Top Infectious Disease News of the Week—August 5, 2018

#5: An Unexpected Meningitis Culprit

HISTORY OF THE PRESENT ILLNESS: An 81-year-old female presented to the emergency department (ED) with altered mental status and was found to be unresponsive, with shaking of her extremities. At baseline, she was ambulatory and verbal, but dependent on family for all activities of daily living. Per her family, the patient was found in her bed, laying on her left side, unresponsive, with mild shaking of the extremities. Her eyes were open but without movement. The family denies any bowel or bladder incontinence. They also reported she had no sick contacts, recent illness, fever, chills, or cough. She had no recent surgeries or health care contacts. The patient was last seen normal 2 hours prior.

PAST MEDICAL HISTORY: Dementia, transient ischemic attacks, type 2 diabetes, hyper­tension, descending thoracic aortic aneurysm status post stent placement in 2008, chronic hepatitis C (untreated), and hyperlipidemia.

KEY MEDICATIONS: Amlodipine (Norvasc), aspirin 81 mg, atorvastatin (Lipitor), and chlorthalidone (Thalitone).

EPIDEMIOLOGICAL HISTORY: Lives with 1 of her granddaughters, not sexually active, nonsmoker, nondrinker, and no illicit drug use. Pet-free home, no recent travel.

Find out more about the meningitis case.

#4: Fidaxomicin Superior to Vancomycin in Achieving C difficile Symptomatic Cure

Fidaxomicin and vancomycin are effective and potentially curative first-line therapeutic options for Clostridium difficile, according to a meta-analysis published in Lancet Infectious Disease. Additionally, several studies evaluated in the pooled analysis suggest that fidaxomicin may be more effective than vancomycin for helping C difficile patients achieve a sustained symptomatic cure, yet there are few differences between the treatments in patients with more severe C difficile infections (CDIs).

“To our knowledge, this study provides the most up-to-date and comprehensive synthesis of evidence for pharmacological treatment of C difficile,” the investigators, led by Venkataraman Subramanian, MD, wrote. While their study demonstrated that fidaxomicin has the strongest evidence for improving the odds of C difficile patients in achieving a symptomatic cure, the data also indicate that both ridinidazole and teicoplanin “could potentially be effective treatments for these infections; however, their routine implementation should await results from larger trials.”

Read more about fidaxomicin.

#3: FDA Approves First Preventative Antimalarial in Almost 2 Decades

The US Food and Drug Administration (FDA) has approved tafenoquine (Arakoda) tablets manufactured by 60 Degrees Pharmaceuticals, LLC, for malaria prophylaxis in patients 18 years and older. This is the first new drug approved for the prevention of malaria in more than 18 years.

The approval comes on the heels of GlaxoSmithKline (GSK)’s tafenoquine (Krintafel) approval last month, which was the first single-dose medicine for the prevention of Plasmodium vivax malaria relapse in patients over the age of 16 years who are receiving antimalarial therapy. Krintafel is the first drug to be approved for the treatment of P vivax in over 60 years.

Both approvals were made under the contingency that GSK, and now 60 Degrees, complete post-marketing studies on the safety and efficacy of the drug formulations.

Read more about tafenoquine for malaria prophylaxis.

#2: Post-Transfusion Anaplasmosis Case Highlights Need for Vigilance in Transfusions

A new report on the case of a 78-year-old man who died of anaplasmosis following a blood transfusion highlights the risks of blood transfusions, and the need for judiciousness when ordering them, according to a new report.

The death prompted an investigation by researchers at the hospital and at the New York City and New York State health departments. The work, published this month, was led by corresponding author Ruchika Goel, MD, MPH, an assistant professor of pathology, laboratory medicine, and pediatrics at New York-Presbyterian Hospital, Weill Cornell Medicine.

The case in question occurred in New York in April 2017. A man with a history of several health issues, including homozygous factor XI deficiency, coronary artery disease, congestive heart failure, diabetes, and chronic kidney disease, was admitted to the hospital for transurethral resection of the bladder as the result of a urologic malignancy.

Read more about post-transfusion anaplasmosis.

#1: Follow Up of At Least 1 Year Recommended for Lyme Disease Patients

In a new study, researchers in Slovenia have examined how Lyme disease patients with solitary rashes and multiple rashes respond to the same clinical course of treatment.

Lyme disease, or borreliosis, is a tick-borne illness caused by Borrelia burgdorferi bacteria. Symptoms of early localized Lyme disease, also known as stage 1, typically occur within days or weeks of a tick bite and include a telltale rash along with fever, headache, and fatigue. When treated early with antibiotics such as doxycycline, amoxicillin, or cefuroxime axetil for 10 days to 4 weeks, Lyme cases can clear rapidly and fully. When left untreated for weeks or months, individuals can experience early disseminated Lyme disease, stage 2 of infection, which may include symptoms such as numbness, pain, paralysis or weakness of the facial muscles, and heart palpitations. Stage 3 of Lyme disease can include complications such as joint swelling, muscle weakness, or cognitive issues.

The erythema migrans (EM) rashes associated with Lyme disease often present as a solitary circular “bullseye” rash. Multiple erythema migrans (MEM) can be an early sign of stage 2 Lyme disease and may occur in 10% to 20% of patients. Recognizing MEM and other early manifestations of progressing illness and initiating treatment are important for avoiding neurological, ophthalmological, cardiac or rheumatic borreliosis.

In a new study published in the journal JAMA Dermatology, researchers from the University of Ljubljana in Slovenia investigated the potential differences in clinical course and treatment outcomes between Lyme cases with solitary EM and MEM.

The prospective cohort study was conducted from June 1, 2010, to October 31, 2015, and researchers analyzed data from June 1, 2017, to January 3, 2018, from a total of 778 consecutive adult patients with early Lyme borreliosis; of those patients, 200 patients with MEM and 403 patients with solitary EM were enrolled in the study. The researchers compared the clinical course and posttreatment outcomes of patients with MEM to those with solitary EM and assessed outcome at 14 days and at 2, 6, and 12 months after enrollment.

Read more about Lyme disease.