bluuebunny/crossref_metadata_2025_split huggingface dataset:
350. Neurocysticercosis – Gender Differences in Clinical Presentations
Authors: Pendyala Bharath , Lingamaneni Prasanth , DeMarais Patricia , Warrior Lakshmi , Huhn Gregory 
Published: January 2021

Abstract

Background
Neurocysticercosis is a Neglected Tropical Disease and an important public health issue. Our goal was to collect and analyze data regarding clinically significant gender differences among our Neurocysticercosis patients.

Methods
A retrospective chart search with ICD 9/ ICD 10 diagnostic code for Neurocysticercosis and neuroimaging suggestive of Neurocysticercosis was performed for clinical encounters in the hospital or affiliated clinics between years 2013–2018. After a careful chart review, patients who were clinically diagnosed with Neurocysticercosis were included in the study. T-test was used to compare means of continuous variables and chi-square test to compare proportions of categorical variables.

Results
Among 90 total patients included, male (49.4%) and female (50.6%) distribution were nearly identical. The mean age in females was found to be higher than males (52.5 vs 42.0, P &lt; 0.0001). Almost an equal number of males and females presented with either seizures (63.6% vs 57.8%, P= 0.85), headaches (25.0% vs 28.9%, p= 0.85), or other symptoms (11.4% vs 13.3%, p= 0.85). Males had more generalized seizures compared to females (60% vs 38%, P= 0.37), although this result was not statistically significant. Females were more likely to present with &gt; 1 lesion (82.2% vs 56.8%, P= 0.01). Males were more likely to have cystic lesions (64.7% vs 27.9%, P &lt; 0.001) compared to females who had more calcified lesions on presentation (65.1% vs 20.6%, P &lt; 0.001). Male patients were more likely to have contrast enhancement or edema surrounding the lesions (61.4% vs 33.3%, P= 0.01) and were more likely to require treatment with Albendazole/Praziquantel (75.8% vs 31.7%, P &lt; 0.001).

Conclusion
Although previously reported data is limited, there is a suggestion that there are gender differences in host immune response and that inflammation surrounding parenchymal lesions is more intense in females. This study suggests that men either present early in the disease phase or have different immune responses than women and require anti-parasitic therapy more frequently. More research in this aspect is needed.

Disclosures
All Authors: No reported disclosures
353. Starry Night, Starry Bright, A Lil’ Doxy Will Help You See the Light
Authors: Smith Brandon , McCreary Erin K , Viehman J Alex 
Published: January 2021

Abstract

Background
Bartonella henselae neuroretinitis (BHNR) is a rare complication of cat scratch disease (CSD) occurring in 1–2% of cases. BHNR requires prompt diagnosis and treatment to prevent potential vision loss. Doxycycline, in combination with rifampin, is consider the treatment of choice. Empiric therapy is often started based on clinical suspicion prior to serologic confirmation. We present a case of BHNR requiring doxycycline graded challenge.

Methods
We report a case of a 45-year-old female with a past history of multiple sclerosis treated with natalizumab presenting with acute right-sided vision loss. She reported suffering a cat scratch 6 weeks prior and had noteworthy tick exposure. She was admitted to our hospital for progressively worsening vision loss. MRI brain demonstrated right-sided enhancement consistent with retinitis. Ophthalmology exam suggestive of infectious papillitis, neuroretinitis, and granulomatous inflammation.

Results
Infectious diseases (ID) was consulted with concern for BHNR and a history of a severe tetracycline allergy, throat swelling age 17. Given declining vision and a differential including both Lyme disease and BHNR, the decision was made to empirically treat with doxycycline while awaiting serologic studies. She successfully underwent doxycycline graded challenge (10mg administered IV followed by 100mg administered IV one hour later) and ultimately completed a 6-week course of doxycycline in combination with 2 weeks of rifampin followed by 4 weeks of azithromycin. Bartonella serologies returned positive 1:256 and her Lyme screen was negative. At her 6-week follow up, her vision had significantly improved but not yet returned to baseline.
Retina images

Visual field testing

Conclusion
Doxycycline serves as a treatment of choice for BHNR; however, our patient reported a severe, likely IgE-mediated reaction to tetracycline 28 years prior. She subsequently tolerated the first doxycycline graded challenge at our institution. Unlike B-lactam allergies, there is a paucity of literature exploring the cross-reaction potentials of various tetracyclines. Limited evidence has suggested that cross-reactions are not absolute. Tetracycline allergies present an opportunity for antimicrobial stewardship.

Disclosures
All Authors: No reported disclosures
354. The Epidemiology and Clinical Features of Acanthamoeba Disease in the United States, 1956–2018
Authors: O’Laughlin Kevin , Cope Jennifer R , Marsh Zachary A 
Published: January 2021

Abstract

Background
Acanthamoeba is a free-living ameba found worldwide in soil and water that can cause severe illness. Transmission is thought to be through the skin, eyes, or lungs; Acanthamoeba can cause disseminated infection (Acanthamoeba disease) in addition to the more widely recognized Acanthamoeba keratitis. Infections however are rare, and only case reports or small case series have been published. We review Acanthamoeba disease cases from the Centers for Disease Control and Prevention (CDC) free-living ameba registry to characterize the disease in the United States.

Methods
CDC maintains a free-living ameba (FLA) registry of laboratory-confirmed Acanthamoeba cases (excluding keratitis) sourced from published case reports, CDC case report forms, and CDC laboratory results. SAS© version 9.4 software was used to calculate descriptive statistics and frequencies.

Results
We identified 163 cases of Acanthamoeba disease between 1956 and 2018. Of cases with documented outcome, 85% were fatal (105/124). Most (88%) cases were in patients who were immunocompromised (136/155): 66 people living with HIV (of whom 49 were classified as having AIDS); 33 recipients of organ transplantation; 30 people diagnosed with malignancy. The most common manifestation of disease was encephalitis (49%). Other clinical presentations included cutaneous lesions (20%) and rhinosinusitis (6%); 40 cases involved multiple organ systems. Median patient age was 42 years (range 0–83 years). Males accounted for 71% (114/160) of cases. California (29) and Texas (14) had the most case reports; 30 other states reported cases. The source of exposure was unknown in most cases (75%); soil and water were documented in 14 and 17 cases, respectively.

Conclusion
Acanthamoeba disease in the United States is primarily characterized by encephalitis and cutaneous lesions that affect predominately immunocompromised individuals. Acanthamoeba as a cause of encephalitis in immunocompromised patients should be considered by clinicians, which may lead to earlier diagnosis and treatment.

Disclosures
All Authors: No reported disclosures
360. A Case Control Study of COVID-19 in Patients with End Stage Renal Disease (ESRD)
Authors: Lim Su Lin , Chan Kok Hoe , Lagudu Sudha , Szabela Maria , Slim Jihad 
Published: January 2021

Abstract

Background
COVID-19 is a major global pandemic. Since the first case reported in Wuhan, China, COVID-19 has spread across the globe with more than 7.6 million individuals affected worldwide. Several studies have tried to investigate the risk factors for mortality but there has bot been a definitive study in patients with ESRD. Herein, we aimed to investigate whether ESRD is associated with mortality as compared to age, gender and comorbidities matched cohorts.

Methods
A retrospective case control study was performed on patients 18-year-old with confirmed SARS-CoV-2 admitted to our hospital during the study period (03/15/2020 to 05/15/2020). Demographic, characteristics and clinical outcome were retrieved and reviewed. We found 39 ESRD patients, we matched them for 5 variables: Age, gender, diabetes mellitus (DM), hypertension (HTN), and body mass index (BMI). Age was stratified into 3 groups (&lt; 30, 30 to 60, &gt;60), history of DM and HTN were defined by reviewing the admission medications, and BMI was divided into 2 categories (&lt; 30 and 30 kg/m2). The primary endpoint was percentage of inpatient mortality.

Results
We had 39 ESRD patients with COVID-19 out of the 400 patients admitted during the study period with known clinical outcome. Nineteen patients (49%) were between 30 to 60 years old while the rest (51%) were older than 60 years old. As for gender, 25 (64%) were males and 14 (36%) females. Additional comorbidities were present in 38 patients with hypertension (92%) being the most common, followed by DM (64%) and BMI &gt;30 kg/m2 (49%). With the 5 variables, we were able to match with 177 controls.
Nineteen individuals expired out of the 39 ESRD patients (49%), as compared to 46 patients from the 177 matched cohort (26%) (z-score 2.80, p=0.0051; odds ratio [OR], 2.71; 95% confidence interval [CI], 1.28–5.41).

Conclusion
Our results suggest that ESRD patients is an independent risk factor for increased mortality in patients with COVID 19 disease. Larger prospective studies will need to confirm this finding and try to find ways to mitigate this very high mortality in this vulnerable population.

Disclosures
Jihad Slim, MD, Abbvie (Speaker’s Bureau)Gilead (Speaker’s Bureau)Jansen (Speaker’s Bureau)Merck (Speaker’s Bureau)ViiV (Speaker’s Bureau)
361. A Case Control Study of COVID-19 Outcome in Patients with HIV
Authors: Atallah Liana , Chan Kok Hoe , Natali Kayla M , Nagarakanti Sindhu , Slim Jihad 
Published: January 2021

Abstract

Background
Little is known regarding outcome of patients living with HIV (PLWH) when they get admitted to a hospital for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection. We decided to conduct a case-controlled study to try to answer the question if PLWH are at higher risk of mortality compared to individuals without HIV infection but with the same risk factors that affects outcome in COVID-19 disease.

Methods
A retrospective case matched control study was performed from 03/15/2020 to 05/15/2020. We reviewed all confirmed SARS-CoV-2 infected patients who were admitted to our hospital during the study period and retrieved 7 variables: Age, gender, diabetes mellitus (DM), hypertension (HTN), body mass index (BMI), chronic kidney disease (CKD), HIV status. We divided the age in 3 groups (&lt; 30, 30 to 60, &gt; 60), we defined the presence of DM and HTN by reviewing the admission medications, BMI &gt; 30 defined obesity, and CKD was present if eGFR &lt; 45 ml/min prior to the current admission. We found 12 PLWH, we matched them for the 6 variables, we found 94 controls. The primary endpoint was percentage of inpatient mortality.

Results
Of the 436 confirmed SARS-CoV-2 infection admitted between 03/15/20 and 05/15/20, 36 were still hospitalized. Twelve were PLWH out of the 400 patients with known outcome; 7 patients (58%) have the age range between 30 to 60 years old while the rest (42%) have age &gt; 60 years old. Male to female ratio was 1:1 (6 patients each). Comorbidities were present in 10 patients (83%) with HTN (83%) being the most common, followed by CKD (58%), obesity (33%), and DM (33%).
Only 1 patient expired out of the 12 PLWH (8%) admitted with COVID-19, as compared to 26 patients from the 98 matched cohort (27%) (z-score 1.38, p=0.17; odds ratio [OR], 3.972; 95% confidence interval [CI], 0.62–44.37).

Conclusion
Our study suggests that PLWH do not have a worse prognosis than their matched controls for the most significant comorbid conditions affecting outcome in COVID-19 disease. Further studies with a larger sample size are urgently needed to confirm this finding.

Disclosures
Jihad Slim, MD, Abbvie (Speaker’s Bureau)Gilead (Speaker’s Bureau)Jansen (Speaker’s Bureau)Merck (Speaker’s Bureau)ViiV (Speaker’s Bureau)
362. A Modified Early Warning Score Predicts Decompensation in COVID-19 Patients
Authors: Cavalier Joanna S , Goldstein Benjamin , O’Brien Cara L , Bedoya Armando 
Published: January 2021

Abstract

Background
The novel coronavirus disease (COVID-19) results in severe illness in a significant proportion of patients, necessitating a way to discern which patients will become critically ill and which will not. In one large case series, 5.0% of patients required an intensive care unit (ICU) and 1.4% died. Several models have been developed to assess decompensating patients. However, research examining their applicability to COVID-19 patients is limited. An accurate predictive model for patients at risk of decompensation is critical for health systems to optimally triage emergencies, care for patients, and allocate resources.

Methods
An early warning score (EWS) algorithm created within a large academic medical center, with methodology previously described, was applied to COVID-19 patients admitted to this institution. 122 COVID-19 patients were included. A decompensation event was defined as inpatient mortality or an unanticipated transfer to an ICU from an intermediate medical ward. The EWS was calculated at 12-hour and 24-hour intervals.

Results
Of 122 patients admitted with COVID-19, 28 had a decompensation event, yielding an event rate of 23.0%. 8 patients died, 13 transferred to the ICU, and 6 both transferred to the ICU and died. Decompensation within 12 and 24 hours were predicted with areas under the curve (AUC) of 0.850 and 0.817, respectively. Using a three-tiered risk model, use of the customized EWS score for patients identified as high risk of decompensation had a positive predictive value of 44.4% and 11.1% and specificity of 99.3% and 99.6% and 12- and 24-hour intervals. Amongst medium-risk patients, the score had a specificity of 85.0% and 85.4%, respectively.

Conclusion
This EWS allows for prediction of decompensation, defined as transfer to an ICU or death, in COVID-19 patients with excellent specificity and a high positive predictive value. Clinically, implementation of this score can help to identify patients before they decompensate in order to triage at time of presentation and allocate step-down beds, ICU beds, and treatments such as remdesivir.

Disclosures
All Authors: No reported disclosures
363. Acute Kidney Injury and Renal Replacement Therapy in Hospitalized COVID-19 Patients in the United States and Other Geographic Regions
Authors: Gilbert Shannon NovosadShannon NovosadLeah , Apata Ibironke W , Overton Rahsaan , Garg Shikha , Kim Lindsey , Jackson Brendan R , Patel Priti 
Published: January 2021

Abstract

Background
Acute kidney injury (AKI) is a complication that has been described among severely ill patients with COVID-19 and may be more common in those with underlying chronic kidney disease (CKD). Some patients with AKI require renal replacement therapy (RRT), including continuous RRT (CRRT). During the COVID-19 pandemic, some US areas experienced CRRT supply shortages. We sought to describe the percent of hospitalized COVID-19 patients who developed AKI or needed RRT to inform patient care and resource planning.

Methods
We searched for studies in the literature and public health investigations that described CKD, AKI, and/or RRT in COVID-19 patients from January 2020 onward. Studies were excluded if no CKD, AKI, or RRT information was provided. We abstracted counts of hospitalized COVID-19 patients, including those admitted to intensive care units (ICU) who developed AKI, underwent RRT, and/or had CKD. Data were pooled across cohorts by geographic region with available data (US, China, or United Kingdom [UK]). We compared proportions using Chi-square tests.

Results
A total of 311 studies were identified; 23 studies (US n=11; China n=11; UK n=1) that described kidney disease and/or kidney-related outcomes in hospitalized COVID-19 patients were included. Underlying CKD prevalence was higher in US cohorts (10.3%) compared with China (2.5%) or UK (1.5%) (p&lt; 0.0001). AKI was markedly higher among hospitalized (31.3% vs. 6.4%; p &lt; 0 .001) and ICU patients (55.4% vs. 18.2%; p&lt; 0.0001) in the US compared to China. The percent of ICU patients requiring RRT in the US (16.8%) was significantly different from that reported in China (12.5%) and the UK (23.9%) (p&lt; 0.0001). Limitations include differences in CKD and RRT definitions across studies.

Conclusion
AKI is a frequent outcome among US COVID-19 patients, affecting almost one third of hospitalized and more than half of ICU patients. AKI was reported more frequently in the US than China. The percent of ICU patients who received RRT was higher in the US and UK than in China. Understanding the occurrence of kidney-related outcomes among patients with COVID-19 including the impact of underlying CKD and regional practice variations is essential for healthcare systems to successfully plan for RRT needs during the pandemic.

Disclosures
All Authors: No reported disclosures
364. Baseline characteristics, comorbidities, and outcomes of COVID-19 patients hospitalized in Southwest Georgia, U.S. – an interim analysis of an early hot spot
Authors: Chastain Daniel B , Osae Sharmon P , Burt Ashley M , VanLandingham Kevin , Sibold Natalie , Henao-Martinez Andres , Franco-Paredes Carlos , Young Henry N 
Published: January 2021

Abstract

Background
Understanding the spectrum of disease severity and death are critical for identifying unrecognized risk factors associated with morbidity and mortality from coronavirus disease 19 (COVID-19). The purpose of this study was to describe the baseline characteristics, clinical presentation, and outcomes among patients hospitalized with COVID-19 in a major hotspot in the U.S. Southeast.

Methods
This multicenter retrospective chart review included adult patients hospitalized with COVID-19, defined by laboratory-detected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, in Southwest Georgia. The primary outcome was mortality, which was assessed through discharge or June 14, 2020, whichever occurred first. Secondary outcomes included comorbidities, laboratory and radiographic findings, as well as clinical course.

Results
A total of 120 patients were included with a median age of 61 years (IQR 50–72). The majority were African American (73%) and female (56%). Comorbidities on admission were present in 88% of patients; most prevalent were hypertension (76%), diabetes mellitus (55%), and chronic pulmonary disease (27%). Median Charlson comorbidity index was 4 (IQR 2–6) and BMI was 32.8 kg/m2 (IQR 26.2–39.5). On presentation, patients most often complained of dyspnea (69%), fever (63%), and cough (53%), with a median SOFA score of 2 (IQR 2–4). Most patients were admitted to the general ward (71%), of which 17% were subsequently transferred to ICU. During hospitalization, 27% were mechanically ventilated for a median 11 days (IQR 5–13.5), 18% developed ARDS, and 43% developed AKI. Median length of stay was 9.5 days (IQR 3.75–14). Overall mortality was 20%, which was significantly higher among patients with comorbidities (p = 0.047), as well as those who developed ARDS (p &lt; 0.001) or AKI (p = 0.027).

Conclusion
Most reports of COVID-19 have focused on large urban settings. However, early during the pandemic, we identified a large cluster of cases with a high-case fatality rate in a semirural setting in Southwest Georgia in the U.S.

Disclosures
All Authors: No reported disclosures
367. Clinical Characteristics and Outcomes in Patients with Pneumonia secondary to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)
Authors: Nichols Courtney , Sobhanie Mahdee , Colburn Nora , Lustberg Mark , El Boghdadly Zeinab , Liscynesky Christina , Hebert Courtney , Day Shandra R 
Published: January 2021

Abstract

Background
Since discovery in December 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which causes the disease of COVID-19 has become a global pandemic. Little is known about which risk factors lead to more severe disease or increased mortality in patients diagnosed with SARS-CoV-2. We aimed in this study to compare clinical characteristics associated with disease severity and increased mortality in hospitalized patients with COVID-19.

Methods
This was a single-center, retrospective study at The Ohio State University Wexner Medical Center to compare clinical characteristics associated with increased mortality in hospitalized patients with confirmed SARS-CoV-2. Adults patients positive for SARS-CoV-2 between March 1, 2020 and April 20, 2020 were included in the study. Prisoners and pregnant women were excluded. Baseline demographics, clinical characteristics, and outcomes were collected, and then compared to determine association with mortality. Statistical analysis used univariate and multivariate logistic regression analysis to evaluate the relationship between patient characteristics and mortality.

Results
The cohort included 92 patients. Median age was 58 years (ranging from 25–93) and 47/92 were men (51%). 12 patients were admitted directly to the intensive care unit (ICU), with 22 additional patients transferred to the ICU. 23 patients required mechanical ventilation. Clinical characteristics significantly associated with mortality in univariate analysis included underlying coronary artery disease (CAD) (OR=7.8, p = 0.002), chronic obstructive pulmonary disease (OR=5.21, p=0.02), living in an extended care facility (ECF) (OR=4.2, p=0.025), and immunocompromised status (OR=4.2, p=0.025). Multivariate analysis showed a statistically significant association in patients with underlying CAD (OR=13.1, p=0.001) and those admitted from an ECF (OR=12.1, p=0.005), when adjusted for other variables in the model.
Characteristics Associated with Mortality in Patients with COVID-19 in Univariate Analysis

Conclusion
Our study found that CAD and admission from an ECF were associated with SARS-CoV-2 mortality, when adjusted for age and other comorbidities. Further studies are necessary to identify potential preventative strategies to mitigate mortality in this vulnerable population.

Disclosures
All Authors: No reported disclosures