Recently we’ve seen some fascinating cases, both things that
are common in Thailand but also diagnostic dilemmas that reveal the
intellectual prowess of the faculty here.
This week we also saw 3 cases of synergistic gangrene. This
is a post-surgical infection where the patient can have multiple expanding
gangrenous lesions caused by either bacteria or fungus. Swabs of the skin
lesions are taken and the patient is treated based on these
culture results. Cultures are specifically used to determine if there is
reason for antifungals or MRSA coverage. These patients require a long course
of antibiotics, and the consequence of nontreatment is certainly very
grave.
Working in Chiang Mai is a special place to practice ID because
they it’s catchment area brings in the very rural diseases in the context
of a functional university hospital system. It just makes one think, that
our careers are so dependent on the clinical environments on which we are
borne, and for obvious reasons. But by extension, I think ID would be a much
more sought after specialty if the case load in the US was similar to that of
Chiang Mai.
