Join Callum and Jame, two infectious diseases doctors, as they discuss everything you need to know to diagnose and treat infections. Aimed at doctors and clinical staff working in the UK.
Lyme serology can be negative in early erythema migrans and remain positive long after infection. The discussion covers two-tier testing, cerebrospinal fluid investigations for neuroborreliosis, antibiotic selection and the assessment of persistent symptoms without unnecessary retreatment.
Lyme disease may present with an expanding rash, painful radiculitis, facial palsy, fluctuating heart block or large-joint swelling. Neither a remembered tick bite nor a bull's-eye rash is required, and late manifestations can follow exposure many months earlier.
Rat-bite fever can follow bites, scratches, urine exposure or contaminated food and drink. Incubation, rash, joint symptoms and bite-site changes help distinguish Streptobacillus moniliformis from Spirillum minus, while laboratory approaches differ between the organisms.
Bacterial vaginosis reflects a polymicrobial shift rather than Gardnerella infection alone, so diagnosis should not rest on a positive molecular test; Amsel criteria, symptom pattern, treatment options and partner-treatment evidence provide a more useful clinical framework.
Antibiotic target attainment depends on the dominant pharmacodynamic index: time above minimum inhibitory concentration for beta-lactams, peak exposure for aminoglycosides and total exposure for vancomycin. Dose timing, infusion duration, renal clearance and tissue penetration can matter as much as dose size.
Oral step-down therapy may replace prolonged intravenous treatment in carefully selected infective endocarditis when the organism, susceptibility, source control and regimen are suitable. Multidisciplinary review and highly bioavailable agents remain central to safe implementation.
Infectious-diseases, general-practice and medical-education clinicians get a structured antimicrobial-prescribing framework. Likely pathogen, culture data, local resistance, allergy, organ function, pregnancy, route, tissue penetration, adverse effects and stewardship are brought together before choosing or narrowing treatment.
.svg)