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Decreasing Time To Broad Spectrum Antibiotics For Septic Patients In The Emergency Department, Joseph J. Zieminski, Emily E. Bryant 2017 Department of Pharmacy, Aurora St. Luke’s Medical Center

Decreasing Time To Broad Spectrum Antibiotics For Septic Patients In The Emergency Department, Joseph J. Zieminski, Emily E. Bryant

Journal of Patient-Centered Research and Reviews

Background: Timely administration of broad spectrum antibiotics has been shown to be directly correlated with decreased mortality for patients with severe sepsis and septic shock. As such, both the Surviving Sepsis Campaign and the SEP-1 CMS measure recognize timely antibiotic administration as a cornerstone of therapy for patients with severe sepsis or septic shock.

Purpose: Decrease time to broad spectrum antibiotic administration for septic patients in the emergency department (ED) of Aurora St. Luke’s Medical Center.

Methods: An alert within the electronic medical record was created to more rapidly identify potentially septic patients in the ED. After receiving the ...


Fmt Placed By Colonoscopy: Systematic Review And Meta-Analysis, Nadia Huq, Veena Kumaravel, Aboud Affi, Maharaj Singh 2017 Department of Internal Medicine, Aurora Sinai Medical Center

Fmt Placed By Colonoscopy: Systematic Review And Meta-Analysis, Nadia Huq, Veena Kumaravel, Aboud Affi, Maharaj Singh

Journal of Patient-Centered Research and Reviews

Background: Fecal transplants are successful in the treatment of recurrent or refractory Clostridium difficile infections (CDI), but there is no consensus on the best method of instillation. Studies have shown greater success with lower gastrointestinal tract placement, but technical aspects of placement are not validated.

Purpose: This review aims to identify common traits and procedural techniques of successful fecal microbiota transplant (FMT) therapy via colonoscopy.

Methods: An electronic search was conducted using OVID Medline and PubMed for articles published from January 2010 to January 2016. The primary outcome of interest was cure by FMT placed via colonoscopy.

Results: Of the ...


Study Design Of A Cluster-Randomized Controlled Trial To Evaluate A Large-Scale Distribution Of Cook Stoves And Water Filters In Western Province, Rwanda, Corey L. Nagel, Miles Kirby, Laura D. Zambrano, Ghislaine Rosa, Christina K. Barstow, Evan A. Thomas, Thomas Clasen 2017 Oregon Health & Science University

Study Design Of A Cluster-Randomized Controlled Trial To Evaluate A Large-Scale Distribution Of Cook Stoves And Water Filters In Western Province, Rwanda, Corey L. Nagel, Miles Kirby, Laura D. Zambrano, Ghislaine Rosa, Christina K. Barstow, Evan A. Thomas, Thomas Clasen

Evan A. Thomas

Background: In Rwanda, pneumonia and diarrhea are the first and second leading causes of death, respectively, among children under five. Household air pollution (HAP) resultant from cooking indoors with biomass fuels on traditional stoves is a significant risk factor for pneumonia, while consumption of contaminated drinking water is a primary cause of diarrheal disease. To date, there have been no largescale effectiveness trials of programmatic efforts to provide either improved cookstoves or household water filters at scale in a low-income country. In this paper we describe the design of a clusterrandomized trial to evaluate the impact of a national-level program ...


Bacterial Development Of Resistance To Botanical Antimicrobials, Guillermo Ruiz, Tiffany Turner, Erik Nelson, Linda Sparks, Jeffrey Langland 2017 Southwest College of Naturopathic Medicine

Bacterial Development Of Resistance To Botanical Antimicrobials, Guillermo Ruiz, Tiffany Turner, Erik Nelson, Linda Sparks, Jeffrey Langland

Journal of Evolution and Health

In recent years, increased numbers of multidrug-resistant strains of bacteria have opportunistically and selectively expanded while the pharmaceutical discovery of new antimicrobial therapies has been lacking to combat this growing threat. Like traditional antibiotics, botanicals have historically been used to treat bacterial infections, but it remains unclear if bacteria may have the capability to develop resistance to these therapeutic botanicals. It is believed that one advantage that may prevent or slow resistance to botanical antimicrobials is the presumed presence of the multiple endogenous substances contained within a plant that may act synergistically to inhibit microbial growth. This study examined the ...


Effectiveness Of Four-Decontamination Techniques On Bacterial Growth On Cpr Manikins After Use In A Cpr Course, Rachel K. Katch, David C. Berry 2017 University of Connecticut - Storrs

Effectiveness Of Four-Decontamination Techniques On Bacterial Growth On Cpr Manikins After Use In A Cpr Course, Rachel K. Katch, David C. Berry

International Journal of First Aid Education

Context: The American Red Cross and American Heart Association are strong advocates of preventing disease transmission during cardiopulmonary resuscitation (CPR) training by promoting careful and consistent manikin decontamination. Because CPR is taught worldwide, identifying low-cost, efficient, and effective means of decontamination is imperative. Objective: Determine the degree of contamination on CPR manikins after routine use, and evaluate the efficacy of four disinfecting methods to reduce bacterial growth. Design: Descriptive laboratory. Setting: CPR class; microbiology laboratory. Subjects Forty-eight Actar 911™ CPR manikins (Armstrong Medical Industries, Lincolnshire, IL). Main Outcome Measure(s): Dependent variable was bacterial colony growth (count); independent variable was ...


Child Contact Management In High Tuberculosis Burden Countries: A Mixed-Methods Systematic Review, Daria Szkwarko, Yael Hirsch-Moverman, Lienki Du Plessis, Karen Du Preez, Catherine W. Carr, Anna M. Mandalakas 2017 University of Massachusetts Medical School

Child Contact Management In High Tuberculosis Burden Countries: A Mixed-Methods Systematic Review, Daria Szkwarko, Yael Hirsch-Moverman, Lienki Du Plessis, Karen Du Preez, Catherine W. Carr, Anna M. Mandalakas

Library Publications and Presentations

Tuberculosis (TB) remains a leading cause of morbidity and mortality worldwide. Considering the World Health Organization recommendation to implement child contact management (CCM) for TB, we conducted a mixed-methods systematic review to summarize CCM implementation, challenges, predictors, and recommendations. We searched the electronic databases of PubMed/MEDLINE, Scopus, and Web of Science for studies published between 1996-2017 that reported CCM data from high TB-burden countries. Protocol details for this systematic review were registered on PROSPERO: International prospective register of systematic reviews (#CRD42016038105). We formulated a search strategy to identify all available studies, published in English that specifically targeted a) population ...


Burkholderia Pseudomallei Enters The Brain And Spinal Cord Via The Trigeminal Nerve, Heidi Walkden, James St John, Lynn Nazareth, Jenny Ekberg 2017 Bond University

Burkholderia Pseudomallei Enters The Brain And Spinal Cord Via The Trigeminal Nerve, Heidi Walkden, James St John, Lynn Nazareth, Jenny Ekberg

Jenny Ekberg

Background

The trigeminal nerve is the largest cranial nerve responsible for sensation in the face and motor functions such as chewing. It constitutes a direct route from the nasal cavity into the brain (Fig. 1). Despite this, only a handful of microorganisms are thought to infect the brain via this route.

The tropical disease melioidosis caused by Burkholderia pseudomallei is endemic to the northern Australia and south-east Asia. The main route of transmission is via inhalation of droplets and soil. The Australian variant can result in brain infection, but the mechanism of infection is unknown.

Here, we investigated whether B ...


Fungal Infections From Human And Animal Contact, Dennis J. Baumgardner 2017 Aurora UW Medical Group, Aurora Health Care; University of Wisconsin School of Medicine and Public Health; Center for Urban Population Health

Fungal Infections From Human And Animal Contact, Dennis J. Baumgardner

Dennis J. Baumgardner. MD

Fungal infections in humans resulting from human or animal contact are relatively uncommon, but they include a significant proportion of dermatophyte infections. Some of the most commonly encountered diseases of the integument are dermatomycoses. Human or animal contact may be the source of all types of tinea infections, occasional candidal infections, and some other types of superficial or deep fungal infections. This narrative review focuses on the epidemiology, clinical features, diagnosis and treatment of anthropophilic dermatophyte infections primarily found in North America. Other human-acquired and zoonotic fungal infections also are discussed in brief.


Colonization Density Of The Upper Respiratory Tract As A Predictor Of Pneumonia-Haemophilus Influenzae, Moraxella Catarrhalis, Staphylococcus Aureus, And Pneumocystis Jirovecii., Daniel E Park, Henry C Baggett, Stephen R C Howie, Qiyuan Shi, Nora L Watson, W Abdullah Brooks, PERCH Study Group 2017 George Washington University

Colonization Density Of The Upper Respiratory Tract As A Predictor Of Pneumonia-Haemophilus Influenzae, Moraxella Catarrhalis, Staphylococcus Aureus, And Pneumocystis Jirovecii., Daniel E Park, Henry C Baggett, Stephen R C Howie, Qiyuan Shi, Nora L Watson, W Abdullah Brooks, Perch Study Group

Epidemiology and Biostatistics Faculty Publications

Background.

There is limited information on the association between colonization density of upper respiratory tract colonizers and pathogen-specific pneumonia. We assessed this association for Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus, and Pneumocystis jirovecii. Methods.

In 7 low- and middle-income countries, nasopharyngeal/oropharyngeal swabs from children with severe pneumonia and age-frequency matched community controls were tested using quantitative polymerase chain reaction (PCR). Differences in median colonization density were evaluated using the Wilcoxon rank-sum test. Density cutoffs were determined using receiver operating characteristic curves. Cases with a pathogen identified from lung aspirate culture or PCR, pleural fluid culture or PCR, blood culture ...


Central Role Of Il-23 And Il-17 Producing Eosinophils As Immunomodulatory Effector Cells In Acute Pulmonary Aspergillosis And Allergic Asthma, Evelyn V. Santos Guerra, Chrono K. Lee, Charles A. Specht, Bhawna Yadav, Haibin Huang, Ali Akalin, Jun R. Huh, Christian Mueller, Stuart M. Levitz 2017 University of Massachusetts Medical School

Central Role Of Il-23 And Il-17 Producing Eosinophils As Immunomodulatory Effector Cells In Acute Pulmonary Aspergillosis And Allergic Asthma, Evelyn V. Santos Guerra, Chrono K. Lee, Charles A. Specht, Bhawna Yadav, Haibin Huang, Ali Akalin, Jun R. Huh, Christian Mueller, Stuart M. Levitz

Christian Mueller

Aspergillus fumigatus causes invasive pulmonary disease in immunocompromised hosts and allergic asthma in atopic individuals. We studied the contribution of lung eosinophils to these fungal diseases. By in vivo intracellular cytokine staining and confocal microscopy, we observed that eosinophils act as local sources of IL-23 and IL-17. Remarkably, mice lacking eosinophils had a >95% reduction in the percentage of lung IL-23p19+ cells as well as markedly reduced IL-23 heterodimer in lung lavage fluid. Eosinophils killed A. fumigatus conidia in vivo. Eosinopenic mice had higher mortality rates, decreased recruitment of inflammatory monocytes, and decreased expansion of lung macrophages after challenge with ...


Analysis Of The Local And Systemic Cytokine Response Profiles In Patients With Community-Acquired Pneumonia. Relationship With Disease Severity And Outcomes., Rafael Fernandez-Botran, Timothy Lee Wiemken, Robert R. Kelley, Paula Peyrani, Jose Bordon, Rodrigo Cavallazzi, Julio A. Ramirez 2017 University of Louisville

Analysis Of The Local And Systemic Cytokine Response Profiles In Patients With Community-Acquired Pneumonia. Relationship With Disease Severity And Outcomes., Rafael Fernandez-Botran, Timothy Lee Wiemken, Robert R. Kelley, Paula Peyrani, Jose Bordon, Rodrigo Cavallazzi, Julio A. Ramirez

The University of Louisville Journal of Respiratory Infections

The goals of this study were to investigate the relationship of systemic and local cytokine responses with time to clinical stability (TCS) in patients with community-acquired pneumonia (CAP) and to develop a model to integrate multiple cytokine data into “cytokine response profiles” based on local vs. systemic and pro- vs. anti-inflammatory cytokine patterns in order to better understand their relationships with measures of CAP severity and outcomes. Forty hospitalized patients enrolled through the Community Acquired Pneumonia Inflammatory Study Group (CAPISG) were analyzed. Based on the ranked distribution of the levels of eight different pro-inflammatory cytokines and chemokines (IL-1b, IL-6, IL-8 ...


Identification And Characterization Of Human Monoclonal Antibodies For Immunoprophylaxis Against Enterotoxigenic Escherichia Coli, Serena Giuntini, Matteo Stoppato, Monir Ejemel, Danielle Wisheart, Mark S. Klempner, Yan Wang 2017 University of Massachusetts Medical School

Identification And Characterization Of Human Monoclonal Antibodies For Immunoprophylaxis Against Enterotoxigenic Escherichia Coli, Serena Giuntini, Matteo Stoppato, Monir Ejemel, Danielle Wisheart, Mark S. Klempner, Yan Wang

UMass Center for Clinical and Translational Science Research Retreat

Background. Enterotoxigenic Escherichia coli (ETEC) infections are the major cause of diarrheal morbidity among children living in developing countries. ETEC mediates small intestine adherence through bacterial adhesion followed by production of enterotoxins that induce diarrhea. Currently there is no vaccine available for ETEC. One of the most predominant adhesin of pathogenic ETEC strains is colonization factor antigen I (CFA/I). The CFA/I adhesion tip, CfaE, is required for ETEC binding to human intestinal cells and colonization. Human antibodies against CfaE have potential to block colonization of ETEC and serve as a potent immunoprophylactic against ETEC-related diarrhea.

Methods. A panel ...


In Vivo Protection With Human Monoclonal Antibody S315 Following Challenge With Diphtheria Toxin, Heidi L. Smith, Maria Lobikin, Wenda Gao, Greg Saia, Yan Wang, Mark Leney, Deborah C. Molrine 2017 University of Massachusetts Medical School

In Vivo Protection With Human Monoclonal Antibody S315 Following Challenge With Diphtheria Toxin, Heidi L. Smith, Maria Lobikin, Wenda Gao, Greg Saia, Yan Wang, Mark Leney, Deborah C. Molrine

UMass Center for Clinical and Translational Science Research Retreat

Background: Morbidity and mortality from Corynebacterium diphtheriae is reduced by prompt administration of equine-derived diphtheria anti-toxin (DAT), which is in short supply worldwide. MassBiologics has developed a human monoclonal antibody (S315) to diphtheria toxin to provide a safer alternative to DAT and address critical supply issues. S315 prevents toxin binding to its putative host receptor and S315 pre-mixed with toxin increased survival in a guinea pig model of intoxication. To further evaluate the ability of S315 to provide in vivo protection, we established a post-exposure treatment model.

Methods: Female Hartley guinea pigs (300-350g) were challenged subcutaneously with diphtheria toxin (0 ...


Pre-Exposure Immunoprophylaxis By Genetically Encoded Dmab Anti-Ospa Human Monoclonal Antibody To Prevent Lyme Disease, Yan Wang, Seleeke Flingai, Aurelie Kern, Sangya Agarwal, Zachary Schiller, Kaori Graybeal, Rianne Esquivel, Ami Patel, Linden Hu, David Weiner, Mark S. Klempner 2017 University of Massachusetts Medical School

Pre-Exposure Immunoprophylaxis By Genetically Encoded Dmab Anti-Ospa Human Monoclonal Antibody To Prevent Lyme Disease, Yan Wang, Seleeke Flingai, Aurelie Kern, Sangya Agarwal, Zachary Schiller, Kaori Graybeal, Rianne Esquivel, Ami Patel, Linden Hu, David Weiner, Mark S. Klempner

UMass Center for Clinical and Translational Science Research Retreat

Tick transmission of Borrelia spirochetes to humans results in significant morbidity from Lyme disease. Animal studies have demonstrated that transmission of Borrelia from tick vector to the mammalian host can be blocked by antibodies against outer surface protein A (OspA). We have recently developed borreliacidal human IgG1 monoclonal antibodies (HuMabs) directed against OspA. HuMab 319-44 was borreliacidal against B. burgdorferi (IC50Borreliatransmission after a single dose of 2 mg/kg administered on the day of tick challenge. Since passively administered IgG1 antibodies do not have a sufficient half-life to provide protection for the 6-7 month peak risk period, we investigated a ...


The Effect Of Bundled Interventions On Prevention Of Hospital Acquired Clostridium Difficile Infection, Kaitlin Kendys 2017 Valparaiso University

The Effect Of Bundled Interventions On Prevention Of Hospital Acquired Clostridium Difficile Infection, Kaitlin Kendys

Evidence-Based Practice Project Reports

Clostridium difficile infection (CDI) rates have steadily increased in hospitalized patients due to the change in epidemiology. Approximately 13 of every 1,000 inpatients are either infected or colonized with C. difficile (CDC, 2013). CDI rates continue to rise due to the hyper-virulent strain of C. difficile and length of therapy needed to treat CDI. The average cost for a single inpatient CDI is more than $35,000, and the estimated annual cost burden for the healthcare system exceeds $3 billion (Walsh, 2012). The purpose of this evidence-based project (EBP) was to reduce hospital-acquired CDI rates over a 3-month period-oftime ...


Superbugs Versus Outsourced Cleaners: Employment Arrangements And The Spread Of Health Care-Associated Infections, Adam Seth Litwin, Ariel C. Avgar, Edmund R. Becker 2017 Cornell University

Superbugs Versus Outsourced Cleaners: Employment Arrangements And The Spread Of Health Care-Associated Infections, Adam Seth Litwin, Ariel C. Avgar, Edmund R. Becker

Articles and Chapters

On any given day, about one in 25 hospital patients in the United States has a health care–associated infection (HAI) that the patient contracts as a direct result of his or her treatment. Fortunately, the spread of most HAIs can be halted through proper disinfection of surfaces and equipment. Consequently, cleaners—“environmental services” (EVS) in hospital parlance—must take on the important task of defending hospital patients (as well as staff and the broader community) from the spread of HAIs. Despite the importance of this task, hospitals frequently outsource this function, increasing the likelihood that these workers are under-rewarded ...


Lymphoid Hematopoiesis And The Role Of B-Cells In Transgenic Mouse Model Of Sickle Cell Disease, Christina Cotte 2017 University of Connecticut - Storrs

Lymphoid Hematopoiesis And The Role Of B-Cells In Transgenic Mouse Model Of Sickle Cell Disease, Christina Cotte

University Scholar Projects

Sickle cell disease (SCD) has been shown to be associated with decreased baseline immunity and thus increased susceptibility to infection. I sought to discern possible causes of this by looking into the correlations between SCD and hematopoiesis, the immune system and the neuroendocrine system, and ultimately by conducting experiments surrounding the impaired immune system of SCD. These experiments focused on the potential causes and effects of the diminution of B-1a cells in the SCD spleen. Adoptive transfers, infections with Streptococcus pneumoniae, and histologic imaging were conducted to establish if the diminution of the B-1a cells in the SCD spleen is ...


Study Of Rickettsia Parkeri Colonization And Proliferation In The Tick Host Amblyomma Maculatum (Acari: Ixodidae), Khemraj B.C. 2017 University of Southern Mississippi

Study Of Rickettsia Parkeri Colonization And Proliferation In The Tick Host Amblyomma Maculatum (Acari: Ixodidae), Khemraj B.C.

Dissertations

Amblyomma maculatum (Gulf coast tick) ticks are prevalent across the Atlantic to Gulf Coast region of United States. These ticks are recognized vectors of Rickettsia parkeri, a spotted fever group of Rickettsia (SFGR) known to cause American boutonneuse fever associated with fever and eschar rashes localized to the site of bites. We hypothesized that Rickettsia parkeri colonization and proliferation in the tick vector involve pathogen-symbiont dynamics and tick-pathogen interactions, which influence rickettsial transmission to the victims after tick bites. The rickettsial infection is maintained across the tick life cycle for many generations due to transovarial and transstadial transmission of the ...


Molecular Subtyping Of Staphylococcus Aureus Isolates From The U.P. Community For The Presence Of Toxin-Encoding Genes, Carol I. Kessel 2017 Northern Michigan University

Molecular Subtyping Of Staphylococcus Aureus Isolates From The U.P. Community For The Presence Of Toxin-Encoding Genes, Carol I. Kessel

All NMU Master's Theses

Staphylococcus aureus is the most common cause of human bacterial infections; however, humans can also be asymptomatically colonized with S. aureus. Asymptomatic carriers can potentially spread S. aureus infection to others. These infections can range from mild to severe. The pathology of a S. aureus infection is often dependent on which toxins are expressed and the virulence factors with which they are associated. One goal of this study was to isolate S. aureus from healthy, consenting adult volunteers who submitted nasal swabs for culture and qRT-PCR analysis to determine which strains are present in the community. This knowledge could potentially ...


The Msaabcr Operon Mutant Staphylococcus Aureus Is Deficient In Persister Cells, Aaliyah D. Cole 2017 The University of Southern Mississippi

The Msaabcr Operon Mutant Staphylococcus Aureus Is Deficient In Persister Cells, Aaliyah D. Cole

Honors Theses

Persister cells comprise a phenotypic variant that shows extreme antibiotic tolerance resulting in chronic infections. While this phenomenon has posed a great threat in public health, mechanism underlying their formation in Staphylococcus aureus remains largely unknown. Increasing evidence of the presence of persister cells in recalcitrant infections underscores the great urgency to unravel the mechanism by which these cells are developed. The Elasri Research group characterized msaABCR operon that plays roles in regulation of virulence, biofilm development and antibiotic resistance. It was hypothesized that the operon also plays a role in persister cell formation. In this study, the persister cell ...


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