Infectious Disease
Expert guidance on antimicrobial stewardship, emerging infections, and complex infectious disease management.
Recent Discussions
Would you treat Scedosporium growth in expectorated sputum in a patient with COPD, pulmonary hypertension, and bronchiectasis, who has chronic dyspnea with exertion, thick sputum production, negative bacterial cultures, and no signs of mold infection on a high resolution CT scan, with no other clinical symptoms of infection?
In persons with bronchiectasis, almost anything that grows can be a pathogen, but it is tough to know. If the patient has COPD and no other immunocompromising conditions, I would not expect typical invasive fungal infection findings. Having said that, scedosporium is not the first common pathogen th...
Given recent data from the REPRIEVE trial, how will you adapt your practice with regards to prescribing statins to patients living with HIV?
This randomized controlled trial (Randomized Trial to Prevent Vascular Events) found that, for people living with HIV between the ages of 40 and 75 years who were taking pitavastatin calcium, the risk of major adverse cardiovascular events was lowered by 35% and the risk of cardiovascular death was ...
What approximate portion of men develop infertility following a mumps infection?
In reviewing the literature, 25% is the number that comes up for males post puberty. The mechanism is one of antibodies being produced against germ cells, impacting spermatogenesis.
How do you approach a positive Quantiferon/PPD test result in a patient for whom testing is sent without a clinical indication and who does not have a risk factor for TB exposure nor TB reactivation?
If a test for TB infection such as a Quantiferon or PPD is done without TB exposure risk factor or clincial indication and is positive, a chest X-ray and good history for symptom assessment and exam should be done. I will assess to see if there is an increased risk of developing TB such as an immuno...
Do you routinely continue dual antibiotic coverage or de-escalate to monotherapy based on peritoneal fluid culture sensitivities in patients with relapsing pseudomonas aeruginosa peritoneal dialysis peritonitis after peritoneal catheter removal?
If the peritoneal dialysis catheter has been removed then I would de-escalate to monotherapy based on the fluid culture sensitivities. Monitor clinical response and obtain new fluid samples for analysis if any concern for persistent infection.
What duration of antibiotics do you use in patients with Actinomyces osteomyelitis, i.e., do you stop after 6 weeks or do you give a longer oral antibiotic course?
With actinomycosis at any site, I would treat for a longer duration than other causes of osteomyelitis. Bioavailable oral agent for 4-6 months after a couple of weeks of intravenous antimicrobials has been my practice.
Are there any concerns with live vaccine innoculation and patients who are on denosumab?
This is a complicated question because while denosumab is a biologic therapeutic that has immunomodulatory effects on innate and adaptive immunity its association with serious infections complications appears modest. An increased rate of background infections and some increase in serious infections ...
How do you approach prophylactic antibiotics in patients who continue to have recurrent neutropenic fever following chemotherapy for solid tumors despite chemotherapy dose reduction and growth factor support?
This has to be individualized to the patient. It depends on the length of neutropenia, previous infections, and local antibiotic resistance. If the patient develops neutropenic fever after every cycle of chemotherapy and no obvious nidus of infection has been identified, a trial of a fluoroquinolone...
How would you approach the management of posterior uveitis caused by Toxoplasma gondii in immunocompromised patients, considering the potential for atypical presentations and treatment resistance?
There are no established studies to confirm the best medications and duration for the treatment of toxoplasmosis retinitis. The recommendations are based on experience and consensus. Further, I am not sure how you established resistance since one rarely has the organism to test, and there is no rout...
How do you decide on supportive care vs empiric antibiotics in a patient with suspected aspiration pneumonitis (i.e., witnessed macroaspiration event within the past 24 hours) but with features that could suggest pneumonia (e.g., acute respiratory distress, fever, leukocytosis, pulmonary infiltrates, etc.)?
Great question and one that comes up all the time for me. As the patient has more signs of true infection, such as those you mention with fever, leukocytosis, and respiratory distress, I am much more likely to start antibiotics. If the patient just has chest radiograph findings of opacities and some...