MJM Wardround - Plague of Athens

The two minute tutorials this week were:
Dr Szulkowski - Typhus (6/8)
Dr Tuck - Smallpox (8/8)
Dr Queen - Typhoid (2/8)
Dr McMahon - Epidemic ergotism (not eligible for marking - too clever)

With regard to the plague of athens, Dr Jones awarded the prize best to Dr Tuck for her arguments supporting a diagnosis of smallpox. It is clearly difficult, if not impossible to know the diagnosis but if you would like to read more, there is a good discussion of the approach to diagnosis in The cause of the plague of Athens: plague, typhoid, typhus, smallpox, or measles? Burke A. Cunha, Infect Dis Clin N Am 18 (2004) 29–43. One learning point is that the epidemiology can help differentiate infectious and non-infectious agents, but also point to the mode of transmission. This could prove life saving if you find yourself in the middle of an undiagnosed epidemic.

I would choose measles as my choice of diagnosis, but this week was an opportunity to review the clinical features of the other diseases. One paper that I found particularly interesting is Osler on typhoid fever: differentiating typhoid from typhus and malaria. Cunha BA. Infect Dis Clin North Am. 2004 Mar;18(1):111-25.

If you would like to know a little more about ergotism have a glance at:
Ergot of Rye - I: Introduction and History
Poisons of the past / ergotism

And if you feel a little more scholarly check out Convulsive ergotism: epidemics of the serotonin syndrome? Mervyn J Eadie, Lancet Neurology 2003; 2: 429–34.


The reading for next week is"Antibiotics, Microsoft® Encarta® Online Encyclopedia 2005 http://encarta.msn.com © 1997-2005 Microsoft Corporation. All Rights Reserved. (All four pages). You should also use your initiative to read a little more about the mechanisms of antibiotic resistance.

Think you know it all already...test yourself with Jeopardy

A non compulsory read is Pearls....glance at the site and see if you find any of the advice useful.


Interesting cases this week:

Late onset asthma, with eosinophilia, renal impairment, and cutaneous ulceration (will this be CSS?)
Erysipelas (do you know the three commonest organisms?)
Lacunar infarction (what are the characteristic features?)
Ace inhibitor induced acute renal failure (Do you know the incidence?)
Hepatorenal failure (what is the prognosis?)

I have still to hear back about clavulanic acid....by Tuesday please.

Don't forget your two minute tutorial...be concise and precise.