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6 Feb, 6 tweets, 3 min read
Weekend Digest

What happens when a person ingests this “egg packet”?

Name the pathogen and its treatment.
2/
 What happens when a person ingests this “egg packet”?

Nothing!
#Dipylidium caninum eggs are NOT infectious to humans.

Then,
How do humans get infected?
3/
 How do humans get infected?

Humans (often children) are infected when they accidentally ingest a flea that contains #Dipylidium larvae (cysticercoid).

Infected fleas in pet dogs and cats

doi.org/10.12980/APJTB…
4/
 #Dipylidiasis in humans is rare but often occur in children from accidental ingestion of infected fleas of pet dogs and cats

Please get rid of fleas!
Take good care of pet dogs and cats.

ncbi.nlm.nih.gov/pmc/articles/P…
5/
 #Dipylidium caninum cases in children

doi.org/10.12980/APJTB…

doi.org/10.1086/587986
/6
#Dipylidium caninum
1. Tapeworm of dogs / cats
2. Humans/ children: accidental ingestion of infected flea
3. Often asymptomatic; abdominal pain; diarrhea
4. Dx: stool has proglottids (“cucumber seeds”) / egg packets
5. Rx: praziquantel / niclosamide

cdc.gov/dpdx/dipylidiu…

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Mayo Clinic Infectious Diseases Profile picture
4 Feb
#MayoIDQ 69M was brought to the ED because of weakness. PE: intoxicated disheveled man with multiple skin ulcers / excoriations.
WBC 27. CK 1486. AST 76.
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Which of the following is most consistent with wound botulism?
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#Botulinum neurotoxin binds to cholinergic nerve terminals and cleaves intracellular proteins needed for #acetylcholine release —> reduced acetylcholine —> neuromuscular blockade —> bulbar palsies, hypotonia, and symmetric, descending, #flaccid #paralysis.
3/
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Clinical features
1. Flaccid paralysis
2. Prominent cranial nerve palsies
3. Descending progression
4. Symmetrical presentation
5. No sensory nerve dysfunction.

43% are correct in MCQ

cdc.gov/botulism/healt…
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Mayo Clinic Infectious Diseases Profile picture
19 Dec 20
Weekend Digest

Name the pathogen!

H & E stain of heart tissue of a 27M who developed severe intractable heart failure 2 months after an allogeneic bone marrow transplant for acute leukemia.

Clue: consumption of food / water contaminated with feces of snakes
2/
 #Sarcocystosis
1. Sarcocystis hominis, suihominis, nesbetti, others
2. Zoonotic: 2 forms for human infection
3. Intestinal and muscular sarcosystosis
4. Dx: intestinal (O/P), muscular (biopsy)
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cmr.asm.org/content/28/2/2…
3/
 Intestinal #Sarcocystosis
1. Ingestion of sarcocyst (S. hominis / beef, suihominis / pork) in tissue
2. Sarcocyst digested —> bradyzoites —> intestinal infection / gametes —> oocysts / sporocyst detected in stool
3. Self limited. No Rx needed

cmr.asm.org/content/28/2/2…
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17 Dec 20
Images of Infectious Diseases

GMS of sinus tissue of 20F with no PMH. She presented with fever and sinus pain. CT pansinusitis. Labs: WBC 1.7 ANC 0. Serum BDG and GM negative.

What is your differential diagnosis and empiric therapy? #MayoIDQ to follow... Image
2/
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Lack of serum BDG suggests Mucor/Rhizopus

The patient was started on AmBisome.

Few days later, the fungal culture of the same sinus sample shows (photo) Image
3/
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Mayo Clinic Infectious Diseases Profile picture
28 Nov 20
Weekend Digest

Giemsa stain of blood smear of a 50M who returned to the US after a 10-year missionary work in Mali and Senegal. He presented with episodic angioedema and eosinophilia.

Name the pathogen, its treatment and complication of Rx.
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 #Loa loa

Bite of chrysops deer fly

Larva migrates in tissues; matures into adult worm in 5 months, and live for 20 years.

Adults produce microfilaria that gets into lymphatics / blood —> tissues. Microfilaria does not mature into adult but lives for a year.
3/
 #Loa loa migrates in tissues

Most infected people ASYMPTOMATIC

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2. Eye worm - visible movement of adult worm across the surface of eye

3. Eosinophilia and pruritus
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26 Nov 20
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6 mo post-tx: H&E (400x) of cervical biopsy of 46F s/p living unrelated donor kidney tx for adult PCKD.

Belatacept. MMF. Prednisone.
Acute cellular + antibody-mediated rejection.

CMV D+/R-. valganciclovir prophylaxis.

DDx / Rx? #MayoIDQ next Image
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H&E intranuclear / intracytoppasmic inclusions within endothelial cells in ectocervical stroma.

Immunohistochemistry stain for CMV shows infected endothelial cells with CMV inclusions.

doi.org/10.1111/tid.13… Image
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If gene sequencing shows the most common CMV gene mutation, what drug would be recommended Rx?
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Mayo Clinic Infectious Diseases Profile picture
23 Aug 20
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This is GMS stain and culture of a skin biopsy from a patient’s leg.

Who is the host? What is the syndrome? Name the pathogen. How to treat?
#MayoIDQ and case details to follow... Image
2/
 66M. 4 mo after heart Tx: painless leg nodules that spread distally x 5 weeks. No pain. No fever.

PE unremarkable except lesions in left leg / foot + tinea pedis

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What is true of this condition?
3/
 Case diagnosis:
#Majocchi’s Granuloma due to #Trichophyton rubrum

Histopath shows fungal elements (GMS) - not sufficient for identification.

Important: Send specimen for culture identification!!!

Treatment: Itraconazole Rx
Read 9 tweets

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