Images of Infectious Diseases

28F SLE on MTX
CC chest pain, vaginal DC
Rx pred for lupus

2 mo: fatigue, pruritic rash, visual floaters Rx pred

1 mo: blurred vision. PE iritis / chorioretinitis. Rx pred

Now b/l vision loss. PE panuveitis + chorioretinitis

DDx? #MayoIDQ Image
2/
28F HIV/HBV/HCV(-) SLE on MTX w chronic pain Rx as flare, vaginal discharge due to BV Rx metro (negative GC/chlamydia), skin rash x 2 w and progressive vision loss (photo). CXR clear. Indiana / no foreign travel. No animal exposures.

What is most likely diagnostic test?
3/
Case diagnosis: bilateral ocular syphilis with neurosyphilis

RPR 1:512
Syphilis antibody with reflex: positive
CSF VDRL 1:1

Rx: IV penicillin
4/
We have previously highlighted a case series of ocular syphilis reported by our fellows

Bilateral eye involvement, pan-uveitis, and CNS involvement are common!

@cristinacorsini @JohnRaymondGo1 @dwchallener

5/
Review of 127 HIV+ and HIV- patients with ocular syphilis in 214 eyes

Uveitis is most common presentation

“Involvements in 214 eyes were anterior (6.1%), intermediate (8.4%), posterior (76.2%) and pan- (8.4%) uveitis, and scleritis (0.9%).”

nature.com/articles/s4159…
6/
Complications of ocular #syphilis

“cataract; ocular hypertension or glaucoma; epiretinal membrane; optic nerve atrophy; and rhegmatogenous retinal detachment”

nature.com/articles/s4159…
7/
In most case series of ocular syphilis, CNS involvement is common (especially those with posterior uveitis / chorioretinitis)

“lumbar puncture should be a routine investigation for all patients diagnosed with ocular #syphilis
8/
Here is a link of brief review of Infectious retinitis with accompanying photos

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More from @MayoClinicINFD

27 Feb
Weekend Digest

Name the disease and its pathogen, risk factor, prevention and treatment. Image
2/
Disease: #Anisakiasis

Pathogens (most common):
Anisakis simplex complex
Pseudoterranova decipiens complex
Contracecum osculatum complex

Photo credit: doi.org/10.1016/j.ijid…
3/
Risk factor #Anisakiasis

Consumption of raw / undercooked fish / squid

“Ascaridoid” nematodes (roundworm) of whales, seals (“seal worm”), marine mammals —> eggs excreted in water —> larva in crustaceans —> ingested by fish (“herringworm”, “codworm”) —> consumed by humans Image
Read 7 tweets
6 Feb
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…
Read 6 tweets
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.
Wound culture: Clostridium botulinum

Which of the following is most consistent with wound botulism?
2/
#Botulism

#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/
#Botulism

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…
Read 11 tweets
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)
5. Rx: not well defined; TMP-SMX, albendazole, others

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…
Read 5 tweets
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/
Histopath of surgically resected tissue shows fungal elements. You suggested Mucor/Rhizopus, Fusarium, Trichosporon.

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/
#MayoIDQ Surgical debridement of the sinuses was performed plus liposomal Amphotericin B was initiated. Patient lives in rural MN and asks you if an oral option is available as step down Rx.
Read 9 tweets
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.
2/
#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

1. Calabar swelling - transient localized, non-tender swellings usually on arms and legs and near joints

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

3. Eosinophilia and pruritus
Read 5 tweets

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