An ongoing dialogue on HIV/AIDS, infectious diseases,
January 4th, 2018
What’s Your Favorite Diagnostic Test in Infectious Diseases? Another Fantasy Draft
If you’re wondering what to do while hunkering down during the “Bomb Cyclone,” here’s just the thing — the latest podcast on Open Forum Infectious Diseases.
(Remember — that’s “O-F-I-D”, not “Oh-FID”.)
Again, I welcome my friend and colleague Rebeca Plank, and this time we’re picking our Favorite Diagnostic Tests in ID.
While winter storm Grayson gives us blizzard conditions and zero visibility outside, inside you’ll sip hot cocoa, pull the blanket around your shoulders, and thrill to our selections.
We choose our top 3 favorite tests, our least favorite test, and something we wish we had in clinical practice now that we lack.
Please listen! And let me know:
- Your favorite and least favorite ID diagnostic tests.
- What should we draft next?
Meanwhile, here’s someone who knows what to do today.
https://twitter.com/CUTEFUNNYANIMAL/status/948170043350769664
14 Responses to “What’s Your Favorite Diagnostic Test in Infectious Diseases? Another Fantasy Draft”
Paul E. Sax, MD
Contributing Editor
NEJM Journal Watch
Infectious Diseases
Biography | Disclosures | Summaries
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Most favorite: 16S/18S sequencing. I hope in a few years I can say WGS.
Least favorite: Anything containing the word ‘Lyme’
Next draft: Favorite organism
Oh how I miss the pre-CLIA days, when I would carry the milky urethral discharge down the hallway, gram stain the specimen and gaze at those beautiful gram negative intracellular diplococci. I must give equal billing to the darting tricomonads on the wet prep. I’ll also give personal testimony to the febrile agglutitins test when I was curled up in the corner in rural Colombia. A quick diagnosis of typhoid fever and a short course of chloramphenicol and I was good as new.
You know what I love? No you don’t, but I’ll tell you. It’s a vaginal wet mount, because I am responsible for running the test. I get to smear stuff on a slide and look at it, and holy moly are vaginal flora interesting, especially for those women unfortunately infected with trichomoniasis. Seeing those bugs scurrying around was an event in clinic. We silently motioned for our colleagues to “come see something cool.” THEN, I get to put some more goo on another slide, put some KOH on it, and then I have to smell it. Amazing! I get to use my whole self to interpret a test all BY myself. Also, women are rad.
Least favorite: Anal cytology. What a pain in the ass.
I’d just like to say that Mark and I came up with the genital fluid microscopy answer independently, because Paul hadn’t approved either of our comments. Mark, we should hang out some time and… play backgammon and eat popcorn.
CSF India ink. As a resident commented when he saw a particularly florid one, “This bud’s for you.” Also, microscopic view of the tumbling motility of Listeria suspended in a hanging drop. The acrobatics, to me, win a gold medal over mere swimming by Trichomonas. And, finally, a positive darkfield in syphilis. I realize this answer dates me, as I am a PGY-48.
Strongyloides serology is my favorite test; a few years ago a patient w eosinophilic pneumonia was clearly getting worse despite an ID consultant who did (negative) stool tests for parasites, a pulmonary consult who did a lung biopsy, and an allergy consult who determined allergy was not the cause. Once treated w antibiotics the recovery seemed miraculous.
Although not good news for the patient, I used to love performing India Ink examinations on CSF and see the bright lights consistent with cryptococcal disease. I could begin treatment immediately and not have to wait for antigen tests to return. Conversely, I will never miss performing any tests that rely on a specimen of fresh stool. No wonder I never considered a career in GI.
Procalcitonin bruh. just order it. then watch the old timers squirm..
My favorito test is questioning the patient. I say it both as internista and severely diseased patient
favorite test: procalcitonin
least favorite: urine culture in asymptomatic patients
next draft: favorite organism
Favorite tests:
• Legionella antigen in urine.
• Hepatitis C viral load
• RPR
Less favorite tests
• Body surface cultures
• Leishmania serology
• Atypical bacteria serology
Next draft: favorite country where the patient comes from
Nonsense, it’s totally “Oh-Fid” – just like it’s “Jam-Uh” and “Knee-Jim”. If that’s wrong, I don’t wanna be right…
Hey E — you have a point!
Paul
Procalcitonin and legionella urinary antigen for me. And least favoured is anything that is for borrelia burgdorferri ,ESP the elisa for igg.