IDNerd_DrMaithreyi

Senior Resident – Infectious Diseases, Manipal Hospital l

MD Internal Medicine- St John’s Medical College l

Clinical Pearls • ID Updates • ID Rounds

[IDNerd_DrMaithreyi @MaithreyiG]

#CIDSCON2026 #InfectiousDiseases #TransplantInfectiousDiseases #ImmunocompromisedHost #FOAMed#IDX

[IDNerd_DrMaithreyi @MaithreyiG]

WHAT DID I LEARN FROM CIDSCON 2026?

DAY 0 | PRE-CONFERENCE WORKSHOP

🛡️ The Zero Defence Challenge – Mastering ID in the Immunocompromised Host

Session: Approach to Infections in Transplant Recipients

[IDNerd_DrMaithreyi @MaithreyiG]

THREE THINGS I'LL REMEMBER 🧠
🔹 CMV: HIV → think retinitis; SOT → think tissue-invasive disease, including colitis/graft dysfunction.
🔹 CNI: remember their antifungal activity, especially against Candida.
🔹 NEW DRUG? STOP & CHECK: *** tacrolimus/cyclosporine and azoles.

[IDNerd_DrMaithreyi @MaithreyiG]

CMV in HIV ≠ CMV in organ transplantation
In advanced HIV, CMV retinitis is a classic manifestation.
In solid-organ transplantation, CMV disease more commonly involves GI and graft while retinitis is less dominant than in advanced HIV.

[IDNerd_DrMaithreyi @MaithreyiG]

Another interesting learning:
Calcineurin inhibitors have intrinsic antifungal activity, particularly against Candida, and can show synergistic antifungal effects with some antifungal agents.

[IDNerd_DrMaithreyi @MaithreyiG]

6/9 | CASE 2
Post Renal Tx - headache hypertension after fluconazole for oral candidiasis; tacrolimus level - 24,
renal biopsy showing tacrolimus toxicity. The final diagnosis PRES - tacrolimus toxicity.
🔑 Learning: Check drug interactions BEFORE starting new drugs

[IDNerd_DrMaithreyi @MaithreyiG]

5/9 | CASE 1
🫁 Renal transplant + diabetes + fever, cough, haemoptysis + thick-walled pulmonary cavity. Routine BAL stains and GeneXpert were negative, but Mucorales PCR was positive and Syncephalastrum grew in culture.
🔑 Learning: Host+syndrome matters

[IDNerd_DrMaithreyi @MaithreyiG]

4/9
🫁 THINK SYNDROME → THEN PATHOGEN
🌡️ Fever without focus → bacterial sepsis, CMV, drug fever
🫁 Pulmonary → bacteria, Aspergillus, PJP, viral pneumonitis
🧠 CNS → Cryptococcus, Toxoplasma, viral encephalitis
GI → CMV, C. difficile, parasites

[IDNerd_DrMaithreyi @MaithreyiG]

3/9
⏳ TIMELINE MATTERS
0–1 month: surgical complications + nosocomial bacteria/Candida
1–6 months: opportunistic infections — CMV, PJP, invasive fungi
>6 months: community-acquired infections + TB/herpes reactivation + chronic viral infections

[IDNerd_DrMaithreyi @MaithreyiG]

2/9
🧬 NET STATE OF IMMUNOSUPPRESSION
Consider:
• Current drugs, dose & duration
• Previous rejection treatment
• Induction/T-cell-depleting therapy
• Diabetes, renal dysfunction, malnutrition
• Mucocutaneous & surgical barriers
• Immunomodulating viruses

[IDNerd_DrMaithreyi @MaithreyiG]

🧵 A few key takeaways:
1/9
The starting point: 3 axes 🔺
Risk factors + Net state of immunosuppression + Exposure history
Don't look at the transplant alone.
Look at the whole immune landscape

[IDNerd_DrMaithreyi @MaithreyiG]

@MayoClinicINFD Neutrophilic dermatoses?

[IDNerd_DrMaithreyi @MaithreyiG]

@MayoClinicINFD Aspergillosis - voriconazole

[Antibiotic Steward Bassam Ghanem 🅱️C🆔🅿️🌟 @ABsteward]

🆕⚡🟢EFFORT RCT
Effectiveness and safety of 7-day high-dose primaquine and single-dose tafenoquine versus 14-day low-dose primaquine in patients with Plasmodium vivax malaria: a multicentre, open-label, randomised, controlled, superiority trial

Both unsupervised 7-day high-dose primaquine and single-dose tafenoquine were well tolerated in patients with normal G6PD activity and they had a lower risk of P vivax recurrence compared with those in the 14-day low-dose primaquine group, albeit with uncertain magnitude
@BradSpellberg #shorterisbetter ?
https://t.co/4eH4mP34AE

[IDNerd_DrMaithreyi @MaithreyiG]

@ABsteward The dosing commonly used in our setup is weekly once for 3 doses for BJIs. Feasibility of OPAT and early recovery has been demonstrated.

[IDNerd_DrMaithreyi @MaithreyiG]

#IDXposts #IDTwitter #Infectiousdiseases

[IDNerd_DrMaithreyi @MaithreyiG]

🔥THIS WEEK IN INFECTIOUS DISEASES🧵
Top papers,Quick critiques and clinical takeaways⬇️

[IDNerd_DrMaithreyi @MaithreyiG]

https://t.co/wpNveBQLNt

[IDNerd_DrMaithreyi @MaithreyiG]

✅ Dual drug regimen

LIMITATIONS

⚠️Risk of HBV reactivation with stopping TAF/FTC
⚠️ Islatravir long term immunologic safety-to be studied
⚠️ Modest metabolic difference

[IDNerd_DrMaithreyi @MaithreyiG]

2️⃣ HIV SWITCH TRIAL -Virologically suppressed adults on B/F/TAF,switching to Doravirine/islatravir(100/0.25 mg OD) was non-inferior for viral suppression with similar short term safety⬇️

[IDNerd_DrMaithreyi @MaithreyiG]

https://t.co/yd8Aov6kWI