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Vibrios other than V cholerae that cause human disease are Vibrio parahaemolyticus, Vibrio vulnificus, and Vibrio alginolyticus All are halophilic marine organisms Infection is acquired by exposure to organisms in contaminated, undercooked, or raw crustaceans or shellfish and warm (> 20 C) ocean waters and estuaries Infections are more common during the summer months from regions along the Atlantic coast and the Gulf of Mexico in the United States and from tropical waters around the world Oysters are implicated in up to 90% of food-related cases V parahaemolyticus causes an acute watery diarrhea with crampy abdominal pain and fever, typically occurring within 24 hours after ingestion of contaminated shellfish The disease is self-limited, and antimicrobial therapy is usually not necessary V parahaemolyticus may also cause cellulitis and sepsis, though these findings are more characteristic of V vulnificus infection V vulnificus and V alginolyticus neither of which is associated with diarrheal illness are important causes of cellulitis and primary bacteremia following ingestion of contaminated shellfish or exposure to sea water Cellulitis with or without sepsis may be accompanied by bulla formation and necrosis with extensive soft tissue destruction, at times requiring debridement and amputation The infection can be rapidly progressive and is particularly severe in immunocompromised individuals especially those with cirrhosis with death rates as high as 50% Patients with chronic liver disease and those who are immunocompromised should be cautioned to avoid eating raw oysters Tetracycline at a dose of 500 mg orally four times a day for 7 10 days is the drug of choice for treatment of suspected or documented primary bacteremia or cellulitis caused by Vibrio species V vulnificus is susceptible in vitro to penicillin, ampicillin, cephalosporins, chloramphenicol, aminoglycosides, and fluoroquinolones, and these agents may also be effective V parahaemolyticus and V alginolyticus produce -lactamase and



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Back to the question - to edit a PDF in any meaningful GUI way, you ... and use a server-side PDF library to render the annotations into the PDF .

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History of animal exposure, ingestion of unpasteurized milk or cheese Insidious onset: easy fatigability, headache, arthralgia, anorexia, sweating, irritability Intermittent and persistent fever Cervical and axillary lymphadenopathy; hepatosplenomegaly

Single-drug regimens are not recommended because the relapse rate may be as high as 50% Combination regimens of two or three drugs are most effective Regimens of doxycycline (200 mg/d orally for 6 weeks) plus rifampin (600 mg/d orally for 6 weeks) or streptomycin (1 g/d intramuscularly for 2 weeks) or gentamicin (240 mg intramuscularly once daily for 7 days) have the lowest recurrence rates Longer courses of therapy may be required to prevent relapse of meningitis, osteomyelitis, or endocarditis

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Hasanjani Roushan MR et al Efficacy of gentamicin plus doxycycline versus streptomycin plus doxycycline in the treatment of brucellosis in humans Clin Infect Dis 2006 Apr 15;42 (8):1075 80 [PMID: 16575723] Pappas G et al New approaches to the antibiotic treatment of brucellosis Int J Antimicrob Agents 2005 Aug;26(2):101 5 [PMID: 16039098]

The infection is transmitted from animals to humans Brucella abortus (cattle), Brucella suis (hogs), and Brucella melitensis (goats) are the main agents Transmission to humans occurs by contact with infected meat (slaughterhouse workers), placentae of infected animals (farmers, veterinarians), or ingestion of infected unpasteurized milk or cheese The incubation period varies from a few days to several weeks Brucellosis is a systemic infection that may become chronic In the United States, brucellosis is very rare Almost all US cases are imported from countries where brucellosis is endemic (eg, Mexico, Mediterranean Europe, Spain, South American countries)

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The onset may be acute, with fever, chills, and sweats, but more often is insidious with symptoms of weakness, weight loss, low-grade fevers, sweats, and exhaustion upon minimal activity Headache, abdominal or back pain with anorexia and constipation, and arthralgias are also common The chronic form may assume an undulant nature, with periods of normal temperature between acute attacks; symptoms may persist for years, either continuously or intermittently Fever, hepatosplenomegaly, and lymphadenopathy are the most common physical findings Infection may present with or be complicated by specific organ involvement with signs of endocarditis, meningitis, epididymitis, orchitis, arthritis (especially sacroilitis), spondylitis, or osteomyelitis

History of contact with rabbits, other rodents, and biting arthropods (eg, ticks in summer) in endemic area Fever, headache, nausea, and prostration Papule progressing to ulcer at site of inoculation Enlarged regional lymph nodes Serologic tests or culture of ulcer, lymph node aspirate, or blood confirm the diagnosis

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The organism can be recovered from cultures of blood, cerebrospinal fluid, urine, bone marrow, or other sites Modern automated systems have shortened the time to detection of the organism in blood culture Cultures are more likely to be negative in chronic cases The diagnosis often is made by serologic testing Rising serologic titers or an absolute agglutination titer of greater than 1:160 supports the diagnosis

Tularemia is a zoonotic infection of wild rodents and rabbits caused by Francisella tularensis Humans usually acquire the infection by contact with animal tissues (eg, trapping muskrats, skinning rabbits) or from a tick or insect bite Hamsters and prairie dogs also may carry the organism An investigation of an outbreak of pneumonic tularemia on Martha s Vineyard in Massachusetts implicated lawn-mowing and brush-cutting as risk factors for infection, underscoring the potential for probable aerosol transmission of the organism F tularensis has been classified as a high-priority agent for potential bioterrorism use because of its virulence and relative ease of dissemination Infection in humans often produces a local lesion and widespread organ involvement but may be entirely asymptomatic The incubation period is 2 10 days

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just realized that it is possible to edit PDF files using javascript . I have some, very small, experience in the past writing controls in javascript but.












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