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Damhorst GL, Fujita AW, Fitts E, Szabo B, Bowers HB, Sabino C, Ahmed A, Wang E, Piantadosi A, McLendon K, Sullivan J, Greenleaf M, McCaslin D, Palmore M, Anderson AM, Aldred B, Gunthel C, Martin GS, Colasanti JA, Lam WA, Bassit L, Rao A, Sheth AN, Titanji BK. Multisite Mpox Infection and Viral Dynamics Among Persons With HIV in Metro Atlanta. J Infect Dis 2024; 229:S213-S218. [PMID: 38019187 DOI: 10.1093/infdis/jiad530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 11/20/2023] [Accepted: 11/27/2023] [Indexed: 11/30/2023] Open
Abstract
The 2022 mpox outbreak primarily involved sexual transmission among men who have sex with men and disproportionately affected persons with human immunodeficiency virus (HIV). We examined viral dynamics and clinical features in a cohort evaluated for mpox infection at a comprehensive HIV clinic in Atlanta, Georgia. Viral DNA was found in 8 oropharyngeal and 5 anorectal specimens among 10 mpox cases confirmed by lesion swab polymerase chain reaction. Within-participant anatomic site of lowest cycle threshold (Ct) value varied, and lower Ct values were found in oropharyngeal and anorectal swabs when corresponding symptoms were present. This provides insight into mpox infection across multiple anatomic sites among people with HIV.
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Affiliation(s)
- Gregory L Damhorst
- Division of Infectious Diseases, Department of Medicine, Emory University
- Ponce de Leon Center, Grady Health System
- Atlanta Center for Microsystems-Engineered Point-of-Care Technologies
| | - A Wendy Fujita
- Division of Infectious Diseases, Department of Medicine, Emory University
- Ponce de Leon Center, Grady Health System
| | - Eric Fitts
- Atlanta Center for Microsystems-Engineered Point-of-Care Technologies
- Department of Pathology and Laboratory Medicine
| | - Brittany Szabo
- Division of Infectious Diseases, Department of Medicine, Emory University
- Ponce de Leon Center, Grady Health System
| | - Heather B Bowers
- Atlanta Center for Microsystems-Engineered Point-of-Care Technologies
- Department of Pediatrics, School of Medicine
- Laboratory of Biochemical Pharmacology
| | - Courtney Sabino
- Atlanta Center for Microsystems-Engineered Point-of-Care Technologies
- Department of Pediatrics, School of Medicine
- Laboratory of Biochemical Pharmacology
| | | | - Ethan Wang
- Department of Pathology and Laboratory Medicine
| | - Anne Piantadosi
- Division of Infectious Diseases, Department of Medicine, Emory University
- Department of Pathology and Laboratory Medicine
| | | | - Julie Sullivan
- Atlanta Center for Microsystems-Engineered Point-of-Care Technologies
- Department of Pediatrics, School of Medicine
| | - Morgan Greenleaf
- Atlanta Center for Microsystems-Engineered Point-of-Care Technologies
| | | | - Melody Palmore
- Division of Infectious Diseases, Department of Medicine, Emory University
- Ponce de Leon Center, Grady Health System
| | - Albert M Anderson
- Division of Infectious Diseases, Department of Medicine, Emory University
- Ponce de Leon Center, Grady Health System
| | - Bruce Aldred
- Division of Infectious Diseases, Department of Medicine, Emory University
- Ponce de Leon Center, Grady Health System
| | - Clifford Gunthel
- Division of Infectious Diseases, Department of Medicine, Emory University
- Ponce de Leon Center, Grady Health System
| | - Greg S Martin
- Atlanta Center for Microsystems-Engineered Point-of-Care Technologies
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University
| | - Jonathan A Colasanti
- Division of Infectious Diseases, Department of Medicine, Emory University
- Ponce de Leon Center, Grady Health System
| | - Wilbur A Lam
- Atlanta Center for Microsystems-Engineered Point-of-Care Technologies
- Department of Pediatrics, School of Medicine
- Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia
| | - Leda Bassit
- Atlanta Center for Microsystems-Engineered Point-of-Care Technologies
- Department of Pediatrics, School of Medicine
- Laboratory of Biochemical Pharmacology
| | - Anuradha Rao
- Atlanta Center for Microsystems-Engineered Point-of-Care Technologies
- Department of Pediatrics, School of Medicine
| | - Anandi N Sheth
- Division of Infectious Diseases, Department of Medicine, Emory University
- Ponce de Leon Center, Grady Health System
| | - Boghuma K Titanji
- Division of Infectious Diseases, Department of Medicine, Emory University
- Ponce de Leon Center, Grady Health System
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Damhorst GL, Watts A, Hernandez-Romieu A, Mel N, Palmore M, Ali IKM, Neill SG, Kalapila A, Cope JR. Acanthamoeba castellanii encephalitis in a patient with AIDS: a case report and literature review. Lancet Infect Dis 2022; 22:e59-e65. [PMID: 34461057 PMCID: PMC10910629 DOI: 10.1016/s1473-3099(20)30933-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 11/22/2020] [Accepted: 11/23/2020] [Indexed: 11/17/2022]
Abstract
Amoebic encephalitis is a rare cause of CNS infection for which mortality exceeds 90%. We present the case of a 27-year-old man with AIDS who presented to a hospital in Atlanta (Georgia, USA) with tonic-clonic seizures and headache. His clinical condition deteriorated over several days. Brain biopsy revealed lymphohistiocytic inflammation and necrosis with trophozoites and encysted forms of amoebae. Immunohistochemical and PCR testing confirmed Acanthamoeba castellanii encephalitis, typically described as granulomatous amoebic encephalitis (GAE). No proven therapy for GAE is available, although both surgical and multiagent antimicrobial treatment strategies are often used. Most recently, these include the antileishmanial agent miltefosine. Here we review all cases of GAE due to Acanthamoeba spp in people with HIV/AIDS identified in the literature and reported to the Centers for Disease Control and Prevention. We describe this case as a reminder to the clinician to consider protozoal infections, especially free-living amoeba, in the immunocompromised host with a CNS infection refractory to traditional antimicrobial therapy.
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Affiliation(s)
- Gregory L Damhorst
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, GA, USA.
| | - Abigail Watts
- Division of Pulmonary Critical Care & Sleep Medicine and Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | | | - Nonglin Mel
- Family Medicine, Broward Health, Fort Lauderdale, FL, USA
| | - Melody Palmore
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, GA, USA
| | - Ibne Karim M Ali
- Free-Living and Intestinal Amebas (FLIA) Laboratory, Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Stewart G Neill
- Department of Pathology & Laboratory Medicine, Emory University, Atlanta, GA, USA
| | - Aley Kalapila
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, GA, USA
| | - Jennifer R Cope
- Domestic Water, Sanitation, and Hygiene Epidemiology Team, Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Davies G, Koenig LJ, Stratford D, Palmore M, Bush T, Golde M, Malatino E, Todd-Turner M, Ellerbrock TV. Overview and implementation of an intervention to prevent adherence failure among HIV-infected adults initiating antiretroviral therapy: lessons learned from Project HEART. AIDS Care 2007; 18:895-903. [PMID: 17012078 DOI: 10.1080/09540120500329556] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Project HEART, an acronym for Helping Enhance Adherence to Retroviral Therapy, was a prospective, controlled study to develop, implement, and evaluate a clinic-based behavioural intervention to prevent adherence failure among HIV-infected adults beginning their first highly active antiretroviral therapy (HAART) regimen (N = 227). In this paper, we describe the conceptualisation of the Project HEART adherence intervention, characteristics of the participants, and lessons learned implementing HEART in an inner-city clinic setting. A multi-component intervention, HEART combined enhanced education, reminders, adherence feedback, social support and adherence-focused problem solving in an integrated manner to address common cognitive, motivational, and social barriers to adherence. Unique components of the intervention included use of participant-identified adherence support partners and a standardized adherence barriers assessment to develop and implement individualised adherence plans. Lessons learned regarding the feasibility of using participant-identified support partners were as follows. Few participants eligible for the study had trouble identifying a support partner. Over 90% of support partners attended at least one intervention visit. Support partners were most available and amenable to participate early in the initiation of therapy. Participants' experiences as the 'supported' partner were generally positive. Though many participants faced barriers not easily addressed by this intervention (for example, housing instability), formally integrating support partners into the intervention helped to address many other common adherence barriers. Family and friends are an under-utilised resource in HIV medication adherence. Enlisting the help of support partners is a practical and economical approach to adherence counselling.
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Affiliation(s)
- G Davies
- Emory University School of Medicine, Atlanta, Georgia 30308, USA.
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