A 34-year-old man comes to the physician because of progressive swelling of the left lower leg for 4 months. One year ago, he had an episode of intermittent fever and tender lymphadenopathy that occurred shortly after he returned from a trip to India and resolved spontaneously. Physical examination shows 4+ nonpitting edema of the left lower leg. His leukocyte count is 8,000/mm3 with 25% eosinophils. A blood smear obtained at night confirms the diagnosis. Treatment with diethylcarbamazine is initiated. Which of the following is the most likely route of transmission of the causal pathogen?
APenetration of the skin by hookworms in feces
BPenetration of the skin by cercariae from contaminated fresh water
CDeposition of larvae into the skin by a female black fly
DIngestion of encysted larvae in undercooked pork
EDeposition of thread-like larvae into the skin by a female mosquito
A 45-year-old man presents to the physician with complaints of fever with rigors, headache, malaise, muscle pains, nausea, vomiting, and decreased appetite for the past 3 days. He informs the physician that he had been backpacking on the Appalachian Trail in the woods of Georgia in the month of June, 2 weeks ago, and had been bitten by a tick there. His temperature is 39.0°C (102.3°F), pulse is 94/min, respirations are 18/min, and blood pressure is 126/82 mm Hg. His physical exam does not reveal any significant abnormality except for mild splenomegaly. Laboratory studies show: Total white blood cell count 3,700/mm3 (3.7 x 109/L) Differential count Neutrophils 85% Lymphocytes 12% Monocytes 2% Eosinophils 1% Basophils 0% Platelet count 88,000/mm3 (95 x 109/L) Serum alanine aminotransferase 140 IU/L Serum aspartate aminotransferase 80 IU/L Microscopic examination of a peripheral blood smear stained with Wright-Giemsa stain shows the presence of morulae in the cytoplasm of leukocytes. In addition to drugs for symptomatic relief, what is the most appropriate initial step in the treatment of this patient?
ADoxycycline
BCeftriaxone
CRifampin
DCiprofloxacin
EDaptomycin
A 33-year-old man presents to the emergency department with a fever and fatigue. He states that he has not felt well since he returned from a hiking trip in Alabama. He is generally healthy and has no other medical conditions. His temperature is 101°F (38.3°C), blood pressure is 127/85 mmHg, pulse is 108/min, respirations are 14/min, and oxygen saturation is 99% on room air. Physical exam including a full dermatologic inspection is unremarkable. Laboratory studies are ordered as seen below. Hemoglobin: 13 g/dL Hematocrit: 39% Leukocyte count: 2,200/mm^3 with normal differential Platelet count: 77,000/mm^3 Serum: Na+: 139 mEq/L Cl-: 100 mEq/L K+: 4.3 mEq/L HCO3-: 24 mEq/L BUN: 19 mg/dL Glucose: 98 mg/dL Creatinine: 1.3 mg/dL Ca2+: 10.2 mg/dL AST: 92 U/L ALT: 100 U/L Which of the following is the most likely diagnosis?
ALyme disease
BBabesiosis
CInfluenza
DEhrlichiosis
ERocky Mountain spotted fever
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