Tweet

𝗡𝗶𝗵𝗮𝗿 𝗗𝗲𝘀𝗮𝗶

Dec 7 • 10 tweets • 5 min read

Hey #medicine residents !!

Let's talk a bit about #mucormycosis today, the monster fungus 😡

Horrible infection w/ an unreasonably high mortality (40-80%) 😭

Risk factors:
🔸DM
🔸Neutropenia
🔸Post-HSCT

DM- Rhino-orbito-cerebral mucor
Neutropenia- Pulmonary mucor

#MedTwitter

The disease is caused by fungi of the order "MUCORALES"

This includes rhizopus/mucor/licthemia/cunninghemela species 😮

DON'T WORRY species identification doesn't change treatment so we don't need to get to that 🙏🏻

#MedTwitter

Coming to the PRACTICAL POINTS that need to be remembered !

🔸Obtain IMAGING even at the slightest suspicion of mucor coz it's RAPIDLY PROGRESSIVE and kills quick.

🔸CT PNS/Orbits
🔸MRI Brain
🔸HRCT chest as per presentation

#MedTwitter

Rx= SURGERY + ANTIFUNGALS

REMEMBER, it's SURGERY and antifungals!!

Urgent SURGICAL DEBRIDEMENT improves outcomes dramatically. Keep your surgery colleagues in the loop 🙏🏻

#MedTwitter

Coming to the drugs💪🏼

⭐1st choice Antifungal:

🔸Liposomal AmpB at 5mg/kg ✅
🔸AmpB deoxycholate ❌

⤴️dose: 10mg/kg for CNS mucor !!

⭐2nd choice:

🔸Isavuconazole ✅
🔸Posaconazole ✅
🔸 Voriconazole ❌

Isavu @ 200mg TDS for 2d➡️200 OD
Posa @ 300mg BD on D1➡️300mg OD

How do we know if the patient is getting better ??

Clinical improvement, obviously. But it may not be very pronounced 😭

So we REPEAT IMAGING WEEKLY if required 😱

Plz keep your surgery colleagues in the loop yet again. Let them re-evaluate the patient 🙏🏻

#MedTwitter

HOW LONG do we continue the ANTIFUNGALS??

Glad you asked !!
The answer is, I don't know 😭

The duration of therapy isn't defined. Most of us will continue till there is resolution of the risk factor 😱

Thus it seems prudent to PREVENT this horrible infection 🙏🏻

How do we do that ?

🔸Keep your sugars in check.
🔸Take your diabetes meds/insulin.
🔸Don't use steroids unless advised.

Now we know MUCOR IS BAD, it's important to know that the drugs used to treat it are not so pleasant either 😭

#MedTwitter

Issues w/ Amphotericin B:
🔸Infusion reactions
🔸⤵️K / ⤵️Mg
🔸 Kidney injury
🔸Cost

Issues w/ azoles:
🔸Hepatotoxicity
🔸Drug-drug interactions
🔸⤴️QT (not isavuconazole)
🔸Cost

#MedTwitter

Hope you guys enjoyed this short thread 👍🏻

#MedTwitter #MedEd

• • •

Missing some Tweet in this thread? You can try to force a refresh

This Thread may be Removed Anytime!

Twitter may remove this content at anytime! Save it as PDF for later use!

More from @nihardesai7

𝗡𝗶𝗵𝗮𝗿 𝗗𝗲𝘀𝗮𝗶

@nihardesai7

Nov 10

If you are a #medicine resident you will be called by your colleague to consult on this topic 👇🏻

**𝐇𝐞𝐩𝐚𝐫𝐢𝐧 𝐈𝐧𝐝𝐮𝐜𝐞𝐝 𝐓𝐡𝐫𝐨𝐦𝐛𝐨𝐜𝐲𝐭𝐨𝐩𝐞𝐧𝐢𝐚**

If you wanna revise, read this thread 👇🏻

#MedTwitter

1/18

Let's get this right, you'll get a lot of consults for suspected HIT. Most of them won't turn out to be HIT but you must know what to do in case it is HIT !

Is every TCP in a patient receiving heparin, HIT?
NOOOO, obviously NOT

The incidence is <1% of all pts on heparin😮

2/18

Why is it so important to recognise it?

Because HIT is not simply thrombocytopenia 😮

It's TCP + THROMBOSIS.

That's bad, very bad !!

Can be limb or life threatening 😭😭

3/18

#MedTwitter

Read 19 tweets

𝗡𝗶𝗵𝗮𝗿 𝗗𝗲𝘀𝗮𝗶

@nihardesai7

Nov 8

You know you are a #hematologist when you see more fungal pneumonia than bacterial pneumonia😭

🔸Why are they so common?
IMMUNOSUPRESSION !

🔸The most common cause?
ASPERGILLUS FUMIGATUS

🔸Treatment of choice?
VORICONAZOLE

Let's run through some common radiological findings👇🏻

Image 👇🏻 shows a "HALO SIGN"

The central "nodule" contains the fungal hyphae, the "halo" around represents hemorrhage caused by the angio-invasiveness of the fungus.

This is an EARLY FINDING !!

It is NOT SPECIFIC for IPA, can be seen in GPA etc.

#MedTwitter

A couple of weeks pass by, you treat with voriconazole and the patients neutropenia has also recovered 💪🏼

You repeat a CT and see this👇🏻

This is an "AIR CRESENT SIGN" and signals an improvement in the immune response against aspergillus !!

#MedTwitter

Read 5 tweets

𝗡𝗶𝗵𝗮𝗿 𝗗𝗲𝘀𝗮𝗶

@nihardesai7

Nov 6

You are a young #medicine resident, again 🤣

You are called in for a consult by your OBGYN colleagues, this happens a lot🤣

THROMBOCYTOPENIA (TCP) yet again !

But now we know the basics, rule out pseudoTCP etc. So that's done!

The patient is really thrombocytopenic

What now?

1st Q: What TRIMESTER ??

Trust me, it's important for you to know this.

Let's say the patient is 34 wks; has a manual count of 120k.

We are not worried, this could be gestational TCP but it's a DX of exclusion = r/o alternate causes

Also, TCP never <50k here !

2/15

But what are the other causes ?

There are many, but let's start with some common ones !!

Wait, did you check the blood pressure ??

If not, do it STAT !!

⤴️BP + ⤴️proteinuria = Pre-eclampsia.

Point to make, consider Pre-eclampsia as a DDx for TCP in pregnancy !

3/15

Read 16 tweets

𝗡𝗶𝗵𝗮𝗿 𝗗𝗲𝘀𝗮𝗶

@nihardesai7

Nov 2

You are a young #medicine resident, you recieve a call from your surgery colleague 📞

The patient posted for surgery has THROMBOCYTOPENIA (TCP) 😲😭

Here's what you need to know 👇🏼

#MedTwitter

1/12

Does the patient REALLY have TCP ?

TCP is defined as platelet count <150k !!

So, 149k is TCP right ?

Yes, but get a smear to look for platelet clumps, satellitism, large platelets etc.
The smear tells you a lot 💪🏼

2/12

Let's enlist what one commonly finds on a BLOOD FILM !!

Platelet clumps = pseudoTCP d/t EDTA
Large platelets = platelet destruction
Schistocytes = TTP/ DIC
Blasts/ atypical cells = leukemia

3/12

Read 12 tweets

𝗡𝗶𝗵𝗮𝗿 𝗗𝗲𝘀𝗮𝗶

@nihardesai7

Mar 3

Hey #hematology aspirants, let's talk about #CMV today !! Post allogenic transplant CMV prophylaxis and pre-emptive therapy to be precise.

A short thread 🧵

1/n

#MedTwitter #MedEd #hematology

CMV a DNA virus, one of the commonest causes of infections post HSCT

Has the largest genome of any known human virus [200 genes]

Most humans harbour latent CMV, infection aquired in childhood.

Site of latency in humans-❓
In murine models- hepatic sinusoidal cells.

2/n

The risk of reactivation depends on CMV sero status:
D-/R+ > D+/R+ > D+/ R- > D- / R -

Other risk factors are:
1️⃣T cell depletion
2️⃣HaploSCT
3️⃣UCB SCT
4️⃣GVHD requiring steroids

So why not give prophylaxis to these "high-risk" patients ??

3/n

Read 11 tweets

𝗡𝗶𝗵𝗮𝗿 𝗗𝗲𝘀𝗮𝗶

@nihardesai7

May 16, 2021

Want to know why #Mucormycosis is more common post #COVID19 and not so common after leukemia's or other illnesses treated with steroids ?

Read on !!

These are the major reasons in my opinion:

1. The NUMBER of #COVID19 pts is far GREATER than the number of leukemia pts we treat in a year. Thus a lot more people are getting steroids at this point in time and thus a lot more are at risk of steroid related complications.

Let's say 1/5k steroid treated pts get mucor, now if we treat 500k pts with steroids we will definitely have 100 mucor cases. SIMPLE MATH !!

Not convinced, read on.

2. A great number of #COVID19 pts have underlying CO-MORBIDITIES like diabetes which are WORSENED by steroids

Read 10 tweets

Support us! We are indie developers!

This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Don't want to be a Premium member but still want to support us?

Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal

Or Donate anonymously using crypto!

Ethereum

0xfe58350B80634f60Fa6Dc149a72b4DFbc17D341E copy

Bitcoin

3ATGMxNzCUFzxpMCHL5sWSt4DVtS8UqXpi copy

Thank you for your support!

Share this page!

𝗡𝗶𝗵𝗮𝗿 𝗗𝗲𝘀𝗮𝗶

People who liked this thread also liked...

Try unrolling a thread yourself!

More from @nihardesai7

𝗡𝗶𝗵𝗮𝗿 𝗗𝗲𝘀𝗮𝗶

𝗡𝗶𝗵𝗮𝗿 𝗗𝗲𝘀𝗮𝗶

𝗡𝗶𝗵𝗮𝗿 𝗗𝗲𝘀𝗮𝗶

𝗡𝗶𝗵𝗮𝗿 𝗗𝗲𝘀𝗮𝗶

𝗡𝗶𝗵𝗮𝗿 𝗗𝗲𝘀𝗮𝗶

𝗡𝗶𝗵𝗮𝗿 𝗗𝗲𝘀𝗮𝗶

Did Thread Reader help you today?

Don't want to be a Premium member but still want to support us?

Send Email!