BWH ID in Primary Care

[BWH ID in Primary Care @BWH_IDinPCARE]

Yesterday @sigal_md on knowns / unknowns in management of mild-to-moderate #COVID19 & generalizing from study results: treating at risk patients, do vaccinated patients still benefit, the rebound problem, managing profoundly immunocompromised patients, long COVID, and more...

[BWH ID in Primary Care @BWH_IDinPCARE]

This morning Dr. Jennifer Johnson on rare problems we never see: sore throats, common colds, and coughs that won't go away.

She was about to tell us how we can tell which respiratory virus our patient have based on their symptoms, but....

turns out she can't.

[BWH ID in Primary Care @BWH_IDinPCARE]

A patient comes in to discuss #PrEP for HIV. Do you feel prepared?

This afternoon @sigal_md makes the case for HIV #PrEP in primary care. How to chose a regimen?

[BWH ID in Primary Care @BWH_IDinPCARE]

Antibiotic allergy guru, @PaigeWickner kicks off our session today.

Your patient has a history of PCN allergy...

Very important distinction: what is the difference between antibiotic "Challenge" and antibiotic "Desensitization"?

[BWH ID in Primary Care @BWH_IDinPCARE]

@BWDionne @PaulSaxMD 🤓🤓🤓

ID pharmacists are ballers. And nerds.

Wait...we don't need to know the mechanism for the drugs to work, right?

[BWH ID in Primary Care @BWH_IDinPCARE]

Quinolones - love 'em or hate 'em?

SO useful (great spectrum of activity, only oral option for PsA, atypical coverage), BUT lots of side effects (tendinopathy, aortic rupture 😱).

Well, we still use them -- so which to choose? h/t @PaulSaxMD for this pocket guide

[BWH ID in Primary Care @BWH_IDinPCARE]

Here's what our local expert, @sigal_md says:

[BWH ID in Primary Care @BWH_IDinPCARE]

Treatment of asymptomatic bacteriuria is a top-tier pet peeve of ID docs esp on #IDtwitter.

@sigal_md challenges us to think about when we SHOULD treat asymptomatic bacteriuria?

@Sonali_Advani is a leader in this space!

[BWH ID in Primary Care @BWH_IDinPCARE]

In October 2021, ACIP voted to recommend RZV in immunocompromised patients. Very impactful for this patient population.

Stay tuned for immunization updates tomorrow!

[Paul Sax @PaulSaxMD]

Thanks to Dr Sarah Hammond for reviewing infectious complications of non-HIV related immunosuppression, here highlighting the markedly elevated risk of zoster seen with JAK inhibitors such as tofacitinib. Speaking today in our course @BWH_IDinPCARE

[BWH ID in Primary Care @BWH_IDinPCARE]

@LisaCC406 @PaulSaxMD @dsolsMD @JakeJohnsonMD @MaryMoWuzHere Yes! Stay tuned for immunization update tomorrow.

ACIP recently approved RZV (Shingrix) for immunocompromised patients <50

Nice summary here: https://t.co/JoIRImRF85

[Paul Sax @PaulSaxMD]

Thanks to Dr Sarah Hammond for reviewing infectious complications of non-HIV related immunosuppression, here highlighting the markedly elevated risk of zoster seen with JAK inhibitors such as tofacitinib. Speaking today in our course @BWH_IDinPCARE

[BWH ID in Primary Care @BWH_IDinPCARE]

Here is the Jamie Maguire (aka the OG)'s differential

Denuge
Chikingunya
Zika
Acute HIV
EBV
Measles
Rubella
Parvo
Enterovirus
Rickettsia
GAS
Syphilis
Typhoid
Lepto
Drug Rxn

How did you do? What did he miss?

[BWH ID in Primary Care @BWH_IDinPCARE]

Test your travel medicine knowledge!

23yo woman with fever and rash 3 days after returning from vacation in Bahia, Brazil

Fever, chills, headache, myalgia, arthralgia
Temp 102, diffuse rash, lymphadenopathy
WBC 3400 with normal differential, platelets 120,000

Ddx?

[BWH ID in Primary Care @BWH_IDinPCARE]

We are UNDERSCREENING for chronic infections in immigrants and long term ex-pats

In asymptomatic immigrants from endemic areas, consider screening for:
- TB
- HIV
- HBV
- Chagas' disease
- Strongy
- Schisto

[BWH ID in Primary Care @BWH_IDinPCARE]

TEASER poll for upcoming talk on tropical infections (stay tuned for answer + additional pearls from master clinician, Jamie Maguire):

What malaria prophylaxis do you recommend for 59-year-old who will spend 10 days traveling to Hanoi, Bangkok, and Singapore for business?

[BWH ID in Primary Care @BWH_IDinPCARE]

@BradSpellberg There must be some way to adapt this instant-classic cartoon for stewardship. Perhaps we should just stop at 3 days and not tempt fate...

[BWH ID in Primary Care @BWH_IDinPCARE]

How to determine length of antibiotic therapy?

ID trade secrets here😂😂😂

Opportunity to plug @BradSpellberg's tireless work to remind us that shorter is better!
https://t.co/uVLWC7R8mU

[BWH ID in Primary Care @BWH_IDinPCARE]

What do you use to treat LTBI?

In the absence of drug-drug interactions or
contraindications, @JakeJohnsonMD (and all of his admirers) uses rifampin x4 months over INH in most cases of LTBI.

See practice-changing study here:

https://t.co/d5nFHVS9Ya

[BWH ID in Primary Care @BWH_IDinPCARE]

How to interpret discordant PPD and IGRA?

Bookmark this online calculator, and use it with your patients!

https://t.co/JsqymSnvw4

(sharing another ID trade secret - we are notoriously terrible at monetizing our expertise)

[BWH ID in Primary Care @BWH_IDinPCARE]

Next up @JakeJohnsonMD on TB for the PCP.

That positive PPD must be due to the history of BCG vaccine, right?

Wrong!

In 240,203 BCG-vaccinated infants, only 56/5639 (1%) were TST-positive if tested >=10 years after BCG.

Classic study here:
https://t.co/Ir7xoKj0Gp