⭐Excitotoxicity due to disruption of inhibitory signals mediated by GABA (esp class A receptor)
⭐Typically caused by β-lactams
⭐Imipenem: more basic amino acid side chain at C2➡️stronger inhibition of GABA➡️more epileptogenic
2/6
Oct 7, 2023 • 4 tweets • 2 min read
Review article on melioidosis @NatureRevMicro
1. Global epidemiology
🦠Endemic in South and SE Asia, as well as Australia doi.org/10.1038/s41579… 2. Virulence factors and host immune response
⚔️B.pseudomallei can persist and reproduce within macrophages for extended durations. They can also escape from endocytic vacuoles by secretion systems
Jun 24, 2023 • 6 tweets • 1 min read
🧵Some non-antibacterial indications of antibiotics 💊
It can be used both for treatment and prophylaxis
2. Clindamycin
➡️ Antifungal: alternative option for pneumocystis jiroveci (+ primaquine)
➡️ Antiprotozoal: alternative option for toxoplasmosis (+ pyrimethamine), babesiosis and malaria (+ quinine for both)
Jun 17, 2023 • 7 tweets • 3 min read
🧵Some combinations of antibiotics and non-antibiotics that should be avoided💊🚫 1. Flucloxacillin
β-lactams are considered to be less prone to drug interactions. Flucloxacillin, however, may ⬇️ tacrolimus concentration presumably through enzyme induction
The same can occur with flucloxacillin and broad spectrum azoles (vori/posa)
Granuloma consisting of dense fibrin ring and epithelioid macrophages surrounding a central lipid vacuole on H&E staining, typically associated with Q fever (Coxiella burnetii infection) 2. Cheese pizza
Yellow white retinal lesions with retinal haemorrhages seen on fundoscopic exam of cytomegalovirus (CMV) retinitis
Jun 3, 2023 • 8 tweets • 1 min read
Infections associated with freshwater exposure
1/8 1. Swimming pools
➡️Gastrointestinal infections are common
➡️Giardia, cryptosporidium and norovirus are chlorine resistant
➡️Outbreak of shigellosis associated with splash pads occurred in Kansas in 2022
2/8
May 28, 2023 • 9 tweets • 2 min read
Infections associated with marine exposure
1/9 1. Vibrio vulnificus
➡️3 types of infections: acute GE, septicemia, necrotizing SSTI
➡️Highly concentrated within oysters 🦪
➡️Risk factors: DM, liver disease, iron overload
➡️💊: Ceftazidime + Doxycycline
➡️Early surgical debridement for necrotizing SSTI
2/9
Mar 26, 2023 • 4 tweets • 2 min read
How Staph aureus manipulates our immune system to cause invasive infections🦠🤒
⭐Inhibits neutrophil extravasation and chemotaxis
⭐Inhibits complement activation and phagocytosis
⭐Inhibits neutrophil-mediated killing
⭐Kills host immune cells
1/4
⭐Secretes coagulase (remember it's coagulase +ve) and Staph aureus superantigen-like 10 (SSL-10)
➡️Promotes agglutination with fibrin
➡️Protects it from phagocytes
2/4
Jan 10, 2023 • 7 tweets • 3 min read
Ceftriaxone is obviously not a popular choice for MSSA bacteremia among #IDtwitter
There is no prospective data showing it's inferior to other options so far
So why?
First of all, why ceftriaxone?
Most common reason: once daily dosing which makes it good for OPAT
There are 2 flaws here...
Jan 1, 2023 • 5 tweets • 2 min read
Management of enterococcal bacteremia
1. Workup and treatment principles for different types of enterococcal bacteremia 2. Mechanism of antibiotic resistance
Nov 25, 2022 • 7 tweets • 2 min read
Double beta-lactam therapy may not sound appealing, but it might be more widely applicable than you think
A 🧵
1. Enterococcus faecalis endocarditis
•Ampicillin + ceftriaxone has comparable efficacy but less toxicity versus ampicillin + aminoglycoside
•Works by complementary PBP binding of the 2 agents
•May not be applicable to Enterococcus faecium
1.General
•1st generation parenteral cephalosporin
•Active against MSSA, Streptococci (A,B,C,G,viridans) and aerobic GNB (E.coli, Klebsiella, Proteus)
•2 most common indications: MSSA BSI, pre-op prophylaxis
2.MSSA BSI
•Both cefazolin and anti-staphylococcal penicillins (ASP) are recommended treatment options for MSSA BSI
•Synergism when combined with ertapenem (complementary PBP binding, action on biofilm, ?effect on immune response) pubmed.ncbi.nlm.nih.gov/31773134/
Nov 10, 2022 • 5 tweets • 1 min read
A few things about Amoxicillin-clavulanate
1. Spectrum
•Broad (Yes it is) aerobic and anaerobic coverage (MSSA, Enterococcus, Bacteroides, common Gram -ve e.g. E.coli, even ESBL if for UTI)
•Also potentially useful for melioidosis, capnocytophaga, certain nocardia, etc
2. WHO Group D3 anti-TB
•Regarded as possessing anti-TB activity, either by itself or in combination with meropenem/imipenem (mainly for the clavulanate component)
•Should only be considered in MDR setting when there are no better alternatives
Oct 24, 2022 • 6 tweets • 2 min read
Something to share about piperacillin/tazobactam
1. Broad spectrum BLBLI
• Covers Gram +ve incl MSSA, Gram -ve incl Pseudomonas, and anaerobes incl Bacteroides
• Good for empiric treatment of neutropenic fever, intra-abdominal infection, nosocomial sepsis
2. Important caveats
• Does not cover MRSA
• Not recommended for CNS infection, due to poor BBB penetration esp for tazobactam
• ESBL/AmpC producers ➡️ meropenem is preferred (MERINO and MERINO-2)
Sep 9, 2022 • 17 tweets • 8 min read
Infectious diseases in a few maps
From someone yearning for travel 1. Meningitis belt
Areas in Sub-Saharan African with high incidence of meningococcal meningitis
Aug 17, 2022 • 12 tweets • 5 min read
Be careful with what you eat...
What you eat What you get
What you eat What you get