Sandbox ID Systemic

Babesiosis

• Preferred regimen (1): Combined therapy with Clindamycin and Quinine
• Preferred regimen (2): Both atovaquone (a hydroxy-1,4-naphthoquinone) alone and azithromycin (an azalide macrolide) alone appeared to be effective.

Note : Neither the regimen of atovaquone and azithromycin nor the regimen of clindamycin and quinine clears Babesiosis microti merozoites from the human blood as rapidly as might be desired.

Fever of unknown origin

• Fever of unknown origin (FUO)

• Management should generally be withheld until the etiology of the fever has been ascertained, so that treatment can be directed against a specific pathology.
• Specific considerations

• Neutropenic fever

• Exception may be made for neutropenic patients in which delayed treatment could lead to serious complications.
• After samples for cultures are obtained, patients with febrile neutropenia should be aggressively treated with broad-spectrum antibiotics covering Pseudomonas.

• HIV/AIDS individuals

• HIV-infected persons with pyrexia and hypoxia should be placed on empiric therapy for Pneumocystis jirovecii.

• Giant cell arteritis

• Empiric corticosteroids may be considered in patients with suspected giant cell arteritis to prevent vascular complications.
• Giant cell arteritis should be suspected in a patient over the age of 50 with the following symptoms:

• Newly onset headaches
• Abrupt onset of blurry vision
• Symptoms of polymyalgia rheumatica
• Jaw claudication
• Unexplained anemia
• Elevated ESR and/or CRP