Open Forum Infectious Diseases

Journal Information
ISSN / EISSN : 2328-8957 / 2328-8957
Current Publisher: Oxford University Press (OUP) (10.1093)
Total articles ≅ 16,295
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, Xiaoyan Lu, Eileen Schneider, Amelia Langston, Carla L Ellis, Stephen Pastan, Julu Bhatnagar, Sarah Reagan-Steiner, Pallavi Annambhotla, Stephen Lindstrom, et al.
Open Forum Infectious Diseases; doi:10.1093/ofid/ofab092

Background Human adenovirus (HAdV) infections can lead to high mortality in solid organ transplant (SOT) recipients, with rare reports of donor-derived infection. Methods Two renal transplant recipients with HAdV-11 infection who received kidneys from the same donor are described. Whole genome sequencing (WGS) was performed. Results WGS showed 100% nucleotide sequence identity for the two HAdV-11 isolates. The patients presented with distinct clinical syndromes, and both were treated with brincidofovir. Conclusions Donor-derived HAdV infection is presumed to be low, however disseminated HAdV in SOT recipients can be severe and clinicians should be aware of the clinical course and treatment options.
Hye-Rin Kang, Eui Jin Hwang, Sung A Kim, Sun Mi Choi, Jinwoo Lee, Chang-Hoon Lee, Jae-Joon Yim,
Open Forum Infectious Diseases; doi:10.1093/ofid/ofab087

Background The presence of cavities is a poor prognostic factor in patients with nontuberculous mycobacterial pulmonary disease (NTM-PD). However, little is known about the characteristics of such cavities and their impact on clinical outcomes. The aim of this study is to investigate the size of cavities and their implications on treatment outcomes and mortality in patients with NTM-PD. Methods We included patients diagnosed with NTM-PD at Seoul National University Hospital between 1 January 2007 and 31 December 2018. We measured the size of cavities on chest computed tomography scans performed at the time of diagnosis, and used multivariable logistic regression and Cox-proportional hazards regression analysis to investigate the impact of these measurements on treatment outcomes and mortality. Results The study cohort comprised 421 patients (non-cavitary, n=329; cavitary, n=92) with NTM-PD. During a median follow-up period of 49 months, 118 (35.9%) of the 329 patients with non-cavitary and 64 (69.6%) of the 92 patients with cavitary NTM-PD received antibiotic treatment. Cavities >2 cm were associated with worse treatment outcomes (adjusted odds ratio, 0.41; 95% confidence interval [CI], 0.17–0.96) and higher mortality (adjusted hazard ratio, 2.52; 95% CI, 1.09–5.84), while there was no difference in treatment outcomes and mortality between patients with cavities ≤2 cm and patients with non-cavitary NTM-PD. Conclusions Clinical outcomes are different according to the size of cavities in patients with cavitary NTM-PD; thus the measurement of the size of cavities could help in making clinical decisions.
, Seung Hyun Won, Hsing-Chuan Hsieh, , Karl Kronmann, Ryan C Maves, Gregory Utz, Christina Schofield, Rhonda E Colombo, Jason F Okulicz, et al.
Open Forum Infectious Diseases; doi:10.1093/ofid/ofab076

Background As morbidity due to viral co-infections declines among HIV-infected persons, changes in liver related morbidity are anticipated. We examined data from the US Military HIV Natural History Study (NHS), a cohort of military beneficiaries, to evaluate incidence and risk factors associated with chronic liver enzyme elevation (cLEE) in HIV mono-infected patients in the combination antiretroviral therapy (cART) era. Methods Participants who were HBV and HCV seronegative with follow-up after 1996 were included. We defined chronic liver enzyme elevation (cLEE) as alanine aminotransferase (ALT) elevations ≥ 1.25 times the upper limit of normal on at least two visits, for a duration of six months or more within 2 years. We used multivariate Cox proportional hazards models to examine risk factors for cLEE. Results Of 2,779 participants, 309 (11%) met criteria for cLEE for an incidence of 1.28/100 PYFU (1.28 – 1.29). In an adjusted model, cLEE was associated with Hispanic/other ethnicity [Reference Caucasian: HR 1.744 (1.270 – 2.395)], non–nucleoside reverse transcriptase (NNRTI) based cART [Reference boosted protease inhibitors: HR 2.232 (1.378 – 3.616)], being cART naïve [HR 6.046 (3.686 – 9.915)] or having cART interruptions [HR 8.671 (4.651 – 16.164)]. African American race [HR 0.669 (0.510 – 0.877)] and integrase strand transfer inhibitor (INSTI) based cART [HR 0.222 (0.104 – 0.474)] were protective. Conclusions Our findings demonstrate initiation and continued use of cART is protective against cLEE and supports the hypothesis HIV infection directly impacts the liver. INSTI based regimens were protective and could be considered in persons with cLEE.
, Seth Helfenstein, Alfred Mahr, Selina Crippa, Regine Garcia Boy, Christian R Kahlert, Timur Yurttas, Christoph Hatz,
Open Forum Infectious Diseases; doi:10.1093/ofid/ofab088

Kawasaki Disease (KD) is a vasculitis that mostly occurs in children, but rare cases in adults have been reported. We describe the case of a 43-year-old Swiss male, who developed symptoms compatible with KD seven weeks after leptospirosis, which was presumably acquired after swimming in a creek in the Swiss Alps. We performed a literature review and identified 10 other cases (all in children), where Kawasaki-like disease was diagnosed in the context of leptospirosis. Outcome was favourable in most cases, including our patient. This exceptional case demonstrates both the possibility of autochthonous cases of leptospirosis in Switzerland as well as a possible association of leptospirosis with Kawasaki-like disease.
Open Forum Infectious Diseases; doi:10.1093/ofid/ofab086

Background Nonpharmaceutical interventions (NPIs) mitigate COVID-19. Essential workplaces remained open during COVID-19, but few U.S.-based settings detail outcomes. Methods Mercury Systems is a U.S.-based manufacturing company that remained open during COVID-19. NPIs – distancing, masking, hand hygiene, ventilation- were successively deployed from March-August 2020. The company expanded sick leave, asked employees to report work outages from illness, and administered employee satisfaction surveys. Three sites in Arizona, southern California and New Hampshire administered testing campaigns via RT-PCR of nasal swabs in late July-early August for all employees at work or at home self-isolating due to symptoms. Descriptive statistics summarized findings. Results Among 586 employees at three sites, only 1.5% employees developed severe illness over the study duration. Testing campaigns revealed 44 with positive PCR results at a cycle threshold (CT) <37 (likely infectious) and 61 with a CT≥37 (low-level viral load). True positivity rates were consistent with community prevalence at the time: 1.1% in New Hampshire, 6.2% in California, 12.9% in Arizona. Of all employees with positive tests, 99% were asymptomatic. Employee surveys showed high satisfaction. Conclusion In a multi-site U.S. company which instituted NPIs for COVID-19 mitigation, the proportion of asymptomatic COVID-19 infections on surveillance testing was high (99%). Although surges in community transmission were seen in two sites over the study, employee prevalence reflected community prevalence, despite daily workplace presence. This study demonstrates that NPIs likely mitigate severe COVID-19 illness, that PCR tests should incorporate CT values, and that expanded sick leave likely encourages self-isolation, suggesting strategies for work re-openings.
, Nathanial S Nolan, Miguel A Chavez, , Gerome V Escota, Wendy Stead
Open Forum Infectious Diseases; doi:10.1093/ofid/ofab084

Social media is an increasingly popular forum for medical education. Many educators, including those in infectious diseases, are now creating and sharing unique and educational patient cases online. Unfortunately, some educators unknowingly threaten patient privacy and open themselves to legal liability. Further, the use of published figures or tables creates risk of copyright infringement. As more and more infectious diseases physicians engage in social media, it is imperative to create best practices to protect both patients and physicians. This summary will define the legal requirements of patient de-identification as well as other practical recommendations as it relates to use of clinical case information, patient images, and attribution of primary references on social media.
Ann W N Auma, Carey Shive, Sofi Damjanovska, Corinne Kowal, Daniel E Cohen, Debika Bhattacharya, Beverly Alston-Smith, Melissa Osborne, Robert Kalayjian, Ashwin Balagopal, et al.
Open Forum Infectious Diseases; doi:10.1093/ofid/ofab079

Background Immune activation markers associate with morbidity and mortality in HIV and HCV infection. We investigated how T-cell and monocyte activation are related over the course of HCV direct-acting antiviral (DAA) therapy during HCV/HIV coinfection. Methods PBMC from AIDS Clinical Trials Group (ACTG) A5329 participants and a single-site separate cohort, treated with DAAs, were analyzed for central memory (CM)/effector memory (EM) T-cell subsets, monocyte subsets, and cell activation (CD38 and HLA-DR expression) before, during and after therapy. Results Before therapy, classical and inflammatory monocyte subset HLA-DR expression positively correlated with absolute counts and frequencies of CD38 +HLA-DR + expressing CD4 + and CD8 T-cells and corresponding CM and EM subsets. After therapy initiation, CD38 +HLA-DR + co-expression on CD4 + and CD8 + memory T-cells decreased by 12-weeks and 36 weeks out, plasma sCD14 positively correlated with CD38 +HLA-DR + CD4 + and CD4 +CM T-cell frequencies. Monocyte subset activation remained similar over time. Conclusion During HCV/HIV coinfection memory T-cell activation is associated with monocyte subset activation, consistent with related underlying mechanisms. Following therapy initiation, memory T-cell, but not monocyte, activation decreased. Residual CD4 + T-cell activation after therapy completion is associated with sCD14, potentially linking remaining CD4 + T-cell activation to residual factors driving activation in ART controlled HIV.
, Nupur Shridhar, Melissa Fazzari, Uriel Felsen,
Open Forum Infectious Diseases; doi:10.1093/ofid/ofab083

Background The opioid crisis in the United States has led to increasing hospitalizations for drug use-associated infective endocarditis (DUA-IE). Outpatient parenteral antimicrobial therapy (OPAT), the preferred modality for intravenous antibiotics for infective endocarditis, has demonstrated similar outcomes among patients with DUA-IE vs. non-DUA-IE but current studies suffer selection bias. The utilization of OPAT for DUA-IE more generally is not well-studied. Methods This retrospective cohort study compared OPAT use for DUA-IE vs. non-DUA-IE in adults hospitalized between 1/1/15 and 9/1/19 at three urban hospitals. We used multivariable regression analysis to assess the association between DUA-IE and discharge with OPAT, adjusting for clinically significant covariables. Results The cohort included 518 patients (126 DUA-IE, 392 non-DUA-IE). Compared to those with non-DUA-IE, DUA-IE patients were younger (53.0 vs. 68.2 years, p<0.001) and more commonly undomiciled (9.5% vs. 0.3%, p<0.01). DUA-IE patients had a significantly lower odds of discharge with OPAT than non-DUA-IE patients (aOR = 0.20, 95% CI 0.10-0.39). Odds of discharge with OPAT remained lower for patients with DUA-IE after excluding undomiciled patients (aOR = 0.22, 95% CI 0.11-0.43) and those with patient-directed discharges (aOR = 0.27, 95% CI 0.14-0.52). Conclusions Significantly fewer patients with DUA-IE were discharged with OPAT compared to those with non-DUA-IE, and undomiciled patients or patient-directed discharges did not fully account for this difference. Efforts to increase OPAT utilization among patients with DUA-IE could have important benefits for patients and the healthcare system.
M Wong, J M Coit, M Mendoza, S S Chiang, H Marin, J T Galea, L Lecca,
Open Forum Infectious Diseases; doi:10.1093/ofid/ofab075

We followed 35 children meeting a research definition for unconfirmed tuberculosis but in whom a pediatric pulmonologist did not diagnose or treat tuberculosis. After a median follow-up of 16.4 months, most children were not diagnosed with tuberculosis following a comprehensive evaluation. However, two were diagnosed with tuberculosis, demonstrating high TB risk (6%; exact 95% confidence interval: 1% - 19%). In some contexts, researchers may wish to supplement these research definitions with clinical decision data and longitudinal follow-up in order to improve specificity.
, David C Kaelber, Maile Y Karris
Open Forum Infectious Diseases; doi:10.1093/ofid/ofab081

Human immunodeficiency virus (HIV) infection is associated with premature bone loss. The potential impact of recently updated osteoporosis screening guidelines is unknown. In a population-based cohort, we found low adherence and sex differences among eligible people living with HIV.
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