Once confined to the tropics, dengue is spreading via its vector, the Aedes mosquito, to more temperate regions, causing increases in global morbidity, mortality and cost. In 2019, the WHO recognised dengue as one of the top ten global health threats alongside climate change and antimicrobial resistance [1]. In this episode of Communicable, Annie Joseph and Nav Narayanan welcome two dengue experts, André Siqueira of the non-profit Drugs for Neglected Diseases Initiative based in Geneva, Switzerland (Rio de Janeiro, Brazil), and Steven Lim of the Raja Permaisuri Bainun Hospital (Ipoh, Malaysia). Together, they discuss the epidemiology, clinical presentation and management of dengue including comparisons to other arboviral infections like zika and chikungunya, and the heightened risk of disease for vulnerable populations such as pregnant women and those with comorbidities. The conversation also highlights innovative vector-control strategies and candidate therapeutics currently under investigation. 

This episode was edited by Kathryn Hostettler and peer reviewed by Loora Grünvald of the University of Tartu, Estonia.

Resources:

• Drug for Neglected Diseases (DNDi), https://dndi.org/ 
• Dengue Alliance, https://dndi.org/global-networks/dengue-alliance/ 
• Qdenga vaccine information: https://travelhealthpro.org.uk/news/763/qdenga-dengue-vaccine-guidance
• Dengavaxia vaccine information: https://www.cdc.gov/dengue/hcp/vaccine/index.html 

References: 

1. World Health Organization, Ten threats to global health in 2019.

Further reading: 

• Treating a feverish planet: The Dengue Alliance, a video

In this episode of Communicable, Erin McCreary and Angela Huttner are joined by Barbara Trautner (St. Louis, USA) and Valéry Lavergne (Vancouver, Canada), the co-chairs and leading authors of the first IDSA guideline on complicated urinary tract infection (cUTI), which was published a few months ago [1]. Together, they discuss the process of developing the guideline from its conception in 2018, the new definition of cUTI, their stepwise approach to clinical decision-making, and some case-by-case scenarios for common antibiotics. They also elaborate on how this guideline compares (and contrasts) to other existing UTI guidelines—including the previous IDSA guideline for UTI [2] —and the clinical need to supply frontline clinicians to identify and distinguish complicated cases from the uncomplicated ones. The episode closes with what essential clinical questions the guests hope to tackle next.
 
This episode was edited by Kathryn Hostettler and peer reviewed by Maria Ana Flores of Santa Maria Local Health Unit, Lisbon, Portugal.

Other resources:

• European Urologic Association guidelines
• UpToDate
• FDA guidance on complicated UTI 

References

1. Trautner BW, et al. Clinical Practice Guideline by Infectious Diseases Society of America (IDSA): 2025 Guideline on Management and Treatment of Complicated Urinary Tract Infections 
2. Gupta, K, et al. Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women: 2010 Update by IDSA

Contrary to popular belief, peer review has only recently become an integral step in scientific publishing. Currently seen by many as a badge of honour ensuring valid, innovative and honest research, peer review seems in reality to be increasingly thankless, exploitative, and sometimes invisible. How did we get here? In this episode of Communicable, Annie Joseph and Angela Huttner are joined by two experts, Melinda Baldwin (University of Maryland, USA) and Serge Horbach (Radboud University, Netherlands), to unpack and examine the role of peer review, why it is still essential, and how it fits within the greater editorial process. The conversation covers the history of peer review, contemporary formats including open review and the use of artificial intelligence, and thoughtful discussion on how to fix and rethink peer review. 

This episode was edited by Kathryn Hostettler and peer reviewed by Barbora Píšová from the Czech Republic.

Related podcast episodes 

• Communicable episode 13: The Wild West of publishing today—predatory journals and how to deal with them https://share.transistor.fm/s/e3abe9af 

Resources

• EASE, the European Association of Science Editors https://ease.org.uk/ 
• Peer review week https://peerreviewweek.net/ 

Further reading

• Csiszar, A. The Scientific Journal: Authorship and the Politics of Knowledge in the Nineteenth Century. The University of Chicago Press, 2018. DOI: 10.7208/chicago/9780226553375.001.0001 
• Entradas, Sousa, Yan, et al. (2023) Public Deliberative Workshops – Findings. POIESIS project deliverable D2.2. https://poiesis-project.eu/deliverables/.
• Ross-Hellauer T and Horbach SPJM. Additional experiments required: A scoping review of recent evidence on key aspects of Open Peer Review, Research Evaluation, 2024. DOI: 10.1093/reseval/rvae004
• Horbach SPJM and Halffman W. The changing forms and expectation of peer review. Res Integr Peer Rev 2018. DOI: 10.1186/s41073-018-0051-5
• Danziger S, et al. Extraneous factors in judicial decisions. Proc Natl Acad Sci USA, 2011. DOI: 10.1073/pnas.1018033108
• Fyfe, A., Moxham, N., McDougall-Waters, J., & Røstvik, C. M. (2022). A History of Scientific Journals: Royal Society publishing, 1665-2015. London: UCL Press.
• “Misconduct in Science,” 9 February 1983, NN3-443-UD-12D-1 box 78, file “RES 12 Misconduct in Science, 1983-1987,” Papers of the NIH Director, National Archives and Records Administration, College Park, MD.
• Baldwin M. In Referees We Trust? How Peer Review Became a Mark of Scientific Legitimacy. MIT Press (Open Access). Work in Progress.

In this second-ever collaboration between SIDP’s Breakpoints and ESCMID’s Communicable podcasts, hosts Erin McCreary and Angela Huttner invite the two principal investigators and visionaries who spearheaded the Bacteraemia Antibiotic Length Actually Needed for Clinical Effectiveness (BALANCE) trial, Nick Daneman and Rob Fowler (Sunnybrook Health Sciences Centre, Toronto), for a “deep dive into all things that went into this trial” (1). The BALANCE trial spanned over ten years investigating - as the acronym title suggests - whether a shorter treatment duration of seven days was non-inferior to the standard of care of fourteen days for bacteraemia. The conversation covers everything from the initial hallway discussions that sparked the trial to the trial itself that screened over 36,000 patients and enrolled +3,600, its key takeaways and its impact on clinical practice as well as what’s next for Daneman and Fowler.

This episode was edited by Kathryn Hostettler and Megan Klatt, and peer reviewed by Dr. Arjana Zerja of Mother Theresa University Hospital Centre, Tirana, Albania.

Related podcast episodes

• Communicable episode 36: Finding BALANCE in antibiotic durations—the BALANCE trial https://share.transistor.fm/s/b680895e
• Communicable episode 26: SNAP out of it—rethinking anti-staphylococcal penicillins for S. aureus bacteremia, the SNAP trial PSSA/MSSA results https://share.transistor.fm/s/2a3c3bb4
• Breakpoints episode covering IDWeek (December 2024) https://breakpoints-sidp.org/108-idweek-2024-recap-late-breaker-abstracts-and-stewardship-talks/ 

References

1. BALANCE Investigators, et al.  Antibiotic Treatment for 7 versus 14 Days in Patients with Bloodstream Infections. N Engl J Med. 2025 March. DOI: 10.1056/NEJMoa2404991

Further reading 

• Fowler VG. Eight days a week – BALANCING duration and efficacy. N Engl J Med. 2025 March. DOI: 10.1056/NEJMe2414037   
• Dulhunty JM, et al. Continuous vs Intermittent β-Lactam Antibiotic Infusions in Critically Ill Patients With Sepsis: The BLING III Randomized Clinical Trial. JAMA 2024. DOI: 10.1001/jama.2024.9779  
• Yahav D, et al. Seven versus 14 days of antibiotic therapy for uncomplicated Gram-negative bactermia: A noninferiority randomized controlled trial. Clin Infect Dis 2018. DOI: 10.1093/cid/ciy1054 
• Von Dach E, et al. Effect of C-reactive protein-guided antibiotic treatment duration, 7-day treatment, or 14-day treatment on 30-day clinical failure rate in patients with uncomplicated Gram-negative bacteremia, a randomized clinical trial. JAMA 2020. DOI: 10.1001/jama.2020.6348 
• Ong SWX, et al. Identifying heterogeneity of treatment effect for antibiotic duration in bloodstream infection: an exploratory post-hoc analysis of the BALANCE randomised clinical trial. EClinicalMedicine 2025. DOI: 10.1016/j.eclinm.2025.103195
• Wallach JD, et al. Evaluation of evidence of statistical support and corroboration of subgroup claims in randomized clinical trials. JAMA Intern Med 2017. DOI: 10.1001/jamainternmed.20169125

In this episode of Communicable, Angela Huttner and Erin McCreary invite two titans of vaccinology, Barney Graham (Atlanta, USA), former deputy director of the NIH NIAID Vaccine Research Center and architect of the mRNA vaccines against COVID-19, and Gary Kobinger (Galveston, USA), leading virologist in the development of the first effective Ebola vaccine, rVSV-ZEBOV, for a candid conversation about their direct experience building two of the most well known vaccines to date, and deploying them to the public. The episode also reviews the different vaccine platforms and addresses vaccine hesitancy, equitable access to vaccines, and global health equity. 

This episode was edited by Kathryn Hostettler and peer reviewed by Eren Ozturk of Ankara University, Ankara, Türkiye. 

Terms and sources

• VSV, vesicular stomatitis virus
• ZEBOV, Zaire Ebolavirus 
• rVSV-ZEBOV, recombinant vesicular stomatitis virus expressing the (Zaire) Ebolavirus glycoprotein (vaccine)
• VRC, the NIH Vaccine Research Center of NIAID 
• Morehouse School of Medicine Satcher Global Health Equity Institute
• GuardRX, https://www.guardrx.org/en/who-we-are/ 

References

1. Marzi A, et al. VSV-EBOV rapidly protects macaques against infection with the 2014/15 Ebola virus outbreak strain. Science 2015. DOI: 10.1126/science.aab3920 
2. Agnandji S, Huttner A, Zinser M, et al. Phase 1 Trials of rVSV Ebola Vaccine in Africa and Europe. New Engl J Med 2015. DOI: 10.1056/NEJMoa1502924
3. Graham BS and Corbett KS. Prototype pathogen approach for pandemic preparedness: world on fire. J Clin Invest 2020. DOI: 10.1172/JCI139601
4. Jackson LA, Anderson EJ, Rouphael NG, et al. An mRNA Vaccine against SARS-CoV-2 - Preliminary Report. New Engl J Med 2020. DOI: 10.1056/NEJMoa2022483

Fungal infections and disease have long been overlooked in terms of healthcare burden, with poor diagnostics and limited options for treatment and management. In 2022, the WHO published its first Fungal Priority Pathogens List as an effort to establish a global prioritised framework that addresses unmet research and development needs in fungal disease and antifungal resistance, as well as guides public health action [1]. In this episode of Communicable, Angela Huttner and Josh Nosanchuk invite Hatim Sati (WHO), the project lead in creating this list, and Dimitrios Kontoyiannis (MD Anderson Cancer Center, Houston, Texas), a clinician researcher studying fungal diagnostics and antifungal discovery, for a candid discussion on the making of and relevance of such a list. Apart from reviewing the fungal pathogens, the conversation also covers limitations of the list, what to expect for the next iteration, contextualising the list in one’s local region, and the impact the list has had already on research funding and public awareness.

This episode was edited by Kathryn Hostettler and peer reviewed by Andrisa Xhaxha from Elbasan, Albania. 

References

1. WHO fungal priority pathogens list to guide research, development and public health action. Geneva: World Health Organization; 2022. 

Related podcast episodes

• Communicable Episode 31: Climate change and fungal spread https://share.transistor.fm/s/db58f558 
• Communicable Episode 08: The nightmare series, part 1 – how to deal with Candida auris https://share.transistor.fm/s/c0616c4d 

Further reading 

• Seidel D, et al. Impact of climate change and natural disasters on fungal infections. Lancet Microbe 2024. DOI: 10.1016/S2666-5247(24)00039-9
• Fisher MC and Denning DW. The WHO fungal priority pathogens list as a gamechanger. Nat Rev Microbiol 2023. DOI: 10.1038/s41579-023-00861-x
• Shor E, et al. Tolerance and heteroresistance to echinocandins in Candida auris: conceptual issues, clinical implications, and outstanding questions. mSphere 2025. DOI: 10.1128/msphere.00161-25
• Panackal AA, et al. Geoclimatic influences on invasive aspergillosis after hematopoietic stem cell transplantation. Clin Infect Dis 2010. DOI: 10.1086/652761
• Lázár-Molnár E, et al. The PD-1/PD-L costimulatory pathway critically affects host resistance to the pathogenic fungus Histoplasma capsulatum. PNAS 2008. DOI: 10.1073/pnas.0711918105
• Mashal M, “A potentially fatal fungal infections cropping up among India’s Covid patients.” New York Times 2021. https://www.nytimes.com/2021/05/09/world/india-covid-mucormycosis.html 
• Thevissen K, et al. International survey on influenza-associated pulmonary aspergillosis (IAPA) in intensive care units: responses suggest low awareness and potential underdiagnosis outside Europe. Crit Care 2020. DOI: 10.1186/s13054-020-2808-8
• Pappas PG, et al. Clinical mycology today: A synopsis of the mycoses study group education and research consortium (MSGERC) second biennial meeting, September 27–30, 2018, Big Sky, Montana, a proposed global research agenda. Medical Mycology 2020. DOI: 10.1093/mmy/myaa034
• Hostettler K, et al. Communicable Episode 31: Climate change and fungal spread. CMI Communications 2025. DOI: 10.1016/j.cmicom.2025.105126

Ethics in the field of infectious disease can be a delicate interplay between treating the individual patient and protecting the collective health of a society. Sometimes these two mandates go hand in hand; at other times they can appear to be in conflict. In this episode of Communicable, Dr. Angela Huttner invites Drs. Zeb Jamrozik (Melbourne, Australia) and Beenish Syed (Karachi, Pakistan), two members of ESCMID’s Ethics Advisory Committee, to unpack different scenarios encountered in the field of infectious disease from an ethics standpoint: how one ethically allocates scarce resources like antimicrobials; whether there is ethical justification for coercive public-health measures like lockdowns; and whether the need to collect evidence to advance patient care could include other models besides opt-in informed consent. 

This episode was edited by Dr. Kathryn Hostettler and peer reviewed by Dr. Goulia Ohan of Yerevan State Medical University, Yerevan, Armenia.

Further reading:

• Barosa M, et al. The Ethical Obligation for Research During Public Health Emergencies: Insights From the COVID-19 Pandemic. Med Health Care Philos 2024. DOI: 10.1007/s11019-023-10184-6
• Symons X, et al. Why should HCWs receive priority access to vaccines in a pandemic? BMC Med Ethics 2021. DOI: 10.1186/s12910-021-00650-2
• Thorsteinsdottir B and Madsen BE. Prioritizing health care workers and first responders for access to the COVID19 vaccine is not unethical, but both fair and effective – an ethical analysis. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2021. DOI: 10.1186/s13049-021-00886-2
• Huttner A, Leibovici L, Theuretzbacher U, Huttner B, Paul M. Closing the evidence gap in infectious disease: point-of-care randomization and informed consent. Clin Microbiol Infect 2017;23(2):73-77. DOI: 10.1016/j.cmi.2016.07.029

Fluoroquinolones (FQs) are valuable given their broad-spectrum activity against Gram-positive and Gram-negative bacteria and their high penetration into various tissues. Yet FQs have also caused concern, with some market withdrawals, important and sometimes long-lasting adverse drug events, and substantial collateral effects on the microbiota. In this episode of Communicable, hosts Emily McDonald and Thomas Tängdén invite Staffan Tevell (Karlstad, Sweden) and Bernadette Young (Oxford, UK) to weigh in on the pro-con debate of FQ use, especially for periprosthetic joint infections (PJIs), which can entail longer treatment durations. They review the standard of care for PJIs, including FQs in combination with rifampicin vs other antibiotic combinations, the impact of the OVIVA trial advocating for early oral switch strategies, the long list of rare but important side effects, and how best to preserve FQs for clinical indications that most need them.     

This episode is a follow-up from Tevell and Young’s recently published systematic review of the role of FQs in PJIs [1]. It was edited by Kathryn Hostettler and peer reviewed by Ljiljana Lukić of University Hospital for Infectious Diseases in Zagreb, Croatia. The executive producer of Communicable is Angela Huttner. 

References

1. Tevell S, et al. To heal or harm: A systematic review of the role of fluoroquinolones in periprosthetic joint infections. CMI Communications 2025. DOI: 10.1016/j.cmicom.2025.105103

Further reading

• Mandell LA, et al. Antimicrobial Safety and Tolerability: Differences and Dilemmas. Clin Infect Dis 2001. JSTOR http://www.jstor.org/stable/4461522.
• Pham TDM, et al. Quinolone antibiotics. Medchemcomm 2019. DOI: 10.1039/c9md00120d. 
• Rodrigues CF and Silva F. The Rise, Fall, and Rethink of (Fluoro)quinolones: A Quick Rundown. Pathogens 2025. DOI: 10.3390/pathogens14060525
• Slimings C and Riley TV. Antibiotics and hospital-acquired Clostridium difficile infection: update of systematic review and meta-analysis. J Antimicrob Chemother 2014. DOI: 10.1093/jac/dkt477
• Davis JS, et al. Predictors of treatment success after periprosthetic joint infection: 24-month follow up from a multicenter prospective observational cohort study of 653 patients. Open Forum Infect Dis 2022. DOI: 10.1093/ofid/ofac048.
• Grossi O, et al. Gram- negative prosthetic joint infections managed according to a multidisciplinary standardized approach: risk factors for failure and outcome with and without fluoroquinolones. J Antimicrob Chemother 2016. DOI: 10.1093/jac/dkw202 
• Cortes-Penfield NW, et al. Adjunctive rifampin following debridement and implant retention for staphylococcal prosthetic joint infection: is it effective if not combined with a fluoroquinolone? Open Forum Infect Dis 2022. DOI:  10.1093/ofid/ofac582
• Pushkin R, et al. A Randomized Study Evaluating Oral Fusidic Acid (CEM-102) in Combination With Oral Rifampin Compared With Standard-of-Care Antibiotics for Treatment of Prosthetic Joint Infections: A Newly Identified Drug-Drug Interaction. Clin Infect Dis 2016. DOI: 10.1093/cid/ciw665
• Bock M, et al. Rifampicin reduces plasma concentration of linezolid in patients with infective endocarditis. J Antimicrob Chemother 2023. DOI: 10.1093/jac/dkad316   
• Zeller V, et al. Influence of the clindamycin administration route on the magnitude of clindamycin-rifampicin interaction: a prospective pharmacokinetic study. Clin Microbiol Infect. 2021. DOI: https://doi.org/10.1016/j.cmi.2021.04.017 
• Bernard L, et al. Antibiotic Therapy for 6 or 12 Weeks for Prosthetic Joint Infection. N Engl J Med 2021. DOI: 10.1056/NEJMoa2020198
• Vollmer NJ, et al. Safety and Tolerability of Fluoroquinolones in Patients with Staphylococcal Periprosthetic Joint Infections, Clin Infect Dis 2021. DOI 10.1093/cid/ciab145
• Gopalakrishnan C, et al. Association of fluoroquinolones with the risk of aortic aneurysm or aortic dissection. JAMA Intern Med 2020. DOI 10.1001/jamainternmed.2020.4199
• Li HK, et al. Oral versus Intravenous Antibiotics for Bone and Joint Infection (OVIVA). N Engl J Med. 2019. DOI: 10.1056/NEJMoa1710926

The adaptability of fungi to warmer temperatures is an obvious consequence of climate change. Perhaps less obvious is the role climate change has played on fungal pathogens emerging as a global health concern. While humans are mostly protected from fungal infections by our immune system and body temperature, a warming global climate could subvert the status quo. Some fungi are already adapted to warmer temperatures and causing invasive acute infections in humans: Candidozyma auris, Cryptococcus neoformans, and Aspergillus fumigatus, to name a few.  In this episode of Communicable, Angela Huttner and Josh Nosanchuk invite Arturo Casadevall, a Bloomberg Distinguished Professor at Johns Hopkins and this year’s recipient of ESCMID’s Excellence in Science Award, to discuss the world of fungi and their pathogenic potential in a warming world. Other topics include how to prepare for their emergence as a health threat, how fungi can be harnessed for applications that can benefit us, and ultimately answering the question Casadevall himself posed in the title of his recently published book, What if fungi win?

This episode was edited by Kathryn Hostettler and peer reviewed by Robin Aerts of University Hospital Antwerp, Belgium. 

References

1.        Casadevall, A with Desmon S. What if fungi win? Johns Hopkins University Press, 2024.

2.        Smith DFG, et al. Environmental fungi from cool and warm neighborhoods in the urban heat island of Baltimore City show differences in thermal susceptibility and pigmentation. BioRxiv 2025. DOI: 10.1101/2023.11.10.566554  

3.        Casadevall A and Pirofski L. Benefits and Costs of Animal Virulence for Microbes. mBio 2019. DOI: 10.1128/mBio.00863-19

4.        Cordero RJB et al. Radiation protection and structural stability of fungal melanin polylactic acid biocomposites in low Earth orbit. PNAS 2025. DOI: 10.1073/pnas.2427118122

5.        Dadachova E, et al. The radioprotective properties of fungal melanin are a function of its chemical composition, stable radical presence and spatial arrangement. Pigment Cell Melanoma Res 2008. DOI: 10.1111/j.1755-148X.2007.00430.x

6.        Cordero RJB et al. The hypothermic nature of fungi. PNAS 2022. DOI: 10.1073/pnas.2221996120

Meningitis remains a major global health threat, with an estimated 2.5 million cases each year; of these, one in six results in death and one in five in long-term disabilities. Although meningitis “can strike anyone, anywhere in the world,” outbreaks disproportionately impact low- and middle-income countries, where diagnostic and treatment resources are limited. In efforts to address this, WHO launched its first-ever guideline on meningitis diagnosis and management in April this year. In this episode of Communicable, hosts Emily McDonald and Marc Bonten are joined by two experts directly involved in creating the guideline, Lorenzo Pezzoli and Nicolò Binello (WHO), as well as Jacob Bodilsen (Aalborg University), clinician-researcher and Chair of ESCMID’s Study Group for Infectious Diseases of the Brain (ESGIB). The guests offer a firsthand look behind the guideline’s development, review key recommendations for diagnosis and treatment - including the use of lumbar puncture, antibiotics, and chemoprophylaxis – and discuss how these fit into various clinical settings. 

This episode was edited by Kathryn Hostettler and peer reviewed by Ljiljana Lukić of University Hospital for Infectious Diseases in Zagreb, Croatia. The executive producer of Communicable is Angela Huttner. 

Terms

• CRP, C-reactive protein
• GDG, Guideline Development Group

Literature 

1. WHO guidelines on meningitis diagnosis, treatment and care. April 2025. https://www.who.int/publications/i/item/9789240108042
2. Defeating meningitis by 2030: a global road map. June 2021. https://www.who.int/publications/i/item/9789240026407
3. Olie SE, et al. Validation and clinical implementation of cerebrospinal fluid C-reactive protein for the diagnosis of bacterial meningitis: a prospective diagnostic accuracy study. Lancet Reg June 2025. DOI: 10.1016/j.lanepe.2025.101309
4. Coldiron ME, et al. Single-dose oral ciprofloxacin prophylaxis as a response to a meningococcal meningitis epidemic in the African meningitis belt: A 3-arm, open-label, cluster-randomized trial. PloS Med 2018. DOI: 10.1371/journal.pmed.1002593
5. Hasbun R, et al. Computed tomography of the head before lumbar puncture in adults with suspected meningitis. N Engl J Med 2001. DOI: 10.1056/NEJMoa010399
6. Glimåker M. Lumbar puncture in adult bacterial meningitis: time to reconsider guidelines? BMJ 2013, DOI: 10.1136/bmj.f361