Infectious Disease

I admitted an elderly woman to the hospital recently.  The previous week, she had presented to the emergency department (ED) with chest pain and shortness of breath.  For some unknown reason, a urinalysis was obtained and was found to be abnormal.  The patient left the hospital with a prescription for cephalexin, in addition to unexplained chest pain and shortness of breath.  The patient presented to the hospital this time with, ...

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It's 2 a.m. And I'm in the emergency room. There are beads of sweat dripping from my forehead. One of my nurses comments that I just don't look quite right. I can feel the urge to vomit and know where the nearest trash can is at all times. I'm clearly sick. Febrile. Shouldn't be working. But it's the middle of a night shift, and I've got patients to see. I place ...

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A wise professor of medicine always told me as a young physician, “Eighty-year olds are to be revered and not messed with.”   This is especially true for those 90 or older.  Here in South Florida, there is always some senior citizen telling us today’s 80 is yesterday’s 60, and today’s 70 is yesterday’s 50.  It just isn’t so.  I see this erroneous belief of the elderly having the healing power ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 19-year-old man is hospitalized with a 6-day history of lightheadedness and nightly fevers. He also reports sore throat, headache, joint and muscle aches, and a dry cough. He recalls a blotchy rash on his trunk and arms, which has resolved. He returned home 12 days ago from a ...

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"We believe that the current entrepreneurial development model for antibiotics is broken and needs to be fundamentally transformed." This provocative opinion is from a recent editorial in the New England Journal of Medicine. The introduction of penicillin, the first antibiotic miracle drug, led to an 80 percent reduction in mortality from infectious diseases. Other antibiotics quickly followed, reducing death rates even further. Over the past several decades, however, the discovery ...

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In response to concerns about the unnecessary use of antibiotics, researchers have sought to identify simple, non-specific tests to help clinicians determine which patients require antibiotics and which do not. Indeed, such tests could facilitate challenging management decisions, which currently rely predominately upon a thorough clinical assessment. To compound the challenge, patients often have pre-conceived ideas about whether or not ...

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Flu vaccination prevents millions of flu-related illnesses and deaths annually, but vaccination rates are low for many reasons. During the 2018-2019 flu season, the Centers for Disease Control and Prevention reported that about 45% of U.S. adults received the flu vaccine. While this is an increase of 8% from 2017-2018, it falls way below the national goal of 70% of American adults ...

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Candida auris (C. auris) is a multidrug-resistant fungus responsible for a rising number of infections and deaths around the world, the origin of which is currently subject to investigation. Spread primarily in the health care setting, it is a growing threat to high-risk patients in hospitals, nursing homes, and other health care facilities. The CDC estimates that between 30 percent and 60 percent of people who become ill with C. auris infections have died. ...

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An episode pitting top administrators at the National Institutes of Health (NIH) against senior scientists at the organization serves as a vital reminder of the importance of academic freedom and the need to communicate and express concerns about scientific research. NIH administrators prohibited two of its senior scientists from speaking out about a research study the scientists claim has serious flaws (Crystalloid Liberal or Vasopressors Early Resuscitation in ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 64-year-old woman is evaluated during a posthospital visit for severe COPD with an FEV₁ of 30% of predicted. She has been admitted three times during the last year with acute exacerbations characterized by cough, increased purulent sputum production, and dyspnea. She is now at baseline of her exertional dyspnea ...

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Antibiotics serve two purposes for large-scale meat farmers. They allow them to raise animals in unsanitary, confined conditions that would otherwise kill or sicken them and they allow factory farmers to use less feed. How much less feed? Without antibiotics, 175,550 more tons of feed would be needed to grow U.S turkeys, lamented Michael Rybolt of the National Turkey Federation at 2008 hearings when the FDA tried ...

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There have been over 1,000 cases of measles in the first half of 2019–the most since 1992, according to the CDC. For comparison, 2018 had 372 cases. With New York at the center of the outbreak, it’s reasonable to have questions–from how to know if you’re fully vaccinated to (if you have infants) whether you should opt for an earlier schedule. Below is a collection of up-to-date answers to ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 38-year-old woman undergoes follow-up evaluation in the office. She was evaluated in the emergency department 3 nights ago with fever and flank pain following 2 days of dysuria. A urine culture and two sets of blood cultures were collected. She was given intravenous ceftriaxone and discharged with a 7-day ...

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Google that phrase, and you will come up with lots of hits. The following is a partial list of things that have been found to have more germs than a toilet seat: Kitchen cutting boards, sponges and sinks, refrigerators, spatulas, pet food bowls, clean laundry, smartphones, electronic tablets, computer keyboards, carpets, faucet handles, handbags, can openers, ice served in restaurants, menus, reusable shopping bags, TV remotes, ...

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The common practice in this country (although not everywhere -- Europe, for example) has long been to treat all acute middle ear infections (otitis media) with antibiotics. This is not necessarily needed. We now know that for many children another reasonable approach is to wait a day or so to see if the symptoms get better on their own without antibiotics. Parents have an important role in making this choice. ...

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In October of 2016, I returned to Bernard Mevs Hospital in Port Au Prince, Haiti. Hurricane Matthew, a category 4 hurricane, had touched down near Jeremie only four days prior. Hurricane Matthew caused significant devastation with over 2 million people directly affected, and over 500 reported deaths.  As local health care facilities in southwest Haiti had limited capabilities to care for pediatric trauma patients, Bernard Mevs had arranged transport ...

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There is a pervasive tendency to turn to medicine looking for magic. Patients and health care professionals alike generally expect medicine to be able to cure diseases, alleviate symptoms, and relieve suffering. Historically, medicine has met and exceeded these expectations in a variety of ways. However, in some cases, these expectations can cause a blurring of the lines between hope and reality, resulting in false "promises" and preventable disappointment. You may be ...

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Ten years ago it would not have been worth my time to write about measles nor yours to read about it. In the year 2000, thanks to a very effective 2-shot childhood vaccination program using a combined measles-mumps-rubella (MMR) vaccine, the U.S. was declared free of this potentially lethal disease. However, by the end of April this year, just over 700 cases have been reported by the CDC; the largest ...

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While the vast majority of measles cases in the U.S. and worldwide are occurring in unvaccinated children, a fair percentage is also occurring in adults.  With more-widespread transmission of measles, it’s becoming more important for all of us – yes, that includes parents – to make sure we’re well-protected. Measles is probably the single most contagious infection that humans face. The key to preventing the return of widespread measles is in ...

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