Infectious Disease

Infectious disease physicians and clinicians writing on KevinMD about outbreaks, antimicrobial resistance, vaccines, and the ongoing challenge of preventing and treating infection. Contributors include the physicians who treat infectious disease and the public health physicians who track it. For a maintained record of what physicians have said about vaccines and vaccine refusal since 2004, see Vaccines: what physicians say, in their own words. For what clinicians wrote during the COVID-19 pandemic as it happened, see COVID-19: what physicians wrote as it happened.

A physician’s breakthrough against prior authorization

Niran S. Al-Agba, MD

Medications

October 15, 2018

A few weeks ago, I saw a young patient who was suffering from an ear infection. It was his fourth visit in eight weeks, as the infection had proven resistant to an escalating series of antibiotics prescribed so far. It was time to bring out a heavier hitter. I prescribed ciprofloxacin, an antibiotic rarely used in pediatrics, yet effective for some drug-resistant pediatric infections.

The patient was on the state Medicaid …

No, the flu shot doesn’t cause the flu

Kevin Tolliver, MD, MBA

Conditions and Diseases

September 29, 2018

Does the flu shot cause the flu?

Let me tell you, without a doubt, that the flu shot does not give you the flu. This is perhaps one of the most common misconceptions I hear as a physician. People absolutely swear by it. I’ve even had people tell me that family members got the flu shot and then died suddenly. I’m sympathetic, but how misguided!

Before we talk more about the flu …

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No, the flu shot doesn’t cause the flu

Inaccurate penicillin allergies worsens antimicrobial resistance

Jasmine Riviere Marcelin

Medications

September 28, 2018

September 28, 2018 marks 90 years since Sir Alexander Fleming discovered penicillin as an effective antimicrobial which would soon save millions of lives. He warned soon afterwards that unless we used penicillin judiciously, we would see antibiotic resistance, and he was right. With decades of inappropriate antibiotic prescribing, we have dug ourselves a deep hole of antimicrobial resistance, and inaccurate penicillin allergies is but one shovel used to put us …

Remembering the age of polio

Roy Benaroch, MD

Conditions and Diseases

September 18, 2018

“Polio. I’ve seen polio.”

Last night, I was speaking with one of the most experienced pediatricians I’ve ever met, Dr. Jack Burstiner. I’ve known him for 50 years. I would have known him even longer if I had been born earlier. He lived in my neighborhood, two doors down. He was my pediatrician.

Jack is almost 90 years old. But he still looks like a pediatrician. He’s got a smile a child …

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Remembering the age of polio

Sepsis awareness: Should there be different awareness goals for the young and the old?

Samuel Harrington, MD

Conditions and Diseases

September 4, 2018

Sepsis, the body’s self-destructive inflammatory response to severe infection, is the leading cause of death in U.S. hospitals, particularly among the elderly. It starts as mild sepsis, advances to severe sepsis, and all too frequently blossoms into septic shock. More than 1.5 million Americans get sepsis each year. More than 250,000 die of the illness. One in three patients who die in a hospital have sepsis. 62percent …

You can’t always expect a miracle, but you can always hope for one

David Edelbaum, MD

Physician

August 29, 2018

I began practicing as an internist/nephrologist in the early 1960s. Having rented an office in Los Angeles, I introduced myself to the local medical community and set out to build a practice.

With a growing family, a mortgage and an office to support, I was hungry for patients. Hospital emergency rooms were good referral sources, so I took ER call at three different hospitals.

Late one Friday night, I got a call …

MKSAP: 25-year-old man with dark-colored urine

mksap

Conditions and Diseases

August 25, 2018

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 25-year-old man is evaluated for dark-colored urine for 2 days, swelling of the face and hands for 1 day, and severe headaches this morning. He reports having an upper respiratory tract infection 1 week ago with fever, sore throat, and swollen glands, but had otherwise felt well. Medical history is otherwise unremarkable, …

This infectious disease physician still finds HIV care rewarding. Here’s why.

Paul Sax, MD

Physician

August 20, 2018

Earlier this year, I wrote a piece about friends and colleagues of mine who have left HIV clinical practice. Something about it touched a nerve.

Admittedly, it was kind of a downer — but it might have been slightly misinterpreted. A lot of the problems my friends cited could have easily applied to almost any area of clinical practice; these challenges were by no means limited to HIV care.

They mentioned the …

MKSAP: 30-year-old woman with HIV infection

mksap

Conditions and Diseases

August 20, 2018

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 30-year-old woman is evaluated in follow-up after being recently diagnosed with HIV infection. She is asymptomatic. Medical history is unremarkable, and she takes no medications; she has not yet started antiretroviral therapy. She received all scheduled childhood immunizations.

On physical examination, vital signs are normal. She has shotty cervical lymphadenopathy, but the examination …

Why doctors don’t call in sick when they should

Jennifer Weiss, MD

Physician

August 5, 2018

Recent research from Florida Atlantic University and Cleveland State University have found a direct correlation between preventative health care and the number of paid sick leave days a worker gets. Workers with more than 10 paid sick days annually access preventative care more frequently than those without paid sick days.

Preventative care, in turn, leads to better overall mental and physical health. Doctors that are in private practice function …

We should all care when patients get too many Z-paks

Linda Girgis, MD

Medications

August 2, 2018

Many people seem to believe that the Z-pak possesses magical qualities. Patients come in requesting it for the common cold, because it worked for them in the past. Not only do many believe it cures the common cold, but they think it can treat any infection. Have a urinary tract infection? Just ask your doctor to prescribe a Z-pak! Sniffles got you under the weather? Do the same!

Anyone who believes …

The double-edged power of the medications we prescribe

Hans Duvefelt, MD

Medications

July 30, 2018

My patient, a rugged sixty year old with massively muscular forearms, gray chest hair at the V of his denim shirt, and a voice that suggested years of liquor and unfiltered cigarettes, lowered his voice and leaned forward.

“I’m not usually scared of anything, but for three nights now, ever since I started taking the Levaquin for this pneumonia, I have had the most horrific nightmares. I can’t even talk about …

Urgent care centers prescribe more antibiotics. Why is that?

Roy Benaroch, MD

Conditions and Diseases

July 30, 2018

Urgent care centers are way ahead in prescribing unnecessary, potentially harmful antibiotics that are doing no one any good – at least no patients any good. The owners of the urgent care centers are the ones who are benefitting. And you and your family are being bilked, misled, and harmed.

A recent study published in JAMA Internal Medicine looked at the proportion of antibiotic prescriptions that were made for viral respiratory …

Should I or shouldn’t I? The dilemmas faced by the chronically ill.

Toni Bernhard, JD

Patient

July 26, 2018

After many years of being mostly housebound by chronic illness (which includes chronic pain), here are a few of the dilemmas I’ve faced over and over. I’m confident that I’m not alone in my “should I/shouldn’t I?” world.

Do I accept an invitation from a friend to get together or do I refuse it?

If I refuse the invitation, depending on who issued it, it may be the last one I’ll receive …

What is proper work attire in medicine?

Michael Edmond, MD, MPH

Physician

July 22, 2018

I’m a creature of habit. My first activity every day is to read the New York Times. Depending on my schedule, some days I read more articles than others. This week I was away at a conference and found myself with some early morning extra time before the first meeting session, so I delved into the Arts section. I began to read the first article: “Women …

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What is proper work attire in medicine?

Never underestimate the power of a smile

Weijie Violet Lin

Conditions and Diseases

July 21, 2018

He was a young patient with AIDS and Pneumocystis jiroveci pneumonia (PJP). Maybe that should have scared me from the start, but it didn’t. In hindsight, I keep wondering when the fear really set in. But downstairs under the glaring lights and the swooshing bustle in the ER, I only remember that he looked slightly bored as he took shallow, quick breaths. There was no blood, no screams of pain. …

MKSAP: 24-year-old woman with atopic dermatitis

mksap

Conditions and Diseases

July 14, 2018

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 24-year-old woman with longstanding atopic dermatitis is evaluated for an acute worsening of her disease in the past week. She has had increased pruritus and now has multiple painful areas within the involved skin. She has been applying petrolatum jelly and triamcinolone ointment and washing with gentle cleansers without improvement. She is otherwise well …

The man with the fedora in the ICU

Daniel Z. Uslan, MD

Physician

June 7, 2018

I visit him in the ICU day in and day out. It’s the man with the fedora. I see him every day because he is not going anywhere. The metastatic cancer has ravaged his colon, bones, liver, and lungs. His oncologist is willing to try more chemo — but not now — maybe someday “when he is stronger.” The man has already failed several other regimens. The oncologist hasn’t seen …

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The man with the fedora in the ICU

Why you should think twice about prescribing antibiotics

Rich Rodriguez, MD

Medications

June 3, 2018

A meme forwarded to me last year showed a chimp with the caption: “Monkey trained to dispense Z-Paks at urgent care.”

As one of the medical directors for a multi-office urgent care practice, one of the tasks is performing a chart review. One of the patterns we see too often is ubiquitous Z-Pak prescriptions for purported cough, sore throat, sinusitis and even an allergic rhinitis this last batch. Z-Paks are one …

6 steps to stop your smartphone from going viral. Literally.

Matthew Katz, MD

Conditions and Diseases

May 25, 2018

I recently went to an infectious disease educational session sponsored by the Massachusetts Medical Society and the New England Journal of Medicine called “Epidemics Gone Viral.” The focus was preparedness for the next epidemic, which may come from anywhere. John Brownstein talked about how its arrival will be monitored and reported using Twitter and artificial intelligence.

With the meeting going viral with excitement as Bill Gates got on …