Antonio Guerrero Profile picture
Retired Prof. Infectious Diseases and Clinical Microbiology. Passionate teacher with thoughts on Infectious Diseases.
Aug 10 9 tweets 8 min read
Clinical presentation and virological assessment of 181 confirmed human #monkeypox virus cases in #Spain
✔️92%, gay men, bisexual men, or other men who have sex with men (MSM) &
✔️8%, heterosexual men or women

(A) genital & pubic region pustules
👇
thelancet.com/journals/lance… ✔️Median age was 37 years (IQR 31–42).
✔️18% patients reported previous smallpox vaccination
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(B) Three semiconfluent pustular #monkeypox lesions with a depressed centre located on the left side of the tongue dorsum.

#MedEd
Aug 9 5 tweets 4 min read
A 40-year-old woman from Brazil, AIDS, CD4 91 cells/μL: headache, diffuse cerebral edema, coma, respiratory distress, tracheal secretion with nematode
(1), alveolar hemorrhage, periumbilical purpuric rash (2), & death

🔬brain: 3
1/

doi.org/10.1093/cid/ci…
#MedEd #IDtwitter 🔬tracheal secretion: Strongyloides stercoralis (1)

Skin biopsy: S. stercoralis larvae at the dermis and hypodermis.

DISSEMINATED STRONGYLOISIASIS WITH EXTENSIVE CUTANEOUS AND CEREBRAL INVOLVEMENT
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#microbiology #MedStudentTwitter
Aug 8 14 tweets 10 min read
Clinical features and novel presentations of human #monkeypox of 197 patients in a #London centre during the 2022 #outbreak

Median age: 38 years
All 197: men, &
196 identified as gay, bisexual, or other men who have sex with men
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bmj.com/content/378/bm…
#IDtwitter #MedTwitter Concomitant infection:
- 35.9%: HIV
- 31.5%: a concomitant sexually transmitted infection.

All presented with mucocutaneous lesions, most commonly on the genitals (n=111 participants, 56.3%) or in the perianal area (n=82, 41.6%).
2/

#Doctor #MedStudentTwitter
Aug 7 4 tweets 4 min read
👩‍🦳 in her 70s: on the L 🦶, initially appeared pruritic papules that evolved to fluid-filled blisters with tense and denuded bullae (Fig1).

Over the ensuing 6 weeks an expanding annular plaque with peripheral scale (Fig2).
¼

DOI:doi.org/10.1016/j.mayo…
#dermatology #mycology 🔬(KOH): hyphae
🧫: Trichophyton rubrum

BULLOUS TINEA PEDIS.

The patient responded well to terbinafine cream and dilute acetic acid soaks.
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#microbiology #IDtwitter
Aug 6 7 tweets 4 min read
34-YO👨‍🦰congenital, idiopathic intestinal pseudo-obstruction, total parenteral nutrition & infusion of lipid emulsions: fever & cough (paroxysmal coughing with his port infusion)

CXR: interstitial infiltrates & areas of faint alveolar opacities
Portacath blood
1/
#microbiology Smear: globose, oval, budding #yeast with a small collarette, suggesting Malassezia spp.
Olive oil–supplemented🧫: Malassezia sympodialis (identified by DNA sequencing)

FUNGEMIA INFECTION & LUNG EMBOLI BY MALASSEZIA SYMPODIALIS IN THE PORTACATH VENOUS ACCESS SYSTEM
2/

#MedEd
Aug 5 9 tweets 6 min read
18-YO👨‍🦱: painful tender, fluctuant mass mass over the R anterior sin, chronic right knee pain, weight loss.

Leukocytosis
⬆️inflammatory markers (ESR, CRP)

XR & MR: ?
1/

doi.org/10.1093/cid/ci…
#Orthopedics #radiology #MedEd X-ray: areas of lucency & sclerosis in the proximal tibial metadiaphysis
MR: consistent with an chronic osteomyelitis & intraosseous abscess with myositis involving the adjacent musculature

A presumptive diagnosis of BRODIE ABSCESS
2/

#IDtwitter #MedTwitter
Jul 29 5 tweets 4 min read
51-YO🧔‍♂️alcoholic homeless living with dog in southern France: fever, confusión, a maculopapular rash on the trunk (A), hypotension, disorientation, an eschar on his right shoulder (B), & several tiny black spots
Platelet:⬇️
AST, ALT, GGT, LDH:⬆️
1/

doi.org/10.1086/420747
#MedEd Careful examination: these spots were actually #ticks (a total of 22) attached on the skin; they were removed

During 25 h, he was examined by diferente doctors. Dermatologic examination was woefully incomplete, as often occurs when unhygienic, homeless, &/or drunken patients
2/
Jul 28 6 tweets 3 min read
Se sugiere que el enigma de la #hepatitis aguda grave de etiología desconocida en #niños lo explica la coinfección con #adenovirus y virus adenoasociado de tipo 2 (AAV2), y con menos frecuencia el virus del herpes 6 (HHV6)
1/
👇
espanol.medscape.com/verarticulo/59… Dos estudios independientes: Un estudio fue dirigido por la University of Glasgow, en Glasgow, y el otro por el Great Ormond Street Hospital de Londres, ambos en Reino Unido.
2/
Jul 28 7 tweets 4 min read
Mystery #hepatitis cases in #kids linked to unexpected viral suspect

Two preliminary studies finding #adeno-associated viruses in pediatric hepatitis cases suggest a child's genetic background and other virusesall act in concert
1/
👇
science.org/content/articl… Researchers found high adeno-associated virus 2 (AAV2) levels in the blood or liver cells in 24 of 25 children with unexplained hepatitis.

In a group of kids without this condition, almost none had AAV2, even those with #adenovirus.
2/
Jul 27 9 tweets 4 min read
#Monkeypox Virus Infection in Humans across 16 Countries, NEJM

Authors report 528 infections diagnosed in 16 countries.
75% were White.
41% had human immunodeficiency virus infection
The median age was 38 years.
1/
👇
DOI: 10.1056/NEJMoa2207323 Image Transmission was suspected to have occurred through sexual activity in 95% of the persons with infection.

Overall, 98% of the persons with infection were gay or bisexual men.
2/

#monkeypox
Jul 27 7 tweets 5 min read
A 28-YO👨‍🦰traveling through Africa & Asia: a pruritic, erythematous rash on his back, trunk, buttocks, genitals, & lower limbs; dry cough & wheeze

X-ray: bilateral reticulonodular infiltrates
Eosinophilia
1/

doi.org/10.1093/cid/ci…
#IDtwitter #MedTwitter #dermatology ImageImageImage CUTANEOUS LARVA MIGRANS (CLM) & LOEFFLER SYNDROME

The “creeping” skin lesions are diagnostic of CLM

The pustular rash across the patient’s buttocks & back is likely secondary to CLM folliculitis—a rarer, but well-described skin manifestation of CLM
2/

#Doctor #MedEd ImageImage
Jul 26 8 tweets 5 min read
42-YO African American man, AIDS, CD4 57 cells/ mm3: 18-mth of progressively multiple papules coalescing into large exophytic nodules & plaques on face, scalp, & neck (A & B); & several lesions in in the groin, penis, & RUE
🔬:?
1/

doi.org/10.1093/cid/ci…
#dermatology #idtwitter ImageImage GIANT MOLLUSCUM CONTAGIOSUM

Molluscum contagiosum is a benign skin tumor caused by molluscum contagiosum virus.

Lesions >1 cm diameter are known as giant molluscum
2/

#Virology #MedEd #MedTwitter
Jul 16 4 tweets 4 min read
3 cause of eosinophilic #meningitis:
1⃣Angiostrongylus,
2⃣Baylisascaris, and
3⃣Gnathostomiasis.

#MedEd #IDTwitter 1) Angiostrongylus cantonensis: a common cause of human eosinophilic meningitis (neural angiostrongyliasis) and occasionally ocular disease.

#neurology #IDtwitter #MedTwitter
Jul 14 6 tweets 3 min read
#Monkeypox outbreak in #England

Potential levels of the outbreak in England: Level 2 (transmission within a defined sub-population).

Geographic spread: cases are concentrated in London (74% of cases)
1/
👇
gov.uk/government/pub… Of cases with information:
✔️97% (681 out of 699) are in gay, bisexual and men who have sex with men (GBMSM)
✔️More than half had history of STI in the last year
✔️30% (123) were living with HIV
✔️31% (134) had 10 or more sexual partners in the last 3 months
2/

#MonkeypoxVirus
Jun 12 5 tweets 3 min read
Monkeypox virus clearly is endemic in #Nigeria.
Cases occur sporadically throughout the year and across the country except to the far northeast.

#Monkeypox cases continue to occur in Nigeria this year (2022): 110 suspected and 31 confirmed cases
1/
👇
ncdc.gov.ng/diseases/sitre… The above report does not indicate which of the 2 clades of #MonkeypoxVirus are responsible for the cases.

The reported case fatality rate of 3.6% is higher than the usual 1% for the West African clade but lower than the up to 10% for the Central African clade.
2/

#Nigeria
Jun 12 5 tweets 2 min read
Unprecedented case series advances promise of #phage therapy
👇
Phage Therapy of #Mycobacterium Infections: Compassionate-use of Phages in 20 Patients with Drug-Resistant Mycobacterial Disease
1/
academic.oup.com/cid/advance-ar…
@MariadelMarTom Treatment of Non-tuberculous Mycobacterium could be challenging due to intrinsic antibiotic #resistance. Bacteriophage therapy represents a potentially novel approach.
2/
Jun 8 4 tweets 3 min read
A 26-YO👩‍🦰, sexually active: 1-month of right knee and metacarpal arthralgia, tenosynovitis & pustules on her hand, developed an enlarging chest wall mass.

CT: an abscess on her chest wall, requiring drainage.
1/4

DOI: doi.org/10.1503/cmaj.2…
#IDTwitter #MedEd Image Urine gonococcal nucleic acid amplification test: ➕ was positive,
16S rRNA with gene sequencing of wall fluid:➕for Neisseria gonorrhoeae.

DISSEMINATED GONOCOCCAL INFECTION

Ceftriaxone IV stopped after the abscess had resolved
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#MedicalStudents #microbiology
Jun 7 5 tweets 6 min read
Lactante 4 meses, dermatitis atópica, su hermana con laringitis aguda: erupción papulosa de evolución a costras en 1 día, predominando sobre placas de eccema preexistentes.

Se inician en el tronco, incluyen cabeza, área del pañal y vesículas en boca.
1/5

#pediatria #Pediatrics PCR (para herpesvirus y enterovirus):➕para enterovirus Coxsackie A6

ECCEMA COXSAKIUM

El A6 produce también: erupción vesículo-bullosa erosiva, cuadro Gianotti-Crosti-like y rash purpúrico-petequial

✒️Martín A y col continuum.aeped.es/screens/play/5… @aepediatria #dermatology
2/5
Jun 6 9 tweets 5 min read
Multi-country #monkeypox #outbreak: situation update

780 laboratory confirmed cases of monkeypox have been reported to or identified by #WHO from 27 Member States across four WHO regions that are not endemic for monkeypox virus.
1/9

who.int/emergencies/di… #Monkeypox outbreaks in endemic countries in the #African región, 2022.

1408 suspected and 44 confirmed cases including 66 deaths were reported from seven endemic countries
2/9
Jun 6 4 tweets 2 min read
La #OMS eleva a 780 los casos (0 muertes) de #ViruelaDelMono en 27 países (fuera de los endémicos donde se alcanzó 1.408 casos sospechosos y 66 muertes)
Más casos en:
1⃣207, Reino Unido
2⃣156, España
3⃣138, Portugal
4⃣58, Canadá
5⃣57, Alemana
1/3

rpp.pe/p/1409769 En lo que va de año, entre los países endémicos (1.408 casos sospechosos de #ViruelaDelMono y 66 muertes), la mayoría se detectó en la República Democrática del #Congo aunque también con más de una decena de contagios en Camerún, República Centroafricana y Nigeria.
2/3
May 30 5 tweets 5 min read
Niña de 5 años, araña entre las sábanas (1): fiebre de 2 días y placa eritematosa indurada en muslo con crecimiento centrífugo y una escara necrótica central (2)
¼

✏️M. Sendín-Martín y col. @HospitalUVRocio
DOI: 10.1016/j.anpedi.2020.12.005
#pediatria #Pediatrics @HospitalUVRocio PICADURA DE LA ARAÑA RECLUSA PARDA

Las arañas del género Loxosceles o arañas reclusas o arañas violinistas debido a la morfología dorsal de su cefalotórax tienen una distribución mundial

La lesión se resolvió los días siguientes, sin dejar cicatriz.
2/4

#MedEd #dermatology