#idboardreview 18 M altered mental status, difficulty walking, urinary retention, sx progressive x4d. He had parotitis/orchitis 2wks ago. CSF150 wbc 100%mono ⬆️protein, gram stain/culture neg. mri leptomeningeal enhancement. Dx? #medEd #idmedEd #IDtwitter
In unimmunized pts: mumps is one of the most common causes of aseptic meningitis & encephalitis (cns involvement 10-30% of all mumps cases). 40-50% mumps meningitis have no parotitis. Males are affected 2-5x more than females. Peak age 5-9 yrs
#mumpss meningitis Defervescence usually accompanied by clinical recovery & in uncomplicated cases illness is 7-10d. Rarely, mumps may cause encephalitis, seizures, polyradiculitis, polyneuritis, cranial nerve palsies, myelitis, Guillain-Barré syndrome, and fatality.
#mumps meningitis csf wbc <500, >80% mono, normal protein half of pts, dec glucose in 25%. Complement fixation & hemagglutination inhibition in serum is reliable serology Dx.

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More from @IUIDfellowship

11 May
#idboardreview 20 M farmer consumes unpasteurized milk presents w/ several months of headache, fever & now ill with projectile vomiting, F 106F, myalgia, back pain, areflexia. Csf 100wbc 70%pmn, protein150, gluc20. Dx? #medEd #idmedEd #idtwitter
#brucellosis ddx chronic meningitis
Pic ref phil.cdc.gov/Details.aspx?p…
#Neurobrucellosis is the most serious form of the disease and affects between 5 and 7% of all brucellosis
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9 May
#idboardreview 30 M from western 🇺🇸 visited Middle East where symptoms of recurrent fevers >102F, headaches, myalgia, chills started
3 wks ago. Peripheral blood smear shown. Dx? #medEd #idmedEd #IDtwitter Image
Rick borne relapsing fever #TBRF #Borrelia persica inspired by jcm.asm.org/content/58/6/e… @ASMicrobiology pic ref P&P Mandell
median incubation period of 7d (range 2-18d): fever x 3d (range 2-7d), alternating w/ afebrile periods lasting about 7d range 4-14d)
If untreated #TBRF can have up to 30 relapses of febrile illness (most pts w/2 relapses)
whereas louse-borne illness is usually has only 1 relapse
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20 Mar
#idboardreview 30 M Paraguay 🇵🇾 living w/ HIV CD4 50 VL 100k presents w/ seizure, no travel/animal contact. Oriented to self, dysarthria, csf (wbc 15 100% lymph, protein80, gluc35). Dx? #medEd #idmedEd #idtwitter
Meningoencephalitis and chagoma, caused by #Trypanosoma cruzi
#Chagas or American #trypanosomiasis parasitic protozoan #Animal Trypanosoma cruzi transmitted by hematophagous “kissing bugs” Reduviidae aka
vinchuca (Argentina 🇧🇴 🇨🇱 🇵🇾
barbeiro (Brazil),
chipo (Venezuela), and
chinche (Central America)
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19 Mar
#idboardreview 40 M injected heroin boiled with tap water, previously used needle: next day developed periorbital swelling, eyelid erythema, pain and blurred vision of one eye. Dx? #medEd #idmedEd #IDtwitter
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18 Mar
#idboardreview 70 M skin opening at pacemaker site with purulent chest wall drainage. No improvement on abx. Dx? #medEd #idmedEd #idtwitter Image
Culture of the swab of the lesion on the chest grew #Trichosporon beigelii
#Trichosporon beigelii yeast in soil & water. In humans, it colonizes skin, GI & GU. It cause superficial skin infections, such as white piedra. In immunocompromised hosts: deep invasive infections, including fungemia, endocarditis and chronic meningitis
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17 Mar
#idboardreview A family visited different U.S. states during a 1week vacation. Seam in hotel pools & waterpark. 8 days post trip, 2 family members had diarrhea. Dx? #medEd #idmedEd #idtwitter Image
#Cryptosporidiosis outbreaks in the U.S. have been linked to swimming pools, water playgrounds, and other swimming venues; unpasteurized cider, juice, and milk; contact with animals; childcare settings; camps; and ill food handlers. Image
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