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Focus on Victoria Fraser, MD

Victoria Fraser, MD, is a J. William Campbell Professor of Medicine and co-director in the division of infectious diseases.

Dr. Fraser sees patients at the Storz Building, 4570 Children’s Place, St. Louis, MO, 63110.

FOR AN APPOINTMENT, PLEASE CALL 314 747-1206.

What happened in the course of schooling to make you choose infectious disease as your speciality?

During my medical residency, I had a rotation at the Albert Schweitzer Hospital in Haiti. At the time, I was thinking about specializing in geriatrics, pulmonary or infectious disease. After working in Haiti, it became clear that infectious disease had the most opportunity for public health work. There were many cases of tuberculosis, tetanus, salmonella and typhoid fever, in addition to vaccine-preventable diseases like measles. These diseases were not at all common in the United States, but worldwide they were causing high morbidity and mortality; even though, in many patients, they were avoidable. I saw infectious disease as a rapidly changing field that would always be stimulating.
Dr. Fraser and family in Sun Valley

Have you been back to Haiti?

I haven’t been back to Haiti, but I’ve worked in Africa and Honduras. In the summer of 2009, my daughter and I went to Honduras with Global Medical Brigades. It’s a not-for-profit organization run predominately by college students. Many different colleges across the United States have brigades, including Washington University.

This organization was set up to get college kids interested in understanding problems in developing countries. They provide public health service, medical service and community service to the underserved. College campus brigades organize volunteer students, physicians, health care workers, and nurse practitioners. The students collect medications and medical equipment to take on their week-long trip.

The volunteers either work in a public health brigade or in a medical brigade. If they are in a public health brigade, they get involved in building sewer systems, cement floors and water treatment plants. If they work in a medical brigade, they drive to distant rural areas to set up MASH units and pharmacies. They perform physical exams, diagnose illness, provide treatment and teach public health education. It’s really quite impressive how much these college kids can do with a little medical supervision.
Dr. Fraser with daughters in Africa


What brought you to Washington University?

Almost 20 years ago I joined the infectious disease fellowship program here. At the time, my husband and I were both chief medical residents in Colorado. He was going to specialize in nephrology. We looked at a number of programs in the country that had good programs in both of our specialties. Washington University was at the top of the list across the country for having outstanding research and clinical programs in both those areas.

Which aspect of your practice is most interesting?

Infectious disease is a great field because it is so diverse. Many common infectious diseases such as HIV and influenza continue to be a major problem, not only in St. Louis, but worldwide.

While there have been tremendous advances in the prevention of healthcare-associated MRSA (methicillin-resistant staphylococcus aureus) infections, there have also been large outbreaks of community-associated MRSA.

There are many newly discovered viruses and emerging infections. Because of globalization, there is the opportunity for rapid transmission and spread of infections from distant parts of the world. It keeps us on our toes and it’s never dull.

What new developments in your field are you most excited about?

The infectious disease division here has grown dramatically over the past five years. We’ve opened two new specialty services on the inpatient side – a bone and joint infection consult service and an infectious disease transplant service.

The bone and joint infection service focuses on patients who have complicated bone and prosthetic joint infections. Unfortunately, this is a growing area because of the tremendous advances in orthopedic surgery as people are getting many more prosthetic joint replacements. With the epidemic of MRSA across the country, there have been increasing infections in prosthetic joints and other devices, and those can be very difficult to treat.

The infectious disease transplant service focuses on prevention and treatment of infections in patients who have had leukemia, bone marrow transplants or solid organ transplants. The patients are very immunosuppressed -- they have special health issues in terms of what vaccines they can receive and what prophylactic medicines can be used to try to prevent rare infections.

On the outpatient side, we have expanded our outpatient practice to five full days a week at the Storz Building in the Central West End. We’ve also opened an outpatient clinic at Barnes-Jewish West County Hospital where we see patients two (half) days a week. We’re very excited to be able to provide additional services to patients in West County and to expand our outpatient practice there.

What types of infectious diseases do you see in your outpatient practice?

We see common infectious diseases like urinary tract infections, pneumonia and blood stream infections. We take care of patients who have bone and joint infections or complicated infections that require intravenous antibiotic therapy for prolonged periods of time.

We have patients with HIV, MRSA, staph and fungal infections. We see a full spectrum of diseases – sometimes they are simple infections, but more commonly they are difficult to treat infections, chronic recurrent infections, or infections due to antimicrobial-resistant bacteria.

Because we are also familiar with tropical and geographic medicine, we see people who have come down with unusual infections after travelling to developing countries. In the summer we see a fair amount of ehrlichiose (sometimes confused with lyme disease). It can cause a fever, rash and low white blood cell count. In this region it is most often a tick-borne illness. It is very treatable if diagnosed early, but it can be quite severe in people who are immunosuppressed.

Can you explain MRSA?

MRSA stands for methicillin-resistant staphylococcus aureus. We started seeing MRSA in the 1950’s. At that time, the resistance to methicillin was an acquired resistance and mostly associated with patients who had been in the hospital or a healthcare setting for a procedure and then developed a complicated infection.

In the past ten years, we started seeing a new strain called community-associated MRSA. This strain of MRSA is associated with abscesses, and skin and soft tissue infections.

Often misdiagnosed as spider-bites, they can develop very rapidly, be very painful and sometimes need to be drained. They can be recurrent and sometimes be associated with severe invasive infections such as blood stream infections and pneumonia.

It is becoming increasingly common in children. There have been outbreaks in schools, on athletic teams and within households.

Where are you from originally?

I’m from St. Louis, so I guess I would have to answer the high school question -- I went to Nerinx Hall High School in Webster Groves, Missouri.

I attended the University of Missouri for medical school and the University of Colorado for my residency and chief residency. I then came back to St. Louis.

What particular award or achievement is most gratifying?

I find it incredibly rewarding to mentor medical students. I have received several mentoring awards, and that is really very humbling.

One of the most exciting things a faculty member can do is to have the opportunity to train young people, get them excited about infectious disease and help them succeed in their career development. As you get older, your students and your trainees start to out-perform you – that is what I am most proud of.

What is the best advice you have ever received?

I have had two fabulous mentors – Dr. Gerald Medoff and Dr. William Powderly. They were both division heads in infectious disease before my tenure. They used to tell me to slow down and try not to fix everything immediately. Medicine is a marathon, not a sprint.

That advice is something I think about every single day. In reality, many of the infectious disease problems we’re faced with are challenges that take years, if not decades, to address. Many short-term fixes don’t really last, so we have to be focused on the right fix – and that takes time.

If you weren’t a doctor, what would you be doing?

It would be very exciting to be a teacher. I like working and interacting with young people. Being a teacher allows me to be a student as well.

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Copyright 2013 Washington University School of Medicine