HIV and ID Observations

April 22nd, 2019

Two New Trials of Combination Therapy for MRSA Bacteremia Answer Some Questions — and Raise Several New Ones

Every clinically active ID specialist, hospitalist, and cardiologist realizes that treatment of bacteremia due to methicillin-resistant Staph aureus (MRSA) is no easy task. In fact, it’s a problem so difficult that persistent bacteremia due to MRSA deserved highlighting here as an “Unanswerable Problem in Infectious Diseases”. I wrote that over 5 years ago, and you […]

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April 7th, 2019

New York Times Highlights the Problem of Antimicrobial Resistance — and the Tricky Issue of Disclosure

Right there, on the homepage of today’s New York Times, our national paper of record — Sunday edition, no less! — appears this headline: A Mysterious Infection, Spanning the Globe in a Climate of Secrecy Most of this piece is about Candida auris, the highly resistant fungus that targets our most vulnerable patients — those with […]

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March 24th, 2019

Tetanus Case, No More MAC Prophylaxis, Playing in Dirt, and Low-Level Viremia — A National Puppy Day ID Link-O-Rama

In honor of spring (March 20), and the very important National Puppy Day (March 23), here are a bunch of ID and HIV-related recent items for consideration, contemplation, and perusal: A life-threatening case of tetanus in an unvaccinated boy highlights the personal and financial cost of the anti-vaccine movement. How deeply embedded are these false beliefs? […]

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March 18th, 2019

Just 1 Month of TB Preventive Therapy Works for People with HIV in TB-Endemic Regions — How About Other People in Other Places?

There’s a look our patients frequently give us when we tell them that preventive therapy for tuberculosis involves 9 months of treatment. If I were to put that look into words, they would be: Yikes, Doc, 9 months is waaay too long — you must be out of your mind. It’s the “9 months?!?!” face. […]

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February 24th, 2019

Why Choose Infectious Diseases as a Medical Specialty? Here’s the Beginning of My Story, with Bonus Podcast

Forgive the autobiographical nature of this post, but here’s a recap on how I started down the the path to becoming an ID doctor. To begin, understand that my first year of medical school was rough going. In hindsight, this wasn’t surprising. After majoring in English during college (with a minor in the Harvard Lampoon to […]

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February 10th, 2019

Six Musings Triggered by the Latest Measles Outbreak

In 2018, there were 372 cases of measles in the United States, the largest number since 2014. This year, we’ve already had 79 cases, many from a large outbreak in the Pacific Northwest — where anti-vaccine proponents recently protested efforts to restrict nonmedical vaccine exemptions. A few ruminations triggered by this outbreak. 1. The vaccine […]

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February 3rd, 2019

An “Interview” with the OVIVA Study of Oral vs. IV Antibiotics for Osteomyelitis

An “interview” inspired by publication of a landmark clinical trial. All responses written by me — but be assured, they are based on reading the paper, the accompanying editorial, the supplemental appendix, hundreds of comments on Twitter (some of them from the study investigators), and even a few generous comments from the the senior author in […]

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January 27th, 2019

For Our Stable HIV Patients, Why Are We Still Sending All These Lab Tests So Often?

Interesting query from a colleague recently: I’m a community ID doc in the trenches (the measles trenches at present) with an HIV question. Why do we still check CBCs & chem panels every 3-6 months in our HIV patients? Particularly our well-controlled, virologically-suppressed patients? This strikes me as a tremendous waste. I haven’t been in practice that […]

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January 22nd, 2019

Unanswerable Questions in Infectious Diseases — Treatment Duration in Endocarditis: 4 Weeks, 6 Weeks, Other?

Time to get back to some tough clinical decisions. It’s been a while. We’ve done The Abdominal Collection and Duration of Antimicrobial Therapy, Persistent MRSA Bacteremia, and The Positive Cultures for Candida in an ICU Patient. However, that series of posts appeared here in early 2014, which means it’s been 5 years with no “Unanswerable Questions.” Lest […]

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January 13th, 2019

Are We ID Doctors Really So Unhappy Outside of Work?

Medscape released their 2019 Physician Lifestyle & Happiness Report, and the results aren’t pretty for a certain cognitive specialty, one commonly abbreviated “ID.” Out of 29 medical and surgical specialties, infectious diseases physicians ranked second to last when responding to a 7-point scale rating on their happiness. Only neurologists were gloomier than we were during their […]

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