bluuebunny/crossref_metadata_2025 huggingface dataset:
P-2062. COVID-19 XBB.1.5-adapted Vaccine Uptake in Immunocompromised Individuals Using Tokenized State Vaccine Registries
Authors: Brouillette Matthew A , Khan Farid L , Lopez Santiago M C , Andersen Kathleen M , Yu Tiange , Carter Benjamin T , McLaughlin John M , McGrath Leah
Published: January 2025

Background

Immunocompromised individuals experience a disproportionate burden of COVID-19-associated hospitalization and death. COVID-19 vaccine uptake has declined over time. We evaluated XBB.1.5-adapted vaccine uptake, regardless of brand, during the 2023-2024 season among immunocompromised persons using data from two large state vaccine registries.

Methods

Individuals with continuous pharmacy and medical enrollment (≥6 months for children < 18 years, ≥12 months for adults ≥18 years) in insurance plans contributing to HealthVerity and residency in either California or Louisiana as of September 11, 2023 (the date XBB.1.5-adapted vaccines were authorized or approved) were selected. A prior dose of any COVID-19 vaccine was required. Persons were defined as immunocompromised if they had one or more of the following conditions as defined by the Centers for Disease Control and Prevention: HIV/AIDS, hematologic malignancy, solid organ or bone marrow transplant, primary immunodeficiency, or recent use of immunosuppressive medications. XBB.1.5-adapted vaccine uptake was assessed using de-identified records from state vaccine registries in California and Louisiana that were linked via tokenization with claims data.

Results

A total of 321,896 California residents (median age 55 years; 57% female) and 43,250 Louisiana residents (median age 45 years; 64% female) with at least one immunocompromising condition were identified. In both states, the most common immunocompromising condition was use of immunosuppressive medications (78% California and 85% Louisiana). By the end of March 2024, 19% and 6% of immunocompromised individuals in California and Louisiana, respectively, received an XBB.1.5-adapted vaccine. Uptake was generally similar regardless of immunocompromising condition (Table 1).

Conclusion

During the 2023-2024 season, COVID-19 vaccine uptake in immunocompromised persons was low, with fewer than 20% of this high-risk population receiving the XBB.1.5-adapted vaccine. Enhanced efforts to increase COVID-19 vaccine uptake in this vulnerable population are urgently needed.

Disclosures

Matthew A. Brouillette, MPH, Pfizer Inc.: Employee|Pfizer Inc.: Stocks/Bonds (Public Company) Farid L. Khan, MPH, Pfizer Inc.: Employee|Pfizer Inc.: Stocks/Bonds (Public Company) Santiago M.C. Lopez, MD, Pfizer Inc.: Employee|Pfizer Inc.: Stocks/Bonds (Public Company) Kathleen M. Andersen, PhD MSc, Pfizer Inc.: Employee|Pfizer Inc.: Stocks/Bonds (Public Company) Tiange Yu, MS, Pfizer Inc.: Employee of Genesis Research Group which has received consulting fees from Pfizer Inc. Benjamin T. Carter, PhD, Pfizer Inc.: Employee of Genesis Research Group which has received consulting fees from Pfizer Inc. John M. McLaughlin, PhD, Pfizer: Employee|Pfizer: Stocks/Bonds (Public Company) Leah McGrath, PhD, Pfizer Inc.: Employee|Pfizer Inc.: Stocks/Bonds (Public Company)
P-2131. Identification of Non-fumigatus Aspergillus Species in Clinical Samples from Southern California
Authors: Rayens Emily , Skela Jessica , Tartof Sara Y
Published: January 2025

Background

Aspergillus is the causative agent of aspergillosis, with presentations ranging from mild skin infections to disseminated disease affecting the central nervous system. Fungal culture from the infected site is the current recommendation to confirm presence of Aspergillus and to speciate based on morphology. A. fumigatus has historically been identified as the source of most serious infections, but there is emerging concern for invasive disease caused by non-fumigatus­ species, especially those that may carry intrinsic resistance to recommended antifungals. In this descriptive analysis, we reviewed trends in Aspergillus species cultured from a large clinical cohort.Figure 1.Percentage of Positive Aspergillus cultures by specimen origin type over time 2012-2023.

Methods

We identified all positive fungal cultures for at least one Aspergillus species across Kaiser Permanente Southern California hospitals and clinics from January 2012–June 2023. Episodes were defined as a combination of any Aspergillus culture results conducted within 30 days of the first positive Aspergillus culture. Only the first episode for each patient was included in analyses if multiple episodes were identified.Figure 2.Number of positive Aspergillus cultures by species identified and specimen type.

Results

10,777 patients were identified at KPSC with at least one positive Aspergillus culture between 2012 and 2023. Isolates were most frequently identified from samples associated with the respiratory tract and bronchoalveolar lavage fluid. However, the proportion of cutaneous cultures has increased over time and was nearly equal to the number of positive respiratory cultures in 2023 (Figure 1). Aspergillus niger (n=3,772) was the most frequently cultured Aspergillus species overall, with 44.6% of isolates originating from skin, nail, and scalp samples (Figure 2). Aspergillus fumigatus was identified in 40.3% of respiratory sample cultures, followed by Aspergillus niger at 25.7%. Finally, non-fumigatus specimens exhibited seasonal trends in respiratory samples compared to A. fumigatus, peaking in early autumn each year (Figure 3).Figure 3.Number of positive Aspergillus cultures in respiratory samples by reported species by month.

Conclusion

Non-fumigatus species were identified more frequently than A. fumigatus in culture of respiratory and non-respiratory clinical samples. Novel observations of seasonal trends and increasing predominance of non-fumigatus species may indicate a shift in clinical expectations and treatment options during management of aspergillosis.

Disclosures

Emily Rayens, PhD, MPH, GSK: Grant/Research Support|Moderna: Grant/Research Support Sara Y. Tartof, PhD MPH, GSK: Grant/Research Support|Pfizer Inc: Grant/Research Support
P-2132. Comparison of Clinical Characteristics and Risk Factors among Adult Patients with Bloodstream Infections due to candida auris vs other candida Species: a 3-year analysis in a Large Care Tertiary Hospital, Saudi Arabia
Authors: Alasmari Faisal , Wali Asiya , Mukahal Mahmoud , Alsurayhi Seham , Dirar Qais , Tamim Hani
Published: January 2025

Background

Candida auris is considered a serious global threat due to its potential to cause invasive infections, staggering transmissibility and mortality. We evaluated the epidemiologic and clinical features of candida bloodstream infections (BSIs) and explored risk factors associated with C. auris.

Methods

A retrospective review of all candida BSI in patients aged ≥ 18 years were conducted during August 2018 to June 2021. C. auris cases were compared to other Candida species cases. Odds ratio (OR), estimated using stepwise regression analysis, was used to assess the association between risk factors and incidence of C. auris infection.

Results

We identified 137 patients with first episode Candida BSIs. 32% patients were secondary to C. auris and the remaining were due to: C.albicans (20%), C.glabrata (18%), C.Parapsilosis (12%), C.trpicalis (15%), and others (4%). 60% of total cohort were male and their age were more than 55 yearsz. The proportions of patients with underlying diseases e.g. diabetes mellitus, hypertension, cardiovascular diseases, chronic renal diseases and COVID-19 infection were not significantly different. The prevalence of malignancy was significantly higher in non C. auris group (P= 0.01). The following risk factors were independently associated with C. auris BSI: Prior Use of antifungals (OR: 3.60, CI: 1.18-10.98), Previous history of multidrug resistant bacterial infection (OR: 3.37, CI: 1.41-8.06), and intensive care unit stay (OR 8.6, CI 2.61-28.37).

Conclusion

The epidemiology of candidemia is changing with non-albicans becoming predominant. Judicious use of all types of antimicrobials including antifungals will help in controlling the emergence of C. auris infection.

Disclosures

All Authors: No reported disclosures
P-2134. Development and Validation of a Quantitative PCR Assay for the Detection of Mucorales in Human Serum Specimens
Authors: Davidson Jerod , Grantham James , Thomas Clayton , Nutt Jamie , Morris Pam , Kockler Zachary , Kleiboeker Steve
Published: January 2025

Background

Mucormycosis are diseases with high morbidity and mortality caused by fungal species belonging to the order Mucorales. The intended use of a Mucorales qPCR assay is as an adjunct to microbiological, clinical, and radiologic means of diagnosing invasive mucormycosis (IM). Serum collection is a non-invasive alternative to BAL and biopsy. Our design process included sequences from all species within the Mucorales genera: Cunninghamella, Lichtheimia, Absidia, Apophysomyces, Mucor, Rhizomucor, Rhizopus and Saksenaea. The Mucorales qPCR assay is designed to detect and quantify Mucorales DNA extracted from human serum.

Methods

Primers and probes were designed to target the 18S regions of Mucorales species. Nucleic acid was extracted using the MagMAX™ Cell-Free DNA Isolation Kit and KingFisher™ Flex system. Amplification and detection were performed using TaqMan™ Fast Universal Master Mix and the Applied Biosystems™ QuantStudio 7 Pro. Quantification was performed using Rhizopus oryzae target-bearing linearized plasmid standards with results reported in copies/mL. Analytical validation was performed by spiking negative human serum with four different Mucorales species’ DNA: Rhizopus oryzae, Rhizomucor miehei, Lichtheimia corymbifera, and Cunninghamella bertholletiae.

Results

The limit of detection was 181 copies/mL, and the lower limit of quantification was determined to be 253 copies/mL as shown in Table 1. Linear regression of dilution data produced an R2=0.997, slope=1.029, and y-intercept=0.212 as show in Figure 1. The Mucorales target detection was 100% (60 of 60) of blinded positive samples with all observed log10 copies/mL results within ±0.5 log10 copies of expected values as shown in Table 2. All (20 of 20) blinded negative samples were negative for Mucorales and positive for Internal Control (IC). Intra-assay precision ranged from 5 – 22 %CV and inter-assay precision ranged from 12 – 17 %CV as Shown in Table 3.

Conclusion

The validated assay described here demonstrates excellent sensitivity, linearity, precision, and accuracy, providing a reliable means of detecting Mucorales DNA in human serum. This assay represents a non-invasive, rapid, and sensitive method to guide clinical decisions on patient populations at high risk of IM.

Disclosures

Jerod Davidson, B.A., Eurofins Viracor: Employee James Grantham, B.S., Eurofins Viracor: Employee Clayton Thomas, B.S., Eurofins Viracor: Employee Jamie Nutt, n/a, Eurofins Viracor: Employee Pam Morris, M.S., PMP, Eurofins Viracor: Employee Zachary Kockler, PhD, Eurofins Viracor: Employee Steve Kleiboeker, PhD, Eurofins: employee|Eurofins: Stocks/Bonds (Public Company)
P-2137. Evaluating the clinical utility of bronchoalveolar lavage polymerase chain reactions for the diagnosis of pulmonary infections in patients with hematological malignancies
Authors: Al-Ghanamah Rakan , Finnigan Katie , Gali Varshini , Kalchiem-Dekel Or , Kamboj Mini , Hohl Tobias M , Babady Esther , Papanicolaou Genovefa , Lee Yeon Joo
Published: January 2025

Background

Invasive pulmonary infections are a significant cause of morbidity and mortality in patients with hematological malignancies and hematopoietic stem cell transplantation (HCT) recipients. A delay in identifying a causative agent may result in late initiation of appropriate treatment and worse outcomes. We explore the diagnostic utility of incorporating commercially available polymerase chain reaction (PCR)-based assays performed on bronchoalveolar lavage (BAL) specimens into evaluating invasive pulmonary infections in patients with hematological malignancies and HCT recipients.

Methods

Patients with hematological malignancies and HCT recipients who underwent a bronchoscopy 1/2020 - 1/2024 with at least one PCR assay (Aspergillus, Mucorales, and Nocardia) sent to Viracor (Lenexa, KS) were included. Multiple bronchoscopies were captured if performed ≥6 weeks apart. “Proven” and “Probable” invasive fungal infection (IFI) were defined as per EORTC/MSG 2020 guidelines. Pulmonary infection was defined by clinical findings, galactomannan antigen (GMA) testing, culture from BAL, histopathology if a biopsy was performed, and radiology imaging studies. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of PCRs and BAL GMA were tested for probable and proven IFI and pulmonary nocardia infection.

Results

Figure 1 describes the study cohort. Fifty-eight of 134 (43.3%) received HCT (Table 1). The sensitivity, specificity, PPV, and NPV for BAL PCRs, and BAL GMA are provided in Table 2. Figure 2 shows diagnosis by standard of care and BAL PCRs. Among 19 patients with positive BAL GMA, 4 were positive with culture. Two patients were negative for BAL GMA and BAL Aspergillus PCR, but culture was positive for A. fumigatus. Culture was negative for all pulmonary mucor, and culture was positive for all pulmonary nocardia.

Conclusion

Aspergillus PCR has lower sensitivity & NPV, and higher specificity & PPV compared to BAL GMA. The sensitivity of Mucorales and Nocardia PCRs was 42.9% and 100%, respectively. The specificity of Mucorales and Nocardia PCRs were 98.2% and 98.8%, respectively. Our study suggests PCRs from BAL can be helpful as an adjunct tool in diagnosing invasive pulmonary infections in highly immunocompromised patients.

Disclosures

Genovefa Papanicolaou, MD, AlloVir: Advisor/Consultant|AlloVir: Data safety monitoring committee|Merck: Advisor/Consultant|Merck: Grant/Research Support|Merck: Investigator|Symbio: Advisor/Consultant Yeon Joo Lee, MD, MPH, AiCuris: institutional research support for clinical trials|Karius: institutional research support for clinical trials|Merck: Grant/Research Support|Scynexis: institutional research support for clinical trials
P-2139. Evaluation of a Multiplex Real-time PCR for the Detection and Differentiation of Sporothrix schenckii and Sporothrix brasiliensis
Authors: López Cano Luisa F , Gade Lalitha , Litvintseva Anastasia P , Sexton Joseph
Published: January 2025

Background

Sporothrix spp is a thermally dimorphic fungi known to cause subacute or chronic subcutaneous lesions in humans and animals and is the cause of increasing public health concern due to spread of feline-associated cases.Figure 1.Limit of detection and genomic DNA standard curve of S. schenckii and S. brasiliensis

Methods

A recently described Real-time PCR assay targeting the β-tubulin gene to detect and differentiate two related species, S. schenckii and S. brasiliensis, was evaluated and adapted by adding lambda primers and probe for internal control amplification. Isolates, fresh tissues and suspected sporotrichosis Formalin-Fixed, Paraffin Embedded (FFPE) tissues from humans and animals were received in the Mycotic Diseases Branch laboratory at the U.S. Centers for Disease Control and Prevention (CDC) for the routine fungal identification by conventional PCR and sequencing, using the primers D1/D2, ITS5/ITS4 and ITS3/ITS4. Ten-fold serial dilutions from 1 ng/μl to 1 fg/μl of DNA were tested with 20 replicates to establish limit of detection (LOD), and DNA from four fresh tissues extracted on three different days was used to assess reproducibility.Table 1.Ct values and coefficient of variation (CV) of the reproducibility test using fresh tissues on three different days

Results

The assay was tested with 55 S. brasiliensis, 19 S. schenckii, and 85 isolates from other clinically relevant fungi, showing 100% concordance with sequencing methods. The test was also able to amplify S. schenckii DNA from 10 fresh tissues, which were previously confirmed by culture and sequencing as S. schenckii (100% sensitivity), with Ct values ranging from 19 to 38. Among 9 FFPE samples, S. schenckii was amplified in 6 samples (67% sensitivity) with Ct values ranging from 29 to 38. LOD was 1pg/μl of DNA. Results of the 20 replicates showed that at this concentration all the DNAs had a positive signal for both targets (fig 1). For reproducibility, the results showed consistent Ct values over the 3 days of the test with the four fresh tissue samples with a coefficient of variation (CV) of 4% (table 1).

Conclusion

This multiplex Real-time PCR assay successfully detected DNA from the S. brasiliensis and S. schenckii isolates as well as S. schenckii from fresh and FFPE tissues. Our results demonstrate this molecular assay performs well and could be a helpful molecular tool to support rapid identification and differentiation at species level from cultures and primary human and animal specimens.

Disclosures

All Authors: No reported disclosures
P-2142. Cross-Reactivity of Fungal Enzyme Immunoassays (EIA): Implications for Clinical Diagnosis in Patients with Autoimmune Disease
Authors: Craney Arryn , Carlson Kendra , Seyfried Kyla , Witt John , Hanzlicek Andrew , Barros Nicolas , Wheat Lawrence J
Published: January 2025

Background

The immune system exhibits remarkable discriminatory power, distinguishing between self and non-self to mount protective responses against infections. In clinical diagnostics targeting dimorphic fungi, this immunological discrimination is leveraged to detect specific antibodies indicative of disease states. However, reliance on immune modulation for diagnostic purposes presents inherent challenges due to the intricate nature of antigen-antibody interactions. This complexity is particularly pronounced in patients with a history of autoimmune disorders, where the risk of false positive results in immunoassays is heightened due to the dysregulated immune response characteristic of autoimmune conditions.

Methods

We assessed the potential for cross-reactivity of serum samples from patients with autoimmune disease in dimorphic fungal Enzyme Immunoassays (EIAs) by analyzing a cohort of clinical serum samples sourced from the Florida region, which is non-endemic for dimorphic fungal diseases. Samples were commercially sourced as remnant-banked serum samples (Medix Biochemica, Florida, USA). 25 serum samples obtained from distinct patients were subjected to testing using Coccidioides, Blastomyces, and Histoplasma EIA (MiraVista Diagnostics, Indiana, USA). This ncluded 5 individuals devoid of autoimmune disorders, cohorts of 5 patients each diagnosed with Rheumatoid Arthritis and Multiple Sclerosis, and 10 patients with Systemic Lupus Erythematosus. Samples were tested in triplicate.

Results

Preliminary findings from our study unveiled nuanced levels of cross-reactivity across the dimorphic fungal EIAs utilized for the three autoimmune disorders examined. Depending on the specific dimorphic fungal EIA assay and autoimmune disorder, approximately 10–30% of serum samples from patients tested intermediate or weakly positive in the respective fungal EIAs. All control patient samples tested negative.

Conclusion

These preliminary findings underscore the complexity of diagnosing dimorphic fungal infections, highlighting the significance of the patient's immune status as a confounding factor. Clinical practitioners should consider the possibility of autoimmunity when encountering weakly positive or intermediate dimorphic fungal EIA results.

Disclosures

Arryn Craney, PhD D(ABMM), MiraVista Diagnostics: Employee; Salary Kendra Carlson, n/a, MiraVista Diagnostics: Employee; Salary Kyla Seyfried, n/a, MiraVista Diagnostics: Employee; Salary John Witt, n/a, MiraVista Diagnostics: Employee; Salary Andrew Hanzlicek, DVM, MiraVista Diagnostics: Employee; Salary Nicolas Barros, MD, MiraVista Diagnostics: Advisor/Consultant Lawrence J. Wheat, MD, MiraVista Diagnostics: Employee; Salary|MiraVista Diagnostics: Ownership Interest
P-2147. Incidence of Invasive Fungal Infection in Venetoclax-based Regimens for AML/MDS Patients on Micafungin Prophylaxis
Authors: Texidor Williams Monier , Amaya Lee , Gauthier Timothy , Andia Marco Ruiz
Published: January 2025

Background

Combining venetoclax with a hypomethylating agent (HMA) is standard of care in Acute Myeloid Leukemia (AML) ineligible for intensive chemotherapy. However, this agent is associated with prolonged neutropenia, potentially increasing the risk of invasive fungal infections (IFI). The necessity of antifungal prophylaxis in this context remains unclear, particularly in regions like the southeastern United States, where the humid climate may contribute to higher overall rates of IFIs.

Methods

A retrospective, observational cohort study evaluated patients admitted to Baptist Health Baptist Hospital in Miami, Florida, from January 2019 to January 2023 who received venetoclax and an HMA with/without low-dose cytarabine for AML/MDS. Exclusions included incomplete first cycle, active IFI treatment, absence of antifungal prophylaxis, or initiation of venetoclax at an outside institution. The primary endpoint was 90-day IFI incidence using 2022 EORTC criteria. The secondary endpoints were complete response (CR) per ELN 2022 guidelines, 1-year mortality, and 90-day count recovery.

Results

Among 102 patients evaluated, the mean±SD age was 73±9 years. Twenty-seven patients (27%) had relapsed refractory disease, and 42 (41%) received prior chemotherapy. Overall, 57% presented with de novo AML/MDS; 13 treated specifically for MDS. Micafungin was the predominant inpatient prophylaxis agent (95%), while posaconazole (40%) and fluconazole (37%) were the predominant prophylaxis agents prescribed at discharge. IFI incidence at 90 days was 7%, consisting mostly of possible IFI (6/7). CR was achieved in 61% of patients, and 1-year mortality was 32%. 90-day neutrophil recovery occurred in 62% (63/102), while platelet recovery occurred in 66% (65/99).

Conclusion

Our findings suggest that micafungin as primary antifungal prophylaxis in AML/MDS patients receiving venetoclax-based regimens demonstrates a comparable incidence of IFI at 90 days to previous studies reporting similar outcomes.

Disclosures

Timothy Gauthier, PharmD, BCPS, BCIDP, AbbVie Pharma: Advisor/Consultant|Antimicrobial Therapy, Inc: Advisor/Consultant|Ferring Pharma: Advisor/Consultant|Firstline Mobile Health: Advisor/Consultant|Gilead Pharma: Advisor/Consultant|GoodRx: Advisor/Consultant|GSK Pharma: Advisor/Consultant|Melinta Pharma: Advisor/Consultant|Pattern Biosciences: Advisor/Consultant|Pfizer Pharma: Advisor/Consultant|ProCE: Honoraria|WWW.LearnAntibiotics.com: Ownership Interest
P-2148. Prospective Study on Microbiological Profile of Fungal Isolates and its Antibiogram in a Tertiary care hospital in South India
Authors: Velmani Vaishnavi , Radhakrishnan Sriram , Muppa Leena , Dorairajan Sureshkumar
Published: January 2025

Background

Fungal infections are increasingly recognized as significant causes of morbidity and mortality, particularly in immunocompromised individuals. Despite their importance, there is limited data on the microbiological profile and antimicrobial resistance patterns of fungal isolates in South India. This prospective study aims to fill this gap by characterizing fungal isolates and determining their antibiograms in a tertiary care hospital, providing crucial insights for clinical management and infection control strategies.

Methods

A Prospective Observational Study was done under the guidance of an Infectious diseases Specialist by collecting the culture positive fungal isolates from the Microbiology department for the 1 year duration of April 2023 to March 2024. Data including patient age, gender, specimen, type of fungus isolated, its sensitivity pattern, average time required for identification of the species and requirement of ICU admission were analyzed. The three classes of antifungals including polyenes, azoles and echinocandins were included. Data was entered and analyzed using Microsoft excel.

Results

A total of n=62 fungal isolates were isolated. The average age of the patients was 49 years with a higher prevalence in male (n=42) compared to females (n=20). Fungal species have been isolated more commonly from blood samples followed by urine samples, tissues, body fluids. In all the cases tested, Azoles, Polyenes and Echinocandins were susceptible in 57%, 76% and 80% of the cases respectively. Average time taken for identification of the subspecies was 124 hrs (∼ 5 days). Candida auris was the most common isolate found, which developed complete resistance to azoles, partially to polyenes, while echinocandin has been found to be a reliable drug of choice. The spectrum and efficacy of Echinocandins were higher compared to azoles and polyenes.

Conclusion

Candida auris was found as the most resistant species and echinocandins have been found as a reliable drug of choice compared to Azoles and Polyenes antifungals. This study highlights the need for rapid diagnostic procedures for rapid identification of the species grown in the culture, thereby enabling rational antifungal therapy. As long as the reporting time delays, initiation of right antifungal therapy also delays.

Disclosures

All Authors: No reported disclosures
P-2150. Eosinophilia in Patients with Suspected Parasitic Infection: a Retrospective Analysis
Authors: Filippov Evgenii , Bass Jessica , Blaha Jiana , O’Connell Elise M , KLion Amy
Published: January 2025

Background

Eosinophilia, defined as an absolute eosinophil count (AEC) ≥500 cells/μL, is common in the setting of helminth infection, though the relationship between the degree of eosinophilia and the likelihood of an underlying helminth infection remains unstudied. To begin to address this question, we performed a retrospective analysis of data from a large cohort of patients referred to the National Institutes of Health for parasitic disease screening.

Methods

Patients evaluated at the NIH from September 2001 to March 2021 on clinical protocols designed to study suspected parasitic infections (NCT00001230 and NCT00001645) and for whom clinical and laboratory information was available in a research database were included. Demographic information, clinical manifestations, final diagnosis, and laboratory values were reviewed. Peak AEC was recorded and categorized as mild (500-1499 cells/μL), moderate (1500-4999 cells/μL), or severe (>5000 cells/μL).

Results

A total of 196 of the 459 included participants (43%) had documented eosinophilia, of whom 61% (n=120), 34% (n=66) and 5% (n=10) had mild, moderate, or severe peak AEC elevations, respectively. Most of the eosinophilic patients were diagnosed with one or more helminth infections (n=150). The remaining patients (n=46) were found to have myiasis (n=1), a non-infectious or no cause identified (n=43) or were lost to follow up (n=2). Among the helminth-infected patients, GM AEC was 1412 cells/μL (range 500-12,800). Most patients likely acquired infection in Africa (n=88) or Central America (n=25). Three patients had no history of travel outside the US. Strongyloidiasis (n=64) and loiasis (n=43) were the most common helminth diagnoses, and 29 individuals had multiple helminths identified. Of the 10 patients in the total patient cohort with peak AEC >5000 cells/μL, 5 were diagnosed with helminth infection (loiasis or strongyloidiasis), none of whom had AEC >20,000 cells/μL.

Conclusion

The study underscores that helminths, particularly strongyloidiasis and loiasis, are commonly associated with mild to moderate eosinophilia. Severe eosinophilia (AECs >5000 cells/μL) is less common and extremely high counts (AEC ≥20,000 cell/μL) should prompt investigation of non-helminth etiologies.

Disclosures

All Authors: No reported disclosures
P-2152. Strongyloides stercoralis Seroprevalence among Solid Organ Transplant Candidates and Recipients in a Multicenter Hospital System in Arizona
Authors: Luna Wong Lucia A , Weerasinghe Sanjeeva , Anania Catherine , Trieu Skyler , Al-Obaidi Mohanad , Zangeneh Tirdad
Published: January 2025

Background

Solid organ transplant (SOT) recipients have a higher risk of Strongyloidiasis associated complications. Universal screening for Strongyloides among SOT candidates and recipients is not well defined in the Southwest United States. We assessed our center’s seropositivity rate for pre- and post-SOT using Strongyloides Ab (strAb) test.

Methods

We conducted a multicenter, IRB-approved retrospective study. Data were collected from January 2019 to March 2024 for patients ≥18 years old before and after SOT. Most of the testing at our center was performed utilizing the Strongyloides ELISA IgG test kit, Gold Standard Diagnostics, Davis, CA, USA.

Results

There were 387 patients with a median age of 61 (range 24-85), the majority being white non-Hispanics, 221 (57%) and 241 (62%) males. There were 152 pre-SOT tests performed: kidney (61), liver (54), lung (17), and other (20), in contrast to the 292 post-SOT: kidney (153), liver (45), lung (41), heart (31), and others (22). The majority (248/387) of patients reported historical travel, with 154 (62%) to Strongyloides endemic regions. There were 269 pre-SOT serology, mostly (85%) positive for Epstein Barr virus (EBV), followed by cytomegalovirus (CMV) with 70%, 5% hepatitis C. There was one case of a patient with positive HTLV-I/II serology (negative by confirmatory testing). Of the 283 patients, 24% reported being born outside the US. Of the171 reported gastrointestinal symptoms at the time of strAb testing, 94% were post-SOT. There were 20/387 (5.2%) positive strAb, with 5.3% in pre-SOT and 4.1% in post-SOT. There were 3 cases with negative pre-SOT that seroconverted after transplantation. All of the 93 patients who underwent microscopic stool examinations tested negative. 17/20 patients with a positive strAb received treatment with ivermectin. There was one case of Hyperinfection Syndrome. There was no statistical association between demographics and aforementioned risks, and seropositivity.

Conclusion

The Strongyloides seropositivity rate in our cohort is comparable to other reports. No associated risk factor was identified. Therefore, universal screening may be needed in similar transplant cohorts, as undetected cases can have devastating outcomes.

Disclosures

Tirdad Zangeneh, DO, AiCuris.: Grant/Research Support
P-2154. Cryptosporidium in pregnancy and the impact upon pregnancy outcomes
Authors: Ben David Shirley Shapiro , Orivieto Noam , Segal Yaakov , Adler Limor
Published: January 2025

Background

Cryptosporidiosis, an infectious disease caused by the protozoan parasite Cryptosporidium, poses a significant threat to individuals with compromised immune systems. Over the past four years, a notable rise in the incidence of cryptosporidiosis has been observed in Israel, including among pregnant women. Despite this increase, little is known about the impact of cryptosporidiosis on obstetrical outcomes. The objective of this study was to evaluate the influence of Cryptosporidium infection on pregnancy outcomes.Figure 1Epidemic curve, cryptosporidiosis in pregnant women, Maccabi Healthcare Services

Methods

A retrospective case-control study. Pregnant women with positive results on multiplex real-time PCR stool tests for Cryptosporidium were compared to pregnant women with negative results, matched by age, week of pregnancy during the stool test, and sector. Medical records of the study cohort were reviewed for symptoms, treatments, pregnancy outcomes including termination, gestational age, birth weight, Apgar score, and head circumference. Significance was determined using Fisher's exact or Chi-square tests.Table 1Baseline patient characteristics and symptoms, pregnant women infected with cryptosporidium

Results

Between January 2020 and December 2023, 2512 pregnant women underwent PCR stool testing. Of them, 96 individuals were positive for Cryptosporidium, mostly in 2022 (Figure 1). Their median age was 31 years and ranged 23-42 years with medium-high socioeconomic status (37 and 39 women, respectively) (Table 1). Among those who tested positive, 93 out of 96 (96.7%) reported symptoms of diarrhea, and the infection was self-limiting in all cases, with none requiring specific treatment. In comparison to matched controls, no statistically significant differences were observed in the rates of intrauterine growth retardation, birth weight, delivery week, miscarriage, Apgar score, and head circumferences among the infants born to mothers with Cryptosporidium infection.

Conclusion

This study sheds light on the clinical course of Cryptosporidium infection in pregnant women, emphasizing a generally favorable outcome without the necessity for therapeutic intervention. Further research may be warranted to explore the potential long-term effects and to refine preventive measures for this specific population.

Disclosures

Shirley Shapiro Ben David, MD, GSK: Lecturer|Pfizer: Grant/Research Support|Pfizer: Lecturer
P-2157. Genomic Characterization of Group A Streptococcus Isolates Circulating among Children in Greece during 2023
Authors: Michos Athanasios , Tatsi Elizabeth Barbara , Dourdouna Maria-Myrto , Dellis Charilaos , Rizou Aspasia , Georgakopoulou Theano , Paradeisis Georgios , Stathi Angeliki , Doudoulakakis Anastassios , Kalogeras George , Bozavoutoglou Elisavet , Zachariadou Levantia , Syriopoulou Vasiliki
Published: January 2025

Background

An increase in invasive Group A Streptococcus (iGAS) and non-invasive GAS cases has been reported worldwide, especially among children, since 2022. The aim of this study was the genetic characterization of GAS isolates in the pediatric population of Greece.

Methods

GAS isolates from children with iGAS reported to National Public Health Organization (NPHO) and a representative number of GAS from non-invasive infections were prospectively collected during 01-12/2023. Isolates were examined for antimicrobial susceptibility with Etest and the emm types were determined by Sanger Sequencing. Whole-genome Sequencing (WGS) was performed to selected GAS isolates to detect the toxin profile regarding 47 virulence factors, among them 11 superantigens.

Results

GAS isolates from 511 children [266/467 (57%) males, median (IQR) age: 5.6 (3.8-8.0) years] were tested. iGAS represented 66/511 (12.9%) of isolates and among them 9/66 (13.6%) deaths were recorded. The most common GAS isolation sites were the following: throat (294/511, 57.5%), ear infusion (84/511, 16.4%) and skin lesions (60/511, 11.7%). All isolates were sensitive to penicillin. The resistance rates in erythromycin, clindamycin and tetracycline were 25/511 (4.9%), 18/511 (3.5%), and 61/511 (11.9%), respectively. We detected 29 different emm types, with the most prevalent being emm12 (232/511, 45.4%) and emm1 (135/511, 26.4%). Among the deceased children with iGAS, the emm1 (7/9, 77.8%) and emm12 (2/9, 22.2%) types were detected. Toxins profiles were examined with WGS in 6 non-invasive GAS isolates, 11 iGAS isolates and 7 iGAS isolates from deceased children. All isolates contained the speB gene (24/24, 100%). The speA, speC, ssa genes were detected: in 3/6 (50%), 3/6 (50%), 1/6 (16.6%) non-invasive GAS isolates, in 4/11 (36.4%), 4/11 (36.4%) and 0/11 (0%) iGAS isolates and in 5/7 (71.4%), 2/7 (28.6%) and 1/7 (14.3%) isolates from deceased children.

Conclusion

During 2023, although several emm types caused infections in Greek children, the most prominent types were emm12 and emm1. Continuous clinical and genomic surveillance of GAS is needed to comprehend the GAS disease trends and inform prevention strategies.

Disclosures

All Authors: No reported disclosures
P-2161. Evaluating the Clinical Utility of Next-Generation Sequencing Cell-Free DNA Testing in Pediatric Patients: A Focus on Medical History
Authors: Alkhafaji Hussain , Downey Rachel , Durham Tyler , Karim Zuena , Russo Susan , McGwier Sarah E , Tough Alyssa , Billeaud Joanie , Hauger Sarmistha Bhaduri
Published: January 2025

Background

The Karius test is a noninvasive, cell-free next-generation sequencing (NGS) test that can detect over 1,000 pathogens from a single blood sample. Validating the Karius test's useful clinical applications in pediatric patients is necessary to elucidate its benefits and limitations compared to conventional diagnostic testing. This pilot study aims to expand on existing evidence for Karius indications by investigating its utility among pediatric patients with specific underlying diagnoses.Figure 1:Age Distribution of Patients in Sample

Methods

A retrospective chart review was conducted, consisting of 251 consecutive pediatric patients [03/2018-06/2022] (fig 1) for whom a Karius NGS test was performed at a free-standing 240-bed children’s hospital and affiliated clinic in Central Texas. Statistical analysis was conducted to evaluate whether a child’s underlying diagnosis was associated with clinically useful Karius results.

The Karius result was considered clinically useful if it was the first or only diagnostic test used to make the diagnosis, had negative predictive value essential to the plan of care, or contributed to changes in the antimicrobial regimen. Underlying diagnoses were categorized into ten groups (fig 2). Statistical analysis was conducted using R software via Pearson’s Chi-Squared Test and Fischer’s Exact Test.Figure 2:Distribution of Underlying Diagnosis in Sample

Results

Evaluation of underlying diagnoses and the clinical usefulness of the Karius test revealed a significant association only for patients with an oncologic diagnosis (p=0.038) (Fig 3).Figure 3:Underlying Diagnosis and Reason Karius Result Deemed Clinically Useful

Conclusion

While Karius testing can be useful in specific patients regardless of the underlying diagnosis, this analysis found the most significant utility among patients with an oncology diagnosis. Further investigation through larger sample sizes and prospective designs is essential to validate and extend these findings, shedding light on cost-effectiveness and patient outcomes.

Disclosures

All Authors: No reported disclosures
P-2173. Evaluation of Self/Parent Collected Oral/Nasal Swabs for Respiratory Illness in Symptomatic Children
Authors: Nelson Hannah , Kayda Iryna , Watson Nicole , Kinshella Maggie Woo , Mooder Karen , Cochrane Jennifer , Desai Neil , Hoang Linda , Dittrick Michelle , Goldfarb David M
Published: January 2025

Background

For children under the age of 4 who are unable to reliably gargle, a combined oral/nasal (ON) swab collected by the parent/caregiver may be offered, and is less invasive than the standard nasopharyngeal (NP) swab. We sought to determine the diagnostic yield and acceptability of self-collected ON swab samples compared to healthcare worker-collected NP swabs for respiratory viruses, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), influenza, and respiratory syncytial virus (RSV) in children.

Methods

Symptomatic participants (0-4 years old) were recruited from a pediatric Emergency Department (ED) where they were undergoing clinical testing with an NP swab. Participants provided an additional ON swab using written self-collection instructions. Caregivers were asked to rate acceptability of ON and NP swab collections on a 5-point Likert scale. Both samples were collected with minitip flocked swabs and were tested with the SARS-CoV-2/Influenza A+B/RSV GeneXpert® assay. A portion of matched samples were also tested with the BioFire® RP2.1 respiratory panel.

Results

A total of 121 matched sample pairs were tested with the GeneXpert assay and had similar detection for RSV (28 ON positive vs 26 NP positive), influenza A (17 ON positive vs 17 NP positive), and SARS-CoV-2 (8 ON positive vs 10 NP positive). Median Ct values were higher for matched ON positives vs NP positives (26.2 vs 23.9). 58 pairs were also tested using the RP2.1 assay and showed a similar yield for total respiratory viruses detected (63 positive ON swabs vs 62 positive NP swabs). With either sample positive set as the reference for calculation of sensitivity, the ON and NP swab sensitivities are as follows: RSV (80.0% ON vs 100.0% NP), influenza A (94.4% ON vs 94.4% NP), SARS-CoV-2 (100.0% ON and 92.9% NP), and all other virus targets (82.6% ON vs 82.6% NP). Caregivers rated higher acceptability for ON swabs than HCW-collected NP swabs (median acceptability 2 vs 4).

Conclusion

The performance of self-collected ON swabs was similar to HCW-collected NP swabs for the detection of a range of respiratory viruses across two commercial molecular assays. Given their significantly higher acceptability ratings, self-collected ON swabs should be considered as a potential less-invasive diagnostic option for children.

Disclosures

All Authors: No reported disclosures
P-2183. Collocating HCV Treatment in a Medically Assisted Therapy Clinic in Dar es Salaam, Tanzania
Authors: Mmasa Christina , Kottilil Shyam , Mathur Poonam , Rwegasha John Christian , Maghimbi Abubakar M , Rugemalila Joan J , Masao Frank Aloyce , Roth Brenna M , Haruna Iddi
Published: January 2025

Background

Tanzania’s estimated HCV prevalence is the highest in Africa at 2.7%. Among people with opioid use disorder (OUD) in Dar es Salaam, Tanzania’s most populous city, positive HCV Ab prevalence is estimated to be 16.2% to 50.2%. With limited HCV treatment available, patient-centered service delivery through collocating HCV treatment with other services, task shifting to non-specialists, and streamlined testing and treatment algorithms are needed to lower barriers to HCV treatment. The objective of this study was to determine the effectiveness of collocating HCV treatment in routine medically assisted therapy (MAT) clinic services to cure HCV infection in clinic attendees with OUD.Figure 1:HCV testing and treatment algorithm completed by participants

Methods

From December 2021 to July 2022, we enrolled regular attendees of the MAT clinic in Muhimbili National Hospital (MNH) (Figure 1) who underwent HCV Ab screening. Those with a positive HCV Ab were tested for HCV RNA and offered treatment with ledipasvir/sofosbuvir if this was detectable. Treatment was directly observed therapy, dispensed daily when the participant attended the clinic. Participants were tested for sustained virologic response (SVR), defined as undetectable HCV RNA at 12 weeks following treatment completion. Figure 2. Study participant demographics*Creatinine, Alanine aminotransferase

Results

The study enrolled 724 regular attendees of the MAT clinic, most men (704/723, 97.37%) aged 40-49 (370/680, 51.2%) (Figure 2). Of those enrolled, 721/724 (99.6%) were screened for HCV, 125/721 (17.34%) had a positive HCV Ab, 119/125 (95.2%) underwent HCV RNA testing, 64/119 (53.8%) had detectable HCV RNA, 57/64 (89.1%) started treatment, 56/57 (98.2%) completed treatment, 52/56 (92.9%) were tested for SVR, and 49/52 (94.2%) achieved SVR at completion of the follow-up period, with an overall cure of 49/64 (76.6%) (Figure 3).Figure 3:HCV care and treatment cascade

Conclusion

In this study, 77% of participants with a detectable HCV RNA completed the treatment cascade and achieved SVR. Collaboration with medical staff and patient advocates to adapt the care and treatment model to the MAT clinic was important for success. Study visits and lab work were minimized to lower cost and barriers to adherence. Cost analyses and implementation studies should be done to evaluate the HCV care and treatment cascade in limited resource settings to build evidence for the benefits of these services and bolster government support.

Disclosures

Shyam Kottilil, MD, PhD, Orsobio: Advisor/Consultant|Red Queen: Advisor/Consultant
P-2194. Prevalence of Hepatitis B and Hepatitis A in People with Chronic Active Hepatitis C in New Jersey
Authors: Slim Jihad , Akiki Maria , Tempalski Barbara , Rosmarin-DeStefano Corey , Torres Juan , Leyden Kevin , Duprey Sheena , Levaggi Emily
Published: January 2025

Background

Most current guidelines recommend hepatitis A (HAV) and hepatitis B (HBV) vaccination for people living with hepatitis C (HCV) and lacking immunity to those viruses. We were interested in studying the prevalence of immunity to those 2 viruses in patients with chronic active HCV infection (CAH C) in NJ, to evaluate the resources needed to vaccinate those who are not immune.

Methods

We reviewed prospectively collected data in people with CAH C living in NJ, and retrieved their age, sex, race, ethnicity, HAV IgG, HBV surface antigen, HBV surface antibody, and HBV total core antibody. We calculated the prevalence of immunity to each virus, and specifically targeted the difference for HBV immunity in those born after 1991, when implementation of universal HBV vaccination of newborns started in the US.

Results

Between 09/01/2020 and 12/31/2023 we collected data on 1586 people living with HCV. The overall prevalence of HAV immunity was 46% (726/1586); for HBV, 36% (578/1586) were immune through vaccination (only HBV surface antibody positive), when divided by age group those born in 1991 and earlier had 34 % immunity compared to 52.5% for those born after 1991 (p< .0001). The prevalence of exposure to HBV was 24% (380/1586) with 7 having Hep B s Ag positive, and 126 only Hep B core antibody positive; when divided by the same age group categories, only 7 % of those < 32 years old had HBV exposure, as compared to 26% of those 33 years and older at a p value < .0001. Prevalence of people with all 3 markers negative for HBV (requiring vaccination) is 40% (628/1586); with no statistical difference between the two-age group, 40.5% for < 32 years old, and 39.5% for those 33 years and older.

Conclusion

Our study shows an urgent need to implement hepatitis A and hepatitis B vaccinations in people living with HCV in NJ, almost half of them are not immune to either virus. On the other hand, it also highlights the success of universal vaccination of newborn for HBV, since we found a statistically significant number of those born after 1991 to be immune and have less HBV exposure.

Disclosures

Jihad Slim, MD, FACP, AbbVie: Grant/Research Support|AbbVie: Honoraria|AbbVie: Speaker Bureau|Gilead Sciences, Inc.: Grant/Research Support|Gilead Sciences, Inc.: Honoraria|Gilead Sciences, Inc.: Speaker Bureau|Merck: Grant/Research Support|Merck: Honoraria|Merck: Speaker Bureau|Theratechnologies: Advisor/Consultant|Theratechnologies: Honoraria|ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Grant/Research Support|ViiV Healthcare: Speaker Bureau