pmc.ncbi.nlm.nih.gov/articles/PMC...

Disseminated #trichosporonosis in immunocompromised host: fatal in 60% pts. Host: neutropenia/malignancy heme or SOT, hiv, catheter related. Skin: Multiple red papules. Typically S to voriconazole & posaconazole

#Trichosporon grow easily on routine fungal plates & appear creamy. Microscopic features include pseudohyphae, hyphae, blastoconidia (which differentiate it from Geotrichum) & arthroconidia (which differentiate it from Candida & can resemble arthroconidia of Coccidioides spp.

#Trichosporon asahii: yeast in soil & water. In humans, it colonizes skin, GI & GU. It cause superficial skin infections, such as white piedra. In immunocompromised hosts: deep invasive infections, including fungemia, endocarditis and chronic meningitis

#Trichosporon asahii is a common cause of breakthrough fungemia in immunocompromised patients receiving echinocandins as the organism is intrinsically resistant to this class. #Voriconazole is drug of choice. High MIC to amphotericin

#idboardreview Person w/AML undergoing induction chemotherapy has febrile neutropenia. Despite on echinocandin, remains febrile and has new, painful, erythematous nodules on his arms & legs. Blood cultures +yeast-like, MALDI-TOF MS id as Trichosporon asahii. treatment? #idsky #idmeded #meded

DDX: Viral #keratitis v painful +perilimbal injection w/ haze in anterior chamber as infection progresses.
-CMV & Toxplasma cause retinitis, not iritis. Retinitis not associated w/ red eye syndromes.
-Iritis can lead to posterior synechiae

DDx: #Conjunctivitis usually w/ exudates on lid margins & diffuse injection of palpebral conjunctivae as well as the bulbar conjunctiva.
-Gonococcal or bacterial conjunctivitis is acute, purulent & very painful.
-Chlamydial or viral conjunctivitis: more discharge +irritation

Ocular involvement is present in about 10% of patients with secondary #syphilis and can be the only presenting finding. Ocular involvement also occurs in congenital and tertiary syphilis.

#syphilitic #iritis #syphilis B/l perilimbal conjunctival injection in absence of conjunctival exudate should suggest iritis or #episcleritis Red ring around cornea (ciliary flush): #iritis. There is no scratchy feeling or conjunctival discharge of conjunctivitis & no intense pain of keratitis

#idboardreview 40 M living with HIV undetectable on ART few unknown sexual partners, presents w/ redness of b/l eyes of 5d +blurred vision +photophobia, no pain, no exudate, no gritty sensation, no fever, no HA, no focal deficits. dx? #meded #idmedEd #idsky

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Observe. Regional lymphadenitis is most common complication of BCG vaccination, occurring in 4–30 per 1,000 vaccinated newborns. Non-suppurative adenitis is normal reaction. Suppurative, tender adenitis, while a SE, usually self-limiting, often resolving spontaneously over several weeks to months.

#idboardreview 4-month-old infant w/ tender, enlarging swelling in the left axilla x3weeks. Afebrile, growing well. Hx of BCG vaccine at birth. +suppurative, mobile left axillary lymph node. Next step? #idsky #idmeded #meded

#shigella #sonnei MSM due to resistance, empiric abx: ceftriaxone www.cdc.gov/han/2023/han...

Shigella sonnei: virulence and antibiotic resistance - Archives of Microbiology Shigella sonnei is the emerging pathogen globally, as it is the second common infectious species of shigellosis (bloody diarrhoea) in low- and middle-income countries (LMICs) and the leading one in de...

link.springer.com/article/10.1...

www.cdc.gov/mmwr/volumes...

#Shigella species are often intrinsically resistant to multiple antibiotics including ampicillin, trimethroprim-sulfamethoxazole and quinolones, and reduced susceptibility to azithromycin is now being reported around the world

#shigella #sonnei, along with S. flexneri serotypes 2a and 3a, are the strains most frequently implicated in outbreaks in MSM populations

#shigella healthcare workers, antibiotic therapy is recommended to reduce the duration of disease and decrease the risk of continued transmission.

In patients with normal immune function: #shigella generally self-limited, resolving after 7d on average; however, pt remain infectious for upto 4wk as pathogens continue to be shed in feces. reportable illness &documentation of stool culture clearance required in food-handlers

#Shigella sp are highly infectious; as few as 10 organisms sufficient to cause disease.(2) Contact w/infected individuals or contaminated food➡️transmission. As an emerging sexually-transmitted infection in MSM, #shigellosis is associated with direct or indirect oral-anal contact

#shigella #sonnei #Shigellosis acute diarrhea, vomiting & abd cramps. (1) Stools often contain blood, although some have watery diarrhea. Rarely, severe shigellosis may be complicated by rectal prolapse, intestinal obstruction & colonic perf. Post infect Reactive arthritis 1-2wks

#idboardreview 30 MSM PLWH Cd4 800 VL<20 on ART presents w/ 2wk abd cramps & watery diarrhea. Blood agar: gram negative, translucent, flat bacterial colony that appeared to spread across plate. Dx? #medEd #idmedEd #IDsky

#babesiosis ixodes tick(parallel distribution/coinfection w/lyme), more common in NY, NJ, CT, RI, MA, MN, WI. So if suspected lyme and pt not improving with doxy: think babesia

#babesiosis @febrilepodcast.com

splenectomized pt with fever: think encapsulated organism: (strep pneumonia, H influenza, N meningitis), capnocytophaga canis, bordetella holmesii, babesia microti, malaria #medEd #IdmedEd @febrilepodcast.com

#babesiosis diagnosis: based on epidemiological risk factors &clinical evidence, and confirmed by blood smear examination or PCR. A single +Ab test is not sufficient to establish dx because Abs can persist in blood >1yr following apparent clearance of infection, with or without treatment.

Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA): 2020 Guideline on Diagnosis and Management of Babesiosis Abstract. The purpose of this guideline is to provide evidence-based guidance for the most effective strategies for the diagnosis and management of babesio

#babesiosis Atovaquone plus azithromycin x7-10days preferred antimicrobial combination (alternative: clindamycin plus quinine). Druation is often extended in immunocompromised academic.oup.com/cid/article/...