I am probably not the only one who doubts the utility of the physical exam in the diagnosis of disease. Indeed, when looking at the imaging modalities that we have at hand, including CT, MRI, PET, Echo, ultrasound, and how quickly we can get any of these studies now, the physical exam seems to be
Month: July 2020
Nocardia spp is an interesting bug. It is a filamentous gram positive rod that is present in the environment, usually found in soil and organic matter aka the environment. Usually patients who are immunosuppressed (i.e. solid-organ transplant, high dose steroids, HIV) tend to be those who are at highest risk of infection. The most common
What to start? In general, start any combination that has an integrase inhibitor. In general, either Descovy OR Truvada + Dolutegravir Biktarvy (I think the most popular choice) Triumeq (if no HLA-B5701) There are newer combinations, which I will not go over (for instance, Dovato aka 3TC/DTG, Juluca aka DTG/RPV, Delstrigo aka TDF/3TC/DOR) nor will
Fever, thrombocytopenia, and transaminitis. I can be describing full blown septic shock with DIC, HIT (especially if you get a clot in this setting) and TTP (again, clots causing fever and Budd Chiari). Having said that, there is a selection of infections that tend to cause this pattern of fever, low platelets, and elevated LFTs.
Acute myocarditis is one of those diseases that is a catastrophic due to its dramatic presentation and because we never pinpoint the etiology. People tend to be deathly ill and almost any virus can lead to this cardiac manifestation. Most of the time, short of giant cell myocarditis, there really is not much to do.
If you don’t get the joke, there is a movie called Meet the Fockers and I am always afraid of saying the wrong thing. The same thing applies to Faget’s sign. Also known as Sphygmothermic dissociation. This is essentially a counterargument to the Liebermeister’s rule (which is in the running for the most epic named
Galactomannan is a component of the cell wall of both Aspergillus spp and Penicillium spp. This component is secreted during the growth phase of the fungus, and higher galactomannan levels are correlated with fungal load in tissues. This is the general structure of the galactomannan: The test of choice is a sandwich ELISA. The double-sandwich
The timely diagnosis of invasive pulmonary aspergillosis is incredibly important. Non-invasive modalities of diagnosis such as beta-D glucan and galactomannan can take a few days to come back and much of the time, we rely on chest imaging to guide treatment decision. The classic finding that has been attributed to invasive pulmonary aspergillosis has been
So MRSA is really hard to kill. If you have done any sort of ID, you will not be surprised by that statement. MRSA bacteremia has a high relapse rate. Because of this, people have tried multiple types of antibiotics, including Daptomycin and Ceftaroline, have been used with minimal change in the outcomes. In the
Lyme disease is a difficult beast to diagnose. I think most people know some of the characteristics, including the fact it is a vector-borne illness that causes a characteristic rash (EM) that can lead to CNS disease, cardiac disease, and large joint arthritis. While the clinical characteristics are known, there is some difficulty in diagnosing