June 2018: General ID

Here's some basic science supporting the idea that IVIG may help combat necrotizing soft tissue infections due to group A streptococcus. The authors found that patients who developed these necrotizing infections were deficient in antibodies to the strains of group A streptococcus causing their infections, as well as in antibodies to those bacteria's exotoxins. The investigators used toxin inhibition assays to show that these antibody deficiencies were corrected after pooled immunoglobulin supplementation. PMID: 29878263


Ntwetwe virus: yet another new arboviral encephalitis. One of the great things about Infectious Diseases as a specialty is that's always evolving - and not just on the therapeutic side. For the past three decades we've identified a significant new human pathogen at a rate of about one a year. Here's another: a Ugandan girl with encephalitis was found to have a novel orthobunyavirus by next-generation sequencing of the CSF. Named Ntwetwe virus after the patient's hometown, the virus is most closely related to Tataguine virus (another virus I've never heard of), which causes a malaria-like illness with fever and rash, and belongs in a clade of arboviruses born by the Anopheles mosquito. PMID: 29893821


qSOFA accurately predicts hospital mortality in Low and Middle-income countries. This study aggregates data from 9 prior studies and compares the diagnostic accuracy of qSOFA and SIRS. I am pointing out this study mainly for the very nice figure 1, which shows hospital mortality rates stratified by qSOFA score and also by SIRS score. Mortality steadily increases with qSOFA score, whereas having more than two SIRS criteria is not associated with greater mortality than just 2 SIRS criteria, and overall qSOFA was the more accurate predictor of death in the hospital. 29800114


Life-long antimicrobial therapy: where is the evidence? This is a nice, short review of the evidence for lifelong prophylactic or suppressive antibiotic therapy for a variety of conditions. We seem to use lifelong antibiotics most often in the cases of infections with retained hardware (e.g. prosthetic joints and cardiac devices), and the evidence for this is moderate - e.g. success in cohort studies. Also, were you are aware that combination clarithromycin, rifabutin and clofazamine can be used for the treatment of Crohn's disease, and that Mycobacterium paratuberculosis can be cultured from 50-100% of patients with Crohn disease (PMID: 26474349)? Because I sure wasn't. PMID: 29873746


The WHO published an updated report with recommendations for the use of the BCG this year. They continue to recommend universal BCG vaccination for children in areas where the incidence of tuberculosis and/or leprosy are high, and also suggest its use in areas where Buruli ulcer is endemic. They recommend that countries with a low incidence of TB consider selective vaccination of children at particularly high risk of TB (e.g. neonates born to parents or close family members with active TB or who come from high-incidence TB countries). The WHO continues to recommend BCG in these settings due to evidence that the vaccine may protect against more severe forms of TB (e.g. TB meningitis and milliary TB) as well as prevent leprosy and Buruli ulcer. This doesn’t mean much for those of us in the US, but this is a good time to point out that while we don't use the BCG vaccine to prevent TB or leprosy in children here, we do use it for the treatment of bladder cancer! Also, a very interesting study was just published suggesting that BCG vaccination may "re-wire" glucose metabolism and significantly ameliorate hyperglycemia in patients with type-1 diabetes, (see: this paper) so keep an eye out for more news on that front. PMID: 29609965