PUPC Conference Coverage

Rethinking Infections: Three Cases Demonstrate How Primary Care Clinicians Can Refine Diagnosis and Treatment Across the Lifespan

Kate Young

Key Highlights

  • Current evidence-based guidelines should guide the diagnosis and treatment of complicated infectious diseases.
  • Appropriate antimicrobial stewardship prescribing may help treat common infectious diseases in varying age groups.

At the Practical Updates in Primary Care 2025 virtual conference, infectious disease expert, Jasmine A. Berry, DNP, APRN, FNP-C, made the case for more nuanced diagnostic approaches to common infectious presentations, urging primary care providers to refine their clinical reasoning amid increasingly complex patient profiles. The session, titled “Infectious Diseases Across the Lifespan: From Pediatrics to Geriatrics,” featured real-world cases that revealed the pitfalls of reflexive diagnosis and overtreatment.

One case involved a 50-year-old woman repeatedly presenting to emergency departments with urinary complaints over several months. Despite consistently negative urine cultures and only mild abnormalities on urinalysis, she was prescribed multiple courses of antibiotics. Ultimately, cystoscopy revealed a bladder malignancy, shifting the clinical narrative away from infection. Dr Berry emphasized that a diagnosis of urinary tract infection (UTI) should never rely solely on symptoms or minor laboratory abnormalities, especially in the absence of a positive culture.

In another example, a 47-year-old woman presented to the emergency department after fainting at a nail salon. She reported feeling unwell for weeks, with symptoms including low-grade fever, fatigue, and oral thrush. Despite a non-toxic appearance and relatively unremarkable imaging, further lab evaluation revealed a reactive fourth-generation HIV test, a viral load exceeding 1.7 million, and a CD4 count of 311. Her symptoms were initially vague, but they masked an advanced HIV infection.

Dr Berry also detailed a third case involving a 54-year-old man with fever, joint pain, and a severe headache. Despite empiric treatment for meningitis and negative imaging, a history of outdoor exposure and a recent tick bite led clinicians to test for Ehrlichia chaffeensis, which returned positive. Fever resolution within 24 hours of doxycycline administration confirmed the diagnosis. The case highlighted that in suspected tickborne illness, clinical history often trumps serologic testing, which may remain positive for months after infection.

Reference:
Berry JA, Polgreen PM. Infectious Diseases Across the Lifespan: From Pediatrics to Geriatrics. Presented at: Primary Care Update Conference; May 7-9, 2025. https://www.hmpglobalevents.com/pupc