@BFMTV

@BFMTV

Antonio Guerrero

@guerreroespejo

A 44-YO♂️, stayed in a rural cottage of France 2 weeks previously: cramping upper abdominal pain with watery diarrhea.
He had passed what he thought were worms in his feces
Eosinophilia
1/6

doi.org/10.1093/cid/ci…
#GITwitter #IDtwitter #microbiology

The specimens: identified as the larvae of the drone fly, Eristalis tenax
These larvae are 2.5–3 cm in length; the posterior tube gives them the name of “rat-tailed maggots”

INTESTINAL MYASIS CAUSED BY ERISTALIS TENAX LARVA
2/6

doi.org/10.1093/cid/ci…
#parasites #GIPath #Doctor

Myiasis caused by E. tenax:
✔️rare but have been
✔️reported from various countries including Europe
✔️most often intestinal myiasis, but cases of infestation of the nasal cavity, urinary tract, and vagina have been described.
3/6

#Doctor #MedStudentTwitter

Read 6 tweets

Antonio Guerrero

@guerreroespejo

A 26-YO♂️ no #sexual contacts other than with his male partner: 6-day of fever, malaise, a swollen parotid gland, & ulcerative lesion on the ipsilateral lower lip.

Mild lymphopenia
⬆️GGT & CRP

1/6
doi.org/10.1016/S0140-…
#IDtwitter #dermatology #EarNoseThroat

PCRs on the throat & ulcer swabs:➕for human #monkeypox (hMPX)
Genomic sequencing: clade IIb variant clustering within the current international mpox virus outbreak

PAROTIDITIS CAUSED BY hMPX virus

2/6
#sexually #maxillofacial #microbiology

7 days after initial presentation, his clinical condition had improved together with a decrease in the parotid swelling and the size of the ulcer.
3/6

#MedTwitter #Doctor #MedStudentTwitter

Read 6 tweets

Antonio Guerrero

@guerreroespejo

A 57-YO Mexican♀️, works on a farm has several pets, including dogs, at home: epigastric fullness, and a 15-pound weight loss.

CT: complex cystic left liver mass.
1/5

doi.org/10.1093/cid/ci…
#gastroenterology #radiology #medicine

Resection: Cyst wall (red➡️), daughter cysts (*) normal liver tissue (yellow⬅️)
🔬acellular laminated wall (*), inner germinal layer (black⬅️), & protoscoleces surrounded by a broad capsule (green⬅️). Refractile hooklets (blue⬅️) & calcareous bodies (red⬅️)
2/5
#GIPath #IDtwitter

ECHINOCOCCAL CYST

The patient underwent total excision of the cyst followed by albendazole therapy for 4 weeks.
3/5

doi.org/10.1093/cid/ci…

#microbiology #GITwitter #MedStudentTwitter

Read 5 tweets

Antonio Guerrero

@guerreroespejo

A 50-YO ♀️ bitten by her pet rat: fever, myalgia, sore throat, headaches a nonpruritic rash on extremities including palms & soles, arthralgias, knees arthritis.

A punctate wound with central necrosis on L palm, & her R thumb.
1/9

#rheumatology #internalmedicine #dermatology

Leukocytosis with neutrophilia
ESR & PCR:⬆️

Purulent R knee synovial fluid:
✔️46 000 cells/mL (88% neutrophils).
✔️Gram stain: scant pleomorphic gram-negative bacilli in chains with lateral bulbar swellings
2/9

doi.org/10.1093/cid/ci…
#microbiology #rheumatologist

Synovial fluid 🧫culture: Streptobacillus moniliformis identified by biochemical testing & confirmed by MALDI-TOF.

RAT BITE FEVER (RBF) WITH SEPTIC ARTHRITIS DUE STREPTOBACILLUS MONILIFORMIS
3/9

#bacteriology #IDtwitter #microbiología

Read 9 tweets

Antonio Guerrero

@guerreroespejo

A 29-YO♂️, 6 months before, HIV + & non–drug-resistant pulmonary tuberculosis, antiretroviral & 4-drug antituberculous therapy initiated but soon reduced to rifampin & isoniazid only: abdominal pain on the L side
CT: ?
1/5

DOI: 10.1056/NEJMicm2206174
#radiologist #GITwitter

CT: an enlarged spleen with numerous hypodense lesions (A).
CD4 cell count: 119/mm3
VIH viral load: 1778 copies/mm3

A splenectomy was performed to evaluate for cancer:
numerous necrotic nodules with purulent discharge (B).
2/5

#microbiology #gastroenterology #IDtwitter

🔬granulomatous inflammation with caseous necrosis (C) and acid-fast bacilli (D, arrowheads).
A tissue🧫: ➖

PCR: ➕for Mycobacterium tuberculosis

SPLENIC TUBERCULOSIS
3/5

#bacteriology #MedTwitter #GIPath

Read 5 tweets

Antonio Guerrero

@guerreroespejo

A 17-YO: a 3-week of dizziness, headache, & weakness of the R leg

MR: ring-enhancing lesions in the frontal lobe & basal ganglia on the L side (A; T1-W) as well as surrounding edema & midline shift (B; T2-W)
1/6

DOI: 10.1056/NEJMicm2202196
#neurology #radiology #IDTwitter

IgG ab for Echinococcus multilocularis & E. granulosus: ➖

Surgical excision🔬: necrotic tissue, granulomatous inflammation, echinococcal laminated membrane (C, arrow) & an intact cyst (D, arrow)

RT-PCR: ➕for E. multilocularis
2/6

#parasitology #Pathologists #pathology

CT imaging of the chest and abdomen did not show any other sites of disease.

CEREBRAL ALVEOLAR ECHINOCOCCOSIS
3/6

DOI: 10.1056/NEJMicm2202196
#microbiology #MedTwitter #Doctor

Read 6 tweets

Antonio Guerrero

@guerreroespejo

A 14-yo ♂️ lived on a farm: a 1-month history of episodic headaches, vomiting, & papilledema
MR: a multiloculated cyst of the brain (A) with a hypointense rim and small projections in T2 phase (B, arrow)
1/5

DOI: 10.1056/NEJMicm2208104
#neurology #radiology #pediatric

Findings suggestive of CYSTIC ECHINOCOCCOSIS.

CT of the body: no other sites of disease.
A craniotomy was performed, during which saline irrigation was used to separate the cyst wall from the brain to avoid rupture.
2/5

DOI: 10.1056/NEJMicm2208104
#IDtwitter #parasitology

🔬: an echinococcal laminated membrane lined by a germinal layer with daughter cysts (Panel D, arrows) and protoscolices (inset, arrows) with hooklets (arrowhead).

PRIMARY CEREBRAL CYSTIC ECHINOCOCCOSIS FROM ECHINOCOCCUS GRANULOSUS
3/5

#microbiology #Pathologists #pathology

Read 5 tweets

Antonio Guerrero

@guerreroespejo

A 46-YO ♂️: oropharyngeal lesions, cervical lymphadenopathy, intermittent fever, hepatosplenomegaly, and deteriorating general health.

Needle aspiration from submandibular lymph node: intra- and extracellular yeasts
1/4

DOI:
doi.org/10.4269/ajtmh.…
#dermpath #mycology

The histopathology of oral lesion showed features of HISTOPLASMOSIS confirmed later from culture of Histoplasma capsulatum on culture
2/4

#IDtwitter #microbiology #MedTwitter

In immunocompetent hosts, when chronic disseminated histoplasmosis occurs from pulmonary infection, oral ulcers, nodules, and vegetative plaques are common and dissemination to liver, spleen, bone marrow, and other organs is frequent.
3/4

#Doctor #MedStudentTwitter #resident

Read 4 tweets

Antonio Guerrero

@guerreroespejo

A 37-YO, farmer in India, #HIV+ immunecompromised ♂️, treatment for suspected pulmonary tuberculosis: papulonodular lesions of 3-month duration over the face, neck, trunk, limbs, palms & soles, & oropharynx; fever & generalized lymphadenopathy
🔬: ?
1/7

#IDTwitter #microbiology

🔬: Blastoconidias within the macrophages.
🧫: Histoplama capsulatum: characteristic colony, conversion to yeast form, characteristic🔬appearance.

PROGRESSIVE DISSEMINATED HISTOPLASMOSIS
2/7

doi: 10.4269/ajtmh.17-0432
#dermpath #mycology #internalmedicine

Diagnosis is usually suspected on visualization of characteristic intracellular yeast (blastoconidias), the pathogenic or tisular form, with a clear rim and garnulomatous cellular infiltrate in tissue specimen or lymph node aspirate
3/7

#MedTwitter #Doctor

Read 7 tweets

Antonio Guerrero

@guerreroespejo

A 31-YO ♂️, sex with men, HIV treatment, HCV: in 2022, fever, cervical lymph nodes & erythemato-squamous papules, with umbilications & ulcerations, vesicles & pustules, & honey-colored crusts on the face, trunk & limbs including his palms & soles
1/7

#IDtwitter #primarycare

PCR: ➕for MPXVirus.
#HIV viral load of < 40 copies/mL and a CD4 + count of 167 cells/mm3

#MPOX (MONKEYPOX)
2/7

#healthcare #internalmedicine #microbiology
doi.org/10.1016/j.idcr…

Supportive care of Mpox was provided, namely,
✔️beta-lactams due to bacterial superinfection of the lesions,
✔️in addition to analgesia, which was initially administered with NSAIDs and then escalated to opioids.
3/7

#MedTwitter #MedStudentTwitter #dermtwitter

Read 7 tweets

Antonio Guerrero

@guerreroespejo

A 32-YO ♂️ sex worker, sex with men unprotected, HIV under treatment: 20 lesions scattered throughout the body of umbilicated, erythematous, violaceous papules with central ulcerations & pustules, fevers, cervical & axillary lymph nodes
1/5

#IDtwitter #primarycare #healthcare

HIV viral load of 1577 copies/mL and a CD4 + count of 932 cells/mm3

PCR: ➕ for Mpox virus

MPOX (MONKEYPOX)
2/5

#internalmedicine #microbiology doi.org/10.1016/j.idcr…

Mpox had been a neglected disease until May, 2022, and since then, there has been a notorious increase in the number of human monkeypox cases in non-endemic areas
3/5

#MedTwitter #MedStudentTwitter #dermtwitter

Read 5 tweets

Antonio Guerrero

@guerreroespejo

An 86-YO ♂️, injury on his L leg 47 years prior, several debridements, skin grafts, & vein stripping procedures: chronic bilateral leg progressive ulcers.

Superficial🧫: multiple organisms including E. coli & coagulase➖Staphylococcus.
1/6

#internalmedicine #IDtwitter

Skin biopsy🔬: bilateral invasive squamous cell carcinomas.

BILATERAL INVASIVE SQUAMOUS CELL CARCINOMAS (MARJOLIN ULCERS)
2/6

#dermatology #dermpath
doi.org/10.1093/cid/ci…

The mean time period between development of a wound to malignancy is 30–35 years.

The most common malignancies seen in Marjolin ulcers are squamous cell carcinomas, but basal cell carcinomas and melanomas have been reported.
3/6

#Doctor #healthcare #MedStudentTwitter

Read 6 tweets

Antonio Guerrero

@guerreroespejo

A 24-YO♀️: a 10-year of episodes of redness & photophobia in eyes, &⬇️visual acuity
SLE: conjunctival hyperemia & peripheral corneal opacification, inflammation & crystalline deposits on the corneal
⬇️
INTERSTITIAL KERATITIS
1/5

DOI: 10.1056/NEJMicm1709103
#eye #internalmedicine

Etiologies:
✔️Bacterial: SYPHILIS, Lyme borreliosis, tuberculosis, etc.
✔️Viral: Herpesviridae (HERPES SIMPLEX, H. zoster, E-B)...
✔️Parasitic: Onchocerciasis, Acanthamoeba...
✔️Immune: Cogan's syndrome, contact lens-associated keratitis, autoimmune disease…
2/5

#microbiology

ESR:⬆️& evaluation for infectious causes: unremarkable.
6 months after the diagnosis of interstitial keratitis: vertigo, tinnitus, & hearing loss.
Audiometry: sensorineural hearing loss in both ears.
Clinical findings consistent with COGAN´S SYNDROME
3/5

#Ophthalmology #MedEd

Read 5 tweets

Antonio Guerrero

@guerreroespejo

A 20-YO ♀️, college wrestling, Mexico: itching in the past 2 months, erythematous & fine-scaling papules with annular plaques having a raised border affecting the face, neck, & torso.
1/6

doi: 10.18502/cmm.6.4.5439
#dermatology #primarycare #MedTwitter

KOH: multiple thin & septate hyphae.
🧫, MALDI-TOF-MS: Trichophyton tonsurans
T. tonsurans was isolated in 4 cases belonging to the school fighting team & from one of the training mats

TINEA GLADIATORUM DUE TO TRICHOPHYTON TONSURANS IN A SCHOLL WRESTLING TEAN
2/6

#mycology

Oral terbinafine for 3 weeks: clinical & mycological cure.
Tinea gladiatorum is a type of dermatophytosis that occurs in combat athletes, such as wrestlers and judo fighters, as a result of Trichophyton species.
3/6

doi: 10.18502/cmm.6.4.5439
#IDtwitter #microbiology #Doctor

Read 6 tweets

Antonio Guerrero

@guerreroespejo

A 32-YO♀️ from Guatemala, Ph+ B-ALL post #chemotherapy: #dyspnea
CT: ground-glass opacities (2A yellow box), interstitial pulmonary edema with septal thickening (2B yellow circles), & pericardial effusion (2C yellow arrows), lymph nodes (2D yellow arrows)
Eosinophilia
1/7

Due to normal ejection fraction, the differential diagnosis of dyspnea included non-cardiogenic pulmonary edema, pneumonitis secondary to chemotoxicity, and infection.
2/7

doi.org/10.1016/j.idcr…
#haematology #radiology #IDtwitter

She progressed to acute hypoxic respiratory failure.

🔬bronchoalveolar lavage: numerous larvae (3A,3B) with short buccal grove (arrow head) and prominent genital primordium (arrow) consistent with STRONGYLOIDES HYPERINFECTION

3/7
#lungdisease #parasitology #Pathologists

Read 7 tweets

Antonio Guerrero

@guerreroespejo

A 24-YO ♂️ 2 years prior bitten by an insect on his left mid-arm in Nicaraguan: within a week, developed a lesion at the site of the bite; over time increased in number and spread in multiple hyperkeratotic, wart-like papules.
1/8

doi.org/10.1093/cid/ci…
#IDtwitter #dermatology

Wet mount slide from cultures of biopsy using rabbit blood agar slant: aggregates of Leishmania promastigotes (arrow), which can be identified based on their elongated shape and flagella.

CUTANEOUS LEISHMANIASIS
2/8

doi.org/10.1093/cid/ci…
#parasitology #MedTwitter

Biopsy cultures in “triple N” media, PCR and DNA sequencing: Leishmania panamensis.

He received a 10-day course of intravenous liposomal amphotericin B. His lesions slowly regressed over 3 months.
3/8

doi.org/10.1093/cid/ci…
#Doctor #microbiology

Read 8 tweets

Antonio Guerrero

@guerreroespejo

A 27-YO ♂️ with #HIV & #syphilis, condomless receptive & insertive vaginal, anal, & oral intercourse with male & female partners: a diffuse, erythematous, macular rash (involved the palms) & umbilicated, pustular lesions on face, arms (A), legs, trunk (B, flank) & neck (C)
1/7

PCR swabbed lesions:➕for #monkeypox

MONKEYPOX in a sexually-active man with HIV and SYPHILIS

He was started on antiretroviral therapy for his recent diagnosis of HIV, & administered IM benzathine penicillin G for syphilis.
2/7

doi.org/10.1016/j.visj…
#IDtwitter #dermatology

As direct contact is the primary mode of transmission, sexual intimacy has been identified as a risk factor for #Mpox, and a high proportion of the current multinational outbreak has been in men who have sex with men.
3/7

#MedTwitter #Doctor

Read 7 tweets

Antonio Guerrero

@guerreroespejo

A 6-YO Bedouin ♂️: a limp, headache, left facial nerve palsy, & left hemiparesis.

Blood eosinophil count of 890/μL.

MRI: a brain cyst.
1/8

DOI: doi.org/10.4269/ajtmh.…
#neurology #pediatric #MedTwitter

Abdominal ultrasound and chest radiography did not reveal additional cysts.
Blood serology (ELISA) for ECHINOCOCCOSIS: ➖

The brain cyst was fully removed surgically.
2/8

DOI: doi.org/10.4269/ajtmh.…
#neuro #Pediatrics #surgery

Histopathological examination of the brain cyst fluid showed several echinococcal larvae (C and D), confirming CYSTIC ECHOCOCCOSIS diagnosis.

Over the following 4 months, he was treated with albendazole without complications.
3/8

#parasitology #microbiology #IDtwitter

Read 8 tweets

Antonio Guerrero

@guerreroespejo

A 39-YO ♂️, same-sex relationships involving condomless anal sex: 38°C, cervical lymphadenopathy, mucosal ulceration on his tongue and a maculopapular rash on his face, neck and anterior chest.
1/5

DOI: doi.org/10.1503/cmaj.2…
#Doctor #emergency #dermatology

RPR: ➖
Immunoassay:➕for HIV antibodies
HIV-1 blood viral load: 4.79 million copies/mL
Blood CD4 T-cell count of 0.1 × 109/L.

ACUTE HIV INFECTION

Started antiretroviral treatment with bictegravir–emtricitabine–tenofovir alafenamide.
2/5

#IDtwitter #microbiology

Features of acute HIV infection occur 2–4 weeks after exposure.
Common presentation includes fever, arthralgia and lymphadenopathy, which may mimic acute mononucleosis.

Seroconversion usually occurs 3–8 weeks after initial infection.
3/5

#virology #MedTwitter

Read 5 tweets

Antonio Guerrero

@guerreroespejo

A 3-month-old ♂️, a dimple at the center of a lumbosacral hemangioma (a): fever & deteriorating condition.

CSF: ⬆️cell count 5717/µL;⬆️protein = 352 mg/dL; ⬇️glucose < 10 mg/dL.

RM (b): ?
1/7

doi.org/10.1016/j.idcr…
#pediatric #IDtwitter #Neurology

RM b): a congenital dermal sinus communicating with the spinal cord.

Enterobacter aerogenes was isolated from CSF and stool cultures

CONGENITAL DERMAL SINUS ASSOCIATED WITH MENINGITIS BY ENTEROBACTER AEROGENES
2/7

#radiology #microbiology #pediatria

Congenital dermal sinus is associated with meningitis caused by atypical pathogens.

Enterobacter aerogenes community-acquired infections associated with congenital dermal sinus are rarely observed.
3/7

#bacteriology #MedTwitter

Read 7 tweets

Antonio Guerrero

@guerreroespejo

A 49-YO♀️: fever, myalgia, headache, blanching papular rash on her trunk & limbs, & conjunctivitis (1)
Neutropenia & mild hepatitis
The patient's husband accompanied the patient to the Cook Islands: a highly similar rash (2)
1/6

doi.org/10.1093/cid/ci…
#IDtwitter #microbiology

Arboviral infection was suspected.
Pan-flavivirus PCR: ➕
PCR was sequenced, & a BLAST search: ➕ for Zika virus.

ZIKA VIRUS INFECTION

The wife (and her husband): recovery over 5 days with no specific treatment.
2/ 6

doi.org/10.1093/cid/ci…
#virology #MedTwitter #MolBiol

Zika virus, endemic to Southeast Asia & Africa, is transmitted by Aedes species mosquitoes.

Clinical manifestations (fever, maculopapular rash, myalgias, and headache) are similar to other arboviral infections, such as dengue and chikungunya,
3/6

#dermatology #Doctor

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