RE: Interesting cases in an interesting week

February 27, 2010

I'm curious as to whether you confirmed your diagnosis with serological testing, and whether you intend to treat for 1.5 months or so.And if the diagnosis is confirmed, whether you wish to write the case up. I did a quick literature scan and couldn't find any reports of Bartonella infection being transferred from non sterile surgical instruments.

Guys,

As a head’s up, I saw a case of mumps this week in a

46 yo female. I have read that there is an outbreak in the NY/NJ area, but this

is the first I have seen here. She grew up as one of 10 kids and apparently her

mom told her she had mumps when she was a kid (so she might not have gotten the

immunization). Apparently her mom told her “You know, the first 5 got it

the first week and the second five got it the second week.” She has done

fine, but you may want to be on the lookout for swelling parotids.

The second case is just really weird. I had a healthy male

in his 50s present about 10 days ago with a swollen lymph node in his groin.

After evaluation of the leg, I noticed an oozing toenail with some scalded skin

around it. I put him on Augmentin. In the next 48 hours, his fever spiked, more

nodes got swollen and he started having terrible night sweats. I did a cbc and

his WBC was 23 with a left shift. Blood culture was negative. Hmmm. I felt it

had to be infectious and had to do with his toe, so I asked more about it.

Apparently he stubbed the toe pretty badly a few weeks ago and the nail became

separated from the nail bed. He noticed when he walked around the nail was

catching on stuff, so he clipped the nail as close as he could to the nail bed.

Well, upon further questioning, his wife uses the same nail clippers to cut the

CAT’s claws. OOPS. I switched him to zithromax to cover for cat-scratch (the

augmentin should have taken care of a Pasturella infection) and told him to buy

his own nail clippers. Within 48 hours he was feeling much better. You gotta

love primary care.

-- Graham Chiuhttp://www.compkarori.co.nz:8090/Synapse - the use from anywhere EMR.

February 27, 2010

No, I did not confirm the cat scratch with the serological testing

as it was clinically consistent and the patient improved within 36 hours of

taking the zithromax. According to Uptodate, as long as the fever seems to be

resolving and the patient is doing better, a z-pack is all that is necessary.

In fact, most resolve without any treatment. No, I’m not interested in

writing it up though it might be interesting to swab the nail clippers for the

Bartonella. J

P.S. I did do serologic confirmation of the suspected mumps case

as that has to be reported to the health department. Because that test takes a

few days, I sent her to the lab with a surgical mask and kept her out of work

for 5 days after she started to get the parotid swelling.

From:

[mailto: ] On Behalf Of Graham Chiu

Sent: Saturday, February 27, 2010 3:29 PM

To:

Subject: Re: Interesting cases in an interesting

week

I'm curious as to whether you confirmed your diagnosis with

serological testing, and whether you intend to treat for 1.5 months or so.

And if the diagnosis is

confirmed, whether you wish to write the case up. I did a quick

literature scan and couldn't find any reports of Bartonella infection being

transferred from non sterile surgical instruments.

On Sun, Feb 28, 2010 at 5:42 AM, Dr. Brady

wrote:

Guys,

As

a head’s up, I saw a case of mumps this week in a 46 yo female. I have

read that there is an outbreak in the NY/NJ area, but this is the first I have

seen here. She grew up as one of 10 kids and apparently her mom told her she

had mumps when she was a kid (so she might not have gotten the immunization).

Apparently her mom told her “You know, the first 5 got it the first week

and the second five got it the second week.” She has done fine, but you

may want to be on the lookout for swelling parotids.

The

second case is just really weird. I had a healthy male in his 50s present about

10 days ago with a swollen lymph node in his groin. After evaluation of the

leg, I noticed an oozing toenail with some scalded skin around it. I put him on

Augmentin. In the next 48 hours, his fever spiked, more nodes got swollen and

he started having terrible night sweats. I did a cbc and his WBC was 23 with a

left shift. Blood culture was negative. Hmmm. I felt it had to be infectious

and had to do with his toe, so I asked more about it. Apparently he stubbed the

toe pretty badly a few weeks ago and the nail became separated from the nail

bed. He noticed when he walked around the nail was catching on stuff, so he

clipped the nail as close as he could to the nail bed. Well, upon further

questioning, his wife uses the same nail clippers to cut the CAT’s claws.

OOPS. I switched him to zithromax to cover for cat-scratch (the augmentin

should have taken care of a Pasturella infection) and told him to buy his own

nail clippers. Within 48 hours he was feeling much better. You gotta love

primary care.

--

Graham Chiu

http://www.compkarori.co.nz:8090/

Synapse - the use from anywhere EMR.

February 27, 2010

we had lots of parotitis last yr inMAineI had to quarantine a few people for 9 days and the college was on precatutions and they called it a mumps outbreak , I never heard the conclusive end of it, however, last time I talked to the state noone was findng mumps Just parotitis The state was puzzled I never and the state said they didn;t either, ever find the virus in any of the specimens