@RCPEdin Day 1 of #RCPEAGIM2019 - 5 days of all things General Medical. Today is all about #infection and we have some great speakers covering key clinical topics - details here: events.rcpe.ac.uk/rcpe-course-ac…
@RCPEdin #RCPEAGIM2019 Session 1 is about diagnosing infection: Clinical perspective (Busi Mooka) ➡️ Modern microbiology diagnostics (Kate Templeton) ➡️ Radiological diagnosis (Peter Garmany) With introduction from @PresidentRCPE @ProfDerekBell
Dr Busi Mooka reminding us of the great diagnostician William Osler - “Listen to your patient, he is telling you the diagnosis” - 100% true for dx infection #rcpeAGIM19 @RCPEdin @SAPGAbx @AntibioticScot
The value of experience is not seeing much but seeing it wisely - William Osler #RCPEAGIM2019
Everything should be made as simple as possible, but no simpler - Albert Einstein #RCPEAGIM2019
Dr Busi Mooka- Wisdom of the past, absurdities today. Definitions of / Screening for sepsis still being debated SIRS/Sepsis v SOFA/Sepsis #rcpeAGIM19 @SepsisUK @curlychris82 @PaulSaxMD @SAPGAbx
Dr Kate Templeton - new diagnostic methods for infection dx. Multiplex PCR of respiratory samples has improved dx accuracy to c. 80% + leads to better targeted Rx #rcpeAGIM19
Rapid dx of Flu (and other resp viruses) - POC test in ED/AMU facilitates rapid discharge, appropriate isolation and more appropriate use of antibiotics #rcpeAGIM19
Peter Garmany - “Fever-imaging” Does PUO really exist in the era of Modern (and rapid) radiology? #rcpeAGIM19
Peter Garmany: Every radiological finding has a differential dx. The clinical context is key e.g. military changes TB v Mets vs Sarcoidosis #rcpeAGIM19
Peter Garmany - something unusual on CT: Xanthogranulomatous pyelonephritis . The “bear paw” sign #rcpeAGIM19
Peter Garmany - “Seagull sign” of giant cell arteritis #rcpeAGIM19
Dr Daire O’Shea- fever in the immune compromised host. Infection risks of biologics - target dependant #rcpeAGIM19 @RCPEdin
Celia Jackson - suspect meningitis? Do LP then start abx. CT only if clinical evidence of brain shift #rcpeAGIM19 @RCPEdin @biainfection see guidelines. - britishinfection.org/files/5614/567…
LP and blood thinning Rx. What should you do? #rcpeAGIM19 @biainfection
When should you use IV aciclovir in suspected CNS infection? 1. NOT in viral meningitis 2. Only if confusion/ ⬇️LOC when suspect encephalitis #rcpeAGIM19
Richard Kennedy: Update in Acute STIs - Fluoroquinolones - no longer using FQs in PID due to toxicity risk, FQ Resistance high in GC (ceftriaxone Resistance also) Importance of lab dx #rcpeAGIM19
Richard Kennedy: Syphilis ⬆️ in 🏴 The great imitator- multisystem disease. Don’t think about it you will miss it #rcpeAGIM19 @RCPEdin
Rob Laing - fever in the returning traveller: where did you go? when?what did you do? ...,,, prophylaxis and immunisations bmj.com/content/bmj/su… #rcpeAGIM19 @RCPEdin
Rob Laing - Malaria is commonest Infection dx in the febrile returning traveller - follow @biainfection malaria Rx guidelines journalofinfection.com/article/S0163-… #rcpeAGIM19
@BCKresp TB conundrums #rcpeAGIM19 1. High index of suspicion in pts on biologic Rx 2. Specialist directed Rx - don’t dable! 3. Monitor LFTs routinely - hepatotxicity not uncommon 4. Beware of paradoxical worsening on Rx 5. Think about steroids in CNS (and other) involvement
Tom Evans - commonest borrelia species in Scotland- afzellii and garinii NOT burgdorferi #rcpeAGIM19 Lyme is widespread in Europe (map)
Don’t give antibiotic prophylaxis v Lyme following tick bite in UK (prev <2%) May be indicated in other regions e.g. East coast US (prev c.50%) #rcpeAGIM19
Claire Mackintosh - S. aureus bacteraemia 🏴 v 🏴 (it’s not a competition) Note low MRSA and HAI differences - may reflect HAI definitions? #rcpeAGIM19 @w_malcolm01 @JacquiSReilly
When testing for Lyme remember Bayes theorum - prob of test depends on pre test probability being positive! #rcpeAGIM19
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