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February 24, 2011

Follow the bug.

I always follow the bug.  Infections have patterns.  Given a name for a bacteria, you can often predict both where it came from and where it is likely to go.  It doesn't matter how unusual the infection might be, the bugs do not lie.

The patient had a cryoablation of a renal tumor.  They stick a probe through the back into the tumor and then crank down the temperature, turning the tumor into a snowball of dead adenocarcinoma. 

48 hours later the patient spikes a fever and grows a gram negative rod in the blood, and it turns out to be a B. fragilis.

Hmmm.  The treating physicians thought it was a complication of the ablation, a urosepsis, and treated the patient with antibiotics.  The patient improved, then dev...

Posted By: Mark Crislip  

February 22, 2011

See it while you still can

I am an adult ID doc, more who I take care of than how I act.  As such there are diseases I do not see.  Otitis media, strep throat and acne are not issues that are a source of inpateint hospital consultation.

RSV is moslty a disease of children, or so I  thought.  A bone marrow patient is admitted with mild shortness of breath and cough of 5 days duration. &nbs...

Posted By: Mark Crislip  

February 20, 2011

Don't ask, but you will receive anyway

I am not prone to superstition and woo.  I do not believe in ghosts or psychic abilities or homeopathy.  I am from the reality-based community , knock on wood.  But I wonder sometimes.  Perhaps the Secret is true, kinda of sorta.

Of cour...

Posted By: Mark Crislip  

February 16, 2011

All that glows is not cancer

Besides taking care of patients with acute infectious diseases, I have Chaired the Infection Control programs at my hospitals for over 20 years.  So I get the occasional calls about what to do when potential communicable diseases get admitted.

I get a call about a patient who had a growing lung nodule on CT, found incidentally.  Second hand smoke was her only risk factor,...

Posted By: Mark Crislip  

February 14, 2011

Creep. Hip Hop or Alt?

"So I creep yeah
Just keep it on the down low
Said nobody is supposed to know
So I creep yeah
'Cause he doesn't know
What I do and no attention
Goes to show oh so I creep."


The patient has S. pneumoniae meningitis and bacteremia.  Nothing too peculiar about the presentation and treatment.

The patient does ha...

Posted By: Mark Crislip  

February 13, 2011

More than the usual shingles?

The patient is an elderly (late 80's)male with little in the way of past medical history.

He gets shingles across three dermatomes: T1, T2 and T3.  Better than a T-101 or T-800, but unpleasant none-the-less. He did remember having chickenpox 70 years ago.  I remember my case and we have super 8 film of me running around with the pox. So cute.

There is nothing odd about...

Posted By: Mark Crislip  

February 9, 2011


Everyone has their biases.  I  have mine.  One is that I am a beta-lactam fan boy.  If I can, I give a beta-lactam, and if I can, its a penicillin or a cephalosporin, especially the first generations.  I grew up before them there high flautin quinolones and beta lactamase inhibitors.  I was a resident when moxilactam, the first third generation cephalosporin, was r...

Posted By: Mark Crislip  

February 7, 2011

Facial Cellulitis?

49 yo male with recurrent facial cellulitis
He has had six outbreaks in the last 4 years,  each on the right cheek.
It originally stated after a splash while cleaning a public restroom, which was aggressively cleaned.  The splash that is. It starts with tingling, then it becomes red, hot and swollen.

Multiple courses of both iv and po antibiotics have been tried a...

Posted By: Mark Crislip  

February 3, 2011


Work is actually lacking in fascinomas.  The cases have been quickies, no great diagnostic or therapeutic decisions.  But there are curiosities none-the-less.

Patient has a cath for coronary artery disease, which is the usual reason I suppose.  Stents were placed. I don't keep up on the indications for a cardiac cath.  When I took care of these patients a quarter ...

Posted By: Mark Crislip  

February 1, 2011


I was rounding at one of my many hospitals and overheard a conversation between a hospitalist and a specialist.  The specialist was adament that she could not and would not do a  cubside, but would only offer general informtion about the condition, not specific answers  to the question at hand. Specific information would require a consult.

It turns out that a member of...

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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