Pearls from Dr. Ben Miko

54 y/o woman with HIV presenting with fever and AMS, found to have MSSA Endocarditis with septic emboli


  •  Head CT prior to LP:

    Posted 07/05/16 11:00:47 AM by Adam Faye

  • Meningitis:
    -Ceftriaxone - used for pneumococcal coverage
    -Vancomycin - used for Resistant pneumococcal  coverage
    -Ampicillin - used for Listeria
    -Cefepime, better than Zosyn for CNS penetration (if needed for spesis)

    **HHV-6 can cause encephalitis in immuno-suppressed  hosts**

    Posted 07/05/16 01:59:41 PM by Adam Faye

  • CSF Studies:

    Posted 07/05/16 03:39:24 PM by Adam Faye

  • Dexamethasone for Meningitis

    Posted 07/05/16 03:42:55 PM by Adam Faye

  • -Staphylococcus (MSSA/MRSA) in urine often comes from bacteremia

    Posted 07/05/16 03:47:02 PM by Adam Faye

  • Beta-lactam + Aminoglycoside for Endocarditis

    Posted 07/05/16 03:50:41 PM by Adam Faye

  • How to think about need for Surgery with Endocarditis: (see below)
    1. Cardiac complications (Heart Block, Severe Valvulopathy)
    2. Failure to treat infection on Abx
    3. Embolic complications

    Treatment course - Usually 6 weeks after initiation of ABx or of surgery (source control)

    Posted 07/05/16 03:55:36 PM by Adam Faye

  • For further reading...

    Dexamethasone in Adults with Bacterial Meningitis
    Indications for Valve Surgery in Endocarditis
    IDSA Guidelines for Endocarditis

    Posted 07/05/16 03:43:28 PM by Adam Faye

  • 25 yo woman from China presenting with 3-4 months of fever found to have subacute bacterial endocarditis


  • Bacille Calmette-Guerin (BCG) vaccine

    Posted 09/28/16 02:03:54 PM by Anna Krigel

  • Fever of Unknown Origin Major Categories
    Fever of Unknown Origin Testing

    Posted 09/28/16 02:38:38 PM by Anna Krigel

  • Subacute bacterial endocarditis

    Posted 09/28/16 02:44:37 PM by Anna Krigel

  • For further reading...

    Infective Endocarditis (NEJM)
    Fever of Unknown Origin: A Clinical Approach (American Journal of Medicine)

    Posted 09/28/16 02:51:41 PM by Anna Krigel

  • 32 yo M with FSGS s/p renal transplant x4 presenting with SOB and found to have PCP pneumonia


  • Induction immunosuppression therapy in renal transplantation

    Maintenance immunosuppression therapy

    Most amount of immunosuppression is required for lung and small bowel transplants, least amount is needed for liver transplants, heart and kidney transplants fall in the middle

    Posted 12/07/16 10:14:04 AM by Anna Krigel

  • Branching gram positive rods

    Posted 12/07/16 10:16:12 AM by Anna Krigel

  • Ribavirin - has known activity against RSV and shown to have activity against human metapneumovirus in vitro; systemic and inhaled ribavirin has been use to treat human metapneumovirus, but inhaled version is exorbitantly expensive and essentially taken off the market

    Posted 12/07/16 10:24:55 AM by Anna Krigel

  • Fungal pneumonias tend to cause nodular pneumonias, except for PCP which causes more of a patchy alveolar process

    Posted 12/07/16 10:25:41 AM by Anna Krigel

  • Causes of fungitell false positives:

    Posted 12/07/16 10:30:02 AM by Anna Krigel

  • Risk factors for PCP in HIV-uninfected patients

    Posted 12/07/16 10:39:08 AM by Anna Krigel

  • For further reading...

    Serum Indicators for the Diagnosis of Pneumocystis Pneumonia (Chest)
    Treatment of Fungal Infections in Adult Pulmonary and Critical Care Patients (AJRCCM)

    Posted 12/07/16 10:43:55 AM by Anna Krigel

  • 43 y/o F p/w fevers, HA's and rash thought to have RMSF


  • Differential of fever, HA, and rash

    Posted 01/19/17 09:39:46 AM by Ying Liu

  • RMSF

    Posted 01/19/17 09:41:00 AM by Ying Liu

  • Miscellaneous

    Posted 01/19/17 09:44:43 AM by Ying Liu

  • 36yo F w/ 2 weeks of painful oral, vaginal hand and foot lesions


  • 70% erythema multiforme is secondary to HSV infection.  

    Posted 05/15/17 09:24:59 AM by Emily Miller

  • Immunocompromised patient's can have "telescoping" of syphilis stages and show signs of primary and secondary syphilis at the same time.n 

    Posted 05/15/17 09:26:03 AM by Emily Miller

  • For people with recurrent HSV associated erythema multiforme, suppressive acyclovir therapy may be beneficial.  

    Posted 05/15/17 09:26:55 AM by Emily Miller

  • 19yo M with FMF who presented with acute onset N/V, HA found to have N. meningitidis meningitis


  • For further reading...

    Community-Acquired Bacterial Meningitis in Adults N Engl J Med 2006;354:44-53.

    Posted 10/09/17 02:36:32 PM by Kaylan Christianer

  • For further reading...

    Bacterial Meningitis in the United States, 1998–2007 N Engl J Med 2011;364:2016-25.

    Posted 10/09/17 02:37:28 PM by Kaylan Christianer

  • Board Review -ID


    36yo F w/ RUQ pain found to have complex echinococcus cysts


    65yoF w/diabetes p/w AMS found to have listeria meningitis & bacteremia


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