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

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Lit Review April #2

April 14, 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 :).

 

Leading Photo by Jakub Kapusnak

Virus in Semen and the Risk of Sexual Transmission

http://www.nejm.org/doi/10.1056/NEJMe1803212

  • We usually just think about sexually transmitted viruses, but non-ST could also be found commonly

  • Zika virus (ZIKV), Ebola virus (EBOV): found in semen from symptomatically infected patients and disease survivors

  • Most reports use molecular detection and not looking at infectivity

  • This study: only 4% of ZIKV RNA–positive semen was infectious

    • Infectivity only in samples obtained within 30 days after onset

    • These samples had viral load of more than 10^7 RNA copies/mL

    • This short period may allow for sexual transmission

  • EBOV: no clear data to confirm sexual transmission, although RNA could be present in semen after 1 year

  • Maybe should be diagnosed using viral culture, but tons of work

  • Guidelines for sexual practices in patients exist, but may need to be updated when new data come out

From Journal Watch: 2018 U.S. Adult Immunization Schedule

  • What’s new?

    • Recombinant VZV vaccine (RZV) is now preferred is most cases

      • Immunocompetent people > 50 should get RZV regardless of previous history of VZV infection

      • People who already received live-attenuated should also get RZV, but should be at least 2 months apart

      • Recommended in most underlying conditions EXCEPT severely IC or pregnant because there is no data

    • Due to mumps outbreak: people who received ≤2 MMR shots should get an extra shot of mumps-containing vaccine

    • Tables below from the CDC

 

 

 

 

Multicenter, randomized controlled, observer‐blinded study of a nitric oxide generating treatment in foot ulcers of patients with diabetes – ProNOx1 study

https://onlinelibrary.wiley.com/doi/abs/10.1111/wrr.12630

  • These wounds are not easy to treat, generally dressing is very important (more important than antimicrobial therapy) but not a lot of data

    • NO: helps maintaining microvascular supply, induce immune system and has a broad spectrum antimicrobial property 

    • Absence of NO in diabetes associated with poor ulcer healing

  • New study showing safety and efficacy of EDX110, a nitric oxide generating medical device

    • Provides moist wound environment

    • Absorbs exudate and triggers autolytic debridement

    • Generate NO in situ when two layers make contact

    • Has been tested per FDA to claim antimicrobial property

      • S. aureus, S. epidermidis, B. subtilis, K. pneumoniae, P. aeruginosa, E. coli

      • C. albicans, Geotrichum candidum

    • Shown to prevent biofilms formation

 

 

 

  • Looked at > 130 patients

  • At 12 wk, 88.6% area reduction compared to 46.9% for SOC

Four-gene Pan-African Blood Signature Predicts Progression to Tuberculosis

https://www.atsjournals.org/doi/abs/10.1164/rccm.201711-2340OC

  • People have been trying to use RNA profiling of blood cells as biomarkers for progression of TB infection

  • This group previously identified expression of 16 genes that could predict progression in  M.tb-infected HIV-negative South African and Gambian adolescents and household contacts

    • These genes identified from small dataset, and may not be application to pan-African population

  • Looked at 4,466 HIV-negative healthy HHC of 1,098 index TB cases between 2006 and 2010

  • Used RNA sequencing, PCR, and Pair Ratio algorithm in a training/test set approach

  • Identified 4-transcript signature panel with differential expression in progressors vs matched controls

    • Predicted TB progression up to 2 years before clinical symptoms

    • Upregulated: GAS6, SEPT4

    • Downregulated: CD1C, BLK

    • Converted to PCR detection and pared down to only SEPT4 and BLK and still performed well in pan-African datasets

Uropathogens and Pyuria in Children With Neurogenic Bladders

 

http://pediatrics.aappublications.org/content/early/2018/04/06/peds.2017-3006

  • Some kids with neurogenic bladder need intermittent cath, and often have pyuria

    • What bugs are associated with presence or absence of pyuria

  • Study looked at > 2400 cultures and associated UA results in patient 18 yo and younger

    • Enterococcus associated with absence of pyuria and neg leu esterase

    • P. mirabilis associated with presence of pyuria and pos esterase

    • P. aeruginosa associated with pos esterase only

  • Moral of the story: kids with neurogenic bladder will need a urine culture regardless of UA results

Clinical presentation of Cardiac implantable electronic devices (CIED) infection following initial implant versus reoperation for generator change or lead addition

 

http://openheart.bmj.com/content/5/1/e000681

  • These infection are disprop