Rubor, Dolor, Calor, Tumor
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November 21, 2010


I like numbers.  What is the importance of "Formate assay in body fluids: application in methanol poisoning?"  It is the first entry in PubMed. #1.   The millionth? "DNA- and RNA-dependent DNA polymerases: progressive changes in rabbit endometrium during preimplantation stage of pregnancy." The ten millionth?  "Optical properties of excitons under an axial-potential perturbation."  The 666th? Curiously its "Patient Acceptance of an Electronic Subcutaneous Identifier."  Go figure.  Put a random, or semi-random number into PubMed and get a result.  My birthday yields "The role of estradiol in experimental parasitosis caused by Schistosoma mansoni in the female golden hamster Cricetus auratus"  Probably not significant.  

Numbers ar...

Posted By: Mark Crislip  

November 17, 2010

First World Disease, Third World Response.

The patient is middle aged with a new diagnosis of lymphoma for which he gets Rituxan and CHOP. He is admitted with several days of shortness of breath and ends up on a ventilator.  His CXR/CT, besides a ground glass inflitrate, has a variety of changes from long term smoking.  Gets a bronch and the diagnosis is made.

That 'P' in CHOP is the worrisome letter which stands ...

Posted By: Mark Crislip  

November 15, 2010

First Ever.

Everybody step right up and see something that noone ever has seen in the history of the this and all other universes.  

Liver mets are bad and difficult to treat.  One of the therapies is to infarct the tumor.  This can be done with heat or cold or, as in the case of this patient, arterial.

The problem with dead tumor is that it is fertile soil for bacteria ...

Posted By: Mark Crislip  

November 13, 2010


Do events come in three's?  Of course not. Except celebrity deaths.  They always occur in three's.

Had a young make with what started as a pneumonia, for which health care was not sought.  Rather than improve, he worsened, and then had altered mental status.  He was brought to the ER and MRI showed two early brain abscess and a RML infiltrate.

As part of...

Posted By: Mark Crislip  

November 11, 2010

Associations II: The Little Things

One of the many things that makes ID so incredibly cool is the breadth and depth of infections. ID has its tentacles in all aspects of the human condition. Sometimes it is big things, like the changing epidemiology of infections due to global warming. Sometimes it is the little things, like how  the effects on single amino acid variations in the Toll-like receptors can markedly increase or...

Posted By: Mark Crislip  

November 9, 2010


ID is often knowing associations.  I have said that give me any situation, and I can come up with a infectious disease you can acquire as a result.  Of course, the smart ass resident said eating antarctic snow, and I could not even come up with a penguin related infection.  Turns out penguins have 

"Positive antibody titers for Chlamydophila ps...

Posted By: Mark Crislip  

November 7, 2010

Worth a Syndrome?

Six months ago I too care of a patient with pneumococcal meningitis, pneumonia and bacteremia, he received 10 days of antibiotics, and is was mostly a cure.  I say mostly as 4 months later he came to the clinic with failure to thrive.  His get up and go got up and went.  Evaluation revealed a new, loud murmur.  Further evaluation showed new severe mitral insufficiency o...

Posted By: Mark Crislip  

November 5, 2010

Bread and Butter?


Infected joints are bread and butter diseases for an ID doc.  No wait, that's pericarditis.  What food is the infected joint?  Pureed Twinkie? Curdled hollandaise?  I am not certain.  But infected joints are a common problem, usually due to a staph or a strep.  Usually.

Young female with no medical problem comes in with 4 days of progressive ...

Posted By: Mark Crislip  

November 3, 2010

Red Bumps Redux

I have been doing this blog for about 2 years. Every other day, more or less, for about two years and I rarely repeat myself.  Well, at least with the clinical material.  The 'humor' maybe not so much. Almost every case I write about I learn something in the process of looking up details.  Again, maybe not so much as I find as I reread some of the old posts I do not remember...

Posted By: Mark Crislip  

November 1, 2010

Not what I had hoped for.

The patient is a 62 yo male with the worst headache of his life.  I once had a patient who was hit on the head with a German sausage; he had the wurst headache of his life. Thank you, I will be here all week.

It had been present for 5 days when he came to the ER and had a spinal tap.  950 WBC's, normal glucose, protein of 100.  Aseptic meningitis. But from what?


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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