r/infectiousdisease

My husband is currently being treated for right iliacus abscess (originally 9.6 cm), recurrent iliacus abscess, right sacroiliac septic arthritis, and osteomyelitis of the right sacrum and iliac bone. I’m looking for opinions on whether his current treatment plan is appropriate and, more importantly, how to make sure this infection is truly eradicated before antibiotics are stopped. We are terrified of this happening a third time.

His initial diagnosis was a 9.6 cm iliacus muscle abscess. Unfortunately, there was a delay in diagnosis that progressed to septic shock, and he nearly died. He underwent CT-guided drainage and was hospitalized for about a week and a half.
Initially, he continued having extremely high fevers (up to 106°F), worsening blood cultures, abnormal inflammatory labs, and remained unable to walk despite drainage and IV antibiotics. Infectious Disease was eventually consulted, changed his antibiotics based on culture and sensitivity results because the original antibiotics were ineffective, and a repeat CT with contrast found a second approximately 5 cm abdominal wall abscess. They attempted to drain it, but it collapsed during the procedure. His original drain also had to be corrected because it wasnt draining.

He completed IV antibiotics through a PICC line for about two weeks after discharge. A CT with contrast reportedly showed the iliacus abscess had resolved, his drain was removed, and once his CBC normalized, his PICC was removed and antibiotics were stopped.

About one month later, he was in sepsis again, but it did not progress into septic shock. Initially they searched for another source of infection (heart, abdominal organs, etc.), but those were negative. MRI with contrast ultimately showed that the iliacus abscess was still present, along with septic arthritis of the right SI joint and osteomyelitis involving the right sacrum and iliac bone. He is now being treated with a PICC line and is expected to receive at least 6-8 weeks of IV antibiotics. They have not placed another drain because they felt the remaining collection was too small.

My questions are:

1. Given this history of abscess not being resolved after treatment was stopped, is 6-8 weeks of IV antibiotics alone the standard approach, or would you expect additional intervention?
2. Before stopping antibiotics this time, what imaging would give the highest confidence that the infection has truly resolved? Wouldnt MRI with contrast generally be preferred over CT with contrast for evaluating a deep iliacus abscess and associated osteomyelitis, or is CT sufficient? From my understanding, MRI with contrast can see small abscesses better than CT?
3. Is it common for a CT with contrast to appear reassuring while residual infection is still present and later identified on MRI?
4. Are there any additional tests, labs, or imaging that you would want before discontinuing antibiotics in a case like this?

We fully understand no one can give medical advice over Reddit, but after he nearly died once and then was in sepsis again a month after treatment ended, we’re trying to make sure everything possible is done before his antibiotics are discontinued again.

Please share how you got rid of PREVOTELLA Bivia

I am a 41 yr old female, 5’7, 135 lbs, non drinker and in the process of quitting vaping (on chantix). On march 1st I was gardening and sustained a deep rose thorn puncture and fell backwards hitting my concrete planter as well. Exactly 7 days later I was in the ER with indescribable pain, swelling and redness to my knuckle on right hand, underneath pinky. They ran blood work, did cultures and doctor said I likely have sporotrichosis. Gave me itraconazole and sent referral to ID. ID stopped itraconazole and ordered MRI, showing osteomyelitis. I had bone biopsy and surgical debridement on May 14th. Hand surgeon found the remaining portion of rose thorn and was confident I had no infection, just synovitis from retained foreign body. ID did 2 weeks of Bactrim, doxy, and itraconazole to be safe and hand was getting better. All cultures, bacterial and fungal came back negative. Then 2 weeks ago my knuckle became swollen, red, warm and the pain started back. Meet with ID tomorrow to discuss PICC line. She doesn’t want to repeat MRI because she says it will just show infection and wants to do broad spectrum IV antibiotics for 6 weeks then transition to oral. This is my dominant hand and is already affecting work, etc. is this curable when we don’t know what organism we are treating? I am so nervous.

We moved into a house next summer and smelled a strong putrid odor on top floor and attic floor (has two bedrooms with attic in between) that we attributed to the previous owners many dogs and cats. Our realtor told us he found a bat in the sink and that it was a random bat that must have gotten in and been there for months between the listing and closing. We had a crew rip out the flooring down to the studs in the top two floors but did not go into the attic. One member of the crew fell ill with respiratory illness and felt generally unwell for a few weeks but seemed to be fine a few weeks later and to my knowledge is doing well and still working. The smell was not pronounced after October and until this past month when it became warm again. A few days ago, several baby bats were found in our house during different times. We started rabies shots and moved into a hotel. We called two different wildlife inspectors and both told us we had a colony or roost of bats living in the attic and that they have been coming to that same place for at least a few years. Legally they cannot be moved until mid august. My partner feels safe to move back into the house this weekend because one of the companies sealed up any visible holes with tape and foam. He recommended door sweeps for our doors and to keep our vents closed. He said it would be fine to move into the house. We cannot do guano removal and remediation until the bats are released. Is it safe to move back into a home and sleep on the same floor with the heavy stench? We would be sleeping on the floor beneath the bat roost. My partner thinks using air purifiers and door sweeps are sufficient. I have hypothyroidism and am generally sensitive things and quick to get sick. There are a few nights in the past month where I remember having a few moments of full body chills at night and thinking that it was strange. There is one night i felt nauseous. My partner thinks I overreact about medical issues because of my autoimmune disease, but I feel like it is impossible for us to live safely in a house with an active bat infestation and sleep on the same floor that has the guano stench, even if the ac and purifier in our room mostly masks it. Any insight on histoplasmosis and how you contract it and how it manifests in symptoms is appreciated. Would you stay in the house? I am ok with going back after remediation and will be listing it for sale shortly thereafter.

I'm living with a confirmed, disseminated/systemic case of Klebsiella granulomatis (donovanosis/granuloma inguinale) in the United States and have been navigating this largely alone early on, until finding my current primary concierge physician. I'm posting because I believe someone with the right background may be able to help, or point me toward someone who can.

Why my case may not look like what you'd expect

Donovanosis is almost universally described as a disease of painless, beefy-red genital ulcers — the classic Donovan body lesion. My presentation has not followed that textbook picture. Not only are the lesions atypical, but this infection has disseminated systemically, affecting multiple body sites beyond the genital tract. The absence of classic findings caused significant diagnostic delays and continues to make this difficult to communicate to providers who are pattern-matching against the textbook description. If you've only seen the classic presentation, you may not recognize this.

Diagnosis

Confirmed via next-generation sequencing (NGS). Donovan bodies have also been identified on Giemsa-stained microscopy.

A note on LGV IgG serology and cross-reactivity with Donovanosis

Both myself and my partner have consistently returned positive LGV (Lymphogranuloma venereum) IgG antibodies, yet both of us have been exhaustively tested for Chlamydia trachomatis and LGV by PCR — all negative. This is not coincidence. Klebsiella granulomatis shares several antigenic structures with Chlamydia trachomatis L-serovars that drive cross-reactive LGV IgG serology, including:

• GroEL/HSP60 homology — Klebsiella GroEL shares ~40–48% amino acid identity with C. trachomatis cHSP60, a dominant immunogenic antigen in LGV serology
• KDO-core LPS structural overlap — both organisms carry gram-negative LPS with shared core epitopes recognized by complement fixation assays
• OmpA/MOMP beta-barrel homology — structural mimicry between outer membrane proteins

I am posting this specifically because this cross-reactivity between K. granulomatis and LGV IgG is essentially undocumented in the clinical literature. If you are a clinician who has seen a patient with persistent LGV IgG positivity, PCR-negative for actual chlamydia/LGV, consider K. granulomatis as a differential — especially with a compatible clinical picture. This serology finding may represent an unrecognized diagnostic signal for disseminated donovanosis. The test used for this was Quest Diagnostic test 19553.

The treatment problem

I have worked through the standard and second-line antibiotic options. The organism has shown resistance across multiple drug classes. The one class that has demonstrated efficacy — aminoglycosides — I was forced to discontinue due to nephrotoxicity. I am now in a position where the drugs that work, I cannot tolerate long-term, and the drugs I can tolerate long-term are not working.

The role of my physician

I want to be clear that I am not navigating this without any support. My concierge medicine physician has been absolutely instrumental in taking this case seriously — she has engaged with the complexity of this infection in a way that most providers have not, and I owe a great deal of the documented progress in my case to her willingness to work with me rather than dismiss what the data shows. That said, donovanosis is rare enough that even exceptional physicians are working without a roadmap.

What I'm looking for

If you are a clinician, researcher, or infectious disease specialist with experience in donovanosis, tropical infections, resistant gram-negative organisms, or disseminated intracellular bacterial disease — or if you know someone who is — I would genuinely welcome contact. I'm not looking for general advice. I'm looking for someone willing to engage with a complex, well-documented case.

Specifically, I am seeking a physician or multidisciplinary team with the expertise and infrastructure to administer aminoglycosides in a monitored, controlled setting — with active nephrotoxicity management built into the protocol. This means therapeutic drug monitoring (TDM), renal function surveillance, and the clinical judgment to navigate the narrow window between efficacy and kidney injury in a patient where aminoglycosides are currently the only viable option. If you or someone you know has experience managing prolonged or intermittent aminoglycoside courses in complex infectious disease cases, I want to hear from you.

I am happy to share NGS sequencing reports, resistance gene profiles, microscopy findings, and a full treatment history privately.

For those who have been diagnosed with encephalitis or have experience with it, can you tell me your experience with being diagnosed? I know how difficult it is to be diagnosed. My main question is, if none of the doctors are listening to you, how do you get the right testing?

So far, I have been to my GP, a functional medicine doctor, and the ER. None of them would give me an autoimmune encephalitis panel, lumbar puncture, or MRI. I know that generally, you need a neurologist to do so. I have been passed off by so many neurologists that they all just say that I have FND and send me home. So I’m trying to get a referral to an autoimmune neurologist, but they will only accept me if I have certain positive blood tests. Which I can’t seem to acquire from any of these doctors.

How the hell do I get the right testing done? And where do I go for that?