Medical Management of Infectious Disease PDF

Preface

The practice of medicine has been shifting to a greater and greater extent to the outpatient setting. This is true for the management of infectious diseases as it is for all other disciplines. This shift has occurred because of economic pressures, improved outpatient and home care, enhanced diagnostics, better understanding of antibiotic pharmacokinetics and dynamics, and a growing armamentarium of antibiotic agents. All of these advances have improved our ability to manage common infections such as pneumonia, bronchitis, cellulitis, and gastrointestinal and genitourinary infections in the community locale. More complex illnesses such as osteomyelitis, septic arthritis, endocarditis, and infections involving immunocompromised hosts and in those receiving renal dialysis or using injection drugs are often being managed in the outpatient setting. Confounding these advances are new and emerging infections, globalization with greater international travel, an increasing number and complexity of immunocompromised patients, and now the threat of bioterrorism.

This text was written for those providing primary care to patients, including family physicians, internists, emergency department physicians, gynecologists, surgeons, nurse practitioners, physician assistants, and medical subspecialists who provide primary care to their specialty patients. It is directed toward the adult patient and deals with infections encountered in the outpatient setting. The text also supplies the provider with initial diagnostic and therapeutic options and suggestions for the office patient needing to be hospitalized because of infections. The book can be read as a general review or used as a quick and practical reference to help the provider manage a large array of infections. Liberal use of tables, charts, photographs, and flow diagrams has been made to help keep the book practical and user-friendly. Every chapter is summarized with ‘‘Key Points'' boxes to help the busy clinician access needed information quickly.

Part I includes reviews of the pathogenesis, interpretation, and treatment of fever, the evaluation of the patient with fever and rash, the febrile patient without an obvious fever source, and noninfectious etiologies of fever. The approach to treating the patient with various infectious disease emergencies or positive blood cultures is summarized. Reviews are provided of antibiotic pharmacokinetics and dynamics, appropriate use of the microbiology laboratory, and commonly used outpatient-based oral and intravenous antibiotics.

Part II examines common infectious syndromes involving the oral, respiratory, genitourinary and gastrointestinal tracts, as well as infections involving intra-abdominal organs, heart, skin and soft tissues, joints, bones, and the eye. An approach to the testing and initial evaluation of the person with human immunodeficiency virus infection is presented. Patients with unique geographic exposure such as those with regionally acquired fungal, parasitic, and viral syndromes, and those with tick-borne infections are presented.

Part III reviews infections in special hosts such as the immunocompromised or pregnant patient, those receiving renal dialysis or living in nursing homes, the international traveler, and patients with animal contact–related illnesses. The continued epidemic of injection drug use necessitated a chapter involving infections in these patients. Epstein Barr virus–related infections are reviewed, as is the poorly understood chronic fatigue syndrome.

Part IV summarizes infectious disease–related health maintenance issues such as vaccination and postexposure prophylaxis. The anthrax attacks in the fall of 2001 necessitated the final chapter on bioterrorism.

Increasing bacterial resistance and widespread drug toxicities have made it imperative that all providers prescribe antibiotics judiciously. The epidemics of vancomycinresistant enterococci, methicillin-resistant Staphylococcus aureus, resistant aerobic gramnegative bacilli, and Clostridium difficile colitis have made it very clear that the overuse of antibiotics is dangerous. Ballooning health care costs and insurance policies with inadequate prescription coverage highlight the importance of being cognizant of antibiotic costs. This is emphasized throughout the text by comparing the average wholesale costs of antibiotics that may be used to treat infections.

The book begins and concludes with quotations from Sir William Osler to emphasize the importance of the primary care clinician's role in the recognition, diagnosis, and appropriate management of infections in the office setting. It is my hope that this text assists the primary provider in achieving these goals.