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20 Nov, 6 tweets, 6 min read
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)
4/
 #Yersinia enterocolitica

Extraintestinal and post-infectious:

1. Septicemia (iron sepsis - see next tweet)
2. Reactive arthritis, erythema nodosum, glomerulonephritis, autoimmune thyroiditis

pubs.rsc.org/en/content/art…
5/
 #Yersinia enterocolitica and Iron sepsis

Iron is an essential nutrient for bacterial survival. Higher iron levels has been suggested to increase risk of bacterial infections, including Yersinia.

doi.org/10.1128/iai.47…
6/
 #Yersinia enterocolitica and iron sepsis

Here are cases of Yersinia sepsis after intake of iron pills!

nejm.org/doi/full/10.10…

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More from @MayoClinicINFD

Mayo Clinic Infectious Diseases Profile picture
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
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
Mayo Clinic Infectious Diseases Profile picture
2 Oct
Weekend Digest

Name the pathogen.

5 clues

Airborne precautions
Cough, coryza, conjunctivitis
Secondary bacterial pneumonia
Vitamin A deficiency
#VaccinesWork Image
2/
 #Measles #morbillivirus
Single stranded RNA virus
#Paramyxoviridae

Humans are the only known natural hosts for the virus

Disease: measles
3/
 #Measles

Prodrome:
Fever, malaise
Cough, #coryza, conjunctivitis
Enanthem: #Koplik spots

Exanthem: erythematous maculopapular blanching (#morbilliform) rash; cephalocaudal spread; generally spares palm and soles
Read 9 tweets

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