#IDBoardPearls #IDtwitter

I get tripped up on these so let’s go over them… head/neck space infections 🤕

1️⃣ Peritonsillar abscess: “Quinsy”

📍- between the tonsil & the pharyngeal muscle
🦠- strep, staph, anaerobes
Clinical: swollen tonsils + uvula deviation, 🤤, trismus, 🤒
‼️ vs - Epiglottis, which has a normal pharyngeal exam. “Worst sore throat of my life” + hoarseness + 🤤
👇🏼

2️⃣ Epiglottis:
📍- invasive cellulitis of the epiglottis
🦠 - Hib (prior to 💉), sometimes no 🆔
Clinical - hoarseness (“muffled voice”), 🤤,🤒, 🍒red epiglottis, 👍🏼 print
sign on lateral xrays

‼️ attempt to use 👅depressor ➡️ 🆘 airway

‼️ vs - Croup. 👶🏻 less toxic, +coughing, no 🤤

3️⃣ Ludwig’s Angina:
📍- b/l floor of the mouth (sublingual + submylohyoid)
🦠- polymicrobial ➡️ 🦷 infection (2nd & 3rd molars)
Clinical -
submandibular swelling, 🤤, swollen 👅

💡MRSA in severally ill

‼️ 🆘 airway

4️⃣ Vincent’s Angina: “trench mouth”
📍- necrotizing, ulcerative gingivitis
🦠- polymicrobial
Clinical - 😣 + bad 😮‍💨, pseudomembranes of gingiva

5️⃣ Lemierre’s Syndrome:
📍Suppurative thrombophlebitis
of jugular vein. Follows pharyngitis of peritonsillar abscess
🦠- Fusobacterium necrophorum, staph aureus, GAS
Clinical - “Worst sore throat of my life,” neck 😣, 🤒, septic emboli

Check out clinical context from @MayoClinicINFD below 👇🏼

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More from @Ashka_TxID

1 Jul
#IDBoardPearls #IDtwitter

Derm round ✌🏼. Let’s do this…

Bacterial Skin Diseases. Follow the 🧶

1️⃣ Impetigo: superficial epidermis
🔎- vesicles/pustular ➡️ crust “🍯 yellow”
🦠- GAS, S aureus

‼️ S aureus causes bullous impetigo similar to poison ivy
❓What other skin manifestations does GAS cause? 👇🏼

2️⃣ Erysipelas: upper dermis and superficial lymphatics
🔎- acute, well-demarcated, 😣, erythematous lesion, 🤒
🦠- GAS, B hemolytic strep

3️⃣ Cellulitis: deeper dermis, subQ tissue
🔎- erythema, warmth, edema, not well-
demarcated
🦠- strep (GAS), S aureus

4️⃣ Necrotizing Fasciitis: muscle, fascia, & fat
🔎- initially spares skin, hence, pain out of proportion to PE ➡️ skin crepitus ➡️ discoloration ➡️ bullae ➡️ tissue necrosis ➡️ sepsis, HD instability
🦠- Type I: mixed aerobic & anaerobic
Read 14 tweets
30 Jun
#IDboardpearls #IDtwitter

Derm… ☠️ Let’s break it down starting with viral exanthems. Follow the 🧶

🚨Coxsackievirus:

1️⃣✋🏼,🦶🏼, & mouth disease - Coxsackie A > Coxsackie B or EV71
🔎 - 😣 ulcerative lesions on hard palate, 👅, buccal mucosa ➡️ vesicular rash on 🤲🏼 &🦶🏼
2️⃣ Atypical HFMD
🔎- vesiculobullous rash or crusted papules (Gianotti-Crosti syndrome). Associated with skin and 💅🏼 peeling. At sites of atopic eczema (eczema coxsackium)

🚨Parvovirus B19:

1️⃣ Erythema infectiosum - Fifth disease
🔎- 👋🏼 cheek syndrome ➡️ lacy erythematous
rash on truck & limbs

2️⃣ Papular-purpuric (🧤&🧦) syndrome
🔎- pruritic erythema & edema of distal limbs (sharp demarcation at wrists/ankles ➡️ petechial or purpuric

🚨Measles:

1️⃣ Measles exanthem
🔎- starts behind the 👂🏼then spreads to face, trunk, limbs (🤲🏼🦶🏼)

2️⃣ Atypical
Read 13 tweets
29 Jun
#IDBoardPearls #IDtwitter

Post-exposure prophylaxis. As with all things, timing maters 😷

1️⃣ HAV:
Indications - close contacts, child care & school contacts, food handlers
⏲ 2 weeks - 💉
👉🏼 + Ig if > 60 YO or immunocompromised
⏲ 28 days - 💉
👉🏼 + Ig if chronic liver disease
or Hep B/C infection
⏲ 8 weeks - 💉 if there are > 1 close contacts in 🏠

2️⃣ HBV:
Indications - percutaneous or mucosal exposure, sex or needling sharing contact, victim of sexual assault
⏲- within 24 hrs, up to 7 days

📌Unvaccinated 🧍🏻‍♀️+ source HBsAg + ➡️ 💉 + Ig
📌Vaccinated 🧍🏻‍♀️+ source HBsAg + ➡️ booster 💉
📌Unvaccinated 🧍🏻‍♀️+ source HBsAg - (or unknown) ➡️ 💉 series
📌Vaccinated 🧍🏻‍♀️+ HBsAg - (or unknown) ➡️ no treatment

3️⃣ VZV:
Indications - face to face contact or in a room for > 15 min with the following:
📌exposure to chickenpox or
Read 10 tweets

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