HIV and ID Observations

October 21st, 2008

Back to School, Day 4: PEP and More PEP

After a lecture on HIV for Primary Care Providers in our course last week, the most controversial topic was, not surprisingly, the use of post-exposure prophylaxis (PEP) for both occupational and non-occupational exposures.  And today, after an entire lecture on PEP to a group of HIV providers in our AIDS course, again the subject drew […]

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October 18th, 2008

Back to School, Day 2

During the course, often the best questions and anecdotes come during the breaks.  Here are a few: Tons of questions about our favorite nemesis, MRSA.  What works for chronic carriers?  How do you manage family members who you suspect would be culture-positive (and the source of recurrences), but are not your patient?  What if the vet […]

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October 15th, 2008

Back to School, Day 1

We offer two post-graduate courses each year, one entitled Infectious Diseases in Primary Care, and the other AIDS Medicine:  An Intensive Case-Based Course.  The Primary Care one started today, the AIDS course starts on Monday. (Both are equally fascinating.  I am entirely unbiased.) What is so striking is that the participants — and content — barely overlap […]

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October 1st, 2008

Deadlines of Note

Just a reminder of some interesting deadlines/events out there, in case you were too wrapped up sharpening pencils for tomorrow’s Vice Presidential debate: As of today, Medicare will no longer reimburse hospitals for medical errors — which includes some hospital-acquired infections.  According to this article, several other payors (including private insurers) are using this as a precedent […]

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September 29th, 2008

Required Reading: The Value of ID Specialists

In the most recent issue of Clinical Infectious Diseases, there’s a comprehensive review of the value of an ID specialist from the perspective of non-patient care activities.  Covered in particular are: Antibiotic stewardship Infection control Monitoring rates of nosocomial infections Managing health care worker “well-being and exposures” Also included are tables listing dozens of studies quantifying the value […]

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September 27th, 2008

Crunchy Frog?

One of the ID fellows just received this curbside consult: A primary care doctor paged me because a patient of his just discovered a dead frog in the salad she was eating, and wanted to know what to do. How about, “Don’t eat it!” But there are definitely some things in our field you just can’t look up […]

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September 18th, 2008

C. diff: The cure for antibiotic abuse

Even with market doom-and-gloom dominating the news, there’s a good article in yesterday’s Wall Street Journal on Clostridium difficile (C. diff).  It gives an accurate summary (in lay language) of the problem, several pertinent clinical anecdotes, and quotations from national experts. But this part in particular caught my eye: She says that among other measures, the hospital has […]

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September 10th, 2008

Yes, TNF blockers increase infection risk. Now what?

So the FDA has issued (another) warning about TNF (tumor necrosis factor) blockers and increased infection risk, this time focusing on fungal infections, in particular histoplasmosis.  TNF blockers are used for treatment of rheumatoid arthritis, Crohn’s Disease, ankylosing spondylitis, psoriasis, and a wide range of other autoimmune diseases, both in approved and in off-label use. ID/HIV specialists […]

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September 5th, 2008

West Nile Virus and Friday Night Lights

The town of Braintree, just south of Boston, has cancelled Friday night high school football games until the first frost of the year due to concerns about West Nile.  Apparently the campus has a lake and wetlands,  good breeding grounds for mosquitoes.  “This is all in the name of safety,” says the school headmaster. (If someone […]

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August 22nd, 2008

We have met the enemy … and it is MRSA

In Jerry Groopman’s recent New Yorker piece on antibiotic-resistant bacteria, he quotes Dr. Louis Rice from the Cleveland VA, who uses the term “ESKAPE” bacteria:  an acronym for Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumanni, Pseudomonas aeruginosa, and Enterobacter. Nothing against the mostly gram-negative nasties in this list (and the focus of the New Yorker article), […]

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