Infectious Disease

You will take part in performing inpatient consultations on both common and uncommon processes including everything from cellulitis to Kawasaki Disease. In the outpatient setting, you will be present to follow up on many of the items seen during inpatient duties and will work closely with the attending physician who will increasingly give more responsibility as it is earned.

You will gain experience in performing ID consults and weekly clinic time. You will learn to recognize specific infectious diseases, understand appropriate antibiotic use and learn guidelines for specific drugs.

Training is designed to acquaint you with major aspects of host-pathogen interaction. These include a general knowledge of:

• clinical aspects of various infectious diseases
• antibacterial, antiviral, antifungal and antiparasitic agents
• laboratory techniques employed for diagnosis of infectious diseases
• concepts of active and passive immunoprophylaxis
• immunologic aspects of host-pathogen interactions

Residents are expected to:

1. Elicit pertinent histories and physical findings.
2. Construct a differential diagnosis, etiologic understanding and initial management of infections in different pediatric age groups, including:
   • sepsis
   • meningitis
   • osteomyelitis
   • respiratory infections
   • intestinal infections
   • urinary tract infections
   • infections in the compromised host
3. Recognize of normal and pathologic microflora.
4. Have a basic knowledge about the choice of appropriate antimicrobial agents for treatment of specific infections.
5. Be familiar with the performance and interpretation of basic laboratory procedures employed in infectious diseases, including:
   • gram stain
   • interpretation of cultures (urine, stool, mucosal, tracheal aspirate)
   • rapid viral diagnosis (fluorescence, ELISA, electron microscopy in a comparative sense)
   • serologic techniques (utility and limitations in diagnosis; knowledge of fluorescence, and ELISA)
   • polymerace chain reaction (PCR) technology
   • minimal inhibitory and bactericidal concentrations
   • antibiotic monitoring
6. Have a conceptual understanding of:
   • immunoprophylaxis and immunization
   • chemoprophylaxis (infective endocarditis, haemophilus vs. Meningococcus, and surgical)
   • diseases such as pertussis, tuberculosis, congenital infections, hepatitis, endocarditis, genital infections, mononucleosis and HIV
   • antibiotic use
   • bacteriologic culture procedures, use of tissue culture techniques in viral diagnosis and their limitations in diagnosis of microbial infection
   • performance and interpretation of serum inhibitory and bactericidal concentrations of antibiotics and their use in monitoring antibiotic usage in patients
   • the epidemiology and management of hospital acquired infections
   • the definition and function of separate aspects of the immune system (granulocytes, t-cells, b-cells, etc.)
   • the understanding of primary and acquired immune deficiency diseases at a cellular level (Agammaglobulinemia, T-cell deficiencies, common variable immunodeficiency, C.G.D., Hyper IGE Syndrome)
   • the management of infections in immunodeficiency states
   • parasitic diseases such as malaria, intestinal parasitic infections, fungal infection and rickettsiae diseases
   • unique infections such as legionelia, lyme arthritis, and cat scratch disease

• PGY-2, PGY-3 or PGY-4

4 weeks

The demographics for this rotation are very broad. The hospital has an 8-county encatchment area that allows the learner to see patients of varied backgrounds including everything from inner city to rural and special populations such as Amish.

Common diagnoses are assorted soft tissue infections and bacteremia, infective endocarditis, pneumonia with effusion and other less common entities such as Kawasaki Disease and Staph Scalded Skin Syndrome.