Infectious Disease
Expert guidance on antimicrobial stewardship, emerging infections, and complex infectious disease management.
Recent Discussions
Do you repeat a lumbar puncture in a patient living with HIV diagnosed with and treated for neurosyphilis and if so, when?
This is a complex issue, and there isn't a one-size-fits-all approach. There are no hard and fast guidelines in place. If the initial CSF abnormalities include only reactive CSF VDRL, along with modest protein elevation and mononuclear pleocytosis (both of which are consistent with HIV infection), a...
Do you recommend testing for HPV in patients with oral lichen planus?
I do not routinely use anti-viral medications for HSV when treating oral lichen planus. I begin treatment with topical steroids. I would only consider testing or treating for HSV in cases of long-term recurrent and or recalcitrant disease.
Do you take into consideration a patient's serum albumin level in your decision to use ertapenem?
A 2023 IDSA guidance recommended against the use of ertapenem in critically ill patients as well those with hypoalbuminemia. The latter is based on PK data indicating rapid clearance of the free fraction of the drug, which has approximately 90% protein binding, resulting in lack of attainment of an ...
Do you find HZV titers useful in diagnosing shingles sine herpete?
VZV sine herpete is an infection/disorder frequently considered but rarely confirmed and represents an atypical presentation of VZV reactivation in the cranial nerve, spinal nerve, viscera, or CNS in the absence of classic cutaneous findings.Serum IgG VZV in isolation is not useful unless followed s...
Is there ever a role for the use of CMV immune globulin for treatment of CMV viremia and/or disease?
CMV immune globulin (CMVIG) should certainly not be first-line therapy for treating CMV syndromes. It can be considered for use in special circumstances when patients are intolerant to 1st or 2nd line therapy, they have resistant/refractory disease, or are at significant risk for morbidity in combin...
Should checking a urinalysis with reflex to culture be part of the standard work up for fever in an ICU patient with a urinary catheter?
Yes, as part of a broad workup for infectious and non-infectious causes of fever, and with many caveats. Patients in the ICU are at high risk for diagnosis with CAUTI, yet as I think you are applying, this is a difficult diagnosis to make given the inability of many patients to give a history (or fo...
What is the utility of granulocyte infusions in patients with neutropenia and severe infection?
Granulocyte transfusion is infrequently used for septic neutropenic patients given that the randomized trial (RING) that looked at this question did not show improved outcomes (with the caveat that the trial did not finish accrual (Price et al., PMID 26333778). Having said that, the criteria to cons...
How do you approach immunosuppression in patients with a positive Interferon Gamma Release Assay and prior intravesicular BCG treatment for bladder cancer?
Bacillus Calmette–Guérin (BCG) is the most widely used vaccine worldwide and has been used to prevent tuberculosis for a century. BCG also stimulates an anti-tumor immune response, which urologists have harnessed for the treatment of non-muscle-invasive bladder cancer. As rheumatologists, we occasio...
Do you treat Candida spp isolated from a bronchoalveolar lavage?
I would only treat if there was evidence of Candida infection from another source/location (at the same time).
Do you avoid performing urine microscopy in patients with AKI who have COVID-19 given concern for potential aerosolization?
No. The risk is very low to non-existent. At the beginning of the epidemic we were doing that but the evidence now is not supporting that practice.