Sébastien Poulin
@sebpoule
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Medical microbiology & Infectious diseases MD MSc @ St-Jérôme & Montréal 🔝 Interests #HBV #HIV & General I.D. ➡️ #IDTwitter #HIVTwitter #IDXposts (French 🇨🇦)
St-Jérôme & Montréal, Québec
Joined March 2009
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#MonkeyPox
#IDtwitter
My patient with MonkeyPox suspicion is now confirmed by PCR.
I can share with you some important details that I could not before.
➡️ The bottom line of this tweet will be; «We must have a high index of suspicion for ‘atypical’ MonkeyPox cases»
(1/4)
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Notre fille de 6 ans a eu sa 2e dose de vaccin COVID-19 aujourd’hui.
Our 6 year-old daughter got the 2nd dose of COVID-19 vaccine today.
Merci/Thank you science !
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Note; I cannot stress enough the ANECDOTAL part of my tweet. We will have to wait and see if reports of ‘atypical cases’ continue or not
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-May 24; mostly crusted lesion(s)
❗️Never had other rash/lesion elsewhere
❗️Never had fever/ prodrome etc.
➡️ Warning; ANECDOTAL n=1..
But I think it’s important to know that there’s a spectrum of disease manifestations and keep a high index of suspicion.
(4/4)
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~20-30y man
-May 6-7 ; sexual contacts with positive cases
-May 15; single ~0,5 cm macule ➡️ papule ➡️ vesicle/pustule on the penis. Not painful (❗️)
-May 16; painful left inguinal lymphadenopathy
(2/4)
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« When death is inevitable, the way of dying is important »
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-May 17; Progression of the single penis lesion. Small crust at the center. Not painful (❗️)
-May 19; Lesion is now ~1,3 cm and mostly crusted with vesicle borders. + 2 or 3 small vesicular «satellite lesions» around it.
(3/4)
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Hier, j’ai accompagné mon père dans une urgence de la grande région de Québec. Meilleure «expérience hôpital» de toute ma vie. Incroyable 😮
-Arrivée 12h15
-Triage 12h30
-Visite urgentologue 13h15
-Couché lit/cabine d’urgence 14h
-Attente imagerie & consult…
Je suis encore
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#ECCMID2022
#IDtwitter
💥SABATO TRIAL💥
S.aureus blood infection
-deep-seated foci are common
-at least 14d of Tx
-oral Tx possible ?
Why shorter ?
-less phlebitis
-shorter hospital stay
but is it less effective ?
(p.s. no mandatory cardiovascular ultrasound)
(1/3)
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💥CLSI M100 34rd Edition
Updates 👇 - A thread 🧵
#MicroRounds
#IDXPosts
#IDTwitter
(a bit late because I’m 🤒)
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#IDtwitter
« Antibiotics are among the most potent psychoactive drugs in all the pharmacopoeia. They are incredibly potent anxiolytics. They just act on the prescriber rather than the patient»
-Dr
@BradSpellberg
That's it. That's the Tweet.
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My wife
@LapointeVero
and I are infectious disease physicians.
We've also followed
#COVID19
vaccine data closely, and reviewed Pfizer's safety & efficacy data in ages 5-11 thoroughly.
We WILL vaccinate our 6 year old with confidence. THANK YOU, science - we are SO grateful.
I am an infectious disease physician. My wife is a registered nurse.
We've followed
#COVID19
vaccine data closely, and reviewed Pfizer's safety & efficacy data in ages 5-11 thoroughly.
We WILL vaccinate our 5 year old with confidence. THANK YOU, science - we are SO grateful.
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An infectious diseases specialist from Montreal just said on live radio that he wasn’t vaccinated against COVID-19 because;
- he’s waiting for more data
- he didn’t have time / was busy
I’m 🤯
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Nouvelle coiffeuse;
«Tu fais quoi comme travail ?»
Moi;
«Je travaille en informatique»
(pour avoir un 30 minutes de Sainte Paix sans parler de COVID-19 😂)
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💥 Montreal public health ↗️↗️↗️ MonkeyPox vaccination starting tomorrow!
➡️Post-exposure (skin-skin) with MonkeyPox + case and/or fomites, <14d or less
➡️Men, Gay Bisexual Trans with 2 or more male sexual partners in the last 14d
8h00-19h30
965 Boul de Maisonneuve E, MTL
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Wow ! Un collègue de St-Jérôme s'en va aider en Ukraine ! Bravo Dr Julien Auger ! ❤️🇺🇦
«35-year-old physician Julien Auger was preparing to leave his young family to become a medic with Ukraine's health ministry and provide "neutral" humanitarian aid.»
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#IDTwitter
, I need your help !
Please share/retweet my 🎁
Happy birthday to my wife, mother of our children and I.D. colleague 🦠 🧫
@LapointeVero
🥳
➡️from
@DGlaucomflecken
😉
(filmed two haircuts ago
@BookCameo
)
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L’Ontario exigera la vaccination contre la COVID-19 pour les travailleurs de la santé.
J’appuie entièrement cette décision courageuse et j’espère que le Québec imitera nos voisins !
#COVID19QC
@cdube_sante
@francoislegault
@GGuilbaultCAQ
@coalitionavenir
Ontario will MANDATE COVID-19 vaccine for all hospital & LTC workers and begin targeted COVID-19 booster shots while keeping current pandemic restrictions in place for now.
Great move,
#ON
!
Big question... who's next up?
#COVID19SK
#COVID19AB
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En nomination dans la catégorie ‘’Ça n’a pas très bien vieilli’’
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Doxy-PEP in a nutshell
➡️Doxycycline for STI prevention: Current research and future directions
-Chase CANNON
#IAS2023
#IDtwitter
#STItwitter
(1/3)
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My I.D. life is complete now
#IDtwitter
;
I’ve seen a patient (consultation) for «HBV» and it turned out to be;
-HBV
-HDV
-Malaria
-Schistosomiasis
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New concept
#IDtwitter
;
➡️ Penicillin injected directly into the infected wound
#TheLastOfUs
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I'm a Med micro / I.D. physician and my wife
@LapointeVero
is a Med micro / I.D. physician (🤷♂️😉)
Our kids will get vaccinated as soon as they are eligible
I'm an Infectious Diseases physician and my wife is a pediatric respiratory therapist.
Our kids will get vaccinated as soon as they are eligible
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En conférence de presse
@cdube_sante
, en 2021, on entend encore de façon récurrente ‘’Madame" ou "Mademoiselle" pour UNE médecin, et immanquablement "Docteur" pour UN médecin
Aujourd'hui, dans la même phrase; Mme Drouin
@Santepub_Mtl
de Mtl et Dr Trépanier de Laval
1/3
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Today, I saw a patient with urine cultures pre-ordered every week since 2018 to rule out ‘’recurrent UTi’’. (I also had a heart attack)
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My first patient with MonkeyPox suspicion this morning…. during a COVID-19 pandemic, avian flu outbreaks (only birds for now) and cases of Anaplasmosis (Estrie, Quebec)
➡️ My Past Self would be like;
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The vast majority of urine cultures, sputum cultures and wound cultures are 🗑️
🙋♂️ What’s your unpopular opinion in medicine that will get you in this position?
#MedTwitter
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💥CLSI M47-Ed2 is out💥
«Principles and Procedures for Blood Culture»
Overview of changes (see image)
(I'll try to post major changes, if any, as soon as I read it... follow & bookmark 👇)
#MicroRounds
#IDtwitter
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Do you know PLWH & Low-Level Viremia despite perfect ART adherence &no other explanation?
Great work by
@SimonettiFR
team
➡️Clonally expanded HIV-1 proviruses with 5’Leader defects can give rise to nonsuppressible residual viremia
#HIVtwitter
#IDtwitter
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Who would you add ?
So many great people to follow 😳
@DrToddLee
@SamuelDM18
@Pharmacist_MTL
*
@PBenoit93
: Vois-tu des résidents absents ?
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Les gouttes💧qui ont fait déborder le vase
➡️«Enfilade» d'un médecin spécialiste de 38 ans découragé et désabusé de la politique qui néglige chroniquement la région des Laurentides
👇
#PolQC
#Laurentides
#CISSSLaurentides
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Ça n'a rien d'un caprice.
Il est juste temps qu'on arrive en 2021.
Voilà, c’est dit.
That’s it
That’s the tweet.
@francoislegault
@AssnatQc
@coalitionavenir
@partiquebecois
@QuebecSolidaire
@LiberalQuebec
3/3
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Est-ce que j’ai manqué le mémo qui dit qu’on ne peut pas rapporter des données rassurantes et/ou encourageantes (sans déni ou délire) à propos de la COVID-19 sur Twitter?
Ces gens se font toujours ‘’ramasser’’ par ceux qui semblent apprécier vivre sans bonne nouvelle
C’est dit.
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Did you ever feel like you're the only one who actually really looked at the medical record of the patient when you’re asked for a consultation ? 🤦♂️
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I don’t know who needs to hear (see) this, but this is NOT CELLULITIS…
*and yes, it’s ok to stop Cefadroxil 😉
** photos posted with patient consent
#LobsterFoot
#PeripheralArteryDisease
#IDtwitter
#NotIDtwitter
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Note à moi-même; toujours avoir un sarrau bien REPASSÉ avant une photo média 😂
Note to self; always have a WELL-IRONED white coat before a media photo 🤦♂️
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114 jours plus tard, ma deuxième dose du vaccin COVID-19 ❤️
114 days later, my second dose of COVID-19 vaccine 👍
Do it !!! 🙏
#vaccination
#polqc
@FMSQ
@AMMIQ1
@AMMICanada
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I’m using my vaccine passport for the first time @ Shang-Chi movie with
@ginopadre
.
Hi 👋
@BogochIsaac
!☺️! 😉
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Here it is 🤪
1- I’m a lefty 💪
2- A mistake* made 18y ago on my right shoulder is now publicly shown (🤦♂️😭)
3- A very good decision made today (COVID19 vaccine, Pfizer) using my mistake as a 🎯
*It’s a logo used by the band Deftones 🤷♂️
#IDtwitter
#COVIDvaccine
#COVID19
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➡️Meningitis B vaccine for prevention of gonorrhoea: What is the evidence?
-
@jmmolinaparis
(with permission)
#IAS2023
#STItwitter
#IDtwitter
(1/6)
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#HIVtwitter
I was today years old when I saw my first patient living with HIV-2 (it's true ! never before 🤷♂️)
Quick review 👇
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#IDtwitter
Can you guess what bacteria is causing this ?
p.s. It’s a trap !
p.s.2. Posted with patient consent
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Consultation téléphonique d’un urgentologue pour une cellulite sur morsure de chat 🐈⬛
Moi; Allô?
Lui: Salut Dr Poulin, écoute, CHAT va pas bien du tout. Ça MATOU l’air que tu devrais voir la patiente.
Bravo 👏 🤣
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I always give my professional email address to my patients living with HIV. Definitely more pros than cons.
''Pro'' example : Email from a patient just to tell me that she will finally get the COVID-19 vaccine & she wanted me to know because I would be ''happy'' 😅😂
#HIVtwitter
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Hier, j’ai été au cinéma 🍿 et utilisé mon passeport vaccinal pour la première fois. Tout a très bien fonctionné!
Aucun reproche à faire, sauf peut-être;
➡️Pourquoi avoir de la publicité pour la 2e dose du vaccin avant le film?
Ce n’est pas vraiment le public cible… 😂😉
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💥NEW 💥
CLSI Performance Standards for Antimicrobial Susceptibility Testing - M100, Ed 32
➡️Overview of Changes (the most useful changes for 🇨🇦 only... where many antibiotics are not available 🤷♂️ex: Cefiderocol, Lefamulin, etc...)
#MicroRounds
#IDtwitter
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➡️Après 6 ans de persévérance, j’ai finalement reçu «mon» Fibroscan 🤩
Merci à la Fondation de mon hôpital 🙏
➡️After 6 years of perseverance, I finally received «my» Fibroscan 🤩
Thanks to my Hospital Foundation 🙏
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Why do I see Paracoccidioides when I look at my wife’s hair tie ?
I need help 😂😉
@LapointeVero
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My clinic today;
-HBV consult
-HBV Tx TDF (cirrhosis)
-HBV no Tx
-HBV/HDV (cirrhosis) Tx discussion
-HCV (SVR12)
-PLWH DOMINO protocol (maturation inhibitor)
-PLWH regular f/u
-PLWH + LTB new INH Tx (DDIs)
-PLWH + primary syphilis
-PrEP on-demand
-Urethritis
...I love my job.
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Aucun patient COVID-19 hospitalisé ici depuis un petit bout… puis notre 3e en 48h. 🤞🤦♂️
Impression de déjà vu désagréable.
Go 💉 Vaccins 💉 Go !
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I called a surgeon for a question about one of my patient living with HIV today.
His response was so full of stigma and prejudice that I was shocked and couldn’t find the right words to say.
Shame on me 😳
I’m still 🤯
I’ll sleep over it.
#HIVtwitter
#stigma
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~60 yo woman living with HIV diagnosed in 2000s.
No sex relation since then because of fear, stigma and never had U=U discussion with previous doctor (~8 years too late).
I swear she almost hugged me this morning when I told her about U=U
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@IdVilchez
Community ID is not inferior to Academic ID (or if you prefer, Academic ID is not superior to Community ID)
Don’t let anyone tell you any different.
Everyone make personal choices.
Life. Family. Health…
Don’t be defined by academic or community.
Just enjoy your work & life
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❤️Update on Cardiovascular Implantable Electronic Device Infections and Their Prevention, Diagnosis, and Management: A Scientific Statement From the American Heart Association
#IDXposts
@ABsteward
@LBaddour1
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💥Breaking news
#HIVmed
CAB + RPV (CABENUVA) approved by Health-Canada 🇨🇦 every 2 months
#IDtwitter
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I.D. consult; fever, cough, weight loss, night sweats and this X-ray.
Me; Let me shave my beard first and I’ll see the patient... 🤷♂️
#FitTest
#N95
#Tuberculosis
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How it started 🥱
-Usual week, normal cases…
How it ended 😲
-West Nile virus encephalitis
-Vibrio cholerae bacteremia
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~30 yo alcohol use disorder
Northern suburbs of Montreal 🇨🇦
➡️ Any idea why this pneumonia did not improve with PipTazo/Vanco and Meropenem ? (😉💥-to🍄)
#IDXposts
#IDTwitter
#MicroRounds
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🥲
@AIDS_conference
is almost over
Thanks to
@iasociety
, co-chairs, organizing committee, community partners, volunteers,
@MTL_ville
& speakers
I'm grateful for all the science presented.. but also for all the persons I have met !
Au revoir !
#IDtwitter
#HIVtwitter
#AIDS2022
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Being hospitalized in a MRSA isolation room is a really bad experience. My whole appreciation of IPC practices is now 🫨. I’m forever changed
#TasteOfOnesOwnMedicine
#IDDocHospitalizedWithMRSA
@DrRossanaRosa
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No! Same patient, leg elevation
2/3
(photo shared with patient consent)
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My dad’s cookies recipe.
It’s strange how the 🧠 and taste memories work 😳
Love you dad.
R.I.P. (April 2023)
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Merci à Dr François Marquis,
@carignan_alex
et
@CaroQuach
pour votre excellent travail d’experts dans les médias en cette année de pandémie.
💥Ah oui, j’oubliais... merci aussi pour votre participation à
@infomantv
- Revue de 2020 😂😉👍
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«Personal I.D. story»
I had this rash x >5 days on my flank.
Pruritus +++ NO PAIN.
I wouldn’t believe in Zoster
My colleague
@MarilyseDrapeau
told me I was in «denial» and kind of laughed at me 😉
She did a PCR… VZV +
🤦♂️😬😳☺️
(French expression; Cordonnier mal chaussé)
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💥Daily Doxycycline in MSM on PrEP for prevention of STDs, The DuDHS Study, CROI2021
Randomized, controlled pilot study (n=52) in HIV(-) MSM or transgender women with prior syphilis
#IDtwitter
@STD_Journal
*1/8
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#AIDS2020Virtual
#AIDS2020
Weight gain before and after switch from TDF to TAF (OAB0604) by
@HIVTox
-Switch to TAF associated with early, pronounced weight ⬆️ over first 9 months
-Results suggest an independent effect of TAF on weight
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Well, here they are.
My first treatments of Mycoplasma genitalium with Pristinamycine.
Both failed Azi, Doxy, Moxi, Mino… 😳
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#CROI2023
Feb 19-22
Oral Abstracts
My personal favorites ❤️
A # thread🧵👇
#HIVtwitter
#IDtwitter
# 119
ANRS 174 DOXYVAC: An Open-Label Randomized Trial to Prevent STIs in MSM on PrEP
# 120
DOXYPEP & Antimicrobial Resistance in N.gonorrhoeae, Commensal Neisseria & S.aureus
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Contact is also
#MonkeyPox
positive
#IDtwitter
Slightly different presentation👇
- May 27: Prodrome with fever, night sweats, fatigue
- May 28 : SINGLE perianal papule/pustule <5mm, not painful (unless we touch it). End of prodrome
- May 30 : Same unique lesion = Ulcerated, PCR+
#MonkeyPox
#IDtwitter
My patient with MonkeyPox suspicion is now confirmed by PCR.
I can share with you some important details that I could not before.
➡️ The bottom line of this tweet will be; «We must have a high index of suspicion for ‘atypical’ MonkeyPox cases»
(1/4)
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The Number 1 prescriber of Vancomycin in Canada is UpToDate
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💥Amox/Clav vs Pip/Tazo ❓
➡️ Amox/Clav (R);
-Acinetobacter sp
-Pseudomonas sp
-Aeromonas sp
-Citrobacter freundii
-Enterobacter cloacae complex
-Klebsiella aerogenes
-Hafnia alvei
-Morganella morganii
-Providencia rettgeri/stuartii
-Serratia marcescens
-Yersinia enterocolitica
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This size of cookie should be illegal
That’s it
That’s the tweet
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I have a confession to make.
I’m ALL IN for ‘’Shorter Is Better’’ and ‘’Oral > IV’’ antibiotics.
But I find it harder and harder to argue with colleagues (I.D. & others) who prefer dogmas over evidences.
It’s time consuming and exhausting.
(Yes, I had a bad day yesterday 😉)
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