ID Consults Roster #10 – 12

By this time in the year, my personal log system had totally broken down. I still have total numbers of new consults I saw each month documented in my personal files, but I wasn’t very good with documenting the reasons for consultation.

Of note, our program had begun to require official logs of consults done each week so I suppose I could go back to them to find out what I logged.

So the following is from my very rudimentary consults note-pad. I thought about going back into my hospital’s electronic medical record and finding out what the final diagnoses or culture results were for the patients whose medical record numbers I had seen, but that could be a violation of HIPAA. So here goes from chicken-scratch records:

Month 10 was actually split between two different hospitals – 2 weeks at each

Month 10, first two weeks (~ 15 new consults)

Once again the list reflects diagnoses – a patient could have had more than one

• Extended spectrum beta-lactamase producing Klebsiella pneumoniae & Vancomycin resistant Enterococcus urinary tract infection
• Cellulitis (3)
• Extended spectrum beta-lactamase producing Klebsiella pneumoniae catheter related bloodstream infection
• Unspecified osteomyelitis of right foot
• Polymyalgia rheumatica (not an ID dx)
• Candida albicans peritonitis
• Candida albicans urostomy colonization
• Prevotella buccae, Bacteroides thethaiotaomicron, Lactococcus & Streptococcus anginosus milleri mixed abdominal wall abscess as complication after exploratory laporatomy for peforated bowel
• Candida albicans catheter related bloodstream infection (2)
• Viral syndrome, unspecified
• Leukocytosis, unspecified
• Group D Salmonella and Methicillin sensitive Staphylococcus aureus mixed bacteremia
• Presumed varicella zoster (shingles)
• Methicillin resistant Staphylococcus aureus bacteremia
• Methicillin resistant Staphylococcus aureus prosthetic joint infection
• Methicillin resistant Staphylococcus aureus pneumonia

Month 10 – second two weeks (~ 16 consults)

• Erhlichiosis
• Clostridium difficile associated diarrhea
• Methicillin sensitive Staphylococcus aureus urosepsis
• Cellulitis (3)
• Escherichia coli retroperitoneal abscess
• Coagulase negative Staphylococcus sepsis
• Unspecified osteomyelitis (2)
• Community acquired pneumonia
• Vancomycin resistant Enterococcus catheter related bloodstream infection
• Klebsiella pneumoniae & Enterococcus catheter related bloodstream infection
• Methicillin resistant Staphylococcus aureus cellulitis/abscess
• Actinomyces on biopsy of gastric ulcer
• Chronic necrotizing aspergillosis
• Ascending cholangitis

Month 11 (~ 45 new consults)

• Methicillin sensitive Staphylococcus aureus bacteremia
• Drug induced hepatitis with hepatic encephalopathy
• Concern for mucormycosis
• Clostridium difficile associated diarrhea (3)
• Pulmonary tuberculosis (not associated with HIV)
• Scrofula (lymph node tuberculosis) in new HIV diagnosis
• Cellulitis (2)
• Septic shock, unspecified
• Osteomyelitis, unspecified (4)
• Candida glabrata multifocal vertebral osteomyelitis
• Methicillin sensitive Staphylococcus aureus epidural abscess
• Viridans group Streptococcus septic arthritis of hip
• Finger laceration in garbage
• Abdominal wall infection s/p myomectomy
• Asthma in an HIV infected patient (not ID diagnosis)
• Acute cholecystitis in HIV infected patient
• Decompensated Hepatitis C related cirrhosis in patient with HIV/AIDS
• Methicillin sensitive Staphylococcus aureus septic arthritis of hip
• New HIV diagnosis in setting of pulmonary embolism
• Presumed varicella zoster
• Lymphadenitis
• Fevers of unknown origin in patient with HIV/AIDS
• Methicillin resistant Staphylococcus aureus hardware associated infection (2
• Extended spectrum beta-lactamase producing Klebsiella pneumoniae catheter related bloodstream infection
• Group A streptococcus chorioamnionitis
• Methicillin sensitive Staphylococcus aureus cellulitis/abscess in intravenous drug abuser
• Rectal candidiasis in patient with HIV/AIDS
• Malaria in traveller returned from Ghana
• Providencia ventilator associated pneumonia
• Gram-negative empyema in gun shot to the neck victim
• Disseminated histoplasmosis in new diagnosis of HIV/AIDS
• Urosepsis
• Methicillin resistant Staphylococcus aureus pneumonia and bacteremia
• Klebseilla pneumoniae & Escherichia coli pyelonephritis
• Community acquired pneumonia in HIV patient
• Methicillin resistant Staphylococcus aureus bursitis
• Candida albicans sepsis

Month 12 (~ 50 new consults)

• Medial malleolus ulcer in patient just arrived from Nigeria
• Recurrent urinary tract infections in woman s/p renal transplant 4 yrs earlier
• Community acquired pneumonia in patient just arrived from Morocco
• Osteomyelitis, unspecified (2)
• Acinetobacter baumanii sepsis
• HIV patient needing to start ARV
• Morganella morganii, Proteus mirabilis & Enterococcus abdominal abscess
• Methicillin resistant Staphylococcus aureus sternal wound dehiscense/infection s/p cardiac bypass surgery
• Neutropenic sepsis, unspecified
• Hospital acquired pneumonia, unspecified
• Pseudomonas aeruginosa wound infection s/p revision of femoral-popliteal bypass surgery
• Colitis, presumed infectioius
• Clostridium difficile associated diarrhea (5)
• Drug fever
• EBV associated encephalitis in patient with lupus
• Pseudomonas aeruginosa osteomyelitis
• Listeria monocytogenes chorioamnionitis
• Streptococcus pneumoniae community acquired pneumonia
• Herpes simplex virus associated encephalitis
• Ventilator associated pneumonia, unspecified (2)
• Fevers secondary to gallbladder cancer (not ID dx)
• Recurrent Proteus mirabilis urinary tract infection in patient with chronic incontinence
• Salmonella associated diarrhea
• Methicillin resistant Staphylococcus aureus hardware associated infection (2)
• Polymicrobial catheter related bloodstream infection/sepsis
• Pseudomonas aeruginosa urinary tract infection s/p penectomy for squamous cell CA
• Microperforation in patient with Crohn’s disease
• Streptococcus sanguis bacteremia
• Streptococcus pneumoniae osteomyelitis in HIV patient
• Cellulitis
• Viridans group streptococcus bacteremia (2)
• Klebsiella pneumoniae ventilator associated pneumonia

Consults while providing weekend cross-cover during second year

• Pseudomonas aeruginosa hip osteomyelitis
• Methicillin resistant Staphylococcus aureus bacteremia in HIV patient
• Methicillin resistant Staphylococcus aureus empyema
• Clostridium difficile associated diarrhea (1)
• Methicillin resistant Staphlococcus aureus bursitis
• Methicillin sensitive Stapylococcus aureus bacteremia
• Cryptococcal meningitis in new diagnosis HIV
• Klebsiella pneumoniae & Pseudomonas aeruginosa hospital acquired pneumonia
• Vancomycin resistant Enterococcus urinary tract infection
• Wound dehiscense, unspecified
• Enterococcus faecalis catheter related bloodstream infection
• Septic arthritis of hip, unspecified
• Cellulitis (2)
• Febrile neutropenia
• Febrile neutropenia with rash
• Cellulitis and infected ulcer in new diagnosis diabetes
• Candida albicans and Klebsiella pneumoniae catheter related bloodstream infection

I spent a month at Mass General Hospital on the transplant infectious diseases team. Since it was winter time, I saw a lot of patients (donors and recipients either pre- or post-transplant) with influenza or other viral respiratory syndromes.

I attended an STD clinic once a week over 3-4 months and got extensive exposures to sexually transmitted diseases and the people who have them. Quite interesting.

I did not keep a record of the variety of consults seen in my longitudinal outpatient clinic where the majority of patients I followed had HIV/AIDS at various levels of health and illness.