A 4-year-old girl presents with a 2-day history of muscle weakness. Her parents state she has stopped walking, and she tells them her legs feel “loose.” Two weeks ago, she had mild flu-like symptoms, including fever, sore throat, headache, and fatigue. Her family is seeking asylum from West Africa. Her vitals are blood pressure 110/78 mm Hg, heart rate 64 bpm, respiratory rate 15 breaths/min, and temperature 98 °F (36.7 °C). The physical examination demonstrates asymmetric proximal muscle weakness in the lower extremities and the absence of reflexes. Polymerase chain reaction confirms the suspected diagnosis. A vaccine would have prevented this child’s condition. Which of the following is a component of this vaccine?

Primary infection with this organism in immunocompetent persons typically follows ingestion of raw or undercooked meat. Although most acute infections are asymptomatic, some patients present with a mild febrile illness resembling infectious mononucleosis. What is the most likely causative pathogen for this illness?

A 30-year-old woman presents with a 4-day history of extreme vulvar pruritus and vaginal discharge. The discharge is thick and white, moderate in amount, without associated foul odor. Her PMH is significant for poorly controlled diabetes for 2 years. On external exam, the vulva is erythematous with excoriations and presence of white plaques on the vaginal walls. The diagnosis was confirmed by examination of the wet-mount preparation of the discharge. Which of the following interventions is the most appropriate treatment for this patient?

Clinical manifestations of botulism typically include a descending symmetric flaccid paralysis.

This type of atypical mycobacterium is found in fresh water or salt water; infection occurs following exposure of a skin or soft tissue injury to the organism, often in a fish tank or other marine animal setting, and typically results in granuloma formation.

A 54-year-old male with HIV presents to the Emergency Department with worsening dry cough, now with increasing shortness of breath. He is currently on antiretroviral therapy. On exam, his temperature is 98.4°F (36.9°C), blood pressure is 124/83 mmHg, pulse is 110/min, respirations are 24/min, and oxygen saturation is 91% on room air. Diffuse crackles are present upon auscultation of bilateral lungs. His most recent CD4 cell count is 140/mm3 and an arterial blood gas reveals a PaO2 of 60 mmHg. CXR is noted to have extensive interstitial infiltrates. Which of the following is the most appropriate treatment for the patient at this time?

A 12-month-old boy presents with a rash that followed a 2-day fever of 102°F. His mother states that she saw a pink, raised rash on the child’s trunk as the fever went away. “The rash looks like pink or red spots that turn white when I touch them.” On physical exam, the child is currently afebrile, and there is a diffuse, maculopapular rash on the chest, abdomen, and thighs. The rash spares the face, palms, and soles. The child has no symptoms of upper respiratory infection, and the physical examination is otherwise normal. Which of the following conditions is the most likely diagnosis for this patient?

A woman presents to your office after a 6-month sabbatical during which she worked in caves in the eastern part of South America. The patient reports fever, chills, productive cough, and joint stiffness that started 1 month before her return. Physical exam reveals 3 ulcerated lesions on her inner cheek. Which of the following is the most appropriate treatment for this patient?

A 4-year-old boy develops fever and an upper respiratory infection in late December. On physical examination, the pediatrician notes whitish spots in his mouth near his second molars (see image below). A day later the boy develops a rash on his face. The rash consists of reddened macules and papules. Within the next several days, the rash becomes confluent and moves downward over his whole body. Which of the following interventions would be most helpful in confirming the diagnosis of this condition? 

Systemic Inflammatory Response Syndrome (SIRS) defines a clinical response to a nonspecific insult of either infectious or noninfectious origin and may be caused by ischemia, inflammation, trauma, infection, or several insults combined.