A day in the life of an infectious disease (ID) specialist

It is summer

At the morning report the following patient is discussed: A female patient (32) with high fever and
some abdominal discomfort only 2 days after giving birth (at home) is admitted in the gynecology
department. She delivered a healthy baby. The differential diagnosis of the gynecologist is
endometritis, pulmonary embolus, or else and we (the ID fellow and I) are going to the department
for a consultation. We do a complete history and examine the patient. She proved to be healthy until
delivery but she was on a short holiday only 1-2 weeks ago. The weather was beautiful. During that
holiday she swam in a small lake. This was extremely pleasant with her big belly. But the lake did not
appear very clean and she even saw some rats around. Her complaints started after delivery and they
were: fever, muscle pain in her legs and back and shivering. Physical examination was uneventful
except for reddish eyes (conjunctivitis?). Now the differential diagnosis became different. Even
leptospirosis or norovirus infection was considered and the empiric antibiotic approach was adapted
to this new insights.

Other consultations await our visit:

A male patient (35yr) with fever and high CRP and ESR (erythrocyte sedimentation rate) . The
patient is known with morbus Marfan and is in the cardiology department admitted with suspicion of
infection of the prosthesis of the thoracic aorta. A multidisciplinary meeting with cardiologists and
thoracic surgeons is initiated.

In our own ward we visit one of our own new HIV patients with very low CD4 count and pulmonary
infection suspected for Pneumocystic jeroveci pneumonia ( PjP ).

After this we go to the Intensive Care multidisciplinary meeting about the patiënts in the ICU

In the afternoon we have a meeting with the microbiologists in the microbiology dept about all the
cultures and patients involved.

After this we see many patients in the outpatient department. Among others there is a patient with
recurrent erysipelas or cellulitis. We advise long acting penicillin injections every 3 weeks. And we
make an appointment to discuss whether this did work for her.

Other patients come for travel advice. These are immune compromised patients that might need or
cannot have specific vaccinations. Also they might need special advice about what to avoid in tropical
countries.

These are only some patients (and meetings) that you could encounter during the day in the life of
an ID specialist