447. Improvement of Anal Pap Collection Documentation and Adequacy in PLWHIV in Infectious Diseases Clinic

Background

Anal Pap smear is an essential screening tool for high-risk human papillomavirus (hrHPV)-associated anal squamous cell carcinoma (ASCC), particularly in people living with HIV (PLWHIV). Currently, there is no consensus regarding time interval or protocols for screening of anal hrHPV-associated cancer. Limited reports suggest self-collected specimens have similar cytology sensitivity compared to physician-collected samples.

Methods

We utilized a Quality Improvement project (QIP) to assess validity of self-collected anal swab specimens (SCS) for screening of hrHPV-related anal lesions versus physician-collected specimens (PCS) over 3 months. The protocol was implemented in an Infectious Diseases clinic by patients and physicians during routine visits. Patients learned about the QIP via educational handout and were offered self- or physician-collection.

Results

A total of 60 patients participated. Seventy-five percent opted for self-collection and 35/45 (78%) SCS were adequate for interpretation, compared to 10/15 (67%) PCS. Fisher exact test value was 0.49, indicating no significant difference between groups (at p< .05). In total, 77% of patients completed the satisfaction survey. Only 13% reported preference for physician-performed procedure, while 63% felt that a self-collection option made them more likely to complete the Pap. A limitation to this project is the Hawthorne effect, as participants were aware of the QIP and that validity of the samples depended on appropriate sample collection. There was also a relatively small sample size of self-collected specimens (n=45).

Survey results

Final result from surveys answered by patients that participated in the project.

Conclusion

Survey analysis showed increased patient satisfaction and similar adequacy of samples collected. While the project was not powered to demonstrate an increase in acceptance of anal Paps, increased satisfaction could lead to improvement over time with a simple and inexpensive workflow adjustment. Additionally, with expansion of telehealth, self-collected anal Paps may increase opportunities to complete screening at times physicians are not available. Studies with larger populations, in multiple institutions and with varying educational handouts/instruction methods may provide better data to corroborate recommendations regarding best practices for screening for ASCC.

Disclosures

All Authors: No reported disclosures.

Tularemia Proximal Interphalangeal Joint Septic Arthritis: A Case Report

CASE

A case of Francisella tularensis finger proximal interphalangeal joint septic arthritis secondary to feral cat bite is presented. The patient underwent operative debridement on presentation. On postoperative day 5, a gram-negative rod resembling F. tularensis was identified. The patient received 4 weeks of gentamicin for culture-confirmed ulceroglandular tularemia. At the final follow-up, the infection had resolved, and full function of the digit had been regained.

CONCLUSION

Francisella tularensis septic arthritis secondary to a feral cat bite is exceedingly rare but should be considered in the appropriate clinical context. Proper identification and treatment with antibiotics is essential for a positive outcome.

Re-drawing the Maps for Endemic Mycoses

Endemic mycoses such as histoplasmosis, coccidioidomycosis, blastomycosis, paracoccidioidomycosis, and talaromycosis are well-known causes of focal and systemic disease within specific geographic areas of known endemicity. However, over the past few decades, there have been increasingly frequent reports of infections due to endemic fungi in areas previously thought to be “non-endemic.” There are numerous potential reasons for this shift such as increased use of immune suppressive medications, improved diagnostic tests, increased disease recognition, and global factors such as migration, increased travel, and climate change. Regardless of the causes, it has become evident that our previous understanding of endemic regions for these fungal diseases needs to evolve. The epidemiology of the newly described Emergomyces is incomplete; our understanding of it continues to evolve. This review will focus on the evidence underlying the established areas of endemicity for these mycoses as well as new data and reports from medical literature that support the re-thinking these geographic boundaries. Updating the endemic fungi maps would inform clinical practice and global surveillance of these diseases.