General Infectious Disease Learning Objectives

Author: Andrew Kitcher

Editor: Lauren Peccoralo, MD

Educational Rationale

A majority of the patients admitted to the general medical service, the specialty services including A4, Popper and Wasserman, and to the MICU have infection either on presentation or as a complication of their primary presenting disease.  General internists should be very familiar with the most common infections seen at the hospital, as well as able to recognize a wide variety of illnesses based on clinical presentation, the physical exam, laboratory and imaging studies.  

I. General Learning Objectives

By the end of a three-year residency in Internal Medicine, all housestaff should be able to:

A. Clinical Skills:

1. Take a detailed history and perform a physical exam with focus on infectious diseases

2. Ask about specific infectious signs, including fever, chills, weight loss, productive cough, diarrhea, urinary symptoms, skin changes and meningeal signs.

3. Take a detailed sexual and social history, and ask about other risks, such as travel and sick contacts.

4. Examine the oropharynx, perform meningeal maneuvers, palpate lymphadenopathy and characterize skin lesions.

B. Interpersonal Skills

1. Relay information to consultants regarding risks and baseline immunological status.

2. Always relaying the latest CD4 count and viral load in HIV + patients

3. Knowing the hospital course, antibiotic and immunosuppresive history, as well as

infectious signs and fever curve of a patient when consulting an infectious disease specialist.

4. Keep documented record in signouts, daily notes and discharge/transfer summaries

the antibiotic history, fever and WBC curve, and clinical course of a hospitalized patient.

C. Procedural Skills

1. Perform a lumbar puncture on uncomplicated patients with normal anatomy:

http://content.nejm.org/cgi/video/355/13/e12/

*Intern Focused Topics

II. Medical Knowledge Learning Objectives

By the end of a three-year residency in Internal Medicine, all housestaff should be able to:

A. *Pneumonia
1. Recognize pneumonia on a chest Xray.

2. Describe the most comon organisms causing pneumonia in adults, the elderly, and in at-risk groups such as HIV patients and ventilated patients.

3. Understand the difference between CAP, HCAP, HAP and VAPs, and initiate treatment based on the likely pathogens.

4. Readings:
a. Associations between initial antimicrobial therapy and medical outcomes for

hospitalized elderly patients with pneumonia. Arch Intern Med 159:2562-72 1999.  

http://eresources.library.mssm.edu:2217/cgi/content/full/159/21/2562

b. A prediction rule to identify low-risk patients with community-acquired

pneumonia. N Engl J Med 336:243-50 1997.

http://eresources.library.mssm.edu:2368/cgi/content/abstract/336/4/243
c. Halm, Teirstein.  Management of Community-Acquired Pneumonia.  NEJM

347: 2039-2045, 2002      

http://eresources.library.mssm.edu:2368/cgi/content/extract/347/25/2039

d. Scheduled change of antibiotic classes: a strategy to decrease the incidence of

ventilator-associated pneumonia. Am J Respir Crit Care Med 156:1040-8 1997.

http://eresources.library.mssm.edu:2192/cgi/content/full/156/4/1040

B. *Sepsis/SIRS
1. Characterize a patient as SIRS/sepsis/severe sepsis/septic shock based on the

DREAM protocol

2. Initiate treatment with appropriate fluid resuscitation, antibiotics, steroids and

pressors as needed, depending on the clinical situation.

3. Know which markers to follow to determine clinical improvement or deterioration.

4. Readings:
a. APACHE II: a severity of disease classification system. Crit Care Med

13:818-29 1985.       

http://eresources.library.mssm.edu:8537/spa/ovidweb.cgi?WebLinkFrameset=1&S=ANFFFPLBFCDDIMJENCFLPCPJFLPMAA00&returnUrl=http%3a%2f%2fovidsp.tx.ovid.com%2fspa%2fovidweb.cgi%3fMain%2bSearch%2bPage%3d1%26S%3dANFFFPLBFCDDIMJENCFLPCPJFLPMAA00&directlink=http%3a%2f%2fgraphics.tx.ovid.com%2fovftpdfs%2fFPDDNCPJPCJEFC00%2ffs046%2fovft%2flive%2fgv023%2f00003246%2f00003246-198510000-00009.pdf&filename=APACHE+II%3a+A+severity+of+disease+classification+system.
b. Early goal-directed therapy in the treatment of severe sepsis and septic shock.

N Engl J Med 345:1368-77 2001. 

http://eresources.library.mssm.edu:2368/cgi/content/abstract/345/19/1368

c. A multicenter, randomized, controlled clinical trial of transfusion

requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med 340:409-17 1999.
http://eresources.library.mssm.edu:2368/cgi/content/abstract/340/6/409

d. Effect of treatment with low doses of hydrocortisone and fludrocortisone on

mortality in patients with septic shock. JAMA 288:862-71 2002.

http://eresources.library.mssm.edu:2213/cgi/content/full/288/7/862

e. Efficacy and safety of recombinant human activated protein C for severe

sepsis. N Engl J Med 344:699-709 2001.

http://eresources.library.mssm.edu:2368/cgi/content/abstract/344/10/699

C. *Osteomyelitis
1. Recognize risk factors and the physical findings concerning for osteomyelitis, as well

as the radiographic studies to order.

2. Treat osteomyelitis with extended antibiotic courses depending on risk factors and

isolates.
3. Readings:

a. Kapoor, A, Page, S, Lavalley, M, et al. Magnetic resonance imaging for

diagnosing foot osteomyelitis: a meta-analysis. Arch Intern Med 2007; 167:125.

http://eresources.library.mssm.edu:2217/cgi/content/full/167/2/125

b. Gentry, LO, Rodriguez-Gomez, G, Ofloxacin versus parenteral therapy for

chronic osteomielitis. Antimicrob Agents Chemother 1991; 35:538.

http://eresources.library.mssm.edu:2200/cgi/reprint/35/3/538?view=long&p mid=2039205

c. Chen, CE, Ko, JY, Fu, TH, Wang, CJ. Results of chronic osteomyelitis of the

femur treated with hyperbaric oxygen: a preliminary report. Chang Gung Med J2004; 27:91.

D. *Line Infections

1. Identify signs and symptoms of line infections

2. Know the indications for line removal and replacement, the likely organisms, and the

indications for TEE.

3. Readings:

a. Durack, DT, Lukes, AS, Bright, DK. New criteria for diagnosis of infective

endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. Am J Med 1994; 96:200.  http://eresources.library.mssm.edu:2968/?sid=Entrez:PubMed&id=pmid:8154507

b. Shively, BK, Gurule, FT, Roldan, CA, et al. Diagnostic value of

transesophageal compared with transthoracic echocardiography in infective endocarditis. J Am Coll Cardiol 1991; 18:391.

http://eresources.library.mssm.edu:2968/?sid=Entrez:PubMed&id=pmid:1856406

c. Petti, CA, Bhally, HS, Weinstein, MP, et al. Utility of extended blood culture

incubation for isolation of haemophilus, actinobacillus, cardiobacterium, eikenella, and kingella organisms: a retrospective multicenter evaluation. J Clin Microbiol 2006; 44:257            http://eresources.library.mssm.edu:2204/cgi/content/full/44/1/257?view=long&pmid=16390985

E. *C. Difficile
1. Recognize the signs/symptoms of C. diff and the risk factors for infection.
2. Discussthe utility of C. difficile antigen testing, the definition of treatment failure or "

resistant C. diff.

3. Treat resistant C. diff
4. Readings:
a. Pepin, J, Saheb, N, Coulombe, MA, et al. Emergence of fluoroquinolones as

the predominant risk factor for Clostridium difficile-associated diarrhea: a cohort study during an epidemic in Quebec. Clin Infect Dis 2005; 41:1254
http://eresources.library.mssm.edu:2284/doi/abs/10.1086/496986

b. Dial, S, Delaney, JA, Barkun, AN, Suissa, S. Use of gastric acid-suppressive

agents and the risk of community-acquired Clostridium difficile-associated disease. JAMA 2005; 294:2989.                      http://eresources.library.mssm.edu:2213/cgi/content/full/294/23/2989

c. Bettin, K, Clabots, C, Mathie, P, et al. Effectiveness of liquid soap vs.

chlorhexidine gluconate for the removal of Clostridium difficile from bare hands and gloved hands. Infect Control Hosp Epidemiol 1994; 15:697.            http://eresources.library.mssm.edu:2968/?sid=Entrez:PubMed&id=pmid:7852725

d. Zar, FA, Bakkanagari, SR, Moorthi, KM, Davis, MB. A comparison of

vancomycin and metronidazole for the treatment of Clostridium difficile-associated diarrhea, stratified by disease severity. Clin Infect Dis 2007; 45:302.   

http://eresources.library.mssm.edu:2284/doi/abs/10.1086/519265?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dncbi.nlm.nih.gov

F. *Urinary tract infections
1. Recognize the signs, symptoms and risk factors for urinary tract infections, inside and

outside the hospital

2. Distinguish between an uncomplicated urinary tract infection, pyelonephritis and

urosepsis, and manage the treatment of each.
3. Readings:
a. Jain, P, Parada, JP, David, A, et al. Overuse of the indwelling urinary tract

catheter in hospitalized medical patients. Arch Intern Med 1995; 155:1425
http://eresources.library.mssm.edu:2217/cgi/reprint/155/13/1425
b. Hooton, TM, Stamm, WE. Diagnosis and treatment of uncomplicated urinary

tract infection. Infect Dis Clin North Am 1997; 11:551.                      

http://eresources.library.mssm.edu:2125/das/article/body/143725865- 2/jorg=journal&source=&sp=9917659&sid=0/N/84667/1.html?issn=0891-5520

d. Johnson, JR, Kuskowski, MA, Wilt, TJ. Systematic review: antimicrobial

urinary catheters to prevent catheter-associated urinary tract infection in hospitalized patients. Ann Intern Med 2006; 144:116.            http://eresources.library.mssm.edu:2308/pqdweb?index=0&did=974775981&SrchMode=1&sid=1&Fmt=4&VInst=PROD&VType=PQD&RQT=309&VName=PQD&TS=1245179147&clientId=15325

G. Bacterial Meningitis
1. *Recognize the signs, symptoms and risk factors for bacterial meningitis.
2. *Perform a physical exam with emphasis on meningeal signs.
3. Be able to perform a lumbar puncture (and ideally an eye exam prior to LP) for

emergent management of meningitis.
4. Distinguish between LP profiles and initiate emergent treatment for bacterial

meningitis.
5. Readings:
a. Van de Beek D, de Gans J, Tunkel AR, Wijdicks EF.  Community-acquired

bacterial meningitis in adults.  N Engl J Med. 2006 Jan 5;354(1):44-53
http://eresources.library.mssm.edu:2368/cgi/content/extract/354/1/44
b. Scarborough, M, Gordon, SB, Whitty, CJ, et al. Corticosteroids for bacterial

meningitis in adults in Sub-Saharan Africa. N Engl J Med 2007; 357:2441.

http://eresources.library.mssm.edu:2368/cgi/content/abstract/357/24/2441
c. de Gans, J, van de Beek, D. Dexamethasone in adults with bacterial

meningitis. N Engl J Med 2002; 347:1549.

http://eresources.library.mssm.edu:2368/cgi/content/abstract/347/20/1549
d. van de Beek, D, de Gans, J, Spanjaard, L, et al. Clinical features and

prognostic factors in adults with bacterial meningitis. N Engl J Med 2004;

351:1849

http://eresources.library.mssm.edu:2368/cgi/content/abstract/351/18/1849

H. Tuberculosis
1. *Recognize signs, symptoms, and risk factors for active and latent tuberculosis.
2. *Interpret a PPD, and initiate screening and treatment.
3. Know the variants of triple therapy, and the side effects of treatment.
4. Recognize signs and symptoms for extrapulmonary TB.
5. Readings:
a. Van den Brande, PM, Van de Mierop, T, Verben, K, Demedts, M. Clinical

spectrum of endobronchial tuberculosis in elderly patients. Arch Intern Med

1990; 150:2105.

http://eresources.library.mssm.edu:2217/cgi/reprint/150/10/2105
b. Marciniuk, DD, McNab, BD, Martin, WT, Hoeppner, VH. Detection of

pulmonary tuberculosis in patients with a normal chest radiograph. Chest

1999; 115:445.

http://eresources.library.mssm.edu:2277/content/115/2/445.long
c. MK.Leonard Jr., E Kourbatova, HM. Blumberg .How many sputum

specimens are necessary to diagnose pulmonary tuberculosis?  American

Journal of Infection Control, Volume 34, Issue 5, June 2006, Pages 328-329. 
http://eresources.library.mssm.edu:2080/science?_ob=ArticleURL&_udi=B6W9M-4FC3626-J&_user=30742&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000000333&_version=1&_urlVersion=0&_userid=30742&md5=05bef8f03392023d2f688ba3f409dc4b

e. Small, PM, Fujiwara, PI. Management of tuberculosis in the United States. N Engl J Med 2001; 345:189.

http://eresources.library.mssm.edu:2368/cgi/content/extract/345/3/189
f. Chang, KC, Leung, CC, Yew, WW, et al. Dosing schedules of 6-month

regimens and relapse for pulmonary tuberculosis. Am J Respir Crit Care Med 2006; 174:1153.

http://eresources.library.mssm.edu:2192/cgi/content/full/174/10/1153
g. Weis, SE, Slocum, PC, Blais, FX, et al. The effect of directly observed

therapy on the rates of drug resistance and relapse in tuberculosis. N Engl J

Med 1994; 330:1179.
http://eresources.library.mssm.edu:2368/cgi/content/abstract/330/17/1179

I. *STDS
1. Distinguish between genitourinary lesions based on history and physical exam.

2. Recognize complications of sexually transmitted disease, including Reiter's

syndrome, secondary and tertiary syphilis, and gonococcal arthritis.

3. Initiate the different antibiotic treatments and the lengths of treatment for gonorrhea,

syphilis, chlamydia, genital warts and pubic parasites.

4. Discuss risk factors for blood-borne and sexually transmitted diseases, including

blood products, sexual transmission, shared needles and cocaine straw use.

5. Readings:

a. Sherrard, J et al.  Gonorrhoea in men: Clinical and diagnostic aspects. 

Genitouin Med 1996; 72:422. http://eresources.library.mssm.edu:2152/articlerender.fcgi?tool=pubmed&pubmedid=9038638

b. Workowski, KA, Berman, SM.  Sexually transmitted diseases treatment

guidelines, 2006.  MMWR Recommn Rep 2006; 55:1. http://eresources.library.mssm.edu:2309/mmwr/preview/mmwrhtml/rr5511a1.htm

c. Rice, PA. Gonococcal arthritis (desseminated gonococcal infection).  Infect

Dis Clin North Am 2005; 19:853. http://eresources.library.mssm.edu:2080/science?_ob=ArticleURL&_udi=B75J9-4HK6YR4-9&_user=30742&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000000333&_version=1&_urlVersion=0&_userid=30742&md5=f8706549126288e5f97ad7fc66a255d3

d. Hook, EW II, Marra, CM. Acquired syphilis in adults. NEJM 1992;326:1060.

http://eresources.library.mssm.edu:2968/?sid=Entrez:PubMed&id=pmid:1549153

e. Rihl et. al.  Infection and musculoskeletal conditions: Reactive arthritis.  Bes

Pract Res Clin Rheumatol 2006; 20:1119. http://eresources.library.mssm.edu:2080/science?_ob=ArticleURL&_udi=B6WBJ-4MDP7DT-8&_user=30742&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000000333&_version=1&_urlVersion=0&_userid=30742&md5=d63e7d8a57cb800da2209cbaf48e066e

f. Laasila et. al.  Antibiotic treatment and long-term prognosis of reactive

arthritis.  Ann Rheum Dis 2003; 62:655.

http://eresources.library.mssm.edu:7026/cgi/content/full/62/7/655

g. Kimberlin DW, Rouse DJ.  Clinical practice. Genital herpes.  N Engl J Med.

2004 May 6;350(19):1970-7.

http://eresources.library.mssm.edu:2368/cgi/content/extract/350/19/1970

h. Pathogen safety of plasma-derived products.  Haemophilia. 2008 Nov;14

Suppl 5:54-71 http://eresources.library.mssm.edu:2968/?sid=Entrez:PubMed&id=pmid:18786011

i. Burnouf, T.  Modern plasma fractionation.  Transfusion Med Rev 2007.

21(2): 101-117. http://eresources.library.mssm.edu:2080/science?_ob=ArticleURL&_udi=B75B5-4NC4KD6-6&_user=30742&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000000333&_version=1&_urlVersion=0&_userid=30742&md5=afb8208a93fa564f0a8b3a76927b8e8e

j. Estrada, AL.  Epidemiology of HIV/AIDS, hepatitis B, hepatitis C, and

tuberculosis among minority injection drug users.  Public Health Rep. 2002;117 Suppl 1:S126-34 http://eresources.library.mssm.edu:2152/articlerender.fcgi?tool=pubmed&pubmedid=12435836

k. Macias et. al.  High prevalence of hepatitis C virus infection among

noninjecting drug users: association with sharing the inhalation implements of crack.  Liver Int. 2008 Jul;28(6):781-6.

http://eresources.library.mssm.edu:2097/journal/120091233/abstract

J. *Vaccines
1. Discuss with patients the utility and indications of the influenza vaccine, including

distinguishing the subtypes of influenza targeted annually, and the antiviral

medications covering the subtypes.           

2. Discuss with patients the efficacy and indications of pnuemococcal vaccination.

3. Discuss with patients the indications and efficacy of HPV vaccination
4. Readings:
a. Effectiveness of pneumococcal polysaccharide vaccine in older adults. N

Engl J Med 348:1747-55 2003

http://eresources.library.mssm.edu:2368/cgi/content/abstract/348/18/1747
b. Glezen WP.  Clinical practice. Prevention and treatment of seasonal

influenza.  N Engl J Med. 2008 Dec 11;359(24):2579-85. 

http://eresources.library.mssm.edu:2368/cgi/content/extract/359/24/2579

d. Szmuness, W, Stevens, CE, Harley, EJ, et al. Hepatitis B vaccine:

Demonstration of efficacy in a controlled clinical trial in a high-risk population in the United States. N Engl J Med 1980; 303:833.
http://eresources.library.mssm.edu:2968/?sid=Entrez:PubMed&id=pmid:6997738

e. Lok, AS, McMahon, BJ. Chronic hepatitis B: update of recommendations.

Hepatology 2004; 39:857. 

http://eresources.library.mssm.edu:2097/journal/107630495/abstract
f. Cardell, K, Akerlind, B, Sallberg, M, Fryden, A. Excellent response rate to a

double dose of the combined hepatitis A and B vaccine in previous

nonresponders to hepatitis B vaccine. J Infect Dis 2008; 198:299.          http://eresources.library.mssm.edu:2284/doi/abs/10.1086/589722?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dncbi.nlm.nih.gov

g. Quadrivalent vaccine against human papillomavirus to prevent high-grade

cervical lesions. N Engl J Med 2007; 356:1915.

http://eresources.library.mssm.edu:2368/cgi/content/abstract/356/19/1915
h. Ault, KA. Effect of prophylactic human papillomavirus L1 virus-like-particle

vaccine on risk of cervical intraepithelial neoplasia grade 2, grade 3, and

adenocarcinoma in situ: a combined analysis of four randomised clinical

trials. Lancet 2007; 369:1861.
http://eresources.library.mssm.edu:2080/science?_ob=ArticleURL&_udi=B6T1B-4NVVDHV-12&_user=30742&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000000333&_version=1&_urlVersion=0&_userid=30742&md5=db1495df8b75b2b4f791bc601e1cb45d

K. Travel Medicine
1. *Recognize the key features of  bloody and non-bloody diarrheal illnesses, and intiate

treatment of each.
2. Recognize the characteristic rashes of rickettsial diseases, Lyme, etc, and initiate

antibiotic therapy.
3. Recognize the different types of gatrointestinal and extra-gastrointestinal parasitic

diseases, and the characteristic ova and parasite stool findings.
4. Recognize the classic fever curve of the different malarial illnesses, their findings on

blood smear, and the pattern of disease in hypnozooite-mediated disase.

5. Readings:
a. Clinical practice: Acute infectious diarrhea. N Engl J Med 350:38-47 2004
http://eresources.library.mssm.edu:2368/cgi/content/extract/350/1/38
b. Musher DM, Musher BL.  Contagious acute gastrointestinal infections.  N

Engl J Med. 2004 Dec 2;351(23):2417-27.
http://eresources.library.mssm.edu:2368/cgi/content/extract/351/23/2417

c. Steere AC.  Lyme disease.  N Engl J Med. 2001 Jul 12;345(2):115-25. 

http://eresources.library.mssm.edu:2368/cgi/content/extract/345/2/115
d. Spach DH, Liles WC, Campbell GL, Quick RE, Anderson DE Jr, Fritsche

TR.  Tick-borne diseases in the United States.  N Engl J Med. 1993 Sep

23;329(13):936-47. 

http://eresources.library.mssm.edu:2368/cgi/content/extract/329/13/936
e. Navin TR, Juranek DD.  Cryptosporidiosis: clinical, epidemiologic, and

parasitologic review.  Rev Infect Dis. 1984 May-Jun;6(3):313-27.           http://eresources.library.mssm.edu:2968/?sid=Entrez:PubMed&id=pmid:6377439

f. Haque R, Huston CD, Hughes M, Houpt E, Petri WA Jr.  Amebiasis.  N Engl

J Med. 2003 Apr 17;348(16):1565-73   http://eresources.library.mssm.edu:2368/cgi/content/extract/348/16/1565

g. Ross AG, Bartley PB, Sleigh AC, Olds GR, Li Y, Williams GM, McManus DP.  Schistosomiasis.  N Engl J Med. 2002 Apr 18;346(16):1212-20. 

http://eresources.library.mssm.edu:2368/cgi/content/extract/346/16/1212

h. Liu LX, Weller PF.  Antiparasitic drugs.  N Engl J Med. 1996 May 2;334(18):1178-84. 

http://eresources.library.mssm.edu:2368/cgi/content/extract/334/18/1178
i. White NJ.  The treatment of malaria.  N Engl J Med. 1996 Sep 12;335:800.    

http://eresources.library.mssm.edu:2368/cgi/content/extract/335/11/800
j. Krogstad DJ, Schlesinger PH.  Acid-vesicle function, intracellular pathogens,

and the action of chloroquine against Plasmodium falciparum.  N Engl J Med. 1987 Aug 27;317(9):542-9. 

http://eresources.library.mssm.edu:2968/?sid=Entrez:PubMed&id=pmid:3302712

k. Imwong M et al.  Relapses of Plasmodium vivax infection usually result from activation of heterologous hypnozoites.  J Infect Dis. 2007 Apr 1;195(7):927-33. Epub 2007 Feb 26.   http://eresources.library.mssm.edu:2284/doi/abs/10.1086/512241?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dncbi.nlm.nih.gov

L. Post-transplant Medicine
1. Recognize viral, bacterial, fungal and parasitic infections in post-transplant patients.
2. Initiate therapy for common post-transplant infections.
3. Readings:
a. Fishman, JA. Infection in solid-organ transplant recipients. N Engl J Med

2007; 357:2601.      http://eresources.library.mssm.edu:2368/cgi/content/extract/357/25/2601

b. Winston, DJ, Emmanouilides, C, Busuttil, RW. Infection in liver transplant recipients. Clin Infect Dis 1995; 21:1077. 

http://eresources.library.mssm.edu:2968/?sid=Entrez:PubMed&id=pmid:8589125

c. Singh, N, Paterson, DL. Mycobacterium tuberculosis infection in solid- organ transplant recipients: Impact and implications for management. Clin Infect Dis 1998; 27:1266.     http://eresources.library.mssm.edu:2968/?sid=Entrez:PubMed&id=pmid:9827281

d. Aguado, JM, Herrero, JA, Gavalda, J, et al. Clinical presentation and outcome of tuberculosis in kidney, liver, and heart transplant recipients in Spain. Transplantation 1997; 63:1278.
http://journals.lww.com/transplantjournal/pages/articleviewer.aspx?year=1997&issue=05150&article=00015&type=abstract

e. Infectious Disease Community of Practice, Amercian Society of Transplantation, Infectious Disease Guidelines for Transplantation. Am J Transpl 2004; 4 (Suppl 10):5. 

http://eresources.library.mssm.edu:2968/?sid=Entrez:PubMed&id=pmid:11777100

http://asheducationbook.hematologylibrary.org/cgi/content/full/2001/1/392

f. Fishman, JA. Pneumocystis carinii and parasitic infections in transplantation. Infect Dis ClinNorth Am 1995; 9:1005.      http://eresources.library.mssm.edu:2968/?sid=Entrez:PubMed&id=pmid:8747777

g. Paya, CV. Fungal infections in solid organ transplantation. Clin Infect Dis 1993; 16:677. 

http://eresources.library.mssm.edu:2968/?sid=Entrez:PubMed&id=pmid:8507760

h. Gardner, SD, MacKenzie, EF, Smith, C, Porter, AA. Prospective study of the human polyomaviruses BK and JC and cytomegalovirus in renal transplant recipients. J Clin Pathol 1984; 37:578. 

http://eresources.library.mssm.edu:7015/cgi/reprint/37/5/578
i. Eid, AJ, Brown, RA, Patel, R, Razonable, RR. Parvovirus B19 infection after

transplantation: a review of 98 cases. Clin Infect Dis 2006; 43:40. 

http://eresources.library.mssm.edu:2284/doi/abs/10.1086/504812?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dncbi.nlm.nih.gov

i. Falagas, M, Snydman, D, George, M, et al. Incidence and predictors of

cytomegalovirus pneumonia in orthotopic liver transplant recipients. Transplantation 1996; 61:1716.                           http://eresources.library.mssm.edu:2968/?sid=Entrez:PubMed&id=pmid:9332531

Note for hyperlinks: several of the older articles are not available online; the hyperlink leads to the MSSM library catalogue entry.