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.

Here’s what it looks like when our health system actually works

Matthew Hahn, MD

Physician

September 2, 2017

The other day, rather than being at the office, I was sitting in the waiting room of our favorite gastroenterologist’s endoscopy suite. I had dutifully accompanied my wife, who was getting her colonoscopy. My cell phone buzzed. It was my nurse calling from the office. I had seen a patient late the previous day who was complaining of right leg pain.

I had ordered a D-dimer, hoping the test would be …

The fine line between do no harm and do nothing

Amy Fan, MD

Physician

September 2, 2017

On a particularly sultry day in a hospital of the Peruvian Amazon, I found myself with the task of telling a group of parents that their babies, who had been waiting in the hallways for days without eating in preparation for surgery, would not be able to have their cleft lip and palate fixed. We, a group of American doctors and medical staff offering this procedure free of charge to …

Stories to help parents think critically about the importance of vaccinations

Cherilyn Cecchini, MD

Conditions and Diseases

September 2, 2017

I was rotating through an infectious disease elective at an outside hospital during my fourth year of medical school when I encountered a startling situation. We were called to evaluate a patient who was suffering from an infection called Haemophilus influenzae. Now, I knew that most children were vaccinated against this pathogen, so I was surprised by the consult.

I was working on a team with three others: one attending, one …

How this physician transitions to becoming an empty nester

Manoj Jain, MD, MPH

Physician

August 30, 2017

Next month when our youngest child leaves for college, the biggest change may not be in his life but in ours.

We are done with dropping them off at school, or giving them driving lessons, or helping them with difficult homework assignments: We will officially become “empty nesters.”

My wife and I ponder sitting at the dinner table and standing by the kitchen counter, where exuberant political dialogue takes place, and …

Alarm fatigue is problem. Here’s a pragmatic solution.

Hans Duvefelt, MD

Physician

August 30, 2017

I missed a drug interaction warning the other day when I prescribed a sulfa antibiotic to Barton, a COPD patient who is also taking dofetilide, an uncommon antiarrhythmic.

The pharmacy called me to question the prescription, and I quickly changed it to a cephalosporin.

The big red warning had popped up on my computer screen, but I x-ed it away with my right thumb on the trackball without reading the warning. Quite …

Hospital sushi and the 5 stages of grief

Ben Gold, MD

Physician

August 29, 2017

Prologue

It’s 1:30 p.m. on a beautiful Saturday afternoon. You’re on call, and hungry, and having not had the forethought to make food ahead of time, you decide you’ll take your chances and see what the hospital cafeteria has to offer. You bustle your way past screaming children, harried caregivers, and distracted hospital staff with their heads buried in smartphones, following signs for the fork and knife.

Finally, you arrive. After considering the stack of soaking wet trays …

Online physician reviews: Patients are the ones who will suffer

Kaci Durbin, MD

Physician

August 20, 2017

The rise of the Internet has changed many things in the world of the customer. Now, in the age of the online consumer, a person can search for not only the exact item or service he or she wants, but read hundreds of reviews on that particular item or service. Thanks to Yelp and a host of other online rating sites, a person can find a reputable painter or contractor …

MKSAP: 36-year-old man with history of fatigue

mksap

Conditions and Diseases

August 19, 2017

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

A 36-year-old man is evaluated for a 1-year history of fatigue, intermittent headaches, sore throat, and joint and muscle pain. He reports no difficulties falling asleep and gets 10 hours of uninterrupted but nonrestorative sleep each night. He has seen several physicians over the past year. Evaluation has included a complete blood …

7 ways to combat compassion fatigue

Jenny Hartsock, MD

Physician

August 17, 2017

This is the patient’s eight admission over the course of two weeks. The patient is a heroin abuser and has bacteremia and endocarditis. Their heart valve is failing and they are in and out of congestive heart failure. Every day, dozens of medical professionals converge on the patient to give treatment and advice. And every day after hearing that advice, the patient leaves the hospital against medical advice and goes …

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7 ways to combat compassion fatigue

A lesson learned after seeing a tick-borne illness

Hans Duvefelt, MD

Conditions and Diseases

August 16, 2017

It was late afternoon. The woman who had seen my colleague, Dr. Wilford Brown, a few days earlier was sitting in my exam room. Her chart note read like a typical unnameable virus: headache, body aches, fatigue, low grade fever. She had always seemed like a level-headed resolute woman, but she had called three days in a row for medical advice because she felt so poorly. And it all sounded …

Should only infectious disease specialists be allowed to prescribe antibiotics?

Craig Bowron, MD

Medications

August 9, 2017

The WHO’s recent announcement of multi-drug resistant strains of gonorrhea raises the specter of a worldwide SuperClap Attack that even the Avengers couldn’t foil. It also comes as yet another ominous reminder of the perils of rampant and indiscriminate antibiotic use.

There’s plenty of blame to spread around. True, here in the U.S., consumers can’t buy antibiotics over the counter, but that hasn’t kept physicians and other providers from over-prescribing them …

The sad direction of hospital care

Steven Reznick, MD

Physician

August 8, 2017

My 74-year old obese, poorly controlled diabetic patient with high blood pressure, high cholesterol, coronary artery disease, asthma, obstructive sleep apnea has been difficult to motivate to improve his lifestyle and his health. He is bright, sweet and caring but just not very disciplined.

At each office visit, we review his medications, review his dietary habits and go through the check list of check-ups for diabetic complications including regular ophthalmology exams …

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The sad direction of hospital care

How long should I take antibiotics? Exploring the Goldilocks problem.

Robert Centor, MD

Physician

August 5, 2017

Antibiotics save lives, but antibiotics can have negative effects. When patients have bacterial infections, we want to treat them to prevent complications of the bacterial infection, but not treat them for an excessive duration. So we have a Goldilocks problem — we want antibiotic duration to be just right — neither too short or too long.

Some clinical conditions have adequate research to define the Goldilocks duration. Community acquired pneumonia only …

MKSAP: 20-year-old male college student with a superficial skin infection

mksap

Conditions and Diseases

July 15, 2017

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

A 20-year-old male college student on the wrestling team is evaluated for a superficial skin infection. He has a history of several episodes of folliculitis and furunculosis over the past year that has required systemic treatment. His recurrent infections were treated with various oral antibiotics, including cephalexin, clindamycin, and trimethoprim-sulfamethoxazole. He currently …

MKSAP: 21-year-old woman with mosquito bites

mksap

Conditions and Diseases

July 1, 2017

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

A 21-year-old woman is evaluated for mosquito bites on her arms and legs that she received 1 week ago that she has been scratching regularly. One of the bites on her left thigh is now painful with a small amount of drainage. She otherwise feels well, has no significant medical history, and …

Xylocaine and Lyme disease: A deer tick story

Hans Duvefelt, MD

Conditions and Diseases

May 24, 2017

It was a small deer tick, hidden by the crus helix, embedded in the cymba conchae, the crevice just above the ear canal of my seven-year-old patient halfway through my Saturday clinic.

He was worried that it would hurt. His parents hadn’t wanted to try removing it on their own. I had a hard time even seeing the small tick as it was sitting at an angle where I saw it …

Malaria is not just a tropical disease

Patricia Walker, MD

Conditions and Diseases

May 15, 2017

Nearly 30 years ago, I attended the labor of a Vietnamese woman on an island off the coast of Thailand. The woman had malaria. She died a few hours after giving birth to her stillborn child.

That experience has never left me. It has fueled in me a passion for global health, and especially for alleviating suffering and death from tropical diseases such as malaria.

It is also worth remembering, however, that …

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Malaria is not just a tropical disease

MKSAP: 29-year-old woman with nodules over her lower extremities

mksap

Conditions and Diseases

April 29, 2017

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

A 29-year-old woman is evaluated for a 5-day history of nodules over her lower extremities. She reports that she regularly visits a local spa that uses whirlpool footbaths during her pedicure procedures; she always shaves her legs with a razor before these visits. Medical history is unremarkable, and she takes no medications.

On …

MKSAP: 44-year-old woman with a painless right neck mass

mksap

Conditions and Diseases

April 15, 2017

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

A 44-year-old woman is evaluated for a 2-month history of a painless right neck mass. Medical history is unremarkable, and she takes no medications. She is a lifelong nonsmoker.

On physical examination, vital signs are normal. A 5-cm right anterior neck mass is palpated. The remainder of the examination is unremarkable.

An initial CT scan …

When you have a cold, I want you to know why I’m not giving you an antibiotic

Eileen Sprys, MD

Conditions and Diseases

February 9, 2017

I want you to know about colds, and integrity.

Every day I see a hand full of colds. Viral upper respiratory infections. Bronchitis. Coughing, sneezing, congestion, fever. You come to me because you are miserable, and I appreciate that you trust my advice. I want you to know that I can commiserate with you. I don’t want you to feel miserable either.

Truthfully, as odd as this sounds, I wish could find …