Ilan Schwartz

Wow, those are so cool

All presentations now available for streaming & 20 CPD credits. A huge thank you to all of our amazing speakers for their expertise presented during our 52nd annual meeting!

Visit www.wintercourse.org for full access

Watch this space for info on our 53rd Annual Meeting in 2027!

#idsky #medsky

Another choice is whether to implement patient portal as a way for patients to contact you 24/7

Epic is good but individual choices of what features and how to implement are important. Part of the problem here is not just the means of communication but how wards in the US are staffed almost exclusively by APPs with little attending supervision

#food

My kids constantly talk about moderate to severe Crohn’s disease (and risk of tuberculosis)

God is woken in the middle of the night by a text message. He reads it and goes back to sleep.

Reminds me a bit of this funny comic I saw yesterday by @extrafabulous.bsky.social

Both are actually crazy making. Not the fault of patients or of teams but as Darcy says, the system. That doesn’t value cognitive work

No that’s Patient Portal… this is messages from primary teams, eg APPs, residents, rarely attendings

Such a good article Darcy

“This is not a system failure. It is a system working exactly as it was intended. And that’s the problem.”

👏 👏 👏 @darcy-id-doc.bsky.social #idsky @cidjournal.bsky.social

“Epic Chat is neither savior nor saboteur. Like anything else, it is just a tool. But how we use it matters. In ID, where the work is complex and the thinking is deep, distractions have costs both to us and to our patients. We must protect the mental space it takes to do this job well.”

“… our ID fellows alone receive an average of 4.1 chat messages per patient, every day. With 15–20 patients, that’s easily 60–80 interruptions daily … a recent study showed that… 99% were non-urgent and 66% were non-actionable.”

More than a message: Death by a 1,000 “Chats” Abstract. Secure electronic messaging within the electronic health record (EHR), such as Epic Chat, has transformed communication in hospitals by enabling

Check out our article and guidance on Epic chat messages in CID. Anyone doing frontline clinical work understands the substantial downsides of constant, on-demand, text communication in the EHR. So great to write this with ID fellows. doi.org/10.1093/cid/...

State-of-the-Art Review: Diagnosis and Management of Acute and Chronic Bacterial Prostatitis Abstract. Acute bacterial prostatitis (ABP) and chronic bacterial prostatitis (CBP) are poorly defined clinical entities, and diagnosis can be challenging.

Check out this fabulous @cidjournal.bsky.social state of the art review on prostatitis from some powerhouse authors (who also happen to be some of my fave peeps)!!!

academic.oup.com/cid/article/...

Pathogenesis of Mucormycosis, Host Defenses, and Potential Future Therapeutic Targets. Mucorales sporangiospores released into the air from sporangia are inhaled, and the sporangiospore coat protein CotH3 binds to GRP78 on the pseudostratified columnar epithelial cells of the upper resp tract, where the sporangiospores may germinate into hyphae to invade nasal airways and sinuses (Panel A). Sporangiospores, by means of another coat adhesin (CotH7), also bind to epidermal growth factor receptor (EGFR) and integrin α3β1 receptor on pulmonary alveolar epithelial cells of the lower respiratory tract, which triggers a downstream transcriptional response involving cytokines (interleukin-6 and interleukin-8), chemokines (CCL2 and CCL5), and intercellular adhesion molecule 1 (ICAM-1). Hyphal invasion also triggers production of hypoxia-inducible factor 1α (HIF1α) and release of proinflammatory cytokines. In wound-related mucormycosis, traumatic inoculation of fungal elements (found on the surfaces of rocks, wood, glass, and metal) into damaged tissue allows for the development of infection in a host with immune paralysis due to trauma. The release of endogenous host-derived molecules known as damage-associated molecular patterns (DAMPs) reduces phagocytosis, impairs chemotaxis, and induces immune paralysis. Mucoricin released by the invading hyphae induces death of immune and endothelial cells, which results in tissue necrosis and accelerates endovascular thrombosis, ischemia, and infarction (Panel B). PMNs and monocytes recognize early germinated sporangiospores by pattern recognition receptors (e.g., TLR2) that detect mucorales-associated molecular patterns (e.g., 1,3-βD-glucans exposed on hyphal structures). Intrinsic host colony-stimulating factors such as granulocyte–macrophage colony-stimulating factor (GM-CSF) and IFN-γ further contribute to augmentation of innate host defenses against the invading hyphae, which in turn dampen immune responses. Factors in the tissue …

Risk factors for Mucormycosis

Risk factors for mucormycosis continued

Mucormycosis

Review in @nejm.org by Dimitrios Kontoyiannis and Tom Walsh

www.nejm.org/doi/10.1056/...

#IDSky #TxID #MedMycoSky @msgerc.bsky.social

Table of recommendations part 1

Table of recommendations part 2

Fungal diagnostic stewardship in immunocompromised populations: a focus on molds and dimorphic fungi

@jmsteinbrink.bsky.social @hannah-imlay.bsky.social et al on behalf of @msgerc.bsky.social

journals.asm.org/doi/10.1128/... #IDSky #MedMycoSky #MicroSky #TxID

RFK Jr. made promises to get his job as health secretary. He's broken many of them In his confirmation hearings, Robert F. Kennedy Jr. told U.S. senators that he would not cut funding for vaccine research or change the nation's official vaccine recommendations. He did both.

In his confirmation hearings, Robert F. Kennedy Jr. told U.S. senators that he would not cut funding for vaccine research or change the nation's official vaccine recommendations. He did both. n.pr/46QDn9p

Like a proper professor

Two adults and two kids in ski helmets and goggles on a snowy mountain

Just back from another excellent @wintercourseid.bsky.social

Highly recommend this meeting, especially for ID fellows and junior faculty. World class faculty, high yield topics, and lots of time to enjoy the 🏔️ #IDSky

Paradoxically puffy and wrinkly

Would be a weird place to do a subcut injection. Probably a blown IV site although you wonder why they couldn’t find a less visible site - you can imagine he’s likely had blown veins up and down his arms

Panel A: The weekly Gravitrap Aedes aegypti index (GAI), which measures the abundance of adult A. aegypti mosquitoes, in the intervention and control clusters before and during the release of wolbachia-infected male mosquitoes. Panel B: A spatial visualization of the intervention (red) and control (teal) clusters.

In this report from Singapore, the release of wolbachia-infected, irradiated male 𝘈𝘦𝘥𝘦𝘴 𝘢𝘦𝘨𝘺𝘱𝘵𝘪 mosquitoes resulted in a reduction in the vector population and in the risk of dengue infection. Full report: nej.md/4atd2iN

#MedSky #IDSky

Opinion | Vinay Prasad’s Vaccine Kill Shot Does the White House know the harm he’s doing to public health?

WSJ editorial board hits FDA: It’s hard to recall a regulator who has done as much damage to medical innovation in as little time as Vinay Prasad who rejected Moderna’s mRNA flu vaccine without even a cursory review.
www.wsj.com/opinion/vina...

Prasad overruled FDA staff to reject Moderna's flu vaccine application The rejection is the latest instance of Vinay Prasad overruling career FDA scientists to place vaccines under harsher scrutiny.

Scoop: Top FDA official Vinay Prasad overruled the agency’s reviewers when he refused to accept Moderna’s application for a new influenza vaccine, STAT has learned.
www.statnews.com/2026/02/11/m...

Looks like this decree from VP is hot garbage.

@drboulware.bsky.social has a thread on it worth checking out (I apparently can’t share a link to someone else’s post?)

Schematic representation of iatrogenic mold central nervous system infections (1). The source of mold includes contamination during medication manufacturing, storage in a mold-contaminated environment, and environmental contamination during procedures (2). Routes of mold inoculation can occur in four situations: spinal puncture (epidural or spinal injection; most common), ventricular drainage devices (VP shunt or external ventricular device), transsphenoidal surgery, and craniotomy (3). Clinical complications of mold CNS infection include aneurysm formation, hemorrhagic stroke due to ruptured aneurysm, ischemic stroke, and meningoencephalitis.

An unintended consequence: a review of iatrogenic central nervous system mold infections and outbreaks

Kontoyiannis and colleagues @msgerc.bsky.social
#IDSky #MedMycoSky

journals.asm.org/doi/10.1128/...

#IDSky I always email residents rotating with me survival tips for their time of the ID consult service. I like to keep this short and high yield but I am constantly editing and improving the tip sheet. What would you add or remove. It cannot be longer that one page 😊.

Wow. Incredible.

Dunno I missed IDWeek this year. I don’t usually use rifampin but levo is great if bugs/susceptibilities align