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Top 5 Contagion&reg News Articles for the Week of August 13, 2017

A herpes infection leads to deadly viral meningitis in an Iowa infant, an ingestible smart pill that can remind you to take your medications, global catastrophic biological risks, whether or not you should complete the full course of antibiotics, and all you need to know about Candida auris make up this week’s Top 5 articles.

#5: Iowa Infant Dies of Viral Meningitis Associated with Herpes Infection

Following the recent death of an Iowa infant who suffered complications after becoming infected with the herpes simplex virus type 1 (HSV-1) likely due to a kiss, health experts are reminding the public that the virus can spread easily to babies.

Oral herpes is a highly contagious virus that is spread via oral-to-oral contact, such as kissing. The World Health Organization (WHO) estimates that 3.7 billion individuals around the world have an HSV-1 infection, with the Americas having the lowest prevalence of the virus. HSV-1 is typically acquired during childhood and never goes away, though the infection is typically asymptomatic with most individuals unaware that they even have it. Visible symptoms of oral herpes appear as open sores or ulcers in and around the mouth, or sores on the lips known as cold sores. Less common is herpes simplex virus type 2 (HSV-2), a sexually transmitted infection affecting an estimated 417 million individuals worldwide. In rare cases, a woman infected with genital HSV-1 can pass the virus on to her baby during vaginal delivery, and less commonly, a baby can contract the virus through other forms of contact.

Continue reading about how herpes can affect infants, here.

#4: Ingestible Smart Pill Can Remind Patients to Take Medications

Because the pill is still in its beginning stages of use at Rush, the patients are using hospital-provided iPads that allow nurses and doctors access to the patient’s medication use; however, Proteus also has an app that patients could use on their own smartphones.

Proteus is working with Rush to keep the cost of medication and the necessary technology to a minimum. Rush patients using smart pills are currently paying the same rates as they would for pills without sensory technology. Proteus has additionally raised more than $300 million for the smart pills.

Despite the plans for expansion, patients at Rush will typically only use the technology for about 3 months. Perry and colleagues at Rush hope that the use of Proteus pills will form daily medication habits in the patients after 3 months.

“From a behavioral perspective, experts would say you need to perform a behavior consistently for about 3 months to create a pattern,” said Dr. Perry.

Learn more about the ingestible smart pill, here.

#3: A Global Catastrophic Biologic Risk By Any Other Name Would Smell As Sweet

Global catastrophic biological risks (GCBRs) have increasingly become an area of concern for policy and research, and yet, we struggle with a core definition. How can we address a distressing concept if we do not truly know what it is?

The Johns Hopkins Center for Health Security took on this challenge and brought forth the collective minds of biodefense and biosecurity experts to formulate a working definition for GCBRs that would allow us to truly address the problem. A subset of global catastrophic risks, these are unique in that they are biological, which requires a particularly exceptional response.

The definition the Center for Health Security developed for GCBRs is, “Those events in which biological agents—whether naturally emerging or reemerging, deliberately created and released, or laboratory engineered and escaped—could lead to sudden, extraordinary, widespread disaster beyond the collective capability of national and international governments and the private sector to control. If unchecked, GCBRs would lead to great suffering, loss of life, and sustained damage to national governments, international relationships, economies, societal stability, or global security.”

Read more about Global Catastrophic Biological Risks, here.

#2: About Antibiotics: Complete the Course, or Stop When You Feel Better?

All medical professionals have likely dealt with the aftermath of the media’s picking up a provocative article or concept and popularizing it, often with an unintended change in the original message. Usually I cringe when I hear these, knowing that I will be facing questions about the mixed message that was sent. After all, how many times have we almost cured cancer? However, this time, I was happy to see a focus on the undetermined importance of fixed antibiotic durations, commonly presented under the guise of “maybe you can stop antibiotics when you feel better” or something similar.

This wave of consumer stories was stimulated by an interesting hybrid review/commentary written in the BMJ at the end of July 2017 by Llewelyn and colleagues.1 Titled “The Antibiotic Course Has Had Its Day,” the article challenged the notion that completing antibiotic courses after symptom resolution has any benefit. The authors were right to do so. The notion of fixed-duration antibiotic courses is not supported in the literature, something that can probably be discerned by the relationships between antibiotic durations and numbers of convenience. Even more intriguing is the lack of an evidence base for the most common reasons cited for the mantra to “take all your medicine even if you feel better.” Two common rationales for this exist.

Continue reading about whether or not you should complete the course of antibiotics, here.

#1: Candida Auris: The Rise of a New Fungal Threat

C. auris is known to have a virulence profile more similar to C. albicans than other nonalbicans Candida species, and has been associated with multiple cases of fungemia and other invasive fungal infections. Acquisition appears to be largely health care-acquired in nature. More specifically, one report of 41 patients with C. auris infection showed that the median time between admission and first isolation was 19 days. Of these 41 patients, 73% had central venous catheters, 61% had urinary catheters, 51% had received some form of surgery within 90 days of diagnosis with C. auris infection, and 41% had received antifungal therapy within 90 days of diagnosis of C. auris infection.

Further illustration of this organism’s ability to be spread patient-to-patient is demonstrated by the asymptomatic colonization of close contacts of those with active infection. Three hundred and ninety close contacts of the first 77 infected patients in the United States were screened for C. auris colonization using axillary and groin swabs. Forty-five of these individuals (12%) were found to be colonized with the organism. Additionally, patients with a previous infection may remained colonized with this organism for weeks to months after treatment of the acute infection.6 Even more troubling, C. auris appears to survive on surfaces within an infected patient’s hospital environment. The organism has been isolated from beds, windowsills, chairs, infusion pumps, and other various surfaces in the rooms of patients with active infections. These factors likely contribute to the potential for patient-to-patient spread in a healthcare environment, which raises major concern given the observed mortality rate of roughly 60% in patients infected with C. auris.

Continue reading about this new fungal threat, here.