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
First, let's start with four rules to understand and master syphilis serologies from Khalil!

#IDTwitter #IDMedEd
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
To really hammer this home, check out this chart as well, which includes false positives.

⭐️What is a prozone effect? FN result due to high Ab titers that interfere with the Ag/Ab complex formation (imbalance of Ag and Ab)➡️if you suspect, discuss with lab to dilute specimen
A pearl from Khalil in the episode: in secondary syphilis, usually everyone has reactive serologies!

If they don't, think about the prozone phenomenon and reconsider what might be going on (that isn't syphilis!)
Moving to the next question: who needs an LP in syphilis? We know that CSF exam is necessary with neuro sxs, but what about these other situations that often come up?

Check out this guide below based on what Khalil discussed in this episode
📌Remember that no single test can be used to diagnose neurosyphilis (combo of CSF testing + reactive serology + neuro s/s)
▪️50% of neurosyphilis cases have negative CSF VDRL (highly specific but insensitive)
▪️CSF trep tests are very sensitive but not specific
📌Last note on neurosyphilis: CSF pleiocytosis is a sensitive test (although not specific)

Listen to the ep. if you haven't already!
Or wherever you listen to 🎙️febrilepodcast.captivate.fm/listen

Let me know if you have other tips or recs for these notes!
⭐️A great overview of syphilis from our guest: pubmed.ncbi.nlm.nih.gov/32101666/

⭐️2021 CDC STI GL: cdc.gov/std/treatment-…

⭐️Check out the @IDSAMedEdCOP Chalk Talk on syphilis from @Darcy_ID_doc for another ID fellow resource for teaching about serologies

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More from @febrilepodcast

18 Aug
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

Bookmark the BCG World Atlas to quickly see BCG vaccination policies by country as well as other information such as TB incidence


While use in the US is uncommon, there are a few select individuals who might be considered for BCG vacc 👇
Read 8 tweets
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
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
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
11 Feb
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
📌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
Read more here about hepatic abscess in pts with CGD:

pubmed.ncbi.nlm.nih.gov/16861554/ ➡️ look at Fig 3!
Read 9 tweets
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
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
Here is a nice summary article tackling liver infection imaging + potential pitfalls:


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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