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Prikvačeni tweet
1/ Let's differentiate pyogenic from amebic liver abscess in a
#Tweetorial today. We will examine DDx, risk factors, microbiology, clinical features, diagnostics, and treatment. This came from my most recent morning report.#IDTwitter#LiverTwitter#MedEdpic.twitter.com/IOZk3j1wht
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CORRECTION: For tweet #14, this should be the chart for associated clinical symptoms of ALApic.twitter.com/ueRDjzHyJn
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Jonathan Ryder, MD proslijedio/la je Tweet
1/9 All day I have been lacking inspiration about which topic to choose for my Sunday
#Tweetorial. Just looked outside & noticed that a rabbit had hopped out a perfect flask-shaped ulcer in my backyard! So get ready for a@BoggildLab tweetorial on#amoebiasis
! @MedTweetorialspic.twitter.com/Y2GdVwGrTA
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Awesome find from
@talhaqureshy that is a summary of my entire#Tweetorial in one chart Looks like it comes from this textbook: https://link.springer.com/chapter/10.1007/978-3-319-98497-1_79 …https://twitter.com/talhaqureshy/status/1223846319619526656?s=20 …Prikaži ovu nitHvala. Twitter će to iskoristiti za poboljšanje vaše vremenske crte. PoništiPoništi -
Amazing seeing the artist at work, I learned a ton from this thread and hope to incorporate these ideas more into future posts! Have you always wanted to make a Tweetorial and haven't? Read these posts first & jump into the pool!https://twitter.com/tony_breu/status/1224015310619127809 …
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Jonathan Ryder, MD proslijedio/la je Tweet
Rare,but also think about heterosexuals (in non endemic region / no travel history) I did see one case (oro-anal transmission). Drainage was done before Dx and was described as ‘’chocolate’’ (similar to anchovy paste I guess
)
Similar cases in Toronto;https://academic.oup.com/cid/article/49/3/346/497179 …Hvala. Twitter će to iskoristiti za poboljšanje vaše vremenske crte. PoništiPoništi -
Have found a good source for DDx as well as a radiography-based schema! https://www.ncbi.nlm.nih.gov/pubmed/27232504 pic.twitter.com/ULYWXmFi9A
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A related post from
@WuidQ in November 2019 regarding E. histolyticahttps://twitter.com/WuidQ/status/1199406534855401472?s=20 …Prikaži ovu nitHvala. Twitter će to iskoristiti za poboljšanje vaše vremenske crte. PoništiPoništi -
Tagging a few who may be interested in this subject:
@IUIDfellowship@IUIntMed@ebtapper@liverprof@tony_breu@thecurbsiders@UNMC_ID@DoctorJinnette@MedEdPGH@eColeID@medrantsPrikaži ovu nitHvala. Twitter će to iskoristiti za poboljšanje vaše vremenske crte. PoništiPoništi -
22/ That's it for this
#Tweetorial. It was a long one! Appreciate feedback as always and hope you learned as much as I did on this one! Appreciate the help on my AM report presentation from@mmcclean1@Strongylady@MitchGoldmanMDpic.twitter.com/YHFDafoRc8
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21/ Some cool history on this topic!
@AdamRodmanMD will appreciate the article about Fyodor Lesh! Science was different in the 19th century https://www.ncbi.nlm.nih.gov/pubmed/1098489 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1048259/ …pic.twitter.com/SwarvnD1ga
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20/ Antibiotics for ALA: - Metronidazole x 7-10 days for abscess - Then need intraluminal treatment (for cysts!) with paramomycin or iodoquinolpic.twitter.com/XtepbuazCK
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19/ Treatment for ALA differs from PLA: - Drainage is not necessary, unless uncertainty of diagnosis, lack of clinical improvement, or high risk for rupture (>10cm) - If drained, cultures will not help for ALA, but the color might! Remember anchovy paste!pic.twitter.com/EmiP9czkeU
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18/ Stool antigen testing is very useful - 87% sensitive, >90% specific - Detects Gal/GalNAc lectin, specific to E. histolytica PCR tests being developed Summary: serum Ab & stool Ag tests are the best methods for diagnosis. Don't order stool microscopy!
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17/ Serum antibody serology is great for rule out - Detectable after 7 days of infection in 85-95% of patients (sensitive), but negative early in infection - Persists for years, so 10-35% of uninfected have +Ab in endemic areas, cannot distinguish old from new infection
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16/ Diagnostics for ALA are tricky! Stool/aspirate microscopy - Insensitive (only 24% in one series) - Non-specific: cannot distinguish between pathogenic E. histolytica & non-pathogenic E. dispar (morphologically the same!) - Need specialized lab personnel & >3 stool samplespic.twitter.com/0lKfhcIdLR
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15/ Lab/Imaging findings of ALA: - 75% leukocytosis (WITHOUT eosinophilia) - 2/3rds elevated AST/ALT, 80% elevated ALP - Anemia, hyperbilirubinemia, and hypoalbuminemia seen - R hemidiaphragm elevation on CXR in 1/3rd - CT & US usefulpic.twitter.com/oEKNnPtk9o
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14/ Clinical presentation of ALA: - Incubation period of weeks to years - Fever, RUQ pain for ~2 weeks - Referred pain to R shoulder/chest, epigastric, pleuritic - Diarrhea in ~1/3rd - Can rupture into peritoneum, pleura, or pericardium uncommonlypic.twitter.com/owtcvu2RPf
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13/ Risk factors for ALA: - Male (10:1, likely due to EtOH-induced liver damage, as colonic amebiasis 1:1) - MSM, Institutionalization, Immunosuppression - Endemic regions: Mexica, Central/South America, India, Africa - 35% in short term travelers (<6w) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3472914/ …pic.twitter.com/N5jBTXzx9g
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12/ E. histolytica lifecycle: - Excreted into feces via cysts which transmit disease via fecal-oral route - Trophozooites multiply and make cysts in the colon Images:
@CDCgovpic.twitter.com/ivxKjTWO4J
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11/ E. histolytica exists as 2 forms: Cysts (figure 1): survive for weeks in environment due to thick walls, transmit the disease via feces Trophozooites (figure 2): die in environment & stomach acid, invade colonic walls (amebic dysentery) into blood stream (liver, brain, etc)pic.twitter.com/neehpVI08Y
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