This transcript details a review of infectious disease literature from late August 2013, delivered by a self-proclaimed "lethargic" host. Honestly, I don't care about the host's fatigue or his porch. The information, while dated, presents several clinical and epidemiological points relevant to infectious disease management and public health.
Abstract:
This "puscast" reviews medical literature from August 2013, focusing on emerging and endemic infectious disease topics. Epidemiological concerns include the potential northern spread of Eastern Equine Encephalitis (EEE) and the identification of MERS-CoV in camels and bats. Clinical evidence is heavily emphasized, supporting the pleomorphic protective benefits of influenza vaccination (including decreased myocardial infarction risk) and the utility of higher-dose flu vaccines for the elderly. The review details optimal antibiotic strategies for serious infections, such as requiring 8+ weeks of IV therapy for MRSA spinal osteomyelitis and using elevated daptomycin dosing (up to 10 mg/kg) for endocarditis. Finally, the host dismissively addresses public health issues, criticizing low vaccination rates in Oregon and highlighting outbreaks resulting from contact with raw milk and pseudoscientific practices like mesotherapy.
Infectious Disease Literature Review (August 2013)
0:50 Emerging Infections - EEE in Panama: An outbreak of Eastern Equine Encephalitis (EEE) was reported in Panama. EEE is endemic to the US and parts of Latin America, but its appearance here suggests a possible northward expansion due to ecosystem changes or climate issues, as far as I can tell.
1:57 Long-Term Flu Effects (1918 Pandemic): A study found that individuals exposed to the 1918 H1N1 influenza pandemic had increased long-term mortality from non-cancer deaths (likely cardiovascular issues) but decreased mortality from cancer later in life. This supports the idea that influenza causes long-term vascular disease.
3:45 Flu Vaccine and Cardiovascular Protection: Australian data reinforces that the influenza vaccine provides systemic protection, showing that vaccinated patients were two times less likely to experience a myocardial infarction than unvaccinated individuals. This protective effect is significant and often overlooked.
4:20 Mask Efficacy on Flights: A study of a flight from New York to Hong Kong showed 0% influenza acquisition for passengers who wore masks near a coughing source, versus 47% acquisition for those who did not. This strongly supports mask usage in confined, high-density environments.
5:26 High-DDose Flu Vaccine: Preliminary data (reported via Medscape) suggested that the high-dose Fluzone vaccine was $24.2%$ more effective in preventing flu in adults 65 and older. While lacking scrutiny, it supports the principle that higher antigen loads may improve immune response in the elderly.
6:20 Vaccine Refusal in Oregon: Oregon reportedly leads the nation in unvaccinated school-aged children (6.7%), increasing the risk of preventable outbreaks like measles and mumps. This is frankly stupid and sets up a predictable public health failure.
7:33 Third MMR Dose Utility: During a mumps outbreak, a study found that giving a third MMR dose to exposed individuals who had previously received two shots resulted in a 0% mumps rate (vs. 5.2% for controls). Though not statistically significant, it's worth considering for post-exposure prophylaxis.
8:19 MERS-CoV Reservoirs: The new Beta coronavirus (MERS-CoV) was reported found in both camels and bats, suggesting potential zoonotic sources for human infection.
9:12 HIV Risk in Fishermen: A meta-analysis revealed an alarmingly high HIV prevalence (30%) among fishermen, correlating their risk profile with female sex workers and truck drivers, primarily due to high rates of transactional sex and low condom use.
10:32 HPV Vaccine in HIV: The HPV vaccine was found to be safe and elicited a good immunologic response in virally suppressed HIV patients (CD4 > 200). Given the high cancer rates in this population, vaccination is highly recommended.
14:20 MRSA Spinal Osteomyelitis Duration: Relapse rates for MRSA osteomyelitis of the spine are highly sensitive to IV antibiotic duration: $\geq 8$ weeks resulted in a $5.6%$ relapse rate, compared to $25%$ for $6-8$ weeks and $42%$ for $4-6$ weeks. Key Takeaway: Treat aggressively for at least eight weeks IV.
15:27 Determining CoNS Significance: Criteria suggesting a coagulase-negative Staph bacteremia is clinically relevant (not contamination) include a time to positivity $<16$ hours (for S. epidermidis), growth from multiple culture sets, the presence of a central line, and a high Charleston score. As far as I can tell, the predictive value (83%) is mediocre, meaning clinical judgment is still paramount.
17:05 High-Dose Daptomycin: Studies show 90% success rates for serious infections (e.g., endocarditis, intra-abdominal infections) using high-dose daptomycin (8β10 mg/kg/day), suggesting these higher doses are superior to the standard 6 mg/kg regimen for severe cases.
18:46 Surgical Prophylaxis Timing: Optimal timing for prophylactic antibiotics was found to be 18 minutes before incision, which is logistically impossible to hit consistently. Decolonization of MRSA patients combined with glycopeptide and cephalosporin prophylaxis was also effective in decreasing infections.
20:20 Risks of Alternative Practices: Outbreaks of Campylobacter linked to raw milk consumption and atypical mycobacterium associated with mesotherapy (injections of unregulated substances into the skin) highlight the inherent dangers of practices not grounded in reality. People should quit doing dumb things instead of relying on regulation (21:43).
24:54 Fluconazole in Pregnancy Risk: A large study found fluconazole use during pregnancy was associated with an increased risk of only one birth defect: Tetralogy of Fallot, with no increased risk found for 14 other defects.