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.

Working in an ER in Liberia: A physician shares his story

Antonio Webb, MD

Physician

October 20, 2014

In June 2014, the first patient with Ebola arrived at Liberia’s county hospital, Redemption. As tensions grew around the city of Monrovia, administrators at JFK Hospital began to devise plans for handling patients with suspected Ebola. Officials from the CDC then came and gave us lectures. They discussed prevention of spreading and what our plans would be in the event of a potential outbreak. Before that moment, there were no …

Enterovirus 68: Why you shouldn’t panic

Claire McCarthy, MD

Conditions and Diseases

October 19, 2014

With all the news about enterovirus 68 sending hundreds of children to hospitals, it’s easy to panic when you hear about a case in your neighborhood — or, even worse, if your child starts coughing.

But please, don’t panic.

This virus has certainly caused trouble and tragedy. But enteroviruses are incredibly common, causing 10-15 million illnesses a year — and usually, those illnesses are minor. This one, for reasons we don’t fully understand, is …

Read more…

Enterovirus 68: Why you shouldn’t panic

The unknown unknowns of Ebola: A message to physicians

Brett Hendel-Paterson, MD

Conditions and Diseases

October 17, 2014

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I did not think I would ever quote Donald Rumsfeld in one of my blog posts, but some of the missed opportunities as well as the media and public panic surrounding the Ebola epidemic in West Africa have brought this quote to the forefront of my mind this past week.

First, let me share my personal view of the Ebola crisis in …

How did a Dallas hospital miss Ebola? Maybe we shouldn’t be surprised.

David Mann, MD

Conditions and Diseases

October 17, 2014

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The first “wild” Ebola case in the United States has occurred in Dallas, Texas. The patient, who is from Liberia and had contact with a pregnant Ebola victim in his native country, was initially sent away from the emergency department (ED) of a Dallas hospital after reporting there with viral symptoms. He told the triage nurse that he had just arrived …

My son depends on herd immunity, so thanks for getting your flu shot

Jennifer Gunter, MD

Conditions and Diseases

October 17, 2014

This weekend the kids and I had our influenza immunizations.

There is always a difficult lead up as Oliver has severe anxiety around every medical procedure. An EKG (painless heart rhythm test) and a throat swab cause extreme fear and often tears and anything with a needle, well, let’s just say that’s on a whole different level of terror and emotional pain.

I remind myself that his anxiety is a normal response …

As Ebola spreads, what can we do to help?

Manoj Jain, MD, MPH

Conditions and Diseases

October 16, 2014

Last week, after dinner, as I was rinsing the dishes, I casually mentioned to my wife, “I spoke with the volunteers at Doctors Without Borders today, and they need help.”

This was before the first case of Ebola was diagnosed on U.S. soil. A pregnant silence fell in the kitchen except for the clattering of dishes and the boiling of water as …

Nurse Nina Pham is a hero: Stop blaming her

Sarah Beth Cowherd, RN

Conditions and Diseases

October 15, 2014

The director of the Center for Disease Control (CDC) in Atlanta, Georgia apologized for implying that the nurse in Texas was responsible for her own infection with the deadly Ebola virus. This comes less than two weeks after hospital officials from Texas Health Presbyterian Hospital and other prominent officials blamed a different nurse for releasing the patient with Ebola from the emergency …

Ebola in Texas: A fascinating story of system errors

Vamsi Aribindi, MD

Conditions and Diseases

October 15, 2014

Ebola is in the United States! Everybody (please don’t) panic! Quarantine all Texans! Though that might be a good idea anyway (just kidding). More on Ebola in general in another post if I have time.

First off though, we’ve found out more information about the sequence of events leading to the hospitalization of the patient, Thomas Duncan. Apparently, he came …

See Ebola through the eyes of the virus

David L. Katz, MD

Conditions and Diseases

October 14, 2014

As you no doubt know, Ebola has been brought to the U.S.

Predictably, this has resulted in a media feeding frenzy, rumination, recrimination, and the familiar blend of hyperbole and hysteria that tends to populate those infamous 15 minutes during which any given crisis holds our attention.

No, we are not suddenly at risk. As the media coverage spells out, …

Read more…

See Ebola through the eyes of the virus

An ER missed Ebola. Here’s how it could happen to you.

Edwin Leap, MD

Physician

October 14, 2014

How did the emergency department staff of a Texas hospital see, and discharge, a patient infected with Ebola? Despite the fact that blame spreads through hospitals faster than hemorrhagic fever viruses, I’m not interested in pinning down a single person or a single thing, which may have allowed that to happen. I am very interested, however, in offering a few insights …

Ebola: We need to act, rather than respond

Kevin R. Campbell, MD

Conditions and Diseases

October 14, 2014

Thousands of people have travelled from West Africa to the U.S. in the last 6 months. While the CDC and others throughout the Obama administration continue to reassure everyone that the U.S. is 100 percent prepared for an outbreak, potential cases and exposures continue to surface all across the country.

In Dallas, the first confirmed case of Ebola has passed away. Even more concerning is the fact that the patient initially …

Ebola in the ER: What you should and shouldn’t worry about

Darria Long Gillespie, MD, MBA

Conditions and Diseases

October 13, 2014

As an ER doctor, right now I’m thinking a lot about Ebola — it’s in the news, in my inbox, and in questions from my patients. Whether it’s an outbreak, a flu epidemic, or a bombing — we in the ER see them first, and so I’m always thinking about how we’ll be ready.

So, what concerns me, and what doesn’t?

Ebola patients in the …

How pay for performance leads to overdiagnosis and overtreatment

Peter Ubel, MD

Conditions and Diseases

October 8, 2014

Not long ago, the Joint Commission established that patients with pneumonia should receive antibiotics within four hours of diagnosis. Timely diagnosis and treatment can be the difference between life and death in patients with this illness. In fact, some people believe this kind of quality measure should play a large role in how we pay for medical care. After all, doctors should not be paid solely on the basis of …

Ebola in Texas: Why you shouldn’t freak out

Albert Fuchs, MD

Conditions and Diseases

October 5, 2014

The first Ebola patient has been diagnosed in the U.S. This news is likely making many of my regular readers wonder, “Should I freak out?” This is a reasonable question, and I will attempt to answer it. But first, let’s go over how this nasty microbe spreads.

Ebola is caused by a virus that is transmitted through contact with the bodily fluids of someone who is sick. It is not airborne; …

The Ebola outbreak: Don’t blame the nurse

Sarah Beth Cowherd, RN

Conditions and Diseases

October 4, 2014

There is a lot of talk about why the man diagnosed with Ebola at Texas Health Presbyterian Hospital was sent home from the emergency room not having been tested for Ebola despite telling the triage nurse he had been in Liberia.

Because they let him go, he came in to contact with up to 20 people including a handful of school aged children. …

MKSAP: 59-year-old woman with pain of the right foot

mksap

Conditions and Diseases

October 4, 2014

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

A 59-year-old woman is evaluated for a 1-week history of increasing pain of the right foot. She recalls stepping on a nail about 1 month before her symptoms began. The patient has a 5-year history of heart failure secondary to idiopathic dilated cardiomyopathy. She has an implantable cardioverter-defibrillator, and her current medications …

Ebola: Is it time for travel restrictions?

Brian C. Joondeph, MD

Physician

October 3, 2014

Should we be worried about Ebola? That’s the question on the minds of many Americans given the first documented case on U.S. soil. And now there is a second possible case, someone having contact with Thomas Duncan, the first U.S. case of Ebola.

Thomas Frieden, director of the Centers for Disease Control and Prevention reassures us, “I have no doubt that we’ll stop this in its tracks in the U.S.” President Obama also told …

The thinnest of margins: An ER physician ponders, “What if?”

Gregory Bledsoe, MD

Physician

September 30, 2014

It had been crazy busy all night in the emergency department and I had been running from room to room patching holes and trying to get patients seen.

I felt behind all night. Finally, I had a moment to collect my thoughts and turned my attention to a patient who had been waiting for quite a while.

This patient had multiple large and deep lacerations to his forearm, self-inflicted wounds caused during …

Handshakes transmit germs: What are doctors to do?

Alex Smith, MD

Physician

September 22, 2014

In a study in the American Journal of Infection Control, researchers coated a gloved hand in E. coli. One person with the E. coli glove then they shook hands, high-fived, and fist bumped another person with a sterile glove. Transfer of E. coli to the sterile glove was measured.

Results:

highest transfer of bacteria: handshake
lowest transfer of bacteria: fist bump (high five was in the middle)
difference: fist bump less than 10% of …
Read more…

Handshakes transmit germs: What are doctors to do?

Ebola: Don’t forget the patients who are left behind

Edwin Leap, MD

Conditions and Diseases

September 20, 2014

Ebola virus is rampant in West Africa. So far, the death toll is around 2,296, which makes it one of the largest outbreaks ever. Ebola is what’s known as a hemorrhagic fever virus, and belongs to a large family of nasty viruses that are widespread around the world. There’s even one in the American Southwest known as hantavirus, that lives in a species of mice. Yellow fever, which killed so …

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