Profile picture
, 5 tweets, 2 min read
My Authors
Read all threads
1/
 Mini-review of three high yield NRTI mutations from rounds today -- Keep scrolling for more!
2/
 🧬🧬M184V🧬🧬

💠selected by Emtricitabine (FTC), Lamivudine (3TC)
💠High resistance to: FTC/3TC
⬇️viral fitness
⬆️susceptibility tenofovir (TDF/TAF), zidovudine (AZT)

💠Pt may stay on FTC or 3TC with M184V in order to maintain ⬇️fitness + hypersusceptibility to TAF/TDF
3/
 🧬🧬K65R🧬🧬
💠selected by TDF/TAF
💠High resistance to tenofovir; cross-class resistance except for AZT
⬆️AZT susceptibility
⬇️viral fitness*

*additive with M184C
4/
 🧬🧬TAMs (thymidine analogue mutations)🧬🧬
💠2 pathways
(1) M41L, L210W, T215F/Y
(2) D67N, K70R, K219Q

💠selected by AZT, Stavudine (d4T)
⬇️all NRTIs. Type 1 has greater impact on tenofovir
5/
 #IDTwitter #MedTwitter #HIVtwitter
Missing some Tweet in this thread? You can try to force a refresh.

Keep Current with BIDMC Infectious Diseases Fellowship

Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!

Twitter may remove this content at anytime, convert it as a PDF, save and print for later use!

Try unrolling a thread yourself!

how to unroll video

1) Follow Thread Reader App on Twitter so you can easily mention us!

2) Go to a Twitter thread (series of Tweets by the same owner) and mention us with a keyword "unroll" @threadreaderapp unroll

You can practice here first or read more on our help page!

Related hashtags

#IDTwitter #MedTwitter #HIVtwitter

More from @BIDMC_IDFellows see all

Profile picture
BIDMC Infectious Diseases Fellowship
@BIDMC_IDFellows
1/
 50M comes to clinic with severe pain on his index finger. It progressed to violaceous lesion with raised borders. PIP/DIP/MCP jts without effusion. No fevers and otherwise feels well.

Works as fisherman on the Cape

What organism?

#IDTwitter #MedTwitter #IDMedEd #FOAMed
2/
 👍Correct answer = E.rhusiopathiae, a GP bacillus
🌳Widespread in nature, infecting domestic and marine animals
🦀Infections in humans often from occupational exposure: animal processing, butchers, fisherman, farmers, vets
🔽Break down clinical syndromes into 3 categories:
3/
 1) Localized cutaneous (erysipeloid) inf, most common
▪️Subacute cellulitis, often hands/fingers (site of exposure), abrasion/wound can be portal of entry
▪️Might hear: seafood packer handling contaminated 🐟/🦀or similar -- but also think about w/😼🐶bites
▪️Incubation: 2-7d
Read 10 tweets
Profile picture
BIDMC Infectious Diseases Fellowship
@BIDMC_IDFellows
1/
 A couple (55M/52F) p/w fever 39F, myalgias, dry cough, and mild diarrhea. Pt and his wife love their pet cockatiels (Charlie + Angel). You dx psittacosis!

Pts ask what should happen to their 🦜🦜, what do you say? #MedTwitter #IDTwitter #IDMedEd
2/
 Let's learn about psittacosis in humans before we get to the poll answer!

🦠Chlamydia psittaci
🧫Obligate intracellular GN bacteria
🔹22 cases were reported in 2018 to CDC NNDS

🦜Birds are primary zoonotic reservoir (altho has been seen in other animals eg sheep, cattle) Image
3/
 🦠C.psittaci documented in >450 spp of birds
🦜Most human inf = pet psittacine 🦜(parakeet/cockatiel/cockatoo/parrot)
🔹Also seen: 🦃,🐔,🦆 , pigeon etc
💥Outbreaks related to pet shops, aviaries, vet facilities, poultry processing (2018, 🐔plant➡️ncbi.nlm.nih.gov/pmc/articles/P…)
Read 9 tweets
Profile picture
BIDMC Infectious Diseases Fellowship
@BIDMC_IDFellows
1/
 Case #2 fr Michelle!
75M with prostate ca s/p rad, HTN
4d back pain, confusion per wife
Likes to garden and spend time outdoors
Noted incidentally to have scattered rash on trunks/extremities

Labs:
WBC 15k, H&H 13.3/38.9
Na 128
Cr 0.6
AST/ALT 50s Image
2/
 Dx'd with early disseminated Lyme.
Has evidence of 1st degree AV block on EKG
Has had some mild mental status fluctuations with confusion per wife but otherwise cognitively intact. No meningismus on exam.
Na 128 --> 125

How would you treat? #IDTwitter #MedTwitter #IDMedEd
3/
 We recently discussed early disseminated Lyme and its manifestations!
Read 6 tweets

Embed code for your website

×
Follow Us on Twitter!

Did Thread Reader help you today?

Support us! We are indie developers!

This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3.00/month or $30.00/year) and get exclusive features!

Become Premium

Too expensive? Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal Become our Patreon

Thank you for your support!