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1/ Happy Opportunistic Monday #IDtwitter #IDfellows! Sharing another interesting learning case. Written by @johnhannamd and @KrutiYagnikDO 
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
-Bacterial meningitis
-Neurosyphilis
-TB
-Cryptococcus
-Other endemic fungi
-HSV
-VZV
-CMV
-PML (JC virus)
-HIV encephalopathy
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
Leading differential diagnosis of pulmonary infiltrates and skin lesions in HIV patients include:
Typical bacterial
TB, NTM
Cryptococcus, histoplasmosis, other dimorphic fungi
Lymphoma, KS
1/ Happy Opportunistic Monday #IDtwitter #IDfellows! Here is another interesting learning case for you all. Written by @KrutiYagnikDO and @johnhannamd
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
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
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.
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.
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
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
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.
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…
- Serine β-L vs. Metallo β-L
- A, B, C, D
See this brief commentary on the classification academic.oup.com/jac/article/55…
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
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:
What is the mechanism of resistance of this E. cloacae?
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.
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)
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)
#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
The #IDFellowsCup will now be open to non-ID fellows. Welcome to the bleacher section!
@IDFellowsCup
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).
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).
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…
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…
academic.oup.com/ofid/article/6…
ncbi.nlm.nih.gov/pmc/articles/P…
#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 👇
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.
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.
pubmed.ncbi.nlm.nih.gov/25701854/
👉ID consult associated with reduced inpatient mortality.
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?
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
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?
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.
MIS-C was first recognized in children in COVID-19 hotspots in March 2020 (kids >12y, mortality rate 2%). Most return to baseline health.
1/🍄#IDFungiFriday🍄
This is part 2 of @A_Spallonii basic med mycology #tweetorial
See Part 1 here…
#IDFellows #IDTwitter #IDMedED @MedTweetorials
This is part 2 of @A_Spallonii basic med mycology #tweetorial
See Part 1 here…
#IDFellows #IDTwitter #IDMedED @MedTweetorials
2/Today, we'll focus on superficial fungal infections, pathogens, and treatments, specifically:
💠 Dermatophytes
💠 Tinea versicolor
💠 Dermatophytes
💠 Tinea versicolor
3/Dermatophytes👉a label given to 3 genera that cause skin disease in humans & animals:
🔹 Trichophyton
🔹 Microsporum
🔹 Epidermophyton
📷@DocWoc71
🔹 Trichophyton
🔹 Microsporum
🔹 Epidermophyton
📷@DocWoc71
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
@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:
30YOM with well-controlled HIV and several months of this itchy red rash with silvery scales:
3/What is the most likely diagnosis?
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
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
What can we do to prevent HCFO-CDI?
✅Inf prevention strategies
✅#AntimicrobialStewardship
❓Probiotics
❓OVP
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/
💊Affects GI microflora
💊VRE overgrowth 📈
💊Increased risk for C. diff colonization
💊Not always tolerated
💊Cost effective?
pubmed.ncbi.nlm.nih.gov/31560048/
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
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
🍄 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 🌎
✅Make you more comfortable with med mycology
✅Learn something you didn’t know before about fungi (🍄)
✅Convince you that 🍄 are fundamental to life on 🌎
3/So let’s start with a question 👉 What are 🍄?
Fungi are organisms that ___
Fungi are organisms that ___
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
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…
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…
Chart illustrating clinical features of different types of weakness assoc'd with WNV infection
ncbi.nlm.nih.gov/pmc/articles/P…
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?!
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⭐️
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 👇
🔹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 👇
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
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)
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
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
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
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
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/
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/
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?!
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)
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)
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
🍄 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
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…
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…
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)
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
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
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:
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
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
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
