This document provides a summary of Mark Crislip's presentation at the 2015 Society for Healthcare Epidemiology of America conference. It discusses various infections associated with exposure to water sources like holy springs, as well as infections transmitted by animals and pets. Specific cases described include a patient who developed Aeromonas hydrophilia from exposure to contaminated water, an outbreak of Cryptococcus gattii infections associated with bark dust in Canada, and a case of Brucella infection transmitted through imported goat cheese. The document emphasizes knowing where different pathogens are endemic and asking patients detailed questions about exposures to make accurate diagnoses.

1. SMACC 2015
Adventures of a Pus Whisperer
Mark Crislip

2. ID is about associations
✤ Travel
✤ Pets
✤ Diet
✤ Sex
✤ Exposure
✤ Know your bug and where it lives
You get what you are exposed to

3. Bloody Diarrhea
✤ 76 yo female presents with bloody diarrhea. Colonoscopy looks like
ulcerative colitis
✤ Cultures grew Aeromonas hydrophilia

4. What to ask?
✤ Aeromonas is a water organism

5. J Water Health. 2012 Sep;10(3):349-57. doi: 10.2166/wh.2012.005.
Holy springs and holy water: underestimated sources of illness?
Kirschner AK1, Atteneder M, Schmidhuber A, Knetsch S, Farnleitner AH, Sommer R.
Author information
Abstract
Use of holy springs and holy water is inherent in religious activities. Holy spring water is also used extensively for
personal drinking water, although not assessed according to drinking water standards. Holy water in churches
and chapels may cause infections via wetting of lips and sprinkling on persons. Our aim was to assess the
microbiological and chemical water quality of holy springs and holy water in churches and hospital chapels. Of
the holy springs investigated, only 14% met the microbiological and chemical requirements of national drinking
water regulations. Considering results from sanitary inspections of the water catchments, no spring was assessed
as a reliable drinking water source. All holy water samples from churches and hospital chapels showed
extremely high concentrations of HPC; fecal indicators, Pseudomonas aeruginosa and Staphylococcus
aureus occurred only in the most frequently visited churches. We conclude that it is highly necessary to
include holy springs in programs for assessment and management of water quality. Public awareness has to be
raised to perceive holy springs as potential sources of illness. Holy water can be another source of infection,
especially in hospital chapels and frequently visited churches. Recommendations are made for proper water
quality management of both water types.

7. water: people do more than drink it
✤ E coli in toilets
✤ Serratia in San Francisco
✤ Acintobacter in tap water and Iraq
✤ MAI in shower
✤ Legionella in Hot Tub
✤ Pseudomonas Hot Tubs
✤ Mucor in brown water
✤ Leptospirosis in rafters and tri atheletes

8. Mind Reader
✤ 18 yo, known congenital heart disease.
✤ fevers, head ache, myalgias, sweats for a week. It goes away for a week.
Returns for a week. Goes away for a week.
✤ It’s back.
✤ I am asked: does she have endocarditis?

9. Mind Reader
✤ Remember, I live and work in Oregon.
✤ The pattern?
✤ A relapsing fever.
✤ I asked?

10. You have to know your disease distribution
✤ How was your vacation at Black Butte?

12. Fewer Diagnoses
✤ No one gets a differential on the CBC
✤ Campers in W. Washington
✤ Hikers in Mexico

13. Aspirations
✤ 17 yo presents with a week of fevers, productive cough, foul breath

15. Lung abscess
✤ Cult with Eichinella and S. anginosus. Mouth organisms.
✤ Good teeth, no drugs, no ETOH, no LOC
✤ Why?
✤ Saxophone player in the school band

16. ax: cohort study of the impact of too much sax on the mortality of famous jazz musicians. BMJ 1999;319:

17. Mulch
✤ 45 yo male with 2 months of progressive headache

18. Are You really sick of it?
✤ 100.8
✤ stiff neck
✤ right eye points medial and canna move laterally
✤ WBC 10 LP 135 (pmn’s) WBC Protein 210 Glucose 22
✤ Before the CNS diagnostics, what does he have and why?

19. Horse trainer
✤ Works in a large barn filled with bark dust
✤ Canadian bark dust

20. Home Security Fail?
Bad Part
of the
World
Good Part
of the
World

21. Those Damn Canadians
✤ An outbreak of infections due to a rare subspecies of Cryptococcus
neoformans (var. gattii) was recognized on Vancouver Island (VI), British
Columbia, in 2002, which had affected 59, mostly immunocompetent,
individuals since 1999
✤ There was no evidence of spread of the outbreak strain to the Greater
Vancouver area.
✤ It has killed at least 4 people, as well as a horse, 11 porpoises that washed
ashore, and dozens of cats and dogs. It is 37 times more infectious on the
island than it is in Australia.

22. Recent data suggests it is the result of same ‘sex’
mating of Cryptococcus

23. Those Damn Canadians
What would the Lorax say?

26. Don’t eat dirt

27. Other cases
✤ Found in bark dust
✤ Secretary in a nursery
✤ Transplant pt lives down wind from tree grinder
✤ can occur years after leaving an endemic area
✤ I anticipate a Christmas tree outbreak one of these years

28. Ask it right
✤ 19 yo Korean, fevers, hepatitis, diffuse lymphadenopathy, pancytopenia
✤ Biopsy: stellate necrotizing granuloma
✤ Was asked by multiple HCW’s: do you have pets?
✤ He kept saying no.

29. Who is this man?

30. German Jesuit Athanasius Kircher born 02 May 1601
✤ Inventor of the “cat piano”, a grisly musical instrument that worked by
prodding the tails of cats with spikes driven by a keyboard.
✤ He died of Bartonella.
✤ Not really.
✤ My hero.

31. He was asked
✤ Are you around cats?
✤ Yes, my roommate has 5 cats
✤ It is all in how you ask the questions

32. CSD is common
✤ as a cause of red bumps
✤ as a cause of encephalitis
✤ as a cause of fevers
✤ as a transfusion disease from veterinarians

33. Pick an animal
✤ And I (or PubMed) will have an infection associated with it.

34. Fagets
✤ 19 yo female
✤ fevers, chills, hepatitis, pancytopenia
✤ gets her gallbladder out
✤ doesn’t improve
✤ call me
✤ temp 105 pulse 70

35. Faget’s
✤ pulse-temp disassociation
✤ every degree elevation, pulse should go up 10
✤ Typhoid, Brucella, Yellow fever are the classic 3

36. Faget’s
✤ when I asked to consult before the cultures returned, they gave a Hispanic
surname
✤ This is Brucella I said
✤ Always call the diagnosis before the cultures come back

37. Faget’s
✤ it was Brucella
✤ problem was, she had never left PDX
✤ a month later her mom let me know they get goat cheese an uncle brings
from Mexico

38. Other Brucella
✤ It is in feral pigs, who contaminate farm pigs
✤ case in S. Pacific Islander who liked to slaughter his own pigs for parties
✤ orchitis in a goat milker

39. Time is up. If you liked this