PEERA HEMARAJATA, M.D., PH.D., D(ABMM)

©2018 BY PEERA HEMARAJATA. PROUDLY CREATED WITH WIX.COM

Archive

Please reload

Tags

Please reload

Lit Review January #1

January 23, 2018

Disclaimer: this compilation of synopses have been collected from multiple sources, including Mark Crislip's Puscast, Journal Watch Infectious Diseases, Medscape Infectious Diseases, CDC MMWR, AMA Morning Rounds, ProMED Mail, Journal of Clinical Microbiology, Antimicrobial Agents and Chemotherapy, Clinical Infectious Diseases, and more. I chose these articles based on their relevance to clinical microbiology and would be of interest to my fellows, and some other pieces that I found amusing to read. All credit goes to these original contributors. I'm just a messenger :).

FDA Panel Does Not Recommend Cipro Dispersion for Inhalation

https://www.medscape.com/viewarticle/891314

  • Seeking FDA recommendation of CIP DI for non-CF bronchiectasis and Psa infection in CF

  • Discrepancy between two large clinical trials (one showed benefit, one didn’t)

New duration of contact precaution guidelines from SHEA (Society for Healthcare Epidemiology of America)

https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/duration-of-contact-precautions-for-acutecare-settings/94E38FDCE6E1823BD613ABE4E8CB5E56/core-reader

  • Previous guidelines were unclear

  • Still not enough data for a formal update – some recommendations based on common practice

  • MRSA

    • Patients not receiving antibiotics with activity against MRSA: 1-3 negative screening cultures

    • Extend contact precautions for high-risk patients with chronic wounds and those from long-term care facilities up to 6 months

  • MDR-Enterobacteriaceae

    • ESBL-E and CRE: CP for duration of the index hospital stay when infection or colonization with these bacteria is first detected.

    • Discontinuation a case-by-case basis

      • At least 6 months since last positive (clearance when 2 rectal swabs collected 1 wk apart neg)

      • If clinical infection is present/ongoing antibiotic use that may select for these organisms: should not discontinue

    • For CPOs or isolates with very limited treatment options (susceptible to ≤2 antibiotic classes used to treat that organism): indefinitely

    • C. diff: continued for at least 48 hours after the resolution of diarrhea (spore shedding continues), consider extending if C difficile infection rates in institution remain high despite appropriate prevention and control measures

    • VRE: discontinue when 1-3 rectal cultures (1 wk apart) neg

Urine lipoarabinomannan glycan in HIV-negative patients with pulmonary tuberculosis correlates with disease severity

http://stm.sciencemag.org/content/9/420/eaal2807

  • Need a non-invasive screening test for low-resource settings

  • Mycobacterial glycan antigen lipoarabinomannan (LAM): marker of active TB shed into urine, but no previous test worked well

  • Instead if Mab, they  used novel chemical affinity bait immobilized in Hydrogel nanocage: captures LAM with very high affinity

  • Tested on concentrated urines form 48 Peruvian patients, all negative for HIV, with confirmed pulmonary TB by culture, enriched by nanocages and quantified by immunomacroassay (looks like dot-blot to me)

  • Sensitivity of >95% and a specificity of >80% (n = 101)

  • Urinary LAM elevated in patients with higher mycobacterial burden

  • May be adapted into POC form

Letermovir Prophylaxis for Cytomegalovirus in Hematopoietic-Cell Transplantation

https://www.ncbi.nlm.nih.gov/pubmed/29211658

  • A new drug for prophylaxis of CMV infection in post-HSCT patients

    • Inhibits CMV replication by binding to components of terminase complex (UL51, UL56, or both)

    • Primary endpoint: clinically significant CMV infection through week 24 after transplantation among patients without detectable CMV DNA at randomization

      • Reduction by almost half!

Exposure to and colonisation by antibiotic-resistant E. coli in UK coastal water users: Environmental surveillance, exposure assessment, and epidemiological study (Beach Bum Survey)

https://www.sciencedirect.com/science/article/pii/S0160412017312345

  • Water users are at risk of ingesting resistant bugs

  • 0.07% of E. coli in UK coastal water harbored CTX-M

    • For every 2.5 mil water sports session, at least one CTX-M-harboring E. coli will be ingested

  • Self-collected rectal swabs from 143 surfers vs 130 controls subjects

    • Prevalence of CTX-M-harboring E. coli 9.1% vs 3.1%

Respiratory Syncytial Virus Seasonality — United States, 2014–2017

https://www.cdc.gov/mmwr/volumes/67/wr/mm6702a4.htm?s_cid=mm6702a4_e

  • Nothing much – just a reminder that RSV seasonality is a little less defined compared to flu, but generally longer (fall through winter/spring of the following year)

Notes from the Field: Legionellosis Outbreak Associated with a Hotel Aquatics Facility — Tennessee, 2017

https://www.cdc.gov/mmwr/volumes/67/wr/mm6702a5.htm?s_cid=mm6702a5_e

  • Eight people in Tennessee with exposure history to same hotel infected with Legionella, one died

  • More specifically, exposure to hotel hot tub

  • Investigation revealed contamination in hotel aquatic system, with improper treatment (low residual chlorine)

  • Identified additional 92 cases from self-reported survey (not all lab-confirmed)

Notes from the Field: Baylisascaris procyonis Encephalomyelitis in a Toddler — King County, Washington, 2017

https://www.cdc.gov/mmwr/volumes/67/wr/mm6702a6.htm?s_cid=mm6702a6_e

  • 19mo M with history of soil and animal feces ingestion a few weeks earlier, presented with irritability that developed into tremor, ataxia, decreased interactivity

  • Eosinophilia with multiple enhancing lesions in both cerebral hemispheres, eyes normal

  • Empirically treated with albendazole and steroids, with good clinical response

  • Recombinant B. procyonis (raccoon round worm, dog can also be definitive host) antigen immunoblot test positive in serum and CFS, negative for Toxocara and Toxoplasma

  • Ingestion of eggs shed in feces: VLM and OLM

A Novel Human Pegivirus, HPgV-2 (HHpgV-1), Is Tightly Associated With Hepatitis C Virus (HCV) Infection and HCV/Human Immunodeficiency Virus Type 1 Coinfection

https://academic.oup.com/cid/article/66/1/29/4085621

  • Background: Species in family Flaviviridae that infections human hepatocyte are Hepacivirus C (HCV) and Pegivirus C (HPgV, formerly known as HGV)

  • HPgV commonly co-infect with HIV (shown to slow progress of HIV infection!) or HCV, no real association with illness

  • Another human pegivirus identified: Pegivirus H (HPgV-2), tightly associated with HIV-1/HCV infection, but again no real association to illness

Climate change influences on the potential geographic distribution of the disease vector tick Ixodes ricinus

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0189092

  • This species transmits Lyme and tick-borne encephalitis in Europe

  • Ticks seemed to be moving further north/east of Europe, potentially due to global warming (they don’t like the heat!)

  • REVIEW TICKSBORNE DISEASES IN US

    • Ixodes scapularis: Anaplasmosis, Babesia, Lyme, Borrelia mayoii, Borrelia miyamotoi, POW

      • I. pacificus: Anaplasmosis, Lyme

    • Dermacentor andersoni: RMSF, Colorado tick fever, turaremia

      • D. variabilis: RMSF, turaremia

      • D. occidentalis: 364D rickettsiosis (aka Pacific Coast tick fever, caused by Rickettsia phillipi, just found recently in CA) this is the same group as RMSF

    • Amblyomma americanum: Ehrlichiosis (E. ewingii causing human ewingii ehrliciosis, E. chaffeensis causing human monocytic ehrlichiosis), STARI (Southern tick-associated rash illness), tularemia

      • Amblyomma maculatum: Rickettsia parkeri rickettsiosis

Pharmacokinetic drug evaluation of dalbavancin for the treatment of skin infections

http://www.tandfonline.com/doi/full/10.1080/17425255.2018.1420162?scroll=top&needAccess=true

  • Treatment of SSTI: just as effective as VAN and LZD, with the advantage of ease of administration (1 dose and done)

  • Breakpoints coming in M100-S28

Propionibacterium avidum: A Virulent Pathogen Causing Hip Periprosthetic Joint Infection

https://academic.oup.com/cid/article/66/1/54/4060443

  • Cutaneous group of Propionibacterium spp: P. acnes, P. avidum, P. granulosum

  • Reported a cluster of 4 hip PJIs caused by P. avidum in one orthopedic center in 2015 in Switzerland

  • Seems to be susceptible to agents commonly used to treat Propionibacterium infections (they used EUCAST breakpoints for GP anaerobes)

  • P. acnes: shoulder joint infection

Improvement in Diagnosis of Histoplasma Meningitis by Combined Testing for Histoplasma Antigen and Immunoglobulin G and Immunoglobulin M Anti-Histoplasma Antibody in Cerebrospinal Fluid

https://www.ncbi.nlm.nih.gov/pubmed/29020213

  • For histoplasma infection in the CNS, detection of both antigen and IgM/IgG by EIA in CSF increased sensitivity to 98%, as opposed to just antigen (78%)

  • Current serological methods (ID, CF) although pretty specific (96%) had only 51% sensitivity

Outbreak of human malaria caused by Plasmodium simium in the Atlantic Forest in Rio de Janeiro: a molecular epidemiological investigation

http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(17)30333-9/fulltext

  • This species looks and acts like P. vivax, but a different species, thought to be present only in monkeys

    That's all for now. Bug Hunters, may the odds be ever in your favor.