Most of use remember that Fifth disease is a viral infection presenting with a distinctive rash (slapped check) caused by Parvovirus B19.  But do you know the numbering of the other six Contagious Illnesses that are associated with rashes:

1. First Disease – Measles caused by the rubeola virus
2. Second Disease – Scarlet Fever caused by Streptococcus pyogenes Group A
3. Third Disease – German Measles caused by rubella virus
4. Fourth Disease – Dukes Disease – In the late 1880-1900’s it was widely published about but in the 1960’s it was not proven to exist by either epidemiologic criteria or isolation of an etiologic agent.  Now felt to be a mild form of scarlet fever.  Some reports of it being caused by a Coxsackvirus or Echovirus
5. Fifth Disease - Erythema infectiosum caused by Parvovirus B19. Slapped Check
6. Sixth Disease - Exanthem subitum (meaning sudden rash), also referred to as roseola infantum (or rose rash of infants), sixth disease. Presents as rapid onset high fever, followed by a fine red rash when the fever subsides. Caused by Herpes Virus 6.

 

 Ludwig’s Angina:

Ludwig’s angina is most commonly a polymicrobial disease of mixed aerobic / anaerobic bacterial origin. Dental disease is the most common cause of Ludwig’s angina.

Diagnosis is usually made after obtaining a CT scan of the Neck and upper chest. 

Once the diagnosis is made, treatment should consist of broad spectrum antibiotics and surgical evaluation by ENT or Oral Surgery for possible I&D. Aggressive management of the patient’s airway is a must, and the patient should be intubated early in the course of the illness if there is any sign of airway compromise. Nasal intubation may be preferred by ENT/Oral Surgery.

Typical Antibiotics include a Penicillin with clindamycin or metronidazole.

Ludwig’s Angina Trivia:

• Initially described in 1836 by the German physician Wilhelm Frederick von Ludwig.
• It was called angina, which finds its origin from the Greek word, anchone, which means strangulation.  The term, angina was used to connote throat pain and infection as angina originates from the Greek word, anchone, that means strangulation.
• It is believed that Elizabeth I of England died of Ludwig's angina in 1603.

A recent study came out which confirms what we already knew... that MRSA infections are no longer confined to ICUs but are spreading to the community. What the new study does show, is that it affects particular populations disproportionately and Baltimore City, more than any other study population. The full article is attached below, or can be obtained for free from the JAMA website.

"Unadjusted incidence rates of all types of invasive MRSA ranged between approximately 20 to 50 per 100 000 in most ABCs sites but were noticeably higher in 1 site (site 7, Baltimore City) (TABLE 2)." "... we calculated interval estimates excluding site 7 (Baltimore City) to allow the reader to interpret a range of estimates reflecting different metropolitan areas. Regarding the high observed incidence rates reported by site 7, we conducted an evaluation to determine whether these results were valid, including a review of casefinding methods, elimination of cases to include only those with zip codes represented in the denominator, contamination in any laboratory, and other potential causes for increased rates; however, none were in error."

Attachments

• 0710170948_jama_mrsa.pdf (129 Kb)

Important EM pearls from the recent 2007 IDSA/ATS guidelines for treatment of community-acquired pneumonia (CAP) Patients should be treated for a minimum of 5 days CURB-65 a new pneumonic; any patient with ? 2 warrants admission Confusion Uremia elevated Respiratory rate low Blood pressure age > 65 Outpatient CAP treatment Healthy + no abx in past 3 months ? macrolide Comorbidities OR use of abx within last 3 months ? a respiratory fluoroquinolone OR ?-lactam + macrolide Inpatient CAP treatment ICU patients ? ?-lactam + either azithromycin or a respiratory fluoroquinolone Non-ICU patients ? respiratory fluoroquinolone OR ?-lactam + macrolide Mandell LA, et al. Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults Clinical Infectious Diseases 2007;44:S27-S72

PPD is considered positive: >= 15 mm Induration: Anybody >= 10 mm induration: Born in a high-revalence country, are in a medically underserved population ( e.g.:Blacks, Hispanics, and Native Americans), individuals with a medical condition that increases risk of TB (e.g.; silicosis, gastrectomy, chronic renal failure, immunosuppressant therapy, malignancy, IV drug abusers, and those that work in the medical field. >=5mm induration: HIV or suspected HIV-positive, close contacts of newly diagnosed TB Cases (everybody on the plane), and abnormal CXR with fibrotic changes suggesting old TB MMWR September 08, 1995/ 44(RR-11);18-34