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Karram S, Sanger C, Convery C, Brantley A. Social Determinants of Health Among Persons Living with HIV Impact Important Health Outcomes in Michigan. AIDS Behav 2024; 28:547-563. [PMID: 38180620 DOI: 10.1007/s10461-023-04243-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 01/06/2024]
Abstract
Addressing social determinants of health (SDOH) is a national priority for improving quality of life and addressing obstacles to accessing care for people living with HIV (PLWH). Utilizing the Oregon Social Determinants of HIV Health Index and CDC's Medical Monitoring Project, we examined the association between social determinants of health and various HIV clinical outcomes and quality of life indicators, including stigma and mental health, for people living with HIV in Michigan. We calculated estimates of SDOHs, clinical outcomes, stigma, and mental health using weighted percentages and prevalence ratios with predicted marginal means, adjusting for age, race/ethnicity, and gender/sexual orientation. Compared with PLWH reporting 0-1 SDOH challenges, those reporting ≥ 4 SDOH challenges were more likely to miss ≥ 1 HIV care appointment (aPR: 2.57, 95% CI 1.70-3.88), have symptoms of depression (aPR: 4.03, 95% CI 2.68-6.05) and anxiety (aPR: 3.55, 95% CI 2.25-5.61), and less likely to have 100% antiretroviral therapy (ART) adherence (aPR: 0.62, 95% CI 0.50-0.78) and sustained viral suppression (aPR: 0.77, 95% CI 0.65-0.90). Stigma scores were highest for those reporting ≥ 4 SDOH challenges. Our findings indicate significant associations between SDOH and adverse HIV health and quality of life outcomes which can inform and direct federal, state, and local strategies aimed at improving these outcomes. Linking PLWH to social support services and providing mental health screening and care services could benefit their mental and emotional well-being, leading to better healthcare outcomes.
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Affiliation(s)
- S Karram
- Michigan Department of Health and Human Services, Bureau of HIV and STI Programs, Lansing, MI, USA.
| | - C Sanger
- Michigan Department of Health and Human Services, Bureau of HIV and STI Programs, Detroit, MI, USA
| | - C Convery
- Michigan Department of Health and Human Services, Bureau of HIV and STI Programs, Detroit, MI, USA
| | - A Brantley
- Michigan Department of Health and Human Services, Bureau of HIV and STI Programs, Detroit, MI, USA
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Convery C, Diesel J, Brantley A, Miller J, Karram S. Brief Report: Ryan White Participation Increased the Prevalence of COVID-19 Vaccination Among People Living with HIV in Michigan. J Acquir Immune Defic Syndr 2024; 95:6-9. [PMID: 37797232 PMCID: PMC10841853 DOI: 10.1097/qai.0000000000003315] [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] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 09/14/2023] [Indexed: 10/07/2023]
Abstract
INTRODUCTION People living with HIV (PLWH) have higher prevalence of adverse COVID-19 outcomes, and many reside in socially vulnerable communities. Our aim was to evaluate how engagement in HIV care may increase vaccination likelihood. METHODS Michigan HIV surveillance data were extracted from the Enhanced HIV/AIDS Reporting System and matched at the person-level to COVID-19 vaccination records from the Michigan Care Improvement Registry (through December 31, 2021 [n = 15,537]). Based on residential census tract, we classified PLWH into quartiles (<25th percentile [least vulnerable], 25th to <50th, 50th to <75th, ≥75th [most vulnerable]) of the 2018 CDC Social Vulnerability Index. Using log binomial regression, we estimated the relative prevalence of COVID-19 vaccine series initiation among PLWH by quartile of social vulnerability and Ryan White participation; models were adjusted for covariates. RESULTS By December 31, 2021, 67% of PLWH in Michigan had initiated a COVID-19 vaccine series; 47% resided in an area deemed most vulnerable and 54% had participated in Ryan White services. Compared with PLWH in the most vulnerable quartile, those who resided in least vulnerable quartiles had higher prevalence of vaccine initiation (Prevalence Ratio [95% Confidence Interval]: 1.67 [1.50 to 1.86]). Participants in Ryan White had greater prevalence of initiation (1.52 [1.42 to 1.62]) compared with those who were not participants; initiation remained higher when adjusted for covariates including social vulnerability quartile. CONCLUSIONS Ryan White participation was associated with increased COVID-19 vaccine initiation regardless of community-level vulnerability. Wraparound services may be key in vaccine promotion interventions in this vulnerable population.
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Affiliation(s)
| | - Jill Diesel
- Michigan Department of Health and Human Services
- Centers for Disease Control and Prevention
| | | | | | - Sarah Karram
- Michigan Department of Health and Human Services
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Da'na S, Abedat S, Nachman D, Rokach Y, Qadan A, Karram S, Tzach-Nahman R, Beeri R, Amir O, Houri-Haddad Y, Asleh R. Induction of periodontitis and oral microbiome dysbiosis in a mouse model with heart failure with preserved ejection fraction results in worsening hypertension and diastolic dysfunction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2956] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Heart Failure with Preserved Ejection Fraction (HFpEF) is characterized by increased inflammation and disruption of the nitric oxide (NO) pathway. Oral microbiota has an essential role in the generation of a large portion of the NO bioavailability pool in the human body. Periodontitis (PD) is a common inflammatory condition that contributes to the development of chronic low-grade inflammation, oral microbiota dysbiosis, and dysregulation of the NO hemostasis.
Purpose
In this study, we sought to investigate the direct effect of PD induction on HFpEF manifestation in a mouse model.
Methods
HFpEF was induced in 11-week-old C57/black male mice by high-fat diet and inhibition of NO synthase using L-NAME (Nω-nitro-l-arginine-methyl-ester) (a “2-hit-model”) for 10 weeks. PD was induced by oral infection with P. gingivalis. Diastolic function of the left ventricle (LV) was assessed by high-frequency echocardiography. Blood pressure (BP) was measured using CODA non-invasive tail-cuff system.
Results
Induction of PD resulted in a significantly impaired diastolic function demonstrated by more pronounced decrease in e' and increase in E/e' ratio compared to HFpEF without PD or control mice (E/e': 39.7±2.6 vs. 30.1±1.9 vs. 24.3±2.1 for PD-HFpEF [n=15], HFpEF [n=15], and controls [n=10], respectively, p<0.001). While LV ejection fraction (EF) was similar, global longitudinal strain (GLS) was decreased in the HFpEF group and further decreased in the PD-HFpEF group compared to controls (p<0.001). BP was elevated in the HFpEF mice and PD induction resulted in a more remarkable increase in BP (systolic BP: 124.7±3.3 vs. 112.7±3.8 vs. 94.8±2.2 mmHg, respectively, p<0.001).
Conclusions
Induction of PD in a mouse model with HFpEF results in a more pronounced BP elevation and diastolic dysfunction compared to HFpEF without PD. Extensive molecular experiments are ongoing to explore the mechanisms responsible for the increased HFpEF severity in the setting of PD.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Israel Science Foundation
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Affiliation(s)
- S Da'na
- Hadassah University Medical Center , Jerusalem , Israel
| | - S Abedat
- Hadassah University Medical Center , Jerusalem , Israel
| | - D Nachman
- Hadassah University Medical Center , Jerusalem , Israel
| | - Y Rokach
- Hadassah University Medical Center , Jerusalem , Israel
| | - A Qadan
- Hadassah University Medical Center , Jerusalem , Israel
| | - S Karram
- Hadassah University Medical Center , Jerusalem , Israel
| | | | - R Beeri
- Hadassah University Medical Center , Jerusalem , Israel
| | - O Amir
- Hadassah University Medical Center , Jerusalem , Israel
| | | | - R Asleh
- Hadassah University Medical Center , Jerusalem , Israel
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Rocco SA, Koneva L, Middleton LYM, Thong T, Solanki S, Karram S, Nambunmee K, Harris C, Rozek LS, Sartor MA, Shah YM, Colacino JA. Cadmium Exposure Inhibits Branching Morphogenesis and Causes Alterations Consistent With HIF-1α Inhibition in Human Primary Breast Organoids. Toxicol Sci 2019; 164:592-602. [PMID: 29741670 DOI: 10.1093/toxsci/kfy112] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Developmental cadmium exposure in vivo disrupts mammary gland differentiation, while exposure of breast cell lines to cadmium causes invasion consistent with the epithelial-mesenchymal transition (EMT). The effects of cadmium on normal human breast stem cells have not been measured. Here, we quantified the effects of cadmium exposure on reduction mammoplasty patient-derived breast stem cell proliferation and differentiation. Using the mammosphere assay and organoid formation in 3D hydrogels, we tested 2 physiologically relevant doses of cadmium, 0.25 and 2.5 µM, and tested for molecular alterations using RNA-seq. We functionally validated our RNA-seq findings with a hypoxia-inducible factor (HIF)-1α activity reporter line and pharmaceutical inhibition of HIF-1α in organoid formation assays. 2.5 µM cadmium reduced primary mammosphere formation and branching structure organoid formation rates by 33% and 87%, respectively. Despite no changes in mammosphere formation, 0.25 µM cadmium inhibited branching organoid formation in hydrogels by 73%. RNA-seq revealed cadmium downregulated genes associated with extracellular matrix formation and EMT, while upregulating genes associated with metal response including metallothioneins and zinc transporters. In the RNA-seq data, cadmium downregulated HIF-1α target genes including LOXL2, ZEB1, and VIM. Cadmium significantly inhibited HIF-1α activity in a luciferase assay, and the HIF-1α inhibitor acriflavine ablated mammosphere and organoid formation. These findings show that cadmium, at doses relevant to human exposure, inhibited human mammary stem cell proliferation and differentiation, potentially through disruption of HIF-1α activity.
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Affiliation(s)
- Sabrina A Rocco
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan 48109-2029
| | - Lada Koneva
- Department of Computational Medicine and Bioinformatics
| | - Lauren Y M Middleton
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan 48109-2029
| | - Tasha Thong
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan 48109-2029
| | - Sumeet Solanki
- Molecular and Integrative Physiology and Internal Medicine, Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan 48109
| | - Sarah Karram
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan 48109-2029
| | - Kowit Nambunmee
- Department of Occupational Health and Safety, Mae Fah Luong University, Chiang Rai, Thailand, 57100
| | - Craig Harris
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan 48109-2029
| | - Laura S Rozek
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan 48109-2029
| | | | - Yatrik M Shah
- Molecular and Integrative Physiology and Internal Medicine, Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan 48109
| | - Justin A Colacino
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan 48109-2029.,Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, 48109
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Munari E, Chaux A, Vaghasia AM, Taheri D, Karram S, Bezerra SM, Gonzalez Roibon N, Nelson WG, Yegnasubramanian S, Netto GJ, Haffner MC. Global 5-Hydroxymethylcytosine Levels Are Profoundly Reduced in Multiple Genitourinary Malignancies. PLoS One 2016; 11:e0146302. [PMID: 26785262 PMCID: PMC4718593 DOI: 10.1371/journal.pone.0146302] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 12/15/2015] [Indexed: 01/22/2023] Open
Abstract
Solid tumors are characterized by a plethora of epigenetic changes. In particular, patterns methylation of cytosines at the 5-position (5mC) in the context of CpGs are frequently altered in tumors. Recent evidence suggests that 5mC can get converted to 5-hydroxylmethylcytosine (5hmC) in an enzymatic process involving ten eleven translocation (TET) protein family members, and this process appears to be important in facilitating plasticity of cytosine methylation. Here we evaluated the global levels of 5hmC using a validated immunohistochemical staining method in a large series of clear cell renal cell carcinoma (n = 111), urothelial cell carcinoma (n = 55) and testicular germ cell tumors (n = 84) and matched adjacent benign tissues. Whereas tumor-adjacent benign tissues were mostly characterized by high levels of 5hmC, renal cell carcinoma and urothelial cell carcinoma showed dramatically reduced staining for 5hmC. 5hmC levels were low in both primary tumors and metastases of clear cell renal cell carcinoma and showed no association with disease outcomes. In normal testis, robust 5hmC staining was only observed in stroma and Sertoli cells. Seminoma showed greatly reduced 5hmC immunolabeling, whereas differentiated teratoma, embryonal and yolk sack tumors exhibited high 5hmC levels. The substantial tumor specific loss of 5hmC, particularly in clear cell renal cell carcinoma and urothelial cell carcinoma, suggests that alterations in pathways involved in establishing and maintaining 5hmC levels might be very common in cancer and could potentially be exploited for diagnosis and treatment.
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Affiliation(s)
- Enrico Munari
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, 21231, United States of America
| | - Alcides Chaux
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, 21231, United States of America
- Department of Scientific Research, Norte University; Centro para el Desarrollo de la Investigación Científica (CEDIC) Asunción, Asunción, Paraguay
| | - Ajay M. Vaghasia
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, 21231, United States of America
| | - Diana Taheri
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, 21231, United States of America
- Department of Pathology, Isfahan University of Medical Sciences, Isfahan Kidney Diseases Research Center, Isfahan, Iran
| | - Sarah Karram
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, 21231, United States of America
| | - Stephania M. Bezerra
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, 21231, United States of America
| | - Nilda Gonzalez Roibon
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, 21231, United States of America
| | - William G. Nelson
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, 21231, United States of America
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, 21231, United States of America
- Brady Urological Institute, Johns Hopkins University, Baltimore, Maryland, 21231, United States of America
| | - Srinivasan Yegnasubramanian
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, 21231, United States of America
| | - George J. Netto
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, 21231, United States of America
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, 21231, United States of America
- Brady Urological Institute, Johns Hopkins University, Baltimore, Maryland, 21231, United States of America
- * E-mail: (MCH); (GJN)
| | - Michael C. Haffner
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, 21231, United States of America
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, 21231, United States of America
- * E-mail: (MCH); (GJN)
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Karram S, Geddes S, Li QK. Cytological Diagnosis of Metastatic Sarcomas in Body Fluids and Correlation With Immunohistochemical/Molecular Studies: A Retrospective Study of Cytologic Cases. Am J Clin Pathol 2015. [DOI: 10.1093/ajcp/144.suppl2.091] [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: 11/13/2022] Open
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Bezerra SM, Lotan TL, Faraj SF, Karram S, Sharma R, Schoenberg M, Bivalacqua TJ, Netto GJ. GATA3 expression in small cell carcinoma of bladder and prostate and its potential role in determining primary tumor origin. Hum Pathol 2014; 45:1682-7. [DOI: 10.1016/j.humpath.2014.04.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 04/04/2014] [Accepted: 04/09/2014] [Indexed: 11/15/2022]
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Bezerra S, Karram S, Sharma R, Ellis C, Berman D, Schoenberg M, Bivalacqua T, Netto G. MP28-08 DPC4 LOSS OF EXPRESSION IN INVASIVE UROTHELIAL CARCINOMAS: AN IMMUNOHISTOCHEMICAL STUDY. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Karram S, Kao CS, Osunkoya AO, Ulbright TM, Epstein JI. Idiopathic granulomatous orchitis: morphology and evaluation of its relationship to IgG4 related disease. Hum Pathol 2013; 45:844-50. [PMID: 24656095 DOI: 10.1016/j.humpath.2013.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 12/06/2013] [Accepted: 12/11/2013] [Indexed: 11/24/2022]
Abstract
Idiopathic granulomatous orchitis (IGO) is rare, thought to result from an autoimmune reaction to spermatogenic elements. Its relationship to IgG4-related disease (IgG4-RD) has not been evaluated. Sixteen orchiectomy specimens (1984-2012) with a prominent intratubular granulomatous reaction were reviewed: IGO (n = 6); intratubular germ cell neoplasia unclassified (IGCNU) with a granulomatous reaction and associated seminoma (GS, n = 6); and unclassified intratubular granulomatous orchitis not fitting into a specific entity (UGO, n = 4). Men with IGO were 32 to 86 years old, presenting with a mass suspicious for malignancy. Only one patient had a history of an inflammatory disease. Clinical follow-up was available for 2 patients with IGO, and both had no evidence of systemic IgG4-RD. All IGO cases had an epithelioid granulomatous reaction confined to seminiferous tubules, an extensive interstitial lymphoplasmacytic inflammation, 3 of 6 had prominent interstitial fibrosis, and 3 of 6 cases had plasma cells with an IgG4+/IgG+ ratio >40%. In GS, 10% to 100% of tubules with IGCNU had a granulomatous reaction, which in 3 cases replaced IGCNU cells. In contrast to IGO, GS had more intratubular multinucleated giant cells, more peritubular sclerosis, fewer interstitial plasma cells, and no interstitial fibrosis. Of the 4 UGO cases, most had predominantly interstitial with less intratubular granulomatous inflammation. Only 1 non-IGO case had elevated tissue IgG4 (GS case). It is critical and sometimes difficult to distinguish GS from IGO. IGO shares some features with IgG4-RD, yet current evidence does not support its classification as a localized manifestation of IgG4-RD occurring in the testis.
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Affiliation(s)
- Sarah Karram
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD, 21231, USA
| | - Chia-Sui Kao
- Department of Pathology, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Adeboye O Osunkoya
- Department of Pathology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Thomas M Ulbright
- Department of Pathology, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Jonathan I Epstein
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD, 21231, USA; Department of Urology, The Johns Hopkins Hospital, Baltimore, MD, 21231, USA; Department of Oncology, The Johns Hopkins Hospital, Baltimore, MD, 21231, USA.
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Bell WR, Dalton JB, McCall CM, Karram S, Pearce DT, Memon W, Lee R, Carroll KC, Lyons JL, Gireesh ED, Trivedi JB, Cettomai D, Smith BR, Chang T, Tochen L, Ratchford JN, Harrison DM, Ostrow LW, Stevens RD, Chen L, Zhang SX. Iatrogenic Exserohilum infection of the central nervous system: mycological identification and histopathological findings. Mod Pathol 2013; 26:166-70. [PMID: 23222492 DOI: 10.1038/modpathol.2012.208] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
An outbreak of fungal infections has been identified in patients who received epidural injections of methylprednisolone acetate that was contaminated with environmental molds. In this report, we present the mycological and histopathological findings in an index case of Exserohilum meningitis and vasculitis in an immunocompetent patient, who received a cervical spine epidural steroid injection for chronic neck pain 1 week before the onset of fulminant meningitis with subsequent multiple brain and spinal cord infarcts. The fungus was recovered from two separate cerebrospinal fluid specimens collected before initiation of antifungal therapy and at autopsy on standard bacterial and fungal culture media. The mold was identified phenotypically as Exserohilum species. DNA sequencing targeting the internal transcribed spacer region and D1/D2 region of 28S ribosomal DNA enabled further speciation as E. rostratum. Gross examination at autopsy revealed moderate brain edema with bilateral uncal herniation and a ventriculostomy tract to the third ventricle. The brainstem, cerebellum, and right orbitofrontal cortex were soft and friable, along with hemorrhages in the cerebellar vermis and thalamus. Microscopic examination demonstrated numerous fungi with septate hyphae invading blood vessel walls and inducing acute necrotizing inflammation. The leptomeninges were diffusely infiltrated by mixed inflammatory cells along with scattered foci of fungal elements. This is the first report of iatrogenic E. rostratum meningitis in humans. This report describes the microbiological procedures and histopathological features for the identification of E. rostratum (a pigmented vascularly invasive fungi), the cause of a current nationwide outbreak of fatal fungal meningitis.
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Affiliation(s)
- W Robert Bell
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21287-7093, USA
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Lyons JL, Gireesh ED, Trivedi JB, Bell WR, Cettomai D, Smith BR, Karram S, Chang T, Tochen L, Zhang SX, McCall CM, Pearce DT, Carroll KC, Chen L, Ratchford JN, Harrison DM, Ostrow LW, Stevens RD. Fatal exserohilum meningitis and central nervous system vasculitis after cervical epidural methylprednisolone injection. Ann Intern Med 2012; 157:835-6. [PMID: 23277893 DOI: 10.7326/0003-4819-158-1-201212040-00557] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Abstract
BACKGROUND Transepidermal elimination has been documented in a myriad of infectious diseases; however, its occurrence in cutaneous leishmaniasis has not been evaluated. METHODS Skin biopsies (n = 212) with cutaneous leishmaniasis in Lebanon (n = 46), Syria (n = 53), Saudi Arabia (n = 45) and Pakistan (n = 68) were evaluated. Clinical data collected included age, gender, eruption type (papule, nodule, verrucous or scar), duration and anatomic location. Histopathologically, multiple parameters were recorded including Ridley's parasitic index and pattern, transepidermal elimination, interface changes, ulceration and necrosis. Transepidermal elimination was defined as the presence of amastigotes in the epidermis in all layers, limited to the basal layer or present in a perforating plug. All cases were confirmed by polymerase chain reaction (PCR) analysis followed by restriction fragment length polymorphism analysis for molecular subspeciation. RESULTS Leishmania tropica was identified in 88.2% and Leishmania major in 11.8% of all cases. Transepidermal elimination was observed in 28.3% of cases (29 perforating plug, 19 all layers and 12 basal layer) with a significant prevalence of L. major in this group (35 vs. 2%, p < 0.001). Cases with transepidermal elimination were associated with interface changes and higher parasitic index (p < 0.001) but not with an increased ulceration rate (p > 0.05). Multivariate analysis showed that transepidermal elimination was independently predicted by L. major [OR (95% confidence interval) = 80 (9-712); p < 0.001], parasitic index [OR = 3.4 (2.1-5.3); p < 0.001], interface changes [OR = 6.24 (2.2-17.8); p < 0.001] and necrosis [OR = 0.2 (0.1-0.8);p = 0.026]. CONCLUSIONS We report the largest multiregional cutaneous leishmaniasis series with a 28.3% documented transepidermal elimination incidence of which 48% were perforating plug; a significant prevalence of L. major was also identified in the transepidermal elimination group. The association of transepidermal elimination with interface changes and a higher parasitic index, without an increased ulceration rate, may reflect a unique biologic alteration in the epidermis, serving to facilitate the extrusion of the parasites through the skin.
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Affiliation(s)
- Sarah Karram
- Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Lee TK, Chaux A, Karram S, Miyamoto H, Miller JS, Fajardo DA, Epstein JI, Netto GJ. Papillary urothelial neoplasm of low malignant potential of the urinary bladder: clinicopathologic and outcome analysis from a single academic center. Hum Pathol 2011; 42:1799-803. [DOI: 10.1016/j.humpath.2011.03.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Revised: 03/04/2011] [Accepted: 03/15/2011] [Indexed: 11/29/2022]
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Karram S, Trock BJ, Netto GJ, Epstein JI. Should intervening benign tissue be included in the measurement of discontinuous foci of cancer on prostate needle biopsy?correlation with radical prostatectomy findings. Int Braz J Urol 2011. [DOI: 10.1590/s1677-55382011000500022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Chaux A, Eifler J, Karram S, Al-Hussain T, Faraj S, Pomper M, Rodriguez R, Netto GJ. Focal positive prostate-specific membrane antigen (PSMA) expression in ganglionic tissues associated with prostate neurovascular bundle: implications for novel intraoperative PSMA-based fluorescent imaging techniques. Urol Oncol 2011; 31:572-5. [PMID: 21640619 DOI: 10.1016/j.urolonc.2011.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Revised: 04/03/2011] [Accepted: 04/03/2011] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Prostate specific membrane antigen (PSMA) is primarily expressed in glandular prostatic tissue and is frequently utilized to detect primary or metastatic prostatic adenocarcinoma (CaP). A purported novel application of PSMA detection is the intraoperative real-time identification of CaP using radioimmunoscintigraphy to define the extension of the surgical resection. Considering that PSMA expression has been reported in other tissues, we evaluated its immunoexpression in prostatic neurovascular bundle elements to assess the convenience and safety of the aforementioned procedure. MATERIALS AND METHODS Twenty consecutive specimens of radical prostatectomy (RP) were retrieved from our surgical pathology archives. PSMA immunoexpression (Clone 3E6, DAKO) was assessed in a representative section from each specimen containing neurovascular bundle elements. RESULTS PSMA expression was documented in 20/20 of examined CaP slides. Most cases exhibited an apical/cytoplasmic or cytoplasmic with membranous accentuation pattern of staining. Focal weak to moderate cytoplasmic staining was detected in associated ganglionic tissue in 3/15 of the examined RP. In all cases, staining was cytoplasmic, less extensive, and weaker than the pattern observed in CaP. None of the peripheral nerve sheath cells or lymphovascular components of the examined neurovascular bundles were positive for PSMA. CONCLUSIONS We found focal positive PSMA expression in the ganglionic cells of the prostatic neurovascular bundle. Our results suggest that the radioimmunoscintigraphic detection of radiolabeled PSMA antibodies might not be entirely specific for prostatic cells; this observation must be taken into account should an intraoperative PSMA-based fluorescent imaging technique be used to define the extension of the surgical procedure.
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Affiliation(s)
- Alcides Chaux
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD 21231, USA
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