By R. Rufus. Saint Petersburg College.
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She does not appear to fall into one of the high-risk groups for whom hepatitis A zithromax 100 mg line, hepatitis B generic zithromax 500mg otc, and pneumococcal vaccinations are recommended. A 43-year-old man with asymptomatic HIV infection (stage A1; CD4+ T cell count, 610; viral load, < 50 copies/ml) seeks your advice regarding immunizations for a planned adventure bicycle tour in Africa. He is otherwise healthy, takes no medications, and has no known allergies. He is known to be immune to hepatitis B but is seronegative for hepatitis A. His trip will last approximately 3 weeks and will include travel to rural areas and to areas beyond usual tourist routes. You counsel him about safe food practices, safe sex, and mosquito-avoidance measures. Amoxicillin Key Concept/Objective: To know the specific indications and options for malaria prophylaxis for the international traveler Appropriate malaria chemoprophylaxis is the most important preventive measure for trav- elers to malarial areas. In addition to advice about the avoidance of mosquitos and the use of repellants, most visitors to areas endemic for malaria should receive chemoprophylax- 8 BOARD REVIEW is, regardless of the duration of exposure. In most parts of the world where malaria is found, including Africa, chloroquine resistance is common, so chloroquine would not be recommended as prophylaxis for this patient. Pyrimethamine-sulfadoxine is no longer rec- ommended for prophylaxis because of the associated risk of serious mucocutaneous reac- tions. Amoxicillin does not have known efficacy against Plasmodium. Mefloquine is the preferred agent for malaria chemoprophylaxis in areas of the world where chloroquine- resistant malaria is present. A 56-year-old man seeks your advice regarding malaria prophylaxis before a planned 10-day business trip to New Delhi, India. His medical problems include atrial fibrillation and medication-controlled bipolar disorder. He has no known allergies; his regular medications include diltiazem and lithium. What should you recommend to this patient regarding malaria prophylaxis? No prophylaxis is required because his trip will be less than 14 days long ❏ B.
The mouth buy zithromax 250mg mastercard, trunk generic zithromax 100 mg line, and soles of the feet are frequently involved. Associated with erythema multiforme, there may be decreased white blood count and red blood cells, and increased erythrocyte sedimentation rate (ESR) and increased blood urea nitrogen/creatinine in severe cases. In severe cases of Stevens-Johnson syndrome, the patient may be at risk for septicemia, particularly if immunocompromised, and therefore require hospitalization for isolation. BULLOUS IMPETIGO (PLATE 9) Bullous impetigo is caused by Staphylococcus aureus and is less common than the non- bullous form. Although it can occur at any age, it is most common in children younger than 6 years old. The patient or parent may recall being exposed to another person with similar lesions. The bullae progress rapidly, have a thin surface that bursts easily, and subsequently erode. A honey-colored crust is characteristic of impetigo, and smaller lesions may develop near the first. If the crust is removed, there is a reddened base visible. Pustules Pustules are lesions that are filled with purulent fluid. Skin 21 ACNE VULGARIS Acne vulgaris affects most people at some time during their life. The multifactorial con- dition affects the sebaceous follicles. The areas most frequently involved include the face and the upper trunk. Patients with moderate acne commonly exhibit a range of lesions, including pustules. Other lesions include comedones, papules, and nodules.
