Infectious Disease
Expert guidance on antimicrobial stewardship, emerging infections, and complex infectious disease management.
Recent Discussions
Do you use letermovir as CMV prophylaxis in solid organ transplant patients?
Letermovir is now FDA-approved for CMV prophylaxis in high-risk (D+/R-) kidney transplant recipients, and the data in the primary study that led to this approval (Limaye et al., PMID 37279999) is quite convincing that it works well in that population. Outside of this specific indication we have used...
Are there any non-beta-lactam antibiotic options for treatment of neurosyphilis in non-pregnant adults?
Doxycycline is a consideration. There are no conclusive data, but a few anecdotal reports are supportive -- the most recent (in a brief PubMed search) cited below. On the other hand, there is at least one case report (also cited) of a patient treated with doxycycline who subsequently re-presented wi...
How would you approach immunomodulatory treatment for systemic lupus associated protein losing enteropathy (PLE) in a patient whose clinical course has been complicated by significant infection?
Lupus protein-losing enteropathy (LPLE) is a rare manifestation of systemic lupus erythematosus (SLE). Therefore, the medical evidence for the "best treatment" of LPLE is only based on anecdotal reports, case series, and retrospective reviews.Although the easy way out would be to say that a SQ or IV...
How do you approach a well controlled HIV patient with diffuse cutaneous kaposi sarcoma who failed to respond to radiation, paclitaxel and monthly liposomal doxorubicin?
Please consider using Pomalidomide 5 mg PO daily (21 days on and seven days off in a 28-day cycle). (Polizotto et al., PMID 27863194). There is significant activity in HIV-positive patients of this regimen (ORR-60%). The NCCN also endorses Pomalyst as a treatment for KS. Other than this, checkpoint ...
Do you treat patients with HIV-AIDS and positive cryptococcal antigenemia but negative CSF cryptococcal antigen with standard meningitis treatment given the potential for the postzone effect?
Hello, What was his CD4 and HIV VL results? What were the LP results exactly: what were the cell count, protein, and glucose levels? Did he have symptoms consistent with meningitis, and what did the head CT show? These patients can sometimes have cryptococcal pneumonia and not meningitis, by the way...