Recent developments in infectious diseases–bugs that bug us – Part I

I was recently asked to give a 15-minute rapid update on changes in infectious diseases that would be of interest both generally and for an audience of family physicians at the CAFP Clinical Update in San Francisco.

The list of interesting items was long and I pared the brief discussion to a few items. The list:

  • Antibiotics in severe sepsis
  • Chikungunya
  • Clostridium difficile
  • Dengue
  • Ebola
  • EV-D68
  • HCV
  • HIV pre-exposure prophylaxis (PrEP)
  • Influenza
  • Measles
  • Microbiome
  • Moxifloxacin failure in short course TB
  • Acute skin and skin structure infections (ASSSI)
  • Carbapenem-resistant enterococcus
  • Polyvalent pneumococcal vaccine

I have culled the following points from the long part of the short talk:

Antibiotics in sepsis – no comment as this wasn’t relevant to most PCPs.

Chikungunya – a mosquito-borne viral illness with over 6,600 cases in U.S. travelers to endemic areas of the Caribbean and even a few home grown cases in Florida – expect to see more in the southeastern U.S.

Dengue – getting close to a vaccine for this other mosquito-spread disease.

EV-D68 – this echovirus causes respiratory illness, particularly in the young with asthma, but it has now also been linked with a polio-like motor paralysis from which recovery is slow and/or incomplete.

Influenza – the vaccine was off-target this past influenza season. But we have learned that vaccination of a pregnant mother does extend protection to the newborn.

Measles – multistate outbreak linked to a source at Disneyland and spread among the unimmunized and in some cases the immunized. Perhaps Disneyland is not the Happiest Place on Earth for a while. 169 cases of measles reported to the CDC from January 1 to May 1, 2015, in 27 states. Wasn’t measles elimination in the US announced in 2000?

Microbiome – fascinating science about how the personal microbiome can affect individual health. Why are 80% of antibiotics used in animal husbandry? It has long been known that antibiotics cause animals to gain weight! Get that!

Moxifloxacin failure in 4 month treatment course of smear-positive TB in combination with other drugs compared to standard treatment regimens.

Carbapenem-resistant enterococcus – spread by endoscope with some fatal outcomes. Makes me sad to be a Bruin alum.

Pneumococcal conjugate vaccine – recommended for those needing pneumonia prophylaxis. Be aware of the separation and sequencing of this new vaccine and the older pneumococcal polysaccharide vaccine 23 (Pneumovax).

That leaves Ebola, HCV, C diff, PrEP, and ASSSI, which I will address in my next blog post.

Marshall Kubota, MD