Last data update: Sep 16, 2024. (Total: 47680 publications since 2009)
Records 1-11 (of 11 Records) |
Query Trace: Wingard R [original query] |
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Clinical Course of SARS-CoV-2 Infection in Adults with ESKD Receiving Outpatient Hemodialysis
Bardossy AC , Korhonen L , Schatzman S , Gable P , Herzig C , Brown NE , Beshearse E , Varela K , Sabour S , Lyons AK , Overton R , Hudson M , Hernandez-Romieu AC , Alvarez J , Roman K , Weng M , Soda E , Patel PR , Grate C , Dalrymple LS , Wingard RL , Thornburg NJ , Halpin ASL , Folster JM , Tobin-D'Angelo M , Lea J , Apata I , McDonald LC , Brown AC , Kutty PK , Novosad S . Kidney360 12/28/2021 2 (12) 1917-1927 BACKGROUND: Patients with ESKD on maintenance dialysis receive dialysis in common spaces with other patients and have a higher risk of severe SARS-CoV-2 infections. They may have persistently or intermittently positive SARS-CoV-2 RT-PCR tests after infection. We describe the clinical course of SARS-CoV-2 infection and the serologic response in a convenience sample of patients with ESKD to understand the duration of infectivity. METHODS: From August to November 2020, we enrolled patients on maintenance dialysis with SARS-CoV-2 infections from outpatient dialysis facilities in Atlanta, Georgia. We followed participants for approximately 42 days. We assessed COVID-19 symptoms and collected specimens. Oropharyngeal (OP), anterior nasal (AN), and saliva (SA) specimens were tested for the presence of SARS-CoV-2 RNA, using RT-PCR, and sent for viral culture. Serology, including neutralizing antibodies, was measured in blood specimens. RESULTS: Fifteen participants, with a median age of 58 (range, 37‒77) years, were enrolled. Median duration of RT-PCR positivity from diagnosis was 18 days (interquartile range [IQR], 8‒24 days). Ten participants had at least one, for a total of 41, positive RT-PCR specimens ≥10 days after symptoms onset. Of these 41 specimens, 21 underwent viral culture; one (5%) was positive 14 days after symptom onset. Thirteen participants developed SARS-CoV-2-specific antibodies, 11 of which included neutralizing antibodies. RT-PCRs remained positive after seroconversion in eight participants and after detection of neutralizing antibodies in four participants; however, all of these samples were culture negative. CONCLUSIONS: Patients with ESKD on maintenance dialysis remained persistently and intermittently SARS-CoV-2-RT-PCR positive. However, of the 15 participants, only one had infectious virus, on day 14 after symptom onset. Most participants mounted an antibody response, including neutralizing antibodies. Participants continued having RT-PCR-positive results in the presence of SARS-CoV-2-specific antibodies, but without replication-competent virus detected. |
Vital signs: Missed opportunities for preventing congenital syphilis - United States, 2022
McDonald R , O'Callaghan K , Torrone E , Barbee L , Grey J , Jackson D , Woodworth K , Olsen E , Ludovic J , Mayes N , Chen S , Wingard R , Johnson Jones M , Drame F , Bachmann L , Romaguera R , Mena L . MMWR Morb Mortal Wkly Rep 2023 72 (46) 1269-1274 INTRODUCTION: Congenital syphilis cases in the United States increased 755% during 2012-2021. Syphilis during pregnancy can lead to stillbirth, miscarriage, infant death, and maternal and infant morbidity; these outcomes can be prevented through appropriate screening and treatment. METHODS: A cascading framework was used to identify and classify missed opportunities to prevent congenital syphilis among cases reported to CDC in 2022 through the National Notifiable Diseases Surveillance System. Data on testing and treatment during pregnancy and clinical manifestations present in the newborn were used to identify missed opportunities to prevent congenital syphilis. RESULTS: In 2022, a total of 3,761 cases of congenital syphilis in the United States were reported to CDC, including 231 (6%) stillbirths and 51 (1%) infant deaths. Lack of timely testing and adequate treatment during pregnancy contributed to 88% of cases of congenital syphilis. Testing and treatment gaps were present in the majority of cases across all races, ethnicities, and U.S. Census Bureau regions. CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Addressing missed opportunities for prevention, primarily timely testing and appropriate treatment of syphilis during pregnancy, is important for reversing congenital syphilis trends in the United States. Implementing tailored strategies addressing missed opportunities at the local and national levels could substantially reduce congenital syphilis. |
Communicating during an HIV outbreak among people who inject drugs-West Virginia 2019
Watson M , Thomasson E , Adkins E , Batdorf S , Kilkenny M , Diaz SS , Pegram L , Rinderle JK , LaFlam M , Wingard R , McClung RP , Oster AM , Stryker J . AIDS Behav 2022 26 165-170 In 2019, the West Virginia Bureau for Public Health (WV BPH), Cabell-Huntington Health Department (CHHD), and CDC collaborated to respond to an HIV outbreak among people who inject drugs (PWID). CDC, WV BPH, and CHHD formed a cross-agency communications team to establish situational awareness, identify knowledge gaps, and establish key audiences for messages, including the general population, PWID, and clinical and social service providers. The team disseminated up-to-date information about the outbreak, and prioritized messages addressing stigma related to drug use, syringe services programs, and HIV. Messages were continually updated to address the evolving situation and to resonate with local values. Messages were disseminated via advertisements, local news media, and directly to PWID, people experiencing homelessness, and providers. The response supplemented CHHD's assets, including strong relationships and community knowledge, with staff capacity and expertise from state and federal agencies. This collaborative approach is a useful model to address communication needs. |
Vital Signs: Deaths among persons with diagnosed HIV infection, United States, 2010-2018
Bosh KA , Johnson AS , Hernandez AL , Prejean J , Taylor J , Wingard R , Valleroy LA , Hall HI . MMWR Morb Mortal Wkly Rep 2020 69 (46) 1717-1724 BACKGROUND: Life expectancy for persons with human immunodeficiency virus (HIV) infection who receive recommended treatment can approach that of the general population, yet HIV remains among the 10 leading causes of death among certain populations. Using surveillance data, CDC assessed progress toward reducing deaths among persons with diagnosed HIV (PWDH). METHODS: CDC analyzed National HIV Surveillance System data for persons aged ≥13 years to determine age-adjusted death rates per 1,000 PWDH during 2010-2018. Using the International Classification of Diseases, Tenth Revision, deaths with a nonmissing underlying cause were classified as HIV-related or non-HIV-related. Temporal changes in total deaths during 2010-2018 and deaths by cause during 2010-2017 (2018 excluded because of delays in reporting), by demographic characteristics, transmission category, and U.S. Census region of residence at time of death were calculated. RESULTS: During 2010-2018, rates of death decreased by 36.6% overall (from 19.4 to 12.3 per 1,000 PWDH). During 2010-2017, HIV-related death rates decreased 48.4% (from 9.1 to 4.7), whereas non-HIV-related death rates decreased 8.6% (from 9.3 to 8.5). Rates of HIV-related deaths during 2017 were highest by race/ethnicity among persons of multiple races (7.0) and Black/African American persons (5.6), followed by White persons (3.9) and Hispanic/Latino persons (3.9). The HIV-related death rate was highest in the South (6.0) and lowest in the Northeast (3.2). CONCLUSION: Early diagnosis, prompt treatment, and maintaining access to high-quality care and treatment have been successful in reducing HIV-related deaths and remain necessary for continuing reductions in HIV-related deaths. |
Revision and Update of the Consensus Definitions of Invasive Fungal Disease From the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium
Donnelly JP , Chen SC , Kauffman CA , Steinbach WJ , Baddley JW , Verweij PE , Clancy CJ , Wingard JR , Lockhart SR , Groll AH , Sorrell TC , Bassetti M , Akan H , Alexander BD , Andes D , Azoulay E , Bialek R , Bradsher RW , Bretagne S , Calandra T , Caliendo AM , Castagnola E , Cruciani M , Cuenca-Estrella M , Decker CF , Desai SR , Fisher B , Harrison T , Heussel CP , Jensen HE , Kibbler CC , Kontoyiannis DP , Kullberg BJ , Lagrou K , Lamoth F , Lehrnbecher T , Loeffler J , Lortholary O , Maertens J , Marchetti O , Marr KA , Masur H , Meis JF , Morrisey CO , Nucci M , Ostrosky-Zeichner L , Pagano L , Patterson TF , Perfect JR , Racil Z , Roilides E , Ruhnke M , Prokop CS , Shoham S , Slavin MA , Stevens DA , Thompson GR , Vazquez JA , Viscoli C , Walsh TJ , Warris A , Wheat LJ , White PL , Zaoutis TE , Pappas PG . Clin Infect Dis 2019 71 (6) 1367-1376 BACKGROUND: Invasive fungal diseases (IFDs) remain important causes of morbidity and mortality. The consensus definitions of the Infectious Diseases Group of the European Organization for Research and Treatment of Cancer and the Mycoses Study Group have been of immense value to researchers who conduct clinical trials of antifungals, assess diagnostic tests, and undertake epidemiologic studies. However, their utility has not extended beyond patients with cancer or recipients of stem cell or solid organ transplants. With newer diagnostic techniques available, it was clear that an update of these definitions was essential. METHODS: To achieve this, 10 working groups looked closely at imaging, laboratory diagnosis, and special populations at risk of IFD. A final version of the manuscript was agreed upon after the groups' findings were presented at a scientific symposium and after a 3-month period for public comment. There were several rounds of discussion before a final version of the manuscript was approved. RESULTS: There is no change in the classifications of "proven," "probable," and "possible" IFD, although the definition of "probable" has been expanded and the scope of the category "possible" has been diminished. The category of proven IFD can apply to any patient, regardless of whether the patient is immunocompromised. The probable and possible categories are proposed for immunocompromised patients only, except for endemic mycoses. CONCLUSIONS: These updated definitions of IFDs should prove applicable in clinical, diagnostic, and epidemiologic research of a broader range of patients at high-risk. |
Phaeohyphomycosis in transplant recipients: results from the Transplant Associated Infection Surveillance Network (TRANSNET)
McCarty TP , Baddley JW , Walsh TJ , Alexander BD , Kontoyiannis DP , Perl TM , Walker R , Patterson TF , Schuster MG , Lyon GM , Wingard JR , Andes DR , Park BJ , Brandt ME , Pappas PG . Med Mycol 2015 53 (5) 440-6 Transplant recipients are at a high risk for developing invasive fungal infections. The agents of phaeohyphomycosis are environmental molds found worldwide, and they cause a broad spectrum of disease including skin and subcutaneous lesions, pneumonia, central nervous system disease, fungemia, and disseminated disease. Using data from the Transplant Associated Infection Surveillance Network (TRANSNET), we evaluated patients with proven and probable phaeohyphomycosis. Centers collected data on demographics, co-morbid conditions, clinical features, treatment, and three-month mortality. Fifty-six patients with phaeohyphomycosis were identified from 15 centers, comprising 26 stem cell transplant (SCT) and 30 solid organ transplant (SOT) recipients. Median time to diagnosis post-transplant was 358 days (SCT 100 days; SOT 685 days; P = <.001). The most frequent pathogen was Alternaria species (32%). Disseminated disease was found in 55.4%. Cutaneous infection was more common in SOT (53.3% vs 23.1%; P = .021), while pulmonary disease was more common in SCT (57.7 vs. 26.7; P = .019). Voriconazole (44.6%) and amphotericin B preparations (37.5%) were the most common antifungal therapies. Overall mortality was 25% and was higher in SCT than in SOT (42% vs 10%; P = <.001). A wide variety of organisms encompass phaeohyphomycosis contributing to varying types of infection in transplant recipients. Site of infection, time to disease, and mortality varies significantly between SCT and SOT recipients. Lipid formulations of amphotericin B and voriconazole were the most common antifungals used to treat this disorder. |
Invasive non-Aspergillus mold infections in transplant recipients, United States, 2001-2006
Park BJ , Pappas PG , Wannemuehler KA , Alexander BD , Anaissie EJ , Andes DR , Baddley JW , Brown JM , Brumble LM , Freifeld AG , Hadley S , Herwaldt L , Ito JI , Kauffman CA , Lyon GM , Marr KA , Morrison VA , Papanicolaou G , Patterson TF , Perl TM , Schuster MG , Walker R , Wingard JR , Walsh TJ , Kontoyiannis DP . Emerg Infect Dis 2011 17 (10) 1855-64 Recent reports describe increasing incidence of non-Aspergillus mold infections in hematopoietic cell transplant (HCT) and solid organ transplant (SOT) recipients. To investigate the epidemiology of infections with Mucorales, Fusarium spp., and Scedosporium spp. molds, we analyzed data from the Transplant-Associated Infection Surveillance Network, 23 transplant centers that conducted prospective surveillance for invasive fungal infections during 2001-2006. We identified 169 infections (105 Mucorales, 37 Fusarium spp., and 27 Scedosporium spp.) in 169 patients; 124 (73.4%) were in HCT recipients, and 45 (26.6%) were in SOT recipients. The crude 90-day mortality rate was 56.6%. The 12-month mucormycosis cumulative incidence was 0.29% for HCT and 0.07% for SOT. Mucormycosis incidence among HCT recipients varied widely, from 0.08% to 0.69%, with higher incidence in cohorts receiving transplants during 2003 and 2004. Non-Aspergillus mold infections continue to be associated with high mortality rates. The incidence of mucormycosis in HCT recipients increased substantially during the surveillance period. |
Factors associated with mortality in transplant patients with invasive aspergillosis
Baddley JW , Andes DR , Marr KA , Kontoyiannis DP , Alexander BD , Kauffman CA , Oster RA , Anaissie EJ , Walsh TJ , Schuster MG , Wingard JR , Patterson TF , Ito JI , Williams OD , Chiller T , Pappas PG . Clin Infect Dis 2010 50 (12) 1559-67 BACKGROUND: Invasive aspergillosis (IA) is an important cause of morbidity and mortality in hematopoietic stem cell transplant (HSCT) and solid organ transplant (SOT) recipients. The purpose of this study was to evaluate factors associated with mortality in transplant patients with IA. METHODS: Transplant patients from 23 US centers were enrolled from March 2001 to October 2005 as part of the Transplant Associated Infection Surveillance Network. IA cases were identified prospectively in this cohort through March 2006, and data were collected. Factors associated with 12-week all-cause mortality were determined by logistic regression analysis and Cox proportional hazards regression. RESULTS: Six-hundred forty-two cases of proven or probable IA were evaluated, of which 317 (49.4%) died by the study endpoint. All-cause mortality was greater in HSCT patients (239 [57.5%] of 415) than in SOT patients (78 [34.4%] of 227; [Formula: see text]). Independent poor prognostic factors in HSCT patients were neutropenia, renal insufficiency, hepatic insufficiency, early-onset IA, proven IA, and methylprednisolone use. In contrast, white race was associated with decreased risk of death. Among SOT patients, hepatic insufficiency, malnutrition, and central nervous system disease were poor prognostic indicators, whereas prednisone use was associated with decreased risk of death. Among HSCT or SOT patients who received antifungal therapy, use of an amphotericin B preparation as part of initial therapy was associated with increased risk of death. CONCLUSIONS: There are multiple variables associated with survival in transplant patients with IA. Understanding these prognostic factors may assist in the development of treatment algorithms and clinical trials. |
Guidelines for preventing infectious complications among hematopoietic cell transplant recipients: a global perspective
Tomblyn M , Chiller T , Einsele H , Gress R , Sepkowitz K , Storek J , Wingard JR , Young J-AH , Boeckh MJ . Bone Marrow Transplant 2009 44 (8) 453-558 This report, cosponsored by Center for International Blood & Marrow Transplant Research (CIBMTR), National Marrow Donor Program (NMDP), European Group for Blood and Marrow Transplantation (EBMT), American Society for Blood and Marrow Transplantation (ASBMT), Canadian Blood and Marrow Transplant Group (CBMTG), Infectious Diseases Society of America (IDSA), Society for Healthcare Epidemiology of America (SHEA), Association of Medical Microbiology and Infectious Disease (AMMI), Centers for Disease Control (CDC) and the Health Resources and Services Administration, represents an update of the guidelines published in 2000 for preventing infections among hematopoietic cell transplant (HCT) recipients.1 An international group of experts in infectious diseases, hematopoietic cell transplantation and public health worked together to compile this document with four goals in mind: (1) to summarize the current available data in the field; (2) to provide evidence-based recommendations regarding the prevention of infectious complications among HCT patients; (3) to serve as a reference for health-care providers worldwide who care for HCT recipients; and (4) to serve as a reference for HCT recipients and their nonmedical caregivers. In updating these guidelines, the committee sought to summarize the currently available data and present them as concisely as possible in an evidence-based manner. |
Guidelines for preventing infectious complications among hematopoietic cell transplant recipients: a global perspective. Preface
Tomblyn M , Chiller T , Einsele H , Gress R , Sepkowitz K , Storek J , Wingard JR , Young JA , Boeckh MJ . Bone Marrow Transplant 2009 44 (8) 453-5 This report, cosponsored by Center for International Blood & Marrow Transplant Research (CIBMTR), National Marrow Donor Program (NMDP), European Group for Blood and Marrow Transplantation (EBMT), American Society for Blood and Marrow Transplantation (ASBMT), Canadian Blood and Marrow Transplant Group (CBMTG), Infectious Diseases Society of America (IDSA), Society for Healthcare Epidemiology of America (SHEA), Association of Medical Microbiology and Infectious Disease (AMMI), Centers for Disease Control (CDC) and the Health Resources and Services Administration, represents an update of the guidelines published in 2000 for preventing infections among hematopoietic cell transplant (HCT) recipients.1 An international group of experts in infectious diseases, hematopoietic cell transplantation and public health worked together to compile this document with four goals in mind: (1) to summarize the current available data in the field; (2) to provide evidence-based recommendations regarding the prevention of infectious complications among HCT patients; (3) to serve as a reference for health-care providers worldwide who care for HCT recipients; and (4) to serve as a reference for HCT recipients and their nonmedical caregivers. In updating these guidelines, the committee sought to summarize the currently available data and present them as concisely as possible in an evidence-based manner. |
Fungal infection prevention after hematopoietic cell transplantation
Marr KA , Bow E , Chiller T , Maschmeyer G , Ribaud P , Segal B , Steinbach W , Wingard JR , Nucci M . Bone Marrow Transplant 2009 44 (8) 483-7 Hematopoietic cell transplantation (HCT) recipients and candidates undergoing conditioning therapy should avoid substances, including certain foods (Table 7) that increase the risk of exposure to fungi (DIII). | Preventing disease | Growth factors (for example, GM-CSF and G-CSF) shorten the duration of neutropenia after HCT.412 However, a meta-analysis showed that use of growth factors did not reduce the attack rate of invasive fungal disease165 and, therefore, no recommendation can be made for the use of growth factors for prophylaxis against invasive fungal disease (CI). | Topical antifungal drugs applied onto the skin or mucosa (for example, nystatin or clotrimazole) might reduce colonization by yeasts and molds in the area of application. However, these agents have not been proven to prevent locally invasive or disseminated yeast or mold infections and their use for prophylaxis is unclear (CIII). Performing fungal surveillance cultures is not indicated for asymptomatic HCT recipients (DII).413,414 | Other recommendations | Patients receiving antifungal prophylaxis who develop clinical signs or symptoms of infection should be evaluated for breakthrough bloodstream or pulmonary fungal infections (AIII). Such infections may occur because the prophylactic drug has no activity against the organism; because the organism has developed resistance to the drug; or because of other factors, such as severe immunosuppression or low serum levels of the prophylactic agent.415 |
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