1/19 Hope you can take a break from COVID-19 & Mpox reading for a Tuesday tweetorial on Eosinophilia in the Returned Traveler. This has taken me all of pandemic to push out but with planes in the sky, now is the time to be prepared😊 Buckle up for some serious tissue invasion🪱 pic.twitter.com/jWsZXSyon7
— Andrea Boggild, MD (@BoggildLab) November 22, 2022
2/19 Eosinophils participate in the critical Th2 arm of immunological control of helminthic infections through Fc-receptor-mediated IgE approximation to worm tegument followed by degranulation. Most labs & literature define eosinophils as ⬆️ when they are bw 0.4-0.5 bil/L
— Andrea Boggild, MD (@BoggildLab) November 22, 2022
3/19 My approach to Parasitic causes of Eosinophilia categorizes the level of eosinophilia as Absent (<400), Mild (400-1000), Moderate (1000-3000), or High (>3000) pic.twitter.com/9ADy26yGst
— Andrea Boggild, MD (@BoggildLab) November 22, 2022
4/19 Blood & tissue protozoa + stool protozoa (w/ few exceptions) tend not to cause eosinophilia; thus, ⬆️ eos in your malaria, leish or giardia patient should raise concern for a competing / intercurrent infection, particularly in those born in STH- & schisto endemic regions
— Andrea Boggild, MD (@BoggildLab) November 22, 2022
5/19 Mild eosinophilia often occurs in the setting of enteric Dientamoeba fragilis or Cystoisospora infection, with certain unencysted nematode larval infections like CLM, & with some enteric nematode infections such as strongyloidiasis (classic eo count 600-800) or hookworm pic.twitter.com/XqF9Zdo76f
— Andrea Boggild, MD (@BoggildLab) November 22, 2022
6/19 CLM occurs due to larval migration of dog or cat hookworm following penetration of intact skin (often of the feet) that has contacted fecally contaminated sand or soil. For more, see our paper on CLM in TMAID:https://t.co/3HkehHoXHB@PatSchlagenhauf
— Andrea Boggild, MD (@BoggildLab) November 22, 2022
7/19 Larva Currens occurs when larvae of Strongyloides migrate rapidly under the skin, producing a CLM-like eruption that is not quite as pruritic or topographical. Rapid rate of migration helps differentiate larva currens from CLM (several cm/hr): https://t.co/Fy1tPU81Ep pic.twitter.com/vWWXYdLfwa
— Andrea Boggild, MD (@BoggildLab) November 22, 2022
8/19 On the DDx of mild eosinophilia are non-helminthic infections such as coccidioidomycosis and TB, both of which can also present with cavitary lung lesions, fever & erythema nodosum: https://t.co/HOjqdq1NIP pic.twitter.com/5DrwbXGfjU
— Andrea Boggild, MD (@BoggildLab) November 22, 2022
9/19 Moderate eosinophilia (1000-3000) tends to be associated with some tissue based protozoa (Sarcocystis), adult trematode infections (schistosomiasis) & adult nematode infections (the filariases) https://t.co/utlWMiQILU pic.twitter.com/KExGq5sTFR
— Andrea Boggild, MD (@BoggildLab) November 22, 2022
10/19 High-grade eosinophilia (>3000) is often due to helminthic ‘syndromes’ such as tropical pulmonary eosinophilia (TPE), visceral larva migrans (VLM), Loeffler’s & eosinophilic meningitis (EM), as well as acute trematodiases & acute nematodiases (like trichinosis & filariases) pic.twitter.com/PbEAMb5GwU
— Andrea Boggild, MD (@BoggildLab) November 22, 2022
11/19 Tropical pulmonary eosinophilia (TPE) is one of the ‘pulmonary infiltrates with eosinophilia’ (PIE) syndromes & arises due to a particular immunologic response to Wuchereria bancrofti antigen. Filarial antibody titres & IgE are ⬆️⬆️ : https://t.co/W66wVjOaAA pic.twitter.com/1Izw1E8rUW
— Andrea Boggild, MD (@BoggildLab) November 22, 2022
12/19 Loeffler’s is another PIE syndrome arising from acute infection with and larval lung migration by Ascaris, Strongyloides, or hookworm (ASH). Eosinophilia can be fantastically elevated as seen here in acute pediatric strongy after a trip to 🇨🇺: https://t.co/zvgOAhVuVL
— Andrea Boggild, MD (@BoggildLab) November 22, 2022
13/19 Acute Fascioliasis leads to high-grade eosinophilia as the worm penetrates Glisson’s capsule (++pain) & migrates through liver parenchyma leading to formation of ‘sterile abscesses’ that can appear to move over time. For more see our @jtravmed paper: https://t.co/w6ilCg2wTB pic.twitter.com/IutC6wum9R
— Andrea Boggild, MD (@BoggildLab) November 22, 2022
14/19 Trichinella infection – due to ingestion of undercooked meat – causes a biphasic febrile syndrome of enteritis followed by eosinophilic myositis. See paper on an outbreak of trichinosis due to bear jerky: https://t.co/HjSHbJdnph High-grade eos can damage the ❤️ incl STEMI pic.twitter.com/bBLftz9cmz
— Andrea Boggild, MD (@BoggildLab) November 22, 2022
15/19 Loiasis may present w/ high-grade eosinophilia, Calabar swellings & frank migration of adult Loa worms across the eye. Travelers are usually amicrofilaremic vs those living in endemic areas of the central African rainforest. See atypical case here: https://t.co/q98nmmiXau pic.twitter.com/aIVSlvVWXP
— Andrea Boggild, MD (@BoggildLab) November 22, 2022
16/19 Any migratory helminthic infection may lead to ⬆️⬆️ eosinophils. For another case of larva currens due to #strongyloides presenting with high-grade rather than the mild eosinophilia profiled above, see our paper here: https://t.co/owiPxQBQzL pic.twitter.com/5hVWNsfxXH
— Andrea Boggild, MD (@BoggildLab) November 22, 2022
17/19 Due to the lifelong nature of #strongyloides infection until treatment (owing to autoinfective capabilities of the worm), a high-index of suspicion in travelers & low-threshold to treat is advised esp in advance of immune suppression. See guidelines: https://t.co/itb2gtbCEj pic.twitter.com/aqdl2UnOSv
— Andrea Boggild, MD (@BoggildLab) November 22, 2022
18/19 Eosinophilic meningitis leading to high-grade eosinophilia is often associated with CNS infection by Angiostrongylus, Gnathostoma, or Baylisascaris. Here’s a complication of baylisascariasis – DUSN – that did not result in peripheral eosinophilia: https://t.co/5X4MAjsEmm pic.twitter.com/wvaTcqImLa
— Andrea Boggild, MD (@BoggildLab) November 22, 2022
19/19 Thanks for staying to the end🙏For more on parasitic infections of travelers in general, see our paper on the topic: https://t.co/8ZjHmGnazi
Happy reading! pic.twitter.com/ix2Oakmj9K— Andrea Boggild, MD (@BoggildLab) November 22, 2022
❗️Publication alert in honor of #WorldNTDDay❗️Five key points about intestinal #schistosomiasis for migrant health practitioners out in @TMAID1. Congratulations to super⭐️ @BoggildLab alums & trainees @LeilaFMakhani @swana_kopal @ShvetaBhasker 🙌👏💯🤗❤️🔥 A short thread 👇 1/13 https://t.co/6rahWJ99hj pic.twitter.com/imSnD9DCDH
— Andrea Boggild, MD (@BoggildLab) January 30, 2021
2/13 #schistosomiasis in migrants from endemic areas is a chronic helminthic infection in which eggs produced by adult trematodes residing in venous plexi can damage the liver & genitourinary tree due to inflammation over time pic.twitter.com/6lAMMYcu0i
— Andrea Boggild, MD (@BoggildLab) January 30, 2021
3/13 Those most at risk of acquiring schistosomiasis include adults & children residing in endemic areas of sub-Saharan Africa, southeast Asia, or eastern South America who have been reliant on freshwater bodies (rivers, lakes, streams) for activities of daily living pic.twitter.com/FP1B2XqgEy
— Andrea Boggild, MD (@BoggildLab) January 30, 2021
4/13 Long-term health consequences of #schistosomiasis relate to the worm burden acquired over time & timing of treatment. This is why chronic sequelae are over-represented in our migrant population compared to travelers who have been exposed to contaminated freshwater abroad pic.twitter.com/X2MZHwGmjp
— Andrea Boggild, MD (@BoggildLab) January 30, 2021
5/13 Migrant health practitioners are advised to screen migrants from endemic areas using a combination of validated & available microbiological assays@AshnaBowry @travelhealthdoc pic.twitter.com/LW2aixPIJN
— Andrea Boggild, MD (@BoggildLab) January 30, 2021
6/13 Co-infection with both S. mansoni causing intestinal schistosomiasis & S. haematobium causing genitourinary schistosomiasis should be considered in migrants from Africa@drsarahmac @SarahKohlMD @daniela_leto @DrJRMarcelin @DrMahaliaD
— Andrea Boggild, MD (@BoggildLab) January 30, 2021
7/13 Furthermore, the possibility of co-infection with the bloodborne viruses – hep B, hep C, & HIV (the treatment of which &/or viruses themselves might have liver damaging effects) should also be excluded
— Andrea Boggild, MD (@BoggildLab) January 30, 2021
8/13 Migrants with #schistosomiasis should be risk stratified for chronic sequelae of the liver (e.g., peri-portal fibrosis) by imaging (e.g., ultrasound) & bladder (e.g., screening for hematuria & metaplasia/SCC of bladder by U/A +/- imaging) if risk of haematobium. Cysto if UA+
— Andrea Boggild, MD (@BoggildLab) January 30, 2021
9/13 Here is @WHO protocol for ultrasonographic assessment of #schistosomiasis morbidity: https://t.co/I6fCo07fes@DocWoc71 @JillWeather @DrMahaliaD @AndreaLConroy @S_Yegorov @DrJRMarcelin @AishaKhatib @AshnaBowry @LeilaFMakhani @daniela_leto @MalikaHSharma @mishrash @linhchen
— Andrea Boggild, MD (@BoggildLab) January 30, 2021
10/13 Travelers to #schistosomiasis endemic areas are advised to avoid swimming or bathing in freshwater bodies incl. rivers, lakes, streams, ponds, waterfalls. pic.twitter.com/KJf6FCEkpc
— Andrea Boggild, MD (@BoggildLab) January 30, 2021
11/13 Given probable low inoculum of worms if infected, direct microbiological detection of eggs from stool or urine of travelers far less sensitive than in migrants. Most sensitive, practical, validated, & commercial diagnostic assay available in non-endemic areas is serology
— Andrea Boggild, MD (@BoggildLab) January 30, 2021
12/13 If infected while visiting an endemic area, travelers may return w/ acute schistosomiasis characterized by syndrome of fever, cough, GI symptoms, rash & high-grade eosinophilia https://t.co/6Sz4v923Fa pic.twitter.com/a3Cf9yTczL
— Andrea Boggild, MD (@BoggildLab) January 30, 2021
13/13 Praziquantel remains the internationally accepted & available drug of choice for treatment of chronic schistosomiasis in travelers & migrants. Dose is weight-based & differs by infecting species, w/ schisto from Asia & southeast Asia requiring higher mg/kg dose #WorldNTDDay
— Andrea Boggild, MD (@BoggildLab) January 30, 2021
☝️to commemorate #WorldNTDDay 🙏❤️ @ahoysvet @YaneValdezT @DrvanTilburg @AnkurKalraMD @DrHowardLiu @doxycyclinitin @Josekoech @Bipin_Tropmed @hanniepower @Wasin_Indy @whialexander @VirusesImmunity @jenheemstra @wordfinga @Docbasia @CardiacPA1 @rajdoc2005 @ruwandi_k91 @AlainnaJJ
— Andrea Boggild, MD (@BoggildLab) January 30, 2021
1/19 Happy Sunday all! Here’s my tweetorial on Skin Lesions in the Returning Traveler. Hope you enjoy! @MedTweetorials @AcademicChatter #MedTweetorials @ASTMH @_ISTM_ @acmcip @AM_Cressman @TheAlyssaLouis @McGillTropMed @UBCDerm @CDCtravel @GHWindow @NaTHNaC @GEORGE_SANT0SH #Skin pic.twitter.com/WnhJufz2ev
— Andrea Boggild, MD (@BoggildLab) March 1, 2020
2/19 In our @GeoSentinel CanTravNet analysis of ill returned travelers over a 2-yr period, skin lesions were second only to GI symptoms in frequency, accounting for almost 15% of illness in that analysis: https://t.co/nS5SHuPbuZ@travelhealthdoc @TravelGecko pic.twitter.com/7juw0hiIbC
— Andrea Boggild, MD (@BoggildLab) March 1, 2020
3/19 While much illness in returned travelers is approached geographically or demographically, the DDx of skin lesions is approached morphologically. Major morphologies encountered frequently in this population include papules, ulcers, nodules, migratory/linear lesions & plaques. pic.twitter.com/72T1zqsvxG
— Andrea Boggild, MD (@BoggildLab) March 1, 2020
4/19 Papules are the most common skin lesion of returning travelers & most often = arthopod bites or contact dermatitis due to sand ☀️ or salt 💦 exposure & new soaps. See our @GeoSentinel CanTravNet analysis of dermatoses in returned Canadian travelers: https://t.co/5Kcp7aSPqC
— Andrea Boggild, MD (@BoggildLab) March 1, 2020
5/19 Ulcers in returned travelers often arise due to secondary staph or strep infection of arthropod bites. These tropical ulcers typically resolve with local wound care + antibacterial (eg, chlorhexidine) shower wash. Occasionally antibiotics are needed. MSSA is the usual bug.
— Andrea Boggild, MD (@BoggildLab) March 1, 2020
6/19 Leishmaniasis is another ulcerating skin condition in returned travelers & transmitted to humans by sandflies. Greatest risk areas include C & S America & Middle East. Cutaneous leish from S America can progress to involve the nose, mouth, and larynx = mucosal leishmaniasis
— Andrea Boggild, MD (@BoggildLab) March 1, 2020
7/19 For more see our @GeoSentinel analysis on cutaneous & mucosal leish in returned travelers: https://t.co/wd9ZwVpXWK
And also this review: https://t.co/hAqLlU6Dj9@_ISTM_ @linhchen @SarahKohlMD @drsarahmac @travelhealthdoc @DrDebTravelDr @SheilaMackell @whialexander
— Andrea Boggild, MD (@BoggildLab) March 1, 2020
8/19 Lore in leish is that one cannot be infected with more than one species at a time, but this is untrue. See just one such example of coinfections published in @ASTMH journal #AJTMH: https://t.co/aWtMAMv9uf
— Andrea Boggild, MD (@BoggildLab) March 1, 2020
9/19 Through a longstanding CL/ML collaboration in Peru, we have found that non-invasive molecular diagnostic techniques are equally sensitive to PCR of invasively obtained specimens. See: https://t.co/6eAP7o5I68
andhttps://t.co/8eWpxhly7D
and https://t.co/bovdmOxGAq pic.twitter.com/2zpx6GsSlt— Andrea Boggild, MD (@BoggildLab) March 1, 2020
10/19 Next are nodules. Nodules can be caused by bacteria (furunculosis), fungi (sporotrichosis), mycobacteria incl. TB (erythema induratum) & parasites (helminths/ectoparasites). Cues to DDx incl. evolution, pt demographics & behavioural & geographic RFs & punctum (hole)👇 pic.twitter.com/rzKmIJEDUF
— Andrea Boggild, MD (@BoggildLab) March 1, 2020
11/19 One of the most common parasitic causes of skin nodules is myiasis (maggot infestation of skin). See @CMAJ paper: https://t.co/mZXsLgmf8J as well as our inaugural paper on use of commercial venom extractors for larval extraction: https://t.co/O9sJ2htAuh@GEORGE_SANT0SH pic.twitter.com/yOhtm84pFC
— Andrea Boggild, MD (@BoggildLab) March 1, 2020
12/19 For more on parasitic causes of skin lesions in returning travelers & migrants in general, see review article: https://t.co/8ZjHmGmCJK@bcopps @GEORGE_SANT0SH @mishrash @AshnaBowry @acmcip @ASTMH @_ISTM_ @McGillTropMed @GHWindow @linhchen @whialexander @GabeOnMed @NaTHNaC
— Andrea Boggild, MD (@BoggildLab) March 1, 2020
13/19 Following papules, ulcers & nodules are migratory/linear lesions, the most common of which is cutaneous larva migrans, due to penetration of intact skin by larval dog or cat hookworms on tropical beaches. See our @TMAID1 case series: https://t.co/3HkehHopS3@GEORGE_SANT0SH pic.twitter.com/KeSwdDOEjf
— Andrea Boggild, MD (@BoggildLab) March 1, 2020
14/19 Larva currens (strongyloidiasis) is more rare than CLM, but it can look similar. Differences: rapid rate of migration (several cms/hr) & duration (can be lifelong until treated). See our case in a short term traveler: https://t.co/Fy1tPU7tOR@GEORGE_SANT0SH @AshnaBowry pic.twitter.com/fnCRlAwuuT
— Andrea Boggild, MD (@BoggildLab) March 1, 2020
15/19 And here’s an example of larva currens due to chronic strongyloidiasis in a migrant who had left the endemic / risk area almost 4 decades prior to presentation: https://t.co/owiPxQkfId@GEORGE_SANT0SH @AshnaBowry @mishrash @MalikaHSharma @bcopps @McGillTropMed @ASTMH pic.twitter.com/gR5hNIoJeK
— Andrea Boggild, MD (@BoggildLab) March 1, 2020
16/19 Plaques & verrucous lesions are a distinct type of papulonodular morphology, w/ a DDx that typically favours fungi & mycobacteria. Leish is on that DDx too. For an example of a plaque following travel, see our case published in @_ISTM_ #JTravelMed: https://t.co/3bk6aFrCgs pic.twitter.com/lPDddtdSpF
— Andrea Boggild, MD (@BoggildLab) March 1, 2020
17/19 Finally, pigmented lesions in returned travelers are often due to phytophotodermatitis or post-inflamm. hyperpigmentation. In migrant population from endemic areas, leprosy remains on DDx. See @CMAJ primer:https://t.co/ePEWOgO7Vq
& tweetorial: https://t.co/PyjFulL3Qc pic.twitter.com/29IYTePqiQ— Andrea Boggild, MD (@BoggildLab) March 1, 2020
18/19 Fever that accompanies skin lesions in the returned traveler should be approached as per Febrile Returned Travelers @PHAC_GC CATMAT guidelines & Fever tweetorial: https://t.co/kbx5VFZGsC. Major DDx includes SSTI, arboviral infections, STIs & rickettsioses. @GEORGE_SANT0SH pic.twitter.com/I9G5Bt3XEQ
— Andrea Boggild, MD (@BoggildLab) March 1, 2020
19/19 As always, I am indebted to my super⭐️ team of trainees, ‘executive’ staff & collaborators who have contributed substantially to many of the works cited above. I am honored & privileged to mentor, teach & collaborate🙏🙏🔥🔥@ruwandik @rachellau25 @StefanieKlowak #gratitude
— Andrea Boggild, MD (@BoggildLab) March 1, 2020
1/10 Today is #WorldNTDDay. Here’s a short #tweetorial on strongyloidiasis to honor #NTDs. @MedTweetorials @AcademicChatter #AcademicChatter @ASTMH @ISTM @GHWindow @acmcip #BeatNTDs @_ISTM_ @CDCtravel @SarahKohlMD @drsarahmac @DrDebTravelDr @travelhealthdoc @SheilaMackell pic.twitter.com/PCYGLtQZhK
— Andrea Boggild, MD (@BoggildLab) January 30, 2020
2/10 Strongyloides is a parasitic nematode (worm) acquired by walking in sand or soil, whereupon infectious larvae penetrate skin & then mature in the gut following an obligatory lung migration phase. For 5 key features of strongyloidiasis see @CMAJ paper:https://t.co/lwfRfv3j4V
— Andrea Boggild, MD (@BoggildLab) January 30, 2020
3/10 Strongyloides is common in the tropics affecting at least 100 million people globally. Likely far more. In Canada, it is most common in migrants, & it is estimated that at least 2.5 million Canadians are infected. See @PHAC_GC CATMAT guidelines: https://t.co/itb2gtb4OL
— Andrea Boggild, MD (@BoggildLab) January 30, 2020
4/10 Strongyloidiasis is asymptomatic in half who are infected. If symptoms occur, they often manifest as GI symptoms, eosinophilia, & a classic rapidly migrating serpiginous rash called “larva currens”. See case of acute strongy in pediatric traveler:https://t.co/Bi4NKrxOw7
— Andrea Boggild, MD (@BoggildLab) January 30, 2020
5/10 Strongyloidiasis is a lifelong infection until treated due to unique autoinfective capabilities. Thus, we can see travelers or migrants with very prolonged histories of symptoms, as in this case of chronic larva currens in a short-term traveler: https://t.co/Fy1tPU7tOR
— Andrea Boggild, MD (@BoggildLab) January 30, 2020
6/10 This autoinfective capacity also means that some infections will remain asymptomatic for yrs after migration or travel, only to manifest decades later when Th2-type control of the infection begins to wane with age or other immunosuppressive factors: https://t.co/owiPxQkfId
— Andrea Boggild, MD (@BoggildLab) January 30, 2020
7/10 In immunologically intact hosts, larval shedding in stool is rare. Thus, serology is the mainstay diagnostic. Some Strongyloides assays are limited in their specificity but have good sensitivity in the absence of immunosuppression. See @TMAID1 paper:https://t.co/PRg5RNyXLF
— Andrea Boggild, MD (@BoggildLab) January 30, 2020
8/10 Treatment of strongyloidiasis is with a drug called ivermectin, which is typically given in 2 doses 14-days apart. Ivermectin is well tolerated & was recently approved by Health Canada for licensure here. See @BMC_series blog post:https://t.co/I9jxGix2Kj@BioMedCentral
— Andrea Boggild, MD (@BoggildLab) January 30, 2020
9/10 In immune compromise it can lead to life-threatening dissemination of larvae, manifesting as sepsis, meningitis & death. Risk factors include HTLV-1/2, prednisone & other immunosuppressants & cancer. See paper in @BioMedCentral journal #TDTMV:https://t.co/euCx5rB6d2
— Andrea Boggild, MD (@BoggildLab) January 30, 2020
10/10 As with all work arising from my program, I am honored & privileged to mentor a fabulous team of trainees & staff who have contributed to works cited above. Thank you to all who work with me to help ease the burden of this potentially fatal #NTD.#gratitude 🙏🙏🙌👏🔥😊
— Andrea Boggild, MD (@BoggildLab) January 30, 2020
Tagging team involved with Strongyloides research program: @StefanieKlowak @MichaelKlowak @michelledaodong @SabrinaYeung1 @Bolsky @rochellegmelvin @AntoineCorbeil @NessikhaK @rachellau25 @LeilaFMakhani @ShvetaBhasker @shareeseclarke @9Anacaona9
— Andrea Boggild, MD (@BoggildLab) January 30, 2020
And tagging more working on strongy: @saru_smiles @AyoAyogirl @miche_zhao @soniaigboanugo @MofeT_A @HagopianEmma @VinitaDhir & Peola & others not on twitter 🙏🙏😊🔥🙌👏
— Andrea Boggild, MD (@BoggildLab) January 30, 2020
1/23 Honored & privileged to have watched Day 1 of the National Dialogues & Action on anti-Black Racism & Black Inclusion in 🇨🇦 Higher Ed. Congratulations to sponsors & organizers for making this happen & for teaching us all who work in academia 🙌👏🔥🙏 https://t.co/9RRFjfT59z
— Andrea Boggild, MD (@BoggildLab) October 5, 2020
2/23 👇A thread summarizing Key Insights & Messages for Action that I learned from Day 1, courtesy of super⭐️ panel & plenary speakers Drs. & Profs. Michael Charles, @deanstudentexp, Heather Hines, Alissa Trotz, Dexter Voisin, @MalindaSmith, @ProfWlkr & Mike DeGagne 🙏🙏🔥🙌👏 pic.twitter.com/FolQEZuoR4
— Andrea Boggild, MD (@BoggildLab) October 5, 2020
3/23 Key points re: academic success:
a. Inadequate complaints resolution process w/ frequent dismissal & re-categorization of issues when raised to leaders;
b. Discipline applied unequally;
c. Safe spaces to raise issues w/ leaders fluent in anti-Black racism needed— Andrea Boggild, MD (@BoggildLab) October 5, 2020
4/23 d. Leaders need to embrace idea of broken processes that lead to broken outcomes (ie, broken process is tantamount to no process);
e. Notion of “fit" emerged repeatedly (ie, will this person “fit" into our academic culture? whom is fitting into whose agenda & workplace?)— Andrea Boggild, MD (@BoggildLab) October 5, 2020
5/23 f. Resistance to dialogue common among leaders; g. Black staff do work of Black inclusion & EDI off sides of their desks w/ little recognition & no compensation (ie, people who stand to benefit from work tasked w/ its execution)
h. Need to publish performance stats re: EDI— Andrea Boggild, MD (@BoggildLab) October 5, 2020
6/23 Key points re: faculty access & success:
a. Mis-attribution of under-representation of Black faculty to ‘pipeline’ issue alone > enables systemic discrimination w/in academy to persist & removes accountability for change > shifts problem back to Black community (vs racism)— Andrea Boggild, MD (@BoggildLab) October 5, 2020
7/23 b. Language of diversity shies away from naming anti-Black racism & Black exclusion;
c. Dearth of mentors for Black faculty;
d. Discounting of Black faculty members’ skills, expertise & value due to tokenism;
e. Work culture that is racist, paternalistic & invisibilizing— Andrea Boggild, MD (@BoggildLab) October 5, 2020
8/23 f. Perpetuation of STEM pedigrees (ie, who trained you leads to ongoing self-selection & grant success, invited podium talks, nominations, etc);
g. Black faculty bear disproportionate work of mentoring junior faculty & trainees;
h. Language of reparations can be exclusionary pic.twitter.com/dtRusSXIaH— Andrea Boggild, MD (@BoggildLab) October 5, 2020
9/23 i. Lack of institutional accountability or repercussions for overt demonstrations of racism;
j. Model of working w/ rather than at expense of or in competition w/ Indigenous colleagues to be embraced;
k. Cluster hires needed to create safe spaces for Black faculty— Andrea Boggild, MD (@BoggildLab) October 5, 2020
10/23 l. Recruitment efforts need to acknowledge & correct deeply exclusionary practices & concepts of what an “ideal" candidate represents (back to the notion of a “good fit" for department, institution). Concept of “fit” decentres Black experience & expertise
— Andrea Boggild, MD (@BoggildLab) October 5, 2020
11/23 Key points re: Inclusive Decision-making:
a. Organizations must have critical voices at table that challenge status quo & leaders need to hold institutions accountable (very challenging for Black leaders who may not feel empowered to voice dissent & call-out racism)— Andrea Boggild, MD (@BoggildLab) October 5, 2020
12/23 b. Normalization of White male leadership & Black exclusion from leadership as default assumption / state of affairs;
c. Targeted opportunity hires that signal institutional commitments (vs. tokenism) need to craft HR language carefully to avoid deficit model thinking— Andrea Boggild, MD (@BoggildLab) October 5, 2020
13/23 d. Power of University boards emphasized > they can shape the agenda of the President, VPs, Deans, etc;
e. All organizations move to homeostasis so challenge to sustain pressure that will lead to change (hence need for metrics of accountability & transparency) pic.twitter.com/4y8NwBTL1M— Andrea Boggild, MD (@BoggildLab) October 5, 2020
14/23 f. Why is it important to have Black expertise in leadership? ie, we *all* benefit from it so need to challenge assumption that Black leaders erode opportunities of or exclude privileged groups (specifically White males)
— Andrea Boggild, MD (@BoggildLab) October 5, 2020
15/23 Key points re: Student success:
a. Pipeline going back to kindergarten > need to increase positive & aspirational experiences for students;
b. Need more Black students, staff, faculty & leaders across the academy;
c. Need safe spaces for Black students— Andrea Boggild, MD (@BoggildLab) October 5, 2020
16/23 d. Financial aid services need to acknowledge & correct that much financial aid is inaccessible or otherwise restricted for Black students, who, due to racism, come from a baseline of income inequality;
e. Intentionality in all that we do required— Andrea Boggild, MD (@BoggildLab) October 5, 2020
17/23 Summary Day 1 – aim was for concrete action & outcomes leading to Scarborough National Charter.
Steps were: ID challenges; transform challenges into set of principles; take action; ensure accountability.
4 main themes: history; language; systems; & how change might occur pic.twitter.com/6yT6SgLl2G— Andrea Boggild, MD (@BoggildLab) October 5, 2020
18/23 Re: History – those doing the work of EDI often surprised at how little literacy exists in Canada re: anti-Black racism & Black exclusion. Concerted efforts needed to raise literacy of BIPOC racial oppression among general public & across the academy
— Andrea Boggild, MD (@BoggildLab) October 5, 2020
19/23 Re: Language – changing language changes social reality (eg, equity seeking vs. equity deserving); inclusiveness (who is ‘including’ whom in whose space & reality?)
— Andrea Boggild, MD (@BoggildLab) October 5, 2020
20/23 Re: Systems – deficit thinking has led to firmly embedded judgments that have directed our processes, systems & institutions into the pillars of racism that they are (ie, “the tyranny of low expectations")
— Andrea Boggild, MD (@BoggildLab) October 5, 2020
21/23 Re: How Change Might Occur? consultation w/ Black community is usually predetermined, short-lived & disrespectful of actual lived experience > leads to “consultation exhaustion”. Consultation needs to take on more substantive meaning
— Andrea Boggild, MD (@BoggildLab) October 5, 2020
22/23 Black community needs to be part of decision-making process, which includes governance *and* determination of own metrics of success, inclusion, equity
— Andrea Boggild, MD (@BoggildLab) October 5, 2020
23/23 Huge thanks to all the incredible panelists, moderators, leaders & sponsors who brought this urgently needed dialogue to fruition. It is incumbent upon us all to listen, engage & act in order to #MoveTheDial. Looking forward to learning more from Day 2 🙏🙏🔥👏👏🙌🙌💯 #EDI
— Andrea Boggild, MD (@BoggildLab) October 5, 2020
❗️Just what you’ve been waiting for❗️Sunday @BoggildLab #Tweetorial on Fever in the Returning Traveler!! 🤒✈️🏝🏖💉🦟🌞Buckle up, friends 😊🙏🙏 @MedTweetorials @AcademicChatter #AcademicChatter #MedTweetorials #Fever #Travel #VectorBorneDisease #VaccinesWork 1/23
— Andrea Boggild, MD (@BoggildLab) February 9, 2020
2/23 Fever = hypothalamic thermostat reset to a ⬆️ temp in response to infection. It’s an adaptive biological response to pathogen invasion that assists w/ immunological control of infections. Most texts refer to fever as temp >38 C. See JAMA paper also: https://t.co/3wT2X3LhVf pic.twitter.com/uvsfS7G2GP
— Andrea Boggild, MD (@BoggildLab) February 9, 2020
3/23 Fever in returning travelers is common in our population due to high mobility & travel proclivities. We collectively log millions of miles of air and land transit annually to countries that have very different endemicity profiles for infectious diseases compared to 🇨🇦 or 🇺🇸 pic.twitter.com/w3IQ59YY1H
— Andrea Boggild, MD (@BoggildLab) February 9, 2020
4/23 Fever in traveler to tropics = medical emergency & malaria until proven otherwise. B/c fever can = serious infections of public health significance, its presence post-travel warrants prompt medical eval. For topic overview, see latest Mandell’s post-travel iillness chapter. pic.twitter.com/Af9yCaTpUh
— Andrea Boggild, MD (@BoggildLab) February 9, 2020
5/23 Our @PHAC_GC CATMAT guidelines in 🇨🇦 provide a step-wise algorithmic approach to fever in the returning traveler, which is rooted in epidemiology & concept that destination is a critical correlate of diagnosis. National guidelines can be found at: https://t.co/1MzbZJvXXG
— Andrea Boggild, MD (@BoggildLab) February 9, 2020
6/23 Our @PHAC_GC CATMAT guidelines ask clinicians to consider several influencers of DDx of fever in returning travelers incl. exposure history, fever duration & pattern. Eg, freshwater exposure + fever duration <21 days + "saddleback" pattern all support DDx of leptospirosis. pic.twitter.com/9ZOmlRGxja
— Andrea Boggild, MD (@BoggildLab) February 9, 2020
7/23 Destination = key influencer of DDx as per 🇨🇦 guidelines. Most malaria in febrile returned travelers is imported from W Africa, while most dengue comes from Asia & Americas. See classic @_ISTM_ @GeoSentinel paper by super⭐️ mentor Dr. Mary Wilson: https://t.co/2tnpi9zGjr pic.twitter.com/rB3Uz9sdc1
— Andrea Boggild, MD (@BoggildLab) February 9, 2020
8/23 If we restrict analyses to returned travelers from W Africa, as we did for our @AnnalsofIM paper, we see that malaria plays an even more prominent role in the DDx, accounting for 40% of travelers returning with fever. https://t.co/GYFbC7T5Mk pic.twitter.com/6Emy0wOm9A
— Andrea Boggild, MD (@BoggildLab) February 9, 2020
9/23 Interval to presentation of fever post-travel = proxy for incubation period. In this classic figure from the @GeoSentinel fever paper, we demonstrate that most falciparum malaria presents w/in 30d, while most vivax malaria presents >30d post-travel. https://t.co/2tnpi9zGjr pic.twitter.com/l7CL3DR6dw
— Andrea Boggild, MD (@BoggildLab) February 9, 2020
10/23 In single- & multi-centre studies, malaria is the most common specific cause of fever in sick travelers returning from the tropics, followed by the febrile gastroenteritides, respiratory tract infections & dengue. Rounding out top 5 is usually enteric fever (typhoid) pic.twitter.com/eboZcd9kM2
— Andrea Boggild, MD (@BoggildLab) February 9, 2020
11/23 This DDx generally holds across studies & over time, except in outbreaks. See DDx from our @PHAC_GC guidelines alongside our CanTravNet analysis of Chikungunya. Prior to Chikv outbreak in Americas, dengue outnumbered Chikv imports by 10:1. Ratio equalized during outbreak. pic.twitter.com/bQ3Q9mAZ9V
— Andrea Boggild, MD (@BoggildLab) February 9, 2020
12/23 In our study of blood from febrile returned travelers back to 🇨🇦 @UofTIMS PhD student phenom @ruwandik demonstrated that 18% of specimens contained malaria, 15% had detectable EBV, 2% had dengue & 1% had hepatitis A virus (vaccine preventable): https://t.co/JLvGPgfuXT
— Andrea Boggild, MD (@BoggildLab) February 9, 2020
13/23 Our CATMAT guidelines recommend that febrile returned travelers undergo this basic set of primary laboratory investigations in order to exclude life-threatening, treatable, and communicable infectious diseases in this population. https://t.co/1MzbZJvXXG pic.twitter.com/0mYrwnzhFv
— Andrea Boggild, MD (@BoggildLab) February 9, 2020
14/23 Despite comprehensive & often exhaustive microbiological work-up, a diagnostic gap remains in febrile returned travelers. “Gap" of 22% observed in @GeoSentinel analysis, 7% in @AnnalsofIM W Africa analysis & 14% in our “Rapid Assessment of Febrile Travelers" seen locally. pic.twitter.com/I8J3esJ6eY
— Andrea Boggild, MD (@BoggildLab) February 9, 2020
15/23 Due to diagnostic gap & poor performing diagnostics for some infections (eg, typhoid), our CATMAT guidelines recommend empiric antimicrobial Rx for typhoid & rickettsial infections/lepto if 4 criteria below are fulfilled. FQs or Azi for typhoid, Doxy for rickettsial/lepto. pic.twitter.com/Bf8Uxo7euH
— Andrea Boggild, MD (@BoggildLab) February 9, 2020
16/23 Some additional “rules" to remember about febrile returned travelers: 1st, Occam’s razor does not apply to this population. Consider coinfections, esp. if signs sx & epi support >1. Eg, see our case published in @TMAID1:https://t.co/dlMPdRJwBb
& @ASTMH #TropMed19 posters pic.twitter.com/ZSpWHsgBHF
— Andrea Boggild, MD (@BoggildLab) February 9, 2020
17/23 Another “rule" about febrile returned travelers is that they can have locally acquired infections that mimic those from tropics. Eg, influenza: circulates year-round in tropics & in season opposite to ours in S hemisphere. See our #JTravMed paper: https://t.co/c8IU6niO2r pic.twitter.com/075pmz89Wl
— Andrea Boggild, MD (@BoggildLab) February 9, 2020
18/23 Here’s another example of a locally-acquired infection from N America masquerading as malaria in a febrile traveler from India. Message: when labs don’t make sense, go back to patient for more history! 90%+ medicine is patient’s history.https://t.co/5k448NISs7#Babesia
— Andrea Boggild, MD (@BoggildLab) February 9, 2020
19/23 For more on our Rapid Assessment of Febrile Travelers (RAFT) program, which is a clinical adaptation of the @PHAC_GC CATMAT guidelines for use by EDs, see first analysis:https://t.co/OQybpXhnaL
as well as our “app": https://t.co/g465rs8Irw@StefanieKlowak @Bolsky pic.twitter.com/TGQceyJBuY
— Andrea Boggild, MD (@BoggildLab) February 9, 2020
20/23 For a case-based discussion of considerations in febrile returned travelers w/ potential risk of viral hemorrhagic fever, see our @CMAJ
paper: https://t.co/YczKgykMUg & recent guidance from @PHAC_GC & @CDCtravel on EVD: https://t.co/M4JNCZFoQJ & https://t.co/B1nquIddSi pic.twitter.com/E5MBOxCEb1— Andrea Boggild, MD (@BoggildLab) February 9, 2020
21/23 For latest guidance on 2019-nCoV & travel see the following expert resources:@CDCtravel: https://t.co/jVgzYjHbjQ@WHO: https://t.co/A6jiXFPruX
Gov’t Canada: https://t.co/cSkxstqLMx@PHAC_GC: https://t.co/tf3jU0NLcQ@McGillTropMed @NaTHNaC @Paromita2015 @tropdocamcc
— Andrea Boggild, MD (@BoggildLab) February 9, 2020
22/23 As with all work arising from my program, I am honored & privileged to mentor a wonderful team of trainees & staff who have contributed to many of the works cited above. Thank you to all who have helped me advance our understanding of fever in returning travelers! 🙌👏🙏🔥
— Andrea Boggild, MD (@BoggildLab) February 9, 2020
23/23 Tagging those working with me in the Febrile Returned Travelers program: @AishaKhatib @MichaelKlowak @ruwandik @rachellau25 @HagopianEmma @shareeseclarke @StefanieKlowak @Bolsky @fjazuli @EricShao15 @melissaphuong @katfaithtan @DavidJamesHarri @AyoAyogirl @celinelecce_ 🙏🙏
— Andrea Boggild, MD (@BoggildLab) February 9, 2020
And more from fever/malaria program: @rochellegmelvin @jason_kwan4 @michelledaodong @dylan_kain @AvinashMukkala @LeilaFMakhani @ShvetaBhasker 🙏🙏🔥🔥🔥🙌👏
— Andrea Boggild, MD (@BoggildLab) February 10, 2020
I read w/ interest @LynfaStroud’s on-point response to the @CMAJ article on sexism in medicine. 🙌🙌Lynfa for articulating well what so many of us #WIM felt. I also read the apology of the EiC: https://t.co/Y6lL1YLIZ6’s-editor-chief
Now, a thread. Warning: it may get salty 1/11 https://t.co/RuzORs9iyk pic.twitter.com/JZtof0Kcfe— Andrea Boggild, MD (@BoggildLab) February 16, 2020
2/11 Full disclosure: Dr. Redelmeier was my staff MD when I was a @uoftmedicine resident on GIM as was @CMAJ EiC Dr. @AndreasLaupacis. Dr. @LynfaStroud was my #CMR that same yr. They are all phenomenally brilliant clinicians whom I admire immensely. #RockStars
My 2-cents follows pic.twitter.com/HBzy7cZV07— Andrea Boggild, MD (@BoggildLab) February 16, 2020
3/11 #WIM face a litany of problems, the least of which is being mistaken for a nurse. RNs are smart, compassionate, vital & predominantly women members of healthcare teams & we lady MDs are taken for nurses regularly👇https://t.co/Jm8DQ8VhBQ
I take it as a compliment. #RNsRock pic.twitter.com/qhpF3gyIiz— Andrea Boggild, MD (@BoggildLab) February 16, 2020
4/11 Speaking of compliments, we #WIM are also routinely mistaken for the B-word. Considering the source of such epithets is helpful. I now wear the badge with honour. #Appropriation #Pride
And:https://t.co/GyWVpir9RJ@choo_ek @hvanspall pic.twitter.com/iZ18olQCD9
— Andrea Boggild, MD (@BoggildLab) February 16, 2020
5/11 #WIM are less likely than men to be: promoted, published, invited onto editorial boards or expert panels & to podiums. We receive fewer grants & of lesser value. We’re paid less too. This literature is captured by @TheLancet theme issue on gender: https://t.co/HkCuJFa3Xl pic.twitter.com/7LCCIodv4x
— Andrea Boggild, MD (@BoggildLab) February 16, 2020
6/11 When racism intersects with sexism in academic medicine (as it invariably does), #WoC face even greater barriers to success & advancement:https://t.co/RUqc61JbxG
And:https://t.co/vhzHnwJcP3@DrMonicaCox @choo_ek @hwitteman @uche_blackstock @AnastasiaSMihai @camilla_wong pic.twitter.com/Frwcz3aNcJ— Andrea Boggild, MD (@BoggildLab) February 16, 2020
7/11 #WIM may also cart around the heavy sack of baggage that is our lived experience, which influences our responses to even more workplace or personal adversity. This baggage is never forgotten curbside…… #MeToo
See: https://t.co/CrGD3D7En7
And:https://t.co/fiYccuy0YH pic.twitter.com/utmpzUWdZT— Andrea Boggild, MD (@BoggildLab) February 16, 2020
8/11 All of the above☝️culminates in a “collective reality” that becomes unbearable for many #WIM who leave the profession altogether.
See:https://t.co/szuY4vzu3b
And:https://t.co/PhIObT6PqP#LeakyPipeline @choo_ek @DBelardoMD @SBowersMD @nrajapakseMD @CardiacPA1 @DrHowardLiu pic.twitter.com/IV9a2L3ypD— Andrea Boggild, MD (@BoggildLab) February 16, 2020
9/11 But don’t worry!! Lest we ladies step out of line & get “hysterical” here, there’s this👇handy checklist, which tells us that our “strong personalities” & lack of invitations(!) should be construed as markers of our incivility & unprofessionalism. #Seriously #NotJoking pic.twitter.com/oyLQOym1Oc
— Andrea Boggild, MD (@BoggildLab) February 16, 2020
10/11 All to say that the MD/RN ‘issue’ is minuscule compared to the big ticket items highlighted above. Don’t make assumptions about someone else’s lived experience👇 And definitely don’t make light of it. Sometimes it just hits way too close to home. https://t.co/c4i2eEqVYy pic.twitter.com/FKfp7cAhV6
— Andrea Boggild, MD (@BoggildLab) February 16, 2020
11/11 I will close this out w/ my own post about why equity & diversity in academic medicine are so important to me as it provides context to the opinions espoused above. Sincere TY to anyone who has managed to get to the end of this thread🙏. #gratitudehttps://t.co/zzOWi0rEZi pic.twitter.com/1WETbPe8Jl
— Andrea Boggild, MD (@BoggildLab) February 16, 2020
1/9 All day I have been lacking inspiration about which topic to choose for my Sunday #Tweetorial. Just looked outside & noticed that a rabbit had hopped out a perfect flask-shaped ulcer in my backyard! So get ready for a @BoggildLab tweetorial on #amoebiasis 🙏! @MedTweetorials pic.twitter.com/Y2GdVwGrTA
— Andrea Boggild, MD (@BoggildLab) February 2, 2020
2/9 Amoebiasis is a parasitic infection caused by a single-celled protozoan named Entamoeba histolytica. It is typically acquired through contaminated food or water, but also can be sexually transmitted. For 5 key features of amoebiasis, see @CMAJ paper: https://t.co/OlQZ6i4UAy
— Andrea Boggild, MD (@BoggildLab) February 2, 2020
3/9 Amoebiasis can cause an acute gastrointestinal syndrome called dysentery. In a small minority of those infected, the amoebae will leave the gut & cause “invasive" disease. Invasive disease can lead to mortality. For risk factors, see book chapter: https://t.co/hS9o1wl4Zo
— Andrea Boggild, MD (@BoggildLab) February 2, 2020
4/9 E. histolytica amoebae elaborate virulence factors that enable penetration of the colonic epithelium, which leads to “flask shaped ulcers" histopathologically. Once they have invaded the bowel lining, they can end up in the liver & at other distant sites, such as brain. #bad
— Andrea Boggild, MD (@BoggildLab) February 2, 2020
5/9 For parasitic differential diagnosis of such liver lesions, see paper: https://t.co/T5prbkIvLA
And this one: https://t.co/w6ilCg1Z43
Unlike worms that invade liver, amoebisis – even invasive infections – tends not to cause eosinophilia.@_ISTM_ @AvinashMukkala @dylan_kain
— Andrea Boggild, MD (@BoggildLab) February 2, 2020
6/9 Amoebic liver abscess is the most common “extraintestinal" manifestation. In our cases, 85% traveled to tropics, 90% reported fever & 75% had tender RUQ. Median incubation was 28 wks. ALAs are usually single unlike pyogenic abscesses. https://t.co/gXnwG2S9bI @hepatoMD
— Andrea Boggild, MD (@BoggildLab) February 2, 2020
7/9 Diagnosis of E. histolytica is by demonstration of amoebae in tisssue or stool, either directly via microscopy, antigen testing or PCR, or indirectly with serology. Under the microscope, E. histolytica looks identical to 2 sister species so confirmatory testing is required.
— Andrea Boggild, MD (@BoggildLab) February 2, 2020
8/9 Treatment of amoebiasis depends on site of infection but always requires 2 drugs: one to 1st target active feeding stages of the parasite, & another to target infectious cyst stages. Metronidazole is typically used first, followed by iodoquinol or paromomycin. @ASP_MirandaS
— Andrea Boggild, MD (@BoggildLab) February 2, 2020
9/9 Medication is usually sufficient to cure amoebiasis. Sometimes ALAs require drainage if they are large or rapidly enlarging, on the left side, unresponsive to meds, or about to rupture. Sometimes “amebomas” can resemble tumours & end up being treated surgically as well.
— Andrea Boggild, MD (@BoggildLab) February 2, 2020
☝️@GHWindow @nityanitingupta @Josekoech @AndreaLConroy @DrMahaliaD @AnnaBanerji @LeilaFMakhani @AishaKhatib @AshnaBowry @mishrash @HotaSusy @Bipin_Tropmed @anitah2 @AntibioticDoc @kbrownmd @rachellau25 @BMC_series @BioMedCentral @ASTMH
— Andrea Boggild, MD (@BoggildLab) February 2, 2020
A short tweetorial in honor of #WorldLeprosyDay today. Leprosy is a stigmatizing infectious disease caused by Mycobacterium leprae, which affects skin, peripheral nerves & eyes, leading to disfigurement & disability if not treated. See primer for MDs:https://t.co/ePEWOgO7Vq 1/7 https://t.co/St2rI6FzoD
— Andrea Boggild, MD (@BoggildLab) January 26, 2020
2/7 Leprosy is rare in N. America, but we see cases in migrants from endemic areas & occasionally in non-travelers who may have been exposed to armadillos. In our analysis of 184 cases in seen in our TDU, most represented source countries were 🇵🇭 🇮🇳 🇻🇳: https://t.co/Yzt0VPqtyn
— Andrea Boggild, MD (@BoggildLab) January 26, 2020
3/7 In very rare cases, the probable exposure remains unknown and without a clear epi link to either endemic country, household / close contact, or armadillo. This was a case in a Canadian man who had never left N. America & had no real risk of exposure: https://t.co/Xs19GSDqVr
— Andrea Boggild, MD (@BoggildLab) January 26, 2020
4/7 Leprosy is curable w/ standard courses of multidrug antibiotic treatment, which is given for 1-2 yrs usually. The drugs are well tolerated & effective. Occasionally we see adverse drug reactions, as with this case of dapsone hypersensitivity syndrome: https://t.co/QVFEJDnkiB
— Andrea Boggild, MD (@BoggildLab) January 26, 2020
5/7 In addition to skin lesions & neuropathy from primary infection w/ M. leprae, “reactions” occur throughout clinical course. These are acute inflammatory episodes leading to painful neuritis & painful skin lesions + other organ involvement sometimes. https://t.co/7VyTNF2xzK
— Andrea Boggild, MD (@BoggildLab) January 26, 2020
6/7 Due to complexity of caring for leprosy patients – high social needs, medically complex, long-term follow-up, polypharm w/ necessary monitoring – we developed a safety tool for use in out unit & published our findings in @BioMedCentral journal #TDTMV. https://t.co/dJF119abzc
— Andrea Boggild, MD (@BoggildLab) January 26, 2020
7/7 Leprosy is truly a #NeglectedTropicalDisease & I have been privileged to mentor trainees across the academic spectrum in this body of work on no budget. TY to the dedicated students working with me to ease the burden of this disease in our population & globally 🙏🙏🙏🔥🙌👏
— Andrea Boggild, MD (@BoggildLab) January 26, 2020
Amazing team of trainees & staff working in our leprosy research / clin program:@MichaelKlowak @StefanieKlowak @swana_kopal @LenaFaust1 @SabrinaYeung1 @rochellegmelvin @shareeseclarke @ShvetaBhasker @OlamideE17 @arghavanomidi @SGholzom @Bolsky @rachellau25 + many not on twitter
— Andrea Boggild, MD (@BoggildLab) January 26, 2020
