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70M with swollen R 5th digit, hand and forearm. No fever / chills.

MRI: complex multi-compartment fluid collection with extensive flexor and extensor tenosynovitis

Debridement. Culture (photo).

What is your diagnosis and Rx?
#MayoIDQ MCQ to follow... Image
Elderly man with swollen right hand and forearm. MRI: complex fluid collection, extensive tenosynovitis. Debridement performed. Culture is shown (photo prior tweet).

Which of the following is the exposure associated with this infection?
3/
 Beaver dam and blastomyces

When #IDBR says #beaverdam - you think #BLASTOMYCOSIS

nejm.org/doi/10.1056/NE…
4/
 #Spelunking and histoplasmosis

When #IDBR says spelunking - you think #Histoplasmosis

doi.org/10.1111/j.1708…
5/
 Insect bite and invasive mucocutaneous mycoses

RARE
Only 22 reports
Mucorales group is most common!
Others: Aspergillus, Sporothrix, Fusarium

doi.org/10.1093/ofid/o…
6/
 #Sporothricosis and sphagnum moss

When #IDBR says sphagnum moss - you think Sporothricosis

This is the suggested answer to the MCQ

What are the other exposures associated with sporothrix? Next...
7/
 #Sporothricosis
Soil and decaying vegetable and organic matter
- Hay
- Sphagnum moss
- Rose garden
Zoonotic- cat scratch and bite
- Endemic in Brazil

Sporotrichosis | Fungal Diseases | CDC Image
8/
 Cat scratch/bite and sporothrix

Animal sporothricosis affects cats > dogs
Endemic in Rio de Janeiro / Brazil

Sporothrix brasiliensis
Transmitted to human: cat scratch and bites

ncbi.nlm.nih.gov/pmc/articles/P…
9/
 Case diagnosis: #Sporothricosis with extensive tenosynovitis

Treatment
- Itraconazole: preferred for localized disease (alternate: terbinafine, high dose fluconazole)

- Potassium iodide (historical Rx)

- Amphotericin B: severely ill patients
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Related hashtags

#MayoIDQ #IDBR #beaverdam #BLASTOMYCOSIS #Spelunking #Histoplasmosis #Sporothricosis

More from @MayoClinicINFD see all

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Mayo Clinic Infectious Diseases
@MayoClinicINFD
Images of Infectious Diseases

This is the histopath and gram stain of culture of a lymph node biopsy of a person with tender purulent inguinal adenopathy.
Dr. @dwchallener
Dr. @ali_eberly
MCQ #MayoIDQ to follow Image
72M. Crohn’s. 2 pet dogs. 1 pet cat.
2 mo after L knee surgery —> tender L inguinal node with purulence. No F/C. No response to TMP-SMX.

Biopsy (see photo): Stellate suppurative granuloma with central necrosis and clumps of bacteria.

What is the most likely diagnosis?
1/
 #Gram stain: a first step in bacterial identification —> two major groups:
1. Gram-positive: retains primary stain (crystal violet)
2. Gram-negative: does not retain crystal violet but counterstained by safranin/fuchsine —> red / pink

Named after Hans Christian Gram (photo) Image
Read 12 tweets
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Mayo Clinic Infectious Diseases
@MayoClinicINFD
On day 14 of neutropenia, an astute ID fellow noted this finding (photo) while examining a patient with fever. Underlying AML and ongoing chemotherapy.

What do you suspect? What work up do you suggest? Details and #MayoIDQ MCQ to follow...
65M acute myeloid leukemia. Rx: CLAG-M. Prophy ACV, posaconazole, Levo, inhaled pentamidine

D14 neutropenia: fever / chills
Exam: onychomycosis, rapidly evolving lesions in arms and torso (photo)

You asked for skin biopsy. Blood culture will grow what fungus?
2/
 Case diagnosis: disseminated fusariosis

Majority got the diagnosis correctly!
Blood culture: Fusarium sp.

Rx: AmBisome / voriconazole
Hope for neutrophil recovery!!!
Read 12 tweets
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Mayo Clinic Infectious Diseases
@MayoClinicINFD
Images of Infectious Diseases

56M Mexico. Chronic abdominal pain, weight loss, anorexia.

Work up: elevated markers (CA19-9, CA-125, AFP). CXR normal. CT peritoneal carcinomatosis.

Laparoscopy (photo). Biopsy showed granuloma. What is your DDx? #MayoIDQ MCQ next... Image
#MayoIDQ
Thank you for your responses.

Culture of tissue (peritoneal nodules) of this 56M (see prior tweet) with granuloma on biopsy: Mycobacterium tuberculosis complex. Resistant to pyrazinamide.

Which of these choices is the most likely mechanism of transmission?
1/
 Case diagnosis: Peritoneal #tuberculosis due to #Mycobacterium #bovis

Path: granuloma and positive #AFB stain
Culture: M tuberculosis complex

Clue: #PZA resistance —> THINK M. bovis

Reported by @GaboMotoa during his rotation in Mayo Clinic

doi.org/10.1002/ccr3.3…
Read 11 tweets

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