1/Welcome to this week’s #IDBoardReview #Tweetorial presented by @bacteri_al
75 YOM w/ DM, CHF, NAFLD p/w fever, swelling & pain of left leg x48h. Gram stain from BCx pictured below 👇
#IDTwitter #IDMedEd @ID_Fellows @IDSAMedEdCOP
75 YOM w/ DM, CHF, NAFLD p/w fever, swelling & pain of left leg x48h. Gram stain from BCx pictured below 👇
#IDTwitter #IDMedEd @ID_Fellows @IDSAMedEdCOP
2/What epidemiological exposure do you suspect?
3/Gram stain shows a curved GNR (oxidase +)
Diagnosis: Vibrio vulnificus necrotizing skin/soft tissue infection (SSTI)
Pt reports recent fishing 🎣 in "brackish water"
Diagnosis: Vibrio vulnificus necrotizing skin/soft tissue infection (SSTI)
Pt reports recent fishing 🎣 in "brackish water"
4/ Lets talk about infections related to flooding/water exposure…
❗️ Floods = #1 natural disaster worldwide (⬆️frequency)
❗️ Floods have early and late health risks, along with social effects that may increase risk of infectious diseases 👇
❗️ Floods = #1 natural disaster worldwide (⬆️frequency)
❗️ Floods have early and late health risks, along with social effects that may increase risk of infectious diseases 👇
5/Trauma from water/debris ⬆️risk for SSTI’s, typically 3-4 days after injury.
Think of common cellulitis 🦠 (staph and strep), gram negatives associated with water, and fungi 🍄
Here are some cases to review the classic scenarios and buzzwords seen on board exams…
Think of common cellulitis 🦠 (staph and strep), gram negatives associated with water, and fungi 🍄
Here are some cases to review the classic scenarios and buzzwords seen on board exams…
6/
56 YOF p/w erythema and warmth of LE following a water-skiing accident on a lake
56 YOF p/w erythema and warmth of LE following a water-skiing accident on a lake
7/Answer: Aeromonas spp
🔸Oxidase+ GNR
🔸Classically presents after freshwater exposure, but outbreaks seen w/ mud🏈and after leech therapy
🔸Cellulitis, necrotizing fasciitis
🔸Produces beta-lactamase➡️ tx with TMP-SMX, doxycycline, ciprofloxacin, or ceftriaxone
🔸Oxidase+ GNR
🔸Classically presents after freshwater exposure, but outbreaks seen w/ mud🏈and after leech therapy
🔸Cellulitis, necrotizing fasciitis
🔸Produces beta-lactamase➡️ tx with TMP-SMX, doxycycline, ciprofloxacin, or ceftriaxone
8/
48 YOM with cirrhosis p/w severe necrotizing skin infection after a trip to the beach along the Gulf coast
48 YOM with cirrhosis p/w severe necrotizing skin infection after a trip to the beach along the Gulf coast
9/Answer: Vibrio spp
🌊A/w saltwater and raw oyster ingestion
🌊Severe dz w/ chronic liver dz, iron overload, immunosuppression
🌊V. vulnificus ➡️ rapidly progressive necrotizing infection
💊 Tx: abx (3rd gen Cephalosporin + doxycycline or FQ) + debridement
🌊A/w saltwater and raw oyster ingestion
🌊Severe dz w/ chronic liver dz, iron overload, immunosuppression
🌊V. vulnificus ➡️ rapidly progressive necrotizing infection
💊 Tx: abx (3rd gen Cephalosporin + doxycycline or FQ) + debridement
10/
51 YOM p/w small papule on his right hand following traumatic injury while cleaning his fish tank several weeks ago
51 YOM p/w small papule on his right hand following traumatic injury while cleaning his fish tank several weeks ago
11/Answer: “Fish tank” granuloma d/t Mycobacterium marinum
🐟Trauma while fishing, cleaning fish tanks
🐟Solitary papule with superficial ulcer, may have sporotrichoid spread
🐟Long incubation period (5-270 days)
🐟Trauma while fishing, cleaning fish tanks
🐟Solitary papule with superficial ulcer, may have sporotrichoid spread
🐟Long incubation period (5-270 days)
12/Other SSTI’s have been a/w rapid growing NTM’s with certain epidemiologic exposures:
🔹 M. fortuitum, M.chelonae ➡️pedicures or tattoo parlors
🔹 M. chimera ➡️cardiac surgery d/t heater-cooler units
🔹 M. fortuitum, M.chelonae ➡️pedicures or tattoo parlors
🔹 M. chimera ➡️cardiac surgery d/t heater-cooler units
13/
52 YO fisherman p/w pain and well demarcated violaceous lesion of his left hand one week after sustaining injury while filleting fish 🐟
52 YO fisherman p/w pain and well demarcated violaceous lesion of his left hand one week after sustaining injury while filleting fish 🐟
14/Answer: Erysipelothrix rhusiopathiae
🎣 Gram + bacillus
🐷 🐮 Localized cutaneous infections d/t occupational exposure: butchers, slaughterhouse workers, farmers, vets, fisherman
💊 Tx: penicillin/amoxicillin (Ciprofloxacin or clindamycin for penicillin allergic)
🎣 Gram + bacillus
🐷 🐮 Localized cutaneous infections d/t occupational exposure: butchers, slaughterhouse workers, farmers, vets, fisherman
💊 Tx: penicillin/amoxicillin (Ciprofloxacin or clindamycin for penicillin allergic)
15/
19 YOM from Thailand p/w skin ulceration that has not responded to prior course of outpatient oral antibiotics
19 YOM from Thailand p/w skin ulceration that has not responded to prior course of outpatient oral antibiotics
16/Answer: Burkholderia pseudomallei
🔹GNR w/ bipolar staining
🔹Endemic in SE Asia, N Australia (see map), ⬆️ in rainy season
🔹Varied presentation (see below 👇)
🔹⬆️risk with CKD, alcohol abuse, DM
💊Tx: inherent resistance is high➡️ceftazidime or carbapenem
🔹GNR w/ bipolar staining
🔹Endemic in SE Asia, N Australia (see map), ⬆️ in rainy season
🔹Varied presentation (see below 👇)
🔹⬆️risk with CKD, alcohol abuse, DM
💊Tx: inherent resistance is high➡️ceftazidime or carbapenem
17/In summary:
🔸Variety of water-related organisms can cause SSTI’s
🔸Epidemiologic hx and gram stain can serve as diagnostic clues. Check out this great review 👇
asm.org/Articles/2019/…
🔸Variety of water-related organisms can cause SSTI’s
🔸Epidemiologic hx and gram stain can serve as diagnostic clues. Check out this great review 👇
asm.org/Articles/2019/…
18/Check out these papers for more info!
