Infectious Disease Commons^™

Clinical Impact Of An Antibiotic Stewardship Program At A Children's Hospital., Brian R. Lee, Jennifer Goldman, Diana Yu, Angela Myers, Leslie M. Stach, Erin Hedican, Mary Anne Jackson, Jason G. Newland

Manuscripts, Articles, Book Chapters and Other Papers

INTRODUCTION: Antibiotic stewardship programs (ASP) improve appropriate antibiotic use. Data are limited on the clinical benefit of ASPs in children's hospitals. This study's objective was to determine the impact of an ASP on length of stay (LOS) and readmission rate among patients admitted to children's hospitals.

METHODS: Data from a prospective-audit-with-feedback ASP were used to examine the ASP review characteristics, including antibiotic(s) prescribed, clinical indication, recommendations made by the ASP, and agreement with recommendations. Propensity score analysis was utilized to determine the impact of the ASP on LOS and 30-day readmission based on whether the patient received an ASP recommendation …

Outpatient Parenteral Antimicrobial Therapy In Pediatric Medicaid Enrollees., Jennifer Goldman, Troy Richardson, Jason G. Newland, Brian R. Lee, Jeffrey S. Gerber, Matt Hall, Matthew Kronman, Adam L. Hersh

Manuscripts, Articles, Book Chapters and Other Papers

Background: Outpatient parenteral antimicrobial therapy (OPAT) is overused in cases where highly bioavailable oral alternatives would be equally effective. However, the scope of OPAT use for children nationwide is poorly understood. Our objective was to characterize OPAT use and clinical outcomes for a large population of pediatric Medicaid enrollees treated with OPAT.

Methods: We analyzed the Truven MarketScan Medicaid claims database between 2009 and 2012. An OPAT episode was identified by capturing children with claims data indicating home infusion therapy for an intravenous antimicrobial. We characterized OPAT use by describing patient demographics, diagnoses, and antimicrobials prescribed. We categorized an antimicrobial …

Frequency Of Worsening Liver Function In Severe Dengue Hepatitis Patients Receiving Paracetamol: A Retrospective Analysis Of Hospital Data., Ahsan Ali Syed, Faisal Aslam, Haris Hakeem, Faraz Siddiqui, Noreen Nasir

Department of Medicine

Objective: To determine the frequency of worsening liver function among hospital in-patients with severe dengue hepatitis receiving paracetamol.

Methods: This retrospective study was conducted at the Department of Medicine, Aga Khan University Hospital, Karachi, and comprised records of dengue patients with severe hepatitis who received paracetamol for control of fever between June 2007 and December 2014. Alanine aminotransferase at baseline and following paracetamol administration was noted, as well as dosage and duration of paracetamol, along with participants' demographic details. Frequency of patients who developed worsening or improvement of alanine aminotransferase was also noted. SPSS 19 was used for data analysis. …

Influence Of Sex/Gender And Race On Responses To Raltegravir Combined With Tenofovir-Emtricitabine In Treatment-Naive Human Immunodeficiency Virus-1 Infected Patients: Pooled Analyses Of The Startmrk And Qdmrk Studies., Kathleen E. Squires, Linda-Gail Bekker, Christine Katlama, Yazdan Yazdanpanah, Yan Zhou, Anthony J Rodgers, Mark J Dinubile, Peter A Sklar, Randi Y Leavitt, Hedy Teppler

Department of Medicine Faculty Papers

BACKGROUND: Antiretroviral therapy in human immunodeficiency virus (HIV)-infected women and blacks merits particular scrutiny because these groups have been underrepresented in clinical trials.

METHODS: To document the effects of raltegravir across sex and racial lines, we conducted a pooled subgroup analysis of the efficacy and safety of raltegravir 400 mg BID plus tenofovir-emtricitabine by sex (women vs men) and self-identified race (black vs non-black) using phase 3 studies in treatment-naive patients.

RESULTS: Study participants included 42 black women, 102 non-black women, 48 black men, and 477 non-black men. Clade B infections were less common in women (43.8%) than men (84.6%) …

Potent Single-Domain Antibodies That Arrest Respiratory Syncytial Virus Fusion Protein In Its Prefusion State, Iebe Rossey, Morgan Gilman, Stephanie Kabeche, Koen Sedeyn, Daniel Wrapp

Dartmouth Scholarship

Human respiratory syncytial virus (RSV) is the main cause of lower respiratory tract infections in young children. The RSV fusion protein (F) is highly conserved and is the only viral membrane protein that is essential for infection. The prefusion conformation of RSV F is considered the most relevant target for antiviral strategies because it is the fusion-competent form of the protein and the primary target of neutralizing activity present in human serum. Here, we describe two llama-derived single-domain antibodies (VHHs) that have potent RSV-neutralizing activity and bind selectively to prefusion RSV F with picomolar affinity. Crystal structures of these VHHs …

Aberrant Neuronal Dynamics During Working Memory Operations In The Aging Hiv-Infected Brain., Tony W. Wilson, Amy L. Proskovec, Elizabeth Heinrichs-Graham, Jennifer O'Neill, Kevin R. Robertson, Howard S. Fox, Susan Swindells

Journal Articles: Infectious Diseases

Impairments in working memory are among the most prevalent features of HIV-associated neurocognitive disorders (HAND), yet their origins are unknown, with some studies arguing that encoding operations are disturbed and others supporting deficits in memory maintenance. The current investigation directly addresses this issue by using a dynamic mapping approach to identify when and where processing in working memory circuits degrades. HIV-infected older adults and a demographically-matched group of uninfected controls performed a verbal working memory task during magnetoencephalography (MEG). Significant oscillatory neural responses were imaged using a beamforming approach to illuminate the spatiotemporal dynamics of neuronal activity. HIV-infected patients were …

Infection Control In Labor And Delivery Room, Learning From The Small Hospital Based Project, Savera Aziz Ali, Sumera Aziz Ali

School of Nursing & Midwifery

Background: It has been estimated that around 36% of the neonatal deaths occur due to infection in the lower and middle income countries. Infection control is a more substantial area of concern, particularly in Labor and delivery room. Multiple factors can cause infection in the labor room, therefore it is important to assess various factors of maternal and neonatal infection. Hence we explored multiple factors through this project and developed the action plan to address those factors effectively.
Methods: During our Leadership and Management course, we conducted a project in Labor room pertaining to a prevalent issue. The whole process …

Freshwater Fungal Infections, Dennis J. Baumgardner

Journal of Patient-Centered Research and Reviews

Fungal infections as a result of freshwater exposure or trauma are fortunately rare. Etiologic agents are varied, but commonly include filamentous fungi and Candida. This narrative review describes various sources of potential freshwater fungal exposure and the diseases that may result, including fungal keratitis, acute otitis externa and tinea pedis, as well as rare deep soft tissue or bone infections and pulmonary or central nervous system infections following traumatic freshwater exposure during natural disasters or near-drowning episodes. Fungal etiology should be suspected in appropriate scenarios when bacterial cultures or molecular tests are normal or when the infection worsens or …

Impact Of Tigecycline Versus Other Antibiotics On The Fecal Metabolome And On Colonization Resistance To Clostridium Difficile In Mice, Robin L.P. Jump, David Kraft, Kelly Hurless, Alex Polinkovsky, Curtis J. Donskey

Faculty Scholarship

Background: The glycylcycline antibiotic tigecycline may have a relatively low propensity to promote Clostridium difficile infection in part because it causes less disruption of the indigenous intestinal microbiota than other broad-spectrum antibiotics. We used a mouse model to compare the effects of tigecycline versus other commonly used antibiotics on colonization resistance to C. difficile and on the metabolic functions of the intestinal microbiota. Methods: To assess in vivo colonization resistance to C. difficile, mice were challenged with oral C. difficile spores 1, 7, or 12 days after completion of 3 days of treatment with subcutaneous saline, tigecycline, ceftriaxone, piperacillin-tazobactam, or …

Improving Adolescent Hpv Vaccination In A Randomized Controlled Cluster Trial Using The 4 Pillars™ Practice Transformation Program., Richard K. Zimmerman, Krissy K. Moehling, Chyongchiou J. Lin, Song Zhang, Jonathan M. Raviotta, Evelyn C. Reis, Sharon Humiston, Mary Patricia Nowalk

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: Uptake of meningococcal vaccine (MCV) and tetanus, diphtheria and pertussis (Tdap) vaccine among adolescents has approached Healthy People 2020 goals, but human papillomavirus (HPV) vaccination has not. This study evaluated an intervention using the 4 Pillars™ Practice Transformation Program to increase HPV, MCV and Tdap uptake among adolescents in primary care practices.

METHODS: Practices with at least 50 patients 11-17years old with estimated vaccination rates less than national goals, were assigned to intervention (n=11) and control (n=11) groups in a randomized controlled cluster trial; 9 intervention and 11 control sites completed the study. The baseline and active study periods …

Febrile Rhinovirus Illness During Pregnancy Is Associated With Low Birth Weight In Nepal., Erin K Philpott, Janet A Englund, Joanne Katz, James Tielsch, Subarna Khatry, Stephen C Leclerq, Laxman Shrestha, Jane Kuypers, Amalia S Magaret, Mark C Steinhoff, Helen Y Chu

Global Health Faculty Publications

BACKGROUND: Adverse birth outcomes, including low birth weight (LBW), defined as <2500 >grams, small-for-gestational-age (SGA), and prematurity, contribute to 60%-80% of infant mortality worldwide and may be related to infections during pregnancy. The aim of this study was to assess whether febrile human rhinovirus (HRV) illness is associated with adverse birth outcomes.

METHODS: Active household-based weekly surveillance was performed for respiratory illness episodes in pregnant women as part of a community-based, prospective, randomized trial of maternal influenza immunization in rural Nepal. Rhinovirus (HRV) febrile illness episodes were defined as fever plus cough, sore throat, runny nose, and/or myalgia with HRV detected …

Genomes Of Fasciola Hepatica From The Americas Reveal Colonization With Neorickettsia Endobacteria Related To The Agents Of Potomac Horse And Human Sennetsu Fevers., Samantha N Mcnulty, Jose F Tort, Gabriel Rinaldi, Bruce A Rosa, Victoria H. Mann, Patricia S. Latham, Paul J. Brindley, +Several Additional Authors

Microbiology, Immunology, and Tropical Medicine Faculty Publications

Food borne trematodes (FBTs) are an assemblage of platyhelminth parasites transmitted through the food chain, four of which are recognized as neglected tropical diseases (NTDs). Fascioliasis stands out among the other NTDs due to its broad and significant impact on both human and animal health, as Fasciola sp., are also considered major pathogens of domesticated ruminants. Here we present a reference genome sequence of the common liver fluke, Fasciola hepatica isolated from sheep, complementing previously reported isolate from cattle. A total of 14,642 genes were predicted from the 1.14 GB genome of the liver fluke. Comparative genomics indicated that F. …

The Promise Of Systems Biology Approaches For Revealing Host Pathogen Interactions In Malaria., Meghan Zuck, Laura S Austin, Samuel A Danziger, John D Aitchison, Alexis Kaushansky

Articles, Abstracts, and Reports

Despite global eradication efforts over the past century, malaria remains a devastating public health burden, causing almost half a million deaths annually (WHO, 2016). A detailed understanding of the mechanisms that control malaria infection has been hindered by technical challenges of studying a complex parasite life cycle in multiple hosts. While many interventions targeting the parasite have been implemented, the complex biology of

Distinct Transcriptome Profiles Of Gag-Specific Cd8+ T Cells Temporally Correlated With The Protection Elicited By Sivδnef Live Attenuated Vaccine, Wuxun Lu, Yanmin Wu, Fangrui Ma, R. Paul Johnson, Qingsheng Li

Nebraska Center for Virology: Faculty Publications

The live attenuated vaccine (LAV) SIVmac239Δnef (SIVΔnef) confers the best protection among all the vaccine modalities tested in rhesus macaque model of HIV-1 infection. This vaccine has a unique feature of time-dependent protection: macaques are not protected at 3±5 weeks post vaccination (WPV), whereas immune protection emerges between 15 and 20 WPV. Although the exact mechanisms of the time-dependent protection remain incompletely understood, studies suggested that both cellular and humoral immunities contribute to this time-dependent protection. To further elucidate the mechanisms of protection induced by SIVΔnef, we longitudinally compared the global gene expression profiles of SIV Gag-CM9+ CD8+ (Gag-specific CD8+) …

Chloroviruses Have A Sweet Tooth, James L. Van Etten, Irina V. Agarkova, David D. Dunigan, Michela Tonetti, Cristina De Castro, Garry A. Duncan

Nebraska Center for Virology: Faculty Publications

Chloroviruses are large double-stranded DNA (dsDNA) viruses that infect certain isolates of chlorella-like green algae. They contain up to approximately 400 protein-encoding genes and 16 transfer RNA (tRNA) genes. This review summarizes the unexpected finding that many of the chlorovirus genes encode proteins involved in manipulating carbohydrates. These include enzymes involved in making extracellular polysaccharides, such as hyaluronan and chitin, enzymes that make nucleotide sugars, such as GDP-L-fucose and GDP-D-rhamnose and enzymes involved in the synthesis of glycans attached to the virus major capsid proteins. This latter process differs from that of all other glycoprotein containing viruses that traditionally use …

Tryptophan 375 Stabilizes The Outer-Domain Core Of Gp120 For Hiv Vaccine Immunogen Design, Duoyi Hu, Dane Bowder, Wenzhong Wei, Jesse Thompson, Mark A. Wilson, Shi-Hua Xiang

Nebraska Center for Virology: Faculty Publications

The outer-domain core of gp120 may serve as a better HIV vaccine immunogen than the full-length gp120 because of its greater stability and immunogenicity. In our previous report, we introduced two disulfide bonds to the outer-domain core of gp120 to fix its conformation into a CD4-bound state, which resulted in a significant increase in its immunogenicity when compared to the wild-type outer-domain core. In this report, to further improve the immunogenicity of the outer-domain core based immunogen, we have introduced a Tryptophan residue at gp120 amino acid sequence position 375 (375S/W). Our data from immunized guinea pigs indeed shows a …

Cryptococcal Empyema: A Rare Manifestation Of Disease, Mohamed Mortagy, Larry Lutwick, Stephen Breisach

Research Day

Introduction: Cryptococcus neoformans is a pathogenic yeast that is generally acquired by man from the environment via the respiratory route. Despite this route of acquisition, overt pulmonary infection is uncommonly diagnosed and the disease is usually manifest as a subacute meningitis which is mostly manifest in individuals who are celluarly immunoincompetent such as those on cancer chemotherapy, receiving anti-solid organ rejection medications and those with HIV/AIDS. Infection of the pleural space with C. neoformans is quite uncommon. We report a non-immunosuppressed man who was found to have infection of the pleural in the wake of bacterial empyema who was successfully …

Infection-Associated Mycobacterium Fortuitum Infection, Dennis T. Huang, Larry Lutwick

Research Day

Introduction: Mycobacterial species are unusual causes of skin and soft tissue infections and can be difficult to diagnose in the absence of consideration as they often require specific culture media and longer incubation times. We report a Mycobacterium fortuitum subcutaneous abscess in a diabetic related to medication injection that was initially diagnosed without specialized media or prolonged incubation times. Case Report: A 48 year old diabetic female developed a progressive subcutaneous swelling in the tissues of the right lower abdominal wall where she had been injecting liraglutide. Because of continued enlargement "to almost egg size" with pain, she was empirically …

Evaluating Adherence To The Sepsis Bundle And The Effectiveness Of Best Practice Alerts, Kate M. Burnett

DNP Projects

PURPOSE: To evaluate the adherence to the CMS sepsis recommendations and sepsis bundle used by the study health system before and after the implementation of Best Practice Alerts (BPAs) and assessing the effect of these alerts on patient outcomes.

METHODS: The study was a single-center, process evaluation through a retrospective chart review within a southwest healthcare system. The sample consisted of 73 patients for the pre-implementation period (May 1, 2016-September 7, 2016) and 75 patients for the post-implementation period (September 8, 2016-April 30, 2017).

RESULTS: No major differences were found between the two groups with regard to patient age, ethnicity, …

Global Health Experience In Swaziland, Anik Patel

Posters

Describes a global health learning experience at the Baylor Center of Excellence in Swaziland, where diagnosis and treatment of HIV/AIDS and TB, along with maternal health, women's health, and adolescent care are provided.

Characterization Of A New Chlorovirus Type With Permissive And Non-Permissive Features On Phylogenetically Related Algal Strains, Cristian F. Quispe, Ahmed Esmael, Olivia Sonderman, Michelle Mcquinn, Irina Agarkova, Mohammed Battah, Garry A. Duncan, David D. Dunigan, Timothy P. L. Smith, Cristina Decastro, Immacolata Speciale, Fangrui Ma, James L. Van Etten

Nebraska Center for Virology: Faculty Publications

A previous report indicated that prototype chlorovirus PBCV-1 replicated in two Chlorella variabilis algal strains, NC64A and Syngen 2-3, that are ex-endosymbionts isolated from the protozoan Paramecium bursaria. Surprisingly, plaque-forming viruses on Syngen 2-3 lawns were often higher than on NC64A lawns from indigenous water samples. These differences led to the discovery of viruses that exclusively replicate in Syngen 2-3 cells, named Only Syngen (OSy) viruses. OSy-NE5, the prototype virus for the proposed new species, had a linear dsDNA genome of 327 kb with 44-nucleotide-long, incompletely base-paired, covalently closed hairpin ends. Each hairpin structure was followed by an identical …

Understanding Zoonotic Enteric Disease In Minnesota: A Spatio Temporal Analysis And Causal Theory Approach, Suchismita Swain

All Graduate Theses, Dissertations, and Other Capstone Projects

With 75 percent of diseases in humans having origin in animals or animal products, zoonotic diseases have an enormous impact on the global disease burden. A significant portion of this can be attributed to bacterial zoonotic enteric pathogens. This study was designed to locate clusters of bacterial zoonotic enteric outbreaks in the State of Minnesota and study the seasonality of these outbreaks. In addition to identifying hot spots for zoonotic enteric outbreaks in Minnesota, the study also aimed to design a causal model to improve understanding of risk factors. This thesis considered only the bacterial zoonotic pathogens with significant disease …

Human Antibody Responses To Pneumococcal Vaccination In Aging Hiv-Positive Individuals, Megan Bickford

MUSC Theses and Dissertations

Introduction: Streptococcus pneumoniae is a major cause of morbidity and mortality in HIV-positive individuals. Despite the widespread use of anti-retroviral medications, the incidence of pneumococcal disease is 20-40 fold higher in the HIV+ population compared to HIV- persons. Consequently, pneumococcal vaccination is recommended for all HIV+ individuals. In 2012 the FDA changed vaccine recommendation from a single vaccination with the 23-valent pneumococcal polysaccharide vaccine (PPV23) to a dual vaccination with 13-valent protein conjugate vaccine (PCV13) followed by PPV23. Studies demonstrating superiority of the PCV13/PPV23 regimen compared to PPV23 alone are limited and controversial. The goal of this study was to …

Swaziland: A Journey Into Culture And Health Care, Claire Hickey

Posters

Describes a global health learning experience with Baylor International Pediatrics AIDS Initiative in Swaziland in 2017.

Sanibonani! A Global Health View Of The Hiv/Aids Epidemic In Swaziland, Angie Schmidt

Posters

Describes a global health learning experience with the Baylor International Pediatric AIDS Initiative in Swaziland.

Retention In Continuous Care And Sustained Viral Suppression: Examining The Association Among Individuals Living With Hiv, Timothy N. Crawford, Alice C. Thornton

Internal Medicine Faculty Publications

Objectives: To examine the relationship between retention in continuous care and sustained viral suppression.

Methods: The authors retrospectively followed 653 persons who were virally suppressed and seeking care at an infectious disease clinic in Kentucky for an average of 6 years to determine the rates of retention in medical care (≥2 visits separated by ≥3 months within a 12-month period) and sustained viral suppression (<400 copies/mL). A generalized linear mixed model was used to determine an association between retention and suppression over time.

Results: Approximately 61% of the study population were retained in continuous care and 75% had sustained viral suppression for all patient-years. Persons retained in care were 3 times the odds of sustaining viral suppression over …

South Africa: Combatting The Rise Of Hiv In Adolescents, Ryan Northrup

Posters

Describes a global health learning experience in South Africa in 2017, focused on educating teenagers in schools about sexual health and AIDS prevention.

Is Tea Tree Oil Preparation An Effective Topical Therapy For Patients With Msra Colonized Wounds?, Mariah A. Gerald

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not tea tree oil preparation an effective topical therapy for patients with MRSA colonized wounds.

STUDY DESIGN: This review is based on three randomized controlled trials (RCTs) published in 2004,2013, and 2014. These studies compared the efficacy of tea tree oil (TIO) topical preparations in MRSA colonized wounds.

DATA SOURCES: All articles used were published in English, in peer-reviewed journals, and found using PubMed and Cochrane Review databases.

OUTCOMES MEASURED: The efficacy of tea tree oil preparations on MRSA colonized wounds were evaluated …

Is Povidone-Iodine Safe And Effective In The Treatment Of Children And Adults With Viral Conjunctivitis?, Danielle M. Mazzuca

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not, “Is povidone-iodine safe and effective in the treatment of children and adults with viral conjunctivitis?” STUDY DESIGN: Review of three English language primary studies, published between 2002 and 2015. DATA SOURCES: Two randomized controlled trials (RCTs) and one non-randomized, prospective, interventional pilot study were found using PubMed and the Cochrane database. OUTCOMES MEASURED: Each study evaluated the efficacy of povidone-iodine for the treatment of viral conjunctivitis measured by days until cured as determined by patient rating of symptom strength and ophthalmological grading of ocular signs. …

Is Intravenous Peramivir 300mg Effective And Safe In Treating Seasonal Influenza?, Michael P. Phytides

PCOM Physician Assistant Studies Student Scholarship

A. Objective: The objective of this selective EBM review is to determine whether or not intravenous Peramivir 300mg is effective and safe in treating seasonal influenza.

B. Study Design: Review of two randomized controlled trials (RCTs) and one randomized open-label study, all published in 2010, 2011, and 2014, respectively.

C. Data sources: Two randomized controlled trials and one randomized open- label study were all researched through the use of PubMed and belonged to peer reviewed journals.

D. Outcome(s) Measured: Primary efficacy endpoint analyzed was time to alleviation of symptoms measured by influenza symptom severity scale (ISS), …