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Davis JW, Wang B, Tomczak E, Chi-Fu C, Harmouch W, Reynoso D, Keiser P, Cabada MM. Prediction of the need for intensive oxygen supplementation during hospitalisation among subjects with COVID-19 admitted to an academic health system in Texas: a retrospective cohort study and multivariable regression model. BMJ Open 2022; 12:e058238. [PMID: 35361651 PMCID: PMC8971360 DOI: 10.1136/bmjopen-2021-058238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE SARS-CoV-2 has caused a pandemic claiming more than 4 million lives worldwide. Overwhelming COVID-19 respiratory failure placed tremendous demands on healthcare systems increasing the death toll. Cost-effective prognostic tools to characterise the likelihood of patients with COVID-19 to progress to severe hypoxemic respiratory failure are still needed. DESIGN We conducted a retrospective cohort study to develop a model using demographic and clinical data collected in the first 12 hours of admission to explore associations with severe hypoxemic respiratory failure in unvaccinated and hospitalised patients with COVID-19. SETTING University-based healthcare system including six hospitals located in the Galveston, Brazoria and Harris counties of Texas. PARTICIPANTS Adult patients diagnosed with COVID-19 and admitted to one of six hospitals between 19 March and 30 June 2020. PRIMARY OUTCOME The primary outcome was defined as reaching a WHO ordinal scale between 6 and 9 at any time during admission, which corresponded to severe hypoxemic respiratory failure requiring high-flow oxygen supplementation or mechanical ventilation. RESULTS We included 329 participants in the model cohort and 62 (18.8%) met the primary outcome. Our multivariable regression model found that lactate dehydrogenase (OR 2.36), Quick Sequential Organ Failure Assessment score (OR 2.26) and neutrophil to lymphocyte ratio (OR 1.15) were significant predictors of severe disease. The final model showed an area under the curve of 0.84. The sensitivity analysis and point of influence analysis did not reveal inconsistencies. CONCLUSIONS Our study suggests that a combination of accessible demographic and clinical information collected on admission may predict the progression to severe COVID-19 among adult patients with mild and moderate disease. This model requires external validation prior to its use.
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Affiliation(s)
- John W Davis
- School of Public and Population Health Sciences, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
- School of Medicine, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Beilin Wang
- Internal Medicine, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Ewa Tomczak
- Internal Medicine, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Chia Chi-Fu
- School of Medicine, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Wissam Harmouch
- School of Medicine, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - David Reynoso
- Internal Medicine, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Philip Keiser
- Internal Medicine, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Miguel Mauricio Cabada
- Internal Medicine, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
- Medicine, Instituto de Medicina Tropical 'Alexander von Humboldt', Wanchaq, Cusco, Peru
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Caravedo MA, White AC, Morales ML, Lopez M, Tanabe MB, Baca-Turpo B, Arque E, Madrid D, Vallabh P, Bascope R, Cabada MM. Comparison of Liver Condemnation and Bile Microscopy As Tools to Estimate Fasciola hepatica Prevalence and Burden in the Anta Province of Cusco in Peru. Vector Borne Zoonotic Dis 2021; 21:707-712. [PMID: 34129405 DOI: 10.1089/vbz.2020.2753] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Fascioliasis is a zoonotic infection linked to significant economic losses in the livestock industry. Infection prevalence and estimated financial burden vary across locations owing to different diagnostic tests used. The accuracy of liver condemnation to estimate the prevalence and costs of fascioliasis has seldom been evaluated. We performed a pilot study to determine the prevalence and burden of Fasciola hepatica infection among cattle slaughtered at the municipal abattoir in the Anta province of the Cusco highlands in Peru. We compared liver condemnation with bile microscopy for the diagnosis of infection and prediction of carcass weight. Data were collected from 2009 slaughtered cattle for 1 year. The overall prevalence of Fasciola infection by bile microscopy was 62.5% (1247/2009). A higher prevalence was observed after the rainy season from March to August than from September to February (p < 0.01). Fascioliasis prevalence during the first 6 months was 77.4% (714/923), combining the results of condemnation and microscopy. Bile microscopy diagnosed more infections than liver condemnation (62.7% (579/923) versus 55.4% (511/923), McNemar test p < 0.01). The agreement of the bile microscopy testing with liver condemnation was fair (κ = 0.247). Animal age, gender, breed, and liver condemnation predicted carcass weight [F (df 4, 704) = 61.1, p < 0.001]. Liver condemnation and bile microscopy are complementary tools for evaluation of the prevalence and burden of fascioliasis in livestock. Large scale studies are warranted to confirm our results.
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Affiliation(s)
- Maria Alejandra Caravedo
- Division of Infectious Disease, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - A Clinton White
- Division of Infectious Disease, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA.,Cusco Branch-Tropical Medicine Institute, Universidad Peruana Cayetano Heredia, Cusco, Peru
| | - Maria Luisa Morales
- Cusco Branch-Tropical Medicine Institute, Universidad Peruana Cayetano Heredia, Cusco, Peru
| | - Martha Lopez
- Cusco Branch-Tropical Medicine Institute, Universidad Peruana Cayetano Heredia, Cusco, Peru
| | - Melinda Barbara Tanabe
- Division of Infectious Disease, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Benicia Baca-Turpo
- Cusco Branch-Tropical Medicine Institute, Universidad Peruana Cayetano Heredia, Cusco, Peru
| | - Eulogia Arque
- Cusco Branch-Tropical Medicine Institute, Universidad Peruana Cayetano Heredia, Cusco, Peru
| | - Daniela Madrid
- Cusco Branch-Tropical Medicine Institute, Universidad Peruana Cayetano Heredia, Cusco, Peru
| | - Prithvi Vallabh
- Division of Infectious Disease, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Ruben Bascope
- Zoonosis Unit, Direccion Regional de Salud del Cusco, Ministerio de Salud, Cusco, Peru
| | - Miguel Mauricio Cabada
- Division of Infectious Disease, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA.,Cusco Branch-Tropical Medicine Institute, Universidad Peruana Cayetano Heredia, Cusco, Peru
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Caravedo MA, Cabada MM. Human Fascioliasis: Current Epidemiological Status and Strategies for Diagnosis, Treatment, and Control. Res Rep Trop Med 2020; 11:149-158. [PMID: 33273878 PMCID: PMC7705270 DOI: 10.2147/rrtm.s237461] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 09/21/2020] [Accepted: 11/12/2020] [Indexed: 12/12/2022] Open
Abstract
Purpose of the Review This review aims to critically assess current knowledge about the epidemiology, diagnosis, and management of Fasciola infection in humans. Recent Findings Fascioliasis is an emerging neglected zoonotic infection affecting the health and wellbeing of human populations. The burden of infection is unclear, and studies have shown the geographic expansion of fascioliasis in human and livestock likely related to climate change. The infection can be asymptomatic or present in acute or chronic forms. Regardless of the presentation, fascioliasis can be associated with long-term complications such as anemia and malnutrition. Early in the infection, antibody testing is the only tool available for diagnosis confirmation. In the chronic forms serology and stool microscopy are helpful. Other tests such as antigen detection and PCR-based methods including isothermal tests have shown promising results. Triclabendazole is the only drug available to treat Fasciola infection. However, reports of resistant infections in livestock and human threaten the clinical care and control of the infection in endemic areas. Summary Fascioliasis is an emerging infection around the world with an uncertain burden. Lack of standardization of diagnostic testing and treatment alternatives hinder treatment and control of the infection.
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Affiliation(s)
- Maria Alejandra Caravedo
- Division of Infectious Diseases Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Miguel Mauricio Cabada
- Division of Infectious Diseases Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA.,Cusco Branch - Tropical Medicine Institute, Universidad Peruana Cayetano Heredia, Cusco, Peru
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Morales ML, Lopez M, Ly P, Anjum S, Fernandez-Baca MV, Valdivia-Rodriguez AM, Mamani-Licona FM, Baca-Turpo B, Farfan-Gonzales N, Chaman-Illanes Y, Cabada MM. Strongyloides stercoralis Infection at Different Altitudes of the Cusco Region in Peru. Am J Trop Med Hyg 2020; 101:422-427. [PMID: 31264557 DOI: 10.4269/ajtmh.18-0568] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Strongyloides stercoralis affects 30-100 million people worldwide. The burden is underestimated because of the paucity of studies, limited geographical areas surveyed, and poor quality of diagnostic tests. This study aimed at determining the epidemiology of strongyloidiasis using sensitive microscopy testing in rural populations living at different altitudes in Cusco, Peru. Data were collected from subjects aged > 3 years living in Quellouno (elevation 2,600 ft) and Limatambo (elevation 8,379 ft) districts. Subjects provided one fresh stool sample and answer a standardized questionnaire. Fresh stool was tested on site using the Baermann's test and agar plate culture. Formalin-preserved stool was tested by rapid sedimentation. Eighty percent (585/715) of eligible subjects consented to participate; after excluding subjects with missing data, 65% (462/715) were included. Fifty-five percentage were female; the median age was 33 years (interquartile range 13-52), and 72% had government health insurance. Half had intestinal parasites, and Strongyloides was the most common (24.5%) followed by Giardia (15.5%), Blastocystis (14.9%), and hookworm (11.5%). The agar plate culture detected more cases of Strongyloides than Baermann's or sedimentation tests. Strongyloides infection was more common at low altitude (26.4%) than at high altitude (18.6%), but the difference was not statistically significant (P = 0.08). Older age, walking barefoot, bathing in rivers/streams, and using municipal sewage were associated with strongyloidiasis. Strongyloides was the most prevalent parasite in the areas studied and was associated with demographic, socioeconomic, and sanitary factors.
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Affiliation(s)
- Maria Luisa Morales
- Universidad Peruana Cayetano Heredia-University of Texas Medical Branch, Collaborative Research Center-Cusco, Universidad Peruana Cayetano Heredia, Cusco, Peru
| | - Martha Lopez
- Universidad Peruana Cayetano Heredia-University of Texas Medical Branch, Collaborative Research Center-Cusco, Universidad Peruana Cayetano Heredia, Cusco, Peru
| | - Priscilla Ly
- School of Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Seher Anjum
- Division of Infectious Diseases, Department of Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Martha Vanessa Fernandez-Baca
- Universidad Peruana Cayetano Heredia-University of Texas Medical Branch, Collaborative Research Center-Cusco, Universidad Peruana Cayetano Heredia, Cusco, Peru
| | - Angela Maria Valdivia-Rodriguez
- Universidad Peruana Cayetano Heredia-University of Texas Medical Branch, Collaborative Research Center-Cusco, Universidad Peruana Cayetano Heredia, Cusco, Peru
| | - Frecia Maribel Mamani-Licona
- Universidad Peruana Cayetano Heredia-University of Texas Medical Branch, Collaborative Research Center-Cusco, Universidad Peruana Cayetano Heredia, Cusco, Peru
| | - Benicia Baca-Turpo
- Universidad Peruana Cayetano Heredia-University of Texas Medical Branch, Collaborative Research Center-Cusco, Universidad Peruana Cayetano Heredia, Cusco, Peru
| | - Nedhy Farfan-Gonzales
- Sede Administrativa de la Red de Servicios de Salud Cusco Norte, Ministerio de Salud, Cusco, Peru
| | - Yeshica Chaman-Illanes
- Centro de Salud de Putucusi, Red de Servicios de Salud Cusco Norte, Ministerio de Salud, Cusco, Peru
| | - Miguel Mauricio Cabada
- Universidad Peruana Cayetano Heredia-University of Texas Medical Branch, Collaborative Research Center-Cusco, Universidad Peruana Cayetano Heredia, Cusco, Peru.,Division of Infectious Diseases, Department of Medicine, University of Texas Medical Branch, Galveston, Texas
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Lopez M, Morales ML, Konana M, Hoyer P, Pineda-Reyes R, White AC, Garcia HH, Lescano AG, Gotuzzo E, Cabada MM. Kato-Katz and Lumbreras rapid sedimentation test to evaluate helminth prevalence in the setting of a school-based deworming program. Pathog Glob Health 2016; 110:130-4. [PMID: 27376503 PMCID: PMC4984960 DOI: 10.1080/20477724.2016.1187361] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 10/21/2022] Open
Abstract
The sensitivity of the Kato-Katz test is suboptimal for the evaluation of intestinal helminth prevalence. Moreover, during mass deworming, as helminth egg burden decreases, the sensitivity is likely to decrease. The Lumbreras rapid sedimentation (Lumbreras) is a low-cost non-quantitative test, but may provide useful information in low burden areas. We compared the prevalence of intestinal helminth infections assessed by the Kato-Katz and the Lumbreras rapid sedimentation test on 3 stool specimens from each of 1083 children. The sensitivities were compared using the McNemar paired test. Using the combined outcome of the 3 different stool tests as the standard, Kato-Katz had lower sensitivity than Lumbreras rapid sedimentation tests for Ascaris lumbricoides (85.1% vs. 95.1%, p = 0.03), Hymenolepis nana (77.7% vs. 97.9%, p < 0.01), Trichuris trichura (41.7% vs. 100%, p = 0.01), hookworm (0% vs. 100%, p = 0.01), and Strongyloides stercoralis (0% vs. 88%, p < 0.01). Kato-Katz demonstrated significantly lower sensitivity, missing most T. trichiura, hookworm, and S. stercoralis infections. The combination of Kato-Katz and Lumbreras rapid sedimentation tests enables the detection of more intestinal helminths infections in post-deworming low prevalence areas.
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Affiliation(s)
- Martha Lopez
- Universidad Peruana Cayetano Heredia and University of Texas Medical Branch Collaborative Research Center, Cusco, Peru
| | - Maria Luisa Morales
- Universidad Peruana Cayetano Heredia and University of Texas Medical Branch Collaborative Research Center, Cusco, Peru
| | - Monisha Konana
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Paige Hoyer
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Roberto Pineda-Reyes
- Universidad Peruana Cayetano Heredia and University of Texas Medical Branch Collaborative Research Center, Cusco, Peru
| | - Arthur Clinton White
- Universidad Peruana Cayetano Heredia and University of Texas Medical Branch Collaborative Research Center, Cusco, Peru
- Infectious Disease Division, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Hector Hugo Garcia
- Cysticercosis Working Group in Peru, Lima, Peru
- Faculty of Science and Philosophy, Infectious Diseases Laboratory Research-LID, Alberto Cazorla Talleri, Universidad Peruana Cayetano Heredia, Lima, Peru
- Cysticercosis Unit, Instituto de Ciencias Neurologicas, Lima, Peru
| | - Andres Guillermo Lescano
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
- US Naval Medical Research Unit No. 6 (NAMRU-6), Lima, Peru
| | - Eduardo Gotuzzo
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Miguel Mauricio Cabada
- Universidad Peruana Cayetano Heredia and University of Texas Medical Branch Collaborative Research Center, Cusco, Peru
- Infectious Disease Division, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
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Crannell ZA, Cabada MM, Castellanos-Gonzalez A, Irani A, White AC, Richards-Kortum R. Recombinase polymerase amplification-based assay to diagnose Giardia in stool samples. Am J Trop Med Hyg 2014; 92:583-7. [PMID: 25510713 DOI: 10.4269/ajtmh.14-0593] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Giardia duodenalis is one of the most commonly identified parasites in stool samples. Although relatively easy to treat, giardiasis can be difficult to detect as it presents similar to other diarrheal diseases. Here, we present a recombinase polymerase amplification-based Giardia (RPAG) assay to detect the presence of Giardia in stool samples. The RPAG assay was characterized on the bench top using stool samples spiked with Giardia cysts where it showed a limit-of-detection nearly as low as the gold standard polymerase chain reaction assay. The RPAG assay was then tested in the highlands of Peru on 104 stool samples collected from the surrounding communities where it showed 73% sensitivity and 95% specificity against a polymerase chain reaction and microscopy composite gold standard. Further improvements in clinical sensitivity will be needed for the RPAG assay to have clinical relevance.
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Affiliation(s)
- Zachary Austin Crannell
- Rice University, Bioengineering, Houston, Texas; Universidad Peruana Cayetano Heredia, Department of Internal Medicine, Cusco, Peru; University of Texas Medical Branch, Department of Internal Medicine, Galveston, Texas
| | - Miguel Mauricio Cabada
- Rice University, Bioengineering, Houston, Texas; Universidad Peruana Cayetano Heredia, Department of Internal Medicine, Cusco, Peru; University of Texas Medical Branch, Department of Internal Medicine, Galveston, Texas
| | - Alejandro Castellanos-Gonzalez
- Rice University, Bioengineering, Houston, Texas; Universidad Peruana Cayetano Heredia, Department of Internal Medicine, Cusco, Peru; University of Texas Medical Branch, Department of Internal Medicine, Galveston, Texas
| | - Ayesha Irani
- Rice University, Bioengineering, Houston, Texas; Universidad Peruana Cayetano Heredia, Department of Internal Medicine, Cusco, Peru; University of Texas Medical Branch, Department of Internal Medicine, Galveston, Texas
| | - Arthur Clinton White
- Rice University, Bioengineering, Houston, Texas; Universidad Peruana Cayetano Heredia, Department of Internal Medicine, Cusco, Peru; University of Texas Medical Branch, Department of Internal Medicine, Galveston, Texas
| | - Rebecca Richards-Kortum
- Rice University, Bioengineering, Houston, Texas; Universidad Peruana Cayetano Heredia, Department of Internal Medicine, Cusco, Peru; University of Texas Medical Branch, Department of Internal Medicine, Galveston, Texas
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