2 Minute Medicine ® - Infectious Disease

1. In this randomized cluster trial, twice-yearly azithromycin distribution reduced all-cause childhood mortality among children aged one to 59 months in rural communities in Niger. 2. Distribution of azithromycin was not effective at reducing infant mortality when only given to children one to 11 months of age.  Evidence Rating Level: 1 (Excellent) Study Rundown: All-cause childhood mortality risk remains an area of concern in Sub-Saharan Africa, with nearly 10% of children passing before their fifth birthday...

1. Time in hospital was modestly reduced in both intervention groups compared to the control. 2. There was little to no improvement in symptom alleviation with oseltamivir and peramivir compared to control. Evidence Rating Level: 1 (Excellent) Study Rundown: There is little consensus around the first-line antiviral treatment for severe influenza. This systematic review of randomized controlled trials assessed different antivirals used in hospitalized patients with severe influenza. This study aimed to assess the effectiveness of various antiviral drugs, including oseltamivir, peramivir, and zanamivir, in reducing important clinical outcomes compared to placebo or standard care...

1. Using either procalcitonin or c-reactive protein as a biomarker to guide antibiotic treatment in patients with community-acquired pneumonia reduces the length of treatment course with no effect to time to reach stability or new antibiotic prescriptions Evidence Rating Level: 1 (Excellent)  20-50% of the 3.3 million people who develop community-acquired pneumonia (CAP) need to be hospitalized every year. Treatment of CAP is recommended to be a 5-21 day course of antibiotics yet in practice, patients are treated for longer than recommended...

1. In this retrospective cohort study, discordance between initial diagnosis and discharge diagnosis occurred in over half of hospitalizations for community-acquired pneumonia from the emergency department. 2. Documentation of diagnostic uncertainty was found in nearly half of clinical discharge notes, reflecting the persistent challenge of refining diagnoses for nonspecific presentations. Evidence Rating Level: 2 (Good) Study Rundown : Community-acquired pneumonia (CAP) is an infection of the lung parenchyma acquired outside of the hospital setting which often leads to symptoms of cough, dyspnea, and increased sputum production...

1. In this follow-up analysis of a cohort of patients from the RECOVER study, there was no clinically meaningful difference in 25 routine laboratory biomarkers between those likely and unlikely to have postacute sequelae of COVID. 2. Participants with a known history of infection had a lower mean platelet count, higher HbA 1c , and higher urinary albumin-creatinine ratio compared to participants with no known prior infection. Evidence Rating Level: 2 (Good) Study Rundown: Postacute sequelae of SARS-CoV-2 infection (PASC), known colloquially as long COVID, has affected many people globally and become a large public health burden...

1. Wearing surgical face masks was superior to not wearing surgical face masks in reducing the risk of respiratory symptoms over 14 days among Norwegian adults. Evidence Rating Level: 2 (Good) During the COVID-19 pandemic, wearing face masks was a widely implemented public health measure to limit the spread of the virus; however, its effectiveness in lowering the risk of respiratory infections is mixed. This pragmatic parallel two-arm individually randomized superiority trial thus evaluated the personal protective effect of wearing versus not wearing surgical face masks in public spaces over 14 days on self-reported symptoms consistent with a respiratory infection...

1. Patient data from a Taiwanese national database demonstrated that those who took fluoroquinolones had a greater risk of aortic and mitral regurgitation. 2. When excluding patients treated for pneumonia however, patients who took fluoroquinolones had a greater risk of mitral but not aortic regurgitation. Evidence Rating Level: 2 (Good) Fluoroquinolones (FQs) are broad-spectrum antibiotics used to treat a variety of infections. There is conflicting evidence for whether FQs increase the risk of aortic and mitral regurgitation...

1. In a cohort of infants born to mothers during the COVID-19 pandemic, neither vaccination nor infection with COVID-19 led to increased risk of any congenital anomaly.  Evidence Rating Level: 1 (Excellent)  There is an increased risk of pregnancy complications in women who contract COVID-19 while pregnant. As a result, it is highly recommended that pregnant women get vaccinated against COVID-19 to prevent transmission. Since there are not many past studies on the effects of vaccinations during pregnancy, these researchers attempted to understand the risk of the fetus developing congenital anomalies from exposure to COVID-19 (whether through the vaccination or infection) during the first trimester...

1. In a prospective cohort study of individuals vaccinated against SARS-CoV-2, symptomatic patients had higher levels of neutralizing antibodies (nAB) compared to those who did not report any symptoms. 2. For every 1°C increase in skin temperature, there was an increase in nAB value one month later and a greater increase in nAB six months later. Evidence Rating Level: 1 (Excellent) Study Rundown: The benefits of the COVID-19 vaccines, including reduced severity, are shown to degrade over time, necessitating booster doses...

1. Administration of antibiotics beyond 330 minutes from emergency department arrival in pediatric patients with sepsis was associated with increased 3-day and 30-day sepsis-attributable mortality.  Evidence Rating Level: 2 (Good) Early administration of antibiotics has long been an important recommendation in the treatment of sepsis by various guidelines. However, a more detailed understanding of the association between time to antibiotic administration and pediatric sepsis outcomes, including clinical differences at multiple time points, has not been well established...

1. In this randomized controlled trial, there was no difference in the median time to sustained alleviation of coronavirus disease 2019 (COVID-19) symptoms between participants who received nirmatrelvir versus placebo. 2. The incidence of adverse events was similar in the nirmatrelvir and placebo groups, with dysgeusia being the most common event associated with nirmatrelvir. Evidence Rating Level: 1 (Excellent) Study Rundown: COVID-19, an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), remains a threat to global health, with severe cases contributing to significant morbidity and mortality...

The Latest A 2023 phase 3 double blind, randomized clinical trial funded by Valneva Austria investigated the safety and efficacy of the world’s first single shot live attenuated chikungunya vaccine. The researchers found that this vaccine known as VLA1553, marketed as Ixchiq, was successful at providing optimally protective antibody levels against the chikungunya virus in over 98% of the participants in the treatment arm. Additionally, the Ixchiq only led to two serious adverse events, but was overall well tolerated by participants and had adverse events similar to other vaccines on the market...

1. In a randomized control trial of women with HIV, both treatment groups had similar adherence to prevention of mother-to-child HIV transmission (PMTCT) clinic visits, or ART administration at 6 weeks, 12 months, and 24 months.  2. At 2 years postpartum, women in the FLC intervention group had better adherence to PMTCT than women in the SOC intervention group.  Evidence Rating Level: 1 (Excellent)  Prevention of mother-to-child HIV transmission (PMTCT) is a huge part of the ongoing fight against HIV/AIDS...

1. RSV-related ALRI incidence was significantly higher among preterm infants than term infants. 2. This pattern for RSV hospitalizations remained true until infants’ second year of life. Evidence Rating Level: 1 (Excellent) Study Rundown: Infants born prematurely face an increased risk for severe respiratory infections, particularly from respiratory syncytial virus (RSV). Until now, few studies have successfully assessed the global burden and risk factors associated with RSV-related acute lower respiratory infections (ALRIs) in preterm infants...

1. Overall vaccine efficacy ranged from 83.1% to 86.6% during the 10-year period. 2. Detectable concentrations of antibodies persisted at the 8.5-year mark in Qindong. Evidence Rating Level: 1 (Excellent) Study Rundown: Hepatitis E virus (HEV) is a leading cause of acute viral hepatitis worldwide. Currently, two recombinant HEV vaccines exist; however, little is known about their long-term safety and efficacy. This randomized controlled trial aimed to assess the durability of hepatitis E vaccine efficacy over 10 years in a Chinese population...

1. Patients randomized to receive the paravertebral block (PVB) and erector spinae plane block (ESPB) had significantly more effective prevention and minimization of the impacts of post-herpetic neuralgia (PHN) in the acute period post-Herpes Zoster infection. 2. Patients randomized to receive PVB or ESPB additionally required less oral rescue analgesics and reported significantly higher quality of life at 15, 30, and 60 days post-block compared to controls.  Evidence Rating Level: 1 (Excellent) Herpes Zoster (HZ, or shingles) is a reactivation of the Varicella Zoster virus, and a painful dermatomal rash is usually a defining acute feature of the condition...

1. Therapeutic response at days 10-13 was greater in the gepotidacin group compared to the nitrofurantoin group across both trials. 2. Gepotidacin use was associated with diarrhea as the most common adverse event and no significant fatalities were reported. Evidence Rating Level: 1 (Excellent) Study Rundown: Urinary tract infections (UTIs) affect a large portion of women worldwide. While many antimicrobial treatment options exist, concerns regarding growing antibacterial resistance prompt a need for novel therapeutics...

1. In this randomized controlled trial, there was a decreased risk of any and severe respiratory syncytial virus (RSV) lower respiratory disease in the group that received the vaccine compared to the group that received the placebo. 2. T he vaccinated group had a higher risk of preterm birth than the placebo group . Evidence Rating Level: 1 (Excellent) Study Rundown: RSV is a major cause of respiratory tract infections in young children, particularly infants under six months. The virus particularly affects those living in low- and middle-income countries, where interventions are needed...

1. In this cohort study, neutralizing autoantibodies against interleukin-23 (anti-IL-23) were associated with severe, persistent opportunistic infections in patients with invasive bacterial, mycobacterial, and fungal infections. 2. Among a cohort of patients with thymoma, anti-IL-23 was associated with higher infection status. Evidence Rating Level: 2 (Good) Study Rundown: Anti-cytokine antibodies are increasingly recognized in immunodeficiency and severe infectious conditions. IL-23 and interleukin-12 (IL-12), whose structures share a common protein subunit (p40), are two cytokines that both engage the IL-12Rβ1 receptor and are essential for the production of interferon-γ...

1. Novel assay, NG-LFA, showed strong sensitivity and specificity compared to NG-PCR in both urine and vaginal specimens. 2. NG-MAST showed 93 different sequence types out of 156 LFA-positive specimens. Evidence Rating Level: 2 (Good) Study Rundown: To address the need for a rapid and cost-effective point-of-care test, a Neisseria gonorrhoeae novel lateral flow assay (NG-LFA) was developed to meet World Health Organization (WHO) and Foundation for Innovative New Diagnostics (FIND) criteria. This randomized controlled trial aimed to evaluate the NG-LFA’s performance in symptomatic male and female patients...