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Abstract
Background Hepatitis C virus (HCV) is a leading cause of advanced liver disease and death. In the United States about 3.5 million people are living with HCV, but only 50% are aware of the infection, 16% are prescribed treatment, and only 9% achieve sustained viral response. The World Health Organization published an HCV elimination goal for 2030 that strives to achieve a 65% reduction in HCV-related deaths and 90% reduction in transmission. An important step toward this goal is micro-elimination at local hospitals by addressing care gaps in the HCV care cascade. Figure 1 ![]()
Methods We created a retrospective cohort of patients who tested positive for HCV antibody (HCV Ab+) between 2016 and 2018 at Tufts Medical Center in Boston, Massachusetts. We assessed achievement of care cascade steps including HCV viral load (VL) testing, linkage to care, treatment initiation, and sustained viral response (SVR). We also assessed patient demographics, clinical factors and HCV risk factors. We used STATA/IC 14.1 to conduct bivariate analysis to identify factors associated with loss to follow-up across each care cascade step. Results A total of 24,308 HCV antibody tests were done during this timeframe, of which 5% (n=1,222) were HCV Ab+. After excluding duplicate tests, 1,041 unique patients with HCV Ab+ were included. This cohort had a mean age of 47 years and were 61% male, 66% white, 72% on public insurance, 12% HIV-positive, 13% HCV treatment-experienced. The most frequent HCV risk factor was injection drug use, occurring in 64% of patients. Of patients with HCV Ab+, 76% (n=791) were tested for an HCV VL, of which 50% (n=393) had detectable VL and 50% (n=398) had undetectable VL. Of the patients with a detectable VL, 58% (n=226) were linked with care. Following care linkage, 69% (n=155) initiated treatment, of which 90% (n=139) completed treatment, of which 97% (n=135) achieved SVR (Figure 1). Factors that were significantly associated with getting a VL test and linking to care included private insurance, HIV co-infection, absence of intravenous drug use and cirrhosis; however, these factors were not significantly associated with achieving subsequent steps. Conclusion Assessment of the HCV care cascade at our hospital allowed us to identify clear care gaps and areas needing improvement towards a local micro-elimination. Disclosures All Authors: No reported disclosures
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Affiliation(s)
| | - Anna Winston
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Tanya Zeina
- Tufts University School of Medicine, Boston, Massachusetts
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Mizusawa M, Vindenes T, Buckley S, Armstrong C. A case series of rapidly growing mycobacterial catheter-related bloodstream infections among immunocompetent patients. J Clin Tuberc Other Mycobact Dis 2020; 21:100196. [PMID: 33195824 PMCID: PMC7642862 DOI: 10.1016/j.jctube.2020.100196] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Rapidly growing mycobacteria (RGM) are ubiquitous in the environment and can cause a variety of human infections. Catheter-related bloodstream infections (CRBSI) caused by RGM have been reported predominantly among immunocompromised patients. Removal of central lines and antimicrobial therapy with at least 2 active agents are generally recommended for immunocompromised patients. RGM bloodstream infections (BSIs) are rare in immunocompetent patients and clinical data are very limited. Retrospective medical record review was conducted on patients with blood cultures positive for RGM from July 2012 through March 2015 at Lemuel Shattuck Hospital, a public teaching hospital in Jamaica Plain, Massachusetts, United States. RGM was suspected by presence of beaded Gram-positive bacilli on Gram staining of positive conventional blood cultures and it was confirmed as RGM by Massachusetts State Public Health Laboratory. Nineteen episodes of RGM BSI were identified in 17 patients who had no known immunocompromised conditions that predispose them to opportunistic pathogens. They were predominantly young male with history of intravenous drug use. Peripherally inserted central catheter (PICC) was present in all episodes of RGM BSI and 74% of them clinically improved with PICC removal alone without specific antibiotic therapy for RGM. They were followed up for median duration of 45 days (interquartile range 25–385). The patients remained alive and asymptomatic until the end of follow-up periods. In immunocompetent patients, removal of catheters alone without adding specific antibiotics may be sufficient for RGM CRBSI.
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Affiliation(s)
- Masako Mizusawa
- Section of Infectious Diseases, Department of Internal Medicine, University of Missouri, Kansas City, MO, USA
| | - Tine Vindenes
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA, USA
| | - Sarah Buckley
- Microbiology Laboratory, The Brigham and Women's Faulkner Hospital, Boston, MA, USA
| | - Catharina Armstrong
- Division of Infectious Diseases, The Newton-Wellesley Hospital, Newton, MA, USA
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Koniares KG, Fadlallah H, Kolettis DS, Vindenes T. Hepatitis C virus screening in pregnancy. Am J Obstet Gynecol MFM 2020; 2:100123. [PMID: 33345869 DOI: 10.1016/j.ajogmf.2020.100123] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/22/2020] [Accepted: 04/19/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND In 2016, the incidence of acute hepatitis C virus infection was 1.0 per 100,000 persons in the United States and 6.2 per 100,000 persons in Massachusetts. Hepatitis C virus infection among pregnant women in the United States increased by 89% from 2009 to 2014. The risk of a mother with hepatitis C virus infection transmitting the infection to her infant is approximately 4% to 7%. The Infectious Disease Society of America and the American Association for the Study of Liver Diseases recommend universal hepatitis C virus screening in pregnancy, whereas the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine recommend risk-based screening. OBJECTIVE The objective of this quality improvement project was to assess the hepatitis C virus screening practices of obstetricians and gynecologists at a tertiary care center located in a high endemic area for hepatitis C virus infection. STUDY DESIGN An electronic 10-question survey was reviewed by the Tufts Medical Center Institutional Review Board and found to be exempt from institutional review board approval. The survey was emailed to resident and attending physicians who provide obstetrical care. RESULTS Of a total of 41 respondents, 38 (92.6%) provided responses; of these 38 respondents, 17 (44.7%) were attending physicians, 4 (10.5%) were fellows, and 17 (44.7%) were resident physicians. In addition, 16 of 37 (43.2%) respondents answered that all pregnant women should be screened for hepatitis C virus, whereas 20 of 37 (54.1%) respondents thought only pregnant women with risk factors for hepatitis C virus infection should be screened. Furthermore, only 13 of 31 (41.9%) respondents correctly identified all of the recommended risk factors that should prompt screening for hepatitis C virus. When asked about their clinical practice, 5 of 36 (13.9%) respondents indicated that they screen all pregnant patients, whereas 28 of 36 (77.8%) respondents indicated that they screen patients based on their risk factors for hepatitis C virus infection. CONCLUSION Our survey showed that risk-based screening for hepatitis C virus may be less effective than universal screening because healthcare providers are not consistent in identifying risk factors for hepatitis C virus infection. Universal screening could decrease the amount of hepatitis C virus infections that go undiagnosed in pregnancy.
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Affiliation(s)
| | - Hasan Fadlallah
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA
| | - Diana S Kolettis
- Department of Obstetrics and Gynecology, Tufts Medical Center, Boston, MA
| | - Tine Vindenes
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA
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Vindenes T, Jordan MR, Tibbs A, Stopka TJ, Johnson D, Cochran J. A genotypic and spatial epidemiologic analysis of Massachusetts' Mycobacterium tuberculosis cases from 2012 to 2015. Tuberculosis (Edinb) 2018; 112:20-26. [PMID: 30205965 DOI: 10.1016/j.tube.2018.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 03/16/2018] [Revised: 06/29/2018] [Accepted: 07/03/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Massachusetts had a rate of 2.8 cases of tuberculosis (TB) per 100,000 individuals in 2015. Although TB in Massachusetts is on the decline, the case rate remains far above the 2020 National TB Target of 1.4 per 100,000. To reduce the TB case rate in Massachusetts, it is necessary to understand the local epidemiology and transmission risks. METHODS We used an existing TB case database of Massachusetts TB cases in the time frame from 2012 to 2015, which links de-identified patient demographic information with TB genotypes obtained from the United States Centers for Disease Control and Prevention's (CDC) TB Genotyping Information Management System database. Two or more cases with identical genotypes, which were close in space (within 50 km), as determined in a geographic information system (GIS), and time (3 years), were considered TB clusters. RESULTS We analyzed 543 genotyped cases. We identified a total of 85 cases that met the TB cluster criteria, and a total of 33 clusters. US-born individuals (p = 0.003), homeless individuals (p = 0.001) and those reporting illicit substance use (p = 0.001) and alcohol use (p = 0.001) were more likely to appear in a TB cluster. CONCLUSION Through a combined genotypic and spatial epidemiological approach, we identified populations and individuals more likely to be in a TB cluster. Testing populations identified as at risk for being in a TB cluster, and providing appropriate treatment, may decrease the overall TB case rate and support efforts to achieve national 2020 TB targets.
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Affiliation(s)
- T Vindenes
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, 800 Washington Street, Tufts University, Boston, MA, USA.
| | - M R Jordan
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, 800 Washington Street, Tufts University, Boston, MA, USA; Department of Public Health and Community Health, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, USA
| | - A Tibbs
- Massachusetts Department of Public Health, 305 South Street, Boston, MA, USA
| | - T J Stopka
- Department of Public Health and Community Health, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, USA
| | - D Johnson
- Department of Public Health and Community Health, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA, USA
| | - J Cochran
- Massachusetts Department of Public Health, 305 South Street, Boston, MA, USA
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Mizusawa M, Vindenes T, Armstrong C, Buckley S. A Case Series of Nontuberculous Mycobacterial Blood Stream Infections Among Non-cancer Patients. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.444] [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: 11/13/2022] Open
Affiliation(s)
- Masako Mizusawa
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts
| | - Tine Vindenes
- Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts
| | | | - Sarah Buckley
- Hematology Laboratory, Lemuel Shattuck Hospital, Jamaica Plain, Massachusetts
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Vindenes T, Beaulac KR, Doron S. The Legislative Momentum of Antimicrobial Stewardship: An International Perspective. Curr Treat Options Infect Dis 2016. [DOI: 10.1007/s40506-016-0072-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Vindenes T, Gardiner BJ, Nierenberg N, Volpe G. Pneumonia, septic arthritis, and brain abscesses in a construction worker. Clin Infect Dis 2016; 60:1722-3; quiz 1684-5. [PMID: 25972445 DOI: 10.1093/cid/civ056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Tine Vindenes
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts
| | - Bradley J Gardiner
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts
| | - Natalie Nierenberg
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts
| | - Gretchen Volpe
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts
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Mehta T, Vindenes T, Beaulac K, Roberts R. Pharmacokinetics of Doxycycline in Extracorporeal Membrane Oxygenation. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.521] [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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Yu E, Vindenes T, Vullaganti M, Tabba M. Acute Hemorrhagic Leukoencephalitis: A Rare Complication of Influenza H3N2. Chest 2015. [DOI: 10.1378/chest.2275545] [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: 11/01/2022] Open
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Vindenes T, Crowl G, Perera BM, Schleiter G. The elusive diagnosis: recurrent benign lymphocytic meningitis. Conn Med 2013; 77:477-479. [PMID: 24156176] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Recurrent benign lymphocytic meningitis (RBLM) or Mollaretmeningitis is a rare disease with a prevalence of 1-2.2/100,000 population. It is characterized by recurrent episodes of aseptic meningitis. The diagnosis is made via history fitting Bruyn's criteria, and confirmatory detection of HSV-2 in cerebrospinal fluid (CSF) via polymerase chain reaction (PCR). CASE A 59-year-old female with a past medical history (PMH) of rheumatoid arthritis in remission and 11 prior episodes of aseptic meningitis presented with sudden and severe headache, photophobia, nausea, vomiting, and meningismus without focal findings. CSF analysis revealed aseptic meningitis with Herpes simplex 2 virus (HSV-2) present by PCR. CONCLUSION RBLM remains a rare and elusive diagnosis but PCR technology has made it easier to diagnose. We present a 59-year-old female with classic features of RBLM, now suffering a 12th episode of aseptic meningitis. Heightened awareness of RBLM among clinicians may allow for an earlier diagnosis, reduced use of unnecessary antibiotics, shortened hospitalizations, and lower costs.
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Affiliation(s)
- Tine Vindenes
- Western Connecticut Health Network (WCHN), Department of Internal Medicine, Danbury Hospital, Danbury, USA.
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Vindenes T, Crump N, Casenas R, Wood K. Pheochromocytoma causing cardiomyopathy, ischemic stroke and acute arterial thrombosis: a case report and review of the literature. Conn Med 2013; 77:95-98. [PMID: 23513638] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Pheochromocytoma is a rare catecholamine secreting neuroendocrine tumor with an estimated annual incidence of one to four per million and prevalence among hypertensive patients of 0.1 to 0.6%. The symptoms and signs of pheochromocytoma include the classic triad of episodic headache, increased sweating, and palpitations. These are as a result of an uncontrolled release of catecholamines. There exist only a small number of reports of pheochromocytoma simulating hypertrophic obstructive cardiomyopathy, few reports of pheochromocytoma-induced ischemic stroke and only two reported cases with pheochromocytoma-induced arterial thrombosis. We present a case of multiple, rare clinical complications of pheochromocytoma occurring in the same patient and the review of literature of these complications.
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Affiliation(s)
- Tine Vindenes
- Department of Internal Medicine, Danbury Hospital, Danbury, CT, USA
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