Top 5 Contagion&reg News Articles for the Week of October 1, 2017

The following is a snapshot of our top 5 infectious disease articles from this past week:

#5: How to Improve Fungal Disease Management Worldwide

In an article published in The Lancet Infectious Diseases, Donald C. Cole, FRCP, from the University of Toronto, Ontario, Canada, and colleagues describe the current state of identification and management of fungal diseases and discuss potential approaches for improving their recognition and treatment.

According to the authors, estimates of the burden of fungal diseases in low-income and middle-income countries made by the Global Action Fund for Fungal Infections (GAFFI) exceed the capability of these countries to manage the burden.

To read more about improving fungal disease management, click here.

#4: Maraviroc-Containing PrEP Regimens Found to be Safe in Women

HIV infections continue to occur at a rate of >2 million globally each year with women accounting for a little over 50% of infections. Although the overall incidence of HIV infections in the United States has decreased in recent years, certain populations remain particularly vulnerable, including racial/ethnic minorities, adolescents/young adults, and people in the southern United States. Antiretroviral therapy has been highly successful in reducing AIDS outcomes and death in HIV-infected patients worldwide; however, transmission of HIV remains a major global health problem.

The approval of oral TDF-FTC for HIV pre-exposure prophylaxis (PrEP) represents an approved intervention to help control this epidemic; however, the tolerability of this regime and the subsequent discontinuation of therapy pose a threat to the efficacy, and therefore, the main purpose of this management approach. Maraviroc (MVC), a CCR5 antagonist HIV entry inhibitor, has been approved for treatment of HIV infection treatment-experienced participants and has many attributes that make it a viable candidate for HIV PrEP in women. Regimens containing MVC have been studied in terms of safety and tolerability in HIV uninfected men and transgender women who undertake risky sexual activity or with unknown sero-status men. The results of these studies showed the regimen to be largely well-tolerated with 84% of the participants completing the 48-week study. Notably, the reasons for discontinuation were similar across the regimens.

Read more about Maraviroc-containing PrEP regimens, here.

#3: What's Hot in Infectious Disease and HIV Science

Basic and clinical research on infectious disease and HIV continued at a brisk pace in the past year. As outlined by 4 speakers at a symposium at the annual ID Week conference in San Diego, California, real advances were made.

A hot clinical topic for a long time in infectious diseases has been multidrug resistance (MDR). Now, according to Stan Deresinski, MD, Stanford University, Palo Alto, California, “the great fear has come true.” A report last year from China described deaths due to hypervirulent and carbapenem-resistant Klebsiella pneumonia (ST11). The report once again highlights the need for an expedited pathway for antibiotic development and approval.

Read more about hot topics in infectious disease and HIV science, here.

#2: New Report Outlines Lyme Disease Management in the UK

In an effort to better diagnose and treat cases of Lyme disease, the United Kingdom’s National Institute for Health and Care Excellence (NICE) has issued a draft guidance to help general practitioners and health professionals better spot cases of the tick-borne disease.

Lyme disease is transmitted to humans through the bites of black-legged ticks infected with Borrelia burgdorferi. Although most ticks don’t carry the bacteria that causes Lyme disease, bites from infected ticks can lead to initial symptoms including fever, headache, fatigue, and a telltale “bullseye” skin rash. Infections are treated with antibiotics such as doxycycline or amoxicillin. According to the Centers for Disease Control and Prevention (CDC), if left untreated, more serious symptoms can develop, including severe headaches and neck stiffness, arthritis with severe joint pain and swelling, facial palsy, heart palpitations, and inflammation of the brain and spinal cord. In the United States, the geographical distribution of Lyme disease has been growing, and the disease has also been reported in forested areas of Asia and Europe according to the World Health Organization (WHO).

Read more about the report, here.

#1: Cephalosporin Use in Penicillin-Allergic Patients: Pros & Cons

Are cephalosporins safe for use in patients allergic to penicillins who haven’t undergone a prior allergy evaluation? Experts debated this very question during the annual meeting of the American Academy of Allergy, Asthma, and Immunology in March, and a summary of the discussion was published on September 22, 2017, in the Journal of Allergy and Clinical Immunology: In Practice.

Currently, there are no widely accepted guidelines regarding the use of cephalosporins in patients allergic to penicillin, which adds to the challenge facing clinicians, given that the most commonly reported drug allergy involves the first-generation antibiotic (and that cephalosporins and penicillin share structural similarities). In general, simply automatically withholding cephalosporins in patients allergic to penicillins would increase the use of broader-spectrum antibiotics, resulting in more adverse events and potential treatment failures.

“Setting standards for cephalosporin use among penicillin-allergic patients… is important to the quality and safety of care we deliver,” Kimberly G. Blumenthal, MD, MSc, Division of Rheumatology, Allergy and Immunology, Department of Medicine and Edward P. Lawrence Center for Quality and Safety, Massachusetts General Hospital, Boston, who argued the “con” perspective, told Contagion®.

During the debate, in arguing the pro-cephalosporin position, Eric Macy, MD, MS, FAAAAI, Department of Allergy, Southern California Permanente Medical Group, San Diego Medical Center, who was unable to respond to a request for comment on deadline, acknowledged that “the literature supports that all individuals, particularly hospitalized individuals, with an unconfirmed penicillin allergy should have the penicillin allergy confirmed or removed for patient safety.” However, he added that, “this does not mean one could not treat a patient with a cephalosporin before removing the penicillin allergy or confirming a penicillin allergy,” and that cephalosporin tolerance testing in patients with a history of penicillin allergy may not improve overall patient safety or clinical outcomes “because of the high number needed to treat, time, expense, and the low likelihood of such testing occurring.”

Read more about cephalosporin use in penicillin-allergic patients, here.