patient with a prior BCG vaccine?
The reaction to PPD testing can vary in patients with prior BCG; therefore, the recommendation is to interpret the same (see Table 11.1 ) and treat based on risk factors.
Lyme Disease
9
What causes Lyme disease?
Borrelia burgdorferi, a spirochete that infects ticks, that then bite humans and thus transmit the disease. It is the most common tickborne disease in the United States.
10
What signs and symptoms might a patient with Lyme disease present with?
Rash, fever, joint pain, muscle pain, headache, tender lymph nodes, Bell palsy.
11
What clinical sign of Lyme disease can be used to make the diagnosis without laboratory confirmation?
Erythema migrans, a rash that can present 1 day to 1 month following exposure. It is an erythematous circular rash, typically a single lesion, but can present as multiple lesions. Of rashes reported, 19% are “bull’s-eye.”
12
What percentage of patients with Lyme disease develop erythema migrans?
Up to 80%.
13
What is the recommended laboratory testing for Lyme disease?
Two-tiered testing using enzyme-linked immunosorbent assay, followed by Western blot for confirmation.
14
What are the clinical stages and symptoms of Lyme disease?
See Table 11.2 .
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