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January 31, 2010

The Real Deal?

Blood cultures drive. me. crazy.

This week I had two patients with positive blood cultures.

The first came in with an acute MI and a ruptured chordae.  At admit he had a fever and all four bottle, drawn at the same time, grew Streptococcus parasanguinis.  Valve was replaced and subsequent cultures, all on antibiotics, are negative. TEE was negative and the mitral valve, at least, was negative for infection in the OR.  The aortic valve was not seen.

The second came in with acute lobar pneumonia and the sputum grew H. influenza, but all the blood cultures grew Staphylococcus hominis, a coagulase negative staph.  Subsequent cultures were negative (on antibiotics) and workup for an endovascular infection is negative...

Posted By: Mark Crislip  

January 28, 2010

Return of the Bad Old Days

It was like the old days, the bad days, the days before HAART.

Patient has not received health care for three years since he lost his job and his insurance and has not been on his HAART.  I do not even pretend to know how to fix the problems with health care, but somehow I do not know why we have people die...

Posted By: Mark Crislip  

January 26, 2010


Posted By: Mark Crislip  

January 23, 2010

Finger Infection?

Last spring the patient smashed the middle finger of his left hand, breaking the bones and requiring a wire to hold it all together.  I do not know about you, but I probably could not drive if I didn’t have ready access to that digit.  

He did well at first, then developed a pin tract infection that required debridement and a course of antibiotics.  Cultures we...

Posted By: Mark Crislip  

January 21, 2010

Little things

I have been doing ID for about 25 years, half a life time and yet I seem to know less and less.  A day does not go by that I do not learn something new, even about diseases I would think I know like the back of my hand.  Hmmm.  Back of hand. Where did the scar some from?  Has that mole always been there? Squirrel......

I'm back. Patient is a middle aged male who...

Posted By: Mark Crislip  

January 19, 2010

Lend me your ears.

The patient is 24 years old student, so an adult. She has Grave's and, since the US ranks  37th in the world for health care, has access to medical care. Not. She has been on her Grave's medications intermittently for cost reasons.

She has the sudden onset of ear pain. No other symptoms and it progresses to the worst pain she has ever had, so she come to the ER.


Posted By: Mark Crislip  

January 17, 2010

My liver quivers.

"My liver quiver my blood pressure high. Yet I don't want no doctor." Reggae Fever by Bob Marley.

Much as I like Mr. Marley, I can't see a liver quivering, at least not from Reggae fever, which is due, I think, to Tb acquired from hotboxing too much ganja. &...

Posted By: Mark Crislip  

January 15, 2010

Itchy Red Bumps

Patient had three months of itchy red bumps.  But you probably guessed that.  I am not a fan of seeing derm patients. I hate making rash decisions.

Thank you thank you, I will be here all week, do not forget to tip your waitress.

These red bumps have been going on for 3 months and she has had multiple treatments for mur-sa to no avail.  They occur on her left arm ...

Posted By: Mark Crislip  

January 12, 2010

All that glitters

Fever.  Almost all my patients have a fever, at least at the beginning.  Sometimes I am asked to figure out why the fever.

Patient is an elderly female who had a steroid injection in her C spine for pain.  Three days after the injection: fevers to 101 sweats, diffuse muscle pain, andprogressive weakness in the arms and legs. Symptoms persist for over a month.

No b...

Posted By: Mark Crislip  

January 9, 2010

Truth, big 'T'

The Greeks had their geometrical theorems to derive truth, at least geometrical truths. Two points define a line. Two parallel lines will never meet unless properly introduced.  There are other systems that have fundamental facts from which all truth and understanding are developed.

All truth, for an infectious disease doc, comes from the cultures. The cultures do not lie, although...

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 on Amazon as The Puswhisperer, Volumes 1 and 2. Really. Perfect for the pus lover in your life.
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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