Private Practice Infectious Disease

(ISSN: 2770-4629) Open Access Journal
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Editorial
1 Rush University Medical Center, Division of Infectious Diseases, Department of Internal Medicine, Chicago, IL 60612, USA;
* Author to whom correspondence should be addressed.
PPID 2022, 2(1), 6; doi: 10.55636/ppid2010006
Received: 26 May 2022 / Revised: 22 Jun 2022 / Accepted: 14 Jun 2022 / Published: 30 Jun 2022
Review
1 Rush University Medical Center, Division of Infectious Diseases, Department of Internal Medicine, Chicago, IL 60612, USA;
* Author to whom correspondence should be addressed.
PPID 2021, 1(2), 8; doi: 10.35995/ppid1020008
Received: 10 Dec 2021 / Revised: 21 Dec 2021 / Accepted: 23 Dec 2021 / Published: 31 Dec 2021
Septic arthritis (SA) is an uncommon but potentially life-threatening condition; it occurs when microorganisms invade the joint space by direct inoculation or by hematogenous spread. Up to a third of patients with septic arthritis suffer long-term disability. Challenges in the management of septic arthritis include selection of appropriate antimicrobials and selection of an appropriate joint fluid drainage method [1]. In this review, I will focus on the epidemiology, mechanism, pathogenesis, clinical signs, diagnosis, and treatment of native joint bacterial septic arthritis in the adult. Full article
Research
1 Department of Internal Medicine, Division of Infectious Diseases, Rush University Medical Center, 600 South Paulina Street, Suite 143, Chicago, IL 60612, USA
2 Division of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA;
3 Department of Infectious Diseases, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL 60612, USA;
4 Department of Pathology, Rush University Medical Center, Chicago, IL 60612, USA;
5 Department of Diagnostic Radiology, Rush University Medical Center, Chicago, IL 60612, USA;
6 Department of Medical Laboratory Science, Rush University Medical Center, Chicago, IL 60612, USA;
* Corresponding author:
* Author to whom correspondence should be addressed.
PPID 2021, 1(1), 5; doi: 10.35995/ppid1010005
Received: 21 Jun 2021 / Revised: 18 Aug 2021 / Accepted: 24 Aug 2021 / Published: 30 Sep 2021
A 50-year-old Nigerian woman presented to the infectious diseases clinic for evaluation of incidental left foot mass [...] Full article
1 Division of Infectious Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, IL 60612, USA;
2 Department of Pharmacy, Rush University Medical Center, Chicago, IL 60612, USA;
* Corresponding author:
* Author to whom correspondence should be addressed.
PPID 2021, 1(2), 6; doi: 10.35995/ppid1020006
Received: 18 Jun 2021 / Revised: 11 Sep 2021 / Accepted: 14 Sep 2021 / Published: 31 Dec 2021
Shewanella spp. is a Gram-negative rod that is normally found in the marine environment and rarely causes illness in humans. Since the late 1970s, cases of Shewanella spp. infection have been described in the literature with a wide array of clinical syndromes and was found to be commonly seen in patients with predisposing conditions. We report a case of a 73 year old woman with end-stage renal disease on peritoneal dialysis who presented with a 3 day history of abdominal pain and was found to have Shewanella putrefaciens peritonitis complicated by bacteremia. She was treated in a novel and successful way by administration of intraperitoneal cefepime. This was further validated by adequate cefepime blood concentrations after drawing a cefepime serum level on day 8 of treatment. To the best of our knowledge, intraperitoneal antibiotic administration to treat both bacterial peritonitis and bacteremia has not been reported in the literature. This treatment approach could potentially be a good precedent for peritoneal dialysis patients needing antibiotics as a less invasive option for antibiotic administration. Full article
1 Metro Infectious Disease Consultants, Huntsville, AL 35801, USA;
* Author to whom correspondence should be addressed.
PPID 2021, 1(2), 7; doi: 10.35995/ppid1020007
Received: 22 Jun 2021 / Revised: 30 Aug 2021 / Accepted: 14 Sep 2021 / Published: 31 Dec 2021
Q (Query) fever is a zoonotic illness caused by the bacterium Coxiella burnetti, which is transmitted to humans via host animals, usually cattle, sheep and goats. Acute Q fever often presents as a flu-like illness or atypical pneumonia that is nonspecific and often self-limiting. The identification of acute infection is clinically important due to the high morbidity and mortality associated with chronic infection. We present a case of a 43-year-old female who lived in the vicinity of cattle and goats and presented with an acute febrile illness found to be secondary to acute Q fever infection. Exposure to Q fever in the United States is frequently not associated with a classical occupational exposure and should be considered in those living in areas near to possible host animals. We discuss clinical presentation and clues to diagnosis, as well as relevant epidemiology. This case highlights important considerations for risk stratification for chronic infection and follow-up in acute Q fever patients. Full article
1 Department of Internal Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, IL 60612, USA;
2 Department of Internal Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, IL 60612, USA;
3 Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA;
4 Department of Bioinformatics and Biostatistics Core, Rush University Medical Center, Chicago, IL 60612, USA;
* Corresponding author:
* Author to whom correspondence should be addressed.
PPID 2022, 2(1), 1; doi: 10.55636/ppid2010001
Received: 4 Dec 2021 / Revised: 15 Mar 2022 / Accepted: 4 Mar 2022 / Published: 31 Mar 2022
Patients with COVID-19 pneumonia on mechanical ventilation can exhibit clinical signs difficult to distinguish from ventilator-associated pneumonia (VAP). Positive sputum cultures in these patients often lead to the use of broad-spectrum antibiotics. Therefore, we aim to evaluate the clinical utility and efficacy of antimicrobial coverage for positive sputum cultures in mechanically ventilated patients with COVID-19. These subjects (n = 98) were on mechanical ventilation and had positive sputum culture after 48 h of intubation during 15 March 2020–25 May 2020 at Rush University Medical Center in Chicago, IL. Only one patient did not receive antibiotics. The primary outcome was defined as the change in Sequential Organ Failure Assessment (delta SOFA score) which was calculated by comparing the SOFA score on the day of sputum culture collection with the score at 48 h and 7 days after the initiation of treatment. There were no statistically significant delta SOFA scores after 48 h of antibiotics administration. Statistically significant changes were observed after 7 days of treatment, which could be reflective of an improvement in viral pneumonia with ICU supportive care. Physicians should consider that positive sputum cultures may not always indicate VAP and apply clinical judgement to avoid the overuse of broad-spectrum antibiotics in critically ill patients with COVID-19. Full article
1 Infectious Disease, Mount Sinai Medical Center of Florida, Miami, FL, USA
* Corresponding author:
* Author to whom correspondence should be addressed.
PPID 2022, 2(1), 3; doi: 10.55636/ppid2010003
Received: 10 Mar 2022 / Revised: 30 Mar 2022 / Accepted: 5 Apr 2022 / Published: 13 Apr 2022
Listeria monocytogenes (L. monocytogenes) infection is a rare cause of meningoencephalitis. Brain abscess represents only 1–10% of Listeria central nervous system (CNS) manifestations. The typical finding on magnetic resonance image (MRI) of the brain is ring enhancement after contrast administration. We report a 71-year-old female patient with anal squamous cell carcinoma who developed a fever and deterioration of mental status caused from a brain abscess. L. monocytogenes is a rare pathogen of thalamic brain abscess. Full article
1 Department of Population Health, University of Kansas School of Medicine–Wichita, Wichita, KS 67214, USA; (E.A.); (H.O.)
2 Ascension via Christi Hospitals, Wichita, KS 67214, USA; (L.B.); (M.A.)
* Corresponding author: or
* Author to whom correspondence should be addressed.
PPID 2022, 2(1), 4; doi: 10.55636/ppid2010004
Received: 4 Apr 2022 / Revised: 14 May 2022 / Accepted: 17 May 2022 / Published: 15 Jun 2022
Objective: This study evaluated the impact of a hospital policy requiring infectious disease (ID) consultation and follow-up from an antimicrobial stewardship (AMS) pharmacist-driven team on S. aureus Bacteremia (SAB) patient mortality and improved clinical outcomes. Methods: This retrospective study included adult inpatients with SAB from 1 August 2016 to 30 May 2018 (pre-policy) and June 1 2018 to 29 February 2020 (post-policy). The primary outcome variable was in-hospital mortality, and secondary outcomes were 30-day readmission rate, acute kidney injury (AKI) at discharge, stay length, and adherence to evidence-based treatment. Results: The final sample included 435 patients for analysis. Management by non-ID physicians was associated with an 8.1 increased likelihood of mortality while hospitalized (CI 95%, 3.701–17.569). Overall mortality was reduced from 11% (n = 25) pre-policy to 6% (n = 13) after policy implementation (p = 0.07). Patients with antibiotics managed by non-ID physicians were 3 times more likely to be readmitted within 30 days. Those with a history of being immunocompromised (64% vs. 36%), or cardiovascular disease (56% vs. 44%), and patients whose providers followed guidelines (23% vs. 7%) were more likely to be discharged with AKI. Policy implementation reduced non-consultant cases from 11% to 0%. Conclusion: A policy of mandatory ID consultation with pharmacist-driven AMS review to ensure compliance can improve patient mortality, 30-day readmission rates, and clinical outcomes. Full article
1 Metro Infectious Disease Consultants, Burr Ridge, IL 60527, USA
* Corresponding author:
* Author to whom correspondence should be addressed.
PPID 2022, 2(1), 5; doi: 10.55636/ppid2010005
Received: 11 Dec 2021 / Revised: 13 Jun 2022 / Accepted: 15 Apr 2022 / Published: 30 Jun 2022
As Infectious Disease (ID) specialists, we are frequently confronted by a clinical scenario with a broad differential diagnosis. Bacterial cellulitis usually responds rapidly to appropriate antibiotic therapy, but when it does not, alternative diagnoses must be rapidly accessed and prioritized. To accomplish this, the ID specialist needs a functional understanding of cellulitis mimics. Utilizing the intensity of illness, appearance of the eruption, and the anatomical pattern of spread, the clinician can rapidly assess, identify, and treat the appropriate malady. Full article
1 Department of Internal Medicine at Advocate Lutheran General Hospital (ALGH), 1775 Dempster Street, Park Ridge, IL 60068, USA
2 Metro Infectious Disease Consultants
* Corresponding author: ; Tel.: +1-(708)-955-2425
* Author to whom correspondence should be addressed.
PPID 2022, 2(1), 7; doi: 10.55636/ppid2010007
Received: 10 May 2022 / Revised: 11 Jun 2022 / Accepted: 16 Jun 2022 / Published: 30 Jun 2022
Burkholderia cepacia complex is a group of closely related opportunistic Gram-negative species that can be found in soil and water. Burkholderia cepacia complex is commonly associated with pulmonary infections in patients with cystic fibrosis, hospital-borne outbreaks related to contaminated medicines and devices, and, rarely, prosthetic valve endocarditis. The treatment of Burkholderia cepacia remains challenging because of the organism’s intrinsic resistance to several antibiotics, and often requires combination therapy. Through this clinical vignette, we review an interesting case of culture-negative Burkholderia prosthetic valve endocarditis identified through metagenomic next-generation sequencing (mNGS) and the challenges associated with the diagnosis and selection of an appropriate treatment. Full article
1 Metro Infectious Disease Consultants, Chicago, IL, USA
*
* Author to whom correspondence should be addressed.
PPID 2021, 1(1), 1; doi: 10.35995/ppid1010001
Received: 9 Jun 2021 / Revised: 28 Jul 2021 / Accepted: 3 Aug 2021 / Published: 30 Sep 2021
Addressing these three simple questions can assist any physician in making the best-informed decision about diagnostic tests and treatments in regard to a solid organ transplant recipient with an infection. This article serves as a preliminary guide to finding the simplest approach to what is typically a complicated patient and the course of the disease. Full article
1 Metro Infectious Disease Consultants, Burr Ridge, IL, USA;
2 Metro Infectious Disease Consultants, Atlanta, GA, USA;
* Corresponding author:
* Author to whom correspondence should be addressed.
PPID 2021, 1(1), 2; doi: 10.35995/ppid1010002
Received: 11 Jun 2021 / Revised: 10 Aug 2021 / Accepted: 17 Aug 2021 / Published: 30 Sep 2021
1 Metro Infectious Disease Consultants, Burr Ridge, IL, USA;
* Author to whom correspondence should be addressed.
PPID 2021, 1(1), 3; doi: 10.35995/ppid1010003
Received: 11 Jun 2021 / Revised: 14 Aug 2021 / Accepted: 17 Aug 2021 / Published: 30 Sep 2021
1 Metro Infectious Disease Consultants, Burr Ridge, IL 60527, USA
* Author to whom correspondence should be addressed.
PPID 2022, 2(1), 2; doi: 10.55636/ppid2010002
Received: 9 Feb 2022 / Revised: 17 Mar 2022 / Accepted: 17 Mar 2022 / Published: 31 Mar 2022
Infectious disease practitioners are often tasked with evaluating fever in the setting of acute stroke. Although fever is often considered a host response to acute ischemia, underlying infections are identified in approximately one-fourth of cases. Physicians should be vigilant in evaluating for infectious triggers of stroke, as well as potential infectious consequences of ischemia and direct infectious invasion of the central nervous system leading to stroke. Full article
Other
1 Metro Infectious Disease Consultants, Chicago, IL, USA;
* Author to whom correspondence should be addressed.
PPID 2021, 1(1), 4; doi: 10.35995/ppid1010004
Received: 29 Jun 2021 / Revised: 20 Aug 2021 / Accepted: 23 Aug 2021 / Published: 30 Sep 2021

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