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de Hoog S, Walsh TJ, Ahmed SA, Alastruey-Izquierdo A, Alexander BD, Arendrup MC, Babady E, Bai FY, Balada-Llasat JM, Borman A, Chowdhary A, Clark A, Colgrove RC, Cornely OA, Dingle TC, Dufresne PJ, Fuller J, Gangneux JP, Gibas C, Glasgow H, Graser Y, Guillot J, Groll AH, Haase G, Hanson K, Harrington A, Hawksworth DL, Hayden RT, Hoenigl M, Hubka V, Johnson K, Kus JV, Li R, Meis JF, Lackner M, Lanternier F, Leal SM, Lee F, Lockhart SR, Luethy P, Martin I, Kwon-Chung KJ, Meyer W, Nguyen MH, Ostrosky-Zeichner L, Palavecino E, Pancholi P, Pappas PG, Procop GW, Redhead SA, Rhoads DD, Riedel S, Stevens B, Sullivan KO, Vergidis P, Roilides E, Seyedmousavi A, Tao L, Vicente VA, Vitale RG, Wang QM, Wengenack NL, Westblade L, Wiederhold N, White L, Wojewoda CM, Zhang SX. Reply to Kidd et al., "Inconsistencies within the proposed framework for stabilizing fungal nomenclature risk further confusion". J Clin Microbiol 2024; 62:e0162523. [PMID: 38441056 PMCID: PMC11005378 DOI: 10.1128/jcm.01625-23] [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] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Affiliation(s)
- Sybren de Hoog
- Radboudumc-CWZ Centre of Expertise for Mycology, Nijmegen, the Netherlands
- Foundation Atlas of Clinical Fungi, Hilversum, the Netherlands
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China
- Department of Basic Pathology, Federal University of Paraná, Curitiba, Brazil
- Research Center for Medical Mycology, Peking University, Beijing, China
- International Society for Human and Animal Mycology (ISHAM), Working Group Nomenclature, ‘s-Hertogenbosch, the Netherlands
| | - Thomas J. Walsh
- International Society for Human and Animal Mycology (ISHAM), Working Group Nomenclature, ‘s-Hertogenbosch, the Netherlands
- Center for Innovative Therapeutics and Diagnostics, Richmond, Virginia, USA
- University of Maryland School of Medicine, Baltimore, Maryland, USA
- Nomenclature Committee for Fungi, International Mycological Association (IMA), Exeter, United Kingdom
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Mycoses Study Group, Education and Research Consortium (MSG-ERC), Pittsburgh, Pennsylvania, USA
- European Confederation of Medical Mycology (ECMM), ‘s-Hertogenbosch, the Netherlands
- Clinical and Laboratory Standards Institute (CLSI), Pittsburgh, Pennsylvania, USA
- Medical Mycological Society of the Americas (MMSA)
- ISHAM Working Group on Diagnostics, Basel, Switzerland
| | - Sarah A. Ahmed
- Radboudumc-CWZ Centre of Expertise for Mycology, Nijmegen, the Netherlands
- Foundation Atlas of Clinical Fungi, Hilversum, the Netherlands
- International Society for Human and Animal Mycology (ISHAM), Working Group Nomenclature, ‘s-Hertogenbosch, the Netherlands
| | - Ana Alastruey-Izquierdo
- International Society for Human and Animal Mycology (ISHAM), Working Group Nomenclature, ‘s-Hertogenbosch, the Netherlands
- Mycology Reference Laboratory, Spanish National Centre for Microbiology, Madrid, Spain
- Fungal Infection Study Group, European Society of Clinical Microbiology and Infectious Diseases (EFISG/ESCMID), Basel, Switzerland
| | - Barbara D. Alexander
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Medical Mycological Society of the Americas (MMSA)
- Departments of Medicine and Pathology, Duke University, Durham, North Carolina, USA
| | - Maiken Cavling Arendrup
- Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
- Department of Clinical Microbiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Antifungal Susceptibility Testing Subcommittee of European Committee of Antimicrobial Susceptibility Testing (EUCAST-AFST)
| | - Esther Babady
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Department of Pathology and Laboratory Medicine, Clinical Microbiology Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Feng-Yan Bai
- Mycology Committee of Chinese Society for Microbiology, Beijing, China
- Institute of Microbiology, State Key Laboratory of Mycology, Chinese Academy of Sciences, Beijing, China
- Medical Mycology Society of Chinese Medicine and Education Association
- Asia PacificSociety for Medical Mycology
- ISHAM Working Group Veterinary Mycology and One Health, ‘s-Hertogenbosch, the Netherlands
- Mycological Society of China (MSC)
| | - Joan-Miquel Balada-Llasat
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Clinical Microbiology at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Andrew Borman
- National Mycology Reference Laboratory, Public Health England, Bristol, United Kingdom
| | - Anuradha Chowdhary
- Fungal Infection Study Group, European Society of Clinical Microbiology and Infectious Diseases (EFISG/ESCMID), Basel, Switzerland
- Department of Microbiology, National Reference Laboratory for Antimicrobial Resistance in Fungal Pathogens, Medical Mycology Unit, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Andrew Clark
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Robert C. Colgrove
- Division of Infectious Diseases, Mount Auburn Hospital, Cambridge, Massachusetts, USA
- Infectious Diseases Society of America (ISDA), Arlington, Virginia, USA
| | - Oliver A. Cornely
- European Confederation of Medical Mycology (ECMM), ‘s-Hertogenbosch, the Netherlands
- Fungal Infection Study Group, European Society of Clinical Microbiology and Infectious Diseases (EFISG/ESCMID), Basel, Switzerland
- University of Cologne, Faculty of Medicine, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, Cologne, Germany
- Department I of Internal Medicine, University of Cologne, Excellence Center for Medical Mycology, Cologne, Germany
| | - Tanis C. Dingle
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Clinical and Laboratory Standards Institute (CLSI), Pittsburgh, Pennsylvania, USA
- Alberta Precision Laboratories, Public Health Laboratory, Calgary, Alberta, Canada
| | - Philippe J. Dufresne
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Clinical and Laboratory Standards Institute (CLSI), Pittsburgh, Pennsylvania, USA
- Department of Mycology, Laboratoire de Santé Publique du Québec, Institut National de Santé Publique du Québec (INSPQ), Sainte-Anne-de-Bellevue, Québec, Canada
| | - Jeff Fuller
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Department of Pathology and Laboratory Medicine, London Health Sciences Center, London, Ontario, Canada
| | - Jean-Pierre Gangneux
- European Confederation of Medical Mycology (ECMM), ‘s-Hertogenbosch, the Netherlands
- Department of Mycology, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Connie Gibas
- University of Texas Health Science Center, San Antonio, Texas, USA
| | - Heather Glasgow
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Clinical and Laboratory Standards Institute (CLSI), Pittsburgh, Pennsylvania, USA
- Department of Pathology, Clinical and Molecular Microbiology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Yvonne Graser
- Department of Parasitology (Charité), Institute of Microbiology and Hygiene, Humboldt University, Berlin, Germany
| | - Jacques Guillot
- ISHAM Working Group Veterinary Mycology and One Health, ‘s-Hertogenbosch, the Netherlands
- Onoris, École Nationale Vétérinaire, Agroalimentaire et de l'Alimentation Nantes-Atlantique, Nantes, France
| | - Andreas H. Groll
- Fungal Infection Study Group, European Society of Clinical Microbiology and Infectious Diseases (EFISG/ESCMID), Basel, Switzerland
- Department of Pediatric Hematology and Oncology, Infectious Disease Research Program, Center for Bone Marrow Transplantation, University Children’s Hospital, Münster, Germany
| | - Gerhard Haase
- Laboratory Diagnostic Center, RWTH Aachen University Hospital, Aachen, Germany
| | - Kimberly Hanson
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Amanda Harrington
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Loyola University Health System, Loyola University Chicago, Maywood, Illinois, USA
| | - David L. Hawksworth
- Royal Botanic Gardens, Kew, Richmond, Surrey, United Kingdom
- Natural History Museum, London, United Kingdom
- University of Southampton, Southampton, United Kingdom
- Jilin Agricultural University, Chanchung, China
- General Committee for Nomenclature, International Botanical Congress (IBC)
- Advisory Board of International Commission on the Taxonomy of Fungi (ICTF)
| | - Randall T. Hayden
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Clinical and Laboratory Standards Institute (CLSI), Pittsburgh, Pennsylvania, USA
- Department of Pathology, Clinical and Molecular Microbiology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Martin Hoenigl
- Mycoses Study Group, Education and Research Consortium (MSG-ERC), Pittsburgh, Pennsylvania, USA
- European Confederation of Medical Mycology (ECMM), ‘s-Hertogenbosch, the Netherlands
- Division of Infectious Diseases, Medical University of Graz, Graz, Austria
- Translational Medical Mycology Research Unit, ECMM Excellence Center for Medical Mycology, Medical University of Graz, Graz, Austria
- European Hematology Association, Specialized Working Group for Infections in Hematology, The Hague, the Netherlands
| | - Vit Hubka
- Department of Botany, Charles University, Prague, Czechia
| | - Kristie Johnson
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Clinical Microbiology Laboratory, UMMC Laboratories of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Julianne V. Kus
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Public Health Ontario, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, Canada and University of Toronto, Toronto, Ontario, Canada
| | - Ruoyu Li
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China
- Research Center for Medical Mycology, Peking University, Beijing, China
- ISHAM Working Group on Diagnostics, Basel, Switzerland
- Fungal Infection Study Group, European Society of Clinical Microbiology and Infectious Diseases (EFISG/ESCMID), Basel, Switzerland
- Antifungal Susceptibility Testing Subcommittee of European Committee of Antimicrobial Susceptibility Testing (EUCAST-AFST)
- Medical Mycology Society of Chinese Medicine and Education Association
| | - Jacques F. Meis
- Radboudumc-CWZ Centre of Expertise for Mycology, Nijmegen, the Netherlands
- ISHAM Working Group on Diagnostics, Basel, Switzerland
- University of Cologne, Faculty of Medicine, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, Cologne, Germany
- Department I of Internal Medicine, University of Cologne, Excellence Center for Medical Mycology, Cologne, Germany
| | - Michaela Lackner
- International Society for Human and Animal Mycology (ISHAM), Working Group Nomenclature, ‘s-Hertogenbosch, the Netherlands
- Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Sixto M. Leal
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Mycoses Study Group, Education and Research Consortium (MSG-ERC), Pittsburgh, Pennsylvania, USA
- Clinical and Laboratory Standards Institute (CLSI), Pittsburgh, Pennsylvania, USA
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Francesca Lee
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Shawn R. Lockhart
- Radboudumc-CWZ Centre of Expertise for Mycology, Nijmegen, the Netherlands
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- European Hematology Association, Specialized Working Group for Infections in Hematology, The Hague, the Netherlands
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Paul Luethy
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Clinical Microbiology Laboratory, UMMC Laboratories of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Isabella Martin
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Dartmouth Health, Lebanon, New Hampshire, USA
| | - Kyung J. Kwon-Chung
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Wieland Meyer
- Nomenclature Committee for Fungi, International Mycological Association (IMA), Exeter, United Kingdom
- Westerdijk Fungal Biodiversity Institute, Utrecht, the Netherlands
| | - M. Hong Nguyen
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Mycoses Study Group, Education and Research Consortium (MSG-ERC), Pittsburgh, Pennsylvania, USA
- Medical Mycological Society of the Americas (MMSA)
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Luis Ostrosky-Zeichner
- Mycoses Study Group, Education and Research Consortium (MSG-ERC), Pittsburgh, Pennsylvania, USA
- University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Elizabeth Palavecino
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Clinical Microbiology Laboratory, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Preeti Pancholi
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Clinical Microbiology at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Peter G. Pappas
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Mycoses Study Group, Education and Research Consortium (MSG-ERC), Pittsburgh, Pennsylvania, USA
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Gary W. Procop
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Clinical and Laboratory Standards Institute (CLSI), Pittsburgh, Pennsylvania, USA
- The American Board of Pathology, Tampa, Florida, USA
- American Board of Pathology (ABP), Chicago, Illinois, USA
| | - Scott A. Redhead
- Nomenclature Committee for Fungi, International Mycological Association (IMA), Exeter, United Kingdom
- National Mycological Herbarium, Ottawa Research and Development Centre, Science and Technology Branch, Agriculture & Agri-Food Canada, Ottawa, Ontario, Canada
| | - Daniel D. Rhoads
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio, USA
- Infection Biology Program, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Stefan Riedel
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Bryan Stevens
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Kaede Ota Sullivan
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - Paschalis Vergidis
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Mayo Clinic, Rochester, Minnesota, USA
| | - Emmanuel Roilides
- International Society for Human and Animal Mycology (ISHAM), Working Group Nomenclature, ‘s-Hertogenbosch, the Netherlands
- European Confederation of Medical Mycology (ECMM), ‘s-Hertogenbosch, the Netherlands
- Fungal Infection Study Group, European Society of Clinical Microbiology and Infectious Diseases (EFISG/ESCMID), Basel, Switzerland
- Hippokration Hospital, Thessaloniki, Greece
| | - Amir Seyedmousavi
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Fungal Infection Study Group, European Society of Clinical Microbiology and Infectious Diseases (EFISG/ESCMID), Basel, Switzerland
- ISHAM Working Group Veterinary Mycology and One Health, ‘s-Hertogenbosch, the Netherlands
- Department of Laboratory Medicine, Microbiology Service, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Lili Tao
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Vania A. Vicente
- Department of Basic Pathology, Federal University of Paraná, Curitiba, Brazil
| | - Roxana G. Vitale
- Consejo Nacional de Investigaciones Científicasy Tecnológicas (CONICET), Buenos Aires, Argentina
- Unidad de Parasitología, Sector Micología, Hospital J.M. Ramos Mejía, Buenos Aires, Argentina
| | - Qi-Ming Wang
- Engineering Laboratory of Microbial Breeding and Preservation of Hebei Province, School of Life Sciences, Institute of Life Sciences and Green Development, Hebei University, Baoding, China
| | - Nancy L. Wengenack
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Mayo Clinic, Rochester, Minnesota, USA
| | - Lars Westblade
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Nathan Wiederhold
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Mycoses Study Group, Education and Research Consortium (MSG-ERC), Pittsburgh, Pennsylvania, USA
- Clinical and Laboratory Standards Institute (CLSI), Pittsburgh, Pennsylvania, USA
- Medical Mycological Society of the Americas (MMSA)
- University of Texas Health Science Center, San Antonio, Texas, USA
| | - Lewis White
- Public Health Wales Microbiology, Cardiff, United Kingdom
| | - Christina M. Wojewoda
- Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Sean X. Zhang
- International Society for Human and Animal Mycology (ISHAM), Working Group Nomenclature, ‘s-Hertogenbosch, the Netherlands
- Fungal Diagnostics Laboratory Consortium (FDLC), Baltimore, Maryland, USA
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Procop GW, Nayar R. Reply to "Fellowship Board Pass Rates Rising: Analysis of Pathology Subspecialty Examination Performance". Arch Pathol Lab Med 2024; 148:382-383. [PMID: 38522471 DOI: 10.5858/arpa.2023-0489-le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2023] [Indexed: 03/26/2024]
Affiliation(s)
- Gary W Procop
- Chief Executive Office, American Board of Pathology, Tampa, Florida
| | - Ritu Nayar
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Procop GW, Sandersfeld TJ, Levesque M, McCarthy T, Woodworth B, Swerdlow SH. When to take the primary certification examination: sooner or later? Acad Pathol 2024; 11:100116. [PMID: 38560423 PMCID: PMC10978466 DOI: 10.1016/j.acpath.2024.100116] [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] [Received: 12/22/2023] [Revised: 02/04/2024] [Accepted: 02/11/2024] [Indexed: 04/04/2024] Open
Abstract
Most Pathology residents take the Anatomic Pathology and/or Clinical Pathology primary pathology certification examination(s) near the end of their final year of training (i.e., Spring), whereas some postpone the examination(s) to the Fall administration of that year or even later. We compared the Spring and Fall administration pass rates of initial primary certification candidates for those who graduated in the same year they took the examination. We also compared the pass rates of same-year graduates with individuals who postponed the examination for a year or more. We also surveyed the candidates regarding the reasons they chose the Spring or Fall administration. Candidates who chose the earlier (i.e., Spring) administration were more likely to pass compared with those who took the later Fall administration (p = 0.0026 for Anatomic Pathology; p = 0.0004 for Clinical Pathology). Delaying the certifying exams beyond the calendar year of residency graduation was associated with a higher failure rate (p < 0.0001 for both Anatomic and Clinical Pathology). The survey results suggest that residents often take their certification examinations earlier to not interfere with fellowship training, because it coincides with the completion of residency training, or it is expected by their program. Pathology residents are more likely to pass the primary certification examinations when they are taken closer to the end of training, rather than postponing it to a later administration. Pathology residency program directors should encourage residents, who are deemed ready, to take their certification examinations at the earliest possible administration.
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George MR, Timmons CF, Johnson K, Barak S, Berg MP, Bryant B, Childs JM, Karp JK, Knollmann-Ritschel BE, Lofgreen A, McCarthy T, Prieto VG, Procop GW, Sandersfeld T, White KL, McCloskey CB. Leadership perspectives on osteopathic medical school applicants to pathology residency training. Acad Pathol 2024; 11:100107. [PMID: 38433776 PMCID: PMC10907156 DOI: 10.1016/j.acpath.2024.100107] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 12/04/2023] [Accepted: 12/10/2023] [Indexed: 03/05/2024] Open
Abstract
The number of graduating allopathic (MD) medical students matching into pathology has declined in recent years, while the number of osteopathic (DO) medical students has increased modestly, given the rapid expansion of osteopathic medical schools. Nonscholarly publications and materials on the internet often perpetuate negative perceptions of osteopathic physicians. Anecdotally, perspectives exist that some pathology residency programs are not DO-friendly; however, the reasons and how widespread an effect this might be are unclear. Our survey queried pathology chairs and residency program directors about their perceptions of osteopathic applicants and their knowledge of osteopathic medical school/training in general. This study utilized two similar, parallel surveys of pathology chairs and residency program directors with general questions structured around the perceptions and knowledge of both allopathic and osteopathic physicians, their medical training, and the consideration of osteopathic applicants to pathology residency. Pathology residency leaders acknowledge some negative perceptions of osteopathic physicians in the medical profession, the news, and social media. They also have some knowledge and perception gaps regarding osteopathic training and applicants, although experience with training osteopathic physicians as residents has been equivalent to that with allopathic physicians, and consideration appears to be fairly equal for osteopathic applicants. Even though negative perceptions of osteopathic physicians persist in news and social media, our surveys demonstrate that the leadership of pathology residency programs does not hold the same degree of bias and that DOs perform well in allopathic pathology residency programs without evidence of inferior outcomes.
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Affiliation(s)
- Melissa R. George
- Department of Pathology and Laboratory Medicine, Penn State Health Hershey Medical Center, Hershey, PA, USA
| | - Charles F. Timmons
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Kristen Johnson
- CAP Learning, College of American Pathologists, Northfield, IL, USA
| | - Stephanie Barak
- Department of Pathology, George Washington University Hospital, Washington, DC, USA
| | - Mary P. Berg
- University of Colorado, Anschutz Medical Campus, Department of Pathology, Aurora, CO, USA
| | - Bronwyn Bryant
- Department of Pathology and Laboratory Medicine, University of Vermont, Burlington, VT, USA
| | | | - Julie Katz Karp
- Department of Pathology & Genomic Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | | | - Amanda Lofgreen
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Victor G. Prieto
- The Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - Kristie L. White
- Department of Laboratory Medicine, UCSF Medical Center, San Francisco, CA, USA
| | - Cindy B. McCloskey
- The Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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5
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de Hoog S, Walsh TJ, Ahmed SA, Alastruey-Izquierdo A, Alexander BD, Arendrup MC, Babady E, Bai FY, Balada-Llasat JM, Borman A, Chowdhary A, Clark A, Colgrove RC, Cornely OA, Dingle TC, Dufresne PJ, Fuller J, Gangneux JP, Gibas C, Glasgow H, Gräser Y, Guillot J, Groll AH, Haase G, Hanson K, Harrington A, Hawksworth DL, Hayden RT, Hoenigl M, Hubka V, Johnson K, Kus JV, Li R, Meis JF, Lackner M, Lanternier F, Leal Jr. SM, Lee F, Lockhart SR, Luethy P, Martin I, Kwon-Chung KJ, Meyer W, Nguyen MH, Ostrosky-Zeichner L, Palavecino E, Pancholi P, Pappas PG, Procop GW, Redhead SA, Rhoads DD, Riedel S, Stevens B, Sullivan KO, Vergidis P, Roilides E, Seyedmousavi A, Tao L, Vicente VA, Vitale RG, Wang QM, Wengenack NL, Westblade L, Wiederhold N, White L, Wojewoda CM, Zhang SX. A conceptual framework for nomenclatural stability and validity of medically important fungi: a proposed global consensus guideline for fungal name changes supported by ABP, ASM, CLSI, ECMM, ESCMID-EFISG, EUCAST-AFST, FDLC, IDSA, ISHAM, MMSA, and MSGERC. J Clin Microbiol 2023; 61:e0087323. [PMID: 37882528 PMCID: PMC10662369 DOI: 10.1128/jcm.00873-23] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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] [Indexed: 10/27/2023] Open
Abstract
The rapid pace of name changes of medically important fungi is creating challenges for clinical laboratories and clinicians involved in patient care. We describe two sources of name change which have different drivers, at the species versus the genus level. Some suggestions are made here to reduce the number of name changes. We urge taxonomists to provide diagnostic markers of taxonomic novelties. Given the instability of phylogenetic trees due to variable taxon sampling, we advocate to maintain genera at the largest possible size. Reporting of identified species in complexes or series should where possible comprise both the name of the overarching species and that of the molecular sibling, often cryptic species. Because the use of different names for the same species will be unavoidable for many years to come, an open access online database of the names of all medically important fungi, with proper nomenclatural designation and synonymy, is essential. We further recommend that while taxonomic discovery continues, the adaptation of new name changes by clinical laboratories and clinicians be reviewed routinely by a standing committee for validation and stability over time, with reference to an open access database, wherein reasons for changes are listed in a transparent way.
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Affiliation(s)
- Sybren de Hoog
- Radboudumc-CWZ Centre of Expertise for Mycology, Nijmegen, the Netherlands
- Foundation Atlas of Clinical Fungi, Hilversum, the Netherlands
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China
- Department of Basic Pathology, Federal University of Paraná, Curitiba, Brazil
- Research Center for Medical Mycology, Peking University, Beijing, China
- International Society for Human and Animal Mycology (ISHAM), Working Group Nomenclature
| | - Thomas J. Walsh
- International Society for Human and Animal Mycology (ISHAM), Working Group Nomenclature
- Center for Innovative Therapeutics and Diagnostics, Richmond, Virginia, USA
- University of Maryland School of Medicine, Baltimore, Maryland, USA
- Nomenclature Committee for Fungi, International Mycological Association (IMA)
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Mycoses Study Group, Education and Research Consortium (MSG-ERC)
- European Confederation of Medical Mycology (ECMM)
- Clinical and Laboratory Standards Institute (CLSI)
- Medical Mycological Society of the Americas (MMSA)
- ISHAM Working Group on Diagnostics
| | - Sarah A. Ahmed
- Radboudumc-CWZ Centre of Expertise for Mycology, Nijmegen, the Netherlands
- Foundation Atlas of Clinical Fungi, Hilversum, the Netherlands
- International Society for Human and Animal Mycology (ISHAM), Working Group Nomenclature
| | - Ana Alastruey-Izquierdo
- International Society for Human and Animal Mycology (ISHAM), Working Group Nomenclature
- Mycology Reference Laboratory, Spanish National Centre for Microbiology, Madrid, Spain
- Fungal Infection Study Group, European Society of Clinical Microbiology and Infectious Diseases (EFISG/ESCMID), Basel, Switzerland
| | - Barbara D. Alexander
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Departments of Medicine and Pathology, Duke University, Durham, North Carolina, USA
| | - Maiken Cavling Arendrup
- Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark; Department of Clinical Microbiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Antifungal Susceptibility Testing Subcommittee of European Committee of Antimicrobial Susceptibility Testing (EUCAST-AFST)
| | - Esther Babady
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Clinical Microbiology Service, Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Feng-Yan Bai
- Mycology Committee of Chinese Society for Microbiology
- Institute of Microbiology, State Key Laboratory of Mycology, Chinese Academy of Sciences, Beijing, China
- Medical Mycology Society of Chinese Medicine and Education Association
- Asia Pacific Society for Medical Mycology
- ISHAM Working Group Veterinary Mycology and One Health
- Mycological Society of China (MSC)
| | - Joan-Miquel Balada-Llasat
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Clinical Microbiology at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Andrew Borman
- National Mycology Reference Laboratory, Public Health England, Bristol, United Kingdom
| | - Anuradha Chowdhary
- Fungal Infection Study Group, European Society of Clinical Microbiology and Infectious Diseases (EFISG/ESCMID), Basel, Switzerland
- Department of Microbiology, National Reference Laboratory for Antimicrobial Resistance in Fungal Pathogens, Medical Mycology Unit, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India
| | - Andrew Clark
- Fungal Diagnostics Laboratory Consortium (FDLC)
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Robert C. Colgrove
- Division of Infectious Diseases, Mount Auburn Hospital, Cambridge, Massachusetts, USA
- Infectious Diseases Society of America (ISDA)
| | - Oliver A. Cornely
- European Confederation of Medical Mycology (ECMM)
- Fungal Infection Study Group, European Society of Clinical Microbiology and Infectious Diseases (EFISG/ESCMID), Basel, Switzerland
- University of Cologne, Faculty of Medicine, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, Cologne, Germany
- Department I of Internal Medicine, University of Cologne, Excellence Center for Medical Mycology, Cologne, Germany
| | - Tanis C. Dingle
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Clinical and Laboratory Standards Institute (CLSI)
- Alberta Precision Laboratories, Public Health Laboratory, Calgary, Alberta, Canada
| | - Philippe J. Dufresne
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Clinical and Laboratory Standards Institute (CLSI)
- Mycology Department, Laboratoire de Santé Publique du Québec, Institut National de Santé Publique du Québec (INSPQ), Sainte-Anne-de-Bellevue, Québec, Canada
| | - Jeff Fuller
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Department of Pathology and Laboratory Medicine, London Health Sciences Center, London, Ontario, Canada
| | - Jean-Pierre Gangneux
- European Confederation of Medical Mycology (ECMM)
- Department of Mycology, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Connie Gibas
- University of Texas Health Science Center, San Antonio, Texas, USA
| | - Heather Glasgow
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Clinical and Molecular Microbiology, Department of Pathology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Yvonne Gräser
- Department of Parasitology (Charité), Institute of Microbiology and Hygiene, Humboldt University, Berlin, Germany
| | - Jacques Guillot
- ISHAM Working Group Veterinary Mycology and One Health
- Onoris, École Nationale Vétérinaire, Agroalimentaire et de l'Alimentation Nantes-Atlantique, Nantes, France
| | - Andreas H. Groll
- Fungal Infection Study Group, European Society of Clinical Microbiology and Infectious Diseases (EFISG/ESCMID), Basel, Switzerland
- Infectious Disease Research Program, Department of Pediatric Hematology and Oncology and Center for Bone Marrow Transplantation, University Children’s Hospital, Münster, Germany
| | - Gerhard Haase
- Laboratory Diagnostic Center, RWTH Aachen University Hospital, Aachen, Germany
| | - Kimberly Hanson
- Fungal Diagnostics Laboratory Consortium (FDLC)
- University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Amanda Harrington
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Loyola University Health System, Loyola University Chicago, Maywood, Illinois, USA
| | - David L. Hawksworth
- Royal Botanic Gardens, Kew, Richmond, Surrey, United Kingdom
- Natural History Museum, London, United Kingdom
- University of Southampton, Southampton, United Kingdom
- Jilin Agricultural University, Chanchung, China
- General Committee for Nomenclature, International Botanical Congress (IBC)
- Advisory Board of International Commission on the Taxonomy of Fungi (ICTF)
| | - Randall T. Hayden
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Clinical and Laboratory Standards Institute (CLSI)
- Clinical and Molecular Microbiology, Department of Pathology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Martin Hoenigl
- Mycoses Study Group, Education and Research Consortium (MSG-ERC)
- European Confederation of Medical Mycology (ECMM)
- Division of Infectious Diseases, Medical University of Graz, Graz, Austria
- Translational Medical Mycology Research Unit, ECMM Excellence Center for Medical Mycology, Medical University of Graz, Graz, Austria
- European Hematology Association, Specialized Working Group for Infections in Hematology, The Hague, the Netherlands
| | - Vit Hubka
- Department of Botany, Charles University, Prague, Czechia
| | - Kristie Johnson
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Clinical Microbiology Laboratory, UMMC Laboratories of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Julianne V. Kus
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Public Health Ontario, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, Canada and University of Toronto, Toronto, Ontario, Canada
| | - Ruoyu Li
- Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China
- Research Center for Medical Mycology, Peking University, Beijing, China
- ISHAM Working Group on Diagnostics
- Fungal Infection Study Group, European Society of Clinical Microbiology and Infectious Diseases (EFISG/ESCMID), Basel, Switzerland
- Antifungal Susceptibility Testing Subcommittee of European Committee of Antimicrobial Susceptibility Testing (EUCAST-AFST)
- Medical Mycology Society of Chinese Medicine and Education Association
| | - Jacques F. Meis
- Radboudumc-CWZ Centre of Expertise for Mycology, Nijmegen, the Netherlands
- ISHAM Working Group on Diagnostics
- University of Cologne, Faculty of Medicine, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, Cologne, Germany
- Department I of Internal Medicine, University of Cologne, Excellence Center for Medical Mycology, Cologne, Germany
| | - Michaela Lackner
- International Society for Human and Animal Mycology (ISHAM), Working Group Nomenclature
- Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Sixto M. Leal Jr.
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Mycoses Study Group, Education and Research Consortium (MSG-ERC)
- Clinical and Laboratory Standards Institute (CLSI)
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Francesca Lee
- Fungal Diagnostics Laboratory Consortium (FDLC)
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Shawn R. Lockhart
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Paul Luethy
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Clinical Microbiology Laboratory, UMMC Laboratories of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Isabella Martin
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Dartmouth Health, Lebanon, New Hampshire, USA
| | - Kyung J. Kwon-Chung
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Wieland Meyer
- Nomenclature Committee for Fungi, International Mycological Association (IMA)
- Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands
| | - M. Hong Nguyen
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Mycoses Study Group, Education and Research Consortium (MSG-ERC)
- Medical Mycological Society of the Americas (MMSA)
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Luis Ostrosky-Zeichner
- Mycoses Study Group, Education and Research Consortium (MSG-ERC)
- University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Elizabeth Palavecino
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Clinical Microbiology Laboratory, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Preeti Pancholi
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Clinical Microbiology at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Peter G. Pappas
- Mycoses Study Group, Education and Research Consortium (MSG-ERC)
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Gary W. Procop
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Clinical and Laboratory Standards Institute (CLSI)
- The American Board of Pathology, Tampa, Florida, USA
- American Board of Pathology (ABP)
| | - Scott A. Redhead
- Nomenclature Committee for Fungi, International Mycological Association (IMA)
- National Mycological Herbarium, Ottawa Research and Development Centre, Science and Technology Branch, Agriculture & Agri-Food Canada, Ottawa, Ontario, Canada
| | - Daniel D. Rhoads
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio, USA
- Infection Biology Program, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Stefan Riedel
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Bryan Stevens
- Fungal Diagnostics Laboratory Consortium (FDLC)
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Kaede Ota Sullivan
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - Paschalis Vergidis
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Mayo Clinic, Rochester, Minnesota, USA
| | - Emmanuel Roilides
- International Society for Human and Animal Mycology (ISHAM), Working Group Nomenclature
- European Confederation of Medical Mycology (ECMM)
- Fungal Infection Study Group, European Society of Clinical Microbiology and Infectious Diseases (EFISG/ESCMID), Basel, Switzerland
- Hippokration Hospital, Thessaloniki, Greece
| | - Amir Seyedmousavi
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Fungal Infection Study Group, European Society of Clinical Microbiology and Infectious Diseases (EFISG/ESCMID), Basel, Switzerland
- ISHAM Working Group Veterinary Mycology and One Health
- Microbiology Service, Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Lili Tao
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Vania A. Vicente
- Department of Basic Pathology, Federal University of Paraná, Curitiba, Brazil
| | - Roxana G. Vitale
- Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET), Buenos Aires, Argentina
- Unidad de Parasitología, Sector Micología, Hospital J.M. Ramos Mejía, Buenos Aires, Argentina
| | - Qi-Ming Wang
- Engineering Laboratory of Microbial Breeding and Preservation of Hebei Province, School of Life Sciences, Institute of Life Sciences and Green Development, Hebei University, Baoding, China
| | - Nancy L. Wengenack
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Mayo Clinic, Rochester, Minnesota, USA
| | - Lars Westblade
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, USA
| | - Nathan Wiederhold
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Mycoses Study Group, Education and Research Consortium (MSG-ERC)
- Clinical and Laboratory Standards Institute (CLSI)
- Medical Mycological Society of the Americas (MMSA)
- University of Texas Health Science Center, San Antonio, Texas, USA
| | - Lewis White
- Public Health Wales Microbiology, Cardiff, United Kingdom
| | - Christina M. Wojewoda
- Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Sean X. Zhang
- International Society for Human and Animal Mycology (ISHAM), Working Group Nomenclature
- Fungal Diagnostics Laboratory Consortium (FDLC)
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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6
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Csiki-Fejer E, Traczewski M, Procop GW, Davis TE, Hackel M, Dwivedi HP, Pincus DH. Multicenter Clinical Performance Evaluation of Omadacycline Susceptibility Testing of Enterobacterales on VITEK 2 Systems. J Clin Microbiol 2023:e0017423. [PMID: 37162363 DOI: 10.1128/jcm.00174-23] [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: 05/11/2023] Open
Abstract
We present the first performance evaluation results for omadacycline on the VITEK 2 and VITEK 2 Compact Systems (bioMérieux, Inc.). The trial was conducted at four external sites and one internal site. All sites were in the United States, geographically dispersed as follows: Indianapolis, IN; Schaumburg, IL; Wilsonville, OR; Cleveland, OH; and Hazelwood, MO. In this multisite study, omadacycline was tested against 858 Enterobacterales on the VITEK 2 antimicrobial susceptibility test (AST) Gram-negative (GN) card, and the results were compared to the Clinical and Laboratory Standards Institute broth microdilution (BMD) reference method. The results were analyzed and are presented as essential agreement (EA), category agreement (CA), minor error (mE) rates, major error (ME) rates, and very major error (VME) rates following the US Food and Drug Administration (FDA) and International Standards Organization (ISO) performance criteria requirements. Omadacycline has susceptibility testing interpretive criteria (breakpoints) established by the FDA only; nevertheless, the analysis was also performed using the ISO acceptance criteria to satisfy the registration needs of countries outside the United States. The analysis following FDA criteria (including only Klebsiella pneumoniae and Enterobacter cloacae) showed the following performance: EA = 97.9% (410/419), CA = 94.3% (395/419), VME = 2% (1/51), with no ME present. The performance following ISO criteria (including all Enterobacterales tested) after error resolutions was EA = 98.1% (842/858) and CA = 96.9% (831/858). No ME or VME were observed. The VITEK 2 test met the ISO and FDA criteria of ≥ 95% reproducibility, and ≥ 95% quality control (QC) results within acceptable ranges for QC organisms. In June 2022, the omadacycline VITEK 2 test received FDA 510(k) clearance (K213931) FDA as a diagnostic device to be used in the treatment of acute bacterial skin and skin-structure infections caused by E. cloacae and K. pneumoniae, and for treatment of community-acquired bacterial pneumonia caused by K. pneumoniae. The new VITEK 2 AST-GN omadacycline test provides an alternative to the BMD reference method testing and increases the range of automated diagnostic tools available for determining omadacycline MICs in Enterobacterales.
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Affiliation(s)
| | | | | | - Thomas E Davis
- Indiana University School of Medicine Indianapolis, Indiana, USA
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7
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Mateta P, Procop GW, Mtotela W, Nyakuwocha R, Fine G. Implementing laboratory quality management in Africa and central Asia: a model for healthcare improvement. Trans R Soc Trop Med Hyg 2022; 116:1077-1081. [PMID: 35793199 DOI: 10.1093/trstmh/trac062] [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] [Received: 11/01/2021] [Revised: 02/24/2022] [Accepted: 06/13/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Optimized laboratory services are recognized as an integral part of high-quality healthcare delivery. However, these services are often unavailable or substandard in resource-limited countries. The implementation of quality management systems (QMSs) in the laboratory can transform laboratory services and ultimately improve patient care in these settings. METHODS The Clinical and Laboratory Standards Institute, through its Global Health Partnerships (GHP) program, has intervened in 32 laboratories to implement QMSs and improve performance. Standardized checklists were used before and after the structured intervention to quantify the impact of this program. RESULTS QMS implementation resulted in a statistically significant improvement in overall mean checklist scores. All participating laboratories demonstrated improvement in their quality and performance, with 13 laboratories achieving national accreditation within the time frame of this study. CONCLUSION A structured program that utilizes well-recognized, standardized checklists and has leadership and laboratory team support, professional training with onsite guidance (i.e. train the trainer) and access to professionals experienced with QMS implementation and maintenance can lead to significant improvements in quality in resource-limited countries.
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Affiliation(s)
- Patrick Mateta
- Clinical and Laboratory Standards Institute, Annapolis Junction, 5 Great Valley Parkway, Suite 219, Malvern, PA 19355, USA
| | - Gary W Procop
- American Board of Pathology, 4830 W. Kennedy Blvd., Suite 690, Tampa, FL 33609, USA
| | - Wilson Mtotela
- Clinical and Laboratory Standards Institute, Annapolis Junction, 5 Great Valley Parkway, Suite 219, Malvern, PA 19355, USA
| | - Raymond Nyakuwocha
- Clinical and Laboratory Standards Institute, Annapolis Junction, 5 Great Valley Parkway, Suite 219, Malvern, PA 19355, USA
| | - Glen Fine
- Clinical and Laboratory Standards Institute, Annapolis Junction, 5 Great Valley Parkway, Suite 219, Malvern, PA 19355, USA
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8
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Esper FP, Adhikari TM, Tu ZJ, Cheng YW, El-Haddad K, Farkas DH, Bosler D, Rhoads D, Procop GW, Ko JS, Jehi L, Li J, Rubin BP. Alpha to Omicron: Disease Severity and Clinical Outcomes of Major SARS-CoV-2 Variants. J Infect Dis 2022. [DOI: 10.1093/infdis/jiac411
https://www.uptodate.com/contents/covid-19-clinical-manifestations-and-diagnosis-in-children/abstract/140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Abstract
Background
Four severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants predominated in the United States since 2021. Understanding disease severity related to different SARS-CoV-2 variants remains limited.
Method
Viral genome analysis was performed on SARS-CoV-2 clinical isolates circulating March 2021 through March 2022 in Cleveland, Ohio. Major variants were correlated with disease severity and patient outcomes.
Results
In total 2779 patients identified with either Alpha (n = 1153), Gamma (n = 122), Delta (n = 808), or Omicron variants (n = 696) were selected for analysis. No difference in frequency of hospitalization, intensive care unit (ICU) admission, and death were found among Alpha, Gamma, and Delta variants. However, patients with Omicron infection were significantly less likely to be admitted to the hospital, require oxygen, or admission to the ICU (χ2 = 12.8, P < .001; χ2 = 21.6, P < .002; χ2 = 9.6, P = .01, respectively). In patients whose vaccination status was known, a substantial number had breakthrough infections with Delta or Omicron variants (218/808 [26.9%] and 513/696 [73.7%], respectively). In breakthrough infections, hospitalization rate was similar regardless of variant by multivariate analysis. No difference in disease severity was identified between Omicron subvariants BA.1 and BA.2.
Conclusions
Disease severity associated with Alpha, Gamma, and Delta variants is comparable while Omicron infections are significantly less severe. Breakthrough disease is significantly more common in patients with Omicron infection.
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Affiliation(s)
- Frank P Esper
- Center for Pediatric Infectious Disease, Cleveland Clinic Children’s , Cleveland, Ohio , USA
| | - Thamali M Adhikari
- Department of Computer and Data Sciences, Case Western Reserve University , Cleveland, Ohio , USA
| | - Zheng Jin Tu
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic , Cleveland, Ohio , USA
| | - Yu-Wei Cheng
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic , Cleveland, Ohio , USA
| | - Kim El-Haddad
- Center for Pediatric Infectious Disease, Cleveland Clinic Children’s , Cleveland, Ohio , USA
| | - Daniel H Farkas
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic , Cleveland, Ohio , USA
| | - David Bosler
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic , Cleveland, Ohio , USA
| | - Daniel Rhoads
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic , Cleveland, Ohio , USA
| | | | - Jennifer S Ko
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic , Cleveland, Ohio , USA
| | - Lara Jehi
- Lerner Research Institute, Cleveland Clinic , Cleveland, Ohio , USA
| | - Jing Li
- Department of Computer and Data Sciences, Case Western Reserve University , Cleveland, Ohio , USA
| | - Brian P Rubin
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic , Cleveland, Ohio , USA
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9
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Esper FP, Adhikari TM, Tu ZJ, Cheng YW, El-Haddad K, Farkas DH, Bosler D, Rhoads D, Procop GW, Ko JS, Jehi L, Li J, Rubin BP. Alpha to Omicron: Disease Severity and Clinical Outcomes of Major SARS-CoV-2 Variants. J Infect Dis 2022; 227:344-352. [PMID: 36214810 PMCID: PMC9619650 DOI: 10.1093/infdis/jiac411] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [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: 07/09/2022] [Revised: 09/29/2022] [Accepted: 10/06/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Four severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants predominated in the United States since 2021. Understanding disease severity related to different SARS-CoV-2 variants remains limited. METHOD Viral genome analysis was performed on SARS-CoV-2 clinical isolates circulating March 2021 through March 2022 in Cleveland, Ohio. Major variants were correlated with disease severity and patient outcomes. RESULTS In total 2779 patients identified with either Alpha (n 1153), Gamma (n 122), Delta (n 808), or Omicron variants (n 696) were selected for analysis. No difference in frequency of hospitalization, intensive care unit (ICU) admission, and death were found among Alpha, Gamma, and Delta variants. However, patients with Omicron infection were significantly less likely to be admitted to the hospital, require oxygen, or admission to the ICU (2 12.8, P .001; 2 21.6, P .002; 2 9.6, P .01, respectively). In patients whose vaccination status was known, a substantial number had breakthrough infections with Delta or Omicron variants (218/808 [26.9] and 513/696 [73.7], respectively). In breakthrough infections, hospitalization rate was similar regardless of variant by multivariate analysis. No difference in disease severity was identified between Omicron subvariants BA.1 and BA.2. CONCLUSIONS Disease severity associated with Alpha, Gamma, and Delta variants is comparable while Omicron infections are significantly less severe. Breakthrough disease is significantly more common in patients with Omicron infection.
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Affiliation(s)
- Frank P Esper
- Correspondence: F. Esper, MD, Center for Pediatric Infectious Diseases, Cleveland Clinic Children's, 9500 Euclid Avenue, Cleveland, OH 44195 ()
| | - Thamali M Adhikari
- Department of Computer and Data Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Zheng Jin Tu
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Yu-Wei Cheng
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kim El-Haddad
- Center for Pediatric Infectious Disease, Cleveland Clinic Children’s, Cleveland, Ohio, USA
| | - Daniel H Farkas
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - David Bosler
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Daniel Rhoads
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Jennifer S Ko
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lara Jehi
- Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jing Li
- Department of Computer and Data Sciences, Case Western Reserve University, Cleveland, Ohio, USA
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10
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Esmaili M, Procop GW, Mirkin G, Hao X. The Pedal Subcutaneous Phaeohyphomycotic Cyst in an Immunocompetent Adult Man: A Case Report. J Am Podiatr Med Assoc 2022; 112:20-249. [PMID: 36074339 DOI: 10.7547/20-249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 02/03/2023]
Abstract
Phaeohyphomycosis is a spectrum of subcutaneous and systemic infections caused by a variety of dematiaceous fungi. It is an opportunistic disease with an increased incidence in immunocompromised patients. We report a case of a pedal phaeohyphomycotic cyst in an immunocompetent adult male immigrant with the goal of highlighting its clinical presentation, diagnosis, and optimal treatment. A 57-year-old male immigrant from Panama presented with a painless, gradually increasing, large cystic lesion in his left foot, first intermetatarsal space, which had been present for many years. The patient was treated with surgical excision without antifungal therapy. Histologic analysis showed multiple granulomas composed of fibrin and necrosis in the centers surrounded by proliferative palisading fibroblasts admixed with heavily infiltrated neutrophils, plasma cells, macrophages, lymphocytes, and eosinophils. Periodic acid-Schiff and Fontana-Masson stains revealed sporadic, scattered dematiaceous fungal hyphae and pseudohyphae among granulomatous tissues. The mass was diagnosed as a phaeohyphomycotic cyst. Polymerase chain reaction-based sequencing failed to identify the fungal species because of the rarity of the fungal elements in the granulomatous tissues. The patient had no recurrence at a follow-up of 2 years. A phaeohyphomycotic cyst is a rare entity that needs to be differentiated from other benign and malignant lesions. Multiple modalities, including clinical evaluation, radiography, histologic analysis, microbiological culture, and nucleic acid sequencing, should be used for the final diagnosis. Surgical excision is an optimal treatment. Antifungal therapy should be considered based on the patient's clinical manifestation, surgical excision, and immune functional status.
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Affiliation(s)
- Mo Esmaili
- *Department of Podiatry, Foot and Ankle Specialists of the Mid-Atlantic, LLC, Kensington, MD
| | | | - Gene Mirkin
- *Department of Podiatry, Foot and Ankle Specialists of the Mid-Atlantic, LLC, Kensington, MD
| | - Xingpei Hao
- ‡Pathology Laboratory, Foot and Ankle Specialists of the Mid-Atlantic, LLC, Rockville MD
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Abstract
Eumycetoma, caused by fungi, is a neglected tropical disease. It is endemic in the "mycetoma belt" countries but rare in North America. We report a case of pedal eumycetoma in the state of Maryland. A 51-year-old male immigrant from Guatemala presented with multiple, enlarging nodules on the dorsal surface of his left great toe present for 1 year, and a new one in the left arch area present for 6 months. The nodular lesions were surgically excised in two separate operations. Pathologic evaluation of all nodules revealed eumycetomas characterized by the Splendore-Hoeppli phenomenon, showing an amorphous eosinophilic center filled with numerous fungal hyphae, observed on periodic acid-Schiff-stained slides, with a surrounding cuff of neutrophils. Polymerase chain reaction-based sequencing identified Cladosporium cladosporioides in the tissues. The patient was further treated with oral fluconazole for 2 months. The patient recovered well postoperatively and had no recurrence at 20-month follow-up. In conclusion, even though eumycetoma is regarded as a rare disease in North America, its incidence may be higher than reported because of millions of immigrants from endemic regions in the United States, which highlights the need to raise awareness of this devastating disease in the medical community. Eumycetoma needs to be differentiated from other infectious and noninfectious benign and malignant lesions. Optimal treatment includes surgical excision with antifungal therapy.
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12
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John TM, Shrestha NK, Procop GW, Grove D, Leal SM, Jacob CN, Butler R, Dweik R. Diagnosis of Clostridioides difficile infection by analysis of volatile organic compounds in breath, plasma, and stool: A cross-sectional proof-of-concept study. PLoS One 2021; 16:e0256259. [PMID: 34407120 PMCID: PMC8372889 DOI: 10.1371/journal.pone.0256259] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 08/03/2021] [Indexed: 02/04/2023] Open
Abstract
Clostridioides difficile infection (CDI) is an important infectious cause of antibiotic-associated diarrhea, with significant morbidity and mortality. Current diagnostic algorithms are based on identifying toxin by enzyme immunoassay (EIA) and toxin gene by real-time polymerase chain reaction (PCR) in patients with diarrhea. EIA’s sensitivity is poor, and PCR, although highly sensitive and specific, cannot differentiate infection from colonization. An ideal test that incorporates microbial factors, host factors, and host-microbe interaction might characterize true infection, and assess prognosis and recurrence. The study of volatile organic compounds (VOCs) has the potential to be an ideal diagnostic test. The presence of VOCs accounts for the characteristic odor of stool in CDI but their presence in breath and plasma has not been studied yet. A cross-sectional proof-of-concept study analyzing VOCs using selected ion flow tube mass spectrometry (SIFT-MS) was done on breath, stool, and plasma of patients with clinical features and positive PCR for CDI (cases) and compared with patients with clinical features but a negative PCR (control). Our results showed that VOC patterns in breath, stool, and plasma, had good accuracy [area under the receiver operating characteristic curve (ROC) 93%, 86%, and 91%, respectively] for identifying patients with CDI.
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Affiliation(s)
- Teny M. John
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio, United States of America
- Department of Infectious Disease, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
- * E-mail:
| | - Nabin K. Shrestha
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Gary W. Procop
- Department of Laboratory Medicine and Pathology, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - David Grove
- Department of Pulmonary Medicine and Critical Care, Respiratory Institute, Cleveland Clinic Foundation, Cleveland, Ohio, United States of America
| | - Sixto M. Leal
- Department of Laboratory Medicine and Pathology, Cleveland Clinic, Cleveland, Ohio, United States of America
- Department of Laboratory Medicine and Pathology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Ceena N. Jacob
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, United States of America
- Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, Texas, United States of America
| | - Robert Butler
- Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio, United States of America
| | - Raed Dweik
- Department of Pulmonary Medicine and Critical Care, Respiratory Institute, Cleveland Clinic Foundation, Cleveland, Ohio, United States of America
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13
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Zimmerman PA, King CL, Ghannoum M, Bonomo RA, Procop GW. Molecular Diagnosis of SARS-CoV-2: Assessing and Interpreting Nucleic Acid and Antigen Tests. Pathog Immun 2021; 6:135-156. [PMID: 34405126 PMCID: PMC8360705 DOI: 10.20411/pai.v6i1.422] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 04/23/2021] [Indexed: 12/11/2022] Open
Abstract
In this review, we summarize the current status of nucleic acid and antigen testing required for diagnosing SARS-CoV-2 infection and COVID-19 disease. Nucleic acid amplification (NAAT) and antigen-detection (Ag) tests occupy a critically important frontline of defense against SARS-CoV-2 in clinical and public health settings. In early stages of this outbreak, we observed that identifying the causative agent of a new illness of unknown origin was greatly accelerated by characterizing the nucleic acid signature of the novel coronavirus. Results from nucleic acid sequencing led to the development of highly sensitive RT-PCR testing for use in clinical settings and to informing best practices for patient care, and in public health settings to the development of strategies for protecting populations. As the current COVID-19 pandemic has evolved, we have seen how NAAT performance has been used to guide and optimize specimen collection, inform patient triage decisions, reveal unexpected clinical symptoms, clarify risks of transmission within patient care facilities, and guide appropriate treatment strategies. For public health settings during the earliest stages of the pandemic, NAATs served as the only tool available for studying the epidemiology of this new disease by identifying infected individuals, studying transmission patterns, modeling population impacts, and enabling disease control organizations and governments to make challenging disease mitigation recommendations to protect the expanding breadth of populations at risk. With time, the nucleic acid signature has provided the information necessary to understand SARS-CoV-2 protein expression for further development of antigen-based point-of-care (POC) diagnostic tests. The advent of massive parallel sequencing (ie, next generation sequencing) has afforded the characterization of this novel pathogen, informed the sequences best adapted for RT-PCR assays, guided vaccine production, and is currently used for tracking and monitoring SARS-CoV-2 variants.
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Affiliation(s)
- Peter A Zimmerman
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio
| | - Christopher L King
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio
| | - Mahmoud Ghannoum
- Center for Medical Mycology and Integrated Microbiome Core, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Robert A Bonomo
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio; Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio; Departments of Pharmacology, Molecular Biology and Microbiology, Biochemistry, and Proteomics and Bioinformatics, Case Western Reserve University School of Medicine, Cleveland, Ohio; and the CWRU-Cleveland VAMC Center for Antimicrobial Resistance and Epidemiology (Case VA CARES) Cleveland, Ohio
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14
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Boyd Tressler A, Markwei M, Fortin C, Yao M, Procop GW, Soper DE, Goje O. Risks for Recurrent Vulvovaginal Candidiasis Caused by Non-Albicans Candida Versus Candida Albicans. J Womens Health (Larchmt) 2021; 30:1588-1596. [PMID: 34292794 DOI: 10.1089/jwh.2020.8811] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background: Vulvovaginal candidiasis (VVC) is the second most common vulvovaginitis (VV). About 20% of women will experience recurrent infections in their lifetime with non-albicans Candida (NAC) species being one of the causative agents. Although studies have looked at risk factors for recurrent VVC they are limited in scope. In this study, we explore whether risks of recurrent VVC are increased with NAC infections compared to Candida albicans infections. Methods: Through an institutional review board-approved retrospective chart review, we identified 174 women with positive yeast cultures and followed their charts to assess recurrent visits and treatments. We also assessed several baseline variables such as race, age, body mass index (BMI), obstetric history, probiotic use, contraceptive use, mycological therapy, steroid use, hormone replacement therapy, menopausal status, and medical comorbidities. Results: Women with NAC VV were more likely to have multiple visits for recurring infections compared to women who had C. albicans VV (66% vs. 34%). The women with multiple recurrences were younger, had a lower BMI, had lower parity, and endorsed higher use of probiotics. Conclusion: Women with positive NAC cultures were more likely to have multiple visits to their physicians for VV complaints. Identifying the causative species using vaginal fungal cultures can more accurately guide therapy and lead to better outcomes for these patients.
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Affiliation(s)
- Andrea Boyd Tressler
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Metabel Markwei
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Chelsea Fortin
- OBGYN and Women's Health Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Meng Yao
- OBGYN and Women's Health Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Gary W Procop
- Pathology and Laboratory Medicine Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - David E Soper
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Oluwatosin Goje
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA.,OBGYN and Women's Health Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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15
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Bruehl FK, Ramsey C, Koval CE, Procop GW. Routine testing for herpes simplex virus in bronchoalveolar lavage specimens is unwarranted. Diagn Microbiol Infect Dis 2021; 100:115400. [PMID: 34030103 DOI: 10.1016/j.diagmicrobio.2021.115400] [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] [Received: 01/29/2021] [Revised: 03/15/2021] [Accepted: 04/14/2021] [Indexed: 10/21/2022]
Abstract
Herpes simplex virus (HSV) infections of the lung are rare, but HSV is occasionally detected in bronchoalveolar lavage (BAL) specimens. We assessed whether routinely performing HSV PCR tests in BAL specimens is warranted. HSV was detected in 7% (52/722) of BALs. In 47% of HSV-positive patients a typical respiratory virus or pathologic microorganism was identified. Oral HSV reactivation was identified in 27%; however, anti-HSV therapy was initiated in just three patients following the positive HSV test. Patients undergoing BAL for transplant surveillance received anti-HSV prophylaxis more often than those with acute respiratory failure, but both groups did not differ significantly in terms of patient outcome or co-infections. No patient was diagnosed with HSV pneumonia. These findings suggest that positive HSV PCR results in BAL specimens most commonly represents contamination from oral HSV reactivation, and that HSV PCR should be ordered selectively, rather than routinely, as part of a test panel.
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Affiliation(s)
- Frido K Bruehl
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Christine Ramsey
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Christine E Koval
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, OH, USA
| | - Gary W Procop
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA.
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16
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Girard V, Monnin V, Giraud D, Polsinelli S, Caillé M, Procop GW, Tuohy M, Wilson D, Richter SS, Kiss K, Clem K, Tolli N, Bridon L, Bradford C, Blamey S, Li J, Pincus DH. Multicenter evaluation of the VITEK MS matrix-assisted laser desorption/ionization-time of flight mass spectrometry system for identification of bacteria, including Brucella, and yeasts. Eur J Clin Microbiol Infect Dis 2021; 40:1909-1917. [PMID: 33837878 DOI: 10.1007/s10096-021-04242-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 01/22/2021] [Accepted: 03/30/2021] [Indexed: 12/19/2022]
Abstract
The use of matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry has proven to be rapid and accurate for the majority of clinical isolates. Some gaps remain concerning rare, emerging, or highly pathogenic species, showing the need to continuously expand the databases. In this multicenter study, we evaluated the accuracy of the VITEK MS v3.2 database in identifying 1172 unique isolates compared to identification by DNA sequence analysis. A total of 93.6% of the isolates were identified to species or group/complex level. A remaining 5.2% of the isolates were identified to the genus level. Forty tests gave a result of no identification (0.9%) and 12 tests (0.3%) gave a discordant identification compared to the reference identification. VITEK MS is also the first MALDI-TOF MS system that is able to delineate the four members of the Acinetobacter baumannii complex at species level without any specific protocol or special analysis method. These findings demonstrate that the VITEK MS v3.2 database is highly accurate for the identification of bacteria and fungi encountered in the clinical laboratory as well as emerging species like Candida auris and the highly pathogenic Brucella species.
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Affiliation(s)
- Victoria Girard
- R&D Microbiology, bioMérieux sa, La Balme les Grottes, France.
| | - Valérie Monnin
- R&D Microbiology, bioMérieux sa, La Balme les Grottes, France
| | - Delphine Giraud
- R&D Microbiology, bioMérieux sa, La Balme les Grottes, France
| | | | - Marion Caillé
- R&D Microbiology, bioMérieux sa, La Balme les Grottes, France.,MSD, Clermont-Ferrand, France
| | - Gary W Procop
- Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Marion Tuohy
- Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Deborah Wilson
- Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sandra S Richter
- Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA.,Medical Affairs, bioMérieux, Inc., Durham, NC, USA
| | | | | | | | | | | | - Sara Blamey
- Clinical Affairs, bioMérieux, Inc., St. Louis, MO, USA
| | - Jay Li
- R&D US Data Science, bioMérieux, Inc., Durham, NC, USA
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17
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Esper FP, Cheng YW, Adhikari TM, Tu ZJ, Li D, Li EA, Farkas DH, Procop GW, Ko JS, Chan TA, Jehi L, Rubin BP, Li J. Genomic Epidemiology of SARS-CoV-2 Infection During the Initial Pandemic Wave and Association With Disease Severity. JAMA Netw Open 2021; 4:e217746. [PMID: 33900399 PMCID: PMC8076962 DOI: 10.1001/jamanetworkopen.2021.7746] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/07/2021] [Indexed: 12/17/2022] Open
Abstract
Importance Understanding of SARS-CoV-2 variants that alter disease outcomes are important for clinical risk stratification and may provide important clues to the complex virus-host relationship. Objective To examine the association of identified SARS-CoV-2 variants, virus clades, and clade groups with disease severity and patient outcomes. Design, Setting, and Participants In this cross-sectional study, viral genome analysis of clinical specimens obtained from patients at the Cleveland Clinic infected with SARS-CoV-2 during the initial wave of infection (March 11 to April 22, 2020) was performed. Identified variants were matched with clinical outcomes. Data analysis was performed from April to July 2020. Main Outcomes and Measures Hospitalization, intensive care unit (ICU) admission, mortality, and laboratory outcomes were matched with SARS-CoV-2 variants. Results Specimens sent for viral genome sequencing originated from 302 patients with SARS-CoV-2 infection (median [interquartile range] age, 52.6 [22.8 to 82.5] years), of whom 126 (41.7%) were male, 195 (64.6%) were White, 91 (30.1%) required hospitalization, 35 (11.6%) needed ICU admission, and 17 (5.6%) died. From these specimens, 2531 variants (484 of which were unique) were identified. Six different SARS-CoV-2 clades initially circulated followed by a rapid reduction in clade diversity. Several variants were associated with lower hospitalization rate, and those containing 23403A>G (D614G Spike) were associated with increased survival when the patient was hospitalized (64 of 74 patients [86.5%] vs 10 of 17 patients [58.8%]; χ21 = 6.907; P = .009). Hospitalization and ICU admission were similar regardless of clade. Infection with Clade V variants demonstrated higher creatinine levels (median [interquartile range], 2.6 [-0.4 to 5.5] mg/dL vs 1.0 [0.2 to 2.2] mg/dL; mean creatinine difference, 2.9 mg/dL [95% CI, 0.8 to 5.0 mg/dL]; Kruskal-Wallis P = .005) and higher overall mortality rates (3 of 14 patients [21.4%] vs 17 of 302 patients [5.6%]; χ21 = 5.640; P = .02) compared with other variants. Infection by strains lacking the 23403A>G variant showed higher mortality in multivariable analysis (odds ratio [OR], 22.4; 95% CI, 0.6 to 5.6; P = .01). Increased variants of open reading frame (ORF) 3a were associated with decreased hospitalization frequency (OR, 0.4; 95% CI, 0.2 to 0.96; P = .04), whereas increased variants of Spike (OR, 0.01; 95% CI, <0.01 to 0.3; P = .01) and ORF8 (OR, 0.03; 95% CI, <0.01 to 0.6; P = .03) were associated with increased survival. Conclusions and Relevance Within weeks of SARS-CoV-2 circulation, a profound shift toward 23403A>G (D614G) specific genotypes occurred. Replaced clades were associated with worse clinical outcomes, including mortality. These findings help explain persistent hospitalization yet decreasing mortality as the pandemic progresses. SARS-CoV-2 clade assignment is an important factor that may aid in estimating patient outcomes.
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Affiliation(s)
- Frank P. Esper
- Center for Pediatric Infectious Disease, Cleveland Clinic Children’s, Cleveland, Ohio
| | - Yu-Wei Cheng
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Thamali M. Adhikari
- Department of Computer and Data Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Zheng Jin Tu
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Derek Li
- Department of Computer and Data Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Erik A. Li
- Department of Computer and Data Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Daniel H. Farkas
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Gary W. Procop
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jennifer S. Ko
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Timothy A. Chan
- Center for Immunotherapy and Precision Immuno-Oncology, Lerner Research Center, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lara Jehi
- Neurological Institute, Chief Research Information Office, Cleveland Clinic, Cleveland, Ohio
| | - Brian P. Rubin
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jing Li
- Department of Computer and Data Sciences, Case Western Reserve University, Cleveland, Ohio
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18
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Procop GW, Tuohy M, Ramsey C, Rhoads DD, Rubin BP, Figler R. Asymptomatic Patient Testing After 10:1 Pooling Using the Xpert Xpress SARS-CoV-2 Assay. Am J Clin Pathol 2021; 155:522-526. [PMID: 33399200 PMCID: PMC7929460 DOI: 10.1093/ajcp/aqaa273] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Objectives Pool testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) preserves testing resources at the risk of missing specimens through specimen dilution. Methods To determine whether SARS-CoV-2 specimens would be missed after 10:1 pooling, we identified 10 specimens with midrange (ie, 25-34 cycles) and 10 with late (ie, >34-45 cycles) crossing threshold (Ct) values and tested these both neat and after 10:1 pooling. Final test results and Ct changes were compared. Results Overall, 17 of 20 specimens that contained SARS-CoV-2 were detected after 10:1 pooling with the Xpert Xpress SARS-CoV-2 Assay (Cepheid), rendering an 85% positive percentage of agreement. All 10 of 10 specimens with an undiluted Ct in the mid-Ct range were detected after 10:1 pooling, in contrast to 7 of 10 with an undiluted Ct in the late-Ct range. The overall Ct difference between the neat testing and the 10:1 pool was 2.9 cycles for the N2 gene target and 3 cycles for the E gene target. The N2 gene reaction was more sensitive than the E gene reaction, detecting 16 of 20 positive specimens after 10:1 pooling compared with 9 of 20 specimens. Conclusions An 85% positive percentage of agreement was achieved, with only specimens with low viral loads being missed following 10:1 pooling. The average impact on both reverse transcription polymerase chain reactions within this assay was about 3 cycles.
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Abstract
OBJECTIVES To clarify the clinical significance and degree of resolution (ie, grade) of Histoplasma granulomas in routinely reviewed surgical pathology specimens and the clinical outcomes of patients with this diagnosis, with an emphasis on those not receiving antifungal therapy. METHODS We performed a retrospective medical record, laboratory data, and surgical pathology slide review of patients with Histoplasma granulomas following institutional review board approval. RESULTS Clinical, pathologic, and laboratory data from 62 patients with Histoplasma granulomas were available for review. Of these, 1 of 19 (5%) fungal cultures, 4 of 12 (33%) fungal serologic studies, 0 of 9 Histoplasma urinary antigen tests, and 0 of 2 Histoplasma serum antigen tests were positive. All but 3 of the Histoplasma granulomas were either in the resolving (grade 2) or resolved (grade 3) stage of resolution. None of the patients, including those who did not receive antifungal therapy after the histologic diagnosis, developed progressive or disseminated histoplasmosis. CONCLUSIONS These findings, which are supportive of clinical guidelines, suggest that patients with old, hyalinized Histoplasma granulomas do not benefit from further laboratory studies or antifungal therapy. The proposed grading of Histoplasma granulomas informs clinicians of the stage of resolution of an excised lesion, which informs therapeutic decisions and thus is recommended.
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Affiliation(s)
- Ryan Demkowicz
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - Gary W Procop
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
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20
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Reddy AJ, Fraser TG, Grover P, Weathers AL, Cruise M, Foxx MA, Babiuch CM, Henricks WH, Meldon SW, Muenzenmeyer A, Pengel SL, Simon JF, Procop GW. Operationalizing COVID-19 testing: Who, what, when, where, why, and how. Cleve Clin J Med 2021:ccjm.87a.ccc048. [PMID: 32518132 DOI: 10.3949/ccjm.87a.ccc048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The authors review the rationale behind and approaches to testing for COVID-19, the quality of currently available tests, the role of data analytics in strategizing testing, and using the electronic medical record and other programs designed to steward COVID-19 testing and follow-up of patients.
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Affiliation(s)
- Anita J Reddy
- Department of Critical Care, Respiratory Institute, Cleveland Clinic
| | - Thomas G Fraser
- Department of Infectious Disease, Respiratory Institute, Cleveland Clinic
| | | | | | - Michael Cruise
- Pathology and Laboratory Medicine Institute, Cleveland Clinic
| | | | | | | | | | | | | | - James F Simon
- Medical Operations and Glickman Urological and Kidney Institute, Cleveland Clinic
| | - Gary W Procop
- Pathology and Laboratory Medicine Institute, Cleveland Clinic
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21
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Abstract
The home test kits for detecting SARS-CoV-2 infection with Food and Drug Administration emergency use authorization primarily use either isothermal nucleic acid amplification or antigen detection, and each test has advantages and limitations in terms of sensitivity and specificity, cost, results reporting, and results turnaround time. In clinical studies, these tests provide accurate positive results in symptomatic individuals, although negative results are less accurate. There are also accuracy concerns for positive results in asymptomatic individuals. These factors have implications for their clinical interpretation and use.
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Affiliation(s)
- Gary W Procop
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - Kamran Kadkhoda
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - Daniel D Rhoads
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - Steven G Gordon
- Department of Infectious Diseases, Respiratory Institute, Cleveland Clinic, Cleveland, OH
| | - Anita J Reddy
- Department of Critical Care and Medical Operations, Respiratory Institute, Cleveland Clinic, Cleveland, OH
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22
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Procop GW. Confronting the COVID-19 Pandemic: A View from the Laboratory. Marshall Journal of Medicine 2021. [DOI: 10.33470/2379-9536.1322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Shrestha NK, Marco Canosa F, Nowacki AS, Procop GW, Vogel S, Fraser TG, Erzurum SC, Terpeluk P, Gordon SM. Distribution of Transmission Potential During Nonsevere COVID-19 Illness. Clin Infect Dis 2021; 71:2927-2932. [PMID: 32594116 PMCID: PMC7337652 DOI: 10.1093/cid/ciaa886] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [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: 05/13/2020] [Accepted: 06/23/2020] [Indexed: 12/20/2022] Open
Abstract
Background Patients recovering from coronavirus disease 2019 (COVID-19) often continue to test positive for the causative virus by polymerase chain reaction (PCR) even after clinical recovery, thereby complicating return-to-work plans. The purpose of this study was to evaluate transmission potential of COVID-19 by examining viral load with respect to time. Methods Health care personnel (HCP) at Cleveland Clinic diagnosed with COVID-19, who recovered without needing hospitalization, were identified. Threshold cycles (Ct) for positive PCR tests were obtained and viral loads calculated. The association of viral load with days since symptom onset was examined in a multivariable regression model, which was reduced by stepwise backward selection to only keep variables significant at a level of .05. Viral loads by day since symptom onset were predicted using the model and transmission potential evaluated by examination of a viral load-time curve. Results Over 6 weeks, 230 HCP had 528 tests performed. Viral loads declined by orders of magnitude within a few days of symptom onset. The only variable significantly associated with viral load was time since onset of symptoms. Of the area under the curve (AUC) spanning symptom onset to 30 days, 96.9% lay within the first 7 days, and 99.7% within 10 days. Findings were very similar when validated using split-sample and 10-fold cross-validation. Conclusions Among patients with nonsevere COVID-19, viral loads in upper respiratory specimens peak by 2 or 3 days from symptom onset and decrease rapidly thereafter. The vast majority of the viral load-time AUC lies within 10 days of symptom onset.
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Affiliation(s)
- Nabin K Shrestha
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Amy S Nowacki
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Gary W Procop
- Department of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sherilynn Vogel
- Department of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Thomas G Fraser
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio, USA
| | - Serpil C Erzurum
- Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Paul Terpeluk
- Department of Occupational Health, Cleveland Clinic, Cleveland, Ohio, USA
| | - Steven M Gordon
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio, USA
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Procop GW, Brock JE, Reineks EZ, Shrestha NK, Demkowicz R, Cook E, Ababneh E, Harrington SM. A Comparison of Five SARS-CoV-2 Molecular Assays With Clinical Correlations. Am J Clin Pathol 2021; 155:69-78. [PMID: 33015712 PMCID: PMC7665304 DOI: 10.1093/ajcp/aqaa181] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES Comparative assessments of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) molecular assays that have been operationalized through the US Food and Drug Administration's Emergency Use Authorization process are warranted to assess real-world performance. Characteristics such as sensitivity, specificity, and false-negative rate are important to inform clinical use. METHODS We compared five SARS-CoV-2 assays using nasopharyngeal and nasal swab specimens submitted in transport media; we enriched this cohort for positive specimens, since we were particularly interested in the sensitivity and false-negative rate. Performance of each test was compared with a composite standard. RESULTS The sensitivities and false-negative rates of the 239 specimens that met inclusion criteria were, respectively, as follows: Centers for Disease Control and Prevention 2019 nCoV Real-Time RT-PCR Diagnostic Panel, 100% and 0%; TIB MOLBIOL/Roche z 480 Assay, 96.5% and 3.5%; Xpert Xpress SARS-CoV-2 (Cepheid), 97.6% and 2.4%; Simplexa COVID-19 Direct Kit (DiaSorin), 88.1% and 11.9%; and ID Now COVID-19 (Abbott), 83.3% and 16.7%. CONCLUSIONS The assays that included a nucleic acid extraction followed by reverse transcription polymerase chain reaction were more sensitive than assays that lacked a full extraction. Most false negatives were seen in patients with low viral loads, as extrapolated from crossing threshold values.
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Affiliation(s)
- Gary W Procop
- Pathology and Laboratory Medicine Institute, Cleveland, OH
| | - Jay E Brock
- Pathology and Laboratory Medicine Institute, Cleveland, OH
| | | | - Nabin K Shrestha
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, OH
| | - Ryan Demkowicz
- Pathology and Laboratory Medicine Institute, Cleveland, OH
| | - Eleanor Cook
- Pathology and Laboratory Medicine Institute, Cleveland, OH
| | - Emad Ababneh
- Pathology and Laboratory Medicine Institute, Cleveland, OH
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Mehta N, Kalra A, Nowacki AS, Anjewierden S, Han Z, Bhat P, Carmona-Rubio AE, Jacob M, Procop GW, Harrington S, Milinovich A, Svensson LG, Jehi L, Young JB, Chung MK. Association of Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers With Testing Positive for Coronavirus Disease 2019 (COVID-19). JAMA Cardiol 2020; 5:1020-1026. [PMID: 32936273 DOI: 10.1001/jamacardio.2020.1855] [Citation(s) in RCA: 308] [Impact Index Per Article: 77.0] [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] [Indexed: 12/11/2022]
Abstract
Importance The role of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARB) in the setting of the coronavirus disease 2019 (COVID-19) pandemic is hotly debated. There have been recommendations to discontinue these medications, which are essential in the treatment of several chronic disease conditions, while, in the absence of clinical evidence, professional societies have advocated their continued use. Objective To study the association between use of ACEIs/ARBs with the likelihood of testing positive for COVID-19 and to study outcome data in subsets of patients taking ACEIs/ARBs who tested positive with severity of clinical outcomes of COVID-19 (eg, hospitalization, intensive care unit admission, and requirement for mechanical ventilation). Design, Setting, and Participants Retrospective cohort study with overlap propensity score weighting was conducted at the Cleveland Clinic Health System in Ohio and Florida. All patients tested for COVID-19 between March 8 and April 12, 2020, were included. Exposures History of taking ACEIs or ARBs at the time of COVID-19 testing. Main Outcomes and Measures Results of COVID-19 testing in the entire cohort, number of patients requiring hospitalizations, intensive care unit admissions, and mechanical ventilation among those who tested positive. Results A total of 18 472 patients tested for COVID-19. The mean (SD) age was 49 (21) years, 7384 (40%) were male, and 12 725 (69%) were white. Of 18 472 patients who underwent COVID-19 testing, 2285 (12.4%) were taking either ACEIs or ARBs. A positive COVID-19 test result was observed in 1735 of 18 472 patients (9.4%). Among patients who tested positive, 421 (24.3%) were admitted to the hospital, 161 (9.3%) were admitted to an intensive care unit, and 111 (6.4%) required mechanical ventilation. Overlap propensity score weighting showed no significant association of ACEI and/or ARB use with COVID-19 test positivity (overlap propensity score-weighted odds ratio, 0.97; 95% CI, 0.81-1.15). Conclusions and Relevance This study found no association between ACEI or ARB use and COVID-19 test positivity. These clinical data support current professional society guidelines to not discontinue ACEIs or ARBs in the setting of the COVID-19 pandemic. However, further study in larger numbers of hospitalized patients receiving ACEI and ARB therapy is needed to determine the association with clinical measures of COVID-19 severity.
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Affiliation(s)
- Neil Mehta
- Department of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, Ohio
| | - Ankur Kalra
- Heart, Vascular and Thoracic Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.,Section of Cardiovascular Research, Heart, Vascular and Thoracic Department, Cleveland Clinic Akron General, Akron, Ohio
| | - Amy S Nowacki
- Lerner Research Institute, Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Scott Anjewierden
- Department of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, Ohio
| | - Zheyi Han
- Department of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, Ohio
| | - Pavan Bhat
- Heart, Vascular and Thoracic Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Andres E Carmona-Rubio
- Heart, Vascular and Thoracic Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Miriam Jacob
- Heart, Vascular and Thoracic Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Gary W Procop
- Pathology and Laboratory Medicine Institute, Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Susan Harrington
- Pathology and Laboratory Medicine Institute, Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Alex Milinovich
- Lerner Research Institute, Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Lars G Svensson
- Heart, Vascular and Thoracic Institute, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | | | - James B Young
- Department of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, Ohio.,Heart, Vascular and Thoracic Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Mina K Chung
- Heart, Vascular and Thoracic Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.,Lerner Research Institute, Department of Cardiovascular and Metabolic Sciences, Cleveland Clinic, Cleveland, Ohio
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McMullen AR, Wallace MA, LaBombardi V, Hindler J, Campeau S, Humphries R, Procop GW, Richter SS, Wise MG, Burnham CAD. Multicenter evaluation of the RAPIDEC® CARBA NP assay for the detection of carbapenemase production in clinical isolates of Enterobacterales and Pseudomonas aeruginosa. Eur J Clin Microbiol Infect Dis 2020; 39:2037-2044. [PMID: 32577953 DOI: 10.1007/s10096-020-03937-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 02/11/2020] [Accepted: 05/29/2020] [Indexed: 01/25/2023]
Abstract
Carbapenem-resistant Gram-negative bacilli are a major public health problem. Accurate and rapid detection of carbapenemase-producing organisms can facilitate appropriate infection prevention measures. The objective was to evaluate the performance of the RAPIDEC® CARBA NP assay (RAPIDEC), a screening assay that utilizes a pH indicator to detect carbapenem hydrolysis within 2 h. A multicenter study evaluated 306 clinical bacterial strains of Enterobacterales (n = 257) and Pseudomonas aeruginosa (n = 49). The RAPIDEC was compared to a composite reference standard-the Clinical Laboratory Standards Institute (CLSI) Carba NP assay, PCR for specific carbapenemase genes (blaKPC, blaNDM, blaOXA-48-like, blaVIM and blaIMP), and phenotypic carbapenem susceptibility testing. The assay was evaluated using two culture incubation times for the bacterial isolates: "routine"(cultures incubated 18-24 h) and "short" (cultures incubated 4-5 h). For the routine incubation, the overall percent agreement was 98.7% with a positive percent agreement (PPA) of 99.6% and a negative percent agreement (NPA) of 97.4%; there were five false positives and one false negative. For the short incubation, the overall percent agreement was 98.0% with a PPA of 98.5% and a NPA of 97.3%; there were five false positives and four false negatives. RAPIDEC results for the P. aeruginosa isolates were 100% concordant with the reference standard for both incubation times. The RAPIDEC assay is an accurate and rapid (≤ 2 h) assay for the detection of the most common carbapenemases in clinical isolates. Growth from a short incubation culture may be used to reliably detect carbapenemase production in clinical strains.
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Affiliation(s)
- Allison R McMullen
- Washington University in St. Louis Medical School, St Louis, MO, USA.
- Augusta University, Augusta, GA, USA.
| | - Meghan A Wallace
- Washington University in St. Louis Medical School, St Louis, MO, USA
| | | | - Janet Hindler
- University of California Los Angeles, Los Angeles, CA, USA
| | - Shelley Campeau
- University of California Los Angeles, Los Angeles, CA, USA
- Accelerate Diagnostics, Tuscon, AZ, USA
| | - Romney Humphries
- University of California Los Angeles, Los Angeles, CA, USA
- Accelerate Diagnostics, Tuscon, AZ, USA
| | | | - Sandra S Richter
- Cleveland Clinic, Cleveland, OH, USA
- bioMérieux, Inc., Durham, NC, USA
| | - Mark G Wise
- International Health Management Associates, Schaumburg, IL, USA
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Abstract
Clinical decision support tools that involve improving test utilization should be jointly overseen by a laboratory stewardship committee and the hospital informatics team. The roles of these groups vary by institution and may overlap. This is a team effort and collaboration is a must. The effectiveness of these efforts in an institution depends on the receptiveness of leadership and providers, as well as the effectiveness of the associated committees. Examples of the challenges and successes of laboratory stewardship interventions that have been operationalized at the Cleveland Clinic that use clinical decision support tools, as well as associated literature, are reviewed.
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Affiliation(s)
- Gary W Procop
- Molecular Microbiology, Mycology, Parasitology and Virology Laboratories, Enterprise Laboratory Stewardship Committee, Department of Medical Operations, Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, 9500 Euclid Avenue/ LL2-131, Cleveland, OH 44195, USA.
| | - Allison L Weathers
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, 25900 Science Park Drive, AC220 Beechwood, OH 44122, USA
| | - Anita J Reddy
- Respiratory Institute, Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, 9500 Euclid Avenue/ G6-156, Cleveland, OH 44195, USA
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Dyhdalo KS, Oshilaja O, Chute DJ, Booth CN, Suchy P, Smith K, Procop GW, Reynolds JP. Cytopathology milestones: can you get to level 5? J Am Soc Cytopathol 2020; 9:242-248. [PMID: 32340924 DOI: 10.1016/j.jasc.2020.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 12/17/2019] [Revised: 03/09/2020] [Accepted: 03/09/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION ACGME Milestones describe 6 areas of proficiency, indicating readiness for practice. Each is divided into 5 levels of mastery; Level 1 (new trainees) through Levels 4 (graduation) and 5 (aspirational). Milestones reporting began Spring 2016. We used Milestones to assess graduated fellows. MATERIALS AND METHODS We conducted phone interviews with previous fellows and collected demographic information including practice setting. We asked graduates if they fulfilled each example of mastery and recorded their answers. RESULTS A total of 22 fellows graduated from 2010 to 2017; 15 responded (10 academic, 5 private). Milestones in which nearly all respondents performed well (Level 4+) were: PC1, MK1, SBP2, SBP4, PROF1-4, ICS1-3. Some were more challenging (PC2, MK2, SBP1/3/5, PBL1). For PC2, 2 respondents achieved Level 1 (did not perform fine-needle aspirations). For MK2, 2 respondents achieved Level 1 (did not evaluate Papanicolaou). For SBP1, 80% in private practice achieved Level 5; 50% in academics achieved Level 3. For SBP3, 80% in private practice achieved Level 4+; 100% in academics achieved maximum Level 2. For SBP5, 60% of all respondents achieved maximum Level 3; only 1 achieved Level 5. CONCLUSIONS Many Milestones are attainable. Eleven of 18 yielded Level 4+ from most respondents. Three (PC2, MK1, MK2) yielded rare Level 1 due to scope of practice. Others (SBP1, SBP3) reflect more of an all-or-nothing phenomenon. For SBP5, most respondents achieved Level 3; only 1 achieved Level 5. Some Milestones are highly dependent on practice setting, and others remain aspirational.
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Affiliation(s)
- Kathryn S Dyhdalo
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Olaronke Oshilaja
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Deborah J Chute
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Christine N Booth
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Paul Suchy
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Kristen Smith
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Gary W Procop
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jordan P Reynolds
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
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Riley JD, Stanley G, Wyllie R, Burt HL, Horwitz SB, Cooper DD, Procop GW. An Electronic Strategy for Eliminating Unnecessary Duplicate Genetic Testing. Am J Clin Pathol 2020; 153:328-332. [PMID: 31665226 DOI: 10.1093/ajcp/aqz163] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To determine the impact of an electronic intervention designed to block duplicate constitutional genetic tests. METHODS We constructed, implemented, and studied an electronic intervention that stopped duplicate genetic tests. The activation frequency, types of tests affected, and cost savings achieved with this intervention were determined. The frequency and justification of override requests were also studied. RESULTS This intervention stopped 710 unnecessary duplicate genetic tests over a 3-year period and saved $98,596. The tests with the highest numbers of alerts were those used for screening presurgical or transplant patients and were commonly part of an order set or test panel. Most override requests were justified because of the lack of exclusion codes in the initial programming. CONCLUSIONS Electronic interventions that stop duplicate genetic testing, if properly constructed, can reduce waste, save health care dollars, and facilitate patient care by directing the provider to a test that has already been performed.
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Affiliation(s)
- Jacquelyn D Riley
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - Glenn Stanley
- Clinical Informatics, Cleveland Clinic, Cleveland, OH
| | | | - Holly L Burt
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - Sandra B Horwitz
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - Donna D Cooper
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
- Quest Diagnostics, Secaucus, NJ
| | - Gary W Procop
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
- Clinical Informatics, Cleveland Clinic, Cleveland, OH
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30
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Modi AR, Miranda CC, Procop GW, Foster CB, Harrington S, Evans D, Johnson LT, Gordon SM. Addressing the threat from within: Investigation of respiratory symptoms in a health care worker with untreated latent tuberculosis infection. Am J Infect Control 2020; 48:82-85. [PMID: 31444095 DOI: 10.1016/j.ajic.2019.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 07/12/2019] [Accepted: 07/13/2019] [Indexed: 10/26/2022]
Abstract
Tuberculosis (TB) in the health care worker demands orchestrated efforts from health care institutions to promptly identify cases and address community risk. We describe a pediatric intensive care unit nurse with latent TB infection who developed hemoptysis and a lung infiltrate concerning for active TB. Her evaluation and contact investigation were facilitated by our institution's command center. Although TB was ultimately ruled out, this case tested our team-based care in response to a suspected high-consequence pathogen.
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Lehman B, Leal SM, Procop GW, O'Connell E, Shaik J, Nash TE, Nutman TB, Jones S, Braunthal S, Shah SN, Cruise MW, Mukhopadhyay S, Banzon J. Disseminated Metacestode Versteria Species Infection in Woman, Pennsylvania, USA 1. Emerg Infect Dis 2019; 25:1429-1431. [PMID: 31211937 PMCID: PMC6590738 DOI: 10.3201/eid2507.190223] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 11/22/2022] Open
Abstract
A patient in Pennsylvania, USA, with common variable immunodeficiency sought care for fever, cough, and abdominal pain. Imaging revealed lesions involving multiple organs. Liver resection demonstrated necrotizing granulomas, recognizable tegument, and calcareous corpuscles indicative of an invasive cestode infection. Sequencing revealed 98% identity to a Versteria species of cestode found in mink.
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Sardiña LA, Kaw U, Jour G, Knabel D, Dyck RM, Procop GW, Bergfeld WF, Harrington S, Demkowicz R, Piliang MP. Diagnosis of Mycobacterium abscessus/chelonae complex cutaneous infection: Correlation of tissue culture and skin biopsy. J Cutan Pathol 2019; 47:321-327. [PMID: 31804711 DOI: 10.1111/cup.13623] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 04/12/2019] [Revised: 10/06/2019] [Accepted: 11/15/2019] [Indexed: 01/05/2023]
Abstract
Mycobacterium abscessus and M. chelonae belong to the rapid-growing nontuberculous mycobacteria (NTM) group, which are defined by their ability to form visible colonies on agar within 7 days of subculture. Cutaneous infections by this complex show a heterogeneous clinical presentation with varied histopathologic findings. However, the presence of vacuoles in many specimens has been reported as a specific histologic finding. Herein, we correlate the histopathology of patients with tissue-culture positive M. abscessus/M. chelonae complex in order to identify features that may prompt a rapid categorization of the infectious etiology. The cohort includes 33 skin punch biopsy specimens from 28 patients who had associated positive tissue cultures. The most frequent clinical presentation was a single or multiple nodule. Twenty-seven specimens (81.81%) were found to have vacuoles. The observation of certain histologic features (ie, polymorphonuclear microabscesses and epithelioid granuloma formation) should raise the possibility of infection by NTM. In addition to these findings, we believe the presence of vacuoles in the dermal and subcutaneous inflammation should raise suspicion for NTM.
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Affiliation(s)
- Luis A Sardiña
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio.,Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
| | - Urvashi Kaw
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
| | - George Jour
- Department of Pathology and Dermatology, New York Langone Medical Center, New York, New York
| | - Daniel Knabel
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio.,Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
| | - Rayna M Dyck
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio.,Skin Wellness Center Of Alabama, Birmingham, Alabama
| | - Gary W Procop
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Wilma F Bergfeld
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio.,Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
| | - Susan Harrington
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ryan Demkowicz
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Melissa P Piliang
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio.,Department of Dermatology, Cleveland Clinic, Cleveland, Ohio
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Procop GW, Nelson SK, Blond BJ, Souers RJ, Massie LW. The Impact of Transit Times on the Detection of Bacterial Pathogens in Blood Cultures: A College of American Pathologists Q-Probes Study of 36 Institutions. Arch Pathol Lab Med 2019; 144:564-571. [PMID: 31729885 DOI: 10.5858/arpa.2019-0258-cp] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Consolidation of clinical microbiology laboratory services has resulted in extended transit time for blood cultures from service points distant from the laboratory. Sepsis is critical; delays in identification of etiologic agents of diseases could adversely impact patient care. OBJECTIVE.— To examine the effect of total preanalytic time and blood culture volume on the instrument time-to-detection for bacterial pathogens in blood cultures. A secondary objective was to obtain relevant blood culture information by questionnaire. DESIGN.— Participants in this Q-Probes study recorded date, time, and volume information for the first 50 positive blood cultures collected during the 12-week study period. Additional information regarding blood culture collection practices was obtained through questionnaire. RESULTS.— Prolonged overall time-to-detection was secondary to prolonged preanalytic time, particularly prolonged transit time, rather than slower organism growth once bottles were placed on the instrument. Among 1578 blood cultures, the overall time from collection to positive result was significantly less for blood cultures collected on-site than for off-site locations. Most institutions lack sufficient training programs and do not monitor preanalytic time metrics associated with blood cultures. Four hundred fifty-six of the 1580 blood cultures with blood volume adequacy reported (28.9%) were inadequately filled. CONCLUSIONS.— Overall process time (specimen collection to positive blood culture detection) is predicted to be higher for blood cultures collected off-site. Transit time is a variable that can be reduced to decrease overall time to detection. Thus, improved training and closer attention to preanalytic metrics associated with blood cultures could decrease hospital stays and mortality rates.
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Affiliation(s)
- Gary W Procop
- From Clinical Microbiology and Medical Operations, Cleveland Clinic, Cleveland, Ohio (Dr Procop); Biostatistics, College of American Pathologists, Northfield, Illinois (Mss Nelson, Blond, and Souers); and Pathology and Laboratory Medicine Service, New Mexico VA Health Care Systems, Albuquerque (Dr Massie)
| | - Suzanne K Nelson
- From Clinical Microbiology and Medical Operations, Cleveland Clinic, Cleveland, Ohio (Dr Procop); Biostatistics, College of American Pathologists, Northfield, Illinois (Mss Nelson, Blond, and Souers); and Pathology and Laboratory Medicine Service, New Mexico VA Health Care Systems, Albuquerque (Dr Massie)
| | - Barbara J Blond
- From Clinical Microbiology and Medical Operations, Cleveland Clinic, Cleveland, Ohio (Dr Procop); Biostatistics, College of American Pathologists, Northfield, Illinois (Mss Nelson, Blond, and Souers); and Pathology and Laboratory Medicine Service, New Mexico VA Health Care Systems, Albuquerque (Dr Massie)
| | - Rhona J Souers
- From Clinical Microbiology and Medical Operations, Cleveland Clinic, Cleveland, Ohio (Dr Procop); Biostatistics, College of American Pathologists, Northfield, Illinois (Mss Nelson, Blond, and Souers); and Pathology and Laboratory Medicine Service, New Mexico VA Health Care Systems, Albuquerque (Dr Massie)
| | - Larry W Massie
- From Clinical Microbiology and Medical Operations, Cleveland Clinic, Cleveland, Ohio (Dr Procop); Biostatistics, College of American Pathologists, Northfield, Illinois (Mss Nelson, Blond, and Souers); and Pathology and Laboratory Medicine Service, New Mexico VA Health Care Systems, Albuquerque (Dr Massie)
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Mandelia Y, Procop GW, Richter SS, Worley S, Liu W, Esper F. 2627. Dynamics of Respiratory Viral Co-infections: Predisposition for and Clinical Impact of Viral Pairings in Children and Adults. Open Forum Infect Dis 2019. [PMCID: PMC6810471 DOI: 10.1093/ofid/ofz360.2305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The clinical relevance of respiratory viral co-infections is unclear. Few studies determine epidemiology and impact of specific co-infection pairings. Here we assess the dynamics of respiratory viral co-infections, determine any predisposition for specific pairings to occur and evaluate resulting clinical impact on hospitalization. Methods We reviewed respiratory viral panel results collected at The Cleveland Clinic between November 2013 to Jun 2018. Monthly prevalences, mono-infections and co-infections of 13 viral pathogens were tabulated. Employing a mathematical model which utilized each individual virus’ co-infection rate and prevalence patterns of concurrent circulating respiratory viruses, we calculated an expected number of occurrences for 132 viral pairing permutations. Expected vs observed co-infection occurrences were compared using binomial tests. For viral pairings occurring at significantly higher prevalence than expected, logistic regression models were used to compare hospitalization between patients with co-infection to ones with mono-infection. Results Of 30,535 respiratory samples, 9,843 (32.2%) samples were positive for at least 1 virus and 1,018 (10.82%) were co-infected. Co-infections occurred in 18% of pediatric samples and only 3% of adult samples (P < 0.001). Adenovirus C (ADVC had the highest co-infection rate (68.3%) while influenza B had the lowest (10.07%). Using our model, ADVC – rhinovirus (HRV), RSVA - HRV, and RSVB - HRV pairings occurred at significantly higher prevalence than expected (P < 0.05). In children, HRV-RSVB co-infection were significantly less likely to be hospitalized than patients with HRV mono-infections (ORmono/co = 2.3; 95% CI 1.1 to 4.7; P = 0.028). Additionally, HRV - ADVC co-infected children were less likely to be hospitalized than either HRV (ORmono/co = 3.3; 95% CI 1.6 to 6.8; P < 0.001) or ADVC (ORmono/co = 1.9; 95% CI 1.1 to 3.2; P = 0.024) mono-infected children. Regardless of the infecting virus, children were less likely to be hospitalized than similarly-infected adults. Conclusion Respiratory viral co-infections are largely a pediatric phenomenon. Select viral pairings occur more often than predicted by our model, many of which are associated with altered severity of resultant disease. ![]()
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Disclosures All authors: No reported disclosures.
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Affiliation(s)
| | | | | | | | - Wei Liu
- Cleveland Clinic, Beachwood, Ohio
| | - Frank Esper
- Cleveland Clinic Children’s, Cleveland, Ohio
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Snider CA, Banzon J, Bhimraj A, Procop GW, Goldfarb J. 1824. Herpes Simplex Encephalitis: Outcomes from a 10-Year Retrospective Single-Center Case Series. Open Forum Infect Dis 2019. [PMCID: PMC6809179 DOI: 10.1093/ofid/ofz359.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Herpes simplex virus (HSV) is the most common cause of infectious encephalitis in the United States. While early treatment with acyclovir has improved acute management, long-term morbidity and mortality remain high and warrant further characterization. Methods We retrospectively identified adult patients (≥18 years) with HSE admitted to the Cleveland Clinic Main Campus and affiliated regional hospitals from April 2006 to June 2016. HSE diagnosis was concordant with Infectious Disease Society of America Encephalitis Guidelines. HSE diagnosis was confirmed in that HSV-1 DNA was detected in cerebrospinal fluid (CSF) by polymerase chain reaction (PCR) assay for all patients included in this study. Patients for which HSV-2 was detected in the CSF were excluded to avoid inclusion of HSV meningitis. Clinical information was collected in a REDCap database and analyzed by descriptive statistics. Patients were indexed at the date of admission, and Kaplan–Meier analysis was used to estimate overall survival. Results We identified 32 patients with confirmed HSE. The median patient age was 62 years (interquartile range [IQR] 45–72). All patients received treatment with intravenous (IV) acyclovir, with a median treatment duration of 24 days (IQR 19–30). The median time from initial symptom onset to IV acyclovir treatment was 5 days (IQR 3–8). Three patients (9%) died during the hospitalization course, 16 (50%) were discharged to a nursing facility, 11 (35%) returned home, and two (6%) transitioned to an acute care facility (Figure 1). Within three months of discharge, 15 (47%) patients were readmitted, six (19%) of which readmitted for HSE relapse. The overall survival rate at one month was 84% and 74% at 12 months (Figure 2). At outpatient follow-up, cognitive deficits were self-reported by 19 (66%) patients, followed in frequency by motor (31%) and sensory deficits (7%). Conclusion Despite appropriate treatment with IV acyclovir, HSE survivors frequently experienced severe morbidities after initial hospitalization, including HSE relapse, discharge to long-term care facilities, and neurocognitive impairment. Risk of death was highest within one month of admission. Further investigation is needed to optimize treatment of HSE to improve mortality and to reduce permanent neurologic deficits. ![]()
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Disclosures All Authors: No reported Disclosures.
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Affiliation(s)
- Christina A Snider
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, University Heights, Ohio
| | - Jona Banzon
- Cleveland Clinic Foundation, Cleveland, Ohio
| | | | | | - Johanna Goldfarb
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, University Heights, Ohio
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Srinivas P, Rivard KR, Pallotta AM, Athans V, Martinez K, Loutzenheiser S, Lam SW, Procop GW, Richter SS, Neuner EA. Implementation of a Stewardship Initiative on Respiratory Viral PCR‐based Antibiotic Deescalation. Pharmacotherapy 2019; 39:709-717. [DOI: 10.1002/phar.2268] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Pavithra Srinivas
- Department of Pharmacy Cleveland Clinic Cleveland Ohio
- Department of Pharmacy Cleveland Clinic Avon Hospital Avon Ohio
| | | | - Andrea M. Pallotta
- Department of Pharmacy Cleveland Clinic Cleveland Ohio
- Department of Pharmacy Cleveland Clinic Medina Hospital Medina Ohio
| | | | - Kristin Martinez
- Department of Pharmacy Cleveland Clinic Fairview Hospital Cleveland Ohio
| | | | - Simon W. Lam
- Department of Pharmacy Cleveland Clinic Cleveland Ohio
| | - Gary W. Procop
- Department of Laboratory Medicine Cleveland Clinic Cleveland Ohio
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Doyle LJ, Betz BL, Weigelin HC, Procop GW, Cook JR. Comparison of real‐time PCR vs PCR with fragment length analysis for the detection of
CALR
mutations in suspected myeloproliferative neoplasms. Int J Lab Hematol 2019; 41:e139-e141. [DOI: 10.1111/ijlh.13040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/02/2019] [Accepted: 04/09/2019] [Indexed: 12/30/2022]
Affiliation(s)
- Laura J. Doyle
- Pathology and Laboratory Medicine Institute Cleveland Clinic Cleveland Ohio
| | - Bryan L. Betz
- University of Michigan School of Medicine Ann Arbor Michigan
| | | | - Gary W. Procop
- Pathology and Laboratory Medicine Institute Cleveland Clinic Cleveland Ohio
| | - James R. Cook
- Pathology and Laboratory Medicine Institute Cleveland Clinic Cleveland Ohio
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Lehman B, Procop GW, Silva Merea V, Harrington SM, Mawhorter SD, Benninger MS. Chronic laryngitis caused by Mycobacterium Kansasii in a traveler. Laryngoscope 2019; 129:2534-2536. [PMID: 30912581 DOI: 10.1002/lary.27952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 08/29/2018] [Revised: 11/28/2018] [Accepted: 12/03/2018] [Indexed: 11/09/2022]
Abstract
Chronic laryngitis commonly presents with dysphonia, and infectious causes include tuberculosis and endemic mycoses. We present a 58-year-old female with laryngitis for 5 years, fevers, chills, fatigue, malaise, myalgias, anterior neck pain, and night sweats after multicontinent exposure. Bronchoscopy cultures were negative. Bilateral microflap excision of vocal fold lesions demonstrated thickened epithelium and a deep vocal fold mass. Biopsy showed necrotizing granulomatous inflammation with acid-fast bacilli. Mycobacterium kansasii was identified. Treatment led to improvement in dysphonia, systemic symptoms, and vocal fold irritation. To our knowledge, this is the first case of isolated nontuberculous mycobacterial vocal fold infection. Laryngoscope, 129:2534-2536, 2019.
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Affiliation(s)
- Bethany Lehman
- Department of Infectious Disease, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Gary W Procop
- Department of Pathology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Valeria Silva Merea
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York, U.S.A
| | | | - Steven D Mawhorter
- Department of Infectious Disease, Cleveland Clinic Foundation, Cleveland, Ohio
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Phelan MP, Nakashima MO, Good DM, Hustey FM, Procop GW. Impact of Interventions to Change CBC and Differential Ordering Patterns in the Emergency Department. Am J Clin Pathol 2019; 151:194-197. [PMID: 30247523 DOI: 10.1093/ajcp/aqy128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives A CBC with leukocyte differential (CBC-DIFF) is a frequently ordered emergency department (ED) test. The DIFF component often does not add to clinical decision making. Our objective was to evaluate the impact of a performance improvement project on CBC ordering. Methods ED orders for CBC-DIFF were identified through the laboratory information system. Two interventions were evaluated: an educational intervention regarding CBC-DIFF uses and a reprioritization of ED CBC-DIFF and CBC in the electronic medical record (EMR) orders. Pearson χ2 tests were used to assess for differences in the proportions. Results There was no difference in the proportion of CBC tests performed after the education intervention (175/6,192, 2.8% [95% CI, 2.39%-3.21%] vs 219/6,270, 3.5% [95% CI, 3.05%-3.95%]). There was a significant increase in CBC samples ordered following the EMR intervention (604/6,044, 9.1% [95% CI, 8.37%-9.83%]; P < .01). Conclusions Reprioritizing EMR laboratory orders can reduce overutilization of CBC-DIFF testing.
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Affiliation(s)
| | - Megan O Nakashima
- Robert J. Tomsich Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | | | | | - Gary W Procop
- Clinical Pathology, The Cleveland Clinic Foundation, Cleveland, OH
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40
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McHugh KE, Gersey M, Rhoads DD, Procop GW, Zhang Y, Booth CN, Sturgis CD. Sensitivity of Cerebrospinal Fluid Cytology for the Diagnosis of Cryptococcal Infections: A 21-Year Single-Institution Retrospective Review. Am J Clin Pathol 2019; 151:198-204. [PMID: 30321269 DOI: 10.1093/ajcp/aqy133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objectives Cryptococcal meningoencephalitis is the most common fungal infection of the central nervous system diagnosed by cerebrospinal fluid cytology (CSF) studies. Existing literature suggests that routine CSF cytomorphologic evaluations are exquisitely specific; however, less is known about their sensitivity. Methods An electronic record review of the cytopathology and microbiology files was conducted for the 21-year interval from January 1, 1995, through December 31, 2015. Results In 21 years, 12,584 CSF samples were processed in the laboratory. Of these, 24 (0.2%) were reported positive for cryptococcal organisms by light microscopy, and 129 CSF fungal cultures were positive for Cryptococcus species. All cotested specimens with positive cytology results were positive on culture (15 specimens, 100% specificity). Twenty-four samples with positive culture results were negative by CSF cytology (sensitivity 39%). Conclusions When culture is used as a gold standard, CSF cytology is 100% specific and 39% sensitive, with a positive predictive value of 100% and a negative predictive value of 99.8%.
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Affiliation(s)
- Kelsey E McHugh
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, OH
| | - Melanie Gersey
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, OH
| | - Daniel D Rhoads
- Department of Pathology, Case Western Reserve University, Cleveland, OH
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Gary W Procop
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, OH
| | - Yaxia Zhang
- Department of Pathology, Hospital for Special Surgery, New York, NY
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41
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Nikolic D, Kohn D, Yen-Lieberman B, Procop GW. Detection of Herpes Simplex Virus and Varicella-Zoster Virus by Traditional and Multiplex Molecular Methods. Am J Clin Pathol 2019; 151:122-126. [PMID: 30239569 DOI: 10.1093/ajcp/aqy111] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives To compare multiplex nucleic acid amplification tests (NAATs) that detect and differentiate herpes simplex virus (HSV) and varicella-zoster virus (VZV) with traditional virologic assays. Methods The HSV ELVIS Test System (Quidel, San Diego, CA) and/or Light Diagnostics VZV direct fluorescent antibody (DFA) kit (Millipore Sigma, Billerica, MA), as well as an ARIES HSV 1&2/VZV assay (Luminex, Austin, TX) and the Solana HSV1 + 2/VZV Assay (Quidel), were performed on non-cerebrospinal fluid specimens. Results The sensitivities/specificities for the ELVIS, Aries, and Solana assays for HSV were 71.1%/93.2%, 94.9%/93.2%, and 94.7%/100%, respectively. The sensitivities/specificities for the DFA, Aries, and Solana assays for VZV were 71.4%/100%, 100%/96.0%, and 95.3%/100%, respectively. HSV and VZV were detected but clinically unsuspected in 5.4% and 4.2% of the specimens, respectively. Conclusions Both NAAT assays were comparable and more sensitive than traditional methods. The recovery of unsuspected HSV and VZV from clinical specimens supports the implementation of a combined HSV/VZV assay.
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Affiliation(s)
- Dejan Nikolic
- Department of Pathology, Cooper University Health Care, Camden, NJ
- Department of Laboratory Medicine, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - Debra Kohn
- Department of Laboratory Medicine, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - Belinda Yen-Lieberman
- Department of Laboratory Medicine, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - Gary W Procop
- Department of Laboratory Medicine, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
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42
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Stempak LM, Vogel SA, Richter SS, Wyllie R, Procop GW. Routine Broad-Range Fungal Polymerase Chain Reaction With DNA Sequencing in Patients With Suspected Mycoses Does Not Add Value and Is Not Cost-Effective. Arch Pathol Lab Med 2018; 143:634-638. [DOI: 10.5858/arpa.2017-0299-oa] [Citation(s) in RCA: 12] [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: 11/06/2022]
Abstract
Context.—
New molecular diagnostic tests regularly become available, and they may be assumed to be superior to traditional diagnostic studies. The added cost of these studies should be considered in conjunction with the value provided for patient care.
Objective.—
To assess the cost and diagnostic value of broad-range polymerase chain reaction (PCR) and DNA sequencing for the diagnosis of fungal infections compared with traditional studies.
Design.—
We reviewed the cost and clinical impact of broad-range fungal PCR/DNA sequencing for 65 specimens for which this test, a direct fungal examination, fungal culture, and a histopathologic assessment were performed.
Results.—
The sensitivity, specificity, and positive and negative predictive values for each of the assays studied were, respectively: histopathology (83.3%, 100%, 100%, and 98.3%); direct examination (66.7%, 100%, 100%, and 96.7%); fungal culture (83.3%, 100%, 100%, and 98.3%); and broad-range fungal PCR/DNA sequencing (83.3%, 95.0%, 62.5%, and 98.3%). The cost for broad-range fungal PCR/DNA sequencing was $32,500, compared with $8,591.70 for all traditional tests combined, for the 65 specimens included in this review.
Conclusions.—
Broad-range fungal PCR/DNA sequencing did not detect any infecting fungal pathogen that was not detected by at least 1 of the traditional methods, but 3 false-positives occurred. Broad-range fungal PCR/DNA sequencing is not a substitute for traditional laboratory studies and should be used judiciously to promote care affordability.
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Affiliation(s)
| | | | | | | | - Gary W. Procop
- From the Department of Pathology, The University of Mississippi Medical Center, Jackson (Dr Stempak); and the Pathology and Laboratory Medicine Institute (Ms Vogel and Drs Richter, Wyllie, and Procop) and Medical Operations (Drs Wyllie and Procop), Cleveland Clinic, Cleveland, Ohio
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43
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Otiso J, Vogel S, Procop GW, Richter SS. 2292. Comparison of Molecular Assays for the Diagnosis of Pertussis. Open Forum Infect Dis 2018. [PMCID: PMC6255653 DOI: 10.1093/ofid/ofy210.1945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Methods Results Conclusion Disclosures
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Affiliation(s)
- Joshua Otiso
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Sherilynn Vogel
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Gary W Procop
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Sandra S Richter
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio
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Richardson S, Athans V, Neuner E, Rivard K, Cober E, McShane A, Procop GW. 1810. Therapeutic Drug Monitoring of Azole Antifungals at an Academic Medical Center: Opportunities and Lessons Learned. Open Forum Infect Dis 2018. [PMCID: PMC6254892 DOI: 10.1093/ofid/ofy210.1466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Methods Results Conclusion Disclosures
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Affiliation(s)
| | | | | | - Kaitlyn Rivard
- Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio
| | - Eric Cober
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio
| | - Adam McShane
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Gary W Procop
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio
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45
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Lehman B, Leal S, Procop GW, O’Connell EM, Nash T, Jones S, Braunthal S, Cruise M, Mukhopadhyay S, Banzon J. 1731. Disseminated Metacestode Infection Due to an Unknown Versteria Species. Open Forum Infect Dis 2018. [PMCID: PMC6252536 DOI: 10.1093/ofid/ofy209.137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background A 68-year-old woman with hypogammaglobulinemia and prior treated lymphoma presented with fever and abdominal pain. Evaluation revealed numerous nodules in the lung, eye, brain, and liver (Figure 1). Initial lung and liver biopsies showed necrotizing granulomas with no organisms and negative serology and cultures. After progression while on broad-spectrum antibiotics for 4 months, an open liver biopsy revealed numerous nodular lesions and a mass made up of multifocal coalescing cystic lesions. The mass consisted of a degenerating 3-layered membrane without scoleces characterized by a wavy protuberant ciliated eosinophilic outer layer, subjacent degenerating cells with pyknotic nuclei, and loose connective tissue suggestive of a bladder wall and calcareous corpuscles in a matrix of granulomatous inflammation with areas of necrosis (Figure 2). This was diagnostic of disseminated metacestodes (larval stage) of a cestode (tapeworm). Treatment with praziquantel and albendazole led to improvement of symptoms and lesions. Disseminated cestode infections other than due to Echinococcus species are rare in humans. Sequencing was pursued due to the unusual findings. Methods DNA was extracted from liver tissue followed by targeted amplification of the cestode COX1 gene. PCR products confirmed to be 134 bp, as expected for a cestode COX1 gene, then inserted into a 2.1 Topo vector and cloned. Five separate isolates were sequenced, and 4 were interpretable. The 129-bp consensus sequence is shown in Figure 3. Basic Local Alignment Search Tool (NCBI BLAST) was used to find highly similar sequences. Results The sequence matched to Versteria sp. (T. mustelae) COX1 gene from a mink in Oregon (accession KT223034) with 98% identity. Conclusion Metacestodes have the propensity to proliferate and rarely disseminate. There is one reported case of Versteria sp. causing a lethal disseminated infection of an orangutan. This is the first report of a Versteria sp. disseminated infection in a human and is singular because the patient survived. The patient likely accidentally ingested ova shed from a tapeworm in a mink or similar mammalian host. Histopathologic assessment is crucial in diagnosing cestode infection. COX1 gene sequencing is useful for cestode identification. ![]()
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Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Bethany Lehman
- Department of Infectious Disease, Cleveland Clinic, Cleveland, Ohio
| | | | - Gary W Procop
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio
| | | | - Theodore Nash
- Clinical Parasitology Section, National Institutes of Health, Bethesda, Maryland
| | | | | | | | | | - Jona Banzon
- Department of Infectious Disease, Cleveland Clinic, Cleveland, Ohio
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46
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John TM, Shrestha N, Procop GW, Grove D, Leal S, Jacob CN, Butler R, Dweik R. 2010. Volatile Organic Compounds Patterns in Breath, Plasma, and Stool in Patients with Clostridium difficile Infection: A Cross-Sectional Proof of Concept Study. Open Forum Infect Dis 2018. [PMCID: PMC6253511 DOI: 10.1093/ofid/ofy210.1666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Volatile organic compounds (VOCs) are hydrocarbon compounds which are end product metabolites of physiological and pathophysiological processes. Many disease processes can be identified by examining metabolome patterns in clinical samples from patients. The purpose of this study was to identify Clostridium difficile infection (CDI) based on differences in VOCs in stool, blood and breath of patients with CDI and controls without. Methods Patients aged >18 years at Cleveland Clinic with CDI (> 3 watery stools in the preceding 24 hours and stool PCR positive for C. difficile), and matched controls (for age, sex, and date of PCR test) were included. Stool and plasma samples (within 24 hours of collection) and fresh breath samples were collected. Headspace gas from clinical samples was tested using selected ion flow tube mass spectrometry (SIFT-MS) on a VOICE200 instrument (Syft Technologies Ltd., Christchurch, New Zealand). The MS assay comprised of 22 common analytes: 2-propanol, acetaldehyde, acetone, acetonitrile, acrylonitrile, benzene, carbon disulfide, dimethyl sulfide, ethanol, isoprene, pentane, 1-decene, 1-heptene, 1-nonene, 1-octene, 3-methyl hexane, 2-nonene, ammonia, ethane, hydrogen sulfide, triethyl amine, and trimethyl amine. VOC analysis findings were classified as positive or negative using the K-nearest neighbors (KNN) method. Model accuracy was evaluated by k-fold cross-validation with 5-folds. Sensitivity and specificity were determined and receiver-operating characteristics curves generated for each sample type. Results Thirty-one patients with CDI and 31 controls were studied. The optimal KNN classifier model was achieved with k = 7, 5, and 9, for breath, plasma, and stool samples, respectively. The sensitivity/specificity for detection of CDI were 87.1%/77.4%, 66.7%/63.6%, and 61.3%/36.4%, for breath, stool, and plasma samples, respectively. Model accuracy was no better if positives were limited to those with C. difficile PCR CT <30 cycles. Conclusion VOC analysis of fresh breath, but not plasma or stool samples ≤24 hours old, by the method studied had good sensitivity and moderate specificity for identifying patients with CDI. Disclosures All authors: No reported disclosures.
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Affiliation(s)
| | | | - Gary W Procop
- Department of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio
| | - David Grove
- Respiratory Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Sixto Leal
- Department of Laboratory Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | | | - Robert Butler
- Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Raed Dweik
- Respiratory Institute, Cleveland Clinic Foundation, Cleveland, Ohio
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47
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Gautham I, Radford DM, Kovacs CS, Calhoun BC, Procop GW, Shepardson LB, Dawson AE, Downs-Kelly EP, Zhang GX, Al-Hilli Z, Fanning AA, Wilson DA, Sturgis CD. Cystic neutrophilic granulomatous mastitis: The Cleveland Clinic experience with diagnosis and management. Breast J 2018; 25:80-85. [PMID: 30449049 DOI: 10.1111/tbj.13160] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [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: 10/09/2017] [Revised: 01/16/2018] [Accepted: 01/17/2018] [Indexed: 12/19/2022]
Abstract
Granulomatous mastitis is an uncommon inflammatory disease that typically presents with painful breast lesions. Recent publications have brought to light a specific subset of granulomatous mastitis patients with a distinct histological pattern of disease termed, "cystic neutrophilic granulomatous mastitis" (CNGM). Although many cases of granulomatous lobular mastitis have been thought to be idiopathic, this rare subset of an uncommon disease has been linked to infections with Corynebacterium species. Herein, a cohort of CNGM patients from a large, tertiary care, North-American, academic medical center is presented. Correlative demographic, clinical, radiographic, pathologic, microbiologic, management, and outcomes data are provided. Collaborative communication between specialists to accurately diagnose and manage these patients is essential to decreasing potential morbidity.
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Affiliation(s)
- Ila Gautham
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio
| | - Diane M Radford
- Department of Breast Surgery, Cleveland Clinic, Cleveland, Ohio
| | | | | | - Gary W Procop
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio
| | | | | | | | - Gloria X Zhang
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio
| | - Zahraa Al-Hilli
- Department of Breast Surgery, Cleveland Clinic, Cleveland, Ohio
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Shetty NU, O'Connell J, Oshilaja OO, Patil DT, Procop GW, Sturgis CD. First documented case of Sarcina in esophageal brushing cytology. Diagn Cytopathol 2018; 46:886-887. [PMID: 30146691 DOI: 10.1002/dc.23986] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 05/13/2018] [Accepted: 05/18/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Nishka U Shetty
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Josephine O'Connell
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Olaronke O Oshilaja
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Deepa T Patil
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Gary W Procop
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Charles D Sturgis
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
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Abstract
OBJECTIVES The impact of clinical decision support tools (CDSTs) that display test cost information has been variable. METHODS We retrospectively analyzed the 3-year impact of a passive CDST that notified providers when the test order cost was $1,000 or more. We determined the most common expensive tests ordered, the frequency with which providers abandoned the order after notification, and the costs saved through this intervention. RESULTS The average monthly abandonment rate was 12.5% (2014), 12.9% (2015), and 14.3% (2016). The cost savings from tests not performed for this 3-year period was $696,007. Molecular hematopathology assays were the most frequently ordered tests, with variable abandonment rates. CONCLUSIONS Although this CDST was passive (ie, could be overridden at the point of order entry) and was associated with a relatively low abandonment rate, it achieved a considerable cost savings each year since each abandoned test saved the institution $1,000 or more.
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Abstract
Background Despite existing clinical and histopathological evidence, the role of inflammation in the pathogenesis of inverted papilloma (IP) is not well understood. The goal of this study was to describe the inflammatory cell component present in sinonasal papilloma (SP), with the intention of further defining the existence of inflammation in IP and perhaps gaining insight into IP pathophysiology. Methods Computerized database analysis was performed to identify all patients with SP who underwent surgery at the Cleveland Clinic Foundation between 1995 and 2001. Histopathological features of all SP were reviewed and semiquantitative analysis of the inflammatory cells present was performed. IP was histopathologically graded into four categories by the extent of inflammatory infiltrate and cellular atypia. Statistical analysis of the inflammatory cell component present in the epithelial layer of exophytic papilloma and IP was performed. Results SP was classified into three types: cylindrical papilloma (5% [2/41]), exophytic squamous papilloma (34% [14/41]), and IP (61% [25/41]). Twenty-eight instances of IP in 25 patients were identified. Altogether, 11% were grade I (3/28), 54% were grade II (15/28), 25% were grade III (7/28), and 11% were grade IV (3/28). The inflammatory cell population was significantly greater in IP compared with other SPs and greater in grades I and II IP when compared with grade III and IV IP. Conclusion Inflammatory cells were identified as a significant cell population in IP, whereas it was less commonly encountered in other forms of SP. The proposed IP staging system may serve as the foundation for improved understanding of IP and, ultimately, may help to predict recurrence or apparent malignant transformation.
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Affiliation(s)
- Hwan-Jung Roh
- Department of Otolaryngology—Head and Neck Surgery, College of Medicine, Pusan National University, Pusan, Korea
| | - Gary W. Procop
- Departments of Pathology and Cleveland Clinic Foundation, Cleveland, Ohio
| | - Pete S. Batra
- Otolaryngology and Communicative Disorders, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Martin J. Citardi
- Otolaryngology and Communicative Disorders, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Donald C. Lanza
- Otolaryngology and Communicative Disorders, Cleveland Clinic Foundation, Cleveland, Ohio
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