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Large Language Models in Infectious Diseases: A Systemic Review.

Alon Gorenshtein1, Eyal Klang2, Jacob J Smith3

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Summary
This summary is machine-generated.

Large language models (LLMs) show promise in infectious disease diagnosis but exhibit significant safety concerns, including errors and fabricated content, necessitating expert oversight for clinical use.

Keywords:
Antimicrobial stewardshipBias and fairnessClinical decision supportHallucinations (AI)Infectious diseasesLarge language modelsPatient safetyRetrieval-augmented generation

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Area of Science:

  • Medical Informatics
  • Artificial Intelligence in Medicine
  • Infectious Disease Management

Background:

  • Clinical reasoning in infectious diseases requires validated evidence.
  • Large language models (LLMs) are increasingly used in healthcare for diagnosis and antimicrobial stewardship.
  • The safety and reliability of LLMs in infectious disease decision-making remain unestablished.

Purpose of the Study:

  • To systematically review studies evaluating LLMs for infectious disease decision-making.
  • To assess the performance, safety, and reliability of various LLM systems in this domain.

Main Methods:

  • A systematic review of studies using GPT, Claude, Gemini, and retrieval-augmented systems.
  • Searches conducted in PubMed, CENTRAL, Scopus, and Web of Science (Jan 2018-Sep 2025).
  • Risk of bias assessed using QUADAS-AI.

Main Results:

  • Thirty-one studies were included; most were cross-sectional and vignette-based.
  • 90% of studies reported safety issues, including incomplete responses and fabricated content.
  • LLMs achieved 80-100% diagnostic sensitivity for structured infections but had ~50% agreement in antimicrobial stewardship.

Conclusions:

  • LLMs demonstrate potential in specific diagnostic tasks but are currently unreliable for autonomous clinical application.
  • High error rates and inconsistent reasoning necessitate expert oversight and validation before deployment.
  • Retrieval-augmented systems show improved specificity and reduced hallucinations compared to standard LLMs.