Infectious Disease
Expert guidance on antimicrobial stewardship, emerging infections, and complex infectious disease management.
Recent Discussions
Do you routinely isolate and test for TB in a patient incidentally found to have a miliary pattern of nodules on chest CT?
The short answer is yes. CDC recommends applying airborne isolation for any "suspected" case of TB. So if you suspect, you should isolate until you rule out with 3 negative AFB or have an alternative diagnosis. Keep in mind pretest probability and risk factors for that patient with the miliary patte...
Do you use steroids in patients with respiratory failure who are infected with both influenza and COVID-19?
Yes, along with Remdesivir, Tamiflu, Bactrim, and supportive care. If there is active GGO on CAT scan, steroids are usually beneficial. Start high and then taper to the lowest necessary for about a 10-day course.
Do you routinely monitor imaging or pulmonary function in patients with pulmonary TB after the completion of therapy?
The simple answer will be: NO.
Do you rule out TB in patients with AIDS and lobar pneumonia?
Depends: +Ve Risk Factors: Travel/contact Hx, recent Quantiferon Conversion, changing CXR, Night sweats Unexplained low-grade temps Then, yes. Otherwise, no.
Does your approach to treating latent tuberculosis differ in a patient on anti-fibrotic therapy?
With the increasingly common indication of progressive pulmonary fibrosis in the setting of CT-ILD, RA, and scleroderma, it is conceivable that patients being started on antifibrotic therapy may be on anti-TNF alpha or other immunosuppressive agents. Specifically with anti-TNF alpha agents such as R...
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?
No, not at this time. Intriguing, but not sure we know enough yet.
Do you consider use of convalescent plasma early in disease course in COVID-19 induced ARDS in mechanically ventilated patients?
At this time, I have not adopted the use of convalescence plasma in COVID-19-induced ARDS. I have read the Belgian study but I believe more evidence from other similar studies is needed before we accept it as standard of care. I have not seen any COVID-19-induced ARDS for almost 18 months.
How do you approach patients with onychomycosis that does not respond to terbinafine and prolonged courses of fluconazole?
Terbinafine is usually effective in the treatment of the most common nail infections. Failure of treatment with terbinafine and fluconazole should make us consider bacterial co-infection or other non-dermatophyte organisms (i.e., aspergillus or non-C albicans). Fungal cultures are often falsely nega...
What is your approach to use of D-mannose for prevention of recurrent uncomplicated cystitis?
Unfortunately, in light of Hayward et al., PMID 38587819, I think there is a very limited role for the use of D-mannose for the prevention of recurrent uncomplicated cystitis. Our evidence-based options for the prevention of recurrent uncomplicated cystitis in postmenopausal women without catheters ...
Does management of NMDA receptor encephalitis change in a patient with HIV/AIDS?
In a patient who is immunodeficient, one must be mindful of the risk of opportunistic infections from additional immunosuppression. With that being said, I would still proceed with first-line therapy (pulse steroids and oral taper, IVIG) and symptomatic/supportive care with anti-seizure medicines an...