Dr. Anthony Cannella, Assistant Professor of Medicine at the USF Division of Infectious Diseases and International Medicine, reviews Non-tuberculosis Mycobacteria, with a focus on Mycobacterium abscessus spp. Dr. Cannella begins his presentation by reviewing the microbiology and epidemiology of M. abscessus and their spectrum of disease. He then transitions to discussing the pathophysiology of how these infections occur as well as the pharmacologic options available for treating them. He closes by presenting the research implications of M. abscessus infections from the perspective of the immunological response and pharmacotherapeutic options.
Dr Amanda Mercurio, ID clinical pharmacist at the James A Haley Veterans Hospital, discusses the latest guidelines regarding the dosing and therapeutic drug monitoring of aminoglycosides and vancomycin. Dr. Mercurio begins by identifying the pharmacokinetic parameters for dosing antibiotic medications. She reviews the concepts of steady state and loading doses. She distinguishes between concentration dependent, AUC dependent, and time dependent dosing. She then discusses the unique pharmacokinetic parameters for aminoglycosides, including the benefits of extended interval dosing. Dr. Mercurio then goes through a step-by-step process for calculating aminoglycoside dosing based upon preferred nomograms. Next, Dr. Mercurio moves on to Vancomycin therapeutic modeling. In particular, she discusses the differences between older peak and trough-based dosing with the newer recommendations to dose based upon AUC modeling. Dr. Mercurio closes by going through a case-based example of dosing using the new guidelines.
Dr. Richard Oehler, Professor of Medicine at the Division of Infectious Diseases, Morsani College of Medicine, presents an update in the management of diabetic foot infections for the 2020s. Dr. Oehler begins by introducing the concept of a multidisciplinary team as essential to the management of these patients. He then describes the current epidemiology of diabetes and diabetic foot ulcers. He also discusses Charcot arthropathy and how it occurs. Annual diabetic foot exams are also crucial to these patients, and Dr. Oehler also reviews proper techniques and what to ask/examine. Some of the newer hypotheses about the importance of biofilms to the creation and persistence of diabetic foot wounds are also presented. He also covers diabetic peripheral vascular disease, diagnostic imaging modalities, wound management, and the proper empiric antibiotic regimens and durations of therapy. Lastly, he discusses prevention techniques necessary to avoid recurrent ulceration.
Dr. Burkhead, infectious diseases fellow at the University of South Florida, covers HIV History, the development of HIV antiviral therapy, and current treatment strategies in this comprehensive update. Dr. Burkhead begins by reviewing the different classes of antiretrovirals. He then traces the chronological history of antiretroviral development, from the initial trials of AZT through the introduction of other NRTIs, Protease inhibitors, NNRTIs, and the Integrase inhibitors. Next, Dr. Burkhead discusses antiretroviral therapy in special situations, such as in those who are pregnant, have chronic kidney disease, or cardiac disease. Important antiretroviral mutations are also discussed. Lastly, Dr. Burkhead closes the talk by discussing future directions for antiretroviral therapy.
Dr. John Toney, Professor of Medicine at the James A Haley Veterans Hospital, reviews information about one of humanity’s greatest and most enduring scourges. Professor Toney begins by recalling the history of syphilis. He next relates the current epidemiology of syphilis in the US. The pathophysiology of syphilis is next discussed, as well as the manifestations of primary, secondary, and tertiary syphilis. The clinical manifestations of neurosyphilis are also reviewed. Lastly the association between syphilis and HIV is presented and therapy for syphilis is briefly covered.
Dr. Pardo, Infectious Diseases Physician and Ambulatory Care Provider at the James A Haley Veterans Hospital, discusses how to manage routine adult vaccinations during the 2020 COVID-19 pandemic. She first discusses the transmission of Coronavirus in vaccination settings and how to determine whether it is safe for patients to come in for vaccinations. She next discusses when the deferring of vaccination visits is appropriate, such as in those persons with suspected or confirmed COVID-19 disease. As we approach the winter season, Dr. Pardo shares information about the importance of influenza vaccination in all adult patients. Lastly, Dr. Pardo discusses catch up strategies for vaccination in pandemic delayed patients as well as reference sources for the clinician to access up to date vaccination recommendations.
Dr. Fredenrich discusses the origins and consequences of the vaccine hesitancy movement in this informative podcast. She begins by tracing back recent anti-vaccine sentiment to the now retracted 1998 Lancet article published by Dr. Andrew Wakefield and its initial origins to 19th Century London. She relates the decades-long success story of vaccines in reducing childhood and adult morbidity from vaccine preventable diseases such as measles, chicken pox, and polio. She identifies some of the factors that cause vaccine hesitancy among new parents. She then highlights some of the relevant laws relating to vaccine exemptions across the U.S. Next, Dr. Fredenrich mentions some of the falsely maligned components of vaccines that are commonly cited as a reason for parent reluctance. She also associates the significance of social media in producing vaccine sentiment among parents and adults. Lastly, she relates how medical providers can use their trusted influence with their patients and their families to help them make the right decisions about vaccines.
Dr. Hernandez reviews one of the more under-recognized manifestations of COVID-19 infection: conjunctivitis. Originally recorded in May 2020, the talk reviews basic epidemiology about Coronavirus infection and then focuses upon the ocular manifestations. She notes that ACE-2 receptors are extensively noted in eye tissue, including the human retina, retinal pigment, and conjunctiva. She next describes the epidemiology of Coronavirus conjunctivitis. Dr. Hernandez then discusses the potential for transmission of COVID-19 through tears. After reviewing the outcomes and prognosis of Coronavirus eye disease, she closes by discussing a couple of helpful case studies.
Drs. John T Sinnott, Kami Kim, and Seetha Lakshmi, distinguished Infectious Diseases faculty at the University of South Florida, discuss updates to the 2019 Coronavirus pandemic. Dr. Sinnott begins by tracing the beginnings of the pandemic, from its sylvatic origins in bats likely through an intermediary vector (a pangolin) to its first human hosts. Dr. Sinnott follows the pandemic to America, and shares some of the early assessments about the threat of the disease which were unheeded. Next, Dr. Sinnott discusses our current understanding of the pathophysiology of the SARS-2 Coronavirus, including its route of infection in the human host. Dr. Kim next discusses the specifics of Coronavirus testing, including the proper use and interpretation of molecular and antibody-based tests. Dr. Lakshmi then discusses current Coronavirus-targeted therapies, including convalescent plasma, remdesivir, dexamethasone, and monoclonal antibody-based treatments. Dr. Sinnott closes by discussing post-COVID syndromes and how the pandemic will likely end.
Dr. Katzman reviews the importance of toxins in the manifestation of bacterial diseases. Bacterial toxins cause injury by producing tissue damage to the host during a bacterial infection. The different mechanisms by which bacterial toxins can produce injury are reviewed, including via intracellular and cell surface targets, membrane damage, superantigens, and involvement of the extracellular matrix. Dr. Katzman next reviews several well-known bacterial toxins, including Staphylococcal and Streptococcal toxins and Pseudomonas exotoxin A. Lastly, toxin therapies, such as toxoids and passive immunization are reviewed.