每日一题_2022.2.6

A 43-year-old male presents to the emergency department with a two-week history of worsening fever and cough. Further history reveals that the patient returned from a vacation in Jamaica one month earlier. He initially sought treatment with a primary care provider and was prescribed azithromycin and prednisone, but when his symptoms worsened, he sought care in the emergency department. On examination, the patient is dyspneic and has an unusual periumbilical petechial rash. He is admitted and deteriorates shortly after, developing hemoptysis, hypoxemia, and respiratory distress. His chest x-ray demonstrates findings consistent with pulmonary edema or alveolar hemorrhage. Bronchoalevolar lavage is performed, and reveals the organism seen here. 

每日一题_2022.2.6

Which treatment is most appropriate for his infection?

A. Levamisole

B. Ivermectin

C. Voriconazole

D. Albendazole

答题情况:

每日一题_2022.2.6

该患者的支气管肺泡灌洗显示粪类圆线虫幼虫。患者可能在牙买加(类圆线虫流行地区)获得感染。丝状幼虫在污染的土壤上赤脚行走时穿透人体皮肤,粪类圆线虫可在人宿主体内完成生命周期导致自身感染。脐周指纹寄生虫性紫癜是幼虫经血管壁或大肠壁真皮移行所致,并提示预后不良。在这种情况下,使用类固醇可能将亚临床类圆线虫感染转化为播散性超感染,引起弥漫性肺泡出血。
伊维菌素是轻度和重度类圆线虫病的推荐治疗药物。阿苯达唑已被成功使用,但治愈率较低。左旋咪唑是一种抗蠕虫药物,可引起人类血管炎,偶尔作为可卡因的污染物被发现。最后,伏立康唑是一种抗真菌药物,治疗类圆线虫病无效。

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