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Ware C, Meledathu S, Tariq Z, Yee R, Lichtenberger JP, Siegel MO. Cryptococcal pneumonia and meningitis in a renal transplant recipient with a false negative serum cryptococcal antigen due to postzone phenomenon. IDCases 2023; 34:e01898. [PMID: 37810462 PMCID: PMC10551614 DOI: 10.1016/j.idcr.2023.e01898] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 09/27/2023] [Indexed: 10/10/2023] Open
Abstract
Cryptococcal infection can cause significant morbidity and mortality in immunocompromised patients. We present a patient who was diagnosed with cryptococcal meningitis and pulmonary disease in the setting of a history of renal transplantation. The diagnosis was made based on growth of Cryptococcus neoformans in blood cultures and identification of cryptococcal antigen (CrAg) in cerebral spinal fluid (CSF) using a lateral flow assay (LFA). Our case is unique since the initial serum CrAg was falsely negative due to excess cryptococcal antigen preventing the formation of antigen-antibody complexes, referred to as the postzone phenomenon. This phenomenon has been reported on CSF samples but rarely reported on serum samples in patients without an HIV diagnosis.
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Affiliation(s)
- Chelsea Ware
- Department of Medicine, George Washington University Medical Faculty Associates, 2150 Pennsylvania Avenue, NW, Washington, DC, USA
| | - Sherin Meledathu
- Department of Medicine, George Washington University Medical Faculty Associates, 2150 Pennsylvania Avenue, NW, Washington, DC, USA
| | - Zoon Tariq
- Department of Pathology, The George Washington University Hospital, 900 23rd Street, NW, Washington, DC, USA
| | - Rebecca Yee
- Department of Pathology, The George Washington University Hospital, 900 23rd Street, NW, Washington, DC, USA
| | - John P. Lichtenberger
- Department of Radiology, The George Washington University Medical Faculty Associates, 900 23rd Street NW, Washington, DC, USA
| | - Marc O. Siegel
- Department of Medicine, George Washington University Medical Faculty Associates, 2150 Pennsylvania Avenue, NW, Washington, DC, USA
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Meledathu S, Firek M, Liappis AP, Patel PC. 250. An Assessment of the Penicillin Allergy Label in Patients Undergoing Orthopedic Procedures at a VA Medical Center. Open Forum Infect Dis 2021. [PMCID: PMC8644258 DOI: 10.1093/ofid/ofab466.452] [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: 11/21/2022] Open
Abstract
Background Approximately 10% of the population is labeled as penicillin (PCN) allergic, while only 1% of these individuals have a true IgE mediated allergy. This label influences the prescription of the most appropriate antibiotic and ultimately leads to antimicrobial resistance, hospital readmission, increased length of hospital stays, use of critical care beds, and greater healthcare costs. Post-surgical complications in patients undergoing total knee arthroplasty (TKA) or total hip arthroplasty (THA) are also increased when patients receive an alternative antibiotic due to PCN allergy. Methods A retrospective chart review identified patients who underwent a TKA or THA during the 2018-2020 calendar years at the Washington DC VA Medical Center. Multiple operations at different times on the same patient were regarded as separate events. The primary outcome was patients who were evaluable for penicillin allergy de-labeling and the secondary outcome was perioperative antibiotic choice. Results Patients in both groups were predominantly male, Black, and over the age of 60. Of a total of 317 procedures performed, we identified 28 procedures in which patients carried a PCN allergy label (PAL) and received a β-lactam alternative antibiotic for surgical prophylaxis. No patients in the PAL group received cefazolin for prophylaxis, compared to 87% of the non-PAL group who were appropriately given cefazolin. In the group carrying the PAL, 62% of patients received vancomycin and 29% of patients received clindamycin for pre-operative prophylaxis. Only one of these patients had a formal allergy consult note, but the PCN allergy was not addressed during that visit. Fewer patients (4%) required ICU admission during their hospitalization in the non-PAL group versus 10% of patients in the PAL group. Table 1. Patient Demographics and Procedure Detail ![]()
Conclusion The use of alternative antibiotics in pre-procedural prophylaxis can contribute to adverse events associated with high-risk broader spectrum antimicrobials as well as increased costs associated with antimicrobials such as vancomycin. Our facility began implementation of a penicillin de-labeling program in 2018 via skin testing and direct oral challenge in collaboration with colleagues from Allergy and Immunology. Removal of PAL in this population can increase rates of appropriate prophylaxis. Disclosures All Authors: No reported disclosures
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Affiliation(s)
- Sherin Meledathu
- Washington DC VA Medical Center, Washington, District of Columbia
| | - MacKenzie Firek
- Belmont University College of Pharmacy, Nashville, Tennessee
| | | | - Pratish C Patel
- Washington DC VA Medical Center, Washington, District of Columbia
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Meledathu S, Denyer R, Roberts A, Simon G. Polymicrobial native valve endocarditis due to Bacillus cereus and Cardiobacterium hominis. BMJ Case Rep 2021; 14:e245417. [PMID: 34853044 PMCID: PMC8638124 DOI: 10.1136/bcr-2021-245417] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2021] [Indexed: 11/03/2022] Open
Abstract
We present a case of polymicrobial subacute bacterial endocarditis and bacteremia with Bacillus cereus and Cardiobacterium hominis in a 72-year-old man with pre-existing mitral valve disease and prior mitral valve repair who presented with renal failure and glomerulonephritis. Bacillus is often a contaminant in blood cultures but has been rarely implicated in patients with invasive infections such as endocarditis. Intravenous drug use, prosthetic heart valves, valvular heart disease and venous catheters are the most frequently described risk factors for Bacillus bacteremia and endocarditis in the medical literature. Management is challenging as Bacillus is resistant to penicillin and cephalosporin antibiotics due to production of beta-lactamase. Polymicrobial endocarditis is uncommon and when it occurs typically involves Staphylococcal species. To our knowledge, this is the first reported case of polymicrobial endocarditis in which both Bacillus and a HACEK organism are implicated.
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Affiliation(s)
- Sherin Meledathu
- Infectious Disease, The George Washington University Hospital, Washington, DC, USA
| | - Rachel Denyer
- Infectious Disease, The George Washington University Hospital, Washington, DC, USA
| | - Afsoon Roberts
- Infectious Disease, The George Washington University Hospital, Washington, DC, USA
| | - Gary Simon
- Infectious Disease, George Washington University School of Public Health and Health Services, Washington, DC, USA
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Okoh AK, Sossou C, Dangayach NS, Meledathu S, Phillips O, Raczek C, Patti M, Kang N, Hirji SA, Cathcart C, Engell C, Cohen M, Nagarakanti S, Bishburg E, Grewal HS. Coronavirus disease 19 in minority populations of Newark, New Jersey. Int J Equity Health 2020; 19:93. [PMID: 32522191 PMCID: PMC7286208 DOI: 10.1186/s12939-020-01208-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 06/02/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The purpose of this study is to report the clinical features and outcomes of Black/African American (AA) and Latino Hispanic patients with Coronavirus disease 2019 (COVID-19) hospitalized in an inter-city hospital in the state of New Jersey. METHODS This is a retrospective cohort study of AA and Latino Hispanic patients with COVID-19 admitted to a 665-bed quaternary care, teaching hospital located in Newark, New Jersey. The study included patients who had completed hospitalization between March 10, 2020, and April 10, 2020. We reviewed demographics, socioeconomic variables and incidence of in-hospital mortality and morbidity. Logistic regression was used to identify predictor of in-hospital death. RESULTS Out of 416 patients, 251 (60%) had completed hospitalization as of April 10, 2020. The incidence of In-hospital mortality was 38.6% (n = 97). Most common symptoms at initial presentation were dyspnea 39% (n = 162) followed by cough 38%(n = 156) and fever 34% (n = 143). Patients were in the highest quartile for population's density, number of housing units and disproportionately fell into the lowest median income quartile for the state of New Jersey. The incidence of septic shock, acute kidney injury (AKI) requiring hemodialysis and admission to an intensive care unit (ICU) was 24% (n = 59), 21% (n = 52), 33% (n = 82) respectively. Independent predictors of in-hospital mortality were older age, lower serum Hemoglobin < 10 mg/dl, elevated serum Ferritin and Creatinine phosphokinase levels > 1200 U/L and > 1000 U/L. CONCLUSIONS Findings from an inter-city hospital's experience with COVID-19 among underserved minority populations showed that, more than one of every three patients were at risk for in-hospital death or morbidity. Older age and elevated inflammatory markers at presentation were associated with in-hospital death.
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Affiliation(s)
- Alexis K Okoh
- Heart and Lung Research Center, RWJ Barnabas Health, Newark Beth Israel Medical Center, 201 Lyons, Avenue, Suite G5., Newark, New Jersey, 07112, USA.
| | - Christoph Sossou
- Heart and Lung Research Center, RWJ Barnabas Health, Newark Beth Israel Medical Center, 201 Lyons, Avenue, Suite G5., Newark, New Jersey, 07112, USA
| | - Neha S Dangayach
- Heart and Lung Research Center, RWJ Barnabas Health, Newark Beth Israel Medical Center, 201 Lyons, Avenue, Suite G5., Newark, New Jersey, 07112, USA
| | - Sherin Meledathu
- Heart and Lung Research Center, RWJ Barnabas Health, Newark Beth Israel Medical Center, 201 Lyons, Avenue, Suite G5., Newark, New Jersey, 07112, USA
| | - Oluwakemi Phillips
- Heart and Lung Research Center, RWJ Barnabas Health, Newark Beth Israel Medical Center, 201 Lyons, Avenue, Suite G5., Newark, New Jersey, 07112, USA
| | - Corinne Raczek
- Heart and Lung Research Center, RWJ Barnabas Health, Newark Beth Israel Medical Center, 201 Lyons, Avenue, Suite G5., Newark, New Jersey, 07112, USA
| | - Michael Patti
- Heart and Lung Research Center, RWJ Barnabas Health, Newark Beth Israel Medical Center, 201 Lyons, Avenue, Suite G5., Newark, New Jersey, 07112, USA
| | - Nathan Kang
- Heart and Lung Research Center, RWJ Barnabas Health, Newark Beth Israel Medical Center, 201 Lyons, Avenue, Suite G5., Newark, New Jersey, 07112, USA
| | - Sameer A Hirji
- Heart and Lung Research Center, RWJ Barnabas Health, Newark Beth Israel Medical Center, 201 Lyons, Avenue, Suite G5., Newark, New Jersey, 07112, USA
| | - Charles Cathcart
- Heart and Lung Research Center, RWJ Barnabas Health, Newark Beth Israel Medical Center, 201 Lyons, Avenue, Suite G5., Newark, New Jersey, 07112, USA
| | - Christian Engell
- Heart and Lung Research Center, RWJ Barnabas Health, Newark Beth Israel Medical Center, 201 Lyons, Avenue, Suite G5., Newark, New Jersey, 07112, USA
| | - Marc Cohen
- Heart and Lung Research Center, RWJ Barnabas Health, Newark Beth Israel Medical Center, 201 Lyons, Avenue, Suite G5., Newark, New Jersey, 07112, USA
| | - Sandhya Nagarakanti
- Heart and Lung Research Center, RWJ Barnabas Health, Newark Beth Israel Medical Center, 201 Lyons, Avenue, Suite G5., Newark, New Jersey, 07112, USA
| | - Eliahu Bishburg
- Heart and Lung Research Center, RWJ Barnabas Health, Newark Beth Israel Medical Center, 201 Lyons, Avenue, Suite G5., Newark, New Jersey, 07112, USA
| | - Harpreet S Grewal
- Heart and Lung Research Center, RWJ Barnabas Health, Newark Beth Israel Medical Center, 201 Lyons, Avenue, Suite G5., Newark, New Jersey, 07112, USA
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