Sara Dong Profile picture
24 Oct, 19 tweets, 16 min read
#IDWeek2020
Session: Viral infections in Ped SOT
Starting with Sharon Chen
#IDWeek2020
Session: Viral infections in Ped SOT
Sharon Chen

1) Thinking about CMV through a new lens
#IDWeek2020
Session: Viral infections in Ped SOT
Sharon Chen

2) Grateful for the discussion on EBV+PTLD one of my interests, we have so so much to learn about this relationship in both adults and pediatrics
#IDWeek2020
Session: Viral infections in Ped SOT
Sharon Chen

It is not as easy as monitoring EBV VL
DNAemia doesn't always translate to more PTLD, there can be a disconnect

We have a lot of space to learn in this area, so hopefully a good place for fellows to jump in!
#IDWeek2020
Session: Viral infections in Ped SOT

3) Thinking about adenovirus and pediatric SOT

Children <2yo may be the ones who need more help, and can we focus picture on those with high risk
#IDWeek2020
Session: Viral infections in Ped SOT
@posfay

Live vaccines after SOT

Can check out these surveys:
pubmed.ncbi.nlm.nih.gov/32964637/
onlinelibrary.wiley.com/doi/abs/10.111…
#IDWeek2020
Session: Viral infections in Ped SOT
@posfay

Tripod/questions to consider for LAV after SOT
#IDWeek2020
Session: Viral infections in Ped SOT
@posfay
#IDWeek2020
Session: Viral infections in Ped SOT
@posfay

Reference:
onlinelibrary.wiley.com/doi/abs/10.111…
#IDWeek2020
Session: Viral infections in Ped SOT

Thanks @posfay !
#IDWeek2020
Session: Viral infections in Ped SOT
Ravi Jhaveri
#IDWeek2020
Session: Viral infections in Ped SOT
Ravi Jhaveri

Starting with HCV

I learned about data on glecaprevir/pibrentasvir (mavyret) in pediatrics

pubmed.ncbi.nlm.nih.gov/31254392/
#IDWeek2020
Session: Viral infections in Ped SOT
Ravi Jhaveri

Saying yes to HCV+ donors
#IDWeek2020
Session: Viral infections in Ped SOT
Ravi Jhaveri

HBV

Key: exists as a closed circular chromosome within nucleus ➡️ because of this, there is no "cure" after HBV infection, only various level of immune control

Because of CCC, liver is forever a reservoir for HBV
#IDWeek2020
Session: Viral infections in Ped SOT
Ravi Jhaveri

HBV

Key resource from @AST_IDCOP : onlinelibrary.wiley.com/doi/full/10.11…
#IDWeek2020
Session: Viral infections in Ped SOT
Ravi Jhaveri

HBV + Transplant scenarios
#IDWeek2020
Session: Viral infections in Ped SOT
Ravi Jhaveri

HBV Vaccination Pre-transplant
#IDWeek2020
Session: Viral infections in Ped SOT
Ravi Jhaveri

How about non-responders?

Follow titers post-tx: if HBV titers fall below 10 IU/ml, revaccinate
#IDWeek2020
Session: Viral infections in Ped SOT
Ravi Jhaveri

Recent changes when thinking about increased risk

Saving link! optn.transplant.hrsa.gov/governance/pub…

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More from @swinndong

24 Oct
#IDWeek2020
Session: Cutting edge adult&ped #TxID

First up, @BrianFisher95 on adenovirus and EBV
#IDWeek2020
Session: Cutting edge adult&ped #TxID
@BrianFisher95

Adenovirus reactivation is more common in pediatric HCT pts, so age is significant risk factor

Chart with reactivation rates, mostly ped data 👇 Progression to sx dz in peds is not uncommon
#IDWeek2020
Session: Cutting edge adult&ped #TxID
@BrianFisher95

So what to do when adenovirus is positive
Read 34 tweets
24 Oct
#IDWeek2020
So excited for challenging cases in #TxID !

Pearlie Chong @PergamIC @ShohamTxID @nikkitheomd @IDdoc4kids Kate Mullane
#IDWeek2020
Session: Challenging Cases in #TxID
56 yo post-auto HSCT with fever, wt loss, scleral icterus. Labs with low WBC, anemia, elevated LFTs. Not neutropenic.

Check out the smear!
#IDWeek2020
Session: Challenging Cases in #TxID

Dx: Babesiosis - Familiar to us here in MA, but this case was from WA!

Very tough to manage in immunosuppressed pts, require prolonged courses
Read 19 tweets
23 Oct
#IDWeek2020
Session: OPAT in PWID
@mmPharmD

Thinking about how PWID can be treated with OPAT at home
#IDWeek2020
Session: OPAT in PWID
@mmPharmD

OPAT completion in PWID was comparable to those who do not inject drugs

Retrospective studies of carefully selected pts -- but that is also true of who you select in real life
#IDWeek2020
Session: OPAT in PWID
@mmPharmD

No difference in keeping of appts, infusion location, infection type

Longer period of abstinence may indicate better OPAT outcome
Read 13 tweets
23 Oct
#IDWeek2020
Session: Hospital infection control and environmental sustainability: challenges and opportunities!
@preets579

Infection prevention reality vs environmental sustainability - can we achieve a balance?
#IDWeek2020
Session: Hospital IC: challenges and opportunities!
@preets579

Learned about life cycle assessments today!

Reusable gowns had 28% reduction in energy consumption, but data is variable - as in those that did note advantage to reusable laryngoscopes vs single use
#IDWeek2020
Session: Hospital IC: challenges and opportunities!
@preets579

Manufacturers are incentivized to make single use products based on recommendations -- so what is the opportunity here? Does the frame of emerging pathogens shape our ethos towards single use devices?
Read 6 tweets
23 Oct
#IDWeek2020
Session: Challenging Cases #PedsID

Some case thinking in a "COVID-free zone"
#IDWeek2020
Session: Challenging Cases #PedsID

Cerebral toxoplasmosis in alloHCT pt

CSF cytology actually noted tachyzoites - great image!
#IDWeek2020
Session: Challenging Cases #PedsID

Fusobacterium necrophorum causing liver and renal abscess

Anonymous vampire pic appreciated 🧛
Read 7 tweets
22 Oct
#IDWeek2020
Now to watch Mano a Mano, always a great session!! @PIDSociety
#IDWeek2020 #PedsID
Session: Mano a Mano
Should we tx + tracheal cultures?

Con: @asicksamuels
3 Reasons not to treat:
1. Positive cxs do not equal infection
2. Trach cxs are unreliable
3. Treated positive trach cxs do not equal improved outcomes
+
Risk patient harm from over-tx
#IDWeek2020 #PedsID
Session: Mano a Mano
Should we tx + tracheal cultures?

Pro:
VAT assoc'd w/⬆️duration of mech vent, ICU LOS, mortality
Tx of VAT can prevent progression to VAP and perhaps mortality
Treating VAT w/impaired oxygenation is really tx'ing VAP, which is warranted
Read 10 tweets

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