Infectious Disease
Expert guidance on antimicrobial stewardship, emerging infections, and complex infectious disease management.
Recent Discussions
Do you treat subarachnoid neurocysticercosis with albendazole alone, or with the addition of praziquantel?
There are no controlled clinical trials for the treatment of subarachnoid neurocysticercosis. That leaves the question of one drug or two and the proper duration open. Since this is a potentially very bad disease, and both albendazole and praziquantel are generally well tolerated, I generally start ...
Do you routinely refer all patients with cutaneous leishmaniasis with a species associated with mucocutaneous leishmaniasis to ENT for comprehensive nasal/oropharyngeal evaluation, or do you refer only if mucocutaneous involvement is suspected based on careful clinical assessment and/or bedside exam?
Yes. Mucocutaneous leishmaniasis-associated Leishmania/Viannia species can involve any part of the oropharynx. This is often difficult to identify and often requires molecular testing. If molecular or culture testing of a skin lesion shows a Viannia species I would also do an oral exam via ENT. If t...
Does your institution have formal policies or work flows to reduce unnecessary IGRAs ordered for patients on biologics?
We have developed a multi-specialty working group to implement this as a lot of unnecessary testing is getting done. This will include having a 2-3 question screening pre start of biologics, and then annually to asses risk, that we hope will be incorporated into the visit or an order set.
Do you recommend lifelong antibiotic prophylaxis, or do you prefer a more selective approach based on risk factors in asplenic patients without a history of severe infections?
The advice is limited by the fact that there are no randomized controlled trials in adults on daily antibiotic prophylaxis post-splenectomy. There are trials in children with sickle-cell disease that do show a benefit, but it is not clear that these can be extrapolated to splenectomized adults. Furt...
For which patients could you consider direct oral amoxicillin challenge as opposed to skin testing for penicillin allergy de-labeling?
If a patient can be identified as low-risk by history they should be considered for either historical removal of the label of direct oral challenge. If the history is not compatible with allergy (e.g. they have a family history or have tolerated another drug like Augmentin), historical de-labeling i...
Do you use combination antibiotic therapy for treatment of bacterial endocarditis due to gram-negative bacilli?
The approach towards different might differ depending on whether the culprit organism belongs to the HACEK group or the nonHACEK group. The mortality rates per literature were approximately 2% for HACEK and 20-30% for the nonHACEK group. Combination therapy is usually not recommended for HACEK endoc...
Do you recommend routine ophthalmologic exam for all patients with hypervirulent Klebsiella pneumoniae bacteremia?
The incidence of endogenous endophthalmitis due to Klebsiella bacteremia, especially due to hypervirulent K. pneumoniae strains, has been increasing. Klebsiella endophthalmitis is associated with poor visual outcomes Several studies, primarily from Asia, have described risk factors for developing en...
Do you routinely recommend doxycycline for pregnant individuals with rickettsial diseases despite the historical concern for side effects in pregnancy?
It has been known for years that short courses (<3 weeks) of doxycycline are safe in pregnancy and in young children. This article just reinforces the recommendations. Rickettsial diseases have significant morbidity and mortality and should be treated with the best (and best proven) antimicrobial. T...
What is your approach to monitoring patients with the indeterminate form of Chagas disease?
Once the diagnosis of Chagas is confirmed (by at least two different serological tests), we routinely evaluate the patient for symptoms or signs of cardiac or GI complications. We also obtain an EKG with 30-second rhythm strip and schedule a transthoracic echocardiogram with contrast (because some p...
Do you usually recommend a modified diet for Clostridioides difficile infection (CDI)?
Post-infection IBS is common after C. diff infection, and some of these patients have dietary intolerances. Other than avoiding foods that exacerbate these symptoms, I do not recommend any particular diet. I also do not recommend probiotics, in keeping with society guidelines.