1
|
Melgar M, Abrams JY, Godfred-Cato S, Shah AB, Garg A, Strunk A, Narasimhan M, Koptyev J, Norden A, Musheyev D, Rashid F, Tannenbaum R, Estrada-Y-Martin RM, Patel B, Karanth S, Achenbach CJ, Hall GT, Hockney SM, Caputo M, Abbo LM, Beauchamps L, Morris S, Cifuentes RO, de St Maurice A, Bell DS, Prabaker KK, Sanz Vidorreta FJ, Bryant E, Cohen DK, Mohan R, Libby CP, SooHoo S, Domingo TJ, Campbell AP, Belay ED. A Multicenter Retrospective Cohort Study to Characterize Patients Hospitalized With Multisystem Inflammatory Syndrome in Adults and Coronavirus Disease 2019 in the United States, 2020-2021. Clin Infect Dis 2023; 77:1395-1405. [PMID: 37384794 PMCID: PMC10654854 DOI: 10.1093/cid/ciad374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/02/2023] [Accepted: 06/27/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND The diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-associated multisystem inflammatory syndrome in adults (MIS-A) requires distinguishing it from acute coronavirus disease 2019 (COVID-19) and may affect clinical management. METHODS In this retrospective cohort study, we applied the US Centers for Disease Control and Prevention case definition to identify adults hospitalized with MIS-A at 6 academic medical centers from 1 March 2020 to 31 December 2021. Patients MIS-A were matched by age group, sex, site, and admission date at a 1:2 ratio to patients hospitalized with acute symptomatic COVID-19. Conditional logistic regression was used to compare demographic characteristics, presenting symptoms, laboratory and imaging results, treatments administered, and outcomes between cohorts. RESULTS Through medical record review of 10 223 patients hospitalized with SARS-CoV-2-associated illness, we identified 53 MIS-A cases. Compared with 106 matched patients with COVID-19, those with MIS-A were more likely to be non-Hispanic black and less likely to be non-Hispanic white. They more likely had laboratory-confirmed COVID-19 ≥14 days before hospitalization, more likely had positive in-hospital SARS-CoV-2 serologic testing, and more often presented with gastrointestinal symptoms and chest pain. They were less likely to have underlying medical conditions and to present with cough and dyspnea. On admission, patients with MIS-A had higher neutrophil-to-lymphocyte ratio and higher levels of C-reactive protein, ferritin, procalcitonin, and D-dimer than patients with COVID-19. They also had longer hospitalization and more likely required intensive care admission, invasive mechanical ventilation, and vasopressors. The mortality rate was 6% in both cohorts. CONCLUSIONS Compared with patients with acute symptomatic COVID-19, adults with MIS-A more often manifest certain symptoms and laboratory findings early during hospitalization. These features may facilitate diagnosis and management.
Collapse
Affiliation(s)
- Michael Melgar
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Joseph Y Abrams
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shana Godfred-Cato
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ami B Shah
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amit Garg
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Andrew Strunk
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Mangala Narasimhan
- Division of Pulmonary, Critical Care, and Sleep Medicine, Northwell Health LIJ/NSUH Medical Center, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Jonathan Koptyev
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Alexandra Norden
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - David Musheyev
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Fahmida Rashid
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Rachel Tannenbaum
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Rosa M Estrada-Y-Martin
- Divisions of Critical Care, Pulmonary, and Sleep Medicine, McGovern Medical School at UTHealth, The University of Texas at Houston, Houston, Texas, USA
| | - Bela Patel
- Divisions of Critical Care, Pulmonary, and Sleep Medicine, McGovern Medical School at UTHealth, The University of Texas at Houston, Houston, Texas, USA
| | - Siddharth Karanth
- Divisions of Critical Care, Pulmonary, and Sleep Medicine, McGovern Medical School at UTHealth, The University of Texas at Houston, Houston, Texas, USA
| | - Chad J Achenbach
- Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Havey Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Gavin T Hall
- Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Sara M Hockney
- Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Matthew Caputo
- Havey Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Lilian M Abbo
- Department of Infection Prevention and Control, Jackson Health System, Miami, Florida, USA
- Division of Infectious Disease, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Laura Beauchamps
- Division of Infectious Disease, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Stephen Morris
- Division of Infectious Disease, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Renzo O Cifuentes
- Division of Infectious Disease, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Annabelle de St Maurice
- Division of Infectious Diseases, Department of Pediatrics, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
- Department of Clinical Epidemiology and Infection Prevention, University of California, Los Angeles, Los Angeles, California, USA
| | - Douglas S Bell
- Division of General Internal Medicine, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, USA
- Clinical and Translational Science Institute, University of California, Los Angeles, Los Angeles, California, USA
| | - Kavitha K Prabaker
- Department of Clinical Epidemiology and Infection Prevention, University of California, Los Angeles, Los Angeles, California, USA
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, USA
| | - Fernando J Sanz Vidorreta
- Clinical and Translational Science Institute, University of California, Los Angeles, Los Angeles, California, USA
| | - Evan Bryant
- Department of Clinical Epidemiology and Infection Prevention, University of California, Los Angeles, Los Angeles, California, USA
| | - David K Cohen
- Department of Clinical Epidemiology and Infection Prevention, University of California, Los Angeles, Los Angeles, California, USA
| | - Rohith Mohan
- Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Christopher P Libby
- Department of Emergency Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Spencer SooHoo
- Division of Informatics, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Tristel J Domingo
- Division of Informatics, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Angela P Campbell
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ermias D Belay
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
2
|
de St Maurice A, Ng G, Aryasomayajula C, Liman A, McDiarmid SV, Venick RS, Wozniak LJ. High prevalence of hepatitis A and B nonimmunity in pediatric liver transplant recipients. Clin Transplant 2023; 37:e15035. [PMID: 37265180 DOI: 10.1111/ctr.15035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 05/04/2023] [Accepted: 05/13/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Pediatric liver transplant recipients are at increased risk of post-transplant infections. The purpose of this study was to quantify hepatitis A and B non-immunity based on antibody titers in liver transplant recipients. METHODS We conducted a retrospective chart review of 107 pediatric liver transplant recipients at a single medical center from 2000 to 2017. We compared hepatitis immune patients to non-immune patients and studied response to vaccination in patients immunized post-transplantation. RESULTS Eighty-one percent of patients had pre-transplant immunity to hepatitis A whereas 68% had pre-transplant immunity to hepatitis B. Post-transplant hepatitis B immunity decreased to 33% whereas post-transplant hepatitis A immunity remained high at 82%. Older age and time since transplantation were significantly associated with hepatitis B non-immunity. Most patients responded to doses post-transplantation with 78% seroconversion following hepatitis A re-immunization and 83% seroconversion following hepatitis B re-immunization. CONCLUSIONS Pediatric liver transplant recipients are at risk of hepatitis A and B non-immunity, particularly with respect to hepatitis B. Boosters post-transplant may improve immunity to hepatitis viruses.
Collapse
Affiliation(s)
- Annabelle de St Maurice
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, California, USA
| | - G Ng
- Department of Pediatrics and Internal Medicine, University of Rochester, Rochester, New York, USA
| | - C Aryasomayajula
- Department of Obstetrics and Gynecology, Santa Clara Homestead Medical Center, Kaiser Permanente, Santa Clara, USA
| | - A Liman
- Division of Pediatric Gastroenterology, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California, USA
| | - S V McDiarmid
- Department of Pediatrics, Division of Pediatric Gastroenterology, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, California, USA
| | - R S Venick
- Department of Pediatrics, Division of Pediatric Gastroenterology, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, California, USA
| | - Laura J Wozniak
- Pediatric Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| |
Collapse
|
3
|
Kaur I, de St Maurice A. Cather-related Aspergillus Fungemia: Case Report and Literature Review. Pediatr Infect Dis J 2023:00006454-990000000-00423. [PMID: 37079559 DOI: 10.1097/inf.0000000000003942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
BACKGROUND Aspergillus fungemia is encountered infrequently in clinical practice, even in the setting of invasive and disseminated disease. Prolonged Aspergillus fungemia secondary to a central venous catheter is notably rarer. METHODS We describe the case of a 13-year-old boy with Aspergillus fungemia in the setting of a central venous catheter who was found to have pulmonary aspergillosis upon evaluation. We reviewed the literature for published cases of catheter-related Aspergillus fungemia and summarized the findings. We also sought to differentiate true fungemia from pseudofungemia and explored the clinical significance of aspergillemia. RESULTS We found 6 published cases of catheter-related Aspergillus fungemia in addition to the 1 discussed in this report. Based on the review of case findings, we propose an algorithm for an approach to a patient with a positive blood culture for Aspergillus spp. CONCLUSIONS True aspergillemia is infrequent even in the setting of disseminated aspergillosis among immunocompromised patients and the presence of aspergillemia does not necessarily portend more severe clinical disease course. The management of aspergillemia should involve a determination of the possibility of contamination, and if deemed genuine, a thorough workup to define the extent of the disease process. Treatment durations should be based on tissue sites of involvement and could be shorter in the absence of tissue-invasive disease.
Collapse
Affiliation(s)
- Ishminder Kaur
- Division of Infectious Diseases, Department of Pediatrics, University of California Los Angeles, CA
| | | |
Collapse
|
4
|
de St Maurice A, Shane AL. Sunscreen, Bug Spray, and Vaccines. J Pediatric Infect Dis Soc 2022; 11:557-558. [PMID: 36054925 DOI: 10.1093/jpids/piac090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/01/2022] [Indexed: 12/31/2022]
Affiliation(s)
- Annabelle de St Maurice
- Division of Infectious Diseases, Department of Pediatrics, University of California Los Angeles, Los Angeles, California, USA
| | - Andi L Shane
- Division of Infectious Diseases, Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| |
Collapse
|
5
|
Sandoval T, Bisht A, Maurice ADS. The impact of COVID-19 and masking practices on pertussis cases at a large academic medical center (2019-2021). Am J Infect Control 2022:S0196-6553(22)00811-2. [PMID: 36417951 PMCID: PMC9675934 DOI: 10.1016/j.ajic.2022.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 11/21/2022]
Abstract
We reviewed cases of Bordatella pertussis (B. pertussis) cases in ambulatory clinics at a large academic health care institution in Los Angeles from 2019-2021. Public health prevention measures during the Coronavirus disease 19 (COVID-19) pandemic impacted the number of pertussis cases identified.
Collapse
Affiliation(s)
- Tessa Sandoval
- Department of Clinical Epidemiology and Infection Prevention, UCLA Health, Los Angeles, CA,Address correspondence to Tessa Sandoval, Department of Clinical Epidemiology and Infection Prevention, UCLA Health, 924 Westwood Blvd. Ste. 900, Los Angeles, CA 90095
| | - Anjali Bisht
- Department of Clinical Epidemiology and Infection Prevention, UCLA Health, Los Angeles, CA
| | - Annabelle de St Maurice
- Department of Clinical Epidemiology and Infection Prevention, UCLA Health, Los Angeles, CA,Division of Pediatric Infectious Disease, David Geffen School of Medicine, UCLA, Los Angeles, CA
| |
Collapse
|
6
|
Liman AYJ, Wozniak LJ, de St Maurice A, Dunkel GL, Wanlass EM, Venick RS, McDiarmid SV. Low post-transplant measles and varicella titers among pediatric liver transplant recipients: A 10-year single-center study. Pediatr Transplant 2022; 26:e14322. [PMID: 35582739 DOI: 10.1111/petr.14322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/17/2022] [Accepted: 04/29/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Vaccine preventable illnesses are important sources of morbidity, mortality, and increased healthcare costs in pediatric LT recipients. Our aim was to measure the seroprevalence of antibodies to measles and VZV in this population. METHODS We conducted a retrospective chart review of 44 patients who received LT before age 18 at UCLA Mattel Children's Hospital from January 2008 to December 2017. RESULTS Median age at transplantation was 2.5 years (IQR 1.2-7.7). Post-transplant measles antibodies were present in 17 of 37 patients (46%); risk factors for seronegativity included younger age at transplant (p = .02) and greater time from transplant to testing (p = .04). Post-transplant VZV antibodies were present in 17 of 39 patients (44%); risk factors for seronegativity included greater time from transplant to testing (p = .04). 6 of 16 patients (38%) who tested positive for pre-transplant VZV antibodies tested negative after transplantation. Fourteen of 20 patients (70%) with at least 1 documented dose of the MMR vaccine tested positive for post-transplant measles antibodies. Ten of 20 of patients (50%) with at least 1 documented dose of the VZV vaccine tested positive for post-transplant VZV antibodies. We also describe 10 patients who received post-transplant measles and VZV vaccines without documented complications. CONCLUSIONS Our study suggests that pediatric LT patients are at greater risk of contracting measles and VZV despite vaccination status, and that prevalence of measles and VZV antibodies decreases as time from transplantation increases. This should weigh into the institutional risk-benefit assessment when deciding whether or not to administer LAVs to these patients.
Collapse
Affiliation(s)
- Andrew Y J Liman
- Department of Pediatrics, Mattel Children's Hospital at UCLA Medical Center, Los Angeles, California, USA
| | - Laura J Wozniak
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Mattel Children's Hospital at UCLA Medical Center, Los Angeles, California, USA
| | - Annabelle de St Maurice
- Division of Pediatric Infectious Diseases, Mattel Children's Hospital at UCLA Medical Center, Los Angeles, California, USA
| | - Gregory L Dunkel
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Mattel Children's Hospital at UCLA Medical Center, Los Angeles, California, USA
| | - Emy M Wanlass
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Mattel Children's Hospital at UCLA Medical Center, Los Angeles, California, USA
| | - Robert S Venick
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Mattel Children's Hospital at UCLA Medical Center, Los Angeles, California, USA
| | - Sue V McDiarmid
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Mattel Children's Hospital at UCLA Medical Center, Los Angeles, California, USA
| |
Collapse
|
7
|
Affiliation(s)
- Zachary Willis
- Division of Pediatric Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Annabelle de St Maurice
- University of California Los Angeles, Mattel Children's Hospital, David Geffen School of Medicine, Los Angeles, CA, USA
| |
Collapse
|
8
|
Trivellas A, Brodke D, Hu V, de St Maurice A, Krogstad P, Silva M, Thompson RM. The utility of echocardiography in paediatric patients with musculoskeletal infections and bacteremia. J Child Orthop 2021; 15:577-582. [PMID: 34987668 PMCID: PMC8670541 DOI: 10.1302/1863-2548.15.210110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 09/07/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The clinical utility of echocardiography in the setting of a positive blood culture in paediatric patients presenting with osteomyelitis (OM) and/or septic arthritis (SA). METHODS Retrospective review between 2013 and 2019: Patients < 18 years with OM, SA or combined infection (OM+SA) were included. Patients were excluded for immunodeficiency, loss of follow-up or penetrating infection. Charts with positive blood cultures were reviewed for echocardiography on that admission. Demographic variables were compared utilizing the Student's t-test and Fisher's exact test. A multivariable linear regression model was constructed to examine the association between echocardiography and length of stay, controlling for age, sex, fever, white blood cell (WBC) on admission, antibiotic administration and surgery performed. RESULTS Of 157 patients with OM, SA or combined infection, 44 had a positive blood culture. In all, 26 had an echocardiogram, and none showed endocarditis. Echocardiography was independently associated with a 6.2-day length of stay increase. WBC count and surgical intervention demonstrated a trend toward significance in length of stay, with each WBC unit increase associated with a 0.53-day increase. Surgical intervention was associated with an average 6.3-day length of stay decrease. CONCLUSION No patient had a positive echocardiogram, and no changes in management were initiated. However, an echocardiogram increased stay by 6.2 days. In addition to costs associated with increased stay, patients were billed between $1460 and $1700 per echocardiogram. The utility of echocardiograms in the setting of bacteremia associated with musculoskeletal infections in the paediatric population should be re-examined, and guidelines should be updated to reflect the cost-benefit analysis. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Andromahi Trivellas
- Department of Orthopaedic Surgery, University of California, Los Angeles, California, United States,Correspondence should be sent to Andromahi Trivellas, Department of Orthopaedic Surgery, University of California, Los Angeles, California, United States. E-mail:
| | - Dane Brodke
- Department of Orthopaedic Surgery, University of California, Los Angeles, California, United States
| | - Vivian Hu
- David Geffen School of Medicine University of California, Los Angeles, California, United States
| | - Annabelle de St Maurice
- David Geffen School of Medicine University of California, Los Angeles, California, United States
| | - Paul Krogstad
- David Geffen School of Medicine University of California, Los Angeles, California, United States
| | - Mauricio Silva
- Renee Meyer Luskin Children’s Clinic, Orthopaedic Institute for Children, University of California, Los Angeles, California, United States
| | - Rachel M. Thompson
- Renee Meyer Luskin Children’s Clinic, Orthopaedic Institute for Children, University of California, Los Angeles, California, United States
| |
Collapse
|
9
|
de St Maurice A, Cheng TL, Devaskar SU. Pediatrician's role in vaccinating children and families for COVID-19: no one left behind. Pediatr Res 2021; 90:1105-1107. [PMID: 34819657 PMCID: PMC8612382 DOI: 10.1038/s41390-021-01804-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/27/2021] [Accepted: 10/10/2021] [Indexed: 12/02/2022]
Affiliation(s)
- Annabelle de St Maurice
- Department of Pediatrics, David Geffen School of Medicine at UCLA, UCLA Mattel Children's Hospital, Los Angeles, CA, USA
| | - Tina L Cheng
- Department of Pediatrics, Cincinnati Children's Hospital and University of Cincinnati, Cincinnati, OH, USA
| | - Sherin U Devaskar
- Department of Pediatrics, Cincinnati Children's Hospital and University of Cincinnati, Cincinnati, OH, USA.
| |
Collapse
|
10
|
Adamson PC, Pfeffer MA, Arboleda VA, Garner OB, de St Maurice A, von Bredow B, Flint J, Kruglyak L, Currier JS. Lower Severe Acute Respiratory Syndrome Coronavirus 2 Viral Shedding Following Coronavirus Disease 2019 Vaccination Among Healthcare Workers in Los Angeles, California. Open Forum Infect Dis 2021; 8:ofab526. [PMID: 35005055 PMCID: PMC8689969 DOI: 10.1093/ofid/ofab526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 10/13/2021] [Indexed: 11/13/2022] Open
Abstract
Among 880 healthcare workers with a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test, 264 (30.0%) infections were identified following receipt of at least 1 vaccine dose. Median SARS-CoV-2 cycle threshold values were highest among individuals receiving 2 vaccine doses, corresponding to lower viral shedding. Vaccination might lead to lower transmissibility of SARS-CoV-2.
Collapse
Affiliation(s)
- Paul C Adamson
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Michael A Pfeffer
- Department of Medicine/Department of Information Services and Solutions, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Valerie A Arboleda
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Department of Human Genetics, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Omai B Garner
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Annabelle de St Maurice
- Division of Pediatric Infectious Diseases, Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Benjamin von Bredow
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jonathan Flint
- Department of Human Genetics, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Leonid Kruglyak
- Department of Human Genetics, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Howard Hughes Medical Institute, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Department of Biological Chemistry, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Judith S Currier
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| |
Collapse
|
11
|
Willis ZI, de St Maurice A. A Piece of the Puzzle: The Role of Molecular Testing in Antimicrobial Stewardship. J Pediatric Infect Dis Soc 2021; 10:930-935. [PMID: 34129044 DOI: 10.1093/jpids/piab037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 04/30/2021] [Indexed: 11/14/2022]
Abstract
Molecular testing may have an important role in expediting the diagnosis of infectious diseases. Pediatric infectious diseases specialists need to be cognizant of the strengths and limitations of these existing and emerging technologies in order to ensure that they are used and interpreted appropriately.
Collapse
Affiliation(s)
- Zachary I Willis
- Division of Infectious Diseases, Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Annabelle de St Maurice
- Division of Infectious Diseases, Department of Pediatrics, University of California Los Angeles, Los Angeles, California, USA
| |
Collapse
|
12
|
Banerjee R, Komarow L, Virk A, Rajapakse N, Schuetz AN, Dylla B, Earley M, Lok J, Kohner P, Ihde S, Cole N, Hines L, Reed K, Garner OB, Chandrasekaran S, de St Maurice A, Kanatani M, Curello J, Arias R, Swearingen W, Doernberg SB, Patel R. Randomized Trial Evaluating Clinical Impact of RAPid IDentification and Susceptibility Testing for Gram-negative Bacteremia: RAPIDS-GN. Clin Infect Dis 2021; 73:e39-e46. [PMID: 32374822 DOI: 10.1093/cid/ciaa528] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 04/30/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Rapid blood culture diagnostics are of unclear benefit for patients with gram-negative bacilli (GNB) bloodstream infections (BSIs). We conducted a multicenter, randomized, controlled trial comparing outcomes of patients with GNB BSIs who had blood culture testing with standard-of-care (SOC) culture and antimicrobial susceptibility testing (AST) vs rapid organism identification (ID) and phenotypic AST using the Accelerate Pheno System (RAPID). METHODS Patients with positive blood cultures with Gram stains showing GNB were randomized to SOC testing with antimicrobial stewardship (AS) review or RAPID with AS. The primary outcome was time to first antibiotic modification within 72 hours of randomization. RESULTS Of 500 randomized patients, 448 were included (226 SOC, 222 RAPID). Mean (standard deviation) time to results was faster for RAPID than SOC for organism ID (2.7 [1.2] vs 11.7 [10.5] hours; P < .001) and AST (13.5 [56] vs 44.9 [12.1] hours; P < .001). Median (interquartile range [IQR]) time to first antibiotic modification was faster in the RAPID arm vs the SOC arm for overall antibiotics (8.6 [2.6-27.6] vs 14.9 [3.3-41.1] hours; P = .02) and gram-negative antibiotics (17.3 [4.9-72] vs 42.1 [10.1-72] hours; P < .001). Median (IQR) time to antibiotic escalation was faster in the RAPID arm vs the SOC arm for antimicrobial-resistant BSIs (18.4 [5.8-72] vs 61.7 [30.4-72] hours; P = .01). There were no differences between the arms in patient outcomes. CONCLUSIONS Rapid organism ID and phenotypic AST led to faster changes in antibiotic therapy for gram-negative BSIs. CLINICAL TRIALS REGISTRATION NCT03218397.
Collapse
Affiliation(s)
- Ritu Banerjee
- Division of Pediatric Infectious Diseases, Vanderbilt University, Nashville, Tennessee, USA
| | - Lauren Komarow
- Biostatistics Center, George Washington University, Rockville, Maryland, USA
| | - Abinash Virk
- Division of Clinical Microbiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Nipunie Rajapakse
- Division of Clinical Microbiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Audrey N Schuetz
- Division of Clinical Microbiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Brenda Dylla
- Division of Clinical Microbiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Michelle Earley
- Biostatistics Center, George Washington University, Rockville, Maryland, USA
| | - Judith Lok
- Department of Mathematics and Statistics, Boston University, Boston, Massachusetts, USA
| | - Peggy Kohner
- Division of Clinical Microbiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sherry Ihde
- Division of Clinical Microbiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Nicolynn Cole
- Division of Clinical Microbiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Lisa Hines
- Division of Clinical Microbiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Katelyn Reed
- Division of Clinical Microbiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Omai B Garner
- Divisions of Pathology and Infectious Diseases, University of California, Los Angeles, California, USA
| | - Sukantha Chandrasekaran
- Divisions of Pathology and Infectious Diseases, University of California, Los Angeles, California, USA
| | - Annabelle de St Maurice
- Divisions of Pathology and Infectious Diseases, University of California, Los Angeles, California, USA
| | - Meganne Kanatani
- Divisions of Pathology and Infectious Diseases, University of California, Los Angeles, California, USA
| | - Jennifer Curello
- Divisions of Pathology and Infectious Diseases, University of California, Los Angeles, California, USA
| | - Rubi Arias
- Divisions of Pathology and Infectious Diseases, University of California, Los Angeles, California, USA
| | - William Swearingen
- Divisions of Pathology and Infectious Diseases, University of California, Los Angeles, California, USA
| | - Sarah B Doernberg
- Division of Infectious Diseases, University of California, San Francisco, California, USA
| | - Robin Patel
- Division of Clinical Microbiology, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
13
|
Price TK, Mirasol R, Ward KW, Dayo AJ, Hilt EE, Chandrasekaran S, Garner OB, de St Maurice A, Yang S. Genomic Characterizations of Clade III Lineage of Candida auris, California, USA. Emerg Infect Dis 2021; 27:1223-1227. [PMID: 33755003 PMCID: PMC8007294 DOI: 10.3201/eid2704.204361] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Candida auris is an emerging multidrug-resistant yeast. We describe an ongoing C. auris outbreak that began in October 2019 in Los Angeles, California, USA. We used genomic analysis to determine that isolates from 5 of 6 patients belonged to clade III; 4 isolates were closely related.
Collapse
|
14
|
Abstract
Emerging infectious diseases, including Ebola, chikungunya, Zika, and dengue, may have significant impacts on maternal-fetal dyads and neonatal outcomes. Pregnant women infected with Ebola demonstrate high mortality and very low evidence of neonatal survival. Maternal chikungunya infection can result in high rates of perinatal transmission, and infected neonates demonstrate variable disease severity. Dengue can be transmitted to neonates via vertical transmission or perinatal transmission. Zika is characterized by mild disease in pregnant women, but congenital infection can be severe. Treatment largely is supportive for these diseases, and vaccine development remains under way, with promising recent advances, notably for Ebola.
Collapse
Affiliation(s)
- Annabelle de St Maurice
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Los Angeles, 924 Westwood Boulevard, Suite 900, CA 90095, USA.
| | - Elizabeth Ervin
- Post-baccalaureate Premedical Program, University of Michigan, Office of Graduate and Postdoctoral Studies, 2960 Taubman Health Science Library, 1135 Catherine Street, Ann Arbor, MI 48109, USA
| | - Alison Chu
- Division of Neonatology and Developmental Biology, Department of Pediatrics, 10833 Le Conte Avenue, MDCC B2-411, Los Angeles, CA 90095, USA
| |
Collapse
|
15
|
Affiliation(s)
- Jennifer E Schuster
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri
| | - Annabelle de St Maurice
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of California, Los Angeles
| |
Collapse
|
16
|
Knust B, Brown S, de St Maurice A, Whitmer S, Koske SE, Ervin E, Patel K, Graziano J, Morales-Betoulle ME, House J, Cannon D, Kerins J, Holzbauer S, Austin C, Gibbons-Burgener S, Colton L, Dunn J, Zufan S, Choi MJ, Davis WR, Chiang CF, Manning CR, Roesch L, Shoemaker T, Purpura L, McQuiston J, Peterson D, Radcliffe R, Garvey A, Christel E, Morgan L, Scheftel J, Kazmierczak J, Klena JD, Nichol ST, Rollin PE. Seoul Virus Infection and Spread in United States Home-Based Ratteries: Rat and Human Testing Results From a Multistate Outbreak Investigation. J Infect Dis 2021; 222:1311-1319. [PMID: 32484879 DOI: 10.1093/infdis/jiaa307] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 05/31/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND During 2017, a multistate outbreak investigation occurred after the confirmation of Seoul virus (SEOV) infections in people and pet rats. A total of 147 humans and 897 rats were tested. METHODS In addition to immunoglobulin (Ig)G and IgM serology and traditional reverse-transcription polymerase chain reaction (RT-PCR), novel quantitative RT-PCR primers/probe were developed, and whole genome sequencing was performed. RESULTS Seventeen people had SEOV IgM, indicating recent infection; 7 reported symptoms and 3 were hospitalized. All patients recovered. Thirty-one facilities in 11 US states had SEOV infection, and among those with ≥10 rats tested, rat IgG prevalence ranged 2%-70% and SEOV RT-PCR positivity ranged 0%-70%. Human laboratory-confirmed cases were significantly associated with rat IgG positivity and RT-PCR positivity (P = .03 and P = .006, respectively). Genomic sequencing identified >99.5% homology between SEOV sequences in this outbreak, and these were >99% identical to SEOV associated with previous pet rat infections in England, the Netherlands, and France. Frequent trade of rats between home-based ratteries contributed to transmission of SEOV between facilities. CONCLUSIONS Pet rat owners, breeders, and the healthcare and public health community should be aware and take steps to prevent SEOV transmission in pet rats and to humans. Biosecurity measures and diagnostic testing can prevent further infections.
Collapse
Affiliation(s)
- Barbara Knust
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shelley Brown
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Shannon Whitmer
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah E Koske
- Wisconsin Department of Health Services, Madison, Wisconsin, USA
| | - Elizabeth Ervin
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ketan Patel
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - James Graziano
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Jennifer House
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - Deborah Cannon
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Janna Kerins
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Chicago Department of Public Health, Chicago, Illinois, USA
| | | | - Connie Austin
- Illinois Department of Public Health, Springfield, Illinois, USA
| | | | - Leah Colton
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - John Dunn
- Tennessee Department of Health, Nashville, Tennessee, USA
| | - Sara Zufan
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mary Joung Choi
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - William R Davis
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Cheng-Feng Chiang
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Craig R Manning
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Linda Roesch
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Trevor Shoemaker
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lawrence Purpura
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennifer McQuiston
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Rachel Radcliffe
- South Carolina Department of Health and Environmental Control, Columbia, South Carolina, USA
| | - Ann Garvey
- South Carolina Department of Health and Environmental Control, Columbia, South Carolina, USA
| | | | - Laura Morgan
- Manitowoc County Health Department, Manitowoc, Wisconsin, USA
| | - Joni Scheftel
- Minnesota Department of Health, St. Paul, Minnesota, USA
| | | | - John D Klena
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Stuart T Nichol
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Pierre E Rollin
- United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | |
Collapse
|
17
|
Oland G, Garner O, de St Maurice A. Prospective clinical validation of 3D printed nasopharyngeal swabs for diagnosis of COVID-19. Diagn Microbiol Infect Dis 2021; 99:115257. [PMID: 33220640 PMCID: PMC7577894 DOI: 10.1016/j.diagmicrobio.2020.115257] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/15/2020] [Accepted: 10/18/2020] [Indexed: 01/27/2023]
Abstract
COVID-19 greatly disrupted the global supply chain of nasopharyngeal swabs, and thus new products have come to market with little data to support their use. In this prospective study, 2 new 3D printed nasopharyngeal swab designs were evaluated against the standard, flocked nasopharyngeal swab for the diagnosis of COVID-19. Seventy adult patients (37 COVID-positive and 33 COVID-negative) underwent consecutive diagnostic reverse transcription polymerase chain reaction testing, with a flocked swab followed by one or two 3D printed swabs. The "Lattice Swab" (manufacturer Resolution Medical) demonstrated 93.3% sensitivity (95% CI, 77.9%-99.2%) and 96.8% specificity (83.3%-99.9%), yielding κ = 0.90 (0.85-0.96). The "Origin KXG" (manufacturer Origin Laboratories) demonstrated 83.9% sensitivity (66.3%-94.6%) and 100% specificity (88.8%-100.0%), yielding κ = 0.84 (0.77-0.91). Both 3D printed nasopharyngeal swab results have high concordance with the control swab results. The decision to use 3D printed nasopharyngeal swabs during the COVID-19 pandemic should be strongly considered by clinical and research laboratories.
Collapse
Affiliation(s)
- Gabriel Oland
- UCLA David Geffen School of Medicine, Department of Surgery, Division of General Surgery, Los Angeles, CA, USA.
| | - Omai Garner
- UCLA, Department of Pathology and Laboratory Medicine, Los Angeles, CA, USA.
| | - Annabelle de St Maurice
- UCLA David Geffen School of Medicine, Department of Pediatrics, Division of Infectious Disease, Los Angeles, CA, USA.
| |
Collapse
|
18
|
Yang S, Stanzione N, Uslan DZ, Garner OB, de St Maurice A. Clinical and Epidemiologic Evaluation of Inconclusive COVID-19 PCR Results Using a Quantitative Algorithm. Am J Clin Pathol 2021; 155:376-380. [PMID: 33274731 PMCID: PMC7799210 DOI: 10.1093/ajcp/aqaa251] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objectives The inconclusive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) result causes confusion and delay for infection prevention precautions and patient management. We aimed to develop a quantitative algorithm to assess and interpret these inconclusive results. Methods We created a score-based algorithm by combining laboratory, clinical, and epidemiologic data to evaluate 69 cases with inconclusive coronavirus disease 2019 (COVID-19) PCR results from the Centers for Disease Control and Prevention (CDC) assay (18 cases) and the TaqPath assay (51 cases). Results We determined 5 (28%) of 18 (CDC assay) and 20 (39%) of 51 (TaqPath assay) cases to be false positive. Lowering the cycle threshold cutoff from 40 to 37 in the TaqPath assay resulted in a dramatic reduction of the false-positive rate to 14%. We also showed testing of asymptomatic individuals is associated with a significantly higher probability of having a false-positive result. Conclusions A substantial percentage of inconclusive SARS-CoV-2 PCR results can be false positive, especially among asymptomatic patients. The quantitative algorithm we created was shown to be effective and could provide a useful tool for clinicians and hospital epidemiologists to interpret inconclusive COVID-19 PCR results and provide clinical guidance when additional PCR or antibody test results are available.
Collapse
Affiliation(s)
| | | | - Daniel Z Uslan
- Department of Clinical Epidemiology and Infection Prevention
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine
| | | | - Annabelle de St Maurice
- Department of Clinical Epidemiology and Infection Prevention
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of California Los Angeles
| |
Collapse
|
19
|
Douglass KM, Strobel KM, Richley M, Mok T, de St Maurice A, Fajardo V, Young AT, Rao R, Lee L, Benharash P, Chu A, Afshar Y. Maternal-Neonatal Dyad Outcomes of Maternal COVID-19 Requiring Extracorporeal Membrane Support: A Case Series. Am J Perinatol 2021; 38:82-87. [PMID: 33069171 PMCID: PMC7869039 DOI: 10.1055/s-0040-1718694] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE This study aimed to describe two cases of acute respiratory distress syndrome (ARDS) secondary to novel coronavirus disease 2019 (COVID-19) in pregnant women requiring extracorporeal membrane oxygenation (ECMO), and resulting in premature delivery. STUDY DESIGN The clinical course of two women hospitalized with ARDS due to COVID-19 care in our intensive care (ICU) is summarized; both participants provided consent to be included in this case series. RESULTS Both women recovered with no clinical sequelae. Neonatal outcomes were within the realm of expected for prematurity with the exception of coagulopathy. There was no vertical transmission to the neonates. CONCLUSION This case series highlights that ECMO is a feasible treatment in the pregnant woman with severe COVID-19 and that delivery can be performed safely on ECMO with no additional risk to the fetus. While ECMO carries its natural risks, it should be considered a viable option during pregnancy and the postpartum period. KEY POINTS · COVID-19 may present with a more severe course in pregnancy.. · ECMO may be used in pregnant woman with severe COVID-19.. · Delivery can be performed on ECMO without added fetal risk..
Collapse
Affiliation(s)
- K. Marie Douglass
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles
| | - Katie M. Strobel
- Division of Neonatology, Department of Pediatrics, University of California, Los Angeles
| | - Michael Richley
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles
| | - Thalia Mok
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles
| | - Annabelle de St Maurice
- Division of Infectious Disease, Department of Pediatrics, University of California, Los Angeles
| | - Viviana Fajardo
- Division of Neonatology, Department of Pediatrics, University of California, Los Angeles
| | - Andrew T. Young
- Division of Critical Care, Department of Anesthesia, University of California, Los Angeles
| | - Rashmi Rao
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles
| | - Lydia Lee
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles
| | - Peyman Benharash
- Divison of Cardiac Surgery, Department of Surgery, University of California, Los Angeles
| | - Alison Chu
- Division of Neonatology, Department of Pediatrics, University of California, Los Angeles
| | - Yalda Afshar
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles,Address for correspondence Yalda Afshar, MD, PhD Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, David Geffen School of MedicineUCLA, 200 Medical Plaza, Suite 430, Los Angeles, CA 90095
| |
Collapse
|
20
|
Altendahl M, Afshar Y, de St Maurice A, Fajardo V, Chu A. Perinatal Maternal-Fetal/Neonatal Transmission of COVID-19: A Guide to Safe Maternal and Neonatal Care in the Era of COVID-19 and Physical Distancing. Neoreviews 2020; 21:e783-e794. [PMID: 33262205 DOI: 10.1542/neo.21-12-e783] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for coronavirus disease 2019 (COVID-19), is highly contagious and can cause serious respiratory illness and other clinical manifestations. The aim of this review is to summarize the clinical presentation, diagnosis, and outcomes of COVID-19 in pregnant women and neonates, who may be especially vulnerable to the effects of COVID-19, and to discuss what is known about potential maternal-fetal and maternal-neonatal transmission of SARS-CoV-2.
Collapse
Affiliation(s)
- Marie Altendahl
- Department of Pediatrics, Division of Neonatology and Developmental Biology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Yalda Afshar
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Annabelle de St Maurice
- Department of Pediatrics, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Viviana Fajardo
- Department of Pediatrics, Division of Neonatology and Developmental Biology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Alison Chu
- Department of Pediatrics, Division of Neonatology and Developmental Biology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| |
Collapse
|
21
|
Grijalva CG, de St Maurice A. Timing Is Everything: Pneumococcal Immunization in Inflammatory Bowel Disease. Clin Infect Dis 2020; 70:605-607. [PMID: 30899960 DOI: 10.1093/cid/ciz231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 03/18/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- Carlos G Grijalva
- Division of Pharmacoepidemiology, Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee.,Veterans Health Administration Tennessee Valley Healthcare System, Geriatric Research and Education Clinical Center, Health Services Research and Development Center, Nashville, Tennessee
| | - Annabelle de St Maurice
- Division of Pediatric Infectious Diseases, Department of Pediatrics, David Geffen School of Medicine at the University of California, Los Angeles
| |
Collapse
|
22
|
Wu S, Huang G, de St Maurice A, Lehman D, Graber CJ, Goetz MB, Haake DA. The Impact of Rapid Species Identification on Management of Bloodstream Infections: What's in a Name? Mayo Clin Proc 2020; 95:2509-2524. [PMID: 32829901 DOI: 10.1016/j.mayocp.2020.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 02/05/2020] [Accepted: 02/12/2020] [Indexed: 10/23/2022]
Abstract
Bloodstream infections are a leading cause of morbidity and mortality. Molecular rapid diagnostic tests (mRDTs) are transforming care for patients with bloodstream infection by providing the opportunity to dramatically shorten times to effective therapy and speeding de-escalation of overly broad empiric therapy. However, because of the novelty of these tests which provide information regarding microbial identification and whether specific antibiotic-resistance mutations were detected, many front-line providers still delay final decisions until complete phenotypic susceptibility results are available several days later. Thus the benefits of mRDTs have been largely limited to circumstances where antimicrobial stewardship programs closely monitor these tests and intervene as soon as the results are available. We searched PubMed and Google Scholar for articles published from 1980 to 2019 using the terms antibiotic, antifungal, bacteremia, bloodstream infection, candidemia, candidiasis, children, coagulase negative staphylococcus, consultation, contamination, costs, echocardiogram, endocarditis, enterobacteriaceae, enterococcus, Gram-negative, guidelines, IDSA, immunocompromised, infectious disease or ID, lumbar puncture, meningitis, mortality, MRSA, MSSA, neonatal, outcomes, pediatric, pneumococcal, polymicrobial, Pseudomonas, rapid diagnostic testing, resistance, risk factors, sepsis, Staphylococcus aureus, stewardship, streptococcus, and treatment. With the data from this search, we aim to provide guidance to front-line providers regarding the interpretation and immediate actions to be taken in response to the identification of common bloodstream pathogens by mRDTs. In addition to antimicrobial therapy, additional diagnostic or therapeutic interventions are recommended for particular organisms and clinical settings to either determine the extent of infection or control its source. Pediatric perspectives are offered for those bloodstream pathogens for which management differs from that in adults.
Collapse
Affiliation(s)
- Simon Wu
- VA Greater Los Angeles Healthcare System, California; David Geffen School of Medicine at the University of California, Los Angeles
| | - Glen Huang
- David Geffen School of Medicine at the University of California, Los Angeles
| | | | - Deborah Lehman
- David Geffen School of Medicine at the University of California, Los Angeles
| | - Christopher J Graber
- VA Greater Los Angeles Healthcare System, California; David Geffen School of Medicine at the University of California, Los Angeles
| | - Matthew B Goetz
- VA Greater Los Angeles Healthcare System, California; David Geffen School of Medicine at the University of California, Los Angeles
| | - David A Haake
- VA Greater Los Angeles Healthcare System, California; David Geffen School of Medicine at the University of California, Los Angeles.
| |
Collapse
|
23
|
Hilt EE, Fitzwater SP, Ward K, de St Maurice A, Chandrasekaran S, Garner OB, Yang S. Carbapenem Resistant Aeromonas hydrophila Carrying bla cphA7 Isolated From Two Solid Organ Transplant Patients. Front Cell Infect Microbiol 2020; 10:563482. [PMID: 33194801 PMCID: PMC7649429 DOI: 10.3389/fcimb.2020.563482] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 09/23/2020] [Indexed: 11/30/2022] Open
Abstract
Aeromonas hydrophila resides in a variety of aquatic environments. Infections with A. hydrophila mainly occur after contact with fresh or brackish water. Nosocomial infections with A. hydrophila can also occur. A. hydrophila infections can be difficult to treat due to both intrinsic and acquired antimicrobial resistance (AMR) mechanisms. In 2018–19, we isolated multi-drug resistant (MDR) A. hyrodphila from two solid organ transplant patients with intra-abdominal infections. We aimed to characterize their AMR mechanisms and to determine their genetic relatedness to aid epidemiological investigation. We performed whole genome sequencing (WGS) using Illumina MiSeq and Nanopore MinIon on 3 A. hydrophila isolates, with one isolate from Patient A (blood) and two isolates from Patient B (abdominal and T-tube fluid, isolated 2 weeks apart). Phenotypic assays included: Broth Microdilution (BMD), Modified Hodge Test (MHT), Modified Carbapenem Inactivation Method (mCIM), and EDTA Carbapenem Inactivation Method (eCIM). Data analyses were performed using CLCbio and Geneious. AMR genomic analysis revealed that all three isolates possess chromosomally encoded genes including blaOXA−12(oxacillinase), blacepS(AmpC), and blacphA7(metallo-beta-lactamase). All isolates tested strongly positive by MHT and mCIM, but only Patient B's second isolate (after 2 weeks of meropenem treatment) tested positive by eCIM. More intriguingly, Patient B's first isolate (before meropenem treatment) tested falsely susceptible to carbapenems by BMD, suggesting blacphA7 gene was not expressed constitutively. Phylogenetic analysis showed the two isolates from Patient B were highly similar with only 1 SNP difference. The isolate from Patient A only differed from Patient B's isolates by 35 and 36 SNPs, respectively, suggesting close genetic relatedness. Further epidemiological investigation is undergoing. We report the first cases of CphA-mediated carbapenem resistant A. hydrophila in the U.S. It is concerning that 1 out of 3 isolates tested falsely susceptible to carbapenems by BMD despite clear carbapenemase production shown by strongly positive MHT and mCIM. In both cases, meropenem was initially used to treat the patients. Clinicians and microbiologists in the US should be aware of the emerging MDR Aeromonas nosocomial infections and the potential false carbapenem susceptible results due to CphA-type carbapenemase, which may be induced during treatment.
Collapse
Affiliation(s)
- Evann E Hilt
- Department of Pathology and Laboratory Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Sean Patrick Fitzwater
- Department of Pediatrics, University of California, Los Angeles, Los Angeles, CA, United States
| | - Kevin Ward
- Department of Pathology and Laboratory Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Annabelle de St Maurice
- Department of Pediatrics, University of California, Los Angeles, Los Angeles, CA, United States
| | - Sukantha Chandrasekaran
- Department of Pathology and Laboratory Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Omai B Garner
- Department of Pathology and Laboratory Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Shangxin Yang
- Department of Pathology and Laboratory Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| |
Collapse
|
24
|
de St Maurice A, Rubin ZA. Outbreak Investigations: A Brief Primer for Gastroenterologists. Gastrointest Endosc Clin N Am 2020; 30:735-743. [PMID: 32891229 DOI: 10.1016/j.giec.2020.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Transmission of pathogens during endoscopy and subsequent outbreak investigations generated by potential nosocomial transmissions have become a major concern for gastroenterologists. These investigations have resulted in significant media coverage for individual institutions and can cause massive disruption to the institution if not handled well. Gastroenterologists should have a central role in investigation of these outbreaks and management of the communications and patient notification that is required. This article summarizes important aspects of outbreak investigations for physicians who do not frequently manage these investigations and gives practical advice for how gastroenterologists can help identify outbreaks and manage these investigations successfully.
Collapse
Affiliation(s)
- Annabelle de St Maurice
- UCLA Division of Infectious Diseases, Department of Pediatrics, 22-442 MDCC, 10833 Le Conte Avenue, Los Angeles, CA 90095-1752, USA; Department of Pediatrics, David Geffen School of Medicine at UCLA, 924 Westwood Boulevard, Suite 900, Los Angeles, CA 90095, USA
| | - Zachary A Rubin
- Acute Communicable Disease Control, Los Angeles County Department of Public Health, 313 North Figueroa Street, Room 212, Los Angeles, CA 90012, USA.
| |
Collapse
|
25
|
Affiliation(s)
- Annabelle de St Maurice
- Division of Pediatric Infectious Diseases, Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; and
| | - Kathryn Edwards
- Division of Pediatric Infectious Diseases, Department of Pediatrics, School of Medicine, Vanderbilt University, Nashville, Tennessee
| |
Collapse
|
26
|
Abstract
Mycoplasma species (spp.) can be commensals or opportunistic pathogens of the urogenital tract, and they can be commonly isolated from amniotic fluid, placenta, and fetal/neonatal tissue or blood in mothers delivering prematurely or their preterm infants. Although the presence of Mycoplasma spp. has been associated with adverse maternal-fetal outcomes such as preterm birth and maternal chorioamnionitis, it is less clear whether vertical transmission to the neonate results in colonization or active infection/inflammation. Moreover, the presence of Mycoplasma spp. in neonatal blood, cerebrospinal fluid, or tissue has been variably associated with increased risk of neonatal comorbidities, especially bronchopulmonary dysplasia (BPD). Although the treatment of the mother or neonate with antibiotics is effective in eradicating ureaplasma, it is not clear that the treatment is effective in reducing the incidence of major morbidities of the preterm neonate (eg, BPD). In this article, we review the animal and clinical data for ureaplasma-related complications and treatment strategies. [Pediatr Ann. 2020;49(7):e305-e312.].
Collapse
|
27
|
Abstract
Although the 2017-2018 influenza season had very high rates of influenza-associated illness, the 2018-2019 influenza season was comparable to previous seasons. Influenza A was the most commonly identified type worldwide, although variations in influenza A subtype prevalence existed. Influenza vaccination remains the single most effective way to prevent influenza-associated illness. A novel influenza antiviral, baloxavir, has demonstrated promising results; however, concerns about development of resistance exist.
Collapse
Affiliation(s)
- Annabelle de St Maurice
- Division of Pediatric Infectious Diseases, Department of Pediatrics, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Natasha Halasa
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| |
Collapse
|
28
|
Abstract
The 2017-18 influenza season brought record numbers of cases in both the Northern and Southern hemispheres, resulting in high rates of influenza-related hospital admission and death. Estimated efficacy of flu vaccine was low against the most common circulating strain, influenza A (H3N2). Decreased efficacy may be due to changes in circulating virus or mutations that occur in the vaccine strain during the manufacturing process.
Collapse
Affiliation(s)
- Annabelle de St Maurice
- Department of Pediatrics, Division of Pediatric Infectious Diseases, UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Natasha Halasa
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee
| |
Collapse
|
29
|
Dulek DE, de St Maurice A, Halasa NB. Vaccines in pediatric transplant recipients-Past, present, and future. Pediatr Transplant 2018; 22:e13282. [PMID: 30207024 DOI: 10.1111/petr.13282] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 07/11/2018] [Accepted: 07/12/2018] [Indexed: 12/20/2022]
Abstract
Infections significantly impact outcomes for solid organ and hematopoietic stem cell transplantation in children. Vaccine-preventable diseases contribute to morbidity and mortality in both early and late posttransplant time periods. Several infectious diseases and transplantation societies have published recommendations and guidelines that address immunization in adult and pediatric transplant recipients. In many cases, pediatric-specific studies are limited in size or quality, leading to recommendations being based on adult data or mixed adult-pediatric studies. We therefore review the current state of evidence for selected immunizations in pediatric transplant recipients and highlight areas for future investigation. Specific attention is given to studies that enrolled only children.
Collapse
Affiliation(s)
- Daniel E Dulek
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Annabelle de St Maurice
- Division of Pediatric Infectious Diseases, Department of Pediatrics, David Geffen School of Medicine, UCLA, Los Angeles, California
| | - Natasha B Halasa
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| |
Collapse
|
30
|
Abstract
Vaccines have had a profound impact on public health; however, parents are increasingly refusing or delaying vaccines for their children. Population-based studies have demonstrated the safety and efficacy of vaccines. Pediatricians should be well informed about vaccine development, safety, and efficacy to inspire parental confidence in vaccines. Systemic challenges in discussing and providing immunizations exist. Discussions about immunizations may be lengthy and time spent discussing immunizations is not routinely reimbursed. Adolescents may be inadequately immunized because they do not routinely present for preventive health visits. Routine immunizations should be offered and discussed at sick visits, particularly for adolescents. Improving immunization rates requires a multifaceted approach. [Pediatr Ann. 2018;47(9):e366-e370.].
Collapse
|
31
|
Affiliation(s)
- Annabelle de St Maurice
- Pediatric Infectious Disease Physician, Mattel Children's Hospital, University of California, Los Angeles
| | - Zachary Willis
- Pediatric Infectious Disease Physician, University of North Carolina at Chapel Hill School of Medicine
| | - Sherry Ross
- Pediatric Urology, University of North Carolina at Chapel Hill School of Medicine
| |
Collapse
|
32
|
de St Maurice A, Ervin E, Schumacher M, Yaglom H, VinHatton E, Melman S, Komatsu K, House J, Peterson D, Buttke D, Ryan A, Yazzie D, Manning C, Ettestad P, Rollin P, Knust B. Exposure Characteristics of Hantavirus Pulmonary Syndrome Patients, United States, 1993-2015. Emerg Infect Dis 2017; 23:733-739. [PMID: 28418312 PMCID: PMC5403056 DOI: 10.3201/eid2305.161770] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Those at highest risk are persons in occupations with potential for rodent exposure and American Indian women 40–64 years of age.
Collapse
|
33
|
Abstract
Influenza-associated infections cause significant morbidity and mortality worldwide, particularly among immunocompromised patients. Immunization is the primary mode of prevention of disease; however, efficacy in immunocompromised patients may be limited. Antiviral medications are important for treatment and prophylaxis of affected individuals. This article reviews treatment and prevention recommendations for the 2016-2017 influenza season in the Northern Hemisphere and Southern Hemisphere.
Collapse
Affiliation(s)
- Annabelle de St Maurice
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Natasha Halasa
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA
| |
Collapse
|
34
|
de St Maurice A, Halasa N. Ensuring adequate immunizations among pediatric liver transplant recipients: A team approach. Pediatr Transplant 2016; 20:1018-1019. [PMID: 27882686 DOI: 10.1111/petr.12814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/26/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Annabelle de St Maurice
- Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA.,Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Natasha Halasa
- Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA.,Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| |
Collapse
|
35
|
de St Maurice A, Nyakarahuka L, Purpura L, Ervin E, Tumusiime A, Balinandi S, Kayondo J, Mulei S, Namutebi AM, Tusiime P, Wiersma S, Nichol S, Rollin P, Klena J, Knust B, Shoemaker T. Notes from the Field: Rift Valley Fever Response - Kabale District, Uganda, March 2016. MMWR Morb Mortal Wkly Rep 2016; 65:1200-1201. [PMID: 27811840 DOI: 10.15585/mmwr.mm6543a5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
On March 9, 2016, a male butcher from Kabale District, Uganda, aged 45 years, reported to the Kabale Regional Referral Hospital with fever, fatigue, and headache associated with black tarry stools and bleeding from the nose. One day later, a student aged 16 years from a different sub-county in Kabale District developed similar symptoms and was admitted to the same hospital. The student also had a history of contact with livestock. Blood specimens collected from both patients were sent for testing for Marburg virus disease, Ebola virus disease, Rift Valley fever (RVF), and Crimean Congo Hemorrhagic fever at the Uganda Virus Research Institute, as part of the viral hemorrhagic fevers surveillance program. The Uganda Virus Research Institute serves as the national viral hemorrhagic fever reference laboratory and hosts the national surveillance program for viral hemorrhagic fevers, in collaboration with the CDC Viral Special Pathogens Branch and the Uganda Ministry of Health.
Collapse
|
36
|
de St Maurice A, Schaffner W, Griffin MR, Halasa N, Grijalva CG. Persistent Sex Disparities in Invasive Pneumococcal Diseases in the Conjugate Vaccine Era. J Infect Dis 2016; 214:792-7. [PMID: 27247342 DOI: 10.1093/infdis/jiw222] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 05/19/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Few studies have characterized the role of sex on the incidence of invasive pneumococcal disease (IPD). We examined sex differences in rates of IPD, and trends after the introduction of pneumococcal conjugate vaccines (PCVs). METHODS We used active population and laboratory-based IPD surveillance data from the Centers for Disease Control and Prevention Active Bacterial Core surveillance program (1998-2013) in Tennessee. Population-based rates of IPD by sex, race, age group, and PCV era were calculated. Rates were compared using incidence rate ratios. RESULTS Throughout the study years, rates of IPD were higher in male than in female subjects, particularly in children <2 years and adults 40-64 years of age, with male subjects having IPD rates 1.5-2 times higher than female subjects. The proportions of comorbid conditions were similar in male and female subjects . Sex rate differences persisted after stratification by race. Although the introductions of 7-valent PCV (PCV7) and 13-valent PCV (PCV13) were associated with declines in IPD rates in both sexes, rates of IPD after PCV13 were still significantly higher in male than in female subjects among children and adults 40-64 and >74 years of age. CONCLUSIONS Rates of IPD were generally higher in male than in female subjects. These sex differences were observed in different race groups and persisted after introduction of both PCVs.
Collapse
Affiliation(s)
| | | | - Marie R Griffin
- Department of Health Policy, Vanderbilt University Department of Geriatric Research Education Clinical Center, VA Tennessee Valley, Nashville
| | | | - Carlos G Grijalva
- Department of Health Policy, Vanderbilt University Department of Geriatric Research Education Clinical Center, VA Tennessee Valley, Nashville
| |
Collapse
|
37
|
de St Maurice A, Edwards KM. Vaccine Hesitancy in Children-A Call for Action. Children (Basel) 2016; 3:children3020007. [PMID: 27417245 PMCID: PMC4934562 DOI: 10.3390/children3020007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 04/15/2016] [Accepted: 04/20/2016] [Indexed: 11/20/2022]
Abstract
Immunizations have made an enormous impact on the health of children by decreasing childhood morbidity and mortality from a variety of vaccine-preventable diseases worldwide. The eradication of polio from Nigeria and India is one of the most recent victories for one of the greatest technological advances in human history. Despite these international successes, the United States has experienced the re-emergence of measles, driven largely by increasing parental refusal of vaccines. Pediatricians should be trained to be very knowledgeable about vaccines and should continue to advocate for parents to immunize their children.
Collapse
Affiliation(s)
| | - Kathryn M Edwards
- Department of Pediatrics, Vanderbilt University, Nashville, TN 37232, USA.
| |
Collapse
|
38
|
de St Maurice A, Grijalva CG, Fonnesbeck C, Schaffner W, Halasa NB. Racial and Regional Differences in Rates of Invasive Pneumococcal Disease. Pediatrics 2015; 136:e1186-94. [PMID: 26459652 PMCID: PMC4621799 DOI: 10.1542/peds.2015-1773] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2015] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Invasive pneumococcal disease (IPD) remains an important cause of illness in US children. We assessed the impact of introduction of the 13-valent pneumococcal conjugate vaccine (PCV13) on pediatric IPD rates, as well as changes in racial and regional differences in IPD, in Tennessee. METHODS Data from active laboratory and population-based surveillance of IPD were used to compare IPD rates in the early-PCV7 (2001-2004), late-PCV7 (2005-2009), and post-PCV13 (2011-2012) eras. IPD rates were further stratified according to age, race, and region (east and middle-west TN). RESULTS Among children aged <2 years, IPD rates declined by 70% from 67 to 19 per 100 000 person-years in the early-PCV7 era and post-PCV13 era, respectively. Similar decreasing trends in IPD rates were observed in older children aged 2 to 4 years and 5 to 17 years. In the late-PCV7 era, IPD rates in children aged <2 years were higher in black children compared with white children (70 vs 43 per 100 000 person-years); however, these racial differences in IPD rates were no longer significant after PCV13 introduction. Before PCV13, IPD rates in children aged <2 years were also higher in east Tennessee compared with middle-west Tennessee (91 vs 45 per 100 000 person-years), but these differences were no longer significant in the post-PCV13 era. CONCLUSIONS PCV13 introduction led to substantial declines in childhood IPD rates and was associated with reduced regional and racial differences in IPD rates in Tennessee.
Collapse
|
39
|
Affiliation(s)
- Annabelle de St Maurice
- Division of Infectious Diseases, Department of Pediatrics, Vanderbilt Vaccine Research Program, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Kathryn M Edwards
- Division of Infectious Diseases, Department of Pediatrics, Vanderbilt Vaccine Research Program, Vanderbilt University School of Medicine, Nashville, Tennessee.
| |
Collapse
|
40
|
de St Maurice A, Frangoul H, Coogan A, Williams JV. Prolonged fever and splenic lesions caused by Malassezia restricta in an immunocompromised patient. Pediatr Transplant 2014; 18:E283-6. [PMID: 25187171 PMCID: PMC4644127 DOI: 10.1111/petr.12351] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2014] [Indexed: 11/29/2022]
Abstract
Malassezia species are commonly found on human skin as commensals but can cause invasive infections in premature infants and immunocompromised hosts. Due to their fastidious growth, diagnosis of Malassezia infections can prove challenging. Molecular techniques can aid in diagnosis and treatment of invasive infections. We describe the case of a pediatric oncology patient with splenic lesions secondary to Malassezia restricta.
Collapse
Affiliation(s)
| | - Haydar Frangoul
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN
| | - Alice Coogan
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, TN
| | - John V. Williams
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, TN
| |
Collapse
|
41
|
Allan BF, Langerhans RB, Ryberg WA, Landesman WJ, Griffin NW, Katz RS, Oberle BJ, Schutzenhofer MR, Smyth KN, de St Maurice A, Clark L, Crooks KR, Hernandez DE, McLean RG, Ostfeld RS, Chase JM. Ecological correlates of risk and incidence of West Nile virus in the United States. Oecologia 2008; 158:699-708. [PMID: 18941794 DOI: 10.1007/s00442-008-1169-9] [Citation(s) in RCA: 135] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2007] [Accepted: 09/22/2008] [Indexed: 11/24/2022]
Abstract
West Nile virus, which was recently introduced to North America, is a mosquito-borne pathogen that infects a wide range of vertebrate hosts, including humans. Several species of birds appear to be the primary reservoir hosts, whereas other bird species, as well as other vertebrate species, can be infected but are less competent reservoirs. One hypothesis regarding the transmission dynamics of West Nile virus suggests that high bird diversity reduces West Nile virus transmission because mosquito blood-meals are distributed across a wide range of bird species, many of which have low reservoir competence. One mechanism by which this hypothesis can operate is that high-diversity bird communities might have lower community-competence, defined as the sum of the product of each species' abundance and its reservoir competence index value. Additional hypotheses posit that West Nile virus transmission will be reduced when either: (1) abundance of mosquito vectors is low; or (2) human population density is low. We assessed these hypotheses at two spatial scales: a regional scale near Saint Louis, MO, and a national scale (continental USA). We found that prevalence of West Nile virus infection in mosquito vectors and in humans increased with decreasing bird diversity and with increasing reservoir competence of the bird community. Our results suggest that conservation of avian diversity might help ameliorate the current West Nile virus epidemic in the USA.
Collapse
Affiliation(s)
- Brian F Allan
- Department of Biology, Washington University, One Brookings Drive, Campus Box 1137, Saint Louis, MO, 63130, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|