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Acosta AM, Simon A, Thomas S, Tunali A, Satola S, Jain S, Farley MM, Tondella ML, Skoff TH. Evaluation of Asymptomatic Bordetella Carriage in a Convenience Sample of Children and Adolescents in Atlanta, Georgia, United States. J Pediatric Infect Dis Soc 2024; 13:105-109. [PMID: 37974480 DOI: 10.1093/jpids/piad104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/15/2023] [Indexed: 11/19/2023]
Abstract
Few data exist on asymptomatic carriage of Bordetella species among populations receiving acellular pertussis vaccine. We conducted a cross-sectional study among acellular-vaccinated children presenting to an emergency department (ED). Bordetella pertussis carriage prevalence was <1% in this population, a lower prevalence than that found in recent studies among whole-cell pertussis-vaccinated participants.
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Affiliation(s)
- Anna M Acosta
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ashley Simon
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Stepy Thomas
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Georgia Emerging Infections Program, Atlanta, GA, USA
| | - Amy Tunali
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Georgia Emerging Infections Program, Atlanta, GA, USA
| | - Sarah Satola
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Georgia Emerging Infections Program, Atlanta, GA, USA
| | - Shabnam Jain
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Monica M Farley
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Georgia Emerging Infections Program, Atlanta, GA, USA
- Medical Subspecialty Section Atlanta Veterans Administration Medical Center, Atlanta, GA, USA
| | - M Lucia Tondella
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tami H Skoff
- Meningitis and Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Adamkiewicz TV, Yee MEM, Thomas S, Tunali A, Lai KW, Omole FS, Lane PA, Yildirim I. Pneumococcal infections in children with sickle cell disease before and after pneumococcal conjugate vaccines. Blood Adv 2023; 7:6751-6761. [PMID: 37698500 PMCID: PMC10660014 DOI: 10.1182/bloodadvances.2022009643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 07/13/2023] [Accepted: 07/13/2023] [Indexed: 09/13/2023] Open
Abstract
Children with sickle cell disease (SCD) are at increased risk of invasive pneumococcal disease (IPD). Over 25 years, the Georgia Emerging Infections Program/Centers for Disease Control and Prevention Active Bacterial Core Surveillance network identified 104 IPD episodes among 3707 children with hemoglobin SS (HbSS) or HbSC aged <10 years, representing 6% of IPD in Black or African American children residing in Metropolitan Atlanta (reference population). Children with IPD and HbSS/SC were older than those with IPD in the reference population (P < .001). From 1994-1999 to 2010-2018, IPD declined by 87% in children with HbSS aged 0 to 4 years, and by 80% in those aged 5 to 9 years. However, IPD incidence rate ratios when comparing children with SCD with the reference population increased from 20.2 to 29.2 over these periods. Among children with HbSS and IPD, death declined from 14% to 3% after 2002, and meningitis declined from 16% to 8%. Penicillin resistance was more prevalent in children with SCD before 7-valent pneumococcal conjugate vaccine (PCV7) licensure. After 2010, all IPD serotypes were not included in the 13-valent PCV (PCV13). Within 3 years of vaccination, the effectiveness of the 23-valent pneumococcal polysaccharide vaccine (PPSV23) against non-PCV13 serotypes included in PPSV23 plus 15A/15C was 92% (95% confidence interval, 40.8- 99.0, P = .014; indirect-cohort effect adjusted for age and hydroxyurea). PPSV23 would cover 62% of non-PCV13 serotype IPD in children with SCD, whereas PCV15, PCV20, and PCV21/V116 (in development) could cover 16%, 51%, and 92%, respectively. Although less frequent, IPD remains a life-threatening risk in children with SCD. Effective vaccines with broader coverage could benefit these children.
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Affiliation(s)
- Thomas V. Adamkiewicz
- Department of Family Medicine, Morehouse School of Medicine, Atlanta, GA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Marianne E. M. Yee
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA
| | - Stepy Thomas
- Department of Medicine, Emory University School of Medicine, Atlanta, GA
- Georgia Emerging Infections Program, Atlanta, GA
- Atlanta Veterans Administration Health System, Decatur, GA
| | - Amy Tunali
- Department of Medicine, Emory University School of Medicine, Atlanta, GA
- Atlanta Veterans Administration Health System, Decatur, GA
| | - Kristina W. Lai
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA
- University of California, Davis, CA
| | - Folashade S. Omole
- Department of Family Medicine, Morehouse School of Medicine, Atlanta, GA
| | - Peter A. Lane
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA
| | - Inci Yildirim
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT
- Yale Center for Infection and Immunity, Yale Institute of Global Health, New Haven, CT
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Weston EJ, Heidenga BL, Farley MM, Tunali A, D'Angelo MT, Moore A, Workowski K, Raphael BH, Weinstock H, Torrone E. Surveillance for Disseminated Gonococcal Infections, Active Bacterial Core surveillance (ABCs) - United States, 2015-2019. Clin Infect Dis 2022; 75:953-958. [PMID: 35090024 DOI: 10.1093/cid/ciac052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Disseminated gonococcal infections (DGI) are thought to be uncommon; surveillance is limited and case reports are analyzed retrospectively or in case clusters. We describe the population-level burden of culture-confirmed DGI through the Active Bacterial Core surveillance (ABCs) system. METHODS During 2015-2016, retrospective surveillance was conducted among residents in two ABCs areas and prospectively in three ABCs areas during 2017-2019. A DGI case was defined as isolation of Neisseria gonorrhoeae (Ng) from a normally sterile site. A case report form was completed for each case and antimicrobial susceptibility testing (AST) was performed on available isolates. RESULTS During 2015-2019, 77 DGI cases were identified (~a rate of 0.13 cases per 100,000 population) and accounted for 0.06% of all reported gonorrhea cases in the three surveillance areas. Most DGI cases were male (64%), non-Hispanic Black (68%), and ranged from 16-67 years; blood (55%) and joint (40%) were the most common sterile sites. Among 29 isolates with AST results during 2017-2019, all were susceptible to ceftriaxone. CONCLUSIONS DGI is an infrequent complication of Ng; since Ng can quickly develop antimicrobial resistance, continued DGI surveillance, including monitoring trends in antimicrobial susceptibility, could help inform DGI treatment recommendations.
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Affiliation(s)
- Emily J Weston
- Division of STD Prevention (DSTDP) National Center for HIV/AIDS, Viral Hepatitis, STDs, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - Monica M Farley
- Emory University School of Medicine, Department of Medicine, Atlanta, GA, United States.,Atlanta VA Medical Center, Atlanta, GA, United States
| | - Amy Tunali
- Emory University School of Medicine, Department of Medicine, Atlanta, GA, United States.,Atlanta VA Medical Center, Atlanta, GA, United States
| | | | - Ashley Moore
- Georgia Department of Public Health, Atlanta, GA, United States
| | - Kimberly Workowski
- Division of STD Prevention (DSTDP) National Center for HIV/AIDS, Viral Hepatitis, STDs, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, GA, United States.,Emory University School of Medicine, Department of Medicine, Atlanta, GA, United States
| | - Brian H Raphael
- Division of STD Prevention (DSTDP) National Center for HIV/AIDS, Viral Hepatitis, STDs, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Hillard Weinstock
- Division of STD Prevention (DSTDP) National Center for HIV/AIDS, Viral Hepatitis, STDs, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Elizabeth Torrone
- Division of STD Prevention (DSTDP) National Center for HIV/AIDS, Viral Hepatitis, STDs, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, GA, United States
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Collins LF, Havers FP, Tunali A, Thomas S, Clennon JA, Wiley Z, Tobin-D’Angelo M, Parrott T, Read TD, Satola SW, Petit RA, Farley MM. Invasive Nontypeable Haemophilus influenzae Infection Among Adults With HIV in Metropolitan Atlanta, Georgia, 2008-2018. JAMA 2019; 322:2399-2410. [PMID: 31860046 PMCID: PMC6990662 DOI: 10.1001/jama.2019.18800] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
IMPORTANCE Invasive nontypeable Haemophilus influenzae (NTHi) infection among adults is typically associated with bacteremic pneumonia. Nontypeable H influenzae is genetically diverse and clusters of infection are uncommon. OBJECTIVE To evaluate an increase in invasive NTHi infection from 2017-2018 among HIV-infected men who have sex with men in metropolitan Atlanta, Georgia. DESIGN, SETTING, AND PARTICIPANTS A population-based surveillance study with a cohort substudy and descriptive epidemiological analysis identified adults aged 18 years or older with invasive NTHi infection (isolation of NTHi from a normally sterile site) between January 1, 2008, and December 31, 2018 (final date of follow-up). EXPOSURES Time period, HIV status, and genetic relatedness (ie, cluster status) of available NTHi isolates. MAIN OUTCOMES AND MEASURES The primary outcome was incidence of invasive NTHi infection (from 2008-2016 and 2017-2018) among persons with HIV and compared with NTHi infection from 2008-2018 among those without HIV. The secondary outcomes were assessed among those aged 18 to 55 years with invasive NTHi infection and included epidemiological, clinical, and geographic comparisons by cluster status. RESULTS Among 553 adults with invasive NTHi infection (median age, 66 years [Q1-Q3, 48-78 years]; 52% male; and 38% black), 60 cases occurred among persons with HIV. Incidence of invasive NTHi infection from 2017-2018 among persons with HIV (41.7 cases per 100 000) was significantly greater than from 2008-2016 among those with HIV (9.6 per 100 000; P < .001) and from 2008-2018 among those without HIV (1.1 per 100 000; P < .001). Among adults aged 18 to 55 years with invasive NTHi infections from 2017-2018 (n = 179), persons with HIV (n = 31) were significantly more likely than those from 2008-2018 without HIV (n = 124) to be male (94% vs 49%, respectively; P < .001), black (100% vs 53%; P < .001), and have septic arthritis (35% vs 1%; P < .001). Persons with HIV who had invasive NTHi infection from 2017-2018 (n = 31) were more likely than persons with HIV who had invasive NTHi infection from 2008-2016 (n = 24) to have septic arthritis (35% vs 4%, respectively; P = .01). Pulsed-field gel electrophoresis of 174 of 179 NTHi isolates from 18- to 55-year-olds identified 2 genetically distinct clonal groups: cluster 1 (C1; n = 24) and cluster 2 (C2; n = 23). Whole-genome sequencing confirmed 2 clonal lineages of NTHi infection and revealed all C1 isolates (but none of the C2 isolates) carried IS1016 (an insertion sequence associated with H influenzae capsule genes). Persons with HIV were significantly more likely to have C1 or C2 invasive NTHi infection from 2017-2018 (28/31 [90%]) compared with from 2008-2016 among persons with HIV (10/24 [42%]; P < .001) and compared with from 2008-2018 among those without HIV (9/119 [8%]; P < .001). Among persons with C1 or C2 invasive NTHi infection who had HIV (n = 38) (median age, 34.5 years; 100% male; 100% black; 82% men who have sex with men), 32 (84%) lived in 2 urban counties and an area of significant spatial aggregation was identified compared with those without C1 or C2 invasive NTHi infection. CONCLUSIONS AND RELEVANCE Among persons with HIV in Atlanta, the incidence of invasive nontypeable H influenzae infection increased significantly from 2017-2018 compared with 2008-2016. Two unique but genetically related clonal strains were identified and were associated with septic arthritis among black men who have sex with men and who lived in geographic proximity.
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Affiliation(s)
- Lauren F. Collins
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Georgia Emerging Infections Program, Atlanta
| | - Fiona P. Havers
- Division of Bacterial Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
- Atlanta VA Medical Center, Decatur, Georgia
| | - Amy Tunali
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Georgia Emerging Infections Program, Atlanta
| | - Stephanie Thomas
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Georgia Emerging Infections Program, Atlanta
| | - Julie A. Clennon
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Zanthia Wiley
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Melissa Tobin-D’Angelo
- Georgia Emerging Infections Program, Atlanta
- Georgia Department of Public Health, Atlanta
| | - Tonia Parrott
- Georgia Emerging Infections Program, Atlanta
- Georgia Department of Public Health, Atlanta
| | - Timothy D. Read
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Georgia Emerging Infections Program, Atlanta
| | - Sarah W. Satola
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Georgia Emerging Infections Program, Atlanta
| | - Robert A. Petit
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Georgia Emerging Infections Program, Atlanta
| | - Monica M. Farley
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
- Georgia Emerging Infections Program, Atlanta
- Atlanta VA Medical Center, Decatur, Georgia
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Adebanjo T, Apostol M, Alden N, Petit S, Tunali A, Torres S, Hollick R, Bell A, Muse A, Poissant T, Schaffner W, Van Beneden CA. Evaluating Household Transmission of Invasive Group A Streptococcus Disease in the United States Using Population-based Surveillance Data, 2013–2016. Clin Infect Dis 2019; 70:1478-1481. [DOI: 10.1093/cid/ciz716] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 07/26/2019] [Indexed: 02/05/2023] Open
Abstract
Abstract
Using population-based surveillance data, we quantified the secondary invasive group A Streptococcus disease risk among household contacts. The disease risk in the 30 days postexposure to an index-case patient was highest among individuals aged ≥65 years, versus the annual background incidence of all ages.
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Affiliation(s)
- Tolulope Adebanjo
- Epidemic Intelligence Service and Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Nisha Alden
- Colorado Emerging Infections Program, Denver
| | - Susan Petit
- Connecticut Department of Public Health, Hartford
| | - Amy Tunali
- Georgia Emerging Infections Program, Atlanta
| | | | - Rosemary Hollick
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | | | | | - Chris A Van Beneden
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Overton R, Fridkin S, Tunali A, Ray SM. 1234. Racial Disparities in Invasive Staphylococcus aureus (iSA) Disease in Metropolitan Atlanta, a Population-Based Assessment, 2016. Open Forum Infect Dis 2018. [PMCID: PMC6253138 DOI: 10.1093/ofid/ofy210.1067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Disparities in incidence of invasive methicillin-resistant S. aureus (iMRSA) infections have been examined, suggesting that differences were in part driven by socio-economic factors. An analysis was conducted to determine whether similar disparities exist for invasive methicillin-susceptible S. aureus (iMSSA). Methods The Georgia Emerging Infections Program (GA EIP) conducts active, population-based surveillance for iSA within the 8-county area of Atlanta. Cases were defined as residents of the surveillance area with SA isolated from a normally sterile site, with cultures within a 30-day period considered a single case. Age- and race-specific incidence were calculated using 2016 US census data; other/unknown race were excluded from analysis (<5% of cases). Incidence rate ratios (RR) between stratum and summary adjusted rate ratios (aRR) were calculated with the Mantel–Hanzel method. Results During 2016, 1,958 cases were identified (42% iMRSA and 58% iMSSA); crude incidence was 48.5/100,000. Rates were highest among those ≥ 65 years of age for both blacks and whites (Figure 1). When compared with iMSSA, iMRSA incidence was consistently lower across all age groups (aRR: 0.7; 95% CI: 0.7–0.8) (Figure 2). However, the incidence of iMRSA among black cases was double that among white cases (aRR: 2.0; CI: 1.7–2.3) across all age groups. This racial disparity was less pronounced in iMSSA: among younger cases (<65 years old), iMSSA incidence among blacks was significantly higher than whites (aRR: 1.6; CI: 1.4–2.0), while rates were similar in older blacks and whites (≥65 years old) (aRR: 0.9; CI: 0.8–1.2). Bloodstream infections were the most common presentation overall; however, for iMSSA infections, joint/synovial infections were significantly less common among black cases than white cases (RR: 0.3; CI: 0.1–0.7). Conclusion In the Atlanta area, racial disparities in iSA were noted, with higher incidence among blacks than whites for both iMSSA and iMRSA. The racial disparity is more extreme for iMRSA. Notably the racial disparity is not observed in cases age 65 and over. Causes for these disparities should be investigated. ![]()
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Disclosures S. Fridkin, Pfizer Inc.: Grant Investigator, Research support.
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Affiliation(s)
- Rahsaan Overton
- Georgia Emerging Infections Program, Atlanta, Georgia
- Atlanta Research and Education Foundation and Atlanta VA Medical Center, Atlanta, Georgia
| | - Scott Fridkin
- Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Amy Tunali
- Georgia Emerging Infections Program, Atlanta, Georgia
| | - Susan M Ray
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
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Moore AE, MacNeil JR, Wang X, Joseph SJ, Lorentzson L, Thomas S, Tunali A, Parrott T, Farley MM, Tobin-D’Angelo M. Emergence of Localized Serogroup W Meningococcal Disease in the United States - Georgia, 2006-2016. MMWR Morb Mortal Wkly Rep 2018; 67:894-897. [PMID: 30114000 PMCID: PMC6095648 DOI: 10.15585/mmwr.mm6732a5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Several countries in Europe and Australia are reporting an increasing incidence of Neisseria meningitidis serogroup W (NmW) as a consequence of the rapid expansion of a single NmW clone belonging to clonal complex 11 (1-5). Because this clone is reported to be associated with more severe disease, unusual clinical presentations, and a high case fatality ratio (CFR), it is considered a hypervirulent strain (1,6). In the United States, NmW accounts for approximately 5% of meningococcal disease reported each year, and this proportion has remained stable for several years (7). However, localized increases in NmW have been reported, most notably in Florida during 2008-2009 (8). In Georgia, NmW accounted for only 3% of meningococcal disease cases reported during 2006-2013; however, between January 2014 and December 2016, 42% of all reported cases were NmW. Surveillance data from Georgia were analyzed to describe the epidemiology and clinical characteristics of NmW cases, and whole-genome sequencing of NmW isolates was performed for comparison with NmW strains circulating in the United States and worldwide. These data indicate that the U.S. NmW strains might have evolved from the same ancestor as the hypervirulent strain that is circulating globally. Genetic analysis demonstrates that these strains are closely related, which would suggest that genetic variation led to the rise of different strains from the same ancestor. Given the recent global expansion of this potentially hypervirulent NmW lineage, clinicians and public health officials need to remain vigilant in obtaining isolates to monitor changes in circulating strains.
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See I, Wesson P, Gualandi N, Dumyati G, Harrison LH, Lesher L, Nadle J, Petit S, Reisenauer C, Schaffner W, Tunali A, Mu Y, Ahern J. Socioeconomic Factors Explain Racial Disparities in Invasive Community-Associated Methicillin-Resistant Staphylococcus aureus Disease Rates. Clin Infect Dis 2017; 64:597-604. [PMID: 28362911 PMCID: PMC5656382 DOI: 10.1093/cid/ciw808] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 12/27/2016] [Indexed: 01/30/2023] Open
Abstract
Background Invasive community-associated methicillin-resistant Staphylococcus aureus (MRSA) incidence in the United States is higher among black persons than white persons. We explored the extent to which socioeconomic factors might explain this racial disparity. Methods A retrospective cohort was based on the Centers for Disease Control and Prevention's Emerging Infections Program surveillance data for invasive community-associated MRSA cases (isolated from a normally sterile site of an outpatient or on hospital admission day ≤3 in a patient without specified major healthcare exposures) from 2009 to 2011 in 33 counties of 9 states. We used generalized estimating equations to determine census tract-level factors associated with differences in MRSA incidence and inverse odds ratio-weighted mediation analysis to determine the proportion of racial disparity mediated by socioeconomic factors. Results Annual invasive community-associated MRSA incidence was 4.59 per 100000 among whites and 7.60 per 100000 among blacks (rate ratio [RR], 1.66; 95% confidence interval [CI], 1.52-1.80). In the mediation analysis, after accounting for census tract-level measures of federally designated medically underserved areas, education, income, housing value, and rural status, 91% of the original racial disparity was explained; no significant association of black race with community-associated MRSA remained (RR, 1.05; 95% CI, .92-1.20). Conclusions The racial disparity in invasive community-associated MRSA rates was largely explained by socioeconomic factors. The specific factors that underlie the association between census tract-level socioeconomic measures and MRSA incidence, which may include modifiable social (eg, poverty, crowding) and biological factors (not explored in this analysis), should be elucidated to define strategies for reducing racial disparities in community-associated MRSA rates.
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Affiliation(s)
- Isaac See
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Paul Wesson
- Division of Epidemiology, School of Public Health, University of California, Berkeley, USA
| | - Nicole Gualandi
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ghinwa Dumyati
- University of Rochester Medical Center, Rochester, New York, USA
| | - Lee H Harrison
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Joelle Nadle
- California Emerging Infections Program, Oakland, USA
| | - Susan Petit
- Connecticut Department of Public Health, Hartford, USA
| | | | | | - Amy Tunali
- Georgia Emerging Infections Program, Atlanta, USA
| | - Yi Mu
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennifer Ahern
- Division of Epidemiology, School of Public Health, University of California, Berkeley, USA
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See I, Mu Y, Gualandi N, Dumyati G, Harrison LH, Lynfield R, Nadle J, Petit S, Reisenauer C, Schaffner W, Tunali A, Wesson P, Ahern J. Socioeconomic Factors Explain Racial Disparities in Community-Associated Methicillin-Resistant Staphyloccocus aureus Disease Rates. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Ali R, Ozkalemkas F, Kimya Y, Koksal N, Ozkan H, Ozkocaman V, Hoyrazli A, Cetinkaya M, Tunali A. Acute leukemia and pregnancy. Leuk Res 2009; 33:e26-8. [DOI: 10.1016/j.leukres.2008.07.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2008] [Revised: 07/09/2008] [Accepted: 07/11/2008] [Indexed: 11/26/2022]
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Ozcelik T, Ozkocaman V, Ozkalemkas F, Ali R, Altundal Y, Ozkan A, Tunali A. Use of recombinant activated factor VII in a patient with severe thrombocytopenia due to myelodysplastic syndrome with uncontrolled gastrointestinal bleeding. Blood Coagul Fibrinolysis 2007; 18:385-6. [PMID: 17473584 DOI: 10.1097/mbc.0b013e32809cc96c] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ozkan A, Hakyemez B, Ozkalemkas F, Ali R, Ozkocaman V, Ozcelik T, Taskapilioglu O, Altundal Y, Tunali A. Tumor lysis syndrome as a contributory factor to the development of reversible posterior leukoencephalopathy. Neuroradiology 2006; 48:887-92. [PMID: 16983525 DOI: 10.1007/s00234-006-0142-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2006] [Accepted: 07/22/2006] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Reversible posterior leukoencephalopathy syndrome (RPLS) is a recently described clinical and radiological entity comprising headache, seizures, altered level of consciousness and visual disturbances in association with transient posterior cerebral white-matter abnormalities. METHOD We report a young woman with Burkitt's lymphoma who developed RPLS after combined chemotherapy administered during the tumor lysis syndrome. RESULTS The symptoms in this patient fitted well with those of RPLS; they included abrupt alterations in mental status, seizures, headache, visual changes and characteristic neuroradiological findings. She was given further combination chemotherapy without any neurological complications, at which time she had already recovered from both RPLS and tumor lysis syndrome. CONCLUSION Although many etiological factors have been reported in the development of RPLS, the underlying mechanism is not yet well understood. With prompt and appropriate management, RPLS is usually reversible, and chemotherapy can be continued after complete recovery from RPLS. We suggest that tumor lysis syndrome should be considered as a contributory factor to the development of RPLS in patients for whom treatment with combined chemotherapy for hematological malignancies is planned.
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Affiliation(s)
- A Ozkan
- Division of Hematology, Department of Internal Medicine, Uludag University Hospital, Uludag University School of Medicine, 16059 Bursa, Turkey.
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Ozkocaman V, Ozcelik T, Ali R, Ozkalemkas F, Ozkan A, Ozakin C, Akalin H, Ursavas A, Coskun F, Ener B, Tunali A. Bacillus spp. among hospitalized patients with haematological malignancies: clinical features, epidemics and outcomes. J Hosp Infect 2006; 64:169-76. [PMID: 16891037 DOI: 10.1016/j.jhin.2006.05.014] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2006] [Accepted: 05/17/2006] [Indexed: 11/22/2022]
Abstract
Between April 2000 and May 2005, 350 bacteraemic episodes occurred among patients treated in our haematology unit. Two hundred and twenty-eight of these episodes were caused by Gram-positive pathogens, most commonly coagulase-negative staphylococci and Staphylococcus aureus. One hundred and twenty-two episodes were due to Gram-negative pathogens, with a predominance of Escherichia coli, Acinetobacter baumannii and Pseudomonas aeruginosa. Bacillus bacteraemias constituted 12 of these episodes occurring in 12 patients, and accounted for 3.4% of all bacteraemic episodes. Of the 12 strains evaluated, seven were Bacillus licheniformis, three were Bacillus cereus and two were Bacillus pumilus. Seven episodes presented with bloodstream infection, three with pneumonia, one with severe abdominal pain and deterioration of liver function, and one with a catheter-related bloodstream infection. B. licheniformis was isolated from five patients who had been hospitalized at the same time. This outbreak was related to non-sterile cotton wool used during skin disinfection. B. cereus and B. licheniformis isolates were susceptible to cefepime, carbapenems, aminoglycosides and vancomycin, but B. pumilus isolates were resistant to all antibiotics except for quinolones and vancomycin. Two deaths were observed. In conclusion, Bacillus spp. may cause serious infections, diagnostic and therapeutic dilemmas, and high morbidity and mortality in patients with haematological malignancies. Both B. cereus and B. licheniformis may be among the 'new' Gram-positive pathogens to cause serious infection in patients with neutropenia.
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Affiliation(s)
- V Ozkocaman
- Division of Haematology, Department of Internal Medicine, Uludag University School of Medicine, Uludag University Hospital, Bursa, Turkey
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Ali R, Ozan U, Ozkalemkas F, Ozcelik T, Ozkocaman V, Ozturk H, Tunali S, Tunali A. Leukaemia cutis in T-cell acute lymphoblastic leukaemia. Cytopathology 2006; 17:158-61. [PMID: 16719862 DOI: 10.1111/j.1365-2303.2006.00289.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ali R, Ozkalemkaş F, Ozkocaman V, Bülbül-Başkan E, Ozçelik T, Ozan U, Kimya Y, Tunali A. Successful labor in the course of chronic lymphocytic leukemia (CLL) and management of CLL during pregnancy with leukapheresis. Ann Hematol 2004; 83:61-3. [PMID: 12961031 DOI: 10.1007/s00277-003-0723-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2003] [Accepted: 06/19/2003] [Indexed: 11/25/2022]
Abstract
We describe the successful management of a 30-year-old woman in the second trimester of her pregnancy with chronic lymphocytic leukemia (CLL) in stage IV by using only leukapheresis. We applied three sessions (courses) of leukapheresis throughout the pregnancy. The procedure did not have any significant adverse effect on the patient and the fetus. The patient gave birth vaginally to a healthy boy, weighing 3100 g, at 39 weeks of gestation. Seven months after delivery, Richter's syndrome developed in the patient. We conclude that leukapheresis may provide an alternative for palliative treatment to chemotherapy in pregnant patients with CLL. To our knowledge, this is the fourth reported case of CLL in pregnancy, and the first management of CLL during pregnancy with leukapheresis.
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Affiliation(s)
- R Ali
- Division of Hematology, Department of Internal Medicine, Uludağ University School of Medicine, Uludağ University Hospital, 16059 Görükle Bursa, Turkey.
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Ali R, Ozçelik T, Ozkalemkas F, Ozkocaman V, Ozan U, Yalçin M, Saricaoğlu H, Tunali A. Successful treatment of acquired haemophilia with prednisolone therapy. Haemophilia 2003; 9:741-3. [PMID: 14750942 DOI: 10.1046/j.1351-8216.2003.00830.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Acquired hemophilia is a rare, life threatening coagulopathy in adults caused by the development of autoantibodies against to factor VIII. No general consensus exists on the best therapeutic approach. We report here a case that presented with extensive cutaneous and mucosal bleedings due to factor VIII inhibitors and treated successfully with steroid therapy alone but complicated with a life threatening thromboembolic attack during her follow up. In conclusion, corticosteroids are "cost effective therapy" associated with high inhibitor elimination rates and although recurrence of inhibitor in a patient with factor VIII inhibitor is an expected clinical situation thrombosis risk should also be considered.
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Affiliation(s)
- R Ali
- Department of Internal Medicine, Division of Hematology, Uludağ University School of Medicine, Uludağ University Hospital, Bursa, Turkey.
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Ali R, Ozkalemkaş F, Ozçelik T, Ozkocaman V, Ozan U, Kimya Y, Köksal N, Bülbül-Başkan E, Develioğlu O, Tüfekçi M, Tunali A. Idiopathic thrombocytopenic purpura in pregnancy: a single institutional experience with maternal and neonatal outcomes. Ann Hematol 2003; 82:348-52. [PMID: 12734677 DOI: 10.1007/s00277-003-0665-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2003] [Accepted: 04/06/2003] [Indexed: 12/01/2022]
Abstract
We observed 13 pregnant women of 70 females with idiopathic thrombocytopenic purpura (ITP) from January 1992 through September 2002. Thirteen mothers with ITP gave birth to twelve babies and two fetuses died. One of the pregnancies produced twins. Seven of the cases were diagnosed with ITP before pregnancy and six during pregnancy. One of the thirteen pregnancies was complicated by preeclampsia, one by ablatio placentae, and one by intrauterine death. Seven mothers received corticosteroid treatment, four high-dose immunoglobulin therapies, and one underwent splenectomy in the second trimester of gestation. At the time of delivery six mothers had normal platelet counts and seven had low platelet counts. Nine deliveries were by vaginal route and four were by cesarean section. Eleven infants were born with normal platelet counts and one was thrombocytopenic at the time of delivery. No infant showed any clinical signs of hemorrhage and there were no neonatal complications. Two fetuses died; one of them because of ablatio placentae and the other was intrauterine dead. In conclusion, ITP in pregnancy requires the management of two patients, the mother and her baby; hence, the close collaboration of a multidisciplinary group composed of a hematologist, obstetrician, anesthesiologist, and neonatologist is essential.
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Affiliation(s)
- R Ali
- Division of Hematology, Department of Internal Medicine, Uludağ University School of Medicine, Uludağ University Hospital, 16059, Görükle, Bursa, Turkey.
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Ali R, Ozkalemkaş F, Ozçelik T, Ozkocaman V, Ozan U, Tunali A, Filiz G, Gözü O. Successful treatment of BALT lymphoma with combined chemotherapy. Thorax 2003; 58:368-9. [PMID: 12668812 PMCID: PMC1746648 DOI: 10.1136/thorax.58.4.368-b] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Başlar Z, Aktuglu G, Bolaman Z, Büyükkeçeci F, Gezer S, Kansu E, Koçak R, Ovali E, Ruacan S, Sargin D, Tunali A, Tüzüner N, Ulkü B. Incidence of aplastic anemia in Turkey: a hospital-based prospective multicentre study. Leuk Res 1997; 21:1135-9. [PMID: 9444948 DOI: 10.1016/s0145-2126(97)00046-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The incidence of aplastic anemia among hospitalized adult patients was prospectively determined in this first study in Turkey. New cases of aplastic anemia among patients 14 years and older who were admitted to the study centers were included in a 3 year survey. Seventy-three patients fulfilled the diagnostic criteria, yielding a mean annual incidence rate of 1.14 cases in 10(3) admissions. The male-to-female ratio of the cases (1.6:1) differed from the almost equal ratio of the larger population of Turkey. The median age was 30 years and females were younger at diagnosis. The age distribution of the cases was different from that of the population; showing two incidence peaks in both sexes. The majority of the patients (89%) had severe disease.
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Affiliation(s)
- Z Başlar
- Department of Internal Medicine, Cerrahpaşa Medical School of University of Istanbul, Turkey
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Ozkalemkaş F, Ali R, Tunali A, Ozkocaman V, Ozyardimci C, Ozçelik T. Multiple myeloma in the region of Bursa, Turkey: a retrospective analysis. J Environ Pathol Toxicol Oncol 1996; 15:267-70. [PMID: 9216819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
We evaluated the clinical and laboratory features of multiple myeloma in our patients and reviewed the factors that affected their survival. The study included 36 patients (12 women and 24 men) with multiple myeloma whom we followed up until death between October 1978 and June 1995. The age range was 34 to 75 years (mean age, 53.9). The chief complaints on admission were lumbar pain and pain in the extremities (77.8%) and generalized weakness (61.1%). The most common laboratory findings were severe anemia (hemoglobin < 8.0 g/dl) (50%), elevated erythrocyte sedimentation rate (75%), monoclonal spike in the serum protein electrophoresis (44.4%), and lytic skull lesions (72.2%). Twenty-three (64%) patients had a monoclonal IgG, 9 (25%) had IgA, 1 had IgD, 2 had light chain disease, and 1 was nonsecretory. Localized plasmacytoma was detected in 4 patients and 4 patients had amyloidosis in rectal and gingival biopsies. According to the Durie-Salmon staging system, 2 patients were in stage 1, 8 were in stage 2, and 26 were in stage 3. The mean survival was 31.4 +/- 4.3 months (range: 1 to 96). The 5-year survival rate was 11%. Sex, age at diagnosis, stage of the disease, hemoglobin level, platelet count, level of serum calcium, creatinine, serum paraprotein, and type of paraproteinemia were tested as prognostic parameters. We could not establish a statistically meaningful effect of these parameters on survival time. The first and second most common causes of death were renal failure and infection, respectively.
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Affiliation(s)
- F Ozkalemkaş
- Department of Hematology, Uludağ University Medical School, Bursa, Turkey
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Koçak N, Tunali A, Ozdoğan E, Tuna S. [The action of allopurinol on uric acid transport]. Turk Tip Cemiy Mecm 1973; 39:264-69. [PMID: 4805462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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