Insane in the Brain
This organism can cause a delayed CNS infection in both immunocompetent and immunosuppressed individuals months after a near-drowning event.
What is Scedosporium apiospermum?
This drug (and to a lesser extent bictegravir) inhibits proximal tubular cation transport protein OCT2 (actively secretes creatinine from the bloodstream into the urine) and can almost immediately cause an increase in serum creatinine by 0.1 to 0.15 mg/dL which impacts eCrCl calculation but does not reflect any decrease in GFR.
What is dolutegravir?
This cause of infectious diarrhea generally presents 2-4 weeks after exposure (larval penetration through skin) but can be dormant for decades without symptoms and manifest in GI tract, lungs, and other tissues during periods of immunosuppression.
What is Strongyloides?
This virus is an unusual cause of fulminant acute viral hepatitis in immunosuppressed individuals or pregnant women in their third trimester?
What is herpes simplex virus (HSV)?
-Can be either primary or reactivation of HSV-1 or HSV-2
- A substantial fraction of patients have NO cutaneous or mucosal HSV lesions
- Diagnosis is serum PCR or liver biopsy and treatment is acyclovir
Mycobacterium bovis vertebral osteomyelitis with psoas abscesses, in a 50 y.o. man with bladder cancer.
What is intravesicular instillation of Bacillus Calmette Guerin (BCG)--a live attenuated derivative of M. bovis--which is a mainstay of therapy for superficial bladder cancer?
This organism may cause meningoencephalitis, typically seen in young boys participating in outdoor lake water activities in the summer.
What is Naegleria fowleri?
This drug is transmitted into proximal tubular cells by anion transport proteins OAT1 & OAT3 and over time can result in some proximal tubular dysfunction including Fanconi's syndrome.
What is tenofovir? (more so TAF formulation which has a 10-fold less plasma concentration of tenofovir than TDF)
This cause of chronic diarrhea is associated with bile duct strictures specifically reported in patient with HIV and low CD4 counts causing HIV-associated cholangiopathy.
What is cryptosporidiosis? (also can be associated with microsporidia, and less commonly giardia or CMV)
- Treatment is ART. Nitazoxanide is reported to be effective in patients with normal immunity but seems to have little effect in immunosuppressed patients
Co-infection of this virus, that causes tropical spastic paraparesis and adult T-cell leukemia/lymphoma, with Strongyloides can be associated with treatment-refractory strongyloidiasis.
What is human T-lymphotropic virus 1 (HTLV-1)?
Burkholderia cepacia bacteremia, in a 43 y.o. MICU patient.
What is contamination of a liquid-based product (e.g., ultrasound gel) from a container brought from room to room for procedures/line placements?
This tick-borne organism causing encephalitis 8-34 days after exposure in Minnesota, Wisconsin, and New York has a mortality rate of 10% with a high incidence of residual neurologic dysfunction in surviving patients.
What is Powassan virus?
While some integrase inhibitors can be taken with rifampin if the integrase inhibitor dose is doubled, this integrase inhibitor cannot be taken with rifampin.
What is bictegravir?
It is not recommended to treat patients with antibiotics for diarrhea due to this organism (the 3rd most common cause of death from diarrheal illness in the U.S.) unless they have a major risk factor for systemic spread (age <3 months, age >65 years, immunosuppression including HIV, sickle cell anemia, irritable bowel diseases), as bacteremia may be seen in as many as 50% of people in these high risk groups.
What is (non-typhoid) Salmonella?
This virus associated with bats (major reservoir) and pigs (intermediate reservoir) in Singapore, Malaysia, India, and Bangladesh can cause fever, headache, myalgias, sore throat, and productive cough with abundant respiratory secretions about 1 week after exposure. It spreads human-to-human through respiratory secretions and infection with this virus is often lethal (~70%).
What is Nipah virus?
Babesia species in a 26 y.o. sickle cell patient during a Chicago winter.
What is blood transfusion?
This mosquito-borne organism typically only causes neuro-invasive disease in immunocompetent people over age 50 or severely immunocompromised individuals.
What is West Nile virus?
This single pill 2-drug combination regimen is not recommended as an initial ART regimen but can be started as a complete regimen for HIV-1 for those who have been virally suppressed on a stable ART regimen at least 6 months without any history of treatment failure or known resistance mutations.
What is dolutegravir + rilpivirine
Brucella melitensis osteomyelitis with abscess formation in a 36 y.o. traveller.
What are unpasteurized dairy products?
This virus present on many CSF PCR panels (with >95% sensitivity) almost never is the etiology of encephalitis in immunocompetent patients and has a high rate of detection in healthy adults. It has only very rarely been documented to cause encephalitis in immunocompromised patients (mostly s/p hematologic stem cell transplant).
What is human herpes virus 6 (HHV6)?
Eikenella endocarditis, in a 47 y.o. IV drug user.
What is licking needles?