#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 + The American Journal of Tro...
❓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 -
😣, pruritic ulcer that looks like raspberries. These are highly contagious. 🩹 in several mo.

Secondary Stage - appear as primary lesion is healing. Wks- mo. Associated with 🤒 & malaise.

1️⃣Daughter Yaws: lesions are raised Pediatric Dermatology
2️⃣🦀 Yaws: plantar or palmer hyperkeratosis causing a painful 🦀like gait Image
3️⃣ Condyloma lata
4️⃣ Periostitis, osteitis, & dactylitis

Tertiary Stage: destructive bone lesions. Rhinopharyngitits mutilans, hypertrophic periostitis, Saber shins Image
🚨Endemic Syphilis:
🦠- T pallidum subsp endemicum
🗺- North Africa, Arabian Peninsula
Incubation ⏲- 3 wks
Transmission - direct contact with fomites
🔎- 👧🏻🧒🏻
Primary Stage - painless ulcer in oropharynx. Lasts mo-yrs

Secondary Stage - within 3-6 mo.
Mucosal lesions of the
oropharynx, laryngitis, condyloma lata, angular stomatitis, periostitis

Tertiary Stage: early adulthood
Similar to Yaws Image
🚨Pinta:
🦠- T pallidum subsp carateum
🗺- Central & South America, Caribbean
Incubation ⏲- 3 wks
Transmission - direct contact with skin lesions
🔎- at any age
Primary Stage - small erythematous papules that coalesce & become hyperpigmented over mo.

Secondary Stage - pintids Image
scaly papules that get darker

Tertiary Stage - lesions become depigmented Image
🔬- dark field microscopy or immunofluroscence
🧪- nontreponemal (RPR and VDRL) and treponemal (FTA-ABS and TPPPA serology
👇🏼
Won’t be able to differentiate between the 3 and Syphilis
💊- IM benzathine pen G

‼️Leishmaniasis is a protozoal infection caused by the sandfly vector.
It can cause visceral (Old World, Kala-azar) or cutaneous (New World, mucocutaneous, Espundia) disease depending on the species and location

L major cause CL but the ulcer, which develops wks-mo. after inoculation are usually painless with induration borders. Think 🍕 Image
I should mention that CL wouldn’t be VDRL & FTA-ABS + either. 🙏🏼

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More from @Ashka_TxID

29 Jul
❓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
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
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
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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