scholarly journals Multidrug-ResistantBacteroides fragilisBacteremia in a US Resident: An Emerging Challenge

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Cristian Merchan ◽  
Sunita Parajuli ◽  
Justin Siegfried ◽  
Marco R. Scipione ◽  
Yanina Dubrovskaya ◽  
...  
Keyword(s):  
United States ◽  
Risk Factor ◽  
Multidrug Resistance ◽  
Bacteroides Fragilis ◽  
The United States ◽  
Travel History ◽  
Lactam B ◽  
Microbiological Cure

We describe a case ofBacteroides fragilisbacteremia associated with paraspinal and psoas abscesses in the United States. Resistance to b-lactam/b-lactamase inhibitors, carbapenems, and metronidazole was encountered despite having a recent travel history to India as the only possible risk factor for multidrug resistance. Microbiological cure was achieved with linezolid, moxifloxacin, and cefoxitin.

scholarly journals 130. increase in Multidrug Resistance (2011–2018) and the Emergence of Extensive Drug Resistance (2020) in shigella Sonnei in the United States

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S195-S195
Author(s):  
Naeemah Z Logan ◽  
Beth E Karp ◽  
Kaitlin A Tagg ◽  
Claire Burns-Lynch ◽  
Jessica Chen ◽  
...  
Keyword(s):  
United States ◽  
Multidrug Resistance ◽  
Disease Surveillance ◽  
Sequence Data ◽  
The United States ◽  
Multidrug Resistant ◽  
Shigella Sonnei ◽  
Short Read ◽  
Men 2 ◽  
The Us

Abstract Background Multidrug-resistant (MDR) Shigella sonnei infections are a serious public health threat, and outbreaks are common among men who have sex with men (MSM). In February 2020, Australia’s Department of Health notified CDC of extensively drug-resistant (XDR) S. sonnei in 2 Australian residents linked to a cruise that departed from Florida. We describe an international outbreak of XDR S. sonnei and report on trends in MDR among S. sonnei in the United States. Methods Health departments (HDs) submit every 20th Shigella isolate to CDC’s National Antimicrobial Resistance Monitoring System (NARMS) laboratory for susceptibility testing. We defined MDR as decreased susceptibility to azithromycin (MIC ≥32 µg/mL) with resistance to ampicillin, ciprofloxacin, and cotrimoxazole, and XDR as MDR with additional resistance to ceftriaxone. We used PulseNet, the national subtyping network for enteric disease surveillance, to identify US isolates related to the Australian XDR isolates by short-read whole genome sequencing. We screened these isolates for resistance determinants (ResFinder v3.0) and plasmid replicons (PlasmidFinder) and obtained patient histories from HDs. We used long-read sequencing to generate closed plasmid sequences for 2 XDR isolates. Results NARMS tested 2,781 S. sonnei surveillance isolates during 2011–2018; 80 (2.9%) were MDR, including 1 (0.04%) that was XDR. MDR isolates were from men (87%), women (9%), and children (4%). MDR increased from 0% in 2011 to 15.3% in 2018 (Figure). In 2020, we identified XDR isolates from 3 US residents on the same cruise as the Australians. The US residents were 41–42 year-old men; 2 with available information were MSM. The US and Australian isolates were highly related (0–1 alleles). Short-read sequence data from all 3 US isolates mapped to the blaCTX-M-27 harboring IncFII plasmids from the 2 Australian isolates with >99% nucleotide identity. blaCTX-M-27 genes confer ceftriaxone resistance. Increase in Percentage of Shigella sonnei Isolates with Multidrug Resistance* in the United States, 2011–2018† Conclusion MDR S. sonnei is increasing and is most often identified among men. XDR S. sonnei infections are emerging and are resistant to all recommended antibiotics, making them difficult to treat without IV antibiotics. This outbreak illustrates the alarming capacity for XDR S. sonnei to disseminate globally among at-risk populations, such as MSM. Disclosures All Authors: No reported disclosures

Characteristics of Hepatitis B virus induced Hepatocellular Carcinoma in Egyptian patients

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Eman Mahmoud Fathy Barakat ◽  
Khalid Mahmoud AbdAlaziz ◽  
Mohamed Mahmoud Mahmoud El Tabbakh ◽  
Mohamed Kamal Alden Ali
Keyword(s):  
United States ◽  
Risk Factors ◽  
Hepatocellular Carcinoma ◽  
Risk Factor ◽  
Hepatitis C ◽  
Hepatitis B ◽  
The United States ◽  
Age Difference ◽  
Co Morbidity ◽  
Incidence And Mortality

Abstract Background Hepatocellular carcinoma (HCC) is the most common primary liver malignancy and is a leading cause of cancer-related death worldwide. In the United States, HCC is the ninth leading cause of cancer deaths. Despite advances in prevention techniques, screening, and new technologies in both diagnosis and treatment, incidence and mortality continue to rise. Cirrhosis remains the most important risk factor for the development of HCC regardless of etiology. Hepatitis B and C are independent risk factors for the development of cirrhosis. Alcohol consumption remains an important additional risk factor in the United States as alcohol abuse is five times higher than hepatitis C. Diagnosis is confirmed without pathologic confirmation. Screening includes both radiologic tests, such as ultrasound, computerized tomography, and magnetic resonance imaging, and serological markers such as αfetoprotein at 6-month interval. Aim To compare characteristics and behavior of Hepatocellular carcinoma (HCC) in chronic HCV patients and HVB patients Patients and Methods The current study was conducted on patients with de HCC presented at HCC clinic, Tropical medicine department Ain Shams University Hospitals between December 2017 and D ecember 2018, aged (18-70 years old) . Results eline characteristics of study population shown in Table 1 at enrolment, including gender, Education status, co-morbidity, underlying presence or absence of cirrhosis, Child-Pugh class of patients infected with viral hepatitis, and alpha-fetoprotein levels. Male proportion observed to be predominant in both HCV (62%) and HBV (75.4%) infected HCC population. Overall prevalence of HCV and HBV in patients having HCC was 65.95% and 34.04%, respectively. Presence of underlying liver cirrhosis was more significantly associated with HCV seropositives as compared to HBV seropositive patients (p0.05). Table 2 shows comparison of means between HCV and HBV seropositive patients with HCC. In univariate analysis, mean age difference (11.6 years), and total bilirubin levels (-1.91mg/dl) were the only statistically significant observations noted among HCV-HCC group (p = 0.05) Conclusion Hepatocellular carcinoma is mainly caused by Hepatitis C and Hepatitis B viruses, but latter showed predominance, comparatively worldwide and correlated HBV directly as a cause of HCC rather than HCV whose relation with HCC is still unclear (Shepard et al., 2006; Di Bisceglie, 2009). Because of the geographical differences and risk factors, the epidemiological burden of HCV and HBV has been observed different in different areas of the world. In developing countries due to high burden of HCV infection as compared to HBV such as in Taiwan (HCV 17.0%, HBV 13.8%) (Kao et al., 2011), Guam (HCV 19.6%, HBV 18%) (Haddock et al., 2013), and Pakistan (HCV 4.8%, HBV 2.5%) (Rehman et al., 1996; Raza et al., 2007; Qureshi et al., 2010; Butt et al., 2012;) will possibly

scholarly journals Is gender inequity a risk factor for men reporting poorer self-rated health in the United States?

PLoS ONE ◽  
2018 ◽  
Vol 13 (7) ◽  
pp. e0200332
Author(s):  
Shane A. Kavanagh ◽  
Julia M. Shelley ◽  
Christopher Stevenson
Keyword(s):  
United States ◽  
Risk Factor ◽  
The United States ◽  
Gender Inequity ◽  
Self Rated Health

scholarly journals Automated Travel History Extraction From Clinical Notes for Informing the Detection of Emergent Infectious Disease Events: Algorithm Development and Validation

10.2196/26719 ◽  
2021 ◽  
Vol 7 (3) ◽  
pp. e26719
Author(s):  
Kelly S Peterson ◽  
Julia Lewis ◽  
Olga V Patterson ◽  
Alec B Chapman ◽  
Daniel W Denhalter ◽  
...  
Keyword(s):  
Public Health ◽  
Infectious Disease ◽  
United States ◽  
Text Processing ◽  
The United States ◽  
Language Models ◽  
Travel History ◽  
Patient Travel ◽  
Electronic Health ◽  
Automated Text Processing

Background Patient travel history can be crucial in evaluating evolving infectious disease events. Such information can be challenging to acquire in electronic health records, as it is often available only in unstructured text. Objective This study aims to assess the feasibility of annotating and automatically extracting travel history mentions from unstructured clinical documents in the Department of Veterans Affairs across disparate health care facilities and among millions of patients. Information about travel exposure augments existing surveillance applications for increased preparedness in responding quickly to public health threats. Methods Clinical documents related to arboviral disease were annotated following selection using a semiautomated bootstrapping process. Using annotated instances as training data, models were developed to extract from unstructured clinical text any mention of affirmed travel locations outside of the continental United States. Automated text processing models were evaluated, involving machine learning and neural language models for extraction accuracy. Results Among 4584 annotated instances, 2659 (58%) contained an affirmed mention of travel history, while 347 (7.6%) were negated. Interannotator agreement resulted in a document-level Cohen kappa of 0.776. Automated text processing accuracy (F1 85.6, 95% CI 82.5-87.9) and computational burden were acceptable such that the system can provide a rapid screen for public health events. Conclusions Automated extraction of patient travel history from clinical documents is feasible for enhanced passive surveillance public health systems. Without such a system, it would usually be necessary to manually review charts to identify recent travel or lack of travel, use an electronic health record that enforces travel history documentation, or ignore this potential source of information altogether. The development of this tool was initially motivated by emergent arboviral diseases. More recently, this system was used in the early phases of response to COVID-19 in the United States, although its utility was limited to a relatively brief window due to the rapid domestic spread of the virus. Such systems may aid future efforts to prevent and contain the spread of infectious diseases.

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