Infectious Diseases

Dexamethasone offers no outcome benefit in HIV-negative TB meningitis with LTA4H CC/CT genotypes

This phase 3 Vietnamese trial randomized 613 HIV-negative adults with tuberculous meningitis and LTA4H CC/CT genotypes to dexamethasone or placebo for 6–8 weeks. The 12-month composite of death or new neurologic event was similar: 35.4% with dexamethasone versus 35.7% with placebo (HR 0.99; 96% CI 0.748–1.31). Serious adverse events were frequent but comparable between groups, indicating steroid safety without clear efficacy in these genotypes. Open-label TT-genotype patients on dexamethasone had outcomes similar to CC/CT groups, questioning simple genotype-based steroid algorithms. 1

Composite MAX MDR-TB+AmPORE-TB platform enables same-day TB diagnosis and resistance profiling

Investigators integrated BD MAX MDR-TB testing with downstream AmPORE-TB targeted next-generation sequencing using residual DNA from the same cartridge. Among 104 spiked and 60 clinical BD MAX-positive samples, the average time to final combined result was 8.5 hours. For samples with Ct ≤28, sequencing produced resistance profiles for at least 12 drugs, with sensitivity about 85% in spiked and 73% in clinical samples. Failure rates were under 11%, with clofazimine, pretomanid, and delamanid resistance calls failing most frequently. 2

CrAg titers and semi-quantitative scores identify highest-risk patients for cryptococcal meningitis

In a South African CD4 network, 2,166 of 2,240 re-tested samples from people with HIV were confirmed cryptococcal antigen-positive. Median lateral flow assay titer was 640, and most patients had titers ≥160 or semi-quantitative scores ≥3+, indicating high fungal burden. Only 31% underwent lumbar puncture near the screening date, and 60% of those had confirmed cryptococcal meningitis, suggesting symptom-driven LP use. High titers and semi-quantitative scores have been previously associated with concurrent meningitis and higher mortality, supporting their role in risk stratification. 3

Meropenem-based triple regimen outperforms tigecycline regimen for pan-drug-resistant Acinetobacter

The DESPAIR study compared two triple regimens for pan-drug-resistant Acinetobacter baumannii hospital-acquired pneumonia or bloodstream infection across 12 centers. Eighty-three adults received colistin+ampicillin-sulbactam+meropenem (regimen A, n=60) or colistin+ampicillin-sulbactam+tigecycline (regimen B, n=23). Tigecycline-containing regimen B was associated with higher clinical failure before and after matching (OR 3.11 and 3.83, respectively). Salvage therapy initiation and discontinuation for toxicity were more frequent with regimen B, indicating poorer overall performance. 4