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Mayo Clinic Infectious Diseases Profile picture
Mayo Clinic Infectious Diseases
@MayoClinicINFD
A Trusted Global Leader in Infectious Diseases Practice, Research and Education
The University of Kansas Health System Profile picture Kavit Shastri Profile picture Ramla Profile picture Rania Kalcouni Profile picture William Xie Ph.D. Profile picture 5 subscribed
Jun 15, 2023 • 6 tweets • 2 min read
#MayoIDCaseConference

Summertime in Minnesota: a man presented with one month fever, chills, jaundice, anemia and this peripheral blood smear (photo). No travel history. What is your diagnosis? Case presented by Dr. Silpita Katragadda @Atiplis Image 2/
 #IDBR #MayoIDQ
This patient who is s/p splenectomy was diagnosed with #babesiosis.

Rx: #atovaquone + #azithromycin

3 wks later: worsening anemia
Labs: LDH 2205, reticulocyte 18%, haptoglobin not detected.
Babesia PCR + / smear (-)

What is the likely cause?
Jul 30, 2022 • 4 tweets • 3 min read
Weekend Digest

Name the Pathogen

Five Clues
1. Tumbling #GPB
2. #Pregnancy
3. #Delicatessen
4. #Meningoencephalitis
5. #Ampicillin + #gentamicin Image #Listeria monocytogenes

High-risk foods: unpasteurized cheeses, hot dogs and deli/lunchmeats.

High-risk groups:
- pregnant women
- newborns
- older adults
- people with weakened immune systems
Jan 15, 2022 • 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)