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
📟 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?
📟 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
📟 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?
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)
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
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