This "puscast," covering medical literature from the first two weeks of August 2016, reviews several key infectious disease topics, focusing heavily on vaccination efficacy, screening utility, and the severe long-term systemic consequences of infection.
Studies confirm significant efficacy for the HPV vaccine (90% reduction in HPV infection and warts) and provide further evidence supporting influenza vaccination in pregnancy (reduced severe disease and pre-term birth). Conversely, the US Preventive Services Task Force recommends against routine screening for asymptomatic genital herpes, arguing that unreliable diagnostics and treatment issues lead to net harm.
The speaker expresses professional skepticism regarding evidence quality, dismissing a meta-analysis on VRE treatment as "GIGO" (Garbage In, Garbage Out). Alarmingly, substantial data confirm that prior sepsis or bacteremia significantly increases the 5-year risk of cardiovascular events (MI/stroke), prompting the call for immediate clinical trials on prophylaxis. Furthermore, a highly surprising study links recent infections (including respiratory illnesses) to an increased risk of death by suicide in the following year, even in individuals without a psychiatric history.
Puscast Summary (August 2016)
0:05 HIV Transmission and ART: Antiretroviral therapy (ART) reduced HIV transmission by 77% in sero-discordant couples, but the rate was still 3.8 per 100 person years. Condoms are still necessary; relying solely on ART is not perfect, particularly in resource-poor settings.
0:21 HPV Vaccine Efficacy: A systematic review confirms the vaccine is extremely effective, showing a 90% reduction in HPV 6/11, 16, and 18 infections, a 90% decrease in genital warts, and an 85% decrease in high-grade cervical abnormalities. As far as I can tell, there are no long-term side effects.
0:59 HSV Screening Rejected: The US Preventive Services Task Force recommends against routine screening for genital herpes (HSV) in asymptomatic adults (ages 14-49). The test is not sensitive or specific enough, leading to false positives and subsequent harm, concluding that screening causes more harm than good.
0:44 Influenza in Pregnancy: Vaccination reduces the risk of severe influenza, early delivery, and fetal loss. One study estimated that one in five pre-term deliveries during flu season could be prevented by vaccination (06:32). Early treatment (antivirals) also decreased hospital length of stay.
7:09 Norovirus Evolution: The highly prevalent norovirus strain GII.4 is being challenged by a new, rapidly evolving strain, GII.17, which emerged around 2014. The organism evolves quickly, potentially keeping ahead of immune system response.
08:40 VRE Bacteremia Treatment: A meta-analysis comparing Daptomycin and Linezolid found no difference in safety or efficacy. The speaker rejects this finding, stating that meta-analyses are often GIGO (Garbage In, Garbage Out) and require cautious interpretation.
12:13 AFib in Sepsis: Anticoagulation for atrial fibrillation during sepsis is ineffective and potentially harmful. It increased the risk of bleeding without decreasing thromboembolic events; the suggestion is to probably leave it alone.
12:47 Cardiovascular Risk Post-Infection: Bacteremia and sepsis significantly increase the 5-year risk of cardiovascular events. Septic shock resulted in a 6.91-fold increase in the odds of myocardial infarction (MI). The speaker demands clinical trials to assess aspirin prophylaxis after infections to mitigate this recognized vascular risk (13:54).
14:13 NSAIDs and Infections: Use of non-steroidal anti-inflammatory drugs (NSAIDs) during infection is discouraged as it blunts the inflammatory response. French data showed NSAID use was associated with an increased risk of empyema as a complication of viral infections in children.
15:39Stenotrophomonas maltophilia Alternative: Minocycline (200mg daily) provided outcomes equivalent to TMP/sulfa in treating S. maltophilia infections in a small retrospective study (16:20). It is a good alternative for TMP/sulfa allergic patients.
16:45 Prosthetic Joint Infection (PJI) Duration: A randomized study found similar cure rates (~50%) for PJI treated with 8 weeks versus 3β6 months of oral levofloxacin plus rifampin. The speaker finds a 50% cure rate unacceptably low and prefers longer, more aggressive treatment courses (18:00).
19:25 Infection and Suicide Risk: A study found that patients who had experienced an infection (including respiratory infections and sepsis) had a 1.42-fold higher incidence of death by suicide in the following year, even if they had no prior psychiatric history (20:14). This surprising effect is speculated to be linked to pro-inflammatory cytokines.
18:04 Surgical Attire: New guidelines recommend changing out of scrubs before leaving the hospital. The speaker expresses general frustration that healthcare professionals often ignore basic germ theory, citing instances of egregious hygiene failure (19:02).