Thanks to the many contributors on @DrDidwania_ID's post on a very interesting variation of Staph aureus that phenotypically matches MRSA, but does not carry the correct genotype.
10/ So how do you treat BORSA, as it is neither MRSA nor MSSA?
Practically, you treat BORSA just like MRSA.
However, if you can demonstrate a 2-fold decrease in MIC with use of a beta-lactamase inhibitor, then a BL/BLI could be used
11/ In summary:
💥 BORSA: borderline oxacillin-resistant Staph aureus
💥 Resistance mediated by beta-lactamases
💥 No mecA or PBP2a, negative cefoxitin disc
💥 Treat similar to MRSA
12/ Thanks again to the commenters on @DrDidwania_ID's fascinating post for teaching.
Tagging amplifiers & those interested. Welcoming comments, as I just learned about this today!
1/ Wow, finishing up my last rotation as a 1st year ID fellow on gen ID has been a whirlwind @UNMC_ID! Had an all-star group of faculty (@Cortes_Penfield, @fadul_nada & @DrJRMarcelin) and an amazing group of residents, students & pharmacists! Time to review a month of learning:
2/ Let's start with an unusual one:
Syphilis can be inoculated via tattoos or manifest with a rash within the tattoo in secondary syphilis. This localization is thought to be due to decreased immune response within the tattoo. pubmed.ncbi.nlm.nih.gov/30363028/ ijam-web.org/article.asp?is…
3/ Erythema multiforme has classic target lesions and can cause mucus membrane involvement. Classic triggers are HSV & Mycoplasma pneumoniae. Adenovirus is also associated, especially with ocular & genital involvement. sciencedirect.com/science/articl… medicaljournals.se/acta/content/h…
1/ Haven't done this in awhile, but want to share some great literature we discussed this week while on the @UNMC_ID general ID service! So happy to have a big multidisciplinary team led by @DrJRMarcelin along with our pharmacists @Molly_M_Miller & @bergmanscott!
2/ Will start with my favorite article on carbapenem-resistant gram-negative infections from Doi et al with my own adaptation of their super useful table
My 3rd week of general ID @UNMC_ID has come to a close with #PasteurellasFellas, led by the wonderful @KellyCawcuttMD! Really appreciate her critical care insight on ID. We had some fascinating discussions this week. Time for another recap! #IDTwitter#IDPearls
A fundamental question this week was TB or not TB (sorry, not sorry for the pun @bergmanscott)
We discussed the differential diagnosis of miliary nodules on imaging. TB leads the list, but dimorphic fungi (histo, blasto, cocci) can be just as common in endemic areas. Malignancy as well.
1/ While on my current GI rotation, I've been reading about Clostridioides difficile because, you know, #IDNerd. I ran across something I had not learned about before:
2/
What is the name of the strain of hypervirulent CDiff?
3/
The hypervirulent strain of CDiff is known as NAP1/B1/027, which stands for North American pulsed-field gel electrophoresis type 1, restriction endonuclease analysis type B1, PCR ribotype O27.
3/ Dating back to 1959, Israel & Goldstein found fever to be the most common sign in patients with PE (78.9%), 10% with temp >39.5C. They admit infection to be an underlying cause. Additionally, PE made based on CXR & EKG findings & autopsy.