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Infectious Disease Clinical Image Review Michael J. Tan, MD, FACP, FIDSA Associate Professor of Internal Medicine Northeastern Ohio Universities College of Medicine, Rootstown, OH Summa Health System, Akron, OH Session Objectives Recognize and recite key words of specific infectious diseases Recognize images associated with specific infectious diseases Credits John Sinnott MD, Todd Wills, MD University of South Florida College of Medicine Division of Infectious Diseases and Tropical Medicine Tampa, FL Dockworker unloading Persian goat-hair rugs CDC Bacillus anthracis 10 year old girl swimming in freshwater lakes near Walt Disney World CDC Naegleria sp.: amoebic meningo-encephalitis Primary amoebic encephalitis 60 year old male in DKA with fever and proptosis Mucormycosis Preoperative external appearance of the patient. The necrotic tissue already reaches the periorbital region. Mucormycosis of the head and neck Metzen, Daniela, Journal of Cranio-Maxillo-Facial Surgery, Volume 40, Issue 8, e321-e327 Copyright © 2012 European Association for Cranio-Maxillo-Facial Surgery Rose gardener Sporotrichosis (Sporothrix schenckii) Lymphocutaneous sporotrichosis with a papular lesion at the inoculation site that becomes nodular and often ulcerates. (From CID, Dr. Watanakunakorn, Universit Press.) Sporotrichosis Kauffman, Carol A., Goldman's Cecil Medicine, 345, 1985-1986 Copyright © 2012 Copyright © 2012, 2008, 2004, 2000, 1996, 1991, 1988, 1982, 1979, 1975, 1971, 1963, 1959, 1955 by Saunders, an imprint of Elsevier Inc. University student from Rhodesia with progressive evidence of dementia May have been bitten by a tsetse fly Trypanosoma brucei gambiense or rhodesiense Geologist from Nevada with fever and a painful knot in his groin Yersinia pestis Exchange student from India with anesthetic skin lesion Mycobacterium leprae Hunter with skin ulcer, lymphadenopathy, and fever Francisella tularensis Turkish male with sudden onset of fever, RUQ pain. Cystic mass on liver CT. Owns dogs. Echinococcus granulosus 30 year old female back from summer in west Africa, alternating fever and shaking chills CDC Plasmodium falciparum 7 year old from Brazil with fever and unilateral periorbital edema Triamtomine bugs Trypanosoma cruzi 35 year old female who developed fever, periorbital edema and myalgias on July 10 CDC Trichinella spiralis 26 year old Venezualan with dyspnea and leg edema Trypanosoma cruzi Traveler from St. Petersburg (Russia) with abdominal cramping and loose stool CDC Giardia lamblia Cornell students with fever, LAD after all had eaten hamburgers in the dormitory cafeteria Toxoplasma gondii 50 year old Greek alcoholic with fever, RUQ pain and raised right hemidiaphragm Entamoeba histolytica 21 year old Chinese male with first-time seizure. Numerous calcified nodules in soft tissue Neurocysticercosis: Taenia solium Geophagic child with rectal prolapse Whipworm: Trichuris trichurii Hawaiian with eosinophilic meningitis Angiostrongyloides cantonensis West African with snowflake lesion of cornea Black Fly River Blindness: Onchocerca volvulus Fever after eating Mexican goat cheese milk Brucellosis Meningitis after caring for a pet hamster LCM: Lymphocytic choriomeningitis virus Pulmonary Abscess in a Vietnam Veteran Melioidosis: Burkholderia pseudomallei Caught it from a pet turtle Salmonella sp. Anemia after walking barefoot in the Southern US Necator americanus, Ancylostoma duodenale “Diphtheroid” meningitis in a renal transplant patient Listeria monocytogenes Nurse with inflamed finger after tracheal suctioning HSV: Herpetic whitlow Continued urethral discharge after ceftriaxone treatment for verified gonorrhea Chlamydia trachomatis, Ureaplasma sp., Mycoplasma sp. Broad Street Pump John Snow – graphical representation of London Cholera outbreak 28 year old female with this: Bullous myringitis: Mycoplasma pneumoniae Sickle Cell Anemia and osteomyelitis Salmonella sp. Calabar swelling (episodic angioedema) of wrists and a worm crawling across the bulbae conjunctiva Loa loa Diplopia five days after eating canned fruit Clostridium botulinum Severe vomiting and small amounts of diarrhea 4 hours after a barbecue Staph aureus toxin Infected abdominal aortic aneurysm Salmonella sp. Californian with egg shell calcifications on chest xray Coccidioides immitis Blister on the foot of a Pakistani which ruptures on cold water immersion Guinea worm: Dracunculus medinensus Saber shins Congenital syphilis: Treponema pallidum “Cancerous” mass in the colon which reveals organisms on biopsy Ameboma: Entamoeba histolytica Hepatic fibrosis and hematuria Schistosoma mansoni Hypotension and plantar desquamation in a menstruating female Staphylococcal toxic shock syndrome Marijuana smoker in Michigan Salmonella sp. Mesenteric lymphadenitis Yersinia enterocolitica “Retinoblastoma” Toxocara canis Visceral larvae migrans Ocular larvae migrans Diarrhea following clindamycin Clostridium difficile Erosion of nasal septum in a Brazilian 5 years after spontaneous healing of a skin ulcer Sandfly Leishmania braziliensis Long white worm crawls out of an actress’ nose as she is about to deliver her line Ascaris lumbricoides Fever in a Caribbean tourist with bony pain Dengue fever Polynesian girl with one leg larger than the other Lymphatic filariais: Wucheria bancrofti Lumpy jaw Actinomyces Pruritis ani Pinworm: Enterobius vermicularis Pneumonia in a woman who recently purchased a parrot Psittacosis: Chlamydia psittaci Chlamydophila Broad based budding Blastomyces dermatitidis Itching of hand following prolonged hand holding with a bar maid Syphilis Pneumonia in a man who recently cleaned out his attic inhabited by pigeons Psittacosis: Chlamydia psittaci Hutchinson’s teeth Congenital syphilis quellung Laboratory test for Streptococcus pneumoniae Asthma and eosinophilia Allergic bronchopulmonary aspergillosis (ABPA) Fever and bleeding disorder in a Nigerian Ebola This rash Herpes Zoster:Varicella Zoster Virus Fever, shifting infiltrates and eosinophilia in a renal transplant patient Stongyloidiasis Pneumonia; this blood test positive Cold agglutinins: Mycoplasma pneumoniae Inguinal lymphadenopathy, patient from India Groove sign: LGV – Lymphogranuloma venereum Neck lesion after fly bite Winterbottom’s sign: Trypanosoma brucei gambiense Child living in a mud hut Romana’s sign: Chaga’s disease – Trypanosoma cruzi Lymphadenopathy, AFB (+) from Bangladesh Scrofula: Mycobacterium tuberculosis Martha’s Vineyard resident with fever Babesia microti Gram stain of Ulcerative genital lesion Donovan body: Calymmatobacterium granulomatis Hepatic disease in a traveler recently returned from a white water rafting trip Leptospirosis with subconjunctival hemorrhage Gram stain of painful penile lesion “School of Fish” – Chancroid Hemophilus ducreyi Lung biopsy of patient with glioblastoma multiforme and pneumonia Gomori methamine silver stain Pneumocystis jiroveci pneumonia (PCP) Pneumonia, diarrhea, hyponatremia - growth on this agar BCYE agar: Legionella pneumoniae Swimming pool granuloma Mycobacterium marinum Relapsing fever Borrelia recurrentis Elevated transaminases; these lesions on liver biopsy Councilman bodies: Associated with Yellow fever – seen with any viral hepatitis River Blindness Onchocerca volvulus Woolsorter’s disease Bacillus anthracis Fever, lympadenopathy OR Violaceous skin lesions OR Cystic liver lesions Bartonella henselae This cell on CBC in a fish eater Fish tapeworm: Diphyllobothrium latum Teichoic Acid Antibodies Staphylococcus aureus Sexually active female with this seen on laparoscopy Fitz-Hugh Curtis: Neisseria gonorrhea Pakistani with this anesthetic skin lesion Hansen’s disease: Mycobacterium leprae Fever, truncal rash as shown Rose spots: Typhoid fever – Salmonella typhi 3 year old with difficulty breathing, x-ray shown Epiglottitis: Hemophilus influenzae type B Undulant fever, chronic back pain Sacroiliitis from Brucellosis Related to these vectors Yersinia pestis Vectors: Rattus rattus and Xenopsylla cheopsis Fever and sore throat – exam as shown Corynebacterium diphtheriae Cough, Coryza, conjunctivitis and physical exam as shown Koplik spots: Measles Peruvian with this skin rash Carrion’s Disease, Oroya Fever – Bartonella bacilliformis Vector: sandfly Weight Loss, chronic fever Pott’s disease: Mycobacterium tuberculosis Buruli ulcer Mycobacterium ulcerans The Great Pox Syphilis, Treponema pallidum Leading cause of blindness in the world Chlamydia trachomatis 10 year old from South Carolina with fever, headache, and this rash after a camping trip Rickettsia rickettsii, Rocky Mountain Spotted Fever Lockjaw Clostridium tetani Fever, facial rash Fifth disease, Parvovirus B19 Recurrence of petechial rash, fever and headache 10 years after similar symptoms in a southeast Asian refugee camp Brill-Zinsser disease: Rickettsia prowazwkii Sign associated with Staphylococcal scalded skin syndrome Nikolsky’s sign 8 month old Japanese child with conjunctivitis, strawberry tongue, fissured lips, truncal rash, lymphadenopathy and desquamation Kawasaki’s syndrome Connecticut resident with this rash and arthritis following a camping trip Lyme disease: Borrelia burgdorferi Persistent facial tingling and numbness in a 21 year old female honeymooning in Florida Ciguatera fish poisoning; consumption of fish which consume dinoflagellates with ciguatera toxin Hypogammaglobulinemia and diarrhea Giardiasis: Giardia lamblia Headache, facial flushing, conjunctival injection, diarrhea and nausea one hour after eating at a seafood restaurant Scombroid poisoning Coughed up this egg Paragonimus westermani Fever and myalgias in arctic explorers Trichinella spiralis This appearance on Mueller-Hinton agar Pseudomonas Aeruginosa - from production of pyoverdin Al Capone Ivan the Terrible Henry VIII Syphilis,Treponema pallidum Laennec Chopin Goethe Brontë Sisters Mycobacterium tuberculosis 9 month old boy with recurrent otitis and pneumonia, normal lymph nodes, no plasma cells, normal cell mediated immunity, hypogammaglobulinemia Bruton’s (X-linked) agammaglobulinemia; deficit of btk (Bruton tyrosine kinase) PMN dysfunction, increased IgE, recurrent staph abscesses, bronchiectesis, eczema, red hair Job’s syndrome Recurrent sinopulmonary infections, decreased IgA, anergy and progressive ataxia Ataxia-Telangectasia Neonatal tetany, lymphopenia, normal immunoglobulins, absent thymus, infections with Herpes, Candida DiGeorge’s Syndrome Recurrent staphylococcal abscesses, normal PMN phagocytosis, abnormal nitroblue tetrazolium test Chronic Granulomatous Disease Recurrent infections, thrombocytopenia, eczema, decreased lymphocytes, decreased IgM, increased IgA Wiscott-Aldrich Syndrome – often recognized as poorly controlled bleeding after circumcision PMNs with giant granules Chediak-Hegashi Syndrome New Guinea child trembling with fear Kuru – spongiform encephalopathy (prion disease) 35 year old male with 6th episode of sterile lymphocytic meningitis in one year Mollaret’s meningitis: HSV 60 year old male with pulmonary infection, arthritis, fever, malabsorption, dementia and this finding on jejunal biopsy Trephorema whippeli: Whipple’s disease Cause of this finding HSV dendritic corneal ulcer Female from India with this finding on soft tissue x-ray Guinea worm: Dracunculus medinensis Biliary carcinoma in a Vietnamese male Clonorchis sinensis Recurrent UTIs and hematuria in an Egyptian male Schistosoma hematobium Infection following a rat bite Rat bite fever: caused by Streptobacillus moniliformis or Spirulina minus Cause of this clinical sign Clostridium tetani Dishwater pus Meleney’s synergistic gangrene Right upper quadrant pain in a Libyan male Amoebic liver abscess: Entamoeba histolytica Fevers occurring every 21 days Cyclic neutropenia – associated with aphthous ulcers Most commonly transmitted infectious agent in blood transfusions CMV - cytomegalovirus Fish handler with this infection of a finger Erysipeloid: Erysipelothrix rhusiopathiae This finding on microscopy of a draining wound Sulfur granules: Actinomyces Sore throat, cervical lymphadenopathy, this finding on peripheral blood smear Atypical lymphocyte: Epstein-Barr Virus Sabin-Feldman test Toxoplasma gondii serology test Weil-Felix test Serologic test for rickettsial diseases; cross reacts with OX strains of Proteus species which may confound test Organism leading to this finding Purpura fulminans: Neisseria meningitidis Cause of this finding on pupil exam Argyll-Robertson pupils; seen in Neurosyphilis – pupils accommodate but do not react to light Hydrophobia Aerophobia Dysphagia Rabies: Negri body Prozone phenomenon False negative non-treponemal antibody test seen in setting of profound antigen excess (especially secondary syphilis) 1 month old infant with decreased ability to suck, weak cry, progressing to floppy condition Clostridium botulinum