Podcast # 392: Maggot Therapy

Author: Jared Scott, MD

Educational Pearls:

  • Interest started as it was noticed soldiers who had wounds infected with maggots had better outcomes than those without maggots
  • Studies have shown that wound care with maggots is essentially equivalent to traditional therapy with oxygen, antibiotics, and debridement
  • Maggots debride the wound with proteolytic enzymes, sterilize the wound, and stimulate wound healing


Sherman RA. Maggot therapy takes us back to the future of wound care: new and improved maggot therapy for the 21st century. J Diabetes Sci Technol. 2009 Mar 1;3(2):336-44. Review. PubMed PMID: 20144365; PubMed Central PMCID: PMC2771513.

Baer WS. The treatment of chronic osteomyelitis with the maggot (larva of the blow fly) J Bone & Joint Surg. 1931;13:438–475.  DOI: 10.1007/s11999-010-1416-3


Summary by Travis Barlock, MS4  | Edited by Erik Verzemnieks, MD


Podcast # 391: Necrotizing Fasciitis

Author: Peter Bakes, MD

Educational Pearls:

  • Necrotizing fasciitis is an infection of the deep soft tissues with destruction of the muscle fascia and overlying fat
  • Think of it if pain is out of proportion to your exam
  • Polymicrobial and Clostridium species typically cause condition in susceptible individuals (immunocompromised, diabetics, obese, penetrating injury)
  • Group A strep typically is less specific and can cause necrotizing infections in otherwise healthy individuals
  • Treatment is typically rapid surgical debridement in addition to broad spectrum antibiotics in addition to clindamycin


Breyre A, Frazee BW. Skin and Soft Tissue Infections in the Emergency Department. Emerg Med Clin North Am. 2018 Nov;36(4):723-750. doi: 10.1016/j.emc.2018.06.005. Review. PubMed PMID: 30297001.

Stevens DL, Bryant AE. Necrotizing Soft-Tissue Infections. N Engl J Med. 2017 Dec 7;377(23):2253-2265. doi: 10.1056/NEJMra1600673. Review. PubMed PMID: 29211672.


Summary by Travis Barlock, MS4  | Edited by Erik Verzemnieks, MD

Podcast #387: Fluoroquinolones are Perfectly Safe?

Author:  Don Stader, MD

Educational Pearls:

  • Fluoroquinolones can cause connective tissue disruption leading not only to tendon rupture but also aortic dissection.
  • Retrospective study from Taiwan showed over a 2x higher rate of dissection when exposed to fluoroquinolones (1.6% vs 0.6%).
  • Remember to think about aortic dissection when you have a patient with chest pain that travels and/or involves neurologic symptoms.
  • Try to use fluoroquinolones when no other appropriate antibiotic exists as they have significant other side effects as well.


Editor’s note:  In July 2018, the FDA required strengthening of warning labels on fluoroquinolones about the risks of mental health effects and hypoglycemia


Lee CC, Lee MG, Hsieh R, Porta L, Lee WC, Lee SH, Chang SS. Oral Fluoroquinolone and the Risk of Aortic Dissection. J Am Coll Cardiol. 2018 Sep 18;72(12):1369-1378. doi: 10.1016/j.jacc.2018.06.067. PubMed PMID: 30213330.

Khaliq Y, Zhanel GG. Fluoroquinolone-associated tendinopathy: a critical review of the literature. Clin Infect Dis. 2003 Jun 1;36(11):1404-10. Epub 2003 May 20. Review. PubMed PMID: 12766835.



Summary by Travis Barlock, MS4    |   Edited by Erik Verzemnieks, MD

Podcast #379: Patient Perspectives of the Flu

Author:  Sam Killian, MD

Educational Pearls:

  • Patients may have certain fears or expectations about the flu based on hearsay and other less reliable sources
  • Taking extra time explaining the risks of the flu may help base these expectations more in reality
  • This includes providing good return precautions and acknowledging that the disease can still be unpredictable


Podcast #377: Endocarditis

Author:  Nick Tsipis, MD

Educational Pearls:

  • Persistent fever or positive blood cultures should raise suspicion for endocarditis
  • Patients with recent dental procedures, recent cardiac surgeries are at risk, or who inject drugs are at higher risk
  • Physical exam findings may include fever with a new murmur, Janeway lesions, Osler nodes, and/or splinter hemorrhages



Long B, Koyfman A. Infectious endocarditis: An update for emergency clinicians. Am J Emerg Med. 2018 Sep;36(9):1686-1692. doi: 10.1016/j.ajem.2018.06.074. Epub 2018 Jul 2. Review. PubMed PMID: 30001813.

Murdoch DR, Corey GR, Hoen B et. al. International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS) Investigators. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study. Arch Intern Med. 2009 Mar 9;169(5):463-73. doi: 10.1001/archinternmed.2008.603

Podcast # 373: Legionnaires Disease

Author:  Gretchen Hinson, MD

Educational Pearls:

  • Legionnaires disease refers to a severe pneumonia caused by Legionella pneumophilia and occurs typically at the extremes of age
  • Associated gastrointestinal symptoms (nausea/vomiting/diarrhea) may be present
  • Hyponatremia is a common laboratory finding
  • Legionella urinary antigen can be a convenient test to identify the infection
  • Treatment is with fluoroquinolones, macrolides and/or tetracyclines




Pierre DM, Baron J, Yu VL, Stout JE. Diagnostic testing for Legionnaires’ disease. Annals of Clinical Microbiology and Antimicrobials. 2017;16:59. doi:10.1186/s12941-017-0229-6.

Cunha BA, Cunha CB. Legionnaire’s Disease and its Mimics: A Clinical Perspective. Infect Dis Clin North Am. 2017 Mar;31(1):95-109. doi: 10.1016/j.idc.2016.10.008. Review.

Podcast # 360: Epidural Abscess Screening

Author: Dylan Luyten, MD.

Educational Pearls:

  • Dangerous causes of back pain: AAA, cauda equina syndrome, epidural abscess.
  • Young person with back pain needs to be evaluated for injection drug use (major risk factor).
  • Patient with focal neurologic deficits (FND) require an MRI.  Patients without FND can be screened with ESR and CRP. An ESR < 20 & CRP < 1 can effectively rule out epidural abscess as it has a 90% sensitivity for epidural abscess.
  • Treatment is IV antibiotics and surgical debridement.


Davis DP et al. Prospective evaluation of a clinical decision guideline to diagnose spinal epidural abscess in patients who present to the emergency department with spine pain, Journal of Neurosurgery: Spine. 2011. 14:765-770.

Podcast #355: Syphilis

Author: Aaron Lessen, MD

Educational Pearls:

  • Re-emerging STI.
  • Progresses through distinct phases if untreated:
  • Primary syphilis: frequently overlooked because initial chancre is painless.
  • Secondary syphilis: viral syndrome, rash on trunk, palms, and soles.
  • Latent syphilis: asymptomatic period, lasting 5-20 years.
  • Tertiary syphilis: includes neurosyphilis (dementia, encephalitis, etc.) and cardiovascular syphilis (aortitis, etc).
  • Treatment penicillin G 2.4 million units once for primary or secondary treatment; once weekly for 3 weeks for latent/tertiary.


Mattei, P., Beachkofsky, T., Gilson, R., Wisco, O. Syphilis: A reemerging infection. 2012. American Family Physician., 86(5), 433-440.

Podcast # 353: Xofluza

Author: Sam Killian, MD

Educational Pearls:

  • Japan recently approved baloxavir marboxil (Xofluza), which may potentially “kill” Flu A/B within 24 hours
  • Recent RCT trial showed superiority over oseltamavir (Tamiflu) in cessation of viral shedding (24 vs 72 hours)
  • Compared to placebo, superior in time to symptom resolution (53.7 vs 80.7  hours)
  • Administered as single dose
  • Yet to be considered for FDA approval


Portsmouth S, Kawaguchi K, Arai M, Tsuchiya K, Uehara T. Cap-dependent Endonuclease Inhibitor S-033188 for the Treatment of Influenza: Results from a Phase 3, Randomized, Double-Blind, Placebo- and Active-Controlled Study in Otherwise Healthy Adolescents and Adults with Seasonal Influenza. Open Forum Infectious Diseases. 2017;4(Suppl 1):S734. doi:10.1093/ofid/ofx180.001.

Podcast # 345: Epidural Abscess

Author: Sue Chilton, MD

Educational Pearls:

  • IV drug use and spinal procedures are major risk factors.
  • Classic triad of back pain, focal neurological deficit and fever. However, presence of fever is highly variable. Neurologic deficits may not present until later, but then they can have a rapid progression of neurological decline.
  • MRSA is most common organism, but GNR and MSSA are also possible.



Chen WC, Wang JL, Wang JT, et al. (2008). Spinal epidural abscess due to Staphylococcus aureus: clinical manifestations and outcomes. Journal of Microbiology, Immunology and Infection. 41:215.

Danner RL, Hartman BJ. (1987).Update on spinal epidural abscess: 35 cases and review of the literature. Review of Infectious Disease. 9:265.

Pfister H-W, Klein M, Tunkel AR, Scheld WM. Epidural abscess. In: Infections of the Central Nervous System, Fourth Edition, Scheld WM, Whitley RJ, Marra CM (Eds), Wolters Kluwer Health, Philadelphia 2014. p.550.