Travis Smith, DO Profile picture
May 30, 2020 10 tweets 5 min read Read on X
Some really good #ClinicalPearls about #Psittacosis with a short #medtweetorial

Something mentioned in today's @CPSolvers #VMR

It's not something that I commonly ask patients with #CAP but I think I will insert the question about them owning a parrot or bird into my questioning
In the 1960s and 1970s it was the model organism that laid the foundation for modern chlamydia research.

Psittacosis is also known as avian chlamydiosis, ornithosis, and parrot fever.

It causes an atypical pneumonia when it infects the lungs.
All birds are susceptible, pet birds and poultry are most frequently involved in transmission to humans but not human to human

It can also be found in non-avian domestic animals, such as cattle & sheep, but cases of clinical disease & transmission to humans have not been proven
It is thought to comprise approximately 1% of all CAP cases but only <50 are reported in the US each year

Due to lack of routine testing, incidence & prevalence are hard to establish.

It is transmitted by air droplets from feces, urine, respiratory secretions, & feather dust.
Dried organisms remain viable for months. YIKES

Infection in the mucosal surfaces of the lung promotes a host immune response, leading to an autoimmune reaction and manifesting as atypical pneumonia
It commonly presents in a young to middle-aged man w/ fever (most common symptom), chills, headache, myalgia, and dry cough.

When systemic, it may present w/ hepatosplenomegaly, hepatitis, endocarditis, myocarditis, and encephalitis
And wait for it......A pulse-temp dissociation (#FagetsSign) has been described for psittacosis pneumonia.

Confirmation is w/ serologic testing, namely micro-immunofluorescent antibody test (MIF).

Cultures are discouraged due to being difficult, infectious to lab personnel
Tx is with doxycycline 100 mg PO or intravenously (IV) 2 times per day for 7 to 10 days.

Macrolides are second-line agents. Azithromycin 250 to 500 mg PO once daily is favored over erythromycin.
Full recovery may take from 6 to 8 weeks, including residual changes on chest films.

Mortality rate in the United States is < 1% with early diagnosis and appropriate treatment

ncbi.nlm.nih.gov/books/NBK52600…

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More from @RosenelliEM

May 30, 2021
Some cool #Syphilis Pearls from an article that @k_vaishnani shared ncbi.nlm.nih.gov/pmc/articles/P… Primary syphilis first manifests into a painless chancre at the site of inoculation 1 to 6 weeks later…
Hematogenous dissemination then can occur typically 4 to 10 weeks later, giving rise to secondary syphilis. <40% of pts w/ syphilis have primary syphilis diagnosed. These “Secondary” lesions last for several weeks before spontaneously resolving. Coined “early, latent infection”
What does late infection mean? When syphilitic lesions recur after 1 year from the initial eruption, or seropositivity is detected more than 1 year after the initial eruption, it is termed late latent syphilis.
Read 5 tweets
May 29, 2021
Some optics neuritis pearls in a short #Medtweetorial 🧵…. We all know that optic neuritis is frequently associated with multiple sclerosis (MS). But optic nerve inflammation can exist from autoimmunity, infection, granulomatous disease, paraneoplastic disorders, & demyelination Image
Classical ON from MS is unilateral, moderate, painful color vision loss with an afferent pupillary defect & normal fundus examination.
In those with ON, 95% of patients showed unilateral vision loss & 92% had associated retroorbital pain that frequently worsened w/ eye movement.
Read 14 tweets
Oct 1, 2020
If you have not listened to the @CuriousClinPod most recent podcast (Episode 10: Why does metronidazole treat both bacterial and parasitic infections?) then I suggest you tune in.

curiousclinicians.com/2020/09/30/why…

I'll summarize their show notes here in short #medtweetorial
First a question:

Was metronidazole first used as an antibiotic or as an antiparasitic?
If you guessed antiparasitic, then you would be correct!

It was developed in the 1950s to treat the parasite trichomonas & then was used in the 1960s to treat other parasitic infections, like giardia and amoebiasis.
Read 14 tweets
Oct 1, 2020
When you order a serum alcohol level, what does the lab measure? An answer and a quick #Medtweetorial on false elevations in #ETOH
If you guessed NADH, you would be correct.
Most lab assays for serum alcohol utilize a reagent containing alcohol dehydrogenase & NAD+

This is used to convert all present ethanol to acetaldehyde

Thereby reducing present NAD+ to NADH.
Read 11 tweets
Sep 26, 2020
A Teal pain in the neck:

Follow along for a short #medtweetorial on #CervicalArteryDissection

or see the full handout here emboardbombs.com/s/Cervical-Art…

from @EMBoardBombs @blakebriggsMD @IltifatMD
This review will focus on spontaneous dissections, not traumatic, as well as the pathophys, risk factors, presentation, diagnosis, and management.

Cervical artery dissections are a common cause of stroke in young(<50 years )w/ some reports of up to 20% being from dissections
Much like aortic dissections, there is some loss of structure along the wall of either the internal carotid artery or vertebral artery

This allows blood to collect within the intima.

In patients <50 years old, cervical artery dissections account for 20% of ischemic strokes.
Read 24 tweets
Sep 26, 2020
Time for some #SpacedRepetition from @CPSolvers @DxRxEdu @rabihmgeha

Some chat recap #ClinicalPearls and bonus pearls from #VirtualMorningReport on Friday Sept 25th clinicalproblemsolving.com/morning-report…

Case by the brilliant @Rafameed Image
A 31-year-old M born and raised in Brazil w/ no PMH presented with a 3 mon history of worsening DOE, orthopnea, 7kg weight loss, abdominal distention, dry cough, and syncope

Base rate of disease for an ID case with @k_vaishnani and @Rafameed is very high
An interesting fact from @3owllearning : Depending on the clinical problems, the studies of disease probability for differential diagnosis often show 10 - 25% of cases are unexplained, even after careful examination and testing.
Read 17 tweets

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