Digital Commons Network^™

Epidemiology And Outcomes Of Candidemia In 2019 Patients: Data From The Prospective Antifungal Therapy Alliance Registry., David L Horn, Dionissios Neofytos, Elias J Anaissie, Jay A Fishman, William J Steinbach, Ali J Olyaei, Kieren A Marr, Michael A Pfaller, Chi-Hsing Chang, Karen M Webster

Jefferson Hospital Staff Papers and Presentations

BACKGROUND: Candidemia remains a major cause of morbidity and mortality in the health care setting, and the epidemiology of Candida infection is changing.

METHODS: Clinical data from patients with candidemia were extracted from the Prospective Antifungal Therapy (PATH) Alliance database, a comprehensive registry that collects information regarding invasive fungal infections. A total of 2019 patients, enrolled from 1 July 2004 through 5 March 2008, were identified. Data regarding the candidemia episode were analyzed, including the specific fungal species and patient survival at 12 weeks after diagnosis.

RESULTS: The incidence of candidemia caused by non-Candida albicans Candida species (54.4%) was higher …

Kinetics And Phenotype Of Vaccine-Induced Cd8+ T-Cell Responses To Toxoplasma Gondii, Kimberly A. Jordan, Emma H. Wilson, Elia D. Tait, Barbara A. Fox, David S. Roos, David J. Bzik

Dartmouth Scholarship

Multiple studies have established that the ability of CD8⁺ T cells to act as cytolytic effectors and produce gamma interferon is important in mediating resistance to the intracellular parasite Toxoplasma gondii. To better understand the generation of the antigen-specific CD8⁺ T-cell responses induced by T. gondii, mice were immunized with replication-deficient parasites that express the model antigen ovalbumin (OVA). Class I tetramers specific for SIINFEKL were used to track the OVA-specific endogenous CD8⁺ T cells. The peak CD8⁺ T-cell response was found at day 10 postimmunization, after which the frequency and numbers of antigen-specific cells …

Tuberculosis In San Bernardino County, 1993-2004 : Lifestyle And Environmental Factors, Anuj Bhatia

Loma Linda University Electronic Theses, Dissertations & Projects

An observational retrospective study was conducted for tuberculosis (TB) cases between San Bernardino County (SBC), Riverside County, and the state of California from 1996 to 2004. A univariate comparison between San Bernardino County and California indicated a higher proportion of U.S. born cases in SBC. Additionally, it was found that San Bernardino had a higher proportion of non-injection drug using TB cases, compared with California in 1996. Further comparisons were made along country of birth between TB cases in San Bernardino County from 1993 to 2004. Notable differences were observed for injection drug use, non injection drug use, alcohol abuse, …

Outbreak Of Dengue Fever In Karachi 2006: A Clinical Perspective, Muhammad Mehmood Riaz, Khalid Mumtaz, Muhammad Shoaib Khan, Junaid Patel, M. Tariq, Harith Hilal, Shaheryar Ahmed Siddiqui, Farrukh Shezad

Section of Internal Medicine

OBJECTIVE: This study reports clinical manifestations and spectrum of severity of dengue fever (DF), dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS) in adult patients admitted during 2006 outbreak in Karachi. A rough estimation of cost of care was also calculated.

METHODS: A cross-sectional study was done at a tertiary care hospital in Karachi from January to December 2006. Patients suspected of having DF with positive dengue IgM antibodies were included and records were reviewed. Patients were divided into DF, DHF and DSS as per WHO classification, and the severity of clinical manifestations was determined.

RESULTS: A total of …

Prion Protein Glycosylation Is Not Required For Strain-Specific Neurotropism, Justin R. Piro, Brent T. Harris, Koren Nishina, Claudio Soto, Rodrigo Morales, Judy R. Rees, Surachai Supattapone

Dartmouth Scholarship

In this study, we tested the hypothesis that the glycosylation of the pathogenic isoform of the prion protein (PrP^Sc) might encode the selective neurotropism of prion strains. We prepared unglycosylated cellular prion protein (PrP^C) substrate molecules from normal mouse brain by treatment with PNGase F and used reconstituted serial protein cyclic misfolding amplification reactions to produce RML and 301C mouse prions containing unglycosylated PrP^Sc molecules. Both RML- and 301C-derived prions containing unglycosylated PrP^Sc molecules were infectious to wild-type mice, and neuropathological analysis showed that mice inoculated with these samples maintained strain-specific patterns of PrP …

Intravenous Inoculation Of A Bat-Associated Rabies Virus Causes Lethal Encephalopathy In Mice Through Invasion Of The Brain Via Neurosecretory Hypothalamic Fibers., Mirjam A R Preuss, Marie-Luise Faber, Gene S Tan, Michael Bette, Bernhard Dietzschold, Eberhard Weihe, Matthias J Schnell

Department of Microbiology and Immunology Faculty Papers

The majority of rabies virus (RV) infections are caused by bites or scratches from rabid carnivores or bats. Usually, RV utilizes the retrograde transport within the neuronal network to spread from the infection site to the central nervous system (CNS) where it replicates in neuronal somata and infects other neurons via trans-synaptic spread. We speculate that in addition to the neuronal transport of the virus, hematogenous spread from the site of infection directly to the brain after accidental spill over into the vascular system might represent an alternative way for RV to invade the CNS. So far, it is unknown …

Impact Of Infection Control Activities On The Rate Of Needle Stick Injuries At A Tertiary Care Hospital Of Pakistan Over A Period Of Six Years: An Observational Study., Afia Zafar, Faiza Habib, Roshan Hadwani, Muslima Ejaz, Khurshid Khowaja, Rozina Khowaja, Seema Irfan

Department of Pathology and Laboratory Medicine

Background:Accidental exposure to blood and body fluids is frequent among health care workers. They are at high risk of nosocomial transmission of blood borne pathogens due to injuries caused by used sharps. We are reporting impact of surveillance and educational program on the rate of needle stick injuries among health care workers at a tertiary care hospital in Pakistan.

Methods:

At Aga Khan University Hospital sharp injuries are reported to infection control office. To reduce these incidents a quality improvement project was inducted in the year 2005. Health care workers were educated, surveillance data from 2002 to 2007 was …

Hiv Policy: The Path Forward--A Joint Position Paper Of The Hiv Medicine Association Of The Infectious Diseases Society Of America And The American College Of Physicians., Christine Lubinski, Judith Aberg, Arlene D Bardeguez, Richard Elion, Patricia Emmanuel, Daniel Kuritzkes, Michael Saag, Kathleen E Squires, Andrea Weddle, Jennifer Rainey, M Renee Zerehi, J Fred Ralston, David A Fleming, David Bronson, Molly Cooke, Charles Cutler, Yul Ejnes, Robert Gluckman, Mark Liebow, Kenneth Musana, Mark E Mayer, Mark W Purtle, P Preston Reynolds, Lavanya Viswanathan, Kevin B Weiss, Baligh Yehia

Department of Medicine Faculty Papers

Executive Summary

The American College of Physicians (ACP) and the Infectious Diseases Society of America (IDSA) have jointly published 3 policy statements on AIDS, the first in 1986 [1], the second in 1988 [2], and the third in 1994 [3]. In 2001, the IDSA created the HIV Medicine Association (HIVMA), and this updated policy paper is a collaboration between the ACP and the HIVMA of the IDSA. Since the last statement, many new developments call for the need to reexamine and update our policies relating to HIV infection. First, there have been major advances …

A Case Study On Using The Via Christi Breastfeeding Assessment Tool In A Clinical Setting, Rouba Taha

Honors Scholar Theses

Aims- The goal of this study is to obtain a subjective point of view of the use, benefits, and shortcomings of the Via Christi breastfeeding Assessment Tool in a clinical setting.

Methods- This case study is based on a single yet detailed interview with a lactation consultant who has utilized the Via Christi Breastfeeding Tool in a clinical setting.

Findings- Advantages of the Via Christi Breastfeeding Assessment Tool include that the tool is practical and concrete, encompassing both a subjective dimension and the basic elements of breastfeeding. Shortcomings of the tool include its non-specificity in focus on the feeding technique …

A Novel Codon Insert In Protease Of Clade B Hiv Type 1., Parris S Jordan, Art Poon, Joseph Eron, Kathleen Squires, Caroline Ignacio, Douglas D Richman, Davey M Smith

Division of Infectious Diseases and Environmental Medicine Faculty Papers

A novel combination of three codon inserts in the pol coding region of HIV-1 RNA was identified in a highly antiretroviral experienced study subject with HIV-1 infection. A one codon insert was observed in the protease region between codon 40 and 41 simultaneously with a two codon insert present in the reverse transcriptase region at codon 69.

Vital Signs, Spring/Summer 2009, Boonshoft School Of Medicine

Vital Signs

A fifty-six page newsletter created by the Boonshoft School of Medicine to document the current affairs of the school. This issue includes a variety of feature articles and smaller pieces that focus on faculty, students, milestones and more.

The Physician's Response To Climate Change., Mona Sarfaty, Safiya Abouzaid

Department of Family & Community Medicine Faculty Papers

Climate change will have an effect on the health and well-being of the populations cared for by practicing physicians. The anticipated medical effects include heat- and cold-related deaths, cardiovascular illnesses, injuries and mental harms from extreme weather events, respiratory illnesses caused by poor air quality, infectious diseases that emanate from contaminated food, water, or spread of disease vectors, the injuries caused by natural disasters, and the mental harm associated with social disruption. Within several years, such medical problems are likely to reach the doorsteps of many physicians. In the face of this reality, physicians should assume their traditional roles as …

Training Tomorrow’S Providers And Expanding Access To Peginterferon/Ribavirin Combination Therapyfor Chronic Hepatatis C In Underinsured/Uninsured Patients: Final Outcomes Of A Pilot, Resident-Initiated, Multidisciplinary, Hepatitis C Clinic, Nicole M. Agostino Do, Suzanne J. Templer Do, Edward Norris Md, Fapm, Charles M. Brooks Md, Eric J. Gertner Md, Mph, Joseph L. Yozviak Do, Facp

Department of Medicine

No abstract provided.

Defining An Emerging Epidemic: Hcv Seroprevalence In A Large, Tertiary-Care Health Network In Pennsylvania, Margaret Hoffman-Terry Md, Facp, Joseph L. Yozviak Do, Facp, K Nadeem Ahmed Md, Sherrine Eid Mph, Timothy J. Friel Md, Kimberly A. Pacella, Luther Rhodes Iii Md

Department of Medicine

No abstract provided.

Esat6-Induced Ifngamma And Cxcl9 Can Differentiate Severity Of Tuberculosis., Zahra Hasan, Bushra Jamil, Mussarat Ashraf, Muniba Islam, Muhammad S Yusuf, Javaid A Khan, Rabia Hussain

Department of Pathology and Laboratory Medicine

Background: Protective responses against Mycobacterium tuberculosis are dependent on appropriate T cell and macrophage activation. Mycobacterial antigen six kDa early secreted antigenic target (ESAT6) and culture filtrate protein 10 (CFP10) can detect M. tuberculosis specific IFNgamma responses. However, most studies have been performed in non-endemic regions and to study pulmonary tuberculosis (PTB). We have studied ESAT6 and CFP10 induced cytokine and chemokines responses in PTB and extrapulmonary (EPul) TB.
Methodology: IFNgamma, IL10, CXCL9 and CCL2 responses were determined using an ex vivo whole blood assay system in PTB (n = 30) and EPulTB Patients with limited (LNTB, n = …

Overview Of Surgical Management Of Infectious Non-Suppurative Brain Lesions (Part 1), Muhammad Shahzad Shamim, Ather Enam, Rushna Pervez Ali, Syed Faizan Ali, Mohammad Wasay

Section of Neurosurgery

No abstract provided.

Associated Symptoms In The Ten Days Before Diagnosis Of Kawasaki Disease., Annette L. Baker, Minmin Lu, L Luann Minich, Andrew M. Atz, Gloria L. Klein, Rosalind Korsin, Linda Lambert, Jennifer S. Li, Wilbert Mason, Elizabeth Radojewski, Victoria L. Vetter, Jane W. Newburger, Pediatric Heart Network Investigators, Girish S. Shirali

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: To describe common associated symptoms within the 10 days before diagnosis in subjects enrolled in the Pediatric Heart Network's trial of steroid therapy in Kawasaki disease (KD).

STUDY DESIGN: Patients with acute KD were enrolled between days 4 and 10 of illness at 8 centers between 2002 and 2004. We defined common associated symptoms as those occurring in >or=10% of patients. Principal clinical criteria for KD were not included in this analysis.

RESULTS: Among 198 patients, irritability was reported in 98 (50%), vomiting in 88 (44%), decreased food/fluid intake in 73 (37%), cough in 55 (28%), diarrhea in 52 …

Antiretroviral Therapy Dose Adjustments Based On Calculated Creatinine Clearance, J. Shavadia, G. Tesfaldet, Majid Twahir

Internal Medicine, East Africa

Background: Whereas therapy for HIV is dependent on level of creatinine clearance, most laboratories locally only report an absolute creatinine value. There is likelihood that the patients already on antiretroviral therapy (ART) may have required dosage adjustment at the time of initiation of therapy or sometime during ongoing therapy. This paper explores a group of patients who are already on ART to determine their creatinine clearance and assess the need for ART dose adjustment.

Objective: To determine the proportion of stable HIV outpatients who have a documented creatinine clearance (CrCI) and the proportion requiring antiretroviral drug dose adjustments depending on …

Vih Y Alcohol En Arica, Chile: Percepciones De Portadores Y Profesionales, Lena Sessions

Independent Study Project (ISP) Collection

This paper investigated the relationship between alcohol consumption and HIV in Arica, Chile. The objectives of this investigation were to understand the demographics of HIV positive Ariqueños who consume alcohol, and understand their perceptions of alcohol consumption with respect to whether they believed they had a drinking problem, whether they believed that the consumption of alcohol facilitated their contracting HIV, and whether the consumption of alcohol affected their treatment. Although there is no literature that specifically addresses the topic of how HIV positive individuals who consume alcohol perceive their disease, former research suggests that a significant number (25-50%) of individuals …

Long-Distance Delivery Of Bacterial Virulence Factors By Pseudomonas Aeruginosa Outer Membrane Vesicles, Jennifer M. Bomberger, Daniel P. Maceachran, Bonita A. Coutermarsh, Siying Ye, George A. O'Toole, Bruce A. Stanton, Frederick M. Ausubel

Dartmouth Scholarship

Bacteria use a variety of secreted virulence factors to manipulate host cells, thereby causing significant morbidity and mortality. We report a mechanism for the long-distance delivery of multiple bacterial virulence factors, simultaneously and directly into the host cell cytoplasm, thus obviating the need for direct interaction of the pathogen with the host cell to cause cytotoxicity. We show that outer membrane–derived vesicles (OMV) secreted by the opportunistic human pathogen Pseudomonas aeruginosa deliver multiple virulence factors, including β-lactamase, alkaline phosphatase, hemolytic phospholipase C, and Cif, directly into the host cytoplasm via fusion of OMV with lipid rafts in the host plasma …

Comparison Of Replication-Competent, First Generation, And Helper-Dependent Adenoviral Vaccines, Eric A. Weaver, Pramod N. Nehete, Stephanie S. Buchl, Julien S. Senac, Donna Palmer, Philip Ng, K. Jagannadha Sastry, Michael A. Barry

Nebraska Center for Virology: Faculty Publications

All studies using human serotype 5 Adenovirus (Ad) vectors must address two major obstacles: safety and the presence of pre-existing neutralizing antibodies. Helper-Dependent (HD) Ads have been proposed as alternative vectors for gene therapy and vaccine development because they have an improved safety profile. To evaluate the potential of HD-Ad vaccines, we compared replication-competent (RC), first-generation (FG) and HD vectors for their ability to induce immune responses in mice. We show that RC-Ad5 and HD-Ad5 vectors generate stronger immune responses than FG-Ad5 vectors. HD-Ad5 vectors gave lower side effects than RC or FG-Ad, producing lower levels of tissue damage and …

Smoking Enhances Risk For New External Genital Warts In Men, Dorothy J. Wiley, David Elashoff, Emmanuel V. Masongsong, Diane M. Harper

Dartmouth Scholarship

Repeat episodes of HPV-related external genital warts reflect recurring or new infections. No study before has been sufficiently powered to delineate how tobacco use, prior history of EGWs and HIV infection affect the risk for new EGWs. Behavioral, laboratory and examination data for 2,835 Multicenter AIDS Cohort Study participants examined at 21,519 semi-annual visits were evaluated. Fourteen percent (391/2835) of men reported or were diagnosed with EGWs at 3% (675/21,519) of study visits. Multivariate analyses showed smoking, prior episodes of EGWs, HIV infection and CD4+ T-lymphocyte count among the infected, each differentially influenced the risk for new EGWs.

Living In Rural New England Amplifies The Risk Of Depression In Patients With Hiv, Siddharth H. Sheth, Paul T. Jensen, Timothy Lahey

Dartmouth Scholarship

The importance of depression as a complication of HIV infection is increasingly understood, and people living in rural areas are at increased risk for depression. However, it is not known whether living in rural areas amplifies the risk of depression in patients with HIV. We compared the prevalence of depression between rural and metropolitan HIV patients seen at the Dartmouth-Hitchcock HIV Program in a retrospective cohort study. Using the validated Rural-Urban Commuting Area Score, we categorized patients as living in small town/rural areas, micropolitan or metropolitan towns. Then, using a multivariate logistic regression model to adjust for demographic factors that …

Recent Trends In Soft-Tissue Infection Imaging., Nicholas Petruzzi, Md, Nylla Shanthly, Mbbs, Drm, Mathew L. Thakur, Phd

Department of Radiation Oncology Faculty Papers

This article discusses the current techniques and future directions of infection imaging with particular attention to respiratory, central nervous system, abdominal, and postoperative infections. The agents currently in use localize to areas of infection and inflammation. An infection-specific imaging agent would greatly improve the utility of scintigraphy in imaging occult infections. The superior spatial resolution of (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG-PET) and its lack of reliance on a functional immune system, gives this agent certain advantages over the other radiopharmaceuticals. In respiratory tract infection imaging, an important advancement would be the ability to quantitatively delineate lung inflammation, allowing one to …

Characterization Of Babies Discharged From Cabell Huntington Hospital During The Calendar Year 2005 With The Diagnoses Of Neonatal Abstinence Syndrome, F. Ross Baxter Md, Robert Nerhood Md, David Chaffin Md

Family and Community Health

Recent concern regarding the impact of maternal drug abuse on neonatal well-being was the impetus for this retrospective cohort study of newborns diagnosed with neonatal abstinence syndrome that were discharged from Cabell Huntington Hospital during the calendar year 2005. Medical records of the neonates and their mothers were analyzed for a variety of health related outcomes and healthcare cost. Forty-eight neonates were diagnosed with Neonatal Abstinence Syndrome in 2005, forty of which required NICU assistance. The average maternal age at delivery was 26; gravity was 3.1 and most were single, separated or divorced. The majority had poor or inconsistent prenatal …

Detection Of Viruses In Human Adenoid Tissues By Use Of Multiplex Pcr, Masatoki Sato, Haijing Li, Mine R. Ikizler, Jay A. Werkhaven, John V. Williams, James D. Chappell, Yi-Wei Tang, Peter F. Wright

Dartmouth Scholarship

By PCR, we detected a high frequency of viruses in adenoids obtained from children without acute respiratory symptoms. Our results suggest that persistent/latent viral infection in the respiratory tract confounds interpretation of the association of pathogen detection by PCR with acute respiratory infection in these sources.

From Genome-Based In Silico Predictions To Ex Vivo Verification Of Leprosy Diagnosis, Annemieke Geluk, John S. Spencer, Kidist Bobosha, Maria C. V. Pessolani, Geraldo M. B. Pereira, Sayera Banu, Nadine Honore, Stephen T. Reece, Murdo Macdonald, Bishwa Raj Sapkota, Chaman Ranjit, Kees L. M. C. Franken, Martha Zewdie, Abraham Aseffa, Rabia Hussain, Mariane M. Stefani, Sang-Nae Cho, Linda Oskam, Patrick J. Brennan, Hazel M. Dockrell

Department of Pathology and Laboratory Medicine

The detection of hundreds of thousands of new cases of leprosy every year suggests that transmission of Mycobacterium leprae infection still continues. Unfortunately, tools for identification of asymptomatic disease and/or early-stage M. leprae infection (likely sources of transmission) are lacking. The recent identification of M. leprae-unique genes has allowed the analysis of human T-cell responses to novel M. leprae antigens. Antigens with the most-promising diagnostic potential were tested for their ability to induce cytokine secretion by using peripheral blood mononuclear cells from leprosy Patients and controls in five different areas where leprosy is endemic, 246 individuals from Brazil, Nepal, Bangladesh, …

Dengue Fever With Hepatitis E And Hepatitis A Infection, Javed Yakoob, Wasim Jafri, Shaheer Siddiqui, Mehmood Riaz

Section of Gastroenterology

Infection with dengue viruses produces a spectrum of clinical illness ranging from a nonspecific viral syndrome to severe and fatal haemorrhagic disease. Important risk factors include the strain and serotype of the infecting virus, as well as the age, immune status, and genetic predisposition of the patient. The teaching point in this case study was Dengue fever which occurred concomitantly with Hepatitis A and Hepatitis E virus infection.

Antibiotic Resistance In Staphylococcus Aureus-Containing Cutaneous Abscesses Of Patients With Hiv, Gus W Krucke, Deanna E Grimes, Richard M Grimes, Thai D Dang

Faculty, Staff and Student Publications

PURPOSE: The aim of this study was to document the resistance patterns found in exudates from cutaneous abscesses of HIV-infected persons.

BASIC PROCEDURES: Patient records were reviewed on 93 culture and sensitivity tests performed on exudates taken from incised and drained abscesses of HIV-infected persons.

MAIN FINDINGS: Of the specimens, 84.6% were Staphylococcus aureus. Of these, 93.5% were penicillin resistant, 87% oxacillin resistant, 84.4% cephazolin resistant, 84.4% erythromycin resistant, 52.2% ciprofloxacin resistant, and 15.6% tetracycline resistant. Fifty-eight specimens were tested for clindamycin with 29.3% found resistant; 85.7% were methicillin-resistant S aureus (MRSA) (defined as resistant to both penicillin G and …

Interconnections Between Sigma B, Agr, And Proteolytic Activity In Staphylococcus Aureus Biofilm Maturation, Katherine J. Lauderdale, Blaise R. Boles, Ambrose L. Cheung, Alexander R. Horswill

Dartmouth Scholarship

Staphylococcus aureus is a proficient biofilm former on host tissues and medical implants. We mutagenized S. aureus strain SH1000 to identify loci essential for ica-independent mechanisms of biofilm maturation and identified multiple insertions in the rsbUVW-sigB operon. Following construction and characterization of a sigB deletion, we determined that the biofilm phenotype was due to a lack of sigma factor B (SigB) activity. The phenotype was conserved in a sigB mutant of USA300 strain LAC, a well-studied community-associated methicillin-resistant S. aureus isolate. We determined that agr RNAIII levels were elevated in the sigB mutants, and high levels of RNAIII expression are …