Dermatology News

“Typhus is not dead. It will live on for centuries and it will continue to break into the open whenever human stupidity and brutality give it a chance, as most likely they occasionally will.” – Hans Zinsser. The lure of infectious disease began with books (science fiction, noir detectives, Arrowsmith), but the hook was sex and drugs. While debating a life in philosophy or neuroscience (but for the slaughter of mice), I stumbled into volunteering at the Berkeley Free Clinic. Mentored by charismatics at the radical front of free health care and harm reduction with dignity, these teachers had weathered the Vietnam War, AIDS crisis and multiple injection-drug epidemics. To keep up and care for clients, I had to understand not only chlamydia, abscesses and hepatitis C, but also feminism, gay liberation, sex work, homelessness and criminal justice. The infections were a window into the vulnerabilities of our social immune system. At the University of California, San Francisco, my ID teachers varied widely in appearance and constitution, as well as where they would return after rounds: the laboratories, the clinics, phone meetings with WHO, the city’s public health department and the one attending who would stop by the freeway underpass to sit with one of her struggling patients. ID was the hopeful work of hopelessly tangled systems: global commerce and immunoglobulins; gender, power and negotiating condoms; heroin, the hospital venting systems and where the water flows. My ID mentors and colleagues continue to inspire and surprise me with endless curiosity, rigorous intellectual integrity and ferocious passion for doing the right thing. Typhus is not dead, nor are MRSA, HIV, or human brutality. I am grateful to be an ID physician who can draw on a rich history and community to push against these with vigor and compassion, immersed in the ambitious life’s work of sex, drugs and microbes.

As a fourth-year medical student at the University of South Florida College of Medicine, I did an elective rotation with Dr. John Greene at Moffitt Cancer Center. I was awestruck as I saw the fellows and Dr. Greene make incredible diagnoses based on details from the patients’ histories. We conversed with radiologists, pathologists, other internal medicine subspecialists and surgeons; a constant busy mission to determine what kind of infections patients had. Their knowledge was superior, having to understand different cultures, practices and hobbies that could lead to the diagnosis. I witnessed the way that the infectious disease physicians conversed with others; their pleasant demeanor toward patients and staff was infectious. Most compelling of all was the microbiology lab, where you came face to face with your patients’ foes: Staphylococcus, Acinetobacter, Fusarium, Cryptosporidium, etc. This to me was the defining moment: looking into the viewing ocular pieces of the microscope to view something that was a millionth our size and had the potential to cause incredible pathologic havoc. This experience, which I also had during my internal medicine residency, is what led me to my interest in host-pathogen responses and to choose a career in infectious diseases.

Xellia Pharmaceuticals announced that the FDA has approved its premixed vancomycin injection in a ready-to-use bag.

The incidence of invasive group B Streptococcus rose among nonpregnant adults between 2008 and 2016, particularly among those with obesity and diabetes, according to a study published in JAMA Internal Medicine.

Argentum Medical announced that it has been awarded a 3-year, $8.4 million contract with the Biomedical Advanced Research and Developmental Authority, or BARDA, to repurpose its commercial Silverlon technology for skin injuries occurring during radiological and nuclear emergencies.

I followed a somewhat circuitous route to a career in ID. In medical school and residency, I was strongly drawn to oncology but got a bit distracted by also falling in love with viruses, especially retroviruses. I worked in research virology labs all through college and medical school, and as retroviruses were considered as potentially causing common cancers in humans, that research was typically found not in ID but rather in oncology divisions. I came to UCSF in 1978 for my oncology fellowship and to work in Jay Levy’s retrovirus lab. But when an ID giant, Merle Sande, offered me the chance to start a medical oncology division at San Francisco General Hospital immediately following the end of my training, I eagerly accepted. I left retrovirus research forever, only to walk into the very beginning of the AIDS epidemic on July 1,st 1981, when I saw the first Kaposi sarcoma KSpatient admitted to SFGH. I started the world’s first comprehensive AIDS clinic with Connie Wofsy, my ID counterpart in 1983 and when HIV was discovered (in part by Jay), I realized I might get back to my favorite viruses! While I still feel as if part of me is in oncology, my community is clearly ID! Definitely hooked on ID!

Modern medicine may face dangerous setbacks if the antimicrobial market does not see a positive shift soon, experts agree.

Antibiotic prescribing by dermatologists has “substantially decreased” in recent years, mostly due to a drop in prescriptions for acne and rosacea, but they are prescribing more antibiotic courses following surgical visits, a practice that should be evaluated, researchers said.

The authors of a new MMWR report on a wound botulism outbreak in San Diego County that was associated with injection heroin use — primarily “skin popping” black tar heroin — said patients’ symptoms were often mistaken for drug intoxication, and one patient died after going a week without proper treatment.

Clinicians can more accurately identify children with cellulitis who need IV antibiotic administration using a score that includes the child’s systemic features, swelling, eye involvement, tenderness, and whether the condition affects 1% or more of the child’s body, according to research published in Pediatrics.