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Background Norovirus and serotypes (40/41) of adenoviruses are the leading cause of viral acute gastroenteritis in adults. The lack of therapeutic options can be devastating especially in the immunocompromised population. Nitazoxanide (NTZ), first designed as an antifolate anti-parasitic agent, is also known to have a broad-spectrum antiviral activity. Efficacy of NTZ in decreasing duration of symptomatic diarrhea in adults was first reported in a placebo controlled trial in 2006. Subsequent reports showed some promise as a possible therapeutic agent for viral gastroenteritis in the immunocompromised hosts. Methods Utilizing the inpatient pharmacy database we identified patients, who received NTZ for documented viral gastroenteritis, from January 1, 2008 to April 15, 2019. Chart review of cases was done to determine demographics, comorbidities, length of stay (LOS) in hospital, LOS in intensive care unit (ICU), duration of therapy, improvement in symptoms, and mortality. Results We identified 48 unique adult patients who were administered NTZ in the period under review. Of these 10 were prescribed NTZ specifically for viral gastroenteritis. 40% of the patients were females. The median age was 59 years (Interquartile Range [IR]: 47.75–69.25). Median LOS in hospital was 9.5 days (IR: 6.75–41.75). None of the patients required admission to the ICU. 4/10 patients had an active concomitant malignancy, of these 3 were receiving ongoing chemotherapy. 9/10 patients were recipients of stem cell (2) or solid-organ transplants (7). 7/10 patients were also on some form of immunosuppressive medications. Most common virus isolated was Norovirus (7/10). All patients received a standard dose of 500mg twice daily NTZ. The median duration of therapy was 7 days (range: 3–21). 6/10 patients had documented improvement in diarrhea at the end of treatment. 1/10 patients died within 30 days of diagnosis from causes unrelated to diarrheal illness (Table 1). Conclusion Our limited data set presents interesting insights into treatment of viral gastroenteritis in immunocompromised hosts, in particular transplant recipients. All of the cases identified were treated in second half of study period after January 1, 2015, signaling an increasing interest in this therapy, especially in cases with prolonged symptoms or viral shedding. Our observations indicate a need for larger studies into this application of NTZ in adult immunocompromised hosts. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background Mycobacterium marinum is a slow-growing, non-tuberculous mycobacterium responsible for skin and soft-tissue infections (SSTIs), tenosynovitis, and osteomyelitis (OM). We conducted a retrospective study describing the risk, clinical course, and outcome of M. marinum infection. Methods Adult patients with culture-confirmed M. marinum infections were identified from the mycology laboratory at Mayo Clinic, Rochester from January 1998 to December 2018. M. marinum infection was defined as uncomplicated (limited to SST) and complicated (tenosynovitis, OM, or disseminated). Results Forty-six cases of culture-confirmed infection with M. marinum were included (Table 1). Only 16 cases (35%) reported a water exposure and 22 (48%) involved finger and/or hand trauma. The median time to diagnosis was 3.6 months. Most patients (76%) presented with uncomplicated M. marinum infection with skin lesions mainly localized in the upper limb (Table 2). QuantiFERON and PPD were positive in 4 (8%) and 2 (4%) cases, respectively. Granulomatous inflammation and positive special stains were noted in 34 (74%) and 11 (24%) cases, respectively. Cases with complicated M. marinum infection had a longer duration of symptoms and length of treatment (P < 0.05) (Table 3). Prior to diagnosis, 63% of patients received at least one antibiotic for bacterial SSTIs. More than 50% of the patients diagnosed with M. marinum received a one drug regimen and 8% did not initiate therapy. Median treatment duration was 4.4 months. Twenty-six cases (56%) had susceptibilities performed and treatment modifications were made in 10 cases (38%). From the patients that started therapy, 73% completed therapy and 33% were lost to follow up. Cured was achieved in 87% of cases that completed therapy, 2 cases (6%) had a recurrence, and only one patient with active malignancy had a positive blood culture and died. Twelve (44%) and 10 cases (37%) were cured with one and two-drug regimens, respectively. Conclusion Most patients with M. marinum infection present as an uncomplicated infection in the upper limb. Classical exposure was only suspected in a third of the cases. Patients with complicated M. marinum infection had a prolonged duration of symptoms and lengthy treatment. Most patients were successfully treated with a one and two-drug regimen. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background Q fever is a zoonotic disease caused by Coxiella burnetii. Primary infection can progress to persistent infection irrespective of initial symptomatology. Our aim is to describe the clinical features, treatment, risk of progression, use of prophylaxis, and outcomes of Coxiella burnetii infection at our institution. Methods We did a retrospective review of all adult patients with positive Coxiella burnetii serology at Mayo Clinic, Rochester from 1st January 2012 to 31st December 2018. Centers for Disease Control and Prevention (CDC) case definition and classification were used to group the patients into confirmed and probable acute Q fever, and confirmed and probable chronic/persistent Q fever. Data on demographics, clinical presentation, comorbid conditions, exposure history, risk factors associated with progression, serology, treatment and outcomes were collected. Results We found 266 patients with positive titres of Coxiella IgG or IgM greater than 1:16, of which 49 patients met the CDC case definition for Q fever. Median age at presentation was 62 years. 45/49 (91. 8%) were men, while 4/49 (8%) were women. 20/49 (40. 8%) patients presented with acute Q fever of which 5 (25%) patients progressed to persistent infection. 29/49 (59%) patients presented with persistent Q fever of which 4 patients could recall symptoms suggestive of acute Q fever. The most common presentation of acute Q fever was acute febrile illness (65%). Endocarditis (11/29) was the most common presentation of chronic/persistent Q fever. Of the 5 patients with acute Q fever that progressed to persistent infection, 3/5(60%) progressed despite being on doxycycline and hydroxychloroquine. 8/29 patients with persistent Q fever had serological resolution at last follow-up. 2/4(50%) deaths were attributable to Q fever. Conclusion Minority of the patients tested met the case definition. 25% of patients with acute disease progressed to chronic Q fever out of which 60%(3/5) progressed despite prophylaxis. Endocarditis and vascular infections were the most common chronic cases. Interestingly we found 4 cases of MPGN in association with Q fever. Prosthetic valves are the most important risk factors for progression (P = 0.02). Serological cure often lags behind clinical cure (27% vs. 68% in persistent infection)(Table 4). Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]