Bacterial Infections and Mycoses Commons^™

Zoliflodacin Versus Ceftriaxone Plus Azithromycin For Treatment Of Uncomplicated Urogenital Gonorrhoea: An International, Randomised, Controlled, Open-Label, Phase 3, Non-Inferiority Clinical Trial, Alison Luckey, Manica Balasegaram, Lindley A. Barbee, Teresa A. Batteiger, Helen Broadhurst, Stephanie E. Cohen, Sinead Delany-Moretlwe, Henry J.C. De Vries, Jodie A. Dionne, Katherine Gill, Chris Kenyon, Rossaphorn Kittiyaowamarn, Drew Lewis, John P. Mueller, Vimla Naicker, Seamus O'Brien, John P. O'Donnell, Nittaya Phanuphak, Elizabeth Spooner, Subasree Srinivasan, Stephanie N. Taylor, Magnus Unemo, Zinhle Zwane, Edward W. Hook, Zoliflodacin Phase 3 Study Group

School of Medicine Faculty Publications

Background Development of new treatments for gonorrhoea is a global public health priority. We aimed to evaluate the efficacy and safety of zoliflodacin versus ceftriaxone plus azithromycin in patients with uncomplicated urogenital gonorrhoea. Methods In this phase 3, multinational, randomised, controlled, open-label, non-inferiority clinical trial, participants aged 12 years and older with clinical suspicion of uncomplicated urogenital gonorrhoea were eligible for inclusion. The trial was done in 17 outpatient clinics in Belgium, the Netherlands, South Africa, Thailand, and the USA. Participating countries with high disease prevalence were identified for participation in the study. Sites selected for participation were led by …

Temporal Trends Of A Cellular Host Response Test For Sepsis And A Comparison With Selected Biomarkers Of Inflammation And Infection, Matthew S. Berlinger, Matt Sorrells, Christopher B. Thomas, Tonya Jagneaux, James E. Walker, Jennifer Daigle, Heather Quiriarte, Youyoung Kim, Guillaume Spielmann, Debbie Robertson, Susan Park Ochsner, Gideon Avornu, Katherine Fenstermacher, Elijah James Kurien, Camille King, Adenine Cembellin-Kao, Chase Yonamine, Querino Maia, Maciej Obrebski, David N. Hager, Roya Sheybani, Henry T.K. Tse, Ajay M. Shah, Robert Scoggins, Hollis R. O’Neal, Richard Rothman

School of Medicine Faculty Publications

Sepsis, a condition characterized by immune dysregulation, is the leading cause of in-hospital mortality and requires rapid treatment. Assessing immune dysregulation has been challenging. The IntelliSep Index (ISI), a novel biomarker which leverages microfluidic deformability cytometry to assess immune activation, has been evaluated as a test for Emergency Department use but it is unclear how the signal evolves as patient condition evolves. In a 47-patient cohort with hospital stays ≤ 14 days, ISI provided a good indicator of disease progression by blinded physician review. ISI trends correlated with clinical improvement over time. During the first 12 h following presentation, ISI …

Chlamydia And Gonorrhea Infections In Genital And Extragenital Samples Among Men And Women, Kristal J. Aaron, Charlotte A. Gaydos, Edward W. Hook, Max Chernesky, Jeanne Moncada, Stephanie N. Taylor, Harold C. Wiesenfeld, Kenneth H. Mayer, Matthew R. Golden, Alexander Boutwell, Barbara Van Der Pol

School of Medicine Faculty Publications

Background For people who have anal and/or oral sex, many programs recommend genital and extragenital (defined here as anorectal and oropharyngeal) screening for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) to identify all potential sites of infection. Methods We assessed genital and extragenital CT and NG prevalence among people reporting extragenital sexual exposure. Results Among 343 gay and bisexual men who reported sex with men (GBMSM), 42 (12.2%) had CT with positivity of 3.5%, 9.3% and 1.8% in the genital, anal, and oral samples, respectively. In this same group, 55 (16.0%) had NG with positivity of 5.2%, 8.5%, and 7.6% …

Gastric Sarcina Ventriculi: A Report On Two Cases, Yaomin Chen, Yu Liu, Zhiyan Fu

School of Medicine Faculty Publications

: Sarcina ventriculi is a rare Gram-positive coccus that thrives in acidic environments such as the human stomach. It has been increasingly identified in individuals with delayed gastric emptying and has been reported in association with various gastric disorders. However, its exact pathogenic role is not fully understood and remains controversial. : We present two cases of patients, one with a small bowel obstruction and the other with epigastric pain, both diagnosed with Sarcina ventriculi infection by histological examination of gastric biopsies. The patients were managed with a combination of antibiotics and a proton pump inhibitor, resulting in symptom resolution …

From M. Chelonae To M. Immunogenum: A Rare Case Of Dual Nontuberculous Mycobacterial Infection, Ifeanyi Kingsley Uche, Nathalia Simonetti, Andrea Murina

School of Medicine Faculty Publications

No abstract provided.

The Impact Of Testosterone Therapy On The Vaginal Microbiota Of Transgender Men And Non-Binary People: A Prospective Study, Olivia T. Van Gerwen, Kristal J. Aaron, Emma Sophia Kay, Krishmita Siwakoti, Angela Pontius, Saralyn Richter, Z Alex Sherman, Keonte J. Graves, Ashutosh Tamhane, Jacob H. Elnaggar, Meng Luo, Evelyn Toh, David E. Nelson, Nicholas J. Van Wagoner, Christopher M. Taylor, Christina A. Muzny

School of Medicine Faculty Publications

BACKGROUND: Understanding the impact of testosterone on the vaginal microbiota of transgender men (TGM) and non-binary people assigned female sex at birth over time is imperative as vaginal dysbiosis and incident bacterial vaginosis (iBV) may cause bothersome genital symptoms and increase HIV/STI acquisition risk. We investigated shifts in the composition of the vaginal microbiota over time in TGM initiating testosterone for gender-affirming hormone therapy, including development of vaginal dysbiosis and iBV.

METHODS: Participants ages ≥18 years, assigned female sex at birth and reporting TGM or non-binary identity, interested in starting injectable testosterone, demonstrating optimal vaginal microbiota, with no current STI(s) …

Trichosporon Asahii And Candida Guilliermondii As A Source Of Orbital Infection In An Immunocompromised Individual, David Morcos, Kevin Hardy, Anthony Makovec, Morgan Schill, John Foxworth

School of Medicine Faculty Publications

A 47-year-old male with a history of immunosuppression and recent intensive care unit admission presented with progressive orbital swelling and pain. Blood cultures grew Trichosporon asahii and Candida guilliermondii, with matching positive cultures from peripheral and central venous samples. Given his fungemia and worsening orbital involvement, induction therapy with amphotericin B and isavuconazole was initiated. Within weeks, clinical improvement was noted, prompting a transition to long-term consolidation therapy with oral posaconazole and isavuconazole. At follow-up, the patient demonstrated sustained clinical stability with no recurrence of infection. Orbital involvement from fungemia due to T. asahii and C. guilliermondii is rare, and …

Jarisch-Herxheimer Reaction After Benzathine Penicillin G Treatment In Adults With Early Syphilis: Secondary Analysis Of A Randomized Clinical Trial., Jodie A. Dionne, Chunming Zhu, Jorge Mejia-Galvis, Kimberly Workowski, Teresa A. Batteiger, Julia C. Dombrowski, Kenneth H. Mayer, Candice J. Mcneil, Arlene C. Seña, Stephanie Taylor, Harold C. Wiesenfeld, Matthew M. Hamill, Charlotte Perlowski, Edward W. Hook Iii

School of Medicine Faculty Publications

Key Points: Question: What proportion of patients with early syphilis have symptoms of the Jarisch-Herxheimer reaction (JHR) after treatment with benzathine penicillin G, and what are the associated characteristics? Findings: This prespecified secondary analysis of a multisite US randomized clinical trial found that, among 249 adults with early syphilis, JHR symptoms occurred after benzathine penicillin G treatment in 59 participants (23.7%). Onset of JHR was within 12 hours of treatment for 86.0% of participants, and JHR was associated with successful treatment response, secondary syphilis, and absence of HIV. Meaning: This study suggests that patients treated with benzathine penicillin G for …

Understanding Orthopaedic Infections: A Conceptual Approach, Gregory Laborde, Christopher Bloise, George Karam

School of Medicine Faculty Publications

BACKGROUND: Memorizing mounds of facts without having an effective conceptual framework to store them is often an unsuccessful learning style because memory frequently fails without understanding. To accomplish this goal, we offer a framework of ideas called "concept maps". Of the many strategies for metacognition (that is, thinking about thinking), concept mapping is proven to improve meaningful and independent learning. We used this approach to guide understanding of common orthopaedic infections. This paper is not meant to serve as an approach on how to treat, but rather as a storage system with the ability to assist in understanding orthopaedic infections. …

Cabotegravir Maintains Protective Efficacy In The Setting Of Bacterial Stis: A Secondary Analysis Of Hptn 083, Meredith E. Clement, Brett Hanscom, Daniel Haines, Jose A. Bazan, Nuntisa Chotirosniramit, Ryan Kofron, Sharon Mannheimer, Kenneth H. Mayer, Mayara Secco Torres Silva, Lydia Soto-Torres, Alex R. Rinehart, James F. Rooney, A Jennings, K Gomez-Feliciano, Marybeth Mccauley, Beatriz Grinsztejn, Raphael J. Landovitz, Et Al.

School of Medicine Faculty Publications

BACKGROUND: Sexually transmitted infections (STIs) have been shown to facilitate HIV transmission and acquisition. HPTN 083, a global clinical trial, demonstrated superiority of long-acting cabotegravir (CAB-LA) versus daily oral tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) for HIV prevention among transgender women and cisgender men who have sex with men. This analysis assessed whether CAB-LA maintained protective efficacy when bacterial STIs (syphilis, rectal/urethral gonorrhea and chlamydia) were present. METHODS: STI events per 100 person-years (PY) were calculated, including by subgroups (age, race/ethnicity, gender, education, treatment arm, drug use, alcohol use, region/country, condom usage, partner number, marital status, baseline STI). Association between baseline factors …

Molecular Architecture Of Chitin And Chitosan-Dominated Cell Walls In Zygomycetous Fungal Pathogens By Solid-State Nmr, Qinghui Cheng, Malitha C. Dickwella Widanage, Jayasubba Reddy Yarava, Ankur Ankur, Jean Paul Latgé, Ping Wang, Tuo Wang

School of Medicine Faculty Publications

Zygomycetous fungal infections pose an emerging medical threat among individuals with compromised immunity and metabolic abnormalities. Our pathophysiological understanding of these infections, particularly the role of fungal cell walls in growth and immune response, remains limited. Here we conducted multidimensional solid-state NMR analysis to examine cell walls in five Mucorales species, including key mucormycosis causative agents like Rhizopus and Mucor species. We show that the rigid core of the cell wall primarily comprises highly polymorphic chitin and chitosan, with minimal quantities of β-glucans linked to a specific chitin subtype. Chitosan emerges as a pivotal molecule preserving hydration and dynamics. Some …

Streptococcus Pneumoniae Spinal Epidural Abscess In An Immunocompetent Patient, Salena Sinnasone, Michelle Blyth

School of Medicine Faculty Publications

Epidural abscesses are a rare diagnosis in immunocompetent patients. The most common risk factors linked with spinal epidural abscesses are intravenous drug use, diabetes mellitus, hepatitis, and iatrogenic factors like prior surgery and catheter usage. The thoracic and lumbar spine are the most common sites of these abscesses. Clinical presentation can include back pain, fever, and neurologic deterioration, with back pain occurring in almost two-thirds of patients. Staphylococcus aureus is the most common causative pathogen. We present a 50 male with no significant past medical or family history who presented with progressive back pain for greater than one week, chills …

A Pilot Program To Improve Tb Care With Primary And Specialty Care Coordination In Tb Public Health Clinic, Priyanka Jadhav, Gabrielle Boudoin, R Miles, Shandrica Seymour, J Parham, Amy Wolfe, Juzar Ali

School of Medicine Faculty Publications

BACKGROUND: The Wetmore Tuberculosis (TB) Clinic in New Orleans serves patients who often lack primary care (PC) or specialty care (SC), which is complicated by comorbidities. An initiative to provide on-site PC and coordinate care aims to enhance TB patient management. METHODS: Data collection involved categorizing patients based on their PC status: Group I (regular PC), Group II (intermittent PC), and Group III (no PC), with on-site Nurse Practitioner-based Bridge Care (NPBC) provided as needed. RESULTS: Over 12 months, 209 out of 354 patients required NPBC and PC/SC coordination, with a 20% shift from Group III to Group I, reducing …

Recruiting Transgender Men In The Southeastern United States For Genital Microbiome Research: Lessons Learned, Olivia Van Gerwen, Z. Alex Sherman, Emma Sophia Kay, Jay Wall, Joy Lewis, Isaac Eastlund, Keonte J. Graves, Saralyn Richter, Angela Pontius, Kristal J. Aaron, Krishmita Siwakoti, Ben Rogers, Evelyn Toh, Jacob H. Elnaggar, Christopher M. Taylor, Nicholas J. Van Wagoner, Christina A. Muzny

School of Medicine Faculty Publications

Background Transgender men (TGM) are underrepresented in genital microbiome research. Our prospective study in Birmingham, AL investigated genital microbiota changes over time in TGM initiating testosterone, including the development of incident bacterial vaginosis (iBV). Here, we present lessons learned from recruitment challenges encountered during the conduct of this study. Methods Inclusion criteria were assigned female sex at birth, TGM or non-binary identity, age ≥18 years, interested in injectable testosterone but willing to wait 7 days after enrollment before starting, and engaged with a testosterone-prescribing provider. Exclusion criteria were recent antibiotic use, HIV/STI infection, current vaginal infection, pregnancy, or past 6 …

Syphilitic Gumma Presenting As Squamous Cell Carcinoma Of Vulva: A Case Report, R.M. Nuss, A.J. Lazenby, Holly C. Provost, Tara Castellano

School of Medicine Faculty Publications

Introduction: Tertiary syphilis, a late form of the disease with neurologic, cutaneous, and cardiovascular manifestations, is rarely seen in the United States in modern times. Also called the “great imitator,” syphilis tends to mimic other disease processes, which can lead to a delay in proper diagnosis and treatment. Case: We present the case of a 59-year-old woman who presented for evaluation of possible squamous cell carcinoma of the vulva. After multiple inconclusive biopsies and extensive workup with multiple providers, she was instead found to have cutaneous and neurologic tertiary syphilis. A correct diagnosis was delayed in this patient due to …

Antimicrobial And Synergistic Effects Of Syzygium Cumini, Moringa Oleifera, And Tinospora Cordifolia Against Different Candida Infections, Adedayo O. Adelakun, Ayoola Awosika, Uzochukwu Adabanya, Adekunle E. Omole, Akinyode I. Olopoda, Emmanuel T. Bello

School of Medicine Faculty Publications

Introduction The burden of multiple drug resistance in human pathogens has necessitated the search for and development of antimicrobial agents with a wide range of structural classes and potentials to selectively act on the several mechanisms of actions exhibited by the pathogens. However, most synthetic antimicrobial agents have been linked with adverse side effects and high costs, furthering the need to explore more options. Syzygium cumini, Moringa oleifera, and Tinospora cordifolia are three medicinal plants used in traditional medicine systems for various infectious diseases. They contain various phytochemicals that exhibit antimicrobial activities against various bacteria, fungi, and parasites. The mechanisms …

Variability In Provider Assessment Of Sepsis And Potential Of Host Response Technology To Address This Dilemma—Results Of An Online Delphi Study, Chadd K. Kraus, Hollis R. O’Neal, Nathan A. Ledeboer, Todd W. Rice, Wesley H. Self, Richard E. Rothman

School of Medicine Faculty Publications

Potentially septic patients have a huge clinical and economic impact on hospitals and often present to the emergency department (ED) with undifferentiated symptoms. The triage of these patients is complex and has historically relied heavily upon provider judgment. This study aims to evaluate the consistency of provider judgment and the potential of a new host response sepsis test to aid in the triage process. A modified Delphi study involving 26 participants from multiple specialties was conducted to evaluate provider agreement about sepsis risk and to test proposed actions based on the results of a sepsis test. The participants considered case …

A Preliminary Analysis Of Vaginal Microbial Changes Prior To Incident Bacterial Vaginosis As Determined By Qpcr And Inferred Absolute Abundance, Jacob H. Elnaggar, Christopher M. Taylor, Caleb M. Ardizzone, Kristal J. Aaron, Isaac C. Eastlund, Keonte J. Graves, Meng Luo, Alison J. Quayle, Nuno Cerca, Christina A. Muzny

School of Medicine Faculty Publications

Infectious Diseases Week, IDWeek 2023, October 11 - 15, 2023, Boston, MA

Promising Changes In Antibiotic Utilization Associated With Implementation Of Rapid Multiplex Polymerase Chain Reaction Testing For Bloodstream Infection, Tat Yau, Michelle Blyth, Julio E. Figueroa Ii

School of Medicine Faculty Publications

Infectious Diseases Week, IDWeek 2023, October 11-15, 2023, Boston, MA

One Vs Three Weekly Doses Of Benzathine Penicillin G For Treatment Of Early Syphilis In Persons With And Without Hiv: A Multicenter Randomized Controlled Trial (Rct), Edward W. Hook, Kimberly Workowski, Jodie A. Dionne, Candice J. Mcneil, Stephanie N. Taylor, Batteiger Teresa, Julia C. Dombrowski, Kenneth H. Mayer, Arlene C. Seña, Harold C. Wiesenfeld, Charlotte Perlowski, Lori Newman, Chunming Zhu, Jorge E. Mejia-Galvis

School of Medicine Faculty Publications

Infectious Diseases Week, IDWeek 2023, October 11-15, 2023, Boston, MA

Bad To The Bone. Not All Bone Tumors Are Cancer: Case Of Long Bone Osteomyelitis, Tat W. Yau, Bennet D. Franz, Hanadi A. Osman, Jessica C. Rivera, Ashaur Azhar

School of Medicine Faculty Publications

Long bone osteomyelitis could mimic bony tumor in clinical presentation and imaging studies. We present a case of a 47-year man who presented with leg pain, weight loss and night sweats that initially was thought to be related to osteosarcoma, later suffered a pathologic fracture from Staphylococcus aureus osteomyelitis. This case highlights the importance of source control of infection and careful clinical evaluation including radiographic and pathologic findings that can help physicians to differentiate between competing diagnoses.

Human Alcohol-Microbiota Mice Have Increased Susceptibility To Bacterial Pneumonia, Kelly C. Cunningham, Deandra R. Smith, Daniel N. Villageliú, Christi M. Ellis, Amanda E. Ramer-Tait, Jeffrey D. Price, Todd A. Wyatt, Daren L. Knoell, Mystera M. Samuelson, Patricia E. Molina, David A. Welsh, Derrick R. Samuelson

School of Medicine Faculty Publications

Preclinical studies have shown that chronic alcohol abuse leads to alterations in the gastrointestinal microbiota that are associated with behavior changes, physiological alterations, and immunological effects. However, such studies have been limited in their ability to evaluate the direct effects of alcohol-associated dysbiosis. To address this, we developed a humanized alcohol-microbiota mouse model to systematically evaluate the immunological effects of chronic alcohol abuse mediated by intestinal dysbiosis. Germ-free mice were colonized with human fecal microbiota from individuals with high and low Alcohol Use Disorders Identification Test (AUDIT) scores and bred to produce human alcohol-associated microbiota or human control-microbiota F1 progenies. …

Outpatient Sexually Transmitted Infection Testing And Treatment Patterns In The United States: A Real-World Database Study, Rebecca Lillis, Louis Kuritzky, Zune Huynh, Rodney Arcenas, Avneet Hansra, Roma Shah, Baiyu Yang, Stephanie N. Taylor

School of Medicine Faculty Publications

Background: Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are the most common notifiable sexually transmitted infections (STIs) in the United States. Because symptoms of these infections often overlap with other urogenital infections, misdiagnosis and incorrect treatment can occur unless appropriate STI diagnostic testing is performed in clinical settings. The objective of this study was to describe STI diagnostic testing and antimicrobial treatment patterns and trends among adolescent and adult men and women with lower genitourinary tract symptoms (LGUTS). Methods: We analyzed insurance claims data from the IBM® MarketScan® Research Databases. Patients included were between 14 and 64 years old with …

Clinical Presentation And Management Of Chromoblastomycosis: A Case Report And Review, Lacey Falgout, Deborah Hilton

School of Medicine Faculty Publications

No abstract provided.

A Case Of Bartonella Vinsonii Endocarditis Of Non-Native Pulmonic Valve In A Patient With Tetralogy Of Fallot., Emily Riley, Jesus C. Jaile Iv, Sergio Bartakian

School of Medicine Faculty Publications

American College of Cardiology Conference ACC.23, March 4 - 6, 2023, New Orleans, LA

Practical Mouse Model To Investigate Therapeutics For Staphylococcus Aureus Contaminated Surgical Mesh Implants, Madison M. Collins, Brent Race, Ronald J. Messer, Chase Baune, Scott D. Kobayashi, Dan Long, Katie Williams, Aaron M. Hasenkrug, Kim Hasenkrug, Natalia Malachowa

School of Medicine Faculty Publications

Introduction: The use of prosthetic mesh in hernia repair provides a powerful tool to increase repair longevity, decrease recurrence rates, and facilitate complex abdominal wall reconstruction. Overall infection rates with mesh are low, but for those affected there is high morbidity and economic cost. The availability of a practicable small animal model would be advantageous for the preclinical testing of prophylactics, therapeutics, and new biomaterials. To this end, we have developed a novel mouse model for implantation of methicillin-resistant Staphylococcus aureus–infected surgical mesh and provide results from antibiotic and immunotherapeutic testing. Materials and Methods: Implantation of surgical mesh between fascial …

Chain-Selective Isotopic Labeling Of The Heterodimeric Type Iii Secretion Chaperone, Scc4:Scc1, Reveals The Total Structural Rearrangement Of The Chlamydia Trachomatis Bi-Functional Protein, Scc4, Thilini O. Ukwaththage, Samantha M. Keane, Li Shen, Megan A. Macnaughtan

School of Medicine Faculty Publications

Scc4 is an unusual bi-functional protein from Chlamydia trachomatis (CT) that functions as a type III secretion system (T3SS) chaperone and an RNA polymerase (RNAP)-binding protein. Both functions require interactions with protein partners during specific stages of the CT developmental cycle. As a T3SS chaperone, Scc4 binds Scc1 during the late stage of development to form a heterodimer complex, which chaperones the essential virulence effector, CopN. During the early-middle stage of development, Scc4 regulates T3SS gene expression by binding the σ66-containing RNAP holoenzyme. In order to study the structure and association mechanism of the Scc4:Scc1 T3SS chaperone complex using nuclear …