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Rowlands J, Dufort E, Chaturvedi S, Zhu Y, Quinn M, Bucher C, Erazo R, Haley V, Kuang J, Ostrowsky B, Southwick K, Vallabhaneni S, Greenko J, Tserenpuntsag B, Blog D, Lutterloh E. Candida auris admission screening pilot in select units of New York City health care facilities, 2017-2019. Am J Infect Control 2023; 51:866-870. [PMID: 36736380 PMCID: PMC10902794 DOI: 10.1016/j.ajic.2023.01.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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] [Received: 11/20/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND This pilot project implemented admission screening for Candida auris (C. auris) using real-time polymerase chain reaction (rt-PCR) in select high-risk units within health care facilities in New York City. METHODS An admission screening encounter consisted of collecting 2 swabs, to be tested by rt-PCR, and a data collection form for individuals admitted to ventilator units at 2 nursing homes (NHA and NHB), and the ventilator/pulmonary unit, intensive care unit, and cardiac care unit at a hospital (Hospital C) located in New York City from November 2017 to November 2019. RESULTS C. auris colonization was identified in 6.9% (n = 188/2,726) of admissions to participating units. Rates were higher among admissions to NHA and NHB (20.7% and 22.0%, respectively) than Hospital C (3.6%). Within Hospital C, the ventilator/pulmonary unit had a higher rate (5.7%) than the intensive care unit (3.8%) or cardiac care unit (2.5%). DISCUSSION Consistent with prior research, we found that individuals admitted to ventilator units were at higher risk of C. auris colonization. CONCLUSIONS This project demonstrates the utility of admission screening using rt-PCR testing to rapidly identify C. auris colonization among admissions to health care facilities so that appropriate transmission-based precautions and control measures can be implemented rapidly to help decrease transmission.
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Affiliation(s)
| | | | - Sudha Chaturvedi
- New York State Department of Health, Wadsworth Center, Albany, NY, USA; School of Public Health, Epidemiology and Biostatistics, and Department of Biomedical Sciences, State University of New York, University at Albany, Albany, NY, USA
| | - YanChun Zhu
- New York State Department of Health, Wadsworth Center, Albany, NY, USA
| | - Monica Quinn
- New York State Department of Health, Albany, NY, USA
| | | | - Richard Erazo
- New York State Department of Health, Albany, NY, USA
| | - Valerie Haley
- New York State Department of Health, Albany, NY, USA; School of Public Health, Epidemiology and Biostatistics, and Department of Biomedical Sciences, State University of New York, University at Albany, Albany, NY, USA
| | - Jiankun Kuang
- New York State Department of Health, Albany, NY, USA
| | - Belinda Ostrowsky
- New York State Department of Health, Albany, NY, USA; Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Jane Greenko
- New York State Department of Health, Albany, NY, USA
| | | | - Debra Blog
- New York State Department of Health, Albany, NY, USA
| | - Emily Lutterloh
- New York State Department of Health, Albany, NY, USA; School of Public Health, Epidemiology and Biostatistics, and Department of Biomedical Sciences, State University of New York, University at Albany, Albany, NY, USA
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2
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Caplan AS, Chaturvedi S, Zhu Y, Todd GC, Yin L, Lopez A, Travis L, Smith DJ, Chiller T, Lockhart SR, Alroy KA, Greendyke WG, Gold JAW. Notes from the Field: First Reported U.S. Cases of Tinea Caused by Trichophyton indotineae - New York City, December 2021-March 2023. MMWR Morb Mortal Wkly Rep 2023; 72:536-537. [PMID: 37167192 DOI: 10.15585/mmwr.mm7219a4] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
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3
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Zhu Y, Hager KM, Manjari SR, Banavali NK, Chaturvedi V, Chaturvedi S. Development and Validation of TaqMan Chemistry Probe-Based Rapid Assay for the Detection of Echinocandin-Resistance in Candida auris. J Clin Microbiol 2023; 61:e0176722. [PMID: 36975998 PMCID: PMC10117040 DOI: 10.1128/jcm.01767-22] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 02/14/2023] [Indexed: 03/29/2023] Open
Abstract
Candida auris is a multidrug-resistant yeast pathogen causing outbreaks in health care facilities worldwide, and the emergence of echinocandin-resistant C. auris is a concern. Currently used Clinical and Laboratory Standards Institute (CLSI) and commercial antifungal susceptibility tests (AFST) are phenotype-based, slow, and not scalable, limiting their effectiveness in the surveillance of echinocandin-resistant C. auris. The urgent need for accurate and rapid methods of assessment of echinocandin resistance cannot be overstated, as this class of antifungal drugs is preferred for patient management. We report the development and validation of a TaqMan chemistry probe-based fluorescence melt curve analysis (FMCA) following asymmetric polymerase chain reaction (PCR) to assess mutations within the hot spot one (HS1) region of FKS1, the gene responsible for encoding 1,3-β-d-glucan synthase that is a target for echinocandins. The assay correctly identified F635C, F635Y, F635del, F635S, S639F or S639Y, S639P, and D642H/R645T mutations. Of these mutations, F635S and D642H/R645T were not involved in echinocandin resistance, while the rest were, as confirmed by AFST. Of 31 clinical cases, the predominant mutation conferring echinocandin resistance was S639F/Y (20 cases) followed by S639P (4 cases), F635del (4 cases), F635Y (2 cases), and F635C (1 case). The FMCA assay was highly specific and did not cross-react with closely and distantly related Candida and other yeast and mold species. Structural modeling of the Fks1 protein, its mutants, and docked conformations of three echinocandin drugs suggest a plausible Fks1 binding orientation for echinocandins. These findings lay the groundwork for future evaluations of additional FKS1 mutations and their impact on the development of drug resistance. The TaqMan chemistry probe-based FMCA would allow rapid, high throughput, and accurate detection of FKS1 mutations conferring echinocandin resistance in C. auris.
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Affiliation(s)
- YanChun Zhu
- Mycology Laboratory, Division of Infectious Diseases, Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Kelli M. Hager
- Mycology Laboratory, Division of Infectious Diseases, Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Swati R. Manjari
- Division of Translational Medicine, Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Nilesh K. Banavali
- Division of Translational Medicine, Wadsworth Center, New York State Department of Health, Albany, New York, USA
- Department of Biomedical Sciences, University at Albany, Albany, New York, USA
| | - Vishnu Chaturvedi
- Westchester Medical Center, New York Medical College, Valhalla, New York, USA
| | - Sudha Chaturvedi
- Mycology Laboratory, Division of Infectious Diseases, Wadsworth Center, New York State Department of Health, Albany, New York, USA
- Department of Biomedical Sciences, University at Albany, Albany, New York, USA
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Kumar A, Sharma H, Chaturvedi S, Maheshwari R. Innovative technique of reducing rewarm ischemia time in robotic assisted kidney transplant with multiple vessels. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01348-9] [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: 02/12/2023]
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Marathe A, Zhu Y, Chaturvedi V, Chaturvedi S. Utility of CHROMagar™ Candida Plus for presumptive identification of Candida auris from surveillance samples. Mycopathologia 2022; 187:527-534. [PMCID: PMC9647746 DOI: 10.1007/s11046-022-00656-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 08/01/2022] [Indexed: 11/11/2022]
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6
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Macy M, Cash T, Pinto N, Pressey J, Szalontay L, Furman W, Bukowinski A, Foster J, Friedman G, HaDuong J, Fox E, Weigel B, Grevel J, Huang F, Phelps C, Childs B, Chung J, Chaturvedi S, Schulz A, DuBois S. Phase I dose-escalation study of the pan-PI3 K inhibitor copanlisib in children and adolescents with relapsed/refractory solid tumors. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)00878-4] [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: 11/17/2022]
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Tharappel AM, Li Z, Zhu YC, Wu X, Chaturvedi S, Zhang QY, Li H. Calcimycin Inhibits Cryptococcus neoformans In Vitro and In Vivo by Targeting the Prp8 Intein Splicing. ACS Infect Dis 2022; 8:1851-1868. [PMID: 35948057 PMCID: PMC9464717 DOI: 10.1021/acsinfecdis.2c00137] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Drug resistance is a significant concern in the treatment of diseases, including cryptococcosis caused by Cryptococcus neoformans (Cne) and Cryptococcus gattii (Cga). Alternative drug targets are necessary to overcome drug resistance before it attains a critical stage. Splicing of inteins from pro-protein precursors is crucial for activities of essential proteins hosting intein elements in many organisms, including human pathogens such as Cne and Cga. Through a high-throughput screening, we identified calcimycin (CMN) as a potent Prp8 intein splicing inhibitor with a minimum inhibitory concentration (MIC) of 1.5 μg/mL against the wild-type Cne-H99 (Cne-WT or Cne). In contrast, CMN inhibited the intein-less mutant strain (Cne-Mut) with a 16-fold higher MIC. Interestingly, Aspergillus fumigatus and a few Candida species were resistant to CMN. Further studies indicated that CMN reduced virulence factors such as urease activity, melanin production, and biofilm formation in Cne. CMN also inhibited Cne intracellular infection in macrophages. In a target-specific split nanoluciferase assay, the IC50 of CMN was 4.6 μg/mL. Binding of CMN to recombinant Prp8 intein was demonstrated by thermal shift assay and microscale thermophoresis. Treating Cne cells with CMN reduced intein splicing. CMN was fungistatic and showed a synergistic effect with the known antifungal drug amphotericin B. Finally, CMN treatment at 20 mg/kg body weight led to 60% reduction in lung fungal load in a cryptococcal pulmonary infection mouse model. Overall, CMN represents a potent antifungal with a novel mechanism of action to treat Cne and possibly Cga infections.
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Affiliation(s)
- Anil Mathew Tharappel
- Department of Pharmacology and Toxicology, College of Pharmacy, The University of Arizona, Tucson Arizona 85721-0207, United States
- Wadsworth Center, New York State Department of Health, Albany, New York 12208, United States
| | - Zhong Li
- Department of Pharmacology and Toxicology, College of Pharmacy, The University of Arizona, Tucson Arizona 85721-0207, United States
- Wadsworth Center, New York State Department of Health, Albany, New York 12208, United States
| | - Yan Chun Zhu
- Wadsworth Center, New York State Department of Health, Albany, New York 12208, United States
| | - Xiangmeng Wu
- Department of Pharmacology and Toxicology, College of Pharmacy, The University of Arizona, Tucson Arizona 85721-0207, United States
| | - Sudha Chaturvedi
- Wadsworth Center, New York State Department of Health, Albany, New York 12208, United States
| | - Qing-Yu Zhang
- Department of Pharmacology and Toxicology, College of Pharmacy, The University of Arizona, Tucson Arizona 85721-0207, United States
| | - Hongmin Li
- Department of Pharmacology and Toxicology, College of Pharmacy, The University of Arizona, Tucson Arizona 85721-0207, United States
- Wadsworth Center, New York State Department of Health, Albany, New York 12208, United States
- The BIO5 Institute, The University of Arizona, Tucson, Arizona 85721, United States
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Tatuene JK, Saba L, Heldner M, Poorthuis M, De Borst G, Rundek T, Kakkos S, Dichgans M, Chaturvedi S, Topakian R, Polak J, Jickling G. Plasma interleukin-6 predicts carotid plaque severity, vulnerability, and progression in the cardiovascular health study. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.172] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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9
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Southwick K, Ostrowsky B, Greenko J, Adams E, Lutterloh E, Denis RJ, Patel R, Erazo R, Fernandez R, Bucher C, Quinn M, Green C, Chaturvedi S, Leach L, Zhu Y. A description of the first Candida auris-colonized individuals in New York State, 2016-2017. Am J Infect Control 2022; 50:358-360. [PMID: 34793894 PMCID: PMC9853438 DOI: 10.1016/j.ajic.2021.10.037] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/29/2021] [Accepted: 10/30/2021] [Indexed: 01/25/2023]
Abstract
Candida auris (C. auris) is a globally emerging multidrug-resistant yeast. New York State (NYS) first detected C. auris in July 2016 and is the state most affected. This brief report describes characteristics of the first 114 individuals colonized with C. auris identified through active surveillance/screening by NYS Department of Health. "Colonized/screened" individuals were old (median age, 74 year), had extensive health care exposures and underlying conditions (multiple health care facility admissions in the 90 days prior with more than 80% requiring mechanical ventilation), and had 30- and 90-day mortality rates of 17.5% and 37.7%, respectively (with approximately 60% expired in the 2-year follow-up period). This description is helpful to inform additional prevention measures and add to the collective understanding of C. auris in the United States.
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Affiliation(s)
- Karen Southwick
- New York State Department of Health (NYSDOH), Metropolitan Regional Office (MARO), New York, NY.
| | - Belinda Ostrowsky
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Jane Greenko
- New York State Department of Health (NYSDOH), Metropolitan Regional Office (MARO), New York, NY
| | - Eleanor Adams
- New York State Department of Health (NYSDOH), Metropolitan Regional Office (MARO), New York, NY
| | - Emily Lutterloh
- New York State Department of Health (NYSDOH), Albany, NY; State University of New York, University at Albany, School of Public Health, Albany, NY
| | - Ronald Jean Denis
- New York State Department of Health (NYSDOH), Metropolitan Regional Office (MARO), New York, NY
| | - Rutvik Patel
- New York State Department of Health (NYSDOH), Metropolitan Regional Office (MARO), New York, NY
| | - Richard Erazo
- New York State Department of Health (NYSDOH), Metropolitan Regional Office (MARO), New York, NY
| | - Raphael Fernandez
- New York State Department of Health (NYSDOH), Metropolitan Regional Office (MARO), New York, NY
| | - Coralie Bucher
- New York State Department of Health (NYSDOH), Albany, NY
| | - Monica Quinn
- New York State Department of Health (NYSDOH), Albany, NY
| | - Crystal Green
- New York State Department of Health (NYSDOH), Metropolitan Regional Office (MARO), New York, NY
| | - Sudha Chaturvedi
- Wadsworth Center, New York State Department of Health, Albany, NY; State University of New York, University at Albany, School of Public Health, Albany, NY
| | - Lynn Leach
- New York State Department of Health (NYSDOH), Albany, NY
| | - YanChun Zhu
- New York State Department of Health (NYSDOH), Albany, NY
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Bansal A, Garg P, Kandhari P, Maheshwari R, Chaturvedi S, Garg H, Singh A, Kumar A. Comparative analysis of perioperative complications in kidney transplant patients with coronary artery disease on dual antiplatelet drugs. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01179-4] [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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Karmarkar EN, O'Donnell K, Prestel C, Forsberg K, Gade L, Jain S, Schan D, Chow N, McDermott D, Rossow J, Toda M, Ruiz R, Hun S, Dale JL, Gross A, Maruca T, Glowicz J, Brooks R, Bagheri H, Nelson T, Gualandi N, Khwaja Z, Horwich-Scholefield S, Jacobs J, Cheung M, Walters M, Jacobs-Slifka K, Stone ND, Mikhail L, Chaturvedi S, Klein L, Vagnone PS, Schneider E, Berkow EL, Jackson BR, Vallabhaneni S, Zahn M, Epson E. Rapid Assessment and Containment of Candida auris Transmission in Postacute Care Settings-Orange County, California, 2019. Ann Intern Med 2021; 174:1554-1562. [PMID: 34487450 PMCID: PMC10984253 DOI: 10.7326/m21-2013] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Candida auris, a multidrug-resistant yeast, can spread rapidly in ventilator-capable skilled-nursing facilities (vSNFs) and long-term acute care hospitals (LTACHs). In 2018, a laboratory serving LTACHs in southern California began identifying species of Candida that were detected in urine specimens to enhance surveillance of C auris, and C auris was identified in February 2019 in a patient in an Orange County (OC), California, LTACH. Further investigation identified C auris at 3 associated facilities. OBJECTIVE To assess the prevalence of C auris and infection prevention and control (IPC) practices in LTACHs and vSNFs in OC. DESIGN Point prevalence surveys (PPSs), postdischarge testing for C auris detection, and assessments of IPC were done from March to October 2019. SETTING All LTACHs (n = 3) and vSNFs (n = 14) serving adult patients in OC. PARTICIPANTS Current or recent patients in LTACHs and vSNFs in OC. INTERVENTION In facilities where C auris was detected, PPSs were repeated every 2 weeks. Ongoing IPC support was provided. MEASUREMENTS Antifungal susceptibility testing and whole-genome sequencing to assess isolate relatedness. RESULTS Initial PPSs at 17 facilities identified 44 additional patients with C auris in 3 (100%) LTACHs and 6 (43%) vSNFs, with the first bloodstream infection reported in May 2019. By October 2019, a total of 182 patients with C auris were identified by serial PPSs and discharge testing. Of 81 isolates that were sequenced, all were clade III and highly related. Assessments of IPC identified gaps in hand hygiene, transmission-based precautions, and environmental cleaning. The outbreak was contained to 2 facilities by October 2019. LIMITATION Acute care hospitals were not assessed, and IPC improvements over time could not be rigorously evaluated. CONCLUSION Enhanced laboratory surveillance and prompt investigation with IPC support enabled swift identification and containment of C auris. PRIMARY FUNDING SOURCE Centers for Disease Control and Prevention.
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Affiliation(s)
- Ellora N Karmarkar
- Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia, and the California Department of Public Health, Richmond, California (E.N.K.)
| | - Kathleen O'Donnell
- Orange County Health Care Agency, Santa Ana, California (K.O., D.S., J.J., M.C., L.M., M.Z.)
| | - Christopher Prestel
- Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia (C.P., J.R., M.T.)
| | - Kaitlin Forsberg
- Centers for Disease Control and Prevention and IHRC, Atlanta, Georgia (K.F.)
| | - Lalitha Gade
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.)
| | - Seema Jain
- California Department of Public Health, Richmond, California (S.J., H.B., T.N., Z.K., S.H., E.E.)
| | - Douglas Schan
- Orange County Health Care Agency, Santa Ana, California (K.O., D.S., J.J., M.C., L.M., M.Z.)
| | - Nancy Chow
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.)
| | - Darby McDermott
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.)
| | - John Rossow
- Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia (C.P., J.R., M.T.)
| | - Mitsuru Toda
- Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia (C.P., J.R., M.T.)
| | - Ryan Ruiz
- Washington State Public Health Laboratories, Shoreline, Washington (R.R., S.H., E.S.)
| | - Sopheay Hun
- Washington State Public Health Laboratories, Shoreline, Washington (R.R., S.H., E.S.)
| | - Jennifer L Dale
- Minnesota Department of Health Public Health Laboratory, St. Paul, Minnesota (J.L.D., A.G., P.S.V.)
| | - Annastasia Gross
- Minnesota Department of Health Public Health Laboratory, St. Paul, Minnesota (J.L.D., A.G., P.S.V.)
| | - Tyler Maruca
- Maryland Department of Health Laboratories Administration, Baltimore, Maryland (T.M., L.K.)
| | - Janet Glowicz
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.)
| | - Richard Brooks
- Centers for Disease Control and Prevention, Atlanta, Georgia, and the Maryland Department of Health, Infectious Disease Epidemiology and Outbreak Response Bureau, Baltimore, Maryland (R.B.)
| | - Hosniyeh Bagheri
- California Department of Public Health, Richmond, California (S.J., H.B., T.N., Z.K., S.H., E.E.)
| | - Teresa Nelson
- California Department of Public Health, Richmond, California (S.J., H.B., T.N., Z.K., S.H., E.E.)
| | - Nicole Gualandi
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.)
| | - Zenith Khwaja
- California Department of Public Health, Richmond, California (S.J., H.B., T.N., Z.K., S.H., E.E.)
| | - Sam Horwich-Scholefield
- California Department of Public Health, Richmond, California (S.J., H.B., T.N., Z.K., S.H., E.E.)
| | - Josh Jacobs
- Orange County Health Care Agency, Santa Ana, California (K.O., D.S., J.J., M.C., L.M., M.Z.)
| | - Michele Cheung
- Orange County Health Care Agency, Santa Ana, California (K.O., D.S., J.J., M.C., L.M., M.Z.)
| | - Maroya Walters
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.)
| | - Kara Jacobs-Slifka
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.)
| | - Nimalie D Stone
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.)
| | - Lydia Mikhail
- Orange County Health Care Agency, Santa Ana, California (K.O., D.S., J.J., M.C., L.M., M.Z.)
| | | | - Liore Klein
- Maryland Department of Health Laboratories Administration, Baltimore, Maryland (T.M., L.K.)
| | - Paula Snippes Vagnone
- Minnesota Department of Health Public Health Laboratory, St. Paul, Minnesota (J.L.D., A.G., P.S.V.)
| | - Emily Schneider
- Washington State Public Health Laboratories, Shoreline, Washington (R.R., S.H., E.S.)
| | - Elizabeth L Berkow
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.)
| | - Brendan R Jackson
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.)
| | - Snigdha Vallabhaneni
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.)
| | - Matthew Zahn
- Orange County Health Care Agency, Santa Ana, California (K.O., D.S., J.J., M.C., L.M., M.Z.)
| | - Erin Epson
- California Department of Public Health, Richmond, California (S.J., H.B., T.N., Z.K., S.H., E.E.)
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Dennis EK, Chaturvedi S, Chaturvedi V. So Many Diagnostic Tests, So Little Time: Review and Preview of Candida auris Testing in Clinical and Public Health Laboratories. Front Microbiol 2021; 12:757835. [PMID: 34691009 PMCID: PMC8529189 DOI: 10.3389/fmicb.2021.757835] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 08/12/2021] [Accepted: 09/13/2021] [Indexed: 01/13/2023] Open
Abstract
The recognition of a new yeast, Candida auris, in 2009 in East Asia, and its rapid global spread, was a reminder of the threats posed by multidrug-resistant fungal pathogens. C. auris had likely remained unrecognized for a long time as accurate tests were not available. The laboratory community responded to the C. auris challenge by publishing 35 new or revised diagnostic methods between 2014 and early 2021. The commercial sector also modified existing diagnostic devices. These C. auris diagnostic tests run the gamut from traditional culture-based differential and selective media, biochemical assimilations, and rapid protein profiles, as well as culture-independent DNA-based diagnostics. We provide an overview of these developments, especially the tests with validation data that were subsequently adopted for common use. We share a workflow developed in our laboratory to process over 37,000 C. auris surveillance samples and 5,000 C. auris isolates from the outbreak in the New York metropolitan area. Our preview covers new devices and diagnostic approaches on the horizon based on microfluidics, optics, and nanotechnology. Frontline laboratories need rapid, cheap, stable, and easy-to-implement tests to improve C. auris diagnosis, surveillance, patient isolation, admission screening, and environmental control. Among the urgent needs is a lateral flow assay or similar device for presumptive C. auris identification. All laboratories will benefit from devices that allow rapid antifungal susceptibility testing, including detection of mutations conferring drug resistance. Hopefully, multiplex test panels are on the horizon for synergy of C. auris testing with ongoing surveillance of other healthcare-associated infections. C. auris genome analysis has a proven role for outbreak investigations, and diagnostic laboratories need quick access to regional and national genome analysis networks.
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Affiliation(s)
- Emily K Dennis
- Mycology Laboratory, Wadsworth Center, New York State Department of Health, Albany, NY, United States
| | - Sudha Chaturvedi
- Mycology Laboratory, Wadsworth Center, New York State Department of Health, Albany, NY, United States.,Department of Biomedical Sciences, University at Albany, Albany, NY, United States
| | - Vishnu Chaturvedi
- Mycology Laboratory, Wadsworth Center, New York State Department of Health, Albany, NY, United States
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Barve D, Dave P, Gulve M, Saquib S, Das G, Sibghatullah M, Chaturvedi S. Assessment of microhardness and color stability of micro-hybrid and nano-filled composite resins. Niger J Clin Pract 2021; 24:1499-1505. [PMID: 34657016 DOI: 10.4103/njcp.njcp_632_20] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background and Aims Composite resins are among the most popular restorative dental materials because of the strength and esthetic properties. The goal of this study was to assess the effect of commonly consumed beverages on microhardness and color stability of microhybrid (MH) and nanofilled NF) composite resins. Material and Methods 240 samples were prepared from the composite material [MH = 120 (material I) and NF = 120 (material II)] and allocated into eight groups of 30 samples. In each group, half of the samples were tested for microhardness and another-half for color stability. After baseline measurements, the samples were immersed in test media, that is, distilled water and beverages (tea, cola, and coffee) for 15 days. Microhardness and color stability measurements were carried out after 15 days to assess the effect of beverages. The color stability and microhardness values were compared and evaluated by analysis of variance (ANOVA) using Tukey's alteration test. Results It was reported that the microhardness decreased for both the materials after immersion in all the beverages. Percentage change in microhardness was considerably higher in material II in comparison to the material I in cola drink. Color change was significantly higher in material II compared to material I in water and coffee. Cola drink caused the maximum change in microhardness among all the beverages and coffee caused the maximum color change among all the beverages. Conclusion Both composite materials (I and II) showed a reduction in microhardness and change in color after immersion in a different type of test media.
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Affiliation(s)
- D Barve
- Departments of Conservative Dentistry and Endodontics. SMBT Institute of Dental Sciences, Nasik, Maharashtra, India
| | - P Dave
- Department of Pediatric Dentistry, SMBT Institute of Dental Sciences, Dhamangaon Nandi Hills, Nasik, Maharashtra, India
| | - M Gulve
- Department of Conservative Dentistry & Endodontics, MGV KBH Dental College and Hospital, Panchavati, Nasik, Maharashtra, India
| | - S Saquib
- Department of Periodontics and Community Dental Sciences, College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - G Das
- Department of Prosthetic Dentistry, College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - M Sibghatullah
- Restorative Dentistry, College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - S Chaturvedi
- Department of Prosthetic Dentistry, College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia
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14
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Chaturvedi S, Victor TR, Marathe A, Sidamonidze K, Crucillo KL, Chaturvedi V. Real-time PCR assay for detection and differentiation of Coccidioides immitis and Coccidioides posadasii from culture and clinical specimens. PLoS Negl Trop Dis 2021; 15:e0009765. [PMID: 34529679 PMCID: PMC8486383 DOI: 10.1371/journal.pntd.0009765] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 10/01/2021] [Accepted: 08/25/2021] [Indexed: 11/19/2022] Open
Abstract
Coccidioidomycosis (Valley fever) is a pulmonary and systemic fungal disease with increasing incidence and expanding endemic areas. The differentiation of etiologic agents Coccidioides immitis and C. posadasii remains problematic in the clinical laboratories as conventional PCR and satellite typing schemes are not facile. Therefore, we developed Cy5- and FAM-labeled TaqMan-probes for duplex real-time PCR assay for rapid differentiation of C. immitis and C. posadasii from culture and clinical specimens. The RRA2 gene encoding proline-rich antigen 2, specific for Coccidioides genus, was the source for the first set of primers and probe. Coccidioides immitis contig 2.2 (GenBank: AAEC02000002.1) was used to design the second set of primers and probe. The second primers/probe did not amplify the corresponding C. posadasii DNA, because of an 86-bp deletion in the contig. The assay was highly sensitive with limit of detection of 0.1 pg gDNA/PCR reaction, which was equivalent to approximately ten genome copies of C. immitis or C. posadasii. The assay was highly specific with no cross-reactivity to the wide range of fungal and bacterial pathogens. Retrospective analysis of fungal isolates and primary specimens submitted from 1995 to 2020 confirmed 168 isolates and four primary specimens as C. posadasii and 30 isolates as C. immitis from human coccidioidomycosis cases, while all eight primary samples from two animals (rhesus monkey and rhinoceros) were confirmed as C. posadasii. A preliminary analysis of cerebrospinal fluid (CSF) and pleural fluid samples showed positive correlation between serology tests and real-time PCR for two of the 15 samples. The Coccidioides spp. duplex real-time PCR will allow rapid differentiation of C. immitis and C. posadasii from clinical specimens and further augment the treatment and surveillance of coccidioidomycosis.
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Affiliation(s)
- Sudha Chaturvedi
- Mycology Laboratory, Wadsworth Center, New York State Department of Health, Albany, New York, United States of America
- Department of Biomedical Sciences, University at Albany, Albany, New York, United States of America
- * E-mail: (SC); (VC)
| | - Tanya R. Victor
- Mycology Laboratory, Wadsworth Center, New York State Department of Health, Albany, New York, United States of America
| | - Anuradha Marathe
- Mycology Laboratory, Wadsworth Center, New York State Department of Health, Albany, New York, United States of America
| | - Ketevan Sidamonidze
- Mycology Laboratory, Wadsworth Center, New York State Department of Health, Albany, New York, United States of America
| | - Kelly L. Crucillo
- Coccidioidomycosis Serology Laboratory, Department of Medical Microbiology and Immunology, University of California School of Medicine, Davis, California, United States of America
| | - Vishnu Chaturvedi
- Mycology Laboratory, Wadsworth Center, New York State Department of Health, Albany, New York, United States of America
- * E-mail: (SC); (VC)
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15
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Rossow J, Ostrowsky B, Adams E, Greenko J, McDonald R, Vallabhaneni S, Forsberg K, Perez S, Lucas T, Alroy KA, Jacobs Slifka K, Walters M, Jackson BR, Quinn M, Chaturvedi S, Blog D. Factors Associated With Candida auris Colonization and Transmission in Skilled Nursing Facilities With Ventilator Units, New York, 2016-2018. Clin Infect Dis 2021; 72:e753-e760. [PMID: 32984882 DOI: 10.1093/cid/ciaa1462] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Candida auris is an emerging, multidrug-resistant yeast that spreads in healthcare settings. People colonized with C. auris can transmit this pathogen and are at risk for invasive infections. New York State (NYS) has the largest US burden (>500 colonized and infected people); many colonized individuals are mechanically ventilated or have tracheostomy, and are residents of ventilator-capable skilled nursing facilities (vSNF). We evaluated the factors associated with C. auris colonization among vSNF residents to inform prevention interventions. METHODS During 2016-2018, the NYS Department of Health conducted point prevalence surveys (PPS) to detect C. auris colonization among residents of vSNFs. In a case-control investigation, we defined a case as C. auris colonization in a resident, and identified up to 4 residents with negative swabs during the same PPS as controls. We abstracted data from medical records on patient facility transfers, antimicrobial use, and medical history. RESULTS We included 60 cases and 218 controls identified from 6 vSNFs. After controlling for potential confounders, the following characteristics were associated with C. auris colonization: being on a ventilator (adjusted odds ratio [aOR], 5.9; 95% confidence interval [CI], 2.3-15.4), receiving carbapenem antibiotics in the prior 90 days (aOR, 3.5; 95% CI, 1.6-7.6), having ≥1 acute care hospital visit in the prior 6 months (aOR, 4.2; 95% CI, 1.9-9.6), and receiving systemic fluconazole in the prior 90 days (aOR, 6.0; 95% CI, 1.6-22.6). CONCLUSIONS Targeted screening of patients in vSNFs with the above risk factors for C. auris can help identify colonized patients and facilitate the implementation of infection control measures. Antimicrobial stewardship may be an important factor in the prevention of C. auris colonization.
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Affiliation(s)
- John Rossow
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Belinda Ostrowsky
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Eleanor Adams
- New York State Department of Health, Metropolitan Area Regional Office, New Rochelle, New York, USA
| | - Jane Greenko
- New York State Department of Health, Metropolitan Area Regional Office, New Rochelle, New York, USA
| | - Robert McDonald
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,New York State Department of Health, Albany, New York, USA
| | - Snigdha Vallabhaneni
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kaitlin Forsberg
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Stephen Perez
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Todd Lucas
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Karen A Alroy
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kara Jacobs Slifka
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Maroya Walters
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Brendan R Jackson
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Monica Quinn
- New York State Department of Health, Albany, New York, USA
| | - Sudha Chaturvedi
- Wadsworth Laboratory, Albany, New York, USA.,Albany School of Public Health, Albany, New York, USA
| | - Debra Blog
- New York State Department of Health, Albany, New York, USA.,Albany School of Public Health, Albany, New York, USA
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16
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Kaplan M, Zhu Y, Kus JV, McTaggart L, Chaturvedi V, Chaturvedi S. Development of a Duplex Real-Time PCR Assay for the Differentiation of Blastomyces dermatitidis and Blastomyces gilchristii and a Retrospective Analysis of Culture and Primary Specimens from Blastomycosis Cases from New York (2005 to 2019). J Clin Microbiol 2021; 59:e02078-20. [PMID: 33298609 PMCID: PMC8106702 DOI: 10.1128/jcm.02078-20] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 12/01/2020] [Indexed: 12/16/2022] Open
Abstract
Blastomycosis due to Blastomyces dermatitidis and Blastomyces gilchristii is a significant cause of respiratory mycoses in North America with occasional reported outbreaks. We developed a highly sensitive, specific, and reproducible TaqMan duplex real-time PCR assay for the differentiation of B. dermatitidis and B. gilchristii The new assay permitted retrospective analysis of Blastomyces cultures (2005 to 2019) and primary clinical specimens from blastomycosis cases (2013 to 2019) from New York patients. We identified B. dermatitidis as the predominant pathogen in 38 cases of blastomycosis, while B. gilchristii was a minor pathogen involved in five cases; these findings expand understanding of blastomycosis in New York. The duplex real-time PCR assay could be implemented in reference and public health laboratories to further understand the ecology and epidemiology of blastomycosis due to B. dermatitidis and B. gilchristii.
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Affiliation(s)
- Mitchell Kaplan
- Mycology Laboratory, Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - YanChun Zhu
- Mycology Laboratory, Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Julianne V Kus
- Public Health Laboratory, Public Health Ontario, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Lisa McTaggart
- Public Health Laboratory, Public Health Ontario, Toronto, Ontario, Canada
| | - Vishnu Chaturvedi
- Mycology Laboratory, Wadsworth Center, New York State Department of Health, Albany, New York, USA
- Department of Biomedical Sciences, University at Albany, Albany, New York, USA
| | - Sudha Chaturvedi
- Mycology Laboratory, Wadsworth Center, New York State Department of Health, Albany, New York, USA
- Department of Biomedical Sciences, University at Albany, Albany, New York, USA
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17
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Bergeron G, Bloch D, Murray K, Kratz M, Parton H, Ackelsberg J, Antwi M, Del Rosso P, Dorsinville M, Kubinson H, Lash M, Rand S, Adams E, Zhu Y, Erazo R, Chaturvedi S, Weiss D. Candida auris Colonization After Discharge to a Community Setting: New York City, 2017-2019. Open Forum Infect Dis 2021; 8:ofaa620. [PMID: 33511238 PMCID: PMC7814391 DOI: 10.1093/ofid/ofaa620] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 12/12/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Patients colonized with multidrug-resistant Candida auris and discharged to a community setting can subsequently seek care in a different healthcare facility and might be a source of nosocomial transmission of C auris. METHODS We designed a case management pilot program for a cohort of New York City residents who had a history of positive C auris culture identified during clinical or screening activities in healthcare settings and discharged to a community setting during 2017-2019. Approximately every 3 months, case managers coordinated C auris colonization assessments, which included swabs of groin, axilla, and body sites yielding C auris previously. Patients eligible to become serially negative were those with ≥2 C auris colonization assessments after initial C auris identification. Clinical characteristics of serially negative and positive patients were compared. RESULTS The cohort included 75 patients. Overall, 45 patients were eligible to become serially negative and had 552 person-months of follow-up. Of these 45 patients, 28 patients were serially negative (62%; rate 5.1/100 person-months), 8 were serially positive, and 9 could not be classified as either. There were no clinical characteristics that were significantly different between serially negative and positive patients. The median time from initial C auris identification to being serially negative at assessments was 8.6 months (interquartile range, 5.7-10.8 months). CONCLUSIONS A majority of patients, assessed at least twice after C auris identification, no longer had C auris detectable on serial colonization assessments.
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Affiliation(s)
- Genevieve Bergeron
- New York City Department of Health and Mental Hygiene, Queens, New York, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Danielle Bloch
- New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Kenya Murray
- New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Molly Kratz
- New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Hilary Parton
- New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Joel Ackelsberg
- New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Mike Antwi
- New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Paula Del Rosso
- New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Marie Dorsinville
- New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Hannah Kubinson
- New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Maura Lash
- New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Sophie Rand
- New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Eleanor Adams
- New York State Department of Health, Albany, Newx York, USA
| | - Yanchun Zhu
- Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Richard Erazo
- New York State Department of Health, Albany, Newx York, USA
| | - Sudha Chaturvedi
- Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Don Weiss
- New York City Department of Health and Mental Hygiene, Queens, New York, USA
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18
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Zhu YC, Kilburn SN, Kapoor M, Chaturvedi S, Shaw KJ, Chaturvedi V. 1275. Evaluation of in vitro activity of manogepix against multidrug-resistant and pan-resistant Candida auris from the New York Outbreak. Open Forum Infect Dis 2020. [PMCID: PMC7777565 DOI: 10.1093/ofid/ofaa439.1459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
An ongoing Candida auris outbreak in the New York metropolitan area is the largest recorded to date in North America. NY C. auris isolates demonstrate resistance to fluconazole and variable resistance to other antifungals. Thus, there is an urgent need for new drugs with a novel mechanism of action to combat the resistance challenge. Manogepix (MGX) is a first-in-class agent that targets the fungal Gwt1 enzyme. The prodrug, fosmanogepix, is in clinical development for the treatment of invasive fungal infections.
Methods
We evaluated the susceptibility of 200 NY C. auris isolates (2017-2020) to MGX and 10 comparators. Testing was performed using TREK frozen broth microdilution panels for FLC, VRC, ITC, ISA, POS, AFG, CAS, and MFG. MGX MICs were evaluated (CLSI M27-A3 guidelines) using a 50% reduction in fungal growth endpoint at 24 h. MICs were determined by ETEST® at 24 h for AMB and FLC. We defined pan-resistant C. auris as isolates with in vitro resistance to two or more azoles, all echinocandins, and AMB. The epidemiological cutoff values (ECVs, ECOFFs) for MGX were estimated using the Microsoft Excel spreadsheet calculator ECOFFinder.
Results
MGX demonstrated lower MICs than comparators (MIC50 and MIC90 0.03 mg/L; range 0.004-0.06 mg/L). MGX was 8-32-fold more active that the echinocandins, 16-64-fold more active than the azoles, and 64-fold more active than AMB. No differences were found in the MGX or comparators’ MIC50, MIC90, or GEOMEAN values when subsets of clinical, surveillance, and environmental isolates were evaluated. The range of MGX MIC values for six C. auris pan-resistant isolates was 0.008-0.015 mg/L, and the median and mode MIC values were 0.015 mg/L, demonstrating that MGX retains activity against these isolates. The MGX epidemiological cutoff value (ECV, 99% cutoff) was 0.06 mg/L.
Conclusion
MGX MICs were low against C. auris isolates including those with variable patterns of resistance to AMB, azoles, and echinocandins. In addition, MGX retained potent activity against six pan-resistant isolates. These data support the continued clinical evaluation of fosmanogepix for the treatment of C. auris infections, including highly resistant isolates.
Disclosures
Karen J. Shaw, PhD, Amplyx (Consultant)Forge Therapeutics (Consultant) Vishnu Chaturvedi, PhD, Amplyx (Grant/Research Support)
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Affiliation(s)
| | - Shannon N Kilburn
- Wadsworth Center, New York State Department of Health, Delmar, New York
| | - Mili Kapoor
- Amplyx Pharmaceuticals, San Diego, California
| | - Sudha Chaturvedi
- New York State Department of Health Wadsworth Center, Albany, New York
| | | | - Vishnu Chaturvedi
- New York State Department of Health Wadsworth Center, Albany, New York
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Forsberg K, Lyman M, Chaturvedi S, Schneider EC, Fischer J, Baynham DF, Dunbar DF, Plehn M, Podzorski D, Gumbis S, Sievert D, Jackson BR, Lockhart SR, Berkow EL. 155. Public Health Action-based System for Tracking and Responding to U.S. candida Drug Resistance: AR Lab Network, 2016–2019. Open Forum Infect Dis 2020. [PMCID: PMC7776543 DOI: 10.1093/ofid/ofaa439.465] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Many U.S. clinical laboratories lack capacity to definitively identify fungi or perform antifungal susceptibility testing (AFST). To expand testing access, CDC’s Antibiotic Resistance Laboratory Network (AR Lab Network) provides Candida species identification and AFST to U.S. facilities for clinical and public health purposes. We describe the first three years of Candida AR Lab Network resistance data. Methods Isolates from any body site with species identification and AFST performed July 2016–June 2019 are included. Submissions were based on clinical and public health need. Patients may have multiple isolates. The 7 AR Lab Network regional laboratories used matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) or DNA sequencing for species identification. AFST was performed using broth microdilution for azoles and echinocandins (anidulafungin and micafungin) and Etest for amphotericin B. This analysis focuses on non-albicans Candida species with Clinical and Laboratory Standards Institute M60 minimum inhibitory concentration breakpoints and C. auris, which has CDC-proposed tentative breakpoints. Results Participation increased from healthcare facilities from 2 states submitting in 2016 to 35 states in 2019. Species identification was performed on 5,234 non-albicans isolates. AFST was performed on 4,222 (81%) isolates, including 2,395 C. glabrata, 815 C. auris, 267 C. parapsilosis, 125 C. tropicalis, 35 C. guilliermondii, and 32 C. krusei. Of isolates with AFST and body site indicated, 22% (900/4,102) were from blood. We found 85% of C. auris, 8% of C. glabrata, and 5% of C. parapsilosis isolates were resistant to azoles; 33% of C. auris isolates were resistant to amphotericin B; and 2% of C. glabrata, 1% of C. auris, and 1% of C. parapsilosis isolates were resistant to echinocandins. Although intrinsically resistant to fluconazole, C. krusei isolates were not resistant to voriconazole. Multidrug resistance was present in 32% of C. auris and 1% of C. glabrata isolates. Conclusion AR Lab Network has expanded access to rapid Candida testing, including AFST, and provides real-time surveillance. Results can be used to detect emerging species and resistance and guide public health action and healthcare practices. Disclosures All Authors: No reported disclosures
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Affiliation(s)
- Kaitlin Forsberg
- Centers for Disease Control and Prevention; IHRC, Inc., Atlanta, Georgia
| | | | - Sudha Chaturvedi
- New York State Department of Health Wadsworth Center, Albany, New York
| | | | - Jill Fischer
- Minnesota Department of Health, St. Paul, Minnesota
| | | | | | | | | | | | - Dawn Sievert
- Centers for Disease Control and Prevention, Atlanta, Georgia
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20
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Wessell AP, Carvalho HDP, Le E, Cannarsa G, Kole MJ, Stokum JA, Chryssikos T, Miller TR, Chaturvedi S, Gandhi D, Yarbrough K, Satti SR, Jindal G. A Critical Assessment of the Golden Hour and the Impact of Procedural Timing in Stroke Thrombectomy. AJNR Am J Neuroradiol 2020; 41:822-827. [PMID: 32414902 DOI: 10.3174/ajnr.a6556] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 03/04/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Previous studies in acute ischemic stroke have demonstrated the importance of minimizing delays to endovascular treatment and keeping thrombectomy procedural times at <30-60 minutes. The purpose of this study was to investigate the impact of thrombectomy procedural times on clinical outcomes. MATERIALS AND METHODS We retrospectively compared 319 patients having undergone thrombectomy according to procedural time (<30 minutes, 30-60 minutes, and >60 minutes) and time from stroke onset to endovascular therapy (≤6 or >6 hours). Clinical characteristics of patients with postprocedural intracranial hemorrhage were also assessed. Logistic regression was used to determine independent predictors of poor outcome at 90 days (mRS ≥3). RESULTS Greater age (OR, 1.03; 95% CI, 1.01-1.06; P = .016), higher admission NIHSS score (OR, 1.10; 95% CI, 1.04-1.16; P = .001), history of diabetes mellitus (OR, 1.96; 95% CI, 1.05-3.65; P = .034), and postprocedural intracranial hemorrhage were independently associated with greater odds of poor outcome. Modified TICI scale scores of 2c (OR, 0.11; 95% CI, 0.04-0.28; P < .001) and 3 (OR, 0.15; 95% CI, 0.06-0.38; P < .001) were associated with reduced odds of poor outcome. Although not statistically significant on univariate analysis, onset to endovascular therapy of >6 hours was independently associated with increased odds of poor outcome (OR, 2.20; 95% CI, 1.11-4.36; P = .024) in the final multivariate model (area under the curve = 0.820). Procedural time was not independently associated with clinical outcome in the final multivariate model (P > .05). CONCLUSIONS Thrombectomy procedural times beyond 60 minutes are associated with lower revascularization rates and worse 90-day outcomes. Procedural time itself was not an independent predictor of outcome. While stroke thrombectomy procedures should be performed rapidly, our study emphasizes the significance of achieving revascularization despite the requisite procedural time. However, the potential for revascularization must be weighed against the risks associated with multiple thrombectomy attempts.
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Affiliation(s)
- A P Wessell
- Departments of Neurosurgery (A.P.W., G.C., M.J.K., J.A.S., T.C.)
| | - H D P Carvalho
- From the Division of Interventional Neuroradiology (H.D.P.C., E.L., T.R.M., D.G., G.J.)
| | - E Le
- From the Division of Interventional Neuroradiology (H.D.P.C., E.L., T.R.M., D.G., G.J.)
| | - G Cannarsa
- Departments of Neurosurgery (A.P.W., G.C., M.J.K., J.A.S., T.C.)
| | - M J Kole
- Departments of Neurosurgery (A.P.W., G.C., M.J.K., J.A.S., T.C.)
| | - J A Stokum
- Departments of Neurosurgery (A.P.W., G.C., M.J.K., J.A.S., T.C.)
| | - T Chryssikos
- Departments of Neurosurgery (A.P.W., G.C., M.J.K., J.A.S., T.C.)
| | - T R Miller
- From the Division of Interventional Neuroradiology (H.D.P.C., E.L., T.R.M., D.G., G.J.)
| | - S Chaturvedi
- Neurology (S.C., K.Y.), University of Maryland Medical Center, Baltimore, Maryland
| | - D Gandhi
- From the Division of Interventional Neuroradiology (H.D.P.C., E.L., T.R.M., D.G., G.J.)
| | - K Yarbrough
- Neurology (S.C., K.Y.), University of Maryland Medical Center, Baltimore, Maryland
| | - S R Satti
- Department of Neurointerventional Surgery (S.R.S.), Christiana Care Health System, Newark, Delaware
| | - G Jindal
- From the Division of Interventional Neuroradiology (H.D.P.C., E.L., T.R.M., D.G., G.J.)
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21
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Ren P, Rajkumar SS, Zhang T, Sui H, Masters PS, Martinkova N, Kubátová A, Pikula J, Chaturvedi S, Chaturvedi V. A common partitivirus infection in United States and Czech Republic isolates of bat white-nose syndrome fungal pathogen Pseudogymnoascus destructans. Sci Rep 2020; 10:13893. [PMID: 32807800 PMCID: PMC7431587 DOI: 10.1038/s41598-020-70375-6] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 07/24/2020] [Indexed: 12/15/2022] Open
Abstract
The psychrophilic (cold-loving) fungus Pseudogymnoascus destructans was discovered more than a decade ago to be the pathogen responsible for white-nose syndrome, an emerging disease of North American bats causing unprecedented population declines. The same species of fungus is found in Europe but without associated mortality in bats. We found P. destructans was infected with a mycovirus [named Pseudogymnoascus destructans partitivirus 1 (PdPV-1)]. The virus is bipartite, containing two double-stranded RNA (dsRNA) segments designated as dsRNA1 and dsRNA2. The cDNA sequences revealed that dsRNA1 dsRNA is 1,683 bp in length with an open reading frame (ORF) that encodes 539 amino acids (molecular mass of 62.7 kDa); dsRNA2 dsRNA is 1,524 bp in length with an ORF that encodes 434 amino acids (molecular mass of 46.9 kDa). The dsRNA1 ORF contains motifs representative of RNA-dependent RNA polymerase (RdRp), whereas the dsRNA2 ORF sequence showed homology with the putative capsid proteins (CPs) of mycoviruses. Phylogenetic analyses with PdPV-1 RdRp and CP sequences indicated that both segments constitute the genome of a novel virus in the family Partitiviridae. The purified virions were isometric with an estimated diameter of 33 nm. Reverse transcription PCR (RT-PCR) and sequencing revealed that all US isolates and a subset of Czech Republic isolates of P. destructans were infected with PdPV-1. However, PdPV-1 appears to be not widely dispersed in the fungal genus Pseudogymnoascus, as non-pathogenic fungi P. appendiculatus (1 isolate) and P. roseus (6 isolates) tested negative. P. destructans PdPV-1 could be a valuable tool to investigate fungal biogeography and the host-pathogen interactions in bat WNS.
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Affiliation(s)
- Ping Ren
- Mycology Laboratory, Wadsworth Center, New York State Department of Health, Albany, NY, USA. .,Department of Pathology, University of Texas Medical Branch, Galveston, TX, USA.
| | - Sunanda S Rajkumar
- Mycology Laboratory, Wadsworth Center, New York State Department of Health, Albany, NY, USA.,ICMR Medical Research Institute, Puducherry, India
| | - Tao Zhang
- Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Haixin Sui
- Cellular and Molecular Basis of Diseases Laboratory, Wadsworth Center, New York State Department of Health, Albany, NY, USA.,Department of Biomedical Sciences, University of Albany School of Public Health, Albany, NY, USA
| | - Paul S Masters
- Department of Biomedical Sciences, University of Albany School of Public Health, Albany, NY, USA.,Viral Replication and Vector Biology Laboratory, Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Natalia Martinkova
- Institute of Vertebrate Biology, Czech Academy of Sciences, Brno, Czech Republic
| | - Alena Kubátová
- Department of Botany, Faculty of Science, Charles University in Prague, Praha, Czech Republic
| | - Jiri Pikula
- Department of Ecology and Diseases of Zoo Animals, Game, Fish and Bees, University of Veterinary and Pharmaceutical Sciences, Brno, Czech Republic
| | - Sudha Chaturvedi
- Mycology Laboratory, Wadsworth Center, New York State Department of Health, Albany, NY, USA.,Department of Biomedical Sciences, University of Albany School of Public Health, Albany, NY, USA
| | - Vishnu Chaturvedi
- Mycology Laboratory, Wadsworth Center, New York State Department of Health, Albany, NY, USA. .,Department of Biomedical Sciences, University of Albany School of Public Health, Albany, NY, USA.
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22
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Maheshwari R, Qadri SY, Rakhul LR, Chaturvedi S, Desai P, Grover R, Chhabra G, Khullar D, Kumar A. Prospective Nonrandomized Comparison Between Open and Robot-Assisted Kidney Transplantation: Analysis of Midterm Functional Outcomes. J Endourol 2020; 34:939-945. [PMID: 32600060 DOI: 10.1089/end.2020.0213] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Introduction: To compare short- and midterm outcomes of the first 55 patients undergoing robot-assisted kidney transplant (RAKT) with patients undergoing open kidney transplant (OKT) during the same period in a tertiary care hospital. Materials and Methods: Data of all end-stage renal disease patients undergoing renal transplant were prospectively maintained. All graft kidneys were harvested laparoscopically. Both RAKT and OKT were performed using standardized techniques, and all RAKTs were performed by a single experienced robotic surgeon. Chi-square test/Fisher exact test was done for categorical data, and Mann-Whitney U test was done for continuous data. Discrete variables were expressed in absolute numbers and percentages. For all tests, p < 0.05 was considered significant. All results were expressed as mean ± standard deviation or median with range. Results: Between April 2016 and September 2018, 55 patients underwent RAKT. The same was compared with 152 patients who underwent OKT. The two groups were comparable in terms of age, gender, and body mass index. Duration on hemodialysis was significantly higher in the RAKT group, and hemoglobin and donor kidney glomerular filtration rate was significantly better in the RAKT group. Requirement of perioperative analgesia was significantly less in the RAKT group. Rewarm ischemia time was significantly longer in the RAKT group. The fall in serum creatinine was slower in RAKT group till 3 months. The serum creatinine levels were statistically similar in the two cohorts at 3 months (p = 0.082), which was maintained at median 29 months of follow-up (p = 0.067). Tacrolimus levels on postoperative day 2 were found to be significantly higher in RAKT cohort (17.98 ± 14.41) vs OKT cohort (11.38 ± 6.93). Surgical-site infections were rare in the RAKT group. Conclusions: RAKT confers advantage of decreased wound morbidity with similar functional outcomes compared with OKT in midterm. It looks promising; however, long-term follow-up of larger numbers of patients is needed.
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Affiliation(s)
- R Maheshwari
- Department of Urology, Kidney Transplantation, Robotics and Uro-oncology and Max Super Speciality Hospital, Saket, New Delhi, India
| | - S Y Qadri
- Department of Urology, Kidney Transplantation, Robotics and Uro-oncology and Max Super Speciality Hospital, Saket, New Delhi, India
| | - L R Rakhul
- Department of Urology, Kidney Transplantation, Robotics and Uro-oncology and Max Super Speciality Hospital, Saket, New Delhi, India
| | - S Chaturvedi
- Department of Urology, Kidney Transplantation, Robotics and Uro-oncology and Max Super Speciality Hospital, Saket, New Delhi, India
| | - P Desai
- Department of Urology, Kidney Transplantation, Robotics and Uro-oncology and Max Super Speciality Hospital, Saket, New Delhi, India
| | - R Grover
- Department of Nephrology and Transplant Medicine, Max Super Speciality Hospital, Saket, New Delhi, India
| | - G Chhabra
- Department of Nephrology and Transplant Medicine, Max Super Speciality Hospital, Saket, New Delhi, India
| | - D Khullar
- Department of Nephrology and Transplant Medicine, Max Super Speciality Hospital, Saket, New Delhi, India
| | - A Kumar
- Department of Urology, Kidney Transplantation, Robotics and Uro-oncology and Max Super Speciality Hospital, Saket, New Delhi, India
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Maheshwari R, Chaturvedi S, Desai P, Panwar P, Singh V, Bansal D, Bansal A, Kumar A. Comparison of outcomes between open and robot assisted kidney transplant in paediatric population - initial results. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33668-5] [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: 11/29/2022] Open
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24
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Geil ES, Ramos AR, Abreu AR, Lambrasko LK, Dib SI, Wallace DM, Junco B, Torre BC, Chediak AD, Chaturvedi S. 0589 Arrhythmia Detection in Obstructive Sleep Apnea (ADIOS). Sleep 2020. [DOI: 10.1093/sleep/zsaa056.586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Obstructive sleep apnea (OSA) is a recognized risk factor for ischemic stroke; however, there is a paucity of studies devoted to modifying stroke risk factors in patients with OSA. We aimed to evaluate the prevalence and treatment of stroke risk factors in newly diagnosed OSA patients.
Methods
We evaluated consecutive patients with an OSA diagnosis made within 12 months and CHADS2 score of >2, consistent with high risk for atrial fibrillation. The patients completed polysomnography, sleep questionnaires, and systematic assessments for demographic variables, vascular risk factors, and medication use. Participants also completed up to four weeks of ambulatory cardiac monitoring. A six-month follow-up visit screened for new hospitalizations associated to vascular events and use of new anticoagulants or antiplatelet therapy.
Results
The sample consisted of 87 patients, mean age 59±8 years, 53% women, and 69% of Hispanic/Latino background. The mean BMI was 35±9. Hypertension was seen in 57% and diabetes mellitus in 33% of the sample. The mean apnea-hypopnea index was 41±27 events/hour. Atrial fibrillation was detected in 3% of the sample through prolonged monitoring. At six-month follow-up, 9% of the sample was hospitalized due to stroke, transient ischemic attack, or coronary artery disease, while 13% reported use of anticoagulants and 38% antiplatelet therapy.
Conclusion
In this high risk sample of OSA patients, there was a high prevalence of cerebrovascular events and use of medical treatment for secondary stroke prevention. Future studies evaluating the treatment of vascular risk factors in OSA can provide strategies to minimize stroke occurrence.
Support
Boehringer Ingelheim
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Affiliation(s)
- E S Geil
- UHealth Sleep Medicine Program, Miller School of Medicine, Miami, FL
| | - A R Ramos
- UHealth Sleep Medicine Program, Miller School of Medicine, Miami, FL
| | - A R Abreu
- UHealth Sleep Medicine Program, Miller School of Medicine, Miami, FL
| | - L K Lambrasko
- Department of Medicine, Miller School of Medicine, Miami, FL
| | - S I Dib
- UHealth Sleep Medicine Program, Miller School of Medicine, Miami, FL
| | - D M Wallace
- Bruce W. Carter VA Medical Center, Miami, FL
| | - B Junco
- Department of Neurology, Miller School of Medicine, Miami, FL
| | - B C Torre
- Department of Neurology, Miller School of Medicine, Miami, FL
| | - A D Chediak
- UHealth Sleep Medicine Program, Miller School of Medicine, Miami, FL
| | - S Chaturvedi
- Department of Neurology, University of Maryland, Baltimore, MD
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25
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Yan L, Xia K, Yu Y, Miliakos A, Chaturvedi S, Zhang F, Chen S, Chaturvedi V, Linhardt RJ. Unique Cell Surface Mannan of Yeast Pathogen Candida auris with Selective Binding to IgG. ACS Infect Dis 2020; 6:1018-1031. [PMID: 32233507 DOI: 10.1021/acsinfecdis.9b00450] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The emerging, multidrug-resistant yeast pathogen Candida auris is responsible for healthcare-associated outbreaks across the globe with high mortality. The rapid spread of C. auris is linked to its successful colonization of human skin, followed by bloodstream infections. We compared glycomics and proteomics of C. auris to closely and distantly related human pathogenic yeasts, C. haemulonii and C. albicans, with the aim to understand the role of cell surface molecules in skin colonization and immune system interactions. Candida auris mannan is distinct from other pathogenic Candida species, as it is highly enriched in β-1,2-linkages. The experimental data showed that C. auris surface mannan β-1,2-linkages were important for the interactions with the immune protein IgG, found in blood and in sweat glands, and with the mannose binding lectin, found in the blood. Candida auris mannan binding to IgG was from 12- to 20-fold stronger than mannan from the more common pathogen C. albicans. The findings suggest unique C. auris mannan could be crucial for the biology and pathogenesis of this emerging pathogen.
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Affiliation(s)
- Lufeng Yan
- Center for Biotechnology & Interdisciplinary Studies and Department of Chemistry & Chemical Biology, Rensselaer Polytechnic Institute, Biotechnology Center 4005, Troy, New York 12180, United States
| | - Ke Xia
- Center for Biotechnology & Interdisciplinary Studies and Department of Chemistry & Chemical Biology, Rensselaer Polytechnic Institute, Biotechnology Center 4005, Troy, New York 12180, United States
| | - Yanlei Yu
- Center for Biotechnology & Interdisciplinary Studies and Department of Chemistry & Chemical Biology, Rensselaer Polytechnic Institute, Biotechnology Center 4005, Troy, New York 12180, United States
| | - Anna Miliakos
- Center for Biotechnology & Interdisciplinary Studies and Department of Chemistry & Chemical Biology, Rensselaer Polytechnic Institute, Biotechnology Center 4005, Troy, New York 12180, United States
| | - Sudha Chaturvedi
- Mycology Laboratory, Wadsworth Center, New York State Department of Health, Albany, New York 12201, United States
- Department of Biomedical Sciences, University at Albany School of Public Health, Albany, New York 12222, United States
| | - Fuming Zhang
- Center for Biotechnology & Interdisciplinary Studies and Department of Chemistry & Chemical Biology, Rensselaer Polytechnic Institute, Biotechnology Center 4005, Troy, New York 12180, United States
| | - Shiguo Chen
- Center for Biotechnology & Interdisciplinary Studies and Department of Chemistry & Chemical Biology, Rensselaer Polytechnic Institute, Biotechnology Center 4005, Troy, New York 12180, United States
| | - Vishnu Chaturvedi
- Mycology Laboratory, Wadsworth Center, New York State Department of Health, Albany, New York 12201, United States
- Department of Biomedical Sciences, University at Albany School of Public Health, Albany, New York 12222, United States
| | - Robert J Linhardt
- Center for Biotechnology & Interdisciplinary Studies and Department of Chemistry & Chemical Biology, Rensselaer Polytechnic Institute, Biotechnology Center 4005, Troy, New York 12180, United States
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26
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Naqash TA, Chaturvedi S, Yaqoob A, Saquib S, Addas MK, Alfarsi M. Evaluation of sagittal condylar guidance angles using computerized pantographic tracings, protrusive interocclusal records, and 3D-CBCT imaging techniques for oral rehabilitation. Niger J Clin Pract 2020; 23:550-554. [PMID: 32246664 DOI: 10.4103/njcp.njcp_544_19] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objective The goal of registering the condylar guidance is to recreate the patient's occlusion as exactly as possible on the articulator, and is therefore essential for successful prosthodontic rehabilitation. Clinical, radiographic, and pantographic methods are used to determine sagittal condylar guidance angles (SCGAs). These methods generate different angles in the same patients. The present study is the first disquisition to evaluate and correlate SCGAs determined by the use of pantographic tracing (PT), protrusive records (PR), and radiographic (CBCT) techniques. Materials and Methods The condylar guidance was measured using PT, PR, and CBCT imaging techniques in 23 nonpatient participants aged between 18 and 30 years irrespective of sex. PT was recorded using Cadiax® Compact system, a computerized recorder of SCGAs. PR was obtained using polyvinyl siloxane bite registration material, transferred to a semiadjustable articulator (Denar Mark II, Whip Mix Corp., USA) using facebow transfer (Denar Mark II, Whip Mix Corp., USA) and CR records, to determine SCGAs. Images of the mid-facial region were obtained using CBCT scan for 3D reconstruction. The angle formed between Frankfort horizontal plane (FHP) and a line extending from the most supero-anterior point on the glenoid fossa to the most convex point on the apex of articular eminence (AE) was measured to obtain SCGAs. Results The mean left and right SCGAs were as follows: PT (34.42° and 33.93°, respectively), PR (32.14° and 31.82°), and CBCT (38.96° and 38.12°). The Pearson coefficients for the correlations with PT and PR on the left and right sides were 0.899 and 0.907, respectively, while it was 0.911 and 0.934, and 0.842 and 0.874 from PT and CBCT, and PR and CBCT, respectively. Conclusion Strong correlations were found between SCGAs obtained using PT, PR, and CBCT techniques.
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Affiliation(s)
- T A Naqash
- Department of Prosthetic Dentistry, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - S Chaturvedi
- Department of Prosthetic Dentistry, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - A Yaqoob
- Department of Prosthetic Dentistry, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - S Saquib
- Department of Periodontics and Community Dental Sciences, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - M K Addas
- Department of Prosthetic Dentistry, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - M Alfarsi
- Department of Prosthetic Dentistry, College of Dentistry, King Khalid University, Abha, Saudi Arabia
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27
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Zhu Y, O'Brien B, Leach L, Clarke A, Bates M, Adams E, Ostrowsky B, Quinn M, Dufort E, Southwick K, Erazo R, Haley VB, Bucher C, Chaturvedi V, Limberger RJ, Blog D, Lutterloh E, Chaturvedi S. Laboratory Analysis of an Outbreak of Candida auris in New York from 2016 to 2018: Impact and Lessons Learned. J Clin Microbiol 2020; 58:e01503-19. [PMID: 31852764 PMCID: PMC7098748 DOI: 10.1128/jcm.01503-19] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [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] [Received: 09/10/2019] [Accepted: 12/11/2019] [Indexed: 12/15/2022] Open
Abstract
Candida auris is a multidrug-resistant yeast which has emerged in health care facilities worldwide; however, little is known about identification methods, patient colonization, environmental survival, spread, and drug resistance. Colonization on both biotic (patients) and abiotic (health care objects) surfaces, along with travel, appear to be the major factors for the spread of this pathogen across the globe. In this investigation, we present laboratory findings from an ongoing C. auris outbreak in New York (NY) from August 2016 through 2018. A total of 540 clinical isolates, 11,035 patient surveillance specimens, and 3,672 environmental surveillance samples were analyzed. Laboratory methods included matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) for yeast isolate identification, real-time PCR for rapid surveillance sample screening, culture on selective/nonselective media for recovery of C. auris and other yeasts from surveillance samples, antifungal susceptibility testing to determine the C. auris resistance profile, and Sanger sequencing of the internal transcribed spacer (ITS) and D1/D2 regions of the ribosomal gene for C. auris genotyping. Results included (a) identification and confirmation of C. auris in 413 clinical isolates and 931 patient surveillance isolates as well as identification of 277 clinical cases and 350 colonized cases from 151 health care facilities, including 59 hospitals, 92 nursing homes, 1 long-term acute care hospital (LTACH), and 2 hospices, (b) successful utilization of an in-house developed C. auris real-time PCR assay for the rapid screening of patient and environmental surveillance samples, (c) demonstration of relatively heavier colonization of C. auris in nares than in the axilla/groin, and (d) predominance of the South Asia clade I with intrinsic resistance to fluconazole and elevated MIC to voriconazole (81%), amphotericin B (61%), flucytosine (5FC) (3%), and echinocandins (1%). These findings reflect greater regional prevalence and incidence of C. auris and the deployment of better detection tools in an unprecedented outbreak.
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Affiliation(s)
- YanChun Zhu
- Mycology Laboratory, Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Brittany O'Brien
- Mycology Laboratory, Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Lynn Leach
- Mycology Laboratory, Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Alexandra Clarke
- Mycology Laboratory, Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Marian Bates
- Mycology Laboratory, Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Eleanor Adams
- Healthcare Epidemiology & Infection Control Program, New York State Department of Health, New Rochelle, New York, USA
| | - Belinda Ostrowsky
- Division of Healthcare Quality Promotion (DHQP), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Monica Quinn
- Bureau of Healthcare Associated Infections, New York State Department of Health, Albany, New York, USA
| | - Elizabeth Dufort
- Division of Epidemiology, New York State Department of Health, Albany, New York, USA
| | - Karen Southwick
- Healthcare Epidemiology & Infection Control Program, New York State Department of Health, New Rochelle, New York, USA
| | - Richard Erazo
- Healthcare Epidemiology & Infection Control Program, New York State Department of Health, New Rochelle, New York, USA
| | - Valerie B Haley
- Bureau of Healthcare Associated Infections, New York State Department of Health, Albany, New York, USA
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Albany, New York, USA
| | - Coralie Bucher
- Bureau of Healthcare Associated Infections, New York State Department of Health, Albany, New York, USA
| | - Vishnu Chaturvedi
- Mycology Laboratory, Wadsworth Center, New York State Department of Health, Albany, New York, USA
- Department of Biomedical Sciences, School of Public Health, University at Albany, Albany, New York, USA
| | - Ronald J Limberger
- Mycology Laboratory, Wadsworth Center, New York State Department of Health, Albany, New York, USA
| | - Debra Blog
- Division of Epidemiology, New York State Department of Health, Albany, New York, USA
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Albany, New York, USA
| | - Emily Lutterloh
- Bureau of Healthcare Associated Infections, New York State Department of Health, Albany, New York, USA
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Albany, New York, USA
| | - Sudha Chaturvedi
- Mycology Laboratory, Wadsworth Center, New York State Department of Health, Albany, New York, USA
- Department of Biomedical Sciences, School of Public Health, University at Albany, Albany, New York, USA
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Ostrowsky B, Greenko J, Adams E, Quinn M, O’Brien B, Chaturvedi V, Berkow E, Vallabhaneni S, Forsberg K, Chaturvedi S, Lutterloh E, Blog D. Candida auris Isolates Resistant to Three Classes of Antifungal Medications - New York, 2019. MMWR Morb Mortal Wkly Rep 2020; 69:6-9. [PMID: 31917780 PMCID: PMC6973342 DOI: 10.15585/mmwr.mm6901a2] [Citation(s) in RCA: 111] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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29
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Chaturvedi S, Haralur SB, Addas MK, Alfarsi MA. CBCT analysis of schneiderian membrane thickness and its relationship with gingival biotype and arch form. Niger J Clin Pract 2019; 22:1448-1456. [PMID: 31607738 DOI: 10.4103/njcp.njcp_186_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objective The purpose of this study was to investigate a relationship between gingival tissue biotypes and arch form with Schneiderian membrane thickness, using limited cone beam computed tomography. Materials and Methods A total of 90 subjects were selected. For each subject three parameters were assessed - gingival biotype - clinically by Probe transparency method as thin or thick and coded as 0 and 1, respectively, gingival thickness and Schneiderian membrane thickness in mm, arch form as square, oval, or tapered (radiographically by cone beam computed tomography images). Central incisors and first molars were assessed for gingival biotype and gingival thickness and Schneiderian membrane thickness was determined at 16. Numerical data were estimated for normal distribution. Analysis of Variance test was followed by Tukey honestly significant difference test and Pearson's correlation coefficient test for analysis. Results Thin gingival biotype was found associated with the central incisors and thick gingival biotype with molars. Limited cone beam computed tomography scans evaluation revealed highest prevalence of square arch form followed by oval, and tapered. The average thickness of the Schneiderian membrane was 1.18 ± 0.43 mm on left side and 1.09 ± 0.41 mm on right side with a range of 0.50 - 2.00 mm. Mean Schneiderian membrane thickness was more in case of thick gingival biotype and with square arc form both on right and left sides. Conclusions The Schneiderian membrane thickness was positively and highly associated with gingival biotype. The gingival biotype and arch form had significant effect on Schneiderian membrane thickness and can provide valuable clinical information on Schneiderian membrane thickness preoperatively for implant placement and sinus lift procedures.
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Affiliation(s)
- S Chaturvedi
- Department of Prosthetic Dentistry, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - S B Haralur
- Department of Prosthetic Dentistry, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - M K Addas
- Department of Prosthetic Dentistry, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - M A Alfarsi
- Department of Prosthetic Dentistry, College of Dentistry, King Khalid University, Abha, Saudi Arabia
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30
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O’Brien B, Chaturvedi S, Chaturvedi V. 1579. Multidrug-Resistant Candida auris Isolates From New York Hospitals and Healthcare Facilities Are Susceptible to Antifungal Combinations. Open Forum Infect Dis 2019. [PMCID: PMC6809003 DOI: 10.1093/ofid/ofz360.1443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Candida auris outbreak continues unabated in New York with the current case counts exceeding 300 patients. We used a modification of standard CLSI broth microdilution method (BMD) if two-drug combinations are efficacious against C. auris isolates with high-resistance to fluconazole (FZ, MIC50 >256 mg/L), and variable resistance to other broad-spectrum antifungal drugs.
Methods
BMD plates were custom-designed and quality controlled by TREK Diagnostic System. The combination tests of 15 drug-resistant C. auris involved microtiter wells with the initial 144 two-drug combinations and their two-fold dilutions (1/2–1/32) to get 864 two-drug combinations finally. We utilized MIC100 endpoints for the drug combination readings as reported earlier for the intra- and inter-laboratory agreements obtained against Candida species and Aspergillus fumigatus (Antimicrob Agents Chemother. 2015. 59:1759–1766). We also tested minimum fungicidal concentrations (MFC).
Results
We tested all possible 864 two-drug antifungal combinations for nine antifungal drugs in use to yield 12,960 MIC100 readings, and MFC readings for 15 C. auris isolates. Flucytosine (FLC) at 2.0 mg/L potentiated most successful combinations with other drugs. Micafungin (MFG), Anidulafungin (AFG), Caspofungin (CAS) at individual concentrations of 0.25 mg/L combined well with FLC (2.0 mg/L) to yield MIC100 for 14, 13, and 12 of 15 C. auris isolates tested, respectively. MFG/FLC combination was also fungicidal for 4 of 15 isolates. AMB / FLC (0.25/1.0 mg/L) yielded MIC100 for 13 isolates and MFC for three test isolates. Posaconazole (POS), and Isavuconazole (ISA) and Voriconazole (VRC) also combined well with FLC (0.25/2.0 mg/L) to yield MIC100 for 12, 13, and 13 isolates, respectively. POS/FLC combination was fungicidal for three isolates.
Conclusion
We identified seven two drug-combinations of antifungals efficacious against drug-resistant C. auris strains. The modified BMD combination susceptibility testing could be used by the clinical laboratories to assist providers with the selection of optimal treatment for C. auris candidemia.
Disclosures
All authors: No reported disclosures.
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Affiliation(s)
- Brittany O’Brien
- New York State Department of Health Wadsworth Center, Albany, New York
| | - Sudha Chaturvedi
- New York State Department of Health Wadsworth Center, Albany, New York
| | - Vishnu Chaturvedi
- New York State Department of Health Wadsworth Center, Albany, New York
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Haralur SB, Majeed MI, Afzal M, Chaturvedi S. Association of sociodemographic factors and emotional intelligence with academic performance in clinical and preclinical dental courses. Niger J Clin Pract 2019; 22:1109-1114. [PMID: 31417054 DOI: 10.4103/njcp.njcp_37_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background The dental graduation program is stressful and challenging as it is essential to master various skills. The emotional intelligence (EI) is reported to help in perceiving, moderating emotions and also play a significant role in academic excellence. Aim The aim of this study was to assess the sociodemographic factors influencing EI and to determine the association of EI in academic performance of clinical and preclinical courses. Materials and Methods This cross-sectional study included the 113 dental clinical internship students from five different dental schools at Pakistan. The self-administered questionnaire data included sociodemographic factors, academic performance in preclinical, clinical courses, and San Diego City College MESA Program-based EI responses. The results were analyzed with multiple linear regression and ordinal regression to identify the independent predictor for EI and academic performance. Results The female participants had marginally higher mean EI score (109.67) in comparison to male counterparts (108.10). The independent predictors among sociodemographic factors for EI were having siblings (P = 0.016), loss of parents (P = 0.002), parents' education (P = 0.022), and relation with parents (P = 0.03). The students enjoy studying dentistry were also associated with higher EI scores (P = 0.002). The mean EI score was an independent predictor of academic performance predominantly in clinical courses [β = -0.041 (95% confidence interval - 0.063 to - 0.020); P = 0.000]. Conclusion The finding of the study indicates the influence of family and social factors in the development of EI. The dental students' EI is vital for higher academic performance in clinical courses.
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Affiliation(s)
- S B Haralur
- Department of Prosthodontics, College of Dentistry, King Khalid University, Kingdom of Saudi Arabia
| | - M I Majeed
- Department of Prosthodontics, College of Dentistry, King Khalid University, Kingdom of Saudi Arabia
| | - M Afzal
- Institute of Dentistry, CMH Medical College, Lahore, Pakistan
| | - S Chaturvedi
- Department of Prosthodontics, College of Dentistry, King Khalid University, Kingdom of Saudi Arabia
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Torres SR, Kim HC, Leach L, Chaturvedi S, Bennett CJ, Hill DJ, De Jesus M. Assessment of environmental and occupational exposure while working with multidrug resistant (MDR) fungus Candida auris in an animal facility. J Occup Environ Hyg 2019; 16:507-518. [PMID: 31116671 DOI: 10.1080/15459624.2019.1594840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In less than a decade since its identification in 2009, the emerging fungal pathogen Candida auris has become a major public health threat due to its multidrug resistant (MDR) phenotype, high transmissibility, and high mortality. Unlike other Candida species, C. auris has acquired high levels of resistance to an already limited arsenal of antifungals. As an emerging pathogen, there are currently a limited number of documented murine models of C. auris infection. These animal models use inoculums as high as 107-108 cells per mouse, and the environmental and occupational exposure of working with these models has not been clearly defined. Using real-time quantitative polymerase chain reaction (PCR) and culture, we monitored the animal holding room as well as the procedure room for up to 6 months while working with an intravenous model of C. auris infection. This study determined that shedding of the organism is dose-dependent, as detectable levels of C. auris were detected in the cage bedding when mice were infected with 107 and 108 cells, but not with doses of 105 and 106 cells. Autoclaving bedding in closed micro-isolator cages was found to be an effective way to minimize exposure for animal caretakers. We found that tissue necropsies of infected mice were also an important source of potential source exposure to C. auris. To mitigate these potential exposures, we implemented a rigorous "buddy system" workflow and a disinfection protocol that uses 10% bleach followed by 70% ethanol and can be used in any animal facility when using small animal models of C. auris infection.
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Affiliation(s)
- Steven R Torres
- a Department of Biomedical Sciences , University at Albany, School of Public Health , Albany , New York
- b Division of Infectious Diseases , Wadsworth Center, New York State Department of Health , Albany , New York
| | - Heather C Kim
- a Department of Biomedical Sciences , University at Albany, School of Public Health , Albany , New York
- b Division of Infectious Diseases , Wadsworth Center, New York State Department of Health , Albany , New York
| | - Lynn Leach
- b Division of Infectious Diseases , Wadsworth Center, New York State Department of Health , Albany , New York
| | - Sudha Chaturvedi
- b Division of Infectious Diseases , Wadsworth Center, New York State Department of Health , Albany , New York
| | - Corey J Bennett
- b Division of Infectious Diseases , Wadsworth Center, New York State Department of Health , Albany , New York
| | - David J Hill
- b Division of Infectious Diseases , Wadsworth Center, New York State Department of Health , Albany , New York
| | - Magdia De Jesus
- a Department of Biomedical Sciences , University at Albany, School of Public Health , Albany , New York
- b Division of Infectious Diseases , Wadsworth Center, New York State Department of Health , Albany , New York
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jaiswal PhD A, Chaturvedi S, Singh H, Agarwal V, Prasad N. MON-212 COMPLETE ABROGATION OF ALPHA SMOOTH MUSCLE ACTIN ON DUAL INHIBITION OF PHOSPHODIESTERASE 5 AND 5-HT2B INHIBITORS IN HUMAN PERITONEAL FIBROBLASTS ISOLATED FROM CAPD PATIENTS. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.1011] [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: 11/17/2022] Open
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Southwick KL, Greenko JA, Adams E, Erazo R, Denis RJ, Green C, Fernandez R, Patel R, Giardina R, Chaturvedi S, Zhu Y, Leach L, Quinn M. A Description of the First Candida Auris-colonized Individuals in New York State, 2016-2017. Am J Infect Control 2019. [DOI: 10.1016/j.ajic.2019.04.155] [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: 10/26/2022]
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Chaturvedi S, Alfarsi MA. 3-D mapping of cortical bone thickness in subjects with different face form and arch form: A CBCT analysis. Niger J Clin Pract 2019; 22:616-625. [PMID: 31089015 DOI: 10.4103/njcp.njcp_642_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objective To determine the relationship between face form (FF), arch form (AF), and cortical bone thickness in anterior and posterior region of the mandibular jaws, using cone beam computed tomography (CBCT). Patients and Methods Total 90 subjects were selected. For each subject FF (euryprosopic, mesoprosopic, and leptoprosopic) was determined using Prosopic Index. CBCT scans were done for each subject to determine mandibular AF (as tapered, oval, or square in horizontal sections) and cortical bone thickness (at two vertical levels 4 and 7 mm from the alveolar crest in the anterior and posterior region of mandible in sagittal sections). Numerical data so obtained were analyzed using descriptive statistics, analysis of variance followed by Tukey HSD (honestly significant difference) test at a statistical significance level of 5%. Results Significant difference in thickness of cortical bone was noted between various AF and face. In square AF, mean value of thickness of cortical bone was highest both at 4 and 7 mm vertical level and tapered AF had minimum mean values at 4 mm and oval at 7 mm in anterior region and posterior region on buccal and lingual sides, in all the three-FF. Conclusion Significant effects of FF and AF on cortical bone thickness were seen both on buccal and lingual side and the effect of AF was more compared to FF. The availability of the cortical bone in euryprosopic FF and square AF patients was more; therefore, implants with a shorter length may be used in these clinical cases.
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Affiliation(s)
- S Chaturvedi
- Department of Prosthetic Dentistry, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - M A Alfarsi
- Department of Prosthetic Dentistry, College of Dentistry, King Khalid University, Abha, Saudi Arabia
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Adams E, Quinn M, Tsay S, Poirot E, Chaturvedi S, Southwick K, Greenko J, Fernandez R, Kallen A, Vallabhaneni S, Haley V, Hutton B, Blog D, Lutterloh E, Zucker H. Candida auris in Healthcare Facilities, New York, USA, 2013-2017. Emerg Infect Dis 2019; 24:1816-1824. [PMID: 30226155 PMCID: PMC6154128 DOI: 10.3201/eid2410.180649] [Citation(s) in RCA: 158] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Candida auris is an emerging yeast that causes healthcare-associated infections. It can be misidentified by laboratories and often is resistant to antifungal medications. We describe an outbreak of C. auris infections in healthcare facilities in New York City, New York, USA. The investigation included laboratory surveillance, record reviews, site visits, contact tracing with cultures, and environmental sampling. We identified 51 clinical case-patients and 61 screening case-patients. Epidemiologic links indicated a large, interconnected web of affected healthcare facilities throughout New York City. Of the 51 clinical case-patients, 23 (45%) died within 90 days and isolates were resistant to fluconazole for 50 (98%). Of screening cultures performed for 572 persons (1,136 total cultures), results were C. auris positive for 61 (11%) persons. Environmental cultures were positive for samples from 15 of 20 facilities. Colonization was frequently identified during contact investigations; environmental contamination was also common.
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Fuchs BB, Chaturvedi S, Rossoni RD, de Barros PP, Torres-Velez F, Mylonakis E, Chaturvedi V. Galleria mellonella experimental model for bat fungal pathogen Pseudogymnoascus destructans and human fungal pathogen Pseudogymnoascus pannorum. Virulence 2019; 9:1539-1547. [PMID: 30289352 PMCID: PMC6177250 DOI: 10.1080/21505594.2018.1518087] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Laboratory investigations of the pathogenesis of Pseudogymnoascus destructans, the fungal causal agent of bat White Nose Syndrome (WNS), presents unique challenges due to its growth requirements (4°-15°C) and a lack of infectivity in the current disease models. Pseudogymnoascus pannorum is the nearest fungal relative of P. destructans with wider psychrophilic - physiological growth range, and ability to cause rare skin infections in humans. Our broad objectives are to create the molecular toolkit for comparative study of P. destructans and P. pannorum pathogenesis. Towards these goals, we report the successful development of an invertebrate model in the greater wax moth Galleria mellonella. Both P. destructans and P. pannorum caused fatal disease in G. mellonella and elicited immune responses and histopathological changes consistent with the experimental disease.
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Affiliation(s)
- Beth Burgwyn Fuchs
- a Division of Infectious Diseases, Rhode Island Hospital , Warren Alpert Medical School at Brown University , Providence , RI , USA
| | - Sudha Chaturvedi
- b Mycology Laboratory, Division of Infectious Diseases , Wadsworth Center, New York State Department of Health , Albany , NY , USA.,c Department of Biomedical Sciences, School of Public Health , University of Albany , Albany , NY , USA
| | - Rodnei Dennis Rossoni
- d Department of Biosciences and Oral Diagnosis, Institute of Science and Technology , UNESP - Univ Estadual Paulista , Sao Jose dos Campos , Brazil
| | - Patricia P de Barros
- d Department of Biosciences and Oral Diagnosis, Institute of Science and Technology , UNESP - Univ Estadual Paulista , Sao Jose dos Campos , Brazil
| | - Fernando Torres-Velez
- e Division of Infectious Diseases , Wadsworth Center, New York State Department of Health , Albany , NY , USA
| | - Eleftherios Mylonakis
- a Division of Infectious Diseases, Rhode Island Hospital , Warren Alpert Medical School at Brown University , Providence , RI , USA
| | - Vishnu Chaturvedi
- b Mycology Laboratory, Division of Infectious Diseases , Wadsworth Center, New York State Department of Health , Albany , NY , USA.,c Department of Biomedical Sciences, School of Public Health , University of Albany , Albany , NY , USA
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Chaturvedi S, Ahmed AR, Hussain MW, Alshehre AS, Abdullah MA. Acquaintance of dental implants as a treatment modality in edentulous states among health workers in Aseer Province, KSA. Niger J Clin Pract 2019; 22:24-33. [PMID: 30666016 DOI: 10.4103/njcp.njcp_469_18] [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: 11/04/2022]
Abstract
Purpose To identify the acquaintance of dental implant (DI) as a treatment modality in edentulous states among health workers in the Aseer region and also to assess the level of understanding about DI among them. Materials and Methods A questionnaire set of 18 questions was used for 500 health workers from the concerned area about DI. Questionnaire set basically consists of questions to assess the attitude, perception, and knowledge among them about DI. The data collected and association with the factors were tested for significance using the Chi-square test and P < 0.05 was considered statistically significant. Results The response rate was 89%. More than 75% were aware of DI, but only 50% of the total respondents were knowing about the difference between the DI, fixed prosthesis, and removable prosthesis. Of the latter, 47.4% have suggested implants for patients and about 55% respondents were agreeing to get DI done for themselves. Dental health care workers have more knowledge than the medical health workers, and the difference was found to be statistically significant. Of respondents, >90% were willing to know more about DI. Conclusion The practice of implant dentistry is growing in the Aseer region. However, general health workers are not fully aware of proper DI information. In addition, all the efforts should be made to include basic implant education in all the branches of health sciences and the CDE program should be conducted regularly to enhance the knowledge, so that correct information can be channelized to the patients.
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Affiliation(s)
- S Chaturvedi
- Department of Prosthetic Dentistry, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - A R Ahmed
- Department of Prosthetic Dentistry, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - M W Hussain
- Department of Prosthetic Dentistry, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - A S Alshehre
- Department of Prosthetic Dentistry, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - M A Abdullah
- Department of Prosthetic Dentistry, College of Dentistry, King Khalid University, Abha, Saudi Arabia
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Nagate RR, Tikare S, Chaturvedi S, AlQahtani NA, Kader MA, Gokhale ST. A novel perspective for predicting gingival biotype via dentopapillary measurements on study models in the Saudi population: Cross-sectional study. Niger J Clin Pract 2019; 22:56-62. [PMID: 30666021 DOI: 10.4103/njcp.njcp_443_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background/Purpose Gingival biotype (GB) is a crucial factor in predicting the success of soft tissue periodontal and peri-implant surgical interventions. Consequently, contemplating noninvasive, less time-consuming procedure to anticipate it has become a part and parcel of the current practice. This article presents a novel algorithm to detect GB in the Saudi population based on the dentopapillary measurements taken on laboratory models. In addition, it targets to allocate a range of values for thick and thin biotypes. Materials and Methods Model analysis was done on 160 patients to measure eight gingival parameters, and an algorithm was developed according to the results of multiple and linear regression analyses. Applying the dentopapillary parameters to the algorithm revealed a prediction of the biotype. Finally, the resultant values and the exact thickness were reassessed directly in a sample of patients using a modified caliper. Results The regression analysis revealed an algorithm predicting biotypes among patients based on their measured dentopapillary values. Discriminant analysis was used to allocate the values to thin and thick biotypes to further demystify that they coincide with <0.7 mm and >1.5 mm, respectively. However, gingival thickness between 0.7 and 1.5 mm was considered intermediate biotype. Conclusion GB could be predicted based on the dentopapillary measurements taken on laboratory models, which may further reduce the chairside time and increase the success rate of the surgical procedures. Significant variations in the range of values of the thick and thin biotype were detected in the Saudi population compared to other races. Clinical Significance The escalating invasion of interventional procedures in the dental practice necessitates measuring the GB as a predictor of procedure success. This study introduces an algorithm for detecting the GB and updates the range of values for thick and thin biotypes in the Saudi population that would consequently reduce chairside time.
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Affiliation(s)
- R R Nagate
- Department of Periodontics and Community Dental Sciences, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - S Tikare
- Department of Periodontics and Community Dental Sciences, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - S Chaturvedi
- Department of Prosthetic Dentistry, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - N A AlQahtani
- Department of Periodontics and Community Dental Sciences, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - M A Kader
- Department of Periodontics and Community Dental Sciences, College of Dentistry, King Khalid University, Abha, Saudi Arabia
| | - S T Gokhale
- Department of Periodontics and Community Dental Sciences, College of Dentistry, King Khalid University, Abha, Saudi Arabia
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Li Z, Fu B, Green CM, Liu B, Zhang J, Lang Y, Chaturvedi S, Belfort M, Liao G, Li H. Cisplatin protects mice from challenge of Cryptococcus neoformans by targeting the Prp8 intein. Emerg Microbes Infect 2019; 8:895-908. [PMID: 31223062 PMCID: PMC6598491 DOI: 10.1080/22221751.2019.1625727] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 05/16/2019] [Indexed: 01/02/2023]
Abstract
The Prp8 intein is one of the most widespread eukaryotic inteins, present in important pathogenic fungi, including Cryptococcus and Aspergillus species. Because the processed Prp8 carries out essential and non-redundant cellular functions, a Prp8 intein inhibitor is a mechanistically novel antifungal agent. In this report, we demonstrated that cisplatin, an FDA-approved cancer drug, significantly arrested growth of Prp8 intein-containing fungi C. neoformans and C. gattii, but only poorly inhibited growth of intein-free Candida species. These results suggest that cisplatin arrests fungal growth through specific inhibition of the Prp8 intein. Cisplatin was also found to significantly inhibit growth of C. neoformans in a mouse model. Our results further showed that cisplatin inhibited Prp8 intein splicing in vitro in a dose-dependent manner by direct binding to the Prp8 intein. Crystal structures of the apo- and cisplatin-bound Prp8 inteins revealed that two degenerate cisplatin molecules bind at the intein active site. Mutation of the splicing-site residues led to loss of cisplatin binding, as well as impairment of intein splicing. Finally, we found that overexpression of the Prp8 intein in cryptococcal species conferred cisplatin resistance. Overall, these results indicate that the Prp8 intein is a novel antifungal target worth further investigation.
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Affiliation(s)
- Zhong Li
- New York State Department of Health, Wadsworth Center, Albany, NY, USA
| | - Bin Fu
- College of Pharmaceutical Sciences, Southwest University, Chongqing, People’s Republic of China
| | - Cathleen M. Green
- Department of Biological Sciences and RNA Institute, University at Albany, Albany, NY, USA
| | - Binbin Liu
- New York State Department of Health, Wadsworth Center, Albany, NY, USA
| | - Jing Zhang
- New York State Department of Health, Wadsworth Center, Albany, NY, USA
| | - Yuekun Lang
- New York State Department of Health, Wadsworth Center, Albany, NY, USA
| | - Sudha Chaturvedi
- New York State Department of Health, Wadsworth Center, Albany, NY, USA
- Department of Biomedical Sciences, School of Public Health, University at Albany, Albany, NY, USA
| | - Marlene Belfort
- Department of Biological Sciences and RNA Institute, University at Albany, Albany, NY, USA
- Department of Biomedical Sciences, School of Public Health, University at Albany, Albany, NY, USA
| | - Guojian Liao
- College of Pharmaceutical Sciences, Southwest University, Chongqing, People’s Republic of China
| | - Hongmin Li
- New York State Department of Health, Wadsworth Center, Albany, NY, USA
- Department of Biomedical Sciences, School of Public Health, University at Albany, Albany, NY, USA
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Chaturvedi V, Bouchara JP, Hagen F, Alastruey-Izquierdo A, Badali H, Bocca AL, Cano-Lira JF, Cao C, Chaturvedi S, Chotirmall SH, van Diepeningen AD, Gangneux JP, Guinea J, de Hoog S, Ilkit M, Kano R, Liu W, Martinez-Rossi NM, de Souza Carvalho Melhem M, Ono MA, Ran Y, Ranque S, de Almeida Soares CM, Sugita T, Thomas PA, Vecchiarelli A, Wengenack NL, Woo PCY, Xu J, Zancope-Oliveira RM. Eighty Years of Mycopathologia: A Retrospective Analysis of Progress Made in Understanding Human and Animal Fungal Pathogens. Mycopathologia 2018; 183:859-877. [PMID: 30506286 DOI: 10.1007/s11046-018-0306-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 11/09/2018] [Indexed: 11/30/2022]
Abstract
Mycopathologia was founded in 1938 to 'diffuse the understanding of fungal diseases in man and animals among mycologists.' This was an important mission considering that pathogenic fungi for humans and animals represent a tiny minority of the estimated 1.5-5 million fungal inhabitants on Earth. These pathogens have diverged from the usual saprotrophic lifestyles of most fungi to colonize and infect humans and animals. Medical and veterinary mycology is the subdiscipline of microbiology that dwells into the mysteries of parasitic, fungal lifestyles. Among the oldest continuing scientific publications on the subject, Mycopathologia had its share of 'classic papers' since the first issue was published in 1938. An analysis of the eight decades of notable contributions reveals many facets of host-pathogen interactions among 183 volumes comprising about 6885 articles. We have analyzed the impact and relevance of this body of work using a combination of citation tools (Google Scholar and Scopus) since no single citation metric gives an inclusive perspective. Among the highly cited Mycopathologia publications, those on experimental mycology accounted for the major part of the articles (36%), followed by diagnostic mycology (16%), ecology and epidemiology (15%), clinical mycology (14%), taxonomy and classification (10%), and veterinary mycology (9%). The first classic publication, collecting nearly 200 citations, appeared in 1957, while two articles published in 2010 received nearly 150 citations each, which is notable for a journal covering a highly specialized field of study. An empirical analysis of the publication trends suggests continuing interests in novel diagnostics, fungal pathogenesis, review of clinical diseases especially with relevance to the laboratory scientists, taxonomy and classification of fungal pathogens, fungal infections and carriage in pets and wildlife, and changing ecology and epidemiology of fungal diseases around the globe. We anticipate that emerging and re-emerging fungal pathogens will continue to cause significant health burden in the coming decades. It remains vital that scientists and physicians continue to collaborate by learning each other's language for the study of fungal diseases, and Mycopathologia will strive to be their partner in this increasingly important endeavor to its 100th anniversary in 2038 and beyond.
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Affiliation(s)
- Vishnu Chaturvedi
- New York State Department of Health and University at Albany, Albany, NY, USA.
| | | | - Ferry Hagen
- Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands
| | | | - Hamid Badali
- Mazandaran University of Medical Sciences, Sari, Iran
| | | | | | - Cunwei Cao
- Guangxi Medical University, Nanning, China
| | - Sudha Chaturvedi
- New York State Department of Health and University at Albany, Albany, NY, USA
| | | | | | | | | | - Sybren de Hoog
- Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands
| | | | - Rui Kano
- Nihon University College of Bioresource Sciences, Fujisawa, Japan
| | - Weida Liu
- Peking Union Medical College, Nanjing, China
| | | | | | | | | | | | | | | | - Philip A Thomas
- Institute of Ophthalmology, Joseph Eye Hospital, Tiruchirappalli, India
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Adams EH, Quinn M, Ostrowsky B, Southwick K, Greenko J, Fernandez R, Patel R, Denis RJ, Erazo R, Chaturvedi S, Leach L, Zhu YC, Haley VB, Tsay S, Vallabhaneni S, Lutterloh EC, Blog DS, Dufort EM. 385. The Value Added From Candida auris Point Prevalence and Environmental Studies in New York State. Open Forum Infect Dis 2018. [PMCID: PMC6254603 DOI: 10.1093/ofid/ofy210.396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background As of March 25 2018, 151 clinical cases of C. auris were diagnosed in NYS. We conducted point prevalence surveys (PPS) and environmental surveys (ES) to detect surveillance cases and assess the burden of environmental contamination in NYS healthcare facilities from September 12, 2016. Methods A PPS was defined as culturing ≥2 individuals at a healthcare facility that diagnosed, cared for, or was near a facility with a C. auris case. ES involved environmental swabbing in facilities where cases resided or were admitted. Cultures and polymerase chain reaction (PCR) were performed at the NYS Wadsworth Center. Results As of March 25, 2018, 81 PPS or ES had been conducted at 55 facilities. From these PPS, a total of 144 (6.1%) individuals were positive for C. auris by culture; 125 were PCR positive. The rates of culture positive C. auris identified patients varied by facility type: hospitals (38/767, 5.0%), long-term care facilities (LTCF) (88/1,404, 6.3%), long-term acute care (1/35, 2.9%), and co-located hospital and LTCF (17/138, 12.3%). The majority of the LTCF C. auris culture-positive cases (80/82) were identified in facilities that cared for ventilated patients. Rates in LTCF caring for ventilated patients were nearly 10 times as high as other LTCF [86/1,121 (7.7%) vs. 2/284 (0.7%)]. ES identified 86 (3.0%) samples positive by culture and 257 (8.9%) by PCR. Thirty-seven (67%) of the 55 facilities had at least one positive environmental sample by PCR or culture; many of these positive samples were from surfaces or equipment deemed to be “clean.” Over 1,900 person-hours were needed to conduct onsite PPS and ES that collected >4,200 human and >2,800 environmental samples and identified opportunities for improving basic infection prevention and environmental cleaning. Ten facilities, including the co-located hospital and LTCF, had multiple positive PPS or ES. Conclusion PPS conducted over 17 months detected many colonized individuals and C. auris in facility environments, likely indicating a silent reservoir for this organism beyond clinical cases, especially in LTCFs. Serial PPS and ES can help improve C. auris detection and inform subsequent infection prevention and control interventions. However, these efforts are resource intensive and can divert resources from other activities. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Eleanor H Adams
- Healthcare Epidemiology and Infection Control, New York State Department of Health, New Rochelle, New York
| | - Monica Quinn
- Bureau of Healthcare-Associated Infections, New York State Department of Health, Albany, New York
| | - Belinda Ostrowsky
- Dhqp, Centers for Disease Control and Prevention, New York, New York
| | | | - Jane Greenko
- Healthcare Epidemiology and Infection Control, New York State Department of Health, Central Islip, New York
| | - Rafael Fernandez
- Healthcare Epidemiology and Infection Control, New York State Department of Health, New York, New York
| | - Rutvik Patel
- Healthcare Epidemiology and Infection Control, New York State Department of Health, New Rochelle, New York
| | - Ronald Jean Denis
- Healthcare Epidemiology and Infection Control, New York State Department of Health, New Rochelle, New York
| | - Richard Erazo
- Healthcare Epidemiology and Infection Control, New York State Department of Health, New Rochelle, New York
| | - Sudha Chaturvedi
- Wadsworth Center, New York State Department of Health, Albany, New York
| | - Lynn Leach
- Wadsworth Center, New York State Department of Health, Albany, New York
| | - Yan Chun Zhu
- Wadsworth Center, New York State Department of Health, Albany, New York
| | - Valerie B Haley
- Bureau of Healthcare-Associated Infections, New York State Department of Health, Albany, New York
| | - Sharon Tsay
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Snigdha Vallabhaneni
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Emily C Lutterloh
- Bureau of Healthcare-Associated Infections, New York State Department of Health, Albany, New York
| | - Debra S Blog
- Division of Epidemiology, New York State Department of Health, Albany, New York
| | - Elizabeth M Dufort
- Division of Epidemiology, New York State Department of Health, Albany, New York
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Dufort EM, Erazo R, Quinn M, Chaturvedi S, Vallabhaneni S, Haley VB, Lutterloh E, Kuang J, Stover C, Bucher C, McDonald R, Adams EH, Blog DS. 384. Findings From a Candida auris Admission Screening Pilot in New York State. Open Forum Infect Dis 2018. [PMCID: PMC6253578 DOI: 10.1093/ofid/ofy210.395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Candida auris is an emerging multidrug-resistant yeast which can spread within healthcare facilities and is associated with significant morbidity. Over 160 clinical cases have been reported in NYS. This pilot aims to assess the feasibility of C. auris admission screening and to better understand its role in controlling spread of C. auris in an area where it has emerged. Methods One hospital and two nursing homes (NHs) with known prior cases participated (one NH and hospital are closely associated and are reported together). Patients were screened on admission to any of three hospital intensive care units (medical, cardiac, pulmonary) or to a ventilator unit in the NHs from November 2017 to April 2018. Screening consisted of bilateral nares and axilla/groin swabs sent to the NYS Department of Health Wadsworth Center (WC) for a WC-developed C. auris real-time polymerase chain reaction (rt-PCR) test. Specimens with detection of C. auris on rt-PCR underwent fungal culture. Facilities were alerted of positive results and infection control precautions were promptly initiated. Results To date, 575 patients (1,371 samples) were screened. Of patients not previously known to be colonized, 39 had C. auris detected on rt-PCR; 34 confirmed by C. auris culture at either site and one culture pending. Of these, 30 (88%) were detected and confirmed from the axilla/groin specimen (Figure 1). Mean age was 76 years and 59% were females. Patients had significant healthcare facility exposure (Figure 2). Eleven (32%) were from NH-A and 23 (68%) from the hospital/NH-B combined. Rates of positivity were 16.2% (11/68) for NH-A and 4.6% (23/498) for the hospital/NH-B. Conclusion C. auris rt-PCR is a useful tool within an admission screening program; however, more accessible and affordable rapid laboratory diagnostics are urgently needed. The axilla/groin site detected the majority of colonized individuals. Admission screening was feasible and increased facility knowledge of colonization status, which led to earlier implementation of infection control precautions potentially limiting spread. However, further study is needed to assess transmission dynamics and potential impact of admission screening on control of C. auris within an outbreak or endemic setting. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Elizabeth M Dufort
- Division of Epidemiology, New York State Department of Health, Albany, New York
| | - Richard Erazo
- Healthcare Epidemiology and Infection Control, New York State Department of Health, New Rochelle, New York
| | - Monica Quinn
- Health Care Epidemiology and Infection Control, New York State Department of Health, Albany, New York
| | - Sudha Chaturvedi
- Wadsworth Center, New York State Department of Health, Albany, New York
| | - Snigdha Vallabhaneni
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Valerie B Haley
- Bureau of Healthcare-Associated Infections, New York State Department of Health, Albany, New York
| | - Emily Lutterloh
- Bureau of Healthcare-Associated Infections, New York State Department of Health, Albany, New York
| | - Jiankun Kuang
- New York State Department of Health, Albany, New York
| | - Carolyn Stover
- University at Albany School of Public Health, State University of New York, Albany, New York
| | - Coralie Bucher
- University at Albany School of Public Health, State University of New York, Albany, New York
| | - Robert McDonald
- Division of Epidemiology, New York State Department of Health, Albany, New York
| | - Eleanor H Adams
- Healthcare Epidemiology and Infection Control, New York State Department of Health, New Rochelle, New York
| | - Debra S Blog
- Division of Epidemiology, New York State Department of Health, Albany, New York
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Southwick K, Adams EH, Greenko J, Ostrowsky B, Fernandez R, Patel R, Quinn M, Vallabhaneni S, Denis RJ, Erazo R, Chaturvedi S, Haley VB, Leach L, Zhu YC, Giardina R, Lutterloh EC, Blog DS. 2039. New York State 2016–2018: Progression from Candida auris Colonization to Bloodstream Infection. Open Forum Infect Dis 2018. [PMCID: PMC6252412 DOI: 10.1093/ofid/ofy210.1695] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background New York State (NYS) is experiencing a continuing outbreak of Candida auris, first identified in 2016. Patients who are colonized asymptomatically with C. auris can progress to bloodstream infection (BSI). Methods Colonized patients with positive nares or axilla/groin C. auris cultures were followed prospectively. Laboratories, hospitals and skilled nursing facilities reported C. auris clinical infections to the NYS Department of Health. Patient demographics, clinical history, hospital admission, procedures, and outcomes data were obtained using a standardized case report form. Patient-days were determined from date of first positive colonization to date of first positive clinical isolate, death, or March 30, 2018, whichever was first. Results Between September 28, 2016 and March 30, 2018, 187 C. auris colonized patients were identified. Of these, seven progressed to BSI during at least 24,781 patient days of follow-up (median: 98 patient-days, range 0–548 days.) The median time from date of first colonization to date of BSI was 86 days (range 3–310 days). The median patient age at time of colonization was 71 years (range 57–89 years). Between colonization and BSI, patients had a median of five admissions in healthcare facilities (range 1–12). All patients had central neurologic disease, gastrostomy tubes, chronic wounds, and vascular lines at time of BSI. All patients had a positive culture for one or more other multi-drug resistant organism within 90 days of a positive C. auris culture, and all received antibiotics in the 30 days before BSI. Six (86%) patients received mechanical ventilation and had tracheostomies. Five (71%) patients had diabetes. Four (57%) had vascular lines replaced in the 30 days before BSI onset. Two (29%) cases had gastrostomy tube replacement between colonization and BSI. One patient died a week after C. auris BSI; a second died 4 months later. Conclusion In NYS, 4% of C. auris colonized patients developed BSI, a rate of 0.3 BSI per 1,000 patient-days. BSI patients have portals of entry such as indwelling medical devices and wounds. Neurologic disease and diabetes may be risk factors for BSI. Meticulous aseptic technique for invasive procedures, device and wound care may help prevent C. auris BSI in colonized patients. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Karen Southwick
- Healthcare Epidemiology and Infection Control, New York State Department of Health, New Rochelle, New York
| | - Eleanor H Adams
- Healthcare Epidemiology and Infection Control, New York State Department of Health, New Rochelle, New York
| | - Jane Greenko
- Healthcare Epidemiology and Infection Control, New York State Department of Health, Central Islip, New York
| | - Belinda Ostrowsky
- Dhqp, Centers for Disease Control and Prevention, New York, New York
| | - Rafael Fernandez
- Healthcare Epidemiology and Infection Control, New York State Department of Health, New York, New York
| | - Rutvik Patel
- Healthcare Epidemiology and Infection Control, New York State Department of Health, New Rochelle, New York
| | - Monica Quinn
- Bureau of Healthcare-Associated Infections, New York State Department of Health, Albany, New York
| | - Snigdha Vallabhaneni
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ronald Jean Denis
- Healthcare Epidemiology and Infection Control, New York State Department of Health, New Rochelle, New York
| | - Richard Erazo
- Healthcare Epidemiology and Infection Control, New York State Department of Health, New Rochelle, New York
| | - Sudha Chaturvedi
- Wadsworth Center, New York State Department of Health, Albany, New York
| | - Valerie B Haley
- Bureau of Healthcare-Associated Infections, New York State Department of Health, Albany, New York
| | - Lynn Leach
- Wadsworth Center, New York State Department of Health, Albany, New York
| | - Yan Chun Zhu
- Wadsworth Center, New York State Department of Health, Albany, New York
| | | | - Emily C Lutterloh
- Bureau of Healthcare-Associated Infections, New York State Department of Health, Albany, New York
| | - Debra S Blog
- Division of Epidemiology, New York State Department of Health, Albany, New York
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Singh A, Lasek-Nesselquist E, Chaturvedi V, Chaturvedi S. Trichoderma polysporum selectively inhibits white-nose syndrome fungal pathogen Pseudogymnoascus destructans amidst soil microbes. Microbiome 2018; 6:139. [PMID: 30089518 PMCID: PMC6083572 DOI: 10.1186/s40168-018-0512-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 07/02/2018] [Indexed: 05/29/2023]
Abstract
BACKGROUND Pseudogymnoascus destructans (Pd), the causative fungal agent of white-nose syndrome (WNS), has led to the deaths of millions of hibernating bats in the United States of America (USA) and Canada. Efficient strategies are needed to decontaminate Pd from the bat hibernacula to interrupt the disease transmission cycle without affecting the native microbes. Previously, we discovered a novel Trichoderma polysporum (Tp) strain (WPM 39143), which inhibited the growth of Pd in autoclaved soil samples. In the present investigation, we used culture-based approaches to determine Tp-induced killing of native and enriched Pd in the natural soil of two bat hibernacula. We also assessed the impact of Tp treatment on native microbial communities by metagenomics. RESULTS Our results demonstrated that Tp at the concentration of 105 conidia/g soil caused 100% killing of native Pd in culture within 5 weeks of incubation. A 10-fold higher concentration of Tp (106 conidia/g soil) killed an enriched Pd population (105 conidia/g soil). The 12,507 fungal operational taxonomic units (OTUs, dominated by Ascomycota and Basidiomycota) and 27,427 bacterial OTUs (dominated by Acidobacteria and Proteobacteria) comprised the native soil microbes of the two bat hibernacula. No significant differences in fungal and bacterial relative abundances were observed between untreated and Tp-treated soil (105 Tp conidia/g soil, p ≤ 0.05). CONCLUSIONS Our results suggest that Tp-induced killing of Pd is highly specific, with minimal to no impact on the indigenous microbes present in the soil samples. These findings provide the scientific rationale for the field trials of Tp in the WNS-affected hibernacula for the effective decontamination of Pd and the control of WNS.
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Affiliation(s)
- Amanpreet Singh
- Mycology Laboratory, Wadsworth Center, New York State Department of Health, 120 New Scotland Avenue, Albany, NY, 12208, USA
| | | | - Vishnu Chaturvedi
- Mycology Laboratory, Wadsworth Center, New York State Department of Health, 120 New Scotland Avenue, Albany, NY, 12208, USA
- Department of Biomedical Sciences, School of Public Health, University at Albany, Albany, NY, USA
| | - Sudha Chaturvedi
- Mycology Laboratory, Wadsworth Center, New York State Department of Health, 120 New Scotland Avenue, Albany, NY, 12208, USA.
- Department of Biomedical Sciences, School of Public Health, University at Albany, Albany, NY, USA.
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Chaturvedi S, Bhattacharya A, Khare SK. Trends in Oil Production from Oleaginous Yeast Using Biomass: Biotechnological Potential and Constraints. APPL BIOCHEM MICRO+ 2018. [DOI: 10.1134/s000368381804004x] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Zhang T, Ren P, De Jesus M, Chaturvedi V, Chaturvedi S. Green Fluorescent Protein Expression in Pseudogymnoascus destructans to Study Its Abiotic and Biotic Lifestyles. Mycopathologia 2018; 183:805-814. [PMID: 29987576 DOI: 10.1007/s11046-018-0285-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 06/28/2018] [Indexed: 12/11/2022]
Abstract
Pseudogymnoascus destructans (Pd) is the etiologic agent of bat White-nose syndrome, a disease that has caused the unprecedented reduction in the hibernating bat populations across eastern North America. The Pd pathogenesis appears to be a complex adaptation of fungus in its abiotic (caves and mines) and biotic (bats) environments. There is a general lack of experimental tools for the study of Pd biology. We described the successful expression of codon-optimized synthetic green fluorescent protein sGFP in Pd. The sGFP(S65T) gene was first fused in frame with the Aspergillus nidulans promoter in the tumor-inducing plasmid pRF-HUE, and the resulting plasmid pHUE-sGFP(S65T) was transformed into Pd by Agrobacterium tumefaciens-mediated transformation system. The integration of sGFP(S65T) in Pd genome was analyzed by PCR, and single integration frequency of approximately 66% was confirmed by Southern hybridization. Fluorescent microscopy and flow cytometric analyses of two randomly selected transformants with single integration revealed high expression of sGFP in both spores and hyphal structures. The biology of mutants as judged by sporulation, growth rate, and urease production was not altered indicating sGFP is not toxic to Pd. Thus, we have generated a valuable tool that will facilitate the elucidation of Pd biology, ecology, and pathogenicity in real time.
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Affiliation(s)
- Tao Zhang
- Mycology Laboratory, Wadsworth Center, New York State Department of Health, Albany, NY, USA
- Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100050, People's Republic of China
| | - Ping Ren
- Mycology Laboratory, Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Magdia De Jesus
- Immunology and Infectious Disease Laboratory, Wadsworth Center, New York State Department of Health, Albany, NY, USA
| | - Vishnu Chaturvedi
- Mycology Laboratory, Wadsworth Center, New York State Department of Health, Albany, NY, USA.
- Department of Biomedical Sciences, School of Public Health, University at Albany, Albany, NY, USA.
| | - Sudha Chaturvedi
- Mycology Laboratory, Wadsworth Center, New York State Department of Health, Albany, NY, USA.
- Department of Biomedical Sciences, School of Public Health, University at Albany, Albany, NY, USA.
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Chaturvedi V, DeFiglio H, Chaturvedi S. Phenotype profiling of white-nose syndrome pathogen Pseudogymnoascus destructans and closely-related Pseudogymnoascus pannorum reveals metabolic differences underlying fungal lifestyles. F1000Res 2018; 7:665. [PMID: 30026932 PMCID: PMC6039956 DOI: 10.12688/f1000research.15067.1] [Citation(s) in RCA: 2] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2018] [Indexed: 09/29/2023] Open
Abstract
Background:Pseudogymnoascusdestructans, a psychrophile, causes bat white-nose syndrome (WNS). Pseudogymnoascus pannorum, a closely related fungus, causes human and canine diseases rarely. Both pathogens were reported from the same mines and caves in the United States, but only P. destructans caused WNS. Earlier genome comparisons revealed that P. pannorum contained more deduced proteins with ascribed enzymatic functions than P. destructans. Methods: We performed metabolic profiling with Biolog PM microarray plates to confirm in silico gene predictions. Results:P. pannorum utilized 78 of 190 carbon sources (41%), and 41 of 91 nitrogen sources (43%) tested. P. destructans used 23 carbon compounds (12%) and 23 nitrogen compounds (24%). P. destructans exhibited more robust growth on the phosphorous sources and nutrient supplements (83% and 15%, respectively) compared to P. pannorum (27% and 1%, respectively.). P. pannorum exhibited higher tolerance to osmolytes, pH extremes, and a variety of chemical compounds than P. destructans. Conclusions: An abundance of carbohydrate degradation pathways combined with robust stress tolerance provided clues for the soil distribution of P. pannorum. The limited metabolic profile of P. destructans validated in silico predictions of far fewer proteins and enzymes. P. destructans ability to catabolize diverse phosphorous and nutrient supplements might be critical in the colonization and invasion of bat tissues. The present study of 1,047 different metabolic activities provides a framework for future gene-function investigations of the unique biology of the psychrophilic fungi.
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Affiliation(s)
- Vishnu Chaturvedi
- Mycology Laboratory, New York State Department of Health, Albany, NY, 12208, USA
- Department of Biomedical Sciences, School of Public Health, University at Albany, Albany, NY, 12208, USA
| | - Holland DeFiglio
- Mycology Laboratory, New York State Department of Health, Albany, NY, 12208, USA
| | - Sudha Chaturvedi
- Mycology Laboratory, New York State Department of Health, Albany, NY, 12208, USA
- Department of Biomedical Sciences, School of Public Health, University at Albany, Albany, NY, 12208, USA
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49
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Chaturvedi V, DeFiglio H, Chaturvedi S. Phenotype profiling of white-nose syndrome pathogen Pseudogymnoascus destructans and closely-related Pseudogymnoascus pannorum reveals metabolic differences underlying fungal lifestyles. F1000Res 2018; 7:665. [PMID: 30026932 PMCID: PMC6039956 DOI: 10.12688/f1000research.15067.2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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] [Accepted: 07/12/2018] [Indexed: 01/28/2023] Open
Abstract
Background:Pseudogymnoascusdestructans, a psychrophile, causes bat white-nose syndrome (WNS). Pseudogymnoascus pannorum, a closely related fungus, causes human and canine diseases rarely. Both pathogens were reported from the same mines and caves in the United States, but only P. destructans caused WNS. Earlier genome comparisons revealed that P. pannorum contained more deduced proteins with ascribed enzymatic functions than P. destructans. Methods: We performed metabolic profiling with Biolog PM microarray plates to confirm in silico gene predictions. Results:P. pannorum utilized 78 of 190 carbon sources (41%), and 41 of 91 nitrogen compounds (43%) tested. P. destructans used 23 carbon compounds (12%) and 23 nitrogen compounds (24%). P. destructans exhibited more robust growth on the phosphorous compounds and nutrient supplements (83% and 15%, respectively) compared to P. pannorum (27% and 1%, respectively.). P. pannorum exhibited higher tolerance to osmolytes, pH extremes, and a variety of chemical compounds than P. destructans. Conclusions: An abundance of carbohydrate degradation pathways combined with robust stress tolerance provided clues for the soil distribution of P. pannorum. The limited metabolic profile of P. destructans was compatible with in silico predictions of far fewer proteins and enzymes. P. destructans ability to catabolize diverse phosphorous and nutrient supplements might be critical in the colonization and invasion of bat tissues. The present study of 1,047 different metabolic activities provides a framework for future gene-function investigations of the unique biology of the psychrophilic fungi.
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Affiliation(s)
- Vishnu Chaturvedi
- Mycology Laboratory, New York State Department of Health, Albany, NY, 12208, USA
- Department of Biomedical Sciences, School of Public Health, University at Albany, Albany, NY, 12208, USA
| | - Holland DeFiglio
- Mycology Laboratory, New York State Department of Health, Albany, NY, 12208, USA
| | - Sudha Chaturvedi
- Mycology Laboratory, New York State Department of Health, Albany, NY, 12208, USA
- Department of Biomedical Sciences, School of Public Health, University at Albany, Albany, NY, 12208, USA
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Tsay S, Welsh RM, Adams EH, Chow NA, Gade L, Berkow EL, Lutterloh E, Quinn M, Chaturvedi S, Fernandez R, Giardina R, Greenko J, Southwick K, Kerins JL, Black S, Kemble SK, Barrett PM, Greeley R, Barton K, Shannon D, Kallen A, Shugart A, Litvintseva AP, Lockhart S, Chiller T, Jackson BR, Vallabhaneni S. Public Health Response to US Cases of Candida auris, a Globally Emerging, Multidrug-Resistant Yeast, 2013–2017. Open Forum Infect Dis 2017. [PMCID: PMC5631649 DOI: 10.1093/ofid/ofx163.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Candida auris is an often multidrug-resistant yeast that causes invasive infections and, unlike most Candida species, spreads in healthcare facilities. CDC released a clinical alert in June 2016 requesting reporting of C. auris cases. We investigated cases to contain transmission and inform prevention measures for this novel organism.
Methods
Clinical cases were defined as C. auris from any clinical specimen from a patient in the United States. Response to cases included implementation of infection control measures, enhanced cleaning and disinfection, and testing of close contacts for C. auris colonisation (isolation from a person’s axilla or groin was defined as a screening case). Microbiology records were reviewed at reporting facilities for missed cases. All isolates were forwarded to CDC for confirmation, antifungal susceptibility testing, and whole-genome sequencing (WGS).
Results
As of April 13, 2017, 61 clinical cases of C. auris were reported from six states: New York (39), New Jersey (15), Illinois (4), Indiana (1), Maryland (1), and Massachusetts (1). All but two occurred since 2016 (Figure). An additional 32 screening cases were identified among contacts. Median age of clinical case-patients was 70 years (range 21–96); 56% were male. Nearly, all had underlying medical conditions and extensive exposure to healthcare facilities before infection. Most clinical isolates were from blood (38, 62%), followed by urine (8, 13%) and respiratory tract (5, 8%). Among the first 35 isolates, 30 (86%) were resistant to fluconazole, 15 (43%) to amphotericin B, and one (3%) to caspofungin. No isolate was resistant to all three. WGS revealed isolates from each state were highly related and different from other states, suggestive of transmission. Microbiology record reviews did not identify additional cases before 2016.
Conclusion
C. auris is an emerging pathogen, with similarities to multidrug-resistant bacteria, that has been transmitted in US healthcare settings. CDC and public health partners are committed to prompt and aggressive action through investigation of cases and heightened infection control practices to halt its spread.
Disclosures
All authors: No reported disclosures.
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Affiliation(s)
- Sharon Tsay
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rory M Welsh
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eleanor H Adams
- Healthcare Epidemiology & Infection Control, New York State Department of Health, New Rochelle, New York
| | - Nancy A Chow
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lalitha Gade
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Emily Lutterloh
- Bureau of Healthcare Associated Infections, New York State Department of Health, Albany, New York
| | - Monica Quinn
- Health Care Epidemiology and Infection Control, New York State Department of Health, Albany, New York
| | - Sudha Chaturvedi
- Wadsworth Center, New York State Department of Health, Albany, New York
| | - Rafael Fernandez
- Healthcare Epidemiology & Infection Control, New York State Department of Health, New York, New York
| | | | - Jane Greenko
- Healthcare Epidemiology & Infection Control, New York State Department of Health, Central Islip, New York
| | | | - Janna L Kerins
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
- Chicago Department of Public Health, Chicago, Illinois
| | | | | | | | | | - Kerri Barton
- Massachusetts Department of Public Health, Jamaica Plain, Massachusetts
| | - Dj Shannon
- Indiana State Department of Health, Indianapolis, Indiana
| | - Alexander Kallen
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alicia Shugart
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Shawn Lockhart
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tom Chiller
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brendan R Jackson
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Snigdha Vallabhaneni
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
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