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Pulmonology

Infectious Disease   

Questions discussed in this category

What is your approach to the use of Paxlovid for patients with risk factors for severe Covid-19 infection but who have received SARS-CoV-2 vaccines in light of the EPIC-SR trial findings?
EPIC-SR Trial
3 Answers available
How do you approach PJP prophylaxis in patients with rheumatic disease on corticosteroids?
Does the presence of ILD change your approach?
3 Answers available
What further evaluation do you pursue for patients who present with vague symptoms such as subjective fevers or intermittent night sweats, who have no pulmonary symptoms but have a positive IGRA?
1 Answer available
How would you treat an asymptomatic patient with a positive Blastomyces antibody, evidence of prior granulomatous lung disease on imaging, and who may require immunosuppression in the future?
1 Answer available
Is there a role for dual antibiotic treatment with ethambutol and macrolide only, as opposed to three-drug antibiotic therapy, in the treatment of treatment-naive pulmonary MAC without cavitary disease?
3 Answers available
What is your preferred third antimicrobial agent for a patient with treatment-naive pulmonary MAC without cavitary disease and strict contraindications to utilization of rifampin or rifabutin?
3 Answers available
What approaches can we take to initiate therapy and improve survival rates in patients with HLH?
2 Answers available
What is the interpretation of two IGRAs with negative mitogen wells, in the absence of immunosuppression?
A patient on meloxicam for LBP developed high, persistent fevers and no other symptoms. An IGRA, among many tests, was sent. The IGRA’s mitogen ...
2 Answers available
Which biomarkers or diagnostic tools do you prioritize to support the decision to start antifungal treatment in septic patients with no clear source of infection but at high risk for fungal infections?
2 Answers available
Do you favor timely bronchoscopy for diagnostics over close surveillance in mildly symptomatic patients with CT findings suspicious for NTM infection who are not able to expectorate?
4 Answers available
Do add a macrolide for immunomodulatory effect in patients with macrolide-resistant M. abscessus?
2 Answers available
Do you use steroids in the management of PJP pneumonia with severe hypoxia in HIV negative patients?
Data on the role of steroids in HIV negative patients with PJP has been conflicting.
2 Answers available
What is your preferred first-line treatment for chronic fatigue in patients with long COVID-19?
7 Answers available
Would you use the pneumococcal conjugate-21 vaccine (Capvaxive) instead of the conjugate-20 (Prevnar-20) for routine vaccinations in immunosuppressed patients?
2 Answers available
Do you consider the use of tocilizumab in patients with COVID pneumonia who have had an improvement in supplemental O2 requirements but have significantly elevated inflammatory markers after day two of remdesivir and dexamethasone?
1 Answer available
Are there clinical scenarios in which you would start empiric treatment for pulmonary TB without microbiologic confirmation?
2 Answers available
Would you treat a sputum culture positive for Aspergillus niger despite an atypical CT chest and a negative serum galactomannan in an immunosuppressed patient who is too high risk for bronchoscopy?
0 Answers available
How do you approach a patient on anti-TNF with positive Quantiferon (previously negative) with negative chest x-ray and no symptoms?
7 Answers available
Do you routinely perform echocardiography in patients with Staphylococcus aureus bacteremia deemed low risk for metastatic infection, or do you selectively omit it based on specific clinical criteria?
Hendriks, et al., PMID 38576380
2 Answers available
How would you approach treatment of latent TB for patients who cannot tolerate rifamycins or isoniazid due to allergy, intolerance, or drug-drug interactions?
2 Answers available
Do you preferentially avoid use of piperacillin-tazobactam for empiric anti-pseudomonal coverage in hospitalized patients due to risk of nephrotoxicity?
ACORN Randomized Clinical Trial 
1 Answer available
Do you give additional pneumococcal vaccines after a dose of PCV20 in patients with asplenia?
1 Answer available
In drawing blood cultures from a central line to evaluate for CLABSI, do you advise drawing separate blood cultures from each port in case of dual or triple lumen line?
If yes, what is the rationale for doing that? 
3 Answers available
Have you used Karius to aid in the diagnosis of a non-resolving pneumonia, with negative bronchoscopy, biopsy, and other infectious work up in an immunocompetent patient?
1 Answer available
Have you incorporated the use of linezolid in lieu of vancomycin plus clindamycin for empiric treatment of necrotizing fasciitis?
1 Answer available
Do you administer prophylactic antibiotics to prevent VAP following intubation in patients with acute brain injury?
Do the findings of the PROPHY-VAP trial influence your approach?
2 Answers available
Do you choose an antibiotic with CSF penetration, such as nafcillin over cefazolin, in the setting of MSSA endocarditis with septic emboli to the brain (assuming no concomitant meningitis or brain abscess)?
3 Answers available
Do you consider use of convalescent plasma early in disease course in COVID-19 induced ARDS in mechanically ventilated patients?
Do the results of the recent study (Misset et al., PMID 37889107) showing reduction in 28-day mortality in patients with high neutralizing antibody ti...
1 Answer available
Is there any utility to trending Histoplasma serology titers to guide duration of therapy or treatment response for pulmonary histoplasmosis with negative urine antigen?
1 Answer available
Do you adhere to the standard 5-day minimum treatment duration for community-acquired pneumonia, or have you used shorter courses for certain low-risk patients?
1 Answer available
What is your approach to treatment of patients with fulminant C difficile infection who required ileostomy creation or colectomy?
Is there a role for oral vancomycin in these patients, or is oral vancomycin redundant if other routes of administration are being used (i.e intracolo...
1 Answer available
Is there a risk of hepatitis C activation with rituximab in a patient who has a history of HCV treated with antivirals and who is in sustained viral response?
1 Answer available
What is your approach to counseling patients regarding re-initiation of anti-TNF therapy after completion of treatment for non-disseminated pulmonary histoplasmosis?
Would it be safe to resume and if so, when?
2 Answers available
For how long do you recommend treatment for latent tuberculosis prior to initiation of anti-TNF therapy?
6 Answers available
Have you incorporated the use of steroids for patients with severe community-acquired pneumonia?
In light of published data from the CAPE COD trial...
1 Answer available
Is there a role for repeat surveillance blood cultures in patients with prosthetic valve endocarditis without associated cardiac abscess after a 6 week course of antibiotic treatment without surgical intervention?
1 Answer available
Is there a role for chronic suppressive oral or inhaled therapy for recurrent Burkholderia cepacia pneumonia causing frequent hospitalizations in a patient with severe bronchiectasis with or without underlying cystic fibrosis?
3 Answers available
Does your institution have formal policies or work flows to reduce unnecessary IGRAs ordered for patients on biologics?
1 Answer available
In which patients do you prefer daily standard three-drug therapy for non-cavitary pulmonary MAC as opposed to three times a week dosing?
2 Answers available
Should checking a urinalysis with reflex to culture be part of the standard work up for fever in an ICU patient with a urinary catheter?
2 Answers available
How do you approach biologic initiation in patients with inflammatory arthritis and repeatedly indeterminate Quantiferon?
5 Answers available
What else do you consider in the differential diagnosis for pulmonary-renal syndromes if there is low clinical and serologic evidence of AAV, Goodpasture's or other rheumatologic disease (SLE, RA, APS, Scleroderma)?
2 Answers available
How long do you continue surveillance with imaging and sputum cultures in a patient with NTM with no indications for treatment?
3 Answers available
Does your approach to treating latent tuberculosis differ in a patient on anti-fibrotic therapy?
1 Answer available
Do you rule out TB in patients with AIDS and lobar pneumonia?
What’s your threshold to get the three AFBs and place the patient in airborne isolation?
1 Answer available
Do you routinely monitor imaging or pulmonary function in patients with pulmonary TB after the completion of therapy?
1 Answer available
Are you using the microbial cell-free DNA “Karius” test to aid in the diagnosis of an atypical pulmonary infection such as PJP or NTM?
2 Answers available
Do you use steroids in patients with respiratory failure who are infected with both influenza and COVID-19?
How do you approach which risk to accept given that steroids have evidence for use in COVID-19 while is suggestion for harm in using steroids in influ...
1 Answer available
Do you routinely isolate and test for TB in a patient incidentally found to have a miliary pattern of nodules on chest CT?
2 Answers available
What is your approach to therapy in patients with progressive Scedosporium pulmonary infection who are not candidates for surgical debridement?
1 Answer available
Do you treat Candida spp isolated from a bronchoalveolar lavage?
1 Answer available
Would you consider prophylactic antifungal treatment prior to immunosuppressive therapies in a patient with previously treated pulmonary coccidiomycosis and residual parenchymal changes?
1 Answer available
Do you ever stop tobramycin prophylaxis in a patient with chronic bronchiectasis previously colonized with pseudomonas?
2 Answers available
How do you treat RA in patients with pulmonary mycobacterium avium complex (MAC) infections?
1 Answer available


Papers discussed in this category

Annals of the rheumatic diseases, 2022 Nov 03
2022 EULAR recommendations for screening and prophylaxis of chronic and opportunistic infections in adults with autoimmune inflammatory rheumatic diseases.
Frontiers in immunology, 2021 Apr 12
Using Routine Laboratory Markers and Immunological Indicators for Predicting Pneumonia in Immunocompromised Patients.
Scientific reports, 2017 Aug 10
Analysis of Factors Influencing Diagnostic Accuracy of T-SPOT.TB for Active Tuberculosis in Clinical Practice.
Medical sciences (Basel, Switzerland), 2018-09-21
Low-Dose Naltrexone (LDN)-Review of Therapeutic Utilization.
The Journal of clinical investigation, 2021 Dec 15
The intersection of COVID-19 and autoimmunity.
Molecular systems biology, 2023 Mar 15
A methylation clock model of mild SARS-CoV-2 infection provides insight into immune dysregulation.
BMJ open, 2024 May 13
Low-dose naltrexone for post-COVID fatigue syndrome: a study protocol for a double-blind, randomised trial in British Columbia.
Ann Am Thorac Soc, 2017 May
Minimizing Tuberculosis Risk in Patients Receiving Anti-TNF Therapy.
Chest, 2023 Feb 17
Patient-Reported Symptom and Health-Related Quality-of-Life Validation and Responsiveness During the First 6 Months of Treatment for Mycobacterium avium Complex Pulmonary Disease.
Arthritis Care Res (Hoboken), 2016 Jan
2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis.
Alimentary pharmacology & therapeutics, 2022 May 20
Review article: latent tuberculosis in patients with inflammatory bowel diseases receiving immunosuppression-risks, screening, diagnosis and management.
Circulation, 2015 Sep 15
Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association.
The Annals of thoracic surgery, 2017 Feb 04
Surgical Versus Medical Therapy for Prosthetic Valve Endocarditis: A Meta-Analysis of 32 Studies.
European heart journal, 2023 Oct 14
2023 ESC Guidelines for the management of endocarditis.
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2015-08-01
Histoplasmosis complicating tumor necrosis factor-α blocker therapy: a retrospective analysis of 98 cases.
Arthritis & rheumatology (Hoboken, N.J.), 2023 Jul 24
The 2022 EULAR/ACR Points to Consider at the Early Stages of Diagnosis and Management of Suspected Haemophagocytic Lymphohistiocytosis/Macrophage Activation Syndrome (HLH/MAS).
N Engl J Med, 2023 Mar 21
Hydrocortisone in Severe Community-Acquired Pneumonia.
Infection control and hospital epidemiology, 2018-05
Time to Detection in Culture Supports Prediction of Low Transmissibility of Tuberculosis and Discontinuation of Isolation for Low-Risk Patients With A Single AFB-Negative and NAAT-Negative Respiratory Specimen.
Clinical microbiology reviews, 2018-10
Incipient and Subclinical Tuberculosis: a Clinical Review of Early Stages and Progression of Infection.
JAMA internal medicine, 2018-10-01
Association of Rapid Molecular Testing With Duration of Respiratory Isolation for Patients With Possible Tuberculosis in a US Hospital.
American journal of respiratory and critical care medicine, 2021 Jan 15
The Epidemiological Importance of Subclinical Tuberculosis. A Critical Reappraisal.
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2024 Apr 18
NTCA Guidelines for Respiratory Isolation and Restrictions to Reduce Transmission of Pulmonary Tuberculosis in Community Settings.
The New England journal of medicine, 2024 Apr 04
Nirmatrelvir for Vaccinated or Unvaccinated Adult Outpatients with Covid-19.
The Journal of infectious diseases, 1980 Mar
A study of cephalothin and desacetylcephalothin in cerebrospinal fluid in therapy for experimental pneumococcal meningitis.
Antimicrobial agents and chemotherapy, 1976 Sep
Pharmacological study of cefazolin during intermittent and continuous infusion: a crossover investigation in humans.
Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, 2020 May 08
Should we reconsider cefazolin for treating staphylococcal meningitis? A retrospective analysis of cefazolin and cloxacillin cerebrospinal fluid levels in patients treated for staphylococcal meningitis.
The Lancet. Infectious diseases, 2020 Dec 14
Effectiveness of adjunctive clindamycin in β-lactam antibiotic-treated patients with invasive β-haemolytic streptococcal infections in US hospitals: a retrospective multicentre cohort study.
Open forum infectious diseases, 2023 Nov 24
Comparison of Adjuvant Clindamycin vs Linezolid for Severe Invasive Group A Skin and Soft Tissue Infections.
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2009-07-01
Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America.
Open forum infectious diseases, 2024 May 02
Should Blood Cultures Be Drawn Through an Indwelling Catheter?
Lancet (London, England), 2021 Mar 27
Discontinuing β-lactam treatment after 3 days for patients with community-acquired pneumonia in non-critical care wards (PTC): a double-blind, randomised, placebo-controlled, non-inferiority trial.
Lancet (London, England), 2021 Mar 27
How low can we go in community-acquired pneumonia therapy?
JAMA internal medicine, 2024 May 13
Mortality of Patients With Sepsis Administered Piperacillin-Tazobactam vs Cefepime.
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2018-05-17
Detecting Infections Rapidly and Easily for Candidemia Trial, Part 2 (DIRECT2): A Prospective, Multicenter Study of the T2Candida Panel.
Lupus, 2014 Jul 30
Serious infections in systemic lupus erythematosus with a focus on pneumococcal infections.
MMWR. Morbidity and mortality weekly report, 2024 Sep 12
Use of 21-Valent Pneumococcal Conjugate Vaccine Among U.S. Adults: Recommendations of the Advisory Committee on Immunization Practices - United States, 2024.
American journal of respiratory and critical care medicine, 2019 Nov 15
Treatment of Drug-Resistant Tuberculosis. An Official ATS/CDC/ERS/IDSA Clinical Practice Guideline.

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