Infectious DiseaseClinical Image Review

Michael J. Tan, MD, FACP, FIDSAAssociate Professor of Internal Medicine

Northeastern Ohio Universities College of Medicine, Rootstown, OHSumma 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

10 year old girl swimming in freshwater lakes near Walt Disney World

60 year old male in DKA with fever and proptosis

Rose gardener

University student from Rhodesia with progressive evidence of dementia

May have been bitten by a tsetse fly

Geologist from Nevada with fever and a painful knot in his groin

Exchange student from India with anesthetic skin lesion

Hunter with skin ulcer, lymphadenopathy, and fever

Turkish male with sudden onset of fever, RUQ pain. Cystic mass on liver CT. Owns dogs.

30 year old female back from summer in west Africa, alternating fever and shaking chills

7 year old from Brazil with fever and unilateral periorbital edema

Triamtomine bugs

35 year old female who developed fever, periorbital edema and myalgias on July 10

26 year old Venezualan with dyspnea and leg edema

Traveler from St. Petersburg (Russia) with abdominal cramping and loose stool

Cornell students with fever, LAD after all had eaten hamburgers in the dormitory cafeteria

50 year old Greek alcoholic with fever, RUQ pain and raised right hemidiaphragm

21 year old Chinese male with first-time seizure. Numerous calcified nodules in soft tissue

Geophagic child with rectal prolapse

Hawaiian with eosinophilic meningitis

West African with snowflake lesion of cornea

Black Fly

Fever after eating Mexican goat cheese milk

Meningitis after caring for a pet hamster

Pulmonary Abscess in a Vietnam Veteran

Caught it from a pet turtle

Anemia after walking barefoot in the Southern US

“Diphtheroid” meningitis in a renal transplant patient

Nurse with inflamed finger after tracheal suctioning

Continued urethral discharge after ceftriaxone treatment for verified gonorrhea

Broad Street Pump

28 year old female with this:

Sickle Cell Anemia and osteomyelitis

Calabar swelling (episodic angioedema) of wrists and a worm crawling across the bulbae conjunctiva

Diplopia five days after eating canned fruit

Severe vomiting and small amounts of diarrhea 4 hours after a barbecue

Infected abdominal aortic aneurysm

Californian with egg shell calcifications on chest x-ray

Blister on the foot of a Pakistani which ruptures on cold water immersion

Saber shins

“Cancerous” mass in the colon which reveals organisms on biopsy

Hepatic fibrosis and hematuria

Hypotension and plantar desquamation in a menstruating female

Marijuana smoker in Michigan

Mesenteric lymphadenitis

“Retinoblastoma”

Diarrhea following clindamycin

Erosion of nasal septum in a Brazilian 5 years after spontaneous healing of a skin ulcer

Sandfly

Long white worm crawls out of an actress’ nose as she is about to deliver her line

Fever in a Caribbean tourist with bony pain

Polynesian girl with one leg larger than the other

Lumpy jaw

Pruritis ani

Pneumonia in a woman who recently purchased a parrot

Broad based budding

Itching of hand following prolonged hand holding with a bar maid

Pneumonia in a man who recently cleaned out his attic inhabited by pigeons

Hutchinson’s teeth

quellung

Asthma and eosinophilia

Fever and bleeding disorder in a Nigerian

This rash

Fever, shifting infiltrates and eosinophilia in a renal transplant patient

Pneumonia; this blood test positive

Inguinal lymphadenopathy, patient from India

Neck lesion after fly bite

Child living in a mud hut

Lymphadenopathy, AFB (+) from Bangladesh

Martha’s Vineyard resident with fever

Gram stain of Ulcerative genital lesion

Hepatic disease in a traveler recently returned from a white water rafting trip

Gram stain of painful penile lesion

Lung biopsy of patient with glioblastoma multiforme and and pneumonia

Pneumonia, diarrhea, hyponatremia - growth on this agar

Swimming pool granuloma

Relapsing fever

Elevated transaminases; these lesions on liver biopsy

River Blindness

Woolsorter’s disease

Fever, lympadenopathy

OR Violaceous skin

lesions OR Cystic liver lesions

This cell on CBC in a fish eater

Teichoic Acid Antibodies

Sexually active female with this seen on laparotomy

Pakistani with this anesthetic skin lesion

Fever, truncal rash as shown

3 year old with difficulty breathing, x-ray shown

Undulant fever, chronic back pain

Related to these vectors

Fever and sore throat – exam as shown

Cough, Coryza, conjunctivitis and physical exam as shown

Peruvian with this skin rash

                                                                                                                           

Weight Loss, chronic fever

Buruli ulcer

The Great Pox

Leading cause of blindness in the world

10 year old from South Carolina with fever, headache, and this rash after a camping trip

Lockjaw

Fever, facial rash

Recurrence of petechial rash, fever and headache 10 years after similar symptoms in a southeast Asian refugee camp

Sign associated with Staphylococcal scalded skin syndrome

8 month old Japanese child with conjunctivitis, strawberry tongue, fissured lips, truncal rash, lymphadenopathy and desquamation

Connecticut resident with this rash and arthritis following a camping trip

Persistent facial tingling and numbness in a 21 year old female honeymooning in Florida

Hypogammaglobulinemia and diarrhea

Headache, facial flushing, conjunctival injection, diarrhea and nausea one hour after eating at a seafood restaurant

Coughed up this egg

Fever and myalgias in arctic explorers

This appearance on Mueller-Hinton agar

Al Capone Ivan the Terrible Henry VIII

Laennec Chopin Goethe Brontë Sisters

9 month old boy with recurrent otitis and pneumonia, normal lymph nodes, no plasma cells, normal cell mediated immunity, hypogammaglobulinemia

PMN dysfunction, increased IgE, recurrent staph abscesses, bronchiectesis, eczema, red hair

Recurrent sinopulmonary infections, decreased IgA, anergy and progressive ataxia

Neonatal tetany, lymphopenia, normal immunoglobulins, absent thymus, infections with Herpes, Candida

Recurrent staphylococcal abscesses, normal PMN phagocytosis, abnormal nitroblue tetrazolium test

Recurrent infections, thrombocytopenia, eczema, decreased lymphocytes, decreased IgM, increased IgA

PMNs with giant granules

New Guinea child trembling with fear

35 year old male with 6th episode of sterile lymphocytic meningitis in one year

60 year old male with pulmonary infection, arthritis, fever, malabsorption, dementia and this finding on jejunal biopsy

Cause of this finding

Female from India with this finding on soft tissue x-ray

Biliary carcinoma in a Vietnamese male

Recurrent UTIs and hematuria in an Egyptian male

Infection following a rat bite

Cause of this clinical sign

Dishwater pus

Right upper quadrant pain in a Libyan male

Fevers occurring every 21 days

Most commonly transmitted infectious agent in blood transfusions

Fish handler with this infection of a finger

This finding on microscopy of a draining wound

Sore throat, cervical lymphadenopathy, this finding on peripheral blood smear

Sabin-Feldman test

Weil-Felix test

Organism leading to this finding

Cause of this finding on pupil exam

Hydrophobia Aerophobia Dysphagia

Prozone phenomenon

1 month old infant with decreased ability to suck, weak cry, progressing to floppy condition