Despite being preventable and curable, tuberculosis remains a major global health threat, infecting over 10 million people and claiming more than 1 million lives every year. In this episode of Communicable, hosts Angela Huttner and Navaneeth Narayanan discuss tuberculosis with experts Lorenzo Guglielmetti of Doctors without Borders and Olha Konstantynovska of Kharkiv National University, Ukraine. Key topics include the history, transmission, and pathophysiology of tuberculosis, as well as current diagnostic challenges and treatments for drug-resistant strains. The conversation highlights Lorenzo's work on the endTB project and Olha's experiences managing tuberculosis during the war in Ukraine. Despite advancements in treatment, the episode underscores the urgent need for political will and funding to combat this global health threat.

This episode was edited by Kathryn Hostettler and peer reviewed by Dr. Maria Ana de Quadros Flores e Santos of Unidade Local de Saude Santa Maria, Lisbon, Portugal.

Abbreviations and terminology used in this episode:

• MSF: Médecins sans Frontières, or Doctors without Borders (msf.org)
• FIND: Foundation for Innovative New Diagnostics (www.finddx.org)
• ‘Intoxication symptoms’ are synonymous with ‘constitutional symptoms’ or ‘B symptoms’ of tuberculosis and include fever, night sweats, and unintentional weight loss. 

Literature:

• endTB Project
• Annual global tuberculosis report by WHO 2024 
• Dorman SE, et al. Four-Month Rifapentine Regimens with or without Moxifloxacin for Tuberculosis. N Engl J Med 2021 doi: 10.1056/NEJMoa2033400
• Guglielmetti L, et al. Oral Regimens for Rifampin-Resistant, Fluoroquinolone-Susceptible Tuberculosis. N Engl J Med 2025 doi: 10.1056/NEJMoa2400327

Sexually transmitted infections (STIs) affect millions globally daily, and multidrug-resistant strains are complicating treatment. Hosts Angela Huttner and Josh Davis welcome experts Dr. Teodora Elvira Wi from WHO and Professor Catriona Bradshaw from Monash University to discuss critical issues surrounding ‘super gonorrhoea,’ chlamydia, syphilis, Mycoplasma genitalium, and bacterial vaginosis. The episode reviews the latest epidemiology and highlights the need to innovate diagnostics and treatment options, destigmatise STIs, and promote people-centred healthcare strategies to manage and prevent these infections. 

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

Literature:

Guidelines for the management of symptomatic sexually transmitted infections. Geneva: World Health Organization; 2021.

Chris Kenyon et al. on screening impact for gonorrhoea and chlamydia infections in key populations The Lancet HIV 2024.

Rising anti-vaccine sentiment and dissemination of misinformation are threats to public health. In the US, calls to revoke certain public health mandates have been proposed by likely members of the incoming administration, among them vaccination against polio. The fourth instalment of the Nightmare Series is both a cautionary tale and an effort to preserve and share clinical expertise on how to diagnose and manage polio and rubella in a world where, until now, few doctors have had to face these illnesses in the clinical setting. Host Angela Huttner welcomes Professor Emeritus of Infectious Diseases Bernard Hirschel at the University of Geneva and Dr. Kerrigan McCarthy of the Centre for Vaccines and Immunology at South Africa’s National Institute for Communicable Diseases (NICD) for that discussion.

This episode was edited by Kathryn Hostettler and peer-reviewed by Dr. Barbora Píšová in Antwerp, Belgium.

Literature

Link-Gelles R et al (2022) MMWR https://www.cdc.gov/mmwr/volumes/71/wr/mm7133e2.htm 

Ryerson AB et al (2022) MMWR https://www.cdc.gov/mmwr/volumes/71/wr/mm7144e2.htm 

Kasstan B et al (2023) Epidemiol Infect doi: 10.1017/S0950268823001127

NICD (2024) Report: Rubella in South Africa, 2024.

https://www.nicd.ac.za/surge-in-rubella-cases-in-south-africa-november-2024/

The last episode of the year carries a special end-of-year message from the CMI Comms editors and replays the very first episode of Communicable aired on 10 May 2024, in which editors Angela Huttner, Marc Bonten, and Erin McCreary discuss late-breaker clinical trials presented at ESCMID Global 2024 in Barcelona, providing insights into the trials’ designs, results, and implications. The DOTS trial compared two doses of long-acting dalbavancin to standard of care in patients with complicated S. aureus bacteraemia. GAME-CHANGER compared cefiderocol to standard of care for Gram-negative infections. PediCAP compared oral step-down therapy with amoxicillin with or without clavulanic acid at shorter durations to the current WHO-recommended standard of five days of intravenous antibiotic therapy in children with severe pneumonia. Additional results from the MULTICAP and CLEEN trials, the CAMERA-2 follow-on in vitro analysis, and the Burkina Faso Escherichia coli transmission study are also discussed. This episode was peer-reviewed by Dr. Yousra Kherabi (Clinical Trials Research Section, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA; Infectious and Tropical Diseases Department, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris; and Université Paris Cité, Inserm, IAME, Paris, France).

The topic of climate change can engender a ‘doom and gloom’ narrative, as many climate and health consequences are already manifesting. Our host, Dr. Navaneeth Narayanan is joined by two ID physicians passionate about climate change and sustainable clinical practice, Dr. Shreya Doshi (Washington DC, US) and Dr. Laura Jung (Leipzig, Germany). Together they discuss new trends in infectious diseases observed in clinical practice as a direct consequence of climate change, including how tropical diseases are not so tropical anymore. They also outline ways individual clinicians and hospitals can be more sustainable and offer additional resources for the listeners (see below).  

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

Literature

• Mora C et al. Nat Clim Chang (2022). doi: 10.1038/s41558-022-01426-1
• Doshi S et al. J Pediatric Infect Dis Soc (2023). doi: 10.1093/jpids/piae029
• Hofmeister RJ et al. OFID (2024). doi: 10.1093/ofid/ofae368 
• Judson SD et al. OFID (2024). doi: 10.1093/ofid/ofae691
• Jung L et al. Lancet Planet Health (2023). 10.1016/S2542-5196(22)00253-4
• UN General Assembly High-Level Meeting on antimicrobial resistance 2024 https://www.who.int/news-room/events/detail/2024/09/26/default-calendar/un-general-assembly-high-level-meeting-on-antimicrobial-resistance-2024 

 Additional resources

• Lancet countdown on health and climate change  https://www.thelancet.com/countdown-health-climate
• Medicine for a changing planet https://www.medicineforachangingplanet.org/
• Rx for climate https://www.rxforclimate.org/

Wastewater surveillance is a powerful epidemiological tool that “mirrors our life,” and has gained wide attention in recent years due to its application during the COVID-19 pandemic. The hosts this week, Drs. Navaneeth Narayanan and Emily McDonald, are joined by two wastewater surveillance experts, Dr. Nasreen Hassoun-Kheir of Geneva University Hospitals, a WHO Collaborating Centre on antimicrobial resistance (AMR), as well as Professor David Graham of Newcastle University, United Kingdom, to discuss how this surveillance method—as well as a multidisciplinary approach—are central to understanding community health, infection control and pandemic preparedness.

This episode was edited by Kathryn Hostettler and peer reviewed by Dr. James Donnelly of the Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland.

Literature

UN Environment Programme (UNEP), Bracing for superbugs (2023) https://www.unep.org/resources/superbugs/environmental-action 

Hassoun-Kheir N, et al. EMBRACE-WATERS statement (2021). doi:10.1016/j.onehlt.2021.100339

Hassoun-Kheir N, et al. Systematic review (2020). doi: 10.1016/j.scitotenv.2020.140804

Trask JD, et al. (1942). https://pmc.ncbi.nlm.nih.gov/articles/PMC2135222/

Chapters

• (00:00) - Introduction

Substandard and falsified (SF) antimicrobials are a neglected global health problem and have been implicated as drivers of antimicrobial resistance (AMR). Substandard medicines are authorized medical products that fail to meet either their quality standards or their specifications, whereas falsified medicines are those that deliberately and fraudulently misrepresent their identity, composition or source. Host Angela Huttner is joined by Pernette Bourdillon Esteve, Technical Officer for the World Health Organization’s Substandard/falsified Medical Products group, and Ben Cooper, epidemiologist at Oxford University and head of its Drug-Resistant Infection and Disease Dynamics (DRIaDD), to explore the effects of SF antimicrobials on people and AMR.

This episode was edited by Kathryn Hostettler and peer-reviewed by Dr. Arjana Zerja of Mother Teresa University Hospital in Tirana, Albania.

Literature

Cavany S et al.  Nat Commun 14, 6153 (2023). doi: 10.1038/s41467-023-41542-w

WHO Global Surveillance and Monitoring System for substandard and falsified medical products (2017). https://www.who.int/publications/i/item/9789241513425 

The market of predatory publishing is as lucrative as it is unethical. Predatory journals are disguised as legitimate entities, and prey on both early-career academics and the naïve. In this episode of Communicable, hosts Angela Huttner and Marc Bonten are joined by Editors-in-chief Ursula Hofer (Lancet Infect Dis) and Leonard Leibovici (CMI) to discuss the various schemes of the ‘Wild West’ of publishing, and how to avoid them. 

This episode was edited by Kathryn Hostettler and peer-reviewed by Dr. Özlem Türkmen Recen, Izmir Public Health Laboratory, Izmir, Türkiye.

Literature 

Research4Life https://www.research4life.org/ 

Benedictus R et al. Nature 2016 https://www.nature.com/articles/538453a

Enterococci are commensal microbes, part of the healthy microflora populating the human gut. But they are also opportunistic pathogens and notorious nosocomial agents with intrinsic traits that promote their pathogenesis and make them difficult to kill. In the third instalment of the Nightmare Series, hosts Angela Huttner and Thomas Tängdén are joined by enterococcal experts Kimberly Kline (University of Geneva) and Louis Rice (Brown University) to discuss what make vancomycin-resistant enterococci, or VRE, such a clinical nightmare. Enterococcus faecalis and Enterococcus faecium are the focus.

This episode was edited by Kathryn Hostettler and peer-reviewed by Dr. Nunzia Esposito of the University of Naples Federico II, Naples, Italy.

Literature 

Stellfox ME et al. J Antimicrob Chemother 14 Feb 2024. doi: 10.1128/mbio.03396-23 

Rogers R & Rice LB. Clin Infect Dis 15 Jan 2024. doi: 10.1093/cid/ciad613

Lebreton F et al. Cell 18 May 2017. doi: 10.1016/j.cell.2017.04.027

Donskey CJ et al. N Engl J Med 28 Dec 2000. doi: 10.1056/NEJM200012283432604

Carbapenemase producers are a nightmare for clinicians. Not only are they resistant to carbapenems, a last resort β-lactam antibiotic, they are notorious for developing multidrug and pandrug resistances resulting in limited to no treatment options.  In this episode of Communicable, hosts Angela Huttner and Thomas Tängdén sit down with Dr. David Paterson (National University of Singapore) and Dr. Souha Kanj (American University of Beirut Medical Center, Lebanon), two ID physicians from regions where carbapenem-resistant Enterobacteriaceae or CRE, and carbapenem-resistant Acinetobacter are widespread.  The episode begins with the history and emergence of CRE and reviews current epidemiology, diagnosis (including the Ambler classification of β-lactamases) and treatment options. Lessons and insights from personal experiences are shared to reflect the current clinical challenges caused by carbapenem-resistant bacteria and the importance of infection prevention and control measures to mitigate further spread.

This episode was edited by Kathryn Hostettler and peer-reviewed by Dr. Filippo Medioli of Policlinico di Modena, Italy. For more related content on the WHO Priority Pathogens List and new antibiotics in the pipeline, check out our previous episodes, Communicable E3 and E10 (see Literature).

Literature 

Communicable E3 - The New WHO Priority Pathogens List: which bugs to target first? June 2024. https://communicable.transistor.fm/episodes/communicable-e3-the-new-who-priority-pathogens-list-which-bacteria-to-target-first 

Communicable E10 - Pipeline update: new antibiotics & other antimicrobials that you might actually use. Sep 2024. https://communicable.transistor.fm/episodes/communicable-e10-pipeline-update-new-antibiotics-other-antimicrobials-that-you-might-actually-use 

Wagenlehner FM, et al. Cefepime-Taniborbactam in Complicated Urinary Tract Infection. N Engl J Med 2024 Feb. doi: 10.1056/NEJMoa2304748

Cohn J, et al. Accelerating antibiotic access and stewardship: a new model to safeguard public health. Lancet Infect Dis 2024 Sep. doi:  10.1016/S1473-3099(24)00070-7

Timsit JF, et al. When should I start broad-spectrum antibiotics? Intensive Care Med 2024 Sep. doi: 10.1007/s00134-024-07654-7 

Paterson DL. Antibacterial agents active against Gram Negative Bacilli in phase I, II, or III clinical trials. Expert Opin Investig Drugs 2024 Apr. doi: 10.1080/13543784.2024.2326028