Cody Cunningham
@cunninghamresus.bsky.social
MD, PhD. Current ID fellow. Former scientist. #IDSky.
Also there are now only 3 strains in the vaccine 2/2: www.thelancet.com/journals/lan...
Probable extinction of influenza B/Yamagata and its public health implications: a systematic literature review and assessment of global surveillance databases
Early after the start of the COVID-19 pandemic, the detection of influenza B/Yamagata
cases decreased globally. Given the potential public health implications of this decline,
in this Review, we syste...
www.thelancet.com
February 11, 2025 at 4:20 AM
Also there are now only 3 strains in the vaccine 2/2: www.thelancet.com/journals/lan...
We (Arizona) peaked at 131% above 5 year average a few weeks ago, thankfully we have continued to downtrend
February 11, 2025 at 4:20 AM
We (Arizona) peaked at 131% above 5 year average a few weeks ago, thankfully we have continued to downtrend
Great paper overall, look forward to seeing how the authors move this work forward #IDSky www.science.org/doi/10.1126/...
Barcoded SARS-CoV-2 viruses define the impact of duration and route of exposure on the transmission bottleneck in a hamster model
Barcoded SARS-CoV-2 enables precise, quantitative studies of transmission.
www.science.org
January 30, 2025 at 2:07 AM
Great paper overall, look forward to seeing how the authors move this work forward #IDSky www.science.org/doi/10.1126/...
During aerosol transmission, virus appeared to be sourced from the upper airway (nasal turbinates) but not the trachea or lungs
January 30, 2025 at 1:57 AM
During aerosol transmission, virus appeared to be sourced from the upper airway (nasal turbinates) but not the trachea or lungs
The number of unique barcodes transferred depended on route of infection with direct contact > aerosol > fomite
January 30, 2025 at 1:57 AM
The number of unique barcodes transferred depended on route of infection with direct contact > aerosol > fomite
During productive aerosol transmission, between 13 - 42 unique viruses were transferred. Upper and lower airways had unique signatures suggesting independent seeding by different virus particles.
January 30, 2025 at 1:57 AM
During productive aerosol transmission, between 13 - 42 unique viruses were transferred. Upper and lower airways had unique signatures suggesting independent seeding by different virus particles.
The authors generated >200 unique (barcoded) viruses that were fitness neutral in vitro and in vivo
January 30, 2025 at 1:57 AM
The authors generated >200 unique (barcoded) viruses that were fitness neutral in vitro and in vivo
3. The test only detects Legionella pneumophilia serogroup 1, and serogroup
composition varies geographically
4 . Peak positivity occurs 5 – 10 days into illnes
composition varies geographically
4 . Peak positivity occurs 5 – 10 days into illnes
January 5, 2025 at 1:17 AM
3. The test only detects Legionella pneumophilia serogroup 1, and serogroup
composition varies geographically
4 . Peak positivity occurs 5 – 10 days into illnes
composition varies geographically
4 . Peak positivity occurs 5 – 10 days into illnes
Bottom line (1/2):
1. Currently, the ATS/IDSA recommend obtaining Legionella testing only in patients with severe CAP or epidemiologic risk factors (such as association w/ an outbreak or recent travel)
2. The urine test only has modest sensitivity but good specificity
1. Currently, the ATS/IDSA recommend obtaining Legionella testing only in patients with severe CAP or epidemiologic risk factors (such as association w/ an outbreak or recent travel)
2. The urine test only has modest sensitivity but good specificity
January 5, 2025 at 1:17 AM
Bottom line (1/2):
1. Currently, the ATS/IDSA recommend obtaining Legionella testing only in patients with severe CAP or epidemiologic risk factors (such as association w/ an outbreak or recent travel)
2. The urine test only has modest sensitivity but good specificity
1. Currently, the ATS/IDSA recommend obtaining Legionella testing only in patients with severe CAP or epidemiologic risk factors (such as association w/ an outbreak or recent travel)
2. The urine test only has modest sensitivity but good specificity
Legionella by both PCR and culture! The patient recovers well after a course of effective
therapy.
therapy.
January 5, 2025 at 1:17 AM
Legionella by both PCR and culture! The patient recovers well after a course of effective
therapy.
therapy.
Back to the case, given the patient’s immunocompromised state he ultimately undergoes
a bronchoscopy with BAL which shows…
a bronchoscopy with BAL which shows…
January 5, 2025 at 1:17 AM
Back to the case, given the patient’s immunocompromised state he ultimately undergoes
a bronchoscopy with BAL which shows…
a bronchoscopy with BAL which shows…
When using the Legionella urine antigen test, it is also critical to know the relative
abundance of L. pneumophila serogroups. For my local area, serogroup 1 (detected by the urine test) makes up less than half of all confirmed Legionella cases.
pubmed.ncbi.nlm.nih.gov/30814318/
abundance of L. pneumophila serogroups. For my local area, serogroup 1 (detected by the urine test) makes up less than half of all confirmed Legionella cases.
pubmed.ncbi.nlm.nih.gov/30814318/
January 5, 2025 at 1:17 AM
When using the Legionella urine antigen test, it is also critical to know the relative
abundance of L. pneumophila serogroups. For my local area, serogroup 1 (detected by the urine test) makes up less than half of all confirmed Legionella cases.
pubmed.ncbi.nlm.nih.gov/30814318/
abundance of L. pneumophila serogroups. For my local area, serogroup 1 (detected by the urine test) makes up less than half of all confirmed Legionella cases.
pubmed.ncbi.nlm.nih.gov/30814318/
A second consideration is the duration of symptoms. One study found that the peak of urine antigen positivity (black bars) occurred 5 – 10 days into illness.
pubmed.ncbi.nlm.nih.gov/14970242/
pubmed.ncbi.nlm.nih.gov/14970242/
January 5, 2025 at 1:17 AM
A second consideration is the duration of symptoms. One study found that the peak of urine antigen positivity (black bars) occurred 5 – 10 days into illness.
pubmed.ncbi.nlm.nih.gov/14970242/
pubmed.ncbi.nlm.nih.gov/14970242/
What's important to remember when interpreting these tests is that they detect only
Legionella pneumophilia serogroup 1. When restricting to this serogroup only, the pooled sensitivity was somewhat improved at 0.86 (95% CI 0.78-0.91)
Legionella pneumophilia serogroup 1. When restricting to this serogroup only, the pooled sensitivity was somewhat improved at 0.86 (95% CI 0.78-0.91)
January 5, 2025 at 1:17 AM
What's important to remember when interpreting these tests is that they detect only
Legionella pneumophilia serogroup 1. When restricting to this serogroup only, the pooled sensitivity was somewhat improved at 0.86 (95% CI 0.78-0.91)
Legionella pneumophilia serogroup 1. When restricting to this serogroup only, the pooled sensitivity was somewhat improved at 0.86 (95% CI 0.78-0.91)
Several SRMAs have addressed this question, the most recent found that the Legionella urine antigen test had a pooled sensitivity of 0.79 (95% CI, 0.71-0.85).
pubmed.ncbi.nlm.nih.gov/34972680/
pubmed.ncbi.nlm.nih.gov/34972680/
Diagnostic accuracy of urinary antigen tests for legionellosis: A systematic review and meta-analysis - PubMed
The review protocol was prospectively registered with the University Hospital Medical Information Network Clinical Trials Registry (UMIN000041080).
pubmed.ncbi.nlm.nih.gov
January 5, 2025 at 1:17 AM
Several SRMAs have addressed this question, the most recent found that the Legionella urine antigen test had a pooled sensitivity of 0.79 (95% CI, 0.71-0.85).
pubmed.ncbi.nlm.nih.gov/34972680/
pubmed.ncbi.nlm.nih.gov/34972680/