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Saw cerebral toxoplasmosis today so here my quick refresher 🧵

🎙Toxoplasmosis:

🦠- protozoal infection caused by Toxoplasma gondii
Transmission - food borne (🥩🥬), zoonotic (🐈), congenital, blood transfusion, organ transplantation 🔎- in immunocompetent pts, it’s usually asymptomatic (maybe flu like illness or chorioretinitis), lifelong
In immunocompromised pts are at risk for reactivation of toxo
👇🏼

💡HIV w/ CD4 < 200
💡SOT

‼️Make sure to screen all organ donors & recipients

⚡️Highest risk of infection

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📟 8 YO admitted w/ flushing, an urticaria rash on face & torso, and itching
His mom says the rash occurred within an hr of him eating a tuna sandwich. He complained of a spicy taste & had perioral burning causing her to seek medical help ❓What is the most likely diagnosis?

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📟 14 YO boy from Ghana with 🤒 & malaise reports a 5 week history of mulriple skin lesions, which are show below. The lesions on his legs are painful & pruritic. He says multiple kids from his school have them too

🧪- VDRL & FTA-ABS + ❓What organism most likely caused this?

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Great example of amebic encephalitis!
👇🏼

https://twitter.com/IUIDfellowship/status/1420546171412549637

❓Can you differentiate between the 3 most common types of amebic encephalitis… follow the 🧵

1️⃣ Naegleria fowleri:

📍- 🌎wide. In warm water & soil
👇🏼
Trophozoites ➡️👃🏼➡️ olfactory nerves ➡️ 🧠

🔎- primary amebic meningioencephalitis -
⚡️incubation ⏲ - 5 days
⚡️fatal

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📟 54 YO M with type II diabetes presents with a mobile, nontender node on the left side of his neck.

Biopsy culture: ❓Clinical presentation & micro is consistent with what infection?

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📟 A farmer from the Dominican Republic is here in the US visiting family & presents with a swollen foot that has been progressing over the past 8 years

📸 of his R foot along with biopsy of lesion ❓What is the mostly likely organism?

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Derm round ✌🏼. Let’s do this…

Bacterial Skin Diseases. Follow the 🧶

1️⃣ Impetigo: superficial epidermis
🔎- vesicles/pustular ➡️ crust “🍯 yellow”
🦠- GAS, S aureus

‼️ S aureus causes bullous impetigo similar to poison ivy ❓What other skin manifestations does GAS cause? 👇🏼

2️⃣ Erysipelas: upper dermis and superficial lymphatics
🔎- acute, well-demarcated, 😣, erythematous lesion, 🤒
🦠- GAS, B hemolytic strep

3️⃣ Cellulitis: deeper dermis, subQ tissue
🔎- erythema, warmth, edema, not well-

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Derm… ☠️ Let’s break it down starting with viral exanthems. Follow the 🧶

🚨Coxsackievirus:

1️⃣✋🏼,🦶🏼, & mouth disease - Coxsackie A > Coxsackie B or EV71
🔎 - 😣 ulcerative lesions on hard palate, 👅, buccal mucosa ➡️ vesicular rash on 🤲🏼 &🦶🏼 2️⃣ Atypical HFMD
🔎- vesiculobullous rash or crusted papules (Gianotti-Crosti syndrome). Associated with skin and 💅🏼 peeling. At sites of atopic eczema (eczema coxsackium)

🚨Parvovirus B19:

1️⃣ Erythema infectiosum - Fifth disease
🔎- 👋🏼 cheek syndrome ➡️ lacy erythematous

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Post-exposure prophylaxis. As with all things, timing maters 😷

1️⃣ HAV:
Indications - close contacts, child care & school contacts, food handlers
⏲ 2 weeks - 💉
👉🏼 + Ig if > 60 YO or immunocompromised
⏲ 28 days - 💉
👉🏼 + Ig if chronic liver disease or Hep B/C infection
⏲ 8 weeks - 💉 if there are > 1 close contacts in 🏠

2️⃣ HBV:
Indications - percutaneous or mucosal exposure, sex or needling sharing contact, victim of sexual assault
⏲- within 24 hrs, up to 7 days

📌Unvaccinated 🧍🏻‍♀️+ source HBsAg + ➡️ 💉 + Ig

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I get tripped up on these so let’s go over them… head/neck space infections 🤕

1️⃣ Peritonsillar abscess: “Quinsy”

📍- between the tonsil & the pharyngeal muscle
🦠- strep, staph, anaerobes
Clinical: swollen tonsils + uvula deviation, 🤤, trismus, 🤒 ‼️ vs - Epiglottis, which has a normal pharyngeal exam. “Worst sore throat of my life” + hoarseness + 🤤
👇🏼

2️⃣ Epiglottis:
📍- invasive cellulitis of the epiglottis
🦠 - Hib (prior to 💉), sometimes no 🆔
Clinical - hoarseness (“muffled voice”), 🤤,🤒, 🍒red epiglottis, 👍🏼 print