Consultations in Infectious Disease: A Case Based Approach to Diagnosis and Management

389 Pages·2012·7.85 MB·English

by  Daniel Caplivski

Consultations in
Infectious Disease
A Case Based Approach to
Diagnosis and Management
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Consultations in
Infectious Disease
A Case Based Approach to
Diagnosis and Management
Daniel Caplivski, MD
Associate Professor of Medicine
Division of Infectious Diseases
Director, Travel Medicine Program
Mount Sinai School of Medicine
New York, NY
W. Michael Scheld, MD
Bayer-Gerald L Mandell Professor of Infectious Diseases
Professor of Medicine
Clinical Professor of Neurosurgery
Director, Pfi zer Initiative in International Health
University of Virginia Health System
Charlottesville, VA
1
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Library of Congress Cataloging-in-Publication Data
Caplivski, Daniel.
Consultations in infectious disease : a case based approach to diagnosis and management
/ Daniel Caplivski, W. Michael Scheld.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-0-19-973500-6 (pbk. : alk. paper)
1. Communicable diseases—Diagnosis—Case studies. 2. Central nervous system—
Infections—Diagnosis—Case studies. I. Scheld, W. Michael. II. Title.
[DNLM: 1. Communicable Diseases—diagnosis—Case Reports. 2. Communicable
Diseases—therapy—Case Reports. 3. Central Nervous System Infections—diagnosis—
Case Reports. 4. Central Nervous System Infections—therapy—Case Reports. WC 100]
RC113.3.C37 2011
616.07'5—dc22 2011012555
9 8 7 6 5 4 3 2 1
Printed in China
on acid-free paper
Dedication
v
Joshua Gibson was a beloved member of the Mount Sinai family. He studied
at Bowdoin College and the Yale School of Medicine before completing his
internship and residency at Mount Sinai Hospital. Together with other resi-
dents, he started the Advancing Idealism in Medicine program so that future
generations of residents would reconnect with the humanistic goals that had
fi rst brought them to the fi eld of medicine. He went on to care for patients in
Mount Sinai’s World Trade Center Program before starting his fellowship in
infectious diseases. Those who knew Josh are quick to smile as they remember
his love for the Boston Celtics and Red Sox, his eclectic music collection
(including many Pavement albums and Lee Scratch Perry’s “Dub Chill Out”),
and his endless spirit of adventure. He traveled all over India, worked in refugee
camps in Africa, and researched the epidemiology of AIDS in China. He was a
great basketball player, and used to commute by running from Mount Sinai to
his home in Brooklyn—a mere 10 miles away. Most of all, we remember him as
a dear friend, husband, son, and brother. We hope that throughout your career
you will return to these pages and be inspired by what a great person he was.
PForerfeawceord
During the writing of this book, we have experienced an operatic range of
emotions as we have relived many of our most interesting infectious disease
consultations. There was the tension of an unresolved set of symptoms, the
joy of a diagnosis confi rmed, and sometimes the shock of an unexpected
assailant. There were dramatic moments at the microscope when a key image
on the glass slide would lift the veil from our eyes and fi nally link all of the
clues together. There were also moments of great sadness, as we recalled
overwhelming infections that claimed the lives of our patients. Names like
Rhizopus and Nocardia stir a visceral reaction when we hear them because
of the devastation that they can cause in an immunocompromised host. In
the many images in this book, we hope to transfer that visceral memory to
physicians and students and to offer a fi eld guide to the limitless territory of
infectious diseases consultations.
Books of this nature are collaborations of a musical sort. We have felt like
vi conductors working with a world-class ensemble of musicians, and the end
result is a refl ection of their hard work and dedication to this project. We
thank all of our contributors for their evocative storytelling and for the illu-
minating discussions they have written. Teaching infectious diseases fellows,
residents, and students is one of the great privileges of a career in academic
medicine, and this book is a written expression of how much we love that
process. We are very grateful to our colleagues at Oxford University Press
for the opportunity to share this work with a wider audience, and to all of our
families and friends who tolerated our reclusiveness as we completed this pro-
ject. Finally, we thank our patients for sharing their stories with us, for helping
us to understand the importance of simple blessings, and for inspiring us to
never stop learning.
Contents
Contributors xv
1. Meningitis 1
Case 1a: A College Student with Altered Mental Status:
Neisseria meningitidis Meninigitis 1
Amy Mathers and W. Michael Scheld
Case 1b: Television Intolerance: Streptococcus
pneumoniae Meningitis 4
Jennifer Jao and Daniel Caplivski
Case 1c: Gait Instability and Slurred Speech in an
Immunosuppressed Patient: Cryptococcus neoformans
Meningitis 8
Sean Pawlowski and W. Michael Scheld vii
Case 1d: A 38-year-old Woman from Thailand with
Pulmonary Infi ltrates and Meningitis: Mycobacterium
tuberculosis Meningitis 13
Najah Doka and W. Michael Scheld
Case 1e: Fever and Confusion after Neurosurgery: Klebsiella
pneumoniae Meningitis 18
Rachel Chasan
2. Encephalitis and Myelopathy 23
Case 2a: Recurrent Meningitis: Herpes simplex virus
Meningoencephalitis 23
Sean Pawlowski and W. Michael Scheld
Case 2b: Confusion and Fever in an Elderly Woman:
Varicella zoster virus Encephalitis 25
Mahesh Swaminathan
Case 2c: A 41-year-old Woodcutter with Progressively
Worsening Mental Status: Acanthamoebã Encephalitis 32
Florence Nana, W. Michael Scheld, and Joshua Dowell
Case 2d: A Renal Transplant Recipient with Weakness
and Gait Instability: Human T-lymphotropic virus-1
Myelopathy 36
Michael Lief and Shirish Huprikar
TSTS 3. Focal Central Nervous System Infections 43
NN
TETE Case 3a: Ataxia, Dizziness, and Altered Mental Status in a
NN
OO Patient Previously Treated for Pneumonia: Streptococcus
CC
intermedius Brain Abscess 43
Sean Pawlowski and W. Michael Scheld
Case 3b: A 55-Year-Old Man with Back Pain: Staphylococcus
aureus Epidural Abscess 47
Rupa Rajesh Patel and Daniel Caplivski
Case 3c: A Bone Marrow Transplant Recipient with Back
Pain and Weakness: Nocardia farcinica Epidural Abscess 50
Nicole M. Bouvier and Daniel Caplivski
Case 3d: A Construction Worker with Headache and
Visual Loss: Neurocysticercosis 54
Luciano Kapelusznik and Daniel Caplivski
Case 3e: A 42-Year-Old Man with Progressive Cognitive
Decline: Progressive Multifocal Leukoencephalopathy 60
Rupa Rajesh Patel and Daniel Caplivski
viii 4. Ophthalmologic Infections 67
Case 4a: A 23-Year-Old Contact Lens Wearer with Eye
Pain and Decreased Vision: Pseudomonas Keratitis 67
Nancy Sun and Chad Zatezalo
Case 4b: A 46-Year-Old Man with a Painful Red Eye and a
Rash: Treponema pallidum Uveitis 70
Chad Zatezalo and Ronni Lieberman
Case 4c: Cytomegalovirus Retinitis in a Patient with AIDS:
Cytomegalovirus Retinitis 76
Chad Zatezalo and Ronni Lieberman
Case 4d: A 17-Year-Old Female with Peripheral Vision
Loss: Streptococcus bovis Endophthalmitis 84
Rupa Rajesh Patel, Katherine Zamecki, Michael Mullen,
and Shirish Huprikar
Case 4e: Fever, Chills, and Unilateral Vision Loss in a
73-Year-Old Man: Streptococcus bovis Endophthalmitis 90
Daniel Caplivski, Chad Zatezalo, and Robert S. Klein
Case 4f: Decreased Vision and a Painful, Red Eye in
a Patient with Acute Myelogenous Leukemia (AML)
and Prolonged Neutropenia: Aspergillus fumigatus
Endophthalmitis 94
Lindsey Reese, Chad Zatezalo, Stephen Mercer, Robert Phelps, and
Shirish Huprikar
Case 4g: Blurry Vision in a Patient with AIDS: Immune SS
TT
NN
Reconstitution Uveitis 99 EE
TT
NN
Ronni Lieberman OO
CC
5. Oropharyngeal and Sinus Infections 107
Case 5a: A 43-Year-Old Man with Neck Swelling and
Stridor: Meenakshi Mehrotra Rana 107
Meenakshi Mehrotra Rana
Case 5b: Sore Throat and Neck Swelling in a 48-Year-Old
Man with AIDS :Streptococcus pyogenes 111
Daniel Caplivski
Case 5c: Sore Throat and Shortness of Breath followed
by Septic Shock in a Healthy 18-Year-Old Polo Player:
Lemierre’s Syndrome 116
Joshua C. Eby and W. Michael Scheld
Case 5d: A Renal Transplant Recipient with Facial Pain and
Swelling: Mucormycosis 120
Daniel Caplivski and Shirish Huprikar
6. Pulmonary Infections in Immunocompetent Hosts 127 ix
Case 6a: A 27-Year-Old Woman with a Fever, Cough, and
Pleuritic Chest Pain: Streptococcus pneumoniae 127
Jennifer Jao and Daniel Caplivski
Case 6b: A 31-Year-Old Man with Skin Lesions Following a
Respiratory Illness: Mycoplasma pneumoniae 132
Mahesh Swaminathan
Case 6c: Persistent Cough in a Woman from Mexico:
Mycobacterium tuberculosis 137
Mahesh Swaminathan
Case 6d: Respiratory Distress in 2009: H1N1 Infl uenza 147
Irini Scordi-Bello and David P. Calfee
Case 6e: Three Men with Severe Pneumonia after Entering
a Mine: Histoplasma capsulatum 153
Daniel Caplivski
7. Pulmonary Infections in Immunocompromised Hosts 161
Case 7a: A 73-Year-Old Man with Nosocomial Pneumonia:
Pseudomonas aeruginosa 161
Keith Sigel, Irini Scordi-Bello, Gopi Patel, and Daniel Caplivski
Case 7b: A 72-Year-Old Woman with Persistent Cough
and Neutropenia: Respiratory Syncytial Virus 167
Daniel Caplivski and Shirish Huprikar