bluuebunny/crossref_metadata_2025_split huggingface dataset:
1642. Comparing Viral Respiratory Infections Between Children Who Do and Do Not Attend Child Care
Authors: DeJonge Peter , Malosh Ryan , Truscon Rachel , Johnson Emileigh , Foote Sydney , Cheng Bonnie , Tiseo Katie E , Getz Amy S , Segaloff Hannah , Monto Arnold , Martin Emily T 
Published: October 2019

Abstract

Background
Out-of-home child care (CC) is a risk factor for viral acute respiratory infection (ARI) in young children. Little is known, however, about differences in frequencies of viral infection between CC children and those cared for exclusively at home.

Methods
Using surveillance data from the HIVE household cohort in southeast Michigan from 2014–2018 (4 seasons), we analyzed 1022 illness cases from 354 children aged 0–6 years. Age groups were dichotomized as infants (aged <2 years) and toddlers/preschoolers (aged 2–6 years). Households were prospectively enrolled and nasal respiratory swabs were collected from children upon report of acute illness symptoms. We used real-time RT–PCR to test for 18 respiratory viruses.

Results
We detected at least one virus in 855 illness cases (83% of all illnesses reported). Age at first illness onset in all four seasons was significantly younger among CC children than homecare children (P < 0.001) across all 4 years (average difference = 1.25 years). CC children <2 years had slightly lower odds of viral detection during illness (OR = 0.89, 95% CI [0.49, 1.61]) but higher odds at ages 2–6y (1.07 [0.65, 1.76]); neither was statistically significant. Neither CC nor homecare children were significantly more or less at risk for any particular pathogen—expect for rhinovirus in the <2-year group, where odds of rhinovirus infection were 58% lower (OR = 0.42) in CC children compared with homecare counterparts (95% CI, 0.21–0.83). Conversely, CC attendees under 3 more frequently had influenza, RSV, hMPV, parainfluenza, and coronavirus; however, none of these associations were significant. Odds of coinfection (> 1 virus detected) were higher among CC children, but not significant (OR = 1.4 [0.63, 2.96] and 1.2 [0.77, 1.88] in <2 year and 2–6 year age groups, respectively). Among all children <7 year, the mean number of pathogens detected was not different between CC and homecare individuals (1.20 vs. 1.23, P = 0.16).

Conclusion
As expected, results indicated that CC attendees aged 0–6y experienced illness episodes earlier in life compared with homecare children. Our analysis also indicated that, compared with children cared for at home, CC children were less at risk for rhinovirus infection when young but could potentially be at higher risk for viruses of greater clinical concern.

Disclosures
All authors: No reported disclosures.
1644. Performance of Symptom-Based Case Definitions to Identify Influenza Virus Infection among Pregnant Women in Middle-Income Countries: Findings from the Pregnancy and Influenza Multinational Epidemiologic (PRIME) Study
Authors: Wesley Meredith G , Tinoco Yeny , Patel Archana , Suntarattiwong Piyarat , Hunt Danielle R , Soto Giselle , Sinthuwattanawibool Chalinthorn , Kittikraisak Wanitchaya , Arriola Carmen S , Hombroek Danielle , Mott Joshua , Kurhe Kunal , Bhargav Savita , Prakash Amber A , Florian Richard , Gonzales Oswaldo , Cabrera Santiago , Llajaruna Zumaeta Edwin , Brummer Tana , Malek Parker , Saha Siddhartha , Garg Shikha , Azziz-Baumgartner Eduardo , Thompson Mark G , Dawood Fatimah S 
Published: October 2019

Abstract

Background
The World Health Organization (WHO) recommends case definitions for influenza surveillance that are also used in public health research, though their performance has not been assessed in many risk groups, including pregnant women in whom influenza may manifest differently. Â We evaluated the performance of symptom-based case definitions to detect influenza in a cohort of pregnant women in India, Peru, and Thailand.

Methods
In 2017, we contacted 4774 pregnant women twice a week during the influenza season to identify illnesses with new or worsened cough, runny nose, sore throat, difficulty breathing or myalgia, and collected data on other symptoms and nasal swabs for influenza rRT–PCR testing. To identify symptom predictors of influenza, we used multivariable logistic regression with forward selection of symptoms significant in univariate analysis after controlling for country, chronic conditions, influenza vaccination, and time from symptom onset to swab collection. We calculated sensitivity and specificity of each symptom, WHO respiratory illness case definitions and a case definition based on significant predictors from the multivariable model.

Results
Of 2431 eligible illness episodes among 1,716 participants, 142 (5.8%) were positive for influenza. Among individual symptoms, runny nose was most sensitive and measured fever ≥ 38° Celsius was most specific (Figure 1). In a multivariable model, measured fever ≥ 38° Celsius [adjusted odds ratio = 3.8, 95% confidence interval [CI] = 2.0–7.2], cough [2.7, CI 1.6–4.7], chills [2.2, CI 1.2–3.8], and myalgia [1.2, CI 2.2, 5.3] were independently associated with influenza illness. A case definition based on these four (measured fever, cough, chills or myalgia), was 91%-sensitive and 37% specific. Sensitivity and specificity of case definitions varied (Figure 2).

Conclusion
While a case definition based on one or more of fever, chills, cough or myalgia is highly-sensitive and moderately specific among pregnant women, case definitions requiring measured or subjective fever may miss many influenza cases making them sub-optimal for studies of burden or vaccine efficacy. The intended use of case definitions should be considered when evaluating the tradeoff between sensitivity and specificity.

Disclosures
All authors: No reported disclosures.
1649. That’s Not Cricket! Outbreak of Legionella pneumophila (L. pneumophila) in a Community Cricket Club in the UK, 2018: Challenges in Legionella Control in This Setting
Authors: Wright Natalie , Fenelon Deborah , Fleeson Rachel , Coopey Diane , Hawker Jeremy , Tahir Mamoona 
Published: October 2019

Abstract

Background
Cricket clubs in the UK are frequently collocated with community venues which host a range of activities, often for vulnerable members of society, such as children and elderly people. In July 2018, two cases of local laboratory-confirmed Legionnaires’ disease were notified to Public Health England (PHE). The cases were found to be players in the same cricket team (via the enhanced Legionnaires’ disease surveillance system) and had multiple shared potential exposures during their incubation periods.

Methods
A three-pronged outbreak investigation was conducted, with epidemiological, microbiological, and environmental components. Case-finding and potential shared exposures were identified through completion and analysis of Legionella enhanced surveillance questionnaires. Following risk assessment, environmental samples were obtained from aerosolizing outlets at identified sites. Additionally, sputum and urine samples were obtained from cases. All samples were sent to the PHE reference laboratory for confirmation of species and sequence typing.

Results
All cases were confirmed as L. pneumophila serogroup 1. Only one case provided a sputum sample suitable for sequence typing, which yielded a partial result. This result was consistent with a strain of L. pneumophila found in abundance at numerous water outlets at a local cricket club epidemiologically linked to all cases. On the emergence of these findings, control measures were put in place to prevent further exposure to the pathogen including shot-dosing of the water systems and closure of aerosolizing outlets. However, eradication of the organism proved challenging.

Conclusion
This is the first known outbreak of L. pneumophila epidemiologically and microbiologically linked to a cricket club in the UK. Control of the outbreak was challenging for two reasons. Firstly, the nature of the setting as a community venue meant that there was a large number of people potentially exposed, many with characteristics putting them at increased risk of Legionnaires’ disease. Secondly, the cricket club was run by a committee of volunteers with limited expertise and financial resource. There was a resultant lack of clarity about who was ultimately responsible for Legionella risk management and the implementation of control measures.

Disclosures
All authors: No reported disclosures.
1655. Performance of Molecular and Serologic Tests for the Diagnosis of Scrub Typhus
Authors: Varghese George M , Kannan Kavitha , Abhilash Kundavaram , Nithyananth Alice , David Thambu , Sathyendra Sowmya , Hansdak Samuel , Iyyadurai Ramya , Prakash John 
Published: October 2019

Abstract

Background
Diagnosis of scrub typhus, caused by the bacterium Orientia tsutsugamushi, is challenging because of the overlap of its nonspecific symptoms with other infections coupled with the lack of sufficient data on the performance of diagnostic tests. Early diagnosis of scrub typhus is crucial to improve outcomes and this study evaluated the diagnostic performance of various tests.

Methods
Adult patients with acute febrile illness and manifestations suggestive of scrub typhus confirmed by positive PCR in the blood or eschar were characterized as cases. Patients with acute febrile illness and a confirmed alternate etiology such as culture-confirmed typhoid, smear/PCR positive for malaria, PCR/NS1 antigen positive for dengue, PCR positive for influenza, PCR/MAT positive for leptospirosis, PCR positive for spotted fever were characterized as controls with other infections. The healthy controls consisted of subjects from the same geographic region. We performed the following tests on blood samples for scrub typhus and calculated the sensitivity, specificity, positive predictive value, and negative predictive value: (1) Quantitative PCR using 47 kDa gene (qPCR); (2) Conventional PCR using 56kDa gene (cPCR); (3) Loop-mediated isothermal amplification assay (LAMP assay); (4) Immunofluorescence assay (IFA); (5) Enzyme-linked immunosorbent assay (ELISA); (6) Weil–Felix test (WF test); and (7) Immunochromatographic Rapid Diagnostic Test (RDT).

Results
Among the 302 participants, 152 had confirmed scrub typhus (cases) and 150 were controls. ELISA and RDT detecting IgM antibodies had excellent discriminative potential with sensitivities and specificities of 94%, 93% and 92%, 93%, respectively. False-positive IgM serology was observed with spotted fever and leptospirosis. The sensitivity and specificity of IFA were found to be 80% and 85%, respectively. qPCR exhibited excellent sensitivity (96%) and perfect specificity.

Conclusion
ELISA and RDT detecting IgM antibodies have excellent sensitivity and specificity while the sensitivity of IFA is suboptimal for the diagnosis of scrub typhus. Given its perfect specificity and superior sensitivity, qPCR is preferred for diagnostic confirmation in reference laboratories.

Disclosures
All authors: No reported disclosures.
1665. The Cascade of Care for the Strong Hearts Chagas Disease Screening and Treatment Program in East Boston, Massachusetts
Authors: Manne-Goehler Jen , Davis Jillian , Huanuco Juan , Gallegos Salazar Jaime , Salazar Alejandra , Camelo Ingrid Y , Collins Katherine , Sun Park Hong , Hochberg Natasha , Hamer Davidson , Barnett Elizabeth , Köhler Julia 
Published: October 2019

Abstract

Background
Over 300,000 people in the United States are infected with Trypanosoma cruzi, the parasite that causes Chagas disease. Less than 1% of those people have received antitrypanosomal therapy. We report findings of an ongoing project to address Chagas disease in East Boston, including the epidemiology and cascade of care for this disease.

Methods
Providers at the East Boston Neighborhood Health Center were offered continuing medical education sessions on Chagas disease by the Strong Hearts project. One-time screening for Chagas disease is recommended for all patients <50 years old who had lived in Mexico, South or Central America for ≥6 months at the provider’s discretion. Screening is performed by a commercial laboratory using the Hemagen ELISA; confirmatory testing is performed at CDC. Patients with confirmed positive serology are referred to the Center for Infectious Diseases (ID) at Boston Medical Center for evaluation and treatment. We compared the prevalence of Chagas disease by age, sex and national origin. We then used a conditional numerator and fixed denominator to construct the cascade of care, with the stages defined as referred to ID care, evaluation in ID, initiation of treatment and completion of antitrypanosomal therapy. We used chi-squared tests to compare proportions.

Results
From March 21, 2017 to April 17, 2019, 5,125 patients were screened. 50 (0.97%) were confirmed to have T. cruzi infection, among them 3 pregnant women. There were no differences in the prevalence of T. cruzi infection by sex (M = 22/1870 [1.18%], F = 28/3305 [0.85%], P = 0.245) but prevalence increased from 0/190 (0%) in those <20 years old to 11/1083 (1.02%) in 40–49 year olds (P = 0.001). The 3 infants of infected mothers were screened. The cascade of care for Strong Hearts is displayed in Figure 1.

Conclusion
Chagas disease prevalence in at-risk communities in Boston is substantial. 20% of patients with T. cruzi infection identified in this program have completed treatment to date. Most infected patients were referred for evaluation, but substantial drop-off occurred at each of the next 3 steps of the cascade. Confronting barriers at each of these steps is a crucial component of efforts to address this neglected disease.

Disclosures
All authors: No reported disclosures.
1678. Assessing Performance of Multiple Methods for Measurement of Body Temperature, Bangladesh
Authors: Martin Daniel W , Das Pritimoy , Friedman Michael , Rahman Mahmudur 
Published: October 2019

Abstract

Background
CDC and icddr,b are conducting an acute febrile illness (AFI) research project in four hospitals in Bangladesh. Enrolled subjects have measured fever of ≥100.4°F. To determine the most-sensitive temperature measurement method, we collected multiple measurements on patients with fever history between March and April 2019.

Methods
Patients were screened in outpatient departments of four hospitals in Bangladesh between March 7 and April 15, 2019. Screening used at least two of three methods: tympanic, oral, or axillary. Records were consolidated using Microsoft Excel and analyzed in R3.4.3. We examined the correlation between temperatures measured by different methods for each patient. For records with all three measures, we calculated the likelihood of meeting AFI inclusion criterion of ≥100.4°F (38°C) by measurement method.

Results
3,060 subjects were enrolled. The highest correlation among measurements was between axillary and oral (r = 0.882, 95% CI 0.868–0.895). The lowest correlation was between tympanic and oral (r = 0.71, 95% CI 0.69–0.73). Axillary and oral had the highest correlation in both children and adults (peds: 0.88, 95% CI 0.86–0.90; adult: 0.89, 95% CI 0.86–0.90). By site, the highest correlation was axillary to oral among children in Hospital 1 (r = 0.98, 95% CI 0.92–1.00), while the lowest was axillary to tympanic for adults in Hospital 3 (r = 0.71, 95% CI 0.65–0.77). 882 subjects (334 pediatric, 548 adult) were assessed using all three measurement methods. 313 (159 pediatric, 154 adult) met AFI inclusion criterion by at least one method. From 49% to 63% of subjects at any site met the criterion by two or three methods (table). Results in hospitals 1, 2 and 4 were similar and grouped for analysis. In every site, subjects were detected by oral who would not have been detected using axillary or tympanic. Only in Hospital 3, subjects were detected by tympanic alone. No subjects in any site met the criterion by axillary measurement alone.

Conclusion
Accurate measurement of body temperature is essential for AFI surveillance, but literature on methodology is limited. We demonstrate that multiple modes of measurement increased detection of febrile patients. The most sensitive combination was oral and tympanic. Axillary measurement did not improve detection.

Disclosures
All authors: No reported disclosures.
1680. Guillain Barré Syndrome in Arbovirus Outbreak in Veracruz, Mexico: The Follow-up to 3 Years of the Pandemic
Authors: Del Carpio-Orantes Luis , Salvador Sánchez-Díaz Jesús , Gabriela Peniche Moguel Karla , García-Méndez Sergio , Arnulfo Perfecto-Arroyo Miguel , Solis-Sánchez Ishar , del Pilar Mata-Miranda Maria , García-Lechuga Maricela , Patricia Moreno-Aldama Nancy , Rosario Contreras-Sánchez Edna , Isela Luna-Ceballos Rosa 
Published: October 2019

Abstract

Background
From the arrival of Zika to America in 2015, and the increase in cases of Guillain sweeten in South America apparently associated with acute viral infection, Mexico had its first contact in 2016, with an increase in the incidence of cases of the syndrome, initiating a protocol study to look for the causal association of the Zika virus syndrome

Methods
We conducted a descriptive, prospective, and longitudinal study in Veracruz, Mexico, where follow-up of cases of Guillain Barre Syndrome (GBS) occurred during 2016 to 2018. The central point of the study is to look for the etiological association of GBS with the presence of acute zika infection. Secondarily, other know neutropic agents, both viral and bacterial were searched. The diagnosis techniques used were PCR-RT (blood and urine) and IgM/IgG for Zika; serum PCR-RT and IgM/IgG for Dengue and Chikungunya; IgM/IgG for TORCH; PCR-RT in CSF for Herpes and Enterovirus; serological panel of Hepatitis B and C; PCR-RT in rectal swab for Campylobacter.

Results
A cohort of 39 patients has been formed over 3 years of study. 38 patients met the operational definition of a suspected case of Zika, of which only 2 cases were identified by PCR-RT in urine; During the search protocol for infectious agents, others were identified such as: Dengue, Chikungunya, Enterovirus, Herpes and Hepatitis B; however, the identification of Campylobacter was even more remarkable, also highlighting that only four patients had diarrhea.
Regarding the treatment, 37 patients received IVIG, 1 patient received plasmapheresis and 1 patient received both. The prognosis was good in 34 patients (basal Hugues from 4–5 to 2), 5 had poor functional prognosis and died.

Conclusion
The incidence of Zika as a cause of GBS is relatively low (5%), so the etiological association could not be demonstrated; other neurotropic viral agents were identified, however the presence of Campylobacter cases was more notable (asymptomatic campylobacteriosis).

Disclosures
All authors: No reported disclosures.
1720. Isolation and Characterization of Candida auris From an Active Surveillance System in Texas
Authors: Alam M Jahangir , Begum Khurshida , Endres Bradley T , McPherson Jacob , Costa Gabriela , Miranda Julie M , Garey Kevin W 
Published: October 2019

Abstract

Background
Candida auris is an emerging new multi-drug-resistant fungal pathogen spreading globally. C. auris is associated with outbreaks due to the bloodstream, ear, and wound infections with a high mortality rate (30 to 60%). As part of our multi-pathogen surveillance system, we began screening for C. auris to understand the ecology, sources, and epidemiology of this important pathogen from leftover stool samples collected from hospitalized patients.

Methods
Four hundred and seventeen stool samples were collected, enriched in brain heart infusion broth for 2–3 days at 37°C, and sub-cultured onto selective Candida agar plates. Agar plates were incubated at 37°C for another 2–3 days and suspected Candida colonies were stocked for DNA extraction, PCR identification, and whole-genome sequencing. PCR amplicons were sequenced to confirm the identification C. auris. Enrichment samples were also screened by PCR to directly detect C. auris. Minimum inhibitory concentration (MIC) of various anti-fungal drugs was determined by the micro-dilution method using a commercial MIC plate (Sensititre “YeastOne”).

Results
Three C. auris samples were identified by PCR (0.7%; 3/417) of which one was able to be cultured. The isolated strain was resistant to fluconazole, itraconazole, voriconazole, posaconazole, and caspofungin. WGS data analysis demonstrates our isolate has high similarity with the Pakistani strains.

Conclusion
We have detected C. auris from stool samples of hospitalized patients in Texas for the first time. WGS data indicate our isolate has high similarity with South Asian patient strains. Long-term surveillance of C. auris is essential to understand the infection or colonization sources and epidemiology of this newly emerging fungal pathogen.

Disclosures
All authors: No reported disclosures.
1737. Impact of Therapeutic Drug Monitoring (TDM) of Azole Prophylaxis in Lung Transplant Recipients on the Development of Positive Fungal Events
Authors: Shah Anooj , D’Agostino Carly , Cunningham Kathleen , Kane Clare , Ison Michael G , Schulte Jamie 
Published: October 2019

Abstract

Background
The utility and clinical impact of therapeutic drug monitoring (TDM) of prophylactic azole antifungals in lung transplant recipients is not well described. The objective of this study was to investigate the impact of TDM of azole prophylaxis in lung transplant recipients on the development of positive fungal events.

Methods
A retrospective analysis was performed on 47 lung transplant recipients between 2013 and 2018 at Northwestern Memorial Hospital. A positive fungal event was defined as fungal species on BAL culture and/or positive BAL Aspergillus galactomannan (GM) with an index value ≥1.0. Study groups were defined based on attainment of therapeutic trough levels after initiation of oral therapy (therapeutic if posaconazole level ≥0.7 μg/mL or voriconazole ≥1–5.5 μg/mL, subtherapeutic if ≥2 consecutive levels of posaconazole <0.7 μg/mL or voriconazole <1 μg/mL after initial dose increase).

Results
There were no differences in baseline characteristics (Figure 1). There were a total of 11 fungal events with 3 (12.0%) occurring in the therapeutic cohort and 8 (36.4%) in those subtherapeutic (P = 0.08). In the 5 patients with a positive GM, the mean index was 2.02 ± 0.95. 7/30 (23.3%) of patients on posaconazole had a fungal event, with 2/7 (28.6%) requiring treatment at the time of event. For patients on voriconazole, 4/17 (23.5%) had a fungal event, with 1/4 (25.0%) requiring treatment. Mean time to fungal event was 164.5 ± 8.9 days vs. 135.9 ± 13.7 days in the therapeutic and subtherapeutic group, respectively (P = 0.05).
All patients on posaconazole suspension who experienced a fungal event were subtherapeutic (3/3, 100%) compared with the majority of patients on posaconazole delayed release (DR) tablets who achieved therapeutic levels (17/22, 77.3%). Mean posaconazole trough level observed in the patients receiving DR tablet was 2.15 ± 0.95 μg/mL.

Conclusion
There was an association between two consecutive subtherapeutic azole prophylaxis levels and positive fungal events indicating a role for TDM in lung transplant recipients. Time to fungal event post-transplant was shorter in subtherapeutic patients. As anticipated, the use of posaconazole suspension resulted in subtherapeutic levels. This study presents an opportunity for further research of the impact of TDM on clinical outcomes to optimize patient care.

Disclosures
All authors: No reported disclosures.