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Saw cerebral toxoplasmosis today so here my quick refresher 🧵
🎙Toxoplasmosis:
🦠- protozoal infection caused by Toxoplasma gondii
Transmission - food borne (🥩🥬), zoonotic (🐈), congenital, blood transfusion, organ transplantation
Saw cerebral toxoplasmosis today so here my quick refresher 🧵
🎙Toxoplasmosis:
🦠- protozoal infection caused by Toxoplasma gondii
Transmission - food borne (🥩🥬), zoonotic (🐈), congenital, blood transfusion, organ transplantation
🔎- in immunocompetent pts, it’s usually asymptomatic (maybe flu like illness or chorioretinitis), lifelong
In immunocompromised pts are at risk for reactivation of toxo
👇🏼
💡HIV w/ CD4 < 200
💡SOT
‼️Make sure to screen all organ donors & recipients
⚡️Highest risk of infection
In immunocompromised pts are at risk for reactivation of toxo
👇🏼
💡HIV w/ CD4 < 200
💡SOT
‼️Make sure to screen all organ donors & recipients
⚡️Highest risk of infection
is D+/R-. Most common in 🫀
⚡️Commonly in the first 6 mo post transplant & in those not on Bactrim ppx
📌Pneumonitis - similar to PCP
📌🧠 mass lesions or encephalitis ➡️ CSF might have ⬆️ protein & mononuclear pleocytosis
📌Myocarditis (commonly mistaken for 🫀allograft
⚡️Commonly in the first 6 mo post transplant & in those not on Bactrim ppx
📌Pneumonitis - similar to PCP
📌🧠 mass lesions or encephalitis ➡️ CSF might have ⬆️ protein & mononuclear pleocytosis
📌Myocarditis (commonly mistaken for 🫀allograft
#IDBoardPearls #IDtwitter #IDPhotoQuiz
📟 8 YO admitted w/ flushing, an urticaria rash on face & torso, and itching
His mom says the rash occurred within an hr of him eating a tuna sandwich. He complained of a spicy taste & had perioral burning causing her to seek medical help
📟 8 YO admitted w/ flushing, an urticaria rash on face & torso, and itching
His mom says the rash occurred within an hr of him eating a tuna sandwich. He complained of a spicy taste & had perioral burning causing her to seek medical help
❓What is the most likely diagnosis?
Answer: Scombroid poisoning
👇🏼
🎙Fish Poisoning Syndromes:
🚨Scombroid:
⚡️commonly misdiagnosed as a seafood allergy so be 👀
Due to the incorrect storage of 🐟 (above 4C) ➡️ bacterial overgrowth & ⬆️ histamine (by bacterial enzyme called histidine decarboxylase)
👇🏼
🦠- Kleb
👇🏼
🎙Fish Poisoning Syndromes:
🚨Scombroid:
⚡️commonly misdiagnosed as a seafood allergy so be 👀
Due to the incorrect storage of 🐟 (above 4C) ➡️ bacterial overgrowth & ⬆️ histamine (by bacterial enzyme called histidine decarboxylase)
👇🏼
🦠- Kleb
#IDBoardPearls #IDtwitter #IDPhotoQuiz
📟 14 YO boy from Ghana with 🤒 & malaise reports a 5 week history of mulriple skin lesions, which are show below. The lesions on his legs are painful & pruritic. He says multiple kids from his school have them too
🧪- VDRL & FTA-ABS +
📟 14 YO boy from Ghana with 🤒 & malaise reports a 5 week history of mulriple skin lesions, which are show below. The lesions on his legs are painful & pruritic. He says multiple kids from his school have them too
🧪- VDRL & FTA-ABS +
❓What organism most likely caused this?
Answer: Treponema pallidum subsp pertenue
🎙Endemic Treponematoes:
🚨Yaws:
🦠- Treponema pallidum subsp pertenue
🗺- Africa, Asia, Latin America, Pacific Islands
Incubation ⏲- 3 wks
Transmission - auto inoculation, close contact with infected lesion
🔎- 🧒🏻👧🏻
Primary Stage -
🎙Endemic Treponematoes:
🚨Yaws:
🦠- Treponema pallidum subsp pertenue
🗺- Africa, Asia, Latin America, Pacific Islands
Incubation ⏲- 3 wks
Transmission - auto inoculation, close contact with infected lesion
🔎- 🧒🏻👧🏻
Primary Stage -
❓Can you differentiate between the 3 most common types of amebic encephalitis… follow the 🧵
1️⃣ Naegleria fowleri:
📍- 🌎wide. In warm water & soil
👇🏼
Trophozoites ➡️👃🏼➡️ olfactory nerves ➡️ 🧠
🔎- primary amebic meningioencephalitis -
⚡️incubation ⏲ - 5 days
⚡️fatal
1️⃣ Naegleria fowleri:
📍- 🌎wide. In warm water & soil
👇🏼
Trophozoites ➡️👃🏼➡️ olfactory nerves ➡️ 🧠
🔎- primary amebic meningioencephalitis -
⚡️incubation ⏲ - 5 days
⚡️fatal
🧪- ⬆️ ICP w/ ⬇️glucose, ⬆️protein & RBCs
🔬- motile trophozoites can be see in CSF wet mount,
brain biopsy (no cysts will be seen)
2️⃣ Acanthamoeba spp.
📍- 🌎wide. In fresh water, brackish water, HVAC, & soil
🔎
Keratitis - contact lens
Cutaneous - papules ➡️ ulcer
🔬- motile trophozoites can be see in CSF wet mount,
brain biopsy (no cysts will be seen)
2️⃣ Acanthamoeba spp.
📍- 🌎wide. In fresh water, brackish water, HVAC, & soil
🔎
Keratitis - contact lens
Cutaneous - papules ➡️ ulcer
#IDBoardPearls #IDtwitter #IDPhotoQuiz
📟 54 YO M with type II diabetes presents with a mobile, nontender node on the left side of his neck.
Biopsy culture:
📟 54 YO M with type II diabetes presents with a mobile, nontender node on the left side of his neck.
Biopsy culture:
❓Clinical presentation & micro is consistent with what infection?
Answer: Actinomyces spp
🎙Cervicofacial Actinomycosis:
Risk factors - diabetes, trauma, 🦷 infections
🧫- “sulfur granules,” molar 🦷 appearing colonies on plates
👇🏼
vs Nocardia’s chalky white ➡️ orange color
🎙Cervicofacial Actinomycosis:
Risk factors - diabetes, trauma, 🦷 infections
🧫- “sulfur granules,” molar 🦷 appearing colonies on plates
👇🏼
vs Nocardia’s chalky white ➡️ orange color
#IDBoardPearls #IDtwitter #IDPhotoQuiz
📟 A farmer from the Dominican Republic is here in the US visiting family & presents with a swollen foot that has been progressing over the past 8 years
📸 of his R foot along with biopsy of lesion
📟 A farmer from the Dominican Republic is here in the US visiting family & presents with a swollen foot that has been progressing over the past 8 years
📸 of his R foot along with biopsy of lesion
❓What is the mostly likely organism?
Answer: Madurella mycetomatis
🎙Cutaneous Fungal/Mold Infections:
🚨Madurella mycetomatis: Eumycetoma or “Madura foot”
🔎- traumatic inoculation ➡️ chronic nodular lesions w/ sinus tracts w/ macroscopic grains ➡️ 🦴 Evolve over yrs
🔬- grain w/ numerous hyphae
👇🏼
This is fungal
🎙Cutaneous Fungal/Mold Infections:
🚨Madurella mycetomatis: Eumycetoma or “Madura foot”
🔎- traumatic inoculation ➡️ chronic nodular lesions w/ sinus tracts w/ macroscopic grains ➡️ 🦴 Evolve over yrs
🔬- grain w/ numerous hyphae
👇🏼
This is fungal
#IDBoardPearls #IDtwitter
Derm round ✌🏼. Let’s do this…
Bacterial Skin Diseases. Follow the 🧶
1️⃣ Impetigo: superficial epidermis
🔎- vesicles/pustular ➡️ crust “🍯 yellow”
🦠- GAS, S aureus
‼️ S aureus causes bullous impetigo similar to poison ivy
Derm round ✌🏼. Let’s do this…
Bacterial Skin Diseases. Follow the 🧶
1️⃣ Impetigo: superficial epidermis
🔎- vesicles/pustular ➡️ crust “🍯 yellow”
🦠- GAS, S aureus
‼️ S aureus causes bullous impetigo similar to poison ivy
❓What other skin manifestations does GAS cause? 👇🏼
2️⃣ Erysipelas: upper dermis and superficial lymphatics
🔎- acute, well-demarcated, 😣, erythematous lesion, 🤒
🦠- GAS, B hemolytic strep
3️⃣ Cellulitis: deeper dermis, subQ tissue
🔎- erythema, warmth, edema, not well-
2️⃣ Erysipelas: upper dermis and superficial lymphatics
🔎- acute, well-demarcated, 😣, erythematous lesion, 🤒
🦠- GAS, B hemolytic strep
3️⃣ Cellulitis: deeper dermis, subQ tissue
🔎- erythema, warmth, edema, not well-
demarcated
🦠- strep (GAS), S aureus
4️⃣ Necrotizing Fasciitis: muscle, fascia, & fat
🔎- initially spares skin, hence, pain out of proportion to PE ➡️ skin crepitus ➡️ discoloration ➡️ bullae ➡️ tissue necrosis ➡️ sepsis, HD instability
🦠- Type I: mixed aerobic & anaerobic
🦠- strep (GAS), S aureus
4️⃣ Necrotizing Fasciitis: muscle, fascia, & fat
🔎- initially spares skin, hence, pain out of proportion to PE ➡️ skin crepitus ➡️ discoloration ➡️ bullae ➡️ tissue necrosis ➡️ sepsis, HD instability
🦠- Type I: mixed aerobic & anaerobic
#IDboardpearls #IDtwitter
Derm… ☠️ Let’s break it down starting with viral exanthems. Follow the 🧶
🚨Coxsackievirus:
1️⃣✋🏼,🦶🏼, & mouth disease - Coxsackie A > Coxsackie B or EV71
🔎 - 😣 ulcerative lesions on hard palate, 👅, buccal mucosa ➡️ vesicular rash on 🤲🏼 &🦶🏼
Derm… ☠️ Let’s break it down starting with viral exanthems. Follow the 🧶
🚨Coxsackievirus:
1️⃣✋🏼,🦶🏼, & mouth disease - Coxsackie A > Coxsackie B or EV71
🔎 - 😣 ulcerative lesions on hard palate, 👅, buccal mucosa ➡️ vesicular rash on 🤲🏼 &🦶🏼
2️⃣ Atypical HFMD
🔎- vesiculobullous rash or crusted papules (Gianotti-Crosti syndrome). Associated with skin and 💅🏼 peeling. At sites of atopic eczema (eczema coxsackium)
🚨Parvovirus B19:
1️⃣ Erythema infectiosum - Fifth disease
🔎- 👋🏼 cheek syndrome ➡️ lacy erythematous
🔎- vesiculobullous rash or crusted papules (Gianotti-Crosti syndrome). Associated with skin and 💅🏼 peeling. At sites of atopic eczema (eczema coxsackium)
🚨Parvovirus B19:
1️⃣ Erythema infectiosum - Fifth disease
🔎- 👋🏼 cheek syndrome ➡️ lacy erythematous
rash on truck & limbs
2️⃣ Papular-purpuric (🧤&🧦) syndrome
🔎- pruritic erythema & edema of distal limbs (sharp demarcation at wrists/ankles ➡️ petechial or purpuric
🚨Measles:
1️⃣ Measles exanthem
🔎- starts behind the 👂🏼then spreads to face, trunk, limbs (🤲🏼🦶🏼)
2️⃣ Atypical
2️⃣ Papular-purpuric (🧤&🧦) syndrome
🔎- pruritic erythema & edema of distal limbs (sharp demarcation at wrists/ankles ➡️ petechial or purpuric
🚨Measles:
1️⃣ Measles exanthem
🔎- starts behind the 👂🏼then spreads to face, trunk, limbs (🤲🏼🦶🏼)
2️⃣ Atypical
#IDBoardPearls #IDtwitter
Post-exposure prophylaxis. As with all things, timing maters 😷
1️⃣ HAV:
Indications - close contacts, child care & school contacts, food handlers
⏲ 2 weeks - 💉
👉🏼 + Ig if > 60 YO or immunocompromised
⏲ 28 days - 💉
👉🏼 + Ig if chronic liver disease
Post-exposure prophylaxis. As with all things, timing maters 😷
1️⃣ HAV:
Indications - close contacts, child care & school contacts, food handlers
⏲ 2 weeks - 💉
👉🏼 + Ig if > 60 YO or immunocompromised
⏲ 28 days - 💉
👉🏼 + Ig if chronic liver disease
or Hep B/C infection
⏲ 8 weeks - 💉 if there are > 1 close contacts in 🏠
2️⃣ HBV:
Indications - percutaneous or mucosal exposure, sex or needling sharing contact, victim of sexual assault
⏲- within 24 hrs, up to 7 days
📌Unvaccinated 🧍🏻♀️+ source HBsAg + ➡️ 💉 + Ig
⏲ 8 weeks - 💉 if there are > 1 close contacts in 🏠
2️⃣ HBV:
Indications - percutaneous or mucosal exposure, sex or needling sharing contact, victim of sexual assault
⏲- within 24 hrs, up to 7 days
📌Unvaccinated 🧍🏻♀️+ source HBsAg + ➡️ 💉 + Ig
📌Vaccinated 🧍🏻♀️+ source HBsAg + ➡️ booster 💉
📌Unvaccinated 🧍🏻♀️+ source HBsAg - (or unknown) ➡️ 💉 series
📌Vaccinated 🧍🏻♀️+ HBsAg - (or unknown) ➡️ no treatment
3️⃣ VZV:
Indications - face to face contact or in a room for > 15 min with the following:
📌exposure to chickenpox or
📌Unvaccinated 🧍🏻♀️+ source HBsAg - (or unknown) ➡️ 💉 series
📌Vaccinated 🧍🏻♀️+ HBsAg - (or unknown) ➡️ no treatment
3️⃣ VZV:
Indications - face to face contact or in a room for > 15 min with the following:
📌exposure to chickenpox or
#IDBoardPearls #IDtwitter
I get tripped up on these so let’s go over them… head/neck space infections 🤕
1️⃣ Peritonsillar abscess: “Quinsy”
📍- between the tonsil & the pharyngeal muscle
🦠- strep, staph, anaerobes
Clinical: swollen tonsils + uvula deviation, 🤤, trismus, 🤒
I get tripped up on these so let’s go over them… head/neck space infections 🤕
1️⃣ Peritonsillar abscess: “Quinsy”
📍- between the tonsil & the pharyngeal muscle
🦠- strep, staph, anaerobes
Clinical: swollen tonsils + uvula deviation, 🤤, trismus, 🤒
‼️ vs - Epiglottis, which has a normal pharyngeal exam. “Worst sore throat of my life” + hoarseness + 🤤
👇🏼
2️⃣ Epiglottis:
📍- invasive cellulitis of the epiglottis
🦠 - Hib (prior to 💉), sometimes no 🆔
Clinical - hoarseness (“muffled voice”), 🤤,🤒, 🍒red epiglottis, 👍🏼 print
👇🏼
2️⃣ Epiglottis:
📍- invasive cellulitis of the epiglottis
🦠 - Hib (prior to 💉), sometimes no 🆔
Clinical - hoarseness (“muffled voice”), 🤤,🤒, 🍒red epiglottis, 👍🏼 print
sign on lateral xrays
‼️ attempt to use 👅depressor ➡️ 🆘 airway
‼️ vs - Croup. 👶🏻 less toxic, +coughing, no 🤤
3️⃣ Ludwig’s Angina:
📍- b/l floor of the mouth (sublingual + submylohyoid)
🦠- polymicrobial ➡️ 🦷 infection (2nd & 3rd molars)
Clinical -
‼️ attempt to use 👅depressor ➡️ 🆘 airway
‼️ vs - Croup. 👶🏻 less toxic, +coughing, no 🤤
3️⃣ Ludwig’s Angina:
📍- b/l floor of the mouth (sublingual + submylohyoid)
🦠- polymicrobial ➡️ 🦷 infection (2nd & 3rd molars)
Clinical -
