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September 7, 2016

PJ Party

The patient is admitted with a three week history of fatigue and shortness of breath on exertion.

CXR shows bilateral infiltrates.

She has a long history of HIV but for a variety of socail reasons has not been on ART and the CD4’s are now less than 50.

PJP and CAP therapy are started and she gets a bronch: all negative including the PJP DFA.

So the antibiotics are simplified to CAP therapy (cetriaxone and doxycycline) and the patient worsens, so they call me.

Of course they want to "broaden coverage" to vancomycin and zosin.  Why?  Because that is what is done, despite an extensive work-up that fails to find a process or a culture that would be amenable to vancomycin or zosin.  The response is always broaden coverage. Not make...

Posted By: Mark Crislip  

August 31, 2016

Pokemon Go

I am getting old (I will turn 60 this spring) and with age comes refractory grumpiness.

I have been doing ID about 31 years if you include fellowship and here is how I see others doing ID.

They do a history, a physical, labs, x-rays and cultures. Then they ignore all of it and treat every organism that pops into their mind, regardless of probability, cultures, or disconfirming s...

Posted By: Mark Crislip  

August 29, 2016

Phone calls can be the coolest cases.

ID weekend call covers a lot of territory. Six hospitals in 2 states. I couldn’t do it without the support of a bunch of tremendous hospitalists and the ability to review the chart on EPIC. I do not offer procedures but answers to odd questions and on the weekend those questions can be fielded without seeing the patients, temporizing until the Monday.

Saturday I get a phone call. ...

Posted By: Mark Crislip  

August 24, 2016


My practice is almost entirely hospital based. At one time I was the only ID doc at 4 widely separated hospitals and so was never able or interested in building an outpatient clinic.

And hospitals get slow, at least for infections, in August. I had one August, back with the last recession, where I had one consult for the entire month.

Partly, I suppose, due to doctors and patien...

Posted By: Mark Crislip  

August 22, 2016

Rare x Rare = Bad

Back from a humid, sweating vacation, first in Boston, then Minnesota, visiting family.

Corn sweat. In rural Minnesota, out in the infinite fields of corn, you can feel the result. Perspiration just does not evaporate.

It i...

Posted By: Mark Crislip  

August 10, 2016


The patient, a young male, had 10 days of non-focal fevers except for a persistent headache that was right behind the eyes.

Four weeks prior to the onset of illness he had been in Central America where he had minimal infectious disease exposures. Two weeks before he had been in Maui, again with minimal ID exposure.

Exam was negative, he looked tired but not toxic, and labs showe...

Posted By: Mark Crislip  

August 9, 2016

Why so serous?

The patient has had HIV for 25 years, mostly well controlled.

She has been ill for a month or so with a febrile illness and has had an extensive work up.

There has been a pericardial effusion/thickening that was tapped: no infection, no malignancy.

Bone marrow biopsy was negative. No infection, no malignancy.

FNA (that just sounds rude as it is pronounced effin A...

Posted By: Mark Crislip  

August 3, 2016

ID Go: Gotta Kill Them All

I wish when I had started out in medicine all those years ago I had kept a record of all the outliers I have seen. Lowest sodium, highest WBC, etc. I have seen a lot of amazing pathology over the years, but just try and remember it. I have easily consulted on 15,000 patients and ten times that number of curbsides and phone calls.  But I no longer remember the cases from last week, much les...

Posted By: Mark Crislip  

August 1, 2016

Not Really Tropical

The patient presents with SIRS with no particular focus. Some chronic stasis changes in the lower extremities from CHF is about it.

He is hypotensive, has a WBC of 33 and altered mental status, so he gets the usual ICU care in addition to ceftazidime and vancomycin.  We have no cefepime.  We have run out.  So ceftazadime instead.  

It seems anymore we are bei...

Posted By: Mark Crislip  

July 27, 2016

Canadian Illegal Aliens

The patient is a healthy middle aged male who has a month of cough, fevers, chills and weight loss.

CXR show a bilateral lower lobe pneumonia and he receives a variety oral antibiotics with no improvement. He is non-toxic and the cough is non-productive.

A chest CT is done and shows dense, confluent round infiltrates. Work up shows a serum cryptococcal antigen of > 1: a very ...

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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