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July 6, 2009

Bad Air

There are diseases that are endlessly interesting because of the variations of the presentation. Endocarditis is one of those diseases.  But endocarditis is an odd disease, in the West a result of IVDA or aging.

Other disease are not so interesting in their presentation but are fascinating due to their impact on culture or history or genetics.
Patient today is freshly returned from a 10 month long trip to sub saharan Africa and presents to the ER with fevers to 104, chills, sweats, cytopenias and 1% of her red cells have Plasmodium falciparum.  Nothing unusual about the case as malaria.  Fairly typical.  I would bet from the timing that she had her mosquito bite the day she left Africa, so she had gone months dodging the malaria bullet until the en...

Posted By: Mark Crislip  

July 3, 2009

I talk the talk, but they don' walk the walk

It is the 4th of July and Portland has shut down, at least as far as infections go.  I am just back from the Zydeco portion of the Blues festival after a slow work day.
So I will make an observation. No references, no pearls, no wisdom.

This week the new house staff started.

Bright eyed, bushy tailed, and scared spitless.
We get good residents.  It is r...

Posted By: Mark Crislip  

July 1, 2009

Why Why Why

Summer time and the living is easy. Except if you have bacteremic pneumococcal pneumonia.  It is a bad disease, and people feel mighty poorly when they have it.

That was todays patient, who had a classic URI, then cough, the rigors and fevers and a marked increase in the cough with chest pain.
Had 'e' to 'a' changes on exam, which is always a fun finding.

The mag...

Posted By: Mark Crislip  

June 30, 2009

Premature Closure

I need a self aggrandizing title.
There is Americans Pediatrician and Americas most Read Pediatrician and there is the conscience of modern medicine.  I am not trademarked and I am neither a world-renowned leader nor a pioneer.  No one calls me Dr. Mark (well one ICU nurse does). And I don't wear scrubs outside the hospital.  I suspect I need to work on my image if  I w...

Posted By: Mark Crislip  

June 29, 2009

Look. Up in the sky. It's a bird. It's a plane. It's

IDman.  pronounded eye-dee, not id, like the Freudian dealybob.

Like Superman, I have powers. Special powers. Not like special education.

I am the only doctor who can stop an antibiotic.
I am the only doctor who can ignore cultures.

Today, I got to do both.  While I was gone this weekend one of my patients had a bronchoscopy and the cultures grew <em...

Posted By: Mark Crislip  

June 25, 2009

I am fat to avoid Tb.

A cool thing (I do use the word cool a lot, phat is a synonym in the dictionary, but I doubt I could use that without looking like an even bigger dork than I am) about ID is that the effect of germs in humans goes well beyond the acute infections.

Humans and germs have evolved together for millions of years, the the bugs have left their footprints in out genome.

It is esti...

Posted By: Mark Crislip  

June 24, 2009

Word History

Most of my great diagnoses exist only in my head.   Not that it is bad, as my internal reality is far superior to the external one.

For many patients I see, I try, for fun, to come up with three lists.
One is the list of diseases the patient probably has, common things, oddly, being common.

Another is the list of things the patient cannot afford to have mis...

Posted By: Mark Crislip  

June 23, 2009

Changing a tire

When I started practice late last century I wore the standard white coat.  After awhile, for reasons I no longer remember, but are probably related to my wife's continued attempts to give me some style (if they ever have a male on What not to Wear, that would be me), I changed to the sport coat and tie look.

Years passed and the sport coats are looking a little ratty.  They...

Posted By: Mark Crislip  

June 22, 2009

Bacterial artha-ritis

The alphabet soup of streptococci. A and B and C and D and E and F and G.
Gee.  Dr Lansfield was a wonderful microbiologist, but all these letters do not help  me to remember which is which. Bacteria need names.

Group G strep is beta hemolytic, like the strep of strep throat and is found in the nasopharynx, skin, gu,  and gi tract of normal people.  It occas...

Posted By: Mark Crislip  

June 20, 2009

Boutonneuse hibou

I was pooped yesterday.  The prior weekend I was on call, so I worked 12 days in a row. As I age, well, wines age and get better, I am more ripening (over ripe?) than aging, I fade at the end of the second week.

Two consults at the end of the day.  The first was a cellulitis, and the second was billed as a fever.  The resident wanted to know why the fever.


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.

While usually written in the present tense, the cases are not necessarily current and all identifying information is altered or obscured as long as it is not absolutely pertinent to the case. Can't have a female with prostate infection for example.

I write these at night or in spare moments. There is always someone who will quibble about spelling, punctuation or grammar. 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.

The first 2 years blog posts have been collected and edited and are available as The Puswhisperer, Volumes 1 and 2. Really. Perfect for the pus lover in your life.
Because The World Needs More Mark Crislip (tm).
Flies in the Ointment: Essays on Supplements, Complementary and Alternative Medicine (SCAM).
A carefully selected and edited compendium of my best blog posts from The sections have been edited for redundancy, updated for 2017, and classified into themes including my influenza rants.

All on Amazon.

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. Links to his multimedia empire of blogs, podcasts, books, apps and tweets can be found at

    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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