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Abstract:
This episode (79) of the Infectious Disease Podcast features Dr. Daniel Griffin and Dr. Sarah Dong reviewing recent infectious disease literature from the past two weeks (recorded April 28, 2025). Key topics include the long-term durability of MMR vaccine protection, a negative trial for Tecovirimat (TPOXX) in treating Clade I Mpox, a novel low-cost rapid TB diagnostic test, a case report linking maternal Strep Toxic Shock Syndrome to breastfeeding a child with scarlet fever, factors increasing mortality in older ICU patients with hospital-acquired bloodstream infections (notably lack of source control and corticosteroid use in gram-negative cases), the potential utility of Ruxolitinib for fungal post-infectious neuroinflammation, using dog serological data as a novel surveillance method for Coccidioidomycosis, Uganda's large-scale malaria vaccine rollout, long-term follow-up data on Chagas disease treatments, and identification of a common antigenic target in fatal Kawasaki disease cases across decades. The episode also touches upon personal anecdotes and alerts regarding screwworm re-emergence.
Infectious Disease Podcast Ep. 79: Literature Review Highlights
0:00:02 Introduction: Drs. Daniel Griffin and Sarah Dong introduce Infectious Disease Podcast Episode 79, recorded April 28, 2025. Dr. Griffin mentions attending the ISHLT conference locally and a recent trip to Paris.
0:02:09 Podcast Scope: The podcast aims to review interesting or entertaining infectious disease literature from the preceding two weeks.
0:02:31 Ancient EBV Genome: A brief mention of an article in JID reporting the recovery of an ancient Epstein-Barr Virus genome from a 20th-century museum penis gourd from Papua New Guinea, highlighting museum collections as sources for pathogen evolution data.
0:03:45 MMR Vaccine Durability (OFID): Discussion of a study tracking neutralizing antibodies after 2nd and 3rd MMR doses over 10 years.
Key Takeaway: Protection against measles and rubella remains high (>90%) 10 years after the 2nd dose. Mumps protection is lower but still present. A 3rd dose in young adulthood is likely unnecessary for most, as two doses provide robust long-term protection.
0:07:48 Tecovirimat (TPOXX) for Mpox (NEJM): Review of a double-blind RCT in the DRC for Clade I Mpox.
Key Takeaway: Tecovirimat did not reduce the time to lesion resolution compared to placebo, adding to negative data for its use in Mpox.
0:08:37 Rapid TB Diagnosis (Science Translational Medicine): A new low-cost (<$800 device, ~$3/test), portable (cell phone size) "lab-in-tube" assay detects MTB DNA from respiratory or blood samples within 1 hour.
Details: Tested in children in the Dominican Republic, it showed high sensitivity (81%) and specificity (94%) for pulmonary and extrapulmonary TB, meeting WHO targets.
0:10:52 Maternal Strep TSS from Breastfeeding (Lancet ID): Case report and literature review of a mother developing severe Group A Strep mastitis and toxic shock syndrome after breastfeeding her 4-year-old child with scarlet fever.
Key Takeaway: Highlights a rare but severe potential transmission route and the lack of specific guidance for breastfeeding mothers when a child has scarlet fever. Discusses potential risk reduction (e.g., expressed milk).
0:13:41 Mortality Factors in Hospital-Acquired Bacteremia (Infectious Diseases and Therapy): Study on older adults (β₯75) in the ICU with hospital-acquired bloodstream infections (HABSI).
Details: 28-day mortality was high (50%). Significant modifiable risk factor was failure to achieve source control.
Key Takeaway: Corticosteroid administration for septic shock was associated with increased mortality, particularly in gram-negative infections, warranting further investigation.
0:16:42 Pediatric Transplant Bacteremia (Transplant Infectious Diseases): Retrospective review of bloodstream infections within one year post-solid organ transplant (heart, liver, kidney) in ~580 pediatric patients.
Details: Overall incidence 8.4%, highest in liver recipients. Most common within 90 days, often line-associated. Coagulase-negative Staph and Klebsiella pneumoniae were most frequent.
Key Takeaway: While mortality wasn't increased, bacteremia led to longer/more frequent hospitalizations.
0:19:02 Gepotidacin (Blue Jepa) for Gonorrhea (The Lancet): Phase 3 non-inferiority trial comparing oral Gepotidacin (a novel antibacterial) to standard IM Ceftriaxone + oral Azithromycin for uncomplicated urogenital gonorrhea.
Key Takeaway: Gepotidacin showed non-inferior microbiological success rates (92.6% vs 91.2%) but had higher rates of mild/moderate GI side effects. Offers a potential future oral treatment option.
0:20:55 NTM and Climate Change (OFID): Study using National Ecological Observatory Network (NEON) data to investigate non-tuberculous mycobacteria (NTM) prevalence in environmental samples (soil, water) across the US.
Details: NTM were more prevalent in soil than water. Modeling suggests NTM are likely to proliferate under future climate change conditions.
Key Takeaway: Explores the environmental reservoirs of NTM and links potential NTM increase to climate change, aligning with observed geographic distributions of NTM lung disease.
0:25:10 Macrolides for Community-Acquired Pneumonia (JAMA): Analysis of electronic health data for hospitalized adults with CAP initially treated with amoxicillin or co-amoxiclav.
Key Takeaway: At a population level, adding macrolides was not associated with improved clinical outcomes compared to beta-lactam monotherapy for moderate-to-high severity CAP.
0:26:03 Point-of-Care PCR in Lung Transplant (Transplant Infectious Diseases): Prospective study comparing multiplex PCR (BioFire Pneumonia Panel) on BAL, sputum, and nasopharyngeal (NP) swabs vs. conventional diagnostics in lung transplant patients with suspected LRTIs.
Key Takeaway: PCR on sputum/NP swabs showed good concordance with BAL PCR for viral detection but lower sensitivity for bacterial detection compared to BAL. Suggests non-invasive samples may be reliable for viral diagnosis but less so for bacteria, often still necessitating bronchoscopy. Panel limitations (no COVID, PJP, Aspergillus) noted.
Details: Transcriptional analysis of patient CSF revealed JAK-STAT pathway dominance. Treatment with the JAK inhibitor Ruxolitinib reduced neuroinflammation in mouse models.
Key Takeaway: Identifies a potential druggable target (JAK-STAT pathway) and therapeutic option (Ruxolitinib) for managing severe neuroinflammation following fungal CNS infections.
0:33:27 Dog Serology for Coccidioidomycosis Surveillance (JID): A "One Health" approach using serological data from dogs (highly susceptible, less mobile) to understand Coccidioides (Valley Fever) epidemiology.
Details: High seropositivity found in dogs (37.6% overall tested). Dog incidence correlated significantly with human incidence in endemic areas (CA, AZ). Data shows geographic expansion of seropositive dogs over time.
Key Takeaway: Dog serological data can serve as a valuable, potentially more sensitive, sentinel surveillance tool to understand and map the risk and spread of Coccidioidomycosis.
0:36:48 Uganda Malaria Vaccine Rollout: WHO reports Uganda launched the largest malaria vaccine (R21/Matrix-M) introduction campaign to date, targeting 1.1 million children. Uganda has a high malaria burden.
0:38:18 Chagas Disease Treatment Follow-Up (CMI): Long-term (up to 11 years) follow-up of patients treated with Posaconazole and/or Benznidazole.
Key Takeaway: Benznidazole treatment (initial or retreatment after posaconazole failure) resulted in sustained negative qPCR in most patients (94%). However, cardiac progression still occurred in 5.5% over follow-up, even among some who received benznidazole.
0:39:39 Kawasaki Disease Antigen Target (Journal of Laboratory Investigation): Study using monoclonal antibodies from children with acute Kawasaki Disease (KD).
Details: Identified antibodies recognizing intracytoplasmic inclusion bodies in bronchial epithelium. A representative antibody detected these inclusions in fatal KD cases spanning five decades from the US and Japan.
Key Takeaway: Suggests a common, persistent antigenic target associated with KD, potentially linked to a single (though still unidentified) infectious agent.
0:41:42 Screwworm Alert: Mexico confirmed its first human case of screwworm myiasis in decades, following increasing reports in Panama and Costa Rica. This highlights the potential re-emergence of this parasitic disease further north.
0:42:51 Outro: Contact information and ways to support the podcast are provided.