Infectious Disease Commons^™

Antimicrobial Resistance In Ukraine—What Healthcare Providers Need To Know When Treating Ukrainian Refugees, Olga Vasylyeva

Advances in Clinical Medical Research and Healthcare Delivery

The scoping review assesses the trends in clinical infectious diseases reporting antimicrobial resistance (AMR) in Ukraine following a year of full-scale Russo-Ukrainian war (2022) to offer recommendations for healthcare providers caring for patients traveling from Ukraine.

Background: Until 2019, antibiotics were available to Ukrainians over the counter, and there was no systematic program to monitor bacterial resistance. Only in 2023 did a document standardizing the rational use of antibacterial and antifungal drugs become available for Ukrainian healthcare providers. By 2020, high levels of carbapenem-resistant bacteria were reported in military hospitals, 29.5%–64.2%, with Acinetobacter baumannii particularly problematic. Nosocomial infections were significantly …

A Multiomics Recovery Factor Predicts Long Covid In The Impacc Study, Gisela Gabernet, Jessica Maciuch, Jeremy P Gygi, John F Moore, Annmarie Hoch, Caitlin Syphurs, Tianyi Chu, Naresh Doni Jayavelu, David B Corry, Farrah Kheradmand, Lindsey R Baden, Rafick-Pierre Sekaly, Grace A Mccomsey, Elias K Haddad, Charles B Cairns, Nadine Rouphael, Ana Fernandez-Sesma, Viviana Simon, Jordan P Metcalf, Nelson I Agudelo Higuita, Catherine L Hough, William B Messer, Mark M Davis, Kari C Nadeau, Bali Pulendran, Monica Kraft, Chris Bime, Elaine F Reed, Joanna Schaenman, David J Erle, Carolyn S Calfee, Mark A Atkinson, Scott C Brakenridge, Esther Melamed, Albert C Shaw, David A Hafler, Alison D Augustine, Patrice M Becker, Al Ozonoff, Steven E Bosinger, Walter Eckalbar, Holden T Maecker, Seunghee Kim-Schulze, Hanno Steen, Florian Krammer, Kerstin Westendorf, Bjoern Peters, Slim Fourati, Matthew C Altman, Ofer Levy, Kinga K Smolen, Ruth R Montgomery, Joann Diray-Arce, Steven H Kleinstein, Leying Guan, Lauren Ir Ehrlich

Faculty, Staff and Students Publications

Background: Following SARS-CoV-2 infection, approximately 10%–35% of patients with COVID-19 experience long COVID (LC), in which debilitating symptoms persist for at least 3 months. Elucidating the biologic underpinnings of LC could identify therapeutic opportunities.

Methods: We utilized machine learning methods on biologic analytes provided over 12 months after hospital discharge from more than 500 patients with COVID-19 in the IMPACC cohort to identify a multiomics “recovery factor,” trained on patient-reported physical function survey scores. Immune profiling data included PBMC transcriptomics, serum O-link and plasma proteomics, plasma metabolomics, and blood mass cytometry by time of flight (CyTOF) protein levels. Recovery factor …

Uptake Of Covid-19 Vaccination And Associated Factors Among Patients Attending Oncology Services At The Ocean Road Cancer Institute In Dar Es Salaam, Tanzania: Insights From Mixed Design Methods’ Trajectory, David Makoko, Anthony Kapesa, Micheal Mugerwa, Mamsau Ngoma, Mark Mseti, Mary Lyimo, Lucy Kisaka, Ntuli Kapologwe, Jeremiah Seni

School of Nursing & Midwifery, East Africa

Background

COVID-19 vaccination campaigns have reduced disease severity and fatalities around the globe. Global data shows that 67.7% of the general population are vaccinated, and Tanzania has reported appealing findings of over 70% coverage among individuals over 18 years of age. However, a group-specific assessment of vaccination coverage is needed in sub-Saharan Africa. This study aimed at assessing the COVID-19 vaccination uptake and associated factors among cancer patients owing to their vulnerability.

Methods

A cross-sectional analytical study design was conducted in September 2022 at Ocean Road Cancer Institute (ORCI) in Dar es Salaam, Tanzania. A multistage sampling approach was employed …

Lyme Disease Presenting As A Dermal Hypersensitivity Reaction, William T. Snider, Ian Depew, Rebecca Hicks, Shane Cook

Marshall Journal of Medicine

Background:

Lyme disease is a well-recognized illness commonly associated with skin manifestations such as erythema migrans. However, atypical presentations can complicate diagnosis, particularly when they deviate from classic clinical and histological findings.

Methods:

We report a potential case of Lyme disease presenting as a dermal hypersensitivity reaction (DHR), with clinical findings resembling urticaria rather than urticarial vasculitis. Skin biopsy findings were reviewed, and Lyme serology testing was performed.

Results:

The biopsy did not demonstrate the characteristic superficial perivascular lymphocytic infiltrate typically seen with erythema migrans. The patient's history included prior tick exposures, but while Lyme IgM was positive, the Lyme …

Rectal Fidaxomicin As Salvage Therapy In Fulminant Clostridioides Difficile Infection After Total Colectomy: A Case Report, Akankcha Alok, Mohamed Ismail, Stephanie Pino Fabara, Mohammed Al Said, Vidya Sagar Kollu

HCA Healthcare Journal of Medicine

Introduction

Clostridioides difficile infection (CDI) is a significant cause of antibiotic-associated diarrhea and colitis, ranging from mild to severe and potentially life-threatening conditions, like fulminant colitis with toxic megacolon and bowel perforation. The 2021 guidelines from the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) recommend vancomycin and metronidazole for fulminant CDI (FCDI), with consideration of rectal vancomycin for cases with ileus. Fidaxomicin, though preferred for initial and recurrent CDI treatment, is not the first line for FCDI due to limited evidence. Fidaxomicin has a narrow spectrum of activity only targeting C difficile and …

Sensitivity And Specificity Of The Cobas Liat Ct/Ng/Mg Nucleic Acid Test In A Clinical Laboratory Setting And Point-Of-Care Location, B Van Der Pol, R Arcenas, C Boraas, S Chavoustie, L L. Crane, N D'Empaire, A C. Ermel, G Harnett, F Hinestrosa, S House, Rebecca A. Lillis, J Miller, A Mills, R Poblete, S A. Young

School of Medicine Faculty Publications

Sexually transmitted infections, e.g., Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Mycoplasma genitalium (MG), present with similar signs/symptoms and are often treated empirically due to delays in receiving diagnostic test results. This study evaluated the clinical performance of the Cobas Liat CT/NG/MG nucleic acid amplification test (NAAT) in detecting these pathogens in a point-of-care (POC) setting. This non-interventional, multicenter study recruited symptomatic/asymptomatic participants from 13 geographically diverse POC sites across the USA. Prospective clinician- and self-collected specimens (urine/vaginal swabs) were used to determine the sensitivity and specificity of the Cobas Liat CT/NG/MG test relative to the composite reference standard (CRS), …

Screening For Trypanosoma Cruzi In Patients Living With The Human Immunodeficiency Virus (Pwh) In The Peruvian Amazon, Silvia Otero-Rodriguez, Martin Casapia-Morales, Lilia-Lorena Pinedo-Ramirez, Esperanza Merino, Eva H Clark, José-Manuel Ramos-Rincón

Faculty, Staff and Students Publications

Introduction: Chagas disease (CD) - Trypanosoma cruzi infection - in people living with HIV (PWH), particularly those with advanced CD4 T cell depletion, can lead to severe syndromes affecting the central nervous system and the heart.

Methods: We performed a cross-sectional study to screen for CD among PWH in Iquitos, Peru, between October 2023 and May 2024, with the objective of understanding the frequency of infection in this population. Adults with confirmed HIV attending outpatient services at two regional hospitals were enrolled. Two ELISA tests (lysate and recombinant) were used, and discordant results were adjudicated by indirect chemiluminescence immunoassay (CLIA). …

Branch Retinal Artery Occlusion After Covid-19, Danielle Kalberer Od, Mba, Grace Tan Od

Optometric Clinical Practice

Background: A healthy, 39-year-old male patient presented with sudden onset, painless vision loss of the right eye’s superior visual field two months after a mild case of COVID-19.

Case Report: The patient was diagnosed with an acute branch retinal artery occlusion and referred to the emergency department for prompt evaluation. When the emergency workup was unremarkable the patient was referred to cardiology and hematology and follow up with a retinal specialist. The exhaustive systemic work-up was unremarkable other than recent COVID-19. Retinal perfusion to the affected area resumed in the weeks after the incident but irreversible vision loss occurred.

Conclusion: …

Tetanus And Diphtheria Vaccination Coverage And Electronic Health Record Alerts For Immigrants And Refugees At Three United States Health Systems, 2017-2023, Abigail Steiner, Ann Settgast, Malini Desilva, Colleen Payton, Kristine Knuti Rodrigues, Margaret Nolan, Ella Chrenka, Mateo Frumholtz, Jeremy J Michel, Amy Stein, Blain Mamo, Janine Young

Department of Medicine Faculty Papers

Tetanus and diphtheria (tetanus/diphtheria) infections are rare in the United States (U.S.), but adequate vaccination is essential to prevent disease and associated morbidity and mortality. Compared with U.S.-born persons, immigrant and refugee adults have lower completion rates for tetanus/diphtheria vaccination series. However, most electronic health record (EHR)-generated recommendations only advise tetanus/diphtheria vaccines every 10 years for persons ≥18 years. This analysis compared documented completion of tetanus/diphtheria 3-dose vaccination series with EHR-generated recommendations for immigrant and refugee patients at three U.S. health systems seen during 2017-2022. The EHR documented complete 3-dose tetanus/diphtheria vaccine series for 28 % of 50,829 adult immigrant …

Interventions To Minimize Unnecessary Antibiotic Use For Acute Otitis Media: A Meta-Analysis., Theresa L. Morin, Amy B. Stein, Rana El Feghaly, Amanda Nedved, Sophie E. Katz, Amy Keith, Heather E. Laferriere, Timothy C. Jenkins, Holly M. Frost

Manuscripts, Articles, Book Chapters and Other Papers

Backgrounds/Objectives: Acute otitis media (AOM) is the leading reason antibiotics are prescribed to children. Despite guidelines advocating for watchful waiting and shorter antibiotic durations, overprescribing remains a concern. This meta-analysis aims to quantify potential reduction in antibiotic days of therapy (DOT) for AOM if prescribers adhered to guidelines. Methods: Cochrane databases were sourced for studies on ear infections, diagnostic accuracy, antibiotic duration, and watchful waiting. Randomized clinical trials, observational studies, and quality improvement reports of children aged 6 months-17 years with uncomplicated AOM published between 2000 and 2024 from the U.S., Canada, and Europe. Of 4187 studies, 425 met selection …

Establishing Priority Pediatric Antimicrobial Stewardship Interventions In The Us: Findings From A Delphi Consensus Study., Harry Obeng, Emmanuel Tetteh, Sara Malone, Lauren Walsh, Tyler Walsh, Fernando J. Bula-Rudas, Ritu Banerjee, Adam W. Brothers, Joshua C. Herigon, Katie Namtu, Scott Weissman, Daniel Riggsbee, Jared Olson, Debra Lynn Palazzi, Ann L. Wirtz, Matthew Sattler, Jessica Tansmore, Brittany A. Rodriguez, Monica Abdelnour, Joshua R. Watson, Alison C. Tribble, Jessica Gillon, Mari Nakamura, Sarah Jones, Jason G. Newland, Virginia R. Mckay

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND/OBJECTIVES: Antimicrobial resistance (AMR) is a major global health threat, with children at higher risk due to developmental differences in drug metabolism, limited treatment options and inappropriate antibiotic use. Pediatric antimicrobial stewardship programs (ASPs) face implementation challenges, often relying on adult-based guidelines and limited pediatric-specific evidence. This study aimed to identify and prioritize the most critical areas for pediatric ASP intervention development through a structured, multi-round Delphi consensus process with experts in antimicrobial stewardship and infectious diseases.

METHOD: A four-round modified Delphi process was conducted to identify and prioritize key pediatric ASP interventions. Experts in antimicrobial stewardship and infectious diseases …

Infective Endocarditis And Meningitis In A Healthy Newborn Without Underlying Heart Disease, Due To Streptococcus Agalactiae - A Case Report., Dalal Siddig Idris, Muath Mohammed Al Ghamdi, Maria Laura Bellovalls, Mohammed Fararjeh

Journal of the Saudi Heart Association

Streptococcus Agalactiae endocarditis is a rare clinical entity in newborns with a normal structured heart. It is generally characterized by acute onset, the presence of large vegetations, rapid valvular destruction and frequent complications, particularly embolization. Mortality is high with medical therapy alone. We are reporting a rare case of infective endocarditis (IE) with mitral valve vegetation in a 9-day old healthy newborn following Streptococcus Agalactiae sepsis, complicated by meningitis and micro-abscesses. Mitral valve (MV) vegetation was removed surgically; the patient received intravenous antibiotics for six weeks. Transthoracic echocardiography after surgery showed severe MV regurgitation and severe pulmonary hypertension which was …

Monitoring The Laboratory Frequency For Musculoskeletal Infections At A Tertiary Care Children's Hospital: A Diagnostic Stewardship Qi Project, Kedar Tilak, Douglas Swanson, Christine Symes, Alaina N. Burns, Ann L. Wirtz, Rana El Feghaly

Posters

Patients with musculoskeletal infections (MSKI) undergo several laboratory tests. To promote laboratory stewardship, our Infectious diseases (ID) division recommended the following frequencies for labs: 1) C-reactive protein (CRP) every 2-3 days until >50% reduction while >3mg/dL, otherwise weekly until normal, 2) Sedimentation rate (ESR) at the start of therapy and end if > 20mm/hr initially, 3) Complete blood cell count (CBC) at the start of therapy and when transitioning to oral therapy if WBC is initially elevated. Baseline data showed that of 42 children evaluated between July 2023-May 2024, only 15 (35.7%) had a CBC and 13 (30.95%) had a CRP …

Implementing A Sepsis Questionnaire To Reduce Readmissions…A Health Plan’S Experience, Vernita L. Kelley

Doctor of Nursing Practice (DNP) Scholarly Project

Problem: Sepsis is a life-threatening condition with high readmission risk, threatening patient recovery and survival. In the managed care organization (MCO) where this DNP project was implemented, sepsis ranks among the top five readmission diagnoses. The organization's 30-day readmission rate of 15.5% is substantially higher than the benchmark of 9.29%, highlighting a clinical quality issue, a strain on patient outcomes, and a strain on healthcare resources.

Aim of the Project: This quality improvement (QI) project aimed to reduce sepsis readmissions by embedding a sepsis questionnaire into case management workflows to identify clinical risks and social determinants of health, improve transitions, …

Circulation Of Respiratory Viruses From Air And Human Specimens In A Pre-Kindergarten-12th Grade School District In Kansas City, Mo, Nicole Neeley, Brian Lee, Brittney Fritschmann, Luke Gard, Nibha Sagar, Dithi Banerjee, Anjana Sasidharan, Rangaraj Selvarangan, Olivia Almendares, Hannah L. Kirking, Jennifer Goldman, Jennifer E. Schuster

Posters

Background: Air sampling with respiratory virus testing in community settings may be a potential non-invasive, scalable method to monitor respiratory viruses. We performed an ecological analysis to describe the correlation between respiratory virus detections in air and human samples across all schools to evaluate the potential for air sampling as a tool for community-level surveillance. Methods: Knowledge of Infectious Diseases in Schools (School KIDS) is a voluntary respiratory virus surveillance program in a pre-kindergarten-12th grade public school district in Kansas City, MO. In 10 schools, students and staff collected anterior nasal swabs while at school, with optional on-demand swabbing when …

Neonatal Early-Onset Sepsis: It’S Not Always What You Think, Gabriela M. Henriquez, Kedar Tilak, Douglas Swanson, Susana Chavez-Bueno

Posters

No abstract provided.

Changes In Antiviral Prescribing For Children With Influenza In Us Emergency Departments., Tess Stopczynski, Olla Hamdan, Justin Z. Amarin, James W. Antoon, Laura S. Stewart, Haya Hayek, James Chappell, Andrew J. Spieker, Eileen J. Klein, Janet A. Englund, Geoffrey A. Weinberg, Peter G. Szilagyi, John V. Williams, Marian G. Michaels, Julie A. Boom, Leila C. Sahni, Mary Allen Staat, Elizabeth P. Schlaudecker, Jennifer E. Schuster, Rangaraj Selvarangan, Ayzsa Tannis, Heidi L. Moline, Samantha M. Olson, Natasha B. Halasa

Manuscripts, Articles, Book Chapters and Other Papers

IMPORTANCE: Despite national recommendations, antiviral prescribing in emergency departments (EDs) for children at higher risk of severe influenza, such as those younger than 5 years and those with specific underlying conditions, remains low.

OBJECTIVE: To assess whether there were changes in antiviral prescribing for children at higher risk of severe influenza in academic pediatric EDs before the COVID-19 pandemic (2016-2020) vs the late pandemic period (2021-2023).

DESIGN, SETTING, AND PARTICIPANTS: This multicenter, cross-sectional study included influenza-positive children younger than 18 years presenting to the ED at 1 of 7 US pediatric academic hospitals participating in the Centers for Disease Control …

Htlv-1 And Atll: Epidemiology, Oncogenesis, And Opportunities For Community-Informed Research In The United States, Adrian D. Altieri, Sean P. Reilly, Abu Mansalay, Alan Khoo, Nettie Johnson, Zafar K. Khan, Amy Leader, Pooja Jain, Pierluigi Porcu

Kimmel Cancer Center Faculty Papers

Human T-cell leukemia virus type 1 (HTLV-1), the first oncogenic human retrovirus, causes adult T-cell leukemia/lymphoma (ATLL), an aggressive neoplasm of mature CD4+ T-cells that is incurable in most patients and is associated with a median survival of less than 1 year. HTLV-1 also causes inflammatory disorders, including HTLV-associated myelopathy/tropical spastic paraparesis (HAM/TSP) and uveitis. The estimated lifetime risks of ATLL and HAM/TSP in HTLV-1 carriers are 3-5% and 0.25-1.8%, respectively. Although there is uncertainty about other health effects of HTLV-1, a recent meta-analysis showed an association between HTLV-1 and cardiovascular, cerebrovascular, and metabolic diseases and a 57% increased risk …

Strongyloides Seropositivity Among Children Utilizing A Mobile Clinic, Lynda Aririguzo, Aditi Gupta, Norma Castillo, Cassandra Duran, Eva H Clark, Ankona Banerjee, Sanghamitra Misra

Faculty, Staff and Students Publications

Experts recommend screening for or presumptively treating strongyloidiasis in foreign-born immigrant children, though prevalence is unknown. Health care providers encounter barriers to following this recommendation. We aimed to describe Strongyloides seropositivity and risk factors among pediatric patients on a mobile clinic. Participants completed a written survey and provided blood for absolute eosinophil count (AEC) and Strongyloides IgG enzyme-linked immunosorbent assay (ELISA). From October 2022 to June 2023, 206 patients participated; 201 (97.6%) were born outside the United States; 97.1% (n = 200) were Hispanic. Most (68.9%) arrived less than 1 year before study enrollment. Four (1.9%) and 3 (1.5%) had …

Hospital And Temporal Variations In Limitations Of Care Among Hospitalized Patients With Covid-19: A Virus Registry Retrospective Cohort Study, Nathan Mesfin, Nitesh Kumar Jain, Anwar Khedr, Hisham Mushtaq, Abbas B. Jama, Noura Attallah, Esraa Hassan, Benjamin Langworthy, Nicholas Ingraham, Juan Pablo Domecq Garces, Thoyaja Koritala, Donna Lee Armaignac, Nicholas Eugene Perkins, Katherine Belden, Vishakha Kumar, Karen Boman, Devang K. Sanghavi, Vikas Bansal, Rahul Kashyap, Rodrigo Cartin-Ceba, Abigail La Nou, Allan J. Walkey, R. Adams Dudley, Syed Anjum Khan

Division of Infectious Diseases and Environmental Medicine Faculty Papers

INTRODUCTION: Life-support limits (i.e., code status), the first step in the continuum of palliation and end-of-life (EoL) care, stem from decisions made by patients and their providers to align care near the EoL with patients' wishes. The pandemic created health care strain that may have influenced life-support limitation practices among patients with serious COVID-19. In this study, we examine variations in life-support limitations (do-not-resuscitate, DNR; do-not-intubate, DNI) depending on the hospital and period of hospitalization.

METHODS: We included all adults admitted to a hospital in the United States with COVID-19 from January 2020 to December 2021 using the VIRUS registry. …