Curriculum standards

Knowledge guides

LG14: Infections in specific hosts and populations

Key presentations and conditions

Advanced Trainees will have a comprehensive depth of knowledge of these presentations and conditions.

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Less common or more complex presentations and conditions

Advanced Trainees will understand these presentations and conditions.

Advanced Trainees will understand the resources that should be used to help manage patients with these presentations and conditions.

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Epidemiology, pathophysiology, and clinical sciences

Advanced Trainees will have a comprehensive depth of knowledge of the principles of the foundational sciences.

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Investigations, procedures, and clinical assessment tools

Advanced Trainees will know the scientific foundation of each investigation and procedure, including relevant anatomy and physiology. They will be able to interpret the reported results of each investigation or procedure.

Advanced Trainees will know how to explain the investigation or procedure to patients, families, and carers, and be able to explain procedural risk and obtain informed consent where applicable.

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Important specific issues

Advanced Trainees will identify important specialty-specific issues and the impact of these on diagnosis and management and integrate these into care.

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In immunocompromised hosts

Diarrhoea, chronic
Febrile neutropenia
Infections:
- Bacterial, such as:
  - Burkholderia cepacia
  - Burkholderia pseudomallei
  - encapsulated organisms
  - Listeria monocytogenes
  - Pseudomonas aeruginosa
  - Stenotrophomonas maltophilia
- central nervous system:
  - brain lesions
  - encephalitis
  - meningitis
- fungal, due to:
  - dimorphic
  - moulds
  - yeasts
- mycobacterial:
  - non-tuberculous
  - tuberculous
- parasitic and ectoparasitic:
  - scabies
  - strongyloidiasis
  - toxoplasmosis
- viral with the potential to reactivate, such as:
  - cytomegalovirus
  - Epstein–Barr virus
  - hepatitis B
  - varicella zoster
Pyrexia of unknown origin

Related to travel

Ehrlichiosis and rickettsioses
Helminthic diseases, such as:
- intestinal nematodes
- schistosomiasis
- tapeworms
- tissue nematodes
- trematodes
Infections:
- bacterial, such as:
  - brucellosis
  - enteric fever
- fungal, such as:
  - coccidioidomycosis
  - histoplasmosis
- spirochete, such as:
  - Lyme disease
- viral, such as:
  - chikungunya
  - haemorrhagic fevers
  - yellow fever
Protozoal diseases, such as:
- amoebiasis
- leishmaniasis
- malaria

PCH

Immunocompromised newborns
Infections:
- congenital
- neonatal
- perinatal
Vertically transmitted infections:
- cytomegalovirus
- enterovirus
- group B streptococcus (GBS)
- hepatitis:
  - B
  - C
- herpes simplex viruses
- human immunodeficiency virus (HIV)
- listeria
- parvovirus
- rubella
- toxoplasma
- Treponema pallidum
- varicella zoster virus

For each presentation and condition, Advanced Trainees will know how to:

Synthesise

recognise the clinical presentation
identify relevant epidemiology, prevalence, pathophysiology, and clinical science
take a comprehensive clinical history
conduct an appropriate examination
establish a differential diagnosis
plan and arrange appropriate investigations
consider the impact of illness and disease on patients and their quality of life when developing a management plan

Manage

provide evidence-based management
prescribe therapies tailored to patients’ needs and conditions
recognise potential complications of disease and its management, and initiate preventative strategies
involve multidisciplinary teams

Consider other factors

identify individual and social factors and the impact of these on diagnosis and management

Infections:
- bacterial, such as:
  - tularaemia
- spirochete, such as:
  - yaws
Infections arising in the transplant patient:
- haematopoietic stem cell
- solid organ
Protozoal diseases, such as:
- trypanosomiasis

PCH

Infections in patients with other chronic conditions:
- complications of prematurity
- heart disease, congenital
- lung disease
- weakness or severe neurological disease

For each presentation and condition, Advanced Trainees will know how to:

Synthesise

recognise the clinical presentation
identify relevant epidemiology, prevalence, pathophysiology, and clinical science
take a comprehensive clinical history
conduct an appropriate examination
establish a differential diagnosis
plan and arrange appropriate investigations
consider the impact of illness and disease on patients and their quality of life when developing a management plan

Manage

provide evidence-based management
prescribe therapies tailored to patients’ needs and conditions
recognise potential complications of disease and its management, and initiate preventative strategies
involve multidisciplinary teams

Consider other factors

identify individual and social factors and the impact of these on diagnosis and management

Antimicrobial resistance patterns of imported infections and its influence on empirical prescribing for infection in return travellers
Clinical features of infections and other disease processes in special hosts
Conditions that may lead to immunosuppression, such as:
- diabetes mellitus
- extremes of age
- severe malnutrition
Epidemiological and clinical features of imported infections in immigrant groups
Epidemiology of infections in Indigenous populations in Australia and Aotearoa New Zealand
Function of the intact immune system
Identification of at-risk patients, including:
- burns and trauma patients
- chronic pulmonary patients, such as those with:
  - bronchiectasis
  - cystic fibrosis
- critically ill patients in intensive care units
- immigrants and refugees
- immunocompromised hosts, such as those with:
  - congenital immunodeficiency syndromes
  - HIV
  - human T-lymphotropic virus
  - hyposplenism / splenectomy
  - malignancy:
    - haematologic
    - solid organ
  - neutropenia
  - other conditions requiring immunosuppressive drugs
  - transplants:
    - haemopoietic
    - solid organ
- Indigenous peoples, such as Aboriginal and Torres Strait Islander peoples and Māori
- living with:
  - homelessness
  - incarceration
  - poverty
- people who inject drugs
- post-surgical patients, including those with implanted medical devices / grafts
- pregnant people
- residing in:
  - rural and remote areas
  - tropical regions of Australia
- travellers
Interactions, modes of action, pharmacokinetics, and side effects of the commonly used agents to treat infection in special hosts
Pathophysiology of special host conditions
Unique aspects of infection presentations in special risk groups, with respect to:
- blunted or atypical clinical features due to immunosuppression
- common syndromic presentations in immunocompromised hosts
- key infective aetiologies in immunocompromised hosts
- paradoxical reactions in the setting of immune reconstitution
- pathogen endemicity
- risk of infection reactivation in the context of immunosuppression
- spectrum of pathogens the patient is potentially exposed and susceptible to, including normally non-pathogenic organisms
- timing of disease onset in relation to immunosuppression
- timing of travel and exposure

PCH

Epidemiology of chronic diseases relating to premature delivery in Aboriginal and Torres Strait Islander peoples and Māori

Investigations

Antenatal and perinatal screening
Assessment of immune compromise
Clinical examination
Immunology tests
Microbiologic tests
Pathology tests, including:
- anatomical pathology
- biochemistry
- genetic pathology
- haematology
- immunopathology
Radiologic investigations

Procedures

Aspiration – joint
Biopsy:
- skin
- tissue
Lumbar puncture
Paracentesis
Pleurocentesis

Aboriginal and Torres Strait Islander peoples and Māori

Barriers to high-quality, evidence-based care in primary, secondary, and tertiary settings that reduce health equity, and the evidence-based strategies used to overcome these
Entrenched inequities in the spectrum of infectious diseases, their burden, common management, and outcomes
Impact of colonisation and racism in the permutation of white privilege, and the implications on this trauma for care

Immigrants and refugees

Diagnostic screening for infections as part of migrant health screening
Health needs of migrant populations

Other factors that may impact care

People living with HIV:
- co-infections, such as:
  - viral hepatitis
- counselling to patients and individuals potentially exposed to HIV
- long-term prevention and management of comorbidities in people living with HIV, such as:
  - bone disease
  - cancer
  - cardiovascular disease
  - diabetes mellitus
  - dyslipidaemia
  - kidney failure
  - lung diseases
- perinatal management of HIV for the prevention of mother-to-child transmission
- pharmacology, such as:
  - antiretroviral treatment
  - drug-drug interactions
  - immunisation
  - mechanisms of resistance and cross-resistance
- prophylaxis:
  - opportunistic infections
  - post-exposure
  - pre-exposure
Pregnant people:
- risk of vertical transmission of infectious diseases during pregnancy, including:
  - cytomegalovirus
  - enterovirus
  - group B streptococcus
  - hepatitis:
    - B
    - C
  - herpes simplex viruses
  - HIV
  - listeria
  - parvovirus
  - rubella
  - syphilis
  - toxoplasma
  - Treponema pallidum
  - varicella zoster virus
Related to travel:
- availability, efficacy, guidelines, safety, and use of vaccines
- geographical patterns of disease and risk factors for acquisition
- patient education regarding risk and risk mitigation strategies
- prevention of travel-associated illness
- safe travel advice for high-risk populations, such as immunocompromised
- travel clinic and the medicolegal issues involved
- travel health websites