Infectious Disease
Expert guidance on antimicrobial stewardship, emerging infections, and complex infectious disease management.
Recent Discussions
How would you approach treatment duration for patients with persistent Candida species fungemia with a history of a prosthetic heart valve but negative TEE/CT PET and no other identifiable source of infection?
Persistent fungemia in the presence of a prosthetic valve with no other identifiable source despite appropriate treatment is challenging. Few studies report high mortality in the nonalbicans candida group, and the risk increases if the patient is immunocompromised. A multidisciplinary management app...
How would you manage a patient with progressive/refractory molluscum contagiosum who is well controlled on methotrexate for seropositive rheumatoid arthritis?
Molluscum can be more challenging to treat when a pt is taking any immunosuppressive. In treating that patient, I would attempt to use cimetidine 400 mg TID along with a topical retinoid such as Retin A 0.1% bid to each individual molluscum. If there are only a few remaining, recalcitrant lesions, I...
When would you consider long-term suppressive antibiotic therapy in patients with chronic or recurrent bacterial prostatitis who continue to experience symptoms despite multiple courses of antibiotics?
I think this would depend on the organism to be honest. First, I would make sure the patient is seen by urology and evaluated for possible structural reasons for recurrent or chronic prostatitis. If there are no structural issues that can be rectified, I would consider a prolonged course of therapy ...
What steps do you take to ensure that partners of patients diagnosed with chlamydia receive treatment?
This is an important question. A lot of "re-infections" occur because partners aren't treated.In my clinical practice, and from a public health perspective, we really try to get the partner(s) into *our clinic* to get treated. We have a walk-in STI program and try our best to get the patient to tell...
How do you approach a persistently positive Mycoplasma genitalium cervical swab PCR in a patient who has undergone multiple courses of the standard CDC-recommended therapy but continues to experience pelvic symptoms and vaginal discharge?
This is a tough one. The first question is whether M. genitalium is in fact the cause of the problem. The second is what "pelvic symptoms" she has. Is a gynecologist involved? If suspicious for PID -- e.g., adnexal and/or uterine tenderness on bimanual exam -- the diagnosis should be confirmed at le...
In patients with possible Bartonella henselae infection and elevated IgG titer, what is the best way to confirm the diagnosis: tissue biopsy with Warthin-Starry staining, tissue sent for Bartonella henselae PCR, or tissue sent for culture?
First of all, it is important to only test people with a compatible clinical syndrome. If the syndrome is not that of babesia, then any positive tests are likely to be false positives. This is a basic testing principle. A very low pretest probability is likely to lead to false positive testing. The ...
Would you give treatment to a male patient with subjective dysuria but no objective pyuria with Ureaplasma urealyticum detected by PCR from urine?
No treatment is indicated. First, dysuria alone in males is not an STD symptom; published research is clear that discharge is required to suspect urethritis. The absence of urine WBCs (i.e. no pyuria) is a pretty good substitute for examining for discharge - not perfect but makes urethritis unlikely...
How would you recommend dosing the MMR or other live vaccines for patients with rheumatoid arthritis on immunosuppressive medications such as DMARDs and anti-TNF alpha therapy?
It is rarely necessary for any live virus vaccine to be mandatory as most employers will accept waiver letters, as will most countries requiring yellow fever vaccination to enter. The risk of disease exposure, illness must be balanced against disease flare holding therapy. Fortunately, with the adve...
Do you routinely treat chronic sacral osteomyelitis when there is no plan for debridement or flap?
I would treat acute febrile cellulitis with a relatively brief course of antibiotics but not with a long course of IV antibiotics attempting to cure osteomyelitis, if surgical debridement is not performed.
In drawing blood cultures from a central line to evaluate for CLABSI, do you advise drawing separate blood cultures from each port in case of dual or triple lumen line?
You don't need to use the central line to draw those cultures. Using the line to draw blood can in it by itself pose risk of introducing a microorganisms. NHSN CLABSi definition does not call for blood culture to be done from a line.