In episode 86 of the Infectious Disease Puscast, Dr. Daniel Griffin provides a solo review of notable infectious disease literature from late July 2025. The discussion covers a range of pathogens, starting with a viral study on the significant, long-term multi-systemic symptoms and prolonged viral RNA shedding observed in Sudan Ebolavirus survivors two years post-infection. In the bacterial section, he highlights the alarming rates of multi-drug resistant (MDR) organism carriage among war-injured Ukrainian refugees and discusses a promising, less-invasive diagnostic method for tuberculosis using oral washes and tongue swabs with Xpert MTB/RIF Ultra. Fungal topics include the progression from Candida auris colonization to clinical infection, noting the risk and lack of effective decolonization strategies, and a study demonstrating the efficacy of a less frequent, twice-weekly Bactrim regimen for PJP prophylaxis in lung transplant recipients. Parasitic articles explore how Toxoplasma gondii manipulates neuron-astrocyte communication in the brain and a sobering report on two pediatric cases of Baylisascariasis (raccoon roundworm), underscoring the need for prompt diagnosis. The episode concludes with a review of Alpha-gal syndrome, emphasizing its diagnostic challenges due to delayed allergic reactions following tick bites.
A Review of Recent Infectious Disease Literature
1:20 Long-Term Effects of Ebola: A study on Sudan Ebolavirus survivors two years after infection reveals significant long-term health consequences. Survivors reported a much higher frequency of musculoskeletal (45%), central nervous system (36%), and ophthalmological (20%) symptoms compared to controls. Furthermore, viral RNA was detectable in semen for up to 210 days and in breast milk for up to 199 days post-infection.
4:17 War and Antimicrobial Resistance: A letter highlights the dramatic increase in multi-drug resistant (MDR) bacteria among war-injured Ukrainian refugees. A study in Finland found that 78.6% of hospitalized patients with war injuries carried MDR organisms, a rate significantly higher than other patient groups, demonstrating how conflict zones can become hotspots for antimicrobial resistance.
6:40 A Less-Invasive TB Test: Researchers evaluated using oral washes and tongue swabs for tuberculosis diagnosis with the Xpert MTB/RIF Ultra test. The method showed high specificity and good sensitivity, with oral washes detecting 80% of cases. This offers a valuable alternative for patients who cannot produce sputum, potentially increasing case detection.
9:32 The Threat of Candida auris: A U.S. study from 2016-2023 investigated the progression from Candida auris colonization to active infection. It found that nearly 7% of colonized patients went on to develop a clinical case, with a median time of 86 days from screening to infection. This underscores the risk posed by colonization and the urgent need for effective infection control, as no reliable decolonization method currently exists.
13:19 Safer Prophylaxis for Transplant Patients: A retrospective study suggests that a less frequent dosing of sulfamethoxazole/trimethoprim (Bactrim) is effective for preventing Pneumocystis jirovecii pneumonia (PJP) in lung transplant recipients. Over an 8-year period, zero cases of PJP were observed among 105 patients taking a single-strength tablet just twice a week. This regimen may reduce adverse events and improve patient adherence.
16:12 How Toxoplasma Manipulates the Brain: A study in PLoS Pathogens shows how Toxoplasma gondii alters brain function at a cellular level. Infected neurons change the content of their extracellular vesicles, which in turn signals astrocytes to become pro-inflammatory and reduce their uptake of the neurotransmitter glutamate. This provides a potential mechanism for the neurological changes seen in toxoplasmosis.
18:08 Raccoon Roundworm Infection in Children: An MMWR report details two unrelated cases of Baylisascariasis (raccoon roundworm infection) in children in Los Angeles County, which caused severe neurological symptoms. One case was linked to raccoon feces (a "latrine") on a rooftop. The report stresses that delays in diagnosis can lead to severe, permanent neurological damage.
20:40 Understanding Alpha-Gal Syndrome: A review article summarizes Alpha-gal syndrome (AGS), the emerging red meat allergy caused by a lone star tick bite. The diagnosis is often delayed for years because the allergic reaction (which can range from GI upset to anaphylaxis) occurs hours after consuming mammalian meat. Clinicians are urged to be aware of the syndrome as the tick's geographic range continues to expand.