{"id":8149,"date":"2016-08-15T07:02:15","date_gmt":"2016-08-15T11:02:15","guid":{"rendered":"http:\/\/blogs.nejm.org\/hiv-id-observations\/?p=8149"},"modified":"2016-09-04T09:11:42","modified_gmt":"2016-09-04T13:11:42","slug":"just-wondering-quick-id-questions-ponder","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/just-wondering-quick-id-questions-ponder\/2016\/08\/15\/","title":{"rendered":"Just Wondering:  Quick ID Questions to Ponder On a Hot Summer Day"},"content":{"rendered":"<p><a href=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2016\/08\/old-shark.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignright wp-image-8150\" src=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2016\/08\/old-shark.jpg\" alt=\"old shark\" width=\"359\" height=\"338\" srcset=\"https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2016\/08\/old-shark.jpg 778w, https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2016\/08\/old-shark-300x282.jpg 300w, https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2016\/08\/old-shark-768x722.jpg 768w\" sizes=\"auto, (max-width: 359px) 100vw, 359px\" \/><\/a>On a lazy, brutally hot summer day, here are some more\u00a0&#8220;quick questions&#8221; to think about as you hope for a cool\u00a0breeze to bring relief from the\u00a0stultifying (love that word) heat:<\/p>\n<ul>\n<li>How soon\u00a0will we be able to look back at contact precautions for MRSA and VRE and laugh at our folly?<\/li>\n<li>Are we again\u00a0recommending antibiotics after incision and drainage of uncomplicated skin abscesses? Hard to keep track of this one. Maybe because there&#8217;s no right answer for everyone.<\/li>\n<li>What&#8217;s the best shorthand\/abbreviation for &#8220;Fourth-Generation combination HIV-1 antigen\/HIV-1\/2 antibody immunoassay?&#8221; Boy I&#8217;m tired of writing that. How about, &#8220;HIV screening blood test&#8221; (with all the rest of the stuff implied)?<\/li>\n<li>What proportion of those with a diagnosis of <em>both<\/em> Lyme and bartonella actually have <em>neither?<\/em><\/li>\n<li>If dalbavancin and oritavancin weren&#8217;t so expensive &#8212; say, $500\/course instead of $3000-5000 &#8212; how much would we use? (I think a lot.)<\/li>\n<li>If\u00a0<em>Sporothrix schenckii<\/em> had a different name, would such a high percentage\u00a0of clinicians remember its association with rose thorns? &#8220;Sporotrichosis&#8221; just sounds like a disease\u00a0you get from something sharp and prickly. Oh, and <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/9237718\" target=\"_blank\"><strong>sphagnum moss<\/strong><\/a>\u00a0(not sharp and prickly) and <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/26156862\" target=\"_blank\"><strong>cats<\/strong><\/a>\u00a0(could be) are also sources, for you trivia buffs.<\/li>\n<li>What percentage of our ID consult notes are actually read by surgical consultants? Regardless &#8212; what do they think of them? Especially the <em>really long<\/em> ones.<\/li>\n<li>In community acquired pneumonia severe enough to require admission, how often are antibiotics stopped after a <em>specific<\/em> viral infection is diagnosed using molecular studies? Seems to <strong><a href=\"http:\/\/www.archivesofpathology.org\/doi\/10.5858\/arpa.2014-0257-OA?url_ver=Z39.88-2003&amp;rfr_id=ori%3Arid%3Acrossref.org&amp;rfr_dat=cr_pub%3Dpubmed&amp;\" target=\"_blank\">work in kids<\/a>\u00a0<\/strong>and<strong><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/27225406\" target=\"_blank\"> adults<\/a>\u00a0<\/strong>for &#8220;respiratory infections&#8221;, but for admitted patients with pneumonia? <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/27311514\" target=\"_blank\"><strong>Unclear,<\/strong><\/a> but I&#8217;d still value the information.<\/li>\n<li>Will anyone ever figure out what is causing\u00a0that <a href=\"http:\/\/www.cdc.gov\/elizabethkingia\/outbreaks\/index.html\" target=\"_blank\"><strong>outbreak of <em>Elizabethkingia anophelis<\/em><\/strong><\/a>\u00a0in the Midwest?<\/li>\n<li>Why isn&#8217;t there more drug development for non-tuberculous mycobacteria? Gosh darn it, there&#8217;s a clinical need here. Hey there, you medicinal chemists, lab-based ID scientists, and PhDs, get on it!<\/li>\n<li>The <strong><a href=\"http:\/\/cid.oxfordjournals.org\/content\/early\/2013\/11\/12\/cid.cit665.full#sec-144\" target=\"_blank\">HIV primary care guidelines<\/a><\/strong> recommend &#8220;anal pap tests&#8221; as a screen for anal cancer &#8212; but how often should they be done? Can anyone\u00a0in good conscious suggest a\u00a0test be done annually (for example) that hasn&#8217;t yet been proven to prevent cancer or improve clinical outcomes?<\/li>\n<li>Will there ever be a flu vaccine you don&#8217;t need to repeat every year? I can dream, can&#8217;t I? Or lower hanging fruit &#8212; a better mumps vaccine?<\/li>\n<li>Who will figure out how to make an ID-approved, well-done hamburger that doesn&#8217;t taste like charred\u00a0sawdust?<\/li>\n<li>In the sofosbuvir combination treatments for HCV, which of the two drugs should be said first? I&#8217;ve been saying &#8220;LDV-SOF&#8221; (spelling out the &#8220;LDV&#8221;) and &#8220;VEL-SOF&#8221; (saying &#8220;VEL&#8221;), but have noticed all kinds of variations. You could do the <a href=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/some-id-stuff-were-talking-about-on-rounds\/2014\/05\/28\/\" target=\"_blank\"><strong>brand names<\/strong><\/a>, but please. The direct-to-patient ads for LDV-SOF are almost as common as those for razors and pickup trucks.<\/li>\n<li><a href=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2016\/08\/The-Sun-Newspaper.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignright wp-image-8152\" src=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2016\/08\/The-Sun-Newspaper.jpg\" alt=\"The-Sun-Newspaper\" width=\"220\" height=\"277\" srcset=\"https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2016\/08\/The-Sun-Newspaper.jpg 440w, https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2016\/08\/The-Sun-Newspaper-238x300.jpg 238w\" sizes=\"auto, (max-width: 220px) 100vw, 220px\" \/><\/a>With\u00a0all the controversy about the Rio Olympics, Zika, and contaminated\u00a0water, is there any ID-related sports story more bizarre than the<strong> <a href=\"https:\/\/www.thesun.co.uk\/sport\/1589723\/wimbledon-poisoning-police-investigate-allegations-of-a-tennis-player-being-poisoned-during-this-years-wimbledon-championships\/\" target=\"_blank\">leptospirosis-poisoned tennis player?<\/a><\/strong>\u00a0Hey &#8212; it gives me first-time chance to link the British <a href=\"https:\/\/www.thesun.co.uk\/\" target=\"_blank\"><strong><em>Sun<\/em><\/strong><\/a>, that fine example of responsible journalism. Am sure they would welcome the\u00a0web traffic from here, though perhaps be a bit surprised to get it.<\/li>\n<li>How many of those &#8220;antigen-positive, toxin negative, PCR positive&#8221; patients treated for\u00a0C diff really don&#8217;t have C diff at all? If you don&#8217;t know what I&#8217;m talking about, read <a href=\"http:\/\/archinte.jamanetwork.com\/article.aspx?articleid=2434732\" target=\"_blank\"><strong>this.<\/strong><\/a><\/li>\n<li>Will I ever remember &#8212; without struggling to come up with the specific name\u00a0&#8212; that <em>Haemophilus aphrophilus<\/em> is now\u00a0<em>Aggregatibacter aphrophilus<\/em> and <em>Aggregatibacter segnis?\u00a0<\/em>Some facts just\u00a0might be for nimble young minds only, but am making this one my personal obsession.<\/li>\n<li>Will TAF\/FTC work for PrEP? Good question\u00a0for a <a href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT02842086?term=pre-exposure+prophylaxis&amp;rank=14\" target=\"_blank\"><strong>clinical trial!<\/strong><\/a><\/li>\n<li>Is there anything more predictable than 1) a scientific paper finding bacteria on some household item, then: 2) the media getting all grossed out by the research, minimal clinical implications notwithstanding? Latest example &#8212; your <a href=\"http:\/\/www.nature.com\/articles\/srep17163\" target=\"_blank\"><strong>coffee maker drip tray!<\/strong><\/a> <a href=\"http:\/\/www.fastcoexist.com\/3056220\/your-coffee-maker-is-a-bacterial-filth-hole\" target=\"_blank\"><strong>Ewww!<\/strong><\/a><\/li>\n<li>How long <em>before<\/em> there&#8217;s a reported antibiotic shortage do the manufacturers know it&#8217;s coming? I&#8217;m thinking about you, cefepime makers! It&#8217;s not as if demand for this drug was low.<\/li>\n<li>How many &#8220;First Zika Transmission in [insert Southern US City here] Reported&#8221; will we see this year? And how many incredibly difficult to carry out pregnancy recommendations?<\/li>\n<li>When will IGRAs completely replace tuberculin skin testing? Not saying that they are more accurate, just that they&#8217;re <em>so much<\/em> easier. Might be a downside in the healthcare screening setting &#8212; <a href=\"http:\/\/www.nature.com\/articles\/srep30781#abstract\" target=\"_blank\"><strong>too many false-positives<\/strong><\/a> over time.<\/li>\n<\/ul>\n<p>That&#8217;s enough for now. Need to stay cool &#8230; just like the <a href=\"https:\/\/twitter.com\/PatrickFrench\/status\/764135895620521984\" target=\"_blank\">400-year-old shark<\/a>, pictured above.<\/p>\n<p>And it&#8217;s not easy being funny in 140 characters. But some people <a href=\"https:\/\/twitter.com\/norock\/status\/761167038178033664\" target=\"_blank\">succeed brilliantly!<\/a><\/p>\n<p><a href=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2016\/08\/squirrels-drive-slowly-twitter.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter wp-image-8151\" src=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2016\/08\/squirrels-drive-slowly-twitter.jpg\" alt=\"squirrels drive slowly twitter\" width=\"516\" height=\"526\" srcset=\"https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2016\/08\/squirrels-drive-slowly-twitter.jpg 677w, https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2016\/08\/squirrels-drive-slowly-twitter-294x300.jpg 294w\" sizes=\"auto, (max-width: 516px) 100vw, 516px\" \/><\/a><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>On a lazy, brutally hot summer day, here are some more\u00a0&#8220;quick questions&#8221; to think about as you hope for a cool\u00a0breeze to bring relief from the\u00a0stultifying (love that word) heat: How soon\u00a0will we be able to look back at contact precautions for MRSA and VRE and laugh at our folly? Are we again\u00a0recommending antibiotics after [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3],"tags":[],"class_list":["post-8149","post","type-post","status-publish","format-standard","hentry","category-health-care"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/8149","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=8149"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/8149\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=8149"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=8149"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=8149"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}