Discover and read the best of Twitter Threads about #TxID
Most recents (14)
🧵1/3 #IDtwitter first trivia of 2023!#TxID
45 F w/Hx of hypertensive nephropathy complicated by ESDR s/p kidney transplant 7 mo ago, on tacrolimus & MMF. CMV D+R-, who after completing prophylaxis w/ valganciclovir for 6mo is admitted with 3 wks of watery diarrhea
45 F w/Hx of hypertensive nephropathy complicated by ESDR s/p kidney transplant 7 mo ago, on tacrolimus & MMF. CMV D+R-, who after completing prophylaxis w/ valganciclovir for 6mo is admitted with 3 wks of watery diarrhea
2/3 Colonoscopy findings consistent with CMV colitis. Initial CMV DNAemia 800 IU/mL. Patient’s immunosuppressive regimen is reduced, and she is treated with ganciclovir 5 mg/kg IV every 12 hours.
3/3 After one week, despite medical treatment diarrhea persists, with up to 6-8 episodes daily.
A repeated CMV DNAemia is 805 IU/mL. What would you do next? 🤔 #IDboardreview
A repeated CMV DNAemia is 805 IU/mL. What would you do next? 🤔 #IDboardreview
Happy to share our review of antiviral treatment of #monkeypox, co-authored with the amazing @EmilySiegrist4 and just published in @CIDJournal! @OUHealth @IDSAInfo @SIDPharm @PaulSaxMD #IDTwitter #TxID #TwitteRx #MedTwitter #OpenAccess
Short 🧵 (1/n)
academic.oup.com/cid/advance-ar…
Short 🧵 (1/n)
academic.oup.com/cid/advance-ar…
In this paper, we review three antiviral agents with activity against #monkeypox:
1. Cidofovir
2. Brincidofovir
3. Tecovirimat
(2/n)
1. Cidofovir
2. Brincidofovir
3. Tecovirimat
(2/n)
For each agent we discuss:
1. Basic Pharmacology
2. Pharmacokinetic Data
3. Animal Data
4. Toxicity
5. Clinical Data in Humans
(3/n)
1. Basic Pharmacology
2. Pharmacokinetic Data
3. Animal Data
4. Toxicity
5. Clinical Data in Humans
(3/n)
🧵 1/5 Hello #IDtwitter. Here is our weekly #IDtrivia 📖 #IDboardreview #TxID #MedEd
37 y/o F PMHx of lupus nephritis complicated by ESRD s/p living-donor kidney transplant 5 months ago, who presents with 3 days Hx of dysuria, hematuria, pelvic pain and subjective fever
37 y/o F PMHx of lupus nephritis complicated by ESRD s/p living-donor kidney transplant 5 months ago, who presents with 3 days Hx of dysuria, hematuria, pelvic pain and subjective fever
2/5 She denies recent lupus flares. Patient is taking tacrolimus, mycophenolate, prednisone and TMP-SMX. Vaccinated against COVID-19x3. No sexually active for the past year. PreTransplant HIV,CMV,HepBC, adenovirus, Toxo and trypanosoma serologies (-) for both patient and donor.
3/5 On presentation BP 140/90 HR 78 RR 16 T 101 O2Sat98% RA. Hydrated mucous membranes. Clear chest to auscultation, normal heart sounds. Abdominal scar healed no signs of infection. Tenderness to palpation of hypogastrium. No CVA tendernesses.
#Remdesivir new trial just published
Here are the clinical implications:
Canadian trial (CATCO) in hospitalized patients with #COVID19 bit.ly/33uktIf
Compared to ACTT-1 trial bit.ly/3msi1In in patients on supplemental O2 as recommended by guidelines
🧵1/
Here are the clinical implications:
Canadian trial (CATCO) in hospitalized patients with #COVID19 bit.ly/33uktIf
Compared to ACTT-1 trial bit.ly/3msi1In in patients on supplemental O2 as recommended by guidelines
🧵1/
Both CATCO and ACTT-1 trials showed
-No liver or renal toxicity with remdesivir, and
-No safety differences between remdesivir and controls in over 2300 patients
Thus, both trials show that remdesivir is safe, prevents intubation, and reduces mortality
3/
-No liver or renal toxicity with remdesivir, and
-No safety differences between remdesivir and controls in over 2300 patients
Thus, both trials show that remdesivir is safe, prevents intubation, and reduces mortality
3/
1/ I'm really excited that the @US_FDA has granted an EUA for #Paxlovid - this is a terrific new option for #OmicronVariant and kudos to the scientists, researchers, and developers at Pfizer. So timely, and so necessary as we face a wave of new #COVID19 infections globally.
2/ I went through the fact sheet and it is critical to highlight that many patients with cancer and organ transplant recipients are on medications that will be effected by the #ritonavir component of #paxlovid.
3/ Note black box warning - Co-administration of ritonavir with sedative hypnotics, anti-arrthythmics, or ergot alkaloids are contraindicated.
Pfizer did a great job in compiling potential drug-drug interactions:
Pfizer did a great job in compiling potential drug-drug interactions:
With #Omicron rapidly spreading nationwide, I am concerned about all the members of our communities with damage and injury in the immune system, particularly to cell-mediated injury (to T cells and Ab-producing cells). In neutralization studies, most monoclonal Abs used to date
2/ have lost activity to #Omicron and are no longer useful in areas with high attack rates (pretty much everywhere in US right now). There are two possible exceptions. The first is #sotrovimab which was originally isolated from an individual with
3/ #SARSCoV1 (not a typo) back in 2003. The Ab recognizes a conserved glycan motif at the base of the Spike protein (away from the ACE-2 receptor-binding domain). Extremely limited supplies and fairly narrow emergency use authorization, as follows:
Finally got to analyze & put my thoughts together on the recent #posaconazole vs. #voriconazole phase 3 trial for invasive #aspergillosis published in .@TheLancet a few weeks ago.
Best is to put the major trials of the 3 #VIP triazoles done over the last 20 years in perspective!
Best is to put the major trials of the 3 #VIP triazoles done over the last 20 years in perspective!
So (re)studied the following key trials & appendices
#Posaconazole vs. #Voriconazole: thelancet.com/journals/lance…
#Isavuconazole vs. Vori: thelancet.com/journals/lance…
#AmphotericinB vs. Vori: nejm.org/doi/10.1056/NE…
#TxID #IDTwitter
#Posaconazole vs. #Voriconazole: thelancet.com/journals/lance…
#Isavuconazole vs. Vori: thelancet.com/journals/lance…
#AmphotericinB vs. Vori: nejm.org/doi/10.1056/NE…
#TxID #IDTwitter
Here is the table with key points of trial design of the #TresAmigos trials, interesting features:
#Vori-Ampho was open label, but with blinded adjudication, including to adverse effects.
All where non-inferiority trials, #vori-amphoB had a clause for claiming superiority.
#Vori-Ampho was open label, but with blinded adjudication, including to adverse effects.
All where non-inferiority trials, #vori-amphoB had a clause for claiming superiority.
#IDWeek2020
Session: Cutting edge adult&ped #TxID
@BrianFisher95
Adenovirus reactivation is more common in pediatric HCT pts, so age is significant risk factor
Chart with reactivation rates, mostly ped data 👇 Progression to sx dz in peds is not uncommon
Session: Cutting edge adult&ped #TxID
@BrianFisher95
Adenovirus reactivation is more common in pediatric HCT pts, so age is significant risk factor
Chart with reactivation rates, mostly ped data 👇 Progression to sx dz in peds is not uncommon
#IDWeek2020
Session: Cutting edge adult&ped #TxID
@BrianFisher95
So what to do when adenovirus is positive
Session: Cutting edge adult&ped #TxID
@BrianFisher95
So what to do when adenovirus is positive
#IDWeek2020
So excited for challenging cases in #TxID !
Pearlie Chong @PergamIC @ShohamTxID @nikkitheomd @IDdoc4kids Kate Mullane
So excited for challenging cases in #TxID !
Pearlie Chong @PergamIC @ShohamTxID @nikkitheomd @IDdoc4kids Kate Mullane
#IDWeek2020
Session: Challenging Cases in #TxID
56 yo post-auto HSCT with fever, wt loss, scleral icterus. Labs with low WBC, anemia, elevated LFTs. Not neutropenic.
Check out the smear!
Session: Challenging Cases in #TxID
56 yo post-auto HSCT with fever, wt loss, scleral icterus. Labs with low WBC, anemia, elevated LFTs. Not neutropenic.
Check out the smear!
#IDWeek2020
Session: Challenging Cases in #TxID
Dx: Babesiosis - Familiar to us here in MA, but this case was from WA!
Very tough to manage in immunosuppressed pts, require prolonged courses
Session: Challenging Cases in #TxID
Dx: Babesiosis - Familiar to us here in MA, but this case was from WA!
Very tough to manage in immunosuppressed pts, require prolonged courses
#IDWeek2020 #PedsID
Session: Mano a Mano
Should we tx + tracheal cultures?
Con: @asicksamuels
3 Reasons not to treat:
1. Positive cxs do not equal infection
2. Trach cxs are unreliable
3. Treated positive trach cxs do not equal improved outcomes
+
Risk patient harm from over-tx
Session: Mano a Mano
Should we tx + tracheal cultures?
Con: @asicksamuels
3 Reasons not to treat:
1. Positive cxs do not equal infection
2. Trach cxs are unreliable
3. Treated positive trach cxs do not equal improved outcomes
+
Risk patient harm from over-tx
#IDWeek2020 #PedsID
Session: Mano a Mano
Should we tx + tracheal cultures?
Pro:
VAT assoc'd w/⬆️duration of mech vent, ICU LOS, mortality
Tx of VAT can prevent progression to VAP and perhaps mortality
Treating VAT w/impaired oxygenation is really tx'ing VAP, which is warranted
Session: Mano a Mano
Should we tx + tracheal cultures?
Pro:
VAT assoc'd w/⬆️duration of mech vent, ICU LOS, mortality
Tx of VAT can prevent progression to VAP and perhaps mortality
Treating VAT w/impaired oxygenation is really tx'ing VAP, which is warranted
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, O2đź‘Ť
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, O2đź‘Ť
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
#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
Answer:
All choices possible and should be considered in the DDx for a neck mass. Let’s get some imaging and labs on our pt and see what shakes out!
Algorithm for working up a neck mass in an adult 👇
All choices possible and should be considered in the DDx for a neck mass. Let’s get some imaging and labs on our pt and see what shakes out!
Algorithm for working up a neck mass in an adult 👇
#ToughTxCase I am going to start an educational series for #transplant professionals/trainees on complex cases I have the privilege to see @UWHealth Patients have provided informed consent for us to discuss their condition in order to help other similar cases @uw_nephrology
#ToughTxCase #1 is the story of Tom, a 73 year old man, who received a living unrelated #kidney tx for #ESRD due to an unknown etiology. Low immunological risk, VXM (-), #CMV D+/R-, basiliximab induction, standard TAC/MPA/P maintenance Rx on Valgan prophylaxis x 6M @TxPharmD
At his 3M visit, Tom complains of #diarrhea, weight loss (4 lbs in 1 month) and poor energy. His kidney fxn is at baseline Scr 1.3 mg/dL. What is the most likely diagnosis? Please feel free to discuss! @uw_IMresidency @askrenal @Nephro_Sparks
First reported case of an immunocompromised child with #COVID-19 infection suggests risk for severe disease. (1/12)@PIDSociety @IDSAInfo #TxID #IDtwitter
Most descriptions of children with #COVID-19 have been reassuring, few have had severe disease and most recover rapidly. However, there is some concern that immunocompromised children will fare much worse. (2/12)
This case in the Chinese Journal of Hematology is reportedly the first case of documented COVID-19 infection in an immunocompromised child. It’s in Chinese and I had a lab colleague read it to me – apologies for any errors. (3/12)
1/
Hi hi hi. We see lots of red flags on a daily basis when we review labs.
One thing we see commonly is #lymphopenia. Should we care? When can we dismiss it and when should we work it up?
Let’s find out.
#MedEd #MedTwitter #IDTwitter #Tweetorial #oncology
Hi hi hi. We see lots of red flags on a daily basis when we review labs.
One thing we see commonly is #lymphopenia. Should we care? When can we dismiss it and when should we work it up?
Let’s find out.
#MedEd #MedTwitter #IDTwitter #Tweetorial #oncology
2/
- Lymphopenia assc w/ ⬆️risk of sepsis
- More common in elderly and w/ co-morbidities
- lymphs account for 20-40% of WBC, may go unnoticed when WBC checked w/o diff
- Primary- recurrent infxns in kids, CVID in adults
- Secondary-⬇️production; ⬆️destruction; hiding in tissue
- Lymphopenia assc w/ ⬆️risk of sepsis
- More common in elderly and w/ co-morbidities
- lymphs account for 20-40% of WBC, may go unnoticed when WBC checked w/o diff
- Primary- recurrent infxns in kids, CVID in adults
- Secondary-⬇️production; ⬆️destruction; hiding in tissue
3/
What is the most common cause of lymphopenia in hospitalized patients?
What is the most common cause of lymphopenia in hospitalized patients?
