This presentation, Infectious Disease Puscast episode #98, provides a high-level clinical synthesis of infectious disease (ID) literature published between January 1, 2026, and January 14, 2026. Key developments include histological evidence confirming human rhinovirus (HRV) tropism in the lower respiratory tract of immunocompetent adults and a critical re-evaluation of the Milwaukee Protocol for rabies, which is increasingly deemed ineffective. Large-scale clinical trials reported in the New England Journal of Medicine and The BMJ establish the non-inferiority of a single-dose HPV vaccine compared to a two-dose regimen and the statistical superiority of topical 5% permethrin over oral ivermectin for treating classic scabies. Furthermore, epidemiological updates highlight the efficacy of wastewater surveillance in providing 10-week early warnings for measles outbreaks. The session also previews updated 2025 IDSA guidelines for urinary tract infections (UTIs) and evidence-based refinements to the Duke criteria for infective endocarditis.
Clinical Review: Infectious Disease Literature Synthesis (Jan 1–14, 2026)
0:00 Rhinovirus Tropism and Pneumonia: A retrospective cohort study (2020–2023) in the Journal of Infectious Diseases (JID) found HRV in 4.6% of hospitalized adults. Immunofluorescent staining of lung biopsies confirmed the presence of VP3 protein in lower respiratory tract cells (alveolar type 1 and 2), proving dual alveolar tropism. Independent predictors for simple rhinovirus pneumonia include male sex (OR 2.7), fever (OR 3.8), and cough (OR 7.3).
4:33 Demise of the Milwaukee Protocol: In a formal correspondence in Clinical Infectious Diseases (CID), experts concluded the Milwaukee Protocol (therapeutic induced coma) lacks efficacy. Data suggests survival in rabies cases is attributed to high-quality critical care rather than the protocol's components (ketamine, ribavirin, amantadine). The protocol is increasingly recommended for abandonment in favor of newer therapeutic approaches.
7:34 Single-Dose HPV Vaccine Non-inferiority: A randomized trial involving 20,330 participants published in NEJM demonstrated that one dose of either bivalent or nonavalent HPV vaccine is non-inferior to two doses. Vaccine effectiveness was at least 97% for preventing new persistent HPV 16/18 infections through month 60.
9:33 Measles Wastewater Surveillance: CDC MMWR reports from Colorado and Oregon indicate that wastewater monitoring can detect wild-type measles virus up to 10 weeks before the first clinical case is reported. This provides a critical early warning signal, especially in communities with low healthcare-seeking behaviors.
13:43 Updated IDSA UTI Guidelines: The 2025 IDSA guidelines simplify UTI classification into a binary system: "Uncomplicated" (localized to the bladder, no fever) and "Complicated" (extension beyond the bladder, fever, systemic symptoms, or presence of medical devices/catheters).
15:15 Refining Duke Criteria for Endocarditis: Validation of the 2023 Duke-ISCVID criteria suggests that excluding fever as a minor criterion improves diagnostic specificity without compromising sensitivity. This challenges the traditional reliance on fever for diagnosing infective endocarditis (IE).
17:11 Procalcitonin and Bacteremia Accuracy: A meta-analysis of 40 studies (192,529 patients) evaluated procalcitonin (PCT) for predicting bacteremia. A 0.10 ng/mL threshold yielded 93% sensitivity but only 36% specificity. While useful for excluding community-acquired bacteremia (NPV 97.1%), clinicians must weigh the risk of a 7.2% miss rate.
18:40Candida auris Persistence and Dissemination: Now taxonomically referred to as Candidozyma auris, research highlights its extreme environmental resilience. A study found air grills have higher contamination rates (31.6% in outbreaks) than high-touch surfaces, indicating long-range air dispersal as a transmission vector requiring specialized infection prevention and control (IPC).
21:51 Scabies Treatment Efficacy: A French multicenter, cluster-randomized trial in The BMJ compared oral ivermectin to 5% permethrin cream for classic scabies. Permethrin demonstrated statistical superiority with an 88.5% cure rate compared to 71.8% for ivermectin on day 28. Dermoscopy remains the preferred diagnostic tool for point-of-care confirmation.