August 23rd, 2018

Eye Worm, MALDI-TOF, New Lyme Testing Approach, Dogs Fail as C. diff Testers, Uiyk (?), and More — A Summer Is Getting Shorter ID Link-o-Rama

Ben Taylor (aka Mometo) (1970–), The Host (2014). Cover of Emerging Infectious Diseases, August 2018

A recent chilly spell here in Boston recalled a universal truth about aging — that summer seems to get shorter every year.

As far as I can tell in my unscientific poll of everyone who will engage with me on this topic, there are no exceptions to this rule. Everyone thinks summer is shorter than when they were kids, even though the calendar says summer lasts around 90 days — every year.

Why is the sun going down so soon? Is it already mid-August? No more free summer weekends? Didn’t it just get warm? Winter coats in catalogs? Back-to-school specials at the office supply stores? Halloween costumes at Costco? Summer is over already???? ARGHHHH!!!!

On to an ID Link-o-Rama, this one designed to accompany the late afternoon slanting sunlight that seems to say, “Too soon, too soon.”

  • Ibalizumab is effective in patients with multi-drug resistant HIV. This humanized IgG4 monoclonal antibody blocks viral entry, and is given as an infusion every two weeks. Notably, drug development of ibalizumab started around two decades ago, when we had many patients who could not achieve virologic suppression because of  resistance — a situation uncommon today. That a phase III trial had only 31 patients and that the FDA approved it anyway demonstrates two things: 1) There are very few people who need this drug; 2) those who do need it really really need it — it can be life-saving. Trivia question — why is it called “ibalizumab-uiyk“?
  • There are significant knowledge gaps about TB diagnosis and treatment among medical residents. Given how rare TB cases have become in the USA — especially in certain regions — these results are unsurprising, but still important. Mandatory ID consult for cases where TB is highly suspected? Certainly would advocate consultation when the diagnosis is confirmed.
  • Fosfomycin susceptibilities are a mess. That’s the only conclusion one can draw from this interesting study of different testing methods, which highlights the difficulties of obtaining a reliable result outside of the cumbersome agar dilution method — a challenge that will become even more important when IV fosfomycin becomes available in the USA. (H/T to ID Journal Club for the link, see below for more information.)
  • It’s been quite the season for Infectious Diseases and baseball. Two cases (!) of hand, foot, and mouth disease landed separate New York pitchers (one Yankee, one Met) on the disabled list. Not only that, Cleveland outfielder Leonys Martin sounds like he had sepsis or toxic shock syndrome. Speedy recovery!

Three more items before you head back to beach.

  1. Shout out to the excellent ID Journal Club, where Dr. Nicolás Cortés-Penfield summarizes recent ID literature in clever, concise snippets. He’s been doing it for around a year — may he long have the energy to continue!
  2. On The OFID Podcast, PharmD extraordinaire Dr. Susan Davis joins me to highlight the critical role ID pharmacists play in improving patient care.
  3. On The Curbsiders Podcast, I spend a bunch of time talking about tick-related infections, in case you can’t get enough of these critters.

Hey, next week I’m on vacation — so summer can’t be over quite yet, right?

7 Responses to “Eye Worm, MALDI-TOF, New Lyme Testing Approach, Dogs Fail as C. diff Testers, Uiyk (?), and More — A Summer Is Getting Shorter ID Link-o-Rama”

  1. Sanjat Kanjilal says:

    Completely agree: Fosfomycin susceptibility testing is a total mess, and the volume of requests for testing against organisms that lack CLSI guidelines is only increasing. This is an example of where a rapid and reliable molecular test would be very helpful.

    Ibrexafung- Stop it. Stop right there. -erp.

  2. Michael Saag says:

    Hey Paul…you are absolutely right re the sense that summer-days are reduced as we get older. Why do you think so many Northeasterners end up living in Florida?!
    Either it’s the sense of shorter summers or increasing intolerance of frigid weather in the winter. So when are you moving south?? Louis would love it here…and he does indeed look like a ‘good boy’!

  3. Linda says:

    Thanks for sharing

  4. Matthew Ryan says:

    Tibetan Terrier ?

  5. dear Paul,
    great blog post as always…
    i had a conversation with a friend recently in jamaica plain who really wants the lyme vaccine to come back…
    why no comments on the west nile situation here in massachusetts?
    agree completely about ibalizumab, i also wrote about it on my blog…
    thanks, keep educating us please!
    regards, phil

  6. Stephanie says:

    From Twitter…Always enjoy reading your posts especially with shout outs to pharmacists! The “-uiyk” is essentially meaningless, but helps differentiate biosimilars from one another (as if monoclonal antibody names weren’t hard enough to say/spell already!)

  7. Dan Simpson says:

    I enjoy your blog Paul, I”m impressed by your wide ranging ID and non-ID knowledge–even Lawrence Ferlinghetti! I chose his rather skeptical poem ‘Christ climbed down” to my high school English class in Bible belt southern Missouri and the teacher couldn’t wait t,for me to finish and to get on to something else. I followed the link in your blog–that guy Patrick Gillespie is really good!
    Keep those wide-ranging links coming!

HIV Information: Author Paul Sax, M.D.

Paul E. Sax, MD

Contributing Editor

NEJM Journal Watch
Infectious Diseases

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