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

*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

*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

*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

*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

*Deep Dive: Osteomyelitis (Merck Manual)

---