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February 24, 2012

Wrong. Big Time.

I was wrong. Big Time.

Remember the case of fever I declared not due to infection?  I thought the fever was due to the myocardial infarction? Boy was I wrong.

His preop fever work up was entirely negative, as was the history and physical, for infection, so he was off to the OR for a repair of his aortic valve and in the OR?  A 2 x 3 cm mass was found in/on the aortic valve.  Size of a strawberry the surgeon said. Looks like endocarditis. Where is was on the preop ECHO is a mystery.

Gram stain had only 1-2 WBC and no organisms. I start antibiotics, since if there is an infection I do not want to delay therapy.   I wait for the pathology and the patient to wake up enough to give a history, and ...

Posted By: Mark Crislip  

February 22, 2012

Vermin Bumps

As I have mentioned before, I am an Occam kind of guy.  But sometimes you have to follow Hickam's dictum when you can't tie everything together in one nice package.

The patient has long standing RA, on methotrexate and Rimicade.  That's Medicaid for Blackberry users, and boy are they going to need it. Yes, I know it is Remicade, but the obscure pun doesn't work otherwise.


Posted By: Mark Crislip  

February 16, 2012

The Oldest Diagnostic Uncertainty

The patient is here to see me for a positive QuantiFERON gold, and needs some immunosuppression.  I see these every now and then.

The underlying disease is curious.  She is an older white female (hence the pronoun) who has had an extensive work up in three hospital systems  over a decade (Kaiser, University and now mine) with the final thought that she has sarcoid. &...

Posted By: Mark Crislip  

February 14, 2012

Doing the Impossible

Sometimes I am asked to do the impossible. Go faster than light?  Nope.  Divide by zero? Hardly.  Have equitable universal health care?  Ho ho ho.

It is impossible to prove a negative, or so I have been told.  You can’t prove there is no Tooth Fairy or effects from homeopathy, just that the preponderance of evidence suggests neither exists in reality ...

Posted By: Mark Crislip  

February 12, 2012


I usually like to write about the cases I have recently seen, but last week I was dead in the water.  Not a single consult at any of my three hospitals.  I have had slow weeks before, but usually in August, not mid-winter.  It is probably a combination of a slow influenza season combined with my hospitals having almost completely eradicated hospital acquired infections. And with ...

Posted By: Mark Crislip  

February 6, 2012

Water You Talking About

“Son, stocks may rise and fall, utilities and transportation systems may collapse. People are no damn good, but the cultures will always tell the truth.”  Lex Luthor. Sort of.

I had this patient who kept having fevers and positive blood cultures.  She was in the hospital for acute onset fevers, delirium and hypotension. &nb...

Posted By: Mark Crislip  

February 4, 2012


Positive blood cultures come in three flavors.

1) Pathologic.  It is real and a manifestation of the disease

2) Contaminant.  Usually a coagulase negative staphylococcus  or diphtheroid.  Can be safely ignored. Most of the time.

3) In between.  Sometime the blood cultures is real, as the bug is in the blood, but not pathologic. Bacteremia is...

Posted By: Mark Crislip  

February 2, 2012


I had shingles young.  V1 distribution as an ID fellow, it involved my eye and is the reason I no longer wear contacts.  I still remember see the ophthalmologist and his mentioning that he understood that shingles was somehow related to chickenpox.  I was not comforted.

If you live long enough, you will get shingles, and you should hopefully get it only once in a lifetime...

Posted By: Mark Crislip  

January 31, 2012

Sinking Feeling

I get a call from the ER.  Do you remember patient Hungadunga? 

Not off hand. I barely remember yesterday anymore

Liver failure.  You treated him for 4 weeks for endocarditis?  Stopped the antibiotics about a week ago?

Oh yeah.  Hungadunga.  S. mitis in the blood in multiple blood cultures.  I remember.

He is back...

Posted By: Mark Crislip  

January 29, 2012

Grumpy Old Man On Call

Weekends can be busy, especially Saturday, when I have to get to know my colleagues' patients.  I share call with two other ID docs, and weekends mean responsibility for 7 hospitals in a wide geographic range.  It can be done thanks to hospitalists, residents and EMR s.  One good thing about EMR s is I no longer have to be on site to review labs and studies.  But I have a lo...

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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