Name That Pathogen!

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RSP200609f3.jpg


A 24 y/o female medical student presents to your clinic with the chief complaint of "I have a weird rash on my foot that itches like crazy." Reports first noticing the rash approximately 1 week after traveling with her boyfriend to coastal Mexico during her Spring Break, where they often walked along the beach barefoot for several hours at a time. Patient tried over-the-counter 1% hydrocortisone cream two times a day to no significant relief. Denies any change in skin products or detergent. Review of systems negative for weight loss, fever, chills, N/V, diarrhea, cough, headache, and muscle or joint pain. No known drug allergies or other allergies reported. Not currently taking any medications, vitamins, or herbal products.

On physical exam, you note a 2-in erythematous, serpiginous pruritic eruption along the patient's right foot. Patient is otherwise healthy.

Diagnosis?
Responsible organism(s) or pathogen(s)?
Treatment?
 
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Cutaneous larva migrans, most commonly caused by Ancylostoma braziliense. Tx... ivermectin?
 
spicedmanna said:
RSP200609f3.jpg


A 24 y/o female medical student presents to your clinic with the chief complaint of "I have a weird rash on my foot that itches like crazy." Reports first noticing the rash approximately 1 week after traveling with her boyfriend to coastal Mexico during her Spring Break, where they often walked along the beach barefoot for several hours at a time. Patient tried over-the-counter 1% hydrocortisone cream two times a day to no significant relief. Denies any change in skin products or detergent. Review of systems negative for weight loss, fever, chills, N/V, diarrhea, cough, headache, and muscle or joint pain. No known drug allergies or other allergies reported. Not currently taking any medications, vitamins, or herbal products.

On physical exam, you note a 2-in erythematous, serpiginous pruritic eruption along the patient's right foot. Patient is otherwise healthy.

Diagnosis?
Responsible organism(s) or pathogen(s)?
Treatment?
Click to expand...

Cutaneous larva migrans
Ancylostoma braziliense (had to look that one up)
albendazole or ivermectin
 
Mother brings in her 4 year old son who complains of a sore throat, malaise, rhinnorhea. Physical exam reveals a very errythematous pharyngeal mucosa.

Culture on blood agar shows the following:

339m3rb.jpg


Significantly, the child is allergic to penicillin.

What is your treatment of choice for this child's infection?
 
Depakote said:
Mother brings in her 4 year old son who complains of a sore throat, malaise, rhinnorhea. Physical exam reveals a very errythematous pharyngeal mucosa.

Culture on blood agar shows the following:

339m3rb.jpg


Significantly, the child is allergic to penicillin.

What is your treatment of choice for this child's infection?
Click to expand...

Erythromycin?
 
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Depakote said:
Mother brings in her 4 year old son who complains of a sore throat, malaise, rhinnorhea. Physical exam reveals a very errythematous pharyngeal mucosa.

Culture on blood agar shows the following:

339m3rb.jpg


Significantly, the child is allergic to penicillin.

What is your treatment of choice for this child's infection?
Click to expand...

Alpha-hemolytic? So maybe it's Strep. Pneumo, so I'd probably hit that bug with a macrolide, like azithromycin, due to the PCN allergy and the child's age.
 
spicedmanna said:
Alpha-hemolytic? So maybe it's Strep. Pneumo, so I'd probably hit that bug with a macrolide, like azithromycin, due to the PCN allergy and the child's age.
Click to expand...

I'll tell you that you're thinking on the right track... but what's more likely to be alpha hemolytic and in the oral cavity?
 
Depakote said:
do the symptoms really warrant vanco?
Click to expand...

My first thought was that Vancomycin was probably too much for this case of URTI/pharyngitis. I'd probably stick with Azithromycin, since it has good gram positive activity, few side effects, and doesn't have cross-allergenicity with PCN. It's good for respiratory infections.
 
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Ok everyone, sorry for being away... life, you know.


These responses are the correct ones to the rapid fire round (although only the genus was given for #8, I'll still count it...this time :))

zipmedic said:
#8 - Shigella
#12 - Lassa virus
Click to expand...
TMP-SMX said:
9=Mycobacterium Tuberculosis
10=Trypanosoma Cruzi (Chagas).
Click to expand...
Kaushik said:
Mystery pathogen #11 is Haemophilus influenzae. Go go microbiology!
Click to expand...



And here is our new hall of fame:

Hall of Fame
1) themule +2
1) cpants +2
1) Mr hawkings +2
1) zipmedic +2
1) TPM-SMX +2
6) Beachblonde +1
6) Whatayear +1
6) Bodonid +1
6) Kaushik +1

Looks like my rapid fire round did not accomplish what it was meant to do :laugh:
 

Attachments

  • Mystery Pathogen #13.pdf
    12.7 KB · Views: 214
spicedmanna said:
My first thought was that Vancomycin was probably too much for this case of URTI/pharyngitis. I'd probably stick with Azithromycin, since it has good gram positive activity, few side effects, and doesn't have cross-allergenicity with PCN. It's good for respiratory infections.
Click to expand...

it is good for bacterial respiratory infx and probably would kill what's growing on the plate... but the culture showed what you correctly identified as viridans strep which is normal oral flora.

Culturing normal oral flora in the context of a URI means it's a virus causing the infx. (no anti-biotic = proper treatment)


It was a trick question but one that showed up on:
-a quiz
-my midterm
-my final

and I'm pretty sure it was in my QBank so worth sharing.
 
Depakote said:
it is good for bacterial respiratory infx and probably would kill what's growing on the plate... but the culture showed what you correctly identified as viridans strep which is normal oral flora.

Culturing normal oral flora in the context of a URI means it's a virus causing the infx. (no anti-biotic = proper treatment)


It was a trick question but one that showed up on:
-a quiz
-my midterm
-my final

and I'm pretty sure it was in my QBank so worth sharing.
Click to expand...

Oooh....tricky! Very nice. Thanks for sharing that. I'm going to add that to my mental algorithm. :thumbup:
 
Depakote said:
Culturing normal oral flora in the context of a URI means it's a virus causing the infx. (no anti-biotic = proper treatment)
Click to expand...

I thought that low-risk antibiotics or placebo was the proper treatment for viral URIs complicated by AMS (annoying mother syndrome), to get them out of your clinic.:laugh:
 
Forthegood said:
I thought that low-risk antibiotics or placebo was the proper treatment for viral URIs complicated by AMS (annoying mother syndrome), to get them out of your clinic.:laugh:
Click to expand...

I've seen "Viral Packs" in offices these days. It contains kleenex, hand sanitizer, green tea, and a brochure about antibiotics and viruses talking about antibiotic resistance and how if the patient takes antibiotics when it isn't needed the antibiotic may not work when the patient really needs it.

As for the next bacterium I'm going to guess:

Escherichia coli.

It's kind of tough to guess though when you give us such an image trying to guess based on a rod-shaped flagellated bacterium.
 
Forthegood said:
I thought that low-risk antibiotics or placebo was the proper treatment for viral URIs complicated by AMS (annoying mother syndrome), to get them out of your clinic.:laugh:
Click to expand...

Well..

This lends support to the fact that:
What is written in the book and what actually happens in real time life is often 2 completely different things...Thats why the "hands on experience" means SO much!

Osler said it elegantly:

[Practicing medicine without books is like sailing an uncharted sea, practicing medicine without patients is like NOT going to sea at all!] :thumbup:
 
spicedmanna said:
RSP200609f3.jpg


A 24 y/o female medical student presents to your clinic with the chief complaint of "I have a weird rash on my foot that itches like crazy." Reports first noticing the rash approximately 1 week after traveling with her boyfriend to coastal Mexico during her Spring Break, where they often walked along the beach barefoot for several hours at a time. Patient tried over-the-counter 1% hydrocortisone cream two times a day to no significant relief. Denies any change in skin products or detergent. Review of systems negative for weight loss, fever, chills, N/V, diarrhea, cough, headache, and muscle or joint pain. No known drug allergies or other allergies reported. Not currently taking any medications, vitamins, or herbal products.

On physical exam, you note a 2-in erythematous, serpiginous pruritic eruption along the patient's right foot. Patient is otherwise healthy.

Diagnosis?
Responsible organism(s) or pathogen(s)?
Treatment?
Click to expand...

Couldn't help but notice the disturbing amount of hair on this girl's leg and foot :laugh:
 
Climberak said:
Ok everyone, sorry for being away... life, you know.


These responses are the correct ones to the rapid fire round (although only the genus was given for #8, I'll still count it...this time :))







And here is our new hall of fame:

Hall of Fame
1) themule +2
1) cpants +2
1) Mr hawkings +2
1) zipmedic +2
1) TPM-SMX +2
6) Beachblonde +1
6) Whatayear +1
6) Bodonid +1
6) Kaushik +1

Looks like my rapid fire round did not accomplish what it was meant to do :laugh:
Click to expand...

#13

I've ruled out vibrio and h. pylori (different flagella schemes)

the only one left that I could think that fits the profile would be e. coli.
 
MDman87 said:
Couldn't help but notice the disturbing amount of hair on this girl's leg and foot :laugh:
Click to expand...

:laugh: Yeah, I noticed that, too, after it was too late and I had already posted the image and wrote the presentation. Figured it wouldn't impact the case anyway, except the possibility that she might have hirsutism. Next time, I'll make sure the picture and the presentation agree better. LOL.
 
No correct guesses so far for #13. I'll give a hint soon if nobody guesses it.
 
Listeria monocytogenes... bamf kills babies.
 
How about the clap? N. gonorhea?
 
Forthegood said:
Listeria monocytogenes... bamf kills babies.
Click to expand...

I agree. Not because I know these things, but b/c the google image search of L. monocytogenes will bring up the same picture....................
 
Well... i guesed based on the lophotrichous arangement (did i mention i taught micro as an undergrad), but 10 times out of 10 google would make a better ___(fill in the blank) than i would!
 
nogolfinsnow said:
I agree. Not because I know these things, but b/c the google image search of L. monocytogenes will bring up the same picture....................
Click to expand...

Cheatin bastards. :D
 
Blastomyces dematitidis?
 
OOOOOOhhhhh.... yeah... Coccidioides immitis
 
Forthegood said:
Listeria monocytogenes... bamf kills babies.
Click to expand...


Correct! here is the new hall of fame:


Hall of Fame
1) themule +2
1) cpants +2
1) Mr hawkings +2
1) zipmedic +2
1) TPM-SMX +2
6) Beachblonde +1
6) Whatayear +1
6) Bodonid +1
6) Kaushik +1
6) Forthegood +1
 

Attachments

  • Mystery Pathogen #14.pdf
    14.5 KB · Views: 190
Climberak said:
Correct! here is the new hall of fame:


Hall of Fame
1) themule +2
1) cpants +2
1) Mr hawkings +2
1) zipmedic +2
1) TPM-SMX +2
6) Beachblonde +1
6) Whatayear +1
6) Bodonid +1
6) Kaushik +1
6) Forthegood +1
Click to expand...

that looks like it could be mycobacterium tuberculosis.

but it could easily be a lot of bacilli.
 
Looks like a rod growing in a biofilm-like environment so my guess is Pseudomonnas aeruginosa. Its generally found in pulmonary infections and UTI's. It has many virulence factors, so it can be deadly once invasion occurs.
 
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