General Internal Medicine

Pulmonary Infections

Questions discussed in this category

How would you manage a patient with necrotizing pneumonia due to a susceptible Pseudomonas aeruginosa strain who continues to have significant purulent secretions and worsening imaging while receiving cefepime?

3 Answers available

How do you consider sending fungal studies in a patient with pneumonia?

When do you have consider sending them as part of your initial workup?

2 Answers available

Would you start treatment for MAC in a patient with nodular bronchiectatic disease who has demonstrated radiographic progression but remains asymptomatic and smear-negative?

3 Answers available

What is the interpretation of two IGRAs with negative mitogen wells, in the absence of immunosuppression?

A patient on meloxicam for LBP developed high, persistent fevers and no other symptoms. An IGRA, among many tests, was sent. The IGRA’s mitogen ...

3 Answers available

Do you treat patients with culture positive mycobacterium abscessus if they are asymptomatic and do not have progression on imaging?

2 Answers available

In light of recent measles outbreaks in the US, would you recommend an MMR booster for an immunocompetent patients born before 1957?

6 Answers available

Is there any role for prophylactic bronchial artery embolization in immunocompromised patients with invasive pulmonary aspergillosis?

1 Answer available

How do you approach a patient on anti-TNF with positive Quantiferon (previously negative) with negative chest x-ray and no symptoms?

11 Answers available

Is there a role for dual antibiotic treatment with ethambutol and macrolide only, as opposed to three-drug antibiotic therapy, in the treatment of treatment-naive pulmonary MAC without cavitary disease?

4 Answers available

What is your approach to therapy in patients with progressive Scedosporium pulmonary infection who are not candidates for surgical debridement?

1 Answer available

Do you treat non-albicans strains of Candida on sputum culture or BAL in patients who are immunosuppressed?

2 Answers available

What is the interpretation of an IGRA with positive TB wells and negative nil and negative mitogen wells?

A patient on meloxicam for LBP developed high, persistent fevers and no other symptoms. An IGRA, among many tests, was sent. The IGRA’s mitogen ...

2 Answers available

Is there any utility to trending Histoplasma serology titers to guide duration of therapy or treatment response for pulmonary histoplasmosis with negative urine antigen?

2 Answers available

What further evaluation do you pursue for patients who present with vague symptoms such as subjective fevers or intermittent night sweats, who have no pulmonary symptoms but have a positive IGRA?

1 Answer available

How would you treat an asymptomatic patient with a positive Blastomyces antibody, evidence of prior granulomatous lung disease on imaging, and who may require immunosuppression in the future?

1 Answer available

Do you favor timely bronchoscopy for diagnostics over close surveillance in mildly symptomatic patients with CT findings suspicious for NTM infection who are not able to expectorate?

4 Answers available

Would you treat a sputum culture positive for Aspergillus niger despite an atypical CT chest and a negative serum galactomannan in an immunosuppressed patient who is too high risk for bronchoscopy?

0 Answers available

Have you used Karius to aid in the diagnosis of a non-resolving pneumonia, with negative bronchoscopy, biopsy, and other infectious work up in an immunocompetent patient?

1 Answer available

In which patients do you prefer daily standard three-drug therapy for non-cavitary pulmonary MAC as opposed to three times a week dosing?

2 Answers available

Does your approach to treating latent tuberculosis differ in a patient on anti-fibrotic therapy?

1 Answer available

Are you using the microbial cell-free DNA “Karius” test to aid in the diagnosis of an atypical pulmonary infection such as PJP or NTM?

2 Answers available

Do you routinely isolate and test for TB in a patient incidentally found to have a miliary pattern of nodules on chest CT?

2 Answers available

Do you treat Candida spp isolated from a bronchoalveolar lavage?

1 Answer available

Would you consider prophylactic antifungal treatment prior to immunosuppressive therapies in a patient with previously treated pulmonary coccidiomycosis and residual parenchymal changes?

1 Answer available

Papers discussed in this category

Ann Am Thorac Soc, 2017 May

Minimizing Tuberculosis Risk in Patients Receiving Anti-TNF Therapy.

Chest, 2023 Feb 17

Patient-Reported Symptom and Health-Related Quality-of-Life Validation and Responsiveness During the First 6 Months of Treatment for Mycobacterium avium Complex Pulmonary Disease.

The New England journal of medicine, 2014 Oct 01

Goal-directed resuscitation for patients with early septic shock.

The European respiratory journal, 2020 Jul 07

Treatment of nontuberculous mycobacterial pulmonary disease: an official ATS/ERS/ESCMID/IDSA clinical practice guideline.

Am J Respir Crit Care Med, 2019 Sep 1

Microbiological Laboratory Testing in the Diagnosis of Fungal Infections in Pulmonary and Critical Care Practice. An Official American Thoracic Society Clinical Practice Guideline.

Chest, 2023 Oct 07

A Diagnostic Approach to Fungal Pneumonia: An Infectious Diseases Perspective.

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2024 Mar 05

Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2024 Update by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM).

General Internal Medicine

Pulmonary Infections

Questions discussed in this category

Papers discussed in this category

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