Discover and read the best of Twitter Threads about #IDTwitter

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A 40F and her 10 yo son present with flushing of neck/face, headache, and diarrhea about 45 min after eating mackerel, rice, and some fruit (mango, cantaloupe).

#IDTwitter #IDMedEd #MedTwitter #FOAMed
What do you think is cause of their sxs? #IDTwitter #IDMedEd #MedTwitter #FOAMed

Pic credits:
3/Dx: Scombroid (histamine) poisoning

🍽️After ingestion of contaminated 🐟(tuna, mackerel, bonito, swordfish, mahi-mahi, and more)
🧀Did you know it can occur after w/contaminated cheese too?
📌Freq misdiagnosed as seafood allergy
🎣Usu fresh fish but can occur with canned fish
Read 11 tweets
Very excited to share our new preprint "#SARSCoV2 viral load dynamics, duration of viral shedding and infectiousness: a living systematic review and meta-analysis" #IDTwitter

A huge team effort screening and synthesising the accumulating evidence. 1/6…
2/6 Main findings:
- In the upper respiratory tract (URT), mean duration of RNA shedding was 17 days (95% CI, 15.5-18.6), max 83d
- Shedding duration increases with age & severity of illness
- There were limited studies reporting shedding duration in sputum (n=7) and stool (n=13)
3/6 - High SARS-CoV-2 viral loads in URT are detectable in the first week, and peak viral load occurs at day 0-5
- In contrast, peaks in SARS-1 and MERS occurred at days 10-14 and 7-10 of illness
- Pts with SARS-CoV-2 are likely to be most infectious day 0-5 (3/6)
Read 7 tweets
1/12 Inspired by @IDdocAdi’s flight experience and dedicated to my friends who are trying to plan a #safewedding, I decided to post how we planned a #sociallydistanced wedding in the midst of the #COVID19pandemic. A thread from a healthcare #epidemiologist 👩‍🔬👰
2/12 Our initial plan was to get married in Birmingham, AL, where my fiancé @jonathanbmeadow grew up, and where we met during my ID training at @UAB. We planned to rent the entire space of our favorite Birmingham restaurant #Ovenbird, and get @bourbonbrothers to perform live
3/12 June/July 2020: Alabama’s #COVID19 cases and rate of positivity kept increasing, and we were worried abt poor compliance with #masking. Grateful that #ovenbird decided to stay closed for safety. We thought about moving our wedding to @CityofDurhamNC.
Read 13 tweets
Hey, friends. Here's what's up in the world of #COVID19 literature from the last 24 hours (7/23). Simple summaries provided, as always, follow the link for original manuscripts. BE WELL! #IDtwitter #MedED #MedTwitter #Microbiology #InfectiousDiseases
1. Title: Addendum to: Children are not COVID-19 super spreaders: time to go back to school
Brief Study Design: This is a letter (addendum) to the author’s original research paper (cited in the letter and can be accessed from it).
Simple Summary: Contact-tracing studies have demonstrated that children have a significantly lower attack rate of COVID-19 compared to adults.
Read 43 tweets
I had a request from a friend to provide some literature on the use of #masks. I am happy to provide that here today. As always, the original manuscripts can be accessed by clicking on the link provided. Stay well!
#COVID19 #MedTwitter #IDTwitter
1.Title: COVID-19: in the absence of vaccination – ‘mask-the-nation’
Brief Study Design: Editorial
Simple Summary: Without an effective vaccine and/or antiviral agent, best way to prevent the spread of the SARS-CoV-2 is to physically block spread. At this time, droplet spread is considered to be the primary form of transmission of the virus.
Read 26 tweets
1/ 55M, h/o psoriatic arthritis on adalimumab, cut hand cleaning🐟after fishing in coastal🌊

~12h later,⬆️finger erythema/edema

Admit: T101, rigors,⬆️HR,⬇️BP

On Ceftriaxone w/o improvement, now finger w/purple hue, blistering. How would you modify abxs?
#IDTwitter #MedTwitter
Did you ID the🦠? Vibrio vulnificus!
🔹In coastal water, saltwater marsh/wetlands, river estuaries
🔹Peak summer/late fall (water temp⬆️)

Filter feeding shellfish (🦪/clam/mussel/🦀) conc bact more than in water ▶️in virtually all oysters Chesapeake Bay, US gulf coast
Leading cause of seafood-related deaths in US

CDC: ~100 persons in US are infected with V.vulnificus/yr…
Read 11 tweets
What do I do if I’m COVID positive? The @WADeptHealthPIO has a great handout on what to do (pictures attached). Highlights (a thread): (1/9)
FIRST, do NOT panic, most people (approx 80%) will have no or mild symptoms. Now let’s talk some specifics on how to keep yourself and others safe in this situation:
1. Your health - each person is very different, so contacting your personal health provider for specific recommendations is important! Things to watch out for: cough, shortness of breath/difficulty breathing, fever, diarrhea, fatigue/body aches, signs of stroke.
Read 9 tweets
#Airborne transmission: defined as the spread of an infectious agent caused by the dissemination of droplet nuclei (#aerosols) that remain infectious when suspended in air over long distances & time. What do we know about this route for #COVID19 #SARSCoV2? A #thread 🧵
Experimental studies have generated #aerosols of infectious samples using high-powered jet nebulizers under controlled laboratory conditions. #SARSCoV2 #Covid_19 #IDtwitter
Some studies in #healthcare settings where symptomatic #COVID19 patients were cared for but where #aerosol generating procedures were not performed found #SARSCoV2 #RNA but the quantity of RNA detected was in extremely low numbers. #airborne #transmission
Read 4 tweets
The latest article by @edyong209 and a recent "Tweetorial" by @epiellie have given me inspiration to write out some thoughts I've had on COVID.

I think a somewhat missed point in current public health efforts is to ask why aren't people heeding expert advice on wearing a mask?
I don't believe there are many infectious disease epidemiologists in the US who have tackled a disease that has no pharmaceutical intervention, but there are certainly some, and I'm one of them.
Guinea worm, a parasitic disease that will hopefully soon be eradicated, has no medicine that will cure or prevent the disease.
Read 19 tweets
1/9 What is the benefit of testing if people don’t get results back for 7-10 days? There is no way to do adequate contact tracing from 10 days ago. We know people aren’t staying home & therefore may be exposing others or getting exposed if they weren’t infected already. #COVID19
2/ Example A: John exposed on June 1st. Develops symptoms June 5th. Gets tested 6/5. Gets results 6/6. Wow. Contact trace for 6/3-6/5. Easy to remember what you did 2 days ago, who you were with and where you went. Get those people tested.
3/ Example B: Steve exposed June 1st. Symptoms 6/5. Thinks it’s allergies. Waits a day or two. Has a fever on 6/7. Someone says get tested. Trying to get access to testing. Everywhere full. No insurance. Gets prescriptions from Walgreens. Groceries for his mom on 6/10. (Cont’d).
Read 11 tweets
As the end of this crazy first year ID fellowship wraps up, here are a list of a few survival tricks I've come up with over the year. Hopefully this is of use to all the new ID fellows about to start! #idtwitter (attributions in parentheses)
It is less a list of medical knowledge that is important for ID (though there is some of that 🦠🦟) it is mostly just skills to get through the day and be an effective fellow.
Like any ID list, this has to start with Staph aureus. Respect the Staph. I thought I had an understanding of this pathogen in residency. I did not. It can do terrible things and form abscesses where you don't think it will (From: every ID attending)
Read 17 tweets
Updated the #RECOVERYtrial topline results summary table of the #dexamethasone arm compared to usual care for treatment of hospitalized patients with #COVID19.

Got additional information colleagues shared in Twitter.

Thread with some comparisons with #ACTT1

#IDtwitter 1/
the #ACTT1 authors have only reported (preliminary) Day 14 mortality, and the #RECOVERYtrial has only posted Day 28 mortality.

But these days the Supplementary Appendices in trial reports have additional relevant information:…

The paper says they were not reporting day 29 mortality, but If you look at Figure S3 in the #NEJM #ACTT1 preliminary report, you have KM estimates out to day 30.

From there you can visualize the probability of death at day

28 (see figure) have left lines and scales
Read 12 tweets
Origin story of the HCQ PEP trial.

I have learned a ton from working with @boulware_dr and @DrToddLee and team on this trial.

Most important lesson:

Don’t let the details (like funding for example) get in the way of doing something important.
This trial was run on a shoe-string using innovative internet-based recruitment and follow up with centralized depot and administration
A reminder of how the 🇺🇸🇨🇦 HCQ PEP trial came to be through #IDTwitter.

We didn’t have any details of how or if this would work... Todd just decided to get it done, adapting David’s protocol to Canada with support from colleagues in Manitoba & Alberta.

Read 8 tweets
1/ While on my current GI rotation, I've been reading about Clostridioides difficile because, you know, #IDNerd. I ran across something I had not learned about before:

A Hypervirulent Strain of CDiff!

So naturally, I had to look into this.

/thread #Tweetorial #CDiff #IDTwitter
What is the name of the strain of hypervirulent CDiff?
The hypervirulent strain of CDiff is known as NAP1/B1/027, which stands for North American pulsed-field gel electrophoresis type 1, restriction endonuclease analysis type B1, PCR ribotype O27.

That's a mouthful.

So what's the big deal about this strain?
Read 11 tweets

I believe that many sentiments, which have recently been put forth, regarding Sweden’s approach to #COVID19 overlook a critical metric. I would like to discuss some of my thoughts.

#MedTwitter #IDTwitter

Preface: this thread was not created to favour one country’s response over another’s; nor do I have evidence to substantiate a definitive conclusion

It is merely to suggest other factors which should be considered when evaluating a response's success

Please keep this in mind 2/
A pandemic’s ‘health footprint’ illustrates the summation of direct & indirect implications on a country’s overall health

This concept may be modelled by 4 distinct curves demonstrating each wave’s respective magnitude

Image for context; may not be accurate or to scale

Read 13 tweets
Ok a few things have been moving in the world of paediatric #COVIDー19 literature

Time for an updated #tweetorial on SARS-CoV-2 infection in children!

#FOAMped #FOAMed #PedsICU #PedsID #IDtwitter

So there are fewer cases in children. How much fewer?

Children consistently make up <2% of confirmed COVID-19 cases. These are usually ascertained by testing sick people in hospital


COVID-19 is less severe in children, but often is it severe?

From a Chinese cohort 0.6% needed PICU but lots of community testing involved…

US CDC data has 2% of admissions in PICU (limited data)…

Read 12 tweets
I’m beside myself about the recent @statnews article. It is deeply unethical to report leaked partial trial results for the sake of some clicks. This article could up having devastating consequences to patients and here’s why. (1/n)
In order to ethically conduct a clinical trial, doctors need to genuinely believe that one treatment option isn’t better than another. Otherwise how could they, given their oath to do no harm, in good conscience randomize a patient to what they think could be a worse drug? (2)
Suggesting that remdesevir is working, even with the half-hearted disclaimer that more data is needed, might tip the balance for some physicians. No equipoise = no patient enrollment. No patient enrollment = clinical trial ended before reaching completion (3)
Read 7 tweets
Thoughts on upcoming #COVID19 #serology tests:
This is actually quite a challenge! (#Diagnostics often involve a lot of complexities). There is a lot of pressure to roll these tests out, but they need to perform well, or we do more harm than good. #MicroRounds (A thread)
WHY we need these soon:
1. Contact tracing.
2. Can be used to test if a vaccine is working during a clinical trial (70 of them ongoing right now, I believe)
3. Inform public policy makers about rate of asymptomatic cases + previous infections/exposures =informed decision making
How is developing a #PCR different than developing a #serology test?
1. #PCR tests detect viral RNA/DNA (in this case RNA) and can be pretty straight-forward in terms of development
2. #Serology relies on knowing about the #SARSCoV2 structure and how the human body responds.
Read 13 tweets
There is no evidence that the Bacille Calmette-Guérin (BCG) #vaccine protects people against #infection with #SARSCoV2 #coronavirus causing #COVID19. But, 2 #clinicaltrials addressing this question are underway. WHO does not recommend BCG vaccine for the prevention of COVID-19.
There is EXPERIMENTAL evidence from animal & human studies that #BCG #vaccine has non-specific effects on the immune system. These effects have not been well characterized; clinical relevance is unknown. WHO updated its evidence review of major scientific databases on this topic
The review yielded 3 pre-prints (before peer-review), where authors compared incidence of #COVID19 cases in countries where the #BCGvaccine is used vs. countries where it is not used & observed countries that routinely used BCG in neonates had less #COVID19 cases to date.
Read 7 tweets
If you're interested to see what infectious disease specialists are saying, here are 300+ of them.
@DrJRMarcelin @GermHunterMD @jdcooperid please let me know if I am missing anyone #IDTwitter…
If you're interested to see what emergency medicine professionals are saying, here are 150+ of them.
@darakass @MDaware @SortaUpToDate please let me know if I'm missing anyone…
If you're interested to see what hospital medicine professionals are saying, here are 100+ of them.
@CarolMarceloMD @buckeye_sanjay @katiewiskar please let me know if I'm missing anyone…
Read 41 tweets
🗂️THREAD: U.S./global #COVID19 clinical/research patient/healthcare worker registries seen on #medtwitter

Many specialty-society/focused registries launched in last few weeks, attempt to collect them here

List 👇🏽

2/n: @SCCM's VIRUS: Viral Infection and Respiratory Illness Universal Study @covid19registry

Inclusion criteria 👇🏽…

Find out if your site is already enrolled:…

#Pulmonology #Pulm #CriticalCare #PCCM
3/n: International #COVID19 Dermatology Registry led by @DrEstherFreeman @AADskin

Looking for:
1. #COVID19 pts who develop #skin findings
2. #dermatology pts who develop #COVID19

h/t @DrStevenTChen #dermtwitter
Read 11 tweets
Although related to the Severe Acute Respiratory Syndrome (#SARSCoV) & the Middle East Respiratory Syndrome (#MERS), #COVID19 virus #SARSCoV2 shows some peculiar pathogenetic, epidemiological & clinical features which have not been completely understood to date.
#SARSCoV2 is more phylogenetically related to #SARSCoV than to #MERS. Only minor differences have been found in the #genome sequences of SARS-CoV-2 comparing with SARS-CoV. SARS-CoV-2 affinity for angiotensin converting enzyme 2 (#ACE2) receptor is higher than in SARS-CoV.
Read 9 tweets
Lessons from past #coronavirus & #influenza #epidemics suggest that #viral #infections can trigger acute coronary syndromes, arrhythmias, exacerbation of heart failure owing to a combination of a significant systemic inflammatory response plus localized vascular inflammation.
#COVID19 may either induce new cardiac pathologies &/or exacerbate underlying cardiovascular diseases. A large proportion of patients have underlying cardiovascular disease &/or cardiac risk factors. Factors associated with mortality include male sex, advanced age, comorbidities.
Acute cardiac injury determined by elevated high-sensitivity #troponin levels is commonly observed in severe #COVID19 cases & strongly associated with mortality. Acute respiratory distress syndrome is also strongly associated with mortality in patients with #SARSCoV2 infection
Read 6 tweets

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