HIV and ID Observations

January 30th, 2013

“So You Think You’re an HIV Expert?”

I’ve been working with the folks over at Clinical Care Options (in particular, Elaine Seeskin) on a program entitled, “So You Think You’re an HIV Expert”, and it was just released here. It’s a series of quick interactive case presentations, and thanks to some nifty programming and great questions submitted by my colleagues Drs. Daar, […]

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December 22nd, 2012

Chaos in the Diagnosis of C diff, and Dogs are Amazing Creatures

If you’re confused about the best way to diagnose C diff these days, welcome to the club. There are all kinds of tests out there, and no uniform approach between labs. Our lab actually does three tests — and will do a fourth (the classic cytotoxicity assay) if you request it. The result? Chaos, confusion, and […]

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November 8th, 2012

Steroids for Bell’s Palsy and the ID Doctor

OK, let’s imagine you’ve just gotten a call/email/text from one of your colleagues about Bell’s palsy; he/she is a busy PCP who periodically asks you very reasonable ID questions. I suspect it went something like this: COLLEAGUE:  Hi Friendly ID Doctor, quick question — I have a patient with Bell’s palsy — wondering whether to give him […]

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October 13th, 2012

More Questions from “ID in Primary Care” Course

Some additional excellent questions from the course: For someone who has had 3 doses of hepatitis B vaccine but does not have the antibody, should we just go ahead and give another 3 shots? A:  (Per vaccine guru Howard Heller):  The guidelines say to just go ahead and give another 3 shots but if the initial […]

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October 11th, 2012

Back to School: Questions at the “ID in Primary Care” Course

We do a post-graduate course each year called “ID in Primary Care,” and it’s a great way for us to find out what people in outpatient primary care practice are thinking about from the ID perspective. I told the participants this year I’d post some of their most interesting questions on this site, with the hope that […]

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August 15th, 2012

Brush with Greatness: Atul Gawande

I was an English major in college, so when my acceptance to medical school (miraculously) arrived, several people gave me books written by doctors about their experience in the medical profession. “See,” these gifts implied, “Just because you’re going to medical school doesn’t mean you need to become a science drone. Doctors can write too!” Sure, doctors […]

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August 8th, 2012

Must-Read Piece: “Imagine a World Without AIDS”

With all the hoopla at last month’s International AIDS Conference about ending AIDS and curing AIDS and bringing us an AIDS-free generation, there was plenty of ink spilled on the topic. Ironically, the attention the meeting received was inversely proportional to its scientific content, which was actually fairly light on a content-per-day scale. The meeting probably […]

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June 24th, 2012

ID Learning Unit — Choosing a Quinolone

We love quinolones on medical services, and it’s easy to understand why. Advantages: Ideal spectrum for several common infections, including community-acquired pneumonia, UTIs, and more complex infections when combined with other drugs Great oral absorption Few drug-drug interactions Once- or twice-daily dosing Generally well tolerated Reasonable cost But how do you choose between them? Below, in […]

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June 18th, 2012

ID Learning Unit — Serologic Tests for Syphilis

Diagnosing syphilis is tricky for lots of reasons, including: The protean disease manifestations, many of which were best described in older medical literature — and hence not known to people who don’t read words on paper (vs a screen) very often. You can’t visualize the bug (Treponema pallidum), unless you happen to have a darkfield microscope […]

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June 15th, 2012

ID Learning Unit — The D Test

I suppose it’s not surprising that we’d follow-up the Etest with the D test, though perhaps if I were being alphabetical, the order would have been reversed. The D test is important, because it screens for a form of clindamycin resistance in MRSA that might otherwise not be detected — the “inducible” kind, which can be […]

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