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Open Forum Infectious Diseases

David J Epstein, Jeffrey Dunn, Stan Deresinski
Multiple sclerosis therapies include interferons, glatiramer, and multiple immunosuppressive drugs. Discerning infectious risks of immunosuppressive drugs requires understanding their mechanisms of action and analyzing interventional studies and postmarketing observational data. Though identical immunosuppressive therapies are sometimes used in non-neurologic conditions, infectious risks may differ in this population. Screening for and treatment of latent tuberculosis (TB) infection should be prioritized for patients receiving alemtuzumab; ocrelizumab is likely not associated with an increased risk of TB...
August 2018: Open Forum Infectious Diseases
Joshua Rhein, Kathy H Hullsiek, Emily E Evans, Lillian Tugume, Edwin Nuwagira, Kenneth Ssebambulidde, Reuben Kiggundu, Edward Mpoza, Abdu K Musubire, Ananta S Bangdiwala, Nathan C Bahr, Darlisha A Williams, Mahsa Abassi, Conrad Muzoora, David B Meya, David R Boulware
Background: Increased antiretroviral therapy (ART) availability has been associated with more patients developing cryptococcosis after ART initiation. Despite this changing epidemiology, data regarding cryptococcal meningitis in those already receiving ART are limited. We compared clinical presentations and outcomes among ART-naïve and ART-experienced Ugandans. Methods: We prospectively enrolled 605 HIV-infected persons with first-episode cryptococcal meningitis from August 2013 to May 2017 who received amphotericin-based combination therapy...
August 2018: Open Forum Infectious Diseases
Dana M Blyth, Alice E Barsoumian, Heather C Yun
Background: With declining interest in infectious disease (ID) noted among internal medicine (IM) residents, national attention has been directed at methods to recruit more prospective ID applicants. The factors driving the recent decline in ID fellowship applications have thus far only been evaluated in survey studies. Since 2008 at our institution, all IM interns were required to complete a 4-week inpatient ID rotation. We evaluated this rotation to determine if any experiential factors could be linked to future ID interest...
August 2018: Open Forum Infectious Diseases
Edward R Cachay, Lucas Hill, Francesca Torriani, Craig Ballard, David Grelotti, Abigail Aquino, W Christopher Mathews
Background: We estimated and characterized the proportion of patients living with HIV (PLWH) who missed hepatitis C (HCV) intake appointments and subsequently failed to establish HCV care. Methods: Logistic regression analyses were used to identify factors associated with missed HCV intake appointments and failure to establish HCV care among PLWH referred for HCV treatment between January 2014 and December 2017. In addition to demographics, variables included HIV treatment characteristics, type of insurance, liver health status, active alcohol or illicit drug use, unstable housing, and history of a mental health disorder (MHD)...
July 2018: Open Forum Infectious Diseases
Khalid M Dousa, Ahmed Babiker, Daniel Van Aartsen, Neel Shah, Robert A Bonomo, John L Johnson, Marion J Skalweit
Ibrutinib is an irreversible inhibitor of Bruton's tyrosine kinase approved for the treatment of B-cell malignancies. There is growing concern about the risk of opportunistic infections following ibrutinib therapy. Herein, we describe the first case of Mycobacterium chelonae skin and soft tissue infection in a patient receiving ibrutinib and recount the challenges in treating this infection.
July 2018: Open Forum Infectious Diseases
Stephanie A Folan, Kayleigh R Marx, Frank P Tverdek, Issam Raad, Victor E Mulanovich, Jeffrey J Tarrand, Samuel A Shelburne, Samuel L Aitken
Background: Coagulase-negative staphylococci, including Staphylococcus epidermidis , are the most common cause of bloodstream infection in cancer patients. Linezolid resistance is increasingly identified in S. epidermidis, but whether such resistance alters the clinical course of S. epidermidis infections is unknown. The purpose of this study was to assess the clinical impact of linezolid resistance in leukemia patients with S. epidermidis bloodstream infection. Methods: This was a retrospective, single-center cohort study of all adult leukemia patients with S...
July 2018: Open Forum Infectious Diseases
Suganya Chandramohan, Bhagyashri Navalkele, Ammara Mushtaq, Amar Krishna, John Kacir, Teena Chopra
Background: Prolonged central line (CL) and urinary catheter (UC) use can increase risk of central line-associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI). Methods: This interventional study conducted in a 76-bed long-term acute care hospital (LTACH) in Southeast Michigan was divided into 3 periods: pre-intervention (January 2015-June 2015), intervention (July-November 2015), and postintervention (December 2015-March 2017)...
July 2018: Open Forum Infectious Diseases
Anna E van Beek, Isatou Sarr, Simon Correa, Davis Nwakanma, Mieke C Brouwer, Diana Wouters, Fatou Secka, Suzanne T B Anderson, David J Conway, Michael Walther, Michael Levin, Taco W Kuijpers, Aubrey J Cunnington
Background: Plasmodium falciparum may evade complement-mediated host defense by hijacking complement Factor H (FH), a negative regulator of the alternative complement pathway. Plasma levels of FH vary between individuals and may therefore influence malaria susceptibility and severity. Methods: We measured convalescent FH plasma levels in 149 Gambian children who had recovered from uncomplicated or severe P. falciparum malaria and in 173 healthy control children...
July 2018: Open Forum Infectious Diseases
Shashi N Kapadia, Harjot K Singh, Sian Jones, Samuel Merrick, Carlos M Vaamonde
Background: Appropriate testing of people at risk for HIV is an important piece of the HIV care continuum. We analyzed HIV testing patterns of patients tested for gonorrhea and chlamydia (GC/CT) at a large urban health care system in New York City. Methods: We retrospectively studied HIV and GC/CT testing from 2010 to 2015. Data were collected from a clinical laboratory database and linked to electronic health records. Patients were older than age 13 years, not known to be HIV positive, and had had a GC/CT test...
July 2018: Open Forum Infectious Diseases
Lesley E Jackson, Mahmoud Shorman
Adrenal abscesses due to disseminated nocardiosis are exceedingly rare in clinical practice, and to date only 8 cases have been reported in the literature, most of which were confined to a single adrenal gland. These infections often occur in patients with underlying immune deficiency. We report a rare case of bilateral nocardial adrenal abscesses in an intravenous drug-using splenectomized patient that presumably originated from direct inoculation using intravenous opana, as his admission chest radiograph was normal...
July 2018: Open Forum Infectious Diseases
Mary A Musgrove, Rachel M Kenney, Ronald E Kendall, Michael Peters, Robert Tibbetts, Linoj Samuel, Susan L Davis
Background: Systematic and behavioral interventions are needed to improve antibiotic use for common conditions like pneumonia. Methods: Single pretest, post-test quasi-experiment in a 4-hospital health system in metropolitan Detroit, Michigan. Hospitalized patients treated with anti-methicillin-resistant Staphylococcus aureus and antipseudomonal antibiotics for respiratory infections from August 1, 2015, through January 31, 2016, and August 1, 2016, through January 31, 2017, were eligible for inclusion...
July 2018: Open Forum Infectious Diseases
Debbie-Ann T Shirley, Laura Farr, Koji Watanabe, Shannon Moonah
Amebiasis, due to the pathogenic parasite Entamoeba histolytica, is a leading cause of diarrhea globally. Largely an infection of impoverished communities in developing countries, amebiasis has emerged as an important infection among returning travelers, immigrants, and men who have sex with men residing in developed countries. Severe cases can be associated with high case fatality. Polymerase chain reaction-based diagnosis is increasingly available but remains underutilized. Nitroimidazoles are currently recommended for treatment, but new drug development to treat parasitic agents is a high priority...
July 2018: Open Forum Infectious Diseases
Margaret A Olsen, Dustin Stwalley, Clarisse Demont, Erik R Dubberke
Background: Numerous studies have found increased risk of Clostridium difficile infection (CDI) with increasing age. We hypothesized that increased CDI risk in an elderly population is due to poorer overall health status with older age. Methods: A total of 174 903 persons aged 66 years and older coded for CDI in 2011 were identified using Medicare claims data. The comparison population consisted of 1 453 867 uninfected persons. Potential risk factors for CDI were identified in the prior 12 months and organized into categories, including infections, acute noninfectious conditions, chronic comorbidities, frailty indicators, and health care utilization...
July 2018: Open Forum Infectious Diseases
Jeanne B Forrester, Lisa L Steed, Barbara A Santevecchi, Patrick Flume, Gloria E Palmer-Long, John A Bosso
Ceftolozane/tazobactam (C/T) was tested and compared against 93 nonfermenting, Gram-negative clinical isolates from cystic fibrosis specimens. Based on current breakpoints for intra-abdominal and urinary tract infections (which may not be appropriate for pulmonary infections), C/T was found to be the most active agent against P. aeruginosa (95.7% susceptible), followed by piperacillin/tazobactam (89.4% susceptible). For other Gram-negative pathogens included, C/T had varying activity.
July 2018: Open Forum Infectious Diseases
Jason Zucker, Justin G Aaron, Daniel J Feller, Jacek Slowikowski, Henry Evans, Matthew L Scherer, Michael T Yin, Peter Gordon
Disease-specific care cascades are important public health and organizational tools to characterize gaps in care and target resources, but they are labor-intensive to maintain. Using data available from the electronic medical record, we developed an algorithm with high accuracy for correctly representing an individual's status in the hepatitis C virus care cascade.
July 2018: Open Forum Infectious Diseases
Natasha Chida, Christopher Brown, Jyoti Mathad, Kelly Carpenter, George Nelson, Marcos C Schechter, Natalie Giles, Paulina A Rebolledo, Susan Ray, Valeria Fabre, Diana Silva Cantillo, Sarah Longworth, Valerianna Amorosa, Christian Petrauskis, Catherine Boulanger, Natalie Cain, Amita Gupta, Jane McKenzie-White, Robert Bollinger, Michael T Melia
Background: Internal medicine physicians are often the first providers to encounter patients with a new diagnosis of tuberculosis. Given the public health risks of missed tuberculosis cases, assessing internal medicine residents' ability to diagnose tuberculosis is important. Methods: Internal medicine resident knowledge and practice patterns in pulmonary tuberculosis diagnosis at 7 academic hospitals were assessed utilizing (a) a 10-item validated pulmonary tuberculosis diagnosis assessment tool and (b) a retrospective chart review of 343 patients who underwent a pulmonary tuberculosis evaluation while admitted to a resident-staffed internal medicine or infectious disease service...
July 2018: Open Forum Infectious Diseases
Amber Martin, Kyle Fahrbach, Qi Zhao, Thomas Lodise
This study quantified mortality associated with serious infections caused by carbapenem-resistant (CRE) and carbapenem-susceptible Enterobacteriaceae (CSE). A systematic literature review was conducted, evaluating outcomes in hospitalized patients with CRE infections from a blood, urinary, pulmonary, or intra-abdominal source. A meta-analysis (MA) calculating odds ratios (ORs) for mortality was performed. Twenty-two studies met the criteria for inclusion in the MA: 12 included mortality data for CRE vs CSE populations...
July 2018: Open Forum Infectious Diseases
Lisa Mangum, Dustin Kilpatrick, Barbara Stryjewska, Rahul Sampath
Both leprosy and tuberculosis (TB) are known to have similar geographic endemicity. In the setting of coinfection, interferon-gamma release assays (IGRAs) to detect latent TB can be falsely positive. We report a case of leprosy with a positive IGRA and asymptomatic active pulmonary TB. Minocycline and dapsone therapy was initiated during the workup for TB and changed to rifampin (Rif), isoniazid, pyrazinamide, and ethambutol, with the addition of dapsone once coinfection was confirmed. Our review of the literature revealed a preponderance of coinfection reported with borderline and lepromatous disease...
July 2018: Open Forum Infectious Diseases
Ameneh Khatami, Tara M Randis, Anna Chamby, Thomas A Hooven, Margaret Gegick, Evan Suzman, Brady A'Hearn-Thomas, Andrew P Steenhoff, Adam J Ratner
Group B Streptococcus (GBS) is a perinatal pathogen and an emerging cause of disease in adults. Culture-independent GBS detection relies on polymerase chain reaction (PCR) of conserved genes, including sip . We demonstrate suboptimal sensitivity of the existing sip PCR strategy and validate an improved method based on consensus sequences from >100 GBS genomes.
July 2018: Open Forum Infectious Diseases
Daniel B Chastain, Joeanna I Sams, Gregory M Steele, Lindsey O Lowder, Carlos Franco-Paredes
In this brief report, we describe a 76-year-old patient with thymoma who underwent craniotomy for a left parietal lobe mass with pathologic findings consistent with Toxoplasma gondii encephalitis in the absence of any features of thymoma with immunodeficiency/Good's syndrome. His clinical course suggested likely Toxoplasma reactivation.
July 2018: Open Forum Infectious Diseases
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