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18 Aug, 8 tweets, 6 min read
1/
 Have you ever been confused about the BCG vaccine?

Check out this graphic that @LeaGoren @AliceCLehman @thie0149 created and the following thread!

#IDTwitter #IDMedEd #MedTwitter #MedPedsID #PedsID
2/💉Bacille-Calmette-Guerin (BCG) immuniz. against TB is a group of related live vaccines derived from attenuated M.bovis.
🌏Used in >100 countries, most widely administered vaccine in world
🧠Given to ⬇️incidence of TB meningitis + miliary dz in children

who.int/immunization/s…
3/
 Bookmark the BCG World Atlas to quickly see BCG vaccination policies by country as well as other information such as TB incidence

bcgatlas.org

While use in the US is uncommon, there are a few select individuals who might be considered for BCG vacc 👇
4/
 BCG + TB testing:
⭐️Many will have +TST after infant BCG vacc, which may or may not wane with time
⭐️BCG for bladder cancer has been reported to convert ~1/2 of patients' TSTs

⭐️IGRAs are NOT affected by BCG vaccination status

55y f/u study of bcg: journal.chestnet.org/article/S0012-…
5/
 Complications of BCG vaccine:
🔹localized skin reactions common
🔹BCG lymphadenitis or abscess can occur
🔹BCG osteomyelitis is a rare cx (listen to the podcast audio for more!)
🔹Disseminated BCG disease can occur in immunocompromised pts (such as young children with SCID)
6/
 Want some other BCG content? A recent tweetorial from @tony_breu discussed use of BCG in bladder cancer if you're interested!

7/
 Check out the podcast episode here:
🍎podcasts.apple.com/us/podcast/fin…
OR
👂febrilepodcast.captivate.fm/listen
8/
 And check out the other episode graphic here:

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More from @febrilepodcast

Febrile Profile picture
15 Sep
1/
 Tired of being confused by syphilis serologies?!
Want more info on who needs an LP?

To complement our newest episode, here are some infographics & pearls about syphilis covered by Khalil Ghanem and @ZachLorenzMD in this 🧵

#IDTwitter #IDMedEd @ID_fellows @MedTweetorials
2/
 First, let's start with four rules to understand and master syphilis serologies from Khalil!

#IDTwitter #IDMedEd
3/
 There are 2 algorithms - do you know what your lab uses?
📘Trad'l starts with nontrep test ➡️then uses trep test to confirm dx
◀️Reverse sequence starts with TT➡️then use NTT to stage your pt

Use this diagram to help sort the possible scenarios 👇

More on those FP/FN next
Read 9 tweets
Febrile Profile picture
17 Aug
1/ A great part of our newest ep. is the discussion about immigrant & refugee health assessments. Check out the great image from our guests @AliceCLehman @LeaGoren @thie0149 ! 👇

Keep scrolling for more resources/links

#IDMedEd #IDTwitter #MedPedsID Image
2/
 Children born outside of the US are vulnerable to increased morbidity due to the lack of awareness of their migration journey and indications for screening/tx. @AliceCLehman outlined some of the definitions that are often used Image
3/
 A key point from @AliceCLehman: refugee children are provided predeparture screening/treatment, which is coordinated with the International Office of Migration -- but immigrant/migrant children do not always undergo the same screens; may have variable predeparture environments Image
Read 8 tweets
Febrile Profile picture
11 Feb
1/
 Liver abscess is estimated to occur in about 1/3 of patients with CGD. In the episode, we discussed how a liver abscess may have distinct characteristics in the setting of CGD

#IDTwitter #IDMedED #PedsID @ID_fellows

PLA = pyogenic liver abscess
2/
 PLA in CGD:
📌septate mass surrounded by a thick pseudocapsule
📌Inside=dense inspissated fluid.
📌Can be homogenously enhancing on imaging while small, but then develop mult locules separated by thick enhancing septations with intense halo/rim of enhancement around abscess
3/
 Read more here about hepatic abscess in pts with CGD:
pubmed.ncbi.nlm.nih.gov/11882760/

pubmed.ncbi.nlm.nih.gov/16861554/ ➡️ look at Fig 3!
Read 9 tweets
Febrile Profile picture
10 Feb
1/ We didn’t cover all of this in Ep.4, but the case is a good reminder to think about the various imaging findings in liver infection

Knowing the defining features & ddx of liver abscess; hydatid cysts; and mult small nodules is very useful!

#IDTwitter #IDMedEd #MedTwitter
2/
 A lot of info for 1 page but a few 🗝️points:
🔸Pyogenic+amebic liver abscess can be indistinguishable on imaging
🔸Echinococcus: check out the WHO classification
🔸Ddx mul small solid nodular liver lesions has a wide ddx. For ID, includes TB/Bartonella/Disseminated fungal inf
3/
 Here is a nice summary article tackling liver infection imaging + potential pitfalls:

pubs.rsna.org/doi/10.1148/rg…

The authors had a flowchart to help think about ddx based on imaging ➡️their 1st branch point = dominant cystic lesion or multiple small solid nodular lesions?
Read 4 tweets

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