Andrew writes:

Hello Vincent and Cynthia,

I am really enjoying the Immune podcast. As a virologist who wants to be an expand my immunology knowledge it is perfect for me. I am learning a lot and I think the way you explain the concepts and experiments is easy to follow and engaging. Your discussions are always fun to listen to! Although Stephanie was not on this particular episode I very much enjoy hearing her perspective on everything as well. I did have a few comments on Episode 11 where you discuss this fascinating new approach to killing Staph aureus. If this works it would be fantastic because prosthetic joint infections are extremely challenging from a clinical infectious disease perspective. They often require lengthy courses of IV antibiotics and repeat surgeries. Most patients with prosthetic joints are elderly and they are often not the best repeat surgery candidates and they often have co-morbidities that make long courses of IV antibiotics challenging as well. So if we can prevent these infections or treat them without repeat surgery it would save a lot of time, money, and morbidity.

You mentioned the term “sepsis” in this episode (and it is often discussed or mentioned in TWIV as well). Sometimes when this term comes up the discussants seem to equate it with bacteremia (bacteria in the blood). This is not entirely correct. It is possible to be septic without being bacteremic and vice-versa. Influenza can cause sepsis, an intra abdominal abscess (without bacteremia) can cause sepsis, and fungi can cause sepsis (I think you get the point). Surprisingly, there is a bit of controversy about how to determine when a patient does or does not have sepsis. This paper: that came out when I was an intern re-defined the clinical parameters we use to determine sepsis, but I don’t think it has been accepted with unanimous enthusiasm. Regardless, the authors did provide a word definition which I quite like. Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection.

Finally, vancomycin was mentioned as an antibiotic to treat MRSA infections. It is true that it is our “go to” MRSA drug, however, there are other antibiotics that have activity against MRSA that may be used depending on the clinical scenario. Also, the CDC does not specifically restrict the use of vancomycin. Each hospital is supposed to have an antimicrobial stewardship program which determines how (and which) antibiotics are restricted so as to ensure that every patient gets the right antibiotic, at the right dose, for the right length of time. At my hospital, for example, most of the time when a clinician wants to prescribe vancomycin they need to get approval from an infectious diseases pharmacist or infectious diseases fellow/attending to do so.

Keep up the excellent work! You are providing a great service to both the scientific community and the public. I am encouraging all my relatives to listen to the CART-cell episode because when you hear it all explained it is like science-fiction come to life.



Andrew H. Karaba M.D. Ph.D

Infectious Diseases Fellow

Johns Hopkins University

Steen writes:

Dear IMMUNE trifecta,

I enjoyed talking to all three of you at ASV 2018.

I have a listener pick of sorts, a video summary of some history and recent developments in plant pathology:

The video accompanies a recently published perspective piece:

Not open access, sadly, but available in PDF form from the authors.

I actually don’t like the emphasis on complexity, and I would quibble with the way they use the word “model” (I prefer “scenario”), but overall it is a nice and accessible summary.

Jolene writes:

Howdy Immuners,

I found this article in the Journal of the American Medical Association left on my desk recently. It describes a deck-building card game that teaches the immune system. In the game, you are a bacterial pathogen that must overcome the human defenses including innate and adaptive responses. I am always interested to hear about creative ways to teach immunology and thought this might fit the bill sometime in the future. Perhaps for a review session. Anyone else heard of this game or used it?


Youtube video description (2 min):