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Ashka Patel, DO

Jul 26, 2021 • 13 tweets • 4 min read • Read on X

#IDBoardPearls #IDtwitter #IDPhotoQuiz

📟 A farmer from the Dominican Republic is here in the US visiting family & presents with a swollen foot that has been progressing over the past 8 years

📸 of his R foot along with biopsy of lesion

❓What is the mostly likely organism?

Answer: Madurella mycetomatis

🎙Cutaneous Fungal/Mold Infections:

🚨Madurella mycetomatis: Eumycetoma or “Madura foot”
🔎- traumatic inoculation ➡️ chronic nodular lesions w/ sinus tracts w/ macroscopic grains ➡️ 🦴 Evolve over yrs
🔬- grain w/ numerous hyphae
👇🏼
This is fungal

infection vs Acintomadura (which can also cause Madura foot but is bacterial)

⚡️ 🤔 👨🏻‍🌾or 🪵 cutting/carrying

💊- itraconazole 6-24 mo

🚨Fusarium solani:
🔎 -
Localized cutaneous disease - neutropenic patient, toe cellulitis in the setting of onychomycosis

Disseminated disease - refractory 🤒 with metastatic skin lesions. + Blood cultures
👇🏼
Similar to ecthyma gangrenosum

🚨Scedosporium:
🔎- papular skin lesions ➡️ necrosis OR mycetoma

⚡️Just know it can affect immunocompetent pts & is resistant to ampho B. Tx w/ voriconazole
⚡️🤔 neurological symptoms after a bear drowning experience. Sinuses/lungs ➡️🧠

🚨Mucormycosis:

⚡️🤔healthcare outbreaks

w/ adhesive bandages & construction.
🔎- necrotic lesions
👇🏼
Similar to ecthyma gangrenosum

🚨Chromoblastomycosis: commonly caused by Fonsecaea pedrosoi
- traumatic inoculation (🪵splinters or soil) ➡️ chronic wart like lesions that progress over years
🔬- sclerotic bodies or

“copper pennies” on KOH prep/skin biopsy

💊- itraconazole 6-24 mo

🚨Histoplasmosis:
🔎 - disseminated histo can cause papillae/nodular lesions
👇🏼
Similar to crytococcus neoformans BUT crypto is more molluscum like

🚨Blastomycosis:
🔎- skin is the most common site for disseminated blasto. Chronic lesions can be large, verrucous or ulcerative
👇🏼
Similar to basal cell carcinoma

Affinity for face

🚨Coccidioidomycosis:
🔎- disseminated cocci is common with the first few weeks of primary infection in immunosuppressed pts. Occurs anywhere with a variety of lesions

🚨Paracoccidioidomycosis:
🔎- mucocutaneous sites. Ulcerated lesions of lips, gum, tongue, & palate

Lastly, remember M ulcerans causes a Buruli ulcer.
⚡️ 🤔West Africa, Latin America, Australia, & Asian Pacific
⚡️AFB staining of skin scrapping can aid in dx

@JClinMicro

See review below for more info on a Buruli ulcer & M ulcerans thanks to @JClinMicro
👇🏼

https://twitter.com/jclinmicro/status/981150100499193860

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More from @Ashka_TxID

Ashka Patel, DO

@Ashka_TxID

Aug 18, 2021

#IDBoardPearls #IDtwitter #medtwitter

Saw cerebral toxoplasmosis today so here my quick refresher 🧵

🎙Toxoplasmosis:

🦠- protozoal infection caused by Toxoplasma gondii
Transmission - food borne (🥩🥬), zoonotic (🐈), congenital, blood transfusion, organ transplantation

🔎- in immunocompetent pts, it’s usually asymptomatic (maybe flu like illness or chorioretinitis), lifelong
In immunocompromised pts are at risk for reactivation of toxo
👇🏼

💡HIV w/ CD4 < 200
💡SOT

‼️Make sure to screen all organ donors & recipients

⚡️Highest risk of infection

is D+/R-. Most common in 🫀
⚡️Commonly in the first 6 mo post transplant & in those not on Bactrim ppx

📌Pneumonitis - similar to PCP
📌🧠 mass lesions or encephalitis ➡️ CSF might have ⬆️ protein & mononuclear pleocytosis
📌Myocarditis (commonly mistaken for 🫀allograft

Read 7 tweets

Ashka Patel, DO

@Ashka_TxID

Aug 6, 2021

#IDBoardPearls #IDtwitter #IDPhotoQuiz

📟 8 YO admitted w/ flushing, an urticaria rash on face & torso, and itching
His mom says the rash occurred within an hr of him eating a tuna sandwich. He complained of a spicy taste & had perioral burning causing her to seek medical help

❓What is the most likely diagnosis?

Answer: Scombroid poisoning
👇🏼

🎙Fish Poisoning Syndromes:

🚨Scombroid:
⚡️commonly misdiagnosed as a seafood allergy so be 👀

Due to the incorrect storage of 🐟 (above 4C) ➡️ bacterial overgrowth & ⬆️ histamine (by bacterial enzyme called histidine decarboxylase)
👇🏼

🦠- Kleb

Read 12 tweets

Ashka Patel, DO

@Ashka_TxID

Aug 3, 2021

#IDBoardPearls #IDtwitter #IDPhotoQuiz

📟 14 YO boy from Ghana with 🤒 & malaise reports a 5 week history of mulriple skin lesions, which are show below. The lesions on his legs are painful & pruritic. He says multiple kids from his school have them too

🧪- VDRL & FTA-ABS +

❓What organism most likely caused this?

Answer: Treponema pallidum subsp pertenue

🎙Endemic Treponematoes:

🚨Yaws:
🦠- Treponema pallidum subsp pertenue
🗺- Africa, Asia, Latin America, Pacific Islands
Incubation ⏲- 3 wks
Transmission - auto inoculation, close contact with infected lesion
🔎- 🧒🏻👧🏻
Primary Stage -

Read 13 tweets

Ashka Patel, DO

@Ashka_TxID

Jul 29, 2021

https://twitter.com/IUIDfellowship/status/1420546171412549637

#IDBoardPearls #IDtwitter

Great example of amebic encephalitis!
👇🏼

https://twitter.com/IUIDfellowship/status/1420546171412549637

❓Can you differentiate between the 3 most common types of amebic encephalitis… follow the 🧵

1️⃣ Naegleria fowleri:

📍- 🌎wide. In warm water & soil
👇🏼
Trophozoites ➡️👃🏼➡️ olfactory nerves ➡️ 🧠

🔎- primary amebic meningioencephalitis -
⚡️incubation ⏲ - 5 days
⚡️fatal

🧪- ⬆️ ICP w/ ⬇️glucose, ⬆️protein & RBCs

🔬- motile trophozoites can be see in CSF wet mount,
brain biopsy (no cysts will be seen)

2️⃣ Acanthamoeba spp.

📍- 🌎wide. In fresh water, brackish water, HVAC, & soil

🔎
Keratitis - contact lens
Cutaneous - papules ➡️ ulcer

Read 8 tweets

Ashka Patel, DO

@Ashka_TxID

Jul 28, 2021

#IDBoardPearls #IDtwitter #IDPhotoQuiz

📟 54 YO M with type II diabetes presents with a mobile, nontender node on the left side of his neck.

Biopsy culture:

❓Clinical presentation & micro is consistent with what infection?

Answer: Actinomyces spp

🎙Cervicofacial Actinomycosis:

Risk factors - diabetes, trauma, 🦷 infections

🧫- “sulfur granules,” molar 🦷 appearing colonies on plates
👇🏼
vs Nocardia’s chalky white ➡️ orange color

Read 7 tweets

Ashka Patel, DO

@Ashka_TxID

Jul 1, 2021

#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

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