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July 21, 2009

Do the feet smell?

Middle aged man with athaletes feet (its atha-lete, not athlete) who gets a spontaneous foot cellulitis and maybe a touch of abscess.  No risk factors, to trauma, no reason for the infection.

He doesn’t respond to a po beta lactams, and eventually gets betterish on Vancomycin. Cultures grow coagulase negative staphylococcus. Ignore it, right? Riiiiiiggggghhhht.
That’s what I would have said last year, but not this year.

Turns out there is a S. lugdunensis, a coagulase negative staph,  that is not an uncommon cause of lower extremity infections.  On the rare times I have seen lugdunensis, it has been endocarditis or a post op knee infection.  Unfortunately  the lab usually doesn’t look for lugdunensis in...

Posted By: Mark Crislip  

July 20, 2009

Time flies like an arrow, fruit flies like a banana

I was searching on a topic this morning and let out a big sigh.  It occurred to me that the first time I searched on this topic was 27 years ago as  a fourth year medical student when I had to talk on the topic of warfarin and endocarditis. Din’t have no echo back in my day. We had to diagnose endocarditis with history and physical. And he didn’t have those high falutin th...

Posted By: Mark Crislip  

July 18, 2009

Itís a gas.

When I was a kid I saw ‘Gone with the WInd’ on a big screen.  The scene where they had to lop off a gangrenous leg without anesthesia, not even acupuncture, but just a shot of whiskey, was for me one of the most horrific pieces of movie making I had seen.  I think I am scarred for life.

Gas Gangrene is one of those diseases that can kill with remarkable rapid...

Posted By: Mark Crislip  

July 16, 2009

Bad Air Re Re Duex Duex

The quinidine worked perfectly.  With in a day her parasitemia was zero.


When I went off to TAM she was looking great in the ICU, ready for transfer, I thought everything was going perfect.

I got back and the sign out said: On a vent, pressors, ECMO, moved to trauma ICU.

I felt all the blood drain from my face and my heart fall into my shoes.  I th...

Posted By: Mark Crislip  

July 15, 2009

Swimming in Body Fluids

Vacation means swimming. In the lakes. In rivers. In oceans. In pools.  Swim in a pool, you are swimming in the microbial flora of everyone else in the pool.  And chlorine does not kill everything.

The family had returned from a 2 week trip to the tropics where they swan with many a young child in the hotel pool.

First one child gets sick with nausea, vomit...

Posted By: Mark Crislip  

July 15, 2009

Have to ask the right question.

When I was a kid I was told by a friend that you got Salmonella from eating salmon.  Seemed reasonable to me at the time, I did not realize it was named after  Sal Mon, one of the top level pokemon.

The patient I saw yesterday had Salmonella in both her diarrhea and her blood.  Simple enough, but why? Everyone assumed she picked it up on her trip to SE Asia, but tha...

Posted By: Mark Crislip  

July 13, 2009

Old OI's Return

<sarcasm>ID is a depressing field.  They keep figuring out ways to decrease infections.  Best practice bundles have almost wiped out hospital acquired infections at all my institutions.  Colony stimulating factors have made prolonged neutropenia and their resultant infections almost a thing of the past.  Thanks to HAART, HIV related opportunistic infections have become...

Posted By: Mark Crislip  

July 8, 2009

A True Story

Years ago the national ID meetings were in Las Vegas.

An attending of mine was waiting at the bar for a ride when a young lady sidled up to him and asked if he were interested in a 'date'.

He declined the opportunity, to which she replied,"What is it with this meeting?  Business is the slowest it has ever been."

5,000 ID docs in the city.  We know too much. No ...

Posted By: Mark Crislip  

July 7, 2009

Bad Air Redux

I have said before that being an ID doc is like being a birder, and I keep a mental list of the infections I have yet to see.  Unlike identifying birds, seeing a new infection is actually interesting.  Just kidding.  Birds are cool.  I had some  Ivory-billed Woodpecker for dinner this weekend, and hope to have Spotted Owl next month.

Today was a first for ...

Posted By: Mark Crislip  

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 re...

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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