Discover and read the best of Twitter Threads about #idfellows

Most recents (24)

1/ Happy Opportunistic Monday #IDtwitter #IDfellows! Sharing another interesting learning case. Written by @johnhannamd and @KrutiYagnikDO Image
2/ What is the best next therapeutic step?
3/ Differential diagnosis for suspected meningoencephalitis without CNS mass lesion in an HIV patient with low CD4 count include:
-Bacterial meningitis
-Neurosyphilis
-TB
-Cryptococcus
-Other endemic fungi
-HSV
-VZV
-CMV
-PML (JC virus)
-HIV encephalopathy Image
Read 18 tweets
1/ Happy Opportunistic Monday #IDtwitter #IDfellows; another interesting case and learning opportunity, written by @johnhannamd and @KrutiYagnikDO
2/ Following tissue diagnosis, what is the best next step in management?
3/ #IDpearls

Leading differential diagnosis of pulmonary infiltrates and skin lesions in HIV patients include:

Typical bacterial
TB, NTM
Cryptococcus, histoplasmosis, other dimorphic fungi
Lymphoma, KS
Read 17 tweets
1/ Happy Opportunistic Monday #IDtwitter #IDfellows! Here is another interesting learning case for you all. Written by @KrutiYagnikDO and @johnhannamd Image
2/ While awaiting pending work-up, what is the best next step?
3/ #IDpearls

Major differential in this newly diagnosed HIV patient, presenting with brain ring enhancing lesions:

-CNS toxoplasmosis
-Primary CNS lymphoma (usually EBV+)
-TB
-Cryptococcus
-brain abscess
-Nocardia
-Chagas (given visit to Peru)
-Malignancy
Read 15 tweets
1/ Hello #IDtwitter #IDfellows and Welcome to “Opportunistic Mondays”! For the next few Mondays, @KrutiYagnikDO and @johnhannamd will be presenting interesting OI cases with major teaching points. Enjoy!
2/ What is the drug of choice for his pneumonia?
3/ + HSV 2 swab from buttock lesion with lymphopenia should prompt HIV screening

HIV ab returned positive; HIV-1 with VL of 790k and CD4 of 10 (5%)

#IDpearls: Pneumocystis Pneumonia (PJP) is the most common respiratory OI in HIV with CD4<200, not on PPx.
Read 13 tweets
Thanks to all that participated on last week polls.
Answers (% right):
1 AmpC (75)
2 ESBL (80)
3 KPC (80)
4 NDM (84)
5 OprD-mediated (80)

Let’s talk about commonly encountered resistance phenotypes.

#IDMedEd #IDTwitter #IDFellows Image
There are a four major types of gram-negative resistance mechanisms:
1.Enzymatic degradation
2.Change in binding site (e.g. MecA)
3.Loss of porin channels
4.Efflux pumps.

We will review here 1 and 3.
The most widely used classification of β-lactamases is the Ambler classification.
- Serine β-L vs. Metallo β-L
- A, B, C, D
See this brief commentary on the classification academic.oup.com/jac/article/55…
Read 12 tweets
Hi #IDfellows #IDtwitter

We have a series of short cases & questions (5) on resistant phenotypes of gram-negative bacteria. Tweetorials to follow

Authors: @LeMiguelChavez & @InfectiousDan

Make sure to participate here or on Instagram (@ID_fellows) #IDmicro #IDinsta #IDMedEd
Female patient presents with clinical symptoms consistent with pyelonephritis and her urine culture grows the following: Image
What is the mechanism of resistance of this E. cloacae?
Read 11 tweets
Hi #IDFellows and #IDTwitter, back with another case: 63F h/o ESRD on HD p/w fever. Blood cx positive for MSSA x 4 days. Blood cx clear on day 5 with Rx Cefazolin. TTE on HD2 without vegetations. What is the best next step?
1/ Let’s talk about when to get a TEE for Staph aureus bacteremia (SAB) to identify infective endocarditis (IE)!

This is a #IDControversy for #IDFellows & #IDTwitter. Let's examine the evidence.
2/ For background, SAB has a high mortality (~20%); determining the presence of IE changes the duration of treatment to 6+ weeks.

The sensitivity of TTE for IE is ~60-65% compared to ~95% for TEE. But TEE has associated costs & procedural risks (sedation, esophageal perf, etc)
Read 16 tweets
#IDTwitter, #IDFellows and #MedTwitter, You asked, and we listened!



The #IDFellowsCup will now be open to non-ID fellows. Welcome to the bleacher section!

@IDFellowsCup Image
We welcome Rookies (Anyone Pre-ID fellowship), Legends (those post-ID fellowship), and everything in between!
Participation includes the full game experience with questions, badges, and individual leaderboard.

Because this is a Fellows competition, you cannot join an individual team for the cup competition. But you can play as a large group (aka the bleachers).
Read 4 tweets
1/ Haven't done this in awhile, but want to share some great literature we discussed this week while on the @UNMC_ID general ID service! So happy to have a big multidisciplinary team led by @DrJRMarcelin along with our pharmacists @Molly_M_Miller & @bergmanscott!
2/ Will start with my favorite article on carbapenem-resistant gram-negative infections from Doi et al with my own adaptation of their super useful table

academic.oup.com/cid/article/69…
3/ We continue to #RespectTheStaph learning of an unusual manifestation of Staph aureus prostatic abscess from a future @UNMC_ID fellow's paper & another lit review.
academic.oup.com/ofid/article/6…
ncbi.nlm.nih.gov/pmc/articles/P…
Read 8 tweets
#IDTwitter #IDFellows
Introducing our new series: “IDFN top 10 articles every fellow should read”🔖

#1: SAB management
by @mmcclean1 @LeMiguelChavez
Reviewers @KaBourgi, @IgeGeorgeMD, @Courtcita, @MDdreamchaser

We know is subjective & expect feedback/future improvements 👇
1. Clinical management of Staphylococcus aureus bacteremia: a review.
pubmed.ncbi.nlm.nih.gov/25268440/
👉 A must read written by Holland et al. where they review the evidence of the management of SAB.
2. Impact of Infectious Disease Consultation on Quality of Care, Mortality, and Length of Stay in Staphylococcus aureus Bacteremia: Results From a Large Multicenter Cohort Study.
pubmed.ncbi.nlm.nih.gov/25701854/
👉ID consult associated with reduced inpatient mortality.
Read 16 tweets
1/ #IDTwitter and #IDFellows, here is another #IDboardreview question: 20F p/w pharyngitis w/fever. There is no cough. Exam: Cervical adenopathy; tonsillar exudate. Rapid Strep antigen test pos. You start to prescribe her Amoxicillin but there is an allergy alert.
2/ She reports an allergic reaction to penicillin around age 8 or 9. She had a rash but no other symptoms. It resolved following discontinuation of med. She did not receive any treatment. Which of the following would you do next?
3/ Today we are going to talk about everyone’s favorite – #penicillin #allergy!
Read 14 tweets
1/38YOF recovered from mild #COVID19 two weeks ago.

Last week, she developed new fevers, headache, photophobia, dyspnea, nausea, vomiting, polyarthralgias, lip peeling, conjunctival injection, and the following pruritic rash:

#IDTwitter #IDFellows #MedTwitter
2/She was admitted to the hospital.

Labs were notable for elevation of ESR, CRP, D-dimer, BNP, and LFTs. COVID-19 NAAT was positive.

CT showed hepatosplenomegaly.

What organism likely triggered her disease process?
3/This is a case of Multisystem Inflammatory Syndrome in Adults (MIS-A).

MIS-C was first recognized in children in COVID-19 hotspots in March 2020 (kids >12y, mortality rate 2%). Most return to baseline health.
Read 6 tweets
2/Today, we'll focus on superficial fungal infections, pathogens, and treatments, specifically:

💠 Dermatophytes
💠 Tinea versicolor
3/Dermatophytes👉a label given to 3 genera that cause skin disease in humans & animals:

🔹 Trichophyton
🔹 Microsporum
🔹 Epidermophyton

📷@DocWoc71 Image
Read 19 tweets
1/@HoustonAETC lunch & learns are 🔥! ​

@MelanieGoebelMD gave a fantastic talk on primary manifestations of skin diseases in PWH (people with HIV)​

Let's review rapid-fire style...​

#IDFellows #IDTwitter #DermTwitter #MedTwitter@idfellows @MedTweetorials
2/​
30YOM with well-controlled HIV and several months of this itchy red rash with silvery scales: Image
3/What is the most likely diagnosis?
Read 27 tweets
1/#ManuscriptMonday #IDTwitter #Tweetorial

​Does oral vanco ppx during systemic abx therapy prevent healthcare facility-onset C. diff infection in high-risk patients? ​

@MannyGuajardoMD recently reviewed a study on this very topic at our virtual JC.​

pubmed.ncbi.nlm.nih.gov/31560051
2/Healthcare facility-onset C diff infection (HCFO-CDI) is ️💰🤒☠️​

What can we do to prevent HCFO-CDI?​

✅Inf prevention strategies​
#AntimicrobialStewardship
❓Probiotics​
❓OVP Image
3/Downsides to OVP:​

​💊Affects GI microflora​
💊VRE overgrowth 📈​
💊Increased risk for C. diff colonization​
💊Not always tolerated​
💊Cost effective?​

pubmed.ncbi.nlm.nih.gov/31560048/
Read 11 tweets
1/ Follow up for our #IDFellows and #IDTwitter on an #IDCase - 25 year old female with behcet's disease and chronic pain who presents for positive T Spot done for screening. Started on Rifampin for latent TB Infection. She calls 3 days later with diffuse pain.
2/ Great job, #IDTwitter, honing in on the issue! This was intentionally vague to stimulate discussion. As you alluded to, the key lies in what else she was taking. But first, what might we worry about as adverse effects Rifampin?
3/ Allergic reactions to rifampin are relatively rare though they have been described. However, patients may experience flushing, rash and itching that is unrelated to hypersensitivity. Rifampin can often be continued in these patients. PMID: 10575418
Read 10 tweets
1/Welcome #IDFellows #IDTwitter #MedTwitter to another #IDFungiFriday

🍄 For the next few tweetorials @A_Spallonii @BCMIDFellowship is presenting a refresher in Med Mycology
🍄 Today’s tweet will focus on basic terminology, 🔬 morphology, and intro to mycoses
2/Goals for these tweets

✅Make you more comfortable with med mycology
✅Learn something you didn’t know before about fungi (🍄)
✅Convince you that 🍄 are fundamental to life on 🌎 Image
3/So let’s start with a question 👉 What are 🍄?

Fungi are organisms that ___
Read 15 tweets
1/
There was a neuro+ID theme at case conference this week! Case 2 was West Nile meningoencephalitis. Michelle reviewed neuroinvasive WNV infections.

#IDTwitter #IDMedEd #IDFellows @ID_fellows
2/
Potential mechanisms for neuroinvasion:
🚩Direct inf of vasc endothelium
🚩Cytokines disrupt BBB integrity➡️pass thru vasc endothelium
🚩Trojan🐎: infected monocytes trafficked into CNS
🚩Retrograde axonal transport after inf of peripheral neurons

ncbi.nlm.nih.gov/pmc/articles/P…
3/
Chart illustrating clinical features of different types of weakness assoc'd with WNV infection

ncbi.nlm.nih.gov/pmc/articles/P…
Read 7 tweets
1/
40M p/w abd pain off and on x 1 mo
No nausea, vomiting, diarrhea, fevers

Labs: WBC 14, T-bili 4.0, D-bili 2.8, ALT 220, AST 330, ALP 270

CT abd/pelvis imaging below

#IDTwitter #IDMedEd #IDFellows @ID_fellows

What is on your ddx?!
2/
More images demonstrating multiple smaller cysts in the periphery of the dominant cyst

This distinct appearance gives the dx!

⭐️Cystic echinococcosis⭐️
3/
🔹Dx was initially made radiographically ➡️ Started on albendazole
🔹Later +Echinococcus Ab to confirm dx
🔹While admitted, ERCP stent of obstructed biliary tree led to improved LFTs

🔹Several wks later, had excision of hydatic cyst and L hepatic lobectomy 👇
Read 11 tweets
1/
25M
- 4d ago HA, myalgias➡️dx’d sinusitis, rx'd Amox
- 2d cough, high fever
- Today CXR: infiltrate on R, small pleural effusion.⬆️LFTs

Landscaper in Marthas Vineyard. No known tick bite. Fevers cont despite change to Ceftriaxone, should we...

#IDTwitter #IDMedEd #IDFellows
2/
Dx: Pneumonic tularemia!
🔸May be a difficult dx. Unlike some forms of tularemia, there are not classic distinguishing features to separate it from CAP/atypicals.
🔸Might see lack of improvement on routine abxs, neg cxs
🔸Inhalation or hematogen spread from other forms (2ary)
3/
Francisella spp, usu tularensis (others in humans: philomiragia, hispaniensis)
🦠GN coccobacillus
🧫Most require cysteine or cystine for growth, so usually doesn’t grow on most routine media
🚨Notify your lab if you suspect as needs special biosafety lab procedures
Read 11 tweets
1/
72F with CML had persistent fever ~102F, cough. CT chest with focal consolidation in LLL. Sputum cx: Klebsiella pneumoniae. Serum BDG, GM negative.

Was on Vanc/Cefepime/LAmB, now narrowed to Cefepime + afebrile 24h

Duration of Cefepime?
#IDTwitter #IDMedEd #IDFellows
Today’s #tweetorial is on fever + neutropenia!

Background:
Up to 50% pts with solid tumors & >80% pts with hem malignancy will develop fever during chemo cycle assoc’d with neutropenia
Only 20-30% of these identify clinical infection
Only 10-25% bacteremia
3/
The very basics:
🔹Here is the classic article from 1966 that demonstrated ⬆️susc to infection as neutrophils<500
🔹Freq and severity of infection inversely proportional to neutrophil count
🔹Risk of severe infection and BSI greatest at ANC <100
pubmed.ncbi.nlm.nih.gov/5216294/
Read 15 tweets
1/Welcome to #IDFungiFriday!

This week by: @A_Spallonii @teena_xu

Let's get started with a real-world case...

65yoM in Brazil (+) fever, fatigue, myalgias. Dx: COVID-19 pneumonia (mild-mod). Tx: HCQ. 4 wk later found w "mold in the lungs." What is going on here?!
2/Answer: all choices are possible!

It’s not often that fungi headline the news. Let's take a few minutes to talk about CAPA today.

(References will be cited by the PMID... google or pubmed the # to find the paper) Image
3/What is CAPA?

🍄 COVID-19 associated pulmonary aspergillosis

🌎 Increasingly reported around the globe by physicians treating patients with COVID-19-related lung disease...

PMID:
🇫🇷 32445626
🇩🇪 32339350 (figure 1)
🇳🇱 32396381
🇵🇰 32585069
🇦🇺 32395423
🇪🇸 32749040
🇧🇪 32488446 Image
Read 16 tweets
1/
85M with CAD s/p CABG and MM on daratumumab/dex
Nausea, vomiting, watery diarrhea 7x per day

Alright #IDFellows, can you ID the organism? Hektoen plate below

#IDTwitter #IDMedEd #MedTwitter @ID_fellows

Photo cred: ASM asmscience.org/content/educat… Image
2/
Guess Salmonella?
🧫Selective hektoen agar
🧫pH indicator dye:agar🟢➡️🟡 if ferment sugar
🟡NOT Salmonella/Shigella
🧫Na thiosulfate for orgs that produce H2S➡️ferric ammonium citrate+H2S gas ➡️⚫️precipitate
🧫Salmonella=🟢+⚫️center (vs Shigella 🟢only)
3/
Salmonella infection, many flavors:
🤮Gastroenteritis (nontyphoidal Salmonella)
🤢Enteric fever (Salmonella typhi/paratyphi)
🩸Bacteremia, endovascular inf
🦵Focal metastatic inf (eg osteomyelitis, abscess)
🙂Asx carriage

💫Let's focus on nontyphoidal salmonellosis today
Read 11 tweets
1/
Thanks to Dan Kuritzkes+Suzanne McCluskey for talk on drug resistance today in the HIV core lecture series! @MGHBWHIDFellows #IDFellows @ID_fellows #IDTwitter

To review high yield mutations, check these prior 🧵

NRTI:
NNRTI:
2/
Additional NNRTI mutations:
🧬E138K🧬
▪️Key rilpivirine resistance mutation
▪️Cross-resistance to ETR

🧬V106I, F227C🧬
▪️Key doravirine resistance mutations
3/
Notes on PI resistance:
🔹RTV-boosted PIs have high barrier to resistance
🔹Prolonged use in setting of virologic failure can select for resistance
🔹More mutations = broader cross-resistance
🔹Certain mutations confer resistance to some drugs, sensitize to others: I50L, L76V
Read 7 tweets

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