Weekend Digest

Name the pathogen

5 Clues

Gram-positive bacillus.
Spore.
Food. Wound. Iatrogenic.
Drooping eyelids.
Preserved sensory function. Image
2/
#Clostridium #botulinum
Spore-forming Gram-positive bacillus
Ubiquitous: vegetable, soil, seafood

Neurotoxin: A-H (A, B, E cause human disease)

Toxin binds to receptor in presynaptic terminal —> blocks neurotransmitter release (blocks cholinergic neuromuscular innervation)
3/
#Botulism (epidemiologic clues)
1. Infant botulism (raw honey)
2. Foodborne (preformed toxin; home-canned fermented food)
3. Wound botulism (IDU/ black tar heroin)
4. Iatrogenic (cosmetic use)
5. Bioterrorism (mass poisoning)
4/
#Botulism is characterized by bilateral cranial neuropathies and symmetric, descending flaccid motor paralysis:
* Dysphagia
* Muscle weakness
* Diplopia
* Ptosis
* Blurry vision
* Slurred speech
* Respiratory distress
* Ocular palsy

Absence of sensory nerve dysfunction
5/
Diagnosis: detect #botulinum toxin in serum, stool, food; culture botulinum-producing C. botulinum from stool, wound.

Rx:
Antitoxin (heptavalent antitoxin; botulinum IG)
Supportive care
Debride wound + PCN

Antibiotics NOT needed in food borne, intestinal and infant botulism
6/
Bonus question: why is it named #botulinum?
/7
Clostridium botulinum#

Sausage - botulus (Latin word)

Causes illness similar to the sausage poisoning in Germany during 1820s vs. bacteria is shaped like a sausage

antimicrobe.org/h04c.files/his…

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More from @MayoClinicINFD

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…
3/
#Yersinia enterocolitica

Enterobacteriaceae #GNB that causes #enterocolitis, diarrhea (often bloody), terminal #ileitis, mesenteric #adenitis, and RLQ pain that may be mistaken as #appendicitis (#pseudoappendicitis)
Read 6 tweets
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
Read 6 tweets
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
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
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
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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