In Infectious Disease Puscast #81, Dr. Daniel Griffin reviews the latest infectious disease literature from May 8-21, 2025, covering viral, bacterial, fungal, and parasitic infections. Key viral updates include the limited efficacy of tecovirimat for clade I MPXV in humans and robust real-world evidence reinforcing remdesivir's role in reducing mortality in hospitalized COVID-19 patients. Additionally, promising monoclonal antibody therapies for Ebola are discussed. The bacterial section highlights azithromycin's superiority over doxycycline for community-acquired pneumonia, the beneficial impact of healthy diets on diverticulitis risk, complex findings on BCG revaccination for tuberculosis, and the emerging understanding of diet's influence on C. difficile infection. Cefazolin is favored over anti-staphylococcal penicillins for MSSA bacteremia. Fungal discussions include Candida auris as an emerging urinary pathogen, a novel gut fungus ameliorating MASH in mice, and predictors of outcome for Candida prosthetic joint infections, alongside a reminder on recognizing histoplasmosis from travel history. Finally, parasitic news addresses the USDA's suspension of livestock imports due to New World screwworm and the promising results of moxidectin combination therapies for lymphatic filariasis elimination.
Infectious Disease Puscast #81: A Comprehensive Literature Review
0:00 Episode Introduction: Dr. Daniel Griffin hosts this episode, providing a bimonthly review of infectious disease literature (May 8-21, 2025), with Sarah Dong absent.
1:21 Viral - Monkeypox (MPXV) Treatment: A NEJM study found tecovirimat did not show statistically significant differences in lesion resolution time compared to placebo (7 days vs 8 days) for clade I MPXV infection in the Democratic Republic of Congo.
2:56 Viral - Remdesivir for Hospitalized COVID-19: Real-world evidence, including a BMC Infectious Diseases study utilizing AI and natural language processing, consistently shows remdesivir is associated with a significant reduction (27-37%) in inpatient mortality for hospitalized COVID-19 patients, reinforcing findings from multiple clinical trials and meta-analyses.
6:22 Viral - Ebola Therapies: A Virology Journal analysis reveals that monoclonal antibody treatments (MAB 114, Regeneron EB3, Remaza, ZMAPP) significantly reduced mortality (ranging from 53% to 74% reduction) in Ebola virus disease patients during the 10th outbreak in the Democratic Republic of Congo, emphasizing the importance of early care and vaccination.
8:18 Bacterial - Community-Acquired Pneumonia (CAP) Treatment: A CID study comparing azithromycin versus doxycycline as adjunctive therapy with beta-lactams for hospitalized CAP patients found azithromycin significantly reduced 30-day all-cause mortality (29% reduction) and led to more hospital-free days.
10:21 Bacterial - Diet and Diverticulitis Risk: A prospective cohort study in Annals of Internal Medicine found no increased risk of diverticulitis from consuming peanuts, nuts, seeds, or fresh fruits with edible seeds. Conversely, adherence to healthy diets like the DASH diet was associated with a reduced risk (23% reduction).
12:01 Bacterial - BCG Revaccination for TB: Data published in NEJM indicates that BCG revaccination did not protect against primary Mycobacterium tuberculosis infection or "sustained quantiferon conversion," leading to a discussion on whether test reversion might signify successful immune control or even clearance of the infection.
15:09 Bacterial - Impact of Diet on Clostridioides difficile Infection (CDI): A JID review suggests that a lower fat, higher fiber diet, including certain vegetables like asparagus, might lower the risk of CDI recurrence. The review also highlights potential negative impacts of high-fat diets and notes significant differences between mouse and human gut microbiomes, cautioning against direct extrapolation of animal model data.
17:01 Bacterial - MSSA Bacteremia Treatment: A systematic review and meta-analysis in Clinical Microbiology and Infection found cefazolin associated with a reduced odds of 30-day all-cause mortality (27% reduction) and fewer adverse events compared to anti-staphylococcal penicillins for methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia.
19:37 Fungal - Candida auris as a Urinary Pathogen: Research in PLoS Pathogens identifies C. auris as an emerging and prevalent urinary pathogen, being the second most common isolation source in the US, often associated with urinary catheters, high mortality, and emerging echinocandin resistance.
21:18 Fungal - Gut Fungus and MASH: A Science article presents a symbiotic filamentous gut fungus, Fusarium fujikuroi, which ameliorates metabolic dysfunction-associated steatohepatitis (MASH) in mice by producing a secondary metabolite that reduces ceramide levels. The human applicability of this finding is yet to be determined.
23:08 Fungal - Candida Prosthetic Joint Infections (PJI): An OFID systematic review identified co-infection with Staphylococcus aureus and prosthesis retention as independent predictors of failure for Candida PJI. First-line amphotericin B therapy was associated with success, while local antifungal therapy had no significant impact.
24:30 Fungal - Cave-Associated Histoplasmosis Outbreak: An MMWR report details a 2024-2025 histoplasmosis outbreak among US travelers who toured a cave in Costa Rica, highlighting the critical importance of eliciting travel history, as initial medical care for some patients was inappropriate due to misdiagnosis.
27:03 Parasitic - New World Screwworm Threat: The USDA suspended livestock imports from Mexico due to the rapid northward spread of New World screwworm, a parasitic fly previously eradicated in the US, which can cause significant livestock loss and sporadic human infections.
28:38 Parasitic - Lymphatic Filariasis Treatment: A Lancet Infectious Diseases trial demonstrated that single-dose moxidectin plus albendazole (Mox A) was superior to ivormectin plus albendazole for Wuchereria bancrofti microfilaria clearance at 12 months, providing prolonged clearance and offering a powerful tool for accelerating lymphatic filariasis elimination in Africa.
30:36 Conclusion & Support: Dr. Griffin concludes the episode, inviting listeners to engage with the podcast (subscribe, like, comment, ask questions) and support MicrobeTV's science education mission through donations.