Primary and Secondary Syphilis- Neurologic or ophthalmic signs or symptoms- Treatment failureAlthough patients with primary and secondary syphilis often have early CNS invasion by spirochetes, the majority of these patients do not go on to develop clinical neurosyphilis when given the standard treatment regimens used for primary and secondary syphilis. Therefore, a CSF evaluation is not recommended in patients with primary and secondary syphilis in the absence of clinical manifestations of neurosyphilis.
Latent Syphilis- Neurologic or ophthalmic signs or symptoms- Evidence of active tertiary syphilis (e.g., aortitis, gumma, iritis)- Treatment failure- HIV infection with late latent syphilis or syphilis of unknown durationA common problem in the primary care setting is the elderly patient with some cognitive deficits who is found to have a reactive serologic test for syphilis with an unknown or remote history of treatment. While strict adherence to sexually transmitted disease treatment guidelines would dictate a CSF evaluation in these cases, the likelihood of having treatable disease in this population is small, and there are no recent data in favor or against this practice.*169/348/5*
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Anti-Infectives Comments Off
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Pneumococcal
Pneumococcal vaccine should be a routine immunization for all adults over the age of 65 years and for younger adults with chronic cardiopulmonary disease, anatomic or functional asplenia, cirrhosis, and diabetes mellitus. Since antibiotic-resistant strains of Streptococcus pneumoniae are being increasingly reported throughout the world and access to effective antibiotics may be limited while abroad, the pneumococcal vaccine should also be considered for travelers to developing countries.Influenza
In the United States, vaccination against influenza is routinely recommended for persons 65 years of age or older, for those with chronic cardiopulmonary conditions, and for persons who anticipate disease exposure. The influenza vaccine is also recommended for all international travelers during influenza season. While influenza typically occurs from November until March in the Northern Hemisphere, the incidence of the disease peaks from April until September in the Southern Hemisphere. Furthermore, influenza may occur at any time of year in the tropics. Practitioners should administer the most current vaccine available, since this is formulated on the recent epidemiology of the influenza virus.
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Acute varicella (chickenpox) may be severe, particularly in adults, and can complicate travel and delay return home. Travelers may be exposed to this highly communicable virus (varicella-zoster virus) while traveling to their destination or through exposure to local populations after arrival. The status of varicella immunity should be reviewed in long-term travelers as well as in those whose activities bring them into contact with children in schools, day care centers, refugee camps, or health care settings. Adults who give no history of varicella or prior immunization should be tested for the presence of antibodies, since 71% to 93% of adults without a reliable history are actually immune. Adults who grew up in tropical or subtropical countries are more likely to be at risk, since varicella infection is rare in childhood in these locations. Children 1 to 12 years of age should receive a single dose of vaccine (Varivax, Merck), and those 13 years of age or older should receive two doses of vaccine 4 to 8 weeks apart. Varicella vaccine may be administered concurrently (but at different sites) with any other vaccine. Pregnant and immunocompromised individuals should not receive this live attenuated vaccine. Immunization should occur prior to the initiation of anti-malarial chemoprophylaxis, since these drugs will interfere the effectiveness of the vaccine.
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