
Botulism
Rapid Review
- 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
- Disposition
- Admission is required for most patients. ICU required if any respiratory involvement.
Pearls
- Early administration of antitoxin (ex. H-Bat) is vital. Although it will not reverse paralysis, it will halt it’s progression. Do not give HBAT for infants < 1 year of age.
- Wound botulism will require thorough wound debridement and parenteral antibiotics (ex. metronidazole or penicillin)
Deep Dive

Chlamydia
Rapid Review
- 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
- Disposition
- Discharge is appropriate for most patients. Follow up with PCP encouraged for to ensure adequate treatment of infection and for additional STI testing as needed.
Pearls
- Infection can present in other areas as well, such as the rectum or the pharynx. Obtain samples from those areas if they are symptomatic in those regions.
- Have a low threshold for testing for chlamydia/gonorrhea in young women, as they are very often asymptomatic.
Deep Dive

COVID-19
Rapid Review
- 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
- Disposition
- Most patients can be discharged if healthy, vaccinated, and hemodynamically stable
- Admission is necessary for patients with tachypnea, hypoxia, or with significant comorbidities.
Pearls
- Paxlovid (nirmatrelvir/ritonavir) is an oral antiviral drug that can be used for mild/moderate COVID-19 infections. However, it cannot be used in patients with severe renal disease (GFR < 30) and it has several drug interactions.
- The current dominant variant (Omicron) is more transmissible and resistant to vaccines/monoclonal therapy than it’s predecessor (Delta), but overall causes less hospitalization and severe disease.
Deep Dive

Meningitis
Rapid Review
- 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
- Disposition
- Admission is required for any known/suspected bacterial infections. ICU is required for any toxic-appearing patients.
- Discharge with close follow-up is appropriate if the infection is clearly viral and symptoms are controlled.
Pearls
- When in doubt, just do the lumbar puncture! Failure to diagnose meningitis early can be life-threatening and often results in medicolegal consequences for providers.
- Although a head CT is often performed prior to lumbar puncture, this can cause a significant delay in diagnosis/treatment. Reserve early CT imaging for patients with AMS, neurological deficits, papilledema, or history of CNS disease.
Deep Dive

Osteomyelitis
Rapid Review
- 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
- Disposition
- Admission is usually required.
- Some cases of chronic or subacute osteomyelitis can be managed outpatient if debridement not needed and home IV antibiotics can be arranged.
Pearls
- The WBC count is often normal, especially in pediatric or subacute/chronic cases.
- Osteomyelitis can be difficult to diagnose in pediatrics (they often present afebrile with no leukocytosis). However,the combination of ESR and CRP elevation has a 98% sensitivity for diagnosing osteomyelitis in the pediatric population.
Deep Dive