1/38YOF recovered from mild #COVID19 two weeks ago.

Last week, she developed new fevers, headache, photophobia, dyspnea, nausea, vomiting, polyarthralgias, lip peeling, conjunctival injection, and the following pruritic rash:

#IDTwitter #IDFellows #MedTwitter 2/She was admitted to the hospital.

Labs were notable for elevation of ESR, CRP, D-dimer, BNP, and LFTs. COVID-19 NAAT was positive.

CT showed hepatosplenomegaly.

What organism likely triggered her disease process?

1/🍄#IDFungiFriday🍄
 
This is part 2 of @A_Spallonii basic med mycology #tweetorial
 
See Part 1 here…

https://twitter.com/BCMIDFellowship/status/1304453941275627520?s=20

#IDFellows #IDTwitter #IDMedED @MedTweetorials 2/Today, we'll focus on superficial fungal infections, pathogens, and treatments, specifically:

💠 Dermatophytes
💠 Tinea versicolor

1/@HoustonAETC lunch & learns are 🔥! ​

@MelanieGoebelMD gave a fantastic talk on primary manifestations of skin diseases in PWH (people with HIV)​

Let's review rapid-fire style...​

#IDFellows #IDTwitter #DermTwitter #MedTwitter ​@idfellows @MedTweetorials

https://twitter.com/HoustonAETC/status/1303742056511279118

2/​
30YOM with well-controlled HIV and several months of this itchy red rash with silvery scales:

1/#ManuscriptMonday #IDTwitter #Tweetorial

​Does oral vanco ppx during systemic abx therapy prevent healthcare facility-onset C. diff infection in high-risk patients? ​

@MannyGuajardoMD recently reviewed a study on this very topic at our virtual JC.​

pubmed.ncbi.nlm.nih.gov/31560051 2/Healthcare facility-onset C diff infection (HCFO-CDI) is ️💰🤒☠️​

What can we do to prevent HCFO-CDI?​

✅Inf prevention strategies​
✅#AntimicrobialStewardship
❓Probiotics​
❓OVP

1/Welcome #IDFellows #IDTwitter #MedTwitter to another #IDFungiFriday

🍄 For the next few tweetorials @A_Spallonii @BCMIDFellowship is presenting a refresher in Med Mycology
🍄 Today’s tweet will focus on basic terminology, 🔬 morphology, and intro to mycoses 2/Goals for these tweets

✅Make you more comfortable with med mycology
✅Learn something you didn’t know before about fungi (🍄)
✅Convince you that 🍄 are fundamental to life on 🌎

1/#IDTwitter #Tweetorial alert! Inspired by a fantastic @HoustonAETC talk by our very own APD @PrathitKulkarni!

Contributors: @MannyGuajardoMD @MelanieGoebelMD

https://twitter.com/HoustonAETC/status/1301959512790892545?s=20

2/You're seeing a 52YO man with new diagnosis of HIV in clinic, no co-morbidities. Risk factors include multiple unprotected sexual encounters (♂️♀️). Thorough review of systems and exam are unrevealing.

What lab and imaging tests would you order at this visit?

1/Welcome to this week’s #IDBoardReview #Tweetorial presented by @bacteri_al

75 YOM w/ DM, CHF, NAFLD p/w fever, swelling & pain of left leg x48h. Gram stain from BCx pictured below 👇

#IDTwitter #IDMedEd @ID_Fellows @IDSAMedEdCOP 2/What epidemiological exposure do you suspect?

1/Welcome to another #IDBoardReview #tweetorial!
Contributors: @MannyGuajardoMD @TeenaXuMD

40Y w fever, cough, myalgias x4d. B/l conjunctival injection👁️, MEG TTP on exam. Moved from Latin America➡️Texas 20yr ago. Works as landscaper🌳. (-) animal/arthropod exposures.

Thoughts? 2/Patient remains persistently febrile on vancopime x72h.

Labs: platelets 90k, AST 90, ALT 75, otherwise wnl.
SARS-CoV-2 negative x3.

CT: reticulonodular pulmonary opacities, right hilar/mediastinal adenopathy, mild splenomegaly.

Welcome to this week’s #IDFungiFriday #Tweetorial by @A_Spallonii 🍄

20yo AML➡️haploSCT➡️GI GVHD➡️relapse

Painful neck mass x2d + fever +sore throat +dysphagia +odynophagia

On exam, you feel a 3cm firm anterior neck mass. No erythema/fluctuance.

T38.1C, HR110, BP138/79, O2👍 What’s going on here?

#IDMedEd #IDTwitter #TxID @idfellows @IDSAMedEdCOP @AST_IDCOP @MarionHemmersb1 @DocWoc71 @TylerLambingMD @FungalDoc @DrFungus_MSGERC @FranciscoMarty_ @GermHunterMD @MSG_ERC @OncIDPharmd @EmilyBlumbergMD @RicardoLaHozMD @PergamIC @josh_nosanchuk @TxID_Edu

1/Welcome to this week’s #IDBoardReview #Tweetorial presented by @Bacteri_Al!

36yo M with ALL s/p hyperCVAD with marrow recovery. Now with persistent fevers but otherwise feels okay. Labs with neutrophilic leukocytosis (WBC 13) and elevated alk phos (170). Blood cx (-). Imaging: 2/What do you think the diagnosis is?

#IDTwitter #IDMedEd @ID_fellows @MedTweetorials

#ManuscriptMonday: Fostemsavir is a first-in-class investigational HIV-1 attachment inhibitor being studied in treatment-experienced PLWH with multiple mutations and limited ART options

Fostemsavir:
🔸oral, +/- food
🔸prodrug of temsavir, which binds directly to gp120 2/BRIGHTE trial @NEJM :
Phase 3 trial in 23 countries
Enrolled 371 pts with MDR HIV into 2 cohorts
🔸Cohort 1 (N=272): patients w/ 1-2 active drug options left
🔸Cohort 2 (N=99): no remaining ART options

DOI: 10.1056/NEJMoa1902493

1/#IDMedEdCase by Drs. Hayon & @Bacteri_Al

50YOM w/ uncontrolled T2DM p/w RUQ pain x 2d and unintentional weight loss x 3m.

T 101F, HR 123, RUQ TTP w/o peritoneal signs, abd non-distended

WBC 18 (93% PMNs), Hb 8.9, ALP >700, ALT 60, Tbili wnl, Alb 2.7

CT A/P shows: 2/CT most suggestive of pyogenic liver abscesses.

What percentage of patients will also have positive blood cultures?

1/Welcome to #IDFungiFriday!

This week by: @A_Spallonii @teena_xu

Let's get started with a real-world case...

65yoM in Brazil (+) fever, fatigue, myalgias. Dx: COVID-19 pneumonia (mild-mod). Tx: HCQ. 4 wk later found w "mold in the lungs." What is going on here?! 2/Answer: all choices are possible!

It’s not often that fungi headline the news. Let's take a few minutes to talk about CAPA today.

(References will be cited by the PMID... google or pubmed the # to find the paper)