This topic is best reviewed by Infectious Disease Specialists, Clinical Microbiologists, Hospital Epidemiologists, and Public Health Officials, as it covers critical updates in clinical guidelines, emerging pathogen threats, vaccine effectiveness, and new surveillance technologies.
Abstract:
This installment of the Infectious Disease Puscast focuses on key findings from the clinical literature published in early January 2026. Highlights include viral epidemiology research confirming Human Rhinovirus (HRV) tropism in the lower respiratory tract (LRT) and its role in adult pneumonia. A definitive critique of the Milwaukee Protocol for rabies therapy is presented, emphasizing its abandonment due to documented lack of efficacy, asserting that critical care is the only beneficial component. Major public health updates feature a randomized controlled trial demonstrating the non-inferiority of single-dose HPV vaccination and the demonstrated effectiveness of wastewater surveillance as an early detection system for measles outbreaks. Bacteriology updates include an overview of the IDSA 2025 guidelines for complicated Urinary Tract Infections (cUTI), proposing a revised binary classification, and an assessment of the Duke-ISCVID criteria for Infective Endocarditis, which found improved specificity by removing fever as a minor criterion. Lastly, emerging threats are reviewed, with a focus on Candidozyma auris endemicity, air dispersal contamination risk, and an RCT confirming the superior clinical efficacy of topical permethrin over oral ivermectin for classic scabies treatment.
Infectious Disease Literature Review: January 1–14, 2026
1:26 Rhinovirus as a Lower Respiratory Pathogen: A retrospective cohort study (JID) evaluating hospitalized adults (Jan 2020–Dec 2023) confirmed the role of Human Rhinovirus (HRV) in lower respiratory tract infection (LRTI).
Epidemiology: HRV was detected in 4.6% of patients, exhibiting a bimodal seasonal peak (Feb–Apr and Sep–Nov).
Pathogenesis: Immunofluorescent staining provided histological evidence of HRV VP3 protein in LRT cells (61.5% positivity), confirming alveolar tropism in adults.
Risk Factors: Multivariate analysis identified male sex (OR 2.69), fever (OR 3.79), and cough (OR 7.33) as independent predictors for simple HRV pneumonia.
4:33 Demise of the Milwaukee Protocol: A letter published in CID provided a robust rebuttal to Dr. Willoughby regarding the Milwaukee Protocol for rabies, arguing that the protocol (therapeutic coma, ketamine, ribavirin, amantadine) is ineffective and should be abandoned.
Critique: Authors asserted that the only effective component of the protocol is critical care. They cited a lack of publicly available supporting data for claimed survivors and noted that some cases included in the "survivor" list either did not have rabies (lacked neutralizing antibodies) or died shortly after critical care discharge.
7:34 Single-Dose HPV Vaccine Non-Inferiority: A randomized controlled trial (NEJM) involving 20,330 participants demonstrated that a single dose of either the bivalent or nonavalent Human Papillomavirus (HPV) vaccine was non-inferior to two doses in preventing persistent HPV 16 or 18 infection.
Efficacy: Vaccine effectiveness remained high (≥97%) across all dosing schedules.
Implication: This finding supports potentially increased global uptake due to simplification of the dosing schedule.
9:33 Measles Wastewater Surveillance: Two MMWR reports (Colorado and Oregon) validated the effectiveness of wastewater surveillance as a proactive public health tool for measles.
Early Detection: Retrospective analysis in Oregon showed wastewater detection preceded the first clinical case by 10 weeks. In Colorado, a significant increase in viral RNA (944,000 gene copies/L) preceded confirmed cases by days, enabling a coordinated public health response.
13:43 IDSA 2025 Complicated UTI Guidelines: CID published the introductory methods for the forthcoming IDSA cUTI guidelines, emphasizing a revised classification system.
New Classification: The proposed system shifts toward a binary distinction: uncomplicated UTI (infection confined to the bladder) versus complicated UTI (pyelonephritis, systemic symptoms, or associated with a medical device/catheter).
15:15 Duke Criteria for Infective Endocarditis (IE): A CID study reassessed the 2023 Duke-ISCVID criteria for IE diagnosis.
Diagnostic Improvement: Exclusion of fever as a minor criterion significantly improved diagnostic specificity (from 49% to 80%) without compromising sensitivity (74% to 77%), challenging the historical reliance on fever in the criteria.
17:14 Procalcitonin Diagnostic Accuracy: A systematic review and meta-analysis (CMI) comprising 40 studies assessed the diagnostic accuracy of Procalcitonin (PCT) for community-acquired bacteremia (CAB).
Performance: A low cut-off of 0.10 ng/mL demonstrated a high pooled sensitivity of 93%, but a low pooled specificity of 36%, suggesting utility for excluding CAB contingent on the clinician's acceptable threshold for risk tolerance regarding missed cases.
18:37Candidozyma auris Endemicity and Air Dispersal: A CMI narrative review documented the global expansion and entrenched endemicity of C. auris due to multidrug resistance and environmental persistence.
Contamination Risk: A related study highlighted that air grille samples showed significantly higher contamination rates (31.6% in outbreak settings) than high-touch surfaces (10.2%), implying that long-range air dispersal is an important source of environmental contamination.
21:45 Scabies Treatment Efficacy: A multicenter, cluster randomized clinical trial (BMJ) comparing oral ivermectin to 5% permethrin cream for classic scabies.
Efficacy: Permethrin demonstrated statistical superiority with a cluster-level cure rate of 88.5% versus 71.8% for ivermectin at day 28.
Compliance vs. Efficacy: While permethrin showed better cure rates, participants reported a stronger preference for the acceptability and ease of use of oral ivermectin.