Daniel J. Minter

The number of transplant infectious disease (TID) training opportunities has grown over the past decade, and training experiences are heterogeneous. Formal TID fellowships are increasingly sought after; however, not all fellowship programs have the means to administer such fellowships, and not all fellows desire additional year(s) of training. TID training tracks embedded within an existing 2‐ or 3‐year general infectious diseases (ID) fellowship training programs offer an opportunity for general ID fellows to gain more TID experience while requiring fewer programmatic resources than a standalone TID fellowship. Here we review experiences from four TID training tracks in the United States, offering insights into clinical and fellowship settings, track requirements and curricula, and facilitators and barriers to managing TID training tracks. These experiences can inform future efforts to develop TID training tracks and harmonize experiences across institutions.

X-linked recessive (XR) complete MCTS1 deficiency underlies Mendelian susceptibility to mycobacterial disease (MSMD) in patients with bacille Calmette-Guérin (BCG) disease. We investigated the genotypic and phenotypic landscape of four new unrelated families from four distinct countries. Three patients had adverse reactions to the BCG vaccine, whereas another patient was not vaccinated with BCG and had an infection with Mycobacterium abscessus at 16 years of age. Whole-exome sequencing of the probands revealed hemizygosity for rare germline MCTS1 variants. In addition to a previously reported loss-of-expression (LOE) and loss-of-function (LOF) variant, we identified three new MCTS1 variants. The p.L170* and E60Kfs5* variants are LOF, whereas p.W175* is hypomorphic when overexpressed. Thus, we report four new MSMD patients with complete or partial forms of XR MCTS1 deficiency, including three patients with newly discovered genotypes. A diagnosis of partial or complete XR MCTS1 deficiency should be considered in boys and men with MSMD displaying mycobacterial infection.

Background: Targeted immunotherapies have transformed the treatment of many diseases. However, some increase the risk of tuberculosis (TB) disease. We sought to develop a comprehensive list of targeted immunotherapies with TB infection screening recommendations in US Food and Drug Administration (FDA)-approved prescribing information and compare these recommendations to clinical resources and quality measures. Methods: Through a gray literature review, we identified TB clinical resources and US quality measures. We created a list of targeted immunotherapies and TB infection screening recommendations by analyzing 4 FDA databases. We then evaluated the consistency of screening recommendations in prescribing information, TB clinical resources, and quality measures. Results: We identified 6 TB clinical resources and 1 quality measure for TB infection. While TB infection screening recommendations for tumor necrosis factor (TNF) inhibitors were consistently included, recommendations for other therapies were less consistent. Through FDA database analyses, we identified 269 targeted immunotherapies, 35 (13%) of which had TB infection screening recommendations in prescribing information, including all therapies targeting TNF and several interleukins (IL); however, therapies targeting IL-6, Janus-associated kinase, and others had variable recommendations. Significant discordance in screening recommendations for immunotherapies was further identified when comparing prescribing information, clinical resources, and quality measures. Conclusions: The number and targets of immunotherapies are rapidly evolving resulting in challenges with creating up-to-date and consistent TB infection screening recommendations. Inconsistent recommendations in clinical resources may contribute to gaps in TB preventive care. Harmonized recommendations and additional epidemiologic studies of TB disease risk with the use of these agents are needed.

Neurosyphilis remains an important and highly morbid neurologic infection. Recent years have seen a dramatic increase in the incidence of syphilis across a variety of populations, making recognition of the many neurologic complications of this infection still relevant for modern clinicians. As manifestations of neurosyphilis are famously varied, a high index of suspicion is essential, especially in the face of atypical presentations. In this review, we discuss updates to the epidemiology, range of clinical presentations, diagnosis, and management of neurosyphilis. ANN NEUROL 2025;98:1070–1076

Background: Complicated urinary tract infections (cUTIs) significantly affect patients’ health-related quality of life (HRQoL), yet current end points defined by the United States Food and Drug Administration for antibiotic registrational trials fail to capture important elements of the patient experience with cUTI. In this systematic review, we aimed to identify measurement tools for HRQoL that have been studied in patients with cUTIs. Methods: Following a prospectively registered protocol in PROSPERO (CRD42020215641), English-language articles were queried using MEDLINE (via PubMed), Embase (Elsevier), and CINAHL (EBSCO) from database inception to 12 October 2022. Results: We identified 24 articles (96% rated as high quality) with 22 distinct measures. Overall, 45% of measures were categorized as generic and 27% as condition-specific; 27% were developed by researchers. Qualitative studies provided details regarding patient experience across multiple HRQoL domains. Conclusions: Our results add to the limited literature on HRQoL measures studied in cUTI and emphasize the importance of standardization, development, and validation of instruments to incorporate patients’ voices into novel trial end points for cUTI.

Background Targeted immunotherapies have transformed the treatment of many diseases. However, some increase the risk of tuberculosis (TB) disease. We sought to develop a comprehensive list of targeted immunotherapies with TB infection screening recommendations in U.S. Food and Drug Administration (FDA)-approved prescribing information and compare these recommendations to clinical resources and quality measures. Methods Through a grey literature review, we identified TB clinical resources and U.S. quality measures. We created a list of targeted immunotherapies and TB infection screening recommendations by analyzing four FDA databases. We then evaluated the consistency of screening recommendations in prescribing information, TB clinical resources and quality measures. Results We identified six TB clinical resources and one quality measure for TB infection. While TB infection screening recommendations for tumor necrosis factor (TNF) inhibitors were consistently included, recommendations for other therapies were less consistent. Through FDA database analyses, we identified 269 targeted immunotherapies, 35 (13%) of which had TB infection screening recommendations in prescribing information, including all therapies targeting TNF and several interleukins (IL); however, therapies targeting IL-6, Janus-associated kinase and others had variable recommendations. Significant discordance in screening recommendations for immunotherapies were further identified when comparing prescribing information, clinical resources and quality measures. Conclusions The number and targets of immunotherapies are rapidly evolving resulting in challenges with creating, up-to-date and consistent TB infection screening recommendations. Inconsistent recommendations in clinical resources may contribute to gaps in TB preventive care. Harmonized recommendations and additional epidemiologic studies of TB disease risk with the use of these agents are needed. Article summary Targeted immunotherapies are increasing in number and complexity but may increase tuberculosis risk, highlighting the challenge of creating tuberculosis infection screening recommendations. We systematically identified these therapies and compared screening recommendations in prescribing information, clinical resources and quality measures.

Natasha Spottiswoode, MD DPhil, Daniel J Minter, MD, Rachel Friedman-Moraco, MD; Rewriting the Script, Clinical Infectious Diseases, , ciae589, https://doi

Case tracking (following-up prior patient encounters) can help inform future clinical decisions and supplement experiential learning. Internal medicine subspecialty fellows see a high volume of patients and need to become subject matter experts within a short time frame, yet little is known about their specific needs and motivations around case tracking. The objective of this study was to explore internal medicine subspecialty fellows' motivations, preferences, and practices around case tracking. We conducted interviews with internal medicine subspecialty fellows at a single academic medical center during the 2022-2023 academic year. Interviews were analyzed using qualitative content analysis. 22 fellows were interviewed for our study. We found that most fellows engaged in case tracking with lists in the electronic health record (EHR). Fellows primarily tracked cases of clinical uncertainty and patients with specific diseases or conditions of interest. Fellows sought information on patients' health outcomes, results, and clinical notes. Motivations for tracking were predominantly related to curiosity, professional growth, and development of practice patterns. Barriers to case tracking included time, challenges maintaining patient lists, losing track of patients, and lack of motivation to develop and maintain an organized system. Internal medicine subspecialty fellows engaged in and valued case tracking as a way to supplement their experiential learning. Our study highlighted their current practices, motivations, preferences, and challenges related to case tracking. We plan to use these findings to help develop an EHR-embedded dashboard to facilitate case tracking among subspecialty fellows.

Case conferences, specifically those in which an unknown case is presented and discussed, are widely utilized in the delivery of medical education. However, the format of case conferences is not always optimized to engage and challenge audience members’ clinical reasoning (CR). Based on the current conception of CR and our experience, we provide recommendations on how to better engineer case conferences to maximize CR education for learners at all levels through case selection, conference format, and intentional case construction.