265 results on '"Bahr, Nathan C."'
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2. Complex Decisions in HIV-Related Cryptococcosis: Addressing Second Episodes of Cryptococcal Meningitis
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Musubire, Abdu, Kagimu, Enock, Mugabi, Timothy, Meya, David B., Boulware, David R., and Bahr, Nathan C.
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- 2024
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3. Advancing Diagnosis and Treatment in People Living with HIV and Tuberculosis Meningitis
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Kimuda, Sarah, Kasozi, Derrick, Namombwe, Suzan, Gakuru, Jane, Mugabi, Timothy, Kagimu, Enock, Rutakingirwa, Morris K., Leon, Kristoffer E., Chow, Felicia, Wasserman, Sean, Boulware, David R., Cresswell, Fiona V., and Bahr, Nathan C.
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- 2023
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4. Decoding the historical tale: COVID-19 impact on haematological malignancy patients—EPICOVIDEHA insights from 2020 to 2022
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Martín-Vallejo, Francisco Javier, Zdziarski, Przemyslaw, Zarrinfer, Hossein, Wittig, Jana, Win, Sein, Wai-Man, Vivien, Víšek, Benjamín, Vinh, Donald C., Vehreschild, Maria, Varricchio, Gina, Tsirigotis, Panagiotis, Torres-Tienza, Ana, Tanase, Alina Daniela, Tafuri, Agostino, Stamouli, Maria, Sramek, Jiří, Soussain, Carole, Shirinova, Ayten, Schubert, Jörg, Schalk, Enrico, Salehi, Mohammad Reza, Saleh, Modar, Rosati, Giorgio, Roldán, Elisa, Reizine, Florian, Rêgo, Mayara, Regalado-Artamendi, Isabel, Popova, Marina, Pinto, Fernando, Philippe, Laure, Orth, Hans Martin, Ommen, Hans-Beier, Obr, Aleš, Núñez-Martín-Buitrago, Lucía, Noël, Nicolas, Neuhann, Julia, Nadali, Gianpaolo, Nacov, Julia A., Munhoz Alburquerque, Ana M., Mitra, Maria Enza, Mikulska, Malgorzata, Mellinghoff, Sibylle, Mechtel, Ben, Martín-González, Juan-Alberto, Malak, Sandra, Loureiro-Amigo, Jorge, Lorenzo De La Peña, Lisset, Liberti, Giulia, Landau, Marianne, Lacej, Ira, Kolditz, Martin, Kho, Chi Shan, Khedr, Reham Abdelaziz, Karthaus, Meinolf, Karlsson, Linda Katharina, Jiménez-Lorenzo, María-Josefa, Izuzquiza, Macarena, Hoell-Neugebauer, Baerbel, Herbrecht, Raoul, Heath, Christopher H., Guolo, Fabio, Grothe, Jan, Giordano, Antonio, Gerasymchuk, Sergey, García-Sanz, Ramón, García-Poutón, Nicole, Funke, Vaneuza Araújo Moreira, Fung, Monica, Flasshove, Charlotte, Fianchi, Luana, Essame, Jenna, Egger, Matthias, Drenou, Bernard, Dragonetti, Giulia, Desole, Maximilian, Della Pepa, Roberta, Deau Fischer, Bénédicte, De Kort, Elizabeth, De Cabo, Erik, Danion, François, Daguindau, Etienne, Cushion, Tania, Cremer, Louise, Criscuolo, Marianna, Cordini, Gregorio, Cingolani, Antonella, Ciceri, Fabio, Chowdhury, Fazle Rabbi, Chelysheva, Ekaterina, Chauchet, Adrien, Chai, Louis Yi Ann, Ceesay, M. Mansour, Busch, Elena, Brehon, Mathias, Borducchi, Davimar M.M., Booth, Stephen, Bologna, Serge, Berg Venemyr, Caroline, Bailén-Almorox, Rebeca, Antoniadou, Anastasia, Anastasopoulou, Amalia N., Altuntaş, Fevzi, Salmanton-García, Jon, Marchesi, Francesco, Farina, Francesca, Weinbergerová, Barbora, Itri, Federico, Dávila-Valls, Julio, Martín-Pérez, Sonia, Glenthøj, Andreas, Hersby, Ditte Stampe, Gomes Da Silva, Maria, Nunes Rodrigues, Raquel, López-García, Alberto, Córdoba, Raúl, Bilgin, Yavuz M., Falces-Romero, Iker, El-Ashwah, Shaimaa, Emarah, Ziad, Besson, Caroline, Kohn, Milena, Van Doesum, Jaap, Ammatuna, Emanuele, Marchetti, Monia, Labrador, Jorge, Zambrotta, Giovanni Paolo Maria, Verga, Luisa, Jaksic, Ozren, Nucci, Marcio, Piukovics, Klára, Cabirta-Touzón, Alba, Jiménez, Moraima, Arellano, Elena, Espigado, Ildefonso, Blennow, Ola, Nordlander, Anna, Meers, Stef, Vian Praet, Jens, Aiello, Tommaso Francesco, Garcia-Vidal, Carolina, Fracchiolla, Nicola S., Sciumè, Mariarita, Seval, Guldane Cengiz, Žák, Pavel, Buquicchio, Caterina, Tascini, Carlo, Gräfe, Stefanie K., Schönlein, Martin, Adžić-VUKIČEVIĆ, Tatjana, Bonuomo, Valentina, Cattaneo, Chiara, Nizamuddin, Summiya, Čerňan, Martin, Plantefeve, Gaëtan, Prin, Romane, Szotkovski, Tomas, Collins, Graham P., Dargenio, Michelina, Petzer, Verena, Wolf, Dominik, Čolović, Natasha, Prezioso, Lucia, Valković, Toni, Passamonti, Francesco, Méndez, Gustavo-Adolfo, Sili, Uluhan, Vena, Antonio, Bavastro, Martina, Limongelli, Alessandro, Duarte, Rafael F., Ledoux, Marie-Pierre, Cvetanoski, Milche, Stojanoski, Zlate, Machado, Marina, Batinić, Josip, Magliano, Gabriele, Biernat, Monika M., Pantić, Nikola, Poulsen, Christian Bjørn, Cuccaro, Annarosa, Del Principe, Maria Ilaria, Kulasekararaj, Austin, Ormazabal-Vélez, Irati, Busca, Alessandro, Demirkan, Fatih, Ijaz, Marriyam, Klimko, Nikolai, Stoma, Igor, Khostelidi, Sofya, Fernández, Noemí, Omrani, Ali S., Bergantim, Rui, De Jonge, Nick, Fouquet, Guillemette, Navrátil, Milan, Abu-Zeinah, Ghaith, Samarkos, Michail, Maertens, Johan, De Ramón, Cristina, Guidetti, Anna, Magyari, Ferenc, González-López, Tomás José, Lahmer, Tobias, Finizio, Olimpia, Ali, Natasha, Pinczés, László Imre, Lavilla-Rubira, Esperanza, Romano, Alessandra, Merelli, Maria, Delia, Mario, Calbacho, Maria, Meletiadis, Joseph, Antić, Darko, Hernández-Rivas, José-Ángel, Marques De Almeida, Joyce, Al-Khabori, Murtadha, Hoenigl, Martin, Tisi, Maria Chiara, Khanna, Nina, Barać, Aleksandra, Eisa, Noha, Di Blasi, Roberta, Liévin, Raphaël, Miranda-Castillo, Carolina, Bahr, Nathan C., Lamure, Sylvain, Papa, Mario Virgilio, Yahya, Ayel, Aujayeb, Avinash, Novák, Jan, Erben, Nurettin, Fernández-Galán, María, Ribera-Santa Susana, José-María, Rinaldi, Ikhwan, Fazzi, Rita, Piedimonte, Monica, Duléry, Rémy, Gonzaga, Yung, Soto-Silva, Andrés, Sapienza, Giuseppe, Serris, Alexandra, Drgoňa, Ľuboš, Groh, Ana, Serrano, Laura, Gavriilaki, Eleni, Tragiannidis, Athanasios, Prattes, Juergen, Coppola, Nicola, Otašević, Vladimir, Mladenović, Miloš, Mitrović, Mirjana, Mišković, Bojana, Jindra, Pavel, Zompi, Sofia, Sacchi, Maria Vittoria, Krekeler, Carolin, Shumilov, Evgenii, Infante, Maria Stefania, García-Bordallo, Daniel, Çolak, Gökçe Melis, Mayer, Jiří, Nygaard, Marietta, Hanáková, Michaela, Ráčil, Zdeněk, Quattrone, Martina, Bonanni, Matteo, Koehler, Philipp, Rahimli, Laman, Cornely, Oliver A., and Pagano, Livio
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- 2024
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5. Age, successive waves, immunization, and mortality in elderly COVID-19 hematological patients: EPICOVIDEHA findings
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MARQUES DE ALMEIDA, Joyce, HERNÁNDEZ-RIVAS, José-Ángel, GUIDETTI, Anna, FINIZIO, Olimpia, STOJANOSKI, Zlate, CVETANOSKI, Milche, MELETIADIS, Joseph, DE JONGE, Nick, ANTIĆ, Darko, ALI, Natasha, TISI, Maria Chiara, SERRANO, Laura, PLANTEFEVE, Gaëtan, KHANNA, Nina, HOENIGL, Martin, ČERŇAN, Martin, MIRANDA-CASTILLO, Carolina, FERNÁNDEZ-GALÁN, María, SERRIS, Alexandra, ERBEN, Nurettin, DULÉRY, Rémy, AUJAYEB, Avinash, PAPA, Mario Virgilio, NOVÁK, Jan, DELIA, Mario, SAPIENZA, Giuseppe, REIZINE, Florian, OMRANI, Ali S., DI BLASI, Roberta, LAMURE, Sylvain, DRGOŇA, Ľuboš, COPPOLA, Nicola, BATINIĆ, Josip, AL-KHABORI, Murtadha, RIBERA-SANTA SUSANA, José-María, PIEDIMONTE, Monica, LOUREIRO-AMIGO, Jorge, FOUQUET, Guillemette, FAZZI, Rita, DANION, François, SCHUBERT, Jörg, HOELL-NEUGEBAUER, Baerbel, BAHR, Nathan C., YAHIA, Ayel Omar, TORRES-ATIENZA, Ana, RINALDI, Ikhwan, POPOVA, Marina, OMMEN, Hans-Beier, MITRA, Maria Enza, MIKULSKA, Malgorzata, LACEJ, Ira, KHOSTELIDI, Sofya, WIN, Sein, VINH, Donald, SALEH, Modar, PRATTES, Juergen, JINDRA, Pavel, GUOLO, Fabio, DELLA PEPA, Roberta, CHELYSHEVA, Ekaterina, ZDZIARSKI, Przemyslaw, WAI-MAN, Vivien, SOTO-SILVA, Andrés, ORTH, Hans Martin, MALAK, Sandra, LORENZO DE LA PEÑA, Lisset, KOLDITZ, Martin, Shan KHO, Chi, HEATH, Christopher H., GROH, Ana, GAVRIILAKI, Eleni, FUNG, Monica, EGGER, Matthias, DE KORT, Elizabeth, DE CABO, Erik, CUSHION, Tania, CHOWDHURY, Fazle Rabbi, CEESAY, M. Mansour, BREHON, Mathias, VARRICCHIO, Gina, TAFURI, Agostino, JIMÉNEZ-LORENZO, María-Josefa, KLIMKO, Nikolai, TSIRIGOTIS, Panagiotis, ANTONIADOU, Anastasia, VEHRESCHILD, Maria, Rossi, Giuseppe, Salmanton-García, Jon, Cattaneo, Chiara, Marchesi, Francesco, Dávila-Valls, Julio, Martín-Pérez, Sonia, Itri, Federico, López-García, Alberto, Glenthøj, Andreas, Gomes da Silva, Maria, Besson, Caroline, Marchetti, Monia, Weinbergerová, Barbora, Jaksic, Ozren, Jiménez, Moraima, Bilgin, Yavuz M., Van Doesum, Jaap, Farina, Francesca, Žák, Pavel, Verga, Luisa, Collins, Graham P., Bonuomo, Valentina, Van Praet, Jens, Nucci, Marcio, Meers, Stef, Espigado, Ildefonso, Fracchiolla, Nicola S., Valković, Toni, Poulsen, Christian Bjørn, Čolović, Natasha, Dragonetti, Giulia, Ledoux, Marie-Pierre, Tascini, Carlo, Buquicchio, Caterina, Blennow, Ola, Passamonti, Francesco, Machado, Marina, Labrador, Jorge, Duarte, Rafael F., Schönlein, Martin, Prezioso, Lucia, Falces-Romero, Iker, Kulasekararaj, Austin, Garcia-Vidal, Carolina, Fernández, Noemí, Abu-Zeinah, Ghaith, Ormazabal-Vélez, Irati, Adžić-Vukičević, Tatjana, Piukovics, Klára, Stoma, Igor, Cuccaro, Annarosa, Magliano, Gabriele, Szotkowski, Tomáš, González-López, Tomás-José, El-Ashwah, Shaimaa, Bergantim, Rui, Sili, Uluhan, Maertens, Johan, Demirkan, Fatih, De Ramón, Cristina, Petzer, Verena, Del Principe, Maria Ilaria, Navrátil, Milan, Dargenio, Michelina, Seval, Guldane Cengiz, Samarkos, Michail, Ráčil, Zdeněk, Pinczés, László Imre, Lahmer, Tobias, Busca, Alessandro, Méndez, Gustavo-Adolfo, Vena, Antonio, Biernat, Monika M., Merelli, Maria, Calbacho, Maria, Barać, Aleksandra, Bavastro, Martina, Limongelli, Alessandro, Ilhan, Osman, Wolf, Dominik, Çolak, Gökçe Melis, García-Sanz, Ramón, Emarah, Ziad, Mišković, Bojana, Gräfe, Stefanie K., Mladenović, Miloš, Aiello, Tommaso Francesco, Núñez-Martín-Buitrago, Lucía, Nordlander, Anna, Arellano, Elena, Zambrotta, Giovanni Paolo Maria, Ammatuna, Emanuele, Cabirta, Alba, Sacchi, Maria Vittoria, Nunes Rodrigues, Raquel, Hersby, Ditte Stampe, Hanakova, Michaela, Rahimli, Laman, Cordoba, Raul, Cornely, Oliver A., and Pagano, Livio
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- 2023
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6. Endemic mycoses – are we making progress in management?
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Bahr, Nathan C. and Thompson, George R., III
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- 2023
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7. Cerebrospinal fluid AFB smear in adults with tuberculous meningitis: A systematic review and diagnostic test accuracy meta-analysis
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Stadelman, Anna M., Ssebambulidde, Kenneth, Buller, Alexandria, Tugume, Lillian, Yuquimpo, Kyle, Bakker, Caitlin J., Boulware, David R., and Bahr, Nathan C.
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- 2022
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8. Low incidence of invasive fungal infection and risk factors in a large observational cohort of patients initiating tumor necrosis factor-alpha inhibitors for dermatologic conditions.
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Hennessee, Ian, Benedict, Kaitlin, Bahr, Nathan C., Lipner, Shari R., and Gold, Jeremy A.W.
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- 2024
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9. Low incidence of invasive fungal infections in a large observational cohort of patients initiating IL-17 or IL-23 inhibitor therapy, United States, 2016-2022.
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Bahr, Nathan C., Benedict, Kaitlin, Toda, Mitsuru, Gold, Jeremy A.W., and Lipner, Shari R.
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- 2024
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10. Diagnostic accuracy of a novel lateral flow assay for histoplasmosis.
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Burrows, Megan, Miller, Janice, Liesman, Rachael M, and Bahr, Nathan C
- Abstract
Antigen testing is an important diagnostic tool for histoplasmosis but has limited availability globally. We evaluated the OIDx urine lateral flow antigen assay among 204 persons suspected to have histoplasmosis. Among patients with proven histoplasmosis, sensitivity was 33.3% (3/9, 95% CI 7.5%–70.1%) and specificity 80.5% (157/195, 95% CI 74.3%–85.8%). The MiraVista urine antigen test had better specificity (96.9%) and equal sensitivity. The OIDx test demonstrated 33.3% (3/9) positive agreement and 84.0% (163/194) negative agreement with the MiraVista test. These results should be considered in the context of our low HIV prevalence population with a mixture of pulmonary and disseminated disease. [ABSTRACT FROM AUTHOR]
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- 2024
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11. Infectious Diseases Physician Management of Cryptococcal Meningitis in North America—Is Single High-Dose Liposomal Amphotericin B Being Used?
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Bahr, Nathan C, Beekmann, Susan E, Polgreen, Philip M, Walker, Jeremey B, Spec, Andrej, Boulware, David R, and Baddley, John W
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AMPHOTERICIN B , *COMMUNICABLE diseases , *DISEASE management , *MENINGITIS , *EMERGING infectious diseases - Abstract
Background Several recent randomized trials have been conducted in resource-limited settings for cryptococcal meningitis that have rapidly innovated international guidelines. The 2010 Infectious Diseases Society of America (IDSA) cryptococcal meningitis guideline has not been updated with recent trials. The 2022 AMBITION-cm trial found that a single 10-mg/kg dose of liposomal amphotericin B plus daily flucytosine and fluconazole for 2 weeks was noninferior to 1 week of amphotericin B deoxycholate with flucytosine. It is unknown whether physicians in high-resource settings are using this regimen or more traditional regimens. Methods We developed an electronic survey in June 2023 to better understand whether physician members of the IDSA Emerging Infections Network (EIN) and Mycoses Study Group Education and Research Consortium (MSG-ERC) had used the AMBITION-cm induction regimen, would use the regimen in hypothetical clinical scenarios, and what perceived barriers to use existed. Results A total of 242 of 561 (43%) physicians responded to the survey, of whom 205 provided care for persons with cryptococcal meningitis in the last year. Overall, 29 (14%) had used the AMBITION-cm regimen, and 176 (86%) had not. In various hypothetical clinical scenarios, only ∼10% of 209 respondents selected the AMBITION-cm regimen as preferred. Perceived barriers to uptake included the applicability of trials performed in low-resource settings to high-resource settings, that the regimen is not recommended in the 2010 IDSA guidelines, and the applicability to persons without HIV. Conclusions Most respondents had not used the single-dose liposomal amphotericin B regimen, but the regimen is being used. Further study of this regimen in other patient populations and settings is necessary. [ABSTRACT FROM AUTHOR]
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- 2024
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12. Persistent fever after coronavirus disease 2019 in liver/kidney transplant recipient.
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Mullis, Caroline E., Heldman, Madeleine, Bahr, Nathan C., Minamoto, Grace Y., Puius, Yoram A., and Malinis, Maricar
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COVID-19 ,KIDNEY transplantation ,FEVER ,LIVER transplantation ,LIVER diseases ,CORONAVIRUS diseases - Abstract
In this case, a 64‐year‐old male with a history of simultaneous orthotopic liver transplant and cadaveric renal transplant presented five years prior presented with persistent fevers two days after a positive SARS‐CoV‐2 nasal PCR. A CT scan of the chest on hospital day nine revealed innumerable 1–2 mm nodules in a miliary pattern throughout the lung. (1,3)‐β‐D‐glucan on hospital day 11 was 133 pg/mL. In this article, the approach, diagnostic and management strategies for patients with persistent fevers after diagnosis of COVID‐19 in a transplant recipient are discussed. [ABSTRACT FROM AUTHOR]
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- 2024
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13. Clinical characteristics, laboratory findings, radiographic signs and outcomes of 61,742 patients with confirmed COVID-19 infection: A systematic review and meta-analysis
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Pormohammad, Ali, Ghorbani, Saied, Baradaran, Behzad, Khatami, Alireza, J. Turner, Raymond, Mansournia, Mohammad Ali, Kyriacou, Demetrios N., Idrovo, Juan-Pablo, and Bahr, Nathan C.
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- 2020
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14. Xpert MTB/RIF Ultra for the diagnosis of HIV-associated tuberculous meningitis: a prospective validation study
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Cresswell, Fiona V, Tugume, Lillian, Bahr, Nathan C, Kwizera, Richard, Bangdiwala, Ananta S, Musubire, Abdu K, Rutakingirwa, Morris, Kagimu, Enock, Nuwagira, Edwin, Mpoza, Edward, Rhein, Joshua, Williams, Darlisha A, Muzoora, Conrad, Grint, Daniel, Elliott, Alison M, Meya, David B, and Boulware, David R
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- 2020
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15. Re-drawing the Maps for Endemic Mycoses
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Ashraf, Nida, Kubat, Ryan C., Poplin, Victoria, Adenis, Antoine A., Denning, David W., Wright, Laura, McCotter, Orion, Schwartz, Ilan S., Jackson, Brendan R., Chiller, Tom, and Bahr, Nathan C.
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- 2020
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16. Adjunctive sertraline for HIV-associated cryptococcal meningitis: a randomised, placebo-controlled, double-blind phase 3 trial
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Rhein, Joshua, Huppler Hullsiek, Kathy, Tugume, Lillian, Nuwagira, Edwin, Mpoza, Edward, Evans, Emily E, Kiggundu, Reuben, Pastick, Katelyn A, Ssebambulidde, Kenneth, Akampurira, Andrew, Williams, Darlisha A, Bangdiwala, Ananta S, Abassi, Mahsa, Musubire, Abdu K, Nicol, Melanie R, Muzoora, Conrad, Meya, David B, Boulware, David R, Ndyetukira, Jane Francis, Ahimbisibwe, Cynthia, Kugonza, Florence, Namuju, Carolyne, Sadiq, Alisat, Namudde, Alice, Mwesigye, James, Tadeo, Kiiza K, Kirumira, Paul, Okirwoth, Michael, Luggya, Tonny, Kaboggoza, Julian, Laker, Eva, Atwine, Leo, Muganzi, Davis, Walukaga, Stewart, Jawed, Bilal, Merry, Matthew, Stadelman, Anna, Stephens, Nicole, Flynn, Andrew G, Fujita, Ayako W, Kwizera, Richard, Mukaremera, Liliane, Lofgren, Sarah M, Cresswell, Fiona V, Morawski, Bozena M, Bahr, Nathan C, and Nielsen, Kirsten
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- 2019
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17. Seroprevalence of Histoplasmosis in Somali, Burmese, and Hmong Refugees Residing in Thailand and Kenya
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Bahr, Nathan C., Lee, Deborah, Stauffer, William M., Durkin, Michelle, Cetron, Martin S., Wheat, L. Joseph, and Boulware, David R.
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- 2018
18. Diagnostic accuracy of Xpert MTB/RIF Ultra for tuberculous meningitis in HIV-infected adults: a prospective cohort study
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Williams, Darlisha A, Taseera, Kabanda, Nyehangane, Dan, Ivan, Mugisha, Orikiriza, Patrick, Rhein, Joshua, Hullsiek, Kathy Huppler, Musubire, Abdu, Pastick, Katelyn, Nabeta, Pamela, Mwesigye, James, Rajasingham, Radha, Bahr, Nathan C, Nuwagira, Edwin, Evans, Emily E, Cresswell, Fiona V, Bystrom, Philip V, Byamukama, Adolf, Bridge, Sarah C, Bangdiwala, Ananta S, Meya, David B, Denkinger, Claudia M, Muzoora, Conrad, and Boulware, David R
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- 2018
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19. Eosinophilic Meningitis Due to Infection With Paragonimus kellicotti
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Bahr, Nathan C., Trotman, Robin L., Samman, Hala, Jung, Richard S., Rosterman, Lee R., Weil, Gary J., and Hinthorn, Daniel R.
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- 2017
20. Differences in Immunologic Factors Among Patients Presenting with Altered Mental Status During Cryptococcal Meningitis
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COAT and ASTRO-CM Trial Teams, Lofgren, Sarah, Hullsiek, Kathy H., Morawski, Bozena M., Nabeta, Henry W., Kiggundu, Reuben, Taseera, Kabanda, Musubire, Abdu, Schutz, Charlotte, Abassi, Mahsa, Bahr, Nathan C., Tugume, Lillian, Muzoora, Conrad, Williams, Darlisha A., Rolfes, Melissa A., Velamakanni, Sruti S., Rajasingham, Radha, Meintjes, Graeme, Rhein, Joshua, Meya, David B., and Boulware, David R.
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- 2017
21. Efficacy of adjunctive sertraline for the treatment of HIV-associated cryptococcal meningitis: an open-label dose-ranging study
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Rhein, Joshua, Morawski, Bozena M, Hullsiek, Kathy Huppler, Nabeta, Henry W, Kiggundu, Reuben, Tugume, Lillian, Musubire, Abdu, Akampurira, Andrew, Smith, Kyle D, Alhadab, Ali, Williams, Darlisha A, Abassi, Mahsa, Bahr, Nathan C, Velamakanni, Sruti S, Fisher, James, Nielsen, Kirsten, Meya, David B, and Boulware, David R
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- 2016
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22. Histoplasmosis
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Wheat, Lawrence J., Azar, Marwan M., Bahr, Nathan C., Spec, Andrej, Relich, Ryan F., and Hage, Chadi
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- 2016
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23. Diagnostic performance of a multiplex PCR assay for meningitis in an HIV-infected population in Uganda
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Rhein, Joshua, Bahr, Nathan C., Hemmert, Andrew C., Cloud, Joann L., Bellamkonda, Satya, Oswald, Cody, Lo, Eric, Nabeta, Henry, Kiggundu, Reuben, Akampurira, Andrew, Musubire, Abdu, Williams, Darlisha A., Meya, David B., and Boulware, David R.
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- 2016
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24. GeneXpert MTB/Rif to Diagnose Tuberculous Meningitis: Perhaps the First Test but not the Last
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Tuberculous Meningitis International Research Consortium, Bahr, Nathan C., Marais, Suzaan, Caws, Maxine, van Crevel, Reinout, Wilkinson, Robert J., Tyagi, Jaya S., Thwaites, Guy E., and Boulware, David R.
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- 2016
25. Single High Dose of Liposomal Amphotericin B in Human Immunodeficiency Virus/AIDS-Related Disseminated Histoplasmosis: A Randomized Trial.
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Pasqualotto, Alessandro C, Lana, Daiane Dalla, Godoy, Cassia S M, Leitão, Terezinha do Menino Jesus Silva, Bay, Monica B, Damasceno, Lisandra Serra, Soares, Renata B A, Kist, Roger, Silva, Larissa R, Wiltgen, Denusa, Melo, Marineide, Guimarães, Taiguara F, Guimarães, Marilia R, Vechi, Hareton T, Mesquita, Jacó R L de, Monteiro, Gloria Regina de G, Adenis, Antoine, Bahr, Nathan C, Spec, Andrej, and Boulware, David R
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HIV infection complications ,DRUG efficacy ,HIV-positive persons ,RESEARCH ,AMPHOTERICIN B ,RANDOMIZED controlled trials ,CD4 lymphocyte count ,DESCRIPTIVE statistics ,SURVIVAL analysis (Biometry) ,DOSE-effect relationship in pharmacology ,HISTOPLASMOSIS ,STATISTICAL sampling ,AIDS ,AIDS patients ,OVERALL survival ,LONGITUDINAL method ,DISEASE complications ,EVALUATION ,SYMPTOMS - Abstract
Background Histoplasmosis is a major AIDS-defining illness in Latin America. Liposomal amphotericin B (L-AmB) is the drug of choice for treatment, but access is restricted due to the high drug and hospitalization costs of the conventional long regimens. Methods Prospective randomized multicenter open-label trial of 1- or 2-dose induction therapy with L-AmB versus control for disseminated histoplasmosis in AIDS, followed by oral itraconazole therapy. We randomized subjects to: (i) single dose 10 mg/kg of L-AmB; (ii) 10 mg/kg of L-AmB on D1, and 5 mg/kg of L-AmB on D3; (iii) 3 mg/kg of L-AmB daily for 2 weeks (control). The primary outcome was clinical response (resolution of fever and signs/symptoms attributable to histoplasmosis) at day 14. Results A total of 118 subjects were randomized, and median CD4
+ counts, and clinical presentations were similar between arms. Infusion-related toxicity, kidney toxicity at multiple time-points, and frequency of anemia, hypokalemia, hypomagnesemia, and liver toxicity were similar. Day 14 clinical response was 84% for single-dose L-AmB, 69% 2-dose L-AmB, and 74% for control arm (P =.69). Overall survival on D14 was 89.0% (34/38) for single-dose L-AmB, 78.0% (29/37) for 2-dose L-AmB, and 92.1% (35/38) for control arm (P =.82). Conclusions One day induction therapy with 10 mg/kg of L-AmB in AIDS-related histoplasmosis was safe. Although clinical response may be non-inferior to standard L-AmB therapy, a confirmatory phase III clinical trial is needed. A single induction dose would markedly reduce drug-acquisition costs (>4-fold) and markedly shorten and simplify treatment, which are key points in terms of increased access. [ABSTRACT FROM AUTHOR]- Published
- 2023
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26. Advanced HIV disease: A review of diagnostic and prophylactic strategies.
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Lehman, Alice, Ellis, Jayne, Nalintya, Elizabeth, Bahr, Nathan C., Loyse, Angela, and Rajasingham, Radha
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MENINGITIS prevention ,OPPORTUNISTIC infection prevention ,HIV infection complications ,OPPORTUNISTIC infections ,POINT-of-care testing ,MEDICAL screening ,RAPID diagnostic tests ,SEVERITY of illness index ,PREVENTIVE health services ,MEDICAL protocols ,HUMAN services programs ,CRYPTOCOCCUS neoformans ,PSYCHOLOGY of HIV-positive persons ,MEDICAL research ,COMORBIDITY - Abstract
Background: Despite expanded access to antiretroviral therapy (ART) and the rollout of the World Health Organization's (WHO) 'test‐and‐treat' strategy, the proportion of people with HIV (PWH) presenting with advanced HIV disease (AHD) remains unchanged at approximately 30%. Fifty percent of persons with AHD report prior engagement to care. ART failure and insufficient retention in HIV care are major causes of AHD. People living with AHD are at high risk for opportunistic infections and death. In 2017, the WHO published guidelines for the management of AHD that included a comprehensive package of care for screening and prophylaxis of major opportunistic infections (OIs). In the interim, ART regimens have evolved: integrase inhibitors are first‐line therapy globally, and the diagnostic landscape is evolving. The objective of this review is to highlight novel point‐of‐care (POC) diagnostics and treatment strategies that can facilitate OI screening and prophylaxis for persons with AHD. Methods: We reviewed the WHO guidelines for recommendations for persons with AHD. We summarized the scientific literature on current and emerging diagnostics, along with emerging treatment strategies for persons with AHD. We also highlight the key research and implementation gaps together with potential solutions. Results: While POC CD4 testing is being rolled out in order to identify persons with AHD, this alone is insufficient; implementation of the Visitect CD4 platform has been challenging given operational and test interpretation issues. Numerous non‐sputum POC TB diagnostics are being evaluated, many with limited sensitivity. Though imperfect, these tests are designed to provide rapid results (within hours) and are relatively affordable for resource‐poor settings. While novel POC diagnostics are being developed for cryptococcal infection, histoplasmosis and talaromycosis, implementation science studies are urgently needed to understand the clinical benefit of these tests in the routine care. Conclusions: Despite progress with HIV treatment and prevention, a persistent 20%–30% of PWH present to care with AHD. Unfortunately, these persons with AHD continue to carry the burden of HIV‐related morbidity and mortality. Investment in the development of additional POC or near‐bedside CD4 platforms is urgently needed. Implementation of POC diagnostics theoretically could improve HIV retention in care and thereby reduce mortality by overcoming delays in laboratory testing and providing patients and healthcare workers with timely same‐day results. However, in real‐world scenarios, people with AHD have multiple comorbidities and imperfect follow‐up. Pragmatic clinical trials are needed to understand whether these POC diagnostics can facilitate timely diagnosis and treatment, thereby improving clinical outcomes such as HIV retention in care. [ABSTRACT FROM AUTHOR]
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- 2023
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27. The Current and Future States of Diagnostic Tests for Histoplasmosis with a Focus on People with HIV and Disseminated Histoplasmosis.
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Villareal, Kenneth, Price, Austin, Pasqualotto, Alessandro C., and Bahr, Nathan C.
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HISTOPLASMOSIS ,HIV-positive persons ,HIV ,DIAGNOSIS methods ,ANTIBODY titer ,ANTIGEN analysis - Abstract
Histoplasmosis is caused by Histoplasma capsulatum and, although endemic in large parts of the world, is often underrecognized in many locations. In addition to underrecognition, inadequate availability of diagnostic tests is a major contributor to poor outcomes in disseminated disease in people with HIV. For those with advanced HIV and disseminated disease, antibody testing is less useful. Culture and histopathology can be useful in this situation, but each has limitations, including variable sensitivity by site and, in the case of culture, the need for a biosafety level three laboratory and a long period of growth. Antigen testing has proven useful for disseminated histoplasmosis due to the excellent sensitivity of urine. Yet, turnaround is slower than ideal due to use in a limited number of centers. The development of lateral flow assays has the potential to make for true rapid point-of-care assays for histoplasmosis, but in order to meet that promise, the tests must be widely available and affordable. [ABSTRACT FROM AUTHOR]
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- 2023
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28. Outcome of COVID-19 in allogeneic stem cell transplant recipients: Results from the EPICOVIDEHA registry
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Busca, Alessandro, Salmanton-García, Jon, Marchesi, Francesco, Farina, Francesca, Seval, Guldane Cengiz, Van Doesum, Jaap, De Jonge, Nick, Bahr, Nathan C., Maertens, Johan, Meletiadis, Joseph, Fracchiolla, Nicola S., Weinbergerová, Barbora, Verga, Luisa, Ráčil, Zdeněk, Jiménez, Moraima, Glenthøj, Andreas, Blennow, Ola, Tanase, Alina Daniela, Schönlein, Martin, Prezioso, Lucia, Khanna, Nina, Duarte, Rafael F., Žák, Pavel, Nucci, Marcio, Machado, Marina, Kulasekararaj, Austin, Espigado, Ildefonso, De Kort, Elizabeth, Ribera-Santa Susana, José-María, Marchetti, Monia, Magliano, Gabriele, Falces-Romero, Iker, Ilhan, Osman, Ammatuna, Emanuele, Zompi, Sofia, Tsirigotis, Panagiotis, Antoniadou, Anastasia, Zambrotta, Giovanni Paolo Maria, Nordlander, Anna, Karlsson, Linda Katharina, Hanakova, Michaela, Dragonetti, Giulia, Cabirta, Alba, Berg Venemyr, Caroline, Gräfe, Stefanie, Van Praet, Jens, Tragiannidis, Athanasios, Petzer, Verena, López-García, Alberto, Itri, Federico, Groh, Ana, Gavriilaki, Eleni, Dargenio, Michelina, Rahimli, Laman, Cornely, Oliver A., Pagano, Livio, EPICOVIDEHA Consortium, [missing], Hematology, Institut Català de la Salut, [Busca A] Stem Cell Transplant Center, AOU Citta’ della Salute e della Scienza, Turin, Italy. [Salmanton-García J] University of Cologne, Faculty of Medicine and University Hospital Cologne, Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany. University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Cologne, Germany. [Marchesi F] Hematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy. [Farina F] IRCCS Ospedale San Raffaele, Milan, Italy. [Seval GC] Ankara University, Ankara, Türkiye. [Van Doesum J] University Medical Center Groningen, Groningen, Netherlands. [Jiménez M] Servei d’Hematologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Experimental Hematology, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain. Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain, and Vall d'Hebron Barcelona Hospital Campus
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hematological malignances ,Cèl·lules mare hematopoètiques - Trasplantació ,SARS-CoV-2 ,Hemic and Lymphatic Diseases::Hematologic Diseases [DISEASES] ,Immunology ,allogeneic HSCT ,Virus Diseases::RNA Virus Infections::Nidovirales Infections::Coronaviridae Infections::Coronavirus Infections [DISEASES] ,COVID-19 (Malaltia) ,COVID-19 infection ,Cancer development and immune defence Radboud Institute for Health Sciences [Radboudumc 2] ,enfermedades hematológicas y linfáticas::enfermedades hematológicas [ENFERMEDADES] ,Settore MED/15 - MALATTIE DEL SANGUE ,All institutes and research themes of the Radboud University Medical Center ,Allogeneic HSCT ,Sang - Malalties ,immunocompromised patients ,Medicine and Health Sciences ,virosis::infecciones por virus ARN::infecciones por Nidovirales::infecciones por Coronaviridae::infecciones por Coronavirus [ENFERMEDADES] ,Hematological malignances ,Immunocompromised patients ,Immunology and Allergy ,Therapeutics::Biological Therapy::Cell- and Tissue-Based Therapy::Cell Transplantation::Stem Cell Transplantation::Hematopoietic Stem Cell Transplantation [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT] ,terapéutica::terapia biológica::tratamientos basados en células y tejidos::trasplante de células::trasplante de células madre::trasplante de células madre hematopoyéticas [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS] - Abstract
COVID-19 infection; Hematological malignances; Immunocompromised patients Infecció per COVID-19; Neoplasies hematològiques; Pacients immunodeprimits Infección por COVID-19; Neoplasias hematológicas; Pacientes inmunodeprimidos Background: The outcome of COVID-19 in allogeneic hematopoietic stem cell transplantation (HSCT) recipients is almost uniformely considered poor. The aim of present study was to retrospectively analyse the outcome and risk factors for mortality in a large series of patients who developed COVID-19 infection after an allogeneic HSCT. Methods: This multicenter retrospective study promoted by the European Hematology Association – Infections in Hematology Study Working Group, included 326 adult HSCT patients who had COVID-19 between January 2020 and March 2022. Results: The median time from HSCT to the diagnosis of COVID-19 was 268 days (IQR 86-713; range 0-185 days). COVID-19 severity was mild in 21% of the patients, severe in 39% and critical in 16% of the patients. In multivariable analysis factors associated with a higher risk of mortality were, age above 50 years, presence of 3 or more comorbidities, active hematologic disease at time of COVID-19 infection, development of COVID-19 within 12 months of HSCT, and severe/critical infections. Overall mortality rate was 21% (n=68): COVID-19 was the main or secondary cause of death in 16% of the patients (n=53). Conclusions: Mortality in HSCT recipients who develop COVID-19 is high and largely dependent on age, comorbidities, active hematologic disease, timing from transplant and severity of the infection. EPICOVIDEHA has received funds from Optics COMMITTM (COVID-19 Unmet Medical Needs and Associated Research Extension) COVID-19 RFP program by GILEAD Science, United States (Project 2020-8223). The funder of the study had no role in study design, data analysis, interpretation, or writing of the report. All authors had full access to the data and had final responsibility for the decision to submit for publication.
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- 2023
29. Rapid Access to Comprehensive Care May Explain Better Outcomes in Persons With Sepsis With Solid Organ Transplant Versus Those Without Solid Organ Transplant
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Bahr, Nathan C., Beaudoin, Amanda, and Drekonja, Dimitri
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- 2015
30. Prevalence of Histoplasma Antigenuria among Outpatient Cohort with Advanced HIV in Kampala, Uganda.
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Sekar, Preethiya, Nalintya, Elizabeth, Kwizera, Richard, Mukashyaka, Claudine, Niyonzima, Godfrey, Namakula, Loryndah Olive, Nerima, Patricia, Fieberg, Ann, Dai, Biyue, Ellis, Jayne, Boulware, David R., Meya, David B., Bahr, Nathan C., and Rajasingham, Radha
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MYCOBACTERIUM tuberculosis ,OPPORTUNISTIC infections ,HIV ,ANTIGEN analysis ,ENZYME-linked immunosorbent assay ,HISTOPLASMOSIS - Abstract
In sub-Saharan Africa, an estimated 25% of people with HIV present with advanced HIV and are at high risk of opportunistic infections. Whereas histoplasmosis has occasionally been seen in Uganda, the understanding of the local risk of acute infection is limited. We sought to determine the prevalence of Histoplasma antigenuria using an enzyme immunoassay (EIA, clarus Histoplasma GM EIA, IMMY; Norman, OK, USA) in a cohort of outpatients with advanced HIV disease in Kampala, Uganda. Among the persons with positive urine Histoplasma antigen tests, we assessed their clinical presentation and outcomes. The EIA was run on stored urine samples as per the manufacturer's instructions. Specimens ≥1 EIA units were considered positive. Among the 388 tested urine samples, 4 (1.2%) were positive for Histoplasma antigen. The histoplasmosis prevalence among participants with a CD4 < 100 cells/mcL was 2.5% (4/158). Three of the four participants with a positive Histoplasma antigen test reported systemic symptoms consistent with histoplasmosis. All four participants had a positive urine lipoarabinomannan test and were treated for tuberculosis. By the four-week follow-up visit, all participants were clinically improved, alive, and in care without antifungal therapy. In advanced HIV, the clinical presentations of tuberculosis and histoplasmosis overlap. The value of histoplasmosis screening and pre-emptive treatment is an area of future research. [ABSTRACT FROM AUTHOR]
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- 2023
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31. COVID-19 in adult acute myeloid leukemia patients: a long-term followup study from the European Hematology Association survey (EPICOVIDEHA)
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Marchesi, Francesco, Salmanton-García, Jon, Emarah, Ziad, Piukovics, Klára, Nucci, Marcio, López-García, Alberto, Rácil, Zdenék, Farina, Francesca, Popova, Marina, Zompi, Sofia, Audisio, Ernesta, Ledoux, Marie-Pierre, Verga, Luisa, Weinbergerová, Barbora, Szotkovski, Tomas, Da Silva, Maria Gomes, Fracchiolla, Nicola, De Jonge, Nick, Collins, Graham, Marchetti, Monia, Magliano, Gabriele, Garcia-Vidal, Carolina, Biernat, Monika M., Van Doesum, Jaap, Machado, Marina, Demirkan, Fatih, Al-Khabori, Murtadha, Žák, Pavel, Víšek, Benjamín, Stoma, Igor, Méndez, Gustavo-Adolfo, Maertens, Johan, Khanna, Nina, Espigado, Ildefonso, Dragonetti, Giulia, Fianchi, Luana, Del Principe, Maria Ilaria, Cabirta, Alba, Ormazabal-Vélez, Irati, Jakšić, Ozren, Buquicchio, Caterina, Bonuomo, Valentina, Batinié, Josip, Omrani, Ali S., Lamure, Sylvain, Finizio, Olimpia, Fernández, Noemí, Falces-Romero, Iker, Blennow, Ola, Bergantim, Rui, Ali, Natasha, Win, Sein, Van Praet, Jens, Tisi, Maria Chiara, Shirinova, Ayten, Schönlein, Martin, Prattes, Juergen, Piedimonte, Monica, Petzer, Verena, Navrátil, Milan, Kulasekararaj, Austin, Jindra, Pavel, Sramek, Jirí, Glenthøj, Andreas, Fazzi, Rita, De Ramón-Sánchez, Cristina, Cattaneo, Chiara, Calbacho, Maria, Bahr, Nathan C., El-Ashwah, Shaimaa, Cordoba, Raul, Hanakova, Michaela, Zambrotta, Giovanni, Sciumè, Mariarita, Booth, Stephen, Rodrigues, Raquel Nunes, Sacchi, Maria Vittoria, García-Poutón, Nicole, Martín-González, Juan-Alberto, Khostelidi, Sofya, Gräfe, Stefanie, Rahimli, Laman, Ammatuna, Emanuele, Busca, Alessandro, Corradini, Paolo, Hoenigl, Martin, Klimko, Nikolai, Koehler, Philipp, Pagliuca, Antonio, Passamonti, Francesco, Cornely, Oliver A., Pagano, Livio, Universitat Autònoma de Barcelona, Institut Català de la Salut, [Marchesi F] Hematology and Stem Cell Transplant Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy. [Salmanton-García J] University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany. University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Cologne, Germany. [Emarah Z] Oncology Center, Mansoura University, Mansoura, Egypt. [Piukovics K] Department of Internal Medicine, South Division Faculty of Medicine University of Szeged, Szeged, Hungary. [Nucci M] Department of Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil. [López-García A] Fundacion Jimenez Diaz University Hospital, Health Research Institute IIS-FJD, Madrid, Spain. [Cabirta A] Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain. Servei d’Hematologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Experimental Hematology, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain, and Vall d'Hebron Barcelona Hospital Campus
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Settore MED/15 - MALATTIE DEL SANGUE ,Leucèmia mieloide aguda ,neoplasias::neoplasias por tipo histológico::leucemia::leucemia mieloide::leucemia mieloide aguda::leucemia monocítica aguda [ENFERMEDADES] ,Medicine and Health Sciences ,virosis::infecciones por virus ARN::infecciones por Nidovirales::infecciones por Coronaviridae::infecciones por Coronavirus [ENFERMEDADES] ,Virus Diseases::RNA Virus Infections::Nidovirales Infections::Coronaviridae Infections::Coronavirus Infections [DISEASES] ,Hematology ,Neoplasms::Neoplasms by Histologic Type::Leukemia::Leukemia, Myeloid::Leukemia, Myeloid, Acute::Leukemia, Monocytic, Acute [DISEASES] ,03.02. Klinikai orvostan ,Settore MED/15 ,Infection ,COVID-19 (Malaltia) ,AML, COVID19 - Abstract
COVID-19; Acute myeloid leukemia; Survey COVID-19; Leucemia mieloide aguda; Encuesta COVID-19; Leucèmia mieloide aguda; Enquesta Patients with acute myeloid leukemia (AML) are at high risk of dying from coronavirus disease 2019 (COVID-19). The optimal management of AML patients with COVID-19 has not been established. Our multicenter study included 388 adult AML patients diagnosed with COVID-19 between February 2020 and October 2021. The vast majority were receiving or had received AML treatment in the preceding 3 months. COVID-19 was severe in 41.2% and critical in 21.1% of cases. The chemotherapeutic schedule was modified in 174 patients (44.8%), delayed in 68 and permanently discontinued in 106. After a median follow-up of 325 days, 180 patients (46.4%) had died; death was attributed to COVID-19 (43.3%), AML (26.1%) or to a combination of both (26.7%), whereas in 3.9% of cases the reason was unknown. Active disease, older age, and treatment discontinuation were associated with death, whereas AML treatment delay was protective. Seventy-nine patients had a simultaneous AML and COVID-19 diagnosis, with better survival when AML treatment could be delayed (80%; P
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- 2022
32. Recurrence of Symptoms Following Cryptococcal Meningitis: Characterizing a Diagnostic Conundrum With Multiple Etiologies.
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Bahr, Nathan C, Skipper, Caleb P, Huppler-Hullsiek, Kathy, Ssebambulidde, Kenneth, Morawski, Bozena M, Engen, Nicole W, Nuwagira, Edwin, Quinn, Carson M, Ramachandran, Prashanth S, Evans, Emily E, Lofgren, Sarah M, Abassi, Mahsa, Muzoora, Conrad, Wilson, Michael R, Meya, David B, Rhein, Joshua, and Boulware, David R
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CEREBROSPINAL fluid examination , *KRUSKAL-Wallis Test , *CD4 antigen , *RETROSPECTIVE studies , *DISEASE relapse , *HIGHLY active antiretroviral therapy , *CRYPTOCOCCUS neoformans , *IMMUNE reconstitution inflammatory syndrome , *CHI-squared test , *MENINGITIS , *SYMPTOMS - Abstract
Background Cryptococcal meningitis is a common cause of AIDS-related mortality. Although symptom recurrence after initial treatment is common, the etiology is often difficult to decipher. We sought to summarize characteristics, etiologies, and outcomes among persons with second-episode symptomatic recurrence. Methods We prospectively enrolled Ugandans with cryptococcal meningitis and obtained patient characteristics, antiretroviral therapy (ART) and cryptococcosis histories, clinical outcomes, and cerebrospinal fluid (CSF) analysis results. We independently adjudicated cases of second-episode meningitis to categorize patients as (1) microbiological relapse, (2) paradoxical immune reconstitution inflammatory syndrome (IRIS), (3) persistent elevated intracranial pressure (ICP) only, or (4) persistent symptoms only, along with controls of primary cryptococcal meningitis. We compared groups with chi-square or Kruskal-Wallis tests as appropriate. Results 724 participants were included (n = 607 primary episode, 81 relapse, 28 paradoxical IRIS, 2 persistently elevated ICP, 6 persistent symptoms). Participants with culture-positive relapse had lower CD4 (25 cells/μL; IQR: 9–76) and lower CSF white blood cell (WBC; 4 cells/μL; IQR: 4–85) counts than paradoxical IRIS (CD4: 78 cells/μL; IQR: 47–142; WBC: 45 cells/μL; IQR: 8–128). Among those with CSF WBC <5 cells/μL, 86% (43/50) had relapse. Among those with CD4 counts <50 cells/μL, 91% (39/43) had relapse. Eighteen-week mortality (from current symptom onset) was 47% among first episodes of cryptococcal meningitis, 31% in culture-positive relapses, and 14% in paradoxical IRIS. Conclusions Poor immune reconstitution was noted more often in relapse than IRIS as evidenced by lower CSF WBC and blood CD4 counts. These easily obtained laboratory values should prompt initiation of antifungal treatment while awaiting culture results. Clinical Trials Registration NCT01802385. [ABSTRACT FROM AUTHOR]
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- 2023
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33. Factors Associated With Adherence to First-line Antiviral Therapy Among Commercially Insured Patients With Chronic Hepatitis B.
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Alpern, Jonathan D, Joo, Heesoo, Bahr, Nathan C, and Leventhal, Thomas M
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Background Nonadherence to antiviral therapy can lead to poor clinical outcomes among patients with chronic hepatitis B (CHB). We used a claims database to evaluate risk factors for nonadherence to antiviral therapy among commercially insured patients with CHB in the United States. Methods We obtained data for commercially insured adult patients with CHB prescribed entecavir or tenofovir disoproxil fumarate (TDF) in 2019. Primary outcomes were adherence to entecavir and adherence to TDF. Enrollees with a proportion of days covered (PDC) ≥80% were considered adherent. We presented adjusted odds ratios (AORs) from multivariate logistic regressions. Results Eighty-three percent (n = 640) of entecavir patients were adherent, and 81% (n = 687) of TDF patients were adherent. Ninety-day supply (vs 30-day supply; AOR, 2.21; P <.01), mixed supply (vs 30-day supply; AOR, 2.19; P =.04), and ever using a mail order pharmacy (AOR, 1.92, P =.03) were associated with adherence to entecavir. Ninety-day supply (vs 30-day supply; AOR, 2.51; P <.01), mixed supply (vs 30-day supply; AOR, 1.82; P =.04), and use of a high-deductible health plan (vs no high-deductible health plan; AOR, 2.29; P =.01) were associated with adherence to TDF. Out-of-pocket spending of >$25 per 30-day supply of TDF was associated with reduced odds of adherence to TDF (vs <$5 per 30-day supply of TDF; AOR, 0.34; P <.01). Conclusions Ninety-day and mixed-duration supplies of entecavir and TDF were associated with higher fill rates as compared with 30-day supplies among commercially insured patients with CHB. [ABSTRACT FROM AUTHOR]
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- 2023
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34. Pneumocystis jirovecii Infections Among COVID-19 Patients: A Case Series and Literature Review.
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Amstutz, Paul, Bahr, Nathan C, Snyder, Karen, and Shoemaker, D Matthew
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Background Pneumocystis jirovecii pneumonia (PCP) is a serious, emerging complication of coronavirus disease 2019 (COVID-19). Methods We performed a systematic review of published cases. We describe 6 new cases of PCP/COVID-19 coinfection. Among our cases (n = 6) and those in the literature (n = 69) with available data, the median age (interquartile range [IQR]) was 59 (44–77) years (n = 38), 72% (47/65) were male, and the mortality rate was 30.9% (21/68). Results Long-term corticosteroid use was noted in 45.1% (23/51), advanced HIV infection (defined as a CD4 count <200 cells/μL) in 17.6% (9/51), and antineoplastic chemotherapy in 13.7% (7/51), consistent with known PCP risk factors. Notably, 56.7% (38/47) had verifiable risk factors for PCP (high-dose corticosteroids, immunosuppressive therapy, and HIV infection) before COVID-19 infection. A median absolute lymphocyte count (IQR) of 0.61 (0.28–0.92) ×103 cells/mm3 (n = 23) and CD4 count (IQR) of 66 (33–291.5) cells/mm3 (n = 20) were also discovered among the study population. Conclusions These findings suggest a need for greater attention to PCP risk factors among COVID-19 patients and consideration of PCP prophylaxis in these high-risk populations. [ABSTRACT FROM AUTHOR]
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- 2023
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35. Histoplasmosis Infections Worldwide: Thinking Outside of the Ohio River Valley
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Bahr, Nathan C., Antinori, Spinello, Wheat, L. Joseph, and Sarosi, George A.
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- 2015
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36. Disseminated Histoplasmosis with Underlying Sarcoidosis-Rheumatoid Arthritis Overlap Syndrome: An Example of Diagnostic Test Threshold of Detection Affecting Test Results and Patient Care
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Pankratz, Daniel, Tichenor, Jordan, Merino, Fernando, and Bahr, Nathan C.
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Article Subject - Abstract
Histoplasmosis is common in many parts of the world but with areas of hyperendemicity. Disseminated histoplasmosis is the deadliest form of histoplasmosis and is most common among immunocompromised patients. Timely diagnosis is crucial to improve outcomes. We describe a patient on azathioprine and rituximab with disseminated histoplasmosis in which diagnosis was delayed in part because of negative early Histoplasma antigen testing, which was positive later in the course. This case serves as an example of the concept of “threshold of detection” in which a certain concentration of a microbe must be present for it to be detected by a diagnostic test that focuses on detection of a microbe or its components. This concept applies to many tests used to diagnose infectious diseases.
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- 2022
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37. Detection of High Cerebrospinal Fluid Levels of (1→3)-β-D-Glucan in Cryptococcal Meningitis
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Rhein, Joshua, Bahr, Nathan C., Morawski, Bozena M., Schutz, Charlotte, Zhang, Yonglong, Finkelman, Malcolm, Meya, David B., Meintjes, Graeme, and Boulware, David R.
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- 2014
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38. Accuracy of Noninvasive Intraocular Pressure or Optic Nerve Sheath Diameter Measurements for Predicting Elevated Intracranial Pressure in Cryptococcal Meningitis
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Nabeta, Henry W., Bahr, Nathan C., Rhein, Joshua, Fossland, Nicholas, Kiragga, Agnes N., Meya, David B., Dunlop, Stephen J., and Boulware, David R.
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- 2014
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39. Reproducibility of CSF quantitative culture methods for estimating rate of clearance in cryptococcal meningitis
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Dyal, Jonathan, Akampurira, Andrew, Rhein, Joshua, Morawski, Bozena M, Kiggundu, Reuben, Nabeta, Henry W, Musubire, Abdu K, Bahr, Nathan C, Williams, Darlisha A, Bicanic, Tihana, Larsen, Robert A, Meya, David B, and Boulware, David R
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- 2016
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40. Seroprevalence of histoplasmosis in Kampala, Uganda
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Bahr, Nathan C, Sarosi, George A., Meya, David B, Bohjanen, Paul R, Richer, Sarah M, Swartzentruber, Samantha, Halupnick, Ryan, Jarrett, Deidre, Wheat, L. Joseph, and Boulware, David R
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- 2016
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41. Evaluation of the Diagnostic Accuracy and Clinical Utility of Fungal Profile Plus Polymerase Chain Reaction Assay in Pulmonary Infections.
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Smith, Clarissa B, Shi, Xiaosong, Liesman, Rachael M, Thomas, Laura A, Bahr, Nathan C, and Brownback, Kyle R
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LUNG infections ,POLYMERASE chain reaction ,NOCARDIOSIS ,NOCARDIA ,ASPERGILLOSIS ,MYCOBACTERIA - Abstract
Background Pulmonary infections due to Aspergillus , Mucorales, and Nocardia have high morbidity and mortality, in part due to diagnostic challenges. Commercially available molecular assays on bronchoalveolar lavage fluid (BALF) may have increased sensitivity over currently available diagnostic options. Our aim was to characterize the diagnostic performance of assays for each of these pathogens in our patient population. Methods The medical records of patients whose BALF was tested by polymerase chain reaction (PCR) for Aspergillus , Mucorales, and Nocardia between 2019 and 2021 were reviewed in a cross-sectional manner. European Organization for Research and Treatment of Cancer and the Mycoses Study Group (EORTC/MSG) definitions of "proven," "probable," and "possible" infection were used, including histopathology, serology, and culture. We used (1) "proven" or "probable" infection by EORTC criteria, (2) improvement or stabilization on targeted antimicrobial therapy, and (3) absence of a more likely diagnosis as the reference standard. Results The Aspergillus PCR assay demonstrated the highest agreement with the diagnostic reference standard, with 31.25% (10/32) sensitivity and 97.17% (206/212) specificity. Positive and negative predictive values were 62.50% (10/16) and 90.35% (206/228), respectively. No Mucorales or Nocardia infections were identified by the diagnostic reference standard, so the sensitivity could not be calculated. The specificity of Mucorales and Nocardia targets was 98.35% and 96.69%, respectively. Conclusions Our data demonstrated relatively poor clinical sensitivity for all 3 constituent PCR assays in our patient population, suggesting a limited role for this test in the diagnosis of Aspergillus , Mucorales, or Nocardia. [ABSTRACT FROM AUTHOR]
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- 2022
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42. Pregnancy-Related Tuberculous Meningitis and Immune Reconstitution Inflammatory Syndrome: A Case Series and Systematic Review.
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Pastick, Katelyn A, Kagimu, Enock, Dobbin, Joanna, Ssebambulidde, Kenneth, Gakuru, Jane, Milln, Jack, Nakabuye, Betty, Meya, David B, Boulware, David R, Cresswell, Fiona V, and Bahr, Nathan C
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TUBERCULOUS meningitis ,IMMUNE reconstitution inflammatory syndrome ,HIV-positive women ,SYMPTOMS ,HIV ,CHILDBEARING age ,NEONATAL mortality - Abstract
Background Tuberculosis is a leading cause of death among women of reproductive age. However, tuberculous meningitis, the most severe form of extrapulmonary tuberculosis, is rarely discussed in pregnancy despite this being a unique period of immune modulation that may predispose women to active disease. Methods We identified and described cases of tuberculous meningitis among pregnant or postpartum women screened during meningitis clinical trials in Uganda from 2018 to 2022. We conducted a systematic literature review via PubMed/Medline and Embase for all English-language publications from 1970 to 10 July 2022, to identify additional cases. Results We identified 8 cases of pregnancy-related tuberculous meningitis in Ugandan women living with human immunodeficiency virus (HIV) and 40 additional cases via systematic literature review (none HIV-positive). Of all combined cases, 50% (24/48) were diagnosed postpartum; 50% (24/48) had initial onset during pregnancy, of which 38% (9/24) had worsening of symptoms or disease relapse following pregnancy cessation. Diagnosis was missed or delayed in 33% (16/48) of cases. For those with known outcomes, maternal mortality was 23% (11/48) and fetal/neonatal mortality was 30% (13/44). Of maternal survivors, 30% (11/37) had residual neurologic deficits. Conclusions The true incidence of tuberculous meningitis in pregnancy or the postpartum period is unclear but likely underappreciated. To date, nearly all published cases have occurred in HIV-negative or otherwise immunocompetent women. Given the well-described physiological immunosuppression during pregnancy and subsequent reconstitution postpartum, physicians must be aware of tuberculous meningitis and pregnancy-related immune reconstitution inflammatory syndrome, especially in countries with a high burden of tuberculosis and in women living with HIV. [ABSTRACT FROM AUTHOR]
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- 2022
- Full Text
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43. Antifungal drug price increases in the United States, 2000–2019.
- Author
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Thomas, Christine M., Shae, Whitney, Koestler, Devin, DeFor, Terese, Bahr, Nathan C., and Alpern, Jonathan D.
- Subjects
PRICE increases ,DRUG prices ,PRICES ,ANTIFUNGAL agents ,UNITS of time ,MANUFACTURING industries ,CONSUMER price indexes - Abstract
Background: Antifungal drugs treat a variety of conditions, ranging from localised dermatologic disease to life‐threatening systemic infections. Some common antifungal drugs experienced large price increases in recent years, however, factors contributing to these price increases are poorly understood. We sought to examine trends in antifungal drug prices and determine underlying drivers of price changes. Methods: Antifungal drug products in the United States were identified using the Food and Drug Administration (FDA) Label database. For each product, we determined the wholesale acquisition cost per unit over time between 2000 and 2019, adjusting for inflation, and examined variables that could impact price: route of administration, number of FDA indications, the quantity of professional guideline recommendations, use for prophylaxis, number of FDA‐approved manufacturers, and whether it was compounded. Price trajectories were clustered into four groups: (1) stable, 2) moderate, (3) high, and (4) extreme price increases. Results: Of 139 identified drug products, one outlier was removed due to exorbitant price increases. Cluster 1 (n = 31) demonstrated the most stable prices with a 25% mean price increase. Clusters 2 (n = 97), 3 (n = 7), and 4 (n = 3) demonstrated moderate, high, and extreme price increases with 52%, 318%, and 900% mean price increases, respectively. Atypical routes of administration and compounding were over‐represented in clusters 3 and 4. There was no correlation between the number of manufacturers and price changes. Conclusions: Antifungal drugs exhibited large, inflation‐adjusted price increases. Atypical routes of administration and compounding were over‐represented within clusters exhibiting extraordinary price increases. Our data support policies aiming to curb large price increases for medically important drugs. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
44. Blastomycosis—Some Progress but Still Much to Learn.
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Pullen, Matthew F., Alpern, Jonathan D., and Bahr, Nathan C.
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BLASTOMYCOSIS ,THERAPEUTICS ,MYCOSES ,SYMPTOMS ,CENTRAL nervous system - Abstract
Blastomycosis, caused by Blastomyces spp., is an endemic mycosis capable of causing significant disease throughout the body. Higher rates of infection are seen in the Mississippi and Ohio River valleys, the Great Lakes region of the United States and Canada, much of Africa, and, to a lesser extent, in India and the Middle East. Limited reporting inhibits our true understanding of the geographic distribution of blastomycosis. An estimated 50% of those infected remain asymptomatic. Of those who present with symptomatic disease, pulmonary involvement is most common, while the most common extrapulmonary sites are the skin, bones, genitourinary system, and central nervous system. Itraconazole is the standard therapy for mild–moderate disease. Data for other azoles are limited. Amphotericin is used for severe disease, and corticosteroids are occasionally used in severe disease, but evidence for this practice is limited. Despite increasing incidence and geographic reach in recent years, there are still significant knowledge gaps in our understanding of blastomycosis. Here, we provide an updated review of the epidemiology, clinical presentations, and diagnostic and therapeutic approaches for this infection. We also discuss areas needing further research. [ABSTRACT FROM AUTHOR]
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- 2022
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45. Fujifilm SILVAMP TB LAM Assay on Cerebrospinal Fluid for the Detection of Tuberculous Meningitis in Adults With Human Immunodeficiency Virus
- Author
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Quinn, Carson M, Kagimu, Enock, Okirworth, Michael, Bangdiwala, Ananta S, Mugumya, Gerald, Ramachandran, Prashanth S, Wilson, Michael R, Meya, David B, Cresswell, Fiona V, Bahr, Nathan C, and Boulware, David R
- Subjects
urologic and male genital diseases - Abstract
BACKGROUND: Tuberculous meningitis (TBM) has a high fatality rate, with inadequate diagnostic tests being a major contributor. The rollout of Xpert MTB/Rif and Xpert MTB/RIF Ultra (Xpert Ultra) have improved time-to-diagnosis with sensitivities similar to culture, yet test availability and sensitivity are inadequate. The TB lipoarabinomannan lateral flow assay (AlereLAM) offers ease of use, but its low sensitivity in cerebrospinal fluid (CSF) limits clinical utility for TBM. The Fujifilm SILVAMP TB LAM (FujiLAM) assay has excellent sensitivity in urine, but performance on cerebrospinal fluid is uncertain. METHODS: We conducted a prospective cohort study at Kiruddu National Referral Hospital in Kampala, Uganda, enrolling patients suspected to have TBM. CSF was tested using AlereLAM, Xpert Ultra, culture, and FujiLAM. Results were compared with 2 reference standards: probable and definite TBM or definite TBM alone by the uniform TBM case definition. RESULTS: Of 101 patients enrolled (95/101 HIV-positive), 34 had definite TBM and 24 had probable TBM. FujiLAM sensitivity on CSF was 52% (30/58) for definite or probable TBM compared with 55% (32/58) for Xpert Ultra. AlereLAM had lower sensitivity than FujiLAM in the subgroup of patients tested with both assays (14% [4/28] vs 50% [14/28]; P < .01). FujiLAM specificity was 98% (42/43) for patients without probable or definite TBM. CONCLUSIONS: FujiLAM showed higher sensitivity than AlereLAM, with sensitivity potentially approaching that of Xpert Ultra. FujiLAM could improve time-to-treatment-initiation, especially in settings where the more technical Xpert Ultra system might not be feasible. Large confirmatory studies are needed.
- Published
- 2021
46. Methods of rapid diagnosis for the etiology of meningitis in adults
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Bahr, Nathan C and Boulware, David R
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- 2014
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47. Management of Histoplasmosis by Infectious Disease Physicians.
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Mazi, Patrick B, Arnold, Sandra R, Baddley, John W, Bahr, Nathan C, Beekmann, Susan E, McCarty, Todd P, Polgreen, Philip M, Rauseo, Adriana M, and Spec, Andrej
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HISTOPLASMOSIS ,COMMUNICABLE diseases ,EMERGING infectious diseases ,PHYSICIANS ,CENTRAL nervous system ,IMMUNOCOMPROMISED patients - Abstract
Background The Infectious Diseases Society of America (IDSA) guidelines for the management of histoplasmosis were last revised 15 years ago. Since those guidelines were compiled, new antifungal treatment options have been developed. Furthermore, the ongoing development of immunomodulatory therapies has increased the population at increased risk to develop histoplasmosis. Methods An electronic survey about the management practices of histoplasmosis was distributed to the adult infectious disease (ID) physician members of the IDSA's Emerging Infections Network. Results The survey response rate was 37% (551/1477). Only 46% (253/551) of respondents reported seeing patients with histoplasmosis. Regions considered endemic had 82% (158/193) of physicians report seeing patients with histoplasmosis compared to 27% (95/358) of physicians in regions not classically considered endemic (P < 0.001). Most ID physicians follow IDSA treatment guidelines recommending itraconazole for acute pulmonary (189/253 [75%]), mild-moderate disseminated (189/253 [75%]), and as step-down therapy for severe disseminated histoplasmosis with (232/253 [92%]) and without (145/253 [57%]) central nervous system involvement. There were no consensus recommendations observed for survey questions regarding immunocompromised patients. Conclusions Though there are increased reports of histoplasmosis diagnoses outside regions classically considered endemic, a majority of ID physicians reported not seeing patients with histoplasmosis. Most respondents reported adherence to IDSA guidelines recommending itraconazole in each clinical situation. New histoplasmosis guidelines need to reflect the growing need for updated general guidance, particularly for immunocompromised populations. [ABSTRACT FROM AUTHOR]
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- 2022
- Full Text
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48. Noninvasive Testing and Surrogate Markers in Invasive Fungal Diseases.
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Thompson, George R, Boulware, David R, Bahr, Nathan C, Clancy, Cornelius J, Harrison, Thomas S, Kauffman, Carol A, Le, Thuy, Miceli, Marisa H, Mylonakis, Eleftherios, Nguyen, M Hong, Ostrosky-Zeichner, Luis, Patterson, Thomas F, Perfect, John R, Spec, Andrej, Kontoyiannis, Dimitrios P, and Pappas, Peter G
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MYCOSES ,BIOMARKERS ,ANTIFUNGAL agents ,CLINICAL medicine ,CLINICAL trials - Abstract
Invasive fungal infections continue to increase as at-risk populations expand. The high associated morbidity and mortality with fungal diseases mandate the continued investigation of novel antifungal agents and diagnostic strategies that include surrogate biomarkers. Biologic markers of disease are useful prognostic indicators during clinical care, and their use in place of traditional survival end points may allow for more rapid conduct of clinical trials requiring fewer participants, decreased trial expense, and limited need for long-term follow-up. A number of fungal biomarkers have been developed and extensively evaluated in prospective clinical trials and small series. We examine the evidence for these surrogate biomarkers in this review and provide recommendations for clinicians and regulatory authorities. [ABSTRACT FROM AUTHOR]
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- 2022
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49. Improving Technology to Diagnose Tuberculous Meningitis: Are We There Yet?
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Ssebambulidde, Kenneth, Gakuru, Jane, Ellis, Jayne, Cresswell, Fiona V., and Bahr, Nathan C.
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TUBERCULOUS meningitis ,CEREBROSPINAL fluid ,NANOTECHNOLOGY ,NUCLEOTIDE sequencing ,DIAGNOSIS methods ,DIAGNOSIS - Abstract
Diagnosis of tuberculous meningitis (TBM) remains challenging due to a paucity of high-performance diagnostics. Even those that have reasonable sensitivity are not adequate to 'rule out' TBM. Therefore, a combination of clinical factors alongside microbiological, molecular, and radiological investigations are utilized, depending on availability. A low threshold for starting empiric therapy in the appropriate clinical scenario remains crucial for good outcomes in many cases. Herein, we review the current TBM diagnostics landscape with a focus on limitations frequently encountered, such as diagnostic test performance, cost, laboratory infrastructure, and clinical expertise. Though molecular technologies, particularly GeneXpert MTB/Rif Ultra, have been a step forward, diagnosis of TBM remains difficult. We also provide an overview of promising technologies, such as cerebrospinal fluid (CSF) lactate, a new lipoarabinomannan test (FujiLAM), metagenomic next-generation sequencing, and transcriptomics that may further improve our TBM diagnostic capacity and lead to better outcomes. [ABSTRACT FROM AUTHOR]
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- 2022
- Full Text
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50. Clinical Characteristics, Laboratory Findings, Radiographic Signs and Outcomes of 52,251 Patients with Confirmed COVID-19 Infection: A Systematic Review and Meta-Analysis
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Pormohammad, Ali, Ghorbani, Saeed, Baradaran, Behzad, Khatam, Alireza, Turner, Raymond, Mansournia, Mohammad Ali, Kyriacou, Demetrios N., Idrovo, Juan-Pablo, and Bahr, Nathan C.
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other - Abstract
Introduction: The 2019 novel coronavirus (COVID-19) is very contagious, and can be transmitted to other people by droplet, aerosol, sneezing, infected surface, and cough. There is no vaccine or effective treatment at this time. Therefore, the prevention of COVID-19 and the rapid diagnosis of infected patients is crucial. Method: We searched all relevant literature published up to February 28, 2020, from Embase, Scopus, PubMed, Web of Science, and the Cochrane library to collect the studies that reported clinical and laboratory characteristics of COVID-19 infected patients. The study quality was assessed with the Critical Appraisal Checklist. Depending on the heterogeneity test, we used either random or fixed-effect models to analyze the appropriateness of the pooled results. Result: Twenty studies were included in the meta-analysis, including a total of 52,251 patients with confirmed COVID-19 infection. 69.5% (95% CI 54.5-81, p < 0.001) of patients had a history of recent travel to Wuhan, contact with people from Wuhan, or lived in Wuhan. The most common symptoms among COVID-19 infected patients were fever 85.6 % (95% CI 73 -93, p < 0.001), and cough 63 % (95% CI 55.5-70, p < 0.001), respectively. The laboratory analysis showed that thrombocytosis was present in 91% (95% CI 81-98, p < 0.001) CRP was elevated in 81% (95% CI 65-91, p < 0.001), and lymphopenia in 62.5% of cases (95% CI 42-79, p < 0.001). The most common radiographic signs were bilateral involvement in 76.8% (95% CI 62.5-87, p < 0.001) and consolidation in 75.5% (95% CI 50.5-91, p < 0.001) of patients. Most patients (85.4%) were hospitalized, 20.6% of patients were admitted to the ICU in critical condition, and the mortality rate was 5.6%. Conclusions: Fever and cough are the most common symptoms of COVID-19 infection in the literature published to date. Thombocytosis, lymphopenia, and increased CRP were common lab findings although most patients included in the overall analysis did not have laboratory values reported. The most common radiographic sign was bilateral involvement in and consolidation. Among Chinese patients with COVID-19, rates of hospitalization, critical condition, and hospitalization were high in this study, but these findings may be biased by reporting only confirmed cases.
- Published
- 2020
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