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July 2, 2014

Better than Expected

The patient has the abrupt onset of fever, rigors, confusion and a rapid decline into unresponsiveness. Not good when in the 8th decade of life.

She is brought into the ER and an LP is consistent with bacterial meningitis, although no organisms are seen on the gram stain. Both sets of blood cultures were growing gram positive cocci in chains.

It was all pointing to a bad outcome:

On admission, 14 percent of patients were comatose and 33 percent had focal neurologic abnormalities. The overall mortality rate was 21 percent. The mortality rate was higher among patients with pneumococcal meningitis than among those with meningococcal meningitis (30 percent vs. 7 percent, P<0.001). The outcome was unfavorable in 34 percent of episodes. Risk fact...

Posted By: Mark Crislip  

June 30, 2014

Go West Young Vector

There are many great things about the Pacific NW. Unrivaled natural beauty (and that is just my wife, you should see the mountains, oceans and high desert), great beer, great food, nice people.

The downside to the Pacific NW is that from an ID perspective, it is kind of dull. We have a touch of relapsing fever in Eastern Oregon, C. gattii invading from Canada and a bit of Br...

Posted By: Mark Crislip  

June 27, 2014

With Great Power

Over the past several years it has become de rigueur to mention in the chart that the recommendations of the consultant are appreciated. Not. The phase has all the sincerity of phone help centers who mention they are sorry about what ever issue you are calling about. No. You are not sorry. You don t really care So stop saying it, wasting time, and lets get my...

Posted By: Mark Crislip  

June 25, 2014

Working with minimal data

Physicians are given wide latitude in deciding on what diagnostic and therapeutic interventions to offer patients.

That can be good and bad. I try and avoid flowery language when I have only the slimmest of data to support a therapy. Treatments in medicine can fade from the proven and true into the grey and then int...

Posted By: Mark Crislip  

June 24, 2014


The patient is an older male on methotrexate amd 5 mg a day prednisone for rheumatoid arthritis. He comes in with fevers and a non-productive cough for several days. CXR shows an upper lobe consolidated infiltrate with some question of hazy nodules.

Usual workup for a community acquired pneumonia is negative: gram stain is WBC and no organisms, blood and sputum cultures are negative ...

Posted By: Mark Crislip  

June 20, 2014

Right. Wrong. Then right, kind of.

I like to call the bug based on history before the lab can identify it by biochemicals. It is fun and impresses others no end.

I get a call to see middle aged male for some sort of strep in the blood.

I tend to me a minimalist for information when I get a call from residents. I want as little bias going in, so I often make them give me a five world question. They can sometime...

Posted By: Mark Crislip  

June 19, 2014

Occam and Fallacies

The patient is a middle aged male with diabetes who is admitted with diabetic ketoacidosis and sepsis.

Exam shows a dead toe, all black, perhaps, it is reported, from trauma.

CT of the abdomen shows what looks to be a splenic infarct although TTE is negative.

And all the blood cultures grow MSSA.

I get the patient on nafcillin for probable endocarditis. It is o...

Posted By: Mark Crislip  

June 16, 2014

Real World, Perfect World

I have to practice medicine in the real world, not always my favorite place since the real world often conspires to prevent perfect care.

It is bad enough to be a homeless uninsured heroin user. Add to that an unwillingness to stick with the plan and reality becomes one crazy Honey Badger.

The patient is a...

Posted By: Mark Crislip  

June 13, 2014

Belize Boil

The patient is a young female who has spend the last 6 months in Belize. Part of her trip involved hikes into the jungle and she remembers numerous bug bites.

Some of them did not heal; they became red bumps that then became small chronic ulcers with surrounding erythema. After several bouts of unsuccessful antibiotics, she sought care at a local hospital and a touch prep showed Le...

Posted By: Mark Crislip  

June 12, 2014

Hit by Lightening Twice. And a Genius Idea

Hit by Lightening Twice

The patient is a young female who has the abrupt onset of fevers, nausea, then vomiting then diarrhea and then moderately severe abdominal pain.

After 24 hours without improvement she was off to the ER. Of note was an elevated WBC, left shift and a CT that showed enteritis and free fluid in the abdomen.

She was cultured and star...

Posted By: Mark Crislip  

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About This Blog

For the Benefit of Mr Kite, there will be ID tonight. Infectious Diseases! Antibiotics! Viruses and Bacteria and Fungi! Oh my! Exclamation marks!!!!!! No trampolines, nor will any band be playing at 10 to 6. And Henry the Horse died of the Strangles. Sorry. That's the problem with infections.

The endless excitement that is the daily practice of Infectious Diseases in a Portland teaching hospital! The need for meta data!

Every day I make infectious disease rounds in the hospital and see at least one cool case or learn something new. 25 years and I still do not know everything. Why be selfish and keep all of that wonder and knowledge to myself? This blog will be a mostly qod account of days events, a cool ID case, a referenced pearl, and a minimum of 1 horrible, yet ultimately feeble, attempt at humor. I write these at night or in spare moments. There is always someone who will quibble about spelling, punctuation or grammer. My response is live with it. It's a blog, not Mandel.

Read and listen to more of me at my multimedia empire linked below.
Because The World Needs More Mark Crislip (tm).

Disclosure: Mark A. Crislip, MD, has disclosed the following relevant financial relationships:
Received income in an amount equal to or greater than $250 from: Pusware LLC
Have a 5% or greater equity interest in: Pusware LLC (owner)

  • Mark Crislip

    Mark Crislip, MD, has been practicing in infectious diseases in Portland, Oregon, since 1990. He is nobody from nowhere, but he has an enormous ego that leads him to think someone might care about what he has to say about infectious diseases. And so he blogs and podcasts and writes on the most endlessly fascinating specialty in all of medicine.

    Mark A. Crislip, MD, has disclosed the following relevant financial relationships: Owner, Pusware LLC. He as not talked to a drug rep in over 25 years and does not even eat the pizza provided at conferences. But he is for sale for the right price. Please. Someone. Buy me.

The content of this blog does not necessarily reflect the viewpoints of Medscape.
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