110 results on '"Lyon GM"'
Search Results
2. Cytomegalovirus immunity in high-risk liver transplant recipients following preemptive antiviral therapy versus prophylaxis.
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Zamora D, Dasgupta S, Stevens-Ayers T, Edmison B, Winston DJ, Razonable RR, Mehta AK, Lyon GM, Boeckh M, Singh N, Koelle DM, and Limaye AP
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- Humans, Male, Middle Aged, Female, Adult, Transplant Recipients, Aged, Antibodies, Neutralizing immunology, Antibodies, Neutralizing blood, Antibodies, Viral immunology, Antibodies, Viral blood, Viremia immunology, Liver Transplantation, Cytomegalovirus Infections immunology, Cytomegalovirus Infections prevention & control, Antiviral Agents therapeutic use, Cytomegalovirus immunology, Killer Cells, Natural immunology
- Abstract
CMV-specific T cells, NK cells, and neutralizing antibodies (nAbs) were assessed in a randomized trial of CMV prevention with preemptive antiviral therapy (PET) versus prophylactic antiviral therapy (PRO) in donor-seropositive/recipient-seronegative (D+R-) liver transplant recipients (LTxR) at 100 days (end of intervention) and at 6 and 12 months after transplant. The PET group had significantly increased numbers of circulating polyfunctional T cells, NK cells, and nAbs compared with the PRO group at day 100, and several CMV immune parameters remained significantly higher by 12 months after transplant. Among PET recipients, preceding CMV viremia (vs. no preceding viremia) was associated with significantly higher levels of most CMV immune parameters at day 100. Higher numbers of CMV-specific polyfunctional T cells and NKG2C+ NK cells at day 100 were associated with a decreased incidence of CMV disease in multivariable Cox regression. The strongest associations with protection against CMV disease were with increased numbers of CMV-specific polyfunctional CD4+ T cells, CD3negCD56dimCD57negNKG2Cpos cells, and CD3negCD56dimCD57posNKG2Cpos NK cells. Our results suggest that PET is superior to PRO for CMV disease prevention by allowing low-level CMV replication and associated antigen exposure that is promptly controlled by antiviral therapy and facilitates enhanced CMV protective immunity in D+R- LTxR.
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- 2024
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3. Cladophialophora bantiana orbital cellulitis after penetrating injury.
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Ghanouni A, Avila SA, de la Garza AG, Sharfi D, Singiser H, Stampfer SD, Lyon GM 3rd, and Babiker A
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- Humans, Male, Aged, Tomography, X-Ray Computed, Ascomycota isolation & purification, Ophthalmologic Surgical Procedures, Orbital Cellulitis microbiology, Orbital Cellulitis etiology, Orbital Cellulitis drug therapy, Orbital Cellulitis surgery, Orbital Cellulitis diagnosis, Eye Injuries, Penetrating surgery, Eye Injuries, Penetrating microbiology, Antifungal Agents therapeutic use, Eye Infections, Fungal microbiology, Eye Infections, Fungal drug therapy, Eye Infections, Fungal diagnosis, Eye Foreign Bodies surgery, Eye Foreign Bodies microbiology, Voriconazole therapeutic use
- Abstract
A 75-year-old immunocompetent male presented with a right orbital cellulitis after a foreign body penetrating injury. He was taken for orbitotomy with foreign body removal and started on broad-spectrum antibiotics. Intra-operative cultures were positive for Cladophialophora bantiana , a mold known for causing brain abscesses with no prior reports of orbital invasion in the literature. Following culture results, the patient was managed with voriconazole and required multiple orbitotomies and washouts for infection control.
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- 2024
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4. Anti-Granulocyte-Macrophage Colony-Stimulating Factor Monoclonal Antibody Gimsilumab for COVID-19 Pneumonia: A Randomized, Double-Blind, Placebo-controlled Trial.
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Criner GJ, Lang FM, Gottlieb RL, Mathews KS, Wang TS, Rice TW, Madduri D, Bellam S, Jeanfreau R, Case AH, Glassberg MK, Lyon GM, Ahmad K, Mendelson R, DiMaio JM, Tran MP, Spak CW, Abbasi JA, Davis SG, Ghamande S, Shen S, Sherman L, and Lowry S
- Subjects
- Antibodies, Monoclonal, Humanized therapeutic use, Double-Blind Method, Humans, Inflammation, COVID-19 Drug Treatment
- Abstract
Rationale: GM-CSF (granulocyte-macrophage colony-stimulating factor) has emerged as a promising target against the hyperactive host immune response associated with coronavirus disease (COVID-19). Objectives: We sought to investigate the efficacy and safety of gimsilumab, an anti-GM-CSF monoclonal antibody, for the treatment of hospitalized patients with elevated inflammatory markers and hypoxemia secondary to COVID-19. Methods: We conducted a 24-week randomized, double-blind, placebo-controlled trial, BREATHE (Better Respiratory Education and Treatment Help Empower), at 21 locations in the United States. Patients were randomized 1:1 to receive two doses of intravenous gimsilumab or placebo 1 week apart. The primary endpoint was all-cause mortality rate at Day 43. Key secondary outcomes were ventilator-free survival rate, ventilator-free days, and time to hospital discharge. Enrollment was halted early for futility based on an interim analysis. Measurements and Main Results: Of the planned 270 patients, 225 were randomized and dosed; 44.9% of patients were Hispanic or Latino. The gimsilumab and placebo groups experienced an all-cause mortality rate at Day 43 of 28.3% and 23.2%, respectively (adjusted difference = 5% vs. placebo; 95% confidence interval [-6 to 17]; P = 0.377). Overall mortality rates at 24 weeks were similar across the treatment arms. The key secondary endpoints demonstrated no significant differences between groups. Despite the high background use of corticosteroids and anticoagulants, adverse events were generally balanced between treatment groups. Conclusions: Gimsilumab did not improve mortality or other key clinical outcomes in patients with COVID-19 pneumonia and evidence of systemic inflammation. The utility of anti-GM-CSF therapy for COVID-19 remains unclear. Clinical trial registered with www.clinicaltrials.gov (NCT04351243).
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- 2022
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5. Cost-effectiveness of Preemptive Therapy Versus Prophylaxis in a Randomized Clinical Trial for the Prevention of Cytomegalovirus Disease in Seronegative Liver Transplant Recipients With Seropositive Donors.
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Singh N, Winston DJ, Razonable RR, Lyon GM, Silveira FP, Wagener MM, and Limaye AP
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- Antiviral Agents therapeutic use, Cost-Benefit Analysis, Cytomegalovirus, Ganciclovir therapeutic use, Humans, Transplant Recipients, Cytomegalovirus Infections drug therapy, Cytomegalovirus Infections prevention & control, Liver Transplantation
- Abstract
Background: The relative costs of preemptive therapy (PET) or prophylaxis for the prevention of cytomegalovirus (CMV) disease in high-risk donor CMV-seropositive/recipient-seronegative (D+/R-) liver transplant recipients have not been assessed in the context of a randomized trial., Methods: A decision tree model was constructed based on the probability of outcomes in a randomized controlled trial that compared valganciclovir as PET or prophylaxis for 100 days in 205 D+/R- liver transplant recipients. Itemized costs for each site were obtained from a federal cost transparency database. Total costs included costs of implementation of the strategy and CMV disease treatment-related costs. Net cost per patient was estimated from the decision tree for each strategy., Results: PET was associated with a 10% lower absolute rate of CMV disease (9% vs 19%). The cost of treating a case of CMV disease in our patients was $88 190. Considering cost of implementation of strategy and treatment-related cost for CMV disease, the net cost-savings per patient associated with PET was $8707 compared to prophylaxis. PET remained cost-effective across a range of assumptions (varying costs of monitoring and treatment, and rates of disease)., Conclusions: PET is the dominant CMV prevention strategy in that it was associated with lower rates of CMV disease and lower overall costs compared to prophylaxis in D+/R- liver transplant recipients. Costs were driven primarily by more hospitalizations and higher CMV disease-associated costs due to delayed onset postprophylaxis disease in the prophylaxis group., (© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)
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- 2021
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6. Association of HHV-6 With Outcomes in CMV-seronegative Liver Transplant Recipients With CMV-seropositive Donors Receiving Preemptive Antiviral Therapy.
- Author
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Singh N, Winston DJ, Razonable RR, Lyon GM, Huang ML, Jerome KR, Silveira FP, Wagener MM, and Limaye AP
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- Antiviral Agents therapeutic use, Cytomegalovirus genetics, Ganciclovir therapeutic use, Humans, Transplant Recipients, Cytomegalovirus Infections diagnosis, Cytomegalovirus Infections drug therapy, Cytomegalovirus Infections prevention & control, Herpesvirus 6, Human genetics, Liver Transplantation adverse effects
- Abstract
Background: Risk factors, virological parameters, and outcomes associated with HHV-6 viremia in high-risk donor CMV-seropositive and recipient CMV-seronegative (D+R-) liver transplant recipients in the current era are incompletely defined., Methods: The study population consisted of patients in the preemptive therapy (PET) arm of a randomized, controlled trial of PET versus valganciclovir prophylaxis for CMV prevention in D+R- liver transplant recipients. Weekly blood samples through 100 d in the PET group were tested for HHV-6 viremia using a real-time quantitative polymerase chain reaction. Assessments included virological characteristics and relationship with CMV, risk factors, and impact of HHV-6 viremia with outcomes through 12 mo posttransplant., Results: HHV-6 viremia at any level developed in 42% (40 of 96). Older patient age (P = 0.03), longer hospitalization (P = 0.015), and ICU stay at transplantation (P = 0.029) were significantly associated with high-grade viremia. Concurrent HHV-6 and CMV viremia was associated with earlier onset of HHV-6 viremia (P = 0.004), higher HHV-6 area under the curve (P = 0.043), and higher peak HHV-6 viral load (P = 0.006) versus HHV-6 viremia alone. High-grade viremia was independently associated with biopsy-proven rejection within 12 mo (P = 0.045) posttransplant., Conclusions: Among D+R- liver transplant recipients receiving valganciclovir as PET, high-grade HHV-6 viremia was associated with increased age and critical illness in ICU at time of transplant and was independently associated with allograft rejection., Competing Interests: D.J.W. has received research support form Merck, Chimerix, Shire, Gilead, and Oxford Immnotech. G.M.L. has received research support from Takeda pharmaceutical company. F.P.S. has received research support from Shire, Ansun, and Novartis. A.P.L. has received research support from Merck and Astellas, and consulting support from Helocyte, Inc, Amplyx, Novartis, and AlloVir. The other authors declare no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2021
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7. Clinical characteristics and outcomes of toxoplasmosis among transplant recipients at two US academic medical centers.
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Adekunle RO, Sherman A, Spicer JO, Messina JA, Steinbrink JM, Sexton ME, Lyon GM, Mehta AK, Phadke VK, and Woodworth MH
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- Academic Medical Centers, Humans, Retrospective Studies, Transplant Recipients, Hematopoietic Stem Cell Transplantation adverse effects, Toxoplasma, Toxoplasmosis diagnosis, Toxoplasmosis epidemiology
- Abstract
Toxoplasma gondii can cause severe opportunistic infection in immunocompromised individuals, but diagnosis is often delayed. We conducted a retrospective review of solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients with toxoplasmosis between 2002 and 2018 at two large US academic transplant centers. Patients were identified by ICD-9 or ICD-10 toxoplasmosis codes, positive Toxoplasma polymerase chain reaction test result, or pathologic diagnosis. Data were collected regarding transplant type, time from transplant to toxoplasmosis diagnosis, clinical and radiographic features, and mortality at 30 and 90 days. Twenty patients were identified: 10 HSCT recipients (80% allogeneic HSCT) and 10 SOT recipients (60% deceased donor renal transplants). Rejection among SOT recipients (70%) and graft-versus-host disease (GVHD) prophylaxis among HSCT recipients (50%) were frequent. Median time from transplant to toxoplasmosis diagnosis was longer for SOT than HSCT (1385 vs. 5 days, P-value .002). Clinical manifestations most commonly were encephalitis (65%), respiratory failure (40%), renal failure (40%), and distributive shock (40%). Cohort 30-day mortality was 45%, and 90-day mortality was 55%. Diagnosis was postmortem in 25% of the cohort. Further evaluation of toxoplasmosis screening is needed for noncardiac SOT recipients, HSCT recipients with GVHD, and periods of increased net immunosuppression., (© 2021 Wiley Periodicals LLC.)
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- 2021
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8. Risk Factors for Cytomegalovirus Viremia following Liver Transplantation With a Seropositive Donor and Seronegative Recipient Receiving Antiviral Therapy.
- Author
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Singh N, Winston DJ, Razonable RR, Lyon GM, Silveira FP, Wagener MM, and Limaye AP
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- Age Factors, Cytomegalovirus, Ganciclovir therapeutic use, Humans, Risk Factors, Tissue Donors, Antiviral Agents therapeutic use, Cytomegalovirus Infections drug therapy, Liver Transplantation, Viremia drug therapy
- Abstract
Background: The risk factors for development of viremia in high-risk donor cytomegalovirus (CMV)-seropositive and recipient CMV-seronegative (D+R-) transplant recipients are incompletely defined., Methods: The study population comprised patients in the preemptive therapy (PET) arm of a randomized, controlled trial of PET versus prophylaxis using valganciclovir in D+R- liver transplant recipients. Weekly surveillance monitoring for viremia for 100 days was performed using a sensitive CMV-DNA polymerase chain reaction assays. Risk factors for viremia and time to onset (≤4 vs >4 weeks) of viremia were examined using logistic regression models., Results: Viremia developed in 84% (79/94) of recipients and older donor age was the only independent factor associated with viremia (odds ratio, 2.20 for each quartile increase in donor age; 95% confidence interval [CI], 1.07-4.52; P = .031). Recipients who developed early-onset viremia (within 4 weeks) also had significantly older donors than those with later-onset viremia (difference in age 10.1 years; 95% CI, 2-19; P = .03)., Conclusions: Older donor age was an independent predictor of viremia and earlier-onset of viremia in D+R- liver transplant recipients. Future studies should assess the mechanistic links underlying this novel association., Clinical Trial Registration: NCT01552369., (© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)
- Published
- 2021
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9. Bioaerosol sampling of a ventilated patient with COVID-19.
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Lane MA, Brownsword EA, Morgan JS, Babiker A, Vanairsdale SA, Lyon GM, Mehta AK, Ingersoll JM, Lindsley WG, and Kraft CS
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- Aerosols, Air Microbiology, COVID-19 virology, Humans, Patient Positioning, Patients' Rooms, Prone Position, Respiration, Artificial, COVID-19 transmission, RNA, Viral analysis, SARS-CoV-2, Ventilators, Mechanical virology
- Abstract
Bioaerosol samples were collected in an airborne infection isolation room, bathroom, and anteroom of a ventilated patient with coronavirus disease 2019. Twenty-eight samples were negative for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleic acid, possibly due to the patient being on a closed-circuit ventilator or the efficiency of the air exchanges in the room., (Copyright © 2020 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)
- Published
- 2020
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10. Effect of Preemptive Therapy vs Antiviral Prophylaxis on Cytomegalovirus Disease in Seronegative Liver Transplant Recipients With Seropositive Donors: A Randomized Clinical Trial.
- Author
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Singh N, Winston DJ, Razonable RR, Lyon GM, Silveira FP, Wagener MM, Stevens-Ayers T, Edmison B, Boeckh M, and Limaye AP
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- Adult, Aged, Cytomegalovirus Infections diagnosis, Cytomegalovirus Infections transmission, Cytomegalovirus Infections virology, Female, Humans, Incidence, Male, Middle Aged, Polymerase Chain Reaction, Tissue Donors, Viral Load, Viremia diagnosis, Antibiotic Prophylaxis, Antiviral Agents therapeutic use, Cytomegalovirus isolation & purification, Cytomegalovirus Infections prevention & control, Liver Transplantation, Valganciclovir therapeutic use, Viremia drug therapy
- Abstract
Importance: Despite the use of a cytomegalovirus (CMV) prevention strategy of antiviral prophylaxis for high-risk CMV-seronegative liver transplant recipients with seropositive donors, high rates of delayed-onset postprophylaxis CMV disease occur. An alternate approach, preemptive therapy (initiation of antiviral therapy for early asymptomatic CMV viremia detected by surveillance testing), has not previously been directly compared with antiviral prophylaxis in these patients., Objective: To compare preemptive therapy with antiviral prophylaxis in CMV-seronegative liver transplant recipients with seropositive donors for the prevention of CMV disease., Design, Setting, and Participants: Randomized clinical trial of preemptive therapy vs antiviral prophylaxis in 205 CMV-seronegative liver transplant recipients with seropositive donors aged older than 18 years. The trial was conducted at 6 academic transplant centers in the United States between October 2012 and June 2017, with last follow-up in June 2018., Interventions: Patients were randomized 1:1 to receive either preemptive therapy (valganciclovir, 900 mg, twice daily until 2 consecutive negative tests a week apart) for viremia detected by weekly plasma CMV polymerase chain reaction for 100 days (n = 100) or valganciclovir, 900 mg, daily for 100 days as antiviral prophylaxis (n = 105)., Main Outcomes and Measures: The primary outcome was incidence of CMV disease by 12 months, defined as CMV syndrome (CMV viremia and clinical or laboratory findings) or end-organ disease. Secondary outcomes included acute allograft rejection, opportunistic infections, graft and patient survival, and neutropenia., Results: Among 205 patients who were randomized (mean age, 55 years; 62 women [30%]), all 205 (100%) completed the trial. The incidence of CMV disease was significantly lower with preemptive therapy than antiviral prophylaxis (9% [9/100] vs 19% [20/105]; difference, 10% [95% CI, 0.5% to 19.6%]; P = .04]). The incidence of allograft rejection (28% vs 25%; difference, 3% [95% CI, -9% to 15%]), opportunistic infections (25% vs 27%; difference, 2% [95% CI, -14% to 10%]), graft loss (2% vs 2%; difference, <1% [95% CI, -4% to 4%]), and neutropenia (13% vs 10%; difference, 3% [95% CI, -5% to 12%]) did not differ significantly for the preemptive therapy vs antiviral prophylaxis group, respectively. All-cause mortality at last follow-up was 15% in the preemptive therapy vs 19% in the antiviral prophylaxis group (difference, 4% [95% CI, -14% to 6%]; P = .46)., Conclusions and Relevance: Among CMV-seronegative liver transplant recipients with seropositive donors, the use of preemptive therapy, compared with antiviral prophylaxis, resulted in a lower incidence of CMV disease over 12 months. Further research is needed to replicate these findings and assess long-term outcomes., Trial Registration: ClinicalTrials.gov Identifier: NCT01552369.
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- 2020
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11. Serosurvey on healthcare personnel caring for patients with Ebola virus disease and Lassa virus in the United States.
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Kraft CS, Mehta AK, Varkey JB, Lyon GM, Vanairsdale S, Bell S, Burd EM, Sexton ME, Cassidy LA, Olinger P, Rengarajan K, Raabe VN, Davis E, Henderson S, DesRoches P, Xu Y, Mulligan MJ, and Ribner BS
- Subjects
- Academic Medical Centers, Adult, Cross Infection prevention & control, Female, Georgia epidemiology, Health Personnel, Hemorrhagic Fever, Ebola prevention & control, Humans, Infection Control methods, Lassa Fever prevention & control, Lassa virus, Male, Middle Aged, United States, Viral Vaccines immunology, Antibodies, Viral blood, Cross Infection blood, Cross Infection epidemiology, Hemorrhagic Fever, Ebola blood, Lassa Fever blood
- Abstract
Objective: Healthcare personnel (HCP) were recruited to provide serum samples, which were tested for antibodies against Ebola or Lassa virus to evaluate for asymptomatic seroconversion., Setting: From 2014 to 2016, 4 patients with Ebola virus disease (EVD) and 1 patient with Lassa fever (LF) were treated in the Serious Communicable Diseases Unit (SCDU) at Emory University Hospital. Strict infection control and clinical biosafety practices were implemented to prevent nosocomial transmission of EVD or LF to HCP., Participants: All personnel who entered the SCDU who were required to measure their temperatures and complete a symptom questionnaire twice daily were eligible., Results: No employee developed symptomatic EVD or LF. EVD and LF antibody studies were performed on sera samples from 42 HCP. The 6 participants who had received investigational vaccination with a chimpanzee adenovirus type 3 vectored Ebola glycoprotein vaccine had high antibody titers to Ebola glycoprotein, but none had a response to Ebola nucleoprotein or VP40, or a response to LF antigens., Conclusions: Patients infected with filoviruses and arenaviruses can be managed successfully without causing occupation-related symptomatic or asymptomatic infections. Meticulous attention to infection control and clinical biosafety practices by highly motivated, trained staff is critical to the safe care of patients with an infection from a special pathogen.
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- 2020
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12. Left Ventricular Assist Device Infections and the Potential Role for Dalbavancin: A Case Report.
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Howard-Anderson J, Pouch SM, Sexton ME, Mehta AK, Smith AL, Lyon GM 3rd, and Friedman-Moraco R
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Left ventricular assist device infections (LVADIs) are common but challenging to treat, often requiring prolonged courses of intravenous antibiotics. Dalbavancin could have a role in treating patients with chronic LVADIs given its less frequent dosing requirements. Here, we illustrate a case in which dalbavancin was used as suppressive therapy for an LVADI for greater than 7 months., (© The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)
- Published
- 2019
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13. Transmission of Eastern Equine Encephalitis Virus From an Organ Donor to 3 Transplant Recipients.
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Pouch SM, Katugaha SB, Shieh WJ, Annambhotla P, Walker WL, Basavaraju SV, Jones J, Huynh T, Reagan-Steiner S, Bhatnagar J, Grimm K, Stramer SL, Gabel J, Lyon GM, Mehta AK, Kandiah P, Neujahr DC, Javidfar J, Subramanian RM, Parekh SM, Shah P, Cooper L, Psotka MA, Radcliffe R, Williams C, Zaki SR, Staples JE, Fischer M, Panella AJ, Lanciotti RS, Laven JJ, Kosoy O, Rabe IB, and Gould CV
- Subjects
- Adult, Animals, Culicidae virology, Encephalitis Virus, Eastern Equine, Encephalomyelitis, Equine blood, Fatal Outcome, Female, Heart Transplantation adverse effects, Humans, Liver Transplantation adverse effects, Lung Transplantation adverse effects, Medical Records, Middle Aged, Encephalomyelitis, Equine transmission, Tissue Donors, Transplant Recipients statistics & numerical data, Transplantation adverse effects
- Abstract
Background: In fall 2017, 3 solid organ transplant (SOT) recipients from a common donor developed encephalitis within 1 week of transplantation, prompting suspicion of transplant-transmitted infection. Eastern equine encephalitis virus (EEEV) infection was identified during testing of endomyocardial tissue from the heart recipient., Methods: We reviewed medical records of the organ donor and transplant recipients and tested serum, whole blood, cerebrospinal fluid, and tissue from the donor and recipients for evidence of EEEV infection by multiple assays. We investigated blood transfusion as a possible source of organ donor infection by testing remaining components and serum specimens from blood donors. We reviewed data from the pretransplant organ donor evaluation and local EEEV surveillance., Results: We found laboratory evidence of recent EEEV infection in all organ recipients and the common donor. Serum collected from the organ donor upon hospital admission tested negative, but subsequent samples obtained prior to organ recovery were positive for EEEV RNA. There was no evidence of EEEV infection among donors of the 8 blood products transfused into the organ donor or in products derived from these donations. Veterinary and mosquito surveillance showed recent EEEV activity in counties nearby the organ donor's county of residence. Neuroinvasive EEEV infection directly contributed to the death of 1 organ recipient and likely contributed to death in another., Conclusions: Our investigation demonstrated EEEV transmission through SOT. Mosquito-borne transmission of EEEV to the organ donor was the likely source of infection. Clinicians should be aware of EEEV as a cause of transplant-associated encephalitis., (© The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)
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- 2019
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14. New filovirus disease classification and nomenclature.
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Kuhn JH, Adachi T, Adhikari NKJ, Arribas JR, Bah IE, Bausch DG, Bhadelia N, Borchert M, Brantsæter AB, Brett-Major DM, Burgess TH, Chertow DS, Chute CG, Cieslak TJ, Colebunders R, Crozier I, Davey RT, de Clerck H, Delgado R, Evans L, Fallah M, Fischer WA 2nd, Fletcher TE, Fowler RA, Grünewald T, Hall A, Hewlett A, Hoepelman AIM, Houlihan CF, Ippolito G, Jacob ST, Jacobs M, Jakob R, Jacquerioz FA, Kaiser L, Kalil AC, Kamara RF, Kapetshi J, Klenk HD, Kobinger G, Kortepeter MG, Kraft CS, Kratz T, Bosa HSK, Lado M, Lamontagne F, Lane HC, Lobel L, Lutwama J, Lyon GM 3rd, Massaquoi MBF, Massaquoi TA, Mehta AK, Makuma VM, Murthy S, Musoke TS, Muyembe-Tamfum JJ, Nakyeyune P, Nanclares C, Nanyunja M, Nsio-Mbeta J, O'Dempsey T, Pawęska JT, Peters CJ, Piot P, Rapp C, Renaud B, Ribner B, Sabeti PC, Schieffelin JS, Slenczka W, Soka MJ, Sprecher A, Strong J, Swanepoel R, Uyeki TM, van Herp M, Vetter P, Wohl DA, Wolf T, Wolz A, Wurie AH, and Yoti Z
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- Filoviridae pathogenicity, Hemorrhagic Fever, Ebola classification, Humans, Filoviridae classification, Filoviridae Infections classification, World Health Organization
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- 2019
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15. Macrophage Activation Marker Soluble CD163 Associated with Fatal and Severe Ebola Virus Disease in Humans 1 .
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McElroy AK, Shrivastava-Ranjan P, Harmon JR, Martines RB, Silva-Flannery L, Flietstra TD, Kraft CS, Mehta AK, Lyon GM, Varkey JB, Ribner BS, Nichol ST, Zaki SR, and Spiropoulou CF
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- Biomarkers, Hemorrhagic Fever, Ebola diagnosis, Hemorrhagic Fever, Ebola virology, Humans, Immunoassay, Killer Cells, Natural immunology, Killer Cells, Natural metabolism, Liver immunology, Liver metabolism, Liver pathology, Macrophages metabolism, Antigens, CD blood, Antigens, Differentiation, Myelomonocytic blood, Ebolavirus immunology, Hemorrhagic Fever, Ebola blood, Hemorrhagic Fever, Ebola immunology, Macrophage Activation immunology, Macrophages immunology, Receptors, Cell Surface blood
- Abstract
Ebola virus disease (EVD) is associated with elevated cytokine levels, and hypercytokinemia is more pronounced in fatal cases. This type of hyperinflammatory state is reminiscent of 2 rheumatologic disorders known as macrophage activation syndrome and hemophagocytic lymphohistiocytosis, which are characterized by macrophage and T-cell activation. An evaluation of 2 cohorts of patients with EVD revealed that a marker of macrophage activation (sCD163) but not T-cell activation (sCD25) was associated with severe and fatal EVD. Furthermore, substantial immunoreactivity of host tissues to a CD163-specific antibody, predominantly in areas of extensive immunostaining for Ebola virus antigens, was observed in fatal cases. These data suggest that host macrophage activation contributes to EVD pathogenesis and that directed antiinflammatory therapies could be beneficial in the treatment of EVD.
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- 2019
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16. Multi-drug-resistant Enterococcus faecium bacteraemia in a liver transplant recipient.
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Summers NA, Gharbin J, Friedman-Moraco R, Lyon GM, and Lutgring J
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Introduction: Enterococcus faecium is a commensal organism commonly colonizing the human gastrointestinal tract. Although it is generally a non-virulent organism, E. faecium can cause significant morbidity and mortality due to its inherent and acquired resistances to commonly used antimicrobials. Patients who are immunosuppressed are particularly vulnerable., Case Presentation: A 65-75-year-old patient with a history of an orthotopic liver transplant for hepatitis C infection and diabetes was re-admitted to the hospital with abdominal pain and fever. The patient had several recent admissions related to the presentation reported here, which included treatment with a prolonged course of broad-spectrum antibiotics. The patient was found to have a recurrent liver abscess and blood cultures grew vancomycin-resistant E. faecium , non-susceptible to all tested agents: ampicillin, penicillin, vancomycin, daptomycin and linezolid. The patient was started initially on chloramphenicol intravenously while awaiting additional susceptibility testing, which ultimately revealed chloramphenicol non-susceptibility. Tigecycline was started but the patient ultimately decided to pursue hospice care., Conclusion: Multi-drug-resistant organisms are increasingly being recognized and are associated with poorer outcomes, particularly in immunosuppressed patients. We describe a particularly resistant organism and discuss potential therapeutic options., Competing Interests: The authors declare that there are no conflicts of interest.
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- 2018
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17. Monocular Ghost Image Offset Thresholds: Dependent on Target Size and Ghost Image Relative Brightness.
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Webster AB, Lyon GM, Blowers KA, Roth GN, Deacon JA, Baan CL, and Carkeet A
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- Adult, Female, Humans, Male, Monitoring, Physiologic, Orientation, Spatial, Visual Acuity physiology, Young Adult, Artifacts, Diplopia physiopathology, Light, Sensory Thresholds physiology
- Abstract
Significance: This is the first report of monocular ghost image offset thresholds measured using O optotypes. Monocular diplopia is a complaint of patients and is the result of a variety of etiologies. Furthermore, monocular image doubling also can be a confounding variable of vectographic stereoacuity tests, warranting an investigation of ghost image offset thresholds., Purpose: To measure ghost image offset thresholds of normal observers and how they are affected by offset orientation, target size, and ghost image relative luminance., Methods: Participants were five individuals without ocular abnormalities aged 21 to 32 years. Stimuli were viewed monocularly and consisted of Sloan "O" optotypes generated on a computer monitor with varying levels of image doubling. Ghost image offset thresholds were determined using a spatial 2-alternative forced-choice paradigm and probit analysis of the frequency of seeing data., Results: Under close-to-optimal conditions, monocular ghost image offset thresholds ranged between 14 and 22 arc seconds, a level that might be considered a hyperacuity. Ghost image offset detection thresholds demonstrated a U-shaped relationship with optotype size, with optimum thresholds occurring for optotypes sizes of approximately -0.15 logarithmic minimum angle of resolution. There was no measurable effect of offset orientation on ghost image offset detection thresholds. Monocular ghost image offset detection thresholds decreased as ghost image relative luminance increased., Conclusions: Ghost image offset detection thresholds can be quite low even when viewing under monocular conditions and relatively low ghost image relative luminance. This should be considered when designing and interpreting the results of vectographic stereoacuity tests.
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- 2018
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18. Detecting Infections Rapidly and Easily for Candidemia Trial, Part 2 (DIRECT2): A Prospective, Multicenter Study of the T2Candida Panel.
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Clancy CJ, Pappas PG, Vazquez J, Judson MA, Kontoyiannis DP, Thompson GR 3rd, Garey KW, Reboli A, Greenberg RN, Apewokin S, Lyon GM 3rd, Ostrosky-Zeichner L, Wu AHB, Tobin E, Nguyen MH, and Caliendo AM
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- Female, Humans, Male, Middle Aged, Prospective Studies, Sensitivity and Specificity, Candida isolation & purification, Candidemia blood, Candidemia diagnosis, Magnetic Resonance Spectroscopy methods, Serologic Tests methods
- Abstract
Background: Blood cultures are approximately 50% sensitive for diagnosing invasive candidiasis. The T2Candida nanodiagnostic panel uses T2 magnetic resonance and a dedicated instrument to detect Candida directly within whole blood samples., Methods: Patients with Candida albicans, Candida glabrata, Candida parapsilosis, Candida tropicalis, or Candida krusei candidemia were identified at 14 centers using diagnostic blood cultures (dBCs). Follow-up blood samples were collected concurrently for testing by T2Candida and companion cultures (cBCs). T2Candida results are reported qualitatively for C. albicans/C. tropicalis, C. glabrata/C. krusei, and C. parapsilosis. T2Candida and cBCs were positive if they detected a species present in the dBC., Results: Median time between collection of dBC and T2Candida/cBC samples in 152 patients was 55.5 hours (range, 16.4-148.4). T2Candida and cBCs were positive in 45% (69/152) and 24% (36/152) of patients, respectively (P < .0001). T2Candida clinical sensitivity was 89%, as positive results were obtained in 32/36 patients with positive cBCs. Combined test results were both positive (T2+/cBC+), 21% (32/152); T2+/cBC-, 24% (37/152); T2-/cBC+, 3% (4/152); and T2-/cBC-, 52% (79/152). Prior antifungal therapy, neutropenia, and C. albicans candidemia were independently associated with T2Candida positivity and T2+/cBC- results (P values < .05)., Conclusions: T2Candida was sensitive for diagnosing candidemia at the time of positive blood cultures. In patients receiving antifungal therapy, T2Candida identified bloodstream infections that were missed by cBCs. T2Candida may improve care by shortening times to Candida detection and species identification compared to blood cultures, retaining sensitivity during antifungal therapy and rendering active candidemia unlikely if results are negative., Clinical Trials Registration: NCT01525095.
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- 2018
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19. New Lineage of Lassa Virus, Togo, 2016.
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Whitmer SLM, Strecker T, Cadar D, Dienes HP, Faber K, Patel K, Brown SM, Davis WG, Klena JD, Rollin PE, Schmidt-Chanasit J, Fichet-Calvet E, Noack B, Emmerich P, Rieger T, Wolff S, Fehling SK, Eickmann M, Mengel JP, Schultze T, Hain T, Ampofo W, Bonney K, Aryeequaye JND, Ribner B, Varkey JB, Mehta AK, Lyon GM 3rd, Kann G, De Leuw P, Schuettfort G, Stephan C, Wieland U, Fries JWU, Kochanek M, Kraft CS, Wolf T, Nichol ST, Becker S, Ströher U, and Günther S
- Subjects
- Animals, Chlorocebus aethiops, Genes, Viral, History, 21st Century, Humans, Lassa Fever history, Phylogeny, Togo epidemiology, Vero Cells, Lassa Fever epidemiology, Lassa Fever virology, Lassa virus classification
- Abstract
We describe a strain of Lassa virus representing a putative new lineage that was isolated from a cluster of human infections with an epidemiologic link to Togo. This finding extends the known range of Lassa virus to Togo.
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- 2018
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20. Effect of positive perioperative donor and recipient respiratory bacterial cultures on early post-transplant outcomes in lung transplant recipients.
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Howell CK, Paciullo CA, Lyon GM, Neujahr D, Lyu P, Cotsonis G, and Hurtik M
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- Adolescent, Adult, Anti-Bacterial Agents pharmacology, Anti-Bacterial Agents therapeutic use, Antibiotic Prophylaxis adverse effects, Antibiotic Prophylaxis methods, Bacteria drug effects, Bronchoalveolar Lavage statistics & numerical data, Bronchoalveolar Lavage Fluid cytology, Child, Female, Humans, Intensive Care Units statistics & numerical data, Length of Stay statistics & numerical data, Male, Microbial Sensitivity Tests, Middle Aged, Neutrophils, Perioperative Period, Postoperative Complications microbiology, Postoperative Complications prevention & control, Respiratory Tract Infections microbiology, Respiratory Tract Infections prevention & control, Retrospective Studies, Time Factors, Tissue Donors statistics & numerical data, Transplant Recipients statistics & numerical data, Treatment Outcome, Young Adult, Bacteria isolation & purification, Bronchoalveolar Lavage Fluid microbiology, Lung Transplantation adverse effects, Postoperative Complications epidemiology, Respiratory Tract Infections epidemiology
- Abstract
Background: It is standard practice to administer prophylactic antibiotics post lung transplantation. However, no studies have evaluated the impact of culture positivity. The purpose of this study was to evaluate early post-transplant outcomes of culture-positive and culture-negative lung transplant (LT) recipients and the appropriateness of the empiric regimens used., Methods: Adult patients who received an LT at Emory University Hospital between January 1, 2010 and August 31, 2015 were reviewed and stratified into three groups: (i) culture-positive appropriate empiric treatment, (ii) culture-positive inappropriate empiric treatment, and (iii) culture-negative. Antibiotics were defined as appropriate if bacteria were sensitive to the empiric regimen. The primary endpoint was 30-day mortality. Secondary endpoints included hospital length of stay (LOS), intensive care unit (ICU) LOS, percent neutrophil count in a bronchoalveolar lavage (BAL) sample, presence of airway ischemia, and appropriateness of the empiric antibiotic regimen., Results: Nine, zero, and four patients died within 30 days in the culture-positive appropriate (n = 113), culture-positive inappropriate (n = 5), and culture-negative groups (n = 29) (P = .564) respectively. The median hospital LOS was 19, 16, and 15 days respectively. Median ICU LOS was 6, 5, and 7 respectively. The respective percent neutrophil counts in the BAL fluid were 79, 83, and 65. The presence of airway ischemia was only documented in eight patients, all in the culture-positive appropriate group., Conclusion: We did not identify an association between antibiotic appropriateness and 30-day mortality, hospital LOS, or ICU LOS in post-LT recipients., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
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- 2017
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21. Favipiravir and Ribavirin Treatment of Epidemiologically Linked Cases of Lassa Fever.
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Raabe VN, Kann G, Ribner BS, Morales A, Varkey JB, Mehta AK, Lyon GM, Vanairsdale S, Faber K, Becker S, Eickmann M, Strecker T, Brown S, Patel K, De Leuw P, Schuettfort G, Stephan C, Rabenau H, Klena JD, Rollin PE, McElroy A, Ströher U, Nichol S, Kraft CS, and Wolf T
- Subjects
- Adult, Humans, Lassa virus genetics, Male, Polymerase Chain Reaction, RNA, Viral analysis, RNA, Viral genetics, Togo, Amides therapeutic use, Antiviral Agents therapeutic use, Lassa Fever drug therapy, Lassa Fever physiopathology, Lassa Fever virology, Pyrazines therapeutic use, Ribavirin therapeutic use
- Abstract
Two patients with Lassa fever are described who are the first human cases treated with a combination of ribavirin and favipiravir. Both patients survived but developed transaminitis and had prolonged detectable virus RNA in blood and semen, suggesting that the possibility of sexual transmission of Lassa virus should be considered., (© The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)
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- 2017
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22. The epidemiology and outcomes of invasive Candida infections among organ transplant recipients in the United States: results of the Transplant-Associated Infection Surveillance Network (TRANSNET).
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Andes DR, Safdar N, Baddley JW, Alexander B, Brumble L, Freifeld A, Hadley S, Herwaldt L, Kauffman C, Lyon GM, Morrison V, Patterson T, Perl T, Walker R, Hess T, Chiller T, and Pappas PG
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- Adult, Antifungal Agents therapeutic use, Candidiasis, Invasive microbiology, Candidiasis, Invasive mortality, Epidemiological Monitoring, Female, Humans, Male, Middle Aged, Organ Transplantation mortality, Prospective Studies, Survival Analysis, Transplant Recipients, United States epidemiology, Allografts microbiology, Antibiotic Prophylaxis adverse effects, Antifungal Agents adverse effects, Candida isolation & purification, Candidiasis, Invasive epidemiology, Organ Transplantation adverse effects
- Abstract
Background: Invasive candidiasis (IC) is a common cause of mortality in solid organ transplant recipients (OTRs), but knowledge of epidemiology in this population is limited., Method: The present analysis describes data from 15 US centers that prospectively identified IC from nearly 17 000 OTRs. Analyses were undertaken to determine predictors of infection and mortality., Results: A total of 639 cases of IC were identified. The most common species was Candida albicans (46.3%), followed by Candida glabrata (24.4%) and Candida parapsilosis (8.1%). In 68 cases >1 species was identified. The most common infection site was bloodstream (44%), followed by intra-abdominal (14%). The most frequently affected allograft groups were liver (41.1%) and kidney (35.3%). All-cause mortality at 90 days was 26.5% for all species and was highest for Candida tropicalis (44%) and C. parapsilosis (35.2%). Non-white race and female gender were more commonly associated with non-albicans species. A high rate of breakthrough IC was seen in patients receiving antifungal prophylaxis (39%). Factors associated with mortality include organ dysfunction, lung transplant, and treatment with a polyene antifungal. The only modifiable factor identified was choice of antifungal drug class based upon infecting Candida species., Conclusion: These data highlight the common and distinct features of IC in OTRs., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
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- 2016
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23. Long-term Management of Panuveitis and Iris Heterochromia in an Ebola Survivor.
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Shantha JG, Crozier I, Varkey JB, Kraft CS, Lyon GM 3rd, Mehta AK, Carlson RD, Hill CE, Kumar G, Debiec MR, Patel PS, Olsen TW, Nussenblatt RB, Martin DF, Ströher U, Uyeki TM, Ribner BS, Smith JR, and Yeh S
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- Administration, Oral, Adult, Amides therapeutic use, Atropine therapeutic use, Drug Combinations, Ebolavirus genetics, Ebolavirus isolation & purification, Eye Infections, Viral diagnosis, Eye Infections, Viral virology, Fluprednisolone analogs & derivatives, Fluprednisolone therapeutic use, Glucocorticoids therapeutic use, Hemorrhagic Fever, Ebola diagnosis, Hemorrhagic Fever, Ebola virology, Humans, Injections, Intraocular, Iris Diseases diagnosis, Iris Diseases virology, Male, Microscopy, Acoustic, Multimodal Imaging, Mydriatics therapeutic use, Ophthalmic Solutions, Panuveitis diagnosis, Panuveitis virology, Pigmentation Disorders diagnosis, Pigmentation Disorders virology, Prednisone therapeutic use, Pyrazines therapeutic use, RNA, Viral genetics, Real-Time Polymerase Chain Reaction, Survivors, Triamcinolone Acetonide therapeutic use, Vitreous Body virology, Eye Infections, Viral drug therapy, Hemorrhagic Fever, Ebola drug therapy, Iris Diseases drug therapy, Panuveitis drug therapy, Pigmentation Disorders drug therapy
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- 2016
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24. Defining antigen-specific plasmablast and memory B cell subsets in human blood after viral infection or vaccination.
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Ellebedy AH, Jackson KJ, Kissick HT, Nakaya HI, Davis CW, Roskin KM, McElroy AK, Oshansky CM, Elbein R, Thomas S, Lyon GM, Spiropoulou CF, Mehta AK, Thomas PG, Boyd SD, and Ahmed R
- Subjects
- Adult, Antibodies, Viral blood, Cell Differentiation, Clone Cells, Hemagglutinin Glycoproteins, Influenza Virus immunology, Humans, Immunologic Memory, Lymphocyte Activation, Somatic Hypermutation, Immunoglobulin genetics, Vaccination, Young Adult, B-Lymphocyte Subsets immunology, B-Lymphocytes immunology, Ebolavirus physiology, Hemorrhagic Fever, Ebola immunology, Influenza A virus physiology, Influenza Vaccines immunology, Influenza, Human immunology, PAX5 Transcription Factor metabolism, Plasma Cells immunology
- Abstract
Antigen-specific B cells bifurcate into antibody-secreting cells (ASCs) and memory B cells (MBCs) after infection or vaccination. ASCs (plasmablasts) have been extensively studied in humans, but less is known about B cells that become activated but do not differentiate into plasmablasts. Here we have defined the phenotype and transcriptional program of a subset of antigen-specific B cells, which we have called 'activated B cells' (ABCs), that were distinct from ASCs and were committed to the MBC lineage. We detected ABCs in humans after infection with Ebola virus or influenza virus and also after vaccination. By simultaneously analyzing antigen-specific ASCs and ABCs in human blood after vaccination against influenza virus, we investigated the clonal overlap and extent of somatic hypermutation (SHM) in the ASC (effector) and ABC (memory) lineages. Longitudinal tracking of vaccination-induced hemagglutinin (HA)-specific clones revealed no overall increase in SHM over time, which suggested that repeated annual immunization might have limitations in enhancing the quality of influenza-virus-specific antibody., Competing Interests: The authors declare no competing financial interests.
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- 2016
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25. Ebola virus disease and critical illness.
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Leligdowicz A, Fischer WA 2nd, Uyeki TM, Fletcher TE, Adhikari NK, Portella G, Lamontagne F, Clement C, Jacob ST, Rubinson L, Vanderschuren A, Hajek J, Murthy S, Ferri M, Crozier I, Ibrahima E, Lamah MC, Schieffelin JS, Brett-Major D, Bausch DG, Shindo N, Chan AK, O'Dempsey T, Mishra S, Jacobs M, Dickson S, Lyon GM 3rd, and Fowler RA
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- Adult, Africa, Western epidemiology, Aged, Critical Care methods, Critical Care standards, Critical Illness mortality, Developing Countries, Ebolavirus pathogenicity, Female, Hospitalization statistics & numerical data, Humans, Male, Middle Aged, Hemorrhagic Fever, Ebola
- Abstract
As of 20 May 2016 there have been 28,646 cases and 11,323 deaths resulting from the West African Ebola virus disease (EVD) outbreak reported to the World Health Organization. There continue to be sporadic flare-ups of EVD cases in West Africa.EVD presentation is nonspecific and characterized initially by onset of fatigue, myalgias, arthralgias, headache, and fever; this is followed several days later by anorexia, nausea, vomiting, diarrhea, and abdominal pain. Anorexia and gastrointestinal losses lead to dehydration, electrolyte abnormalities, and metabolic acidosis, and, in some patients, acute kidney injury. Hypoxia and ventilation failure occurs most often with severe illness and may be exacerbated by substantial fluid requirements for intravascular volume repletion and some degree of systemic capillary leak. Although minor bleeding manifestations are common, hypovolemic and septic shock complicated by multisystem organ dysfunction appear the most frequent causes of death.Males and females have been equally affected, with children (0-14 years of age) accounting for 19 %, young adults (15-44 years) 58 %, and older adults (≥45 years) 23 % of reported cases. While the current case fatality proportion in West Africa is approximately 40 %, it has varied substantially over time (highest near the outbreak onset) according to available resources (40-90 % mortality in West Africa compared to under 20 % in Western Europe and the USA), by age (near universal among neonates and high among older adults), and by Ebola viral load at admission.While there is no Ebola virus-specific therapy proven to be effective in clinical trials, mortality has been dramatically lower among EVD patients managed with supportive intensive care in highly resourced settings, allowing for the avoidance of hypovolemia, correction of electrolyte and metabolic abnormalities, and the provision of oxygen, ventilation, vasopressors, and dialysis when indicated. This experience emphasizes that, in addition to evaluating specific medical treatments, improving the global capacity to provide supportive critical care to patients with EVD may be the greatest opportunity to improve patient outcomes.
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- 2016
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26. Ebola Virus Persistence in Semen of Male Survivors.
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Uyeki TM, Erickson BR, Brown S, McElroy AK, Cannon D, Gibbons A, Sealy T, Kainulainen MH, Schuh AJ, Kraft CS, Mehta AK, Lyon GM 3rd, Varkey JB, Ribner BS, Ellison RT 3rd, Carmody E, Nau GJ, Spiropoulou C, Nichol ST, and Ströher U
- Subjects
- Adult, Cohort Studies, Ebolavirus pathogenicity, Humans, Male, Survivors, Ebolavirus isolation & purification, Hemorrhagic Fever, Ebola virology, Semen virology
- Abstract
We investigated the duration of Ebola virus (EBOV) RNA and infectious EBOV in semen specimens of 5 Ebola virus disease (EVD) survivors. EBOV RNA and infectious EBOV was detected by real-time RT-PCR and virus culture out to 290 days and 70 days, respectively, after EVD onset., (Published by Oxford University Press for the Infectious Diseases Society of America 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.)
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- 2016
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27. Comparison of FilmArray and Quantitative Real-Time Reverse Transcriptase PCR for Detection of Zaire Ebolavirus from Contrived and Clinical Specimens.
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Southern TR, Racsa LD, Albariño CG, Fey PD, Hinrichs SH, Murphy CN, Herrera VL, Sambol AR, Hill CE, Ryan EL, Kraft CS, Campbell S, Sealy TK, Schuh A, Ritchie JC, Lyon GM 3rd, Mehta AK, Varkey JB, Ribner BS, Brantly KP, Ströher U, Iwen PC, and Burd EM
- Subjects
- Humans, Plasma virology, Sensitivity and Specificity, Urine virology, Ebolavirus isolation & purification, Hemorrhagic Fever, Ebola diagnosis, Molecular Diagnostic Techniques methods, Polymerase Chain Reaction methods, Real-Time Polymerase Chain Reaction methods, Reverse Transcriptase Polymerase Chain Reaction methods
- Abstract
Rapid, reliable, and easy-to-use diagnostic assays for detection of Zaire ebolavirus (ZEBOV) are urgently needed. The goal of this study was to examine the agreement among emergency use authorization (EUA) tests for the detection of ZEBOV nucleic acids, including the BioFire FilmArray BioThreat (BT) panel, the FilmArray BT-E panel, and the NP2 and VP40 quantitative real-time reverse transcriptase (qRT) PCR assays from the Centers for Disease Control and Prevention (CDC). Specimens used in this study included whole blood spiked with inactivated ZEBOV at known titers and whole-blood, plasma, and urine clinical specimens collected from persons diagnosed with Ebola virus disease (EVD). The agreement for FilmArray and qRT-PCR results using contrived whole-blood specimens was 100% (6/6 specimens) for each ZEBOV dilution from 4 × 10(7) to 4 × 10(2) 50% tissue culture infective dose (TCID50)/ml, as well as the no-virus negative-control sample. The limit of detection for FilmArray and qRT-PCR assays with inactivated ZEBOV, based on duplicate positive results, was determined to be 4 × 10(2) TCID50/ml. Rates of agreement between FilmArray and qRT-PCR results for clinical specimens from patients with EVD were 85% (23/27 specimens) for whole-blood specimens, 90% (18/20 specimens) for whole-blood specimens tested by FilmArray testing and matched plasma specimens tested by qRT-PCR testing, and 85% (11/13 specimens) for urine specimens. Among 60 specimens, eight discordant results were noted, with ZEBOV nucleic acids being detected only by FilmArray testing in four specimens and only by qRT-PCR testing in the remaining four specimens. These findings demonstrate that the rapid and easy-to-use FilmArray panels are effective tests for evaluating patients with EVD., (Copyright © 2015, American Society for Microbiology. All Rights Reserved.)
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- 2015
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28. The Use of TKM-100802 and Convalescent Plasma in 2 Patients With Ebola Virus Disease in the United States.
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Kraft CS, Hewlett AL, Koepsell S, Winkler AM, Kratochvil CJ, Larson L, Varkey JB, Mehta AK, Lyon GM 3rd, Friedman-Moraco RJ, Marconi VC, Hill CE, Sullivan JN, Johnson DW, Lisco SJ, Mulligan MJ, Uyeki TM, McElroy AK, Sealy T, Campbell S, Spiropoulou C, Ströher U, Crozier I, Sacra R, Connor MJ Jr, Sueblinvong V, Franch HA, Smith PW, and Ribner BS
- Subjects
- Adult, Humans, Male, Middle Aged, Prospective Studies, Treatment Outcome, United States, Antibodies, Viral therapeutic use, Hemorrhagic Fever, Ebola therapy, RNA, Small Interfering therapeutic use
- Abstract
Background: The current West Africa Ebola virus disease (EVD) outbreak has resulted in multiple individuals being medically evacuated to other countries for clinical management., Methods: We report two patients who were transported from West Africa to the United States for treatment of EVD. Both patients received aggressive supportive care measures, as well as an investigational therapeutic (TKM-100802) and convalescent plasma., Results: While one patient experienced critical illness with multi-organ failure requiring mechanical ventilation and renal replacement therapy, both patients recovered without serious long-term sequelae to date., Conclusions: It is unclear what role the experimental drug and convalescent plasma had in the recovery of these patients. Prospective clinical trials are needed to delineate the role of investigational therapies in the care of patients with EVD., (© The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.)
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- 2015
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29. Serological Correlates of Protection against a GII.4 Norovirus.
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Atmar RL, Bernstein DI, Lyon GM, Treanor JJ, Al-Ibrahim MS, Graham DY, Vinjé J, Jiang X, Gregoricus N, Frenck RW, Moe CL, Chen WH, Ferreira J, Barrett J, Opekun AR, Estes MK, Borkowski A, Baehner F, Goodwin R, Edmonds A, and Mendelman PM
- Subjects
- Adolescent, Adult, Caliciviridae Infections immunology, Double-Blind Method, Enzyme-Linked Immunosorbent Assay, Female, Humans, Immunoglobulin A blood, Immunoglobulin G blood, Male, Middle Aged, Placebos administration & dosage, Vaccines, Virus-Like Particle administration & dosage, Viral Vaccines administration & dosage, Young Adult, Antibodies, Viral blood, Biomarkers blood, Caliciviridae Infections prevention & control, Norovirus immunology, Vaccines, Virus-Like Particle immunology, Viral Vaccines immunology
- Abstract
Noroviruses are the leading cause of acute gastroenteritis worldwide, and norovirus vaccine prevention strategies are under evaluation. The immunogenicity of two doses of bivalent genogroup 1 genotype 1 (GI.1)/GII.4 (50 μg of virus-like particles [VLPs] of each strain adjuvanted with aluminum hydroxide and 3-O-desacyl-4'monophosphoryl lipid A [MPL]) norovirus vaccine administered to healthy adults in a phase 1/2 double-blind placebo-controlled trial was determined using virus-specific serum total antibody enzyme-linked immunosorbent assay (ELISA), IgG, IgA, and histoblood group antigen (HBGA)-blocking assays. Trial participants subsequently received an oral live virus challenge with a GII.4 strain, and the vaccine efficacy results were reported previously (D. I. Bernstein et al., J Infect Dis 211:870-878, 2014, doi:10.1093/infdis/jiu497). This report assesses the impact of prechallenge serum antibody levels on infection and illness outcomes. Serum antibody responses were observed in vaccine recipients by all antibody assays, with first-dose seroresponse frequencies ranging from 88 to 100% for the GI.1 antigen and from 69 to 84% for the GII.4 antigen. There was little increase in antibody levels after the second vaccine dose. Among the subjects receiving the placebo, higher prechallenge serum anti-GII.4 HBGA-blocking and IgA antibody levels, but not IgG or total antibody levels, were associated with a lower frequency of virus infection and associated illness. Notably, some placebo subjects without measurable serum antibody levels prechallenge did not become infected after norovirus challenge. In vaccinees, anti-GII.4 HBGA-blocking antibody levels of >1:500 were associated with a lower frequency of moderate-to-severe vomiting or diarrheal illness. In this study, prechallenge serum HBGA antibody titers correlated with protection in subjects receiving the placebo; however, other factors may impact the likelihood of infection and illness after virus exposure. (This study is registered at ClinicalTrials.gov under registration number NCT1609257.)., (Copyright © 2015, American Society for Microbiology. All Rights Reserved.)
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- 2015
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30. Characteristics and Clinical Management of a Cluster of 3 Patients With Ebola Virus Disease, Including the First Domestically Acquired Cases in the United States.
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Liddell AM, Davey RT Jr, Mehta AK, Varkey JB, Kraft CS, Tseggay GK, Badidi O, Faust AC, Brown KV, Suffredini AF, Barrett K, Wolcott MJ, Marconi VC, Lyon GM 3rd, Weinstein GL, Weinmeister K, Sutton S, Hazbun M, Albariño CG, Reed Z, Cannon D, Ströher U, Feldman M, Ribner BS, Lane HC, Fauci AS, and Uyeki TM
- Subjects
- Adult, Early Diagnosis, Ebolavirus genetics, Ebolavirus metabolism, Fatal Outcome, Female, Hemorrhagic Fever, Ebola virology, Humans, Male, RNA, Viral blood, Renal Insufficiency etiology, Respiratory Insufficiency etiology, Retrospective Studies, Texas, Viremia diagnosis, Viremia therapy, Critical Care methods, Hemorrhagic Fever, Ebola diagnosis, Hemorrhagic Fever, Ebola therapy
- Abstract
Background: More than 26,000 cases of Ebola virus disease (EVD) have been reported in western Africa, with high mortality. Several patients have been medically evacuated to hospitals in the United States and Europe. Detailed clinical data are limited on the clinical course and management of patients with EVD outside western Africa., Objective: To describe the clinical characteristics and management of a cluster of patients with EVD, including the first cases of Ebola virus (EBOV) infection acquired in the United States., Design: Retrospective clinical case series., Setting: Three U.S. hospitals in September and October 2014., Patients: First imported EVD case identified in the United States and 2 secondary EVD cases acquired in the United States in critical care nurses who cared for the index case patient., Measurements: Clinical recovery, EBOV RNA level, resolution of Ebola viremia, survival with discharge from hospital, or death., Results: The index patient had high EBOV RNA levels, developed respiratory and renal failure requiring critical care support, and died. Both patients with secondary EBOV infection had nonspecific signs and symptoms and developed moderate illness; EBOV RNA levels were moderate, and both patients recovered., Limitation: Both surviving patients received uncontrolled treatment with multiple investigational agents, including convalescent plasma, which limits generalizability of the results., Conclusion: Early diagnosis, prompt initiation of supportive medical care, and moderate clinical illness likely contributed to successful outcomes in both survivors. The inability to determine the potential benefit of investigational therapies and the effect of patient-specific factors that may have contributed to less severe illness highlight the need for controlled clinical studies of these interventions, especially in the setting of a high level of supportive medical care., Primary Funding Source: None.
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- 2015
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31. Persistence of Ebola Virus in Ocular Fluid during Convalescence.
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Varkey JB, Shantha JG, Crozier I, Kraft CS, Lyon GM, Mehta AK, Kumar G, Smith JR, Kainulainen MH, Whitmer S, Ströher U, Uyeki TM, Ribner BS, and Yeh S
- Subjects
- Adult, Convalescence, Fundus Oculi, Humans, Male, Aqueous Humor virology, Ebolavirus isolation & purification, Hemorrhagic Fever, Ebola complications, Panuveitis virology, Vision Disorders virology
- Abstract
Among the survivors of Ebola virus disease (EVD), complications that include uveitis can develop during convalescence, although the incidence and pathogenesis of EVD-associated uveitis are unknown. We describe a patient who recovered from EVD and was subsequently found to have severe unilateral uveitis during convalescence. Viable Zaire ebolavirus (EBOV) was detected in aqueous humor 14 weeks after the onset of EVD and 9 weeks after the clearance of viremia.
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- 2015
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32. Phaeohyphomycosis in transplant recipients: Results from the Transplant Associated Infection Surveillance Network (TRANSNET).
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McCarty TP, Baddley JW, Walsh TJ, Alexander BD, Kontoyiannis DP, Perl TM, Walker R, Patterson TF, Schuster MG, Lyon GM, Wingard JR, Andes DR, Park BJ, Brandt ME, and Pappas PG
- Subjects
- Adult, Aged, Antifungal Agents therapeutic use, Epidemiological Monitoring, Female, Humans, Male, Middle Aged, Opportunistic Infections drug therapy, Opportunistic Infections mortality, Opportunistic Infections pathology, Phaeohyphomycosis drug therapy, Phaeohyphomycosis mortality, Phaeohyphomycosis pathology, Prospective Studies, Survival Analysis, Opportunistic Infections epidemiology, Phaeohyphomycosis epidemiology, Transplant Recipients
- Abstract
Transplant recipients are at a high risk for developing invasive fungal infections. The agents of phaeohyphomycosis are environmental molds found worldwide, and they cause a broad spectrum of disease including skin and subcutaneous lesions, pneumonia, central nervous system disease, fungemia, and disseminated disease. Using data from the Transplant Associated Infection Surveillance Network (TRANSNET), we evaluated patients with proven and probable phaeohyphomycosis. Centers collected data on demographics, co-morbid conditions, clinical features, treatment, and three-month mortality. Fifty-six patients with phaeohyphomycosis were identified from 15 centers, comprising 26 stem cell transplant (SCT) and 30 solid organ transplant (SOT) recipients. Median time to diagnosis post-transplant was 358 days (SCT 100 days; SOT 685 days; P = <.001). The most frequent pathogen was Alternaria species (32%). Disseminated disease was found in 55.4%. Cutaneous infection was more common in SOT (53.3% vs 23.1%; P = .021), while pulmonary disease was more common in SCT (57.7 vs. 26.7; P = .019). Voriconazole (44.6%) and amphotericin B preparations (37.5%) were the most common antifungal therapies. Overall mortality was 25% and was higher in SCT than in SOT (42% vs 10%; P = <.001). A wide variety of organisms encompass phaeohyphomycosis contributing to varying types of infection in transplant recipients. Site of infection, time to disease, and mortality varies significantly between SCT and SOT recipients. Lipid formulations of amphotericin B and voriconazole were the most common antifungals used to treat this disorder., (© The Author 2015. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology.)
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- 2015
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33. Clinical management and humoral immune responses to rabies post-exposure prophylaxis among three patients who received solid organs from a donor with rabies.
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Vora NM, Orciari LA, Niezgoda M, Selvaggi G, Stosor V, Lyon GM 3rd, Wallace RM, Gabel J, Stanek DR, Jenkins P, Shiferaw M, Yager P, Jackson F, Hanlon CA, Damon I, Blanton JD, Recuenco S, and Franka R
- Subjects
- Adult, Humans, Immunity, Humoral, Male, Middle Aged, Post-Exposure Prophylaxis, Rabies transmission, Retrospective Studies, Tissue Donors, Treatment Outcome, Antibodies, Viral blood, Heart Transplantation adverse effects, Kidney Transplantation adverse effects, Liver Transplantation adverse effects, Rabies immunology, Rabies Vaccines administration & dosage, Rabies virus immunology
- Abstract
Background: The rabies virus causes a fatal encephalitis and can be transmitted through organ transplantation. In 2013, a man developed rabies 18 months after receiving a kidney from a donor with rabies, who was not known to have been infected when the organs were procured. Three additional persons who received organs from the same donor (liver, kidney, heart), all of whom were not vaccinated for rabies before transplantation, received rabies post-exposure prophylaxis (PEP) with rabies immune globulin and 5 doses of rabies vaccine as soon as the diagnosis of rabies was made in the donor (18 months after their transplant surgeries). We describe their clinical management., Methods: As the 3 recipients were all on immunosuppressive medications, post-vaccination serologic testing was performed using the rapid fluorescent focus inhibition test to measure rabies virus neutralizing antibodies (RVNAs). An acceptable antibody response to administration of rabies vaccine was defined as detection of RVNAs at a concentration ≥0.1 IU/mL from a serum specimen collected ≥7 days after the fifth vaccine dose., Results: All 3 recipients demonstrated an acceptable antibody response despite their immunosuppressed states. More than 36 months have passed since their transplant surgeries, and all 3 recipients have no evidence of rabies., Conclusions: The survival of 3 previously unvaccinated recipients of solid organs from a donor with rabies is unexpected. Although the precise factors that led to their survival remain unclear, our data suggest that PEP can possibly enhance transplant safety in settings in which donors are retrospectively diagnosed with rabies., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
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- 2015
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34. Treatment of Ebola.
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Mehta AK, Lyon GM, and Varkey JB
- Subjects
- Female, Humans, Male, Antibodies, Monoclonal therapeutic use, Antibodies, Viral therapeutic use, Drugs, Investigational therapeutic use, Ebolavirus immunology, Hemorrhagic Fever, Ebola therapy
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- 2015
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35. Human Ebola virus infection results in substantial immune activation.
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McElroy AK, Akondy RS, Davis CW, Ellebedy AH, Mehta AK, Kraft CS, Lyon GM, Ribner BS, Varkey J, Sidney J, Sette A, Campbell S, Ströher U, Damon I, Nichol ST, Spiropoulou CF, and Ahmed R
- Subjects
- CD4-Positive T-Lymphocytes metabolism, CD8-Positive T-Lymphocytes metabolism, Ebolavirus metabolism, Enzyme-Linked Immunosorbent Assay, Flow Cytometry, Hemorrhagic Fever, Ebola blood, Hemorrhagic Fever, Ebola virology, Humans, Immunity, Humoral immunology, Immunoglobulin G blood, Immunoglobulin G immunology, Immunophenotyping, Interferon-gamma immunology, Interferon-gamma metabolism, Lymphocyte Activation immunology, Precursor Cells, B-Lymphoid immunology, Precursor Cells, B-Lymphoid metabolism, Tumor Necrosis Factor-alpha immunology, Tumor Necrosis Factor-alpha metabolism, Viral Proteins immunology, Viral Proteins metabolism, CD4-Positive T-Lymphocytes immunology, CD8-Positive T-Lymphocytes immunology, Ebolavirus immunology, Hemorrhagic Fever, Ebola immunology, Immunity, Cellular immunology
- Abstract
Four Ebola patients received care at Emory University Hospital, presenting a unique opportunity to examine the cellular immune responses during acute Ebola virus infection. We found striking activation of both B and T cells in all four patients. Plasmablast frequencies were 10-50% of B cells, compared with less than 1% in healthy individuals. Many of these proliferating plasmablasts were IgG-positive, and this finding coincided with the presence of Ebola virus-specific IgG in the serum. Activated CD4 T cells ranged from 5 to 30%, compared with 1-2% in healthy controls. The most pronounced responses were seen in CD8 T cells, with over 50% of the CD8 T cells expressing markers of activation and proliferation. Taken together, these results suggest that all four patients developed robust immune responses during the acute phase of Ebola virus infection, a finding that would not have been predicted based on our current assumptions about the highly immunosuppressive nature of Ebola virus. Also, quite surprisingly, we found sustained immune activation after the virus was cleared from the plasma, observed most strikingly in the persistence of activated CD8 T cells, even 1 mo after the patients' discharge from the hospital. These results suggest continued antigen stimulation after resolution of the disease. From these convalescent time points, we identified CD4 and CD8 T-cell responses to several Ebola virus proteins, most notably the viral nucleoprotein. Knowledge of the viral proteins targeted by T cells during natural infection should be useful in designing vaccines against Ebola virus.
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- 2015
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36. Norovirus vaccine against experimental human GII.4 virus illness: a challenge study in healthy adults.
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Bernstein DI, Atmar RL, Lyon GM, Treanor JJ, Chen WH, Jiang X, Vinjé J, Gregoricus N, Frenck RW Jr, Moe CL, Al-Ibrahim MS, Barrett J, Ferreira J, Estes MK, Graham DY, Goodwin R, Borkowski A, Clemens R, and Mendelman PM
- Subjects
- Adjuvants, Immunologic administration & dosage, Adolescent, Adult, Double-Blind Method, Female, Gastroenteritis virology, Humans, Lipid A administration & dosage, Lipid A analogs & derivatives, Male, Middle Aged, Vaccination, Viral Load, Viral Vaccines administration & dosage, Young Adult, Caliciviridae Infections prevention & control, Gastroenteritis prevention & control, Norovirus immunology
- Abstract
Background: Vaccines against norovirus, the leading cause of acute gastroenteritis, should protect against medically significant illness and reduce transmission., Methods: In this randomized, double-blind, placebo-controlled trial, 18- to 50-year-olds received 2 injections of placebo or norovirus GI.1/GII.4 bivalent vaccine-like particle (VLP) vaccine with 3-O-desacyl-4'-monophosphoryl lipid A (MPL) and alum. Participants were challenged as inpatients with GII.4 virus (4400 reverse transcription polymerase chain reaction [RT-PCR] units), and monitored for illness and infection., Results: Per protocol, 27 of 50 (54.0%) vaccinees and 30 of 48 (62.5%) controls were infected. Using predefined illness and infection definitions, vaccination did not meet the primary endpoint, but self-reported cases of severe (0% vaccinees vs. 8.3% controls; P = .054), moderate or greater (6.0% vs. 18.8%; P = .068), and mild or greater severity of vomiting and/or diarrhea (20.0% vs. 37.5%; P = .074) were less frequent. Vaccination also reduced the modified Vesikari score from 7.3 to 4.5 (P = .002). Difficulties encountered were low norovirus disease rate, and inability to define illness by quantitative RT-PCR or further antibody rise in vaccinees due to high vaccine-induced titers. By day 10, 11 of 49 (22.4%) vaccinees were shedding virus compared with 17 of 47 (36.2%) placebo recipients (P = .179)., Conclusions: Bivalent norovirus VLP vaccine reduced norovirus-related vomiting and/or diarrhea; field efficacy studies are planned. Clinical Trials Registration. NCT01609257., (© The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.)
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- 2015
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37. Communication gaps associated with donor-derived infections.
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Miller R, Covington S, Taranto S, Carrico R, Ehsan A, Friedman B, Green M, Ison MG, Kaul D, Kubak B, Lebovitz DJ, Lyon GM, Nalesnik MA, Pruett TL, Teperman L, Vasudev B, and Blumberg E
- Subjects
- Humans, Prognosis, Transplant Recipients, Communication, Disease Transmission, Infectious, Organ Transplantation adverse effects, Tissue Donors supply & distribution, Tissue and Organ Procurement
- Abstract
The detection and management of potential donor-derived infections is challenging, in part due to the complexity of communications between diverse labs, organ procurement organizations (OPOs), and recipient transplant centers. We sought to determine if communication delays or errors occur in the reporting and management of donor-derived infections and if these are associated with preventable adverse events in recipients. All reported potential donor-derived transmission events reviewed by the Organ Procurement and Transplantation Network Ad Hoc Disease Transmission Advisory Committee from January 2008 to June 2010 were evaluated for communication gaps between the donor center, OPO and transplant centers. The impact on recipient outcomes was then determined. Fifty-six infection events (IEs; involving 168 recipients) were evaluated. Eighteen IEs (48 recipients) were associated with communication gaps, of which 12 resulted in adverse effects in 69% of recipients (20/29), including six deaths. When IEs and test results were reported without delay, appropriate interventions were taken, subsequently minimizing or averting recipient infection (23 IEs, 72 recipients). Communication gaps in reported IEs are frequent, occur at multiple levels in the communication process, and contribute to adverse outcomes among affected transplant recipients. Conversely, effective communication minimized or averted infection in transplant recipients., (© Copyright 2014 The American Society of Transplantation and the American Society of Transplant Surgeons.)
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- 2015
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38. Radiographic imaging for patients with contagious infectious diseases: how to acquire chest radiographs of patients infected with the Ebola virus.
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Auffermann WF, Kraft CS, Vanairsdale S, Lyon GM 3rd, and Tridandapani S
- Subjects
- Cross Infection diagnostic imaging, Georgia, Humans, Cross Infection prevention & control, Hemorrhagic Fever, Ebola diagnostic imaging, Hemorrhagic Fever, Ebola prevention & control, Patient Safety standards, Practice Guidelines as Topic, Radiography, Thoracic standards, Safety Management standards
- Abstract
Objective: Contagious infectious diseases add a new dimension to radiology and pose many unanswered questions. In particular, what is the safest way to image patients with contagious and potentially lethal infectious diseases? Here, we describe protocols used by Emory University to successfully acquire chest radiographs of patients with Ebola virus disease., Conclusion: Radiology departments need to develop new protocols for various modalities used in imaging patients with contagious and potentially lethal infectious diseases.
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- 2015
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39. Predictors of immune reconstitution syndrome in organ transplant recipients with cryptococcosis: implications for the management of immunosuppression.
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Sun HY, Alexander BD, Huprikar S, Forrest GN, Bruno D, Lyon GM, Wray D, Johnson LB, Sifri CD, Razonable RR, Morris MI, Stosor V, Wagener MM, and Singh N
- Subjects
- Aged, Calcineurin Inhibitors administration & dosage, Female, Humans, Male, Middle Aged, Prevalence, Risk Factors, Cryptococcosis complications, Immune Reconstitution Inflammatory Syndrome epidemiology, Immunosuppression Therapy methods, Organ Transplantation adverse effects, Transplant Recipients
- Abstract
Background: Risk factors including how changes in immunosuppression influence the occurrence of immune reconstitution syndrome (IRS) in solid organ transplant (SOT) recipients with cryptococcosis have not been fully defined., Methods: SOT recipients with cryptococcosis were identified and followed for 12 months. IRS was defined based on previously proposed criteria., Results: Of 89 SOT recipients, 13 (14%) developed IRS. Central nervous system (CNS) disease (adjusted odds ratio [AOR], 6.23; P = .03) and discontinuation of calcineurin inhibitor (AOR, 5.11; P = .02) were independently associated with IRS. Only 2.6% (1/13) of the patients without these risk factors developed IRS compared with 18.8% (6/32) with 1 risk factor, and 50% (6/12) with both risk factors (χ(2) for trend, P = .0001). Among patients with CNS disease, those with neuroimaging abnormalities (P = .03) were more likely to develop IRS, irrespective of serum or CSF cryptococcal antigen titers and fungemia. Graft rejection after cryptococcosis was observed in 15.4% (2/13) of the patients with IRS compared with 2.6% (2/76) of those without IRS (P = .07)., Conclusions: We determined variables that pose a risk for IRS and have shown that discontinuation of calcineurin inhibitors was independently associated with 5-fold increased risk of IRS in transplant recipients with cryptococcosis., (© The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.)
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- 2015
- Full Text
- View/download PDF
40. Successful delivery of RRT in Ebola virus disease.
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Connor MJ Jr, Kraft C, Mehta AK, Varkey JB, Lyon GM, Crozier I, Ströher U, Ribner BS, and Franch HA
- Subjects
- Acute Kidney Injury complications, Health Personnel, Hemorrhagic Fever, Ebola complications, Humans, Occupational Exposure, Patient Safety, Pilot Projects, Practice Guidelines as Topic, Real-Time Polymerase Chain Reaction, Treatment Outcome, Acute Kidney Injury therapy, Communicable Disease Control methods, Hemorrhagic Fever, Ebola therapy, Patient Isolation methods, Renal Replacement Therapy methods
- Abstract
AKI has been observed in cases of Ebola virus disease. We describe the protocol for the first known successful delivery of RRT with subsequent renal recovery in a patient with Ebola virus disease treated at Emory University Hospital, in Atlanta, Georgia. Providing RRT in Ebola virus disease is complex and requires meticulous attention to safety for the patient, healthcare workers, and the community. We specifically describe measures to decrease the risk of transmission of Ebola virus disease and report pilot data demonstrating no detectable Ebola virus genetic material in the spent RRT effluent waste. This article also proposes clinical practice guidelines for acute RRT in Ebola virus disease., (Copyright © 2015 by the American Society of Nephrology.)
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- 2015
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- View/download PDF
41. Clinical care of two patients with Ebola virus disease in the United States.
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Lyon GM, Mehta AK, Varkey JB, Brantly K, Plyler L, McElroy AK, Kraft CS, Towner JS, Spiropoulou C, Ströher U, Uyeki TM, and Ribner BS
- Subjects
- Adult, Disease Outbreaks, Female, Hemorrhagic Fever, Ebola drug therapy, Hemorrhagic Fever, Ebola epidemiology, Humans, Liberia, Male, Middle Aged, United States, Antibodies, Monoclonal therapeutic use, Antibodies, Viral therapeutic use, Drugs, Investigational therapeutic use, Ebolavirus immunology, Hemorrhagic Fever, Ebola therapy
- Abstract
West Africa is currently experiencing the largest outbreak of Ebola virus disease (EVD) in history. Two patients with EVD were transferred from Liberia to our hospital in the United States for ongoing care. Malaria had also been diagnosed in one patient, who was treated for it early in the course of EVD. The two patients had substantial intravascular volume depletion and marked electrolyte abnormalities. We undertook aggressive supportive measures of hydration (typically, 3 to 5 liters of intravenous fluids per day early in the course of care) and electrolyte correction. As the patients' condition improved clinically, there was a concomitant decline in the amount of virus detected in plasma.
- Published
- 2014
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42. Ebola hemorrhagic fever in 2014: the tale of an evolving epidemic.
- Author
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Del Rio C, Mehta AK, Lyon GM 3rd, and Guarner J
- Subjects
- Africa epidemiology, Hemorrhagic Fever, Ebola diagnosis, Hemorrhagic Fever, Ebola transmission, Hemorrhagic Fever, Ebola virology, Humans, Ebolavirus, Epidemics, Hemorrhagic Fever, Ebola epidemiology
- Published
- 2014
- Full Text
- View/download PDF
43. Reply to "Insufficient demonstration of long-term stability of Aspergillus galactomannan".
- Author
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Wheat LJ, Nguyen MH, Alexander BD, Denning D, Caliendo AM, Lyon GM, Baden LR, Marty FM, Clancy C, Kirsch E, Noth P, Witt J, Sugrue M, and Wingard JR
- Subjects
- Humans, Aspergillosis diagnosis, Aspergillus isolation & purification, Bronchoalveolar Lavage Fluid chemistry, Freezing, Mannans analysis, Serum chemistry, Specimen Handling methods
- Published
- 2014
- Full Text
- View/download PDF
44. Solid organ transplant donors with central nervous system infection.
- Author
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Kaul DR, Covington S, Taranto S, Green M, Lyon GM, Kusne S, Miller RA, and Blumberg EA
- Subjects
- Adult, Balamuthia mandrillaris, Central Nervous System microbiology, Central Nervous System parasitology, Central Nervous System virology, Cryptococcus neoformans, Databases, Factual, Female, Humans, Lymphocytic choriomeningitis virus, Male, Middle Aged, Organ Transplantation adverse effects, Risk, West Nile virus, Central Nervous System Infections transmission, Organ Transplantation methods, Tissue Donors
- Abstract
Background: While donor-derived infections (DDI) remain uncommon, multiple reports describe DDI with pathogens that cause central nervous system (CNS) infection resulting in significant recipient disease. The Ad Hoc Disease Transmission Advisory Committee (DTAC) reviewed the records of potential donor-derived disease transmission events (PDDTE) to describe donor characteristics and outcomes associated with DDI from CNS pathogens., Methods: All PDDTE reported from January 2008 to September 2010 were reviewed for characteristics suggesting CNS infection in the donor or the recipient. Identified cases were further examined to determine if donor CNS infection resulted in recipient infection., Results: Ninety-one PDDTE cases in which there was concern for CNS infection in the donor or recipient were identified. Further review confirmed CNS infection in 12 donors, six of whom transmitted infection to 10 of 15 exposed recipients with five recipient deaths. Pathogens included Balamuthia mandrillaris, Cryptococcus neoformans, lymphocytic choriomeningitis virus, and West Nile virus. Listed cause of death at procurement for these donors included stroke, anoxia, acute disseminated encephalomyelitis, and meningoencephalitis. Confounding diagnoses were present in 6 of 12 donors that would have allowed them to be considered at low risk of transmitting a CNS pathogen. Of the six donors with no confounding conditions, three exhibited at least two suspicious "DTAC warning criteria" for CNS infection., Conclusion: Careful clinical assessment of donors combined with a high index of suspicion for ambiguous or misleading findings associated with CNS infection can reduce, but not eliminate, DDI with CNS pathogens.
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- 2014
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45. Severity of rhinovirus infection in hospitalized adults is unrelated to genotype.
- Author
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McCulloch DJ, Sears MH, Jacob JT, Lyon GM, Burd EM, Caliendo AM, Hill CE, Nix WA, Oberste MS, and Kraft CS
- Subjects
- Adult, Aged, Asthma diagnosis, Female, Genetic Testing methods, Genotype, Hospitalization, Humans, Male, Middle Aged, RNA, Viral analysis, Respiratory Tract Infections diagnosis, Reverse Transcriptase Polymerase Chain Reaction methods, Asthma virology, Picornaviridae Infections virology, Respiratory Tract Infections virology, Rhinovirus genetics
- Abstract
Objectives: To determine whether rhinovirus (RV) species is associated with more severe clinical illness in adults., Methods: Seventy-two RV-positive viral respiratory samples from adult patients were sequenced and analyzed phylogenetically after reverse transcriptase polymerase chain reaction of the region spanning the VP4 gene and 5' terminus of the VP2 gene. The clinical features and severity of illness associated with the different RV species were compared., Results: Phylogenetic analysis identified three distinct clusters as RV-A (54%), B (11%), or C (35%) species. In an unadjusted model, patients with RV-B infection were significantly more likely to have the composite outcome variable of death or intensive care unit admission (P=.03), but this effect diminished when controlling for patient sex. A logistic model of the relationship between RV species and adverse outcomes produced nonsignificant odds ratios when controlling for patient sex., Conclusions: Infection with RV-A or RV-B was associated with greater severity of illness in our adult population; however, the association disappeared after controlling for confounders., (Copyright© by the American Society for Clinical Pathology.)
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- 2014
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46. Race and invasive fungal infection in solid organ transplant recipients.
- Author
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Boehme AK, McGwin G, Andes DR, Lyon GM, Chiller T, Pappas PG, and Baddley JW
- Subjects
- Adult, Age Factors, Case-Control Studies, Female, Humans, Male, Middle Aged, Risk Factors, Sex Factors, Black or African American, Health Status Disparities, Mycoses ethnology, Organ Transplantation, White People
- Abstract
Health disparities in access to solid organ transplantation (SOT) and graft survival are well recognized, but there are limited data on the relationship of race to risk of invasive fungal infection (IFI) among SOT recipients. We conducted a case-control study using data from the Transplant-Associated Infection Surveillance Network (TRANSNET) to investigate race and IFI. Cases (n = 1,214) and controls (n = 16,550) were compared on demographic variables using chi-square, and the relationship between race and IFI was assesses with unconditional logistic regression. Compared to White transplant patients, Blacks had similar odds of developing IFI (OR = .97, 95% Cl 0.82-1.15, P = .7125), while participants who identified as other ethnicity were less likely to develop IFI (OR = .56, 95% Cl .41-.75, P < .001). Blacks, when compared to White patients, were at increased odds of developing cryptococcal infection (OR 2.19, 95% CI 1.35-3.54, P = .002). Despite pharmacogenetic differences, Black transplant recipients were not more likely overall to develop IFI compared to White transplant recipients.
- Published
- 2014
47. Long-term stability at -20 °C of Aspergillus galactomannan in serum and bronchoalveolar lavage specimens.
- Author
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Wheat LJ, Nguyen MH, Alexander BD, Denning D, Caliendo AM, Lyon GM, Baden LR, Marty FM, Clancy C, Kirsch E, Noth P, Witt J, Sugrue M, and Wingard JR
- Subjects
- Galactose analogs & derivatives, Humans, Immunoenzyme Techniques methods, Time Factors, Aspergillosis diagnosis, Aspergillus isolation & purification, Bronchoalveolar Lavage Fluid chemistry, Freezing, Mannans analysis, Serum chemistry, Specimen Handling methods
- Abstract
Research to develop and validate novel methods for diagnosis of aspergillosis based on detection of galactomannan requires the use of clinical specimens that have been stored frozen. Data indicating that galactomannan remains stable when frozen are scant. The objective of this study was to determine the stability of galactomannan in clinical specimens stored at -20 °C that were positive in the Platelia Aspergillus enzyme immunoassay when initially tested. Prospective real-time testing of serum and bronchoalveolar lavage (BAL) fluid pools from positive and negative patient specimens showed no decline in galactomannan index (GMI) over 11 months at -20 °C and no development of positive reactions in the negative-control pool. Retrospective testing of positive specimens that had been stored at -20 °C for 5 years showed that 28 of 30 serum (n = 15) or BAL (n = 15) specimens remained positive. These findings support the use of frozen serum or BAL specimens stored for at least 5 years in evaluation of diagnostic tests based on detection of galactomannan., (Copyright © 2014, American Society for Microbiology. All Rights Reserved.)
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- 2014
- Full Text
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48. Endemic fungal infections in solid organ and hematopoietic cell transplant recipients enrolled in the Transplant-Associated Infection Surveillance Network (TRANSNET).
- Author
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Kauffman CA, Freifeld AG, Andes DR, Baddley JW, Herwaldt L, Walker RC, Alexander BD, Anaissie EJ, Benedict K, Ito JI, Knapp KM, Lyon GM, Marr KA, Morrison VA, Park BJ, Patterson TF, Schuster MG, Chiller TM, and Pappas PG
- Subjects
- Adolescent, Adult, Aged, Amphotericin B therapeutic use, Antifungal Agents therapeutic use, Blastomycosis drug therapy, Child, Coccidioidomycosis drug therapy, Coinfection drug therapy, Coinfection epidemiology, Comorbidity, Female, Histoplasmosis drug therapy, Humans, Incidence, Itraconazole therapeutic use, Male, Middle Aged, Prospective Studies, Respiratory Tract Infections epidemiology, Respiratory Tract Infections microbiology, Time Factors, United States epidemiology, Young Adult, Blastomycosis epidemiology, Coccidioidomycosis epidemiology, Endemic Diseases, Hematopoietic Stem Cell Transplantation adverse effects, Histoplasmosis epidemiology, Organ Transplantation adverse effects
- Abstract
Background: Invasive fungal infections are a major cause of morbidity and mortality among solid organ transplant (SOT) and hematopoietic cell transplant (HCT) recipients, but few data have been reported on the epidemiology of endemic fungal infections in these populations., Methods: Fifteen institutions belonging to the Transplant-Associated Infection Surveillance Network prospectively enrolled SOT and HCT recipients with histoplasmosis, blastomycosis, or coccidioidomycosis occurring between March 2001 and March 2006., Results: A total of 70 patients (64 SOT recipients and 6 HCT recipients) had infection with an endemic mycosis, including 52 with histoplasmosis, 9 with blastomycosis, and 9 with coccidioidomycosis. The 12-month cumulative incidence rate among SOT recipients for histoplasmosis was 0.102%. Occurrence of infection was bimodal; 28 (40%) infections occurred in the first 6 months post transplantation, and 24 (34%) occurred between 2 and 11 years post transplantation. Three patients were documented to have acquired infection from the donor organ. Seven SOT recipients with histoplasmosis and 3 with coccidioidomycosis died (16%); no HCT recipient died., Conclusions: This 5-year multicenter prospective surveillance study found that endemic mycoses occur uncommonly in SOT and HCT recipients, and that the period at risk extends for years after transplantation., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
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- 2014
- Full Text
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49. Fecal microbiota transplantation for refractory Clostridium difficile colitis in solid organ transplant recipients.
- Author
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Friedman-Moraco RJ, Mehta AK, Lyon GM, and Kraft CS
- Subjects
- Aged, Clostridioides difficile pathogenicity, Clostridium Infections etiology, Colitis etiology, Diarrhea etiology, Diarrhea therapy, Feces microbiology, Female, Humans, Prognosis, Recurrence, Transplant Recipients, Clostridium Infections therapy, Colitis therapy, Drug Resistance, Multiple, Bacterial, Feces cytology, Kidney Transplantation adverse effects, Lung Transplantation adverse effects, Microbiota
- Abstract
Fecal microbiota transplantation (FMT) has been shown to be safe and efficacious in individuals with refractory Clostridium difficile. It has not been widely studied in individuals with immunosuppression due to concerns about infectious complications. We describe two solid organ transplant recipients, one lung and one renal, in this case report that both had resolution of their diarrhea caused by C. difficile after FMT. Both recipients required two FMTs to achieve resolution of their symptoms and neither had infectious complications. Immunosuppressed individuals are at high risk for acquisition of C. difficile and close monitoring for infectious complications after FMT is necessary, but should not preclude its use in patients with refractory disease due to C. difficile. Sequential FMT may be used to achieve cure in these patients with damaged microbiota from antibiotic use and immunosuppression., (© Copyright 2014 The American Society of Transplantation and the American Society of Transplant Surgeons.)
- Published
- 2014
- Full Text
- View/download PDF
50. Risk for transmission of Naegleria fowleri from solid organ transplantation.
- Author
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Roy SL, Metzger R, Chen JG, Laham FR, Martin M, Kipper SW, Smith LE, Lyon GM 3rd, Haffner J, Ross JE, Rye AK, Johnson W, Bodager D, Friedman M, Walsh DJ, Collins C, Inman B, Davis BJ, Robinson T, Paddock C, Zaki SR, Kuehnert M, DaSilva A, Qvarnstrom Y, Sriram R, and Visvesvara GS
- Subjects
- Adolescent, Adult, Amebiasis mortality, Central Nervous System Protozoal Infections mortality, Child, Fatal Outcome, Female, Humans, Male, Amebiasis parasitology, Amebiasis transmission, Central Nervous System Protozoal Infections parasitology, Central Nervous System Protozoal Infections transmission, Naegleria fowleri pathogenicity, Organ Transplantation adverse effects, Tissue Donors
- Abstract
Primary amebic meningoencephalitis (PAM) caused by the free-living ameba (FLA) Naegleria fowleri is a rare but rapidly fatal disease of the central nervous system (CNS) affecting predominantly young, previously healthy persons. No effective chemotherapeutic prophylaxis or treatment has been identified. Recently, three transplant-associated clusters of encephalitis caused by another FLA, Balamuthia mandrillaris, have occurred, prompting questions regarding the suitability of extra-CNS solid organ transplantation from donors with PAM. During 1995-2012, 21 transplant recipients of solid organs donated by five patients with fatal cases of PAM were reported in the United States. None of the recipients developed PAM, and several recipients tested negative for N. fowleri by serology. However, historical PAM case reports and animal experiments with N. fowleri, combined with new postmortem findings from four patients with PAM, suggest that extra-CNS dissemination of N. fowleri can occur and might pose a risk for disease transmission via transplantation. The risks of transplantation with an organ possibly harboring N. fowleri should be carefully weighed for each individual recipient against the potentially greater risk of delaying transplantation while waiting for another suitable organ. In this article, we present a case series and review existing data to inform such risk assessments., (© Copyright 2013 The American Society of Transplantation and the American Society of Transplant Surgeons.)
- Published
- 2014
- Full Text
- View/download PDF
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