Episode #78 of the Infectious Disease Puscast features Drs. Daniel Griffin and Sara Dong reviewing key infectious disease literature published between March 27th and April 9th, 2025. They discuss recent findings across viral, bacterial, fungal, parasitic, and miscellaneous categories. Significant topics include the critique of the Milwaukee protocol for rabies, a study linking herpes zoster vaccination to reduced dementia risk, updated CMV management guidelines in transplant patients, the potential link between EBV and Crohn's disease, the FDA approval of gepotidacin (Bluejeepa) as a new oral antibiotic for uncomplicated UTIs, challenges with pediatric UTI treatment duration, the cost barrier of blood cultures in LMICs, issues with fungal disease coverage in medical textbooks, the diagnostic utility of plasma cell-free DNA for invasive fungal diseases, fatal amoeba cases linked to contaminated water exposure (splash pad, nasal irrigation), and the authorization of the first at-home test for chlamydia, gonorrhea, and trichomoniasis.
Infectious Disease Literature Review (Weeks of 3/27/25 - 4/9/25)
2:06 Milwaukee Protocol for Rabies Critiqued: A CID article argues for abandoning the Milwaukee protocol (therapeutic coma, antivirals) for rabies. Despite an initial promising case in 2004, subsequent evidence shows a lack of efficacy (β₯64 reported failures) and suggests the protocol may have hindered progress in finding effective therapies.
6:41 Herpes Zoster Vaccination and Dementia Risk: A Nature study using a natural experiment in Wales (eligibility based on exact birth date for the original live attenuated zoster vaccine) found that vaccination was associated with a 3.5 percentage point reduction (20% relative reduction) in new dementia diagnoses over 7 years. The effect appeared stronger in men.
9:33 Updated CMV Management Guidelines:Lancet Infectious Diseases published updated European recommendations for CMV management post-transplant and T-cell therapies. Key updates include recommending Letermovir for primary prophylaxis in adult allo-HCT recipients and highlighting Maribavir for resistant/refractory cases, while generally not recommending agents like val/ganciclovir or foscarnet for prophylaxis.
13:25 Epstein-Barr Virus (EBV) Exposure and Crohn's Disease: A study in Gastroenterology using a military cohort (PREDICTS) found that individuals who developed Crohn's disease had increased evidence of EBV exposure (seroconversion) 5-7 years prior to their diagnosis, suggesting a potential link.
16:48 FDA Approves New Oral UTI Antibiotic (Gepotidacin/Bluejeepa): GSK's Gepotidacin (marketed as Bluejeepa) received FDA approval for uncomplicated UTIs in females aged 12+. It represents the first new oral antibiotic class for this indication in nearly three decades, inhibiting bacterial DNA replication via gyrase and topoisomerase IV.
19:06 Pediatric Febrile UTI Treatment Duration Trial: The INDI-UTI trial (Lancet ID) compared individualized antibiotic duration (median 5.3 days) versus standard 10 days for pediatric febrile UTIs. The individualized group had a higher 28-day recurrence rate (11% vs 6%), failing to meet non-inferiority at that point, although non-inferiority was met at 100 days. This raises questions about balancing shorter duration/fewer AEs against early recurrence risk.
25:04 Myasthenia Gravis Exacerbations and Antibiotics: A retrospective review (Muscle & Nerve) found low rates (1.5-2.4%) of Myasthenia Gravis exacerbations following ciprofloxacin, levofloxacin, or azithromycin use, similar to the rate seen with amoxicillin (1.3%), questioning the common warning against these antibiotics in MG patients.
27:36 Cost of Blood Cultures as a Barrier in LMICs: A comment in Lancet Microbe highlights that the cost of blood cultures (often >$10-15 USD paid by patients/facilities) is a significant barrier to diagnosis in many low- and middle-income countries, far exceeding a suggested optimal price of <$5.
30:51 Trends in Anaplasmosis: A CID review of Mayo Clinic cases (2012-2022) found most anaplasmosis cases were managed outpatient. The classic triad (leukopenia, thrombocytopenia, transaminitis) was present in only ~25% but associated with hospitalization risk. Co-infection didn't significantly impact outcomes.
33:46 Deficiencies in Fungal Disease Coverage in Textbooks: An OFID article assessed major medical textbooks (e.g., Harrison's, Mandel's) and found significant gaps, outdated information, and inadequate coverage of fungal diseases, particularly in general internal medicine texts, potentially compromising education.
37:54 Emerging Fungal Pathogen (Kazachstania slooffiae):OFID reports the first documented human fungemia case caused by Kazachstania slooffiae (formerly Candida slooffiae), an emerging opportunistic yeast, in a complex patient post-esophagectomy.
39:22 Plasma Cell-Free DNA for Invasive Fungal Diagnosis: A CID study evaluated microbial cell-free DNA sequencing (e.g., Karius test) for diagnosing invasive fungal infections. It showed high specificity (100%) but variable sensitivity (~50% overall, higher for proven vs. probable disease, and notably high for mucormycosis, though based on few cases).
43:53 Fatal Naegleria fowleri Linked to Splash Pad: An MMWR report details a fatal case of primary amoebic meningoencephalitis (PAM) in an infant in Arkansas associated with playing in a community splash pad, underscoring the risk of improperly treated recreational water.
45:55 Fatal Acanthamoeba Encephalitis Linked to Tap Water Use: An MMWR report describes fatal granulomatous amoebic encephalitis (GAE) in a patient in New Mexico who regularly used untreated tap water in an electronic nasal irrigation device and a CPAP machine.
47:20 Malaria Review Article Recommendation: A comprehensive review article on malaria in the New England Journal of Medicine is recommended, noting it includes updates on vaccines and monoclonal antibodies.
48:17 First At-Home Test for STIs Authorized: The FDA granted marketing authorization for the Visby Medical Women's Sexual Health Test, the first test for chlamydia, gonorrhea, and trichomoniasis that can be bought over-the-counter and performed entirely at home using a self-collected vaginal swab, providing results in about 30 minutes via a connected app.