Infectious Diseases John Bennett, MD, Program Director Overview The Laboratory of Clinical Investigation, the Laboratory of Immunoregulation, the Laboratory of Parasitic Diseases, and the Laboratory of Host Defenses of the National Institute of Allergy and Infectious Diseases offer an intensive, three-year training program in infectious diseases. The first year of the program is largely clinical, while in the second two years trainees pursue their individual research interests under the direction of an excellent faculty member. The purpose of the program is to develop clinical and laboratory skills in young physicians who are already well grounded in clinical medicine, and who intend to pursue academic careers in infectious diseases. Structure of the Clinical Training Program (Year 1) Rotations Clinical training in the first year of the Infectious Disease Program consists of rotations within the Clinical Center at NIH and at outside affiliated institutions. The fellow spends four months on the NIAID Medical Service caring for patients in the forty four-bed clinical research ward, as well as in the outpatient department. All patients are participants in research protocols of senior investigators in the Laboratory of Clinical Investigation, the Laboratory of Immunoregulation, the Laboratory of Host Defenses or the Laboratory of Parasitic Diseases. The patients have a wide variety of disorders including, genetic and acquired immunodeficiencies, disorders of neutrophil and monocyte function, complement abnormalities, severe acute or chronic viral infections including Herpes simplex, Epstein- Barr, and human immunodeficiency virus infections, parasitic diseases, and mycoses. Fellows also spend two weeks in the Clinical Center Microbiology Laboratory. In addition, fellows rotate through the Infectious Disease Consultation Service which provides consultative services throughout the 480-bed Clinical Center of the NIH. There is also a four-month training period at outside institutions such as Johns Hopkins Hospital, the National Naval Medical Center, George Washington University Medical Center, and Walter Reed Army Medical Center. Rounds and Conferences The Clinical Center and NIAID Medical Grand Rounds are conducted on a weekly basis, and there are a variety of conferences and lectures on topics pertaining to clinical infectious diseases. Journal club meets every other week, and a clinical infectious disease conference is held each week. The monthly meeting of the Greater Washington Infectious Disease Society is held at the NIH Clinical Center. Numerous conferences and didactic lectures are offered on a wide range of subjects on an almost daily basis at the NIH. Structure of the Research Training Program (Years 2 and 3) The core of the training program is the research experience gained through over two years spent in the laboratory. Trainees work under the direct supervision of one of the MD or PhD senior staff members. This allows for close daily contact, individual instruction and continuity during the training period. The fellow may choose to work in one of the following laboratories in the National Institute of Allergy and Infectious Diseases: The Laboratory of Clinical Investigation The Laboratory of Immunoregulation The Laboratory of Parasitic Diseases The Laboratory of Host Defenses These laboratories are involved in a wide range of investigations in various aspects of clinical immunology and infectious diseases. Research projects range in scope from clinical to the most basic aspects of cell and molecular biology. Opportunities for collaborative work in other NIAID laboratories are also available on an individual basis. Areas of investigation in which an associate may wish to participate are: Bacterial diseases Clinical immunology Clinical mycology Clinical parasitology Medical virology Mucosal immunity and mast cell physiology Clinical and molecular retrovirology Immunopathogenesis Immunology and molecular biology Host-parasite relations Major Clinical Faculty And Research Interests Dr. John Bennett, Director, Infectious Diseases Training Program, Chief of the Clinical Mycology Section of the Laboratory of Clinical Investigation. Dr. Bennett is an internationally recognized expert on fungal diseases and an editor, along with Drs. Mandel and Douglas, of Principles and Practice of Infectious Disease. Dr. Anthony S. Fauci, Director of the National Institute of Allergy and Infectious Diseases, and Chief, Laboratory of Immunoregulation. Dr. Fauci's research has focused on the immunopathogenic mechanisms of human immunodeficiency virus (HIV) infection, induction of expression of HIV, and the control of HIV expression by endogenous cytokines. Dr. John Gallin, Scientific Director of the Division of Intramural Research, NIAID, and Chief, Laboratory of Host Defenses. Dr. Gallin's research interests are the study of the basic mechanisms of protection against microbial infection. Special emphasis is given to the study of the physiology and molecular biology of phagocytic cell function, and the development of therapeutic strategies for patients with genetic defects in these processes. Dr. Clifford Lane, Clinical Director for NIAID, and Chief, Clinical and Molecular Retrovirology Section of the Laboratory of Immunoregulation. Dr. Lane directs the intramural segment of NIAID's clinical research efforts against AIDS, and his laboratory interests have focused on the immunopathogenesis of HIV infection and vaccine development. Dr. Harry Malech, Co-director, Laboratory of Host Defenses. Dr. Malech's interests involve the study of phagocytic cell function, particularly in patients with immune deficiency disorders such as chronic granulomatous diseases of childhood, leukocyte adhesion deficiency, Chediak-Higashi syndrome, Job's syndrome of hyperimmunoglobulin-E and recurrent infections, neutrophil specific granule deficiency, and cyclic neutropenia. A major goal is to utilize the technology of gene transfer to develop therapies to correct abnormalities in these patients. Dr. Henry Masur, Director of the Critical Care Unit of the Clinical Center, NIH. Dr. Masur's main research interests are the opportunistic infections which complicate human immunodeficiency virus (HIV) infection. Dr. Masur is a leader in developing new diagnostic and therapeutic approaches for pneumocystosis and toxoplasmosis. Dr. Theodore Nash. Dr. Nash has clinical interests in the field of tropical medicine and clinical parasitology. His clinical research interests include giardiasis, schistosomiasis, cysticercosis, and cryptosporidiosis. Dr. Nash's basic research interests are in the biology and molecular biology of Giardia lamblia, with a specific emphasis on understanding various aspects of surface antigenic variation. Dr. Franklin Neva, Chief of the Laboratory of Parasitic Diseases. Dr. Neva's research interests include leishmaniasis and strongyloidiasis. In addition, Dr. Neva is a staff member of the Clinical Parasitology Section which studies patients with parasitic diseases, and provides consultation services on parasitic diseases throughout the 480-bed Clinical Center at the NIH. Dr. Stephen Straus, Chief, Laboratory of Clinical Investigation. Some recent research projects carried out under Dr. Straus' direction include: molecular analysis of Herpes Simplex Virus 1 and 2 latent gene expression in human ganglia, characterization of Varicella-Zoster Virus regulatory genes involved in virus latency in human ganglia, and testing of recombinant Herpes Simplex Virus type 2 glycoprotein vaccines. Examples Of Papers Authored By Program Faculty Croen KD, Ostrove JM, Dragovic LJ, Straus SE. Patterns of gene expression and sites of latency in human nerve ganglia are different for varicella-zoster and herpes simplex viruses. Proc Natl Acad Sci USA 1988;85:9773-9777. Gallin JI, Malech HL, Melnick DA, et al. A controlled trial of interferon gamma to prevent infection in chronic granulomatous disease. The International Chronic Granulomatous Disease Cooperative Study Group. N Engl J Med 1991;324:509-516. Lane HC, Davey V, Kovacs JA, Feinberg J, Metcalf JA, Herpin B, Walker R, Deyton L, Davey RT, Falloon J, Polis MA, Salzman NP, Baseler M, Masur H, Fauci AS. Interferon-alpha in patients with asymptomatic human immunodeficiency virus (HIV) infection. Ann Intern Med 1990;112:805-811. Nash TE, Herrington DA, Levine MM, Conrad JT, Merritt JW Jr. Antigenic variation of Giardia lamblia in experimental human infections. J Immunol 1990;144:4362-4369. Rex JR, Bennett JE, Gallin JI, Malech HL, DeCarlo ES, Melnick DA. In vivo interferon gamma therapy augments the in vivo ability of chronic granulomatous disease neutrophils to damage Aspergillus hyphae. J Infect Dis (In Press). Program Graduates A list of recent program graduates is provided below: Completed Program 1988 David O. Freedman, MD - Geographic Medicine Division, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama. Alison Freifeld, MD - Pediatric Oncology Branch, National Cancer Institute, NIH. Gregory Harriman, MD - Assistant Professor, Clinical Immunology, Baylor College of Medicine, Methodist Hospital, Houston, Texas. Phillip Murphy, MD - Laboratory of Host Defenses, National Institute of Allergy and Infectious Diseases, NIH. Steven Schnittman, MD - Division of AIDS Research, National Institute of Allergy and Infectious Diseases, NIH. Completed Program 1989 Edward McManus, MD - Private practice, Randolph, New Jersey. John Zurlo, MD - Assistant Professor of Medicine, Division of Infectious Diseases and Epidemiology, Hershey Medical Center, Hershey, Pennsylvania. Michael Kleinberg, MD - Assistant Professor Infectious Disease Division, Department of Medicine, University of Maryland, Baltimore, Maryland. Beverly Lee Hall, MD - Extramural Program, National Institute of Allergy and Infectious Diseases, NIH. Completed Program 1990 Christopher King, MD - Infectious Disease Division, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio. John Rex, MD - Laboratory of Clinical Investigation, Clinical Mycology Section, National Institute of Allergy and Infectious Diseases, NIH. Philip Krause, MD - Food and Drug Administration, Bethesda, MD. Completed Program 1991 Louis Safranek, MD - Assistant Professor, Infectious Disease Division, Department of Medicine, University of Nebraska, Omaha, Nebraska. David Paar, MD - Medical Staff Fellow, Division of AIDS, National Institute of Allergy and Infectious Diseases, NIH. Antonia Geber, MD - Laboratory of Clinical Investigation, Clinical Mycology Section, National Institute of Allergy and Infectious Diseases, NIH. Richard Kenny, MD - Laboratory of Host Defenses, National Institute of Allergy and Infectious Diseases, NIH. David Margolis, MD - University of Massachusetts Medical Center, Molecular Medicine, Worcester, Massachusetts. Lawrence Deyton, MD - Division of AIDS Research, National Institute of Allergy and Infectious Diseases, NIH. Bach Yen Nguyen, MD - Division of Cancer Therapy, National Cancer Institute, NIH. Application Information The Infectious Disease Training Program is accredited by the Accreditation Council for Graduate Medical Education. After their second year, fellows are eligible to take examinations for the Board of Infectious Diseases. Qualified candidates must have completed residency training in internal medicine or pediatrics prior to entering the fellowship program. Residents will be accepted in the new Clinical Investigator Pathway offered by the American Board of Internal Medicine. Associates entering under the Clinical Investigator Pathway must pass the boards in internal medicine and take their examinations in infectious disease after their third year of fellowship training. There are up to six positions available per year, and candidates should apply approximately one and one-half years prior to their expected date of entry into the fellowship program. The length of the Clinical Associate program is three years, however, many fellows apply for an additional year. The prospective Clinical Associate may apply to the Infectious Diseases Training Program through two different mechanisms. Applications may go directly to any of the laboratories of the National Institute of Allergy and Infectious Diseases, that is, the Laboratory of Clinical Investigation, the Laboratory of Immunoregulation, the Laboratory of Parasitic Diseases, or the Laboratory of Host Defenses. Candidates may apply to more than one laboratory, since each one accepts it's own Clinical Associates. Alternatively, applicants without a specific laboratory in mind may apply to the Director of the Infectious Diseases Training Program. For further information, the applicant should contact: Dr. John Bennett Program Director, Infectious Diseases Training Program Clinical Mycology Section National Institute of Allergy and Infectious Diseases National Institutes of Health Building 10, Room 11N107 9000 Rockville Pike Bethesda, MD 20892 Telephone: (301) 496-3461 FAX: (301) 480-0050 .