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Ashka Patel, DO Profile picture
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29 Jul, 8 tweets, 3 min read
#IDBoardPearls #IDtwitter

Great example of amebic encephalitis!
👇🏼
❓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
Nasopharyngeal - chronic sinusitis, septal erosion

Granulomatous amebic encephalitis -
⚡️insidious onset wks - mo)
⚡️behavioral changes

🧪- LP contraindicated due to focal lesions
👇🏼
‼️MRI will have space occupying lesions

BUT trophozoites not usually seen in CSF
👇🏼
vs
Naegleria

🔬- needs brain biopsy. Tissue w/ trophozoites & cysts (unlike Naegleria)
‼️Acanthamoeba & Naegleria can be cultured on non-nutrient agar plates covered w/ bacteria. Tracks can be seen as motile trophozoites move while eating the bacteria

3️⃣ Balamuthia mandrillaris:

📍- 🌎wide. In soil & dust. Common in Hispanics, solid organ transplantations
🔎- granulomatous amebic encephalitis
⚡️follows skin lesions (👃🏼) caused by trauma
⚡️mo - yrs later ➡️ 🧠 involvement

🧪- LP contraindicated due to focal lesions
👇🏼
‼️thrombotic angiitis w/ hemorrhage & necrosis seen on brain MRI American Journal of Neuroradiology: http://www.ajnr.org/cont
Again, trophozoites NOT usually seen in CSF

CSF will be lymphocytic pleocytosis similar to Acanthamoeba
👇🏼
vs Naegleria, which has a PMN pleocytosis

🔬- brain biopsy. Tissue w/ trophozoites & cysts (unlike Naegleria)

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More from @Ashka_TxID

Ashka Patel, DO Profile picture
28 Jul
#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: Journal of clinical and diagnostic research
❓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 Profile picture
26 Jul
#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 Indian Journal of Surgery S...University of Adelaide
❓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
Read 13 tweets
Ashka Patel, DO Profile picture
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
Ashka Patel, DO Profile picture
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
Ashka Patel, DO Profile picture
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
Ashka Patel, DO Profile picture
28 Jun
#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 -
Read 6 tweets

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