Antonio Guerrero Profile picture
Retired Prof. Infectious Diseases and Clinical Microbiology. Passionate teacher with thoughts on Infectious Diseases.
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Jul 8, 2023 5 tweets 2 min read
A 32-YO HIV+ patient, from a rural area of Colombia, severely immunosuppressed (<50 CD4 cells/mm3): ulcers in lower limbs, was found with a larvae coming out from one ulcer (Figure).
1/5

W Villamil et al. Rev Panam Enf Inf 2018; 1(1):40-41.
#parasitology #microbiology The larva was identified, as possible Tenebrio molitor.

CANTHARIASIS: ULCE INFESTACIÓN DUE TENEBRIO MOLITORIN IN AN AIDS PATIENT

Patient was treated with trimethoprim with a successful evolution
2/5

#healthcare #primarycare
Jun 17, 2023 5 tweets 3 min read
23 años ♀️, LES en tratamiento inmunosupresor: pápulas asintomáticas de un año de evolución en el párpado izquierdo, con aumento progresivo en número y tamaño.
1/5

revistainfectio.org/P_OJS/index.ph…
#oftalmologia #MedicinaInterna C.A.  Morales-Cardona,  et ... La biopsia de una de las lesiones confirmó el diagnóstico de MOLUSCO CONTAGIOSO DEL PÁRPADO

Extracción de las lesiones con una pinza hemostática curva: sin recurrencia al año.
2/5

#dermatology #infecciosas
Jun 15, 2023 4 tweets 7 min read
6 años♂️: dolor y alopecia en placas en cuero cabelludo de 3 meses de evolución; en las últimas 48 horas, fiebre y cefalea, adenopatías cervicales < 2 cm.
1/4

🖊️@lauracatty95, @juliaserralabos, @SeanPYeh continuum.aeped.es/courses/info/1…, @ContinuumAEP @aepediatria
#pediatria #MIR Image @lauracatty95 @juliaserralabos @SeanPYeh @ContinuumAEP @aepediatria QUERION DE CELSO:
✔️ forma inflamatoria de infección por Tinea capitis
✔️El agente etiológico más frecuente en los países mediterráneos es Microsporum canis
2/4

#infecciosas #microbiología #micología
Jun 5, 2023 4 tweets 3 min read
A 44-yo♂️, HIV +, CD4 cell count of 86/mL, viral load of 35,900 copies/mL: a 1-month history of fevers and pruritic blackish-brown lamellated plaques on the limbs and scalp.
¼
👇
DOI: 10.1056/NEJMicm2213894
#IDtwitter #dermatology Ming J. Liu, M.D., and Wei ... A RPR titer of 1:32.
A Treponema pallidum particle agglutination: ➕.
A skin-biopsy of the left forearm 🔬: diffuse dermal lymphocytes and histiocytes admixed with a plasma-cell infiltrate.

MALIGNANT SYPHILIS
2/4

#microbiology #dermpath #RareInfection
Jun 3, 2023 12 tweets 10 min read
Human #intestinal #spirochetosis:
✔️#sexual #transmitted infections
✔️of the large intestine by anaerobic spirochetes of the genus Brachyspira spp.
1/10

🖊️A De Gea, @alfredomaldo ,@clarapath, @MarianaDazAlmi1, @alirri, Raquel Escudero, et al.
👇
sciencedirect.com/science/articl… Colonoscopic biopsy. In rou... @alfredomaldo @clarapath @MarianaDazAlmi1 @alirri Gastrointestinal symptoms such as abdominal pain, proctitis, or chronic diarrhea are the most common manifestations.

Most cases with accompanying symptoms show improvement with metronidazole antibiotic therapy.
2/10

#IntestinalSpirochetosis
May 17, 2023 7 tweets 6 min read
Lactante, un mes de vida: fiebre, placa en la cara ligeramente sobreelevada, eritematosa, con coloración anaranjada periférica, delimitada, y con aumento de temperatura a la palpación
1/7

🖊️F Rivera y col. continuum.aeped.es/courses/info/9… @ContinuumAEP @aepediatria
#AtencionPrimaria Image @ContinuumAEP @aepediatria ERISIPELA
✔️infección superficial que afecta a la dermis superior, el tejido celular subcutáneo y a veces al sistema linfático,
✔️causada en la mayoría de los casos por S. pyogenes o estreptococos de los grupos B, C o G.
2/7

#urgencias #microbiología
May 16, 2023 9 tweets 7 min read
A 31-YO♂️, #sexually active with 2♂️partners in the previous month: 8 days before redness of the R eye, an itchy perianal rash & rectal pain; scattered, tender, shallow ulcers & pustules on chest (A), abdomen (B), back (C) & perianal (D)
1/9

nej.md/44ILgLy
#proctology Image PCR from the perianal vesicel:➕for nonvariola orthopoxvirus DNA.
Species-specific PCR: ➕for #mpox virus, clade II.

The patient reported a new rash with numerous ulcer on his chest, abdomen, and back

MPOX (formerly known as #monkeypox)
2/9

#MolBiol #virology
Apr 29, 2023 4 tweets 2 min read
3 años♂️, dermatitis atópica: fiebre, aftas en el dorso lingual, pápulas, vesículas y lesiones costrosas cutáneas de 12 horas en miembros inferiores.
1/4

🖊️@berzosa_lopeza, C. Muñoz, y @roipipe @Hosp_Villalba
#pediatría #dermatología #AtencionPrimaria https://t.co/KAV247UPx2pap.es/articulo/13403…
@roipipe @Hosp_Villalba ECCEMA HERPETICUM

A las 48 horas de inicio del tratamiento con aciclovir las lesiones se habían extendido más allá de las zonas de flexión de extremidades, pero habían mejorado, estando todas en fase costrosa, sin aparición de nuevas vesículas.
2/4

#infecciosas #microbiología
Apr 11, 2023 19 tweets 8 min read
An 85-YO in rural Mississippi: months of tender, erythematous plaques & edema on bilateral hands extending to the elbows & on feet extending below the knees with significant pain

🔬skin granulomatous inflammation & numerous AFB
Mycobacterial🧫:➖
1/19

#IDtwitter #dermatology ImageImage A repeat skin extensive granulomatous inflammation (A), with Ziehl-Neelsen stain clusters of acid-fast bacilli throughout the dermis (B).
Kinyoun stain >9 AFB/high-power field (C & D).
2/19

DOI: doi.org/10.1128/jcm.00…
#dermpath #microbiology (A) Skin biopsy specimen, h...
Mar 3, 2023 6 tweets 6 min read
A 44-YO♂️, stayed in a rural cottage of France 2 weeks previously: cramping upper abdominal pain with watery diarrhea.
He had passed what he thought were worms in his feces
Eosinophilia
1/6

doi.org/10.1093/cid/ci…
#GITwitter #IDtwitter #microbiology “Worm” specimen brought to clinic by patient (petri dish The specimens: identified as the larvae of the drone fly, Eristalis tenax
These larvae are 2.5–3 cm in length; the posterior tube gives them the name of “rat-tailed maggots”

INTESTINAL MYASIS CAUSED BY ERISTALIS TENAX LARVA
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doi.org/10.1093/cid/ci…
#parasites #GIPath #Doctor “Worm” specimen brought to clinic by patient (petri dish
Feb 27, 2023 12 tweets 10 min read
3 años ♀️, padre con lesiones cutáneas similares: lesiones cutáneas polimorfas localizadas en los glúteos, con elementos papulares, vesiculares y pustulosos umbilicados
1/13

🖊️M Roguera y col. @hgermanstrias @aepediatria
DOI: 10.1016/j.anpedi.2022.09.006
#pediatria #infecciosas Lesiones cutáneas en glúteo izquierdo. Detalle de las lesi @hgermanstrias @aepediatria Se confirmó en el padre la infección por virus de la viruela del mono (MPXV).

PCR de líquido vesicular de las lesiones:➕para MPXV.

VIRUELA DEL MONO (Mpox)
2/13

#MolBiol #virology #virología
Feb 25, 2023 5 tweets 5 min read
2 meses ♂️, madre VIH+, toxicómana, y chancro perineal indoloro en 2º trimestre del embarazo:
Un mes de rinorrea serosanguinolenta, lesiones dérmicas, FC 180lpm, FR 50rpm, Tª 38,8°C, crepitantes finos en tórax, hepatoesplenomegalia,
1/5

#dermatología #pediatria #infecciosas Queilitis y exantema generalizado macular con hiperqueratosi 🧪CMIA anti-Treponema pallidum :➕
⬇️: glucosa, hemoglobina, plaquetas, albúmina
⬆️:transaminas, bilirrubinemia directa
RX: periostitis en huesos largos
PL: hipoglucorraquia, hiperproteinorraquia, sin pleocitosis y VDRL➕
VDRL materno:➕
2/5

#microbiologia #urgencias Periostitis en huesos largos.
Feb 23, 2023 6 tweets 5 min read
A 26-YO♂️ no #sexual contacts other than with his male partner: 6-day of fever, malaise, a swollen parotid gland, & ulcerative lesion on the ipsilateral lower lip.

Mild lymphopenia
⬆️GGT & CRP

1/6
doi.org/10.1016/S0140-…
#IDtwitter #dermatology #EarNoseThroat Swelling of left parotid gland (A)  The ulcerative lesion on PCRs on the throat & ulcer swabs:➕for human #monkeypox (hMPX)
Genomic sequencing: clade IIb variant clustering within the current international mpox virus outbreak

PAROTIDITIS CAUSED BY hMPX virus

2/6
#sexually #maxillofacial #microbiology
Feb 22, 2023 7 tweets 6 min read
A 58-YO♂️, DM, fever & L lower quadrant abdominal pain 2 months prior: acute R-sided back pain, & 3/6 diastolic murmur at R upper sternal border.

CT: a R renal infarction & splenic embolism

MR: multiple infarctions
1/7

doi.org/10.1016/j.idcr…
#Cardiology #medicine #cardiologia Enhanced abdominal computed tomography showing right renal i Transesophageal echocardiography: a vegetation and severe aortic regurgitation.

Blood 🧫: Cardiobacterium hominis

CARDIOBACTERIUM HOMINIS ENDOCARDITIS ASSOCIATED WITH CEREBRAL, RENAL, AND SPLENIC INFARCTIONS
2/7

#IDtwitter #microbiology Transesophageal echocardiogram revealing a large vegetation
Feb 21, 2023 6 tweets 3 min read
Emergence of extensively drug-resistant (XDR) and multidrug-resistant (MDR) #Shigella flexneri serotype 2a associated with #sexual transmission among men who have sex with men (MSM), in #England: a descriptive epidemiological study
1/6
👇
thelancet.com/journals/lanin… In this study, authors report the emergence and sustained transmission of #XDR and #MDR strains of S flexneri among among MSM, harbouring plasmid-encoded blaCTX-M-27, in England since September, 2021.

There were clinically severe cases, including hospitalisations.
2/6
Feb 20, 2023 8 tweets 5 min read
A 71-YO therapy for multiple mieloma, voriconazole for Aspergillus fumigatus sinusitis, prophylaxis with TMP-SMX: febrile neutropenia, nodular lesion on abdominal wall
CT: pulmonary nodule unchanged in last a month
🔬biopsy of pulmonary nodule?
1/8

#Pathologists #haematology Histopathology of the fine-...Image 🔬: Histiocytic process with granular basophilic cytoplasm and Michaelis-Gutmann bodies (arrows), positive for calcium with von Kossa special stain (arrowhead); findings pathognomonic for malakoplakia.

PULMONARY MALAKOPLAQUIA
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doi.org/10.1093/cid/ci…
#pathTwitter
Feb 17, 2023 5 tweets 5 min read
A 57-YO Mexican♀️, works on a farm has several pets, including dogs, at home: epigastric fullness, and a 15-pound weight loss.

CT: complex cystic left liver mass.
1/5

doi.org/10.1093/cid/ci…
#gastroenterology #radiology #medicine Resection: Cyst wall (red➡️), daughter cysts (*) normal liver tissue (yellow⬅️)
🔬acellular laminated wall (*), inner germinal layer (black⬅️), & protoscoleces surrounded by a broad capsule (green⬅️). Refractile hooklets (blue⬅️) & calcareous bodies (red⬅️)
2/5
#GIPath #IDtwitter
Feb 15, 2023 9 tweets 7 min read
A 50-YO ♀️ bitten by her pet rat: fever, myalgia, sore throat, headaches a nonpruritic rash on extremities including palms & soles, arthralgias, knees arthritis.

A punctate wound with central necrosis on L palm, & her R thumb.
1/9

#rheumatology #internalmedicine #dermatology Leukocytosis with neutrophilia
ESR & PCR:⬆️

Purulent R knee synovial fluid:
✔️46 000 cells/mL (88% neutrophils).
✔️Gram stain: scant pleomorphic gram-negative bacilli in chains with lateral bulbar swellings
2/9

doi.org/10.1093/cid/ci…
#microbiology #rheumatologist
Feb 14, 2023 7 tweets 7 min read
13 años ♂️: lesiones verrugosas en mucosa oral de 2 años de evolución, con progresivo aumento en tamaño y número.
1/7

🖊️Alonso P, Vázquez A, Santos JL.
continuum.aeped.es/screens/play/1…
@ContinuumAEP @aepediatria
#pediatria #dentista #AtencionPrimaria @ContinuumAEP @aepediatria HIPERPLASIA EPITELIAS FOCAL o ENFERMEDAD DE HECK:
📌infección viral rara de la mucosa oral
📌causada por el virus del papiloma humano, especialmente los subtipos 13 o 32.
2/7

#infecciosas #microbiología #MIR
Feb 12, 2023 5 tweets 4 min read
A 17-YO♀️, unprotected #sexual intercourse with multiple male partners: a 1-month history of pruritic genital lesions, multiple smooth, grayish-white papules & plaques were noted on the vulva & upper inner thighs.
1/5

DOI: 10.1056/NEJMicm2207538
#gynecology #womenshealth Image A Treponema pallidum particle agglutination assay:➕
Rapid plasma reagin titer: ➕1:16.

CONDYLOMA LATA OF SECONDARY SYPHILIS
2/5

#microbiology #gynecologist #primarycare
Feb 11, 2023 5 tweets 4 min read
A 29-YO♂️, 6 months before, HIV + & non–drug-resistant pulmonary tuberculosis, antiretroviral & 4-drug antituberculous therapy initiated but soon reduced to rifampin & isoniazid only: abdominal pain on the L side
CT: ?
1/5

DOI: 10.1056/NEJMicm2206174
#radiologist #GITwitter CT: an enlarged spleen with numerous hypodense lesions (A).
CD4 cell count: 119/mm3
VIH viral load: 1778 copies/mm3

A splenectomy was performed to evaluate for cancer:
numerous necrotic nodules with purulent discharge (B).
2/5

#microbiology #gastroenterology #IDtwitter