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23 male hiker from Michigan presented with 4 days history of fever, malaise, nausea, vomiting, joint aches. Physicals unremarkable and no rash seen.
CBC showed severe leukopenia. Gram stain did not help.
Blood film is here
fasf.jpg
click image to enlarge

What is the drug of choice?
Doxycyclin
TMP-SMX
Amantidine
Flucanazole
Mebendazole
 

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This picture is small to really tell if those are yeast forms or not, but the attached picture is what Histoplasmosis would look like on a blood smear.

I think the key here is in the history/presentation. Histoplasmosis does not classically cause leukopenia. Additionally, we are told that the man is a hiker. This should clue us in on some sort of tick borne disease or arbovirus type infection.

I did not know that this was Erlichiosis, but since the question was asking about treatment, I was able to guess right with Doxycycline. As a general rule, many of the rare infections such as those that are tick borne (lyme, RMSF, etc) are usually treated with Doxycycline.
 

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This picture is small to really tell if those are yeast forms or not, but the attached picture is what Histoplasmosis would look like on a blood smear.

I think the key here is in the history/presentation. Histoplasmosis does not classically cause leukopenia. Additionally, we are told that the man is a hiker. This should clue us in on some sort of tick borne disease or arbovirus type infection.

I did not know that this was Erlichiosis, but since the question was asking about treatment, I was able to guess right with Doxycycline. As a general rule, many of the rare infections such as those that are tick borne (lyme, RMSF, etc) are usually treated with Doxycycline.
thank you :)
 
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