Clinical Infectious Diseases

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BACKGROUND: The inability to identify individuals with acute fever at risk of death is a barrier to effective triage and management of severe infections, especially in low-resource settings. Since endothelial and immune activation contribute to the pathogenesis of various distinct life-threatening infections, we hypothesized that measuring mediators of these pathways at clinical presentation would identify febrile adults at risk of death. METHODS: Plasma concentrations of markers of endothelial (Angpt-2, sFlt-1, sVCAM-1, sICAM-1) and immune (sTREM-1, IL-6, IL-8, CHI3L1, sTNFR1, PCT, CRP) activation pathways were determined in consecutive adults with acute fever (>38°C) at presentation to outpatient clinics in Dar es Salaam, Tanzania...

BACKGROUND: Safety and tolerability of analytical treatment interruptions (ATIs) as a vital part of HIV-1 cure studies are discussed. We analyzed current evidence for occurrence of adverse events (AEs) during treatment interruptions (TIs). METHODS: Our analysis included studies reporting on AEs in HIV-1 infected patients undergoing TIs (including ATIs and structured TIs). All interventional and observational studies were reviewed and results extracted based on predefined criteria...

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BACKGROUND: The exact contribution of congenital CMV infection (cCMV) to congenital and early-onset permanent hearing loss in highly seropositive populations is unknown. OBJECTIVES: To determine the contribution of the cCMV to hearing impairment and to estimate the effectiveness of newborn hearing screening (HS) in identifying infants with CMV-related hearing loss. STUDY DESIGN: A total of 11,900 infants born from a population with ≥97% maternal seroprevalence were screened for cCMV and hearing loss...

BACKGROUND: To eliminate hepatitis B virus (HBV) infection, it is essential to scale up testing and treatment. However, conventional tools to assess treatment eligibility, particularly nucleic acid testing (NAT) to quantify HBV DNA, are hardly available and affordable in resource-limited countries. We therefore assessed the performance of novel immunoassay, hepatitis B core-related antigen (HBcrAg), as an inexpensive (US$ <10-15/assay) alternative to NAT to diagnose clinically important HBV DNA thresholds (≥2,000; ≥20,000; and ≥200,000 IU/ml), and select patients for antiviral therapy in Africa...

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Observational studies have consistently shown that influenza vaccine effectiveness is lower for H3N2 relative to H1N1pdm09 and type B, and this is not entirely explained by antigenic match. The triad of virus, vaccine, and host immunity provides a framework to examine contributing factors. Antigenic evolution facilitates H3N2 immune escape, and increasing glycosylation of the hemagglutinin shields antigenic sites from antibody binding. Egg passage adaptation of vaccine viruses generates mutations that alter glycosylation, impair the neutralizing antibody response, and reduce vaccine effectiveness...

Estimates of the number of deaths from antimicrobial-resistant (AMR) infections are important data for clinicians and public health officials advocating for resources to prevent and treat these infections. The aims of this paper are to describe the various approaches to calculating deaths from AMR infections, to compare the tally of deaths by each approach, and to explain how to interpret the results. Currently, none of the three methods employed by vital statistics systems to count deaths from specific causes (underlying cause of deaths, multiple causes of death, and avoidable deaths) count deaths from AMR infections...

BACKGROUND: Recent studies have reported weight gain in virologically-suppressed persons living with HIV (PLWH) switched from older antiretroviral therapy (ART) to newer integrase strand transfer inhibitor (INSTI)-based regimens. In this study, we investigated whether weight gain differs among treatment-naïve PLWH starting INSTI-based regimens compared to other ART regimens. METHODS: Adult, treatment-naïve PLWH in the Vanderbilt Comprehensive Care Clinic cohort initiating INSTI, protease inhibitor (PI), and non-nucleoside reverse-transcriptase inhibitor (NNRTI)-based ART between January 2007 and June 2016 were included...

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BACKGROUND: Many people who inject drugs in the US have chronic Hepatitis C (HCV). Onsite treatment in opiate agonist treatment (OAT) programs addresses HCV treatment barriers, but few evidence-based models exist. METHODS: We evaluated the cost-effectiveness of HCV treatment models for OAT patients using data from a randomized trial conducted in Bronx, NY. We used a decision analytic model to compare self-administered individual treatment (SIT), group treatment (GT), directly observed therapy (DOT), and no intervention for a simulated cohort with demographic characteristics of trial participants...

BACKGROUND: Reactive case detection (RACD) is a widely practiced malaria elimination intervention whereby close contacts of index cases receive malaria testing to inform treatment and other interventions. However, the optimal diagnostic and operational approaches for this resource-intensive strategy are not clear. METHODS: We conducted a three-year prospective national evaluation of RACD in Eswatini, a malaria elimination setting. Loop-mediated isothermal amplification (LAMP) was compared to traditional rapid diagnostic test (RDT) for the improved detection of infections, and hotspots (RACD events yielding ≥1 additional infection)...

BACKGROUND: Hepatitis C virus (HCV) testing and treatment uptake in prisons remains low. We aimed to estimate clinical outcomes, cost-effectiveness (CE), and budgetary impact (BI) of HCV testing and treatment in United States (U.S.) prisons or linkage to care at release. METHODS: We used individual-based simulation modeling with healthcare and Department of Corrections (DOC) perspectives for CE and BI analyses, respectively. We simulated a U.S. prison cohort at entry using published data and Washington State DOC individual-level data...

BACKGROUND: Outpatient antibiotic prescribing for acute upper respiratory infections (URI) is a high priority target for antimicrobial stewardship that has not been described for cancer patients. METHODS: We conducted a retrospective cohort study of adult patients at an ambulatory cancer center with ICD-10 diagnosis code consistent with URI from October 1, 2015 to September 30, 2016. We obtained antimicrobial prescribing, respiratory viral testing, and other clinical data at first encounter for the URI through day 14...

BACKGROUND: Pneumococcal conjugate vaccines (PCV) have reduced pneumococcal diseases globally. Pneumococcal genomic surveys elucidate PCV effects on population structure but are rarely conducted in low-income settings despite the high disease burden. METHODS: We undertook whole genome sequencing of 660 pneumococcal isolates collected through surveys from healthy carriers two years from PCV14 introduction and one-year post-rollout in northern Malawi. We investigated changes in population structure, within-lineage serotype dynamics, serotype diversity, and frequency of antibiotic resistance (ABR) and accessory genes...

BACKGROUND: Timely availability of microbiological results from positive blood cultures is essential to enable early pathogen-directed therapy. The Accelerate Pheno™ system (ADX) is a novel technology using fluorescence in-situ hybridization for rapid species identification (ID) and morphokinetic bacterial analysis for phenotypic antimicrobial susceptibility testing (AST) with promising results. Yet the impact of this technology on clinical management and patient outcome remains unclear...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

No abstract text is available yet for this article.