Infectious Disease
I.
Rationale
Family physicians are often the first health care providers to whom individuals with infections turn for
treatment. The diagnosis and treatment of patients with acute infections makes up an enormous part of
primary care practice. In addition, we are uniquely suited through our efforts at preventive care to
diagnose many chronic infectious diseases in their asymptomatic stage and coordinate intervention as the
disease progresses. Likewise, family physicians are increasingly being called to provide primary care for
patients with chronic infectious diseases such as HIV. It is therefore necessary that a family physician be
knowledgeable about infectious disease and the multiple issues related to the care of patients with HIV
infection.
II.
Competencies
Medical Knowledge and Patient Care
Goal: Provide Evidence Based Care and medically competent care to patients with infectious conditions.
Objectives:
A. Learn the common pathogens and the treatment for infections encountered in family
practice.
B. Understand the pharmacological principles of treatment for bacterial, viral, and fungal
infections including choice of antimicrobial, major side effects, dosage adjustments based on
metabolism of the drug or derangement in hepatic or renal function, and major drug-drug
interactions.
C. Learn the immunization recommendations for adults and children and how to access updated
information.
D. Be able to compare the spectrum of infections in immunocompetent hosts versus those seen
in the immunocompromised host.
E. Learn how to approach the febrile patient including fever of unknown origin both in the
immunocompromised and immunocompetent host.
F. Learn the screening principles for asymptomatic chronic infections.
G. Be able to take a careful history including travel, sexual, occupational and environmental
exposures.
H. Learn and be able to describe the diagnosis, management and potential complications of:
1. CNS infections: bacterial meningitis, aseptic meningitis, and encephalitis.
2. ENT infections: sinusitis, otitis media, otitis externa, and pharyngitis.
3. Respiratory infections: URI, bronchitis, community acquired pneumonia, nosocomial
pneumonia, and aspiration pneumonia
4. Cardiovascular infections: endocarditis
5. Gastrointestinal and intraabdominal infections: gastroenteritis, colitis, cholecystitis,
hepatitis, peritonitis, and appendicitis.
6. Musculoskeletal infections: necrotizing fasciitis, septic arthritis, and osteomyelitis.
7. Sexually transmitted diseases: HIV, syphilis, gonorrhea, chlamydia, herpes, trichomonas,
and hepatitis B
8. Genito-urinary infections: UTI, pyelonephritis, vaginitis, cervicitis, pelvic inflammatory
disease, prostatitis, urethritis, and proctitis.
9. Skin infections: impetigo, cellulitis, erythrasma, and the various fungal infections of the
skin and nails.
Last Updated April 19, 2013
I.
J.
Be able to evaluate and manage patients with HIV infection in the asymptomatic and
symptomatic stages with referrals made when appropriate.
1. The resident will be able to list and be familiar with conditions commonly encountered in
the HIV population such as: candida, cryptococcus, cryptosporidiosis, CMV, HSV, M.
tuberculosis, M. avium complex (MAC), M. kansasii, pneumocystis jiroveci (carinii),
toxoplasmosis, Kaposi’s sarcoma, progressive multifocal leukoencephalopathy, HIV
dementia, and HIV wasting syndrome.
2. The resident will know the appropriate health maintenance recommendations for
patients with HIV including additional immunizations and prophylactic therapy.
Residents will strive to perform and gain competence in the following:
1. Gram staining and interpretation
2. Wet prep/KOH and interpretation
3. Lumbar puncture
4. Urinalysis with microscopic evaluation and interpretation
Learning Activities
Attending Rounds
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty Conference
Morning Report
X
Didactics
Other
Evaluation Methods
X
Attending Evaluation
X
Program Director
Review
360 ᵒ evaluation
Other
X
X
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
Faculty Supervision
Procedures
X
X
X
X
Directly Supervised Procedures
In-Training Exam
X
Videotape Review
X
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Morning Report
Faculty Supervision
and Feedback
Quarterly Review
Interpersonal and Communication Skills
Goal: Residents will develop and demonstrate effective information exchange and teaming with
patients, their families and other health professionals.
Objectives:
A. Learn to communicate to the patient and family members a diagnosis, treatment plan, and
prognosis in a way that is comprehensible and compassionate.
B. Learn how to effectively provide counseling to adults regarding immunizations and screening.
C. Learn how to effectively provide pre and post test counseling to patients regarding HIV
testing.
D. Learn how to effectively and efficiently communicate and coordinate with infectious disease
consultants.
Learning Activities
Attending Rounds
Multidisciplinary Rounds
Grand Rounds
Last Updated April 19, 2013
Research Conference
Ethics/Comm Conference
Specialty Conference
X
X
Outpatient Clinics
Direct Patient care
Resident Seminar
X
Sub-Specialty Conference
Morning Report
Didactics
Other
Evaluation Methods
X
Attending Evaluation
X
Program Director
Review
360 ᵒ evaluation
Other
X
X
Noon Conference
Faculty Supervision
Procedures
X
X
Directly Supervised Procedures
In-Training Exam
X
Videotape Review
X
X
Journal Club
Readings
Morning Report
Faculty Supervision
and Feedback
Quarterly Review
Systems-Based Practice
Goal: Demonstrate an awareness of and responsiveness to the larger context and system for health care
and the ability to effectively call on system resources to provide care that is of optimal value.
Objectives:
A. Learn the appropriate documentation and coding for screenings and immunizations.
B. Understand the medico-legal aspects of diagnosing a patient with an infectious disease
including your responsibility to the patient’s close contacts and to the state.
C. Understand the ethical and legal aspects of diagnosing a patient with an infectious disease as
they relate to confidentiality.
D. Learn OSHA guidelines for blood borne pathogens.
E. Learn the different types of precautions used in the health care setting (universal,
respiratory, contact)
F. Residents will be able to use ancillary testing such as laboratory, imaging, and biopsy in a
cost effective manner to arrive at a timely diagnosis.
Learning Activities
Attending Rounds
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty Conference
Morning Report
X
Didactics
Other
Evaluation Methods
X
Attending Evaluation
X
Program Director
Review
360 ᵒ evaluation
Other
X
X
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
Faculty Supervision
Procedures
X
X
X
X
Directly Supervised Procedures
In-Training Exam
X
Videotape Review
X
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Morning Report
Faculty Supervision
and Feedback
Quarterly Review
Professionalism
Goal: Residents will demonstrate a commitment to carrying out professional responsibilities, adherence
to ethical principles, and sensitivity to a diverse patient population.
Last Updated April 19, 2013
Objectives:
A. Understand the need for continuing medical education to stay abreast of the constant
changes in therapy for infectious diseases.
B. Become familiar with resources available in the community for patients with chronic illness
and learn how to incorporate them into the treatment plan when needed.
C. Gain awareness of one’s own attitudes towards sexuality, intravenous drug abuse,
communicable diseases and death.
D. Demonstrate integrity, honesty, respect and a commitment to excellence in all activities.
E. Demonstrate sensitivity, respect and adapt appropriately to the social and cultural issues of
each patient.
F. Display initiative and resourcefulness in patient care and in solving problems.
G. Be timely in attendance of activities and completion of tasks.
H. Demonstrate respect, compassion, and integrity; a responsiveness to the needs of patients
and society that supersedes self-interest; accountability to patients, society, and the
profession; and a commitment to excellence and on-going professional development.
I. Demonstrate a commitment to ethical principles pertaining to provision or withholding of
clinical care, confidentiality of patient information, informed consent, and business practices.
J. Arrive at the rotation in a timely fashion.
K. Work effectively as a member of a team.
L. Respect patient privacy by guarding medical records and discussion of personal information
about patients.
M. Assist patients and their families in planning for future care needs and care decisions based
on prognosis for the disease.
N. Support the patient in their healthcare decisions.
O. Demonstrate professional, respectful demeanor when addressing team members, patients,
ancillary staff, and consultants.
P. Appear professionally dressed and well groomed.
Q. Completes clinic notes in a timely fashion.
R. Attends required conferences.
Learning Activities
Attending Rounds
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty Conference
Morning Report
X
Didactics
Other
Evaluation Methods
X
Attending Evaluation
X
Program Director
Review
360 ᵒ evaluation
Other
X
X
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
Faculty Supervision
Procedures
X
X
X
X
Directly Supervised Procedures
In-Training Exam
X
Videotape Review
X
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Morning Report
Faculty Supervision
and Feedback
Quarterly Review
Practice-based Learning and Improvement
Goal: The resident should develop skills in evaluating their own patient care, appraising and assimilation
of scientific evidence to improve patient care.
Last Updated April 19, 2013
Objectives:
A. Analyze practice experience and perform practice-based improvement activities using a
systematic methodology.
B. Locate, appraise, and assimilate evidence from scientific studies related to their patients'
health problems.
C. Obtain and use information about their own population of patients and the larger population
from which their patients are drawn.
D. Apply knowledge of study designs and statistical methods to the appraisal of clinical studies
and other information on diagnostic and therapeutic effectiveness.
E. Use information technology to manage information, access on-line medical information; and
support their own education.
F. Learn to incorporate health promotion and disease prevention into patient care.
G. Use evidence-based medicine, evaluation of available evidence, and use of best-available
evidence at morning report meetings and during routine clinical care.
Learning Activities
Attending Rounds
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty Conference
Morning Report
X
Didactics
Other
Evaluation Methods
X
Attending Evaluation
X
Program Director
Review
360 ᵒ evaluation
Other
III.
X
X
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
Faculty Supervision
Procedures
X
X
X
X
Directly Supervised Procedures
In-Training Exam
X
Videotape Review
X
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Morning Report
Faculty Supervision
and Feedback
Quarterly Review
Instructional Strategies (see above)
This curriculum has three instructional arms:
A. There is a four week rotation that takes place at the private practice of Al Lopez, M.D.
1730 Montreal Road, Suite 130, Tucker, GA 30084
6916 McGinnis Ferry Road, Ste. 100, Suwanee, GA 30024
(770) 939-1601 ofc
(770) 270-1711 fax
B.
During the rotation the resident will actively participate in the management of patients
under his direct supervision.
C. There is a longitudinal experience that occurs in the inpatient setting.
D. There is an outpatient experience which occurs during the resident’s continuity clinics.
Readings can be obtained from section VI and should also be solicited from the supervising
attending physicians.
Last Updated April 19, 2013
IV.
Evaluation Strategies (see above)
A.
B.
C.
D.
E.
V.
Observation of the resident by Dr. Lopez.
Review of resident’s clinic notes and discussion of the assessment and plan.
Procedure documentation by the resident.
End of rotation evaluation.
Monograph quizzes – take the two quizzes and score > 90% (open book).
Implementation Methods
The rotation is an outpatient elective. However, part of the longitudinal experience will be gained
during night call and hospital admissions. The resident is expected to spend five half days per
week at the rotation site. Four half days will be spent in continuity clinic and one half day in
didactics.
Rotation
Morning
Afternoon
VI.
Monday
ID Clinic
ID Clinic
Tuesday
FM Clinic
FM Clinic
Wednesday
ID Clinic
ID Clinic
Thursday
Didactics
ID Clinic
Friday
FM Clinic
FM Clinic
Required Readings
AFP Monograph #296
AFP Monograph #303
Infectious Diseases
Travel Medicine
Suggested Readings
CNS
Norris C, Danis P, Gardner T. Aseptic Meningitis in the Newborn and Young Infant. Am Fam Physician
1999:May 15:2761.
Tunkel AR, Sheld WM. Issues in the Management of Bacterial Meningitis. Am Fam Physician 1997;56(5).
Attia J, et al. Does this adult patient have acute meningitis? JAMA July 14, 1999;282:175-81.
ENT
Sander, R. Otitis Externa: A Practical Guide to Treatment and Prevention. Am Fam Physician 2001:March
1.
Semchenko A, Baroody F, Culpepper L. Management of Acute Sinusitis and Acute Otitis Media. American
Family Physician Monograph 2001:1.
Fagnan, LJ. Acute Sinusitis: A Cost-Effective Approach to Diagnosis and Treatment. Am Fam Physician
1998:Nov 15.
Dowell SF, Schwartz B, Phillips WR. Appropriate use of antibiotics for URI's in children: part 1. Otitis
media and acute sinusitis. Am Fam Physician 1998;58:1113-8,1123.
Culpepper L, Froom J. Routine antimicrobial treatment of acute otitis media: is it necessary? JAMA
1997;278:1643-5.
Last Updated April 19, 2013
Froom J. Culpepper L, Jacobs M, DeMelker RA, Green LA, van Buchem L, et al. Antimicrobials for acute
otitis media? A review from the International Primary Care Network. BMJ 1997;315:98-102.
Glasziou PP, Hayem M, Del Mar CB. Antibiotic versus placebo for acute otitis media in children (Cochrane
Review). In: The Cochrane Library, Issue 1, 1999.
Del Mar C, Gasziou P, Hayem M. Are antibiotics indicated for children with acute otitis media? A metaanalysis. BMJ 1997;314:1526-9.
Kozyrskyj AL, Hildres-Ripstein GE, Longstaffe SE, Wincott JL, Sitar DS, Klassen TP, Moffatt ME. Treatment
of acute otitis media with a shortened course of antibiotics: a meta-analysis. JAMA June 3,
1998;279:1736-42.
Pulmonary
Birkebaek NH, et al. Bordetella pertussis and chronic cough in adults. Clin Infect Dis November 1999;
29:1239-42.
Identification and Management of Tuberculosis. Am Fam Physician 2000;May 1:2667-2681.
Tuberculosis morbidity--United States, 1997. MMWR Morb Mortal Wkly Rep 1998;47:253-6.
Screening for tuberculosis and tuberculosis infection in high-risk populations. Recommendations of the
Advisory Council for the Elimination of Tuberculosis. MMWR Morb Mortal Wkly Rep 1995; 44:19-34.
TB care guide: highlights from Core Curriculum on Tuberculosis. Atlanta: U.S. Dept. of Health and Human
Services, Public Health Services, Centers for Disease Control and Prevention, National Center for
Prevention Services, Division of Tuberculosis Elimination, 1994:19-26.
Treating Acute Exacerbations of Chronic Bronchitis, Hospital Practice 2000:Nov 15.
Community-Acquired Pneumonia in Adults: Initial Antibiotic Therapy. Am Fam Physician 1997:56(2);544.
Pneumocystis carinii Pneumonia: A Clinical Review. Am Fam Physician 1999:Oct 15;1699-1713.
Cardiovascular
Giessel BE, Koenig CJ, Blake RL. Management of Bacterial Endocarditis. Am Fam Physician
2000;61:1725-32,1739.
Taubert KA, Dajani AS. Preventing Bacterial Endocarditis: American Heart Association Guidelines. Am
Fam Physician 1998:Feb 1.
Gastrointestinal
Rothrock SG, Pagane J. Acute appendicitis in children: emergency department diagnosis and
management. Ann Emerg Med July 2001;36:39-51.
Hardin, DM. Acute Appendicitis: Review and Update. Am Fam Physician 1999;60:2027-34.
Ahmed A, Keeffe EB. Cost-effective evaluation of acute viral hepatitis. West J Med January 2000;172:2932.
Moyer LA, Mast EE, Alter MJ. Hepatitis C: Part I. Routine Serologic Testing and Diagnosis. Am Fam
Physician 1999:Jan 1.
Last Updated April 19, 2013
Moyer LA, Mast EE, Alter MJ. Hepatitis C: Part II. Prevention Counseling and Medical Evaluation. Am
Fam Physician 1999:Jan 15.
Eliason BC, Lewan RB. Gastroenteritis in Children: Principles of Diagnosis and Treatment. Am Fam
Physician 1998:Nov 15.
Ahmad M, et al. Differential diagnosis of gallstone-induced complications. South Med J March
2000;93:261-4.
Burkhart, DM. Management of Acute Gastroenteritis in Children. . Am Fam Physician 1999:Dec.
Guerrant RL, Van Gilder T, Steiner TS, Theilman NM, Slutsker L, Tauxe RV, et al. Practice guidelines for
the management of infectious diarrhea. Clin Infect Dis 2001;32:334.
de Bruyn G. Infectious disease: diarrhea. West J Med June 2000;172:409-12.
Herbert ME. Medical myths. Measuring white blood cells in the stools is useful in the management of
acute diarrhea. West J Med June 2000; 172:414.
Musculoskeletal
Kocher MS, et al. Differentiating between septic arthritis and transient synovitis of the hip in children: an
evidence-based clinical prediction algorithm. J Bone Joint Surg December 1999;81A:1662-70.
Newton PO, et al. Oral antibiotic therapy of bacterial arthritis. Pediatr Infect Dis J December
1999;18:1102-3.
Kallio MJ, et al. Serum C-reactive protein, erythrocyte sedimentation rate and white blood cell count in
septic arthritis of children. Pediatr Infect Dis J 1997;16:411-2.
Wall DB, et al. A simple model to help distinguish necrotizing fasciitis from nonnecrotizing soft tissue
infection. J Am Coll Surg September 2000;191:227-31.
Carek PJ, et al. Diagnosis and Management of Osteomyelitis. Am Fam Physician 2001;63:2413-20.
STDs
Update on the Prevention and Treatment of Sexually Transmitted Diseases - January 15,
2000 - American Academy of Family Physicians
http://www.aafp.org/afp/20000115/379.html 01/15/00,
Drug Treatment of Common STDs: Part II. Vaginal Infections, Pelvic Inflammatory Disease
and Genital Warts - October 15, 1999 - American Academy of Family Physicians
http://www.aafp.org/afp/991015ap/1716.html 11/17/00
Management of Female Sexual Assault - September 15, 1998 - American Academy of Family
Physicians http://www.aafp.org/afp/980915ap/petter.html 11/17/00
Drug Treatment of Common STDs: Part I. Herpes, Syphilis, Urethritis, Chlamydia and
Gonorrhea - October 1, 1999 - American Academy of Family Physicians
http://www.aafp.org/afp/991001ap/1387.html 10/01/99,
Last Updated April 19, 2013
Genitourinary
Urinary Tract Infections in Adults - March 1, 1999 - American Academy of Family Physicians
http://www.aafp.org/afp/990301ap/1225.html 11/17/00,
Antimicrobial Therapy and Acute Pyelonephritis - September 15, 2000 - American Academy
of Family Physicians http://www.aafp.org/afp/20000915/tips/2.html 09/19/00,
The Woman with Dysuria - May 1, 1998 - American Academy of Family Physicians
http://www.aafp.org/afp/980501ap/kurowski.html 11/16/00,
Treatment of Prostatitis - May 15, 2000 - American Academy of Family Physicians
http://www.aafp.org/afp/20000515/3015.html 07/02/01,
Prostatitis: What It Is, How to Cure It - May 15, 2000 - American Academy of Family
Physicians http://www.aafp.org/afp/20000515/3025ph.html 07/13/00,
Health Issues in Men: Part I. Common Genitourinary Disorders - June 15, 2000 - American
Academy of Family Physicians http://www.aafp.org/afp/20000615/3657.html 07/06/00,
Skin Infections
Skin and Wound Infections: An Overview - May 15, 1998 - American Academy of Family
Physicians http://www.aafp.org/afp/980515ap/odell.html 11/16/00,
Diagnosis and Management of Common Tinea Infections - July 1998 - American Academy of
Family Physicians http://www.aafp.org/afp/980700ap/noble.html 11/16/00,
AAFP Recommended Book List For Selected Topics:
AIDS & SEXUALLY TRANSMITTED DISEASES
1999 USPHS/IDSA Guidelines for the Prevention of Opportunistic Infections in Persons Infected with
HIV: Part II. Prevention of the First Episode of Disease. U.S. DEPARTMENT OF HEALTH AND HUMAN
SERVICES, PUBLIC HEALTH SERVICE CENTERS FOR DISEASE CONTROL AND PREVENTION. Am Fam
Physician 2000:Jan 15.
DeVita, Vincent T., Jr., et al., eds. AIDS: Etiology, Diagnosis, Treatment, and Prevention. 4th ed.
Philadelphia: Lippincott-Raven, 1997.
Holmes, King K. et al., eds. Sexually Transmitted Diseases. 3d ed. New York: McGraw-Hill, 1999.
Masci, Joseph R. Outpatient Management of HIV Infection. 2nd ed. St. Louis: Mosby, 1996.
Sande, Merle A., and Volberding, Paul A., eds. The Medical Management of AIDS. 6th ed.
Philadelphia: Saunders, 1999.
INFECTIOUS DISEASES
Benenson, Abram S., ed. Control of Communicable Diseases: An Official Report of the American
Public Health Association. 16th ed. Washington, DC: American Public Health Association, 1995.
Bennett, John V., and Brachman, Philip S., eds. Hospital Infections, 4th ed. Philadelphia:
Lippincott, Williams & Wilkins, 1998.
Mandell, Gerald L. et al., eds. Mandell, Douglas and Bennett's Principles and Practice of Infectious
Diseases. 5th ed. New York: Churchill Livingstone, 2000.
Remington, Jack S., and Klein, Jerome O., eds. Infectious Diseases of the Fetus & Newborn
Infant. 5th ed. Philadelphia: Saunders, 2000.
Last Updated April 19, 2013
Schlager, Seymour I. Clinical Management of Infectious Diseases: A Guide to Diagnosis and
Therapy. Philadelphia: Lippincott Williams & Wilkins, 1998.
MICROBIOLOGY
Brooks, George F. et al., eds. Jawetz, Melnick & Adelberg's Medical Microbiology. 21st ed.
Stamford, CT: Appleton & Lange, 1998.
Isenberg, Henry D., ed. Essential Procedures for Clinical Microbiology. Washington, D.C., ASM
Press, 1998.
Murray, Patrick R. et al., eds. Manual of Clinical Microbiology. 7th ed. Washington, DC: American
Society for Microbiology, 1999.
Last Updated April 19, 2013