Brad Spellberg Totally agree! The sensitivity and specificity of the 'criteria' have never been tested, and we know they are non specific. See pubmed.ncbi.nlm.nih.gov/38066877/

Does anyone else think that maybe we over diagnose HLH these days, that the criteria are overly sensitive for identifying which patients need frieking chemotherapy as opposed to treating the underlying dz? I mean, sometimes you need to. But it feels maybe more common these days?

Todd C. Lee Brad Spellberg caldas92 Emily McDonald WikiGuidelines In our last 1867 participants with a LPs conducted since Jan 1, 2019 among persons with HIV in Uganda without an antecedant head CT, no herniations with or immediately after an LP.
A write up is in the works. A substantial number did later have head CTs.

Challenging all the dogma and BS in medicine probably feels Sisyphean, but it’s the only way forward. 🤙

Brad Spellberg caldas92 Emily McDonald WikiGuidelines High icp is bad in cryptococcus. It's treated by drainage.

People theorize lumbar drain might be beneficial in true bacterial meningitis.

I agree with you that risk of herniation as a function of CT scan findings and performance/not of LP is poorly evidenced

Practice can evolve. It is absolutely disheartening and demoralizing to call out the extensive amounts of BS in medicine day after day. But when we consider over the course of years to decades, I guess things can progress. We just have to keep fighting the fight day by day.

Brad Spellberg Todd C. Lee Emily McDonald WikiGuidelines In fact, if we compare the different guidelines, those that ask for more requirements are associated with worse outcomes and higher mortality.

doi.org/10.1093/cid/ci…

Brad Spellberg Todd C. Lee Emily McDonald WikiGuidelines 19 years later, we are STILL asking the same question! I was taught by neurosurgeons that as long as there’s no focal neuro deficits, can do an LP without a CT. That’s what I do. In fact, that was one of my Royal College oral exam questions & I obviously passed 😃

On ID consults, pulled out this old letter to editor, criticizing guidelines for recommending CT before LP. I been howling at the moon for 20 yrs. Scary. Take a good look Todd C. Lee and Emily McDonald and team WikiGuidelines at your old & cranky future...

academic.oup.com/cid/article/40…

Time for regular reminder (every year when salaries are released) that this problem is not new; solutions are known but they won't happen until US ID docs decide to either start a new specialty society, or force the current one to do its job. academic-oup-com.libproxy1.usc.edu/ofid/article/7…

#IDtwitter What is your number 1 Infectious Diseases Myth? Can you refute it with evidence? Todd C. Lee Brad Spellberg Alice Han Annette Hennigs
Sam Aitken Gabe 🦊 Boris Jegorović, MD, PhD Dr Patrick Lillie David Paterson Steven Tong Darcy Wooten she/her

Traumatisch Cris Ojeda-Thies Absolutely! Look at WikiGuidelines - that came from #IDTwitter - it’s awesome!

honestly going to go for the Brad Spellberg special on this one: that IV antibiotics are in any way ''inherently'' superior to oral in any situation where both options exist & the pt has a functioning gut.

Per @absteward's request, here are updated slides showing # new abx approved by 5 year periods, & table showing specific new Abx since 2009--green = meets unmet need; yellow = sorta maybe has some use; red = does not address unmet need. We continue to get new abx we don't need.

We extend our heart-filled thanks to our renowned Epidemiologist PD Holtom as he opens his next life chapter into retirement. Thank you for the 48 years of dedicated service, we miss you already!😭💙
youtu.be/nSrdxK9k4eo
#LAGeneral #YearsofService #HappyRetirement

It is clear that reluctance to adopt the practice of IV-to-oral antibiotic switch has much more to do with tradition & inertia than an absence of data!
🆕️🔥 Challenging Dogma in The Treatment of Childhood Infections: Oral Antibiotics & Shorter Durations journals.lww.com/pidj/fulltext/…

Beautiful work 🤩 Brendan McMullan Brad Spellberg OA 🔥Ped Infect Diseases journals.lww.com/pidj/fulltext/… 🔥 ANZPID PIDS ESPIDSociety