#idboardreview A businessman develops diarrhea while traveling to Thailand.The illness progresses to passage of grossly bloody stools. Sick x3d when returns home. +bloody stools, weak, febrile, tachycardic, stool:gull wing shaped GNR. Treatment? #medEd #idmedEd #idtwitter
Single dose of azithromycin (1 gram). Acute febrile & dysenteric diarrhea in single adult traveling to a developing region is most likely caused by strains of Shigella, #Campylobacter or Salmonella. Campylobacter shown here Ref pic casereports.bmj.com/content/2014/b…
Treatment of choice must be guided by antibiograms of likely organisms in geographic region where pathogen was acquired. In South Asia ciprofloxacin-resistant Campylobacter is most likely cause of febrile dysentery. Tinidazole is useful for giardiasis not Campylobacter diarrhea
A single dose of azithromycin is effective in treating the major causes of febrile dysentery of travelers. Rifaximin not effective for mucosally invasive bacterial infections. Illness significantly shortened by azithromycin
#travelersdiarrhea Plesiomonas, Vibrio, and norovirus are underappreciated diarrhea pathogens in Thailand per this study tdtmvjournal.biomedcentral.com/articles/10.11…

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More from @IUIDfellowship

12 Jul
#idboardreview heart-lung transplant 2yrs ago on tacrolimus, mycophenolate, TMP/SMX, lung nodules on voriconazole, +diffuse body aches, AlkP 2x ULN, Bone scan numerous scattered areas of uptake. Xray periosteal thickening, Calcified excrescences. dx? #medEd #idmedEd #idtwitter
#Voriconazole SE vision changes, rash, nausea, vomiting, abnormal liver function tests, hallucinations
#Periostitis w/ long term voriconazole diffuse body aches, ,inc AlkP patches of periosteal thickening on Xray &+bone scan. Calcified excrescences are sometimes seen.
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10 Jul
#idboardreveiw 45 F hx IUD w/ incarcerated, inguinal hernia. During surgery: hernial sac w/ putrid, inflammatory, tumorous formation around R ovary. Histopath highly active zone of abscess formation, w/ granular conglomerates of a filamentous organism. #idmedEd #medEd #idtwitter Image
#Actinomycetes anaerobic, gram+ filamentous bacteria sulfur granules in tissue & highly sensitive to penicillin. This pt needs tx as abscess but in general #Actinomyces normal GI flora & asymptomatic female genital colonization is not uncommon, especially if an IUD is in place
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16 May
#idboardreview 30 goat farmer helped w/ goats birth 20d ago now presents w/ fever, rigors, severe retrobulbar headache, dyspnea, hepatitis. Dx? #medEd #idmedEd #IDtwitter
#coxiella burnetti (Q fever) manifest as a self-limited febrile illness, pneumonia, endocarditis, or hepatitis. There are many other less common manifestations, such as meningitis, encephalitis, and osteomyelitis. Infections are divided into acute and chronic forms.
#Qfever zoonosis usually acquired by inhalation or, much less commonly, by ingesting unpasteurized milk
Cattle, sheep, goats most common reservoirs
Infected parturient cats are important in spread in some areas
-extensive wildlife reservoir
-Windborne spread occur over 10 km
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14 May
#idboardreview 25 MSM PLWH on ART VL<20 presents w/ rectal bleeding, dyschezia x 1mo. Anoscopy anal ulcer. Biopsy suspicious for IBD. Sigmoidoscopy erythematous mucosa w/white exudates & heaped folds. Starry abscess. Dx? #medEd @idmedEd #IDtwitter Image
Lymphogranuloma venereum (#LGV) STI caused by L1, L2, L3 serovars of C. trachomatis (CT) can mimick IBD
#LGV proctitis typically present w/ rectal sx (> 90%) w/ moderate to severe ulcerative proctitis or proctocolitis w/ mucopurulent discharge, constipation, and tenesmus. Systemic symptoms like fever, malaise, and weight loss are also relatively common
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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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10 May
#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
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