The danger of course is that this nuance is lost on whoever orders the test and TB gets erroneously “ruled out”. This seems to be more of an issue of education and result presentation that an intrinsic fault in the test

I’ve often wondered about whether we are too dogmatic about this in ID. There are lots of tests (eg all of the physical exam!) that have comparably bad performance characteristics. We don’t pretend they are 100 sens/spec but understand their limitations and do a good bit of Bayesian inference

Great summary Alasdair. I suspect asymptotic carriage is less of a phenomenon in adults - but still happens.
Some of my colleagues would argue though that the specificity is near enough 100% in adults that the diagnosis is made when you get a +ve (NPS) PCR. Anyone got thoughts (or a reference!)?

Ah amazing - glad you liked it! Please do feel free to add to it

A global health starter back would be a great public service. I’m an ID clinical academic currently working on bacterial/viral confection in West Africa

Looks like the link Bluesky has made doesn’t work - but clicking the link directly in the text is fine

It's fine on a phone but best read on a browser.

This project started life as a custom markdown template for our research group. The tutorial links to that package and has a section at the bottom on customising the logo and branding for your lab/group.

(Key **players** this should say!)

I was lucky enough to work on the AMBITION trial (although had nothing to do with the design) and it has to be said that their motivation was to improve treatment options in low resource settings. This is just a happy bonus.

But PICC lines and hospitalisation are risky anywhere (especially if you have no immune system). This feels especially relevant to people how are surprisingly well with crypto but would be very vulnerable to nosocomial complications.

The design is very smart as it has hard fungal dynamic outcomes too. If it didn’t have this then you could easily argue that the risks/benefits of hospitalisation and long term IV access could be different in different countries.

There is an excellent article by the key player in the AMBITION-cm trial on just this topic: academic.oup.com/cid/article/....

Amazing public service. Thank you!