Department of Medicine - Division of Infectious Diseases
Professor and Head
Robert R. Redfield, MD
Infectious Diseases Elective
The discipline of infectious diseases is uncommon in internal medicine in that it is not restricted to a single organ system. Indeed the Infectious Diseases Consultative Service serves patients in virtually all departments of the hospital. Many of these patients are among the most acutely ill and they often pose the most difficult diagnostic enigmas. These presentations are more than an academic challenge; many infectious diseases can be cured and the patient restored to previous health.
A practical working knowledge of clinical infectious diseases has become absolutely critical for the following reasons: (1) there has been a huge increase in the numbers of immunosuppressed people, not only from HIV infection but also from the substantial increase in bone marrow and solid organ transplant recipients, the more aggressive use of cytotoxic chemotherapy and more invasive and life-sustaining ICU modalities; (2) the explosion of new antiviral, antifungal and antibacterial agents requiring familiarity with their spectrum of action and toxicities; (3) the proliferation of multiple-antibiotic resistant pathogens which presents virtually untreatable infections; and (4) the focus upon infection control, cost containment and quality of practice which have arisen with the increased attention to the economics of health care. The diagnosis of infections and proper management of patients with these diseases are taught by exposing students to a broad spectrum of clinical problems. The appropriate use of microbiology, virology and serology laboratories is stressed. The student sees consultations under the supervision of a full-time attending at the University of Maryland Medical Center and Baltimore Veterans Affairs Medical Center. Specialized programs are available in HIV/AIDS, in transplant infections, in surgical infections, at Shock Trauma, and at the Greenebaum Cancer Center. Additionally there are training programs available through our international programs in Africa and the Caribbean. A clinical infectious disease conference for faculty, house staff and students is held weekly.
The Division of Infectious Diseases offers two postgraduate fellowship programs: one in General Infectious Diseases and one designed for individuals who would like to specialize in HIV care. Within each program, there is a clinical track and a research track. The first year is similar in both programs and tracks. This year is clinically oriented and is spent consulting on patients with problems related to infectious diseases. A very diverse experience is obtained through rotations at the University of Maryland Medical Center and Baltimore Veterans Affairs Medical Center, the Greenebaum Cancer Center, the solid organ transplant service, the inpatient HIV unit, and in the Clinical Microbiology Laboratory. Fellows see consults and supervise residents and medical students, and spend much of their time teaching and providing patient care. This is all performed under the guidance of full-time faculty, many of whom are experts in subspecialties within infectious diseases, such as infections in transplant recipients, neutropenic host infections, surgical infections and infections in HIV-infected people. Those individuals in either program who have chosen a clinical track spend the second year equally divided between the various rotations and on electives. Available electives include rotations in the Shock Trauma unit, in the Baltimore City Health Department, on the infectious disease service at the National Institutes of Health, and performing clinical research. Those individuals on the research track spend the second and subsequent years of the program performing original research. Research interests in the division include molecular pathogenesis of bacterial infections, HIV infections, the physiology of acute inflammation, CMV, HIV, papilloma virus infections, infections in cancer patients or severely traumatized patients, and infection control and nosocomial infections. Research interests within geographic medicine include microbial genetics, pathogenesis of diarrheal diseases, pathogenesis of malarial infections, and vaccine development. During the second and subsequent years the general and HIV program differ in that the electives and research opportunities of individuals in the latter program are oriented toward HIV infection. All fellows participate throughout their fellowship in a weekly longitudinal infectious diseases clinic, where under the supervision of the faculty they follow patients with HIV infections and other infectious diseases. Application is made through the fellowship program director.