A rough guide to infectious diseases that I've learnt over the past one year combined into a short thread.
This is for newbies/students, experts can add to the thread. A humble attempt -
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1/n
This is for newbies/students, experts can add to the thread. A humble attempt -
#MedTwitter #IDtwitter
1/n
2. Always approach your diagnosis in a syndromic way with available history. Is it LRTI or URTI, lower UTI or Phyelonephritis, meningitis or Encephalitis or meningoencephalitis, AUFI, hospital acquired or Community acquired, etc.
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3. Details of the Host - Age, immunocompromised or competent, his or her occupation/place of stay, travel, exposure to antibiotics, comorbidities, socioeconomic status, etc
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4. Think of environment / exposure - mosquito prone area, local infectious disease prevalence, travel, contact with a diseased person, frequent hospital visits in past, old age homes, etc.
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5. Organism - which is the organism which will explain the syndrome, the host features, the local epidemiology. What could you do to diagnose. Don't believe random cultures unless its in line with the clinical presentation/host and environment.
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6. Aim for tissue diagnosis. Histopathological correlation and culture. Deep seated culture> superficial cultures. Biopsy a lymph node if possible. Biopsy anything that you can. You can rule out autoimmune and other diseases.
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7. In immunocompromised patient, its a party of organisms. Rule out concurrent infections. Dont forget viruses, fungii and protozoa. Multiple organisms may cause multiple disease.
Don't forget that an organism may just be a colonizer.
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Don't forget that an organism may just be a colonizer.
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8. Antibiotic / antiviral / antifungal - does the agent work against the organism, local resistance pattern, does it achieve a good concentration in the tissue you're targeting, it's side effects, are you dosing it correctly as per creat and weight
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9. Guidelines are there to guide, but you should know when to bend it for your patient, individualize your treatment as per the patient. You may not have all the diagnostic tests available, understand your limits and place where you're working.
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