For each of the following patients presenting with a suspected zoonotic or tick-borne illness, identify the most appropriate targeted antimicrobial therapy.
- A 28-year-old woman in her first trimester of pregnancy presents with a 10-cm annular erythematous rash with central clearing on her thigh after a camping trip in Connecticut.Oral amoxicillin
- A 45-year-old man with a history of splenectomy presents with fever, jaundice, and hemolytic anemia; peripheral blood smear reveals intraerythrocytic tetrads.Atovaquone and azithromycin
- A 32-year-old man presents with high fever, severe headache, and a petechial rash beginning on the palms and soles following a hiking trip in North Carolina.Oral doxycycline
- A 30-year-old man presents with a painful, ulcerated lesion on his hand and tender axillary lymphadenopathy after skinning wild rabbits in Missouri.Intravenous gentamicin
Answer
The correct pairings match each specific infectious disease presentation to its targeted antimicrobial therapy, carefully accounting for patient-specific contraindications.
Each pair correctly matches a zoonotic or tick-borne disease with its definitive therapy. The pregnant patient has early localized Lyme disease and must receive amoxicillin, as doxycycline is teratogenic. The asplenic patient has severe babesiosis, treated with atovaquone and azithromycin. The hiker in North Carolina has Rocky Mountain spotted fever, which is universally treated with doxycycline because the risk of mortality outweighs potential side effects. The rabbit hunter has ulceroglandular tularemia, which requires treatment with an aminoglycoside such as intravenous gentamicin.
Step-by-Step Solution
Key Concept
Targeted antimicrobial therapy for tick-borne and zoonotic infections, including modifications for patient-specific contraindications.