Lightning Lecture – Syphilis by Landon Pehle

• Treponema pallidum
• “The Great Imitator”
• Stages
  • Primary – painless chancre
  • Secondary – rash, lymphadenophty, condyloma lata
  • Tertiary – meningitis, aortitis, aneurysms, argyll robertson pupil
  • Congenital syphilis 
• Testing
  • PRP/VDRL (1st line screening)
  • FTA-ABS (specific testing)
  • Darkfield microscopy
• USPSTF recommends screening in high risk groups
• LP in neurologic, ocular, latent syphilis, HIV coinfection
• Treatment
  • Penicillin G
    • Jarisch-Herxheiner reaction
    • Desensitization

Lightning Lecture – Botulism by Madison Wilson

• Clostridium botulinum
  • Spores
  • Found in soil, water
  • Anareobic
• DDX for MG, GBS, tick paralysis, hypothyroid
  • Botulism with no CNS effects
• Workup
  • Neutralization assay is gold standard
  • CT head
  • Basic lab work
  • LP
• CDC algorithm for initiating treatment
  • Equine derived antitoxin
• Admit to ICU
  • Airway watch, NG tube, foley catheter
  • Recovery is slow
• Infantile botulism
  • pH is higher in GI tract, easier for spores to colonize and release in large intestine
  • Flaccid paralysis, loss of head control, respiratory failure, loss of reflexes
  • Human based botulism IG
• Wound botulism
  • In vivo toxin 
  • Treat with debridement, penicillin, and antitoxin
• Inhalation botulism
  • Aerosol for bioterrorism

Infectious Recommendations from Pharmacy – Dr. Hannah Moore

• Sepsis
  • 30CC/kilo fluids
  • Empiric antibiotic therapy
    • Assess risk factors
    • Previous + micro
      • Previous resistance?
    • MRSA – Vanc (IV), Doxy (PO)
    • Pseudomonas – Zosyn (IV), Cefepime (IV), Cipro/Levaquin (PO)
  • Bacterial meningitis
    • S pneumo, N meningitides, listeria, GBS, H influenza, HSV, VZV
    • CSF findings – bacterial vs viral vs fungal
    • Empiric therapy
      • Ceftriaxone, vanc, ampicillin, acyclovir
    • Steroids
      • Early treatment with decadron improvs outcomes wacute bacterial meningitis 
      • 10mg Q6
  • Bacterial PNA
    • S pneumo, N meningitides, listeria, GBS, H influenza, mycoplasma, chlamydia
    • Outpatient therapy
      • No comorbidities – amoxicillin or doxy, or macrolide
      • Comorbities – augmentin or cephalosporin and macrolide or doxy or respiratory fluoroquinolone
    • Inpatient therapy
      • Non severe vs severe
        • See IDSA guidelines, multiple therapy options given patients history, severity
  • Intraabdominal infections
    • Classifications – uncomplicated vs complicated
    • E coli, proteus, bacteroids, kleibsiella, bacteroides
    • Empiric therapy
      • Based on severity (mild to high risk)
        • See IDSA guidelines, usually recommending combination therapy with flagyl
  • UTI
    • Classifications – uncomplicated vs complicated
    • Asymptomatic bacteriuria
      • Treat pregnant women, patient undergoing urologic procedures, patient with kidney transplant w/n 3 months
    • E coli, klebsiella, proteus, pseudomonas, enterococcus, staph, enterobacter
    • Empiric therapy
      • See IDSA guidelines
  • Skin/soft tissue infections
    • Staph, strep, clostridial, aeromonas
    • See IDSA guidelines
  • Hypersensitivty reactions
    • Type 1 – IgE, anaphylaxis
    • Type 4 – T cell mediated, SJS/TEN
    • Penicillin desensitization in the ED

Sepsis – Dr Hugh Shoff

• Hospital scoring
• Patient safety measures and trends

Infective endocarditis – Dr Jarred Thomas

• Most common site of infection – tricuspid valve
• Most common bacteria – S aureus
• Highest risk factor – previous IE
• Average age of infection is now increasing
  • Current high risk: MRSA, prosthetic valves, ESRD, IV drug use
• Acute vs subacute
• Systemic issues from IE based on left vs right side infection
• Blood cultures
  • Ideally three sets as well as fungal culture
  • Do not obtain from port site
• Treatment
  • Abx
  • Surgery
• Valvular conditions that needs PPX as established by AHA 2021 Guidelines