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Indiana University Infectious Diseases Fellowship

27 Feb, 11 tweets, 5 min read

#idboardreview 70 F presents w/ fever, myalgia, dyspnea: CXR RLL pneumonia/effusion, resp fail leading to death. Her dog recently died who was seen with rabbit caracass. Diagnosis? #medEd #idmedEd #idtwitter

#tularemia cdc.gov/mmwr/volumes/6…

#tularemia transmission via tick (dog tick, wood tick & lone star tick) or deer fly bite, handling infected animals, inhaled contaminated aerosole or dust (mowing over animals), contaminated water, potential for bioterrorism

#tularemia types cdc.gov/tularemia/sign…
ulceroglandular
glandular
oculoglandular
oropharyngeal
pneumonic
typhoidal

#tularemia dx: culture is definitive. Clinical suspicion leads to appropriate specimens: swabs or scrapings of skin lesions, lymph node aspirates or biopsies, pharyngeal swabs, sputum specimens, gastric aspirates. Paradoxically, blood cultures are often negative.

#tularemia serology (4x increase in 4 wks), PCR can be helpful. Tx: streptomycin x10d. Alternative: tetracycline x14d

https://twitter.com/IUIDfellowship/status/1328876775229825025?s=20

previous case #tularemia

https://twitter.com/IUIDfellowship/status/1328876775229825025?s=20

#tularemia nejm.org/doi/full/10.10…

nejm.org/doi/full/10.10… #tularemia

#tularemia Francisella tularensis tiny, faintly staining, pleomorphic gram-negative coccobacillus, aerobic nonmotile, nonsporulating cidrap.umn.edu/infectious-dis…

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#idboardreview 30 F 2nd/3rd molar pain now presents w/ fever, rapid bilateral cardboard swelling of neck, mouth open w/ tongue touching the palate. Diagnosis? #medEd #idmeded #IDTwitter

#ludwigs #angina loose term for infections of sublingual, submaxillary & submandibular spaces, always bilateral, rapid indurated cellulitis w/o lymphadenopathy w/o abscess. Behind from floor of mouth

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