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28 Aug, 5 tweets, 3 min read
Weekend Digest

Name the pathogen!

5 Clues: TMP-SMX, levofloxacin, minocycline, ceftazidime, ticarcillin-clavulanic acid Image
2/
 #Stenotrophomonas #maltophilia

Ubiquitous. Soil. Water. Plants.

Hospital environment.

Adheres to foreign materials. #biofilm formation
3/
 #Stenotrophomonas #maltophilia

Hospital environment. Devices. Biofilm. —> nosocomial infections.

Two major syndromes:
1. Pneumonia - often ventilator associated
2. Bacteremia - often vascular catheter associated (especially in Heme/Onc/BMT patients)
4/
 #Stenotrophomonas #maltophilia
Multi-drug resistant

Intrinsic R to beta-lactams due to inducible beta-lactamases
1. Penicillinase
2. Cephalosporinase

R to Aminoglycosides
5/
 #Stenotrophomonas
TMP-SMX Rx of choice

Check susceptibility pattern!

Others: levofloxacin (maybe moxifloxacin), minocycline / tigecycline, ceftazidime, ticarcillin-clav (if available)

Some data with cefiderocol

Our previous fellow research:
doi.org/10.1093/ofid/o…

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More from @MayoClinicINFD

Mayo Clinic Infectious Diseases Profile picture
20 Nov
Weekend Digest

Name the Pathogen

5 Clues:

- #Chitlins
- #Iron sepsis
- Mesenteric #adenitis
- Reactive #arthritis
- Terminal #ileitis Image
2/
 #Yersinia enterocolitica

It is #zoonotic and is acquired by exposure to contaminated food.

When #IDBR says #chitlins (#chitterlings), you say Y. enterocolitica

Chitlins are food made of pork intestines (where Y enterocolitica resides)

ncbi.nlm.nih.gov/pmc/articles/P…
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 #Yersinia enterocolitica

Enterobacteriaceae #GNB that causes #enterocolitis, diarrhea (often bloody), terminal #ileitis, mesenteric #adenitis, and RLQ pain that may be mistaken as #appendicitis (#pseudoappendicitis)
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18 Nov
Images of Infectious Diseases

46F with diabetes presents with orbital apex syndrome. Imaging and histopathology shown. What is your differential diagnosis? #MayoIDQ to follow @StephanieGrach @ZYetmar @omarabusaleh15 Image
2/ #MayoIDQ
46F with uncontrolled DM and recent DKA is admitted because of left sided HA for a month. PE: orbital apex syndrome. Head imaging shown. ENT/neurosurgery proceeded with debridement. Pathology shown. Which one of the following choices is most correct?
3/
 Case diagnosis: Rhinocerebral #mucormycosis due to #Rhizopus in a person with poorly controlled diabetes mellitus

Rx:
Surgical debridement
Liposomal #Amphotericin B

Later: transitioned to #Posaconazole upon clinical control and improvement
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Mayo Clinic Infectious Diseases Profile picture
13 Nov
Weekend Digest

Name the pathogen

5 clues

GNB with musty odor
Clenched fist injury
Culture negative endocarditis
Needle licker osteomyelitis
Toothpick septic arthritis Image
2/
 #Eikenella corrodens

Part of human oral flora

Component of polymicrobial infection related to human bites.

#IDBR buzzword is clenched-fist injury – when it is inoculated to injured knuckle of a clenched fist that strikes teeth of an opponent.

doi.org/10.1016/S0363-…
3/
 #Eikenella corrodens is the “E” in HACEK – agents of culture negative endocarditis

HACEK organisms can now be cultured with current culture techniques, hence they should no longer be called “culture negative” pathogens!
Read 9 tweets
Mayo Clinic Infectious Diseases Profile picture
6 Nov
Weekend Digest

Name the pathogen.

Pain and discomfort when you pee
But Hans Christian Gram cannot see
Try to kill me with Doxy
Moxi chaser sets you symptom-free. Image
2/
 #Mycoplasma #genitalium

“Cause of #NGU not visible by Gram stain and treated with two-stage approach using #doxycycline followed by #moxifloxacin chaser!”

Fellows, this is #IDBR material, definitely!
3/
 #Mycoplasma #genitalium
Diseases;

Men: persistent / recurrent non-gonococcal urethritis (NGU) / non-chlamydia urethritis

Women: cervicitis, PID, preterm delivery, spontaneous abortion, infertility

Many infections are asymptomatic!
Don’t forget: rectal / pharyngeal infection
Read 5 tweets
Mayo Clinic Infectious Diseases Profile picture
5 Nov
Images of Infectious Diseases

“Food gets stuck in my Adam’s apple”

A 68 year old man presents with weight loss and dysphagia for 6 weeks. Upper endoscopy is shown. What is your diagnosis? #MayoIDQ and case details to follow Image
2/
 68M. No PMH. 6w gradual dysphagia to solids with 20 lb weight loss. No F/C/sweats. PE: cachexia. WBC 4.7 Cr 0.9 CXR normal. HBV(-). Rx fluconazole.

Per your suggestion: HIV VL 56K CD4 26. Patient willing to start ART immediately. Genotype pending. You suggest which one?
3/
 Case diagnosis: Esophageal candidiasis in a man with newly diagnosed AIDS

Suggested ART: TAF-FTC-bictegravir

ART consists of 2 NRTI in combo with 3rd drug: INSTI, NNRTI or boosted PI.

Among them: INSTI is preferred for various reasons (next)
Read 6 tweets
Mayo Clinic Infectious Diseases Profile picture
10 Oct
Images of Infectious Diseases

2 months after visiting family and friends in Manila:

39M. No PMH. One week of fever, chills, cough, pleuritic chest pain, RUQ pain.

Now complains of blurred vision due to endophthalmitis.

Your DDx? #MayoIDQ and case details to follow… Image
2/
 39M. No PMH. HIV-. No IDU.
PE: jaundice, endophthalmitis, no dental issues, b/l rales, new systolic murmur, tender RUQ
WBC 18.3 Alk phos 250.
CT chest / abdomen (photo)
TEE: mitral valve vegetation
Which of the following is the most likely pathogen? #MayoIDQ
3/
 Let us use this case to highlight clinical pearls about liver abscess:

Two major categories
1. Pyogenic liver abscess
2. Amoebic liver abscess

In this case, there are factors that favor pyogenic liver abscess: endocarditis, septic pulmonary emboli and endophthalmitis
Read 9 tweets

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