Resident Curriculum for Adult Infectious Disease Rotations

Updated 3/5/04

 

 

 

Residents who rotate on the infectious diseases service have clinical rotations on the inpatient General Infectious Diseases Consultation Service, the inpatient Immunocompromised Host Infectious Diseases Consultation Service, or both. Most residents will split the rotation equally between the two inpatient services. A packet of articles is available for reading. Residents are also given a series of questions to be answered by the end of the rotation (post-test).

 

Adult General Infectious Diseases

 

Materiel in the General Infectious Diseases Article Packet

 

1.      Li JS, et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clinical Infectious Diseases 1999; 30: 633-638.

 

2.      Durack D, et al. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. American Journal of Medicine 1994; 96: 200-209.

 

3.      Bartlett J, et al. Practice guidelines for the management of community-acquired pneumonia in adults. Clinical Infectious Diseases 2000; 31: 347-382.

 

4.      Garau J. Treatment of drug-resistant pneumococcal pneumonia. Lancet Infectious Diseases 2002; 2: 404-415.

 

5.      O’Grady NP, et al. Guidelines for the prevention of intravascular catheter-related infections. Clinical Infectious Diseases 2002; 35: 1281-1307.

 

6.      Mermel LA, et al. Guidelines for the management of intravascular catheter-related infections. Clinical Infectious Diseases 2000; 32: 1249-1272.

 

7.      Hooper D. Fluoroquinolone resistance among Gram-positive cocci. Lancet Infectious Diseases 2002; 2: 530-538.

 

8.      Hiramatsu K. Vancomycin-resistant Staphylococcus aureus: a new model of antibiotic resistance. Lancet Infectious Diseases 2001; 1: 147-155.

 

9.      Bonten MJM, et al. Vancomycin-resistant enterococci: why are they here, and where do they come from? Lancet Infectious Diseases 2001; 1: 314-325.

 

10.  Van Der Poll T. Immunotherapy of sepsis. Lancet Infectious Diseases 2001; 1:165-174.

 

11.  MacArthur RD, et al. Adequacy of early empiric antibiotic treatment and survival in severe sepsis: experience from the MONARCS trial. Lancet Infectious Diseases 2004; 38: 284-288.

 

12.  O’Grady NP, et al. Practice guidelines for evaluating new fever in critically ill adult patients. Clinical Infectious Diseases 1998; 26: 1042-1059.

 

13.  Stengel D, et al. Systematic review and meta-analysis of antibiotic therapy for bone and joint infections. Lancet Infectious Diseases 2001; 1: 175-188.

 

14.  Liewelyn M, et al. Superantigens: microbial agents that corrupt immunity. Lancet Infectious Diseases 2002; 2: 156-162.

 

15.  Wirsing CH. Pertussis of adults and infants. Lancet Infectious Diseases 2002; 2: 744-750.

 

16.  American Thoracic Society, CDC, and IDSA. Treatment of tuberculosis. MMWR Recommendations and Report, 2003; 52 (RR11): 1-77.

 

17.  Hengge UR, et al. Lyme borreliosis. Lancet Infectious Diseases 2003; 3: 489-500.

 

18.  Wormser GP, et al. Practice guidelines for the treatment of Lyme disease. Clinical Infectious Diseases 2000; 31: S1-S14.

 

19.  Pappas P, et al. Guidelines for the treatment of candidiasis. Clinical Infectious Diseases 2004; 38: 161-189.

 

20.  Canuto MM, et al. Antifungal drug resistance to azoles and polyenes. Lancet Infectious Diseases 2002; 2: 550-563.

 

21.  Saag MS, et al. Practice guidelines for the management of cryptococcal disease. Clinical Infectious Diseases 2000; 30: 710-718.

 

22.  2001 USPHS / IDSA Guidelines for the prevention of opportunistic infections in persons infected with human immunodeficiency virus.

 

23.  Department of Health and Human Services. Guidelines for the use of antiretroviral agents in HIV-1 infected adults and adolescents. November 10, 2003. AIDSinfo Web site (http://AIDSinfo.nih.gov)

 

24.  Nunez M, et al. Treatment of chronic hepatitis B in the human immunodeficiency virus-infected patient: present and future. Clinical Infectious Diseases 2003; 37:1678-1685.

 

25.  CDC et al. Recommendations for incorporating HIV prevention into the medical care of persons living with HIV. Clinical Infectious Diseases 2004; 38: 104-121.

 

26.  Rupprecht CE, et al. Rabies re-examined. Lancet Infectious Diseases 2002; 2: 327-343.

 

27.  Campbell LC, et al. West Nile Virus. Lancet Infectious Diseases 2002; 2: 519-529.

 

28.  Ramasamy I, et al. Organ distribution of prion proteins in variant Creutzfeldt-Jakob disease. Lancet Infectious Diseases 2003; 3: 214-222.

 

29.  Monnath TP. Yellow fever: un update. Lancet Infectious Diseases 2001; 1: 11-20.

 

30.  Yuan MF, et al. Treatment of chronic hepatitis B. Lancet Infectious Diseases 2001; 1: 232-241.

 

31.  Guzman MG, et al. Dengue: an update. Lancet Infectious Diseases 2001; 2: 33-42.

 

32.  Salgado CD, et al. Influenza in the acute hospital setting. Lancet Infectious Diseases 2002; 2: 145-155.

 

33.  Winstanley P. Modern chemotherapeutic options for malaria. Lancet Infectious Diseases 2001; 1: 242-250.

 

34.  Carpio A. Neurocysticercosis: an update. Lancet Infectious Diseases 2002; 2: 751-762.

 

General Infectious Diseases Clinical Curriculum:

 

1.                Evaluation and management of the patient with fever

a.       Community-acquired febrile illness

b.      Nosocomial febrile illness

c.       Fever of unknown origin (FUO)

d.      Management of fever in AIDS and HIV

e.       Post-partum fever

 

2.                Community-acquired infections

a.       Upper and lower respiratory infections

b.      Urinary tract infections

c.       Skin and soft tissue infections

d.      Septic arthritis and osteomyelitis

e.       Endocarditis, catheter sepsis, and other intravascular infections

f.        CNS infections-meningitis, encephalitis, and brain abscess

g.       Intraabdominal infections

h.       Gastrointestinal infections, and food poisoning

i.         Infections related to trauma, burns, and bite wounds

j.        Infections of reproductive organs

k.      Ocular infections

l.          

3.                Nosocomial infections

a.       Pneumonia

b.      Urinary tract infections

c.       Wound infections

d.      Septicemia, candidemia, and intravenous catheter sepsis

e.       Other nosocomial infections

 

4.                Sepsis syndrome and septic shock

a.       Pathophysiology

b.      Clinical manifestations, including ARDS and DIC

c.       Management, including the use of antibiotics, biological agents and steroids

d.      Toxic shock syndromes

 

5.                Sexually transmitted diseases

a.       Urethritis

b.      Genital ulcers

c.       Cervicitis

d.      Pelvic inflammatory disease

e.        Syphilis

f.        Other sexually transmitted diseases

 

6.                Tuberculosis and atypical mycobacterial infections

a.       Pulmonary TB

b.      Extrapulmonary TB

c.       PPD reactor

d.      TB in HIV and other immune deficiency states

e.       Atypical mycobacterial infections

f.        Antimycobacterial agents

 

7.                Fungal infections

a.       Endemic fungal infections

b.      Opportunistic fungal infections

c.       Antifungal agents

 

8.                HIV Infection

a.       Epidemiology of HIV infection

b.      Prophylaxis of transmission

                                                     i.      Post-exposure prophylaxis

                                                   ii.      Vertical transmission prophylaxis

c.       Diagnosis of chronic and acute HIV infection

d.      Immunology of HIV infection

e.       General clinical manifestations

                                                     i.      Acute HIV infection

                                                   ii.      Chronic, uncomplicated HIV infection

                                                  iii.      Non AIDS-defining complications of HIV, including:

1.       Autoimmune complications

2.      Metabolic complications

3.      Neurological diseases

                                                 iv.      AIDS-Defining conditions, including:

1.      Opportunistic infections

2.      Malignancy

3.      Wasting syndrome and other AIDS-defining conditions

f.        Prophylaxis and management of opportunistic infections

g.       Management of other AIDS-related conditions

h.       Antiretroviral therapy

                                                     i.      Indications

                                                   ii.      Initiation of therapy

                                                  iii.      Testing for efficacy of therapy and for resistance to therapy

                                                 iv.      Salvage regimen

                                                   v.      Complications of therapy

 

9.                Viral hepatitis

a.       Hepatitis A, B, C, D, E, a

b.      EBV, CMV, HSV, adenovirus

c.       Therapy of chronic viral hepatitis

 

10.            Infections in IV drug users

 

11.            Infections in travelers

 

12.            Infections in geriatric patients

 

13.            Infections during Pregnancy

 

14.            Antimicrobial Agents

 

a.       Classes of drugs (antibacterial, antiviral, antifungal, and antiparasitic agents)

b.      Pharmacokinetics

c.       Mechanisms of antimicrobial resistance

d.      Interpretation of susceptibility results

e.       Adverse effects, drug interactions and contra-indications

f.        Allergy and pseudo-allergy

g.       Use in pregnancy

h.       Dose adjustment in liver and renal failure

i.         Monitoring therapy including drug levels

 

15.            Immunization of adults

 

16.            Hospital Epidemiology and Infection Control

 

a.       Surveillance for nosocomial infections

b.      Outbreak evaluation

c.       Strain typing

d.      Isolation and other infection control measures

e.       Employee Health Evaluation

f.        Precautions for blood-borne pathogens, including evaluation and post-exposure prophylaxis for HBV, HCV, syphilis, and HIV infection   

 

 

Adult Inpatient Infectious Diseases Immuno-Compromised Host Rotation

 

Residents have experience dealing with infections in recipients of bone marrow and solid organ transplants (heart, kidney, liver, pancreas, and small bowel transplants) and immunocompromised patients with hematologic malignancies.

 

Materiel in the Immuno-Compromised Host Article Packet

 

35.  Rosen FS, et al. The Primary immunodeficiencies. New England Journal of Medicine 1995; 333:431-440.

 

36.  Hughes WT, et al. 2002 Guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clinical Infectious Diseases 2002; 34:730-751.

 

37.  Buckley, RH. Transplantation immunology: organ and bone marrow. Journal of Allergy Clinical Immunology 2003; 111:S733-S744

 

38.  Pursell, K. Handout on immunosuppression.

 

39.  Avery RK. Recipient screening prior to solid-organ transplantation. Clinical Infectious Diseases 2002; 35:1513-1519.

 

40.  Delmonico, FL. Cadaver donor screening for infectious agents in solid organ transplantation. Clinical infectious diseases 2000; 31:781-786.

 

41.  Fishman, FA, et al. Infections in organ-transplant recipients. New England Journal of Medicine, 1998; 338:1741-1751.

 

42.  Sable, CA, et al. Infections in bone marrow transplant recipients. Clinical Infectious Diseases 1994; 18:273-281.

 

43.  Pizzo, PA. Fever in immunocompromised patients. New England Journal of Medicine 1999; 341: 893-900.

 

44.  Herbert, H, et al. Management of Cytomegalovirus Infection after solid-organ or stem-cell transplantation. Drugs 1998; 55: 59-72.

 

45.  Zaia, JA. Prevention and management of CMV-related problems after hematopoietic stem cell transplantation. Bone Marrow Transplantation 2002; 29:633-638.

 

46.  Kwak, EJ, et al. Pathogenesis and management of polyomavirus infection in transplant recipients. Clinical Infectious Diseases 2002; 35: 1081-1087.

 

47.  LaRocco, MT, et al. Infection in the bone marrow transplant recipient and role of the microbiology laboratory in clinical transplantation. Clinical Microbiology Reviews 1997; 10: 277-297.

 

48.  Ferrara, JLM, et al. Graft-versus-host disease. New England Journal of Medicine 1991; 324: 667-674.

 

49.  Soave, R. Prophylaxis strategies for solid-organ transplantation. Clinical Infectious Diseases 2001; 33: S26-S31.

 

50.  Duchini, A, et al. Vaccinations for adult solid-organ transplant recipients: current recommendations and protocols. Clinical Microbiology Reviews 2003; 16: 357-364.

 

Immuno-Compromised Host Clinical Curriculum:

Infections in transplant patients:

 

1.      Risk Factors and Approach to Transplant Infectious Diseases

a.       Host factors

b.      Effect of type of transplant

c.       Immunosuppressive therapy

 

2.      Infecting Microbial Agents

 

3.      Diagnosis

 

a.       Role of the microbiology lab

b.      Other diagnostic testing

 

4.      Monitoring for infection

 

5.      Prophylaxis

 

6.      Infection Control Measures

 

7.      Approach to Fever in the Transplant Patient

 

8.      Infections in Stem Cell Transplant Recipients

 

a.       Basic techniques of stem cell transplantation

b.      Syndromes unique to stem cell transplantation

c.       Patterns of infection at different time points post-transplant

d.      Individual infections

e.       Methods of immune reconstitution

 

9.      Infections in solid organ transplantation

 

a.       Time of occurrence of infections of infections after transplantation

b.      Types of transplants

 

10.  Sites and types of infections

 

11.  Specific problems with herpes viruses

 

12.  Lymphoproliferative disease and EBV

 

Infections in Cancer Patients

 

  1. Infections in acute leukemia and lymphoma

 

    1. Granulocytopenia
    2. Empiric therapy of neutropenic fever
    3. Types of infecting pathogens
    4. Common clinical syndromes

 

  1. Infections in solid tumor patients

 

    1. Host factors
    2. Effect of the type of tumor
    3. Immunosuppressive therapy

 

  1. Infecting microbial agents

 

  1. Sites of infection