Name That Pathogen!
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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?
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?
Cutaneous larva migrans
Ancylostoma braziliense (had to look that one up)
albendazole or ivermectin
curse you zippy
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Ah.. didn't even know about albendazole.
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You and I sure make it seem like med school doesn't take up too much of one's time. 🙄
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:
Significantly, the child is allergic to penicillin.
What is your treatment of choice for this child's infection?
Culture on blood agar shows the following:
Significantly, the child is allergic to penicillin.
What is your treatment of choice for this child's infection?
wiki... 🙄
couldn't remember the causative organism.
but albendazole "bends" worms.... that's what reminds me.
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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:
Significantly, the child is allergic to penicillin.
What is your treatment of choice for this child's infection?
Erythromycin?
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146233
Ooo, I like it.
nope
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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:
Significantly, the child is allergic to penicillin.
What is your treatment of choice for this child's infection?
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.
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?
Strep. Viridans group? Hit it with Vancomycin?
do the symptoms really warrant vanco?
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 🙂)
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
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
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.
Oooh....tricky! Very nice. Thanks for sharing that. I'm going to add that to my mental algorithm. 👍
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.
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.
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.
Yeah, that's about where I left off. Some sort of flagellated rod. Might need a bit more information.
Who's that pokemon?!
Giardia lamblia?
Shigella, that's clearly actin based motility.
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.
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!] 👍
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?
Couldn't help but notice the disturbing amount of hair on this girl's leg and foot
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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 🙂)
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
#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.
Not only the flagella, but those two bad boys are curved. The one presented is a pretty straight on rod.
Couldn't help but notice the disturbing amount of hair on this girl's leg and foot
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.
I dunno...wild guess: Pseudomonas aeruginosa
Listeria monocytogenes... bamf kills babies.
Gram Negative Diplococci without flagella.
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!
The following comes from a 26 year old ranch-hand complaining of "flu-like" symptoms which have progressed to a severe pulmonary infection with possible dissemination to other sites.
Blastomyces dematitidis?
you're on the right track... I gave you (or tried to give you) a geography clue with his occupation.
OOOOOOhhhhh.... yeah... Coccidioides immitis
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It's also a nice spherule
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
that looks like it could be mycobacterium tuberculosis.
but it could easily be a lot of bacilli.
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