Infectious Disease Commons^™

Reducing Surgical Site Infections Post Cesarean Section Through Multi-Modal Standardized Education, Ari Meyers, Fereshteh Pirayesh, Tracie Tolme

Providence Nursing Research Conference 2023 – Present

No abstract provided.

A Puzzling Case Of Visual Disturbances Leads To A Fatal Neurodegenerative Diagnosis, Courtney J. Austin, Aaron Carrillo, Jennifer Rojas Huen, Victoria Parada

Research Colloquium

Background: Creutzfeldt-Jakob disease (CJD) is a rare neurodegenerative disease in which early diagnosis is complicated by the presence of early non-specific and atypical presentations. Sporadic CJD (sCJD), the most common type of CJD, is caused by the spread of a disease-forming prion known as PrPSc. PrPSc multiplies and binds to the normal form of prion, or PrP, converting it to an abnormal, structurally altered disease form that spreads throughout the brain. sCJD can initially present with six different phenotypes: cognitive, affective, classic, visual (Heidenhain variant), atactic (Oppenheimer-Brownell variant), and indeterminate. The classic presentation of CJD includes rapidly progressive dementia with …

Optimizing Antibiotic Stewardship In Pneumonia: Evidence-Based Protocols For Enhanced Treatment And Resistance Reduction In A University-Affiliated Community Hospital, Carlos Luis Alejos, Jennifer Rojas Huen, Joan Beatrice Capellan, Ricardo Serna, Tejaswini Swamy, Jose Campo Maldonado

Research Colloquium

Introduction: National guidelines recommend early, targeted diagnostics such as respiratory viral panels, procalcitonin testing, Methicillin resistant staphylococcus aureus (MRSA) nasal swabs, and sputum cultures, for the effective management of pneumonia. However, our retrospective review at a university-affiliated community hospital revealed inconsistent application of these tools. These may contribute to excessive use of broad-spectrum antibiotics, higher costs, and increased antimicrobial resistance. The reason is that we aim to implement a standardized pneumonia order set in the electronic medical record (EMR) to improve diagnostic accuracy and antibiotic stewardship.

Methods: We conducted a retrospective chart review of adult inpatients admitted with community-acquired, hospital-acquired, …

Expansion Of A Rapid Reentry Program To Improve Viral Suppression And Retention In Hiv Care, Danielle L. Gilbert Do, Mph, Shafay Shams Md, John G. Phillips Md, Paula S. Seal Md, Mph

Quality Improvement & Patient Safety Forum

No abstract provided.

From Knowledge To Action: Assessing The Influence Of Provider Education On Vaccine Importance, Tat W. Yau Md, Mph, Lauren E. Richey Md, Mph

Quality Improvement & Patient Safety Forum

No abstract provided.

Viral Detection In Anterior Nasal Swabs Versus Nasopharyngeal Swabs In Children, Nicole Neeley, Abby Kietzman, Rangaraj Selvarangan, Dithi Banerjee, Jennifer Goldman, Jennifer Schuster

Research Days

Background: Respiratory viruses are a significant cause of pediatric illness and healthcare utilization. Diagnostic testing for respiratory viruses is generally performed using nasopharyngeal (NP) specimens obtained by trained staff, limiting testing to medical settings. Evaluating additional sampling methods in children that are easier to collect and can be performed outside of medical settings, such as anterior nasal swab (NS) specimens may expand access to diagnostic testing and aid public health surveillance.

Methods: Eligible children hospitalized at Children’s Mercy Hospital who had a standard of care NP specimen collected for respiratory viral testing were enrolled. Research NS specimens were obtained through …

Reducing Antibiotic Duration For Pneumonia And Sinusitis In The Emergency Department: A Quality Improvement Approach, Joshua Saucedo, Leslie Hueschen, Amanda Nedved, Marsha Dannenburg, Patricia Phillips, Jennifer Floyd, Alaina N. Burns, Rana El Feghaly

Research Days

Background: Our aim is to increase the percentage of children discharged home from the ED with a diagnosis of CAP or ABRS treated with an optimal antibiotic duration (3-5 days for CAP, 5-7 days for ABRS) from 13% to 70% by July 25.

Methods: Outcome metric is the percentage of patients receiving recommended antibiotic duration for CAP and ABRS. Process metrics include use of order set, "Quick Discharge” order set, and clinical pathway QR codes. Balancing metric is the number of return visits with the same diagnosis < 14 days. Plan-Do-Study-Act methodology was used. In Aug 23, our ASP disseminated a handbook that emphasized shorter durations. A new multidisciplinary team (infectious diseases, ED, and urgent care physicians, advanced practice providers, nurses, and pharmacy) formed in Dec 23. We utilized cause-and-effect analysis, driver diagram, and prioritization matrix, which helped identify other impactful interventions, including implementation of new internal CAP clinical pathway order set (April 24) and “Quick Discharge” order sets (May 24). Next, we surveyed prescriber comfort (June 24) with shorter duration identifying barriers and providing education, leading to posted evidence for lower duration treatment in practitioner workrooms and developing a new ABRS clinical pathway (Sept 24). Top prescribers providing optimal duration received email acknowledgement (Oct 24) and resident rotators received antibiotic handbook and CAP clinical pathway QR codes (Nov 24). New best treatment practices for ABRS were elucidated and disseminated through clinical pathway and internal article publishing to our hospital and associated clinics (Dec 24).

Results: We saw shifts in the outcome metric’s center line in Sept 23 …

Evaluation Of Human Mesenchymal Stromal Cells (Msc) As An Adjuvant Therapeutic For Chronic Lyme Disease, Matthew Teryek

Rowan-Virtua Research Day

Background: Lyme disease, caused by the spirochetal bacterium Borrelia burgdorferi, is the most prevalent vector-borne illness in the Northern Hemisphere. If undiagnosed or untreated, the disease progresses through multiple stages of increasing clinical severity. While antibiotics such as doxycycline and ceftriaxone are the current standard of care, patients with chronic or late-stage Lyme disease may require additional therapeutic interventions.

Rationale: Human mesenchymal stem cells (MSCs) are of growing clinical interest due to their immunomodulatory properties, low immunogenicity, and potential to promote tissue repair. These characteristics position MSCs as promising adjuvant therapies for chronic Lyme disease, with the potential to …

A Ticking Time Bomb: An Overview Of A Case Report Of Neutropenic Fever Secondary To Tick-Borne Illness, Yasemin Galiboglu, Danielle Thor, Joann Ha, Kristine Wong, Cindy Hou

Rowan-Virtua Research Day

The advent of immunomodulatory therapies and their ever-expanding number of treatment indications necessitates the understanding of their associated complications. Neutropenic fever serves as an example of these complications often encountered in clinical practice. Although neutropenic fever can result from virtually any pathogen, episodes of the syndrome secondary to tick-borne illness remain relatively undocumented in the scientific literature. In the case presented, a 77-year-old female with a pertinent past medical history of smoldering IgG multiple myeloma on active immunosuppressive therapy presented with a first-time episode of neutropenic fever likely secondary to tick-borne illness. Through this overview of a broader report, attention …

An Unusual Cause Of Sepsis: Capnocytophaga Canimorsus, Capnocytophaga, Christopher Dellmyer, Kishan B. Patel

Rowan-Virtua Research Day

Septic shock can be caused by numerous different pathogens. A few of the more common causes are Streptococcus Pneumoniae, Staphylococcus Aureus, Escherichia Coli, Pseudomonas Aeruginosa, and Candida Albicans. Although these are the pathogens involved in the majority of septic shock cases, it is imperative to take the entire clinical picture into account when treating a patient with septic shock. Here we will discuss a seemingly unimpressive dog bite leading to Capnocytophaga canimorsus bacteremia, septic shock and end organ failure.

Case Report: Haemophilus Influenzae Meningitis In A 65 Year Old Female, Kaywan Saed, Russell Mordecai

Rowan-Virtua Research Day

We report a case of a 65-year-old female who presented with fever, altered mental status, and neck stiffness. Cerebrospinal fluid (CSF) analysis confirmed Haemophilus influenzae meningitis. The differential diagnosis of bacterial meningitis in older adults is broad and includes Streptococcus pneumoniae, Neisseria meningitidis, Listeria monocytogenes, and Haemophilus influenzae. However, in the post-Hib vaccine era, non-typeable H. influenzae has emerged as a significant cause of invasive disease in older adults, particularly in those with underlying comorbidities.

Older patients often present with atypical symptoms, which may delay diagnosis and treatment. In this case, early recognition and prompt administration of empiric antibiotic therapy …

The Impact Of Emergency Room Overcrowding On The Incidence Of Healthcare-Acquired Infections Among Patients, Hayya Ali

Rowan-Virtua Research Day

Emergency department (ED) visits are vital components of healthcare delivery, serving as the primary site for acute medical care, particularly for individuals with urgent medical needs. The ED is among the most crowded hospital units. The fast-paced setting and over-crowdedness of an emergency room have become the reality of every hospital across the United States. Overcrowding causes problems for patients and staff, which include the risk of contracting healthcare-acquired infections. This is due to several factors that in most cases lead to an increase in the number of people within the ED, an increase in mortality and morbidity, and a …

Assessing The Efficacy Of Prolonged Doxycycline Pep Use In High-Risk Populations For Sti Prevention, Lam Doan, Pearl Joslyn, Lizann Sung, Timothy Breiner, Sarah Marotta, Shikhar Rastogi

Rowan-Virtua Research Day

First recommended in October 2022, doxycycline post-exposure prophylaxis (DoxyPEP) has been increasingly used as a treatment for multiple sexually transmitted infections (STIs). To evaluate the efficacy of prolonged DoxyPEP use in high risk populations - men who have sex with men (MSM) and transgender women - for STIs, different sources addressing various aspects of DoxyPEP, its efficacy in STI prevention, and the potential consequences of its widespread use in terms of antimicrobial resistance were examined. Across 9 studies, DoxyPEP was found to decrease the incidence of bacterial STIs, specifically, syphilis, chlamydia, and gonorrhea with varying efficacy, especially for gonorrhea. Furthermore, …

Atypical Dengue Fever With Severe Hematological Manifestations: A Case From The Rio Grande Valley, Elias Arellano Villanueva, Alhasan Asaad, Jose Campo Maldonado

Research Symposium

Background: Dengue fever, a mosquito-borne viral illness, is endemic in tropical regions, including border regions like the Rio Grande Valley while often self-limited, severe presentations such as dengue hemorrhagic fever and dengue shock syndrome highlight its challenges and complexities. This report describes an atypical dengue case with severe hematological manifestations, underscoring the diagnostic challenges and the importance of early recognition, multidisciplinary evaluation, and evidence-based management.

Case Presentation: A 22-year-old Hispanic female with no significant past medical history presented to the ED with hematemesis and fever following her travel to Monterrey, Mexico. Initial symptoms included high fever (107.6°F), chills, diarrhea, vomiting, …

The Influence Of The Covid-19 Pandemic On Spinal Cord Injury Prevalence And Cause Of Injury In Texas: A Four-Year Retrospective Analysis, Blake C. Martin, Daniel Salinas, Kelsey Baker

Research Symposium

Background: COVID-19 was the most significant medical issue since the Spanish Flu and was declared a pandemic on March 11, 2020. Current literature states that during the COVID-19 pandemic, in which about 10% of the global population was affected, there was a decrease in the frequency of trauma injuries observed in the clinic. Of note, spinal cord injury (SCI) has been suggested to show changing epidemiology from the COVID-19 pandemic. For example, a study in Scotland has suggested that the cause of SCI was significantly influenced during the pandemic, with an increase in self-harm. Such epidemiological changes may influence economic …

Utilidad De La Combinación De Los Biomarcadores: Procalcitonina, Proteína C Reactiva Y Volumen Plaquetario Medio En El Diagnóstico Temprano De Sepsis Neonatal [Usefulness Of The Combination Of Biomarkers: Procalcitonin, C-Reactive Protein And Mean Platelet Volume In The Early Diagnosis Of Neonatal Sepsis], Oscar Manuel Berlanga Bolado Jr, Patricia Rivera Vazquez, Arely Socorro Hernández García, Angelica Lizbeth Martinez Ortiz

Research Symposium

Introducción: La sepsis neonatal es una causa frecuente de morbilidad y mortalidad infantil. Se le ha definido como un síndrome clínico caracterizado por signos sistémicos de infección, acompañado de bacteriemia en el primer mes de vida. Por lo tanto, el diagnóstico temprano es fundamental.

Objetivo: Conocer la sensibilidad y especificidad de la combinación de biomarcadores séricos como procalcitonina, proteína C reactiva y volumen plaquetario medio en el diagnóstico temprano de sepsis neonatal.

Material y métodos: Estudio clínico, de tipo prospectivo, predictivo, observacional, analítico, longitudinal y conveniencia. Se analizaron los biomarcadores como PCT, PCR, VPM para diagnosticar sepsis neonatal. Se incluyeron …

Structural And Interpersonal Determinants Of Covid-19 Vaccine Uptake In Vulnerable Populations Of The United States, Alyea Wood

Capstone Showcase

Since its introduction in late 2020, the uptake of the COVID-19 vaccine has had the lowest rates in marginalized populations like minorities, elderly, and those of low socioeconomic status. Decreased rates of vaccination uptake in these groups has resulted in increased burden of disease and subsequently higher rates of hospitalization and death. Many inequities in poor COVID-19 health outcomes can be explained by examining common predictive factors that determine vaccination rates in these United States populations. This special article research aims to explore these various predictive factors with the goal to provide targeted strategies to boost COVID-19 vaccination rates, especially …

Early Recognition Of Sepsis-Induced Hypotension In Dsu, Rebeca Zamora

St. Joseph Hospital, Orange, CA. Evidence Based Practice Conference

No abstract provided.

Flexor Tenosynovitis Of The Wrist And Hand Due To Non-Tuberculous Mycobacteria, Mariafe Reyes, Tatevik Malisetyan, Skylar Harmon, Mohammadali M. Shoja Md, Gary B. Schwartz Md

HCA-NSU MD Research Day

Title: Flexor Tenosynovitis of the Wrist and Hand Due to Non-tuberculous Mycobacteria Authors: Mariafe Reyes1,Tatevik Malisetyan1, Skylar Harmon1, Mohammadali M. Shoja, MD1 Gary B. Schwartz, MD1 1Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA INTRODUCTION: Non-tuberculous mycobacteria (NTM) are a group of bacteria, including Mycobacterium marinum, Mycobacterium kansasii, and Mycobacterium avium intracellulare (MAI), that usually exist in the soil and water sources. The most common site of infection is the lungs, but extra-pulmonary involvement of the skin and rarely the musculoskeletal (MSK) system does occur, especially the hands and wrists. CASE PRESENTATION: A 45-year-old, …

Houston, We Have A Problem: Diagnostic Difficulties In The Aids Patient With Tuberculosis Infection, Hector D. Preciado, Maria E. Torres, Muhammad A. Siddiqui, Liza Salloum, Lee Gelpi, Jose E. Campo Maldonado

Research Colloquium

Background: Tuberculosis (TB) is the leading cause of infectious death worldwide with 1.5 million deaths annually and nearly 1/4th of the world’s population (1.7 billion) infected with latent tuberculosis infection (LTBI) in 2014. Its diagnosis conventionally relies on tuberculin skin testing (TST), and Interferon-Gamma Release Assay (IGRA) which relies on the production of Interferon Gamma (IFN-y) in response to Mycobacterium tuberculosis (MTB) specific antigens. IGRA is a useful tool for detecting latent TB disease, and can be used as an adjunct for the diagnosis of active TB cases. Increases in IFN-y levels might support the diagnosis of a new TB …

Atypical Clinical Presentation Of Murine Typhus Infection In Relative Immunosuppressed Patient In South Texas, Johanna Mora, Kirhyn Stein, Hernan Guanajuato, Sobia Memon, Laura Garcia, Jose Campo Maldonado

Research Colloquium

Background: Murine typhus, caused by Rickettsia typhi, is a zoonotic infection transmitted to humans via fleas. It typically begins with nonspecific symptoms such as fever, headache, and nausea. Most cases resolve without complications after a 7–14-day incubation period. The primary reservoirs are rats, opossums, cats, and dogs. This case highlights an atypical presentation of murine typhus in an immunosuppressed patient in South Texas.

Case Presentation: 34-year-old female with ankylosing spondylitis treated recently with secukinumab presented to her Primary Care Physician (PCP) due to fevers. PCP ordered laboratory workup which was unrevealing. Four days later, the patient went to the …

Characterizing New Invasive Infections In Children’S Mercy Extracorporeal Membrane Oxygenation And And Continuous Renal Replacement Therapy Patients, Samantha M. Davidson, Jay F. Rilinger, Jenna O. Miller, Caroline Holten, Josh Herigon

Research Days

This abstract characterizes the patients at Children's Mercy who developed a new serious bacterial infection while on extracorporeal support.

Let's Talk About Sex & Prep: District 2 Does!, Chrissa M. Shaffer

Georgia Public Health Association Annual Meeting & Conference

Defining what a PrEP Service Program entails and how it could benefit your district or county health center. Discussing methods that have been used to set up PrEP Services within a district – including training, resources, and promotion. Identifying the challenges and working through them. Reviewing the results of the PrEP Services over the past year, and the ongoing goals to encourage and increase our PrEP Services.

A Quality Improvement Project To Improve Antibiotic Choice For Children Admitted With Urinary Tract Infections (Utis), Philip Jurasinski Do, Pgy-3, Adrienne Deporre Md, Kathleen Berg Md, Allison Hadley Md, Viktoriya Stoycheva Mha, Rn, Cpn, Rana El Feghaly Md

Research Days

This is an antibiotic stewardship quality improvement project focused on improving antibiotic choices for children with urinary tract infections who are in the Children's Mercy Kansas City system. This project aims to improve the rates of cefazolin or cephalexin for treatment from 27% to 60%. 96% of urinary tract infections in our system are caused by E. Coli that are susceptible to these first generation cephalosporins.

Medication Access Barriers To Hepatitis C Anti-Viral Therapy Following Transplantation Of Hepatitis C Positive Donors Into Hepatitis C Negative Recipients, Harry Rockower, Md, Sarah Yeager, Pharmd, Jami Schulte, Pharmd, Dagan Coppock, Md, Jonathan Fenkel, Md, Katherine Belden, Md

Health Equity and Quality Improvement (HEQI) Summit

Background

• Over the past decade there has been a paradigm shift in solid organ transplantation with the use of Hepatitis C (HCV) positive donor organs for HCV negative recipients.
• This evaluation looks through the lens of insurance approval for direct acting antivirals (DAA) and the process needed for obtaining and ensuring affordability of these medications.
• While the AASLD/IDSA guidelines recommend early initiation of pangenotypic DAA therapy after organ transplant without the need to confirm recipient viral replication many centers often initiate the DAA approval process after viremia is detected due to insurance barriers.¹
• The process for obtaining insurance approval …

Lower Extremity Weakness In The Setting Of Covid Myositis, Christopher Dellmyer, Frank Wheeler

Rowan-Virtua Research Day

Bilateral lower extremity weakness has numerable causes including stroke, peripheral neuropathy, deconditioning, Guillain-Barre, Multiple Sclerosis, anterior cord syndrome, trauma, spinal epidural abscess and many more. It is imperative however, that we investigate and understand more rare causes of lower extremity weakness. Here we present the case of a 74-year-old female presented to the ED with a complaint of lower extremity weakness due to Covid myositis causing significant bilateral lower extremity weakness.

Case Report: Monkeypox Diagnosed In The Ed, Richard M. Baluyot, Joseph Pagano, James A. Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Rashes are one of the most common chief complaints we see as emergency medicine physicians on a day-to-day basis. Most of them tend to be self-limited and require very little workup and can be discharged home; however, it is our job to try to identify rashes that may require isolation in order to prevent an outbreak in our communities. Here we present a case of one such rash that has gained major media attention as of late, Monkeypox.

What Is The Efficacy Of The Newly Developed Hpv Vaccine, Cecolin, In Providing Protection Against Hpv-Induced Cervical Cancers In Females Aged 9-14 Years Old, Yolanda Williams

Rowan-Virtua Research Day

In low to middle income countries, there's a rise in invasive cervical squamous cell carcinoma. Affordability emerges as a crucial factor influencing this trend. This research is based on the development of a new HPV vaccine made in China called Ceolin priced at $47 and its efficacy to be incorporated into the WHO vaccination program. A peer review was conducted based on an ongoing randomized phase 3 clinical trial of a 2 dose regimen bivalent Cecolin vaccine (types 16,18) . The study includes 1025 females aged 9-14 years old split amongst 5 groups. The control group received Gardasil at the …

Out Of Time: Altered Mental Status And Temporal Seizure On Background Of Dementia & Uti, Jennifer Nguyen, Victoria Wong Murray, Judith Anne Lightfoot, Mukarram Razvi, Kasturi Etukuru

Rowan-Virtua Research Day

Herpes simplex virus is common in the US, with an estimated seroprevalence of HSV-1 of 40% and HSV-2 of 11%. Although herpes encephalitis is rare, with an incidence of roughly 1/100,000 individuals per year in the US, the mortality rate of 70% and rapid progression make identification and treatment imperative.

An 85 year old woman was brought to the emergency department from nursing home with altered mental status of unknown duration in refractory status epilepticus on a background of dementia, history of multiple falls, and indwelling foley catheter in addition to hypertension and bilateral knee replacement. EEG demonstrated abnormal discharges …

Determinants Of Vaccine Hesitancy Among Parents And Caregivers, Priya Srivastava

Rowan-Virtua Research Day

•Vaccination efforts in the United States and globally are one of the largest contributors to pediatric preventative health

•Routine immunizations in the U.S for children ≤ 10 years old cover 14 vaccine-preventable diseases. As a result, an estimated 732,000 deaths, 21 million hospitalizations, and 322 diagnosed cases of diseases have been prevented between 1993 and 2013.

•Vaccines remain a point of contention with pediatricians and their patients' caregivers

•Many parents maintain hesitancy to give vaccines; to a number of reasons. Perceived risk and fear of side effects from vaccines more than the disease itself, can cause out-of-proportion concern

•Misinformation spread …