Category: #FOAMID

The Semi-Procalcitonin in Bacteremia

Trying to figure out if a febrile patient showing up to the ED is having a bacterial infection is a conundrum. The main concern is bacteremia, since it confers higher mortality depending on the type of bacteremia a patient has. Inflammatory markers such as CRP and the neutrophil-to-lymphocyte ratio are relatively useful surrogates that may

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The Trojan Horse of Antibiotics

I reckon it’s time to write about new antibiotics. I do not like beta-lactamases. Mostly due to their ability to confuse clinicians, however also because it makes it difficult to pick an antibiotic for certain infections. I have written extensively about these, so look at this post. In general, carabepenemases and cephalosporinases within class A

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Straight from the Horse’s Lung: Rhodococcus Equi

Originally described as a pathogen in 1923, Corynebacterium equi was isolated from the lungs of ten foals (aka a young horse) who had pneumonia (1). Its name was later changed to rhodococcus (aka red coccus), and can be mistaken for mycobacterium spp due to its sometimes acid-fast appearance (2). It is known to infect horses,

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Monkey see, Monkey do: The Monkeypox Comeback

“A term that has been used in a number of systems of classification is variola vera. It is this idea of true or typical smallpox so often forming the subject of illustrations in text-books of medicine that has fixed in the minds of practitioners a single picture of what smallpox should look like. The literature

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TB or not TB: A Journey Through Chemotherapy

This is quite a corny and overtold joke. I have discussed some new drugs for multidrug resistant tuberculosis (MDR-TB), which is defined as resistance to both rifampin and isoniazid, however I felt like going back to the basics of TB therapy. Indeed, we all learn in STEP 1 and med school about “RIPE-ing it up”

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Lines on lines on lines: CLABSI, CRBSI, and Line Infections

Central lines are cool, for the most part. Except for when they’re infected. The pathophysiology behind these is explained in this diagram (1): Microorganisms gain access to the extraluminal or intraluminal surface of the device. Both skin and hub may be the important entry point of organisms, with the development of biofilm contributing to their

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Cephamycins: The Odd Sibling of the Cephalosporin Family

The cephalosporins are a class of beta-lactam antibiotics that is generally classified based on “generations.” These denote the spectrum of bacteria they target, with each successive generation having more gram negative coverage. I am convinced most people only know about ceftriaxone, the prototype third-generation cephalosporin aka an “extended-spectrum beta lactam” along with cefepime, which is

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COVID-19 Therapies in Non-Hypoxemic Patients – A Work in Progress

COVID-19 is still among us. I had actually predicted it would be an endemic virus, similar to influenza, where we would have to get annual “flu+covid” shots each year to avoid disaster. I have a lot of issues with the initial response, not to mention the amount of useless COVID-related papers that have been published.

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Rheumatism Mimic – Getting to know Chronic Chikungunya

Topics dealing with tropical medicine are difficult to tackle, as I am never quite sure where to begin. Do I talk about their epidemiology or the clinical presentation? I’ll never recognize one and even if I did, I could offer no therapy outside of “supportive management.” Chikungunya is one of these diseases. This is a

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Basics of Pulmonary Valley Fever

Coccidioides (from now on, called Cocci) is an endemic fungi that exists in two forms, yeast and mold, that is endemic to the southeastern United States (1). It is related to both Histoplasma and Blastomyces with two species known to infect humans. C. immitis and C. posadasii. Arthroconidia can be transported in soil or fomites,

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