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First of 2 tweets! #GalactoMagic
30M from Indiana w/ peptic ulcer disease presents w/ abdominal pain & hematemesis. He reports taking ibuprofen 4000mg daily for the past 3 weeks. T 38.5C, HR 120, BP 100/60, RR 18, O2 93% on RA. Labs notable for WBC 11,000, Hb 4, plt 155,000
First of 2 tweets! #GalactoMagic
30M from Indiana w/ peptic ulcer disease presents w/ abdominal pain & hematemesis. He reports taking ibuprofen 4000mg daily for the past 3 weeks. T 38.5C, HR 120, BP 100/60, RR 18, O2 93% on RA. Labs notable for WBC 11,000, Hb 4, plt 155,000
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Over the next 2 days, the patient receives 10 units of blood products. On day 3, the patient has a fever. A serum beta-d-glucan is ordered and results at 90 (positive > 80). What is the likely cause of the beta-d-glucan elevation?
Over the next 2 days, the patient receives 10 units of blood products. On day 3, the patient has a fever. A serum beta-d-glucan is ordered and results at 90 (positive > 80). What is the likely cause of the beta-d-glucan elevation?
1/11
Answer: Positive from blood products
🍎Patient developed an upper GI bleed from excess ibuprofen, requiring 10 units of blood products
🍊Blood products can contain glucans, and once infused into patients, it may cause a positive serum BDG. Plasma and IVIg can also do this
Answer: Positive from blood products
🍎Patient developed an upper GI bleed from excess ibuprofen, requiring 10 units of blood products
🍊Blood products can contain glucans, and once infused into patients, it may cause a positive serum BDG. Plasma and IVIg can also do this
2/
Ibuprofen itself does not cause +BDG
⭐️Although aspergillus can cause a positive BDG, the question does not suggest any signal for aspergillus (no host factors or clinical picture consistent with aspergillosis)
Ibuprofen itself does not cause +BDG
⭐️Although aspergillus can cause a positive BDG, the question does not suggest any signal for aspergillus (no host factors or clinical picture consistent with aspergillosis)
3/
As we have reviewed in the past, typically blasto does not result in a positive BDG. We see in our Venn diagram that Blasto is on the perimeter of the BDG circle
pubmed.ncbi.nlm.nih.gov/29125373/
As we have reviewed in the past, typically blasto does not result in a positive BDG. We see in our Venn diagram that Blasto is on the perimeter of the BDG circle
pubmed.ncbi.nlm.nih.gov/29125373/
4/
The reason that Blasto is called a dimorphic fungus is because in the environment at lower temperatures, it is found as a mold. At higher temperatures (in humans), it is found as a yeast.
The reason that Blasto is called a dimorphic fungus is because in the environment at lower temperatures, it is found as a mold. At higher temperatures (in humans), it is found as a yeast.
5/
Blasto cell wall as a mold (environment) has a 60/40 ratio of 1,3-α glucan/1,3-B glucan (BDG)
🌈When it transitions from mold to yeast in humans, the amount of 1,3-α glucan in the cell wall increases from 60 to 95%, while BDG decreases from 40 to 5%!
pubmed.ncbi.nlm.nih.gov/5557599/
Blasto cell wall as a mold (environment) has a 60/40 ratio of 1,3-α glucan/1,3-B glucan (BDG)
🌈When it transitions from mold to yeast in humans, the amount of 1,3-α glucan in the cell wall increases from 60 to 95%, while BDG decreases from 40 to 5%!
pubmed.ncbi.nlm.nih.gov/5557599/
6/
This is why on the Venn diagram, blasto is found on the BDG perimeter, as the Blasto yeast phase (what we find in humans), can produce very little BDG
This is why on the Venn diagram, blasto is found on the BDG perimeter, as the Blasto yeast phase (what we find in humans), can produce very little BDG
7/
In the case of blood products, the filtration of blood plasma through cellulosic filters can result in leached plant BDG, which is then transfused in patients and can cause elevated serum BDG results
This elevation in BDG is transient
In the case of blood products, the filtration of blood plasma through cellulosic filters can result in leached plant BDG, which is then transfused in patients and can cause elevated serum BDG results
This elevation in BDG is transient
8/
Although I do not know of studies that show the transient rise and fall of serum BDG levels with packed red blood cells, we have some data with IVIg
Although I do not know of studies that show the transient rise and fall of serum BDG levels with packed red blood cells, we have some data with IVIg
9/
This study looked at BDG levels in patients that received IVIg (pre and post) and compared to those who did not receive IVIg
🌝IVIg led to positive BDG results in a majority of patients, all of which cleared 3 weeks after the infusion
pubmed.ncbi.nlm.nih.gov/29174967/
This study looked at BDG levels in patients that received IVIg (pre and post) and compared to those who did not receive IVIg
🌝IVIg led to positive BDG results in a majority of patients, all of which cleared 3 weeks after the infusion
pubmed.ncbi.nlm.nih.gov/29174967/
10/
BDG can help in diagnosing invasive fungal infections (IFI) while considering host factors, clinical presentation, & prevalence of the fungal infection in your pt population
If +BDG doesn't fit w/ an IFI, ask these Qs to evaluate other causes of +BDG
pubmed.ncbi.nlm.nih.gov/33383818/
BDG can help in diagnosing invasive fungal infections (IFI) while considering host factors, clinical presentation, & prevalence of the fungal infection in your pt population
If +BDG doesn't fit w/ an IFI, ask these Qs to evaluate other causes of +BDG
pubmed.ncbi.nlm.nih.gov/33383818/
11/
For a review of test characteristics of serum BDG and GM, which pathogens test positive for both biomarkers, and the causes of “false positive”, I refer you to this wonderful table by @febrilepodcast and @swinndong
For a review of test characteristics of serum BDG and GM, which pathogens test positive for both biomarkers, and the causes of “false positive”, I refer you to this wonderful table by @febrilepodcast and @swinndong
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