Top Infectious Disease News of the Week—December 8, 2019

#5: Malaria Response Could Trigger Developments in HIV, Lupus

Thanks to a discovery about the immune system’s response to malaria, better treatments for HIV and lupus may be on the horizon, according to a new paper published Cell Reports. This can be accomplished either through new therapies or yet-to-be-developed vaccines.

Investigators from Australia continued their work examining the relationship between the host immune system and malaria infection. It was previously assumed that the infection avoids detection within the immune system—a major reason for our inability to fight malaria.

“It is well known that an individual must continuously be exposed to malaria over many decades in order to develop protective immunity, during which time they are often sick, as well as spreading the disease,” study author Diana Hansen, BMedSc, PhD, said in a press release. The team wanted to examine what made malaria different than other diseases because in most cases, a single exposure can result in lifelong immunity.

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#4: An Unknown Contagious Rash: Case Report and Literature Review of Norwegian Crusted Scabies

FINAL DIAGNOSIS

Norwegian crusted scabies

HISTORY OF PRESENT ILLNESS

A 29-year-old African American man presented to Hahnemann University Hospital in Philadelphia, Pennsylvania, with odyno­phagia, visible thrush, and a diffuse body rash that was worse on his lower extremities. The patient reported receiving an HIV diagnosis in 2015; however, he started antiretroviral therapy just 1 month prior at an outside hospital, where he was found to have pneumonia and neurosyphilis. He left the outside hospital against medical advice (AMA) and was since off antiretroviral therapy. On admission, he reported odynophagia leading to a 30-pound weight loss over the past 4 months. He reported having a diffuse body rash of unclear onset, which was nonpruritic. On review of systems, he reported 2 episodes of watery diarrhea.

MEDICAL HISTORY

The patient received an HIV diagnosis in 2015 and was not engaged in care or on treatment. He took antiretroviral treat­ment for a short period 1 month earlier. Records obtained from an outside hospital noted neurosyphilis, which was inad­equately treated when the patient left AMA.

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#3: FDA Releases Analysis of HIV Drug Approval Program for Low-Income Countries

The US Food and Drug Administration’s (FDA) program to evaluate HIV drugs for use in low-resource countries is achieving its goals, but a new agency analysis finds there are also ways the program could be made more efficient.

Since 2004, the FDA has reviewed antiretroviral drugs as part of the President’s Emergency Plan for AIDS Relief (PEPFAR). The program, which is overseen by the US State Department, is designed to help prevent the spread of HIV in low-income countries and to treat people living with the condition in the more than 50 countries in which PEPFAR operates. The FDA’s role in the program is to help the State Department determine which antiretroviral therapies (ARTs) are safe and effective, and therefore worthy of use in the program.

In a new study, published in JAMA Network Open, officials from the FDA review the successes and challenges of the program, and offer recommendations to make it work even better.

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#2: Hepatitis A Outbreaks on the Rise in the US

Although hepatitis A virus (HAV) is the most common cause of viral hepatitis worldwide, cases in the United States have been steadily declining since 1996, after the vaccine became available, until recent years.¹ As of 2016, widespread outbreaks of hepatitis A infections have caused over 27,000 cases in the United States.

Twenty-five years ago, large community outbreaks were driven by infections among children, most of whom are asymptomatic when infected with HAV.² Initial vaccine recommendations focused on children in high-prevalence counties but in 2006 were expanded to recommend that all children be vaccinated with 2 doses of vaccine starting at 12 months of age. As a result, the epidemiology of hepa­titis A has shifted, reflecting a higher proportion of adults susceptible to infection compared with children, particu­larly adults reporting certain risk behaviors and exposures.³ This article describes the changing epidemiology of hepa­titis A and the community-wide person-to-person outbreaks of hepatitis A infections occurring among adults in the United States.

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#1: Vaginal Microbiome Transplantation Effective in Intractable Bacterial Vaginosis

Microbiome transplantation has been a controversial topic since the introduction of fecal microbiome transplantation (FMT) for the treatment of recurrent Clostridioides difficile infections. While this treatment modality may be considered unconventional, multiple FMT trials have reported favorable outcomes, with some studies showing up to 100% C difficile cure rates (Table 1).^1-4 Four-year follow-up studies of FMT-treated patients showed significantly improved bowel habits and decreased gastrointestinal tract symptoms compared to antibiotic therapy, which indicates that the long-term effects can prove to be beneficial.⁵ Given the reported efficacy and safety profile of FMT, researchers have begun investigating a potential role for the procedure in the management of other disease states believed to be affected by the microbiome, including inflammatory bowel disease and depression.^6-7 A natural progression in the research of microbiome transplantation for the treatment and prevention of chronic disease is to study the role of microbiome transplantation at other sites of human colonization. A recent study by Lev-Sagie and colleagues reported the benefit of vaginal microbiome transplantation (VMT) for the treatment of recurrent bacterial vaginosis (BV).⁸ Their results are striking and are likely to spur a significant amount of further research in this area.

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