#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
#Talaromyces marneffei cause of morbidity and mortality in HIV-infected & other immunosuppressed patients who live in or are from endemic areas especially Southeast Asia. Amphotericin B or Itraconazole should be initiated as soon as possible for patients with talaromycosis
Mortality ranges 8-40%. Common clinical manifestations include fever, weight loss, anemia, weakness, skin lesions, lymphadenopathy and hepatosplenomegaly #talaromycosis
Skin lesions generally on face, up trunk & extremities as pustules, papules, nodules, ulcers or abscesses. Ddx molluscum Pharyngeal/palatial lesions may be seen. Lung lesions are nodular, reticulonodular,or diffuse alveolar infiltrates #talaromycosis
Dx smear of skin lesions or lymph node biopsy. Intercellular yeast resembles histo but extracellular yeast is large & septate in 2-3 cells sausage shape. Mold with red pigment that diffuse in agar #talaromycosis
Galactomannan+ in two third of cases. Disseminated cases in hiv treat w/ ampho x2 wks f/b itraconazole x10 wks #talaromycosis

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More from @IUIDfellowship

24 Jan
#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
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23 Jan
#idboardreview 12 prisoners from Mississippi jail present with varying symptoms of acute b/l cranial neuropathies and descending weakness after drinking 'hooch'. Diagnosis? #medEd #idmedEd Image
#botulism Hooch is defined as an illicitly made alcoholic beverage cdc.gov/mmwr/volumes/6…
honey, potatoes, apples & tomato paste from a bulging can were combined, hidden, fermented in sealed plastic bag at room temperature for 3–5 days. Possible sources of Clostridium botulinum or toxin include tomato paste, potatoes, contamination from the environment.
Read 5 tweets
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
Spontaneous traumatic gas gangrene is most commonly due to Clostridium perfingens & sometimes other clostridia sp. Non-traumatic spontaneous gas gangrene: most commonly due to C septicum: 80% malignancy related, most common CA are colon f/b hematologic
Read 10 tweets
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.
Read 8 tweets
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
#Rothia mucilaginosa is increasingly recognized as an emerging opportunistic pathogen associated with prosthetic device infections. Gram-positive cocci, catalase negative, sticky “staph-like” colonies whitish to gray in color, nonhemolytic, smooth, and round
Read 6 tweets

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