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In the newest Febrile Digest, we chat about SCORTCH as a framework for congenital infections. Check out our guest's overview:

Some nice figs below fr the paper 👇

But where did "TORCH" come fr? I tried to take a look in this 🧵

#IDTwitter #IDMedEd ImageImage
2/ From what I could tell, the ToRCH acronym originated in the 1970s and has been attributed to Dr. Nahmias:… Image
There was a proposal from Harold Fuerst for "STORCH" in 1975, to include the omitted syphilis… Image
Read 6 tweets
#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…
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
Read 5 tweets
#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…
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
Read 5 tweets
#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
Read 9 tweets
#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
Read 3 tweets
#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 Image
Read 6 tweets
#idboardreview Peritoneal dialysis pts with exit site infection outbreak. Aqueous Chlorhexidine with gram negative bacteria. dx? #meded #idmeded #idtwitter ImageImage
#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
Read 7 tweets
#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 ImageImage
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…
Read 7 tweets
#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 Image
#Wohlfahrtiimonas #chitiniclastica bacteremia Ref… in this case identified w/ MALDI-TOF; Image Ref…
#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
Read 5 tweets
#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 ImageImage
Endovascular Infection #Kingella #kingae Complicated by Septic Arthritis in Immunocompromised Adult Patient Ref…
#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
Read 6 tweets
#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 ImageImage
Read 10 tweets
#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 Image
Inhalation #tularemia bioterrorism needs standard precautions as
Not transmitted from person to person…
Read 5 tweets
#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 ImageImage
Read 3 tweets
#idboardreview 60 M asymptomatic who recently travelled to Ethiopia underwent screening colonoscopy and this worm was found. Dx? #meded #idmeded #idtwitter Image
The nematode (roundworm) #Trichuris trichiura, also called the human #whipworm Ref @CDCgov…
Read 3 tweets
#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 ImageImageImage
#Cunninghamella bertholletiae characteristic sporangiophores with swollen terminal vesicles and ovoid sporangioles
Read 8 tweets
#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 ImageImage
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
Read 9 tweets
#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 ImageImage
#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
Read 5 tweets
#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 ImageImage
#tularemia Francisella tularensis , an aerobic catalase-positive, gram negative coccobacilli… Image
Read 7 tweets
#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 ImageImage
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…
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
Read 5 tweets
#idboardreview Recently returned traveler from camping trip in Mexico presents w/ abdominal pain, nausea, fever, and bloody diarrhea. O&P: structure with ingested erythrocyte (arrow). dx? #medEd #idmedEd #idtwitter ImageImage
trophozoite form of #Entamoeba #histolytica etiologic agent of #amebiasis… @CDCgov
Read 5 tweets
#idboardreview 40 M presents in summer w/fever, headache, myalagia later rash started on wrists, palms & soles and then diffuse. No hiking or travel. Multiple recent bug bites from her pet dogs who are not uptodate with flea/tick meds. Dx? #meded #idmeded #idtwitter Image
Rocky mountain spotted fever #RMSF…
Read 7 tweets
#idboardreview 45 MSM camp vacation in national park last week, drank stream water now w/ acute diarrhea, foul smelling greasy stool, malaise, no fever. Dx? #medEd #IdMedEd #idtwitter Image
Read 3 tweets
#idboardreview Pt attended a holiday party 4 days ago and ate julesylte Christmas brawn & pork chops now presents w/ fever, R sided abd pain, bloody diarrhea. short gram neg rod. dx? #medEd #idmedEd #idtwitter ImageImage
#yersinia #enterocolitica aerobic & anaerobic growth, non-spore forming, pleomorphic, non-lactose fermenting gram negative bacilli, motile ar 25C but nonmotile at 37C
-growth at 37C on Mcconkey, brain-heart infusion, CIN cefsulodin, irgasan, novobiocin agar
#yersinia #enterocolitica Case Ref… Brawn is prepared by layering pork meat (precooked head muscles), veal, lard, spices in a mold. cooked to 74°C & maintained at 70°C for at least 30 min. After removal from the mold, the brawn is vacuum-packed for sale
Read 9 tweets
#idboardreview 60 yo garbage handler from Pakistan presents w/ fever, severe rice water diarrhea w/fishy odor, hypotension, metabolic acidosis, AKI. BC curvy gram neg rods. Dx? #meded #idmedEd #IDTwitter ImageImage
Vibrio #cholera curved gram neg rod, fecal oral, poor sanitation, severe watery diarrhea to death. Pics Ref…
#cholera Infographic Ref: graphic guide to ID by Kloss Image
Read 10 tweets

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