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#idboardreview A college football player w/fever & Left leg hot tender erythema from ankle to mid-calf. There is no nodularity, fluctuance, drainage, purulence, or evidence of lymphangitis. Antibiotic choice? #idtwitter #idmeded #meded pic for ref only 
non-purulent cellulitis likely due to strep pyogenes so first gen cephalosporins so cephalexin or cefadroxil is reasonable choice
Ref IDSA SSTI guidelines idsociety.org/practice-guide…
ICU Infectious Disease Pearls and Pet Peeves-Part3: These are some extra points & random thoughts regarding commonly used antimicrobials & frequently encountered ID scenarios in the ICU. Comments from ID & Pharm friends are welcome as what I post comes from memory. Here it goes:
1. Especially in immunosuppressed patients with severe septic shock, don’t be in a hurry to de-escalate the antibiotics when the Microbiology lab calls you to report a positive blood culture result. In a number of patients, likely close to 5%, the bacteremias can be polymicrobial
2. The role of anaerobes in aspiration pneumonia is probably over-rated. Not much else to say here since the topic is extensively discussed recently. The message is that anaerobic coverage is frequently redundant. In addition, there is a huge debate about...
ICU Infectious Disease Pearls and Pet Peeves – Part2: These are some additional points and random thoughts regarding commonly used antimicrobial agents and frequently encountered ID clinical scenarios in the ICU. Comments from my ID and Pharm friends are welcome. Here it goes:
1. Candida pneumonia is essentially a non-existent entity (except in the presence of SEVERE immunodeficiency). Candida in the sputum is almost always a colonizer. You can use it as a marker of systemic candidiasis in order to justify antifungal coverage but the studies...
...are not supportive of significant clinical benefit
2. If u suspect Candida in a septic pt, echinocandin (not an azole) is the preferred empirical tx. Most people in US start w 100 mg of micafungin but u can easily give 150 or even 200 (if your pharmacist doesn't freak out...)
2. If u suspect Candida in a septic pt, echinocandin (not an azole) is the preferred empirical tx. Most people in US start w 100 mg of micafungin but u can easily give 150 or even 200 (if your pharmacist doesn't freak out...)
#idboardreview 17 M w/hx of meningitis s/p course of iv ceftriaxone. Now 2 wks later present with fever, RUQ abd pain. Ultrasound: gallstones that disappeared on repeat imaging in 2 weeks. dx? #idtwitter #idmeded #meded
#Ceftriaxone-associated #pseudocholelithiasis Ceftriaxone, excreted & concentrated in gallbladder bile, can form a precipitate, ceftriaxone–calcium salt, which may cause biliary sludge formation rarely in pts who receive high-dose treatment (≥2 g)
incidence around 20%. #ceftriaxone induced #pseudocholelithiasis occurs within 4–17 days of administration & generally disappear by 10–26 days after ceftriaxone discontinuation 10.1016/s0140-6736(89)90228-6
1/
In the newest Febrile Digest, we chat about SCORTCH as a framework for congenital infections. Check out our guest's overview: pubmed.ncbi.nlm.nih.gov/32586930/
Some nice figs below fr the paper 👇
But where did "TORCH" come fr? I tried to take a look in this 🧵
#IDTwitter #IDMedEd
In the newest Febrile Digest, we chat about SCORTCH as a framework for congenital infections. Check out our guest's overview: pubmed.ncbi.nlm.nih.gov/32586930/
Some nice figs below fr the paper 👇
But where did "TORCH" come fr? I tried to take a look in this 🧵
#IDTwitter #IDMedEd
2/ From what I could tell, the ToRCH acronym originated in the 1970s and has been attributed to Dr. Nahmias: nature.com/articles/pr197…
3/
There was a proposal from Harold Fuerst for "STORCH" in 1975, to include the omitted syphilis
publications.aap.org/pediatrics/art…
There was a proposal from Harold Fuerst for "STORCH" in 1975, to include the omitted syphilis
publications.aap.org/pediatrics/art…
#idboardreview Pt recent travel to Malaysia, spend time on the beach now w/ this itchy rash x2wks. Also w/ cough, occasional dyspnea, eosinophilia, ill defined reticulonodular infiltrates on chest CT #idtwitter #idmeded #MedEd
cutaneous larva migrans (#CLM) with #Löeffler’s syndrome. Tx w/ albendazole x7d and symptoms resolved Ref ajtmh.org/view/journals/…
Cutaneous larva migrans frequent travel-associated skin diseases on beach destinations in tropics or subtropics. #Ancylostoma braziliense. Most lesions are on lower extremities. Larvae migrate aimlessly within epidermis at rate of 2mm to 2cm/day lacks enzymes to penetrate deeper
#idboardreview 80 M originally from Philippines w/ yearly travel there, presents w/ fever, abd pain, chills, inc LFTs, +liver abscess. BC+ organism? #meded #idmeded #idtwitter
hypervirulent #klebsiella pneumoniae liver abscess Ref academic.oup.com/ofid/article/7…
Infections with #hypervirulent #Klebsiella pneumoniae isolates most frequently occur among pts with an Asian, Pacific Islander, or Hispanic ethnic background, even in absence of travel to high-prevalence areas (eg, Asian Pacific Rim). Diabetes is also a risk factor
#idboardreview 40 M originally from Cameroon, also travel to Ghana & Mali, now w/6 mo progressive weakness requiring wheelchair use,lethargy, 30lb wt loss, confusion. CSF lymphocytic pleocytosis. dx? #meded #idmeded #IDtwitter
Human African #trypanosomiasis endemic to sub-Saharan Africa & fatal when untreated. parasite Trypanosoma #brucei transmitted by tsetse fly (Glossina spp) vector
2 dz forms T #brucei #gambiense West/Central Africa: slowly progressive illness leading to progressive sx & death over mo-yrs
-T brucei #rhodesiense eastern/ southern Africa: more acute illness that evolves over a span of wks, leading to death w/in months
-T brucei #rhodesiense eastern/ southern Africa: more acute illness that evolves over a span of wks, leading to death w/in months
🔥@Marcelaaos is back with another group of lovely infographics!! Keep scrolling to learn about histo!
First, Histo is NOT just in Ohio!
A nice review article to save on re-drawing endemic mycoses maps: pubmed.ncbi.nlm.nih.gov/32040709/
#IDTwitter #IDMedEd #MedTwitter 1/
First, Histo is NOT just in Ohio!
A nice review article to save on re-drawing endemic mycoses maps: pubmed.ncbi.nlm.nih.gov/32040709/
#IDTwitter #IDMedEd #MedTwitter 1/
Dimorphic fungi means Histo exists as mold form in environment and yeast form at body temperature
@ID_fellows, Want some online mycology references?
Save the Univ of Adelaide's mycology online : adelaide.edu.au/mycology/
and @DrFungus_MSGERC drfungus.org
2/
@ID_fellows, Want some online mycology references?
Save the Univ of Adelaide's mycology online : adelaide.edu.au/mycology/
and @DrFungus_MSGERC drfungus.org
2/
For more on Histo pathogenesis, here are two papers:
pubmed.ncbi.nlm.nih.gov/26920886/
ncbi.nlm.nih.gov/pmc/articles/P…
3/
pubmed.ncbi.nlm.nih.gov/26920886/
ncbi.nlm.nih.gov/pmc/articles/P…
3/
#idboardreview patient on chronic steroids with bilateral lung nodules and skin lesions. Skin AFB stain shown. dx? #meded #idmeded #IDtwitter
#Nocardia species form long, branching, beaded filaments. Organisms that stain with #modified #AFB:
Mycobacterium species
Legionella micdadei (in specimens only)
Nocardia species
Rhodococcus species
Tsukamurella species &
Gordonia species
#iddailypearl
Mycobacterium species
Legionella micdadei (in specimens only)
Nocardia species
Rhodococcus species
Tsukamurella species &
Gordonia species
#iddailypearl
#idboardreview 60 F recent travel to Cairns, Australia, had multiple🦟 bites, 1wk later fever, fatigue, headache, myalgia & arthralgia of hands, wrists, feet & ankles. +itchy papular rash on her face, neck and trunk.Dx? #meded #idmeded #IDTwitter
#idboardreview Peritoneal dialysis pts with exit site infection outbreak. Aqueous Chlorhexidine with gram negative bacteria. dx? #meded #idmeded #idtwitter
#Burkholderia #cepacia is type species of genus Burkholderia & ubiquitous MDR, motile, non–glucose-fermenting, gram-negative organism found in water & soil. Major pathogen in cystic fibrosis & opportunistic pathogen in pts w/ indwelling medical devices & immunosuppression
#idboardreview 60 M 6 months post heart transplant on atovaquone px presents w/ cough, dyspneax10d. CT b/l nodules w/ cavities, l leg mass aspirated. Dx? #meded #idmeded #IDTwitter
Risk factors of #nocardia in #SOT
high calcineurin inhibitor trough levels in month before dx
use of tacrolimus
corticosteroid dose at time of dx
patient age
length of stay in ICU after SOT
academic.oup.com/cid/article/63…
high calcineurin inhibitor trough levels in month before dx
use of tacrolimus
corticosteroid dose at time of dx
patient age
length of stay in ICU after SOT
academic.oup.com/cid/article/63…
#idboardreview Pt w/ LE venous insufficiency found in his camper unconscious and covered in feces and maggots: septic shock, wbc 35k, Cr 6, blood culture w/ gram negative non-motile bacteria. Dx? #meded #idmeded #idtwitter
#Wohlfahrtiimonas #chitiniclastica bacteremia Ref wwwnc.cdc.gov/eid/article/27… in this case identified w/ MALDI-TOF; Image Ref jgid.org/article.asp?is…
#Wohlfahrtiimonas #chitiniclastica was first identified in culture from the third-stage larvae of Wohlfahrtia magnifica flies which are known to cause myiasis, commonly in sheep and cattle
#idboardreview 60 F with Myelodysplastic syndrome presents w/ L knee pain, rash on unilateral sole, PET: L iliac artery uptake. Knee fluid 80k 98% PMN, gram stain gram negative cocobacilli. dx? #meded #idmeded #idtwitter
Endovascular Infection #Kingella #kingae Complicated by Septic Arthritis in Immunocompromised Adult Patient Ref wwwnc.cdc.gov/eid/article/26…
#Kingella kingae gram-negative coccobacillus,normal flora of upper respiratory tract. Causative agent of osteoartricular infections in kids<4 years. Rarely HACEK IE in adults
R.f poor oral hygiene, pharyngitis, & mucosal ulcerations
R.f poor oral hygiene, pharyngitis, & mucosal ulcerations
#idboardreview 50 M Texan welder w/ diarrhea, cough, dyspnea x2d, presented to ED, sepsis and rapid progression to resp fail & death <8hrs after presentation. CT necrotizing pneumonia. +GPR #idtwitter #meded #idmeded
#IdBoardReview sudden onset of fever, bronchitis, pneumonia, severe resp illness outbreak in pts of all ages/immune status that attended a game last week. BAL pleomorphic gm- bacteria. What type of isolation? #IDtwitter #idmedEd #medEd
Inhalation #tularemia bioterrorism needs standard precautions as
Not transmitted from person to person
cdc.gov/infectioncontr…
Not transmitted from person to person
cdc.gov/infectioncontr…
#idboardreview A pt wearing same contact lens for 3 months presents with cloudy vision, photophobia and increasingly exquisite pain in one eye not improved w/topical and oral abx and antivirals. dx? #idmeded #meded #idtwitter
#idboardreview 60 M asymptomatic who recently travelled to Ethiopia underwent screening colonoscopy and this worm was found. Dx? #meded #idmeded #idtwitter
The nematode (roundworm) #Trichuris trichiura, also called the human #whipworm Ref @CDCgov cdc.gov/dpdx/monthlyca…
#idboardreview 50 M s/p renal transplant 50 days ago, present w/ fever, seizures, pneumonia, skin lesions. Biopsy with wide ribbon aseptate hyphae, typical fruiting head on SABDX, LPCB stain. dx? #meded #idmeded #idtwitter
Disseminated #mucormycosis due to #Cunninghamella bertholletiae Pics Ref ir.library.louisville.edu/cgi/viewconten…
#Cunninghamella bertholletiae characteristic sporangiophores with swollen terminal vesicles and ovoid sporangioles
#idboardreview 25 F w/ gross hematuria x 1 mo. Previous remote travel to Kenya & swimming in fresh water lake +eosinophilia, thickening of bladder. Sandy patches appearance in cystoscopy. #IDtwitter #idmeded #meded
Morbidity caused by #schistosome infections is induced by host reaction to eggs of Schistosoma rather than by adult worm itself. Hematuria is classic symptom of urogenital schistosomiasis & often w/urinary frequency, burning micturition, and suprapubic pain or discomfort
#idboardreview 20 F w/ SLE on hydroxychloroquine & recently high dose steroids for SLE flare presents w/F, dyspnea, diarrhea, wbc6k, Na133, COVID/RVPneg, procal9, galactomann neg, dx? #meded #idmeded #idtwitter
#Legionella cavitary pneumonia is atypical presentation of Legionnaire’s disease & more commonly w/ impaired cellular immunity due to corticosteroids (particularly high-dose steroid), immunosuppressive therapy, organ transplant & HIV infection; Case Ref idimages
Cavitation seen w/ #Legionella pneumophila serotypes 1,3,4,5,6,8 as well as L. micdadei, L. bozemanae, L. dumoffii, L. longbeachae.
L. pneumophila 1 is main agent of Legionnaire’s disease. Non-serotype 1 & non-pneumophila Legionella occur in severely immunocompromised hosts
L. pneumophila 1 is main agent of Legionnaire’s disease. Non-serotype 1 & non-pneumophila Legionella occur in severely immunocompromised hosts
#idboardreview 60 F who handles hares w/ 1wk lesion on R 2nd finger +F/chills, HA, axillary lymphadenopathy, no improvement on amoxicillin/clav. Culture+ colonies 2 to 4 mm in size, greenish-white, round, smooth, slightly mucoid. #idmedEd #medEd #IDTwitter
#tularemia Francisella tularensis , an aerobic catalase-positive, gram negative coccobacilli omicsonline.org/open-access/tu…
#idboardreview 30 M chef, 2 🐈4 🐀 pets w/close contact, no bites/scratches present w/ diffuse maculopapular, non-blanching slightly palpable rash some petechiae involves palms/soles. Tender swollen R knee, L Ankle/wrist. #IdMedEd #IDTwitter #medEd
Rat-bite fever is a bacterial infection caused by #Streptobacillus moniliformis, which is more common in North America, and Spirillum minus, which is more common in Asia journals.asm.org/doi/10.1128/CM…
Exposure to #Streptobacillus #moniliformis may involve contact with rat’s saliva or excreta; bite is not necessary to transmit infection. Groups at higher risk: exposure to rats/rodents, snake owners, pet store workers, lab tech, inhabitants of crowded urban dwellings. IP 10d
