📟 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
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🎙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
E. coli, Proteus, Salmonella, Clostridum, Shigella, Vibrio
⚡️Once histamine ⬆️, it can’t be broken down by 🧊or👩🏻🍳
🔎- within an hr of eating
Cutaneous flushing, urticarial rash
usually on face & torso, 🤕, 💩, perioral burning, blurry 👁
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Fish will have peppery or spicy taste
⚡️👵🏼 who are in MOAIs or INH, which 🚫 breakdown of histamine ➡️ severe & prolonged symptoms
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Tachycardia, bronchospasm, hypotension, dizziness, edema
💊- antihistamine
🚨Tetrodotoxin:
⚡️ Due to the incorrect storage of 🐟 ➡️ bacterial overgrowth & toxin production ➡️ blocks Na channels
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⚡️🐟➡️ eat algae laced w/ ciguatoxin (produced my dinoflagellates that adhere to it) ➡️ consumption of fish allows toxin to ⬇️ opening threshold of Na channel
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Barracudas, groupers, moray eels, snappers, amberjacks
⚡️toxin is heat resistant, lipid solvable
odorless, & tasteless
🔎- within 3-6 hrs of consumption
🤢,💩, painful 🦷, blurry 👁, hot/cold reversal, 🤕, pruritus, hallucination, metallic taste in mouth, bradycardia
💊- supportive care. Possible neurological reversal with amitriptyline, gabapentin, or pregabalin
📟 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 -
📟 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
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This is fungal
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)