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This is the first of 2 tweets! #GalactoMagic
62M w/ PMHx of liver transplant 8 months ago presents w/ 3 weeks of cough & fevers. He recently moved from Indiana (where he had his transplant) to Florida. He has been adherent to his meds (tacro, mycophenolate, pred, trim/sulfa)
This is the first of 2 tweets! #GalactoMagic
62M w/ PMHx of liver transplant 8 months ago presents w/ 3 weeks of cough & fevers. He recently moved from Indiana (where he had his transplant) to Florida. He has been adherent to his meds (tacro, mycophenolate, pred, trim/sulfa)
2/
T 38.1C, HR 99, BP 115/85, RR 16, 95% on RA. Exam notable for shallow ulcer on soft palate. CT chest shows new nodules bilaterally in lung parenchyma. Serum BDG assay is 85 (positive>80), serum GM index is 0.55 (positive>0.5). Patient likely has which infection?
T 38.1C, HR 99, BP 115/85, RR 16, 95% on RA. Exam notable for shallow ulcer on soft palate. CT chest shows new nodules bilaterally in lung parenchyma. Serum BDG assay is 85 (positive>80), serum GM index is 0.55 (positive>0.5). Patient likely has which infection?
1/8
This patient from Indiana had a liver transplant 8 months ago & presented w/ a palate ulcer, pulm nodules, & a positive BDG & GM, all of which point to disseminated histo
This patient from Indiana had a liver transplant 8 months ago & presented w/ a palate ulcer, pulm nodules, & a positive BDG & GM, all of which point to disseminated histo
2/
PJP should not cause a positive GM or a soft palate ulcer, crypto rarely causes a positive BDG, & mucorales should not cause either a positive BDG/GM. For a review of which fungi can lead to a positive BDG or GM, please see this Venn diagram
pubmed.ncbi.nlm.nih.gov/29125373/
PJP should not cause a positive GM or a soft palate ulcer, crypto rarely causes a positive BDG, & mucorales should not cause either a positive BDG/GM. For a review of which fungi can lead to a positive BDG or GM, please see this Venn diagram
pubmed.ncbi.nlm.nih.gov/29125373/
3/
I want to draw your attention to the global reach of histo.
We say “endemic” but in fact it is really an infection that happens globally (except Antarctica). This review looked at the geographic landscape of endemic mycoses worldwide
pubmed.ncbi.nlm.nih.gov/32040709
I want to draw your attention to the global reach of histo.
We say “endemic” but in fact it is really an infection that happens globally (except Antarctica). This review looked at the geographic landscape of endemic mycoses worldwide
pubmed.ncbi.nlm.nih.gov/32040709
4/
When you're approaching a patient w/ possible Histo, it’s important to think about the host & risk factors. Below is a very nice table taking into account the epidemiologic (region and activities), host (cellular deficiencies), & pathogen risk factors
pubmed.ncbi.nlm.nih.gov/28797485/
When you're approaching a patient w/ possible Histo, it’s important to think about the host & risk factors. Below is a very nice table taking into account the epidemiologic (region and activities), host (cellular deficiencies), & pathogen risk factors
pubmed.ncbi.nlm.nih.gov/28797485/
5/
Gold standard for diagnosis is seeing yeast on path. However, it's not the most sensitive. An important consideration for testing is what kind of histo syndrome you're trying to diagnose. Depending on the syndrome, the sensitivity of your test changes
pubmed.ncbi.nlm.nih.gov/32000281/
Gold standard for diagnosis is seeing yeast on path. However, it's not the most sensitive. An important consideration for testing is what kind of histo syndrome you're trying to diagnose. Depending on the syndrome, the sensitivity of your test changes
pubmed.ncbi.nlm.nih.gov/32000281/
6/
Pulm histo syndromes can differ with respect to time course, imaging, diagnostics & treatment. Thankfully, Dr. Marwan Azar and others created this great table that separates acute, subacute, chronic, and progressive disseminated histo
pubmed.ncbi.nlm.nih.gov/32000281/
Pulm histo syndromes can differ with respect to time course, imaging, diagnostics & treatment. Thankfully, Dr. Marwan Azar and others created this great table that separates acute, subacute, chronic, and progressive disseminated histo
pubmed.ncbi.nlm.nih.gov/32000281/
7/
Serum BDG & GM are not primarily used for the work up of histoplasmosis because they are neither sensitive or specific for its diagnosis, but if the tests are sent and return positive, you can use these tests to help you if you have the appropriate host and clinical syndrome
Serum BDG & GM are not primarily used for the work up of histoplasmosis because they are neither sensitive or specific for its diagnosis, but if the tests are sent and return positive, you can use these tests to help you if you have the appropriate host and clinical syndrome
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