IDWeek 19: A Record Year for USF Infectious Disease Participation

October 22nd, 2019

USF Infectious Diseases Fellows, From Left to Right: Dr. Vidhya Sabapathy, Dr. Ju Hee Katzman, Dr. Greg Teo, Dr. Carlos Lopez-Perez, and Dr. Andrew Nguyen

 

USF’s Infectious Diseases fellows and faculty were well-represented at the Infectious Diseases Society of America’s annual IDWeek ’19 session, held in Washington, D.C., from October 2 to 6, 2019.  USF’s ID Division was collectively responsible for 14 poster presentations displayed between October 3rd through the 5th, and USF ID faculty Associate Professor Dr. Jamie Morano presented in a symposium on her experience in crafting the James A. Haley VA hospital’s outstanding ID Telehealth program, a national leader in the VA system.

 

 A selection of the diverse poster sessions that were presented appears below:

 

Author and second-year ID fellow Ju Hee Katzman and her co-authors shared data on a series of 38 breast cancer patients who developed gram-negative skin and soft tissue infections following tissue expander surgery.  The three most common pathogens found were Pseudomonas aeruginosa, Serratia marcescens, and Klebsiella pneumoniae. They concluded that in centers with a high percentage of gram-negative rods skin and soft tissue infections following tissue expander surgery, treating physicians should consider using perioperative antibiotics that include coverage against Pseudomonas, the most common isolate (45%).

 

Former (2017-2019) infectious disease fellow Dr. Shylah Moore and colleagues presented a poster on a five-year retrospective review within Florida’s Hillsborough County Department of Health comparing the trends and outcomes among HIV infected versus HIV uninfected patients with tuberculosis. Results suggested an HIV-TB coinfection rate that is slightly higher than the national population, with co-infected patients in the study sample having a statistically significant higher rate for cavitary TB.

 

 

Dr. Vidhya Sabapathy in front of her poster

Second year fellow Dr. Vidhya Sabapathy and colleagues reported on a retrospective analysis of 61 adult patients between 2010 and 2018 who were diagnosed and being treated for acute leukemia. All of the selected patients experienced severe neutropenia for 7 days or greater. Patient characteristics and infectious complications were examined. The most common diagnosis was AML. Bloodstream infections were the most common site, followed by respiratory tract infections. Gram-positive organisms were the leading etiology of bacteremias. In the subset of patients undergoing multiple induction chemotherapy, gram-negative pathogens were the leading cause of the bloodstream infections.

 

 

 

Dr. Shylah Moore and Colleagues’ Poster on Nocardia beijingensis

Dr. Shylah Moore, Dr. Johanna Asquith, and colleagues also reported on a retrospective chart review of 6 cases of a more recently described Nocardia strain first isolated in 2001 from sewage soil in China. The purpose of the study was to determine the risk factors and clinical manifestations of Nocardia beijingensis infection. All of the cases reviewed involved immunocompromised patients, were predominantly male, and had a mean age of 48. Most had lung involvement. Atypical manifestations included thecal sac infection and femur osteomyelitis. All isolates were susceptible to trimethoprim/sulfamethoxazole, but ceftriaxone and carbapenems were mostly used.

 

Dr. Carlos Perez-Lopez, a second year infectious diseases fellow and other co-authors reviewed a retrospective cohort of patients for seropositivity to Strongyloides stercoralis who underwent transplant evaluation from 2014-2016. A total of 228 charts were reviewed, and 113 seropositive patients were identified. Male gender and caucasian race predominated in both the seronegative and seropositive groups. The study did not find any statistically significant difference in the demographic characteristics or risk factors that can be used for prediction of Strongyloides seropositivity among solid organ transplant candidates. Thus, the validity of universal screening was reinforced.

 

Dr. Jamie Morano, far left, on the panel at “Success Stories in Telehealth.”

Dr. Jamie Morano presented as part of the symposium, “Success Stories in Teleheath,” on “ID Telehealth Best Practices: Veterans Administration.” She presented with Christopher Crnich, MD, and Rima Abdel-Massih, MD, with Moderator John Lynch, MD, also on the podium.

 

For more information about IDWeek’s 2019 Scientific program, please visit the interactive program page.

IDPodcasts’ YouTube channel reaches 1 million lifetime views!

October 22nd, 2019

Tampa, FL, October 22nd – USF Health’s IDPodcasts Youtube Channel, a production of the Division of Infectious Diseases of the University of South Florida Morsani College of Medicine, announced this week that it has reached its one millionth lifetime view milestone as of October 20, 2019.  Although this number is modest in comparison to top 100 YouTube channel rankings with millions of subscribers, IDPodcasts’ subscriber base is #1 among all YouTube Channels belonging to the University of South Florida or its medical affiliates. IDPodcast’s YouTube channel first went online on January 13, 2012, and now has almost 7,000 subscribers.

Although it took more than seven years to reach one million views, according to social media statistics aggregator SocialBlade.com, IDPodcasts’ YouTube channel is projected to double its lifetime views to 2,000,000 by August, 2020, and to achieve its 10,000 subscriber milestone by next summer.

In addition to the latest podcasts obtained from IDPodcast’s website (www.idpodcasts.net), ID Podcast’s YouTube audience can select from more than 250 podcasts taken from IDPodcast’s 12 year history of broadcasting infectious diseases content online. IDPodcasts leverages the talent and teaching skills of the USF Health’s Infectious Diseases (ID) medical faculty and fellows to present compelling ID content for its audience.  Select invited national thought leaders in infectious diseases such as Henry Chambers, MD, and Debbie Goff, Pharm.D., have also provided content over the years.

All of IDPodcast’s content is provided free to users, is self-sponsored, and is open access across the online universe.  In addition to the YouTube Channel, IDPodcasts offers its content via smartphone and tablet apps, an iTunes Podcast series, and its website. New apps are currently under production for 2019 to bring an enhanced state-of-the-art IDPodcasts listening experience to the latest smartphone devices and tablets.

IDPodcasts was co-founded in 2007 by Dr. Richard L. Oehler, Professor of Medicine at the University of South Florida College of Medicine, and Dr. John T. Sinnott, current Chairman of the Department of Internal Medicine at the Morsani College of Medicine at USF. Dr. Oehler has been its editor-in chief and webmaster since its inception.

IDPodcasts’ Editor, Richard Oehler, MD, authors “Viewpoints” Commentary in Clinical Infectious Diseases

October 22nd, 2019

An important commentary by IDPodcasts’ editor-in-chief and USF Division of Infectious Diseases Professor, Dr. Richard L. Oehler, has now been published online in the Infectious Diseases Society of America’s flagship journal, Clinical Infectious Diseases.

The “Viewpoints” article, entitled, “On Measles, Vaccination, Social Media Activism, and How to Win Back Our Role as our Patients’ Best Advocates,” is awaiting publication in the print version of the journal.

The article’s focus is about how the recent decline in vaccination rates has led to multiple outbreaks of measles and other vaccine-preventable diseases across the US in 2019. This is surprising, Dr. Oehler notes, “when you consider that less than two decades ago, in 2000, measles was declared eliminated in all 50 states.” Unfortunately, since then, an erosion in public confidence about vaccines and a great resurgence in active measles cases has occurred. At the core of this trend, he writes, is a “perfect storm” of factors:

“The rise of the internet, and the availability of easily accessible but often inaccurate and poorly vetted health information have emboldened patients to make their own medical decisions apart from their provider.” Dr. Oehler explains.  “At the same time, the emergence of online social media has permitted like-minded lay people to share online health-related opinions and to engage in healthcare activism.  These opinions are magnified in an online echo chamber that has drowned out the voices of a physician community that is often unprepared for communicating in modern ways.”

It is well past time, Dr. Oehler surmises, for the medical community to regain its voice, using smart and sensible tools suitable for the modern era of smartphones and twitter.  In his commentary, the author suggests several accessible ways that the medical community can develop its own influencers, bolster and cultivate its own online presence, and leverage social media in positive ways–thus restoring our influential role as our patients’ best advocates.

“Few practicing physicians have heard of Felix Kjellberg, Logan Paul, or Liza Koshy,” Dr. Oehler notes, “but each of these social media celebrities are online superstars known to vast numbers of people worldwide. When either ‘PewDiePie,’ ‘Logan,’ or ‘Liza‘ tweets an idea, promotes a brand, or practices online activism, literally tens of millions of people listen and act. With the exception of a few celebrity media figures (perhaps Bill Nye or Neil Degrasse-Tyson) and physician reporters (Dr. Sanjay Gupta), why can’t the scientific/medial community develop and cultivate more celebrity communicators and online influencers to promote vaccination and other ideas we’re trying to get across to the public? The social media accounts of even major medical organizations can have one-tenth of the followers or less of some accounts run by activist moms from their kitchen counters.”

In addition to his USF teaching responsibilities and editorial responsibilities at IDPodcasts, Dr. Oehler is also a full-time practicing infectious diseases clinician at the James A Haley Veterans Hospital and Moffitt Cancer Center, and the father of two teenagers. “I get plenty of social media exposure [as a parent],” Dr. Oehler asserts.

Dr. Oehler’s publication can be accessed here.

ID Podcast’s YouTube Channel Reaches its 5000th Subscriber!

February 5th, 2019

Tampa, FL, February 5th – USF Health’s IDPodcasts Youtube Channel, a production of the Division of Infectious Diseases of the University of South Florida Morsani College of Medicine, announced today that it has reached its five-thousanth (5000) subscriber milestone as of February 1st, 2019.  Although this number is modest in comparison to top 100 YouTube channel rankings with millions of subscribers, IDPodcasts subscriber base is #1 among all YouTube Channels belonging to the University of South Florida or its medical affiliates, exceeding USF Athletics (3,892 subscribers), the USF Channel (3,989 subscribers) Moffitt Cancer Center (4,793 subscribers), Tampa General Hospital (2,300 subscribers) and USF Health (996 subscribers). IDPodcast’s subscriber base also places it ahead of YouTube channels from infectious diseases thought leaders like the National Institute of Allergy and Infectious Diseases [NIAID] (3,038 subscribers) and Medpage today (1,330 subscribers), and within striking distance of popular medically oriented YouTube Channels such as Medscape (16,322 subscribers), NIHvcast (14,596 subscribers)

This year, according to social media statistics aggregator SocialBlade.com, IDPodcasts’ YouTube channel is expected to receive more than 276,000 views from a worldwide audience originating from more than 200 countries. The channel is expected to exceed its next milestone of its one millionth view before the end of 2019.

In addition to the latest podcasts obtained from IDPodcast’s website (www.idpodcasts.net), ID Podcast’s YouTube audience can select from more than 225 podcasts taken from IDPodcast’s 12 year history of broadcasting infectious diseases content online. IDPodcasts leverages the talent and teaching skills of the USF Health’s Infectious Diseases (ID) medical faculty and fellows to present compelling ID content for its audience.  Select invited national thought leaders in infectious diseases such as Henry Chambers, MD, and Debbie Goff, Pharm.D., have also provided content over the years.

All of IDPodcast’s content is provided free to users, is self-sponsored, and is open access across the online universe.  In addition to the YouTube Channel, IDPodcasts offers its content via smartphone and tablet apps, an iTunes Podcast series, and its website. New apps are currently under production for 2019 to bring an enhanced state-of-the-art IDPodcasts listening experience to the latest smartphone devices and tablets.

IDPodcasts was co-founded in 2007 by Dr. Richard L. Oehler, Professor of Medicine at the University of South Florida College of Medicine, and Dr. John T. Sinnott, current Chairman of the Department of Internal Medicine at the Morsani College of Medicine at USF. Dr. Oehler has been its editor-in chief and webmaster since its inception.

App Updates

November 29th, 2018

The IDPodcasts Team appreciates all the interest we receive on a regular basis for our smartphone and tablet apps. Although we premiered an all new web site in 2018, our app updates have lagged behind. A few months ago, our Android app stopped working due to software compatibility. Our IOS app continues to function, but is sorely in need of new updates.

Fortunately, in 2019, the IDPodcasts platform will welcome new Android and IOS apps! We hope that these new generation apps will include additional functionality that all of our users will enjoy. Specifically, we wish to integrate:

1. Standalone audio podcast compatibility for listening in environments where an audio podcast is appropriate (such as in the car) and where you need your phone for other purposes.
2. Feedback comment capability within the app.
3. More comprehensive indexing.
4. News, blogs, and other features we have added to our web site this year.

While we bring our new apps to completion, for (especially Android) smartphone and tablet users who cannot use our apps, please note that our website is mobile device friendly and should play in any browser. Also, all of our podcast content is still available at our youtube channel at http://www.youtube.com/idpodcasts.

Thank you for supporting our content now for over ten years!

Can Technology Reduce Infection in the Food Industry?

July 13th, 2018

As I often do, I recently spent a few moments on a Friday morning reviewing the CDCs “Current Outbreak List” page. This resource is a single page clearinghouse for recent United States and international outbreaks reported on by the Centers for Disease Control and Prevention. On the day I reviewed the page, recent Salmonella-based outbreaks in breakfast cereal, pre-cut melon, live poultry and backyard flocks and pet guinea pigs were mentioned. Other Salmonella-related outbreaks occurring in 2018 included dried coconut, chicken salad, Kratom, raw sprouts, cucumbers, and papayas.

The predominance of Salmonella among food-borne pathogens is not surprising, as non-typhoidal Salmonellae in the US is one of the leading causes of foodborne disease. It is also a major cause of worldwide diarrhea. The high prevalence of non-typhoidal salmonellosis in the food supply has been primarily associated with agricultural reservoirs, most commonly with poultry and chicken eggs. In recent years, outbreaks associated with raw produce have increased in prevalence, perhaps related to contamination of the food chain resulting from run off from animal agricultural lots, or the secondary cross-contamination of produce during harvesting, processing, or food preparation. Yet this is not a new phenomenon. Foodborne outbreaks have been an issue in the U.S. food industry for decades.

In the course of researching this topic, I came across a media report entitled, “Expert: Technology could help make food safer.” The article was an interview of Dr. Dennis Maki, a well-known professor in epidemiology at the University of Wisconsin School of Medicine and Public Health. Dr. Maki noted that the era of feeding 300 million plus people through the use of small farms and simple agricultural techniques has long since passed.

Dr. Maki said,

“it’s important to realize there are 300 million people in the US. The only way you are going to feed 300 million people is by industrial techniques. The common complaint or the plea is, ‘lets return back to 1945, let’s have small farms, let’s not have industrial farming and industrialized production of food on a huge scale. Then we wouldn’t have the problems that we have now.” But such an approach would not result in the ability of our agricultural industry to feed a 21st Century population, he asserted.

Dr. Maki emphasized several approaches for the consumer to reduce their likelihood of acquiring foodborne illness. (1) Buy food from reputable sellers. Most large grocery chains are highly reputable, or they would not be in business. (2) Wash fruits and vegetables thoroughly as this will greatly reduce, though not completely eliminate contamination. (3) Cook meats properly and to the recommended temperature.

The article featuring Dr. Maki, though very relevant today, was not from 2018, but 2007. And over the last decade, seemingly very few manufacturing components of the agricultural industry appear to have changed. However, the grocery marketplace continues to emphasize foods that are more “natural,’ ‘organic,’ or preservative-free. Similarly, upscale grocery chains promote food products that are marketed as being less associated with the food-industrial complex (grain fed beef, cage-free eggs, organic sprouts, etc.). At the same time, the public’s insatiable demand for all-season produce results a food distribution system that needs to be worldwide. (i.e., grapes from Chile, avocados from Mexico, pineapples from Thailand, oranges from Brazil, figs from Turkey, etc.)

So the original question in the 2007 article still applies today: “Can technology reduce infection in our food?” One of the most fascinating and progressive areas where technology is pushing the envelope is in the meat industry. American consumers eat 26 billion pounds of beef a year. A single cow is said to consume up to 11,000 gallons of water annually. The fast food chain McDonald’s cells 75 hamburgers every second. As a result, the cultivation of meat products requires a huge worldwide industry that is estimated to be responsible for 15-20% of all greenhouse gas emissions. Furthermore, the production of the millions of poultry, pork and beef livestock animals places considerable demands on agricultural areas to contain and manage the tremendous quantities of animal waste and other industrial byproducts of meat processing, much of which is at risk for contamination of the environment and at various points in the food chain.

As a result, several Silicon Valley technology start ups have for several years now been working on different lab-based techniques for the production of meat. The concept in itself is deceptively elementary: What if the production of meat could be made as simple as growing yeast in a vat? If we could turn the philosophy of, “kill it and grill it” to “fill it and then distill it.” If we could culture meat in a lab and then grow it utilizing industrial techniques similar to beer production, this would eliminate a large proportion of the land use, water consumption, greenhouse gas admissions, and production of animal byproducts that result in the runoff of enteric pathogens such as Salmonella and the contamination of the environment and of our food.

Just, a Silicon Valley company, is perhaps the leader in attempts to bring the first “clean meat” products to market. Their process involves the development of a large-scale cell culture process for cultivating sustainable meat cells into high-grade meat and seafood with a production process that promises to be over 10 times more efficient then the world’s largest slaughter houses. They claim their process uses unmodified cells which naturally occur in livestock animals and can be grown antibiotic free. Because the process does not involve slaughtering live animals, they claim their manufacturing chain will have a significantly lower risk of foodborne illness (and be much less negatively impactful on the animals in general). Other lab-based meat companies looking to develop similar technologies include Memphis Meats and Future Meat Technologies.

Such food technology elicits a wide variety of reactions from the public, ranging from those who say, “I would never eat that,” to individuals who claim that “cultured meat is not natural,” to the more adventurous who boast, “I’ll eat it if it tastes good and is safe.” But the history of food in the U.S. suggests that similar battles have been waged in the past, from the adoption of margarine as a butter substitute in the late 19th Century to the rise of nut-based milk products (e.g., soy milk, almond milk, etc) in the last 15 years, with the new products ultimately finding acceptance if they are felt to be economical, healthier, and no less palatable than their traditional counterparts. But with the production of meat and seafood estimated to double to 1.2 trillion pounds by 2050, given a finite land supply and limited environimental resources, current industrialized processes for meat and food production are unsustainable, and new techniques are clearly needed.

The development of cultured meat products has led to an industry debate, led mainly by traditional agricultural industry firms and trade associations, on what constitutes the terms “meat” and “beef” at all. The FDA will hold public hearings on this topic this summer.

As consumers, all of us can play a role in ensuring the safety of the U.S. food system in the products we consume, the choices we make, the food preparation techniques we use, and in the ways we maintain awareness of what is going on with our food supply.

Please note that the opinions expressed in this blog post are my own and do not necessarily reflect the views of IDPodcasts, the Division of Infectious Diseases, USF Health, or the University of South Florida.

IDPodcast’s iTunes Podcast Series is Back Online!

May 8th, 2018

Fans of downloadable podcast content can now rejoice.  IDPodcast’s iTunes Podcast Series is now back and better than ever!  The series, originally started in 2007, and one of the original infectious diseases podcast series on iTunes, got sidetracked in January after the migration of IDPodcast’s website to an all new WordPress-based platform.  For technical reasons, podcast updates had to be suspended until new software updates could be completed.  With the updates having been accomplished earlier this week, “IDPodcasts on iTunes” made its glorious return.

IDPodcasts on iTunes will feature ten of the most recently uploaded podcasts available for downloading or streaming directly via a podcast app. The re-inaugurated podcast series is another way that IDPodcasts is “making knowledge contagious.”

To access IDPodcast’s podcast series on iTunes, please enter the following link:

Click here

 

Dr. Ana Velez’s “Art In Infectious Diseases”

April 10th, 2018

 

Dr. Ana Velez is an accomplished artist and University of South Florida Associate Professor and Infectious Diseases physician who has practiced at Moffitt Cancer Center among immunocompromised patients since 2007.  Although she paints in many different styles, among her favorite subjects are the microorganisms she confronts everyday as a health care provider.  With her art, she conveys the complexity and beauty present in even some of the most challenging pathogens.  Her paintings mix bright colors and subtle shades to capture the simple yet elegant nature of fungi, bacteria, and viruses. Below is some of her artwork each with an accompanying legend. Please click each picture to link to a larger version.

 

Aspergillus

Aspergillus is a fungus found throughout the world that can cause infection in primarily immunocompromised hosts and individuals with the underlying pulmonary disease. There most important types of respiratory tract infections caused by aspergillus include: invasive aspergillosis, and allergic bronchopulmonary aspergillosis. Aspergillosis infection can also manifest as sinus disease in immunocompromised hosts and cutaneous disease after traumatic inoculation.

The treatment of choice is Voriconazole. Isavuconazole, Posaconazole and Amphotericin also have activity.

The painting below illustrate aspergillus with its septate acute angle hyphae (white arrow) a vesicle (blue arrow) with phialides (orange arrow) and sporulating conidia (red arrow).

 

 

Dengue Virus

The dengue virus is a single positive-stranded RNA virus of the family Flaviviridae. It is transmitted by the Aedes aegypti female mosquito. The clinical presentations include dengue fever, dengue hemorrhagic fever and dengue shock syndrome.

The painting below illustrates the main parts of the virus including the E protein (white arrow), the M protein (black arrow), the capsid protein (red arrow) and the genomic RNA (blue arrow)

 

 

Fusarium

Fusarium is a hyaline mold that can cause severe invasive infections in neutropenic and transplant patients. The most common type of infections in this population includes invasive nodular pneumonia, sinusitis and necrotizing cutanous infections from traumatic inoculation.

This mold is angioinvasive, but can also cause disseminated disease from metastatic conidias that travel distally from the initial site of inoculation thru the bloodstream.

The treatment is Voriconazole orAmphotericin depending on the subspecies and suceptibilities of fusarium.

The painting below illustrates septated hyphae (green arrow) and banana shape conidia (black arrow).

 

 

Actinomycetes

Actinomycetes are acid-fast gram positive bacilli that are sometimes branching depending of the species.

The Actinomycetes sppinclude Mycobacterium spp, Corynebacterium spp, Nocardia spp, Actinomyces spp, Rhodococcus spp, Tsukumurella spp, Gordona spp, Actinomadura spp, Streptomyces spp, and Tropheryma wippelii.

The painting below illustrates Nocardia, Actinomyces and Rhodococcus.

Nocardia spp(black arrow) are aerobic filamentous branching beaded, gram positive rod, that stain acid-fast positive given its mycolic content of the cell wall.

Actinomyces spp(white arrow) are anaerobic branching gram positive rods that can be differentiated from Nocardia because they are acid-fast negative.

Rhodococcus spp(yellow arrow) are aerobic gram positive rod non branching acid-fast positive.

 

Chikungunya

Chikungunya virus is an RNA alphavirus transmitted by Aedes mosquitoes in the tropical and subtropical areas.

It causes acute febrile illness with polyarthralgia, arthritis and occasionally headache, rash and periarticular edema.

The painting below illustrates the structure of the Chikungunya virus with the E proteins (yellow arrow) Membrane (white arrow) capsid (red arrow) and the genomic structure (black arrow).

 

 

Herpes Simplex Virus

HSV is an enveloped double stranded DNA virus that belongs to alpha herpes virus.

There are 2 types of herpes virus (HSV): herpes virus type 1 (HSV-1) and herpes virus type 2 (HSV-2). Both are closely related.  HSV1 is more commonly associated with orofacial disease whereas HSV2 is more commonly associated with genital disease.

Medications to treat HSV infections include acyclovir, valacyclovir, and famciclovir.

The painting below illustrates the HSV virus. It has the DNA gene (white arrow), nucleocapsid (black arrow) the tegument (blue arrow), the lipid envelop (orange arrow), and the envelope proteins (red arrow).

 

 

Polymicrobial abscess

The painting below illustrates the polymicrobial purulent and bloody fluid from an abscess. The gram positive cocci in chains are Streptococcus spp (orange arrow), the gram positive cocci in clusters are Staphylococcus aureus (blue arrow) and the gram negative rods are Pseudomonas spp (white arrow).

 

 

Scedosporium

Scedosporium is a filamentous mold present in soil, sewage, and polluted water. It has two main species: Scedosporium apiospermum(and its sexual form Pseudallescheria boydii) and Scedosporium prolificans. Scedosporium spp may colonize transitory previously damaged airways, but can also cause severe respiratory infections in near-drowning and immunosuppressed patients. The infection may spread locally by angioinvasion or hematogenously to distant organs (lung and brain are common organs). Scedosporium spp are often resistant to several antifungals. Voriconazole can be used to treat infections by Sedosporium angiospermum. Scedosporium prolificans is often multi-drug resistant.

The painting below illustrates Scedosporium spp with broad hyphae (blue arrow) and Pseudallescheria boydii (red arrow) with fully developed and ruptured cleistothecium, the typical form of the sexual stage of Scedosporium apiospermum.

 

 

Zygomyces

Zygomyces is hyaline fungus that causes severe invasive infections in transplant and neutropenic patients. It can also cause severe infections in poorly controlled diabetic patients.

The most common type of infections includes invasive necrotizing nodular pneumonia, severe sinusitis with peri-orbital cellulitis, and cutaneous infections  from traumatic inoculation.

The treatment of choice is Amphotericin. Isavuconazole and Posaconazole are also effective but are often used as an alternative to Amphotericin.

The painting below illustrates different Zygomyeces spp with the typical large ribbon like non septate 90 degree angle hyphae (green arrow).

 

A Textbook Case: Making the Transition to the Online Universe

January 28th, 2017

With this blog, IDPodcasts inaugurates its new online presence. At its inception in 2007, our original goal was to make our division’s infectious diseases teaching available via a simple web site to a broad online audience. Since then, IDPodcasts has followed the pace of technology, explanding its reach to smartphones, tablets, YouTube, and to social media. In 2017, we celebrated our tenth anniversary. Recently, the development of our new web site led me to reflect again on how far online medical education resources have progressed since the beginning of this decade. For instance, In 2010, one of Oxford University’s “great medical legends” received a long awaited transplant. Long the close confidant and trusted aide to generations of doctors and medical students, it had become impersonal, grossly overweight, and unwieldy. Oxford University Press’s Textbook of Medicine, 5th Edition, first published in 1983, long regarded as perhaps the most comprehensive medical reference in publication and an emissary for evidence-based medicine around the world, was launched as a complete online edition. The project, five years in the making, brought the entirety of its massive twenty-five pound, three-volume, six thousand page print edition to the web, complete with all of the text, figures and illustrations. Though available to hospitals, universities and individuals as a paid subscription, the move to an online edition offered an unexpected benefit: inexpensive and even free access for more than 3,500 institutions in less-developed countries sponsored by the U.K.’s Wellcome Trust. 1

Oxford’s initiative, following a trend established by many medical publishers in the last decade and a half, reflected not just a gesture of altruism to third world countries but also a matter of contemporary professional and economic necessity. Since at least 2600 B.C., when Imhotep is said to have written his first papyrus on ancient Egyptian medicine 2, heralding the age when medical knowledge could be shared and adopted by others, clinicians have attempted to codify the practice of medicine onto the printed page. For more than 4500 years, the tradition of the paperbound medical text thrived, surviving the destruction of the Alexandria library in Egypt, the austere anti-intellectualism of the middle ages, and even the emergence of the new broadcast media of the second half of the 20th century. But as the practice of medicine now approaches the third decade of the new millennium, the bound medical textbook, so symbolic of the scholarly traditions that form the basis of our craft, is facing extinction. The solidification of electronic media, from online peer-reviewed information resources, medical web portals and search engines, to personal smart phones and tablet computers has now supplanted the hardbound textbook for many health providers.

In an original informal January, 2011 survey of internal medicine housestaff I conducted at my institution, only 15% had consulted a hardbound textbook in the last month, preferring instead to reference online resources such as “Up to Date,” “Harrison’s Online, “ and “Emedicine.” Less than half (47%) had reviewed a printed reference of any kind, underscoring the waning popularity of the softbound handbook or pocket guide. Now, seven years later, that number is probably close to nil. The migration that medical publications have made online reflects a societal shift away from the printed page, especially in basic and secondary education. Having a son and daughter, in both college and high school, respectively, I know that it is possible for my tablet and notebook-laden kids to never open a physical text if they wished to do so. For those of us who have been in practice more than twenty years, the transition away from the printed textbook in the last decade has presented some unexpected problems. No longer is a clinical question or controversial medical decision between clinicians resolvable via an obsolescent, forlorn text in the corner of a nurse’s station. Many resourceful clinicians now consider even a newly published hardbound volume to be out of date, questioning the validity of any reference that is not updated continuously. In an era where every question seems to be answerable via an online query, use of the search engine may have even superseded Pubmed or the National Library of Medicine, with sometimes variably reliable results.

In the past, the immutability and permanence of the printed page added certainty to hardbound textbook-based medical decisions. With the increasing reliance on online resources, it has become more difficult to distinguish credible from less credible sources of medical information, especially for patients who are sometimes forced to seek online medical advice in an era of “fake news.”. For less technologically adroit clinicians, clinging to hardbound medical resources they have used for decades, adaptation to electronic media may present formidable obstacles to reaching the information they once felt comfortable obtaining.

Yet, the online transition has had far more positive than negative consequences. Online reference sources are easier to produce and distribute, and for subscribers, often more affordable to obtain. In many medical facilities equipped with an electronic medical record, online medical references have been integrated with desktop, mobile or handheld devices at the point of care, permitting instantaneous access to evidence-based information critical to medical decision making. In fact, the growth of the evidence-based medicine (EBM) movement is likely to have been fueled since the turn of the millennium by the rapid growth of online medical resources. For many providers, the availability of medical blogs, subscription online content, YouTube videos, podcasts like our own, online access to full text medical journals and even social networking sites (e.g., Facebook and Twitter) ensure that no major medical advance, clinical trial, drug recall or outbreak can escape our awareness. In less developed countries, where medical reference resources were once limited to antiquated or donated textbooks, online resources offer resource-challenged providers with access that can level the playing field of medical information with wealthy countries, a development that is likely to be crucial to improving the quality of medical training and care in the third world. In the U.S., health information companies have also increasingly begun to acknowledge the promise of the new online frontier. Both Emedicine and Up-to-Date, among the most popular of the online peer-reviewed sites, began as struggling start-up firms in the 1990s, attracted an sizable user base, and then were ultimately acquired by large multimedia conglomerates. 3,4 For traditional publishers, almost every major hardbound text now coexists with an online edition, many enhanced for portable devices.

Like audiophiles who still extol the tonality, sonic imperfection, and nostalgia of the vinyl LP in an age of digital music streaming, there will always be those who cherish the great joy inherent in un-wrapping a new-edition hardbound text, resting its weighty spine on one’s lap, and thumbing through its unwrinkled and carefully typeset pages. Although classic medical textbooks may never completely disappear, they may be relegated to the novelty of display cases.   The ongoing transformation of medical information to the online universe will continue to affect the discipline of medicine in many ways and may even alter the foundation of what it means to be a physician. For if healthcare providers can now have access to a portal that can instantly provide them with unlimited online knowledge, updated constantly, and personalized to their patient’s individual needs, at what point could the physician, like an out of print textbook, also become obsolete, replaced by an artificially intelligent machine? It seems unlikely that this will happen anytime soon, one might think, because it is not what we know that endears us most to our patients.   “The art of medicine,” the 16th century Renaissance physician Paracelsus once wrote, “cannot be inherited, nor can it be copied from books.” 5

 

 

References:

  1. Moisse K. A medical classic gets a 21st century makeover, going online and low cost. Scientific American http://bit.ly/dpVuEk. Accessed February 2, 2010.
  2. Breasted JH, ed The Edwin Smith Surgical Papyrus: published in facsimile and hieroglyphic transliteration with translation and commentary on two volumes. Chicago: University of Chicago Press; 1991; No. 3-4.
  3. Emedicine.com. http://emedicine.medscape.com.
  4. Uptodate.com. http://www.uptodate.com. Accessed 01/15/2018.
  5. Jacobi J, ed Paracelsus, Selected Writings. New York: Pantheon books; 1951.