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Smith-Norowitz TA, Shulman A, Abdelmajid H, Hammerschlag MR, Joks R, Weaver D, Kohlhoff S. Chlamydia pneumoniae-Immunoglobulin E antibody responses in serum from children with asthma. Pathog Dis 2023:ftad015. [PMID: 37403376 DOI: 10.1093/femspd/ftad015] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2023] Open
Abstract
Chlamydia pneumoniae is an obligate intracellular bacterium that causes respiratory infection in humans. An association between persistent C. pneumoniae infection and asthma pathogenesis has been described. It is unknown whether specific IgE is a marker of persistent immune activation responses. Therefore, the association between C. pneumoniae specific IgE antibodies (Abs) and interferon (IFN)-gamma produced by C. pneumoniae-stimulated PBMC was examined. Blood was collected and serum separated. Peripheral blood mononuclear cells (PBMC) from 63 children with or without stable asthma (N = 45 and 18, respectively) were infected or not infected with C. pneumoniae AR-39 and cultured up to 7 days. Supernatants were collected, and IFN-gamma levels measured (ELISA). Serum C. pneumoniae- IgE Abs were detected by immunoblotting. C. pneumoniae IgE Abs were detected in asthmatics (27%), compared with non-asthmatics (11%) (P = NS). IFN-gamma responses were more prevalent among asthmatics who had positive C. pneumoniae-IgE Abs (91%) compared with asthmatics without C. pneumoniae-IgE Abs (20%) (P = 0.0046). IFN-gamma responses in C. pneumoniae stimulated PBMC from children with asthma were significantly more frequent in children who had specific anti-C. pneumoniae IgE Abs compared to those who did not. This immune response may reflect persistent infection which may contribute to ongoing asthma symptoms.
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Affiliation(s)
- Tamar A Smith-Norowitz
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Health Sciences University, Brooklyn, New York 11203
| | - Anastasiya Shulman
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Health Sciences University, Brooklyn, New York 11203
| | - Haram Abdelmajid
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Health Sciences University, Brooklyn, New York 11203
| | - Margaret R Hammerschlag
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Health Sciences University, Brooklyn, New York 11203
| | - Rauno Joks
- Department of Medicine, State University of New York Downstate Health Sciences University, Brooklyn, New York 11203
| | - Diana Weaver
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Health Sciences University, Brooklyn, New York 11203
| | - Stephan Kohlhoff
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Health Sciences University, Brooklyn, New York 11203
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Shaoba A, Hammerschlag MR, Bamgbola OF. Diagnostic Challenges of Urinary Schistosomiasis Among Adolescent Immigrants in New York City: A Report of Three Cases. Pediatr Infect Dis J 2023; 42:e95-e97. [PMID: 36749927 DOI: 10.1097/inf.0000000000003807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Urinary schistosomiasis is endemic in the tropical world. It is uncommon in geographical areas with advanced public health resources. Modern immigration from endemic communities to the United States supports the need to improve our diagnostic awareness. We describe 3 Brooklyn adolescent immigrants from Africa with urinary schistosomiasis, all of whom had an initial misdiagnosis that led to delay in therapeutic intervention.
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Affiliation(s)
- Asma Shaoba
- From the Divisions of Pediatric Nephrology, Department of Pediatrics
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3
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Franco S, Hammerschlag MR. Neonatal ocular prophylaxis in the United States: is it still necessary? Expert Rev Anti Infect Ther 2023; 21:503-511. [PMID: 36691840 DOI: 10.1080/14787210.2023.2172401] [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: 01/25/2023]
Abstract
INTRODUCTION Much has changed since Credé reported that silver nitrate decreases the incidence of ophthalmia neonatorum. Prenatal screening and treatment of pregnant women for Neisseria gonorrhoeae became standard in the 1950s and for Chlamydia trachomatis in 1993. Neonatal gonococcal and chlamydial conjunctivitis are consequently uncommon today. Currently, only 0.5% erythromycin ophthalmic ointment is available in the United States (U.S.) for neonatal ocular prophylaxis, which is ineffective against C. trachomatis. AREAS COVERED This article addresses the altered epidemiology of ophthalmia neonatorum in the U.S. since prophylactic practices began, the lack of data supporting ophthalmic erythromycin for prevention of neonatal gonococcal and chlamydial conjunctivitis, and the impact of prenatal screening and treatment of pregnant women for N. gonorrhoeae and C. trachomatis on conjunctivitis incidence. The authors discuss why erythromycin ophthalmic ointment is likely ineffective against gonococcal ophthalmia, including the development of macrolide resistance. Physiologic limitations and pharmacokinetic properties are considered with respect to ophthalmic erythromycin for the prevention of gonococcal and chlamydial conjunctivitis. EXPERT OPINION Administration of erythromycin ophthalmic ointment for the prevention of neonatal conjunctivitis is not literature-supported. Prenatal screening and treatment of pregnant women is the most effective way to prevent ophthalmia neonatorum. National mandates for prophylaxis should be withdrawn.
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Affiliation(s)
- Susannah Franco
- Department of Pharmacy, SUNY Downstate Medical Center, Pharmacy, Brooklyn, NY, USA
| | - Margaret R Hammerschlag
- Department of Pediatrics, Division of Infectious Diseases, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
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Franco S, Rampersad D, Mesa D, Hammerschlag MR. Treatment options for neonatal infections in the post-cefotaxime era. Expert Rev Anti Infect Ther 2022; 20:1253-1259. [PMID: 35924433 DOI: 10.1080/14787210.2022.2110069] [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: 11/04/2022]
Abstract
INTRODUCTION : Cefotaxime has been used for the management of neonatal infections since the 1990s for suspected meningitis and to mitigate gentamicin-associated renal injury. Its shortage in 2015 and subsequent removal from the U.S. pharmaceutical market forced providers to consider alternatives. Ceftriaxone, a cephalosporin with an identical antibacterial spectrum of activity to cefotaxime, is contraindicated in neonates due to its risk of biliary pseudolithiasis. Ceftazidime was recommended as an alternative by the American Academy of Pediatrics but is inequivalent. AREAS COVERED : This article addresses indications for cephalosporin use and considerations when selecting an alternative to cefotaxime. Differences among cefotaxime, ceftriaxone, ceftazidime, and cefepime are discussed and compared to the standard-of-care presumptive regimen, ampicillin and gentamicin. The authors consider the data behind the neonatal contraindication to ceftriaxone and provide recommendations for their application to practice. EXPERT OPINION : The data against ceftriaxone use in neonates remain poor, particularly in the context of the cefotaxime shortage and lack of an equivalent alternative. Ceftriaxone could be considered in low-risk neonates without hyperbilirubinemia or exposure to calcium-containing fluids on a case-by-case basis. Ceftazidime monotherapy for presumptive management of neonatal infections is inappropriate; cefepime should be more frequently utilized in neonates who are poor candidates for ceftriaxone.
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Affiliation(s)
| | | | | | - Margaret R Hammerschlag
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
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5
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Smith-Norowitz TA, Kohlhoff S, Hammerschlag MR. Coronavirus-19 infection and vaccination rates in a private school in Brooklyn, New York. Eur J Clin Invest 2022; 52:e13747. [PMID: 35032036 DOI: 10.1111/eci.13747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Tamar A Smith-Norowitz
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
| | - Stephan Kohlhoff
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
| | - Margaret R Hammerschlag
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
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Pastolero PC, Suss A, Cambridge R, Hammerschlag MR. If We Make It, Will They Take It? Attitudes Toward the Acceptability of Chlamydia Point-of-Care Testing Among Adolescents and Young Adults. Sex Transm Dis 2022; 49:204-207. [PMID: 34561372 DOI: 10.1097/olq.0000000000001563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adolescent women, 15 to 19 years of age, have the highest rate of Chlamydia trachomatis infection in the United States. The objective of this study was to ascertain knowledge and experience of C. trachomatis and acceptance of C. trachomatis point-of-care testing (POCT) if made available over-the-counter (OTC). Currently, there are no tests for C. trachomatis available OTC for purchase. METHODS Patients attending adolescent clinics at University Hospital of Brooklyn and Kings County Hospital received an anonymous 12-item questionnaire. Both clinics serve predominantly African and Caribbean American urban populations. Questions included demographics, sexual orientation, chlamydia knowledge, testing history, prior infection, partner notification, and acceptance of OTC POCT for C. trachomatis. RESULTS Surveys from 151 patients (116 women, 35 men) aged 12 to 21 years (mean age, 17.6 years) were analyzed. Only 34 of the 151 (22.5%) respondents understood C. trachomatis transmission; 31 (20.5%) knew its complications. Sixty-seven (44.4%) would purchase an OTC test but 101 (66.8%) would pay no more than $20. All 151 patients reported that they would follow-up with doctor if positive; 143 (94.7%) would notify partners, although 5 of the 31 (16.1%) women with prior infection did not notify partners. CONCLUSIONS Nearly half (44%) of adolescents in our population would be interested in using a potential OTC test for C. trachomatis. Cost was a major disincentive. Knowledge of infection remains cursory. However, those with a history of C. trachomatis infection and familiar with its complications were more interested in purchasing a home test. Although 100% of the respondents reported that they would follow-up with their physician if they tested positive, past behavior suggests that partner notification might be suboptimal.
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Affiliation(s)
| | - Amy Suss
- From the Division of Adolescent Medicine
| | | | - Margaret R Hammerschlag
- Division of Pediatric Infectious Diseases, Department of Pediatrics, SUNY Downstate Health Sciences University, Brooklyn, NY
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Smith‐Norowitz TA, Shidid S, Hammerschlag MR, Kohlhoff S. Rates of SARS-CoV-2 infection in paediatric patients with atopic dermatitis or asthma in Brooklyn, New York. Acta Paediatr 2022; 111:602-603. [PMID: 34850447 DOI: 10.1111/apa.16203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/25/2021] [Accepted: 11/29/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Tamar A. Smith‐Norowitz
- Department of Pediatrics Division of Infectious Diseases State University of New York Downstate Health Sciences University Brooklyn New York USA
| | - Sarah Shidid
- Department of Pediatrics Division of Infectious Diseases State University of New York Downstate Health Sciences University Brooklyn New York USA
| | - Margaret R. Hammerschlag
- Department of Pediatrics Division of Infectious Diseases State University of New York Downstate Health Sciences University Brooklyn New York USA
| | - Stephan Kohlhoff
- Department of Pediatrics Division of Infectious Diseases State University of New York Downstate Health Sciences University Brooklyn New York USA
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8
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Smith‐Norowitz TA, Silverberg JI, Norowitz EM, Loeffler J, Hammerschlag MR, Kohlhoff S. Olfactory dysfunction in children and adults post-COVID-19 infection in Brooklyn, New York. Acta Paediatr 2022; 111:128-129. [PMID: 34599528 PMCID: PMC8652898 DOI: 10.1111/apa.16134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/13/2021] [Accepted: 09/30/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Tamar A. Smith‐Norowitz
- Division of Infectious Diseases Department of Pediatrics State University of New York Downstate Medical Center Brooklyn NY USA
| | - Jonathan I. Silverberg
- Department of Dermatology George Washington University School of Medicine and Health Sciences Washington DC USA
| | - Esther M. Norowitz
- Division of Infectious Diseases Department of Pediatrics State University of New York Downstate Medical Center Brooklyn NY USA
| | - Jeffrey Loeffler
- Division of Infectious Diseases Department of Pediatrics State University of New York Downstate Medical Center Brooklyn NY USA
| | - Margaret R. Hammerschlag
- Division of Infectious Diseases Department of Pediatrics State University of New York Downstate Medical Center Brooklyn NY USA
| | - Stephan Kohlhoff
- Division of Infectious Diseases Department of Pediatrics State University of New York Downstate Medical Center Brooklyn NY USA
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9
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Smith‐Norowitz TA, Norowitz YM, Kohlhoff S, Hammerschlag MR. SARS-CoV-2 Positivity rates are lower in school compared with local rates in Brooklyn, New York. Acta Paediatr 2021; 110:2576-2577. [PMID: 34160094 PMCID: PMC8444930 DOI: 10.1111/apa.16003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 06/22/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Tamar A. Smith‐Norowitz
- Department of Pediatrics Division of Infectious Diseases State University of New York Downstate Medical Center Brooklyn NY USA
| | - Yitzchok M. Norowitz
- Department of Pediatrics Division of Infectious Diseases State University of New York Downstate Medical Center Brooklyn NY USA
| | - Stephan Kohlhoff
- Department of Pediatrics Division of Infectious Diseases State University of New York Downstate Medical Center Brooklyn NY USA
| | - Margaret R Hammerschlag
- Department of Pediatrics Division of Infectious Diseases State University of New York Downstate Medical Center Brooklyn NY USA
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10
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Kohlhoff S, Roblin PM, Clement S, Banniettis N, Hammerschlag MR. Universal Prenatal Screening and Testing and Chlamydia trachomatis Conjunctivitis in Infants. Sex Transm Dis 2021; 48:e122-e123. [PMID: 33346588 DOI: 10.1097/olq.0000000000001344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT We retrospectively reviewed all infant Chlamydia trachomatis eye cultures submitted to the Chlamydia Research Laboratory from 1986 to 2002. The positivity rate was 15.6% during the period before the implementation of universal prenatal screening (1986-1993) compared with 1.8% during the screening period (1994-2002).
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Affiliation(s)
- Stephan Kohlhoff
- From the Division of Pediatric Infectious Diseases, Department of Pediatrics, State University of New York Downstate Medical Center
| | - Patricia M Roblin
- From the Division of Pediatric Infectious Diseases, Department of Pediatrics, State University of New York Downstate Medical Center
| | | | - Natalie Banniettis
- From the Division of Pediatric Infectious Diseases, Department of Pediatrics, State University of New York Downstate Medical Center
| | - Margaret R Hammerschlag
- From the Division of Pediatric Infectious Diseases, Department of Pediatrics, State University of New York Downstate Medical Center
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11
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Smith‐Norowitz TA, Kohlhoff S, Hammerschlag MR. Coronavirus disease 2019 prevalence rates in reopened private schools in New York City: Impact of diagnostic methods. Acta Paediatr 2021; 110:2382-2384. [PMID: 33760250 PMCID: PMC8251272 DOI: 10.1111/apa.15853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 03/22/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Tamar A. Smith‐Norowitz
- Division of Infectious Diseases Department of Pediatrics State University of New York Downstate Medical Center Brooklyn NY USA
| | - Stephan Kohlhoff
- Division of Infectious Diseases Department of Pediatrics State University of New York Downstate Medical Center Brooklyn NY USA
| | - Margaret R Hammerschlag
- Division of Infectious Diseases Department of Pediatrics State University of New York Downstate Medical Center Brooklyn NY USA
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12
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Smith-Norowitz TA, Silverberg JI, Norowitz EM, Kohlhoff S, Hammerschlag MR. Factors impacting vaccine hesitancy toward Coronavirus disease-19 (COVID-19) vaccination in Brooklyn, New York. Hum Vaccin Immunother 2021; 17:4013-4014. [PMID: 34242124 DOI: 10.1080/21645515.2021.1948786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
The Coronavirus disease-2019 (COVID-19) pandemic led to the development of several candidate vaccines. However, current research suggests that the potential of successful vaccines is tempered by vaccine skepticism or hesitancy. If vaccine efficacy is 80%, then the herd immunity required from vaccination is about 75-90%. The aim of the current study was to study factors impacting COVID-19 vaccine hesitancy in a representative sample of adults (age≥18 years) in a COVID-19 hotspotAbbreviations: COVID-19: coronavirus disease-19.
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Affiliation(s)
- Tamar A Smith-Norowitz
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - Jonathan I Silverberg
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Esther M Norowitz
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - Stephan Kohlhoff
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - Margaret R Hammerschlag
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Brooklyn, NY, USA
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13
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Smith‐Norowitz TA, Hammerschlag MR, Kohlhoff S. Coronavirus disease 2019 (COVID-19) infection rates in a private school in Brooklyn, New York. Acta Paediatr 2021; 110:1569-1570. [PMID: 33523495 PMCID: PMC8014433 DOI: 10.1111/apa.15786] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 01/28/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Tamar A. Smith‐Norowitz
- Department of Pediatrics Division of Infectious Diseases State University of New York Downstate Medical Center Brooklyn NY USA
| | - Margaret R. Hammerschlag
- Department of Pediatrics Division of Infectious Diseases State University of New York Downstate Medical Center Brooklyn NY USA
| | - Stephan Kohlhoff
- Department of Pediatrics Division of Infectious Diseases State University of New York Downstate Medical Center Brooklyn NY USA
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14
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Banniettis N, Wisecup K, Boland L, Watanabe I, Hammerschlag MR, Kohlhoff S. Association of Routine Chlamydia trachomatis Screening During Pregnancy and Seroprevalence of Chlamydial Infection in Children, 1991-2015. J Pediatric Infect Dis Soc 2021; 10:172-174. [PMID: 31958120 DOI: 10.1093/jpids/piaa002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 01/08/2020] [Indexed: 11/14/2022]
Abstract
We performed a seroepidemiologic study of sera from children in Brooklyn, New York, before and after the implementation of prenatal chlamydial screening almost 20% of children aged ≤10 years in the prescreening group had anti-Chlamydia trachomatis immunoglobulin G compared with none in the postscreening group.
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Affiliation(s)
- Natalie Banniettis
- Department of Pediatrics, State University of New York, Downstate Medical Center, Brooklyn, New York, USA.,Division of Infectious Diseases, State University of New York, Downstate Medical Center, Brooklyn, New York, USA
| | - Kimberly Wisecup
- Department of Pediatrics, State University of New York, Downstate Medical Center, Brooklyn, New York, USA
| | - Leah Boland
- Department of Pediatrics, State University of New York, Downstate Medical Center, Brooklyn, New York, USA
| | - Izumi Watanabe
- Department of Pediatrics, State University of New York, Downstate Medical Center, Brooklyn, New York, USA
| | - Margaret R Hammerschlag
- Department of Pediatrics, State University of New York, Downstate Medical Center, Brooklyn, New York, USA.,Division of Infectious Diseases, State University of New York, Downstate Medical Center, Brooklyn, New York, USA
| | - Stephan Kohlhoff
- Department of Pediatrics, State University of New York, Downstate Medical Center, Brooklyn, New York, USA.,Division of Infectious Diseases, State University of New York, Downstate Medical Center, Brooklyn, New York, USA
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15
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Smith-Norowitz TA, Ukaegbu C, Kohlhoff S, Hammerschlag MR. Neonatal prophylaxis with antibiotic containing ointments does not reduce incidence of chlamydial conjunctivitis in newborns. BMC Infect Dis 2021; 21:270. [PMID: 33731049 PMCID: PMC7971948 DOI: 10.1186/s12879-021-05974-3] [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] [Received: 11/11/2020] [Accepted: 02/08/2021] [Indexed: 11/22/2022] Open
Abstract
Background Neonatal ocular prophylaxis with silver nitrate does not prevent neonatal conjunctivitis due to Chlamydia trachomatis. The efficacy of antibiotic containing preparations for prevention of neonatal chlamydial conjunctivitis (NCC) has not been established. Objective To examine published literature to determine whether antibiotic containing preparation are efficacious for prevention of NCC and C. trachomatis in the nasopharynx. Methods A literature search of MEDLINE and EMBASE. Articles were selected for review if their content included 4 key criteria: (1) Prospective/comparative study. (2) Prenatal screening of mothers for C. trachomatis with results reported. (3) Follow-up of infants born to chlamydia-positive women. (4) Infants prospectively followed at regular intervals and tested for C. trachomatis in the eye/ nasopharynx (NP). Results The search yielded 159 studies; 11 were selected for full reviews, eight were excluded; three addressed the four criteria. Rates of C. trachomatis conjunctivitis in infants in included studies who received silver nitrate was 20–33%; positive NP, 1–28% and pneumonia, 3–8%. Rates of C. trachomatis conjunctivitis in neonates who received erythromycin or tetracycline prophylaxis did not differ from silver nitrate; 0–15 and 11%, respectively, who received erythromycin or tetracycline developed NCC. Similarly, 4–33 and 5% of infants who received erythromycin or tetracycline, respectively, had positive NP cultures; 0–4% developed chlamydial pneumonia. Conclusion Neonatal ocular prophylaxis with erythromycin or tetracycline ophthalmic ointments does not reduce incidence of neonatal chlamydial conjunctivitis or respiratory infection in infants born to mothers with C. trachomatis infection compared to silver nitrate.
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Affiliation(s)
- Tamar A Smith-Norowitz
- Department of Pediatrics, State University of New York Downstate Medical Center, 450 Clarkson Ave., Box 49, Brooklyn, NY, 11203, USA.
| | - Crystal Ukaegbu
- Department of Pediatrics, State University of New York Downstate Medical Center, 450 Clarkson Ave., Box 49, Brooklyn, NY, 11203, USA.,School of Public Health, State University of New York Downstate Medical Center, New York, Brooklyn, USA
| | - Stephan Kohlhoff
- Department of Pediatrics, State University of New York Downstate Medical Center, 450 Clarkson Ave., Box 49, Brooklyn, NY, 11203, USA
| | - Margaret R Hammerschlag
- Department of Pediatrics, State University of New York Downstate Medical Center, 450 Clarkson Ave., Box 49, Brooklyn, NY, 11203, USA
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16
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Fernandes DM, Oliveira CR, Guerguis S, Eisenberg R, Choi J, Kim M, Abdelhemid A, Agha R, Agarwal S, Aschner JL, Avner JR, Ballance C, Bock J, Bhavsar SM, Campbell M, Clouser KN, Gesner M, Goldman DL, Hammerschlag MR, Hymes S, Howard A, Jung HJ, Kohlhoff S, Kojaoghlanian T, Lewis R, Nachman S, Naganathan S, Paintsil E, Pall H, Sy S, Wadowski S, Zirinsky E, Cabana MD, Herold BC. Severe Acute Respiratory Syndrome Coronavirus 2 Clinical Syndromes and Predictors of Disease Severity in Hospitalized Children and Youth. J Pediatr 2021; 230:23-31.e10. [PMID: 33197493 PMCID: PMC7666535 DOI: 10.1016/j.jpeds.2020.11.016] [Citation(s) in RCA: 119] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 11/02/2020] [Accepted: 11/10/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To characterize the demographic and clinical features of pediatric severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) syndromes and identify admission variables predictive of disease severity. STUDY DESIGN We conducted a multicenter, retrospective, and prospective study of pediatric patients hospitalized with acute SARS-CoV-2 infections and multisystem inflammatory syndrome in children (MIS-C) at 8 sites in New York, New Jersey, and Connecticut. RESULTS We identified 281 hospitalized patients with SARS-CoV-2 infections and divided them into 3 groups based on clinical features. Overall, 143 (51%) had respiratory disease, 69 (25%) had MIS-C, and 69 (25%) had other manifestations including gastrointestinal illness or fever. Patients with MIS-C were more likely to identify as non-Hispanic black compared with patients with respiratory disease (35% vs 18%, P = .02). Seven patients (2%) died and 114 (41%) were admitted to the intensive care unit. In multivariable analyses, obesity (OR 3.39, 95% CI 1.26-9.10, P = .02) and hypoxia on admission (OR 4.01; 95% CI 1.14-14.15; P = .03) were predictive of severe respiratory disease. Lower absolute lymphocyte count (OR 8.33 per unit decrease in 109 cells/L, 95% CI 2.32-33.33, P = .001) and greater C-reactive protein (OR 1.06 per unit increase in mg/dL, 95% CI 1.01-1.12, P = .017) were predictive of severe MIS-C. Race/ethnicity or socioeconomic status were not predictive of disease severity. CONCLUSIONS We identified variables at the time of hospitalization that may help predict the development of severe SARS-CoV-2 disease manifestations in children and youth. These variables may have implications for future prognostic tools that inform hospital admission and clinical management.
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Affiliation(s)
- Danielle M Fernandes
- Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, NY.
| | | | - Sandra Guerguis
- Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, NY
| | - Ruth Eisenberg
- Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, NY
| | - Jaeun Choi
- Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, NY
| | - Mimi Kim
- Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, NY
| | - Ashraf Abdelhemid
- Department of Pediatrics, Kings County Hospital Center, Brooklyn, NY
| | - Rabia Agha
- Department of Pediatrics, Maimonides Children's Hospital, Brooklyn, NY
| | - Saranga Agarwal
- Department of Pediatrics, Joseph M. Sanzari Children's Hospital, Hackensack, NJ
| | - Judy L Aschner
- Department of Pediatrics, Joseph M. Sanzari Children's Hospital, Hackensack, NJ
| | - Jeffrey R Avner
- Department of Pediatrics, Maimonides Children's Hospital, Brooklyn, NY
| | - Cathleen Ballance
- Department of Pediatrics, K. Hovnanian Children's Hospital, Neptune City, NJ
| | - Joshua Bock
- Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, NY
| | - Sejal M Bhavsar
- Department of Pediatrics, Joseph M. Sanzari Children's Hospital, Hackensack, NJ
| | - Melissa Campbell
- Department of Pediatrics, Yale School of Medicine, New Haven, CT
| | - Katharine N Clouser
- Department of Pediatrics, Joseph M. Sanzari Children's Hospital, Hackensack, NJ
| | - Matthew Gesner
- Department of Pediatrics, Kings County Hospital Center, Brooklyn, NY
| | - David L Goldman
- Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, NY
| | | | - Saul Hymes
- Department of Pediatrics, Stony Brook University Renaissance Hospital, Stony Brook, NY
| | - Ashley Howard
- Department of Pediatrics, Yale School of Medicine, New Haven, CT
| | - Hee-Jin Jung
- Department of Pediatrics, Joseph M. Sanzari Children's Hospital, Hackensack, NJ
| | - Stephan Kohlhoff
- Department of Pediatrics, SUNY Downstate Medical Center University Hospital, Brooklyn, NY
| | | | - Rachel Lewis
- Department of Pediatrics, Joseph M. Sanzari Children's Hospital, Hackensack, NJ
| | - Sharon Nachman
- Department of Pediatrics, Stony Brook University Renaissance Hospital, Stony Brook, NY
| | - Srividya Naganathan
- Department of Pediatrics, K. Hovnanian Children's Hospital, Neptune City, NJ
| | - Elijah Paintsil
- Department of Pediatrics, Yale School of Medicine, New Haven, CT
| | - Harpreet Pall
- Department of Pediatrics, K. Hovnanian Children's Hospital, Neptune City, NJ
| | - Sharlene Sy
- Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, NY
| | - Stephen Wadowski
- Department of Pediatrics, SUNY Downstate Medical Center University Hospital, Brooklyn, NY
| | - Elissa Zirinsky
- Department of Pediatrics, Yale School of Medicine, New Haven, CT
| | - Michael D Cabana
- Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, NY
| | - Betsy C Herold
- Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, NY
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17
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Abstract
INTRODUCTION Azithromycin was recommended as the first-line therapeutic regimen for treatment of genital infections in men and women by the Centers for Disease Control in 1998. A series of studies of azithromycin for treatment of rectal chlamydial infection in men who have sex with men (MSM) found that azithromycin was significantly less effective than doxycycline. AREAS COVERED Literature on treatment of rectal C. trachomatis from 2000 through May 2020 was searched using PubMed. Retrospective and observational studies were identified documenting the frequency and treatment of rectal chlamydial infection in MSM, heterosexual men and women that reported lower efficacy of single-dose azithromycin compared to doxycycline. Literature on possible reasons for the lower efficacy were also reviewed including studies of antibiotic resistance, impact of organism load, and persistent infection in rectal specimens and pharmacokinetics and pharmacodynamics of azithromycin in rectal tissue. EXPERT OPINION The available data suggests that single-dose azithromycin is not as effective as azithromycin for the treatment of rectal infection in MSM and women. Most of these data have been retrospective or from observational studies. Final recommendations will depend on the outcome of prospective, randomized, treatment studies. We may also need to examine other dosage regimens for azithromycin.
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Affiliation(s)
- Margaret R Hammerschlag
- Division of Pediatric Infectious Diseases, Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - Roopali Sharma
- Department of Pharmacy Practice, Touro College of Pharmacy, New York, NY, USA.,Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
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18
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Penton ME, Otto C, Hammerschlag MR. Outsourcing Microbiology Services in Medical Centers: Is It Worth It? J Pediatric Infect Dis Soc 2020; 9:293-297. [PMID: 30989191 DOI: 10.1093/jpids/piz019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 03/04/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Outsourcing of microbiology laboratory services is a growing trend in US medical centers. Data on the actual impact of outsourcing on patient care, safety, and medical education, including costs, are limited. The objective of this study was to examine the published literature on the potential benefits and harms when medical centers outsource common microbiology services. METHODS We conducted a 16-step literature search of PubMed and Embase. Articles were selected for full-text review if their content matched our key questions: (1) What are the potential benefits of outsourcing core microbiology laboratory testing? (2) What are the potential harms to patient care and medical education when medical centers outsource essential microbiology services? RESULTS The initial search yielded 6111 unique published articles; 36 were selected for full-text review, which resulted in the identification of 8 articles that addressed our key questions (2 editorials, 3 editorials with observational data, 1 survey, 1 case series, and 1 study of blood culture transport). These articles described a variety of issues, including longer turnaround times for blood cultures that resulted in delays in diagnosis and treatment, errors that resulted in patient morbidity, limited cost savings, and communication barriers. CONCLUSIONS In this study, with the exception of the blood culture transport study, we found no published prospective studies that quantified the effects of outsourcing microbiology services on patient care, patient safety, or medical education. However, these largely anecdotal reports suggest that outsourcing microbiology services may have a detrimental impact on medical education, especially infectious disease training programs.
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Affiliation(s)
- Manuel E Penton
- Department of Pediatrics, Division of Pediatric Infectious Diseases, SUNY Downstate Medical Center, Brooklyn, New York
| | - Caitlin Otto
- Department of Pathology, Division of Pediatric Infectious Diseases, SUNY Downstate Medical Center, Brooklyn, New York
| | - Margaret R Hammerschlag
- Department of Pediatrics, Division of Pediatric Infectious Diseases, SUNY Downstate Medical Center, Brooklyn, New York
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19
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Smith-Norowitz TA, Huang Y, Loeffler J, Klein E, Norowitz YM, Hammerschlag MR, Joks R, Kohlhoff S. Azithromycin decreases Chlamydia pneumoniae-mediated Interleukin-4 responses but not Immunoglobulin E responses. PLoS One 2020; 15:e0234413. [PMID: 32511255 PMCID: PMC7279567 DOI: 10.1371/journal.pone.0234413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 05/24/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Chlamydia pneumoniae is an obligate intracellular bacterium that causes respiratory infection. There may exist an association between C. pneumoniae, asthma, and production of immunoglobulin (Ig) E responses in vitro. Interleukin (IL-4) is required for IgE production. OBJECTIVE We previously demonstrated that doxycycline suppresses C. pneumoniae-induced production of IgE and IL-4 responses in peripheral blood mononuclear cells (PBMC) from asthmatic subjects. Whereas macrolides have anti-chlamydial activity, their effect on in vitro anti-inflammatory (IgE) and IL-4 responses to C. pneumoniae have not been studied. METHODS PBMC from IgE- adult atopic subjects (N = 5) were infected +/- C. pneumoniae BAL69, +/- azithromycin (0.1, 1.0 ug/mL) for 10 days. IL-4 and IgE levels were determined in supernatants by ELISA. IL-4 and IgE were detected in supernatants of PBMC (day 10). RESULTS When azithromycin (0.1, 1.0 ug/ml) was added, IL-4 levels decreased. At low dose, IgE levels increased and at high dose, IgE levels decreased. When PBMC were infected with C. pneumoniae, both IL-4 and IgE levels decreased. Addition of azithromycin (0.1, 1.0 ug/mL) decreased IL-4 levels and had no effect on IgE levels. CONCLUSIONS These findings indicate that azithromycin decreases IL-4 responses but has a bimodal effect on IgE responses in PBMC from atopic patients in vitro.
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Affiliation(s)
- Tamar A. Smith-Norowitz
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Health Sciences University, Brooklyn, New York, United States of America
- * E-mail:
| | - Yvonne Huang
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Health Sciences University, Brooklyn, New York, United States of America
| | - Jeffrey Loeffler
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Health Sciences University, Brooklyn, New York, United States of America
| | - Elliot Klein
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Health Sciences University, Brooklyn, New York, United States of America
| | - Yitzchok M. Norowitz
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Health Sciences University, Brooklyn, New York, United States of America
| | - Margaret R. Hammerschlag
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Health Sciences University, Brooklyn, New York, United States of America
| | - Rauno Joks
- Department of Medicine, State University of New York Downstate Health Sciences University, Brooklyn, New York, United States of America
| | - Stephan Kohlhoff
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Health Sciences University, Brooklyn, New York, United States of America
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20
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Smith-Norowitz TA, Loeffler J, Huang Y, Klein E, Norowitz YM, Hammerschlag MR, Joks R, Kohlhoff S. Chlamydia pneumoniae immunoglobulin E antibody levels in patients with asthma compared with non-asthma. Heliyon 2020; 6:e03512. [PMID: 32140608 PMCID: PMC7052057 DOI: 10.1016/j.heliyon.2020.e03512] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 01/15/2020] [Accepted: 02/26/2020] [Indexed: 12/24/2022] Open
Abstract
Chlamydia pneumoniae is an obligate intracellular bacterium that causes respiratory infection in adults and children. There is evidence for an association between atypical bacterial pathogens and asthma pathogenesis. We sought to determine whether past C. pneumoniae infection triggers C. pneumoniae- IgE antibodies (Abs) in asthmatics and non-asthmatics, who had detectable IgG titers. C. pneumoniae IgE Abs were quantified using enzyme immunoassay (EIA). C. pneumoniae IgE Ab levels were higher in asthmatics compared with non-asthmatics. There was no correlation found between total serum IgE levels and specific C. pneumoniae IgE Ab levels. C. pneumoniae infection may trigger IgE-specific responses in asthmatics.
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Affiliation(s)
- Tamar A Smith-Norowitz
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Brooklyn, New York, 11203, USA
| | - Jeffrey Loeffler
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Brooklyn, New York, 11203, USA
| | - Yvonne Huang
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Brooklyn, New York, 11203, USA
| | - Elliot Klein
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Brooklyn, New York, 11203, USA
| | - Yitzchok M Norowitz
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Brooklyn, New York, 11203, USA
| | - Margaret R Hammerschlag
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Brooklyn, New York, 11203, USA
| | - Rauno Joks
- Department of Medicine, State University of New York Downstate Medical Center, Brooklyn, New York, 11203, USA
| | - Stephan Kohlhoff
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Brooklyn, New York, 11203, USA
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21
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Sharma R, Hammerschlag MR. Treatment of Methicillin-Resistant Staphylococcus aureus (MRSA) Infections in Children: a Reappraisal of Vancomycin. Curr Infect Dis Rep 2019; 21:37. [PMID: 31486979 DOI: 10.1007/s11908-019-0695-4] [Citation(s) in RCA: 15] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE OF REVIEW In the last 50 years, vancomycin has been the agent of choice to treat infections due to methicillin-resistant Staphylococcus aureus (MRSA). However, vancomycin treatment failure is not uncommon, even when MRSA strains are fully susceptible to vancomycin. Treatment with vancomycin requires careful monitoring of drug levels as there is a potential for nephrotoxicity. Resistance to clindamycin is not infrequent, which also limits therapeutic options for treating infections due to MRSA in children. This paper reviews the current data on pharmacokinetics and pharmacodynamics and clinical efficacy of vancomycin in children. RECENT FINDINGS Resistance to vancomycin in MRSA (MIC >2 mg/L) is infrequent; there is increasing evidence in the literature that vancomycin maybe ineffective against increasing proportion of isolates with MICs between 1 and 2 mg/L. Recent studies and meta-analyses have demonstrated that strains with high vancomycin MICs are associated with poor outcomes especially in patients with bacteremia and deep tissue infections due to MRSA. This gradual increase in vancomycin MIC has been reported as MIC creep or vancomycin heteroresistance. Patients infected with MRSA isolates that exhibit MIC creep experience poorer clinical outcomes, including delayed treatment response, increased mortality, increase rate of relapse, and extended hospitalization. There are limited data to guide vancomycin dosing in children with MRSA. Although the vancomycin area under the curve AUC24/MIC ratio > 400 has been shown to predict clinical efficacy in adults, this relationship has not been documented very well for treatment outcomes in MRSA infections in children. Use of higher vancomycin dosages in attempts to achieve higher trough concentrations has been associated with increased nephrotoxicity. New recently approved antibiotics including ceftaroline, dalbavancin, and tedizolid offer a number of advantages over vancomycin to treat staphylococcal infections: improved antimicrobial activity, superior pharmacokinetics, pharmacodynamics, tolerability, and dosing, including once-daily and weekly regimens, and less need for monitoring drug levels.
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Affiliation(s)
- Roopali Sharma
- Department of Pharmacy Practice, Touro College of Pharmacy, New York, NY, USA. .,Department of Pharmacy, Downstate Medical Center, Brooklyn, NY, USA.
| | - Margaret R Hammerschlag
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Brooklyn, NY, USA
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22
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Brownell AD, Shapiro RA, Hammerschlag MR. Caution Is Required When Using Non-Food and Drug Administration-Cleared Assays to Diagnose Sexually Transmitted Infections in Children. J Pediatr 2019; 206:280-282. [PMID: 30466791 DOI: 10.1016/j.jpeds.2018.10.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 10/19/2018] [Accepted: 10/23/2018] [Indexed: 10/27/2022]
Abstract
Nucleic acid amplification testing is the gold-standard for Chlamydia trachomatis and Neisseria gonorrhoeae testing in adults. We present 3 pediatric cases in which testing resulted in probable false-positive results. Clinicians should avoid tests without clearance from a regulatory agency and should maintain consistent communication with laboratories.
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Affiliation(s)
- Amanda D Brownell
- Mayerson Center for Safe and Healthy Children, Cincinnati Children's Hospital, Cincinnati, OH.
| | - Robert A Shapiro
- Mayerson Center for Safe and Healthy Children, Cincinnati Children's Hospital, Cincinnati, OH
| | - Margaret R Hammerschlag
- Department of Pediatrics, Division of Infectious Diseases, State University of New York, Downstate Medical Center, Brooklyn, NY
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23
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Dong SL, Smith-Norowitz TA, Hammerschlag MR, Joks R, Kohlhoff SA. Comparison of Th1 and Th2 Immune Responses in Chlamydia pneumoniae-infected Peripheral Blood Mononuclear Cells (PBMC) of Adult and Pediatric Asthmatics. J Allergy Clin Immunol 2019. [DOI: 10.1016/j.jaci.2018.12.065] [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: 10/27/2022]
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24
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Norowitz YM, Huang Y, Loeffler J, Klein E, Banniettis N, Penton M, Hammerschlag MR, Durkin HG, Kohlhoff SA, Smith-Norowitz TA. Effect of azithromycin on Chlamydia pneumoniae –mediated Interleukin-4 responses. J Allergy Clin Immunol 2019. [DOI: 10.1016/j.jaci.2018.12.057] [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: 11/16/2022]
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25
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Loeffler J, Huang Y, Klein E, Hammerschlag MR, Joks R, Kohlhoff SA, Smith-Norowitz TA. Levels of Chlamydia pneumoniae Immunoglobulin E antibody in patients with asthma compared with non-asthma. J Allergy Clin Immunol 2019. [DOI: 10.1016/j.jaci.2018.12.028] [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: 10/27/2022]
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26
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Ditkowsky J, Rahman A, Hammerschlag MR, Kohlhoff S, Smith-Norowitz TA. Cost-Benefit Analysis of a Chlamydia trachomatis Vaccine Program in Adolescent Girls in the United States. J Pediatric Infect Dis Soc 2018; 7:296-302. [PMID: 28992068 DOI: 10.1093/jpids/pix072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 08/08/2017] [Indexed: 11/14/2022]
Abstract
BACKGROUND With >1.4 million cases in the United States reported to the Centers for Disease Control and Prevention in 2012, Chlamydia trachomatis infection is a major public health concern. We examined the impact of a C trachomatis vaccination program using a decision-analysis model to estimate the effects of vaccination on C trachomatis-associated costs and morbidity. METHODS We developed a Markov model considering a cohort of 2158117 US females aged 9 to 26 years. Morbidity, death, and healthcare-associated costs associated with chlamydial infection of mothers and fetuses/neonates were calculated over a 17-year time frame. We developed 2 major comparison arms, namely, a C trachomatis vaccination program and no C trachomatis vaccination program. Base-case efficacy and coverage were set to those of human papillomavirus in the United States with all variables, including efficacy and coverage, ranged in sensitivity analyses. RESULTS On the basis of a base-case analysis, a vaccination program would cost an estimated $710 million for a cohort of 2158117 women over a 17-year period, an increase of $41 million over having no vaccination program. A vaccination program would prevent 34000 cases of C trachomatis infection and 5976 cases of pelvic inflammatory disease. CONCLUSIONS A C trachomatis vaccination program results in increased cost to the healthcare system but averts significant morbidity and death.
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Affiliation(s)
- Jared Ditkowsky
- Division of Infectious Diseases, Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn
| | - Afsana Rahman
- Division of Infectious Diseases, Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn
| | - Margaret R Hammerschlag
- Division of Infectious Diseases, Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn
| | - Stephan Kohlhoff
- Division of Infectious Diseases, Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn
| | - Tamar A Smith-Norowitz
- Division of Infectious Diseases, Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn
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27
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Banniettis N, Beekmann SE, Polgreen PM, Kaushik S, Kohlhoff S, Gilbert D, Bennett JE, Hammerschlag MR. Management Practices for Methicillin-Resistant Staphylococcus aureus Bacteremia by Adult Infectious Diseases Physicians. Open Forum Infect Dis 2018; 5:ofy093. [PMID: 29876367 PMCID: PMC5961149 DOI: 10.1093/ofid/ofy093] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 11/22/2017] [Accepted: 05/09/2018] [Indexed: 11/13/2022] Open
Abstract
To assess current use of vancomycin for methicillin-resistant Staphylococcus aureus bacteremia, we surveyed adult infectious disease physicians. Most respondents reported personal experience with infections failing to respond to vancomycin despite minimum inhibitory concentration data indicating susceptibility. In a hypothetical case of such an infection, most would change to daptomycin with or without other agents.
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Affiliation(s)
| | - Susan E Beekmann
- Emerging Infections Network, University of Iowa, Iowa City, Iowa
| | | | | | | | - David Gilbert
- Providence-Portland Medical Center, Portland, Oregon
| | - John E Bennett
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
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28
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Smith-Norowitz TA, Chotikanatis K, Weaver D, Ditkowsky J, Norowitz YM, Hammerschlag MR, Joks R, Kohlhoff S. Chlamydia pneumoniae-induced tumour necrosis factor alpha responses are lower in children with asthma compared with non-asthma. BMJ Open Respir Res 2018; 5:e000239. [PMID: 29755754 PMCID: PMC5942456 DOI: 10.1136/bmjresp-2017-000239] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 01/16/2018] [Accepted: 03/08/2018] [Indexed: 01/15/2023] Open
Abstract
Introduction Chlamydia pneumoniae respiratory tract infection has been implicated in the pathogenesis of reactive airway disease and asthma. Innate cytokine responses that are protective of infection with intracellular pathogens may be impaired in patients with asthma. Tumour necrosis factor alpha (TNF-α) is a cytokine related to functions of monocytes and may inhibit C. pneumoniae infection. We investigated TNF-α responses in C. pneumoniae-infected peripheral blood mononuclear cells (PBMCs) in patients with asthma and non-asthma, and whether ciprofloxacin, azithromycin or doxycycline affects TNF-α responses. Methods PBMC (1.5×106) from paediatric patients with asthma (n=19) and non-asthmatic controls (n=6) were infected or mock infected for 1 hour with or without C. pneumoniae AR-39 at a multiplicity of infection=0.1, and cultured+ciprofloxacin, azithromycin or doxycycline (0.1 ug/mL) for 48 hours. TNF-α levels were measured in supernatants by ELISA. Results When PBMC from patients with asthma were infected with C. pneumoniae, levels of TNF-α were significantly lower than in subjects without asthma (48 hours) (5.5±5.6, 38.4±53.7; p=0.0113). However, baseline responses (no infection with C. pneumoniae) were similar in asthma and non-asthma (1.0±1.7, 1.1±1.2; p=0.89). When PBMC frompatiens with asthma were infected with C. pneumoniae+ciprofloxacin, azithromycin or doxycycline, TNF-α levels increased (25%–45%); this affect was not observed in PBMC from patients without asthma. Conclusions We identified differences in the quantity of TNF-α produced by C. pneumoniae-infected PBMC in asthma compared with non-asthma.
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Affiliation(s)
- Tamar Anne Smith-Norowitz
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Brooklyn, New York, USA
| | - Kobkul Chotikanatis
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Brooklyn, New York, USA
| | - Diana Weaver
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Brooklyn, New York, USA
| | - Jared Ditkowsky
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Brooklyn, New York, USA
| | - Yitzchok Meir Norowitz
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Brooklyn, New York, USA
| | - Margaret R Hammerschlag
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Brooklyn, New York, USA
| | - Rauno Joks
- Department of Medicine, State University of New York Downstate Medical Center, Brooklyn, New York, USA
| | - Stephan Kohlhoff
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Brooklyn, New York, USA
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29
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Arun A, Swamy S, Jacob K, Sharma R, Kohlhoff SA, Hammerschlag MR. Evaluation of clinical outcome in children and adolescents receiving vancomycin for invasive infections due to methicillin-resistant Staphylococcus aureus: impact of increasing vancomycin MICs. Minerva Pediatr (Torino) 2018; 70:207-211. [DOI: 10.23736/s0026-4946.16.04688-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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30
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Smith-Norowitz TA, Weaver D, Norowitz YM, Hammerschlag MR, Joks R, Durkin HG, Kohlhoff S. Doxycycline suppresses Chlamydia pneumoniae induced interferon-gamma responses in peripheral blood mononuclear cells in children with allergic asthma. J Infect Chemother 2018; 24:470-475. [PMID: 29615379 DOI: 10.1016/j.jiac.2018.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 01/30/2018] [Accepted: 02/07/2018] [Indexed: 11/16/2022]
Abstract
Persistent respiratory infections caused by Chlamydia pneumoniae have been implicated in the pathogenesis of chronic diseases (e.g. asthma). Antibiotics are used to treat C. pneumoniae respiratory infections; however, the use of antibiotics as anti-inflammatory agents in treatment of asthma remains controversial. The current study investigated whether ciprofloxacin, azithromycin, or doxycycline can suppress C. pneumoniae-induced production of immunoglobulin (Ig) E or cytokines in peripheral blood mononuclear cells (PBMC) obtained from asthmatic children. Apart from blood, nasopharyngeal swab specimens were also collected to test for the presence of C. pneumoniae and/or M. pneumoniae (qPCR). PBMC (1.5 x 106) from asthmatic pediatric patients (N = 18) were infected or mock infected for 1 h ± C. pneumoniae AR-39 at a multiplicity of infection (MOI) = 0.1, and cultured ± ciprofloxacin, azithromycin, or doxycycline (0.1 or 1.0 μg/mLmL) for either 48 h (cytokines) or 10 days (IgE). Interleukin (IL)-4, interferon (IFN)-γ and IgE levels in supernatants were measured (ELISA). When PBMC were infected with C. pneumoniae, IL-4 and IFNγ production increased (p = 0.06 and 0.03, respectively); IgE levels were low. The now-elevated levels of IL-4 didn't decrease significantly after addition of ciprofloxacin, azithromycin, or doxycycline. However, infected PBMC IFNγ formation decreased significantly when 0.1 μg/mL doxycycline was employed (p = 0.04); no dose of ciprofloxacin or azithromycin had any impact. This inhibitory outcome with doxycycline lends support to the use of tetracyclines as immune modulators and anti-inflammatory medications in treatment of C. pneumoniae-infected asthma patients.
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Affiliation(s)
- Tamar A Smith-Norowitz
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Brooklyn, NY, 11203, USA.
| | - Diana Weaver
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Brooklyn, NY, 11203, USA.
| | - Yitzchok M Norowitz
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Brooklyn, NY, 11203, USA.
| | - Margaret R Hammerschlag
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Brooklyn, NY, 11203, USA.
| | - Rauno Joks
- Department of Medicine State University of New York Downstate Medical Center, Brooklyn, NY, 11203, USA.
| | - Helen G Durkin
- Department of Pathology State University of New York Downstate Medical Center, Brooklyn, NY, 11203, USA.
| | - Stephan Kohlhoff
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Brooklyn, NY, 11203, USA.
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Norowitz YM, Kohlhoff S, Banniettis N, Hammerschlag MR, Smith-Norowitz TA. Chlamydia pneumoniae enhances CD4+ and CD8 +T effector memory cell IL-2 and IL-4 responses in stimulated peripheral blood mononuclear cells in human subjects. J Allergy Clin Immunol 2018. [DOI: 10.1016/j.jaci.2017.12.390] [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: 10/18/2022]
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Smith-Norowitz TA, Weaver D, Chorny V, Norowitz YM, Lent D, Hammerschlag MR, Joks R, Kohlhoff S. Chlamydia pneumoniae Induces Interferon Gamma Responses in Peripheral Blood Mononuclear Cells in Children with Allergic Asthma. Scand J Immunol 2017; 86:59-64. [PMID: 28480606 DOI: 10.1111/sji.12561] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 04/28/2017] [Indexed: 11/28/2022]
Abstract
Respiratory infections caused by Chlamydia pneumoniae have been associated with exacerbations of asthma. Cell-mediated immunity (CMI) is critical for maintaining immunity. We compared interferon (IFN)-γ responses in C. pneumoniae-infected peripheral blood mononuclear cells (PBMC) in paediatric patients ± asthma. Presence of C. pneumoniae was tested from asthma patients (N = 17) and non-asthmatic controls (N = 16) (PCR). PBMC were infected for 1 h ± C. pneumoniae AR-39 (MOI = 0.1) and cultured for 48 h. IFN-γ levels were measured in supernatants (ELISA). C. pneumoniae-IgG antibodies in serum were determined (MIF). All subjects tested negative for C. pneumoniae (PCR). C. pneumoniae-induced IFN-γ production in vitro was more prevalent in asthma compared with non-asthma; levels of IFN-γ were higher in asthma compared with non-asthma (P = 0.003). There was no association between recent respiratory infection and positive IFN-γ responses. These data show that C. pneumoniae modulates IFN-γ responses in patients with asthma, even in absence of active infection.
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Affiliation(s)
- T A Smith-Norowitz
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - D Weaver
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - V Chorny
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - Y M Norowitz
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - D Lent
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - M R Hammerschlag
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - R Joks
- Department of Medicine, State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - S Kohlhoff
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Brooklyn, NY, USA
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Ditkowsky J, Shah KH, Hammerschlag MR, Kohlhoff S, Smith-Norowitz TA. Cost-benefit analysis of Chlamydia trachomatis screening in pregnant women in a high burden setting in the United States. BMC Infect Dis 2017; 17:155. [PMID: 28214469 PMCID: PMC5316151 DOI: 10.1186/s12879-017-2248-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 09/13/2016] [Accepted: 02/07/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Chlamydia trachomatis is the most common bacterial sexually transmitted infection (STI) in the United States (U.S.) [1] and remains a major public health problem. We determined the cost- benefit of screening all pregnant women aged 15-24 for Chlamydia trachomatis infection compared with no screening. METHODS We developed a decision analysis model to estimate costs and health-related effects of screening pregnant women for C. trachomatis in a high burden setting (Brooklyn, NY). Outcome data was from literature for pregnant women in the 2015 US population. A virtual cohort of 6,444,686 pregnant women, followed for 1 year was utilized. Using outcomes data from the literature, we predicted the number of C. trachomatis cases, associated morbidity, and related costs. Two comparison arms were developed: pregnant women who received chlamydia screening, and those who did not. Costs and morbidity of a pregnant woman-infant pair with C. trachomatis were calculated and compared. RESULTS Cost and benefit of screening relied on the prevalence of C. trachomatis; when rates are above 16.9%, screening was proven to offer net cost savings. At a pre-screening era prevalence of 8%, a screening program has an increased expense of $124.65 million ($19.34/individual), with 328 thousand more cases of chlamydia treated, and significant reduction in morbidity. At a current estimate of prevalence, 6.7%, net expenditure for screening is $249.08 million ($38.65/individual), with 204.63 thousand cases of treated chlamydia and reduced morbidity. CONCLUSIONS Considering a high prevalence region, prenatal screening for C. trachomatis resulted in increased expenditure, with a significant reduction in morbidity to woman-infant pairs. Screening programs are appropriate if the cost per individual is deemed acceptable to prevent the morbidity associated with C. trachomatis.
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Affiliation(s)
- Jared Ditkowsky
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Box 49, 450 Clarkson Ave, Brooklyn, NY, 11203, USA
| | - Khushal H Shah
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Box 49, 450 Clarkson Ave, Brooklyn, NY, 11203, USA
| | - Margaret R Hammerschlag
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Box 49, 450 Clarkson Ave, Brooklyn, NY, 11203, USA
| | - Stephan Kohlhoff
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Box 49, 450 Clarkson Ave, Brooklyn, NY, 11203, USA
| | - Tamar A Smith-Norowitz
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Box 49, 450 Clarkson Ave, Brooklyn, NY, 11203, USA.
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Smith-Norowitz TA, Perlman J, Norowitz YM, Joks R, Durkin HG, Hammerschlag MR, Kohlhoff S. Chlamydia pneumoniae induces interleukin-12 responses in peripheral blood mononuclear cells in asthma and the role of toll like receptor 2 versus 4: a pilot study. Ir J Med Sci 2016; 186:511-517. [PMID: 28035483 DOI: 10.1007/s11845-016-1549-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 12/26/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Chlamydia pneumoniae causes respiratory infection in adults and children, and has been associated with asthma exacerbations and induction of Immunoglobulin (Ig) E responses. We previously reported that C. pneumoniae enhances T helper (Th) 2 responses of peripheral blood mononuclear cells (PBMC) from asthmatic patients. It is likely that toll like receptor (TLR)-2 and TLR-4 mediate cytokine responses and host defense against C. pneumoniae. Thus, we sought to determine whether engagement of TLR-2 or TLR-4 may induce IL-12 production in our C. pneumoniae model. METHODS PBMC (1.5 × 106) from asthmatic patients (N = 10) and non-asthmatic controls (N = 5) were infected or mock-infected for 1 h ± C. pneumoniae TW183 at a multiplicity of infection (MOI) = 1 and MOI = 0.1, and cultured for 48 h ± anti- TLR-2 and TLR-4 antibodies (Abs) (1 mg/mL). Interleukin (IL)-12 (48 h p.i.) and total IgE levels (day 10) were measured in supernatants (ELISA). RESULTS High IgE levels were detected in supernatants of C. pneumoniae- infected PBMC from asthmatics on day 10, compared with mock-infected PBMC (p < 0.03). In contrast, IgE was not detected (<0.3 ng/mL) in either C. pneumoniae infected or mock-infected PBMC from non-asthmatics. IL-12 production by C. pneumoniae-infected asthmatic and non-asthmatic PBMC were similar. When anti-TLR4, but not anti-TLR2, was included in culture, IL-12 production by C. pneumoniae- infected asthmatic PBMC decreased. CONCLUSIONS C. pneumoniae infection induces IgE production and modulates IL-12 responses in patients with asthma, which may be caused, in part, by differences in TLR-2 and TLR-4 stimulation.
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Affiliation(s)
- T A Smith-Norowitz
- Division of Infectious Diseases, Department of Pediatrics, State University of New York Downstate Medical Center, Box 49, 450 Clarkson Ave., Brooklyn, NY, 11203, USA.
| | - J Perlman
- Division of Infectious Diseases, Department of Pediatrics, State University of New York Downstate Medical Center, Box 49, 450 Clarkson Ave., Brooklyn, NY, 11203, USA
| | - Y M Norowitz
- Division of Infectious Diseases, Department of Pediatrics, State University of New York Downstate Medical Center, Box 49, 450 Clarkson Ave., Brooklyn, NY, 11203, USA
| | - R Joks
- Department of Medicine, State University of New York Downstate Medical Center, Brooklyn, NY, 11203, USA
| | - H G Durkin
- Department of Pathology, State University of New York Downstate Medical Center, Brooklyn, NY, 11203, USA
| | - M R Hammerschlag
- Division of Infectious Diseases, Department of Pediatrics, State University of New York Downstate Medical Center, Box 49, 450 Clarkson Ave., Brooklyn, NY, 11203, USA
| | - S Kohlhoff
- Division of Infectious Diseases, Department of Pediatrics, State University of New York Downstate Medical Center, Box 49, 450 Clarkson Ave., Brooklyn, NY, 11203, USA
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Smith-Norowitz TA, Chotikanatis K, Tam E, Norowitz YM, Joks R, Durkin HG, Hammerschlag MR, Kohlhoff S. Epigallocatechin gallate suppresses Chlamydia pneumoniae mediated IgE responses in peripheral blood mononuclear cells: a pilot study. Minerva Med 2016; 107:363-369. [PMID: 27309037] [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: 06/06/2023]
Abstract
BACKGROUND Chlamydia pneumoniae (C. pneumoniae) causes respiratory infection in children and adults and is associated with asthma and induction of immunoglobulin E (IgE) responses. Previous studies in our laboratory reported that green tea extract (GTE) and its catechin, epigallocatechin gallate (EGCG) have immunoregulatory effects on IgE responses. Whereas tea polyphenols have in vitro inhibitory effects on the proliferation of C. pneumoniae, the in vitro effects of EGCG on C. pneumoniae- mediated IgE responses haven't been studied. We sought to clarify the in vitro effect of EGCG on C. pneumoniae mediated IgE responses by peripheral blood mononuclear cells (PBMC) in asthma. METHODS PBMC from subjects with asthma and non-asthmatic controls were incubated with C. pneumoniae and cultured for 10 days ±EGCG (0.5, 5.0, 50 ng/mL). IgE levels in supernatants were determined (ELISA). RESULTS Elevated IgE levels were detected in supernatants of PBMC from an asthma patient (2.6 ng/mL), whereas IgE levels of PBMC from non-asthmatics were low (<2.0 ng/mL) at baseline. When EGCG (0.5-50 ng/mL) was added to PBMC from the asthma patient, IgE production was suppressed in a dose-dependent manner (10-30%), compared with no EGCG. When PBMC from the asthma patient were incubated with C. pneumoniae, IgE production was suppressed (70%); when PBMC from non-asthmatics were incubated with C. pneumoniae, IgE levels remained undetectable (<2.0 ng/mL). When EGCG (0.5-50 ng/mL) was added to PBMC from the asthma patient, C. pneumoniae-induced IgE production was suppressed moderately (35-48%). CONCLUSIONS EGCG suppressed C. pneumoniae- mediated IgE responses in PBMC from a patient with asthma.
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Affiliation(s)
- Tamar A Smith-Norowitz
- Division of Infectious Diseases, Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn, New York, NY, USA -
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Rours GIJG, Smith-Norowitz TA, Ditkowsky J, Hammerschlag MR, Verkooyen RP, de Groot R, Verbrugh HA, Postma MJ. Cost-effectiveness analysis of Chlamydia trachomatis screening in Dutch pregnant women. Pathog Glob Health 2016; 110:292-302. [PMID: 27958189 PMCID: PMC5189868 DOI: 10.1080/20477724.2016.1258162] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Chlamydia trachomatis infections during pregnancy may have serious consequences for women and their offspring. Chlamydial infections are largely asymptomatic. Hence, prevention is based on screening. The objective of this study was to estimate the cost-effectiveness of C. trachomatis screening during pregnancy. We used a health-economic decision analysis model, which included potential health outcomes of C. trachomatis infection for women, partners and infants, and premature delivery. We estimated the cost-effectiveness from a societal perspective using recent prevalence data from a population-based prospective cohort study among pregnant women in the Netherlands. We calculated the averted costs by linking health outcomes with health care costs and productivity losses. Cost-effectiveness was expressed as net costs per major outcome prevented and was estimated in base-case analysis, sensitivity, and scenario analysis. In the base-case analysis, the costs to detect 1000 pregnant women with C. trachomatis were estimated at €527,900. Prevention of adverse health outcomes averted €626,800 in medical costs, resulting in net cost savings. Sensitivity analysis showed that net cost savings remained with test costs up to €22 (test price €19) for a broad range of variation in underlying assumptions. Scenario analysis showed even more cost savings with targeted screening for women less than 30 years of age or with first pregnancies only. Antenatal screening for C. trachomatis is a cost-saving intervention when testing all pregnant women in the Netherlands. Savings increase even further when testing women younger than 30 years of age or with pregnancies only.
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Affiliation(s)
- G. I. J. G. Rours
- Department of Paediatric Infectious Diseases and Immunology, Erasmus MC, Rotterdam, The Netherlands
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - Tamar Anne Smith-Norowitz
- Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn, NY 11203, USA
| | - Jared Ditkowsky
- Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn, NY 11203, USA
| | - Margaret R. Hammerschlag
- Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn, NY 11203, USA
| | - R. P. Verkooyen
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - R. de Groot
- Department of Paediatric Infectious Diseases and Immunology, Erasmus MC, Rotterdam, The Netherlands
| | - H. A. Verbrugh
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - M. J. Postma
- Unit of PharmacoEpidemiology & PharmacoEconomics (PE²), Department of Pharmacy, University of Groningen, Groningen, The Netherlands
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Seña AC, Hsu KK, Kellogg N, Girardet R, Christian CW, Linden J, Griffith W, Marchant A, Jenny C, Hammerschlag MR. Sexual Assault and Sexually Transmitted Infections in Adults, Adolescents, and Children. Clin Infect Dis 2016; 61 Suppl 8:S856-64. [PMID: 26602623 DOI: 10.1093/cid/civ786] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Survivors of sexual assault are at risk for acquiring sexually transmitted infections (STIs). We conducted literature reviews and invited experts to assist in updating the sexual assault section for the 2015 Centers for Disease Control and Prevention sexually transmitted diseases (STD) treatment guidelines. New recommendations for STI management among adult and adolescent sexual assault survivors include use of nucleic acid amplification tests (NAATs) for detection of Trichomonas vaginalis by vaginal swabs; NAATs for detection of Neisseria gonorrhoeae and Chlamydia trachomatis from pharyngeal and rectal specimens among patients with a history of exposure or suspected extragenital contact after sexual assault; empiric therapy for gonorrhea, chlamydia, and trichomoniasis based on updated treatment regimens; vaccinations for human papillomavirus (HPV) among previously unvaccinated patients aged 9-26 years; and consideration for human immunodeficiency virus (HIV) nonoccupational postexposure prophylaxis using an algorithm to assess the timing and characteristics of the exposure. For child sexual assault (CSA) survivors, recommendations include targeted diagnostic testing with increased use of NAATs when appropriate; routine follow-up visits within 6 months after the last known sexual abuse; and use of HPV vaccination in accordance with national immunization guidelines as a preventive measure in the post-sexual assault care setting. For CSA patients, NAATs are considered to be acceptable for identification of gonococcal and chlamydial infections from urine samples, but are not recommended for extragenital testing due to the potential detection of nongonococcal Neisseria species. Several research questions were identified regarding the prevalence, detection, and management of STI/HIV infections among adult, adolescent, and pediatric sexual assault survivors.
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Affiliation(s)
- Arlene C Seña
- Institute for Global Health and Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill
| | - Katherine K Hsu
- Division of STD Prevention, Bureau of Infectious Diseases, Massachusetts Department of Public Health, Jamaica Plain
| | - Nancy Kellogg
- Division of Child Abuse Pediatrics, Department of Pediatrics, University of Texas Health Science Center at San Antonio
| | - Rebecca Girardet
- Division of Child Protection Pediatrics, Department of Pediatrics, University of Texas Health Science Center at Houston
| | - Cindy W Christian
- Child Abuse and Neglect Prevention, Children's Hospital of Philadelphia, Pennsylvania
| | - Judith Linden
- Department of Emergency Medicine, Boston Medical Center and Boston University School of Medicine, Massachusetts Massachusetts Sexual Assault Nurse Examiner Program, Massachusetts Department of Public Health, Boston
| | - William Griffith
- Women's Emergency Services, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas
| | - Anne Marchant
- Massachusetts Sexual Assault Nurse Examiner Program, Massachusetts Department of Public Health, Boston
| | - Carole Jenny
- Division of General Pediatrics, Department of Pediatrics, University of Washington, Seattle
| | - Margaret R Hammerschlag
- Division of Pediatric Infectious Diseases, Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn
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Smith-Norowitz TA, Carvajal-Raga S, Weedon J, Joks R, Norowitz KB, Weaver D, Durkin HG, Hammerschlag MR, Kohlhoff S. Increased seroprevalence of Enterovirus 71 IgE antibodies in asthmatic compared with non-asthmatic children. Ir J Med Sci 2016; 186:495-503. [PMID: 27440276 DOI: 10.1007/s11845-016-1480-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 07/13/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Asthma is a common pediatric chronic inflammatory airway disease. Respiratory viral infections are frequent infectious triggers for exacerbations of asthma. OBJECTIVE We sought to determine whether Enterovirus 71 (EV71), a ubiquitous virus that causes systemic inflammatory responses in children but is not a known respiratory pathogen, can also serve as an infectious trigger for asthma. METHODS Specific EV71 IgE and IgM antibodies (Abs), total serum IgE, and IL-2 and IL-4 cytokine levels in serum of asthmatic and non-asthmatic children (N = 42, ages 5-19; N = 35, ages 1-20, respectively) were measured (ELISA). RESULTS Asthmatic children had higher EV71 IgE Ab levels than non-asthmatic (P < 0.001). Non-asthmatic children had significantly higher EV71 IgM Ab levels than asthmatic (P < 0.001). Despite low serum IgE levels of non-asthmatic, compared with asthmatic (P < 0.001), the non-asthmatic children produced significantly more IL-2 and IL-4 than asthmatic (P < 0.001; P < 0.001). The ages of the asthmatics, but not the non-asthmatics had a significant effect on the levels of EV 71 IgE Abs (P = 0.02; P = 0.356). A test of difference between these two slopes was significant. However, the ages of the non-asthmatic, but not the asthmatic children had a significant effect on the levels of EV 71 IgM Abs; a test of difference between these two slopes was significant. CONCLUSIONS Increased specific EV71 IgE Ab responses may indicate that EV71 infection may also be an infectious trigger in asthma. However, the role of specific EV71 IgM Abs, Th2 cytokines, and age in non-asthmatic children should be further studied.
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Affiliation(s)
- T A Smith-Norowitz
- Department of Pediatrics, State University of New York Downstate Medical Center, Box 49, 450 Clarkson Ave., Brooklyn, New York, 11203, USA. .,Center for Allergy and Asthma Research, State University of New York Downstate Medical Center, Brooklyn, New York, 11203, USA.
| | - S Carvajal-Raga
- Department of Pediatrics, State University of New York Downstate Medical Center, Box 49, 450 Clarkson Ave., Brooklyn, New York, 11203, USA
| | - J Weedon
- Statistical Design and Analysis Research Division, State University of New York Downstate Medical Center, Brooklyn, New York, 11203, USA
| | - R Joks
- Department of Medicine, State University of New York Downstate Medical Center, Brooklyn, New York, 11203, USA.,Center for Allergy and Asthma Research, State University of New York Downstate Medical Center, Brooklyn, New York, 11203, USA
| | - K B Norowitz
- Department of Pediatrics, State University of New York Downstate Medical Center, Box 49, 450 Clarkson Ave., Brooklyn, New York, 11203, USA
| | - D Weaver
- Department of Pediatrics, State University of New York Downstate Medical Center, Box 49, 450 Clarkson Ave., Brooklyn, New York, 11203, USA
| | - H G Durkin
- Department of Pathology, State University of New York Downstate Medical Center, Brooklyn, New York, 11203, USA.,Center for Allergy and Asthma Research, State University of New York Downstate Medical Center, Brooklyn, New York, 11203, USA
| | - M R Hammerschlag
- Department of Pediatrics, State University of New York Downstate Medical Center, Box 49, 450 Clarkson Ave., Brooklyn, New York, 11203, USA
| | - S Kohlhoff
- Department of Pediatrics, State University of New York Downstate Medical Center, Box 49, 450 Clarkson Ave., Brooklyn, New York, 11203, USA.,Center for Allergy and Asthma Research, State University of New York Downstate Medical Center, Brooklyn, New York, 11203, USA
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Smith-Norowitz TA, Saadia TA, Banniettis N, Norowitz YM, Joks R, Hammerschlag MR, Durkin HG, Kohlhoff S. IgE anti-Haemophilus influenzae type b (Hib) antibodies detected in serum of Hib-vaccinated asthmatic and non-asthmatic pediatric patients. Minerva Pediatr 2016; 70:111-116. [PMID: 27187042 DOI: 10.23736/s0026-4946.16.04564-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Haemophilus influenzae type b (Hib) bacterium causes severe illness in infants and children, but has largely been eliminated by introducing a universal Hib conjugate vaccine. While effects of certain vaccinations on atopic disease have been studied, little is known about the relationship between Hib vaccination and diseases of altered immunoglobulin E (IgE) regulation (asthma or atopy). As such, it is necessary to provide more evidence concerning Hib vaccination as a possible risk factor for atopic disease. METHODS Total serum IgE and IgE-and IgG-anti-Hib antibody responses were studied in Hib vaccinated asthmatic (N.=14) and non-asthmatic children (N=26) (VaccZyme™ Human Anti Hib Enzyme Immunoassay Kit). Data are reported as mean optical density (OD) values. RESULTS We found that: 1) total serum IgE levels were higher in asthmatic compared with non-asthmatic subjects (389±125 vs. 125±129, P<0.001); 2) IgE and IgG anti-Hib antibody responses were similar in both asthmatic and non-asthmatic subjects (0.722±0.279 and 0.681±0.280, respectively; P=0.65; 0.450±0.505 and 0.573±0.779, respectively; P=0.580). CONCLUSIONS The universal Hib vaccine antigen did not result in either increased IgE, or IgG anti-Hib antibody responses in asthmatic or non-asthmatics subjects. Thus, in this cohort, no association between Hib vaccination and asthma status was identified.
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Affiliation(s)
- Tamar A Smith-Norowitz
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Brooklyn, NY, USA -
| | - Tehila A Saadia
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - Natalie Banniettis
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - Yitzchok M Norowitz
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - Rauno Joks
- Department of Medicine, Division of Allergy and Immunology, State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - Margaret R Hammerschlag
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - Helen G Durkin
- Department of Pathology, State University of New York Downstate Medical Center, Brooklyn, NY, USA
| | - Stephan Kohlhoff
- Department of Pediatrics, Division of Infectious Diseases, State University of New York Downstate Medical Center, Brooklyn, NY, USA
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Smith-Norowitz TA, Chotikanatis K, Erstein DP, Perlman J, Norowitz YM, Joks R, Durkin HG, Hammerschlag MR, Kohlhoff S. Chlamydia pneumoniae enhances the Th2 profile of stimulated peripheral blood mononuclear cells from asthmatic patients. Hum Immunol 2016; 77:382-8. [PMID: 26924667 DOI: 10.1016/j.humimm.2016.02.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 02/23/2016] [Accepted: 02/24/2016] [Indexed: 01/31/2023]
Abstract
Chlamydia pneumoniae is a cause of respiratory infection in adults and children. There is evidence for an association between atypical bacterial respiratory pathogens and the pathogenesis of asthma. We compared T helper (Th) responses in C. pneumoniae - infected peripheral blood mononuclear cells (PBMC) in patients with or without asthma. PBMC (1×10(6)/mL) from asthmatic patients (N=11) and non-asthmatic controls (N=12) were infected or mock-infected for 1h +/- C. pneumoniae TW-183 at a multiplicity of infection (MOI)=1 and MOI=0.1, or cultured for 24h +/- Lactobacillus rhamnosus GG (LGG). Interleukin (IL)-4, IL-10, IL-12, Interferon (IFN)-gamma and total IgE levels were measured in supernatants (ELISA). C. pneumoniae infection led to an increase (>50%) of IgE levels in PBMC from asthmatics, compared with mock-infected on day 10; IgE wasn't detected in non-asthmatics. C. pneumoniae - infected PBMC from asthmatics increased levels of IL-4 and IFN-gamma after 24h, compared with PBMC alone; levels of IL-10 and IL-12 were low. When uninfected-PBMC from asthmatics were LGG-stimulated, after 24h, IL-4 was undetectable, but IL-10, IL-12, and IFN-gamma increased, compared with PBMC alone. Thus, C. pneumoniae infection has the ability to induce allergic responses in PBMC of asthmatics, as evidenced by production of Th2 responses and IgE.
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Affiliation(s)
- Tamar A Smith-Norowitz
- Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn, NY 11203, United States; Center for Allergy and Asthma Research, State University of New York Downstate Medical Center, Brooklyn, NY 11203, United States.
| | - Kobkul Chotikanatis
- Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn, NY 11203, United States
| | - David P Erstein
- Department of Medicine, State University of New York Downstate Medical Center, Brooklyn, NY 11203, United States
| | - Jason Perlman
- Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn, NY 11203, United States
| | - Yitzchok M Norowitz
- Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn, NY 11203, United States
| | - Rauno Joks
- Department of Medicine, State University of New York Downstate Medical Center, Brooklyn, NY 11203, United States; Center for Allergy and Asthma Research, State University of New York Downstate Medical Center, Brooklyn, NY 11203, United States
| | - Helen G Durkin
- Department of Pathology, State University of New York Downstate Medical Center, Brooklyn, NY 11203, United States; Center for Allergy and Asthma Research, State University of New York Downstate Medical Center, Brooklyn, NY 11203, United States
| | - Margaret R Hammerschlag
- Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn, NY 11203, United States
| | - Stephan Kohlhoff
- Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn, NY 11203, United States; Center for Allergy and Asthma Research, State University of New York Downstate Medical Center, Brooklyn, NY 11203, United States
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Banniettis N, Sharma R, Hand I, Peloquin CA, Kohlhoff S, Hammerschlag MR. Steady-state pharmacokinetics of oral linezolid suspension in a premature infant with osteomyelitis. J Antimicrob Chemother 2016; 71:1738. [PMID: 26851607 DOI: 10.1093/jac/dkv507] [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)
- Natalie Banniettis
- Department of Pediatrics, State University of New York Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY, USA
| | - Roopali Sharma
- Department of Pharmacy Practice, State University of New York Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY, USA
| | - Ivan Hand
- Department of Pediatrics, State University of New York Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY, USA
| | - Charles A Peloquin
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, PO Box 100486, Gainesville, FL, USA
| | - Stephan Kohlhoff
- Department of Pediatrics, State University of New York Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY, USA
| | - Margaret R Hammerschlag
- Department of Pediatrics, State University of New York Downstate Medical Center, 450 Clarkson Avenue, Brooklyn, NY, USA
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Chotikanatis K, Suman N, Bäcker M, Paudyal B, Schoeneman M, Kohlhoff S, Hammerschlag MR. Pediatric Fistula Initiative: Reducing Bloodstream Infections in an Outpatient Pediatric Hemodialysis Center. J Pediatric Infect Dis Soc 2015; 4:363-6. [PMID: 26582876 DOI: 10.1093/jpids/piu053] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 05/07/2014] [Indexed: 11/12/2022]
Abstract
Bloodstream infection is a major contributor to morbidity and mortality in children on hemodialysis (HD). From January 2009 through April 2011, the incidence of access-related bloodstream infections (ARBs) in pediatric patients on HD at our hospital was 3.45/1000 patient days. Almost all of these children were receiving HD via central line catheters, and none were receiving HD via arteriovenous fistulas (AVFs). In an effort to reduce the rate of infection in children receiving HD at our institution, we introduced the Pediatric Fistula Initiative, a program to increase creation and use of AVFs in children. Thirty-three children on HD were observed, 9 of whom received AVFs during the study period. The incidence of ARBs decreased to 1.30/1000 patient days (P < .001) during the 24-month intervention period from May 2011 through May 2013.
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Affiliation(s)
| | | | - Martin Bäcker
- Department of Pediatrics Division of Pediatric Infectious Diseases
| | - Bandana Paudyal
- Department of Pediatrics Division of Nephrology, Children's Hospital at Downstate, SUNY Downstate Medical Center, Brooklyn, New York
| | - Morris Schoeneman
- Department of Pediatrics Division of Nephrology, Children's Hospital at Downstate, SUNY Downstate Medical Center, Brooklyn, New York
| | - Stephan Kohlhoff
- Department of Pediatrics Division of Pediatric Infectious Diseases
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Banniettis N, Szigeti A, Thumu S, Kohlhoff S, Hammerschlag MR. P03.03 Seroprevalence of chlamydia trachomatis(ct) in american children and adolescents – implications for vaccine development. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.231] [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: 11/04/2022]
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Banniettis N, Szigeti A, Sharma S, Chotikanatis K, Hammerschlag MR, Kohlhoff S. P03.04 The impact of universal chlamydia trachomatis(ct) screening during pregnancy on seroepidemiology of chlamydial infection in american children, 1991–2013. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.232] [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: 11/03/2022]
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Abstract
INTRODUCTION Chlamydiae are obligate intracellular bacterial pathogens whose entry into mucosal epithelial cells is required for intracellular survival and subsequent growth. The life cycle of Chlamydia spp. and the ability to cause persistent, often subclinical infection, has major ramifications for diagnosis and treatment of Chlamydia trachomatis and C. pneumoniae infections in humans. AREAS COVERED This paper reviews the current literature on the antimicrobial susceptibilities and treatment of genital infections due to C. trachomatis and respiratory infections due to C. pneumoniae published since 2011. EXPERT OPINION Chlamydiae are susceptible to antibiotics that interfere with DNA and protein synthesis, including tetracyclines, macrolides and quinolones, which are the compounds that have been most extensively studied and used for treatment of human infection. Since our original review was published in 2011, there have been some major advances in diagnostic tests for C. trachomatis and the introduction of the first FDA-approved test for the detection of C. pneumoniae in respiratory samples. However, the options for treating chlamydial infections have largely remained the same. There are a small number of new drugs currently in preclinical development and early clinical trials that may have a role in the treatment of chlamydial infections.
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Affiliation(s)
- Stephan A Kohlhoff
- SUNY Downstate Medical Center, Division of Infectious Diseases, Department of Pediatrics , 450 Clarkson Ave., Brooklyn, NY 11203-2098 , USA
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Kumar S, Smith-Norowitz TA, Kohlhoff S, Apfalter P, Roblin P, Kutlin A, Harkema J, Ng SP, Doherty-Lyons S, Zelikoff JT, Hammerschlag MR. Exposure to cigarette smoke and Chlamydia pneumoniae infection in mice: Effect on infectious burden, systemic dissemination and cytokine responses: A pilot study. J Immunotoxicol 2015; 13:77-83. [PMID: 25640695 DOI: 10.3109/1547691x.2015.1006346] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Cigarette smoke exposure has been considered a risk factor for infection with Chlamydia pneumoniae. C. pneumoniae infection is associated with respiratory tract infection and chronic respiratory disease, which is a serious public health concern. To determine whether prior exposure to cigarette smoke worsens C. pneumoniae infection (specifically, increases infectious burden and systemic dissemination) as well as alters cytokine responses in mice, adult female C57BL/6 mice were exposed to either filtered air (FA) or mainstream cigarette smoke (MCS) (15 mg/m(3), total suspended particulates) for 5 days/week for 2 weeks and then infected with C. pneumoniae (10(5) IFU) via intratracheal instillation. Mice were euthanized on Days 7, 14 or 26 post-infection (p.i.). Chlamydial burdens in the lungs and spleen were quantified by quantitative PCR (qPCR) and histologic analyses were performed; cytokine levels (TNFα, IL-4, IFNγ) in bronchoalveolar lavage fluid and serum were assayed by enzyme-linked immunosorbent assay (ELISA). The results indicated that: (1) mice exposed to either FA or MCS had similar chlamydial burdens in the lungs and spleen on Days 14 and 26 p.i.; (2) proximal and distal airway inflammation was observed on Day 14 p.i. in both FA and MCS mice, but persisted in MCS mice until Day 26 p.i.; FA exposed mice demonstrated resolution of distal airway inflammation; and (3) MCS mice displayed higher serum levels of IFNγ and IL-4 on Day 26 p.i. These findings indicate that exposure of mice to MCS (at a concentration equivalent to smoking < 1 pack cigarettes/day) led to greater C. pneumoniae-induced inflammation, as indicated by prolonged inflammatory changes.
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Affiliation(s)
- Swati Kumar
- a Department of Pediatrics , State University of New York Downstate Medical Center , Brooklyn , NY , USA
| | - Tamar A Smith-Norowitz
- a Department of Pediatrics , State University of New York Downstate Medical Center , Brooklyn , NY , USA
| | - Stephan Kohlhoff
- a Department of Pediatrics , State University of New York Downstate Medical Center , Brooklyn , NY , USA
| | - Petra Apfalter
- a Department of Pediatrics , State University of New York Downstate Medical Center , Brooklyn , NY , USA
| | - Patricia Roblin
- a Department of Pediatrics , State University of New York Downstate Medical Center , Brooklyn , NY , USA
| | - Andrei Kutlin
- a Department of Pediatrics , State University of New York Downstate Medical Center , Brooklyn , NY , USA
| | - Jack Harkema
- b Center for Integrative Toxicology, Michigan State University , East Lansing , MI , USA
| | - Sheung P Ng
- c DuPont Stine Haskell Research Center , Newark , DE , USA , and
| | - Shannon Doherty-Lyons
- d Department of Environmental Medicine , New York University School of Medicine , Tuxedo , NY , USA
| | - Judith T Zelikoff
- d Department of Environmental Medicine , New York University School of Medicine , Tuxedo , NY , USA
| | - Margaret R Hammerschlag
- a Department of Pediatrics , State University of New York Downstate Medical Center , Brooklyn , NY , USA
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Dzhindzhikhashvili MS, Joks R, Smith-Norowitz T, Durkin HG, Chotikanatis K, Estrella E, Hammerschlag MR, Kohlhoff SA. Doxycycline suppresses Chlamydia pneumoniae-mediated increases in ongoing immunoglobulin E and interleukin-4 responses by peripheral blood mononuclear cells of patients with allergic asthma. J Antimicrob Chemother 2013; 68:2363-8. [PMID: 23749949 DOI: 10.1093/jac/dkt179] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Chlamydia pneumoniae, an obligate intracellular bacterium, has been associated with asthma and the induction of immunoglobulin E (IgE) responses. Whereas tetracyclines have anti-chlamydial activity, their effect on human IgE responses to C. pneumoniae has not been studied. METHODS Peripheral blood mononuclear cells (PBMCs) from serum IgE+ allergic asthmatic subjects (n = 11) and healthy controls (n = 12) were infected with C. pneumoniae and cultured for 12 days with or without doxycycline (0.01-1.0 mg/L). IgE, interferon (IFN)-γ and interleukin (IL)-4 levels in supernatants were determined on days 1-12 post-infection, and C. pneumoniae DNA copy numbers in PBMC culture were measured on day 2 (quantitative PCR). RESULTS C. pneumoniae-infected PBMCs from allergic asthmatic individuals had increased levels of IgE in supernatants compared with uninfected PBMCs (520% on day 10 post-infection, P = 0.008). IgE levels in PBMC cultures from controls were undetectable (<0.3 ng/mL). Increases in C. pneumoniae-induced IgE in asthmatics correlated with those of C. pneumoniae-induced IL-4 (r = 0.98; P < 0.001), but not with IFN-γ. The addition of doxycycline (1.0 mg/L) to the culture strongly suppressed the production of IgE (>70%, P = 0.04) and IL-4 (75%, P = 0.018), but not IFN-γ. The suppressive effect on IL-4 production remained significant even at concentrations of doxycycline that were subinhibitory (0.01 mg/L) for C. pneumoniae. In both asthmatic participants and controls, no significant effect of doxycycline on DNA copy numbers of C. pneumoniae was observed. CONCLUSIONS Doxycycline suppressed the C. pneumoniae-induced production of IgE and IL-4, but not IFN-γ, in PBMCs from IgE+ allergic asthmatic subjects. These findings resulted from the immunomodulatory anti-allergic properties of tetracyclines.
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Affiliation(s)
- M S Dzhindzhikhashvili
- Center for Allergy and Asthma Research at SUNY Downstate, State University of New York (SUNY) Downstate Medical Center, 450 Clarkson Ave., Brooklyn, NY 11203, USA
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Abstract
INTRODUCTION Chlamydiae are obligate intracellular bacterial pathogens whose entry into mucosal epithelial cells is required for intracellular survival and subsequent growth. The life cycle of Chlamydia spp. and the ability to cause persistent, often subclinical infection, has major ramifications for diagnosis and treatment of C. trachomatis and C. pneumoniae infections in humans. AREAS COVERED This up-to-date review describes the current state of knowledge of antimicrobial susceptibilities and treatment of genital infections due to C. trachomatis and respiratory infections due to C. pneumoniae. EXPERT OPINION Chlamydiae are susceptible to antibiotics that interfere with DNA and protein synthesis, including tetracyclines, macrolides and quinolones, which are the compounds that have been most extensively studied and used for treatment of human infection. Treatment of individuals with C. trachomatis genital infection prevents sexual transmission and complications, including pelvic inflammatory disease. Treatment of pregnant women will prevent the transmission of infection to infants during delivery. The benefits of treatment of respiratory infections due to C. pneumoniae are more difficult to assess, primarily because of the lack of FDA-approved, specific diagnostic tests for detection of the organism in clinical samples. The majority of published studies have relied on serology for diagnosis, making it difficult to assess microbiologic efficacy.
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Affiliation(s)
- Margaret R Hammerschlag
- SUNY Downstate Medical Center, Division of Infectious Diseases, Department of Pediatrics, 450 Clarkson Avenue, Brooklyn, NY 11203-2098, USA.
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Hammerschlag MR, Gaydos CA. Guidelines for the use of molecular biological methods to detect sexually transmitted pathogens in cases of suspected sexual abuse in children. Methods Mol Biol 2012; 903:307-17. [PMID: 22782828 PMCID: PMC4117404 DOI: 10.1007/978-1-61779-937-2_21] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Testing for sexually transmitted infections (STIs) in children presents a number of problems for the practitioner that are not usually faced when testing adults for the same infections. The identification of an STI in a child, in addition to medical implications, can have serious legal implications. The presence of an STI is often used to support the presence or allegations of sexual abuse and conversely, the identification of an STI in a child will prompt an investigation of possible abuse. The significance of the identification of a sexually transmitted agent in such children as evidence of possible child sexual abuse varies by pathogen.While culture has historically been used for the detection of STIs in cases of suspected abuse in children, the increasing use of nucleic acid amplification tests (NAATs) in adults and the increasing proliferation of second-generation tests with better sensitivity and specificity has made inroads into the use of such tests in children, especially for diagnostic and treatment purposes. Acceptance by the medicolegal system for sexual abuse cases is still controversial and more test cases will be necessary before definitive use becomes standard practice. In addition, if these assays ever become legally admissible in court, there will be recommendations that more than one NAAT assay be used in order to assure confirmation of the diagnostic result.
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Affiliation(s)
- Margaret R Hammerschlag
- Division of Pediatric Infectious Diseases, Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn, NY, USA.
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