Infectious Diseases
General competencies
1. Understand basic and clinical knowledge of pathophysiology of common
infectious diseases
2. Relevant history and physical examination, documentation of findings,
differential diagnosis generation and plan for further evaluation and
management
3. Use evidence based knowledge regarding primary and secondary prevention
of infectious diseases
4. Knowledge of current practices regarding the care of patients with infectious
diseases and develop plans to improve care.
5. Work with physicians, nurses, pharmacists, dieticians and other health care
professionals to improve patient care
Topic Areas
1. Fever in the 0-3 month old
2. Fever of unknown origin
3. Fever in the elderly
4. Immunization
a. Guidelines
b. Documentation
c. Identification of at risk patients
d. Appropriate administration
e. Counseling
5. Rational antibiotic use (i.e. first line therapy, patient’s drug and medical
history, local resistance patterns, empiric use, verification of drug allergies)
6. Appropriate management of infections other than antibiotics
7. Sexually transmitted infections
8. Urinary tract infection
9. Respiratory infections:
a. Pneumonia
b. Tuberculosis
For each topic area
1. Epidemiology
2. Anatomy
3. Pathophysiology/Etiology
4. Risk factors
5. History and physical exam
6.
7.
8.
9.
Diagnostic Tests
Differential diagnosis
Management
Psychosocial implications
Highlighted teaching points
1. Risk Factors
a. Identify patients who will specifically benefit from immunization (e.g.,
not just the elderly and children, but also the immunosuppressed,
travellers, those with sickle cell anemia, and those at risk for pneumonia
and hepatitis A and B)
b. Patients at high risk for UTI: high-risk patients: pregnancy, immune
compromise, neonate, young male, elderly male (prostatic hypertrophy)
2. History and physical exam
a. In elderly, do not use fever, or lack thereof, as pathognomonic for
pathology
3. Diagnostic tests:
a. Use a selective approach in ordering cultures before initiating antibiotic
therapy (usually not in uncomplicated cellulitis, pneumonia, urinary tract
infections, and abscesses; usually for assessing community resistance
patterns, in patients with systemic symptoms, and in
immunocompromised patients)
b. Screening appropriately for sexually transmitted infections
c. Urinary tract infections
i.
rule out complications – sepsis, pyelonephritis, impacted infected
renal calculi)
ii.
appropriate work-up of boys with UTIs, young girls with recurrent
UTIs (ultrasound, etc)
4. Differential diagnosis
a. Include infection in differential of confusion in the elderly, failure to
thrive, unexplained pain (necrotizing fasciitis, abdominal pain in children
with pneumonia) etc.
b. Antibiotic allergy (rule out other causes before accepting the diagnosis)
c. Fever in the 0-3 mo old: rule out bacteremia
d. Fever of unknown origin
i.
Rule out life-threatening causes (meningitis, endocarditis)
ii.
Rule out non-infectious causes (i.e. drug reaction, heat stroke)
e. Include diseases for which vaccination has been given in differential – do
not assume complete immunity
f.
5.
6.
Consider other diagnoses if patient is not responding to usual treatment
for infection
g. Rule out sexually transmitted infection in any genito-urinary-abdominal
symptom
h. Rule out urinary tract infection in very young or elderly patients with
non-specific symptoms (abdominal pain, fever, delirium)
i. Differential diagnosis for dysuria:
i.
Sexually transmitted infections
ii.
Vaginitis
iii.
Renal calculi
iv.
Interstitial nephritis
v.
Prostatitis
vi.
Urinary tract infection
Management
a. Rational antibiotic use
i.
First line therapy, patient’s drug and medical history, local
resistance patterns
ii.
Avoidance of antibiotic use in patient with suspected viral illness
iii.
Empiric use in urgent situations (meningitis, septic shock, febrile
neutropenia)
b. Appropriate management of infections other than antibiotics
i.
Fluid resuscitation in septic shock
ii.
I & D for abscess
iii.
Pain relief
c. Sexually transmitted infections
i.
High risk and symptomatic: treat empirically
ii.
Treatment of partners
iii.
Contact tracing (public health agency)
d. Urinary tract infections
i.
Modify treatment for high risk individuals (neonate, pregnancy,
immune compromise, you and elderly men)
ii.
Treat empirically in pregnancy, sepsis, pyelonephritis
Psychosocial implications
a. Counseling for parents against vaccination
References:
1. College of Family Physicians of Canada. (2010). Defining Competence for the
purposes of certification by the College of Family Physicians of Canada: The
evaluation objectives in family medicine. Mississauga, ON.