Discover and read the best of Twitter Threads about #idtwitter

Most recents (24)

Clinical features and novel presentations of human #monkeypox of 197 patients in a #London centre during the 2022 #outbreak

Median age: 38 years
All 197: men, &
196 identified as gay, bisexual, or other men who have sex with men
1/

bmj.com/content/378/bm…
#IDtwitter #MedTwitter
Concomitant infection:
- 35.9%: HIV
- 31.5%: a concomitant sexually transmitted infection.

All presented with mucocutaneous lesions, most commonly on the genitals (n=111 participants, 56.3%) or in the perianal area (n=82, 41.6%).
2/

#Doctor #MedStudentTwitter
86.3% participants reported systemic illness:
✔️ fever 61.9%),
✔️ lymphadenopathy (57.9%), and
✔️ myalgia (31.5%).
3/

#monkeypox #resident
Read 14 tweets
👩‍🦳 in her 70s: on the L 🦶, initially appeared pruritic papules that evolved to fluid-filled blisters with tense and denuded bullae (Fig1).

Over the ensuing 6 weeks an expanding annular plaque with peripheral scale (Fig2).
¼

DOI:doi.org/10.1016/j.mayo…
#dermatology #mycology
🔬(KOH): hyphae
🧫: Trichophyton rubrum

BULLOUS TINEA PEDIS.

The patient responded well to terbinafine cream and dilute acetic acid soaks.
2/4

#microbiology #IDtwitter
Bullous tinea, seen in adults and children, and most often affecting the feet, presents with an erythematous scaly rash with serous fluid-filled bullae, as opposed to the pus-filled blisters of bullous impetigo.
3/4

#MedTwitter #Doctor #MedStudentTwitter #MedEd
Read 4 tweets
34-YO👨‍🦰congenital, idiopathic intestinal pseudo-obstruction, total parenteral nutrition & infusion of lipid emulsions: fever & cough (paroxysmal coughing with his port infusion)

CXR: interstitial infiltrates & areas of faint alveolar opacities
Portacath blood
1/
#microbiology
Smear: globose, oval, budding #yeast with a small collarette, suggesting Malassezia spp.
Olive oil–supplemented🧫: Malassezia sympodialis (identified by DNA sequencing)

FUNGEMIA INFECTION & LUNG EMBOLI BY MALASSEZIA SYMPODIALIS IN THE PORTACATH VENOUS ACCESS SYSTEM
2/

#MedEd
The portacath was removed, & the patient was given liposomal amphotericin B, for 4 weeks.

His symptoms were gone by week 2, and the interstitial infiltrates were nearly resolved by week 4.
3/

doi.org/10.1093/cid/ci…
#mycology #IDtwitter #MedTwitter
Read 7 tweets
18-YO👨‍🦱: painful tender, fluctuant mass mass over the R anterior sin, chronic right knee pain, weight loss.

Leukocytosis
⬆️inflammatory markers (ESR, CRP)

XR & MR: ?
1/

doi.org/10.1093/cid/ci…
#Orthopedics #radiology #MedEd
X-ray: areas of lucency & sclerosis in the proximal tibial metadiaphysis
MR: consistent with an chronic osteomyelitis & intraosseous abscess with myositis involving the adjacent musculature

A presumptive diagnosis of BRODIE ABSCESS
2/

#IDtwitter #MedTwitter
Debridement with sequestrectomy
3 deep bone: Aggregatibacter aphrophilus
🔬: bone remodeling, fibrosis, & mixed lymphoplasmacytic & histiocytic infiltrates

BRODIE ABSCESS OF THE TIBIA DUE TO AGGREGATIBACTER APHROPHILUS
3/

doi.org/10.1093/cid/ci…
#microbiology #Doctor
Read 9 tweets
Summary of our paper (was supposed to write yesterday, sorry Aatish)
A descriptive case series of 197 MPX patients in london & novel presentations
- 197 cases were male.
- 196 identified as GBSMSM.
- Genital or perianal lesions occurred in 88.3% bmj.com/content/378/bm…
- fever, lymphadenopathy, myalgia were common systemic features; though the classic "prodrome" was not observed with 38.5% of developing symptoms after lesions.
- 36% reported rectal pain
- 16.8% sore throat
- 15.7% penile oedema
- 13.7% oral lesions.
- 4.6% tonsillar signs.
- 35.9% infections occurred in people living with HIV.
- 31.5% of those screened had a concomitant STI - highlighting the importance of a full STI screen when MPX suspected.
- 10.2% of cohort were admitted for clinical reasons (though as a HCID referral center this number is
Read 13 tweets
#Paxlovid can reduce the risk of severe COVID.

Should we give to all "high risk" patients though - even if they're vaccinated +/- boosted ?

And does being in the BA.4/5 wave change anything?

#IDTwitter #MedTwitter #FOAMed
🧵
Pax is one of the options for outpatients (ie, mild-moderate disease) with COVID to prevent severe disease (ie, O2/hospitalization or death)

Here's the best table I've seen, created by @RMKGandhi, as shown in a recent @IMJournalClub - Image
As you can see, Pax stacks up well in terms of
-the relative risk reduction (88%)
-the absolute risk reduction (-5.5%), and
-the inverse of the latter - number needed to treat (NNT, 18)

So in other words, you need to give Pax to 18 patients to prevent one case of severe disease
Read 20 tweets
Happy to share our review of antiviral treatment of #monkeypox, co-authored with the amazing @EmilySiegrist4 and just published in @CIDJournal! @OUHealth @IDSAInfo @SIDPharm @PaulSaxMD #IDTwitter #TxID #TwitteRx #MedTwitter #OpenAccess

Short 🧵 (1/n)

academic.oup.com/cid/advance-ar…
In this paper, we review three antiviral agents with activity against #monkeypox:
1. Cidofovir
2. Brincidofovir
3. Tecovirimat
(2/n)
For each agent we discuss:
1. Basic Pharmacology
2. Pharmacokinetic Data
3. Animal Data
4. Toxicity
5. Clinical Data in Humans
(3/n)
Read 5 tweets
51-YO🧔‍♂️alcoholic homeless living with dog in southern France: fever, confusión, a maculopapular rash on the trunk (A), hypotension, disorientation, an eschar on his right shoulder (B), & several tiny black spots
Platelet:⬇️
AST, ALT, GGT, LDH:⬆️
1/

doi.org/10.1086/420747
#MedEd
Careful examination: these spots were actually #ticks (a total of 22) attached on the skin; they were removed

During 25 h, he was examined by diferente doctors. Dermatologic examination was woefully incomplete, as often occurs when unhygienic, homeless, &/or drunken patients
2/
All ticks were identified as #Rhipicephalus sanguineus, the brown dog tick, including 1 female (A) and nymphs (B).

MEDITERRANEAN SPOTTED FEVER IN ITS MALIGNANT FORM
3/

doi.org/10.1086/420751
#IDtwitter #dermatolgy
Read 5 tweets
A 28-YO👨‍🦰traveling through Africa & Asia: a pruritic, erythematous rash on his back, trunk, buttocks, genitals, & lower limbs; dry cough & wheeze

X-ray: bilateral reticulonodular infiltrates
Eosinophilia
1/

doi.org/10.1093/cid/ci…
#IDtwitter #MedTwitter #dermatology ImageImageImage
CUTANEOUS LARVA MIGRANS (CLM) & LOEFFLER SYNDROME

The “creeping” skin lesions are diagnostic of CLM

The pustular rash across the patient’s buttocks & back is likely secondary to CLM folliculitis—a rarer, but well-described skin manifestation of CLM
2/

#Doctor #MedEd ImageImage
The patient’s cough and chest radiograph findings are characteristic of Loeffler syndrome, a recognized but rare complication of CLM.

CLM is caused by the infective stage larvae of animal hookworms from the family Ancylostomidae.
3/

#MedStudentTwitter #resident Image
Read 7 tweets
42-YO African American man, AIDS, CD4 57 cells/ mm3: 18-mth of progressively multiple papules coalescing into large exophytic nodules & plaques on face, scalp, & neck (A & B); & several lesions in in the groin, penis, & RUE
🔬:?
1/

doi.org/10.1093/cid/ci…
#dermatology #idtwitter ImageImage
GIANT MOLLUSCUM CONTAGIOSUM

Molluscum contagiosum is a benign skin tumor caused by molluscum contagiosum virus.

Lesions >1 cm diameter are known as giant molluscum
2/

#Virology #MedEd #MedTwitter
Well-circumscribed intraepidermal lobules containing molluscum bodies (arrow)
These structures, which are composed of viral particles & cellular debris, are pathognomonic for this condition
Molluscum bodies enlarge and rise to the surface as cells age
3/

#Doctor #dermatologia Image
Read 8 tweets
👧22 meses, finca familiar con muchas moscas: secreción conjuntival y ojo derecho rojo de 2-3 semanas con algo que se mueve. No refieren viajes al extranjero
En canto externo de ojo D, nematodos en movimiento (vídeo)
1/3
continuum.aeped.es/screens/play/1…
#pediatria #ophthalmology
TELAZIOSIS OCULAR
Thelazia callipaeda es un nematodo y la causa más frecuente de telaziosis en humanos, perros y gatos.
Produce sensación de cuerpo extraño, epífora, conjuntivitis y úlceras corneales.
Tratamiento: extracción manual de los parásitos
2/3

#pediatric #parasitology
Los cánidos salvajes y domésticos son los principales hospedadores definitivos.
La mosca de la fruta Phortica variegata: vector y hospedador intermedio.
3/3

🖋️Martín Valbuena J
#MedEd #IDtwitter #MedTwitter
Read 3 tweets
🧵 #IDtwitter , the #ImagesinID files bring us this tongue lesion 🔍 🗂 #IdBoardReview #MedTwitter

44 year old male, HIV (+), non adherent to antiretroviral therapy (CD4 120) presents for evaluation of this lesion: Image credits: Academia Esp...
🤔 The most likely microorganism responsible for this finding is:
🪡1/5 B) Treponema Pallidum

This patient presents with a syphilitic gumma in the setting of tertiary syphilis

Although gummatous disease is uncommon, HIV patients have an increased risk of developing gummas most frequently in the oral cavity, skin or a viscera.
Read 7 tweets
3 cause of eosinophilic #meningitis:
1⃣Angiostrongylus,
2⃣Baylisascaris, and
3⃣Gnathostomiasis.

#MedEd #IDTwitter
1) Angiostrongylus cantonensis: a common cause of human eosinophilic meningitis (neural angiostrongyliasis) and occasionally ocular disease.

#neurology #IDtwitter #MedTwitter
2) Baylisascaris procyonis, the raccoon roundworm, is a rare but serious cause of neurologic and ocular disease in humans.

#neurology #IDtwitter #MedTwitter
Read 4 tweets
Dear @WHO why do you put your #COVID19 guidance behind a paywall at @bmj_company @bmj_latest
Are you embarrassed and don't wish for anyone to read?

"there’s no evidence <#fluvoxamine> help, according to a panel of experts advising WHO"
#IDTwitter
bmj.com/content/378/bm…
WHO expert panel is contrained by meta-analysis given to them by @cochranecollab. The Cochrane review on fluvoxamine was poor. The endpoints being assessed were incorrect for an outpatient trial. As a peer reviewer, I advised Cochrane of this, and they apparently did not care.
As a peer reviewer, I was asked to edit my language of the fluvoxamine review as it was too negative.

I had some rather pointed comments, such as did the authors of the Cochrane review actually read the clinical trial manuscripts? as there were numerous factual errors.
Read 9 tweets
#IDTwitter #SIDPharm #Microbiology

#AMRrounds Called to review a laboratory confirmed blood isolate associated with a clinically confirmed infection but contraindications to use of LZD & DOX.

Two questions arise:
1. Mechanism of DAP tolerance?
2. Should AMP or CPT be added?
Recall the proposed mechanism of action for DAP

DOI: 10.1128/microbiolspec.VMBF-0016-2015
Review the proposed DAP-R mechanisms for Enterococcus species.

1. Diversion of DAP from prefered binding site (E faecalis only)
2. Repulsion of DAP-Ca+ complexes from cell membrane by ⬆️ conversion to lysyl-phospholipid phosphatidylglycerol (PG)
Read 8 tweets
1/8
This week’s Tweetorial topic at @jac_amr:

Two to tango? Moving towards individualized antibiotic therapy to identify patients who would benefit from combination therapy
#IDTwitter @lab_rao
3/8
Combination therapy is only associated with improved survival among patients with a high probability of death as measured by the INCREMENT-CPE mortality score
Read 8 tweets
1/ You’re on rounds when a concerned fellow states “They aren’t clearing their bacteremia. It’s day 5 of therapeutic vancomycin and the daily blood cultures are STILL growing MRSA. What agents can we add on or change to clear this bacteremia?” #IDTwitter #NeoTwitter
2/ Is knowing they are a neonatology fellow, caring for a <30 wk GA, 2-week-old for a disseminated MRSA infection (+blood cx with MRI-confirmed osteomyelitis and a 10mm non-obstructive mass in the RA) enough information? How different can babies be from adults?
3/ A LOT different. As the article is titled “Neonates are not just little children”. Neonates have altered protein binding, larger volumes of distribution, smaller fat and muscle stores and immature kidney and liver function.

pubmed.ncbi.nlm.nih.gov/29745792/
Read 16 tweets
NIH ACTIV-6 #ivermectin early #covid19 treatment results with 1591 randomized participants.
No difference in ER visits, hospitalizations, deaths (all numerically higher with IVM, but no statistical difference).
Time to recovery 11 vs 11.5 days. #idtwitter
medrxiv.org/content/10.110…
Activ-6
Hospitalizations or deaths: n=10 ivermectin vs n=9 placebo

ER visits / hospital / death n=32 IVM vs n=28 placebo
The symptom duration data are interesting. The trial is large enough that it can detect differences that are not clinically meaningful, but there are some subgroups that are interesting. Not conclusive as they are small, but hypothesis generating for verification in future arm
Read 12 tweets
A 51-YO🧔‍♂️, in Turkey: dyspnea, cough & production of yellowish, foul-smelling, & salty sputum

XR & CT (A-D): cavitary lesion containing irregular, serpiginous intracavitary material
1/3

DOI: doi.org/10.4269/ajtmh.…
#IDTwitter #radiology
2nd day of hospitalization: fever, myalgia, & sore throat

CT: subpleural ground glass opacities (fig.)

PCR for #SARSCoV2:➕
Eosinophilia
IFA IgG against Echinococcus granulosus:➕at 1/5,120

RUPTURED PULMONARY HYDATIC CYST COMPLICATED BY COVID-19
2/3

#microbiology #MedEd
Gross examination showed removed cyst (fig.).

Surgery combined with medical therapy remains the standard form of treatment of large cysts with multiple daughter cysts, complicated cysts, etc.
3/3

#parasitology #surgery
Read 3 tweets
A 26-YO👩‍🦰, sexually active: 1-month of right knee and metacarpal arthralgia, tenosynovitis & pustules on her hand, developed an enlarging chest wall mass.

CT: an abscess on her chest wall, requiring drainage.
1/4

DOI: doi.org/10.1503/cmaj.2…
#IDTwitter #MedEd Image
Urine gonococcal nucleic acid amplification test: ➕ was positive,
16S rRNA with gene sequencing of wall fluid:➕for Neisseria gonorrhoeae.

DISSEMINATED GONOCOCCAL INFECTION

Ceftriaxone IV stopped after the abscess had resolved
2/4

#MedicalStudents #microbiology
Neisseria gonorrhoeae is transmitted mainly through unprotected vaginal, anal and oral intercourse
3/4

#MedTwitter #MedStudentTwitter
Read 4 tweets
Lactante 4 meses, dermatitis atópica, su hermana con laringitis aguda: erupción papulosa de evolución a costras en 1 día, predominando sobre placas de eccema preexistentes.

Se inician en el tronco, incluyen cabeza, área del pañal y vesículas en boca.
1/5

#pediatria #Pediatrics
PCR (para herpesvirus y enterovirus):➕para enterovirus Coxsackie A6

ECCEMA COXSAKIUM

El A6 produce también: erupción vesículo-bullosa erosiva, cuadro Gianotti-Crosti-like y rash purpúrico-petequial

✒️Martín A y col continuum.aeped.es/screens/play/5… @aepediatria #dermatology
2/5
@aepediatria El eccema coxsackium puede producir fiebre con pápulas, vesículas y costras confluyentes en región peribucal, cuello, tronco, antebrazos, pantorrillas y dorso de manos y pies.

Generalmente, una enfermedad autolimitada con buen pronóstico.
3/5

@ContinuumAEP #Pediatrics
Read 5 tweets
1/
TIL about BORSA/MODSA, so cue the #IDTwitter #Tweetorial.

Thanks to the many contributors on @DrDidwania_ID's post on a very interesting variation of Staph aureus that phenotypically matches MRSA, but does not carry the correct genotype.

/thread
2/
Methicillin resistance is usually conferred by an altered penicillin-binding protein (PBP2a) via the gene mecA (or sometimes mecC).

MecA is detected by current molecular testing as a marker of methicillin-resistance for Staphylococcal species

link.springer.com/chapter/10.100…
3/
What is BORSA & MODSA?

BORSA: borderline oxacillin-resistant Staph aureus
MODSA: modified Staph aureus

Just add this to MSSA, MRSA, VISA, and VRSA in the genre of Staph aureus-related acronyms!!

Key article I referenced for this thread: pubmed.ncbi.nlm.nih.gov/28893360/
Read 12 tweets
Niña de 5 años, araña entre las sábanas (1): fiebre de 2 días y placa eritematosa indurada en muslo con crecimiento centrífugo y una escara necrótica central (2)
¼

✏️M. Sendín-Martín y col. @HospitalUVRocio
DOI: 10.1016/j.anpedi.2020.12.005
#pediatria #Pediatrics
@HospitalUVRocio PICADURA DE LA ARAÑA RECLUSA PARDA

Las arañas del género Loxosceles o arañas reclusas o arañas violinistas debido a la morfología dorsal de su cefalotórax tienen una distribución mundial

La lesión se resolvió los días siguientes, sin dejar cicatriz.
2/4

#MedEd #dermatology
@HospitalUVRocio Las arañas reclusas parda causan lesiones necróticas a través de una enzima denominada esfingomielinasa D1. Los síntomas sistémicos incluyen fiebre o náuseas.

De forma infrecuente, signos graves como coagulación vascular diseminada o la rabdomiólisis
3/4
#IDtwitter #MedTwitter
Read 5 tweets
#IDTwitter #SIDPharm #Microbiology

#AMRrounds Team is called about this laboratory confirmed respiratory isolate. AST QC certify the susceptibility profile (Step 1).

Clinical scenario is consistent with CDC criteria for VAP.
Step 2: Review natural/intrinsic resistance.

Example is CLSI M100
Step 3: Review epidemiology of carbapenem resistant Pseudomonas.

From the ERASE-PA Global Surveillance Program (Gill CM, et al. Eur J Clin Microbiol Infect Dis. 2021] carbapenemase positive resistance is low in the USA compared to other countries.
Read 4 tweets

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