This 80th episode of the Infectious Disease Puscast features Dr. Daniel Griffin and Dr. Sara Dong reviewing noteworthy infectious disease literature published between April 24 and May 7, 2025. Key viral topics include the incidence and optimal monitoring timing for Epstein-Barr Virus (EBV) in solid organ transplant recipients, high infant RSV immunization coverage with Nirsevimab and its significant impact on reducing hospitalizations, optimal timing for COVID-19 antiviral treatment in the emergency department, and updated CDC recommendations for HIV postexposure prophylaxis (PEP). Bacterial discussions cover the utility of CSF C-Reactive Protein in diagnosing bacterial meningitis, a case study on long-term Dalbavancin use for Chronic Granulomatous Disease, and a critical look at the nitrite test for UTIs. Fungal discussions include high mortality rates in kidney transplant recipients with cryptococcosis. Parasitic topics feature a novel rapid diagnostic test for P. falciparum in areas with HRP2/3 deletions, the spread of Anopheles stephensi, and Demodex mites. Miscellaneous items address scientific integrity, teaching management reasoning, and billing for provider-to-provider consults.
Infectious Disease Puscast #80: Highlights from Recent Medical Literature (April 24 - May 7, 2025)
0:00 Introduction: Dr. Daniel Griffin and Dr. Sara Dong introduce episode 80, a review of infectious disease literature from the preceding two weeks (April 24 - May 7, 2025).
2:13 Viral: EBV DNAemia in Solid Organ Transplant Recipients: Dr. Dong discusses a retrospective cohort study in Transplant Infectious Diseases on the incidence and timing of Epstein-Barr Virus (EBV) DNAemia in EBV-mismatched adult and pediatric solid organ transplant recipients.
Key Details: 126 out of 257 recipients (about 50%) developed DNAemia in the first year, with a median onset of 83 days (~3 months). Incidence varied by organ (highest in liver, 62%; lower in heart, 28%). PTLD was diagnosed in 15%.
Key Takeaway: A very low risk of EBV DNAemia was observed in recipients less than 6 months old. The study suggests potentially delaying monitoring initiation to about 1 month post-transplant and focusing on months 2-6 for maximum detection, with less frequent checks for very young recipients.
8:22 Viral: Infant RSV Immunization Coverage (US 2023-2024): Dr. Dong reviews a Pediatrics paper assessing RSV immunization coverage (either maternal Abrysvo or infant Nirsevimab) in the US via the Vaccine Safety Datalink.
Key Details: Among eligible infants, 72% were immunized. Coverage was highest among infants of non-Hispanic Asian mothers (84%) but lower among infants of non-Hispanic Black or Middle Eastern/North African mothers (60%).
Key Takeaway: While overall coverage in the first season is high, significant racial and ethnic disparities exist, highlighting the need for equitable access and communication.
10:53 Viral: Real-World Impact of Nirsevimab in Spain: Dr. Griffin discusses a paper in Influenza and other respiratory viruses on the impact of Nirsevimab introduction in Spain.
Key Details: Respiratory infection-related hospital admissions dropped by 63%, ICU admissions by 75%, and RSV-specific admissions by 78%. Infants hospitalized despite receiving Nirsevimab had shorter stays and milder disease.
Key Takeaway: Nirsevimab has demonstrated a profound real-world effect in reducing severe respiratory infections and hospitalizations in infants.
12:04 Viral: Timing of Antiviral Treatment for Mild-Moderate COVID-19 in ED: Dr. Griffin covers a study in Internal and Emergency Medicine on the influence of prescribing physician and timing on outcomes for vulnerable patients receiving antivirals for mild-moderate COVID-19 in Spanish emergency departments.
Key Details: Longer time to antiviral treatment was associated with worse outcomes. Each day of delay raised the risk of hospitalization or death by 17.9%. Prescription by an ED physician was linked to faster treatment and shorter hospital stays.
Key Takeaway: Timely administration of antivirals in the emergency department is critical for improving clinical outcomes in vulnerable COVID-19 patients.
14:41 Viral: Updated HIV Postexposure Prophylaxis (PEP) Recommendations: Dr. Griffin highlights an update from the CDC in MMWR regarding nonoccupational HIV PEP.
Key Details: Preferred regimens for adults and adolescents now include Bictegravir/emtricitabine/tenofovir alafenamide (Biktarvy) or Dolutegravir plus TDF/emtricitabine (or lamivudine).
Key Takeaway: The emphasis remains on initiating PEP as soon as possible, ideally within 72 hours of exposure, with simplified preferred drug regimens.
16:54 Bacterial: CSF C-Reactive Protein for Bacterial Meningitis Diagnosis: Dr. Griffin discusses a prospective diagnostic accuracy study in Lancet Regional Health on using CSF C-reactive protein (CRP) for diagnosing bacterial meningitis.
Key Details: In Danish adult and Dutch pediatric cohorts, CSF CRP (using a 0.3 mg/L cutoff) demonstrated high diagnostic accuracy (AUROCs 0.92-0.99), with sensitivities between 85-100% and specificities between 94-98%.
Key Takeaway: The combination of CSF leukocytes and CSF CRP significantly improved diagnostic accuracy for bacterial meningitis compared to CSF leukocytes alone.
19:13 Bacterial: Outpatient Dalbavancin in Chronic Granulomatous Disease (CGD): Dr. Dong presents a case report from OFID on therapeutic drug monitoring (TDM)-guided outpatient Dalbavancin therapy for a 23-year-old with X-linked CGD and extensive deep-seated abscesses, used for nearly a year as a bridge to transplant.
Key Details: The patient successfully received long-term outpatient Dalbavancin with dose adjustments based on TDM for complex, inoperable infections prior to bone marrow transplant.
Key Takeaway: This case highlights the potential for extended outpatient Dalbavancin use in complex CGD cases and serves as a reminder of common CGD pathogens (Staph aureus, Burkholderia, Serratia, Nocardia, Aspergillus).
21:42 Bacterial: Questioning the Utility of Urine Nitrites for UTI: Dr. Griffin discusses a perspective piece in JAMA Internal Medicine that critically examines the historical use and interpretation of the urine nitrite test for UTI diagnosis.
Key Details: The nitrite test dates back to the early 1900s. Its specificity is often cited based on studies that included asymptomatic bacteriuria within the definition of UTI. False negatives can occur if urine hasn't been in the bladder long enough (~4 hours) or if the infecting organism does not possess nitrate reductase (e.g., Enterococcus, Acinetobacter).
Key Takeaway: Clinicians should use caution when interpreting positive or negative nitrite results, understanding its limitations and potential for misinterpretation, especially in the context of asymptomatic bacteriuria.
27:17 Fungal: Cryptococcosis Mortality in Kidney Transplant Recipients: Dr. Dong reviews a nationwide cohort study in OFID using USRDS data on hospitalizations and outcomes for cryptococcosis in kidney transplant recipients over a decade.
Key Details: Among 1,265 hospitalized patients, the overall 6-month mortality rate was high at 22%. Factors associated with increased mortality included cirrhosis, ICU admission, age >60 years, and being more than two years post-transplant.
Key Takeaway: Cryptococcosis in kidney transplant recipients is associated with high early mortality, and conditions like cirrhosis are significant independent risk factors.
30:22 Parasitic: Novel RDT for P. falciparum in HRP2/3 Deletion Areas: Dr. Griffin discusses a study in CID evaluating a new rapid diagnostic test (RDT) for Plasmodium falciparum malaria that detects both HRP2 and P. falciparum LDH.
Key Details: In an Ethiopian setting where 80% of P. falciparum infections had HRP2 or HRP3 deletions, the novel RDT showed a sensitivity of 77% and specificity of 96%.
Key Takeaway: This new RDT offers improved diagnostic performance in areas where the reliability of standard HRP2-only RDTs is compromised by gene deletions.
31:43 Parasitic: Prevalence of Anopheles stephensi in the Horn of Africa: Dr. Griffin highlights a systematic review and meta-analysis in BMC Infectious Diseases on the prevalence of the Anopheles stephensi malaria vector.
Key Details: The pooled prevalence was 41.26%. This vector, historically Asian and urban-adapted, is spreading and establishing itself in urban areas in the Horn of Africa.
Key Takeaway: The presence and urban adaptation of An. stephensi in Africa represent a new challenge for malaria control strategies, potentially leading to urban outbreaks.
33:05 Parasitic: Raising Awareness of Demodex Mites: Dr. Griffin mentions an article in Infection that aims to raise awareness about Demodex mites as a neglected cause of skin disease, providing discussion on diagnosis and evidence-based treatments.
34:43 Miscellaneous: Scientific Integrity Under Threat: Dr. Dong highlights a joint statement published across major ID journals (including CID, JPIDS) by their editors-in-chief, addressing threats to scientific integrity in an evolving political landscape.
Key Takeaway: The statement emphasizes the journals' commitment to open scientific discourse based on facts and transparency against political pressures.
35:42 Miscellaneous: Teaching Management Reasoning: Dr. Dong discusses an article in the Journal of General Internal Medicine offering a framework for teaching management reasoning in the inpatient setting, distinguishing it from diagnostic reasoning.
37:52 Miscellaneous: Billing for Provider-to-Provider Consults: Dr. Dong reviews a pilot process described in JPIDS for documenting and billing for interprofessional "curbside" consultations among providers (using codes like 9944x).
Key Details: A pilot study showed that 50% of such consults for which notes were written received reimbursement, with median payments ranging from ~$40 (Medicaid) to ~$130 (commercial insurance).
Key Takeaway: This provides a potential strategy for ID physicians to gain compensation for often unpaid consultation work, though reimbursement rates can vary.
41:06 Conclusion: Dr. Dong and Dr. Griffin wrap up the episode, encourage listener interaction and support for MicrobeTV.
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