This episode of the Infectious Disease Puscast, dated late November 2025, covers recent clinical microbiology literature. The most significant finding discussed is a study in Science Translational Medicine that presents a mechanistic link for Epstein-Barr virus as a causal driver of Systemic Lupus Erythematosus by reprogramming B-cells, which, if true, is a major development. A critical public health alert concerns a multi-state outbreak of infant botulism in the US linked to recalled "ByHeart" brand formula. Other topics include the predictable rise of tetracycline-resistant gonorrhea due to DoxyPEP, the risk of Hepatitis B reactivation when altering HIV regimens, and real-world efficacy data for the RTS,S malaria vaccine.
Infectious Disease Puscast #94: Key Literature Review
01:34 EBV Drives Lupus: A new study claims EBV actively reprograms autoreactive B cells into antigen-presenting cells, making it a direct cause of SLE, not just a correlated virus. This is a strong claim that moves EBV from bystander to a central actor in this autoimmune disease.
04:10 Hepatitis B Reactivation: Switching HIV patients from tenofovir-containing ART to newer regimens risks severe Hepatitis B reactivation. A case series of four patients underscores this; it's a basic clinical risk that should be managed by screening before any switch.
06:53 DoxyPEP Drives Resistance: The DoxyPEP strategy has resulted in a threefold increase in high-level tetracycline resistance in N. gonorrhoeae. This was entirely predictable. Prophylactic antibiotic use creates selective pressure.
09:40 PrEP and STIs: An observational study suggests HIV PrEP use does not increase gonorrhea or chlamydia incidence. The premise of "risk compensation" seems to be false, likely because mandatory quarterly visits increase testing and awareness.
11:40 Maternal Sepsis Bundle: A multicomponent intervention in Malawi and Uganda using a simple treatment bundle (FAST-M) significantly reduced infection-related maternal death and illness. As far as I can tell, this is a straightforward, effective public health win.
15:13 Public's Antibiotic Knowledge is Poor: A meta-analysis confirms that a substantial portion of the public does not understand that antibiotics are ineffective against viruses. This is not surprising.
18:14 Infant Botulism Outbreak:Critical Alert. An ongoing US outbreak of infant botulism (31 cases in 13 states) is linked to "ByHeart" Whole Nutrition Infant Formula. The products have been recalled. This is the most immediately actionable information in the episode.
21:54 Vitamin D and Pneumonia Mortality: A cohort study associated Vitamin D deficiency with a 3.5-fold higher 90-day mortality risk in patients with community-acquired pneumonia. This is almost certainly due to confounding; sicker, frailer people have lower Vitamin D levels. This finding is likely useless.
23:07 Bat Mycoplasmas in Children: Four immunosuppressed children in Spain were found to have hemotropic mycoplasmas genetically identical to a strain from local bats. There was no direct contact, suggesting an unknown transmission vector. The clinical significance is unclear.
27:15 Real-Time Fungal Resistance: A case study reports Candida auris evolving multidrug resistance in vivo while a patient was receiving antifungal therapy. It demonstrates rapid adaptation under selective pressure.
28:58C. parapsilosis Resistance Growing: Fluconazole resistance in Candida parapsilosis in the US has more than doubled in the past decade, from 8.2% to 20.3%.
30:05 Fatal Alpha-Gal Syndrome: A case of fatal anaphylaxis in a man four hours after eating beef. The cause was a tick-bite-induced allergy to alpha-gal. The delayed reaction is the key danger, as the trigger is not obvious.
34:43 Malaria Vaccine Real-World Efficacy: Field data from Africa confirms the RTS,S malaria vaccine works about as well as it did in trials, reducing severe malaria by ~58% and hospitalizations by 36%. It's another tool, not a cure-all.
39:05 Ivermectin in Small Children: A meta-analysis suggests the contraindication for ivermectin in children weighing less than 15 kg is baseless. Existing data from over 1,000 children show it to be safe. The guidance should probably be changed.
40:43 A Rare Immunodeficiency in North America: IL-12 receptor beta 1 deficiency presents in the US with severe NTM, Salmonella, or fungal infections, unlike elsewhere where it is associated with BCG vaccine reactions. A reminder that disease presentation depends on environmental exposures.