Sandbox mj

• Bartonella Return to Top

• Bartonella

• 1. Bartonella quintana

• 1.1 Acute or chronic infections without endocarditis

• Preferred regimen: Doxycycline 200 mg PO qd or 100 mg bid for 4 weeks AND Gentamicin 3 mg/kg IV qd for the first 2 weeks

• 1.2 Endocarditis

• Preferred regimen: Gentamicin 3 mg/kg/day IV q8h for 14 days AND Ceftriaxone 2 g IV q24h for 6 weeks ± Doxycycline 100 mg PO bid for 6 weeks

• 2. Bartonella elizabethae

• 2.1 Endocarditis

• Preferred regimen: Gentamicin 3 mg/kg/day IV q8h for 14 days AND Ceftriaxone 2 g IV q24h for 6 weeks ± Doxycycline 100 mg PO bid for 6 weeks

• 3. Bartonella bacilliformis

• 3.1 Oroya fever

• Preferred regimen: Ciprofloxacin 500 mg PO bid for 14 days
• Note: If severe disease, add Ceftriaxone 1 g IV qd for 14 days

• 3.2 Verruga peruana

• Preferred regimen: Azithromycin 500 mg PO qd for 7 days
• Alternative regimen (1): Rifampin 600 mg PO qd for 14-21 days
• Alternative regimen (2): Ciprofloxacin 500 mg bid for 7-10 days

• 4. Bartonella henselae

• 4.1 Cat scratch disease

• No treatment recommended for typical cat scratch disease, consider treatment if there is an extensive lymphadenopathy
• 4.1.1 If extensive lymphadenopathy

• Preferred regimen (1) (pediatrics): Azithromycin 500 mg PO on day 1 THEN 250 mg PO qd on days 2 to 5
• Preferred regimen (2) (adults): Azithromycin 1 g PO at day 1 THEN 500 mg PO for 4 days

• 4.2 Endocarditis

• Preferred regimen: Gentamicin 3 mg/kg/day IV q8h for 14 days AND Ceftriaxone 2 g/day IV for 6weeks ± Doxycycline 100 mg PO bid for 6 weeks

• 4.3 Retinitis

• Preferred regimen: Doxycycline 100 mg bid AND Rifampin 300 mg bid PO for 4-6 weeks

• 4.4 Bacillary angiomatosis

• Preferred regimen (1): Erythromycin 500 mg PO qid for 2 months at least
• Preferred regimen (2): Doxycycline 100 mg PO bid for 2 months at least

• 4.5 Bacillary Pelliosis

• Preferred regimen (1): Erythromycin 500 mg PO qid for 4 months at least
• Preferred regimen (2): Doxycycline 100 mg PO bid for 4 months at least

Neurocysticercosis

• Neurocysticercosis Return to Top

• Neurocysticercosis treatment

• 1. Parenchymal neurocysticercosis

• 1.1 Single lesions

• Preferred regimen: Albendazole 15 mg/kg/day PO bid for 3 to 8 days AND Prednisone 1 mg/kg/day PO qid for 8 to 10 days followed by a taper

• 1.2 Multiple cysts

• Preferred regimen: Albendazole 15 mg/kg/day PO bid for 8 to 15 days and high-dose steroids
• Preferred regimen: Praziquantel 50 mg/kg/day PO tid AND Albendazole 15 mg/kg/day PO bid

• 1.3 Cysticercal encephalitis

• Cysticercal encephalitis (diffuse cerebral edema associated with multiple inflamed cysticerci) is a contraindication for antiparasitic therapy, since enhanced parasite killing can exacerbate host inflammatory response and lead to diffuse cerebral edema and potential transtentorial herniation. Most cases of cysticercal encephalitis improve with corticosteroid therapy

• 1.4 Calcified cysts

• Radiographic evidence of parenchymal calcifications is a significant risk factor for recurrent seizure activity; these lesions are present in about 10 percent of individuals in regions where neurocysticercosis is endemic. Seizures in these patients should be treated with antiepileptic therapy.

• 2. Extraparenchymal NCC

• 2.1 Subarachnoid cysts

• Preferred regimen: Albendazole 15 mg/kg/day PO bid for 28 days AND Prednisone up to 60 mg/day PO OR Dexamethasone (up to 24 mg per day) along with the antiparasitic therapy. The dose can often be tapered after a few weeks. However, in cases for which more prolonged steroid therapy is required, methotrexate can be used as a steroid-sparing agent

• 2.2 Giant cysts

• Giant cysticerci are usually accompanied by cerebral edema and mass effect, which should be managed with high-dose corticosteroids (with or without mannitol).

• 2.3 Intraventricular cysts

• Emergent management with CSF diversion via a ventriculostomy or placement of a ventriculo-peritoneal shunt
• Treatment of residual hydrocephalus may be managed with endoscopic foraminotomy and endoscopic third ventriculostomy; this approach may also allow debulking of cisternal cysticerci

• 2.4 Ocular cysticercosis

• Surgical excision is warranted in the setting of intraocular cysts
• Cysticercal involvement of the extraocular muscles should be managed with albendazole and corticosteroids.

• 2.5 Spinal cysticercosis

• Medical therapy with corticosteroids and antiparasitic drugs

Parasites – Ectoparasites

• Body lice Return to Top

• Body lice

• Pediculus humanus, corporis treatment

• A body lice infestation is treated by improving the personal hygiene of the infested person, including assuring a regular (at least weekly) change of clean clothes.
• Clothing, bedding, and towels used by the infested person should be laundered using hot water (at least 130°F) and machine dried using the hot cycle.
• Sometimes the infested person also is treated with a pediculicide Ivermectin Lotion; however, a pediculicide Ivermectin generally is not necessary if hygiene is maintained and items are laundered appropriately at least once a week. A pediculicide Ivermectin should be applied exactly as directed on the bottle or by your physician.

• Head lice Return to Top

• Head lice

• Pediculus humanus, capitis treatment

• Preferred regimen (1): Permethrin 1% lotion apply to shampooed dried hair for 10 min.; repeat in 9-10 days
• Preferred regimen (2): Malathion 0.5% lotion (Ovide) apply to dry hair for 8–12hrs, then shampoo (2 doses 7-9 days apart)
• Alternative regimen: Ivermectin 200 μg/kg PO once; 3 doses at 7 day intervals reported effective.

• Pubic lice Return to Top

• Pubic lice

• Phthirus pubis treatment

• Preferred regimen (1): Permethrin 1% cream rinse applied to affected areas and washed off after 10 minutes
• Preferred regimen (2): Pyrethrins with piperonyl butoxide applied to the affected area and washed off after 10 minutes
• Alternative regimen (1): Malathion 0.5% lotion applied to affected areas and washed off after 8–12 hours
• Alternative regimen (2): Ivermectin 250 ug/kg PO, repeated in 2 weeks

• Myiasis Return to Top

• Preferred regimen: No medications approved by the FDA are available for treatment
• Note: Fly larvae need to be surgically removed.

• Fly larvae treatment
• Preferred treatment (1): Occlude punctum to prevent gas exchange with petrolatum, fingernail polish, makeup cream or bacon.
• Preferred treatment (2): When larva migrates, manually remove.
• Note (1): Myiasis is due to larvae of flies.
• Note (2): Usually cutaneous/subcutaneous nodule with central punctum.

Scabies

• Scabies Return to Top

• Sarcoptes scabiei treatment

• 1. Adult

• Preferred regimen (1): Permethrin 5% cream applied to all areas of the body from the neck down and washed off after 8–14 hours
• Preferred regimen (2): Ivermectin 200 ug/kg PO qd and repeated in 2 weeks
• Alternative regimen: Lindane (1%) 1 oz of lotion or 30 g of cream applied in a thin layer to all areas of the body from the neck down and thoroughly washed off after 8 hours

• 2. Infants and young children

• Preferred regimen: Permethrin 5% cream applied to all areas of the body from the neck down and washed off after 8–14 hours
• Note: Infants and young children aged< 10 years should not be treated with lindane.

• 3. Crusted Scabies

• Crusted scabies (i.e., Norwegian scabies) is an aggressive infestation that usually occurs in immunodeficient, debilitated, or malnourished persons, including persons receiving systemic or potent topical glucocorticoids, organ transplant recipients, persons with HIV infection or human T-lymphotrophic virus-1-infection, and persons with hematologic malignancies.

• Preferred regimen: (Topical scabicide 5% topical Benzyl benzoate 5% OR topical Permethrin 5% cream (full-body application to be repeated daily for 7 days then twice weekly until discharge or cure) AND treatment with Ivermectin 200 ug/kg PO on days 1,2,8,9, and 15. Additional Ivermectin treatment on days 22 and 29 might be required for severe cases

• 4.Pregnant or Lactating Women

• Preferred regimen: Permethrin 5% cream applied to all areas of the body from the neck down and washed off after 8–14 hours