#idboardreview 25 M ‘mud run’ in Hawaii 2wks go, ski trip in Colorado 1wk ago now presents w/ F, hypoxia, wbc20k, Hb7, plt90, ⬆️cpk 2k⬆️Cr, mild⬆️lft, required mech ventilation, bloody respiratory secretions. Diagnosis? #medEd #idmedEd #idtwitter
diffuse alveolar hemorrhage (DAH) due to leptospirosis pulmonary hemorrhage syndrome (LPHS) #leptospira interrogans
DIffuse alveolar hemorrhage Infectious DDx dengue, malaria, influenza A, leptospirosis, hantavirus, staph aureus, adenovirus, cmv, aspergillosis, Mycoplasma, Legionella, Strongyloides
#Leptospirosis occurs in humans following contact of mucous membranes or abraded skin with the spirochete Leptospira interrogans, excreted in the urine of infected animals. Hawaii has the highest endemicity
#leptospirosis Exposure to contaminated water, soil, and other matter places several populations at risk: rural animal or vegetable farmers, slaughterhouse workers, flood victims, soldiers, and urban sanitation workers or children exposed to rat urine in garbage or alleyways
#leptospirosis aka
Weil’s syndrome,
hemorrhagic jaundice,
swineherd’s disease,
Fort Bragg fever,
swamp fever,
mud fever,
autumn fever,
field fever,
rice-field fever,
cane-cutter’s fever, and
canicola fever
protean nature of most cases of leptospirosis, coupled with notoriously poor sensitivity & specificity of IgM for any infection make dx difficult. Convalescent sera & PCR can confirm dx but a ⬆️clinical suspicion w/ biphasic illness in high risk pt is crucial for early abx
Treatment for severe #leptospirosis should include penicillin, or a third generation cephalosporin

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More from @IUIDfellowship

25 Jan
#idboardreview 30 M from Thailand 🇹🇭 new dx HIV CD4 5 presents w/ fever, sore throat, dry cough, generalized umbilicated skin lesions x2wks. Diagnosis? #medEd #idmedEd #IDtwitter ImageImageImage
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23 Jan
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31 Aug 20
#IdBoardReview 65 M presents w/ severe pain in leg for few hours, progressed to rapid swelling/bullae and +gas on X-ray. hx of bright blood per rectum for few months. diagnosis? #idmedEd #medEd
#Clostridium septicum spontaneous non-traumatic gas gangrene associated with malignancy likely colorectal CA in this case
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12 Aug 20
#IdBoardReview 25 F recent Caribbean vacation, walked barefoot on sand and now with creepy rash. diagnosis? #idmedEd #MedEd
Cutaneous larva migrans is a characteristic serpiginous skin lesion which may be seen in travelers Carribean & Americas. most common causative organisms are Ancylostoma braziliense and Ancylostoma caninum.
#CLM most commonly transmitted by animal feces depositing eggs in soil/sand, with larvae entering humans through direct contact with skin. Cutaneous larva migrans is distinguished from cutaneous manifestation of Strongyloides stercoralis infection termed larva currens
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24 Jul 20
#idboardreview 65 F no PMH p/w fever, headache x2d, winter, brought by family as not acting like herself, hyperactive, animated movements. No animals, no outdoor activities, not sexually active. Diagnosis? #medEd #IDMedEd
Herpes simplex #HSV encephalitis is most common acute sporadic focal encephalitis in USA (1-2cases/1 million persons/yr. 1º infection or by reactivation of latent virus. In case of 1º oropharyngeal disease, spread along olfactory or trigeminal nerve has been hypothesized
other neuronal pathways may be involved in reactivation of latent virus. Infection or reactivation leads to focal inflammation, often in the temporal lobe, with associated neurologic deficits.
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22 Jul 20
#IdBoardReview 30 M injection drug use, hx of MRSA IE s/p tricuspid/mitral valve repair 1 year ago now presents with weakness, chills, BC+GPC w/ aerobic sticky staph-like white-gray colonies. TEE+TV vegetation. pathogen? #idmedEd #medEd
#Rothia mucilaginosa endocarditis
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