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Allen Cheng

@peripatetical.bsky.social
1.1K followers 99 following 45 posts

Infectious diseases physician, epidemiologist. Melbourne, Australia.

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Allen Cheng @peripatetical.bsky.social · 13/04/2025
Congratulations to Steve Tong, Josh Davis and the huge SNAP team (including Monash Health). Clear outcome that cefazolin is less nephrotoxic than flucloxacillin for MSSA, and pencillin is better for PSSA. @steventong.bsky.social @gurujosh.bsky.social
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BK. Titanji @boghuma.bsky.social · 01/03/2025
Cool paper from Florian Kramer & colleagues about a novel feature of circulating H5N1 clade 2.3.4.4. These viruses have a longer stalk in their neuraminidase (NA) enzyme, a key viral protein. This was not seen in past H5N1 strains (2002-2019) Why does it matter?🧪 journals.asm.org/doi/10.1128/...
journals.asm.org
Clade 2.3.4.4b H5N1 neuraminidase has a long stalk, which is in contrast to most highly pathogenic H5N1 viruses circulating between 2002 and 2020 | mBio
While the truncated version of the N1 neuraminidase stalk domain may be associated with increased virulence in poultry, the long version of the stalk domain has been associated with increased transmis...
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Allen Cheng @peripatetical.bsky.social · 02/03/2025
Looks like PubMed is down - not sure if this is a temporary outage or something more sinister. Europe PMC is an alternative search engine for medical literature that is publicly accessible. europepmc.org
europepmc.org
Europe PMCHome - Europe PMC
Europe PMC is an archive of life sciences journal literature.
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Josh Davis @gurujosh.bsky.social · 12/12/2024
Great list @absteward.bsky.social! Mine is coming soon (limited to 10)
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Allen Cheng @peripatetical.bsky.social · 12/12/2024
Paul Sax's "oh wow" moments in HIV: AZT during pregnancy reduces vertical transmission; triple ARVs improve survival; integrase inhibitors as effective salvage therapy; PrEP is very effective; undetectable = untransmissible and now 6 monthly lenacapravir PReP is 100% effective
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Allen Cheng @peripatetical.bsky.social · 06/12/2024
Not my area of expertise, but I understand there are restrictions on the use of the Individual Healthcare Identifier so that it can't be used in linkage. But I could be wrong - others might know.
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Allen Cheng @peripatetical.bsky.social · 03/12/2024
Very annoying when you’re writing a manuscript - can’t easily find/replace to change full stops to interpuncts. I understand it’s a historical anachronism, like the New Yorker using diaereses (coöperation”) en.m.wikipedia.org/wiki/Interpu...
en.m.wikipedia.org
Interpunct - Wikipedia
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Allen Cheng @peripatetical.bsky.social · 01/12/2024
Five years ago (1 Dec 2019), the first person became unwell in a case cluster of a new infection that we now know as COVID-19. pmc.ncbi.nlm.nih.gov/articles/PMC...
pmc.ncbi.nlm.nih.gov
Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China
A recent cluster of pneumonia cases in Wuhan, China, was caused by a novel betacoronavirus, the 2019 novel coronavirus (2019-nCoV). We report the epidemiological, clinical, laboratory, and radiologica...
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Allen Cheng @peripatetical.bsky.social · 27/11/2024
My father's family were originally rice farmers in China, and I ended up doing my PhD on melioidosis, a disease of rice farmers, partly based in Thailand where many of his siblings moved to (and where my cousin is an infectious diseases physician).
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Allen Cheng @peripatetical.bsky.social · 26/11/2024
C is the Schrödinger's result - simultaneously inferior and non-inferior.
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Allen Cheng @peripatetical.bsky.social · 21/11/2024
I've been off social media mostly for almost three years, was enticed back by Tony Korman, and tentitively wading back in!
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Allen Cheng @peripatetical.bsky.social · 21/11/2024
Supports routinely using 7 days of treatment in bacteraemia (other than S aureus, fungaemia, and if there is a definite indication for longer eg endocarditis)
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Allen Cheng @peripatetical.bsky.social · 21/11/2024
90 day mortality was *lower* in 7 day group (14.5%) vs 14 day group (16.1%); met non-inferiority criteria There were no major differences between shorter/longer groups in subgroups, i8ncluding ICU, APACHE-II >25, by site or pathogen.
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Allen Cheng @peripatetical.bsky.social · 21/11/2024
Broad variety of infection sites but majority gram neg (71%); clear separation in duration between shorter group (median 8 days) vs longer duration group (median 14 days)
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Allen Cheng @peripatetical.bsky.social · 21/11/2024
It included ICU patients (55% of enrolled patients) but notably excluded immunocompromised, S aureus, candida, deep infection (eg endocarditis).
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Allen Cheng @peripatetical.bsky.social · 21/11/2024
This was a large trial (n=3608) at 74 hospitals in 7 countries. (COI: The Australian arm was co-ordinated from Monash by Ben Rogers). It was a non inferiority, 7 vs 14 days of treatment; primary outcome 90 day mortality.
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Allen Cheng @peripatetical.bsky.social · 21/11/2024
Congratulations to the BALANCE group on the trial published in NEJM today. This trial tested 7 vs 14 days of antibiotics for bloodstream infection. #IDSky www.nejm.org/doi/full/10....
nejm.org
Antibiotic Treatment for 7 versus 14 Days in Patients with Bloodstream Infections | NEJM
Bloodstream infections are associated with substantial morbidity and mortality. Early, appropriate antibiotic therapy is important, but the duration of treatment is uncertain. In a multicenter, non...
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Sonia Koning @sonkoning.bsky.social · 15/11/2024
Lessons from practice for immunocompromised hosts by Dr Ai Li Yeo and A/Prof Claire Dendle #ForbesWeek #IDSky 1. There can be more than two pathologies in immunocompromised patients
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Allen Cheng @peripatetical.bsky.social · 16/11/2024
Thanks for coming to Melbourne! It's been an honour to have you join our ID community here and benefit from your expertise.
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Allen Cheng @peripatetical.bsky.social · 16/11/2024
28. In community-acquired infection, resistant organisms do not cause more severe illness than their sensitive counterparts. The only reason for using broader than usual therapy is when you (and the patient) cannot afford to be wrong.
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Allen Cheng @peripatetical.bsky.social · 16/11/2024
27. When you suspect bacteraemia, do not wait for the patient’s temperature to go up before doing blood cultures.
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Allen Cheng @peripatetical.bsky.social · 16/11/2024
26. In patients with unexplained neurological features, think of the five great infective mimics: HIV, syphilis, tuberculosis, Lyme disease (with epidemiological history), Whipple’s disease.
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Allen Cheng @peripatetical.bsky.social · 16/11/2024
25. Bacterial aortitis needs to be excluded in a patient who develops abdominal pain or back pain within weeks of an episode of diarrhoea.
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Allen Cheng @peripatetical.bsky.social · 16/11/2024
24. Remember that Listeria monocytogenes meningoencephalitis can masquerade clinically as herpes simplex encephalitis.
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Allen Cheng @peripatetical.bsky.social · 16/11/2024
23. Avoid the term “atypical pneumonia” in children, adults over the age of 50 years, the immunocompromised, the severely ill, or patients with diffuse bilateral interstitial pulmonary infiltrates.
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Allen Cheng @peripatetical.bsky.social · 16/11/2024
22. Not everyone with aseptic meningitis has viral meningitis; unless confirmed by PCR, viral meningitis is a diagnosis made after the patient has recovered.
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Allen Cheng @peripatetical.bsky.social · 16/11/2024
21. Specific IgM antibodies are a useful but unreliable marker of primary infections in pregnancy, thus clinical decisions should not be based solely on a positive IgM.
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Allen Cheng @peripatetical.bsky.social · 16/11/2024
20. Consider common bacterial infections, and not just opportunistic infections in febrile patients with HIV.
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Allen Cheng @peripatetical.bsky.social · 16/11/2024
19. Think of vertebral osteomyelitis and epidural abscess in a patient with fever and back pain.
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Allen Cheng @peripatetical.bsky.social · 16/11/2024
18. Infection in the diabetic patient will flourish until the diabetes is controlled.
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Allen Cheng @peripatetical.bsky.social · 16/11/2024
17. Think of acute bacterial epiglottitis in an adult patient with a normal looking throat who is complaining of acute sore throat, pain on swallowing and/ or hoarse voice.
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Allen Cheng @peripatetical.bsky.social · 16/11/2024
16. More than one infection may be present in a patient, particularly in the elderly, the immunosuppressed, and the returned traveller. (Occam’s razor is an instrument with which many clinicians eventually slit their own throats!)
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Allen Cheng @peripatetical.bsky.social · 16/11/2024
15. A moveable joint does not exclude septic arthritis.
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Allen Cheng @peripatetical.bsky.social · 16/11/2024
14. Staphylococcus aureus meningitis without preceding central nervous system instrumentation indicates the presence of endocarditis until proven otherwise
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Allen Cheng @peripatetical.bsky.social · 16/11/2024
13. Never underestimate staphylococcal bacteraemia: look into the heart and at the bone.
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Allen Cheng @peripatetical.bsky.social · 16/11/2024
12. Staphylococcus aureus in the urine is a sign of staphylococcal bacteraemia until proven otherwise.
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Allen Cheng @peripatetical.bsky.social · 16/11/2024
11. An elderly patient from a tuberculosis endemic setting with fever and multisystem disease has disseminated tuberculosis until proven otherwise.
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Allen Cheng @peripatetical.bsky.social · 16/11/2024
10. Malaria (P. falciparum in particular), must be excluded on presentation of a febrile traveller returning from a malaria endemic area.
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Allen Cheng @peripatetical.bsky.social · 16/11/2024
9. Generalized rashes that also involve the palms and soles are likely to be caused by drugs, viral infections, rickettsial infections or syphilis.
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Allen Cheng @peripatetical.bsky.social · 16/11/2024
8. Early meningococcaemic rash may resemble a non-specific viral rash.
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Allen Cheng @peripatetical.bsky.social · 16/11/2024
7. Jaundice in a febrile patient is rarely caused by viral hepatitis.
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Allen Cheng @peripatetical.bsky.social · 16/11/2024
6. “When a patient has a fever post operatively, it is usually related to the surgical procedure”. (Petersdorf’s Law)
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Allen Cheng @peripatetical.bsky.social · 16/11/2024
5. Hypothermia in a septic patient is a medical emergency that carries a worse prognosis than a high fever.
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Allen Cheng @peripatetical.bsky.social · 16/11/2024
4. Sepsis in the elderly may not present with a fever. (“The older the colder”)
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Allen Cheng @peripatetical.bsky.social · 16/11/2024
3. Fever in the elderly is rarely caused by a viral illness.
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Allen Cheng @peripatetical.bsky.social · 16/11/2024
2. Severe muscle pain may be a symptom of sepsis, even in the absence of fever.
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Allen Cheng @peripatetical.bsky.social · 16/11/2024
1. Recurrent rigors are most likely to be caused by bacterial infections.
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Allen Cheng @peripatetical.bsky.social · 16/11/2024
Allen Yung's Golden Rules of ID. Copied over from the Other Place for @kottonnelson.bsky.social #IDSky
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