The appropriate review group for this material is Infectious Disease (ID) Physicians and Clinical Microbiologists. They demand high standards of evidence and will focus relentlessly on the practical implications for patient management and public health.
Here is the abstract and summary, presented with the frankness and critical scrutiny expected by that audience.
Abstract
This "puscast" reviews selected infectious disease literature from the last two weeks of August 2019, covering topics ranging from emerging pathogens and antibiotic resistance mechanisms to diagnostic controversies and clinical practice guidelines. Key points address the suboptimal uptake of the HPV vaccine in the US, the impact of Original Antigenic Sin (OAS) on adult influenza outcomes, and concerning data regarding Colistin/Meropenem combination therapy for XDR Acinetobacter baumannii. The review also highlights recurring failures in regional ID recognition (Coccidioidomycosis) and critiques weak evidence supporting certain interventions (recurrent UTI management).
ID Clinician Review: Key Literature Updates (August 2019)
0:51 Cane Toads & Fungal Resistance: The resistance of invasive Cane Toads to the global amphibian fungal plague (Batrachochytrium dendrobatidis) is correlated with antifungal properties in their cutaneous microbiome. Interesting biological mechanism, clinically irrelevant.
1:46 Bourbon Virus (Tickborne): Seropositivity in white-tailed deer and raccoons suggests these are important environmental reservoirs, guiding public health strategies for tick control.
2:23 HIV Virologic Failure Risk: African data shows patients with viral loads between 200 and 999 copies/mL have double the risk of virologic failure. Furthermore, Dolutegravir exposure at conception increased neural tube defect risk from $1/1000$ to $3/1000$ deliveries. Critical data for monitoring and ARV selection.
3:00 HPV Vaccination Failure: US uptake is poor; only $16%$ of adolescents are vaccinated by age 13. Takeaway: The majority of adolescents are missing the optimal window for this cancer-preventing vaccine.
3:47 Influenza & Original Antigenic Sin (OAS): The first influenza A strain exposure sets the immune response trajectory. Birth cohorts exposed early to H1 (pre-1957) or H3 (1968β1977) demonstrate differential adult susceptibility (hospitalization/death) to currently circulating strains. Epidemiologically important for predicting severity.
5:33 Acute Flaccid Myelitis (AFM): Enterovirus D68 (EVD68) remains the leading suspect for AFM, despite the ongoing controversy regarding its irregular detection in CSF, a pattern also seen with Poliovirus.
6:21 Japanese Spotted Fever (JSF):Rickettsia japonica is now confirmed in Xinjiang, China, expanding its known geographic distribution across Southeast/East Asia. Relevant for travel medicine diagnostics.
7:33 Gonorrhea Light Sensitivity (In Vitro):N. gonorrhoeae lacks superoxide dismutase, making it sensitive to singlet oxygen generated by $405 \text{ nm}$ antimicrobial blue light. Rejection: I don't care about in vitro findings. The delivery mechanism required for treating cervicitis or urethritis is impractical (8:02).
8:25 Lyme Diagnosis Evolution: The FDA has approved non-Western Blot serological assays as a second step in the two-tiered testing protocol, contingent on matching or exceeding the performance of the Western Blot. This is likely intended to curb the proliferation of unsupported testing protocols used by certain private labs.
9:15 Lyme Treatment (ECM): A small case series suggests two weeks of Amoxicillin $500 \text{ mg}$ TID may suffice for Erythema Chronicum Migrans (ECM). If confirmed, a shorter course is more efficient.
9:38 Transplant-Related Tularemia:Francisella tularensis transmission via transplanted organs is a rare but lethal event. Diagnosis is hampered by its slow growth in standard blood cultures (usually held for 5 days). Clinical Takeaway: Maintain a high index of suspicion in post-transplant sepsis unresponsive to $\beta$-lactams and vancomycin.
12:04 Colistin Resistance and Meropenem Synergy: Colistin-resistant Acinetobacter baumannii infections paradoxically showed better outcomes with colistin monotherapy compared to colistin plus meropenem. Premise Rejection: This is highly counterintuitive, but cited data suggests carbapenems at low concentrations might increase virulence. Stop combining these agents in XDR infections until this is resolved.
13:48 Recurrent Uncomplicated UTIs: AUA guidelines find insufficient data for most non-antibiotic treatments (Lactobacillus, D-mannose, etc.). The recommendation for cranberry juice is explicitly noted as based on expert opinion (Level C). Rejection: Cranberry juice is a non-starter and serves only to make cosmopolitans.
15:18 IV Iron Safety: A Taiwan case-crossover study in hemodialysis patients showed no increased infection risk (Odds Ratio 1.0) following IV iron administration. I remain skeptical, as iron is a critical bacterial growth factor, but this data is reassuring.
16:49 Coccidioidomycosis (Coxy) Recognition: Studies in endemic Arizona show a lack of recognition among providers, resulting in delayed diagnosis, unnecessary antibiotic use, and significant cost ($>$500\text{k}$ in Tucson). A basic failure in endemic regional ID education.
17:31 Mycobacterium haemophilum: Requires specialized low-temperature culture media and combination therapy (macrolide/quinolone/rifampin). Clinical Takeaway: Consider this organism in immunocompetent patients with AFB-positive, non-growing skin lesions.
19:06 Value of ID Consultation (OPIVA): Patients discharged on Outpatient IV Antibiotics (OPIVA) who had ID follow-up within two weeks demonstrated a decreased risk of 30-day all-cause readmission. Not surprised that expert involvement yields better outcomes.Criticism: The prevailing guideline suggesting weekly follow-up lacks supporting data and seems like a scam intended to increase clinic revenue (19:53).