Infectious Disease Puscast #101

From Microbe TV, this is Infectious Disease Puscast Episode one zero one a hundred and one recording. Hello everyone, I'm Dr. Daniel Griffin and joining me today is Dr. Sarah Dog. Hi everyone, it's Sarah. How are you doing today, Daniel? I am doing great, you know, hanging out in my uh my T shirt. Uh I don't know if you can hear the waves breaking in the background. Sounds very Well I was looking fifty fifty four nautical miles north of Venezuela.

I was looking up because um daylight savings time is coming up. So postcast listeners I can remind that I had to go I was googling it on Sunday, March eighth, at least for the US and the areas that do Daylight savings time, we're springing forward. So good for minding from it. I'm looking forward to that, Sarah. That's gonna be great. Yeah, I'm on service. I'm like, that's great. One one less hour.

Um well welcome everyone to another puscast. References as always are available in our show notes at micro dot TV, the home of our growing multimedia app. Puscast is a review of the infectious disease literature for the last two weeks that we found interesting or entertaining. So on to the literature, shall we?

All right. Well, hopefully the uh waves in the background is uh calming people down because the world is uh a little little crazy at the moment. Um but let's start off with our viral section. Remember to listen to Twiv This Weekend Virology. Both the clinical update and our deep dive. Um now the first one I'm gonna start with is one that uh comes ha comes up on rounds all the time at Columbia.

And it's this issue and I'll talk with the article, impact of proviral DNA M one eighty four V slash I. uh ninety-six week outcomes of DTG slash three T C maintenance therapy results from the Vulvar Clinical Trial published in CID. So here's this idea that we're going to explore in this study that archived mutations might actually be important to consider in selecting drugs for HIV therapy.

So this open label, single arm, multi-center phase two A trial enrolled biologically suppressed adults with documented or suspected historical lymividine resistance. If the M one eighty four V slash I mutation was not detected in baseline probile DNA population sequencing. So participants switch to DTG three T C were followed through week ninety six.

Proviral DNA. Um M184 V slash I was assessed retrospectively for next generation sequencing of peripheral blood mononuclear cells at baseline, and then they're going to do it at ninety-six. So of 121 participants, 94% had documented historical M184 V slash I. For background, as many of our listeners might not treat or just HIV meds on a regular basis for the

The M184 V slash I mutation um in the HIV one reverse transcriptase confirms high level resist resistance. And I mean high level, a hundred to a thousand-fold resistance to Limividine, that's your three T C and M tracitabine, um F T C. Along with this resistance, the mutation reduces viral fitness and replication capacity. So there are some subtleties of us forcing that mutation.

But here we've got this background. So pi proviral DNA, next generation sequencing, detected M184V at greater than five percent frequency in 37. Um so thirty point six percent at baseline and or week ninety-six, twelve only at baseline, thirteen only at week ninety-six, and twelve at both time points. So they looked at the impact, right? So okay, here this is, we're seeing these people.

Now, what is the impact on treatment? So they looked at the impact of this on treatment with the combination of Dalutegaver and Lamividine. The idea for those who believe archive mutations matter is that seeing archives limividine resistance. would be associated with failure because the lambividine resistant population would be selected for and emerge during treatment.

Two virological failures occurred within the first 48 weeks among these 121 participants. None were observed thereafter. No treatment emergent resistance was detected. In the intent to treat exposed. I like that. ITT slash E. So the intent to treat exposed population. They're going to do this snapshot analysis. And really just think about a snapshot. They're going to look at a particular time point.

Um HIV one RNA less than fifty copies per ml at week ninety six was maintained in eighty four 85.7% with no detection of the mutation, 66.7% with detection only at baseline, and 100% with detection only at week 96 or both time points. So they're gonna conclude that the proviral DNA um M184 detection was not associated with virological outcomes in participants receiving the doluteger libividine.

Supporting its limited clinical value in the specific setting, or you can say not supporting its role in treatment selection. All right. Hm. Okay, now now this is a this is a big one. The article Techovirabat for the treatment of MPOX was published in the New England Journal of Medicine. So these are the results of the stomp trial with Jason Zucker from Columbia University as the first author. He was one of my ID fellow like mentees. So we're very proud of Jason.

Um, for many other reasons. This too, first author, New England Journal of Medicine. So these results come from that phase three international double-blind randomized placebo-controlled trial, where they evaluated the efficacy of laurel. oral techovirmat in adults with lab confirmed CLAD two MPOX. Participants were randomly assigned in a two to one ratio to receive techovirmat or placebo for fourteen days.

Primary outcome was clinical resolution assessed in a time to event analysis in participants with active skin or mucosal lesions. Secondary outcomes included reduction in pain, assessed in all participants with lab confirmed MPOX and in those with severe pain at baseline, complete lesion healing, viral DNA clearance and safety.

Of four hundred and twelve four hundred and twelve participants who underwent randomization, you end up with this two to one. So two hundred and seventy-five get Techoviramat, 137 placebo. Um Three hundred and thirty six had active skin hermeocosal lesions. Three hundred and forty four had that lab confirmed, so the DNA. By day 29, the estimated cumulative incidence of clinical resolution was 83% those that got techoviromed, 84% with placebo.

So basically no substantial group differences. Um Not seen in clinical resolution, not seen in pain reduction, not seen in complete lesion healing, really no difference in efficacy, no difference in side effects. And they have a a nice figure where you basically can see the lines just following each other up to the right. Yeah. All right.

That brings us into your s your section, Sarah. Guys, I put a lot of stuff in bacter bacterial today. So um, you know, hang in there with me. Be sure to listen to this week at microbiology. Uh I will start with an article from MMWR.

Multi county outbreak of salmonella agony linked to ice in a cooler at a county fair in Illinois, August twenty twenty four. So this report shared thirteen cases of Salmonella and Terica serotype acne infection, which was linked to, as you can tell from the title, ice that was contaminated likely during handling of sort of you know, putting cans in and out of this makeshift beer cooler.

Um, it's actually really fascinating. I mean, these articles are always really interesting, but um it was like initially picked up because The local sheriff called the health department because they were screening for jurors for a trial and multiple pa people had GI illnesses. But there wasn't an investigation at the time because of confidentiality, um, but later once Summella was identified, uh the outbreak investigation was performed.

And it it sounds like from reading the article that it's a pretty small, close knit community, so I think finding cases and talking through the outbreak investigation maybe had some challenges there. Um, so ICE is not a common vehicle for salmonella transmission. So I think that's one piece that of course is interesting. This was uh improvised.

Beer tent cooler. They actually have a picture of it. Um basically seems like there was sort of like um a plastic sheet and then ice put in there and the standing water wasn't really drained or cleaned and there may have been some leftovers that were stored in there as well. But because that uh investigation was done a little bit later, you know, the tent, the ice and the water for this county fair wasn't available for environmental sampling, so um we don't have confirmation.

But um the other thing that's really fascinating Is they use Chat GPT to create the background info and to quote contextualize the environmental health team assessment, meaning like spit out a hypothesis of the possible sources of exposure by reviewing the It sounds like kinda like intake type interviews. And so they put, you know, the questions at the ass. Like the first question entered into the AI model was will Salmonella Agony grow in an improperly drained cooler?

And then chap GPT spits out that yes, salmonola Agbeny could grow in a cooler under conditions that are favorable for salmonella growth and blah blah blah, and then subsequent questions like are there other sources other than the ice? Uh likely if only canned beverages and no foods were available.

And then what is the likelihood that these infections occurred with contaminated ice and and so on? But that I don't know that I've seen that in our prior MM uh MMWRs that came up, but um very interesting to see how that was incorporated. I have so much to say, sir. Yeah, I have at the MMWR using Chat GPT like uh they use it when they I didn't they use it to like create the tariffs? Chat GPT, how much should we tariff Denmark? And they'll get a screen lint. Uh tariff them a lot.

Oh my gosh. And I you know, and I also could I I think it's funny. So I'm trying to figure this out. So they're calling everybody to do jury duty and everyone's like, Oh, I'm too sick. I got the trots and then they're like, This seems fishy. Why's everyone why's everyone like getting out of jury duty? Yeah. And then I guess it's embarrassing because like they were all hanging out in the beer tet and people are like, Well, you want the beer? Oh, wasn't that the beer tent?

Yeah. Well I uh yeah, I remember there being like a GI illness that went around in a Christmas party during my residency and I think it was a Kind of I'm sure folks felt awkward and you know, uh saying they got a GI illness after the holiday party, but anyw. Yes, be careful of holiday parties. Just warning, warning out there.

What happens at holiday parties does not stay at the holiday parties. All right. The article, Legendella, Pneumonia in the Modern Era, Clinical Features and Predictors of Mortality Published in CID. So these are the results of a retrospective multi-center cohort study of adults with lab confirmed legionella pneumonia across an integrated health system between January 2019 and September 2025. Sort of a crazy time, right?

Severe disease was defined as having a requirement for high flow nasal cannula, non invasive ventilation, mechanical ventilation, or extracorpal membrane oxygenation. So I gotta say this is one of these articles where it really kind of challenges I think how we think about um lead to know it. So Three hundred forty-four patients with lab confirmed legional pneumonia during the study period, median age sixty-six point six years.

Forty five percent were immunocompromised. Most patients required hospital admission, ninety four percent. I mean that may have been a sort of a bias to making the diagnosis. 36.1% admitted to the ICU, 22.7 required mechanical ventilation, 1.5% uh extracorpal membrane oxygenation, so ECMO. 30 and 90 day mortality were 11.9 and 16.6%, respectively. It's really high.

Um and what were the drivers? So cirrhosis, you had cirrhosis, odds ratio of ten point two, immunocompromise, two point two four, age, a little bit, um, lymphopenia on presentation, odds ratio two point zero nine. And independently associated with increased 30 day mortality among patients who were PCR culture positive, urinary antigen testing was positive and only.

I wanna sort of say this twenty five point six percent. So think about how we usually make the diagnosis, right? Normally not looking at outpatients, right? So that's probably why we're seeing like ninety five percent is inpatient. But only twenty five point six are we picking up on the urinary legionella. So they really had to actually send off sputums.

getting PCRs, getting culture positivity. And I think that's the big thing I wanna bring up. It's so standard. They come in with pneumonia, they're really sick. You know, maybe that sodium isn't low, so we're not thinking. It's probably not. But we only do urinary antigen, 75% of the time we're missing it. So just sort of reminder that we're probably missing more leechin'.

Yeah, I thought this one was was really great and that You can quote that twenty five percent to remind people uh I I think we knew it was lower and that it's zero type one and we teach that, but um maybe you weren't thinking it's necessarily quite Um, all right. This next one's pretty quick. This one's from Journal of Antimicrobial Chemotherapy. Cephalaxin use in UK, acute polynephritis practice, unaddressed challenges in dosing, breakpoints, and clinical evidence.

Like I mentioned, it's it's a very quick read. It's just kind of an overview talking about the limitations and knowledge regarding the use of cephalaxin. Or I realize I probably should say kefelexin because it's UK and I feel They do the hard uh Sorry to anyone who's in the UK that I said cephelex instead of kephile.

Um, so you know, some of their points, they just gave an overview about in particular, you know, UCAST breakpoints for cephalaxina are restricted to uncomplicated cystitis that there aren't breakpoints for systemic infection like pilo and that there's just generally a paucity of PKPD data. Um, but of course if someone sees a urine susceptibility there, it may influence their prescribing decisions, uh, whether that is a cute pilo.

Um and of course we worry about risk of treatment failure if they're not getting a um adequate drug exposure. And I think another part of this as well is that there's these huge dosing variations that are often reported for Cephhylaxin and you know that lower end hasn't really been Study for acute pilo and we probably need these really particularly high doses to hit our pharmacodynamic targets for pilo, but

those are probably doses higher than we really would want to give. And then there's, you know, kind of a lack of robust clinical data as well. So I I thought this was just a nice, you know, summary putting it all together. I think we often think about um Cafe X for UTIs, but um sort of reasons to hesitate having this as sort of your In that sort of first bucket of things that you use for acute pilo. And so I think they were sort of advocating for adjustments and some other recommendations.

So thought I would pull that out'cause I thought it was a useful review. Yeah, no, it's uh it's it makes me kinda think, right? You know, you get the you know, the antibiotic susceptibilities back, it says it's super sensitive to Capilexin, cephalexin.

Um, yeah, should you send them out on Keflex? Should you use, you know, Cefuroxeme or Cefadoxime? You know, and it is nice to sort of, you know, at least the head nod to we just don't have the PK, you know, data data that we don't uh but we would like. All right. Couple here in a row. Um they're all kind of linked here, the commentary.

Strong real world evidence that a single dose of benzotine penicillin G or twenty eight day course of oral doxocyclin is not inferior to three doses. of benzazine penicillin G for the treatment of late latent or syphilis of unknown duration, published in CID. So this is an editorial commentary on the retrospective study by Pugsley et al. So let us go to that article.

Is three really what we need? Relative effectiveness of benzetine penicillin G and doxycycline treatment regimens for late or unknown duration syphilis. in six United States jurisdictions, twenty sixteen to twenty twenty one, published in CID. So here they conducted a retrospective cohort study using surveillance data for male and female cases diagnosed with late or unknown duration syphilis between twenty sixteen and twenty twenty one from six jurisdictions.

They categorized uh the BPG, the benzithine penicillin G. Um doxycycline treatment based on the recorded number of doses received and the timing between doses. They define treatment effectiveness as a four-fold decrease in non-trepanemal serum titers by 24 months post-treatment and compared treatment effectiveness. Among eighteen thousand twenty seven cases eligible for inclusion, over half had three doses of BPG recorded.

Um relatively few had only one dose, only 11%, or received 28 days of doxy, that was 17%. Four-fold tighter decreases were reserved for 75%, and 80% of cases given three doses or one dose of BPG. And 74% given doxies. Very much the same. So treatment effectiveness was similar across all treatment, dose, interval categories. Comparable when stratified by baseline titer, pregnancy status, and HIV infection. So is three what we really need, or is one enough?

And you know what I thought was really funny, Sarah? You know, big scheme of things, stuff that doesn't really matter, but I'm an odd fellow. They benzithine, penicillin, G, they never tell you what the G stands for. Does anyone know? Oh I certainly don't know. Yeah, so it's gold. It goes back to this history of the early penicillin preparations. She's had all kinds of issues with them. And then finally they got this really nice purified.

penicillin gold preparation. But everyone seems to have forgotten the G. And here we are with this whole article with three letter acronyms and they never mention the the G. Okay. That's just call it penicillin gold is a pretty good name. It is. Ooh, we're gonna give you one or three shots of the penicillin. You want the penicillin gold? Yeah, yeah. Marketing, marketing uh giving. Or the pen v K, that's the Viking product. We got the Viking product here. The pen v K.

Uh yeah. And let's see. So I have a handful of additional bacterial papers. Actually, this next one. uh was sent in by Patrick, one of the authors. So thank you for sending in articles. And as a reminder, please feel free to send us um articles to take a look at. Um so this was published in

Microbial drug resistance. Show me the minnow in vitro efficacy of minacycline on clinical gram negative bacterial isolates. Actually, I have reached for minocycline for some resistant gram-negative infection, so this is Um interesting for me. So it was a retrospective review of minnow susceptibilities at Mayo Clinic from twenty thirteen to twenty twenty two.

um including a wide variety of isolates including E. coli, clebnummo, ampcderepressors. I'm going to kind of mention the bug names as we look at them so I won't read off the list. Um but they had about eighteen thousand anaerobectorales uh species and about eight thousand that were um non-anerobector. So pulling out a few overview numbers. 80% of all the NR bacterales isolates were susceptible to minacycline. Looking at multidrug resistant E. coli isolates.

Uh minnow susceptibility was 71%. And for MDR Club Pneumo, that susceptibility was about 40%. And I pulled some of these figures, uh, you know, folks can take a look at it. Um they kind of have a the isolate separated by if they were uh ceftractone resistant alone, CIPRO, Miro, you know, and the multi-drug. Um, so that was all in figure two. For the AMP C bug.

Those, so Citrobacter Fruindii, Enrobacter cloicae, Clebsiella erogenes, those were all susceptible in the sort of eighty to eighty-five percent range. And they also included achromabacter, which their is 84% of isolates were susceptible, uh 66% of acinidobacter, and 99% of steno isotopes. So these were all the minacycline susceptible.

Isolates. As far as where these samples came from, they were mostly um urine or prostate followed by respiratory samples, but there was a mixture of other uh sources of isolates and they have Um in figure one sort of showing those isolates, the organism source, and then kind of on the other side if they fell into susceptible versus resistant.

I thought one other piece that was useful is, you know, they included some info on the three hundred and fifty isolates that were tested for both minacycline and doxycycline. Um and so for those that were doxycycline resistant Forty eight percent were minacycline resistant for those that were doxycycline. Doxycycline susceptible there was only six percent resistance, so ninety six ish percent of

uh were both doxy and minacycline susceptible. So there is a high concordance between susceptible isolates, but some doxy resistant isolates were were still susceptible to minacycline. Um there was a high discordance among the tigocycline susceptible isolates. So 30% of those that were susceptible to tickacycline were resistant to minus. Don't forget about Menacyclin.

As far as plugging other things out, it's highly orally bioavailable, it distributes well through tissues, it doesn't have major renal dosing requirements or SIP P four fifty drug drug interactions. Um And, yeah.

What else would I add? Yeah, th and then the minocyton susceptibility. Might clear up a little bit of your skin blessing. Yes, you do have to talk about the hyperpigmentation, but especially for those who don't have to be on it for as long, maybe they'll be okay. But I I think this is this is quite useful and I think one of the larger or maybe it's the largest one now as far as numbers of isolates looking at minocycline. All right, I'll

So moving away from that, we're gonna talk about C diff. I pulled this resource from JAMMA Network Open. The paper is entitled. Initial vancomycin taper for the prevention of recurrent C diff infection, a randomized clinical trial. So in this trial, there were 265 adult patients, and the authors compared a four-week what they called pulse and taper regimen of vacomycin versus

Standard pulse regimen. So these are adult patients with their first episode of C. diff infection or their first recurrent. So that was everyone getting 14 days of POVANC like you would expect, 125 milligrams four times a day. And then on day 15. You know, they would split. So some would go to 125 milligrams of Vank twice a day, uh, for a week, and then they'd step down to once daily for a week, and the other patients would receive placebo. So that's our pulse taper versus standard pulse.

And just to say the uh acronym for the trial is Taper V. I'm not actually sure where the taper comes from is like initial vancomycin taper for the prevention of recurrent C. diff infection. I'm not sure they totally match, but taper V is is easy to remember and descriptive. So In the intention to treat population, the fifty-six day recurrence, so that's their primary outcome, occurred in 14.8% in the taper group versus about

17.7% in the placebo group. So these groups were about 130 patients. So the posterior probability of superiority for the pulse. And taper of Inc was seventy four percent. If you look at the recurrence at day thirty eight and Uh that occurred in uh at a rate of 6.7% for those who had the taper versus 15% and those who just had the regular 14 days. So that's a probability of superiority of 99%.

So I just pulled out, you know, figure two, which is the Kappa-Meyer curve. And you can see how the placebo and fang curves basically converge around the it's like 60-ish day mark. Um and the trial was stopped early due to feasibility of recruit. So I think, you know, maybe there's some people who are optimists and they look at this and think, oh, maybe a longer taper would have prevented recurrences and they needed more patience. Um and that's why we see these

Maybe converging later. I think you could also interpret this as well. Maybe this approach kind of just delayed recurrence by a couple weeks. Um, which could be valuable if someone was really ill in the hospital, but for most patients I don't know that that's necessarily helpful. Um so I I guess it depends on how

how uh how you view this. You know, there I think there is supposed to be a taper uh a subsequent taper trial or maybe it's ongoing comparing to fidoxamycin. Um Uh so hopefully we'll get more in the future, but I think a really good journal club pick for people to to um dissect and form a Any any thoughts, Daniel? So I'm looking at the thirty day readmission, right?'Cause sometimes that's like the battle.

And so if you did, like that's your metric. Like if you come in at day thirty one or day thirty two, that's okay, right? You come in first thirty days, like, Oh my gosh, the hospital is gonna be like, What's going on with you, Doctor Griffin? You're getting all these C diff So if you look at the thirty day time point, you're taking like an eighteen percent recurrence rate and potential readmission and dropping it to less than ten.

Mm-hmm. That's my cynical worldview. I'm like in the corporate world, you know. It's only worried about thirty day readmissions, but yeah, it it's It almost looked like the taper just prolonged the inevitable.

Um, all right, and then I'll wrap up this section. Uh I just grabbed two things from New England Journal. Uh the first one I'll give a little bit more detail. So this was entitled Microbial Flora and War Wounds from the Ukrainian frontline. This correspondence was sent in to share data from wound cultures of about 120 or so Ukrainian soldiers. Pretty much all of these patients had blast injuries from drone explosives.

And I did not know this, but I guess the concern for antimicrobial resistance is high enough that the US military guidelines suggest prophylaxis with URDA or moxifoxin for open wounds. Um and so I think, you know, their goal here is to look at these initial wounds and see, you know, what kind of uh bugs are living in there. And so you can check out their uh figure one, which has these two pie charts, but of over 300 isolates, there were 23 bacterial families.

It was split where about sixty five percent were gram positive, and most of those were commensal bacteria like coagulase negative staph. Um MSSA was only isolated in three patients. They had one vancusceptible ephesium. Uh uh sorry, they had that in I think about eighteen or so patients. And then for gram negatives, they actually didn't show a large amount of resistance. So there was one cleb pneumo that had um some antimicrobial resistance genes and um one single isolate with acinidobacter.

You know, overall this showed that at least this initial injury, the flora that were in there were environmental commensal bugs, not necessarily immediately filled with you know, resistant organisms. So kind of suggesting that those resistant organisms are probably showing up somewhere else in the care process.

Um, whether that is, you know, nosocomial infection at facilities, uh um or or other sources. But I thought this I think we've grabbed a couple other articles like this or maybe I have in in the past, but I thought this was really interesting. Um Yeah, I have a couple of pet peeves. I mean one is this is horrible, right? That this is going on. But it looks like maybe the well, it does look like the erotipedum is is overkill, right, in this context.

Um the other is I don't see why we keep calling it flora, right? Just say microbes and warwoods, because they're not flowers, right? So I don't know, that's a pep pee. If you ever on rounds with me and they say, Oh, normal commensal flora, I'm like, Oh my gosh, flowers where the flowers growing, but yeah. Yeah, I don't know. All right. It's a living language.

Um and then this other one I I I'm not gonna dig into, but I was just gonna mention if you know you're checking out the New England Journal, there is a new review article on groupie strap uh disease that I thought was really nice and that focused um should check out. But uh I figured I had filled up the bacterial section enough.

So I'll hand it over to you. You've done good. All right. Well, I just threw this hot off the press from open form infectious disease. in the fungal section and you know, I'm hoping we got another season of uh The Last of Us on the way. Who knows? Uh, you know, is uh Mr Pascal is not returning my email so He's leaving me in the dark here, so I don't really know what's happened there. Um, I think he was busy prepping for the some halftime show. Was the last email, something about, I don't know.

Yeah. It was in Spanish and my Spanish is getting worse. No, so the article, Epidemiology of Asprogillosis Diagnosis in US adults using a national EHR database, twenty thirteen-twenty twenty-three, was published in Open Form of Infectious Disease. So here they're looking at adjusted prevalence ratios, a little A PRs.

um for aspergillosis diagnosis. Now, I think you know they talk about aspergillosis prevalence, but it's really diagnosis, right? So from 2013 to 2023, they say aspergillosis prevalence. Increased by 5% annually. I should say the diagnosis increased 5% annually, peaking in 2022. Now, Rhode Island had the highest state adjusted prevalence ratio. Interesting, right, Rhode Island? Utah had the low. Diagnosis was higher among males, so uh adjusted one point three seven.

Older adults, so those are folks sixty-five or older versus the eighteen to twenty-four. That was the big difference. That was an adjusted prevalence um ratio of four point nine five. So I'm a five-fold type. Um urban residents versus rural. That was zero point eight six. Now following the emergence of COVID nineteen, prevalence increased disproportionately among Hispanics.

or Latino patients and several racial minority groups, a non significant upward trend was also observed among rural residents. And and I was, you know, I I read the first part and this is what I was looking for. This is map So you can see the map, and it's really interesting, right? So aspergillosis, you've got the the orange, which is going to be the greater than 30, right? So that's going to be a lot. You know, so you've got California, you've got uh

Arizona, right? Um North Dakota, you have Oklahoma, and then you've got Rhode Island. Right, sort of sitting in a in a sea of lower prevalence. So so I mean, I I think this stuff is fascinating, but I'm a little worried that we might be dealing with a diagnosis issues here. All right. Parasitic. Be sure to listen to this weekend parasitism. We've got some pretty cool mystery cases coming up. Uh the article State of the Art Review. Shagas disease. Sarah, did I grab this before you?

You did. You wanted to put this in. I would have if you didn't so. An Enduring Challenge was published in C I D. In this review, they described the most relevant aspects of the pathogenesis of Shagas disease and examined critical aspects of patient care. including identification of high risk populations for targeted screening and analysis of current barriers to diagnosis and treatment implementation.

The comprehensive assessment covered the spectrum of clinical presentations based on transmission pathways and individual host factors, alongside current approaches to disease staging. diagnostic methodology, and therapeutic interventions for both acute infection and chronic complications. Furthermore, they provided key and practical evidence based care concepts.

for the immunosuppressed patient with T cruz I infection, an increasingly important patient subset that highlights evolving treatment paradigms in specialized populations. So I am going to encourage people to read this state of the root article and listen to Lincoln to Febral Cruising USA, the uh, I think the latest February podcast, right?

Yeah. W uh well I guess one came out this Monday. Yeah, folks should definitely check it out. And we're working on I mean obviously the state of the art review will all invite the authors and then we're hoping to try to do a congenital. Shaga's episode if we can get that put together. So doing trying to get people knowledgeable about it.

Yeah, so the link is in there. It's a it's a great row. Um really sort of working through a couple of different cases and sort of how diagnosis was made. So good stuff. All right, though this is a little little disturbing here. This is the article autochthonous rat lungworm angiostrungolus.

Cantinensis infections in accidental and definitive hosts, San Diego, California, USA, published in EIS. Now I have to say, it was really interesting when I started to read this. I was like, wait a second. We're talking about wallabies. So in mid December twenty twenty four, I feel like a mono like one of my like this week in Paris to be like, wait, the two year old who eats all that raw fish is a penguin.

Well, this seven year old who gets sick is a Parma wallaby that was born and raised at the San Diego Zoo. Unfortunately, this wallaby showed progressive neurological signs, head shaking, nystagmus, central blindness, ataxia, hind limb, paresis.

and extensor rigidity in all limbs. The wallaby was euthanized after eleven days of hospitalization, and the cropsy revealed multifocal hemorrhage in the cerebellum, Half a dozen nematodes um on the lepto meningial surfaces of the cerebellum, brainstem, and cervical spinal cord. Um so yeah, basically this was uh uh a cantinensis lungworm uh identified through PCR sequencing, but who's even, you know, visible. Um and I put in a picture of these cute little uh marsupials from uh from Australia.

All right. I think uh this is gonna be our last one in miscellaneous. This is fun. There's been a lot of stuff going on about um

This stuff. What is this stuff? So the article, first genome sequence, and functional profiling of psych psychrobacter sc 65A.3. preserved in 5,000 year old cave ice, insights into ancient resistome, antimicrobial potential, and enzymatic activities as published in Frontiers in Microbiology. Right. So there's this cave. There's this the Scario Sora ice cave in Romania. And it is among the most extensively studied ice caves globally.

Um it's one hundred thousand cubic meter perennial ice block dated to approximately thirteen thousand years before present. I like before present, B P. in one of the oldest and largest of its kind. So it's sort of what is that like eleven thousand before common era? So like way back. So in this cave they found isolated and performed a functional characterization of a novel

psychropactor strain from five thousand year old ice, right? So you've got sort of the different periods of time. This stuff is five thousand years. And it's belonging to the P cryololentis species. This isolated bacteria is poly extremo a poly extremo five. So it can grow in up to 15 C. It can tolerate, you know, different levels of salt and magnesium chloride. Um phylogenetic analysis classified it.

Um functional assays showed broad hydrolytic activity. Resistance, you're right, it's 5,000 years ago, resistance to 10 antibiotics across eight classes. including third generation cephalosporins, fluoroquinolones, aminoglycosides, and rifampacins. Whole genome sequence identify greater than a hundred antimicrobial resistance associated genes, including clinically relevant determinants, and they list them all out, as well as multiple heavy metal resistance and multidrug efflux genes.

Um I just I think at this point I'm just overwhelmed that 5,000 years ago the microbes had already like prophesized the advent of antimicrobials and developed all these incredible um resistance um genetics. I don't I don't get this, Sarah. What's going on? I I was looking up the the uh ice cave, which I didn't notice one. So I will admit I was distracted by the photos of said cave.

Fascinating. Well, I will say they also I'll finish up. So they found out that this SC65A.3, right, rolls off the tongue, inhibited 14 escape group pathogens, right? So it's like fighting off. Clebsiella pneumonia, MRC, Enerocusphysium, Enerobacter, Pseudomonas, Asenidobacter Balmani.

um consistent with genes linked to antimicrobial compounds. So not only is it resistant to all these microbes, but it's actually producing its own antimicrobial agents to kill the other bacteria. I mean, this is like Abs yeah, where's where's Michael Crichton when you need him to write another really cool screenplay? Yeah, we'll be waiting.

Um well on that note, that brings us to the end of this podcast. As always, the references for this show are available at MyCurve.tv, the home of our growing multimedia. You can find the infectious disease puscast at Apple Podcasts, microbe.tv forward slash puscast, or grab it with your favorite podcatcher or on YouTube, and then make sure to subscribe, like us, ring the bell, and leave comments. We love to get your questions, comments, paper suggestions, send them to PostCast at microbe.tv.

Please send us your paper, we might even chat about it. If you like what we do or you just want us to keep doing it, consider supporting the side shows of Microbe TV at microbe.tv for it slash contribute or go to parasiteswithoutborders dot com, click on the donate button. I'm Sarah Dong. You can find me on Blue Sky at Sarah Wyn Dong or over at the Brow Podcast.

I'm Daniel Griffin, and you can find me at Columbia University Irving Medical Center or ParasiteswithoutBorders dot com, as well as on the other podcasts this week in parasitism and this week in Virology Clinical Update. And as always, thank you for this most interesting consultation and allowing us to participate in the care of this most difficult and challenging case. We shall continue to follow along with you. Thank you and dictation and goodbye.

Thanks for listening, we'll be back in two weeks. Another podcast is