Infectious Disease Commons^™

Assessment And Improvement Of Data Collection Errors Through Inter-Departmental Collaboration, Charlott Williams, Kelli L. Behr, Mary Moffatt, Rangaraj Selvarangan

Posters

Specific Aims:

1. To maintain the ED team's high rate of accuracy in data collection
2. To begin team participation in corrective action planning
3. To improve interdepartmental problem solving

Conclusion

Open communication about errors among all collaborating departments, combing with a shared approach to solving them:

• improved morale and perception of error tracking by the team
• led to a decrease in errors overall, and
• increased interdepartmental collaboration

When all members of the interdepartmental team work together with a positive approach to corrective action, improvement in error rates is a natural outcome of the solutions derived.

The Essential Role Of Carbon Metabolism In The Virulence Of Cryptococcus Neoformans, Mara Weigner

Senior Honors Theses

Cryptococcus neoformans infections are a major cause of meningoencephalitis in immunosuppressed patients worldwide. Inhaled as spores or desiccated yeast cells, C. neoformans can undergo metabolic changes in response to the new host environment that allow it to cross the blood brain barrier and cause deadly central nervous system (CNS) infections. Nutrient acquisition, and specifically carbon metabolism, is critical for survival and proliferation within the host. Notably, efficient carbon metabolism is necessary to produce the polysaccharide capsule, which is arguably C. neoformans’ most important and well-studied virulence factor. As such, a better understanding of carbon acquisition and regulation is essential for …

Improving Pneumococcal Vaccination Rates In High Risk Patients Across Multiple Specialty Divisions, Rachel Moran, Julia G. Harris, Claire Olsen, Rana El Feghaly, Liset Olarte, Douglas Blowey, Luke A. Harris

Posters

Pediatric patients with deficient immune systems or certain chronic medical conditions have an increased risk of acquiring invasive pneumococcal disease.

The 23-valent pneumococcal (PPSV23) vaccine provides protection against 23 pneumococcal serotypes and is recommended for patients aged 2 years or older who are high-risk for invasive pneumococcal disease.

Unfortunately, many high-risk patients are not properly vaccinated due to lack of provider knowledge or understanding of accountability between primary care and specialty providers.

The goal of this project was to improve PPSV23 vaccination rates by 10-20% across multiple Children's Mercy Kansas City specialty divisions.

Inactivated Rabies Virus-Based Ebola Vaccine Preserved By Vaporization Is Heat-Stable And Immunogenic Against Ebola And Protects Against Rabies Challenge., Drishya Kurup, Christine R. Fisher, Todd G. Smith, Tiago Abreu-Mota, Yong Yang, Felix R. Jackson, Nadia Gallardo-Romero, Richard Franka, Victor Bronshtein, Matthias J. Schnell

Department of Microbiology and Immunology Faculty Papers

BACKGROUND: Ebola virus (EBOV) is a highly lethal member of the Filoviridae family associated with human hemorrhagic disease. Despite being a sporadic disease, it caused a large outbreak in 2014-2016 in West Africa and another outbreak recently in the Democratic Republic of Congo. Several vaccine candidates are currently in preclinical and clinical studies but none are stable without cold chain storage.

METHODS: We used preservation by vaporization (PBV), a novel processing technology to heat-stabilize FiloRab1 (inactivated rabies-based Ebola vaccine), a candidate Ebola vaccine, and stored the vials at temperatures ranging from 4°C to 50°C for 10 days to 12 months. …

Treatment Of Podoconiosis With Complicating Polyinfections Within Rural African Villages: A Case Study, Amanda R. Beering, Abigail R. Florence, Soon Bahrami Md

Journal of Refugee & Global Health

This case study aims to provide a treatment plan for the treatment of podoconiosis with complicating polyinfections in a resource poor setting. A second objective is to help healthcare providers teach preventive measures to villagers in affected regions.

West Nile Virus: An Old Tale, New Mystery, Seetha Venkateswaran, Patricia Gilford

Family Medicine

• West Nile Virus (WNV), belongs to the Flavivirus family, is considered an endemic disease in many states including Florida.
• In the last decade, the virus has been prominently reported in the Southern and Midwest States.
• The disease is most prevalent during the summer to fall month periods due to elevated temperatures leading to enhanced vector transmission.
• WNV is acquired via the bite of an infected mosquito particularly the Culex species, and is considered as the vector for the disease.
• Equines and humans are incidental hosts of WNV and disease transmission from these sources are rare. There are various human risk …

Will New Mrsa Guidelines Make A Difference In Clinical Outcomes? A Comparison Of United States And United Kingdom Guidelines And Outcomes, Kelly Fargo, Erica Schoenberger, Kristen Thatcher, Lindsey Hallman, Andrew Roecker, Tarek Mahfouz

Pharmacy and Wellness Review

As of February 2011, the Infectious Disease Society of America (IDSA) published the first guidelines assessing the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections. S. aureus is present in the environment and is also located on the skin's surface. MRSA can cause a variety of clinical syndromes presenting with different symptoms that vary with the type and stage of the infection. MRSA is also classified into community-acquired MRSA (CA-MRSA) and hospital-acquired (HA-MRSA), both of which possess different treatment options and strategies. Due to the complex treatment of MRSA, as well the concern over the development of resistance, suggested treatment guidelines …

Dmbt1 Inhibition Of Pseudomonas Aeruginosa Twitching Motility Involves Its N-Glycosylation And Cannot Be Conferred By The Scavenger Receptor Cysteine-Rich Bacteria-Binding Peptide Domain., Jianfang Li, Stephanie J Wan, Matteo M E Metruccio, Sophia Ma, Kamran Nazmi, Floris J Bikker, David J. Evans, Suzanne M J Fleiszig

Faculty Publications & Research of the TUC College of Pharmacy

The scavenging capacity of glycoprotein DMBT1 helps defend mucosal epithelia against microbes. DMBT1 binding to multiple bacterial species involves its conserved Scavenger Receptor Cysteine-Rich (SRCR) domains, localized to a 16-mer consensus sequence peptide, SRCRP2. Previously, we showed that DMBT1 bound Pseudomonas aeruginosa pili, and inhibited twitching motility, a pilus-mediated movement important for virulence. Here, we determined molecular characteristics required for twitching motility inhibition. Heat-denatured DMBT1 lost capacity to inhibit twitching motility and showed reduced pili binding (~40%). Size-exclusion chromatography of Lys-C-digested native DMBT1 showed that only high-Mw fractions retained activity, suggesting involvement of the N-terminal containing repeated SRCR domains with …

Reduction Of Catheter Associated Urinary Tract Infections (Cauti) In A Critical Care Setting, Deborah Jackson, Lindsey Lucas, Shawn Taylor, Jonathan Archibald, Stephen Tyzik, Suneela Nayak, Ruth Hanselman, Amy Sparks

Operations Transformation

Urinary tract infections (UTIs) are the most common type of healthcare associated infections. Seventy five percent are related to indwelling urinary catheters. These infections come with increased morbidity and mortality risk. A team of intensive care providers at a large academic tertiary medical center initiated a quality improvement project to reduce the number of CAUTIs.

Baseline data established the total number of catheter days and CAUTIs by month. A subsequent root cause analysis was completed and several counter measures were developed to include a KPI implementation to track that all intensive care providers are educated in CAUTI and creation of …

Human Polyomavirus Jcpyv And Its Role In Progressive Multifocal Leukoencephalopathy And Oncogenesis, Luis Del Valle, Sergio Piña-Oviedo

School of Medicine Faculty Publications

The human neurotropic virus JCPyV, a member of the family, is the opportunistic infectious agent of Progressive Multifocal Leukoencephalopathy (PML), a fatal disease seen in severe immunosuppressive conditions and, during the last decade, in patients undergoing immunotherapy. JCPyV is a ubiquitous pathogen with up to 85% of the adult population word-wide exhibiting antibodies against it. Early experiments demonstrated that direct inoculation of JCPyV into the brain of different species resulted in the development of brain tumors and other neuroectodermal-derived neoplasias. Later, several reports showed the detection of viral sequences in medulloblastomas and glial tumors, as well as expression of the …

Rig-I-Like Receptors Direct Inflammatory Macrophage Polarization Against West Nile Virus Infection., Amy E. L. Stone, Richard Green, Courtney Wilkins, Emily A. Hemann, Michael Gale Jr.

College of Osteopathic Medicine (TUN) Publications and Research

RIG-I-Like Receptors (RLRs) RIG-I, MDA5, and LGP2, are vital pathogen recognition receptors in the defense against RNA viruses. West Nile Virus (WNV) infections continue to grow in the US. Here, we use a systems biology approach to define the contributions of each RLR in the innate immune response to WNV. Genome-wide RNAseq and bioinformatics analyses of macrophages from mice lacking either RLR reveal that the RLRs drive distinct immune gene activation and response polarization to mediate an M1/inflammatory signature while suppressing the M2/wound healing phenotype. While LGP2 functions to modulate inflammatory signaling, RIG-I and MDA5 together are essential for M1 …

Longitudinal Quantification Of Adenovirus Neutralizing Responses In Zambian Mother-Infant Pairs: Impact Of Hiv-1 Infection And Its Treatment, Sara R. Privatt, Brianna L. Bullard, Eric A. Weaver, Charles Wood, John T. West

Nebraska Center for Virology: Faculty Publications

Vaccination offers the most cost-effective approach to limiting the adverse impact of infectious and neoplastic diseases that reduce the quality of life in sub-Saharan Africa (SSA). However, it is unclear what vaccine vectors would be most readily implementable in the setting and at what age they should be applied for maximal efficacy. Adenoviruses (Ad) and Ad-based vectors have been demonstrated to induce effective humoral and cellular immune responses in animal models and in humans. However, because immunity associated with Ad infection is lifelong, there exists a debate as to whether pre-existing immunity might decrease the efficacy of Ad vectored vaccines. …

Group A Streptococcus Brain Abscess In A Patient On Adalimumab Therapy, Ryan Carroll, Ahmad Abu-Hashyeh, James Gainer, Kara Willenburg, Charles Meadows

Marshall Journal of Medicine

Brain abscesses represent a group of dangerous infections typically caused by a number of classic organisms. Group A Streptococcus is a rare cause of brain abscesses and those patients that do have this particular condition will typically have a distal source of infection. We present a case of patient with a biopsy confirmed Group A Streptococcal without a distal source of infection. His only identifiable risk factor was his adalimumab therapy for ankylosing spondylitis. While adalimumab has not been linked to Streptococcal infection in the past, it has been associated with multiple atypical infections and some of the consequences of …

“I Don’T Want To Look Sick Skinny”: Perceptions Of Body Image And Weight Loss In Hispanics Living With Hiv In South Texas, Jordan W. Abel, Omar Allen, Delia Bullock, Erin Finley, Elizabeth Walter, Phillip Schnarrs, Barbara S. Taylor

Journal of Health Disparities Research and Practice

Objective: Obesity is rising in people with HIV (PLWH) and Hispanics. Both HIV and obesity are associated with cardiovascular disease morbidity and mortality. Our goal is to understand perceptions of body image and lifestyle in Hispanics with HIV to adapt interventions appropriately.

Methods: We conducted semi-structured interviews with 22 Hispanic PLWH and 6 providers. Purposive sampling selected patient participants across weights and genders. Interviews were coded and analyzed using grounded theory, comparing perspectives between patients with and without obesity, and patients and providers.

Results: Participants felt obesity and diabetes were “normal” in the community. Patients exhibited understanding of healthy diet …

Transmissible Dermatological Diseases Affecting Syrian Refugees In Lebanon, Nisrine Kawa, Edith Hanna, Abdul Rahman Bizri

Journal of Refugee & Global Health

The Syrian war led many to seek shelter in Lebanon, creating a major refugee crisis. Displaced populations in crowded unequipped settlements are vulnerable to infectious diseases. The burden and incidence of various transmissible skin conditions affecting Syrian refugees in Lebanon and their impact on the Lebanese public health system were evaluated. Literature regarding these conditions among Syrian refugees in host countries, and epidemiological data from the Lebanese Ministry of Public Health Surveillance Unit and primary health-care network were reviewed. Lebanon has witnessed skin disorder outbreaks associated with the Refugee crisis, mainly leishmaniasis, scabies and lice infestations with little data about …

Antibiotic Resistance And Molecular Characterization Of Bacteremia Escherichia Coli Isolates From Newborns In The United States., Bryan K. Cole, Marko Ilikj, Cindy B. Mccloskey, Susana Chavez-Bueno

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Escherichia coli is a major cause of neonatal sepsis. Contemporary antibiotic resistance data and molecular characterization of neonatal E. coli bacteremia isolates in the US are limited.

METHODS: E. coli blood isolates, antibiotic susceptibility data, and clinical characteristics were obtained from prospectively identified newborns from 2006 to 2016. The E. coli isolates were classified using an updated phylogrouping method and multi-locus sequence typing. The presence of several virulence traits was also determined.

RESULTS: Forty-three newborns with E. coli bacteremia were identified. Mean gestational age was 32.3 (SD±5.4) weeks. Median age was 7 days (interquartile range 0-10). Mortality (28%) occurred …

When An Infected Meniscus Portends A Perforated Viscus, Michelle Hannon, Stephen Zachariah, Neha Bansal Etherington, Anusha Govind, Devin Weber, Bryan Hess

Division of Infectious Diseases and Environmental Medicine Faculty Papers

A 59-year-old woman with a status of post–renal transplant 7 years prior for autosomal dominant polycystic kidney disease on tacrolimus and mycophenolate mofetil presented with subacute left knee and right wrist pain. She received local steroid injections to both areas as an outpatient without improvement in her symptoms. She had recently traveled to India, her home country, to visit relatives. Aspiration of the knee revealed 4+ acid fast bacilli on smear, and she was taken for surgical debridement. She was started on empiric antibiotics for presumed infection with rapidly growing mycobacteria. Her course was complicated by acute onset abdominal pain …

Increasing Actual And Perceived Burden Of Tick-Borne Disease In Maine, Robert P. Smith Md Mph, Carol A. Mccarthy Md, Susan P. Elias Phd

Journal of Maine Medical Center

Introduction: The burden of tick-borne disease (TBD) in Maine has steadily increased since the first case of Lyme disease was reported in the late 1980s. The emergence of five different agents of TBD in Maine has been challenging and confusing for clinicians and the public.

Methods: We reviewed the ecology of emerging of tick -borne disease, then reviewed risk factors for tick bites and tick-borne disease in Maine. We then compared the burden of TBD versus community-acquired comparison infections in terms of hospitalizations, deaths, and media attention.

Results and Discussion: In Maine, risk of exposure to bites from the vector …

Signs Of Psychosis Leading To A Diagnosis Of Progressive Multifocal Leukoencephalopathy: A Case Report, Bryan L. Walker, Christina Holt Md, Msc

Journal of Maine Medical Center

Introduction: Progressive multifocal leukoencephalopathy (PML) is a rare demyelinating process of the central nervous system that occurs in in the setting of severe immunocompromise. Patients with PML develop varying focal neurological deficits and mental status changes that have not been well-described previously.

Clinical findings: We present a patient who was found by security wandering the lobby of this hospital. He was oriented only to self and unable to state a reason for presentation. Medical records were limited and included a visit to an outside hospital that documented a past medical history of HIV infection. He exhibited multiple signs of psychosis …

Role Of Gp120 Glycosylation In Sexual Transmission Of Hiv, Yingxue Sun, Adam Meadows, Najwa Zebian, Eric Arts, Carole Creuzenet

Western Research Forum

Background:

In chronic HIV patients, the viral populations are genetically diverse due to mutations introduced by the viral reverse transcriptase during HIV replication. However, more than 80% new infections result from single transmission founder (TF) viruses; therefore, targeting the TFs is key to control AIDS worldwide.

Gp120 is a glycosylated envelope protein required for HIV infection, propagation, and transmission. Glycans on gp120 influence HIV infectivity through their interactions with lectins, the carbohydrate-binding immune proteins in the host mucosa. To transmit sexually, viruses must overcome the lectin traps to access more target T cells.

Hypothesis:

TF viruses are less likely to …