Podcast # 429: Oldschool Syphilis Treatment

Author: Chris Holmes, MD

Educational Pearls:

  • In WWI, the 2nd leading cause of soldier disability were STDs.
  • An early treatment of syphilis included topical and inhaled mercury
  • Bloodletting, vitriol, arsenic, and bismuth were other treatments for syphilis.
  • Infecting patients with Malaria and treating the Malaria was also tried
  • Thankfully penicillin was discovered for our syphilis woes

References

Frith J. . Syphilis – Its early history and Treatment until Penicillin and the Debate on its Origins. Journal of Military and Veterans Health. 2012. 20(4): 49-58 https://jmvh.org/article/syphilis-its-early-history-and-treatment-until-penicillin-and-the-debate-on-its-origins/

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

Podcast # 424: Hunting for Measles

Author: Mike Hunt, MD

Educational Pearls:

  • Measles is highly contagious and successfully infects 90% of those at risk exposed to the virus.
  • 10 day prodrome where patients are asymptomatic.
  • 3 day period of characteristic cough, coryza, conjunctivitis, fever and Koplick spots with a maculopapular rash that moves from head through trunk
  • Infection risk extends three to four days after the onset of rash but also three to four days prior to onset.  Have fun with that.
  • A potential exposure, say in an emergency department waiting room, needs review of any exposed patient’s immunization history to contain spread

References:

Moss WJ. Measles. Lancet. 2017 Dec 2;390(10111):2490-2502. doi: 10.1016/S0140-6736(17)31463-0. Epub 2017 Jun 30. Review. PubMed PMID: 28673424.

Bester JC. Measles and Measles Vaccination: A Review. JAMA Pediatr. 2016 Dec 1;170(12):1209-1215. doi: 10.1001/jamapediatrics.2016.1787. Review. PubMed PMID: 27695849.

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

Podcast #398: Who is gonna fail your antibiotic plan?

Author: Erik Verzemnieks, MD

Educational Pearls:

  • Recent study provides at least some evidence to help predict antibiotic failure for cellulitis, which is not necessarily straight forward
  • Intuitive risk factors such as recent cellulitis, chronic ulcers, history of MRSA are associated with antibiotic treatment failure
  • Oddly, tachypnea at triage was associated with the highest odds ratio for treatment failure

References:

Yadav K, Suh KN, Eagles D, MacIsaac J, Ritchie D, Bernick J, Thiruganasambandamoorthy V, Wells G, Stiell IG. Predictors of Oral Antibiotic Treatment Failure for Nonpurulent Skin and Soft Tissue Infections in the Emergency Department. Acad Emerg Med. 2018 Jun 5. doi: 10.1111/acem.13492.

Summarized and edited by Erik Verzemnieks, MD

 

 

Check out this episode!

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

References:

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

References:

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

References:

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.

https://www.fda.gov/downloads/Drugs/DrugSafety/UCM612834.pdf

 

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

 

References:

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

 

 

References

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.

References

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.