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Infectious Diseases Fellowship at Indiana University @iuidfellowship.bsky.social · 10h

www.clinicalmicrobiologyandinfection.org/article/S119...

Mycobacterial peritonitis: difference between non-tuberculous mycobacteria and Mycobacterium tuberculosis

Unlike tuberculous peritonitis, peritonitis due to non-tuberculous mycobacteria (NTM) has unclear clinical manifestations. This study aimed to clarify the clinical manifestations and laboratory result...

www.clinicalmicrobiologyandinfection.org

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Infectious Diseases Fellowship at Indiana University @iuidfellowship.bsky.social · 10h

Laparoscopic findings of #tuberculous #peritonitis include
Thickened peritoneum w/ yellowish-white lesions +/-adhesions

Thickened peritoneum +/-adhesions

Fibroadhesive pattern

Other findings include enlarged lymph nodes, "violin-string" fibrinous strands & omental thickening

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Infectious Diseases Fellowship at Indiana University @iuidfellowship.bsky.social · 10h

In patients with renal failure on continuous ambulatory peritoneal dialysis (CAPD), clinical manifestations of #tuberculous #peritonitis typically develop within the first year of beginning CAPD and are usually indistinguishable from bacterial peritonitis.

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Infectious Diseases Fellowship at Indiana University @iuidfellowship.bsky.social · 10h

10% cases w/ a more advanced "dry" phase with doughy abdomen, which represents a fibroadhesive form

absence of signs of chronic liver disease (such as palmar erythema, spider angiomata, and dilated abdominal wall veins) should increase clinical suspicion for #TB #peritonitis

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Infectious Diseases Fellowship at Indiana University @iuidfellowship.bsky.social · 10h

Clinical manifestations of #peritoneal #TB include ascites (93%), abdominal pain (73%), fever (58%) Typically, sx for week or months before dx.
>90% with tb peritonitis have ascites at time of presentation, with SAAG<1.1 g/dL (in the absence of cirrhosis)

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Infectious Diseases Fellowship at Indiana University @iuidfellowship.bsky.social · 10h

#TB #peritonitis can also occur via hematogenous spread in the setting of active pulmonary TB or miliary TB. Much less commonly, mycobacteria enter the peritoneal cavity transmurally from an infected small intestine or via contiguous spread from tuberculous salpingitis

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Infectious Diseases Fellowship at Indiana University @iuidfellowship.bsky.social · 10h

#Peritoneal #TB occurs most commonly following reactivation of latent tuberculous foci in the peritoneum established via hematogenous spread from a primary lung focus

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Infectious Diseases Fellowship at Indiana University @iuidfellowship.bsky.social · 10h

peritoneal biopsies showed caseating granulomas #peritoneal #tb #Mycobacterium #tuberculosis Ref t.co/rD772Gs7f1

https://www.sciencedirect.com/science/article/pii/S2214250922000592

t.co

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Infectious Diseases Fellowship at Indiana University @iuidfellowship.bsky.social · 10h

#idboardreview pt w/hx of tb lymphadenitis (s/p rif/inh x10mo) 10yr ago. S/p renal transplant 3yrs ago & now 3mo intermittent fever, anorexia, weight loss, fatigue, ascites: exudative 800 wbc 59%lymph, ADA upp limit of normal, AFB neg, exp lap peritoneal biopsy granuloma #IDsky #idmeded #meded

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Infectious Diseases Fellowship at Indiana University @iuidfellowship.bsky.social · 1d

DDX of plaque #sporotrichosis (chronic, indurated hyperkeratotic plaques): Blasto, paracocci, chromoblastomycosis, lobomycosis. Neoplasms ddx: squamous cell, basal cell, mycosis fungoides. Other ddx: psoriasis, lupus vulgarisms, pyoderma gangrenosum #IdMedEd

Infectious Diseases Fellowship at Indiana University @iuidfellowship.bsky.social · 1d

Differential diagnosis of lymphocutaneous #sporotrichosis
Nocardiosis N.brasiliensis, cutaneous leishmania, MTB, NTM (marinum, chelonae, kansasii, fortuitum.

Less likely ddx: leprosy, cowpox, SA, strep pyrogens, tularemia, scedosporium, fusarium #idmedEd

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Infectious Diseases Fellowship at Indiana University @iuidfellowship.bsky.social · 1d

academic.oup.com/cid/article/...

Clinical Practice Guidelines for the Management of Sporotrichosis: 2007 Update by the Infectious Diseases Society of America

Abstract. Guidelines for the management of patients with sporotrichosis were prepared by an Expert Panel of the Infectious Diseases Society of America and

academic.oup.com

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Infectious Diseases Fellowship at Indiana University @iuidfellowship.bsky.social · 1d

www.nejm.org/doi/full/10....

Sporotrichosis | NEJM

A 65-year-old farmer presented with a progressively enlarging annular rash over the right hand and forearm. Biopsy was performed, and fungal culture grew Sporothrix schenckii.

www.nejm.org

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Infectious Diseases Fellowship at Indiana University @iuidfellowship.bsky.social · 1d

Tx: itraconazole 200mg po qd 3-6 mo for lymphocutaneous #sporotrichosis (potassium iodide can be used but has SE). Itra for extracutaneous dz as well but extended courses. In severe cases: amphoB. ART or reduction of immunosuppressive therapy in some cases

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Infectious Diseases Fellowship at Indiana University @iuidfellowship.bsky.social · 1d

most common #sporotrichosis extracutaneous: osteoarticular. Pulmonary (usually cavitary) & meningeal dis can be seen. Multifocal dissemination in immunosuppressed pts.

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Infectious Diseases Fellowship at Indiana University @iuidfellowship.bsky.social · 1d

#sporotrichosis Dx: lymphocutaneous disease: presents w/ indolent papulonodular lesion, sometimes ulcerates. Secondary lesions along lymphangitis channels. Biopsy pyogranulomas w/o visible organisms but culture+

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Infectious Diseases Fellowship at Indiana University @iuidfellowship.bsky.social · 1d

Risk factors: exposure to soil, plants, plant products hay, straw, sphagnum moss & variety of animals esp cats. Grows slowly on fungal culture from involved tissues #sporotrichosis#sporotrichiosis

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Infectious Diseases Fellowship at Indiana University @iuidfellowship.bsky.social · 1d

#sporothrix schenckii sensu lato, a group of closely related species, causes #sporotrichiosis dimorphic fungi w/ budding yeast in tissue & mold in culture. Worldwide distribution esp in tropical/subtropical regions

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Infectious Diseases Fellowship at Indiana University @iuidfellowship.bsky.social · 1d

#sporotrichiosis www.cdc.gov/sporotrichos...

Sporotrichosis Basics

Sporotrichosis typically causes severe skin infections but can affect other parts of the body.

www.cdc.gov

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Infectious Diseases Fellowship at Indiana University @iuidfellowship.bsky.social · 1d

#idboardreview 40 F had trauma to foot while gardening and initially had a small nodule but slowly progressed to multiple lesions over-few months, not improved with abx. Diagnosis? #medEd #idmedEd #IDtwitter

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Infectious Diseases Fellowship at Indiana University @iuidfellowship.bsky.social · 2d

www.cdc.gov/leishmaniasi...

Clinical Care of Leishmaniasis

Generally, all clinically manifest cases of visceral leishmaniasis and mucosal leishmaniasis should

www.cdc.gov

Infectious Diseases Fellowship at Indiana University @iuidfellowship.bsky.social · 2d

Species id is helpful in tx decision. Serology is rarely used due to variable sensitivity & specificity.Tx (topical or systemic) is based on location # & chronicity of lesions, species id & host immune status. high-risk (close to eye), multiple lesions, IC state favor systemic tx

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Infectious Diseases Fellowship at Indiana University @iuidfellowship.bsky.social · 2d

Cutaneous #leishmania lesions may spontaneously heal within 6 to 15 months of disease onset. Self-resolution confers lifelong protection from the disease but leaves a scar.

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Infectious Diseases Fellowship at Indiana University @iuidfellowship.bsky.social · 2d

#leishmaniasis incubation period 2-8 wk: dz begins as erythematous papule at site of sandfly bite on exposed parts of body
papule increases in size➡️nodule➡️ulcerates➡️crusts over. The border is usually raised & ulcer is large but painless unless 2ndry bacterial or fungal infect

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Infectious Diseases Fellowship at Indiana University @iuidfellowship.bsky.social · 2d

Cutaneous #leishmaniasis amastigotes in macrophages

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