#idboardreview 40 M presents in summer w/fever, headache, myalagia later rash started on wrists, palms & soles and then diffuse. No hiking or travel. Multiple recent bug bites from her pet dogs who are not uptodate with flea/tick meds. Dx? #meded #idmeded #idtwitter Image
Rocky mountain spotted fever #RMSF ncbi.nlm.nih.gov/pmc/articles/P…
#RMSF typically fever early in the course. OTher sx: HA, myalgias, N, V, abd pain. Rash is common but may not occur in first few days. Rash starts on wrists and ankles before spreading proximally. Palms/Soles 36-82% cases.
#RMSF Severe: skin necrosis, gangrenous digits, neurologic complications, azotemia, pulmonary edema, acute reps distress. Case fatality rate 23% without appropriate abx and upto 4% despite appropriate abx
#RMSF indirect immunofluorescence assage is serologic test of choice. 4fold increase in IgG titer from actue illness to convalescence confirms it. Dx: doxy 100bid x7-10d

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More from @IUIDfellowship

9 Dec
#idboardreview 60 F recent travel to Cairns, Australia, had multiple🦟 bites, 1wk later fever, fatigue, headache, myalgia & arthralgia of hands, wrists, feet & ankles. +itchy papular rash on her face, neck and trunk.Dx? #meded #idmeded #IDTwitter Image
Read 6 tweets
8 Dec
#idboardreview Peritoneal dialysis pts with exit site infection outbreak. Aqueous Chlorhexidine with gram negative bacteria. dx? #meded #idmeded #idtwitter ImageImage
#Burkholderia #cepacia is type species of genus Burkholderia & ubiquitous MDR, motile, non–glucose-fermenting, gram-negative organism found in water & soil. Major pathogen in cystic fibrosis & opportunistic pathogen in pts w/ indwelling medical devices & immunosuppression
Read 7 tweets
7 Dec
#idboardreview 60 M 6 months post heart transplant on atovaquone px presents w/ cough, dyspneax10d. CT b/l nodules w/ cavities, l leg mass aspirated. Dx? #meded #idmeded #IDTwitter ImageImage
Risk factors of #nocardia in #SOT

high calcineurin inhibitor trough levels in month before dx

use of tacrolimus

corticosteroid dose at time of dx

patient age

length of stay in ICU after SOT

academic.oup.com/cid/article/63…
Read 7 tweets
6 Dec
#idboardreview Pt w/ LE venous insufficiency found in his camper unconscious and covered in feces and maggots: septic shock, wbc 35k, Cr 6, blood culture w/ gram negative non-motile bacteria. Dx? #meded #idmeded #idtwitter Image
#Wohlfahrtiimonas #chitiniclastica bacteremia Ref wwwnc.cdc.gov/eid/article/27… in this case identified w/ MALDI-TOF; Image Ref jgid.org/article.asp?is…
#Wohlfahrtiimonas #chitiniclastica was first identified in culture from the third-stage larvae of Wohlfahrtia magnifica flies which are known to cause myiasis, commonly in sheep and cattle
Read 5 tweets
5 Dec
#idboardreview 60 F with Myelodysplastic syndrome presents w/ L knee pain, rash on unilateral sole, PET: L iliac artery uptake. Knee fluid 80k 98% PMN, gram stain gram negative cocobacilli. dx? #meded #idmeded #idtwitter ImageImage
Endovascular Infection #Kingella #kingae Complicated by Septic Arthritis in Immunocompromised Adult Patient Ref wwwnc.cdc.gov/eid/article/26…
#Kingella kingae gram-negative coccobacillus,normal flora of upper respiratory tract. Causative agent of osteoartricular infections in kids<4 years. Rarely HACEK IE in adults
R.f poor oral hygiene, pharyngitis, & mucosal ulcerations
Read 6 tweets
4 Dec
#idboardreview 50 M Texan welder w/ diarrhea, cough, dyspnea x2d, presented to ED, sepsis and rapid progression to resp fail & death <8hrs after presentation. CT necrotizing pneumonia. +GPR #idtwitter #meded #idmeded ImageImage
Read 10 tweets

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