A 26-yo👩‍🦰, #sexually active, with 1 partner: right knee and metacarpal arthralgia, tenosynovitis and pustules on her hand.

CT: an abscess on her chest wall
1/9

doi.org/10.1503/cmaj.2…
#IDtwitter #MedTwitter #emergency Image
✔️Urine gonococcal nucleic acid amplification test (NAAT):➕
✔️🧫from the patient’s chest wall fluid:➖but
✔️16S rRNA with gene sequencing confirmed presence of Neisseria gonorrhoeae.

CHEST WALL ABSCEST WITH DISSEMINATED GONOCOCAL INFECTION
2/9

#microbiology #MolBiol
Her doctors treated her with incision and drainage and intravenous ceftriaxone 2 g/d. for 17 days after resolution of the abscess

If chlamydia infection has not been ruled out, chlamydia treatment with doxycycline for 7 days should be added.
3/9

#surgery #MedStudentTwitter
Neisseria gonorrhoeae is a highly infectious Gram-negative diplococcus transmitted mainly through unprotected vaginal, anal and oral intercourse.
4/9

#MedicalStudents #sexual
NAAT is now the recommended method for diagnosis of N. gonorrhoeae as
✔️it provides increased sensitivity while maintaining high specificity,
✔️compared with 🧫 for detecting N. gonorrhoeae in samples from genital and nongenital sites.
5/9

#microbiology #MolBiol #bacteriology
Nucleic acid amplification tests are designed to amplify and detect organism-specific nucleic acid sequences and do not require viable organisms to be present in samples.
6/9

#MedStudentTwitter #MedicalStudents
16S rRNA is a highly conserved gonococcal nucleic acid that, when targeted in testing, allows for identification of bacteria to the species level.
7/9

#sexually #resident
Nucleic acid amplification testing should be done using ✔️first-void urine samples or
✔️swabs from the vagina, cervix, urethra, rectum or other site of clinical concern.
8/9

#sexual #MedEd #Doctor
Given the rates of N. gonorrhea infections, clinicians should maintain a high degree of suspicion in sexually active patients.
9/9

#IDtwitter #MedTwitter #medicine

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More from @guerreroespejo

Nov 14
46 años ♂️, consumo de #cocaína: dolor en ambos pabellones auriculares con color violáceo.

La prueba de tóxicos en orina:➕a cocaína y benzodiacepinas
1/

dx.doi.org/10.4321/s0376-…
#urgencias #AtencionPrimaria Image
Al cabo de unos días: NECROSIS AURICULAR BILATERAL
SECUNDARIA A #COCAÍNA ADULTERADA CON LEVAMISOL

2/6
dx.doi.org/10.4321/s0376-…
#dermatología #Cirugíaplástica Image
La #cocaína en #España:
📌 adulterada en el 82,5% de la dosis con otro tipo de sustancias como el levamisol, la fenacetina y la cafeína.
📌Desde 2009, un aumento de cocaína adulterada con levamisol
3/6

#MIR #EducaciónMédica
Read 6 tweets
Nov 13
An 81-YO👵, type 2 DM: malaise, fever & anorexia, with oral pain & odynophagia, yellowish-white, pseudomembranous lesions on the tongue (A)

#endoscopy showed multiple shallow ulcers with a white coating (B)
1/6

doi.org/10.1503/cmaj.2…
#emergency #gastroenterology #MedEd Image
Glossal & esophageal🔬: multinucleated cells with moulded, ground-glass nuclei

PCR & immunohistochemical staining of the specimens: ➕ for herpes simplex virus type 1 (HSV-1)

HERPETIC GLOSSITIS AND ESOPHAGITIS
2/6

#GIPath #IDtwitter #microbiology
Her hemoglobin A1c was 7.2%.

Doctors treated her with a 7-day course of acyclovir, intravenously because of her odynophagia, and the oral and esophageal lesions completely resolved.
3/6

#MedStudentTwitter #MedicalStudents
Read 6 tweets
Nov 9
👧de 7 años, picadura de #garrapata (fig.) en el sur de #España: febrícula, astenia, múltiples ganglios linfáticos cervicales laterales y posteriores, y escara negra rodeada de eritema en la región occipital (fig.).
1/5

DOI: 10.1016/j.anpedi.2020.03.010
#pediatría #dermatología ImageImage
La niña fue diagnosticada de linfadenopatía transmitida por garrapatas, TIBOLA (TIck-BOrne LymphAdenopathy).

Claritromicina de 5 días: asintomática un mes después. La escara negra desapareció a las 5 semanas.
2/5

#AtenciónPrimaria #urgencias #MedEd
TIBOLA
✔️enfermedad emergente en Europa
✔️causada mayoritariamente por Rickettsia slovaca (también por R. rioja, R. sibirica mongolotimonae, R. massiliae, Bartonella haenselae y Francisella tularensis) y
✔️transmitida por garrapatas Dermacentor

3/5
#microbiología #microbiology
Read 5 tweets
Nov 8
An 85-YO👨‍🦳, chronic kidney disease, gouty arthritis: fever, neck pain & stiffness.

WBC & CRP:⬆️
MRI suggested cervical meningitis (A): enhancement along the epidural space (arrows), & thin enhancement in a portion of the meninges (arrowheads).

1/5
#neurology #radiology
CSF: not meningitis, & CSF🧫& molecular tests ➖ for bacteria & mycobacteria

CT: calcifications of the transverse ligament of the atlas (B).

Diagnosed with crowned dens syndrome: 20 mg prednisolone, & his symptoms dramatically improved.
2/5

#rheumatology #radres #emergency
However, CSF examination under polarising microscopy revealed monosodium urate crystals (C).
Dual-energy CT confirmed the calcifications to be monosodium urate crystals (D).
Uric acid:⬆️
MONOSODIUM URATE CRYSTALS IN CSF THAT CAUSED MENINGITIS-LIKE SYMPTOMS
3/5
#neurology #MedEd
Read 5 tweets
Oct 20
A 29-YO👨‍⚕️#physician, a needlestick injury with a needle used to collect a fluid sample from a man who had a pustular rash (later confirmed to be #monkeypox), the gloves appeared intact to him
Four days later, a vesicle appeared on the pricked finger (A)
1/7

#MedTwitter #Doctor
#Monkeypox virus was identified in its fluid by PCR

MONKEYPOX AFTER OCCUPATIONAL NEDDLESTICK INJURY FROM PUSTULE
2/7

doi.org/10.3201/eid281…
#IDtwitter #MedStudentTwitter
Progress of #monkeypox index lesion:
A) on the 4th day of illness
B) on the 6th day of illness
C) on the 18th day of illness
D) Necrotic scab underneath the devitalized tissue of the index lesion on the 24th day of illness
3/7

#resident #medicine
Read 8 tweets
Oct 19
A👨, HIV + (CD4 = 25 cells/mm3): rash on arms, hands, chest, & buttocks compatible with #monkeypox
Ocular: redness, pain, itching, swelling, discharge, photosensitivity, & vision changes

Unilateral conjunctivitis, ulcer, & keratitis (fig.)
1/8

#ophthalmology #IDtwitter
A PCR swab of the conjunctival lesion:➕for Orthopoxvirus

OCULAR #MONKEYPOX
2/8

DOI: dx.doi.org/10.15585/mmwr.…
#eye #ojo #oftalmologia
Patients with #monkeypox can experience serious ocular complications:
5 consecutive patients with ocular monkeypox, have experienced delays in treatment, prolonged illness, hospitalization, & vision impairment.
3/8

DOI: dx.doi.org/10.15585/mmwr.… #MedEd #MedTwitter
Read 8 tweets

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