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Jan 15 8 tweets 5 min read
Weekend Digest

Name the Pathogen

Five Clues
1. Gram-positive bacillus with tumbling motility
2. Food safety
3. Age, pregnancy and steroids
4. Rhombencephalitis
5. Ampicillin+Gentamicin Image 2/
#Listeria monocytogenes

Soil
Decaying plant matter

Processed/unprocessed food (deli meats, hotdog, soft cheese, pate, fruits, greens/salads)

Oral route —> intestinal mucosa penetration —> systemic infection
Nov 20, 2021 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…
Nov 18, 2021 6 tweets 6 min read
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?
Nov 13, 2021 9 tweets 6 min read
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-…
Nov 6, 2021 5 tweets 4 min read
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!
Nov 5, 2021 6 tweets 2 min read
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?
Oct 10, 2021 9 tweets 4 min read
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
Oct 2, 2021 9 tweets 6 min read
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
Sep 18, 2021 5 tweets 4 min read
Weekend Digest

Name the pathogen

5 Clues
#Lymphocytosis
#Macrolide
Posttussive #vomiting
Respiratory #droplet
#VaccinesWork Image 2/
#Bordetella pertussis

Fastidious gram-negative coccobacillus

Transmit: respiratory droplets - highest transmission during the catarrhal stage
Sep 11, 2021 7 tweets 3 min read
Weekend Digest

Name the pathogen

5 Clues

Gram-positive bacillus.
Spore.
Food. Wound. Iatrogenic.
Drooping eyelids.
Preserved sensory function. Image 2/
#Clostridium #botulinum
Spore-forming Gram-positive bacillus
Ubiquitous: vegetable, soil, seafood

Neurotoxin: A-H (A, B, E cause human disease)

Toxin binds to receptor in presynaptic terminal —> blocks neurotransmitter release (blocks cholinergic neuromuscular innervation)
Sep 4, 2021 4 tweets 2 min read
Weekend Digest
Name the pathogen!

5 Clues:
Rodents.
Triathlon.
Conjunctival suffusion.
Jaundice.
Jarisch-Herxheimer. Image 2/
#Leptospira

Spiral-shaped bacteria

Zoonotic: rodents important reservoir

Enters though skin breaks, mucosa, conjunctiva

Freshwater. Floodwater. Rainfall.

Recreational water activities. Triathlon. Swimming. Wading.

Rice farmers. Abattoir workers.
Aug 28, 2021 5 tweets 3 min read
Weekend Digest

Name the pathogen!

5 Clues: TMP-SMX, levofloxacin, minocycline, ceftazidime, ticarcillin-clavulanic acid Image 2/
#Stenotrophomonas #maltophilia

Ubiquitous. Soil. Water. Plants.

Hospital environment.

Adheres to foreign materials. #biofilm formation
Aug 22, 2021 6 tweets 4 min read
Images of Infectious Diseases
58M. NYC. No PMH.

1 mo ago: high dose prednisone, rituximab, plasma exchange for presumed paraneoplastic autoimmune polyneuropathy.

Now: PET-CT. Biopsy (shown)

ROS: fever, cough, chest pain
What is the DDx? Case details #MayoIDQ to follow… Image 2/
No travel. No farm exposure. No pets.
Work up:
CXR RML opacity
WBC 13.7. 94%N.
HIV neg.
Galactomannan negative
Histoplasma serology negative
BDG >500
What is the most likely pathogen? #MayoIDQ
Aug 7, 2021 5 tweets 3 min read
Weekend Digest

Name the pathogen and its treatment
(Photo CDC) 2/
#Plasmodium #falciparum
1. Anopheles bite
2. Endemic regions / returning travelers: 12-14 day incubation period
3. Fever +/- severe symptoms (see next)
4. Dx: blood smear, rapid diagnostic Ag or Ab test
5. Rx: chloroquine, artemisin-based combination Rx (depends on region)
Aug 2, 2021 7 tweets 4 min read
Images of Infectious Diseases

A young man presents to the ER because of leg numbness. While undergoing evaluation, he had a seizure. CT head is shown (photo). #IDTwitter what is your differential diagnosis?

Case details #MayoIDQ MCQ to follow… Image 2/
36M migrant from Mexico
No PMH. HIV negative.
CC: leg numbness
ED: witnessed seizure
WBC 16. Cr 0.7. AST 35.
CT (photo)

Which one of the following is least likely the correct answer about this condition? #MayoIDQ
Jul 31, 2021 6 tweets 3 min read
Weekend Digest

Name the pathogen and its treatment. Image 2/
#Prototheca
1. Unicellular achlorophyl algae
2. Exogenous transmit (e.g., trauma inoculation)
3. Cutaneous/bursitis (indolent/ chronic); disseminated in ICH
4. Dx yeast-like; sporangia w endospores in daisy-like pattern / septation
5. Rx ampho B / azole
doi.org/10.1128/JCM.02…
Jul 17, 2021 9 tweets 6 min read
Weekend Digest

Name the pathogen and its treatment.

Clues:
1. Grows within protozoa
2. Decorative fountains
3. Hotel stay during travel
4. Cough + diarrhea
5. Antigen test 2/
#Legionella species

Aerobic “intracellular” GNB
>60 species

L. #pneumophila serogroup 1 - most common cause of human illness (water exposure)

L. #longbeachae (ANZ / soil, potting mix and compost exposure)
Jun 3, 2021 12 tweets 4 min read
Images of Infectious Diseases

42M on obinutuzumab for CLL. 4 mo ago: mild COVID-19 - no specific Rx. 3 mo ago: SARS-CoV-2 mRNA vaccine.

CC: 2 mo on/off fever, cough, dyspnea. NP SARS-CoV-2 PCR neg. Rx as CAP w doxycycline - no response.

CT chest. DDx? Work up? #MayoIDQ next Image 2/
Four months after mild COVID-19, an ICH man with CLL on obinutuzumab presents with prolonged / recurrent doxycycline-non responsive CAP. CT chest shown. See prior tweet for other details. Which of the following is the most likely diagnosis? #MayoIDQ
Apr 3, 2021 7 tweets 4 min read
Weekend Digest

An Korean immigrant presented with early stage cholangiocarcinoma.

H & E stained tissue biopsy shown.

Name the pathogen and mechanism of infection. 2/
Case Diagnosis:
#Clonorchis sinensis - oriental liver fluke

“The eggs of Clonorchis are practically indistinguishable from those of #Opisthorchis” (photo credit: CDC)
Apr 1, 2021 4 tweets 2 min read
Images of Infectious Diseases

This is middle turbinate of a 64 ICH with epistaxis s/p CAR-T for refractory diffuse large B cell lymphoma.

What is your DDx? #MayoIDQ next Image 64M refractory DLBCL
s/p CAR-T —> cytokine release syndrome Rx tocilizumab and steroids

CC: epistaxis x 2w
PE: lesion in hard palate; nasal endoscopy (photo). CT dense material in sinuses.

What is next best step?
Mar 23, 2021 7 tweets 4 min read
Images of Infectious Diseases

H&E of brain biopsy specimen.

Who is the host? What is the most likely pathogen? How do you treat?
#MayoIDQ Image 2/ #MayoIDQ
75F. Immunocompetent.
CC: headache x few months —> now left leg weakness, blurred vision, seizure. CBC/CMP normal. CT head: mass in right ventricle, pons. CT chest/abdomen for CA work up (-). Brain biopsy (photo).

Which of the following is the most likely pathogen?