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Thanks to all that participated in our 1st live #IDFellowCase yest! Here is a wrap-up review tweetorial for reference + those who missed it.
Special thanks to @MDdreamchaser!
If you have feedback OR want to sign up to do a future case, use this form:forms.gle
Thanks to all that participated in our 1st live #IDFellowCase yest! Here is a wrap-up review tweetorial for reference + those who missed it.
Special thanks to @MDdreamchaser!
If you have feedback OR want to sign up to do a future case, use this form:forms.gle
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A case of 70F with ring-enhancing brain/lung lesions was presented. Here is how @MDdreamchaser walked thru the case:
1⃣Define pt risk of infection (e.g. splenectomy, steroid use)
2⃣Take presenting clinical syndrome
3⃣Tempo of illness: abrupt? gradual?
A case of 70F with ring-enhancing brain/lung lesions was presented. Here is how @MDdreamchaser walked thru the case:
1⃣Define pt risk of infection (e.g. splenectomy, steroid use)
2⃣Take presenting clinical syndrome
3⃣Tempo of illness: abrupt? gradual?
3/
In this case, co-occurrence of brain-lung nodules was helpful clue
🖼️Infographic below
Also check out this 🧵 from @WuidQ
⭐️One other pearl. Embolizing disease might include endocarditis, Lemierre's dz, infectious aortitis, infected cardiac thrombus
In this case, co-occurrence of brain-lung nodules was helpful clue
🖼️Infographic below
Also check out this 🧵 from @WuidQ
⭐️One other pearl. Embolizing disease might include endocarditis, Lemierre's dz, infectious aortitis, infected cardiac thrombus
4/
As the case continues, pt found to have endophthalmitis in light of persistent brain-lung lesions -- led to high suspicion for endocarditis --> at this point cx negative
BDG was very high in this scenario (>500). More on BDG next
As the case continues, pt found to have endophthalmitis in light of persistent brain-lung lesions -- led to high suspicion for endocarditis --> at this point cx negative
BDG was very high in this scenario (>500). More on BDG next
5/ BDG
🔹Very high levels make FP less likely, can be clin useful in dx IFI
🔹⬆️BDG in many fungi except Mucorales,Crypto, Blasto
🔹🗝️: interpret in light of pt+clinical synd.This case = exceedingly rare for PCP, so think aspergillus, other molds, candida
@swinndong @AxellHouse⬇️
🔹Very high levels make FP less likely, can be clin useful in dx IFI
🔹⬆️BDG in many fungi except Mucorales,Crypto, Blasto
🔹🗝️: interpret in light of pt+clinical synd.This case = exceedingly rare for PCP, so think aspergillus, other molds, candida
@swinndong @AxellHouse⬇️
6/
Some pearls on AF resistant spp
⭐️Ampho-R fungi
C.lusitaniae (higher MICs to ampho)
C.auris (some)
A.terreus
Fusarium (some)
Scedosporium (Lomentospora) prolificans
Scedosporidum apiospermum (some)
Pseudallescheria boydii
Sporothrix schenckii
🔹Another from @k_vaishnani ⬇️
Some pearls on AF resistant spp
⭐️Ampho-R fungi
C.lusitaniae (higher MICs to ampho)
C.auris (some)
A.terreus
Fusarium (some)
Scedosporium (Lomentospora) prolificans
Scedosporidum apiospermum (some)
Pseudallescheria boydii
Sporothrix schenckii
🔹Another from @k_vaishnani ⬇️
7/
We saw septated branching hyphae in this great📷: Aspergillus and Fusarium are prototypical. Can also include dematiaceous molds (Fontana Masson stain can differentiate this). Shape of conidia is helpful as well! Check out this infographic, adapted from ncbi.nlm.nih.gov
We saw septated branching hyphae in this great📷: Aspergillus and Fusarium are prototypical. Can also include dematiaceous molds (Fontana Masson stain can differentiate this). Shape of conidia is helpful as well! Check out this infographic, adapted from ncbi.nlm.nih.gov
8/
Few notes on fungal endocarditis:
⭐️Most common cause = C.albicans > non-albicans Candida > Aspergillus > other
🔸Risk factors in recent yrs shift toward indwelling lines, immunocompromised hosts, IV drug use
🔸⬆️mortality
Few notes on fungal endocarditis:
⭐️Most common cause = C.albicans > non-albicans Candida > Aspergillus > other
🔸Risk factors in recent yrs shift toward indwelling lines, immunocompromised hosts, IV drug use
🔸⬆️mortality
9/
Some of IDSA tx GL are in chart below: academic.oup.com
This pt transitioned to vori, plan for indefinite therapy due to endocarditis, MVR - but this can be difficult due to side effects
A reference for tissue penetration of AF fr @mmPharmD pubmed.ncbi.nlm.nih.gov
Some of IDSA tx GL are in chart below: academic.oup.com
This pt transitioned to vori, plan for indefinite therapy due to endocarditis, MVR - but this can be difficult due to side effects
A reference for tissue penetration of AF fr @mmPharmD pubmed.ncbi.nlm.nih.gov
10/
Some notes on vori:
🔹Non-linear kinetics
🔹QTC changes (⬆️vori/posa;⬇️ isav). @ConanMacDougall provided paper with some context for QTc prolongation academic.oup.com
🔹CYP interactions! is azole strong/mod/weak inhibitor?
▪️Tip fr @mmPharmD
Some notes on vori:
🔹Non-linear kinetics
🔹QTC changes (⬆️vori/posa;⬇️ isav). @ConanMacDougall provided paper with some context for QTc prolongation academic.oup.com
🔹CYP interactions! is azole strong/mod/weak inhibitor?
▪️Tip fr @mmPharmD
11/
We finished up with discussion on combination therapy for aspergillosis
⭐️Evidence is limited⭐️
🔸Theoretical issues with antagonisms with amphoB+azoles
🔸Excellent article that @TxID_Edu @MDdreamchaser like: link.springer.com
We finished up with discussion on combination therapy for aspergillosis
⭐️Evidence is limited⭐️
🔸Theoretical issues with antagonisms with amphoB+azoles
🔸Excellent article that @TxID_Edu @MDdreamchaser like: link.springer.com
12/
Few other pearls from: @A_Spallonii
🔸Thinking about breakthrough old infections, esp in H/O pts pubmed.ncbi.nlm.nih.gov
🔸And this pearl:
Few other pearls from: @A_Spallonii
🔸Thinking about breakthrough old infections, esp in H/O pts pubmed.ncbi.nlm.nih.gov
🔸And this pearl:
13/
Hope you enjoyed the case. Here are some of the other links again:
Ellis: pubmed.ncbi.nlm.nih.gov
Patterson: academic.oup.com
Marr: academic.oup.com
Martin-Pena: pubmed.ncbi.nlm.nih.gov
Hope you enjoyed the case. Here are some of the other links again:
Ellis: pubmed.ncbi.nlm.nih.gov
Patterson: academic.oup.com
Marr: academic.oup.com
Martin-Pena: pubmed.ncbi.nlm.nih.gov
14/
Can't wait to see you next time!!
Can't wait to see you next time!!
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