Infectious Disease

  • Botulism
  • Chlamydia
  • COVID-19
  • Meningitis
  • Osteomyelitis

Botulism

  • Background
    • Botulism is a neuro-paralytic disease caused by the ingestion, injection, or inhalation of a pre-formed toxin produced by Clostridium botulinum
    • The toxin can be found in incorrectly canned/preserved foods and honey
  • Signs/Symptoms
    • Facial paralysis, descending weakness, respiratory arrest
  • Diagnosis
    • Clinical diagnosis based on history and physical exam
    • Confirmation of diagnosis requires identification of toxin in serum, stool, vomit, or food sources (may take 1-6 days)
  • Treatment
    • Early ventilatory management and wound debridement
    • Heptavalent antitoxin
Video Credit: USMLE Pass

*Deep Dive: Botulism (emDOCs)



Chlamydia

  • Background
    • Chlamydia is the most common sexually transmitted infection in the US caused by the baceteria Chlamydia trachomatis. It is a leading cause of infertility.
    • Can affect the cervix, urethra, salpinges, uterus, and epididymis.
  • Signs/Symptoms
    • Dysuria, mucopurulent urethral discharge, +/- fever
    • Over 50% of infected individuals are asymptomatic
  • Diagnosis
    • NAAT (urine or vaginal swab)
  • Treatment
    • Ceftriaxone IM + Azithromycin PO
    • Provide prescription for expedited partner treatment
Video Credit: USMLE Pass

*Deep Dive: Chlamydia (Merck Manual)



COVID-19

  • Background
    • Acute respiratory illness caused by the novel SARS-CoV-2 virus
    • Often causes pulmonary, cardiac, and neurological complications
  • Signs/Symptoms
    • Range from mild cold-like symptoms to respiratory failure
    • Most common symptoms include fever, dry cough, fatigue, and SOB. 
    • Associated with cardiac complications and thromboembolic phenomenon. 
  • Diagnosis
    • Viral testing (Rapid antigen and/or RT-PCR testing)
  • Treatment
    • Pulmonary support (O2, NIPPV, Intubation)
    • Consider Dexamethasone and Remdesivir for moderate-severe infections
Video Credit: Osmosis

*Deep Dive: REBEL COVID-19 Series (REBEL EM)



Meningitis

  • Background
    • Inflammation of the meninges and subarachnoid space. May be bacterial (most lethal), viral (most common), or in rare cases due to fungal or tuberculosis infection. 
    • Bacterial meningitis is most commonly caused by Streptococcus pneumoniae
  • Signs/Symptoms
    • Fever, headache, nuchal rigidity, photophobia
    • (+) Brudzinski sign, (+) Kernig Sign
  • Diagnosis
    • Lumbar puncture w/ CSF fluid analysis 
  • Treatment
    • Broad-spectrum antibiotics (ex. Ceftriaxone + Vancomycin) and corticosteroids (ex. Dexamethasone)
    • If viral, treat with Acyclovir
Video Credit: Osmosis

*Deep Dive: Meningitis: Pearls and Pitfalls (emDOCs)



Osteomyelitis

  • Background
    • Infection of the bone with persistent inflammatory destruction. Most commonly caused by bacteria (Staph aureus, pasteurella multocida, pseudomonas aeruginosa), but can also be caused by fungi. 
  • Signs/Symptoms
    • Localized bony tenderness w/ warmth, swelling, erythema
    • May experience weight loss, fatigue, and fever.
  • Diagnosis
    • X-ray  (will show bony erosions, regional osteopenia, periosteal elevation)
    • Radiography may be normal the first 2-3 weeks of symptoms. CT/MRI will provide earlier detection.
  • Treatment
    • Empiric broad-spectrum antibiotics (ex. Vancomycin + Piperacillin/Tazobactam)
    • Obtain bone cultures prior to initiating antibiotics
Video Credit: Medmastery

*Deep Dive: Osteomyelitis (Merck Manual)


Brandon Simpson, PA-C
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