Target Audience for Review: Infectious Disease fellows, clinical microbiologists, antimicrobial stewardship pharmacists, and public health epidemiologists.
Abstract:
This clinical review synthesizes high-impact infectious disease (ID) literature from early April 2019, covering advancements in diagnostics, vaccinology, and antimicrobial therapy. Key findings include a systematic meta-analysis of normothermia, which identifies 36.59°C as the mean body temperature, with significant downward variance in geriatric populations. Epidemiological shifts are highlighted, including the northward migration of Borrelia species and the emergence of Streptococcus agalactiae ST283 in South American aquaculture.
In therapeutics, the review evaluates the clinical utility of Maribavir for refractory CMV and the efficacy of high-dose, short-course Primaquine for Plasmodium vivax. Critical assessments of MRSA management challenge the necessity of high vancomycin troughs (15–20 mg/L) for non-pneumonia infections and advocate for beta-lactam combination therapy in severe cases. Finally, the review addresses "pathovars" in E. coli-associated ventilator pneumonia and the rising resistance profiles of Mycoplasma genitalium, emphasizing the urgent need for stricter adherence to outpatient antibiotic stewardship guidelines.
Clinical Literature Review: Infectious Disease Updates (April 2019)
0:48 Defining Normothermia: A meta-analysis of 9,227 measurement sites confirms mean body temperature is 36.59°C. Temperature varies by site (rectal: 37.04°C; axillary: 35.97°C) and age; patients over 60 average 0.23°C lower, potentially masking febrile responses to infection.
2:36 Antibiotic Stewardship Failures: Data from English primary care shows 80% of antibiotic prescriptions exceed duration guidelines for upper respiratory infections. Clinicians are urged to adopt shorter courses to mitigate resistance.
4:05 Maribavir for CMV: Maribavir (a UL97 kinase inhibitor) shows a 67% response rate in refractory/resistant CMV cases in transplant recipients, offering a less toxic alternative to foscarnet or cidofovir.
5:20 HPV Vaccine Efficacy: Population-level studies show a marked decline in high-grade cervical lesions (CIN2+) in young women, demonstrating the vaccine's success as a primary cancer prevention tool.
6:16 HTLV1 Transmission: Ten cases in the UK highlight a novel transmission route for HTLV1 via unsterile shared implements during religious self-flagellation.
7:13Mycoplasma genitalium Resistance: In MSM populations, M. genitalium shows alarmingly high macrolide resistance (84%), complicating standard treatment protocols for urethritis.
8:10 Invasive Group B Strep (ST283): A virulent strain of S. agalactiae (ST283) associated with raw fish consumption has migrated from Asia to Brazilian tilapia farms, signaling a potential global foodborne threat.
9:10 Zoonotic Plague Risks: Domestic pets (dogs/cats) in Colorado acting as vectors for bubonic plague after contact with prairie dogs; highlights the need for veterinary vigilance in endemic regions.
10:21 Transplant-Acquired Tularemia: A case of Francisella tularensis transmission via solid organ transplantation from a donor exposed to infected rabbits underscores gaps in donor screening for regional zoonoses.
11:33 Lyme Disease Expansion:Borrelia burgdorferi and B. miyamotoi are trending northward into Maine. Clinical data suggests co-infections (e.g., Babesia) are rare exceptions rather than the rule, contrary to "chronic Lyme" anecdotal claims.
15:32 Vancomycin Trough Efficacy: Retrospective data suggests no mortality benefit in maintaining MRSA vancomycin troughs at 15–20 mg/L for most infections, except for MRSA pneumonia, where higher troughs improved clinical and microbiological success.
16:29 MRSA Combination Therapy: Combining vancomycin with a beta-lactam (e.g., Cefepime) for MRSA bacteremia results in faster microbiological clearance compared to vancomycin monotherapy.
17:37 Cefazolin vs. Nafcillin for MSSA: Both agents are equivalent for MSSA bacteremia; however, the "inoculum effect" may favor Nafcillin in cases with high pathogen burdens and poor source control.
21:40 Chronic Suppression in PJI: For infected prosthetic joints where the hardware is retained, chronic suppressive oral antibiotics significantly improve joint survival rates, though the risk of relapse remains high if therapy is discontinued.
23:31 Fecal Microbiota Transplant (FMT): Systematic reviews show FMT is highly effective for recurrent C. difficile, though cure rates in randomized controlled trials (67%) are lower than in open-label studies (82%).
25:52 Fosfomycin for Prostatitis: Long-term oral Fosfomycin (6–12 weeks) shows an 82% cure rate for chronic bacterial prostatitis, offering a viable alternative to quinolones.
28:51 Lobo mycosis Identification:Lacazia loboi, a fungal pathogen in Central/South America, causes skin lesions often mistaken for Leishmaniasis. It is non-culturable and requires biopsy for diagnosis.
30:52P. vivax Dosing: A 7-day high-dose Primaquine regimen (1 mg/kg/day) is non-inferior to the standard 14-day regimen for eradicating the liver phase of malaria, improving potential compliance.