#idboardreview 40 F returned from Europe 2 wks ago, has been tired, now w/ F & rash on face quickly spread to trunk & legs involves palms & soles. Pharyngeal erythema, leukopenia, thrombocytopenia, mild transaminitis. Diagnosis? #medEd #idmedEd #IDtwitter Image
#measles negative-stranded RNA virus that belongs to the genus ‘Morbillivirus’, hence the term morbilliform rash
From Jan-Se2019 >1,200 cases of #measles greatest # of cases in 🇺🇸 since 1992. occurs primarily among unvaccinated children/young adults. Spread via droplet nuclei when an infected person coughs or sneezes. most contagious vaccine-preventable dz w/ 2ndry attack rate 90%
#measles Incubation period is 7-21 days. Patient is infectious from 4 days before until 4 days after onset of rash. spreads first to local lymphoid tissue & then disseminated throughout blood stream through infected lymphocytes, infecting cells in almost all organ systems
#measles prodrome of fever, malaise, Koplik’s spots, 3 C cough, coryza conjunctivitis ➡️maculopapular rash w/ cephalocaudal & centrifugal spread. Complications (laryngitis, otitis media, pneumonia, diarrhea) ~30%. Subacute sclerosing pan-encephalitis rare but potentially fatal
#measles On initial suspicion: 😷 & negative pressure room. Dx IgM serology or nasopharyngeal/throat swab PCR. Treatment usually supportive; typically improve <48 hours after rash onset. Airborne isolation is recommended for at least 4 days after rash onset

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More from @IUIDfellowship

5 Mar
#idboardreview 25 M from Madagascar 🇲🇬 swam all life in freshwater lakes presents w/ 1wk fever, pleuritic chest pain, hemoptysis, hypoxia. CT chest shown s/p lobectomy +tissue necrosis. CT pelvis:bladder wall calcification. Diagnosis? #medEd #idmedEd #IDTwitter ImageImage
#Schistosomiasis #haematobium helminthic infect 235 million people globally w/ 200k deaths annually
2 major #Schistosoma species in Africa S. mansoni (GI) & S. haematobium (GU). Both species are endemic to Madagascar, where S. mansoni in eastern, central, southern regions & S. haematobium predominant in northwest & west coast. Both species coexist in certain irrigated regions
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4 Mar
#idboardreview 40 pig farmer recently got abrasions to his arms and face during a hike, also had duck bite to his finger, presents w/ fever & diffuse annular body rash. Diagnosis? #medEd #idmedEd #idtwitter ImageImage
Gram-positive facultative anaerobe rod #Erysipelothrix rhusiopathiae. Mainly an occupationally acquired zoonosis transmitted by feces, water, soil, or food scraps contaminated by a wide variety of mammals, birds, and fish
#erysipelothrix is acquired through puncture wounds & scratches of the skin. Occupational zoonosis of butchers, veterinarians, and fishermen. Most important reservoir is healthy domestic swine, up to half of which harbor it their tonsils
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2 Mar
#idboardreview 2 kidney transplant recipients post day 20 present w/ altered mental status, neutrophilic pleocytosis, MRI ring enhancing lesion. No improvement on abx & antivirals. Same donor died w/ dx of ADEM/exposure to wading pool. Diagnosis? #medEd #idmesEd #idtwitter
#Balamuthia amebas can infect skin, brain & other organs of the body. Can begin with skin wound on face, trunk, or limbs & progress to granulomatous amebic encephalitis (GAE).
Diagnosis of Balamuthia GAE can be difficult because symptoms are not specific to GAE
Read 10 tweets
1 Mar
#idboardreview 60 M sarcoidosis w/ 2wks x fever, unsteady gait, fluctuating arm weakness/dysarthria, horizontal diplopia. CSF 200wbc 90%lymph, shock on vanc,cefepime,amp, ampho, rapid inc brain edema➡️death. Diagnosis? #medEd #idmedEd #idtwitter
#Amebic meningoencephalitis caused by #acanthamoeba culbertsoni cdc.gov/parasites/acan…
#acanthamoeba rapidly progressive meningoencephalitis & uncontrollable cerebral edema, resulting in death from increased intracranial pressure w/in few days after presentation & no response to broad-spectrum abx, antiviral, antifungal, and immune-modulation therapies
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27 Feb
#idboardreview 60 F RA on chronic steroids presents w/ progressive R wrist pain/swelling s/p I&D, progressively worse erythema spreading up the arm. Tendon micro+small gray colonies & thin, septate hyphae branching at acute angles. Diagnosis? #medEd #idmeded #idtwitter ImageImage
#scedosporium apiospermum is the anamorph or asexual form of #Pseudallescheria boydii. Usual sites of infection include CNS, eyes, lungs, sinuses, bones, joints, and soft tissues jcm.asm.org/content/43/2/9…
#scedosporium Fast growing, greyish-white colonies suede-like to downy w/ greyish-black reverse. Numerous single-celled, pale-brown, broadly clavate to ovoid conidia, 4-9 x 6-10 µm, rounded above w/ truncate bases are observed mycology.adelaide.edu.au/descriptions/h…
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27 Feb
#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 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
Read 11 tweets

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