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
#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!
#Mycoplasma #genitalium

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
#Mycoplasma #genitalium

Lacks cell wall: no organism seen on Gram stain!

Difficult to culture.

Use nucleic acid amplification test NAAT (if able, check macrolide resistant gene)

#Mycoplasma #genitalium
Two-stage Treatment

Doxycycline 100 mg PO BID for 7 days folllowed by moxifloxacin 400 mg daily for 7 days (or if susceptible, by a macrolide)

Test and treat sexual partners

Test of cure not needed.
(CDC guidance 2021) Image

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More from @MayoClinicINFD

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
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?
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
7 Aug
Weekend Digest

Name the pathogen and its treatment
(Photo CDC)
#Plasmodium #falciparum
1. Anopheles bite
2. Endemic regions / returning travelers: 12-14 day incubation period
3. Fever +/- severe symptoms (see next)
4. Dx: blood smear, rapid diagnostic Ag or Ab test
5. Rx: chloroquine, artemisin-based combination Rx (depends on region)
#Plasmodium #falciparum is severe if with end-organ S/S

AMS / seizures
Severe anemia
Renal failure
Pulmonary edema
High level parasitemia
Read 5 tweets
2 Aug
Images of Infectious Diseases

A young man presents to the ER because of leg numbness. While undergoing evaluation, he had a seizure. CT head is shown (photo). #IDTwitter what is your differential diagnosis?

Case details #MayoIDQ MCQ to follow… Image
36M migrant from Mexico
No PMH. HIV negative.
CC: leg numbness
ED: witnessed seizure
WBC 16. Cr 0.7. AST 35.
CT (photo)

Which one of the following is least likely the correct answer about this condition? #MayoIDQ
Case diagnosis: #Neurocysticercosis NCC due to #Taenia #solium

There was an almost equal spread in the answers (probably due to poorly constructed MCQ :-) )

The least likely correct association is undercooked pork…. which leads to #taeniasis but not directly to NCC
Read 7 tweets
17 Jul
Weekend Digest

Name the pathogen and its treatment.

1. Grows within protozoa
2. Decorative fountains
3. Hotel stay during travel
4. Cough + diarrhea
5. Antigen test
#Legionella species

Aerobic “intracellular” GNB
>60 species

L. #pneumophila serogroup 1 - most common cause of human illness (water exposure)

L. #longbeachae (ANZ / soil, potting mix and compost exposure)
#Legionella #pneumophila

Lakes. Streams. Reservoirs.

In water:
1. Planktonic
2. Biofilms
3. Intracellular in protozoa / free-living amoeba (protects bacteria from disinfection)
Read 9 tweets
3 Jun
Images of Infectious Diseases

42M on obinutuzumab for CLL. 4 mo ago: mild COVID-19 - no specific Rx. 3 mo ago: SARS-CoV-2 mRNA vaccine.

CC: 2 mo on/off fever, cough, dyspnea. NP SARS-CoV-2 PCR neg. Rx as CAP w doxycycline - no response.

CT chest. DDx? Work up? #MayoIDQ next Image
Four months after mild COVID-19, an ICH man with CLL on obinutuzumab presents with prolonged / recurrent doxycycline-non responsive CAP. CT chest shown. See prior tweet for other details. Which of the following is the most likely diagnosis? #MayoIDQ
All of the MCQ choices could be possible in this case. Imaging suggested viral or PJP.

Work up:
Serum BDG / GM negative
CMV PCR negative
BAL PJP PCR negative
SARS-CoV-2 spike/nucleocapsid Ab negative (despite infection / vaccine)
Read 12 tweets
3 Apr
Weekend Digest

An Korean immigrant presented with early stage cholangiocarcinoma.

H & E stained tissue biopsy shown.

Name the pathogen and mechanism of infection.
Case Diagnosis:
#Clonorchis sinensis - oriental liver fluke

“The eggs of Clonorchis are practically indistinguishable from those of #Opisthorchis” (photo credit: CDC)
#Chlonorchis sinensis (and #Opistorchis)

Human infection is acquired by ingestion of undercooked, salted, pickled, or smoked freshwater fish (with metacercariae)

—> excyst in duodenum —> ascend biliary tree —> mature into adults in biliary ducts

Read 7 tweets

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