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December 10, 2014

Three Dog Night

Did you miss me? I just spent the last week in the NE, wandering around Boston and Newport. Great time, although I will note that downtown Boston has the highest percentage of old, thin, well dressed patricians with most sour looks on their faces of any city I have ever visited. Dudes: you are rich and live in Boston. Revel in it.

Oh well. Back to Portlandia.

My problem since returning is the number one. I have the understanding that one is the loneliest number that you'll ever do. It has also been the most common MIC in my gram positives since returning.

Gram negative rods tend to become resistant to antibiotics in a binary way. They acquire a new chunk of DNA and the next thing you know, resistance.

Gram positives can be sneakier. The slow accumulation ...

Posted By: Mark Crislip  

December 1, 2014

How did THAT get THERE?

The patient is a young female who had S. aureus tricuspid valve endocarditis a year ago secondary to IV drug use. She did well from an ID perspective but not from an addiction perspective and she continued to use until three weeks before admission.

While in rehab she developed the same symptoms as before: fevers and chills and some moderate pleuritic chest pain and so to the ER...

Posted By: Mark Crislip  

November 26, 2014

Pre-Thanksgiving Irritation

I have been ill all week. Some sort of viral grunge that is not bad enough to warrant staying home but bad enough to make functioning unpleasant.  Damn but the steps have gotten steeper. Fortunately work is slow and with a bit of self isolation I kept away from most patients. It wasn’t ebola level PPE (I keep calling it PPI at meetings) but more than enough to keep patients safe from...

Posted By: Mark Crislip  

November 24, 2014

Last Ditch Effort

The patient has a history of kidney stones and recurrent urinary tract infections

Somewhere along the line C. glabrata got into his collecting system and he gets recurrent signs and symptoms of pyelonephritis: fevers, flank pain, vomiting, pyuria and cultures that only grow C. glabrata.

There have been numerous attempts to remove the stones, but they recur/are ...

Posted By: Mark Crislip  

November 21, 2014

A Case From One of the Country's Best

I sometimes wish I could tell my referring docs, hey you ordered the test, you decide what it means.  But it doesn’t work that way. The most common is EBV serologies on people with no syndrome consistent with EBV and I get to be the final arbitrator as to the significance of a diagnostic test.

It became easier to weigh in on these cases this wee...

Posted By: Mark Crislip  

November 19, 2014

Consider The Heel

Any bug can cause disease in any part of the body. It is a soil within which many a curriculum vitae has grown.

Still, you tend to play the odds and do not fret over much about rare infections in day to day medical care. Common things being common and all that.

I have mentioned in the past how much it annoys me that most case reports of unusual infections so often concl...

Posted By: Mark Crislip  

November 17, 2014

Words Fail

A picture may be worth a thousand words, but no amount of words will ever adequate describe a picture, especially if it is from the Radiology department.

I was asked to see a patient with a complex abdominal history: cancer, radiation, fistula, gallbladder removal, shunts, stents, hysterectomy, pancreatitis, and colectomy all in the last year.

After the most recent surgery (chol...

Posted By: Mark Crislip  

November 14, 2014

Clinical Call

I am often called upon to weigh in on complex cases with no clear answer.

A typical case is an ICU patient with MOSF, intermittent fevers, a leukocytosis all for no good reason. The what and why of admission is rarely relevant as they are now deep into their hospital stay. All the cultures are negative except for a scant Candida here or a low amount of normal flora there.  All the ...

Posted By: Mark Crislip  

November 10, 2014


The patient went to bed feeling fine. When she awoke in the morning she could not move her right arm. She waited a day to see if it would improve (no insurance). It did not, so off to the ER.

She has no past medical history or exposures of note. She was not intoxicated and did not sleep in a 'funny' position.

Exam shows no sensory problems and she can ever so barely move her ind...

Posted By: Mark Crislip  

November 5, 2014


I sometimes think being a specialist means being ignorant with style. All too often I am asked to weigh in on a case about which I know nothing and, after a review of the literature, I am none the wiser. So I reason as best I can with the information I have and provide an answer. Not the right answer perhaps, but an answer.

A case in point.

Patient is a middle aged male with asc...

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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