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Kaperak C, Eller D, Devlin SA, Hall A, Schmitt J, Friedman EE, Beavis KG, Stanford KA, Pitrak D, McNulty MC. Reflex Human Immunodeficiency Virus (HIV) Type 1 RNA Testing Enables Timely Differentiation of False-Positive Results From Acute HIV Infection. Open Forum Infect Dis 2024; 11:ofad629. [PMID: 38269050 PMCID: PMC10807991 DOI: 10.1093/ofid/ofad629] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 12/11/2023] [Indexed: 01/26/2024] Open
Abstract
Accurate, timely human immunodeficiency virus (HIV) diagnosis is critical. Routine HIV screening program data were examined before and after reflex HIV type 1 RNA testing. Reflex testing facilitated confirmation of reactive HIV screening assays (as true or false positives) (odds ratio, 23.7 [95% confidence interval, 6.7-83.4]; P < .0001), improving detection of acute HIV and reducing unconfirmed discordant results.
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Affiliation(s)
- Christopher Kaperak
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois, USA
| | - Dylan Eller
- Section of Infectious Diseases and Global Health, University of Chicago, Chicago, Illinois, USA
- Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois, USA
| | - Samantha A Devlin
- Section of Infectious Diseases and Global Health, University of Chicago, Chicago, Illinois, USA
- Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois, USA
| | - André Hall
- Section of Infectious Diseases and Global Health, University of Chicago, Chicago, Illinois, USA
- Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois, USA
| | - Jessica Schmitt
- Section of Infectious Diseases and Global Health, University of Chicago, Chicago, Illinois, USA
- Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois, USA
| | - Eleanor E Friedman
- Section of Infectious Diseases and Global Health, University of Chicago, Chicago, Illinois, USA
- Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois, USA
| | - Kathleen G Beavis
- Department of Pathology, University of Chicago, Chicago, Illinois, USA
| | - Kimberly A Stanford
- Section of Emergency Medicine, University of Chicago, Chicago, Illinois, USA
| | - David Pitrak
- Section of Infectious Diseases and Global Health, University of Chicago, Chicago, Illinois, USA
- Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois, USA
| | - Moira C McNulty
- Section of Infectious Diseases and Global Health, University of Chicago, Chicago, Illinois, USA
- Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois, USA
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2
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Odenwald MA, Lin H, Lehmann C, Dylla NP, Cole CG, Mostad JD, Pappas TE, Ramaswamy R, Moran A, Hutchison AL, Stutz MR, Dela Cruz M, Adler E, Boissiere J, Khalid M, Cantoral J, Haro F, Oliveira RA, Waligurski E, Cotter TG, Light SH, Beavis KG, Sundararajan A, Sidebottom AM, Reddy KG, Paul S, Pillai A, Te HS, Rinella ME, Charlton MR, Pamer EG, Aronsohn AI. Bifidobacteria metabolize lactulose to optimize gut metabolites and prevent systemic infection in patients with liver disease. Nat Microbiol 2023; 8:2033-2049. [PMID: 37845315 PMCID: PMC11059310 DOI: 10.1038/s41564-023-01493-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 09/08/2023] [Indexed: 10/18/2023]
Abstract
Progression of chronic liver disease is precipitated by hepatocyte loss, inflammation and fibrosis. This process results in the loss of critical hepatic functions, increasing morbidity and the risk of infection. Medical interventions that treat complications of hepatic failure, including antibiotic administration for systemic infections and lactulose treatment for hepatic encephalopathy, can impact gut microbiome composition and metabolite production. Here, using shotgun metagenomic sequencing and targeted metabolomic analyses on 847 faecal samples from 262 patients with acute or chronic liver disease, we demonstrate that patients hospitalized for liver disease have reduced microbiome diversity and a paucity of bioactive metabolites, including short-chain fatty acids and bile acid derivatives, that impact immune defences and epithelial barrier integrity. We find that patients treated with the orally administered but non-absorbable disaccharide lactulose have increased densities of intestinal bifidobacteria and reduced incidence of systemic infections and mortality. Bifidobacteria metabolize lactulose, produce high concentrations of acetate and acidify the gut lumen in humans and mice, which, in combination, can reduce the growth of antibiotic-resistant bacteria such as vancomycin-resistant Enterococcus faecium in vitro. Our studies suggest that lactulose and bifidobacteria serve as a synbiotic to reduce rates of infection in patients with severe liver disease.
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Affiliation(s)
- Matthew A Odenwald
- Department of Medicine, Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, IL, USA.
| | - Huaiying Lin
- Duchossois Family Institute, University of Chicago, Chicago, IL, USA
| | - Christopher Lehmann
- Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago, Chicago, IL, USA
| | - Nicholas P Dylla
- Duchossois Family Institute, University of Chicago, Chicago, IL, USA
| | - Cody G Cole
- Duchossois Family Institute, University of Chicago, Chicago, IL, USA
- Department of Microbiology, University of Chicago, Chicago, IL, USA
| | - Jake D Mostad
- Duchossois Family Institute, University of Chicago, Chicago, IL, USA
| | - Téa E Pappas
- Duchossois Family Institute, University of Chicago, Chicago, IL, USA
| | | | - Angelica Moran
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Alan L Hutchison
- Department of Medicine, Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, IL, USA
| | - Matthew R Stutz
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Cook County Health, Chicago, IL, USA
| | - Mark Dela Cruz
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Emerald Adler
- Duchossois Family Institute, University of Chicago, Chicago, IL, USA
| | - Jaye Boissiere
- Duchossois Family Institute, University of Chicago, Chicago, IL, USA
| | - Maryam Khalid
- Duchossois Family Institute, University of Chicago, Chicago, IL, USA
| | - Jackelyn Cantoral
- Duchossois Family Institute, University of Chicago, Chicago, IL, USA
| | - Fidel Haro
- Duchossois Family Institute, University of Chicago, Chicago, IL, USA
| | - Rita A Oliveira
- Duchossois Family Institute, University of Chicago, Chicago, IL, USA
| | - Emily Waligurski
- Duchossois Family Institute, University of Chicago, Chicago, IL, USA
- Department of Microbiology, University of Chicago, Chicago, IL, USA
| | - Thomas G Cotter
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, TX, USA
| | - Samuel H Light
- Duchossois Family Institute, University of Chicago, Chicago, IL, USA
| | | | | | | | - K Gautham Reddy
- Department of Medicine, Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, IL, USA
| | - Sonali Paul
- Department of Medicine, Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, IL, USA
| | - Anjana Pillai
- Department of Medicine, Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, IL, USA
| | - Helen S Te
- Department of Medicine, Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, IL, USA
| | - Mary E Rinella
- Department of Medicine, Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, IL, USA
| | - Michael R Charlton
- Department of Medicine, Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, IL, USA
| | - Eric G Pamer
- Duchossois Family Institute, University of Chicago, Chicago, IL, USA.
- Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago, Chicago, IL, USA.
- Department of Microbiology, University of Chicago, Chicago, IL, USA.
| | - Andrew I Aronsohn
- Department of Medicine, Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, IL, USA
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3
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Kim DY, Cheknis AK, Serna-Perez F, Lin MY, Hayden MK, Moore NM, Harrington A, Tesic V, Beavis KG, Gerding DN, Johnson S, Skinner AM. 403. Strain Epidemiology of Clostridioides difficile across Three Geographically Distinct Medical Centers in Chicago. Open Forum Infect Dis 2022. [PMCID: PMC9752158 DOI: 10.1093/ofid/ofac492.481] [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: 12/23/2022] Open
Abstract
Background Clostridioides difficile infections (CDI) are caused by a large and diverse group of strains with differences in prevalence and associated morbidity. Over the past 20 years the C. difficile (CD) molecular epidemiology has changed as the prevalence of the epidemic strain recognized as restriction endonuclease analysis (REA) group BI or PCR-Ribotype group (RT) 027 has decreased. The objective of this study was to determine the current epidemiology of CD in the city of Chicago. Methods Baseline characteristics and symptoms were compared for 81 patients who tested positive for CD by PCR (tcdB) between 9/1/2021 and 10/7/2021 at 3 hospitals in the city of Chicago. Patients were classified as having healthcare-associated CDI (HA-CDI) if symptoms began >72 hours after hospital admission, community-associated CDI (CA-CDI) if symptoms began ≤72 hours prior to admission, and community-onset healthcare-associated CDI (COHA-CDI) if they had been hospitalized ≤4 weeks prior to CDI diagnosis. Available stools were cultured and recovered CD isolates underwent REA typing. Determination of CD colonization was made by review of symptoms including chronicity of symptoms, stool frequency, and response to treatment. Results Among all patients, 33% (27/81) were CA-CDI, 28% (23/81) COHA-CDI, 11% (9/81) HA-CDI, and 27% (22/81) were classified as colonized. Primary CDI accounted for 66% (39/59) of the infections. Among patients with a primary CDI, 46% (18/39) of patients were classified as CA-CDI whereas COHA-CDI and HA-CDI accounted for 54% (21/39) of infections. REA group Y was the most common group strain accounting for 29% (22/75) of isolates. (Figure 1) REA group Y accounted for 26% (7/27) of CA-CDI compared to 0 REA group BI [p=0.06], and REA group Y accounted for 35% (7/20) of all colonized patients. (Figure 2)
![]() ![]() Conclusion There has been a marked change in the CD epidemiology within the city of Chicago since 2009 when REA group BI accounted for 61% of CDI (Black et al ICHE 2011; 32:897-902). REA group Y (typically identified as RT 014/020) is now the most common group strain in Chicago supplanting REA group BI (RT027). REA group Y appears to be associated primarily with CA-CDI and CD colonization. A detailed genomic analysis of REA group Y is required to determine potential reservoirs of REA group Y. Disclosures Mary K. Hayden, MD, Sanofi: Member, clinical adjudication panel Nicholas M. Moore, PhD, D(ABMM), Abbott Molecular: Grant/Research Support|Cepheid: Grant/Research Support Amanda Harrington, PhD, Beckman Coulter, Inc.: Clinical trial data collection funded by Beckman Coulter, Inc.|bioMeriuex/BioFire: Grant/Research Support Dale N. Gerding, MD, Destiny Pharma plc.: Advisor/Consultant Stuart Johnson, M.D., Ferring Pharmaceuticals: Membership on Ferring Publication Steering Committee|Ferring Pharmaceuticals: Employee|Summit Plc: Advisor/Consultant.
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Affiliation(s)
| | | | | | | | | | | | | | - Vera Tesic
- University of Chicago, Department of Pathology, Chicago, Illinois
| | | | - Dale N Gerding
- Edward Hines, Jr. Veterans Affairs Hospital, Hines, Illinois
| | - Stuart Johnson
- Hines VA Hospital and Loyola University Medical Center, Hines, Illinois
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Rouhani SJ, Trujillo JA, Pyzer AR, Yu J, Fessler J, Cabanov A, Higgs EF, Cron KR, Zha Y, Lu Y, Bloodworth JC, Abasiyanik MF, Okrah S, Flood BA, Hatogai K, Leung MY, Pezeshk A, Kozloff L, Reschke R, Strohbehn GW, Chervin CS, Kumar M, Schrantz S, Madariaga ML, Beavis KG, Yeo KTJ, Sweis RF, Segal J, Tay S, Izumchenko E, Mueller J, Chen LS, Gajewski TF. Severe COVID-19 infection is associated with aberrant cytokine production by infected lung epithelial cells rather than by systemic immune dysfunction. Res Sq 2021:rs.3.rs-1083825. [PMID: 34845442 PMCID: PMC8629200 DOI: 10.21203/rs.3.rs-1083825/v1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The mechanisms explaining progression to severe COVID-19 remain poorly understood. It has been proposed that immune system dysregulation/over-stimulation may be implicated, but it is not clear how such processes would lead to respiratory failure. We performed comprehensive multiparameter immune monitoring in a tightly controlled cohort of 128 COVID-19 patients, and used the ratio of oxygen saturation to fraction of inspired oxygen (SpO2 / FiO2) as a physiologic measure of disease severity. Machine learning algorithms integrating 139 parameters identified IL-6 and CCL2 as two factors predictive of severe disease, consistent with the therapeutic benefit observed with anti-IL6-R antibody treatment. However, transcripts encoding these cytokines were not detected among circulating immune cells. Rather, in situ analysis of lung specimens using RNAscope and immunofluorescent staining revealed that elevated IL-6 and CCL2 were dominantly produced by infected lung type II pneumocytes. Severe disease was not associated with higher viral load, deficient antibody responses, or dysfunctional T cell responses. These results refine our understanding of severe COVID-19 pathophysiology, indicating that aberrant cytokine production by infected lung epithelial cells is a major driver of immunopathology. We propose that these factors cause local immune regulation towards the benefit of the virus.
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Affiliation(s)
- Sherin J Rouhani
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Jonathan A Trujillo
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Athalia R Pyzer
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Jovian Yu
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Jessica Fessler
- Department of Pathology, University of Chicago, 5841 S. Maryland Ave, MC2115, Chicago, IL
| | - Alexandra Cabanov
- Department of Pathology, University of Chicago, 5841 S. Maryland Ave, MC2115, Chicago, IL
| | - Emily F Higgs
- Department of Pathology, University of Chicago, 5841 S. Maryland Ave, MC2115, Chicago, IL
| | - Kyle R Cron
- Department of Pathology, University of Chicago, 5841 S. Maryland Ave, MC2115, Chicago, IL
| | - Yuanyuan Zha
- The Human Immunological Monitoring Facility, University of Chicago, Chicago, IL 60637
| | - Yihao Lu
- Department of Public Health Sciences, The University of Chicago, Chicago, IL 60637
| | - Jeffrey C Bloodworth
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | | | - Susan Okrah
- Pritzker School of Molecular Engineering, University of Chicago, Chicago, IL, USA
| | - Blake A Flood
- Department of Pathology, University of Chicago, 5841 S. Maryland Ave, MC2115, Chicago, IL
| | - Ken Hatogai
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
- Department of Pathology, University of Chicago, 5841 S. Maryland Ave, MC2115, Chicago, IL
| | - Michael Yk Leung
- Department of Pathology, University of Chicago, 5841 S. Maryland Ave, MC2115, Chicago, IL
| | - Apameh Pezeshk
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Lara Kozloff
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Robin Reschke
- Department of Pathology, University of Chicago, 5841 S. Maryland Ave, MC2115, Chicago, IL
| | - Garth W Strohbehn
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Carolina Soto Chervin
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Madan Kumar
- Department of Pediatrics, Section of Infectious Diseases, University of Chicago
| | - Stephen Schrantz
- Department of Medicine, Section of Infectious Diseases, University of Chicago
| | | | - Kathleen G Beavis
- Department of Pathology, University of Chicago, 5841 S. Maryland Ave, MC2115, Chicago, IL
| | - Kiang-Teck J Yeo
- Department of Pathology, University of Chicago, 5841 S. Maryland Ave, MC2115, Chicago, IL
| | - Randy F Sweis
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Jeremy Segal
- Department of Pathology, University of Chicago, 5841 S. Maryland Ave, MC2115, Chicago, IL
| | - Savaş Tay
- Pritzker School of Molecular Engineering, University of Chicago, Chicago, IL, USA
| | - Evgeny Izumchenko
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL
| | - Jeffrey Mueller
- Department of Pathology, University of Chicago, 5841 S. Maryland Ave, MC2115, Chicago, IL
| | - Lin S Chen
- Department of Public Health Sciences, The University of Chicago, Chicago, IL 60637
| | - Thomas F Gajewski
- Department of Pathology, University of Chicago, 5841 S. Maryland Ave, MC2115, Chicago, IL
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5
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Chan CW, Kwon S, Matushek SM, Ciaglia C, Bethel C, Beavis KG. Implementation of a Sample Pooling Strategy for the Direct Detection of SARS-CoV-2 by Real-Time Polymerase Chain Reaction During the COVID-19 Pandemic. Am J Clin Pathol 2021; 156:15-23. [PMID: 33978164 PMCID: PMC8136033 DOI: 10.1093/ajcp/aqab035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Indexed: 12/23/2022] Open
Abstract
Objectives To report our institutional experience in devising and implementing a pooling protocol and process for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcription polymerase chain reaction (RT-PCR) testing over a 3-month period in the fall of 2020. Methods The widespread testing implemented in the United States for detecting SARS-CoV-2 infection in response to the coronavirus disease 2019 pandemic has led to a significant shortage of testing supplies and therefore has become a major impediment to the public health response. To date, several institutions have implemented sample pooling, but publications documenting these experiences are sparse. Nasal and nasopharyngeal samples collected from low-positivity (<5%) areas were tested in pools of five on the Roche cobas 6800 analyzer system. Routine SARS-CoV-2 RT-PCR turnaround times between sample collection to result reporting were monitored and compared before and after sample pooling implementation. Results A total of 4,131 sample pools were tested over a 3-month period (during which 39,770 RT-PCR results were reported from the Roche system), allowing our laboratory to save 13,824 tests, equivalent to a conservation rate of 35%. A 48-hour or less turnaround time was generally maintained throughout the pooling period. Conclusions Sample pooling offers a viable means to mitigate shortfalls of PCR testing supplies in the ongoing pandemic without significantly compromising overall turnaround times.
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Affiliation(s)
| | | | - Scott M Matushek
- Clinical Microbiology and Immunology Laboratory, University of Chicago, Chicago, IL, USA
| | - Carol Ciaglia
- Clinical Microbiology and Immunology Laboratory, University of Chicago, Chicago, IL, USA
| | - Cindy Bethel
- Clinical Microbiology and Immunology Laboratory, University of Chicago, Chicago, IL, USA
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6
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Abasiyanik MF, Flood B, Lin J, Ozcan S, Rouhani SJ, Pyzer A, Trujillo J, Zhen C, Wu P, Jumic S, Wang A, Gajewski TF, Wang P, Hartley M, Ameti B, Niemiec R, Fernando M, Mishra V, Savage P, Aydogan B, Bethel C, Matushek S, Beavis KG, Agrawal N, Segal J, Tay S, Izumchenko E. Sensitive detection and quantification of SARS-CoV-2 in saliva. Sci Rep 2021; 11:12425. [PMID: 34127708 PMCID: PMC8203799 DOI: 10.1038/s41598-021-91835-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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] [Received: 01/08/2021] [Accepted: 05/31/2021] [Indexed: 01/12/2023] Open
Abstract
Saliva has significant advantages as a test medium for detection of SARS-CoV-2 infection in patients, such as ease of collection, minimal requirement of supplies and trained personnel, and safety. Comprehensive validation in a large cohort of prospectively collected specimens with unknown SARS-CoV-2 status should be performed to evaluate the potential and limitations of saliva-based testing. We developed a saliva-based testing pipeline for detection of SARS-CoV-2 nucleic acids using real-time reverse transcription PCR (RT-PCR) and droplet digital PCR (ddPCR) readouts, and measured samples from 137 outpatients tested at a curbside testing facility and 29 inpatients hospitalized for COVID-19. These measurements were compared to the nasal swab results for each patient performed by a certified microbiology laboratory. We found that our saliva testing positively detects 100% (RT-PCR) and 93.75% (ddPCR) of curbside patients that were identified as SARS-CoV-2 positive by the Emergency Use Authorization (EUA) certified nasal swab testing assay. Quantification of viral loads by ddPCR revealed an extremely wide range, with 1 million-fold difference between individual patients. Our results demonstrate for both community screening and hospital settings that saliva testing reliability is on par with that of the nasal swabs in detecting infected cases, and has potential for higher sensitivity when combined with ddPCR in detecting low-abundance viral loads that evade traditional testing methods.
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Affiliation(s)
| | - Blake Flood
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Jing Lin
- Pritzker School of Molecular Engineering, University of Chicago, Chicago, IL, USA
| | - Sefika Ozcan
- Pritzker School of Molecular Engineering, University of Chicago, Chicago, IL, USA
| | - Sherin J Rouhani
- Section of Hematology and Oncology, Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Athalia Pyzer
- Section of Hematology and Oncology, Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Jonathan Trujillo
- Section of Hematology and Oncology, Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Chaojie Zhen
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Ping Wu
- Section of Hematology and Oncology, Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Stephen Jumic
- Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Andrew Wang
- Pritzker School of Molecular Engineering, University of Chicago, Chicago, IL, USA
| | | | - Peng Wang
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Madeline Hartley
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Bekim Ameti
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Rachael Niemiec
- Section of Hematology and Oncology, Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Marian Fernando
- Section of Hematology and Oncology, Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Vasudha Mishra
- Section of Hematology and Oncology, Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Peter Savage
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Bulent Aydogan
- Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA
| | - Cindy Bethel
- Microbiology Laboratory, University of Chicago Medicine, Chicago, IL, USA
| | - Scott Matushek
- Microbiology Laboratory, University of Chicago Medicine, Chicago, IL, USA
| | | | - Nishant Agrawal
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Jeremy Segal
- Department of Pathology, University of Chicago, Chicago, IL, USA.
| | - Savaş Tay
- Pritzker School of Molecular Engineering, University of Chicago, Chicago, IL, USA.
| | - Evgeny Izumchenko
- Section of Hematology and Oncology, Pritzker School of Medicine, University of Chicago, Chicago, IL, USA.
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7
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Madariaga MLL, Guthmiller JJ, Schrantz S, Jansen MO, Christensen C, Kumar M, Prochaska M, Wool G, Durkin-Celauro A, Oh WH, Trockman L, Vigneswaran J, Keskey R, Shaw DG, Dugan H, Zheng NY, Cobb M, Utset H, Wang J, Stovicek O, Bethel C, Matushek S, Giurcanu M, Beavis KG, di Sabato D, Meltzer D, Ferguson MK, Kress JP, Shanmugarajah K, Matthews JB, Fung JF, Wilson PC, Alverdy JC, Donington JS. Clinical predictors of donor antibody titre and correlation with recipient antibody response in a COVID-19 convalescent plasma clinical trial. J Intern Med 2021; 289:559-573. [PMID: 33034095 PMCID: PMC7675325 DOI: 10.1111/joim.13185] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/11/2020] [Accepted: 09/08/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Convalescent plasma therapy for COVID-19 relies on transfer of anti-viral antibody from donors to recipients via plasma transfusion. The relationship between clinical characteristics and antibody response to COVID-19 is not well defined. We investigated predictors of convalescent antibody production and quantified recipient antibody response in a convalescent plasma therapy clinical trial. METHODS Multivariable analysis of clinical and serological parameters in 103 confirmed COVID-19 convalescent plasma donors 28 days or more following symptom resolution was performed. Mixed-effects regression models with piecewise linear trends were used to characterize serial antibody responses in 10 convalescent plasma recipients with severe COVID-19. RESULTS Donor antibody titres ranged from 0 to 1 : 3892 (anti-receptor binding domain (RBD)) and 0 to 1 : 3289 (anti-spike). Higher anti-RBD and anti-spike titres were associated with increased age, hospitalization for COVID-19, fever and absence of myalgia (all P < 0.05). Fatigue was significantly associated with anti-RBD (P = 0.03). In pairwise comparison amongst ABO blood types, AB donors had higher anti-RBD and anti-spike than O donors (P < 0.05). No toxicity was associated with plasma transfusion. Non-ECMO recipient anti-RBD antibody titre increased on average 31% per day during the first three days post-transfusion (P = 0.01) and anti-spike antibody titre by 40.3% (P = 0.02). CONCLUSION Advanced age, fever, absence of myalgia, fatigue, blood type and hospitalization were associated with higher convalescent antibody titre to COVID-19. Despite variability in donor titre, 80% of convalescent plasma recipients showed significant increase in antibody levels post-transfusion. A more complete understanding of the dose-response effect of plasma transfusion amongst COVID-19-infected patients is needed.
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Affiliation(s)
- M L L Madariaga
- From the, Departments of, Department of, Surgery, University of Chicago, Chicago, IL, USA
| | - J J Guthmiller
- Department of, Medicine, University of Chicago, Chicago, IL, USA
| | - S Schrantz
- Department of, Medicine, University of Chicago, Chicago, IL, USA
| | - M O Jansen
- Department of, Medicine, University of Chicago, Chicago, IL, USA
| | - C Christensen
- Department of, Pathology, University of Chicago, Chicago, IL, USA
| | - M Kumar
- Department of, Medicine, University of Chicago, Chicago, IL, USA
| | - M Prochaska
- Department of, Medicine, University of Chicago, Chicago, IL, USA
| | - G Wool
- Department of, Pathology, University of Chicago, Chicago, IL, USA
| | - A Durkin-Celauro
- From the, Departments of, Department of, Surgery, University of Chicago, Chicago, IL, USA
| | - W H Oh
- From the, Departments of, Department of, Surgery, University of Chicago, Chicago, IL, USA
| | - L Trockman
- From the, Departments of, Department of, Surgery, University of Chicago, Chicago, IL, USA
| | - J Vigneswaran
- From the, Departments of, Department of, Surgery, University of Chicago, Chicago, IL, USA
| | - R Keskey
- From the, Departments of, Department of, Surgery, University of Chicago, Chicago, IL, USA
| | - D G Shaw
- Committee on Immunology, University of Chicago, Chicago, IL, USA
| | - H Dugan
- Committee on Immunology, University of Chicago, Chicago, IL, USA
| | - N-Y Zheng
- Department of, Medicine, University of Chicago, Chicago, IL, USA
| | - M Cobb
- Department of, Medicine, University of Chicago, Chicago, IL, USA
| | - H Utset
- Department of, Medicine, University of Chicago, Chicago, IL, USA
| | - J Wang
- Department of, Medicine, University of Chicago, Chicago, IL, USA
| | - O Stovicek
- Department of, Medicine, University of Chicago, Chicago, IL, USA
| | - C Bethel
- Clinical Microbiology and Immunology Laboratory, University of Chicago, Chicago, IL, USA
| | - S Matushek
- Clinical Microbiology and Immunology Laboratory, University of Chicago, Chicago, IL, USA
| | - M Giurcanu
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - K G Beavis
- Biological Sciences Division, Department of Pathology, University of Chicago, Chicago, IL, USA
| | - D di Sabato
- From the, Departments of, Department of, Surgery, University of Chicago, Chicago, IL, USA
| | - D Meltzer
- Department of, Medicine, University of Chicago, Chicago, IL, USA
| | - M K Ferguson
- From the, Departments of, Department of, Surgery, University of Chicago, Chicago, IL, USA
| | - J P Kress
- Department of, Medicine, University of Chicago, Chicago, IL, USA
| | - K Shanmugarajah
- From the, Departments of, Department of, Surgery, University of Chicago, Chicago, IL, USA
| | - J B Matthews
- From the, Departments of, Department of, Surgery, University of Chicago, Chicago, IL, USA
| | - J F Fung
- From the, Departments of, Department of, Surgery, University of Chicago, Chicago, IL, USA
| | - P C Wilson
- Department of, Medicine, University of Chicago, Chicago, IL, USA
| | - J C Alverdy
- From the, Departments of, Department of, Surgery, University of Chicago, Chicago, IL, USA
| | - J S Donington
- From the, Departments of, Department of, Surgery, University of Chicago, Chicago, IL, USA
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8
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Abasiyanik MF, Flood B, Lin J, Ozcan S, Rouhani SJ, Pyzer A, Trujillo J, Zhen C, Wu P, Jumic S, Wang A, Gajewski TF, Wang P, Hartley M, Ameti B, Niemiec R, Fernando M, Aydogan B, Bethel C, Matushek S, Beavis KG, Agrawal N, Segal J, Tay S, Izumchenko E. Sensitive detection and quantification of SARS-CoV-2 in saliva. medRxiv 2020. [PMID: 33330880 DOI: 10.1101/2020.12.04.20241059] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Saliva has significant advantages as a test medium for detection of SARS-CoV-2 infection in patients, such as ease of collection, minimal requirement of supplies and trained personnel, and safety. Comprehensive validation in a large cohort of prospectively collected specimens with unknown SARS-CoV-2 status should be performed to evaluate the potential and limitations of saliva-based testing. We developed a saliva-based testing pipeline for detection of SARS-CoV-2 nucleic acids using real-time reverse transcription PCR (RT-PCR) and droplet digital PCR (ddPCR) readouts, and measured samples from 137 outpatients tested at a curbside testing facility and 29 inpatients hospitalized for COVID-19. These measurements were compared to the nasal swab results for each patient performed by a certified microbiology laboratory. We found that our saliva testing positively detects 100% (RT-PCR) and 93.75% (ddPCR) of curbside patients that were identified as SARS-CoV-2 positive by the Emergency Use Authorization (EUA) certified nasal swab testing assay. Quantification of viral loads by ddPCR revealed an extremely wide range, with 1 million-fold difference between individual patients. Our results demonstrate for both community screening and hospital settings that saliva testing reliability is on par with that of the nasal swabs in detecting infected cases, and has potential for higher sensitivity when combined with ddPCR in detecting low-abundance viral loads that evade traditional testing methods.
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9
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Olson G, McNulty MC, Mullane K, Beavis KG, Tesic V. Cording in Disseminated Mycobacterium chelonae Infection in an Immunocompromised Patient. Lab Med 2020; 52:e50-e52. [PMID: 32954440 DOI: 10.1093/labmed/lmaa082] [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: 11/14/2022] Open
Abstract
Cording is a phenomenon in which acid fast bacilli grow in parallel and was previously used as a means of presumptive microscopic identification of Mycobacterium tuberculosis (TB). However, this process has been shown in multiple other nontuberculous mycobacterial (NTM) species. Here we present the case of an immunocompromised adult who presented with wrist pain, weight loss, and cough. A positron emission tomography scan showed uptake in the right ulna, multiple soft tissue sites, and the left lung. Biopsies and cultures were obtained from multiple sites, and the patient was ultimately diagnosed with disseminated Mycobacterium chelonae infection. The organism showed cording in culture. As seen in this patient, cording may occur in multiple NTM species and is not reliable as the sole indicator of the presence of TB.
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Affiliation(s)
- Gregory Olson
- Infectious Diseases and Global Health, University of Chicago Medical Center, Chicago, Illinois
| | - Moira C McNulty
- Infectious Diseases and Global Health, University of Chicago Medical Center, Chicago, Illinois
| | - Kathleen Mullane
- Infectious Diseases and Global Health, University of Chicago Medical Center, Chicago, Illinois
| | - Kathleen G Beavis
- Department of Pathology, University of Chicago Medical Center, Chicago, Illinois
| | - Vera Tesic
- Department of Pathology, University of Chicago Medical Center, Chicago, Illinois
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10
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Beavis KG, Matushek SM, Abeleda APF, Bethel C, Hunt C, Gillen S, Moran A, Tesic V. Evaluation of the EUROIMMUN Anti-SARS-CoV-2 ELISA Assay for detection of IgA and IgG antibodies. J Clin Virol 2020; 129:104468. [PMID: 32485620 PMCID: PMC7255182 DOI: 10.1016/j.jcv.2020.104468] [Citation(s) in RCA: 188] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 05/20/2020] [Indexed: 02/06/2023]
Abstract
As the Coronavirus 2019 (COVID-19) pandemic evolves, the development of immunoassays to help determine exposure and potentially predict immunity has become a pressing priority. In this report we present the performance of the EUROIMMUN enzyme-linked immunosorbent assay (ELISA) for semi-quantitative detection of IgA and IgG antibodies in serum and plasma samples using recombinant S1 domain of the SARS-CoV-2 spike protein as antigen. Specimens from patients, with and without COVID-19 infection, were tested at the University of Chicago Clinical Microbiology and Immunology Laboratory. Of 86 samples from SARS-CoV-2 PCR-negative patients, including 28 samples positive for common human coronavirus strains, 76 tested negative and 10 tested positive for IgA (88.4% agreement, 95% CI: 79.9-93.6) while 84 tested negative and 2 tested positive for IgG (97.7% agreement, 95% CI: 91.9-99.6). Of 82 samples from SARS-CoV-2 PCR-positive patients, 14 tested negative and 68 tested positive for IgA (82.9% agreement, 95% CI: 73.4-89.5) while 27 tested negative and 55 tested positive for IgG (67.1% agreement, 95% CI: 56.3-76.3). Of samples collected ≥4 days after positive PCR, 38 of 42 (90.5% agreement, 95% CI: 77.9-96.2) were positive for IgA, and 42 of 42 (100% agreement, 95% CI: 91.6-100) were positive for IgG, respectively. The EUROIMMUN Anti-SARS-CoV-2 ELISA Assay demonstrated good sensitivity for detection of IgA and excellent sensitivity for detection of IgG antibodies from samples collected ≥4 days, after COVID-19 diagnosis by PCR. This assay demonstrated good specificity for IgA and excellent specificity for IgG and demonstrated only borderline cross reaction in 2 of the 28 samples from patients with common human coronaviruses infection, types NL63 and OC43.
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Affiliation(s)
- Kathleen G Beavis
- Department of Pathology, University of Chicago, Chicago, IL 60637-1470, USA
| | - Scott M Matushek
- Clinical Microbiology and Immunology Laboratory, University of Chicago Medicine, Chicago, IL, USA
| | - Ana Precy F Abeleda
- Clinical Microbiology and Immunology Laboratory, University of Chicago Medicine, Chicago, IL, USA
| | - Cindy Bethel
- Clinical Microbiology and Immunology Laboratory, University of Chicago Medicine, Chicago, IL, USA
| | - Carlissa Hunt
- Clinical Microbiology and Immunology Laboratory, University of Chicago Medicine, Chicago, IL, USA
| | - Stephanie Gillen
- Clinical Microbiology and Immunology Laboratory, University of Chicago Medicine, Chicago, IL, USA
| | - Angelica Moran
- Department of Pathology, University of Chicago, Chicago, IL 60637-1470, USA
| | - Vera Tesic
- Department of Pathology, University of Chicago, Chicago, IL 60637-1470, USA.
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11
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Ridgway JP, Pisano J, Landon E, Beavis KG, Robicsek A. Clinical Sensitivity of Severe Acute Respiratory Syndrome Coronavirus 2 Nucleic Acid Amplification Tests for Diagnosing Coronavirus Disease 2019. Open Forum Infect Dis 2020; 7:ofaa315. [PMID: 32818146 PMCID: PMC7423294 DOI: 10.1093/ofid/ofaa315] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 06/08/2020] [Accepted: 07/17/2020] [Indexed: 11/13/2022] Open
Abstract
Utilizing 34 348 severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) nucleic acid amplification test (NAAT) results from 2 health systems, we estimated the clinical sensitivity of a single SARS-CoV-2 NAAT. We found that SARS-CoV-2 NAAT has 82%-97% sensitivity for diagnosing coronavirus disease 2019 among symptomatic patients.
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Affiliation(s)
- Jessica P Ridgway
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Jennifer Pisano
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Emily Landon
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Kathleen G Beavis
- Department of Pathology, University of Chicago, Chicago, Illinois, USA
| | - Ari Robicsek
- Providence St. Joseph Health, Seattle, Washington, USA
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12
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Chun LY, Dolle-Molle L, Bethel C, Dimitroyannis RC, Williams BL, Schechet SA, Hariprasad SM, Missiakas D, Schneewind O, Beavis KG, Skondra D. Rapid pathogen identification and antimicrobial susceptibility testing in in vitro endophthalmitis with matrix assisted laser desorption-ionization Time-of-Flight Mass Spectrometry and VITEK 2 without prior culture. PLoS One 2019; 14:e0227071. [PMID: 31887220 PMCID: PMC6936829 DOI: 10.1371/journal.pone.0227071] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 12/10/2019] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Prompt clinical diagnosis and initiation of treatment are critical in the management of infectious endophthalmitis. Current methods used to identify causative agents of infectious endophthalmitis are mostly inefficient, owing to suboptimal sensitivity, length, and cost. Matrix Assisted Laser Desorption-Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS) can be used to rapidly identity pathogens without a need for culture. Similarly, automated antimicrobial susceptibility test systems (AST, VITEK 2) provide accurate antimicrobial susceptibility profiles. In this proof-of-concept study, we apply these technologies for the direct identification and characterization of pathogens in vitreous samples, without culture, as an in vitro model of infectious endophthalmitis. METHODS Vitreous humor aspirated from freshly enucleated porcine eyes was inoculated with different inocula of Staphylococcus aureus (S. aureus) and incubated at 37°C. Vitreous endophthalmitis samples were centrifuged and pellets were directly analyzed with MALDI-TOF MS and VITEK 2 without prior culture. S. aureus colonies that were conventionally grown on culture medium were used as control samples. Time-to-identification, minimum concentration of bacteria required for identification, and accuracy of results compared to standard methods were determined. RESULTS MALDI-TOF MS achieved accurate pathogen identification from direct analysis of intraocular samples with confidence values of up to 99.9%. Time from sample processing to pathogen identification was <30 minutes. The minimum number of bacteria needed for positive identification was 7.889x106 colony forming units (cfu/μl). Direct analysis of intraocular samples with VITEK 2 gave AST profiles that were up to 94.4% identical to the positive control S. aureus analyzed per standard protocol. CONCLUSION Our findings demonstrate that the direct analysis of vitreous samples with MALDI-TOF MS and VITEK 2 without prior culture could serve as new, improved methods for rapid, accurate pathogen identification and targeted treatment design in infectious endophthalmitis. In vivo models and standardized comparisons against other microbiological methods are needed to determine the value of direct analysis of intraocular samples from infectious endophthalmitis with MALDI-TOF MS and VITEK 2.
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Affiliation(s)
- Lindsay Y. Chun
- Department of Ophthalmology and Visual Science, The University of Chicago Hospitals and Health System, Chicago, Illinois, United States of America
| | - Laura Dolle-Molle
- Clinical Microbiology Laboratory, The University of Chicago Hospitals and Health System, Chicago, Illinois, United States of America
| | - Cindy Bethel
- Clinical Microbiology Laboratory, The University of Chicago Hospitals and Health System, Chicago, Illinois, United States of America
| | - Rose C. Dimitroyannis
- Department of Ophthalmology and Visual Science, The University of Chicago Hospitals and Health System, Chicago, Illinois, United States of America
| | - Blake L. Williams
- Department of Ophthalmology and Visual Science, The University of Chicago Hospitals and Health System, Chicago, Illinois, United States of America
| | - Sidney A. Schechet
- Department of Ophthalmology and Visual Science, The University of Chicago Hospitals and Health System, Chicago, Illinois, United States of America
| | - Seenu M. Hariprasad
- Department of Ophthalmology and Visual Science, The University of Chicago Hospitals and Health System, Chicago, Illinois, United States of America
| | - Dominique Missiakas
- Department of Microbiology, The University of Chicago, Chicago, Illinois, United States of America
| | - Olaf Schneewind
- Department of Microbiology, The University of Chicago, Chicago, Illinois, United States of America
| | - Kathleen G. Beavis
- Clinical Microbiology Laboratory, The University of Chicago Hospitals and Health System, Chicago, Illinois, United States of America
- Department of Pathology, The University of Chicago Hospitals and Health System, Chicago, Illinois, United States of America
| | - Dimitra Skondra
- Department of Ophthalmology and Visual Science, The University of Chicago Hospitals and Health System, Chicago, Illinois, United States of America
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13
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Parker KG, Gandra S, Matushek S, Beavis KG, Tesic V, Charnot-Katsikas A. Comparison of 3 Nucleic Acid Amplification Tests and a Rapid Antigen Test with Culture for the Detection of Group A Streptococci from Throat Swabs. J Appl Lab Med 2019; 4:164-169. [DOI: 10.1373/jalm.2018.028696] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 03/26/2019] [Indexed: 11/06/2022]
Abstract
Abstract
Background
Recently, the US Food and Drug Administration cleared 3 nucleic acid amplification test (NAAT) assays for detection of Streptococcus pyogenes [group A Streptococcus (GAS)] in pharyngeal specimens. However, there are limited studies evaluating the performance of these NAAT assays.
Methods
We compared the results of 3 NAATs (cobas Liat, Luminex Aries, and Cepheid Xpert Xpress) and a rapid antigen assay (Quidel QuickVue in-line strep A) with the accepted gold standard method, bacterial culture.
Results
Sixty-eight throat swab specimens collected between August and October 2017 were tested. Compared to bacterial culture, the sensitivities, specificities, positive predictive value, and negative predictive value for detecting GAS were as follows: cobas Liat: 100%, 97.4%, 96.7%, and 100%; Cepheid Xpert: 100%, 97.4%, 96.7%, and 100%; Luminex Aries: 95.2%, 100%, 100%, and 95.5%. The Quidel QuickVue in-line strep A assay showed poor sensitivity, detecting only 5.2% of culture-positive specimens.
Conclusion
The 3 NAATs have high sensitivity when compared with bacterial culture for detection of GAS. With rapid turnaround time and ease of use, these tests can be considered as reliable point-of-care tests for the diagnosis of GAS, replacing the need for back-up culture.
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Affiliation(s)
- Kyle G Parker
- Department of Pathology, University of Chicago, Chicago, IL
| | - Sumanth Gandra
- Department of Pathology, University of Chicago, Chicago, IL
| | - Scott Matushek
- Department of Pathology, University of Chicago, Chicago, IL
| | | | - Vera Tesic
- Department of Pathology, University of Chicago, Chicago, IL
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14
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Pettit NN, Han Z, Nguyen CT, Choksi A, Charnot-Katsikas A, Beavis KG, Tesic V, Pisano J. Antimicrobial Stewardship Review of Automated Candidemia Alerts Using the Epic Stewardship Module Improves Bundle-of-Care Adherence. Open Forum Infect Dis 2019; 6:ofz412. [PMID: 31660370 PMCID: PMC6788339 DOI: 10.1093/ofid/ofz412] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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] [Received: 06/06/2019] [Accepted: 09/30/2019] [Indexed: 11/14/2022] Open
Abstract
Background Antimicrobial stewardship interventions utilizing real-time alerting through the electronic medical record enable timely implementation of the bundle of care (BOC) for patients with severe infections, such as candidemia. Automated alerting for candidemia using the Epic stewardship module has been in place since July 2015 at our medical center. We sought to assess the impact of these alerts. Methods All adult inpatients with candidemia between April 1, 2011, and March 31, 2012 (pre-intervention), and June 30, 2016, and July 1, 2017 (post-intervention), were evaluated for BOC adherence. We also evaluated the impact on timeliness to initiate targeted therapy, length of stay (LOS), and 30-day mortality. Results Eighty-four patients were included, 42 in the pre- and 42 in the post-intervention group. Adherence to BOC was significantly improved, from 48% (pre-intervention) to 83% (post-intervention; P = .001). The median time to initiation of therapy was 4.8 hours vs 3.3 hours (P = .58), the median LOS was 24 and 18 days (P = .28), and 30-day mortality was 19% and 26% (P = .60) in the pre- and post-intervention groups, respectively. Conclusions Antimicrobial stewardship program review of automated alerts identifying patients with candidemia resulted in significantly improved BOC adherence and was associated with a 1.5-hour reduction in time to initiation of antifungal therapy. No significant change was observed with 30-day mortality or LOS.
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Affiliation(s)
- Natasha N Pettit
- Department of Pharmacy, The University of Chicago Medicine, Chicago, Illinois, USA
| | - Zhe Han
- Department of Pharmacy, The University of Chicago Medicine, Chicago, Illinois, USA
| | - Cynthia T Nguyen
- Department of Pharmacy, The University of Chicago Medicine, Chicago, Illinois, USA
| | - Anish Choksi
- Department of Pharmacy, The University of Chicago Medicine, Chicago, Illinois, USA
| | | | - Kathleen G Beavis
- Department of Pathology, The University of Chicago Medicine, Chicago, Illinois, USA
| | - Vera Tesic
- Department of Pathology, The University of Chicago Medicine, Chicago, Illinois, USA
| | - Jennifer Pisano
- Infectious Diseases and Global Health, The University of Chicago Medicine, Chicago, Illinois, USA
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15
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Bartlett A, Ridgway JP, Marrs R, Henson AM, Chu V, Enriquez A, Murillo C, Runjo D, Seguin A, Beavis KG, Guenette C, Landon E. 1159. Influenza Symptoms in Vaccinated Healthcare Workers in an H3N2-Dominant Season. Open Forum Infect Dis 2018. [PMCID: PMC6254885 DOI: 10.1093/ofid/ofy210.992] [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: 11/13/2022] Open
Abstract
Background Influenza vaccination of healthcare workers is an important component of keeping patients safe, but must be paired with exclusion of ill healthcare workers (HCW) from work. CDC recommends exclusion from work until afebrile for 24 hours, but not all HCW with influenza develop fever and may still be a risk for spreading. Half of HCW with influenza in an H1N1-dominant season (2013–2014) at our institution were afebrile. Methods From 1/31–4/24/18 (H3N2-dominant season), HCW with fever or cough were screened for influenza and respiratory syncytial virus by polymerase chain reaction of flocked nasopharyngeal swabs. Additional HCW were tested by their primary care providers. We collected influenza vaccination status and symptoms and calculated the proportion of influenza-positive HCWs with fever or cough. Infection control practitioners (ICPs) contacted each influenza-positive HCW to identify potential patient or HCW exposures 24 hours prior to symptom onset and offered oseltamivir prophylaxis to exposed patients and HCW. Results Of 186 HCW tested by UCM, 49 (26%) tested positive for influenza (35 with influenza A; 14 with influenza B) and 11 (6%) tested positive for RSV. Forty-eight HCW (98%) received influenza vaccination. Fever was reported in only 19 (54%) HCW with influenza A and three (21%) HCW with influenza B. Cough was present in the majority of HCW (34 (97%) with influenza A and 12 (86%) with influenza B). An additional 55 HCW were diagnosed with influenza by their primary care providers. ICPs performed contact investigations for 43 HCW who reported exposure to patients or other HCW between 24 hours before symptom onset through the time of diagnosis. Occupational medicine provided 138 courses of prophylactic oseltamivir to HCW. Conclusion Afebrile influenza illness is common; current workforce guidelines are insufficient to prevent exposure in the healthcare setting. Expanding employee influenza screening to include fever OR cough doubled the number influenza positive HCW identified. Despite excellent influenza vaccination rates, vigilance is critical to prevent influenza transmission in the hospital. HCW screening for influenza based on fever OR cough, exclusion from work, and identification of potential exposures can help keep patients and colleagues safe. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Allison Bartlett
- Department of Pediatrics, Section Infectious Disease, University of Chicago/Comer Children Hospital, Chicago, Illinois
| | - Jessica P Ridgway
- Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, Illinois
| | - Rachel Marrs
- Infection Control Program, The University of Chicago Medicine, Chicago, Illinois
| | - Amanda M Henson
- Infection Control Program, The University of Chicago Medicine, Chicago, Illinois
| | - Vera Chu
- Infection Control Program, The University of Chicago Medicine, Chicago, Illinois
| | - Aurea Enriquez
- Infection Control Program, The University of Chicago Medicine, Chicago, Illinois
| | - Cynthia Murillo
- Infection Control Program, The University of Chicago Medicine, Chicago, Illinois
| | - Demetria Runjo
- Infection Control Program, The University of Chicago Medicine, Chicago, Illinois
| | - Alexandra Seguin
- Infection Control Program, The University of Chicago Medicine, Chicago, Illinois
| | | | - Caroline Guenette
- Department of Occupational Medicine, The University of Chicago Medicine, Chicago, Illinois
| | - Emily Landon
- Infectious Diseases and Global Health, The University of Chicago Medicine, Chicago, Illinois
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16
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Newman ME, Landon E, Bartlett A, Marrs R, Seguin A, Murillo C, Beavis KG, Ridgway JP. 526. An EMR-Based Diagnostic Stewardship Intervention for GI mPCR Aimed at Reducing Inappropriate C. difficile Tests. Open Forum Infect Dis 2018. [PMCID: PMC6255672 DOI: 10.1093/ofid/ofy210.535] [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 Diagnostic stewardship is an emerging tool that can be used to prevent overuse of diagnostics. Because GI mPCR (GI multiplex PCR panel) tests can be ordered on formed stool, the test has lower pre-test probability for Clostridium difficile (C. difficile) infection than traditional singleplex PCR. Furthermore, after 48hours of admission, most other targets on the GI mPCR are no longer clinically relevant. Any C. difficile testing on inappropriate specimens may increase the rate of Lab ID events (positive C. difficile tests after 3 days of admission) without improving detection of true infections. Methods In January 2018, our 700-bed academic medical center implemented an informatics-based intervention that restricted ordering of the GI mPCR to the first 48 hours of hospitalization. After 48 hours, providers were required to contact microbiology to request an exception (see Figure 1). Singleplex PCR testing for C. difficile was available throughout admission. Orders for the GI mPCR test require the provider to note whether the patient had >3 loose stools in the previous day. Statistical analysis performed with STATA software. Results A total of 282 late (after 48 hours of admission) GI mPCR tests were ordered in the 104 days before restriction and 210 late tests were ordered in the 104 days after. Late GI mPCR tests (before and after restriction) resulted in diagnoses other than C. difficile less than 5% of the time (20 of 492 tests). 11.7% (24 of 210) of late GI mPCR tests were ordered for patients who did not have >3 loose stools in the previous day. Prior to restriction, 15% (41 of 282) of Lab ID events from GI mPCR were for patients who had already tested positive for C. difficile earlier in the same admission. Following the intervention, there was a decreased proportion of GI mPCR tests that were positive for C. difficile (from 14.5% to 11.3%, P = 0.26), as well as a significantly decreased rate of Lab ID events detected by GI mPCR, from 7.2/10,000 patient days to 4.0/10,000 patient days (P = 0.01). Conclusion Accurate diagnosis of C. difficile infection is important for treatment and prevention efforts, yet these data show that many rapid GI mPCR tests are inappropriately ordered on patients who may not have loose stools and who are unlikely to have an alternate diagnosis. EMR-based restriction on the GI mPCR ordering time reduced Lab ID events of C. difficile infection without missing important alternate diagnoses. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Margaret E Newman
- Infectious Diseases and Global Health, The University of Chicago Medicine, Chicago, Illinois
| | - Emily Landon
- Infectious Diseases and Global Health, The University of Chicago Medicine, Chicago, Illinois
| | - Allison Bartlett
- Department of Pediatrics, Section Infectious Disease, University of Chicago / Comer Children Hospital, Chicago, Illinois
| | - Rachel Marrs
- Infection Control Program, The University of Chicago Medicine, Chicago, Illinois
| | - Alexandra Seguin
- Infection Control Program, The University of Chicago Medicine, Chicago, Illinois
| | - Cynthia Murillo
- Infection Control Program, The University of Chicago Medicine, Chicago, Illinois
| | - Kathleen G Beavis
- Department of Pathology, The University of Chicago, Chicago, Illinois
| | - Jessica P Ridgway
- Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, Illinois
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17
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McNulty MC, Shibib DR, Steinbeck JL, Mullane K, Pisano J, Matushek S, Beavis KG, Tesic V, Pitrak D. Misdiagnosis of Bordetella bronchiseptica Respiratory Infection as Bordetella pertussis by Multiplex Molecular Assay. Clin Infect Dis 2018; 67:1919-1921. [DOI: 10.1093/cid/ciy469] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 05/29/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Moira C McNulty
- Section of Infectious Diseases and Global Health, University of Chicago, Illinois
| | - Dena R Shibib
- Department of Pathology, University of Oklahoma Health Sciences Center
- Oklahoma City Veterans Affairs Health Care System
| | | | - Kathleen Mullane
- Section of Infectious Diseases and Global Health, University of Chicago, Illinois
| | - Jennifer Pisano
- Section of Infectious Diseases and Global Health, University of Chicago, Illinois
| | - Scott Matushek
- Department of Pathology, University of Chicago, Illinois
| | | | - Vera Tesic
- Department of Pathology, University of Chicago, Illinois
| | - David Pitrak
- Section of Infectious Diseases and Global Health, University of Chicago, Illinois
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18
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N Pettit N, Han Z, Choksi A, Bhagat PH, Beavis KG, Bartlett AH, Charnot-Katsikas A, Pisano J. Using the Epic® Antimicrobial Stewardship (ASP) Module to Optimize Antimicrobial Stewardship Interventions. Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx163.580] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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McMullen P, Boonlayangoor S, Charnot-Katsikas A, Beavis KG, Tesic V. The performance of Luminex ARIES ® Flu A/B & RSV and Cepheid Xpert ® Flu/RSV XC for the detection of influenza A, influenza B, and respiratory syncytial virus in prospective patient samples. J Clin Virol 2017; 95:84-85. [PMID: 28892765 DOI: 10.1016/j.jcv.2017.08.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 07/20/2017] [Revised: 08/23/2017] [Accepted: 08/31/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND The demand for rapid, accurate viral testing has increased the number of assays available for the detection of viral pathogens. One of the newest FDA cleared platforms is the Luminex ARIES® Flu A/B & RSV, which is a fully automated, real-time PCR-based assay used for detection of influenza A, influenza B, and respiratory syncytial virus (RSV). OBJECTIVES We sought to compare the performance of Luminex ARIES® Flu A/B & RSV assay to the Cepheid Xpert® Flu/RSV XC assay for rapid Flu and RSV testing. STUDY DESIGN A series of consecutive nasopharyngeal specimens received in the clinical microbiology laboratory during peak influenza season at a major academic center in Chicago, IL, were prospectively tested, using both the ARIES® Flu A/B & RSV and Xpert® Flu/RSV XC assays, side by side. Discrepant results were tested on the BioFire FilmArray® Respiratory Panel for resolution. RESULTS A total of 143 consecutive nasopharyngeal specimens, obtained from patients ranging from six months to ninety-three years in age were received between January 1st, 2017 and March 21st, 2017. There was 96.6% agreement between the two assays for detection influenza A, 100% agreement for detection influenza B and RSV, and 98.9% agreement for negative results. The Xpert® Flu/RSV XC performed with an average turn-around time of approximately 60min, compared to the ARIES® Flu A/B & RSV of approximately 120min. Both assays were equally easy to perform, with a similar amount of hands-on technologist time for each platform. CONCLUSIONS Overall, these results indicate that both tests are comparable in terms of result agreement and technical ease-of-use. The Xpert® Flu/RSV XC assay did produce results with less turn-around-time, approximately 60min quicker than the ARIES® Flu A/B & RSV.
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Affiliation(s)
- Phillip McMullen
- Department of Pathology, The University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, IL 60637, USA
| | - Sue Boonlayangoor
- Department of Pathology, The University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, IL 60637, USA
| | - Angella Charnot-Katsikas
- Department of Pathology, The University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, IL 60637, USA
| | - Kathleen G Beavis
- Department of Pathology, The University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, IL 60637, USA
| | - Vera Tesic
- Department of Pathology, The University of Chicago Medicine, 5841 S. Maryland Avenue, Chicago, IL 60637, USA.
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Acree ME, Beavis KG, Charnot-Katsikas A, Nunes K, Bartlett AH. A Series of False-Positive Fourth-Generation Rapid Human Immunodeficiency Virus (HIV) Tests in an Urban Labor and Delivery Setting. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.387] [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: 11/14/2022] Open
Affiliation(s)
- M. Ellen Acree
- Department of Medicine, Section of Infectious Diseases and Global Health, The University of Chicago Medicine, Chicago, Illinois
| | - Kathleen G. Beavis
- Department of Pathology, The University of Chicago Medicine, Chicago, Illinois
| | | | - Kenneth Nunes
- Department of Obstetrics/Gynecology, The University of Chicago Medicine, Chicago, Illinois
| | - Allison H. Bartlett
- Department of Pediatrics, Section of Infectious Diseases, The University of Chicago Medicine, Chicago, Illinois
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Petty L, Ridgway JP, Pettit N, Charnot-Katsikas A, Tesic V, Beavis KG, Pisano JM. Effects of the Implementation of Reflexive Urine Cultures on Antibiotic Utilization in Hospitalized Patients. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.1050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pettit N, Han Z, Beavis KG, Pisano JM, Charnot-Katsikas A. Correlation Between Vancomycin Utilization and Methicillin-Resistant Staphylococcus aureus (MRSA) Blood Culture Isolate Minimum Inhibitory Concentration (MIC). Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.58] [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: 11/15/2022] Open
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Mcnulty MC, Shibib DR, Steinbeck JL, Matushek S, Pisano J, Mullane K, Beavis KG, Tesic V, Pitrak D. Bordetella bronchiseptica Respiratory Infection Misdiagnosed as Pertussis by Multiplexed Nucleic Acid Test. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.1281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ridgway JP, Bartlett AH, Garcia-Houchins S, Cariño S, Enriquez A, Marrs R, Perez C, Shah M, Guenette C, Mosakowski S, Beavis KG, Landon E. Influenza among afebrile and vaccinated healthcare workers. Clin Infect Dis 2015; 60:1591-5. [PMID: 25733370 PMCID: PMC7108074 DOI: 10.1093/cid/civ163] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [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: 10/02/2014] [Accepted: 11/22/2014] [Indexed: 11/21/2022] Open
Abstract
Background. To prevent transmission of influenza from healthcare workers (HCWs) to patients, many hospitals exclude febrile HCWs from working, but allow afebrile HCWs with respiratory symptoms to have contact with patients. During the 2013–2014 influenza season at our hospital, an influenza-positive HCW with respiratory symptoms but no fever was linked to a case of possible healthcare-associated influenza in a patient. Therefore, we implemented a temporary policy of mandatory influenza testing for HCWs with respiratory symptoms. Methods. From 3 January through 28 February 2014, we tested HCWs with respiratory symptoms for influenza and other respiratory pathogens by polymerase chain reaction of flocked nasopharyngeal swabs. HCWs also reported symptoms and influenza vaccination status, and underwent temperature measurement. We calculated the proportion of influenza-positive HCWs with fever and prior influenza vaccination. Results. Of 449 HCWs, 243 (54%) had a positive test for any respiratory pathogen; 34 (7.6%) HCWs tested positive for influenza. An additional 7 HCWs were diagnosed with influenza by outside physicians. Twenty-one (51.2%) employees with influenza had fever. Among influenza-infected HCWs, 20 had previously received influenza vaccination, 18 had declined the vaccine, and 3 had unknown vaccination status. There was no significant difference in febrile disease among influenza-infected employees who had received the influenza vaccine and those who had not received the vaccine (45% vs 61%; P = .32). Conclusions. Nearly half of HCWs with influenza were afebrile prior to their diagnosis. HCWs with respiratory symptoms but no fever may pose a risk of influenza transmission to patients and coworkers.
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Affiliation(s)
| | | | | | | | | | | | | | - Mona Shah
- Department of Infection Control Program
| | | | - Steve Mosakowski
- Department of Respiratory Therapy, University of Chicago Medicine
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Ridgway JP, Bartlett AH, Garcia-Houchins S, Cariño S, Enriquez A, Marrs R, Perez C, Shah M, Guenette C, Mosakowski S, Beavis KG, Landon E. 532Influenza Among Afebrile and Vaccinated Healthcare Workers. Open Forum Infect Dis 2014. [DOI: 10.1093/ofid/ofu051.51] [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: 11/13/2022] Open
Affiliation(s)
| | - Allison H. Bartlett
- Pediatrics (Infectious Diseases), University of Chicago Medicine, Chicago, IL
| | | | - Sean Cariño
- Infection Control Program, The University of Chicago Medicine, Chicago, IL
| | - Aurea Enriquez
- Infection Control Program, The University of Chicago Medicine, Chicago, IL
| | - Rachel Marrs
- Infection Control Program, The University of Chicago Medicine, Chicago, IL
| | - Cynthia Perez
- Infection Control Program, The University of Chicago Medicine, Chicago, IL
| | - Mona Shah
- Infection Control Program, The University of Chicago Medicine, Chicago, IL
| | - Caroline Guenette
- Occupational Medicine, The University of Chicago Medicine, Chicago, IL
| | | | | | - Emily Landon
- Infectious Diseases & Global Health, University of Chicago, Chicago, IL
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Popovich KJ, Aroutcheva A, Hota B, Beavis KG, Hayden MK, Weinstein RA. Anatomic sites of colonization with community-associated methicillin-resistant Staphylococcus aureus. Infect Control Hosp Epidemiol 2014; 35:1192-4. [PMID: 25111931 DOI: 10.1086/677627] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Beavis KG. Medical care for people in transition: symptoms may point to stories. Health Prog 2014; 95:49-52. [PMID: 24683736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Popovich KJ, Hota B, Aroutcheva A, Kurien L, Patel J, Lyles-Banks R, Grasso AE, Spec A, Beavis KG, Hayden MK, Weinstein RA. Community-associated methicillin-resistant Staphylococcus aureus colonization burden in HIV-infected patients. Clin Infect Dis 2013; 56:1067-74. [PMID: 23325428 DOI: 10.1093/cid/cit010] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The epidemic of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has had a disproportionate impact on patients with human immunodeficiency virus (HIV). METHODS We evaluated CA-MRSA colonization burden (number of colonized sites per total number sampled) among HIV-infected and HIV-negative inpatients within 72 hours of hospitalization. From March 2011 through April 2012, we obtained cultures from nasal and extranasal sites (throat, axilla, inguinal, perirectal, and chronic wound if present) and collected risk factor data. RESULTS Of 745 patients (374 HIV-infected, 371 HIV-negative), 15.7% were colonized with CA-MRSA at any site: 20% of HIV and 11% of HIV-negative patients (relative prevalence=1.8, P=.002). HIV-infected patients had a higher prevalence of nasal, extranasal, and exclusive extranasal colonization as well as higher colonization burden. Perirectal and inguinal areas were the extranasal sites most frequently colonized, and 38.5% of colonized patients had exclusive extranasal colonization. Seventy-three percent of isolates were identified as USA300. Among HIV-infected patients, male sex, younger age, and recent incarceration were positively associated whereas Hispanic ethnicity was negatively associated with higher colonization burden. Among HIV-negative patients, temporary housing (homeless, shelter, or substance abuse center) was the only factor associated with higher colonization burden. Predictors of USA300 included HIV, younger age, illicit drug use, and male sex; all but 1 colonized individual with current or recent incarceration carried USA300. CONCLUSIONS HIV-infected patients were more likely to have a higher CA-MRSA colonization burden and carry USA300. In certain populations, enhanced community and outpatient-based infection control strategies may be needed to prevent CA-MRSA cross-transmission and infection.
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Affiliation(s)
- Kyle J Popovich
- Rush University Medical Center, Stroger Hospital of Cook County, and University of Illinois at Chicago Medical Center, Chicago, Illinois 60612, USA.
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Popovich KJ, Smith KY, Khawcharoenporn T, Thurlow CJ, Lough J, Thomas G, Aroutcheva A, Zawitz C, Beavis KG, Weinstein RA, Hota B. Community-associated methicillin-resistant Staphylococcus aureus colonization in high-risk groups of HIV-infected patients. Clin Infect Dis 2012; 54:1296-303. [PMID: 22354926 DOI: 10.1093/cid/cis030] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND We examined the epidemiology of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) nasal colonization among 3 groups of human immunodeficiency virus (HIV)-infected and 1 group of HIV-negative outpatients. METHODS We determined prevalence and risk factors associated with MRSA colonization among women, recently incarcerated, and Hispanic HIV-infected patients and HIV-negative patients; isolates were typed by pulsed-field gel electrophoresis. Relative prevalence was calculated using Poisson regression, and logistic regression was used for multivariate analysis. RESULTS Of 601 patients, 9.3% were colonized with MRSA; 11% of HIV-infected and 4.2% of HIV-negative patients were colonized (relative prevalence, 2.6; 95% confidence interval [CI], 1.12-6.07; P = .03). Among HIV-infected patients, recently incarcerated patients had the highest colonization prevalence (15.6%) followed by women (12%); Hispanic patients had the lowest (2.8%). Eighty percent of confirmed MRSA isolates were identified as USA300. On multivariate analysis, history of incarceration or residence in alternative housing (odds ratio [OR], 2.3; 95% CI, 1.1-4.7; P = .03) was associated with MRSA colonization; Hispanic ethnicity was negatively associated (OR, 0.3; 95% CI, .11-.98; P = .045). There was a trend (OR, 1.6; 95% CI, .9-3.0; P = .097) toward geographic location of residence being associated with colonization. After controlling for incarceration, residence, and geography, HIV status was no longer significantly associated with colonization. CONCLUSIONS The CA-MRSA and HIV epidemics have intersected. Examination of networks of individuals released from incarceration, both HIV positive and negative, is needed to assess the role of social networks in spread of CA-MRSA and inform prevention strategies.
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Affiliation(s)
- Kyle J Popovich
- Rush University Medical Center, Chicago, Illinois 60612, USA.
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Rank EL, Sautter RL, Beavis KG, Harris S, Jones S, Drechsel R, Goad B, Althouse M. A two-site analytical evaluation of the BD Viper System with XTR Technology in Nonextracted Mode and Extracted Mode with seeded simulated specimens. ACTA ACUST UNITED AC 2011; 16:271-5. [PMID: 21764022 DOI: 10.1016/j.jala.2011.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Indexed: 10/18/2022]
Abstract
The BD ProbeTec CT Q(x) Amplified DNA Assay and the BD ProbeTec GC Q(x) Amplified DNA Assay (both BD Diagnostics, Sparks, MD) represent two new assays developed for use with the BD Viper System with XTR Technology (BD Diagnostics). These assays were built on the foundation of the former BD ProbeTec ET assays (BD Diagnostics) and its accompanying instrumentation. The study described below compared the new assay format, Extracted Mode, to the former assay format, Nonextracted Mode, with the primary objective of examining and measuring overall time expenditures and efficiency of operation. An 80-142-min reduction in "hands-on" total processing time was observed for the Extracted Mode whether testing urines or swabs. The second objective was to assess the accuracy of performance at low simulated analytical loads for the pathogens Chlamydia trachomatis and Neisseria gonorrhoeae. Performance accuracies for simulated positive and negative urine or swab specimens were calculated to be 99.97% for Extracted Mode and 99.76% for Nonextracted Mode.
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Affiliation(s)
- Elliot L Rank
- Medical Affairs, BD Diagnostic Systems, 7 Loveton Circle, MC 662, Sparks, MD 21152, USA.
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Wagar EA, Mitchell MJ, Carroll KC, Beavis KG, Petti CA, Schlaberg R, Yasin B. A review of sentinel laboratory performance: identification and notification of bioterrorism agents. Arch Pathol Lab Med 2010; 134:1490-503. [PMID: 20923306 DOI: 10.5858/2010-0098-cp.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [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 The anthrax incident of 2001 in the United States prompted the College of American Pathologists (CAP), the Association of Public Health Laboratories, and the Centers for Disease Control and Prevention to develop exercises for Laboratory Response Network (LRN) sentinel laboratories. OBJECTIVE To provide an overview of the results of the CAP bioterrorism Laboratory Preparedness Survey (LPS, 2007) and Laboratory Preparedness Exercise (LPX, 2008) and assist LRN sentinel laboratories and public health agencies in planning for bioterrorism events. DESIGN Bioterrorism agents and nonbiothreat mimic organisms were provided in 2 mailings per year (2007 and 2008, 20 total challenges). Within each mailing, 2 to 3 agents were category A or category B bioterrorism agents (total of 10 categoric challenges). Some category A/B isolates were modified/vaccine strains. The total number of laboratories participating in these exercises ranged from 1316 to 1381. Isolate characteristics used to identify the organisms were compiled along with the participants' reporting actions. Educational commentary was provided with each exercise. RESULTS Acceptable identification responses were as follows: Bacillus anthracis, 90% (2007) and 99.9% (2008); Yersinia pestis, 83.8% (2007) and 87.6% (2008); and Francisella tularensis subsp Holarctica, 86.6% (2007) and 91.6% (2008). The time interval between specimen receipt and notification of results to an LRN reference laboratory decreased from more than 10 days in 2007 to 3 or 4 days in 2008 for some challenges. CONCLUSIONS The bioterrorism challenge program (LPS, LPX) provides important comparative data from more than 1300 sentinel laboratories that can be used by individual laboratories to evaluate their identification and LRN reporting performance.
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Affiliation(s)
- Elizabeth A Wagar
- Department of Laboratory Medicine, University of Texas, M. D. Anderson Cancer Center, Houston, TX 77030, USA.
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Abstract
This paper reviews the recent US history of infection with Mycobacterium tuberculosis and discusses the emergence of drug-resistant strains. The paper continues with brief discussions of the clinical presentation of tuberculosis, tuberculosis in the pediatric population, and nontuberculous pulmonary disease. We discuss laboratory techniques that will rapidly identify Mycobacterium tuberculosis and provide susceptibility test results. The advances and limitations of currently available diagnostic techniques are presented. The chapter concludes with an explanation of the current strengths and limitations of molecular diagnosis of disease and resistance.
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Affiliation(s)
- D F Gardiner
- Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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DeSimone JA, Beavis KG, Eschelman DJ, Henning KJ. Sustained bacteremia associated with transjugular intrahepatic portosystemic shunt (TIPS). Clin Infect Dis 2000; 30:384-6. [PMID: 10671346 DOI: 10.1086/313653] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Transjugular intrahepatic portosystemic shunt (TIPS) has become a routine procedure in patients with portal hypertension, yet there are few data concerning the incidence of bacteremia associated with this shunt. All patients who underwent TIPS placement at a university hospital from January 1992 through January 1999 were studied. Ninety-nine TIPS were placed, and 10 patients subsequently developed sustained bacteremia; 5 patients had no identifiable source of bacteremia despite rigorous evaluation and were presumed to represent TIPS infections, for an estimated annual incidence of 7 cases/1000 TIPS procedures. Case patients developed bacteremia a median of 100 days after TIPS placement (range, 6-732 days). Bacteremia resolved in all patients after treatment with appropriate intravenous antibiotics (median, 2 weeks of therapy). Although the incidence of TIPS-associated bacteremia appears low, the increasing frequency of this procedure suggests that more information is needed to define this entity and to develop appropriate treatment recommendations.
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Affiliation(s)
- J A DeSimone
- Department of Medicine, Division of Infectious Diseases, Thomas Jefferson University, Philadelphia, PA 19107, USA.
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Naktin J, Beavis KG. Yersinia enterocolitica and Yersinia pseudotuberculosis. Clin Lab Med 1999; 19:523-36, vi. [PMID: 10549424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Yersinia enterocolitica can cause enteritis, right lower-quadrant pain mimicking appendicitis, reactive arthritis, and erythema nodosum. This organism is transmitted through food, animal contact, and contaminated blood products. Patients with iron excess are at a higher risk for serious infection. This article describes the history, microbiology, virulence factors, epidemiology, clinical manifestations, diagnosis, and therapy of Y. enterocolitica and Y. pseudotuberculosis. In addition, the immune response of those developing reactive arthritis following infection with Y. enterocolitica is discussed.
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Affiliation(s)
- J Naktin
- Division of Infectious Diseases, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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Cornfield DB, Beavis KG, Greene JA, Bojak M, Bondi J. Mycobacterial growth and bacterial contamination in the mycobacteria growth indicator tube and BACTEC 460 culture systems. J Clin Microbiol 1997; 35:2068-71. [PMID: 9230383 PMCID: PMC229904 DOI: 10.1128/jcm.35.8.2068-2071.1997] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The BACTEC 460 system currently provides the most rapid detection of mycobacterial growth, but the system is radiometric and requires needles to inoculate specimens through the bottle's septum. The Mycobacteria Growth Indicator Tube (MGIT) system has a liquid medium, like the BACTEC system, and does not require needles when inoculating specimens. We compared mycobacterial growth from 510 specimens in the two systems. Average time to acid-fast bacillus (AFB) detection and identification to the species level was less with the BACTEC system, but this result was statistically significant only for AFB detection in specimens containing Mycobacterium avium-M. intracellulare complex. The contamination rate with MGIT was 29%; the BACTEC rate was 5%. To investigate MGIT contamination, we initiated a second study with changes in specimen processing. The MGIT contamination rate was reduced to 12%; the BACTEC rate was not significantly affected (5.5%). The most likely explanation for the contamination in MGIT is the richness of its medium compared to the BACTEC medium. Cost analysis for the two systems in a laboratory that processes 4,500 specimens a year is presented. The data suggest that the BACTEC 460 and the MGIT systems are approximately equivalent in cost and ability to support the growth of AFB. The MGIT system appears safer and easier to use and was preferred by laboratory personnel, but it cannot currently be used for blood specimens or antituberculosis susceptibility testing.
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Affiliation(s)
- D B Cornfield
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107, USA
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Jungkind D, Direnzo S, Beavis KG, Silverman NS. Evaluation of automated COBAS AMPLICOR PCR system for detection of several infectious agents and its impact on laboratory management. J Clin Microbiol 1996; 34:2778-83. [PMID: 8897182 PMCID: PMC229403 DOI: 10.1128/jcm.34.11.2778-2783.1996] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
We evaluated the COBAS AMPLICOR (CA) PCR system (Roche Diagnostic Systems) designed for automated PCR amplification and detection of nucleic acids from infectious agents in clinical samples. The Roche AMPLICOR microwell plate (MWP) PCR was the reference method. CA amplifies target nucleic acid, captures the biotinylated amplification products by using magnetic particles coated with specific oligonucleotide probes, and detects the bound products colorimetrically. For Mycobacterium tuberculosis, the correlation of the results of CA tests with those of MWP tests was 100% with 230 samples, including 20 culture-positive samples. For hepatitis C virus, the correlation was 100% with 214 samples, including 60 positive samples. MultiPlex CA analysis of 199 cervical specimens for Chlamydia trachomatis, Neisseria gonorrhoeae, and the internal control gave 100% concordance. These samples included 19 C. trachomatis and 3 N. gonorrhoeae culture-positive samples. Overall, the agreement between PCR methods for all 842 comparisons was 100%. Compared with culture, the sensitivities of the assays for C. trachomatis and M tuberculosis were > or = 95%. After spiking alternating amplification tubes in the CA system with 10(14) copies of the Chlamydia amplicon per ml, we were unable to demonstrate any carryover cross-contamination of negative samples. Using the criteria of the College of American Pathologists workload recording method, we found that the total hands-on time to produce CA PCR results was 4.4, 7.9, and 3.3 min for M. tuberculosis, hepatis C virus, and the MultiPlexed assay for chlamydia plus gonorrhea and an internal control, respectively. The CA system brings true PCR automation to laboratories. In addition to the accuracy of automated results, the CA system provides labor savings, provides containment of the amplification and detection components of PCR, and supports both MultiPlex amplification and sequential algorithm (ReFlex) detection of analytes.
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Affiliation(s)
- D Jungkind
- Department of Pathology, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA
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Abstract
We evaluated the Amplicor PCR assay (Roche Molecular Systems, Branchburg, N.J.) for direct detection of Mycobacterium tuberculosis in sputum. A total of 532 specimens from 270 patients were decontaminated and stored at 4 or -75 degrees C until assayed by PCR. This assay used three-step sample preparation, biotinylated primer pairs, AmpErase, and a microtiter format for amplicon capture and detection. Amplicor PCR results were compared with clinical history, culture from a Lowenstein-Jensen slant, and results from the BACTEC TB-460 system. Eighty-seven cultures from 15 patients grew M. tuberculosis; of these, 83 (95%) were positive with the Amplicor PCR test. The false negatives were most likely due to sample variation and inhibitors. Of the 445 specimens from which M. tuberculosis was not isolated, 428 (96%) were negative with the Amplicor PCR test. Of the 17 M. tuberculosis culture-negative, Amplicor-positive specimens, 15 were reclassified as true positives because previous cultures grew M. tuberculosis. Of the 445 specimens which did not grow M. tuberculosis, Mycobacterium spp. other than M. tuberculosis were isolated from 150 specimens. Three of these 150 specimens were Amplicor positive; two were from a patient with a history of tuberculosis, and one specimen gave a false-positive result. We do not feel that this represents cross-reactivity, because repeated Amplicor testing of the isolate gave negative results. The microtiter plate has 96 wells. Allowing for six controls, 90 decontaminated specimens can be tested by one technologist in 7.5 h. This PCR assay took 7.5 h to complete and is a sensitive and specific, rapid method for the direct detection of M. tuberculosis from sputum.
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Affiliation(s)
- K G Beavis
- Department of Pathology, Anatomy and Cell Biology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Powers C, Saltarelli MG, Beavis KG. Pelvic retroperitoneal mass in a 36-year-old man. Cleve Clin J Med 1992; 59:429-33. [PMID: 1525977 DOI: 10.3949/ccjm.59.4.429] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- C Powers
- Department of Diagnostic Radiology, Cleveland Clinic Foundation, OH 44195
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Powers C, Glicklich M, Beavis KG. Mental status changes in an immunocompromised patient. Cleve Clin J Med 1992; 59:211-5. [PMID: 1587021 DOI: 10.3949/ccjm.59.2.211] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- C Powers
- Department of Diagnostic Radiology, Cleveland Clinic Foundation, OH 44195
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41
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Affiliation(s)
- C Powers
- Department of Diagnostic Radiology, Cleveland Clinic Foundation, OH 44195
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42
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Affiliation(s)
- R J Lorig
- Department of Diagnostic Radiology, Cleveland Clinic Foundation, OH 44195
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43
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Beavis KG. Ordering stool exams: room for improvement. Cleve Clin J Med 1991; 58:299-300. [PMID: 1889111 DOI: 10.3949/ccjm.58.4.299] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- K G Beavis
- Department of Microbiology, Cleveland Clinic Foundation, OH 44195
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44
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Affiliation(s)
- R G Barr
- Department of Radiology, San Francisco General Hospital Medical Center/University of California
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45
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Powers C, Beavis KG. Left atrial lesion in a 68-year-old. Cleve Clin J Med 1991; 58:171-2, 175-6. [PMID: 1851055 DOI: 10.3949/ccjm.58.2.171] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- C Powers
- Department of Diagnostic Radiology, Cleveland Clinic Foundation, Ohio 44195
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46
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Meziane MA, Beavis KG. Lung nodules in an immunocompromised patient. Cleve Clin J Med 1991; 58:67-9. [PMID: 2070519 DOI: 10.3949/ccjm.58.1.67] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
MESH Headings
- Adult
- Aspergillosis/diagnostic imaging
- Aspergillosis/etiology
- Aspergillosis/pathology
- Female
- Humans
- Immunosuppressive Agents/adverse effects
- Immunosuppressive Agents/therapeutic use
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/surgery
- Lung Diseases, Fungal/diagnostic imaging
- Lung Diseases, Fungal/etiology
- Lung Diseases, Fungal/pathology
- Tomography, X-Ray Computed
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Affiliation(s)
- M A Meziane
- Department of Diagnostic Radiology, Cleveland Clinic Foundation, Ohio 44195
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