Tweet

Nihar Ranjan Nayak

Jan 1 • 10 tweets • 6 min read

Aspergillosis (disease spectrum, Dx, Rx):
1. Refers collectively to all invasive and allergic disease caused by aspergillus species
2. A.fumigatus: causes most of the invasive & chronic aspergillosis & allergic disease
3. A.flavus: sinus, cutaneous infection & keratitis

4. A.niger: otitis externa
5. It's a hyaline, septate branching mold
6. Risk factors: neutropenia, glucocorticoid use, CGD, severe influenza or Covid-19, COPD, pulmonary TB, infliximab, ibrutinib use, ECMO
7. Invasiv: pulmonary, sinusitis, cutaneous, endocarditis, cerebral

8. Chronic pulmonary aspergillosis(CCPA) : single or multiple cavities in upper lobe, a/w fatigue, weight loss, hemoptysis, prior lung disease like TB etc, untreated can cause fibrosis & destroyed lung
9. Aspergilloma: fungal ball. A/w CPA.

10. Chronic aspergillus sinusitis: fungal ball of the sinuses, chronic invasive sinusitis, chronic granulomatous sinusitis
11. ABPA: hypersensitivity reaction to A.fumigatus. can be seen in pt of asthma & CF. Eosinophilia, high serum total IgE, high Aspergillus-specific IgE

12. Allergic fungal rhinosinusitis
13. Superficial disease: keratitis, otitis externa, onychomycosis
14: Dx on invasive disease: imaging, antigen detection (galactomannan), PCR, microscopy showing septate hyphae with branching, histopath showing angioinvasion, necrosis, Culture

15. Dx of CCPA: imaging & high aspergillus specific antibody
16. ABPA: high total & aspergillus specific IgE. T/t with antifungal & glucocorticoid.
17. Invasive disease: preferred are voriconazole, isavuconazole & posaconazole. Ampho B as 2nd line. TDM of voriconazole level

18. CCPA: oral voriconazole, itraconazole, posaconazole. TDM of itraconazole.
19. BAE for hemoptysis. Surgical debridement in endocarditis, brain abscess, fungal ball.
20. Prophylactic posaconazole in high risk pt undergoing chemotherapy effective in reducing infection rates.

@AaronGoodman33

@AaronGoodman33
@NicoGagelmann
@nihardesai7
@aekdkk
@DoctorBhavsar
@arunraja4u
@BijoyTelivala
@knowmedge
@Drshantanu2110
@DrVinay118
@BrownHospMed
@infinity4UAll
@yajadev
@Sreenath_Sree
#MedTwitter
#IDTwitter
#medicine
#mycology

@RajaNatarajanS1

@RajaNatarajanS1

@DrNikhilvasudev

@DrNikhilvasudev @SolarSunil

• • •

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 @nihar_nayak2

Nihar Ranjan Nayak

@nihar_nayak2

Jan 2

Mucormycosis:
1. Fatal invasive disease with high mortality
2. Genus: rhizopus, mucor, cunninghamella, lichtheimia etc
3. Risk factors: Uncontrolled DM, DKA, neutropenia, prolonged glucocorticoid use, elevated levels of free iron, SOT, HSCT, COVID-19 infection.

4. Rhino-orbital-cerebral disease: most common form, seen in diabetes, steroid use. Ethmoid sinus-->orbit-->frontal lobe/cavernous sinus, hard palate in advanced case.
5. Pulmonary disease: second most common, in organ transplant, chemotherapy receiving pt.

6. Cutaneous: hematogenous dissemination or direct inoculation. Can be highly invasive. Needs prompt debridement.
7. GIT: GI bleeding, fungating mass seen at UGIE, perforation, high mortality.
8. Disseminated disease: most common site is brain. Mortality >90%.

Read 7 tweets

Nihar Ranjan Nayak

@nihar_nayak2

Jan 2

Iron metabolism & IDA:
1. Transferrin (iron binding protein in plasma) has two iron-binding sites & exists in 3 forms: apotransferrin (not bound to iron), monoferric & diferric forms: diferric has the highest affinity for Tf receptors.

2. Developing erythroblasts have the highest number of Tf receptors
3. Normally adult male & female need to absorb 1 mg & 1.4 mg elemental iron respectively to meet needs
4. No regulated pathway of iron excretion, lost by blood loss or loss of epithelial cells.

5. Heme iron is most readily absorbed.
6. Hepcidin regulates iron absorption by controlling the activity of ferroprotein.
7. Erythroferron: Suppresses hepcidin level to increase iron absorption in states of erythroid hyperplasia.

Read 6 tweets

Nihar Ranjan Nayak

@nihar_nayak2

Dec 31, 2022

Necrobiosis lipoidica:
1. Chronic granulomatous disease
2. Commonly involve lower limbs: pretibial area most common
3. A/w T1DM, T2DM but can happen in non-DM also
4. Common in young, middle aged pt

5. Red-brown, yellowish papule or plaques that enlarge, undergo atrophy & form ulcers & telangiectasia
6. Bx: granulomatous dermatitis, inflammatory infiltrates
7. Rx: avoid trauma, topical & intra-lesional corticosteroid, topical tacrolimus, PUVA photochemotherapy

Source: UTD.

Read 4 tweets

Nihar Ranjan Nayak

@nihar_nayak2

Nov 5, 2022

Heparin induced thrombocytopenia (HIT) :
1. Risk with UFH>LMWH
2. Thrombocytopenia develops 5-10 days after exposure, may develop rapidly if prior exposure is there, rarely delayed for >2weeks
3. Incidence is around 1% in critically ill patients, overdiagnosis is common.

4. IgG antibody formed against heparin-PF4 complex-->activation of platelets-->thrombosis+thrombocytopenia
5. Venous thrombosis more common than arterial and lower limb thrombosis more common than upper limb
6. Adrenal vein, mesenteric vein thrombosis can occur.

7. When suspected, calculate the 4T score: 0-3 low risk, 4-5 intermediate, 6-8 high risk.
8. Low risk- continue heparin, consider other causes
9. Intermediate n high risk- stop heparin, start non heparin anticoagulation, screen for PF4 antibody by ELISA.

Read 5 tweets