33 results on '"Marcus, Joseph E"'
Search Results
2. A systematic review of variability in the reporting of extracorporeal membrane oxygenation-associated infections and recommendations for standardization
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Sweet, Lauren M. and Marcus, Joseph E.
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- 2024
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3. Clearance of blood stream infections in patients receiving extracorporeal membrane oxygenation: a retrospective single-center cohort study
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Frankford, Stone A., Sobieszczyk, Michal J., Markelz, Ana E., and Marcus, Joseph E.
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- 2023
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4. Epidemiology and clinical significance of persistent bacteremia in severely burned patients
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Marcus, Joseph E., Townsend, Lisa C., Rizzo, Julie A., James, K. Aden, Markelz, Ana E., and Blyth, Dana M.
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- 2024
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5. Treatment and outcome of gram-positive bacteremia in patients receiving extracorporeal membrane oxygenation
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Marcus, Joseph E., Ford, Mary B., Sattler, Lauren A., Iqbal, Sonia, Garner, Chelsea L., Sobieszczyk, Michal J., and Barsoumian, Alice E.
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- 2023
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6. Follow-up of Military Blood Donors Who Test Positive for Syphilis
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Hojnoski, Cara E., Kieffer, John W., Casey, Theresa M., Osuna, Angela B., Casleton, Brian G., Okulicz, Jason F., and Marcus, Joseph E.
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- 2023
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7. Nosocomial Infections in Adults Receiving Extracorporeal Membrane Oxygenation: A Review for Infectious Diseases Clinicians.
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Marcus, Joseph E, Shah, Aditya, Peek, Giles J, and MacLaren, Graeme
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INFECTION prevention , *COMMUNICABLE diseases , *EXTRACORPOREAL membrane oxygenation , *CROSS infection , *POPULATION health , *ANTIMICROBIAL stewardship , *VENTILATOR-associated pneumonia , *INFORMATION needs , *ATTITUDES of medical personnel , *SEPSIS , *ANTIBIOTIC prophylaxis , *ALGORITHMS - Abstract
Over the past 10 years, there has been a rapid expansion in the use of extracorporeal membrane oxygenation (ECMO) in the care of patients with refractory cardiac or respiratory failure. Infectious diseases clinicians must reconcile conflicting evidence from limited studies as they develop practices at their own institutions, which has resulted in considerably different practices globally. This review describes infection control and prevention as well as antimicrobial prophylaxis strategies in this population. Data on diagnostics and treatment for patients receiving ECMO with a focus on diagnostic and antimicrobial stewardship is then examined. This review summarizes gaps in the current ECMO literature and proposes future needs, including developing clear definitions for infections and encouraging transparent reporting of practices at individual facilities in future clinical trials. [ABSTRACT FROM AUTHOR]
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- 2024
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8. COVID-19 Monitoring and Response Among U.S. Air Force Basic Military Trainees — Texas, March–April 2020
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Marcus, Joseph E., Frankel, Dianne N., Pawlak, Mary T., Casey, Theresa M., Blackwell, Rebecca S., Tran, Francis V., Dolan, Mathew J., and Yun, Heather C.
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- 2020
9. The utility of sepsis scores for predicting blood stream infections in extracorporeal membrane oxygenation.
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Lee, Daniel G, Sobieszczyk, Michal J, Barsoumian, Alice E, and Marcus, Joseph E
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RISK assessment ,CROSS infection ,EXTRACORPOREAL membrane oxygenation ,GRAM-positive bacterial infections ,ACADEMIC medical centers ,STAPHYLOCOCCAL diseases ,BACTEREMIA ,QUESTIONNAIRES ,ENTEROCOCCAL infections ,DESCRIPTIVE statistics ,RETROSPECTIVE studies ,MANN Whitney U Test ,HOSPITAL mortality ,SEPSIS ,ENTEROCOCCUS faecium ,CASE-control method ,STAPHYLOCOCCUS ,DATA analysis software ,GRAM-negative bacterial diseases ,DISEASE risk factors - Abstract
Introduction: Extracorporeal membrane oxygenation (ECMO) is an increasingly used modality of life support with high risk for nosocomial infections. The accuracy of sepsis prediction tools in identifying blood stream infections (BSI) in this population is unknown as measurement of multiple variables commonly associated with infection are altered by the circuit. Methods: This study compares all blood stream infections for patients receiving ECMO between January 2012 and December 2020 to timepoints when blood cultures were negative using the Sequential Organ Failure Assessment (SOFA), Logistic Organ Dysfunction Score (LODS), American Burn Association Sepsis Criteria (ABA), Systemic Inflammatory Response Syndrome (SIRS) scores. Results: Of the 220 patients who received ECMO during the study period, 40 (18%) had 51 blood stream infections and were included in this study. Gram-positive infections composed 57% (n = 29) of infections with E. faecalis (n = 12, 24%) being the most common organism isolated. There were no significant differences in sepsis prediction scores at the time of infection compared to infection-free time points for SOFA (median (IQR) 7 (5–9) vs. 6 (5–8), p = 0.22), LODS (median (IQR) 12 (10–14) vs. 12 (10–13), p = 0.28), ABA (median (IQR) 2 (1–3) vs. 2 (1–3) p = 0.75), or SIRS (median (IQR) 3 (2–3) vs. 3 (2–3), p = 0.20). Conclusions: Our data shows that previously published sepsis scores are elevated throughout a patient's ECMO course, and do not correlate with bacteremia. Better predictive tools are needed to determine the appropriate timing for blood cultures in this population. [ABSTRACT FROM AUTHOR]
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- 2024
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10. Impact of SARS-CoV-2 Arrival Surveillance Screening by Nucleic Acid Amplification Versus Rapid Antigen Detection on Subsequent COVID-19 Infections in Military Trainees.
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Cybulski, Daniel J, Matthews, Zachary, Kieffer, John W, Casey, Theresa M, Osuna, Angela B, Kasper, Korey, Frankel, Dianne N, Aden, James, Yun, Heather C, and Marcus, Joseph E
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PUBLIC health surveillance ,MILITARY education ,SARS-CoV-2 ,CONFIDENCE intervals ,COVID-19 ,COMMUNICABLE diseases ,MEDICAL screening ,RAPID diagnostic tests ,RETROSPECTIVE studies ,INTERNSHIP programs ,DESCRIPTIVE statistics ,COVID-19 testing ,NUCLEIC acid amplification techniques ,MILITARY personnel - Abstract
Background For persons entering congregate settings, optimal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) arrival surveillance screening method, nucleic acid amplification test (NAAT) versus rapid antigen detection test (RADT), is debated. To aid this, we sought to determine the risk of secondary symptomatic coronavirus disease 19 (COVID-19) among military trainees with negative arrival NAAT or RADT screening. Methods Individuals who arrived for US Air Force basic military training from 1 January–31 August 2021 were placed into training groups and screened for SARS-CoV-2 via NAAT or RADT. Secondary symptomatic COVID-19 cases within 2 weeks of training were then measured. A case cluster was defined as ≥5 individual symptomatic COVID-19 cases. Results 406 (1.6%) of 24 601 trainees screened positive upon arrival. The rate of positive screen was greater for those tested with NAAT versus RADT (2.5% vs 0.4%; RR: 5.4; 95% CI: 4.0–7.3; P <.001). The proportion of training groups with ≥1 positive individual screen was greater in groups screened via NAAT (57.5% vs 10.8%; RR: 5.31; 95% CI: 3.65–7.72; P <.001). However, NAAT versus RADT screening was not associated with a difference in number of training groups to develop a secondary symptomatic case (20.3% vs 22.5%; RR:.9; 95% CI:.66–1.23; P =.53) or case cluster of COVID-19 (4% vs 6.6%; RR:.61; 95% CI:.3–1.22; P =.16). Conclusions NAAT versus RADT arrival surveillance screening method impacted individual transmission of COVID-19 but had no effect on number of training groups developing a secondary symptomatic case or case cluster. This study provides consideration for RADT arrival screening in congregate settings. [ABSTRACT FROM AUTHOR]
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- 2024
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11. Infectious etiologies among post‐donation deferrals in a military blood donation center.
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Kwon, Somin, Casleton, Brian G., Rivera, Glorimar Z., Gella, Melita M., Winkler, Erin L., Kieffer, John W., Osuna, Angela B., Casey, Theresa M., Yun, Heather C., and Marcus, Joseph E.
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HTLV ,WEST Nile virus ,HIV ,HEPATITIS B ,HEPATITIS C - Abstract
Background: The burden of transfusion‐transmitted infections among blood recipients remains low due to extensive pre‐ and post‐donation screening. However, the military has the unique challenge of providing blood in austere environments with limited testing capabilities. This study evaluates the infectious etiologies of deferred blood donors at a large military blood donation center. Methods: All blood donors at the Armed Service Blood Bank Center, San Antonio, between 2017 and 2022 with positive post‐donation screening for hepatitis C (HCV), hepatitis B (HBV), human immunodeficiency virus (HIV), human T‐lymphotropic virus (HTLV‐I/II), Zika (2018–2021), West Nile virus, Trypanosoma cruzi, Treponema pallidum, or Babesia microti (2020–2022) were evaluated. Donors were deferred based on Food and Drug Administration (FDA) guidance. Results: Two‐hundred and thirteen (213) donors met FDA criteria for deferral. T. pallidum (n = 45, 50.3 per 100,000), HCV (n = 34, 38.0 per 100,000), and HBV (n = 19, 21.2 per 100,000) were the most common pathogens among those with both positive screening and confirmatory testing. The majority of HIV (95%), Chagas (78%), HTLV‐I/II (50%) deferrals were due to indeterminate confirmatory tests following initial positive screens. The majority of deferrals for HBV were for a second occurrence of a positive screen despite negative confirmatory testing. Conclusion: The rates of post‐donation deferral for transfusion‐transmissible infections were low in this military cohort. Our findings suggest that donor testing in deployed service members should focus on HBV, HCV, and T. pallidum and highlight the need for better diagnostics for HIV, Chagas, and HTLV‐I/II. [ABSTRACT FROM AUTHOR]
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- 2023
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12. Fever and Leukocytosis Are Poor Predictors of Bacterial Coinfection in Patients With COVID-19 and Influenza Who Are Receiving Extracorporeal Membrane Oxygenation.
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Jackson, Luke B, Sobieszczyk, Michal J, Aden, James K, and Marcus, Joseph E
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COVID-19 ,EXTRACORPOREAL membrane oxygenation ,LEUKOCYTE count ,LEUCOCYTOSIS ,INFLUENZA - Abstract
Background Fever and leukocytosis are 2 parameters commonly cited in clinical practice as indications to perform an infectious workup in patients receiving extracorporeal membrane oxygenation (ECMO), but their utility is unknown. Methods All patients who received ECMO between December 2014 and December 2020 with influenza or COVID-19 were included in this retrospective cohort study. Cultures were included if they were drawn from patients without signs of decompensation. Maximum temperature and white blood cell count were recorded on the day of culture collection. Workups with infections were compared with those that were negative. Results Of the 137 infectious workups in this 45-patient cohort, 86 (63%) were performed in patients with no signs of decompensation, totaling 165 cultures. These workups yielded 10 (12%) true infections. There were no differences in median (IQR) temperature (100.4 °F [100.2–100.8] vs 100.4 °F [99.3–100.9], P =.90) or white blood cell count (18.6 cells/mL [16.8–20.1] vs 16.7 cells/mL [12.8–22.3], P =.90) between those with and without infections. Conclusions In patients with influenza or COVID-19 who require ECMO, fever and leukocytosis were common indications for infectious workups, yet results were frequently negative. Despite their use in clinical practice, fever and leukocytosis are not reliable indicators of infection in patients who are hemodynamically stable and receiving ECMO. [ABSTRACT FROM AUTHOR]
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- 2023
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13. Are the new ISHLT definitions of infection during mechanical circulatory support appropriate for ECMO?
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Marcus, Joseph E. and MacLaren, Graeme
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ARTIFICIAL blood circulation , *DEFINITIONS , *INFECTION - Published
- 2024
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14. An RNA Interference (RNAi) Toolkit and Its Utility for Functional Genetic Analysis of Leishmania (Viannia).
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Lye, Lon-Fye, Owens, Katherine L., Jang, Soojin, Marcus, Joseph E., Brettmann, Erin A., and Beverley, Stephen M.
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LEISHMANIA ,FUNCTIONAL analysis ,RNA ,GENETIC testing ,CELL differentiation ,RECOMBINASES - Abstract
RNA interference (RNAi) is a powerful tool whose efficacy against a broad range of targets enables functional genetic tests individually or systematically. However, the RNAi pathway has been lost in evolution by a variety of eukaryotes including most Leishmania sp. RNAi was retained in species of the Leishmania subgenus Viannia, and here we describe the development, optimization, and application of RNAi tools to the study of L. (Viannia) braziliensis (Lbr). We developed vectors facilitating generation of long-hairpin or "stem-loop" (StL) RNAi knockdown constructs, using Gateway
TM site-specific recombinase technology. A survey of applications of RNAi in L. braziliensis included genes interspersed within multigene tandem arrays such as quinonoid dihydropteridine reductase (QDPR), a potential target or modulator of antifolate sensitivity. Other tests include genes involved in cell differentiation and amastigote proliferation (A600), and essential genes of the intraflagellar transport (IFT) pathway. We tested a range of stem lengths targeting the L. braziliensis hypoxanthine-guanine phosphoribosyl transferase (HGPRT) and reporter firefly luciferase (LUC) genes and found that the efficacy of RNAi increased with stem length, and fell off greatly below about 128 nt. We used the StL length dependency to establish a useful 'hypomorphic' approach not possible with other gene ablation strategies, with shorter IFT140 stems yielding viable cells with compromised flagellar morphology. We showed that co-selection for RNAi against adenine phosphoryl transferase (APRT1) using 4-aminopyrazolpyrimidine (APP) could increase the efficacy of RNAi against reporter constructs, a finding that may facilitate improvements in future work. Thus, for many genes, RNAi provides a useful tool for studying Leishmania gene function with some unique advantages. [ABSTRACT FROM AUTHOR]- Published
- 2023
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15. Outcomes of Fungemia in Patients Receiving Extracorporeal Membrane Oxygenation.
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Rosas, Melissa M, Sobieszczyk, Michal J, Warren, Whittney, Mason, Phillip, Walter, Robert J, and Marcus, Joseph E
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EXTRACORPOREAL membrane oxygenation ,MYCOSES ,TREATMENT effectiveness ,DISEASE relapse - Abstract
There are limited data on the treatment of fungal infections complicating extracorporeal membrane oxygenation (ECMO). In 14 patients who developed fungal bloodstream infections on ECMO, 8 (57%) survived to discharge. Of the 5 patients completing treatment prior to decannulation, 2 (40%) developed recurrent fungal infections. [ABSTRACT FROM AUTHOR]
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- 2022
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16. Infectious diseases and infection control prevention strategies in adult and pediatric population on ECMO.
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Vazquez-Colon, Zasha, Marcus, Joseph E., Levy, Emily, Shah, Aditya, MacLaren, Graeme, and Peek, Giles
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As survival after ECMO improves and use of ECMO support increases in both pediatric and adult population, there is a need to focus on both the morbidities and complications associated with ECMO and how to manage and prevent them. Infectious complications during ECMO often have a significant clinical impact, resulting in increased morbidity or mortality irrespective of the underlying etiology necessitating cardiorespiratory support. In this review article, we discuss the prevention, management, challenges, and differences of infectious complications in adult and pediatric patients receiving ECMO support. [ABSTRACT FROM AUTHOR]
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- 2024
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17. Effect of Arrival Quarantine on Subsequent COVID-19 Testing in a Cohort of Military Basic Trainees.
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Marcus, Joseph E, Frankel, Dianne N, Pawlak, Mary T, Casey, Theresa M, Enriquez, Erin, and Yun, Heather C
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COVID-19 testing , *INSTITUTIONAL review boards , *BASIC training (Military education) , *PUBLIC health surveillance , *QUARANTINE - Abstract
Introduction: Basic Military Training at Joint Base San Antonio-Lackland implemented several sequential non-pharmaceutical interventions in response to coronavirus disease-2019 (COVID-19). One measure, arrival quarantine, has not been studied as a modern military disease prevention strategy. This study aimed to determine the effect of a 14-day arrival quarantine on symptomatic COVID-19 testing.Material and Methods: A retrospective cohort study compared symptomatic COVID-19 testing among all trainees who entered Basic Military Training between March 17, 2020, and April 17, 2020, before the implementation of universal arrival COVID-19 testing, during their first 2 weeks in arrival quarantine compared to the rest of their training. Furthermore, symptomatic COVID-19 testing in the last 5 weeks of training in those who completed arrival quarantine was compared to testing in the last 5 weeks for trainees who arrived between February 16, 2020, and March 16, 2020, and did not undergo arrival quarantine. Nominal variables were compared by chi-square test, and continuous variables were compared by Mann-Whitney U test. This study was approved as a public health surveillance project by the 59th Medical Wing Institutional Review Board.Results: Five thousand five hundred and seventy-six trainees started training between February 16, 2020, and April 17, 2020, with 2,573 trainees undergoing an arrival quarantine compared to 3,003 trainees who did not. Trainees who underwent arrival quarantine had higher rates of COVID-19 testing while in arrival quarantine (10.5 tests per 1,000 trainee-weeks vs. 2.3, P ≤ .001) and higher rates of concomitant influenza testing (74% vs. 38%, P = .001) compared to after they completed quarantine. Trainees that completed quarantine had less symptomatic COVID-19 testing after day 14 of training (2.3 tests per 1,000 trainee-weeks vs. 14.3, P ≤ .001) and influenza testing (38% vs. 74%, P = .001) compared to trainees that did not undergo arrival quarantine.Conclusion: Arrival quarantine appears to be an effective non-pharmaceutical intervention associated with fewer symptomatic COVID-19 tests, especially after completion of quarantine. [ABSTRACT FROM AUTHOR]- Published
- 2021
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18. Response to a Serogroup B Meningococcal Disease Case Among Military Trainees.
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Marcus, Joseph E, Bennett, William N, Frankel, Dianne N, Kieffer, John W, Casey, Theresa M, Huston, Amanda E, Hintz, Courtney N, Keller, Alexander P, Smolka, Michael T, Sikorski, Cynthia S, Yun, Heather C, Dolan, Matthew J, and Kiley, John L
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MENINGOCOCCAL infections , *MENINGOCOCCAL vaccines , *NEISSERIA meningitidis , *PUBLIC health - Abstract
We describe the public health response to a military trainee who developed serogroup B meningococcal disease while sharing underwater breathing equipment. Despite high transmission risk, with rapid isolation and postexposure prophylaxis administration, there were no secondary cases. This case supports carefully weighing serogroup B meningococcal vaccination in high-risk settings. [ABSTRACT FROM AUTHOR]
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- 2022
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19. Infections in patients with burn injuries receiving extracorporeal membrane oxygenation.
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Marcus, Joseph E., Piper, Lydia C., Ainsworth, Craig R., Sams, Valerie G., Batchinsky, Andriy, Okulicz, Jason F., and Barsoumian, Alice E.
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EXTRACORPOREAL membrane oxygenation , *BURN patients , *SOFT tissue infections , *MYCOSES , *RESPIRATORY infections , *ADULT respiratory distress syndrome treatment , *COMMUNICABLE disease epidemiology , *BACTEREMIA , *BURN care units , *BURNS & scalds , *CANDIDIASIS , *COMMUNICABLE diseases , *CROSS infection , *DRUG resistance in microorganisms , *GRAM-negative bacterial diseases , *INTENSIVE care units , *MILITARY hospitals , *PNEUMONIA , *ADULT respiratory distress syndrome , *SKIN diseases , *TIME , *URINARY tract infections , *WOUND infections , *GRAM-positive bacterial infections , *RETROSPECTIVE studies , *STEVENS-Johnson Syndrome , *CANDIDEMIA , *DISEASE complications - Abstract
Introduction: Extracorporeal Membrane Oxygenation (ECMO) has only recently been described in patients with burn injuries. We report the incidence and type of infections in critically ill burn and non-burn patients receiving ECMO.Methods: A retrospective chart review was performed on all patients at Brooke Army Medical Center who received ECMO between September 2012 and May 2018.Results: 78 patients underwent ECMO. Approximately half were men with a median age of 34 years with a median time on ECMO of 237 h (IQR 121-391). Compared to patients without burns (n = 58), patients with burns (n = 20) had no difference in time on ECMO, but had more overall infections (86 vs. 31 per 1000 days, p = 0.0002), respiratory infections (40 vs. 15 per 1000 days, p = 0.01), skin and soft tissue infections (21 vs. 5 per 1000 days, p = 0.02) and fungal infections (35% vs 10%, p = 0.02). Twenty percent of bacterial burn infections were due to drug resistant organisms.Conclusion: This is the first study to describe the incidence of infection in burn injury patients who are undergoing ECMO. We observed an increase in infections in burn patients on ECMO compared to non-burn patients. ECMO remains a viable option for critically ill patients with burn injuries. [ABSTRACT FROM AUTHOR]- Published
- 2019
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20. Diagnostic Evaluation of Military Blood Donors Screening Positive for Trypanosoma cruzi Infection.
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Marcus, Joseph E., Webber, Bryant J., Cropper, Thomas L., Wilson, Matthew C., and Yun, Heather C.
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- 2018
21. Risk Factors Associated With COVID-19 Transmission Among US Air Force Trainees in a Congregant Setting.
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Marcus, Joseph E., Frankel, Dianne N., Pawlak, Mary T., Casey, Theresa M., Cybulski, Robert J., Enriquez, Erin, Okulicz, Jason F., and Yun, Heather C.
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- 2021
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22. Infections complicating extracorporeal membrane oxygenation in patients with traumatic injuries.
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Schweickhardt, Samantha K., Sams, Valerie G., Radowsky, Jason S., Sobieszczyk, Michal J., and Marcus, Joseph E.
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EXTRACORPOREAL membrane oxygenation , *MULTIDRUG resistance in bacteria , *TRAFFIC accidents , *WOUNDS & injuries , *URINARY organs - Abstract
Introduction: Extracorporeal Membrane Oxygenation (ECMO) has increasing utility in adult patients with traumatic injuries. There is currently limited data on the pathogens complicating a trauma patient's ECMO course, making empiric antibiotic decisions difficult. This study aims to characterize the types of infection among patients with traumatic injuries on ECMO.Methods: A chart review was performed on all trauma patients at Brooke Army Medical Center receiving ECMO between February 2013 and July 2021. Charts were reviewed to identify pathogens by culture site as well as time to infection following cannulation.Results: Twenty-one trauma patients underwent ECMO during the study period. The majority of patients were men (90%) with a median age of 30 [IQR 27-38], and a median ECMO course of 9.8 days [IQR 3.9-14.1]. Motor vehicle crashes (81%) accounted for the majority of mechanisms of injury. Of the 24 infections, the majority were respiratory (n = 13, 58/1000 ECMO days) followed by skin and soft tissue (n = 6, 26/1000 ECMO days), blood stream (n = 4, 18/1000 ECMO days), and urinary tract (n = 1, 5/1000 ECMO days). Gram-negative bacteria were the most commonly isolated organism from all sites and at all time periods following cannulation. Multi-drug resistant organisms accounted for 35% (n = 9) of infections and were independent of time from cannulation.Discussion/conclusion: This is the first study to describe infections in trauma patients requiring ECMO support. We observed majority Gram-negative infections regardless of culture site or time after cannulation. Thus, with infection in this population, empiric antibiotics should have broad spectrum coverage of Gram-negative organisms. [ABSTRACT FROM AUTHOR]- Published
- 2023
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23. Tracheostomy Placement in Patients with Acute Respiratory Distress Syndrome Requiring Extracorporeal Membrane Oxygenation: Did COVID-19 Change Our Practice?
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Adams, Alexandra M., Laverty, Robert B., McCarthy, Patrick M., Marcus, Joseph E., Boster, Joshua M., Sattler, Lauren A., Sobieszczyk, Michal J., Mason, Phillip E., and Sams, Valerie G.
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ADULT respiratory distress syndrome , *EXTRACORPOREAL membrane oxygenation , *COVID-19 , *TRACHEOTOMY - Published
- 2021
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24. Universal versus targeted coronavirus disease 2019 (COVID-19) arrival antigen testing on subsequent COVID-19 infections in military trainees.
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Westbrook MD, Aden J, Kieffer JW, Winkler EL, Osuna AB, Casey TM, Frankel DN, Kiley JL, Yun HC, and Marcus JE
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In this retrospective cohort study of military trainees, symptomatic-only coronavirus disease 2019 (COVID-19) arrival antigen testing decreased isolation requirements without increasing secondary cases compared to universal antigen testing. Symptomatic-only arrival antigen testing is a feasible alternative for individuals entering a congregant setting with a high risk of COVID-19 transmission., (© Cambridge University Press 2024.)
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- 2024
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25. Etiology of Leukemoid Reaction in Patients Undergoing Extracorporeal Membrane Oxygenation.
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Wells CB, Sobieszczyk MJ, and Marcus JE
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Introduction: Nosocomial infections are frequent in patients receiving extracorporeal membrane oxygenation (ECMO). Leukemoid reaction, defined as >50,000 white blood cells (WBCs) per microliter, has been associated with infections in some populations. As ECMO is associated with significant inflammation activation between the patient's immune system and the circuit components, it is hypothesized that leukemoid reactions may have low specificity for identifying new infections in patients receiving ECMO., Materials and Methods: A retrospective cohort study was performed on all adult patients admitted to the Brooke Army Medical Center who received ECMO for greater than 72 hours between 2018 and 2022. Maximum WBCs were obtained for all charts. For those with leukemoid reaction, demographic information and clinical management was obtained. This study was determined to be exempt by Brooke Army Medical Center Institutional Review Board., Results: Among 182 patients receiving ECMO for greater than 72 hours, 15 (8%) developed a leukemoid reaction while on ECMO. The median (Interquartile range, IQR) WBC was 53.94 (50.98 to 62.55). Fourteen (93%) patients underwent an infectious evaluation. Patients had a median of 2 (IQR: 2 to 3) etiologies contributing to their leukemoid reaction. At the time of leukemoid reaction, 11 (73%) patients were receiving treatment for a known infection, 6 (40%) were found to have a new thrombus, and 4 (27%) were receiving glucocorticoids. Only 1 (7%) patient was found to have a new infection, an Acinetobacter baumannii bacteremia., Conclusions: Leukemoid reactions occur infrequently in patients receiving ECMO and are generally multifactorial. In this cohort, leukemoid reactions rarely occurred in the setting of a new infection and suggest low utility to starting or broadening antimicrobials for these patients. Future studies identifying useful infectious markers are needed for patients receiving ECMO., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2024. This work is written by (a) US Government employee(s) and is in the public domain in the US.)
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- 2024
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26. The Impact of Infectious Diseases Scholarly Mentorship on Subsequent Infectious Disease Fellowship Application.
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Marcus JE, Yun HC, and Barsoumian AE
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Introduction: Infectious diseases physicians invest significant time mentoring medical students and internal medicine residents through research projects as well as case reports. While having an infectious diseases mentor has been shown to be associated with subsequent infectious diseases fellowship application, the impact of specific scholarly activities on future application to infectious diseases fellowship is unknown., Methods: All research and case reports published or presented from Brooke Army Medical Center between 2014-2022 with an infectious diseases senior author and a medical student or internal medicine resident first author were evaluated. The presentations and publications that resulted from each project as well as whether the trainee applied to infectious diseases were recorded., Results: During the study period, 16 faculty mentored 35 medical student and resident research projects and 26 case reports. Research and case reports were primarily performed by residents (88% and 96% respectively). Compared to case reports, research projects were more likely to be presented at national meetings (77% vs 32%, p=0.0009). Of the 55 projects performed by trainees who completed training, research was associated with greater rates of infectious disease fellowship application as compared to case reports (41% vs. 4%, p=0.0012)., Conclusion: Internal medicine resident and medical student involvement in research mentored by an infectious disease physician was associated with a greater infectious diseases fellowship application rate as compared to those who were mentored for case reports. Investment in trainee research may be a strategy for recruiting the next generation of infectious diseases physicians., (Published by Oxford University Press on behalf of Infectious Diseases Society of America 2024.)
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- 2024
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27. The utility of procalcitonin for identifying secondary infections in patients with influenza or COVID-19 receiving extracorporeal membrane oxygenation.
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Patel KD, Aden JK, Sobieszczyk MJ, and Marcus JE
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Background: Identifying secondary infections in patients receiving extracorporeal membrane oxygenation (ECMO) presents challenges due to the ECMO circuit's influence on traditional signs of infection., Objectives: This study evaluates procalcitonin as a diagnostic marker for secondary infections in patients receiving ECMO with influenza or COVID-19 infection., Design: Single-center retrospective cohort study., Methods: All adult patients receiving veno-venous ECMO with underlying influenza or COVID-19 from November 2017 to October 2021 were included. Patient demographics, time receiving ECMO, culture data, and procalcitonin levels were examined. The first procalcitonin within 3 days of infection was compared to negative workups that were collected at least 10 days from the last positive culture. Furthermore, we compared procalcitonin levels by the type of pathogen and site of infection., Results: In this study, 84 patients with influenza or COVID-19 who received ECMO were included. A total of 276 procalcitonin labs were ordered in this cohort, with 33/92 (36%) of the secondary infections having an associated procalcitonin value. When comparing procalcitonin levels, there was no significant difference between the infection and negative workup groups [1 ng/mL (interquartile ranges, IQR: 0.4-1.2) versus 1.3 (0.5-4.3), p = 0.19]. Using 0.5 ng/mL as the cut-off, the sensitivity of procalcitonin was 67% and the specificity was 30%. In our cohort, the positive predictive value of procalcitonin was 14.5% and the negative predictive value was 84%. There was no difference in procalcitonin by type of organism or site of infection. Procalcitonin levels did not routinely decline even after an infection was identified., Conclusion: While procalcitonin is a proposed potential diagnostic marker for secondary infections in patients receiving ECMO, this single-center study demonstrated low sensitivity and specificity of procalcitonin in identifying secondary infections. Furthermore, there was no association of procalcitonin levels with etiology of infection when one was present. Procalcitonin should be used cautiously in identifying infections in veno-venous ECMO., (© The Author(s), 2024.)
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- 2024
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28. Sensitivity of Symptom-Based Screening for COVID-19 in Active Duty Basic Trainees.
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Matthews ZK, Cybulski DJ, Frankel DN, Kieffer JW, Casey TM, Osuna AB, Yun HC, and Marcus JE
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- Humans, Male, Female, Adult, Sensitivity and Specificity, Dyspnea diagnosis, Dyspnea etiology, Headache etiology, Headache diagnosis, Headache epidemiology, Cough diagnosis, Cough etiology, Pandemics, COVID-19 diagnosis, COVID-19 epidemiology, Military Personnel statistics & numerical data, Mass Screening methods, Mass Screening statistics & numerical data, SARS-CoV-2
- Abstract
Introduction: Symptomatic Coronavirus Disease 2019 (COVID-19) screening has been a cornerstone of case identification during the pandemic. Despite the myriad of COVID-19 symptoms, symptom screens have primarily focused on symptoms of influenza-like illnesses such as fever, cough, and dyspnea. It is unknown how well these symptoms identify cases in a young, healthy military population. This study aims to evaluate the utility of symptom-based screening in identifying COVID-19 through three different COVID-19 waves., Materials and Methods: A convenience sample of 600 military trainees who arrived at Joint Base San Antonio-Lackland in 2021 and 2022 were included. Two hundred trainees with symptomatic COVID-19 before the emergence of the Delta variant (February-April 2021), when Delta variant was predominant (June-August 2021), and when Omicron was the predominant variant (January 2022) had their presenting symptoms compared. At each time point, the sensitivity of a screen for influenza-like illness symptoms was calculated., Results: Of the 600 symptomatic active duty service members who tested positive for COVID-19, the most common symptoms were sore throat (n = 385, 64%), headache (n = 334, 56%), and cough (n = 314, 52%). Although sore throat was the most prominent symptom during Delta (n = 140, 70%) and Omicron (n = 153, 77%), headache was the most common before Delta (n = 93, 47%). There were significant differences in symptoms by vaccination status; for example, ageusia was more common in patients who were not completely vaccinated (3% vs. 0%, P = .01). Overall, screening for fever, cough, or dyspnea had a 65% sensitivity with its lowest sensitivity in the pre-Delta cases (54%) and highest sensitivity in Omicron cases (78%)., Conclusions: In this descriptive cross-sectional study evaluating symptomatic military members with COVID-19, symptom prevalence varied based on predominant circulating COVID-19 variant as well as patients' vaccination status. As screening strategies evolve with the pandemic, changing symptom prevalence should be considered., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2023. This work is written by (a) US Government employee(s) and is in the public domain in the US.)
- Published
- 2024
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29. An RNA Interference (RNAi) Toolkit and Its Utility for Functional Genetic Analysis of Leishmania ( Viannia ).
- Author
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Lye LF, Owens KL, Jang S, Marcus JE, Brettmann EA, and Beverley SM
- Subjects
- RNA Interference, Phenotype, Leishmania genetics, Leishmania braziliensis genetics
- Abstract
RNA interference (RNAi) is a powerful tool whose efficacy against a broad range of targets enables functional genetic tests individually or systematically. However, the RNAi pathway has been lost in evolution by a variety of eukaryotes including most Leishmania sp. RNAi was retained in species of the Leishmania subgenus Viannia , and here we describe the development, optimization, and application of RNAi tools to the study of L . ( Viannia ) braziliensis ( Lbr ). We developed vectors facilitating generation of long-hairpin or "stem-loop" (StL) RNAi knockdown constructs, using Gateway
TM site-specific recombinase technology. A survey of applications of RNAi in L. braziliensis included genes interspersed within multigene tandem arrays such as quinonoid dihydropteridine reductase ( QDPR ), a potential target or modulator of antifolate sensitivity. Other tests include genes involved in cell differentiation and amastigote proliferation ( A600 ), and essential genes of the intraflagellar transport (IFT) pathway. We tested a range of stem lengths targeting the L. braziliensis hypoxanthine-guanine phosphoribosyl transferase (HGPRT) and reporter firefly luciferase (LUC) genes and found that the efficacy of RNAi increased with stem length, and fell off greatly below about 128 nt. We used the StL length dependency to establish a useful 'hypomorphic' approach not possible with other gene ablation strategies, with shorter IFT140 stems yielding viable cells with compromised flagellar morphology. We showed that co-selection for RNAi against adenine phosphoryl transferase ( APRT1 ) using 4-aminopyrazolpyrimidine (APP) could increase the efficacy of RNAi against reporter constructs, a finding that may facilitate improvements in future work. Thus, for many genes, RNAi provides a useful tool for studying Leishmania gene function with some unique advantages.- Published
- 2022
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30. Rates of nosocomial infection associated with interhospital transfer of patients receiving extracorporeal membrane oxygenation.
- Author
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Marcus JE, Sams VG, Aden JK, Batchinsky A, Sobieszczyk MJ, Okulicz JF, and Barsoumian AE
- Subjects
- Adult, Humans, Incidence, Retrospective Studies, Risk Factors, Cross Infection epidemiology, Cross Infection etiology, Extracorporeal Membrane Oxygenation adverse effects
- Abstract
Objectives: Critically ill patients requiring extracorporeal membrane oxygenation (ECMO) frequently require interhospital transfer to a center that has ECMO capabilities. Patients receiving ECMO were evaluated to determine whether interhospital transfer was a risk factor for subsequent development of a nosocomial infection., Design: Retrospective cohort study., Setting: A 425-bed academic tertiary-care hospital., Patients: All adult patients who received ECMO for >48 hours between May 2012 and May 2020., Methods: The rate of nosocomial infections for patients receiving ECMO was compared between patients who were cannulated at the ECMO center and patients who were cannulated at a hospital without ECMO capabilities and transported to the ECMO center for further care. Additionally, time to infection, organisms responsible for infection, and site of infection were compared., Results: In total, 123 patients were included in analysis. For the primary outcome of nosocomial infection, there was no difference in number of infections per 1,000 ECMO days (25.4 vs 29.4; P = .03) by univariate analysis. By Cox proportional hazard analysis, transport was not significantly associated with increased infections (hazard ratio, 1.7; 95% confidence interval, 0.8-4.2; P = .20)., Conclusion: In this study, we did not identify an increased risk of nosocomial infection during subsequent hospitalization. Further studies are needed to identify sources of nosocomial infection in this high-risk population.
- Published
- 2022
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31. Elevated secondary infection rates in patients with coronavirus disease 2019 (COVID-19) requiring extracorporeal membrane oxygenation.
- Author
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Marcus JE, Sams VG, and Barsoumian AE
- Subjects
- Adult, COVID-19 complications, Cross Infection epidemiology, Female, Humans, Immunosuppressive Agents adverse effects, Immunosuppressive Agents therapeutic use, Influenza, Human complications, Influenza, Human therapy, Male, Middle Aged, Retrospective Studies, Texas epidemiology, COVID-19 therapy, Cross Infection etiology, Extracorporeal Membrane Oxygenation adverse effects
- Published
- 2021
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32. COVID-19 Monitoring and Response Among U.S. Air Force Basic Military Trainees - Texas, March-April 2020.
- Author
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Marcus JE, Frankel DN, Pawlak MT, Casey TM, Blackwell RS, Tran FV, Dolan MJ, and Yun HC
- Subjects
- COVID-19, COVID-19 Testing, Clinical Laboratory Techniques methods, Coronavirus Infections diagnosis, Coronavirus Infections transmission, Humans, Male, Patient Isolation, Pneumonia, Viral transmission, Texas epidemiology, Coronavirus Infections epidemiology, Coronavirus Infections prevention & control, Military Personnel education, Pandemics prevention & control, Pneumonia, Viral epidemiology, Pneumonia, Viral prevention & control
- Abstract
The coronavirus disease 2019 (COVID-19) pandemic has resulted in substantial morbidity and mortality since it was first described in December 2019 (1). Based on epidemiologic data showing spread in congregate settings (2-4), national, state, and local governments instituted significant restrictions on large gatherings to prevent transmission of disease in early March 2020. This and other nonpharmaceutical interventions (NPIs) have shown initial success in slowing the pandemic across the country (5). This report examines the first 7 weeks (March 1-April 18) of implementation of NPIs in Basic Military Training (BMT) at a U.S. Air Force base. In a population of 10,579 trainees, COVID-19 incidence was limited to five cases (47 per 100,000 persons), three of which were in persons who were contacts of the first patient. Transmission of symptomatic COVID-19 was successfully limited using strategies of quarantine, social distancing, early screening of trainees, rapid isolation of persons with suspected cases, and monitored reentry into training for trainees with positive test results after resolution of symptoms., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.
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- 2020
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33. Retrotransposons Are the Major Contributors to the Expansion of the Drosophila ananassae Muller F Element.
- Author
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Leung W, Shaffer CD, Chen EJ, Quisenberry TJ, Ko K, Braverman JM, Giarla TC, Mortimer NT, Reed LK, Smith ST, Robic S, McCartha SR, Perry DR, Prescod LM, Sheppard ZA, Saville KJ, McClish A, Morlock EA, Sochor VR, Stanton B, Veysey-White IC, Revie D, Jimenez LA, Palomino JJ, Patao MD, Patao SM, Himelblau ET, Campbell JD, Hertz AL, McEvilly MF, Wagner AR, Youngblom J, Bedi B, Bettincourt J, Duso E, Her M, Hilton W, House S, Karimi M, Kumimoto K, Lee R, Lopez D, Odisho G, Prasad R, Robbins HL, Sandhu T, Selfridge T, Tsukashima K, Yosif H, Kokan NP, Britt L, Zoellner A, Spana EP, Chlebina BT, Chong I, Friedman H, Mammo DA, Ng CL, Nikam VS, Schwartz NU, Xu TQ, Burg MG, Batten SM, Corbeill LM, Enoch E, Ensign JJ, Franks ME, Haiker B, Ingles JA, Kirkland LD, Lorenz-Guertin JM, Matthews J, Mittig CM, Monsma N, Olson KJ, Perez-Aragon G, Ramic A, Ramirez JR, Scheiber C, Schneider PA, Schultz DE, Simon M, Spencer E, Wernette AC, Wykle ME, Zavala-Arellano E, McDonald MJ, Ostby K, Wendland P, DiAngelo JR, Ceasrine AM, Cox AH, Docherty JEB, Gingras RM, Grieb SM, Pavia MJ, Personius CL, Polak GL, Beach DL, Cerritos HL, Horansky EA, Sharif KA, Moran R, Parrish S, Bickford K, Bland J, Broussard J, Campbell K, Deibel KE, Forka R, Lemke MC, Nelson MB, O'Keeffe C, Ramey SM, Schmidt L, Villegas P, Jones CJ, Christ SL, Mamari S, Rinaldi AS, Stity G, Hark AT, Scheuerman M, Silver Key SC, McRae BD, Haberman AS, Asinof S, Carrington H, Drumm K, Embry T, McGuire R, Miller-Foreman D, Rosen S, Safa N, Schultz D, Segal M, Shevin Y, Svoronos P, Vuong T, Skuse G, Paetkau DW, Bridgman RK, Brown CM, Carroll AR, Gifford FM, Gillespie JB, Herman SE, Holtcamp KL, Host MA, Hussey G, Kramer DM, Lawrence JQ, Martin MM, Niemiec EN, O'Reilly AP, Pahl OA, Quintana G, Rettie EAS, Richardson TL, Rodriguez AE, Rodriguez MO, Schiraldi L, Smith JJ, Sugrue KF, Suriano LJ, Takach KE, Vasquez AM, Velez X, Villafuerte EJ, Vives LT, Zellmer VR, Hauke J, Hauser CR, Barker K, Cannon L, Parsamian P, Parsons S, Wichman Z, Bazinet CW, Johnson DE, Bangura A, Black JA, Chevee V, Einsteen SA, Hilton SK, Kollmer M, Nadendla R, Stamm J, Fafara-Thompson AE, Gygi AM, Ogawa EE, Van Camp M, Kocsisova Z, Leatherman JL, Modahl CM, Rubin MR, Apiz-Saab SS, Arias-Mejias SM, Carrion-Ortiz CF, Claudio-Vazquez PN, Espada-Green DM, Feliciano-Camacho M, Gonzalez-Bonilla KM, Taboas-Arroyo M, Vargas-Franco D, Montañez-Gonzalez R, Perez-Otero J, Rivera-Burgos M, Rivera-Rosario FJ, Eisler HL, Alexander J, Begley SK, Gabbard D, Allen RJ, Aung WY, Barshop WD, Boozalis A, Chu VP, Davis JS, Duggal RN, Franklin R, Gavinski K, Gebreyesus H, Gong HZ, Greenstein RA, Guo AD, Hanson C, Homa KE, Hsu SC, Huang Y, Huo L, Jacobs S, Jia S, Jung KL, Wai-Chee Kong S, Kroll MR, Lee BM, Lee PF, Levine KM, Li AS, Liu C, Liu MM, Lousararian AP, Lowery PB, Mallya AP, Marcus JE, Ng PC, Nguyen HP, Patel R, Precht H, Rastogi S, Sarezky JM, Schefkind A, Schultz MB, Shen D, Skorupa T, Spies NC, Stancu G, Vivian Tsang HM, Turski AL, Venkat R, Waldman LE, Wang K, Wang T, Wei JW, Wu DY, Xiong DD, Yu J, Zhou K, McNeil GP, Fernandez RW, Menzies PG, Gu T, Buhler J, Mardis ER, and Elgin SCR
- Subjects
- Animals, Base Composition genetics, Base Sequence, Codon genetics, Female, Gene Expression Profiling, Genes, Insect, Histones metabolism, Protein Processing, Post-Translational genetics, Wolbachia genetics, Chromosomes genetics, Drosophila genetics, Retroelements genetics
- Abstract
The discordance between genome size and the complexity of eukaryotes can partly be attributed to differences in repeat density. The Muller F element (∼5.2 Mb) is the smallest chromosome in Drosophila melanogaster , but it is substantially larger (>18.7 Mb) in D. ananassae To identify the major contributors to the expansion of the F element and to assess their impact, we improved the genome sequence and annotated the genes in a 1.4-Mb region of the D. ananassae F element, and a 1.7-Mb region from the D element for comparison. We find that transposons (particularly LTR and LINE retrotransposons) are major contributors to this expansion (78.6%), while Wolbachia sequences integrated into the D. ananassae genome are minor contributors (0.02%). Both D. melanogaster and D. ananassae F-element genes exhibit distinct characteristics compared to D-element genes ( e.g. , larger coding spans, larger introns, more coding exons, and lower codon bias), but these differences are exaggerated in D. ananassae Compared to D. melanogaster , the codon bias observed in D. ananassae F-element genes can primarily be attributed to mutational biases instead of selection. The 5' ends of F-element genes in both species are enriched in dimethylation of lysine 4 on histone 3 (H3K4me2), while the coding spans are enriched in H3K9me2. Despite differences in repeat density and gene characteristics, D. ananassae F-element genes show a similar range of expression levels compared to genes in euchromatic domains. This study improves our understanding of how transposons can affect genome size and how genes can function within highly repetitive domains., (Copyright © 2017 Leung et al.)
- Published
- 2017
- Full Text
- View/download PDF
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