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==Primary Prevention==
==Test==
Well-timed and effective postexposure [[prophylaxis]] can potentially save thousands of lives. Postexposure [[prophylaxis]] of [[asymptomatic]] persons should ideally start as soon as possible after exposure because its effectiveness decreases with delay in implementation.


After exposure to anthrax, it is recommended 60 days of [[antibiotic]] drug [[prophylaxis]] for immediate protection and a 3-dose series of Anthrax Vaccine Adsorbed (AVA) for long-term protection.<ref name="pmid20651644">{{cite journal| author=Wright JG, Quinn CP, Shadomy S, Messonnier N, Centers for Disease Control and Prevention (CDC)| title=Use of anthrax vaccine in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009. | journal=MMWR Recomm Rep | year= 2010 | volume= 59 | issue= RR-6 | pages= 1-30 | pmid=20651644 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20651644 }} </ref> To ensure adequate and continued protection, everyone exposed to aerosolized [[Bacillus anthracis]] [[spores]] should receive a full 60 days of postexposure prophylaxis antibiotic drugs, whether they are unvaccinated, partially [[vaccinated]], or fully vaccinated.<ref name=CDC>{{cite web | title = Centers for Disease Control and Prevention Expert Panel Meetings on Prevention and Treatment of Anthrax in Adults | url = http://wwwnc.cdc.gov/eid/article/20/2/13-0687_article }}</ref>
==Parenchymal lesions==
*Tuberculoma
:* Single or multiple lesions of > 0.5 cm
:* May occur in primary or secundary TB
:* Main finding on Chest X-ray in 5% cases of secondary TB<ref name="pmid3484866">{{cite journal| author=Woodring JH, Vandiviere HM, Fried AM, Dillon ML, Williams TD, Melvin IG| title=Update: the radiographic features of pulmonary tuberculosis. | journal=AJR Am J Roentgenol | year= 1986 | volume= 146 | issue= 3 | pages= 497-506 | pmid=3484866 | doi=10.2214/ajr.146.3.497 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3484866  }} </ref>
:* Results from the surrounding of M. tuberculosis with inflammatory or connective tissue.<ref name="pmid8456658">{{cite journal| author=Lee KS, Song KS, Lim TH, Kim PN, Kim IY, Lee BH| title=Adult-onset pulmonary tuberculosis: findings on chest radiographs and CT scans. | journal=AJR Am J Roentgenol | year= 1993 | volume= 160 | issue= 4 | pages= 753-8 | pmid=8456658 | doi=10.2214/ajr.160.4.8456658 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8456658  }} </ref><ref name="pmid472765">{{cite journal| author=Palmer PE| title=Pulmonary tuberculosis--usual and unusual radiographic presentations. | journal=Semin Roentgenol | year= 1979 | volume= 14 | issue= 3 | pages= 204-43 | pmid=472765 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=472765  }} </ref><ref name="pmid3484866">{{cite journal| author=Woodring JH, Vandiviere HM, Fried AM, Dillon ML, Williams TD, Melvin IG| title=Update: the radiographic features of pulmonary tuberculosis. | journal=AJR Am J Roentgenol | year= 1986 | volume= 146 | issue= 3 | pages= 497-506 | pmid=3484866 | doi=10.2214/ajr.146.3.497 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3484866  }} </ref>
:* The center of the tuberculoma is often necrotic
:* Satellite lesions (80%)
:* Nodular or diffused calcifications in 20-30% cases<ref name="pmid8456658">{{cite journal| author=Lee KS, Song KS, Lim TH, Kim PN, Kim IY, Lee BH| title=Adult-onset pulmonary tuberculosis: findings on chest radiographs and CT scans. | journal=AJR Am J Roentgenol | year= 1993 | volume= 160 | issue= 4 | pages= 753-8 | pmid=8456658 | doi=10.2214/ajr.160.4.8456658 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8456658  }} </ref>
*Thin-walled cavity
:* Present in active and inactive disease
:* May regress after treatment
:* Air-filled sect may persist<ref>{{cite book | last = Fraser | first = Richard | title = Synopsis of diseases of the chest | publisher = W.B. Saunders | location = Philadelphia | year = 1994 | isbn = 0721636691 }}</ref>
:* May be misidentified as an emphysematous bulla or pneumatocelle.
*Cicatrization:
:* Common in secondary TB
:* Marked fibrosis in ≤40% of secondary TB cases, which may present as:
::*Upper love atelectasis
::*Compensatory hyperinflation of the lower lobe
::*Hilar retraction
::*Mediastinal shift
*Unspecific X-Ray findings:<ref name="pmid11452057">{{cite journal| author=Kim HY, Song KS, Goo JM, Lee JS, Lee KS, Lim TH| title=Thoracic sequelae and complications of tuberculosis. | journal=Radiographics | year= 2001 | volume= 21 | issue= 4 | pages= 839-58; discussion 859-60 | pmid=11452057 | doi=10.1148/radiographics.21.4.g01jl06839 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11452057  }} </ref>
::*Parenchymal bands
::*Fibrotic cavities
::*Fibrotic nodules
::*Traction bronchiectasis
*Lung Destruction:<ref name="pmid11452057">{{cite journal| author=Kim HY, Song KS, Goo JM, Lee JS, Lee KS, Lim TH| title=Thoracic sequelae and complications of tuberculosis. | journal=Radiographics | year= 2001 | volume= 21 | issue= 4 | pages= 839-58; discussion 859-60 | pmid=11452057 | doi=10.1148/radiographics.21.4.g01jl06839 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11452057 }} </ref>
:*Common in end-stage of TB
:*Involvement of the airways and parenchyma
:*May follow primary TB or secondary TB
:*Spreads across the lung with cavitation and fibrosis<ref name="pmid8456658">{{cite journal| author=Lee KS, Song KS, Lim TH, Kim PN, Kim IY, Lee BH| title=Adult-onset pulmonary tuberculosis: findings on chest radiographs and CT scans. | journal=AJR Am J Roentgenol | year= 1993 | volume= 160 | issue= 4 | pages= 753-8 | pmid=8456658 | doi=10.2214/ajr.160.4.8456658 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8456658  }} </ref>
:*Concomitant infection with bacteria or bacteria may occur
:*Complicates assessment of TB activity in the lung with the X-ray.
*[[Aspergilloma]]
:*Mass of hyphae, cell debris and mucus, commonly located in a cavity or bronchus<ref name="pmid8744521">{{cite journal| author=Logan PM, Müller NL| title=CT manifestations of pulmonary aspergillosis. | journal=Crit Rev Diagn Imaging | year= 1996 | volume= 37 | issue= 1 | pages= 1-37 | pmid=8744521 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8744521  }} </ref><ref name="pmid8838945">{{cite journal| author=Miller WT| title=Aspergillosis: a disease with many faces. | journal=Semin Roentgenol | year= 1996 | volume= 31 | issue= 1 | pages= 52-66 | pmid=8838945 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8838945  }} </ref><ref name="pmid8577955">{{cite journal| author=Thompson BH, Stanford W, Galvin JR, Kurihara Y| title=Varied radiologic appearances of pulmonary aspergillosis. | journal=Radiographics | year= 1995 | volume= 15 | issue= 6 | pages= 1273-84 | pmid=8577955 | doi=10.1148/radiographics.15.6.8577955 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8577955  }} </ref>
:*Previous history of chronic cavitary TB in 25-55% of cases presenting with [[aspergilloma]]
:*Frequently courses with [[hemoptysis]] (50-90%)
:*X-ray shows a mobile mass ringed by an air shadow 
:*CT shows a mobile mass, generally interspaced with air shadows
:*May be calcified
*Bronchogenic carcinoma<ref name="pmid11452057">{{cite journal| author=Kim HY, Song KS, Goo JM, Lee JS, Lee KS, Lim TH| title=Thoracic sequelae and complications of tuberculosis. | journal=Radiographics | year= 2001 | volume= 21 | issue= 4 | pages= 839-58; discussion 859-60 | pmid=11452057 | doi=10.1148/radiographics.21.4.g01jl06839 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11452057  }} </ref>


===Antibiotic Drugs===
:*May be misinterpreted as TB progression
[[Ciprofloxacin]], [[levofloxacin]], and [[doxycycline]] are [[FDA]]-approved for the [[antibiotic]] drug portion of postexposure [[prophylaxis]] for inhalation anthrax in adults ≥18 years of age.  
:*Scar formation in TB may lead to carcinoma
:*May cause reactivation of TB<ref name="pmid4975011">{{cite journal| author=Snider GL, Placik B| title=The relationship between pulmonary tuberculosis and bronchogenic carcinoma. A topographic study. | journal=Am Rev Respir Dis | year= 1969 | volume= 99 | issue= 2 | pages= 229-36 | pmid=4975011 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4975011  }} </ref><ref name="pmid1265261">{{cite journal| author=Ting YM, Church WR, Ravikrishnan KP| title=Lung carcinoma superimposed on pulmonary tuberculosis. | journal=Radiology | year= 1976 | volume= 119 | issue= 2 | pages= 307-12 | pmid=1265261 | doi=10.1148/119.2.307 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1265261  }} </ref>


No safety data are available for [[levofloxacin]] use beyond 30 days; thus, oral [[ciprofloxacin]] and [[doxycycline]] are recommended as first-line [[antibiotic]] drugs for postexposure [[prophylaxis]]. Alternative [[antibiotic]] drugs that might be used for postexposure [[prophylaxis]], if first-line agents are not tolerated or are unavailable, include:
==Airway Lesions==
* [[Levofloxacin]] and [[moxifloxacin]]
<!--
* [[Amoxicillin]] and [[penicillin V Potassium]] if the isolate is [[penicillin]] susceptible
-->
* [[Clindamycin]].


===Vaccine===
==Differential Diagnosis of Infectious Diarrhea==
There is evidence of [[seroconversion]] after 3 doses of AVA. The [[vaccine]] should be administered [[subcutaneous|subcutaneously]] at [[diagnosis]] and 2 and 4 weeks later.<ref name="pmid20651644">{{cite journal| author=Wright JG, Quinn CP, Shadomy S, Messonnier N, Centers for Disease Control and Prevention (CDC)| title=Use of anthrax vaccine in the United States: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009. | journal=MMWR Recomm Rep | year= 2010 | volume= 59 | issue= RR-6 | pages= 1-30 | pmid=20651644 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20651644 }} </ref> AVA is not FDA-approved for postexposure [[prophylaxis]] and could be made available under an Investigational New Drug protocol or an Emergency Use Authorization in a declared emergency.
Acute inflammatory diarrhea may be caused by different pathogens. Bellow is a table describing some of these pathogens in terms of transmission and symptoms:<ref name="pmid14702426">{{cite journal| author=Thielman NM, Guerrant RL| title=Clinical practice. Acute infectious diarrhea. | journal=N Engl J Med | year= 2004 | volume= 350 | issue= 1 | pages= 38-47 | pmid=14702426 | doi=10.1056/NEJMcp031534 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14702426  }} </ref><ref name="pmid15537721">{{cite journal| author=Khan AM, Faruque AS, Hossain MS, Sattar S, Fuchs GJ, Salam MA| title=Plesiomonas shigelloides-associated diarrhoea in Bangladeshi children: a hospital-based surveillance study. | journal=J Trop Pediatr | year= 2004 | volume= 50 | issue= 6 | pages= 354-6 | pmid=15537721 | doi=10.1093/tropej/50.6.354 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15537721 }} </ref>


==Prophylaxis Regimen==
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
 
! style="background: #4479BA; padding: 5px 5px;" rowspan=2 | {{fontcolor|#FFFFFF|Pathogen}}
<SMALL><font color="#FF4C4C">'''▸ Click on the following categories to expand treatment regimens.'''</font></SMALL><ref>{{Cite journal | doi = 10.3201/eid2002.130687 | issn = 1080-6059 | volume = 20 | issue = 2 | last = Hendricks | first = Katherine A. | coauthors = Mary E. Wright, Sean V. Shadomy, John S. Bradley, Meredith G. Morrow, Andy T. Pavia, Ethan Rubinstein, Jon-Erik C. Holty, Nancy E. Messonnier, Theresa L. Smith, Nicki Pesik, Tracee A. Treadwell, William A. Bower, Workgroup on Anthrax Clinical Guidelines | title = Centers for disease control and prevention expert panel meetings on prevention and treatment of anthrax in adults | journal = Emerging Infectious Diseases | date = 2014-02 | pmid = 24447897 | pmc = PMC3901462 }}</ref><ref>{{Cite journal | doi = 10.1542/peds.2014-0563 | issn = 1098-4275 | last = Bradley | first = John S. | coauthors = Georgina Peacock, Steven E. Krug, William A. Bower, Amanda C. Cohn, Dana Meaney-Delman, Andrew T. Pavia, AAP COMMITTEE ON INFECTIOUS DISEASES and DISASTER PREPAREDNESS ADVISORY COUNCIL | title = Pediatric Anthrax Clinical Management | journal = Pediatrics | date = 2014-04-28 | pmid = 24777226 }}</ref><ref>{{Cite journal | doi = 10.3201/eid2002.130611 | issn = 1080-6059 | volume = 20 | issue = 2 | last = Meaney-Delman | first = Dana | coauthors = Marianne E. Zotti, Andreea A. Creanga, Lara K. Misegades, Etobssie Wako, Tracee A. Treadwell, Nancy E. Messonnier, Denise J. Jamieson, Workgroup on Anthrax in Pregnant and Postpartum Women | title = Special considerations for prophylaxis for and treatment of anthrax in pregnant and postpartum women | journal = Emerging Infectious Diseases | date = 2014-02 | pmid = 24457117 | pmc = PMC3901460 }}</ref>
! style="background: #4479BA; padding: 5px 5px;" rowspan=2  | {{fontcolor|#FFFFFF|Transmission}}
 
! style="background: #4479BA; padding: 5px 5px;" colspan=4 | {{fontcolor|#FFFFFF|Clinical Manifestations}}
{|
| valign=top |
 
<div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 350px; background: #A1BCDD; text-align: center;">
<font color="#FFF">
'''PEP for Infection with B. anthracis'''
</font>
</div>
 
<div class="mw-customtoggle-table01" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 350px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Adult Patients'''
</font>
</div>
 
<div class="mw-customtoggle-table02" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 350px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Pediatric Patients'''
</font>
</div>
 
<div class="mw-customtoggle-table03" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 350px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Pregnant Patients'''
</font>
</div>
 
<!--COLLECT ALL THE BOXES BELOW-->
| valign=top |
 
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table01" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 450px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|PEP, Adult Patients}}
|-
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
! style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Fever}}
! style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Nausea/Vomiting}}
! style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Abdominal Pain}}
! style="background: #4479BA; padding: 5px 5px;" | {{fontcolor|#FFFFFF|Bloody Stool}}
|-
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ciprofloxacin]] 500 mg PO q12h'''''<BR> OR <BR> ▸ '''''[[Levofloxacin]]  750 mg PO q24h'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]]  400 mg PO q24h'''''<BR> OR <BR> ▸ '''''[[Doxycycline]]  100 mg PO q12h'''''
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" | ''[[Salmonella]]''
| style="padding: 5px 5px; background: #F5F5F5;" | Foodborne transmission, community-acquired
! style="padding: 5px 5px; background: #F5F5F5;" | ++
! style="padding: 5px 5px; background: #F5F5F5;" | +
! style="padding: 5px 5px; background: #F5F5F5;" | ++
! style="padding: 5px 5px; background: #F5F5F5;" | +
|-
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" | ''[[Shigella]]''
| style="padding: 5px 5px; background: #F5F5F5;" | Community-acquired, person-to-person
! style="padding: 5px 5px; background: #F5F5F5;" | ++
! style="padding: 5px 5px; background: #F5F5F5;" | ++
! style="padding: 5px 5px; background: #F5F5F5;" | ++
! style="padding: 5px 5px; background: #F5F5F5;" | +
|-
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Clindamycin]] 600 mg PO q8h'''''<BR> OR <BR> ▸ '''''[[Penicillin VK]] 500 mg PO q6h'''''<BR> OR <BR> ▸ '''''[[Amoxicillin]] 1 g PO q8h'''''
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" | ''[[Campylobacter]]''
|}
| style="padding: 5px 5px; background: #F5F5F5;" | Community-acquired, ingestion of undercooked poultry
|}
! style="padding: 5px 5px; background: #F5F5F5;" | ++
 
! style="padding: 5px 5px; background: #F5F5F5;" | +
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table02" style="background: #FFFFFF;"
! style="padding: 5px 5px; background: #F5F5F5;" | ++
| valign=top |
! style="padding: 5px 5px; background: #F5F5F5;" | +
{| style="float: left; cellpadding=0; cellspacing= 0; width: 450px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|PEP, Pediatric Patients}}
|-
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" | [[Escherichia coli|''E. coli'' (EHEC or EIEC)]]
| style="padding: 5px 5px; background: #F5F5F5;" | Foodborne transmission, ingestion of undercooked hamburger meat
! style="padding: 5px 5px; background: #F5F5F5;" | ±
! style="padding: 5px 5px; background: #F5F5F5;" | +
! style="padding: 5px 5px; background: #F5F5F5;" | ++
! style="padding: 5px 5px; background: #F5F5F5;" | ++
|-
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ciprofloxacin]] 30 mg/kg/day PO q12h, max: 500 mg/dose'''''<BR> OR <BR> ▸ '''''[[Levofloxacin]]  16 mg/kg/day PO q12h, max: 250 mg/dose (<50 kg)'''''<BR> OR <BR> ▸ '''''[[Levofloxacin]]  500 mg PO q24h (≥50 kg)'''''<BR> OR <BR> ▸ '''''[[Doxycycline]]  4.4 mg/kg/day PO q12h, max: 100 mg/dose (<45 kg)'''''<BR> OR <BR> ▸ '''''[[Doxycycline]]  100 mg/dose PO q12h (≥45 kg)'''''
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" | ''[[Clostridium difficile]]''
| style="padding: 5px 5px; background: #F5F5F5;" | Nosocomial spread, antibiotic use
! style="padding: 5px 5px; background: #F5F5F5;" | +
! style="padding: 5px 5px; background: #F5F5F5;" | ±
! style="padding: 5px 5px; background: #F5F5F5;" | +
! style="padding: 5px 5px; background: #F5F5F5;" | +
|-
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" | ''[[Yersinia]]''
| style="padding: 5px 5px; background: #F5F5F5;" | Community-aquired, foodborne transmission
! style="padding: 5px 5px; background: #F5F5F5;" | ++
! style="padding: 5px 5px; background: #F5F5F5;" | +
! style="padding: 5px 5px; background: #F5F5F5;" | ++
! style="padding: 5px 5px; background: #F5F5F5;" | +
|-
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Clindamycin]] 30 mg/kg/day PO q8h, max: 600 mg/dose'''''<BR> OR <BR> ▸ '''''[[Penicillin VK]] 50–75 mg/kg/day PO q6–8h'''''<BR> OR <BR> ▸ '''''[[Amoxicillin]] 75 mg/kg/day PO q8h, max: 1 g/dose'''''
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" | ''[[Entamoeba histolytica]]''
|}
| style="padding: 5px 5px; background: #F5F5F5;" | Travel to or emigration from tropical regions
|}
! style="padding: 5px 5px; background: #F5F5F5;" | +
 
! style="padding: 5px 5px; background: #F5F5F5;" | ±
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table03" style="background: #FFFFFF;"
! style="padding: 5px 5px; background: #F5F5F5;" | +
| valign=top |
! style="padding: 5px 5px; background: #F5F5F5;" | ±
{| style="float: left; cellpadding=0; cellspacing= 0; width: 450px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|PEP, Pregnant Patients}}
|-
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" | ''[[Aeromonas]]''
| style="padding: 5px 5px; background: #F5F5F5;" | Ingestion of contaminated water
! style="padding: 5px 5px; background: #F5F5F5;" | ++
! style="padding: 5px 5px; background: #F5F5F5;" | +
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|-
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ciprofloxacin]] 500 mg PO q12h'''''
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold;" | ''[[Plesiomonas]]''
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| style="padding: 5px 5px; background: #F5F5F5;" | Ingestion of contaminated water or undercooked shellfish, travel to tropical regions
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! style="padding: 5px 5px; background: #F5F5F5;" | ±
 
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==References==
==References==
{{reflist|2}}
{{reflist|2}}

Latest revision as of 18:19, 16 September 2014

Test

Parenchymal lesions

  • Tuberculoma
  • Single or multiple lesions of > 0.5 cm
  • May occur in primary or secundary TB
  • Main finding on Chest X-ray in 5% cases of secondary TB[1]
  • Results from the surrounding of M. tuberculosis with inflammatory or connective tissue.[2][3][1]
  • The center of the tuberculoma is often necrotic
  • Satellite lesions (80%)
  • Nodular or diffused calcifications in 20-30% cases[2]
  • Thin-walled cavity
  • Present in active and inactive disease
  • May regress after treatment
  • Air-filled sect may persist[4]
  • May be misidentified as an emphysematous bulla or pneumatocelle.
  • Cicatrization:
  • Common in secondary TB
  • Marked fibrosis in ≤40% of secondary TB cases, which may present as:
  • Upper love atelectasis
  • Compensatory hyperinflation of the lower lobe
  • Hilar retraction
  • Mediastinal shift
  • Unspecific X-Ray findings:[5]
  • Parenchymal bands
  • Fibrotic cavities
  • Fibrotic nodules
  • Traction bronchiectasis
  • Lung Destruction:[5]
  • Common in end-stage of TB
  • Involvement of the airways and parenchyma
  • May follow primary TB or secondary TB
  • Spreads across the lung with cavitation and fibrosis[2]
  • Concomitant infection with bacteria or bacteria may occur
  • Complicates assessment of TB activity in the lung with the X-ray.
  • Mass of hyphae, cell debris and mucus, commonly located in a cavity or bronchus[6][7][8]
  • Previous history of chronic cavitary TB in 25-55% of cases presenting with aspergilloma
  • Frequently courses with hemoptysis (50-90%)
  • X-ray shows a mobile mass ringed by an air shadow
  • CT shows a mobile mass, generally interspaced with air shadows
  • May be calcified
  • Bronchogenic carcinoma[5]
  • May be misinterpreted as TB progression
  • Scar formation in TB may lead to carcinoma
  • May cause reactivation of TB[9][10]

Airway Lesions

Differential Diagnosis of Infectious Diarrhea

Acute inflammatory diarrhea may be caused by different pathogens. Bellow is a table describing some of these pathogens in terms of transmission and symptoms:[11][12]

Pathogen Transmission Clinical Manifestations
Fever Nausea/Vomiting Abdominal Pain Bloody Stool
Salmonella Foodborne transmission, community-acquired ++ + ++ +
Shigella Community-acquired, person-to-person ++ ++ ++ +
Campylobacter Community-acquired, ingestion of undercooked poultry ++ + ++ +
E. coli (EHEC or EIEC) Foodborne transmission, ingestion of undercooked hamburger meat ± + ++ ++
Clostridium difficile Nosocomial spread, antibiotic use + ± + +
Yersinia Community-aquired, foodborne transmission ++ + ++ +
Entamoeba histolytica Travel to or emigration from tropical regions + ± + ±
Aeromonas Ingestion of contaminated water ++ + ++ +
Plesiomonas Ingestion of contaminated water or undercooked shellfish, travel to tropical regions ± ++ + +

References

  1. ↑ 1.0 1.1 Woodring JH, Vandiviere HM, Fried AM, Dillon ML, Williams TD, Melvin IG (1986). "Update: the radiographic features of pulmonary tuberculosis". AJR Am J Roentgenol. 146 (3): 497–506. doi:10.2214/ajr.146.3.497. PMID 3484866.
  2. ↑ 2.0 2.1 2.2 Lee KS, Song KS, Lim TH, Kim PN, Kim IY, Lee BH (1993). "Adult-onset pulmonary tuberculosis: findings on chest radiographs and CT scans". AJR Am J Roentgenol. 160 (4): 753–8. doi:10.2214/ajr.160.4.8456658. PMID 8456658.
  3. ↑ Palmer PE (1979). "Pulmonary tuberculosis--usual and unusual radiographic presentations". Semin Roentgenol. 14 (3): 204–43. PMID 472765.
  4. ↑ Fraser, Richard (1994). Synopsis of diseases of the chest. Philadelphia: W.B. Saunders. ISBN 0721636691.
  5. ↑ 5.0 5.1 5.2 Kim HY, Song KS, Goo JM, Lee JS, Lee KS, Lim TH (2001). "Thoracic sequelae and complications of tuberculosis". Radiographics. 21 (4): 839–58, discussion 859-60. doi:10.1148/radiographics.21.4.g01jl06839. PMID 11452057.
  6. ↑ Logan PM, Müller NL (1996). "CT manifestations of pulmonary aspergillosis". Crit Rev Diagn Imaging. 37 (1): 1–37. PMID 8744521.
  7. ↑ Miller WT (1996). "Aspergillosis: a disease with many faces". Semin Roentgenol. 31 (1): 52–66. PMID 8838945.
  8. ↑ Thompson BH, Stanford W, Galvin JR, Kurihara Y (1995). "Varied radiologic appearances of pulmonary aspergillosis". Radiographics. 15 (6): 1273–84. doi:10.1148/radiographics.15.6.8577955. PMID 8577955.
  9. ↑ Snider GL, Placik B (1969). "The relationship between pulmonary tuberculosis and bronchogenic carcinoma. A topographic study". Am Rev Respir Dis. 99 (2): 229–36. PMID 4975011.
  10. ↑ Ting YM, Church WR, Ravikrishnan KP (1976). "Lung carcinoma superimposed on pulmonary tuberculosis". Radiology. 119 (2): 307–12. doi:10.1148/119.2.307. PMID 1265261.
  11. ↑ Thielman NM, Guerrant RL (2004). "Clinical practice. Acute infectious diarrhea". N Engl J Med. 350 (1): 38–47. doi:10.1056/NEJMcp031534. PMID 14702426.
  12. ↑ Khan AM, Faruque AS, Hossain MS, Sattar S, Fuchs GJ, Salam MA (2004). "Plesiomonas shigelloides-associated diarrhoea in Bangladeshi children: a hospital-based surveillance study". J Trop Pediatr. 50 (6): 354–6. doi:10.1093/tropej/50.6.354. PMID 15537721.
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