Name That Pathogen!

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SomeDoc said:
A 45 year-old American male on tour in Europe presents to an Emergency Department in rural Germany, with complaints of pain in the right side of his chest, and noticeable yellowing of his skin and eyes. He had recently been touring the backwoods of Germany in order to appreciate the foil foliage of the countryside, and ate a variety of the local wild vegetation. Physical examination reveals significant tenderness in the right upper quadrant, scleral icterus, and jaundice. Abdominal CT scan reveals toxin-induced massive hepatic necrosis. The patient was admitted as an inpatient for palliative care due to the extent of his liver failure. Due to the lack of availability of a donor liver, or the presence of a commercially available antitoxin, the PT expired shortly after admission. What organism is this?
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Aspergillus, Aflatoxin Induced hepatic failure....
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stefanlukic said:
Aspergillus, Aflatoxin Induced hepatic failure....
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This is in the differential, and produces symptoms similar to that of the organism ingested.:)thumbup:) Can you think of another organism that produces very similar physical findings given the patient history?

The PT stated that he nibbled on the following vegetation:
dstyng2.jpg
 
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Bump, I'm getting rusty on my micro. I posted this bug before but nobody had a guess- it was at the end of a page so I think it was overlooked. Anybody wanna play?

prazivali-1.jpg
 
Trichomonas vaginasty.

Sometimes I screw up the species.
 
Picture1.jpg

A 37yo male presents with a mild fever, a non-productive cough, and visual impairment that has progressively worsened over the past 3 weeks. The above is a retina image showing a characteristic feature. What is the diagnostic feature? What is the causative agent of the cough and eye involvement? What else are you going to have to discuss with the patient?
 
Forthegood said:
View attachment 12525

A 37yo male presents with a mild fever, a non-productive cough, and visual impairment that has progressively worsened over the past 3 weeks. The above is a retina image showing a characteristic feature. What is the diagnostic feature? What is the causative agent of the cough and eye involvement? What else are you going to have to discuss with the patient?
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shot in the dark... I was bored, why not?
retinal whitening due to CMV retinitis 2ndary to HIV-AIDS? just an educated guess, no idea what the feature is- no path for me yet. i like the prettty pictures tho. Its way too late I'm going to bed.
 
Not CMV... but your head is in the right place. This is definately an opportunistic infection...
 
Forthegood said:
View attachment 12525

A 37yo male presents with a mild fever, a non-productive cough, and visual impairment that has progressively worsened over the past 3 weeks. The above is a retina image showing a characteristic feature. What is the diagnostic feature? What is the causative agent of the cough and eye involvement? What else are you going to have to discuss with the patient?
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Is it Mycobacterium tuberculosis with eye involvement due to HIV-AIDS? You would have to discuss the potential for reactivation of the disease due to his immunocompromised state.
 
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i haven't decided on my 2nd guess yet (good lord, how can you tell?) but is the finding called "cotton wool spots"? And is this Robbins type stuff, cause I really wanna see if this stuff is in there, but I'm on "holiday" right now and I don't have my text.
 
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Yeah I have no clue what the finding is called. I actually just came upon it while reading Cecil's and was like "hey that kind of looks like that", lol.
 
okay, tuberculosis sounds totally plausible, but if that's not it, then I'm going to say:

- NOT Toxo.
- Candidiasis???

this is my last guess. :D hopefully someone who actually knows this stuff will enlighten us.
 
Indeed, those are very cottony and wooly, and are considered "cotton wool spots". Now that you've got the diagnostic feature, add fever and non productive cough and HIV...

Candidiasis was a good guess, toxo was not, TB is a possibility, but you should be thinking more HIV at this point.

37yo male HIV+ presents with fever and cough. What's the first thing that pops in your head???
 
Forthegood said:
Indeed, those are very cottony and wooly, and are considered "cotton wool spots". Now that you've got the diagnostic feature, add fever and non productive cough and HIV...

Candidiasis was a good guess, toxo was not, TB is a possibility, but you should be thinking more HIV at this point.

37yo male HIV+ presents with fever and cough. What's the first thing that pops in your head???
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Pnuemocystis jirovecii or cryptococcus neoformins? Leaning towards pnuemocystis.
 
Whatayear said:
Pnuemocystis jirovecii or cryptococcus neoformins? Leaning towards pnuemocystis.
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Excellent diagnosis and differential. Sure, it is extrapulmonary PCP, but crypto is a good diff. Of course, I couldn't just present a chest ct or GMS stain... where would the fun be in that?
 
Alright, so I learned a bit about HIV and had my ego dropped down a few hundred pegs. Anyone else got anything? If not I'll find something tonight after work.
 
37 yo white male presents with a one month history of insomnia, fatigue, raised red papules and itching. The papules are localized to the area of his penis. The itching is worse at night and has spread from his penis to his inner thighs. The patient is sexually active. He went to his PCP two weeks ago and got a penicillin shot. Since then, the papules have begun to spread as well, with no obvious change in any of the symptoms. Irregular red streaks are apparent on physical exam. The following is an image of the man's lower abdomen.
scabies.jpg
 
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The girl from Ipanema gave him Treponema and now he has 2* syph?



bodonid said:
37 yo white male presents with a one month history of insomnia, fatigue, raised red papules and itching. The papules are localized to the area of his penis. The itching is worse at night and has spread from his penis to his inner thighs. The patient is sexually active. He went to his PCP two weeks ago and got a penicillin shot. Since then, the papules have begun to spread as well, with no obvious change in any of the symptoms. The following is an image of the man's lower abdomen.
scabies.jpg
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EDIT: I take it back. After re-reading the question, I realized that it said that they itch. Syph lesions are painless.
 
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Forthegood said:
There, I think i fixed it for you. And a little cream or Ivermectin should fix that unfortunate fellow as well.
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:thumbup:

Animals are disgusting. Protists, fungi, bacteria, etc. may be mean, but animals take the freaking ugly cake.

scabies_mite.jpg
 
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naegleria.htm_txt_Naeg1.gif

This guy may look pretty generic, but his identifying characteristic is that you show up to the ER P.U.D. The drug that they recommend to use is pretty freaking terrible (can be lethal on its own). What's more, you or I are even more likely to get this than the immunocompromized or the elderly (we are more likely to meet this fella). >99% fatal. Scary, but rare.

what is the pathogen? what is the drug? And given the mechanism, how the freak does it work on these guys?
 
bodonid said:
naegleria.htm_txt_Naeg1.gif

This guy may look pretty generic, but his identifying characteristic is that you show up to the ER P.U.D. The drug that they recommend to use is pretty freaking terrible (can be lethal on its own). What's more, you or I are even more likely to get this than the immunocompromized or the elderly (we are more likely to meet this fella). >99% fatal. Scary, but rare.

what is the pathogen? what is the drug? And given the mechanism, how the freak does it work on these guys?
Click to expand...

Naegleria fowleri, Amphotericin B by forming channels with membrane sterols.
 
bodonid said:
naegleria.htm_txt_Naeg1.gif

This guy may look pretty generic, but his identifying characteristic is that you show up to the ER P.U.D. The drug that they recommend to use is pretty freaking terrible (can be lethal on its own). What's more, you or I are even more likely to get this than the immunocompromized or the elderly (we are more likely to meet this fella). >99% fatal. Scary, but rare.

what is the pathogen? what is the drug? And given the mechanism, how the freak does it work on these guys?
Click to expand...

Unless you are on House :)
 
Jolie South said:
To be honest, it wasn't really fair. I have a degree in parasitology.

The "PAM" was always my favorite. :)
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Me two! The nasal-route infections (naegleria, balmuthia etc) I have always been fascinated by. You jump into a lake... 4 days later you are toast. These were always some of my favorite case reports to present. The differentials are great also because w/out adequate hx, its a far reach until its way to late.

BTW, did anyone else notice the nucleus is denoted with an "n"!!! Gee, thanks soo much for the help, i would have never guessed! Reminded me that House episode where he's looking at the xray --"And the green thing, next to the blue thing on the map, is an island."
 
FutureInternist said:
Unless you are on House :)
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meh, I can't imagine Foreman randomly swimming in a pond.

okay, since that one was so quick, try this one:

a 59 year old woman with a history of long term dexamethasone treatment for severe RA (above the recommended max) develops a slowly progressing pneumonia- at which point the dexamethasone is discontinued- that waxes and wanes for a couple weeks, and finally resolves. She presents to the ER two days later with pronounced left hemineglect. CT scan shows an absess.
perron_pic_11.jpg


The sputum culture from the initial infection yielded acid fast bacilli and a tenative diagnosis of tuberculosis absess of the brain- though her PPD from the week before was negative. Whole-blood test was negative too (???), brain biopsy reveals branching hyphae (??????)

What caused the lung infection? What caused the brain infection?

may have given too much info this time...
 
bodonid said:
meh, I can't imagine Foreman randomly swimming in a pond.

okay, since that one was so quick, try this one:

a 59 year old woman with a history of long term dexamethasone treatment for severe RA (above the recommended max) develops a slowly progressing pneumonia- at which point the dexamethasone is discontinued- that waxes and wanes for a couple weeks, and finally resolves. She presents to the ER two days later with pronounced left hemineglect. CT scan shows an absess.
perron_pic_11.jpg


The sputum culture from the initial infection yielded acid fast bacilli and a tenative diagnosis of tuberculosis absess of the brain- though her PPD from the week before was negative. Whole-blood test was negative too (???), brain biopsy reveals branching hyphae (??????)

What caused the lung infection? What caused the brain infection?

may have given too much info this time...
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Nocardia asteroides? is semi acid fast and looks sorta like hyphae . . . causes pneumonia with brain abscesses in immunosuppressed.
 
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Jolie South said:
Nocardia asteroides? is semi acid fast and looks sorta like hyphae . . . causes pneumonia with brain abscesses in immunosuppressed.
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yeah- that is about the furthest extent of my micro knowledge... when I get out that far my brain goes a little fuzzy with the details. they're called pseudohyphae, right? I was a cell major, so you probably know more about this than I do. Was parasitology post BS, or was that your major? I think this stuff is really interesting, and I wish I had done a little more in undergrad- but i have always been most interested in what I know least about. except history taking.
 
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last one for awhile, I guess. I need to go to sleep (tried to earlier): if this doesn't stump you I don't think that I can (of course you are more than welcome to school us if you want)

patient presents with neurological symptoms including ataxia, giddiness, staggering gait, and fever. motor dysfunction is the main clinical concern due to potential for respiratory arrest. cdc concerned due to this guy's presence in the area:

catenella.jpg


what causes the syptoms, and how did the patient get it/them?
 
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Don't eat shellfish. Ever.
 
Forthegood said:
Don't eat shellfish. Ever.
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:thumbup:

Class starts again monday, so I might take a break from sdn for awhile. But I bow to your collective wisdom.

Oh, and in case anyone was wondering, shellfish eat the dinoflagellates (above) or diatoms (in other types of disease), concentrating powerful toxins, and consumption of the shellfish by humans causes various (4 relatively common) kinds of poisoning. The one indicated above is paralytic shellfish poisoning (PSP) caused by saxitoxins (produced by alexandria spp. dinos). The other three are neurotoxic, amnesic, and diarrhetic shellfish poisoning.
 
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Wikipedia says heat stabile, and so does the review cited... but the primary literature on the subject is too old for pubmed as of yet...

Certainly makes you wonder tho...

That boy in the bubble is looking more and more appealing.
 
Tasty. So diarrhea. Any projectile vomiting involved like Staph aureus enterotoxin? :barf: Lol reminds me of when I was in Micro last semester and I had a chicken wrap thing that made me sick and I had lovely projectile vomiting and then I felt better once it was done. It had to be S. aureus toxin.

Now that that is over with back to our regularly scheduled programming. :cool:
 
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