#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
failure)

🔬- serology (IgM, IgG), PCR, tissue
IgM -, IgG + ➡️ no acute infection
IgM + ➡️ acute infection
IgM & IgG + ➡️ ⁉️since IgM can stay + for up to 12 mo

⚡️PCR is more sensitive for acute infection ➡️ 🩸, CSF, BAL

💊 - PO pyrimethamine + sulfadiazine + leucovorin
Immunocompetent: only with severe or prolonged
symptoms ➡️ 2-4 wks

Ocular disease: 6 wks

Immunocompromised: 6 wks induction ➡️ chronic suppression w/ the same 💊 or Bactrim
👇🏼

💡💊 work on proliferative tachyzoite form but not the encysted parasite

⚡️Serial PCR testing to
monitor response can be useful

❓Sulfadiazine can cause what kind of adverse drug reaction?
Answer: renal obstruction. Due to crystallized sulfadiazine similar to acyclovir or atazanavir

❓Why do we add leucovorin to the pyrimethamine + sulfadiazine regimen?

Comment 👇🏼

• • •

Missing some Tweet in this thread? You can try to force a refresh
 

Keep Current with Ashka Patel, DO

Ashka Patel, DO Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!

PDF

Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

More from @Ashka_TxID

6 Aug
#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 N Engl J Med 2013; 368:e31 DOI: 10.1056/NEJMicm1300169
❓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
3 Aug
#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 -
Read 13 tweets
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

Did Thread Reader help you today?

Support us! We are indie developers!


This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Too expensive? Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal Become our Patreon

Thank you for your support!

Follow Us on Twitter!

:(