Episode #84 of the Infectious Disease Puscast features Drs. Daniel Griffin and Sara Dong reviewing recent literature from late June and early July 2025. Key topics include viral, bacterial, fungal, and public health issues. In virology, they discuss the BEYOND study, which confirms the effectiveness and high patient preference for long-acting injectable HIV therapy, and a separate study revealing significant knowledge gaps among providers regarding correct West Nile Virus diagnostic testing. Bacterial discussions cover C. difficile management, highlighting the efficacy of fecal microbiota transplantation (FMT) alongside barriers to prescribing guideline-recommended drugs. Other bacterial topics include a case series on early-onset donor-derived tuberculosis in organ transplant recipients, a botulism outbreak linked to improperly home-canned food, and the high failure rates of one-stage revisions for polymicrobial prosthetic joint infections. A study on fungal infections finds that amphotericin B significantly improves success rates for Candida prosthetic joint infections, likely due to its anti-biofilm properties. Finally, the hosts cover miscellaneous topics, including the high cost of certain neglected tropical disease drugs, a comparison showing the effectiveness of tele-ID care, and a Lancet analysis on the life-saving impact of USAID funding, projecting millions of excess deaths if funding is cut.
Infectious Disease Puscast #84: A Review of Recent ID Literature
2:05 Long-Acting HIV Therapy Success: A real-world study (BEYOND) on long-acting injectable cabotegravir and rilpivirine for HIV confirms its effectiveness. At 12 months, 97% of participants maintained viral suppression and 97% preferred the long-acting injection over daily oral pills, citing reduced treatment fatigue and stigma.
4:41 West Nile Virus Testing Gaps: A survey found that only a quarter of U.S. healthcare providers ordered the correct diagnostic tests for West Nile Virus. The hosts review the proper approach: IGM antibody tests on serum are standard, with PCR testing recommended for immunocompromised patients or those with neurological symptoms.
8:46 C. Difficile Management Strategies: The hosts discuss two papers on C. difficile (C. diff). Fecal Microbiota Transplantation (FMT) is an effective treatment, with cure rates reaching 81% after repeated treatments. However, clinicians face significant cost and insurance barriers that prevent them from using guideline-recommended first-line therapies like fidaxomicin.
15:34 Donor-Derived Tuberculosis: A report details three cases of tuberculosis transmitted from a single organ donor to the recipients. Key takeaway: Donor-derived TB should be considered in transplant recipients with unexplained fevers in the first few months post-transplant, as it presents much earlier than typical reactivation TB.
19:52 Botulism from Home Canning: An MMWR report on a botulism outbreak from home-canned cactus (nopales) highlights the dangers of improper food preservation. The incident serves as a crucial reminder to use correct sterilization methods, such as a pressure canner, for low-acid foods.
22:32 Prosthetic Joint Infection (PJI) Challenges: A study on one-stage revision surgery for polymicrobial prosthetic joint infections reveals a high reinfection rate, with nearly one-third of patients experiencing septic failure.
27:57 Treating Fungal Joint Infections: A meta-analysis on Candida prosthetic joint infections found that using amphotericin B as a first-line therapy was associated with a more than threefold increase in treatment success. This is likely due to its superior activity against fungal biofilms compared to other antifungals.
31:25 High Cost of Neglected Tropical Disease (NTD) Drugs: A review of NTD drug pricing in the U.S. found that miltefosine, a treatment for leishmaniasis, remains exceptionally expensive at approximately $48,000 per course, highlighting significant access challenges.
34:01 The Rise of Tele-ID: A study comparing daily tele-ID care to periodic in-person consultations at a community hospital showed encouraging results. The tele-ID model, used for sicker patients, led to shorter hospital stays and better antibiotic stewardship without increasing in-hospital mortality.
36:05 The Impact of Global Health Funding: A comprehensive analysis in The Lancet estimated that USAID-funded programs have helped prevent over 91 million deaths globally in the last two decades. The paper projects that proposed funding cuts could result in over 14 million additional, avoidable deaths by 2030.