Dr. Kakande Reagan, Dr. Bri Bennett, and Dr. Jessica Pelletier discuss the epidemiology, pathophysiology, clinical presentation, diagnostic workup, management, and prevention of loiasis.

Take-Home Points:

• Loa loa is a multi-system parasitic disease with potentially serious complications if untreated.
• Diagnosis requires diurnal blood smears or thick-drop methods, and Giemsa or H&E staining is necessary to diagnose the worms appropriately.
• Microfilarial load dictates the treatment strategy.
• There is a risk of life-threatening encephalopathy not only with ivermectin, but also with DEC, which is the first-line therapy for loiasis.
• Prevention involves avoiding Chrysops fly bites.
• Loiasis complicates MDA in areas with co-endemicity for onchocerciasis and lymphatic filariasis. Caution should be used with drug selection in co-endemic areas.

You can view the full show notes and references here: https://docs.google.com/document/d/1FFoxvW_quKvmRS2Rph09-azch8jb61aemniR8AOX8Ps/edit?usp=sharing

Image attribution: Magne Flåten, CC BY-SA 3.0 <https://creativecommons.org/licenses/by-sa/3.0>, via Wikimedia Commons

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• Counting to 20: Creative Commons 0: http://creativecommons.org/publicdomain/zero/1.0/
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• Bike bell 10.flac by cdrk -- https://freesound.org/s/495492/ -- License: Attribution 4.0

Dr. Stuart Allen, Dr. Jessica Pelletier, and Dr. Akan Otu discuss the epidemiology, pathophysiology, clinical presentation, diagnostic workup, management, and prevention of dengue.

Take-Home Points:

• Dengue is an arboviral disease transmitted by the Aedes aegypti mosquito
• It is an NTD with a huge global burden of disease
• The majority of cases are self-limiting, but severe dengue infections can cause massive hemorrhage, shock, multiorgan failure, and death
• There is no cure for dengue; supportive care for critically ill patients involves IV fluid resuscitation, blood product transfusion for those with massive bleeding, vasopressors for shock that is not responsive to fluid or blood product administration, and management of organ failure sequelae
• There is only 1 vaccine for dengue prevention - Qdenga® (TAK-003) - and it is only recommended in children 6-16 years right now
  • Other vaccines are under development
• Preventing mosquito bites is key for disease prevention

You can view the full show notes and references here: https://docs.google.com/document/d/1DpCmbj3TMztOuzdusmHZ4rqu9PaMkOX_m6wWBhgfWjg/edit?usp=sharing

Episode art attribution: Adobe Firefly

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Dr. Jessica Pelletier, John George Johnson, and Dr. Sheikh Omar Bittaye discuss the epidemiology, pathophysiology, clinical presentation, diagnostic workup, management, and prevention of lymphatic filariasis (LF).

Take-Home Points:

• LF is the second most common mosquito-borne illness after malaria.
• This disease involves repeated cycles of infection and inflammation, much like trachoma, and can cause severe morbidity and social isolation.
• Treatment is with anti-parasitic agents and must be tailored regionally based on which other parasites are co-endemic. Avoid ivermectin where loa loa is prevalent.
• At least 3 weeks of DEC is needed to treat tropical pulmonary eosinophilia from LF.
• MDA and avoiding mosquito bites are critical for interrupting transmission and preventing ongoing infections.

You can view the full show notes and references here: https://docs.google.com/document/d/1Pf4RBMHfHW5GHl2WYK_8PrTl-GOBbz4va_vSnJCmUEM/edit?usp=sharing

Episode art attribution: By Photo Credit:Content Providers: CDC/ - This media comes from the Centers for Disease Control and Prevention's Public Health Image Library (PHIL), with identification number #373.Note: Not all PHIL images are public domain; be sure to check copyright status and credit authors and content providers.العربية | Deutsch | English | македонски | slovenščina | +/−, Public Domain, https://commons.wikimedia.org/w/index.php?curid=223538

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• Vitamins in a jar: https://tinyurl.com/49swy2zw

Dr. Jessica Pelletier, Dr. Kakande Reagan, and Dr. Bri Bennett discuss the epidemiology, pathophysiology, clinical presentation, diagnostic workup, management, and prevention of onchocerciasis.

Take-Home Points:

• Onchocerciasis is the second leading cause of blindness worldwide
• Transmission occurs via blackfly bites
• Clinical manifestations are typically dermatologic followed by ocular
• Diagnosis ideally occurs via PCR of skin snips, or RDT where this is available
• Treatment is either with ivermectin or doxycycline (which kills the Wolbachia symbiont)
• Prevention on a large scale involves ivermectin MDA, traps, and vegetation clearing, but individuals living in endemic areas need to avoid blackfly bites at all costs

You can view the full show notes and references here: https://docs.google.com/document/d/1WPhP2hvVHlQClwN6K3lZ1BPM4fjeX2XdIFWcTI_gnV4/edit?usp=sharing

Episode art attribution: image generated using Adobe Firefly and an image of Simulium blackfly By xpda - Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=67748232

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Dr. Jessica Pelletier and Dr. Tracy Walczynski discuss the epidemiology, pathophysiology, clinical presentation, diagnostic workup, management, and prevention of trachoma.

Take-Home Points:

• Trachoma is the most common infectious cause of blindness worldwide
• Chlamydia trachomatis is spread via direct contact, and its spread is propagated in resource-limited settings where there is poor access to good sanitation and personal hygiene
• This is a chronic condition involving cycles of infection and scarring that eventually lead to blindness
• SAFE - Surgery, Antibiotics, Facial cleanliness, and Environmental improvement - are the cornerstones of management

You can view the full show notes and references here: https://docs.google.com/document/d/1vYMyw76A9oRW-hZtCmqgH_SYEghtWY7GxGKqjCzqHvo/edit?usp=sharing

Episode art attribution: image generated using Adobe Firefly

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Dr. Jessica Pelletier and Dr. Kamoga Dickson discuss the epidemiology, pathophysiology, clinical presentation, diagnostic workup, management, and prevention of cholera.

Take-Home Points:

• Cholera is a disease with high morbidity that disproportionately affects sub-Saharan Africa
• The O1 and O139 serogroups of V. cholera make cholera toxin and cause the disease
• Colonization happens in the small intestine, so higher volumes of bacteria that make it to the small intestine are more likely to cause disease
• The classic presentation involves rice water stools and dehydration, but vomiting is also possible
• Patients with mild to moderate dehydration should receive oral rehydration, and those with severe dehydration should receive balanced IV fluids (where available)
• Severe cases need antibiotics based on local guidelines
• Prevention involves sanitation measures and vaccination

You can view the full show notes and references here: https://docs.google.com/document/d/1HCMld8vCdiPMRSAdSeWu2VWZFBhEF15Nvrsa_ov9YuA/edit?usp=sharing

Episode art attribution: image generated using Adobe Firefly

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Dr. Jessica Pelletier and Noah Kronk speak with Dr. Steve Liang and Dr. Gaston Omba about the diagnostic workup, management, and prevention of ebola virus disease (EVD).

Take-Home Points:

• Patients may present in either the dry or wet phases of disease and may progress to death or recovery
• Early recognition of possible EVD cases helps protect more people from becoming infected
• IPC measures are critical to break the cycle of infection and stop outbreaks
• Care in the ED is primarily supportive
• Patients with the Zaire strain of EVD OR neonates born to mothers who test positive are eligible to receive mAb114 or REGN-EB3, where available
• Individuals exposed to the Zaire strain of EVD should receive the Ervebo vaccine

You can view the full show notes and references here: https://docs.google.com/document/d/1193rLGFHzSXLY2rnUzUc5m0utFjAGCRVUPNG3oULKFw/edit?usp=sharing

Episode art attribution: image generated using Adobe Firefly

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Dr. Jessica Pelletier and Noah Kronk speak with Dr. Gaston Omba, an emergency medicine resident physician with expertise in international cooperation, humanitarian aid, health management, and ebola epidemic response.

Take-Home Points:

• Ebola virus outbreaks typically occur in Sub-Saharan Africa
• The natural reservoir is thought to be bats, but this isn’t definitive
• Early detection of suspected Ebola cases is crucial to prevent viral spread
• Fever is the most common early symptom, and may be accompanied by headaches, myalgias, GI symptoms, or rash
  • Since these symptoms are non-specific, we need to take excellent travel and exposure histories
• Later symptoms include bleeding, shock, multiorgan failure, and death, which occur in the 2nd week of disease
• Transmission is via direct contact with infected patients or their body fluids
• Healthcare workers need to ensure strict use of PPE to prevent infection of themselves or other patients

You can view the full show notes and references here: https://docs.google.com/document/d/1193rLGFHzSXLY2rnUzUc5m0utFjAGCRVUPNG3oULKFw/edit?usp=sharing

Episode art attribution: By BernbaumJG - Own work, CC BY 4.0, https://commons.wikimedia.org/w/index.php?curid=64106638

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• water splash 5.wav by lwdickens -- https://freesound.org/s/269008/ -- License: Attribution NonCommercial 4.0

Dr. Jessica Pelletier and Noah Kronk speak with Dr. Stephen Liang, an emergency medicine physician and infectious disease expert, about the diagnosis and management of mpox in the ED setting.

Take-Home Points:

• Two clades:
  • Clade 1 (Central Africa): classic, more severe disease
  • Clade 2 (West Africa): subtle, non-classic presentations including genital/anal lesions and proctitis in the 2022 global outbreak
• Transmitted via exposure to body fluids, skin lesions, or respiratory secretions
• Incubation period: 5-14 days
• Lesions can mimic a wide range of diseases - keep a broad differential, including other sexually transmitted infections in the right context
• For most patients, care is supportive
• Those with or at high risk for severe disease should receive tecovirimat

You can view the full show notes and references here: https://docs.google.com/document/d/1CS5lo3HhvE_FiuDDgPPDkUnXHf49gydahGSWiGBlDFA/edit?usp=sharing

Episode art attribution: NIAID, CC BY 2.0 <https://creativecommons.org/licenses/by/2.0>, via Wikimedia Commons

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Dr. Jessica Pelletier speaks with Ambrose Ndabahwerize, a nurse working in Uganda, regarding his first-hand experience working with mpox patients in a resource-limited setting.

Take-Home Points:

• Most cases of mpox are non-severe
• Treatment of mpox is primarily supportive
• Community education, isolation of suspected cases, and proper PPE access are key for preventing the spread of disease

Episode art attribution: image generated using Adobe Firefly

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