Murli Purswani, M.D.
Stefan Hagmann, M.D.
GOALS & OBJECTIVES
The overall goal of the Division of Pediatric Infectious Diseases
in training Pediatric Residents is to prepare these future pediatricians to
approach the evaluation and management of most important infections in
infants, children and adolescents with confidence, accuracy, compassion, and
efficiency. This goal will be achieved by didactic teaching of a core
curriculum, formal and informal interactions in a clinical setting between
members of the Infectious Diseases Division and house staff regarding
individual patients seen by the I.D. service, and ideally, more formal
direct clinical training on the clinical Infectious Diseases elective. A
resident who has completed the Pediatrics training program, in addition to
developing a strong familiarity with the more common infections of childhood
(e.g., uncomplicated upper respiratory viral illnesses, viral exanthematous
diseases, simple lower urinary tract infections, acute gastroenteritis)
should have achieved the additional objectives outlined below.
The resident should develop a fundamental base of knowledge regarding the
age-related etiology, epidemiology, pathogenesis, pathophysiology, natural
history, and prognosis and sequelae of important infectious diseases of each
of the major organ systems, including the central nervous system, upper and
lower respiratory tract, heart and vessels, liver and gastrointestinal tract
(including the gallbladder and pancreas), genitourinary tract,
musculoskeletal system, reticuloendothelial system (lymph nodes, spleen,
liver, bone marrow, etc.), and skin. This should also include basic
knowledge regarding likely causes of infections that often produce
multisystem disease, including septicemia, and disseminated viral and
mycoplasmal infections.
The resident should develop an appreciation for the clinical presentations
and the approach to the evaluation of patients who may have non-infectious
conditions of obscure origin (including "fever of unknown origin") in which
infectious diseases figure prominently in the differential diagnosis. These
may include such categories of disease as rheumatologic and related
disorders (including SLE, JRA, Crohn's disease, ulcerative colitis, Kawasaki
disease, Behcet's disease); other immunologically-mediated processes, such
as serum sickness, erythema multiforme/Stevens-Johnson syndrome, and similar
reactive process whether in response to drugs or infectious agents; and
malignancies or malignancy-like disorders, including lymphoma, leukemia, and
histiocytosis and related erythrophagocytic syndromes.
The resident should become familiar with all of the major classes of
antimicrobial agents used in pediatric patients with respect to their
antimicrobial spectrum, mechanisms of action, pharmacokinetics, appropriate
clinical usage, adverse effects, and patterns and mechanisms of microbial
resistance.
The resident should develop a working knowledge of the clinical
microbiology laboratory as it relates to the diagnosis of bacterial, fungal,
viral , and parasitic diseases, as well as the basics of serodiagnosis of
infectious diseases. This includes the judicious choice of laboratory
studies, appropriate acquisition and proper handling of clinical specimens,
interpretation of serologic or microbiologic data, including
susceptibility testing, familiarity with rapid diagnostic techniques and
molecular diagnostic modalities.
The resident should develop a strong appreciation for the importance
of considering the nature of the individual host in formulating clinical
assessments. Factors such as age, immunologic status, and the presence of
underlying conditions may be critical factors in the evaluation of patients
with infectious diseases, and this concept will be stressed.
The resident's skills in managing patients with infectious diseases should
include the ability to recognize situations in which the patient's immediate
clinical status or, at times, even the reasonable possibility of certain
infections warrants immediate intervention or an empiric and aggressive
approach to management because of the potential adverse consequences of
failing to do so. Examples would include understanding the presumptive need
to treat possible sepsis in the newborn infant, the ability to recognize the
early manifestations of septic shock and institute appropriate therapeutic
measures, understanding the importance of antibiotic therapy for febrile
children who are neutropenic due to cancer chemotherapy, treating newborn
infants with disease consistent with herpes simplex virus infection,
recognizing and treating meningococcemia, understanding the relatively low
threshold for performing lumbar puncture in a young infant because of the
difficulties often associated with the clinical diagnosis of meningitis in
such patients .
The resident on the clinical elective in Pediatric Infectious Diseases
will gain experience in the consultative practice of the subspecialty and
will expand and solidify her/his base of knowledge in this area. Pediatric
patients who require Infectious Diseases consultation will be seen by the
resident who will record a careful and complete, but focused, history and
physical exam, summarize relevant laboratory data, and formulate a working
differential diagnosis and provisional recommendations for further
evaluation and management, including rationale and citations from the
relevant literature where appropriate. Patients will be presented to the
I.D. attending on daily rounds, when the resident should be prepared to
discuss the case in detail and defend the differential diagnosis and
management recommendations. This approach to the resident's involvement
should optimize his/her role as a member of the I.D. team and promote a
continued pattern of self-learning.
Immunodeficiency
Understand the role of the general pediatrician in the assessment and
management of patients with immunodeficiency.
Prevention, Counseling and Screening
Understand the role of the pediatrician in preventing infectious diseases,
and in counseling and screening individuals at risk for these diseases.
Normal Versus Abnormal
Differentiate between normal and pathologic states related to infectious
disease
Undifferentiated Signs and Symptoms
Evaluate, treat, and/or refer patients with presenting signs and symptoms
that may indicate an infectious disease process.
Human Immunodeficiency Virus (HIV)
Recognize, screen for, refer, and co-manage patients with HIV
Use of Antibiotics
Use antibiotics appropriately in managing infections in children
Immunizations
Use vaccines to prevent common childhood diseases
Infection Control
Understand principles of infection control in pediatric care settings
Laboratory Procedures (Infectious Disease)
Understand the laboratory methods used in pediatrics relating to the
diagnosis and management of infectious diseases in children
BRONX-LEBANON HOSPITAL CENTER
