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We engaged medical students with antimicrobial stewardship (AS) and resistance (AMR) through patient stories and a panel on AMR advocacy with experts from the Centers for Disease Control and Prevention and the Infectious Diseases Society of America. Students were surveyed on their perceptions about AS and AMR (response rate=139/166, 84%).

The importance of antibody immunity in protection against Cryptococcus neoformans remains unresolved. We measured serum C neoformans-specific and total antibody levels and peripheral blood B cell subsets of 12 previously healthy patients with cryptococcosis (cases) and 21 controls. Before and after adjustment for age, sex, and race, cryptococcal capsular polysaccharide immunoglobulin G was higher in cases than controls, whereas total B and memory B cell levels were lower. These associations parallel previous findings in patients with human immunodeficiency virus-associated cryptococcosis and suggest that B cell subset perturbations may also associate with disease in previously normal individuals with cryptococcosis.

Background Medical history plays a foundational role in shaping the characters and habits of thought of developing physicians. Specifically, it cultivates an ability to assess the quality and durability of current knowledge and contributes to the growth of resilience, humility and intellectual curiosity. Especially for Infectious Diseases, knowledge of its history fosters an appreciation for our evolving understanding of the field and an opportunity to spark interest in a future career. Nevertheless, it is hard to find the space for this content amidst competing priorities in the medical school curriculum. An integrative approach has been described as a way to introduce history as a longitudinal component of the existing curriculum. Our aim, using this approach, was to pilot the incorporation of history modules into the Microbiology and Infectious Diseases (Micro/ID) course at Albert Einstein College of Medicine. Methods Students participating in Micro/ID were shown four history modules integrated into the existing course. The first was embedded within the introductory lecture and the remaining three were prerecorded videos available through the virtual learning environment. The modules offered context to course material and introduced principles of medical history, such as the potential pitfalls of retrospective diagnosis and changing definitions of disease over time. Comprehension and retention were assessed via two questions on each of two exams. Students had the opportunity to evaluate the course material in both their examination and end-of-course evaluations. Results On the first examination, 99% and 68% of students answered correctly. On the second examination, 92% and 54% answered correctly. Student evaluation of the content was positive overall with 91% rating the content satisfactory, very good or excellent. However, some questioned the value of the material while others requested expansion of the modules to include topics such as history of research ethics (Tuskegee and syphilis) and more recent history (the HIV epidemic). Conclusion An integrative approach to teaching medical history is largely well-received by students and offers a way to introduce historical topics to an entire class. Comments from students serve as a guide to topics of interest for future iterations of the course. Disclosures All authors: No reported disclosures.

A 40-year-old woman with HIV (CD4 270, viral load undetectable) from Zambia presented with fevers, urinary tract infection symptoms, sterile pyuria and haematuria. She was found to have genitourinary tuberculosis (TB) via mycobacterial culture of urine and ascites, and treated with rifabutin, isoniazid, pyrazinamide and ethambutol. She later had multiple episodes of asymptomatic transaminitis, triggering changes to both TB and HIV regimens. The patient then presented with diffuse rash, fevers, transaminitis and eosinophilia concerning for drug reaction with eosinophilia and systemic symptoms (DRESS). After initial improvement on discontinuation of likely responsible medications and completion of corticosteroid therapy, the patient returned with acute liver failure. This new episode was felt to be severe organ dysfunction due to DRESS, and she was treated with a prolonged corticosteroid taper and changes to her TB regimen. She has since completed therapy for TB, has improving CD4 counts and is without evidence of liver dysfunction.