#idboardreview 25 military returned from Iraq 3wks ago: Fever, myalgia/arthralgia, headache, cough x1wk, mild abd pain, exposure to goat herders & bought a wool rug +sick contacts w/flu like sx. wbc3k, plt110 Cr1.2, mild⬆️AST/ALT+interstitial pneumonia #medEd #idmedEd #idtwitter #Qfever well documented in military stationed in Iraq. Infection acquired by inhalation of #Coxiella burnetii from soil or fomites contaminated w/urine, feces or parturition products of cattle, goats, sheep. Organisms can survive in fomites for months. Pic Ref radiopedia

#idboardreview 50 M from 🇬🇧 recent mountain biking trip to 🇩🇪 🇪🇸 presents w/ fever, sore throat, cervical lymphadenopathy, myalgia, plt100, AST300, ALT200, prickly rash face then arms, now on trunk. Spares palms/soles. Diagnosis? #medEd #idmedEd #idtwitter #rubella or atypical #measles in adult

#idboardreview 17 M w/hx of meningitis s/p course of iv ceftriaxone. Now 2 wks later present with fever, RUQ abd pain. Ultrasound: gallstones that disappeared on repeat imaging in 2 weeks. dx? #idtwitter #idmeded #meded #Ceftriaxone-associated #pseudocholelithiasis Ceftriaxone, excreted & concentrated in gallbladder bile, can form a precipitate, ceftriaxone–calcium salt, which may cause biliary sludge formation rarely in pts who receive high-dose treatment (≥2 g)

#idtwitter #idboardreview by our now faculty @mmcclean1 @CIDJournal @SamirGu02674263 doi.org/10.1093/cid/ci… 58 M Indiana farmer using manuer fertilizer x months w/progressive cough, dyspnea, pleuritic chest pain, chills x11mo: CT: pulm nodules. BC: gram+bacilli #meded #Rhodococcus hoagii (previously R equi) bacteremia with septic pulmonary emboli
-aerobic gram+coccobacillus
-Cells adopt a coccoid morphology when grown on solid media &
-in liquid media bacilli of varying lengths that often appear beaded in gram-stained preparations are formed

#IdBoardReview Amazonian farmer w/ multiple skin nodules of L leg x20+yrs (which itch & bleed frequently)started post penetrating injury w/ thorn of a plant. biopsy chronic granulomatous process: dermis w/ thick walled round fungi forming single chains. #IDTwitter #meded #lobomycosis Ref ajtmh.org/view/journals/…

#idboardreview Pt recent travel to Malaysia, spend time on the beach now w/ this itchy rash x2wks. Also w/ cough, occasional dyspnea, eosinophilia, ill defined reticulonodular infiltrates on chest CT #idtwitter #idmeded #MedEd cutaneous larva migrans (#CLM) with #Löeffler’s syndrome. Tx w/ albendazole x7d and symptoms resolved Ref ajtmh.org/view/journals/…

#idboardreview 80 M originally from Philippines w/ yearly travel there, presents w/ fever, abd pain, chills, inc LFTs, +liver abscess. BC+ organism? #meded #idmeded #idtwitter hypervirulent #klebsiella pneumoniae liver abscess Ref academic.oup.com/ofid/article/7…

#idboardreview 40 M originally from Cameroon, also travel to Ghana & Mali, now w/6 mo progressive weakness requiring wheelchair use,lethargy, 30lb wt loss, confusion. CSF lymphocytic pleocytosis. dx? #meded #idmeded #IDtwitter Human African #trypanosomiasis endemic to sub-Saharan Africa & fatal when untreated. parasite Trypanosoma #brucei transmitted by tsetse fly (Glossina spp) vector

#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 #RossRiverVirus Ref eurosurveillance.org/content/10.280…

#idboardreview Peritoneal dialysis pts with exit site infection outbreak. Aqueous Chlorhexidine with gram negative bacteria. dx? #meded #idmeded #idtwitter #Burkholderia #cepacia wwwnc.cdc.gov/eid/article/26…

#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 #Nocardia #ignorata wwwnc.cdc.gov/eid/article/26…

#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 #Wohlfahrtiimonas #chitiniclastica bacteremia Ref wwwnc.cdc.gov/eid/article/27… in this case identified w/ MALDI-TOF; Image Ref jgid.org/article.asp?is…

#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 Endovascular Infection #Kingella #kingae Complicated by Septic Arthritis in Immunocompromised Adult Patient Ref wwwnc.cdc.gov/eid/article/26…

#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 #Bacillus #cereus causing #anthrax #pneumonia cdc.gov/mmwr/volumes/7…

#IdBoardReview sudden onset of fever, bronchitis, pneumonia, severe resp illness outbreak in pts of all ages/immune status that attended a game last week. BAL pleomorphic gm- bacteria. What type of isolation? #IDtwitter #idmedEd #medEd Inhalation #tularemia bioterrorism needs standard precautions as
Not transmitted from person to person
cdc.gov/infectioncontr…

#idboardreview 50 M s/p renal transplant 50 days ago, present w/ fever, seizures, pneumonia, skin lesions. Biopsy with wide ribbon aseptate hyphae, typical fruiting head on SABDX, LPCB stain. dx? #meded #idmeded #idtwitter Disseminated #mucormycosis due to #Cunninghamella bertholletiae Pics Ref ir.library.louisville.edu/cgi/viewconten…

#idboardreview 25 F w/ gross hematuria x 1 mo. Previous remote travel to Kenya & swimming in fresh water lake +eosinophilia, thickening of bladder. Sandy patches appearance in cystoscopy. #IDtwitter #idmeded #meded #Schistosoma #haematobium Ref ncbi.nlm.nih.gov/pmc/articles/P…

#idboardreview 20 F w/ SLE on hydroxychloroquine & recently high dose steroids for SLE flare presents w/F, dyspnea, diarrhea, wbc6k, Na133, COVID/RVPneg, procal9, galactomann neg, dx? #meded #idmeded #idtwitter #Legionella cavitary pneumonia is atypical presentation of Legionnaire’s disease & more commonly w/ impaired cellular immunity due to corticosteroids (particularly high-dose steroid), immunosuppressive therapy, organ transplant & HIV infection; Case Ref idimages

#idboardreview 60 F who handles hares w/ 1wk lesion on R 2nd finger +F/chills, HA, axillary lymphadenopathy, no improvement on amoxicillin/clav. Culture+ colonies 2 to 4 mm in size, greenish-white, round, smooth, slightly mucoid. #idmedEd #medEd #IDTwitter #tularemia Francisella tularensis , an aerobic catalase-positive, gram negative coccobacilli omicsonline.org/open-access/tu…

#idboardreview 30 M chef, 2 🐈4 🐀 pets w/close contact, no bites/scratches present w/ diffuse maculopapular, non-blanching slightly palpable rash some petechiae involves palms/soles. Tender swollen R knee, L Ankle/wrist. #IdMedEd #IDTwitter #medEd Rat-bite fever is a bacterial infection caused by #Streptobacillus moniliformis, which is more common in North America, and Spirillum minus, which is more common in Asia journals.asm.org/doi/10.1128/CM…

#idboardreview Recently returned traveler from camping trip in Mexico presents w/ abdominal pain, nausea, fever, and bloody diarrhea. O&P: structure with ingested erythrocyte (arrow). dx? #medEd #idmedEd #idtwitter trophozoite form of #Entamoeba #histolytica etiologic agent of #amebiasis cdc.gov/parasites/ameb… @CDCgov