Digital Commons Network^™

Macrolide-Resistant Mycoplasma Pneumoniae, United States, Xiaotian Zheng, Stella Lee, Rangaraj Selvarangan, Xuan Qin, Yi Wei Tang, Jeffrey Stiles, Tao Hong, Kathleen Todd, Amy E. Ratliff, Donna M. Crabb, Li Xiao, T. Prescott Atkinson, Ken B. Waites

Manuscripts, Articles, Book Chapters and Other Papers

© 2015, Centers for Disease Control and Prevention (CDC). All rights reserved.

Macrolide-resistant Mycoplasma pneumoniae (MRMP) is highly prevalent in Asia and is now being reported from Europe. Few data on MRMP are available in the United States. Using genotypic and phenotypic methods, we detected high-level MRMP in 13.2% of 91 M. pneumoniae–positive specimens from 6 US locations.

New Evidence Prompts Rethinking The Clinical Management Of Community Acquired Pneumonia In Patients Admitted To General Medical Services., J. Timothy Caldwell

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Postma DF, van Werkhoven CH, van Elden LJR, et al. Antibiotic treatment strategies for community-acquired pneumonia in adults. N Engl J Med. 2015;372(14):1312-1323. doi:10.1056/NEJMoa1406330

Common Cell Shape Evolution Of Two Nasopharyngeal Pathogens, Frédéric J. Veyrier, Nicolas Biais, Pablo Morales, Nouria Belkacem, Cyril Guilhen, Sylvia Ranjeva, Odile Sismeiro, Gérard Péhau-Arnaudet, Eduardo P. Rocha, Catherine Werts, Muhamed-Kheir Taha, Ivo G. Boneca

Publications and Research

Respiratory infectious diseases are the third cause of worldwide death. The nasopharynx is the portal of entry and the ecological niche of many microorganisms, of which some are pathogenic to humans, such as Neisseria meningitidis and Moraxella catarrhalis. These microbes possess several surface structures that interact with the actors of the innate immune system. In our attempt to understand the past evolution of these bacteria and their adaption to the nasopharynx, we first studied differences in cell wall structure, one of the strongest immune-modulators. We were able to show that a modification of peptidoglycan (PG) composition (increased proportion of pentapeptides) …

Convalescent Serum Therapy As Rapid Advance Treatment For Ebola In West Africa, J Bankole Thompson Md, Phd, Patricia F. Mejabi Msc., Olugbenga O. Mejabi Phd, S Ahmed Tejan-Sie Md

International Journal of African Development

The 2014 public health crisis in Guinea, Liberia, and Sierra Leone has brought Ebola Viral Disease (EVD) to everyone’s attention. Discovered in 1976, this deadly disease infrequently struck in remote areas of Africa. This article will critically review the literature and describe the pathobiology, transmission, signs and symptoms, diagnosis, treatment, and prevention of EVDwhich, was predicted by the Centers for Disease Control to potentially infect 1.4 million persons in Liberia and Sierra Leone by January 2015 (“Questions and Answers”, 2014). Thankfully this worst case scenario did not occur and we may be experiencing natural burn out of the outbreak along …

The Kynurenine Pathway Of Tryptophan Catabolism And Aids-Associated Kaposi's Sarcoma In Africa, Helen Byakwaga, Peter W. Hunt, Miriam Laker-Oketta, David V. Glidden, Yong Huang, Bosco M. Bwana, Rain Mocello, John Bennett, Victoria Walusansa, Sheila C. Dollard, David R. Bangsberg, Edward K. Mbidde, Jeffrey N. Martin

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background—Other than Kaposi's sarcoma (KS)-associated herpesvirus and CD4+ T cell lymphopenia, the mechanisms responsible for KS in the context of HIV are poorly understood. One recently explored pathway of HIV pathogenesis involves induction of the enzyme indoleamine 2,3 dioxygenase-1 (IDO), which catabolizes tryptophan into kynurenine and several other immunologically active metabolites that suppress T cell proliferation. We investigated the role of IDO in the development of KS in HIV disease.

Methods—In a case-control study among untreated HIV-infected Ugandans, cases were adults with KS and controls were without KS. IDO activity was assessed by the ratio of plasma kynurenine to tryptophan …

Lesion-Specific Immune Response In Granulomas Of Patients With Pulmonary Tuberculosis: A Pilot Study, Selvakumar Subbian, Liana Tsenova, Mi-Jeong Kim, Helen C. Wainwright, Annalie Visser, Nirmalya Bandyopadhyay, Joel S. Bader, Petros C. Karakousis, Gabriele B. Murrmann, Linda-Gail Bekker, David G. Russell, Gilla Kaplan

Publications and Research

The formation and maintenance of granulomas is central to the host response to Mycobacterium tuberculosis (Mtb) infection. It is widely accepted that the lungs of patients with tuberculosis (TB) usually contain multiple infection foci, and that the granulomas evolve and differentiate independently, resulting in considerable heterogeneity. Although gene expression profiles of human blood cells have been proposed as biomarkers of Mtb infection and/or active disease, the immune profiles of discrete lesion types has not been studied extensively. Using histology, immunopathology and genome-wide transcriptome analysis, we explored the immunological profile of human lung TB granulomas. We show that although the different …

Development Of A Biosensor-Based Rapid Urine Test For Detection Of Urogenital Schistosomiasis., Kathleen E Mach, Ruchika Mohan, Shailja Patel, Pak Kin Wong, Michael Hsieh, Joseph C Liao

Urology Faculty Publications

No abstract provided.

Neurocysticercosis, Abigail Hill

Nursing Student Class Projects (Formerly MSN)

Neurocysticercosis (NCC) is one of the most common parasitic infections of the central nervous system in humans and is the most serious clinical manifestation of cysticercosis. NCC is caused by the ingestion of the larval form of the pork tapeworm Taenia solium. NCC is endemic in low income developing countries where pigs are commonly raised, including the countries of Central America, South America, and parts of Africa and Asia. (Naddaf, Seeger, & Stafstrom, 2014). The parasite Taenia solium encysts in the brain and can express a broad range of symptoms including seizures, headache, hydrocephalus, encephalitis, stroke and mental health and …

Chagas Disease: Immigrating Into The United States, Angela Metzger

Nursing Student Class Projects (Formerly MSN)

Chagas Disease is starting to make a profound entrance into our communities within the United States. The influx of the immigrant population is the principal cause of the accumulation in the number of reported cases. (Center for Disease Control and Prevention, 2014). The Trypanosoma cruzi is a parasite that causes Chagas disease. The triatomine blood sucking insect enjoys the mucosal membranes of their pray, both humans and animals. The most common regions of the penetrating bite are the conjunctiva of the eye or around the mouth. It is through the feces of the vector entering the inoculation site that initiates …

Exploring The Pathophysiological Concepts Of Ebola Virus, Andrew T. Wasson

Nursing Student Class Projects (Formerly MSN)

The Ebola virus is a member of the filoviridae family. Five distinctive species of ebolavirus have been identified, four of which are known to cause disease in humans (Martines, Ng, Greer, Rollin, and Zaki, 2014). The specific species known to cause disease in humans are Zaire, Sudan, Ivory Coast, and Bundibugyo (Bray & Chertow, 2014). Bah et al. (2015) report that the Zaire ebolavirus (EBOV) was the cause of the most recent West African outbreak and carries the highest human mortality rate among the five known species, with up to 90% of cases being fatal. Ebola is a filamentous, enveloped, …

Chikungunya Virus: More Than A Mosquito Bite, Abigail Shaw

Nursing Student Class Projects (Formerly MSN)

Chikungunya fever is a viral infection caused by the Chikungunya virus (CHIKV). Although seldom fatal, CHIKV causes high fevers, polyarthralgia, and rash. The mosquito-borne virus has spread rapidly in the last ten years, causing over three million cases of CHIKV worldwide (Powers, 2015). The recent outbreak initiated in Africa and the islands of the Indian Ocean in 2004 has quickly spread to Asia, Europe and the Americas (CDC, 2015). According to the CDC (2015), until 2014, cases in the United States had only been linked to foreign travel outside of the Americas. As the outbreak has grown, cases of local …

Lyme Disease, Jared Hostetler

Nursing Student Class Projects (Formerly MSN)

Lyme disease is the most common vector borne illness found in the United States. Each year 30,000 people are diagnosed with the disease, with many more cases going unreported (Centers for Disease Control and Prevention, 2015). The vector responsible for spreading the disease is the deer tick. The infection itself is caused by the spirochete Borrelia burgdorferi. This bacteria is transmitted through the saliva from the bite of a deer tick. Diagnosis can be challenging due to the fact that multiple systems of the body can be affected with different severities. Early diagnosis and treatment is critical in the prevention …

Lyme Disease: A Tick’S Risky Bite, Jana Keller

Nursing Student Class Projects (Formerly MSN)

Lyme Disease is a bacterial infection transmitted primarily by the deer tick and is commonly seen in the United States. It is an infectious disease caused by the bacterium Borrelia burgdorferi, which is a spirochete (Pearson, 2014). Lyme disease’s prevalence is confirmed by the Centers for Disease Control and Preventions whom estimates that 30,000 people per year are diagnosed with Lyme disease in the Unites States (Moore, 2015). It is imperative that primary health care workers (such as Nurse Practitioners) are familiar with this disease and the early signs and symptoms. If early signs and symptoms go unnoticed or misdiagnosed …

Chikungunya Virus: A Case Study Of The Emerging Vector-Borne Disease, Lindsay D. Sullivan

Nursing Student Class Projects (Formerly MSN)

The Chikungunya virus (CHIKV) has spread like a wildfire in the Americas. Since its emergence in Sub-Saharan Africa as early at the 18th century, CHIKV has caused many isolated outbreaks in Africa, Southeast Asia, and Australia. Over the last decade, the vector-borne disease has inflicted millions of people on islands in the Indian Ocean, India, and now the Americas with the aid of viral mutations and international travel (Weaver and Lecuit, 2015). The first case of local CHIKV transmission in the Western Hemisphere was fairly recent. On the island of St. Martin in October 2013, an individual carrying an Asian …

Tuberculosis, Lindsay Mackey

Nursing Student Class Projects (Formerly MSN)

Tuberculosis (TB) is an infectious bacterial disease caused by Mycobacterium tuberculosis and mostly affects the lungs and sometimes other organs such as the kidneys, spine, and brain (Center for Disease Control and Prevention, 2015). In 2013, the CDC (2015) estimated that approximately 9 million people were infected with Mycobacterium tuberculosis worldwide and approximately 1.5 million deaths were a result of TB. Tuberculosis is an airborne infection which can be spread through the air from an infected individuals cough, sneeze, or speech. Individuals infected with TB can either have latent or active stage. Latent TB is when an individual becomes infected …

Congenital Cytomegalovirus (Cmv), Patty Fleming

Nursing Student Class Projects (Formerly MSN)

Cytomegalovirus (CMV) is a common herpes virus infection that is usually harmless and belongs to a group of herpes viruses that includes the herpes simplex viruses, varicella-zoster virus (which causes chickenpox and shingles), and the Epstein-Barr virus (which causes infectious mononucleosis). Once CMV is in a person's body, it stays there throughout their life. (Centers for Disease Control and Prevention, 2010). CMV is shed in various bodily secretions, especially urine and saliva (Congenital Cytomegalovirus Foundation, 2014). According to the Centers for Disease Control and Prevention (CDC), the majority of otherwise healthy children and adults infected with CMV are asymptomatic while …

Implications Of Underlying Pathophysiology Of Osteomyelitis In Diabetics For Nursing Care, Danielle Spencer

Nursing Student Class Projects (Formerly MSN)

Osteomyelitis is an infection of the bone caused by either bacteria, fungi, parasites, viruses or mycobacteria (McCance, et. al., 2014). The infection can enter bone either through an outside source or through the blood from a blood borne infection (McCance, et. al., 2014). The most common bacteria involved with osteomyelitis is Staphylococcus aureus (Hatzenbuehler & Pulling, 2011, p. 1027). Recently, at Dublin Methodist Hospital there has been an increase in the number of osteomyelitis cases in chronic uncontrolled diabetic patients requiring below the knee amputations. Two of the cases specifically were linked to chronic diabetic foot ulcers. Each of these …

Clostridium Difficile, Kristen Johnson

Nursing Student Class Projects (Formerly MSN)

Clostridium difficile (CD) is an infectious disease that has a direct impact on our healthcare resources. “Clostridium difficile, an anaerobic, spore forming, toxin-forming, gram-positive bacillus, has become the leading cause of health care—associated infectious diarrhea (Walters & Zuckerbraun, 2014, p. 329).” I chose this topic because CD is a hypervirulent organism that is not only affecting hospitalized patients but is now emerging as a community acquired infection. Healthcare treatments and costs are on the rise due to persistent and recurrent CD infections. Understanding the pathogenesis, risk factors, diagnostic testing, and management strategies are important in reducing the spread of CD …

Levels Of 8-Oxodg Predict Hepatobiliary Pathology In Opisthorchis Viverrini Endemic Settings In Thailand., Prasert Saichua, Anna Yakovleva, Christine Kamamia, Amar R. Jariwala, Paul J. Brindley, Jeffrey M. Bethony, + 8 More

Microbiology, Immunology, and Tropical Medicine Faculty Publications

Opisthorchis viverrini is distinct among helminth infections as it drives a chronic inflammatory response in the intrahepatic bile duct that progresses from advanced periductal fibrosis (APF) to cholangiocarcinoma (CCA). Extensive research shows that oxidative stress (OS) plays a critical role in the transition from chronic O. viverrini infection to CCA. OS also results in the excision of a modified DNA lesion (8-oxodG) into urine, the levels of which can be detected by immunoassay. Herein, we measured concentrations of urine 8-oxodG by immunoassay from the following four groups in the Khon Kaen Cancer Cohort study: (1) O. viverrini negative individuals, (2) …

Noroviruses As A Cause Of Diarrhea In Immunocompromised Pediatric Hematopoietic Stem Cell And Solid Organ Transplant Recipients, X. Ye, J. N. Van, F. M. Munoz, P. A. Revell, Claudia A. Korinetz, R. A. Krance, R. L. Atmar, M. K. Estes, H. L. Koo

ETSU Faculty Works

Case reports describe significant norovirus gastroenteritis morbidity in immunocompromised patients. We evaluated norovirus pathogenesis in prospectively enrolled solid organ (SOT) and hematopoietic stem cell transplant (HSCT) patients with diarrhea who presented to Texas Children's Hospital and submitted stool for enteric testing. Noroviruses were detected by real-time reverse transcription polymerase chain reaction. Clinical outcomes of norovirus diarrhea and non-norovirus diarrhea patients, matched by transplanted organ type, were compared. Norovirus infection was identified in 25 (22%) of 116 patients, more frequently than other enteropathogens. Fifty percent of norovirus patients experienced diarrhea lasting ≥14 days, with median duration of 12.5 days (range 1–324 …

Effects Of Antiretroviral Therapy On Kaposi’S Sarcoma–Associated Herpesvirus (Kshv) Transmission Among Hiv-Infected Zambian Children, Landon Olp, Veenu Minhas, Clement Gondwe, Chipepo Kankasa, Janet M. Wojcicki, Charles Mitchell, John T. West, Charles Wood

Nebraska Center for Virology: Faculty Publications

Background: The risk of Kaposi’s sarcoma–associated herpesvirus (KSHV) acquisition among children is increased by HIV infection. Antiretroviral therapy (ART) was recently made widely available to HIV-infected children in Zambia. However, the impact of early ART on KSHV transmission to HIV-infected children is unknown.

Methods: We enrolled and followed a cohort of 287 HIV-exposed, KSHV-negative children under 12 months of age from Lusaka, Zambia, to identify KSHV seroconversion events. Potential factors associated with KSHV infection—with an emphasis on HIV, ART, and immunological measures—were assessed through structured questionnaires and blood analyses. Incidence rate, Kaplan- Meier, and multivariable Cox regression models were used …

A Combination Sms And Transportation Reimbursement Intervention To Improve Hiv Care Following Abnormal Cd4 Test Results In Rural Uganda: A Prospective Observational Cohort Study, Mark J. Siedner, Data Santorino, Alexander J. Lankowski, Michael Kanyesigye, Mwebesa B. Bwana, Jessica E. Haberer, David R. Bangsberg

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Up to 50 % of HIV-infected persons in sub-Saharan Africa are lost from care between HIV diagnosis and antiretroviral therapy (ART) initiation. Structural barriers, including cost of transportation to clinic and poor communication systems, are major contributors.

Methods: We conducted a prospective, pragmatic, before-and-after clinical trial to evaluate a combination mobile health and transportation reimbursement intervention to improve care at a publicly operated HIV clinic in Uganda. Patients undergoing CD4 count testing were enrolled, and clinicians selected a result threshold that would prompt early return for ART initiation or further care. Participants enrolled in the pre-intervention period (January – …

Obesity Early In Adulthood Increases Risk But Does Not Affect Outcomes Of Hepatocellular Carcinoma, Manal M. Hassan, Reham Abdel-Wahab, Ahmed Kaseb, Ahmed Shalaby, Alexandria Phan, Hashem El-Serag, Ernest Hawk, Jeff Morris, Kanwal Pratap Singh Raghav, Ju-Seog Lee, Jean-Nicolas Vauthey, Gehan Bortus, Harrys Torres, Christopher Amos, Robert Wolff, Donghui Li

Dartmouth Scholarship

Despite the significant association between obesity and several cancers, it has been difficult to establish an association between obesity and hepatocellular carcinoma (HCC). Patients with HCC often have ascites, making it a challenge to accurately determine body mass index (BMI), and many factors contribute to the development of HCC. We performed a case–control study to investigate whether obesity early in adulthood affects risk, age of onset, or outcomes of patients with HCC.

Inhaled Nitric Oxide As An Adjunctive Treatment For Cerebral Malaria In Children: A Phase Ii Randomized Open-Label Clinical Trial, Juliet Mwanga-Amumpaire, Ryan W. Carroll, Elisabeth Baudin, Elisabeth Kemigisha, Dorah Nampijjah, Kenneth Mworozi, Data Santorino, Dan Nyehangane, Daniel I. Nathan, Pierre De Beaudrap, Jean-Francois Etard, Martin Feelish, Bernadette O. Fernandez, Annie Berssenbrugge, David Bangsberg, Kenneth D. Bloch, Yap Boum Ii, Warren M. Zapol

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background. Children with cerebral malaria (CM) have high rates of mortality and neurologic sequelae. Nitric oxide (NO) metabolite levels in plasma and urine are reduced in CM.

Methods. This randomized trial assessed the efficacy of inhaled NO versus nitrogen (N2) as an adjunctive treatment for CM patients receiving intravenous artesunate.We hypothesized that patients treated with NO would have a greater increase of the malaria biomarker, plasma angiopoietin-1 (Ang-1) after 48 hours of treatment.

Results. Ninety-two children with CM were randomized to receive either inhaled 80 part per million NO or N₂ for 48 or more hours. Plasma Ang-1 levels …

A Cysteine Zipper Stabilizes A Pre-Fusion F Glycoprotein Vaccine For Respiratory Syncytial Virus, Guillaume B. E. Stewart-Jones, Paul V. Thomas, Man Chen, Aliaksandr Druz, Gordon M. Joyce, Wing-Pui Kong, Mallika Sastry, Conque Soto, Yongping Yang, Baoshan Zhang, Lei Chen, Gwo-Yu Chuang, Ivelin S. Georgiev, Jason S. Mclellan

Dartmouth Scholarship

Recombinant subunit vaccines should contain minimal non-pathogen motifs to reduce potential off-target reactivity. We recently developed a vaccine antigen against respiratory syncytial virus (RSV), which comprised the fusion (F) glycoprotein stabilized in its pre-fusion trimeric conformation by “DS-Cav1” mutations and by an appended C-terminal trimerization motif or “foldon” from T4-bacteriophage fibritin. Here we investigate the creation of a cyste- ine zipper to allow for the removal of the phage foldon, while maintaining the immunogenic- ity of the parent DS-Cav1+foldon antigen. Constructs without foldon yielded RSV F monomers, and enzymatic removal of the phage foldon from pre-fusion F trimers resulted in …

Middle East Respiratory Syndrome: A Global Health Challenge, Lawrence O. Gostin, Daniel Lucey

Georgetown Law Faculty Publications and Other Works

Beginning in May 2015, Middle-East respiratory syndrome (MERS) experienced its first publicly reported “super-spreading” event in South Korea. By mid-June, more than 120 cases and 11 deaths in South Korea had been linked to a businessman returning from travel to Bahrain, United Arab Emirates, the Kingdom of Saudi Arabia and Qatar. Globally more than 1200 had been infected of whom more than 450 died—a high fatality rate of 37%.

What are the most effective legal, social, and public health responses to MERS and other emerging diseases? First, the World Health Organization’s International Health Regulations (IHR) did not effectively guide the …

Evolution And Otitis Media: A Review, And A Model To Explain High Prevalence In Indigenous Populations, Mahmood F. Bhutta

Human Biology Open Access Pre-Prints

Inflammation of the middle ear (otitis media) comprises a group of disorders that are highly prevalent in childhood, and indeed are amongst the most common disorders of childhood. Otitis media is also heritable, and has effects on fecundity. This means that otitis media is subject to evolution, yet the evolutionary selection forces that may determine susceptibility to otitis media have never been adequately explored.

Here I undertake a critical analysis of evolutionary forces that may determine susceptibility to middle ear inflammation. These forces include those determining function of the middle ear, those affecting host immunity, and those affecting colonization by, …

Cronobacter Sakazakii Bacteremia In A 76-Year-Old Woman: A Case Report, Amy Y. Kang, Nancy Garcia, Bhanu Sud, Lee Nguyen

Pharmacy Faculty Articles and Research

Cronobacter sakazakii, commonly found in contaminated infant formula and thereby causes infantile bacteremia, is rarely associated with adult bacteremia. We present the tenth case of C. sakazakii bacteremia in adults. The patient is a 76-year-old woman who resides in a skilled nursing facility and presents with risk factors including bullous pemphigoid, Type II diabetes mellitus, hypertension, hyperlipidemia, chronic kidney disease, and anemia. The therapy was started with intravenous ciprofloxacin and vancomycinempirically. After consultation with an Infectious Diseases specialist, ciprofloxacin and vancomycin was replaced with meropenem based on the patient’s extensive bullous lesions, history of ESBL infections, and possible pneumonia. Later, …

Draft Genome Sequences Of Six Different Staphylococcus Epidermidis Clones, Isolated Individually From Preterm Neonates Presenting With Sepsis At Edinburgh's Royal Infirmary, Paul Walsh, M. Bekaert, J. Carroll, T. Manning, B. Kelly, A. O'Driscoll, X. Lu, C. Smith, P. Dickinson, K. Templeton, P. Ghazal, Roy D. Sleator

Department of Biological Sciences Publications

Herein, we report the draft genome sequences of six individual Staphylococcus epidermidis clones, cultivated from blood taken from different preterm neonatal sepsis patients at the Royal Infirmary, Edinburgh, Scotland, United Kingdom.

The Medical Response To The Black Death, Joseph A. Legan

Senior Honors Projects, 2010-2019

This paper discusses the medical response to the Black Death in both Europe and the Middle East. The Black Death was caused by a series of bacterial strands collectively known as Yersinia pestis. The Plague originated in the Mongolian Steppes. It was spread westward by the east-west trading system. Once it arrived in the Crimea in 1346, Italian merchants helped spread it throughout the Mediterranean. Medicine in Europe and the Middle East were centered on Galen’s theory of humors. There were many religious explanations for the Plague, but the main medical explanation was the spread of bad air, or …