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Abstract:
Episode #77 of the Infectious Disease Puscast features hosts Dr. Daniel Griffin and Dr. Sara Dong reviewing key infectious disease literature published between March 13th and March 26th, 2025. Opening with reflections on the challenging environment for infectious disease research and public health due to funding cuts and misinformation, the hosts delve into recent studies. Viral topics include the positive impact of medically tailored food programs on hospitalization and adherence in people with HIV, and the significant burden of parainfluenza hospitalizations in children. Bacterial discussions cover bloodstream infections in burn units, prophylactic vancomycin for C. difficile prevention in stem cell transplant patients, the high incidence and severity spectrum of scrub typhus in South India, the non-inferiority of 7-day versus 14-day antibiotic courses for bloodstream infections (BALANCE trial), new AHA guidelines for culture-negative endocarditis, and a case of Brucella suis infection linked to feral swine. Fungal highlights include infections in people who use drugs (noting crucial drug interactions with antifungals), updated IDSA guidelines on managing histoplasmosis, the changing epidemiology and increasing prevalence of Candida auris, and the utility of Beta-D-Glucan testing for Pneumocystis jirovecii pneumonia diagnosis. Parasitic studies examine the impact of Strongyloides co-infection on TB severity, the diagnostic equivalence of hematology thin smears versus traditional parasitology smears for Plasmodium and Babesia in low-prevalence settings, and a case report of Sleeping Sickness in a returning traveler. The episode concludes by discussing the history of phage therapy and a perspective piece urging the ID community to resist threats to science and public health, invoking the "Silence = Death" rallying cry.
Infectious Disease Puscast #77: Literature Review (March 13-26, 2025)
0:00 Introduction & Context: Drs. Daniel Griffin and Sara Dong introduce the episode, noting the review period. They express concerns about the current climate impacting infectious disease research and care, including funding cuts for virology/vaccine research, the closure of the NIH long COVID office, and the harmful effects of misinformation on public health, particularly childhood vaccinations.
2:42 Viral - Food is Medicine for HIV (JID): Discussion of the CHEFS-HIV trial, a pragmatic RCT showing that comprehensive medically tailored meals for people with HIV significantly reduced hospitalizations (by almost 90%) and depressive symptoms, and improved ART adherence, although viral non-suppression and quality of life metrics didn't differ significantly over 6 months compared to standard food services.
8:43 Viral - Human Parainfluenza Burden (JPIDS): Review of a study using surveillance network data (NVSN) quantifying the substantial hospitalization burden of parainfluenza virus (PIV) in US children, responsible for 7% of single-virus acute respiratory hospitalizations, with over half of affected children having no underlying comorbidities and highest rates in infants 0-5 months.
10:46 Bacterial - Bloodstream Infections in Burn ICU (OFID): A retrospective study from a French burn ICU found 22% of patients developed BSIs, with Pseudomonas aeruginosa being the most common pathogen. Risk factors included older age, higher burn severity, and TPN. A shift towards Gram-negative infections was noted after the first week.
13:27 Bacterial - Prophylactic Vancomycin for C. difficile (Transplant ID): A retrospective study in allogeneic stem cell transplant patients showed oral vancomycin prophylaxis significantly reduced the incidence of C. difficile infection in the first 100 days post-transplant (1.4% vs 23.6% in the unexposed group, a 95% reduction).
15:22 Bacterial - Scrub Typhus Incidence in South India (NEJM): A large, population-based cohort study documented the epidemiology of scrub typhus (Orientia tsutsugamushi) in an endemic rural area. Estimated incidence was 6 cases per 10,000 person-years. While most infections were asymptomatic/mild, symptomatic cases often resulted in severe disease, with 21.6% requiring hospitalization. High baseline antibody levels seemed to predispose to clinical infection.
20:20 Bacterial - 7 vs 14 Days Antibiotics for BSIs (NEJM): The BALANCE trial, a large multicenter RCT, demonstrated that a 7-day course of antibiotics was non-inferior to a 14-day course for patients with bloodstream infections regarding 90-day mortality (14.5% vs 16.1%). Reinforces the "less is more" approach.
23:43 Bacterial - Culture-Negative Endocarditis Guidelines (JAHA): Review of a new AHA scientific statement endorsed by ISCVID. It categorizes causes (prior antibiotics vs. fastidious/non-bacterial organisms like Coxiella, Bartonella), provides diagnostic algorithms (including mentioning plasma metagenomics), and offers empiric antibiotic recommendations (e.g., Vancomycin + Ceftriaxone for native valve) while noting controversies around agents like Rifampin and Gentamicin.
27:36 Bacterial - Brucella suis Cardiac Device Infection (EID): Case report of a man in Florida with an ICD infection caused by Brucella suis, acquired from handling feral swine meat. Diagnosis was delayed despite multiple admissions for culture-negative infection. Highlights include Brucella reservoir in feral swine and potential misidentification by Vitek systems (as Ochrobactrum).
29:44 Bacterial - Hyperbilirubinemia & Nosocomial Infection in Cirrhosis (Hepatology Comm): A follow-up analysis of the ATTIRE trial found that elevated baseline serum bilirubin (>188 µmol/L) was the primary predictor of subsequent nosocomial infection in hospitalized patients with decompensated cirrhosis (Specificity 80%), associated with significantly higher 28-day mortality. Discusses potential implications for targeted prophylaxis but cautions against broad application without considering infection types (many respiratory infections likely viral).
35:44 Fungal - Infections in People Who Use Drugs (OFID): Review highlighting fungal infection risks associated with drug use (e.g., Candidemia with IVDU, Aspergillus/Mucorales with marijuana). Crucially emphasizes the potential for dangerous drug interactions between substances like cannabis, methamphetamines, and opioids and antifungal medications (triazoles, terbinafine) via CYP enzyme inhibition, increasing overdose risk.
37:25 Fungal - IDSA Histoplasmosis Guideline Update (IDSA): Summary of 2025 updates suggesting against routine treatment for asymptomatic Histoplasma pulmonary nodules (histoplasmomas) and mild acute pulmonary histoplasmosis in immunocompetent individuals. Treatment is considered for moderate acute cases and recommended for immunocompromised patients with moderate/high risk of progression.
38:33 Fungal - Candida auris Trends (AJIC): A study from a large health system (2019-2023) shows continually increasing clinical cultures of C. auris. While blood cultures remain most common, their proportion is decreasing relative to increasing bone/soft tissue isolates. Infection sources are expanding. All isolates were Clade III (South African), resistant to fluconazole but susceptible to echinocandins and amphotericin B.
40:24 Fungal - Fungitell (Beta-D-Glucan) for Pneumocystis Pneumonia (CMI): A meta-analysis supports a categorical approach to using serum (1→3)-β-D-glucan (BDG) for diagnosing Pneumocystis jirovecii pneumonia (PJP): a level <80 pg/mL helps rule out PJP (especially with low pre-test probability), while a level >400 pg/mL significantly increases specificity (93.6%) and helps rule in PJP (especially with high pre-test probability).
42:08 Parasitic - Strongyloides & Tuberculosis Co-infection (OFID): Study showing that pulmonary TB patients co-infected with Strongyloides stercoralis had higher bacterial loads, increased bilateral and cavitary lung disease, and altered cytokine profiles (more pro-fibrotic factors, less IFN-gamma/IL-2), indicating worse disease severity.
43:32 Parasitic - Hematology vs. Parasitology Smears for Malaria/Babesia (JCM): A retrospective study found that standard hematology lab thin blood smears performed equally well compared to specialized parasitology thick/thin smears for the initial diagnosis of Plasmodium and Babesia infections in a low-prevalence setting (100% concordance for new diagnoses). This could be valuable where full parasitology services are limited, though trained technicians are still needed.
45:52 Parasitic - Rhodesiense Sleeping Sickness Case (MMWR): Report of a US traveler returning from a safari in Zimbabwe who developed Rhodesian Human African Trypanosomiasis (Trypanosoma brucei rhodesiense). Despite initial treatment with fexinidazole, the patient rapidly deteriorated to multi-organ failure, requiring additional treatment with pentamidine before eventually recovering.
47:21 Miscellaneous - History of Phage Therapy (Lancet ID): Discussion of a book ("The Living Medicine") reviewing the history of bacteriophage therapy and reasons it failed to gain traction in the West (e.g., poor matching, false claims, discreditation).
48:33 Miscellaneous - Silence = Death Redux (CID): Review of a perspective piece urging the infectious diseases and public health communities to actively resist current threats to science, funding, and patient care, drawing parallels to the "Silence = Death" slogan of AIDS activism during the HIV epidemic. Calls for defending science, opposing censorship, and protecting patients and colleagues.
51:52 Outro: Concluding remarks, subscription information, and funding appeals.