SMACC 2015

Adventures of a Pus WhispererMark Crislip

ID is about associations

✤ Travel

✤ Pets

✤ Diet

✤ Sex

✤ Exposure

✤ Know your bug and where it lives

You get what you are exposed to

Bloody Diarrhea

✤ 76 yo female presents with bloody diarrhea. Colonoscopy looks like ulcerative colitis

✤ Cultures grew Aeromonas hydrophilia

What to ask?

✤ Aeromonas is a water organism

J Water Health. 2012 Sep;10(3):349-57. doi: 10.2166/wh.2012.005.Holy springs and holy water: underestimated sources of illness?

Kirschner AK1, Atteneder M, Schmidhuber A, Knetsch S, Farnleitner AH, Sommer R.Author information

Abstract

Use of holy springs and holy water is inherent in religious activities. Holy spring water is also used extensively for personal drinking water, although not assessed according to drinking water

standards. Holy water in churches and chapels may cause infections via wetting of lips and sprinkling on persons. Our aim was to assess the microbiological and chemical water quality of holy springs and holy water in churches and hospital chapels. Of the holy springs investigated,

only 14% met the microbiological and chemical requirements of national drinking water regulations. Considering results from sanitary inspections of the water catchments, no spring was

assessed as a reliable drinking water source. All holy water samples from churches and hospital chapels showed extremely high concentrations of HPC; fecal indicators, Pseudomonas aeruginosa and Staphylococcus aureus occurred only in the most

frequently visited churches. We conclude that it is highly necessary to include holy springs in programs for assessment and management of water quality. Public awareness has to be raised to

perceive holy springs as potential sources of illness. Holy water can be another source of infection, especially in hospital chapels and frequently visited churches. Recommendations are

made for proper water quality management of both water types.

water: people do more than drink it✤ E coli in toilets

✤ Serratia in San Francisco

✤ Acintobacter in tap water and Iraq

✤ MAI in shower

✤ Legionella in Hot Tub

✤ Pseudomonas Hot Tubs

✤ Mucor in brown water

✤ Leptospirosis in rafters and tri atheletes

Mind Reader

✤ 18 yo, known congenital heart disease.

✤ fevers, head ache, myalgias, sweats for a week. It goes away for a week. Returns for a week. Goes away for a week.

✤ It’s back.

✤ I am asked: does she have endocarditis?

Mind Reader

✤ Remember, I live and work in Oregon.

✤ The pattern?

✤ A relapsing fever.

✤ I asked?

You have to know your disease distribution

✤ How was your vacation at Black Butte?

Fewer Diagnoses

✤ No one gets a differential on the CBC

✤ Campers in W. Washington

✤ Hikers in Mexico

Aspirations

✤ 17 yo presents with a week of fevers, productive cough, foul breath

Lung abscess

✤ Cult with Eichinella and S. anginosus. Mouth organisms.

✤ Good teeth, no drugs, no ETOH, no LOC

✤ Why?

✤ Saxophone player in the school band

Unsafe sax: cohort study of the impact of too much sax on the mortality of famous jazz musicians. BMJ 1999;319:1612–3

Mulch

✤ 45 yo male with 2 months of progressive headache

Are You really sick of it?

✤ 100.8

✤ stiff neck

✤ right eye points medial and canna move laterally

✤ WBC 10 LP 135 (pmn’s) WBC Protein 210 Glucose 22

✤ Before the CNS diagnostics, what does he have and why?

Horse trainer

✤ Works in a large barn filled with bark dust

✤ Canadian bark dust

Home Security Fail?

Bad Partof theWorld

Good Partof the World

Those Damn Canadians

✤ An outbreak of infections due to a rare subspecies of Cryptococcus neoformans (var. gattii) was recognized on Vancouver Island (VI), British Columbia, in 2002, which had affected 59, mostly immunocompetent, individuals since 1999

✤ There was no evidence of spread of the outbreak strain to the Greater Vancouver area.

✤ It has killed at least 4 people, as well as a horse, 11 porpoises that washed ashore, and dozens of cats and dogs. It is 37 times more infectious on the island than it is in Australia.

Recent data suggests it is the result of same ‘sex’mating of Cryptococcus

Those Damn CanadiansWhat would the Lorax say?

Don’t eat dirt

Other cases

✤ Found in bark dust

✤ Secretary in a nursery

✤ Transplant pt lives down wind from tree grinder

✤ can occur years after leaving an endemic area

✤ I anticipate a Christmas tree outbreak one of these years

Ask it right

✤ 19 yo Korean, fevers, hepatitis, diffuse lymphadenopathy, pancytopenia

✤ Biopsy: stellate necrotizing granuloma

✤ Was asked by multiple HCW’s: do you have pets?

✤ He kept saying no.

Who is this man?

German Jesuit Athanasius Kircher born 02 May 1601

✤ Inventor of the “cat piano”, a grisly musical instrument that worked by prodding the tails of cats with spikes driven by a keyboard.

✤ He died of Bartonella.

✤ Not really.

✤ My hero.

He was asked

✤ Are you around cats?

✤ Yes, my roommate has 5 cats

✤ It is all in how you ask the questions

CSD is common

✤ as a cause of red bumps

✤ as a cause of encephalitis

✤ as a cause of fevers

✤ as a transfusion disease from veterinarians

Pick an animal

✤ And I (or PubMed) will have an infection associated with it.

Fagets

✤ 19 yo female

✤ fevers, chills, hepatitis, pancytopenia

✤ gets her gallbladder out

✤ doesn’t improve

✤ call me

✤ temp 105 pulse 70

Faget’s

✤ pulse-temp disassociation

✤ every degree elevation, pulse should go up 10

✤ Typhoid, Brucella, Yellow fever are the classic 3

Faget’s

✤ when I asked to consult before the cultures returned, they gave a Hispanic surname

✤ This is Brucella I said

✤ Always call the diagnosis before the cultures come back

Faget’s

✤ it was Brucella

✤ problem was, she had never left PDX

✤ a month later her mom let me know they get goat cheese an uncle brings from Mexico

Other Brucella

✤ It is in feral pigs, who contaminate farm pigs

✤ case in S. Pacific Islander who liked to slaughter his own pigs for parties

✤ orchitis in a goat milker

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