bluuebunny/crossref_metadata_2025_split huggingface dataset:
1633. Human Co-infection with Borrelia burgdorferi and Babesia microti Among High-Risk Hispanic/Latino Workers on Eastern Long Island, New York: A Preliminary Cross-Sectional Analysis in 2016
Authors: Vilcarromero Stalin , Nunez Ana M , Vivas Katherine , Mahmood Saadia , Russo Julianna , Wellins Anna-Marie , Xu Yun , Yang Xiaohua , Arcan Chrisa , Luft Benjamin J 
Published: October 2019

Abstract

Background
Lyme disease has serious public health implications and has a high prevalence in Suffolk County, NY. Furthermore, there is a high risk for coinfection with Babesiosis, a potentially life-threatening tick-borne infection in the same area. This population-based cohort study was implemented in 2016 to assess the risk factors for Borreliosis among the Hispanic/Latino work population, which gave us the opportunity to measure clinical and epidemiological features of co-infection.

Methods
Invitation to participate in the study occurred during a Spanish educational lecture about tick-borne diseases. Following signed informed consent, a questionnaire and blood sample were obtained for each participant Borreliosis was defined based on 2-tiered serologic testing. Antibodies to B. microti were detected by indirect immunofluorescence assay (IFA). Between June and December 2016, 126/199 (66%) with a completed visit 1 (survey and blood draw) were included in the first analysis.

Results
Sample characteristics include 60% 18–39 years old, 75% male, 79% had elementary school education or less, 86% reported having tick exposure, 79% lived in Eastern North Fork, 65% lived 10 or more years in the United States, and 48% were gardeners and landscapers. The seroprevalence for Borreliosis burgdorferi, Babesiosis microti, and co-infection were n = 13(10.3%), n = 36 (28.6%), and n = 7 (5.6%), respectively. In the univariate analysis having a fatigue severity score of <4 or having fatigue most of the time or stiff neck or joint pain or facial paralysis, or a previous diagnosis of other tick-borne diseases were associated with co-infection (Pearson chi-square, P < 0.05).

Conclusion
However, none of these factors were statistically significant in the multivariate analysis after adjusting for the above variables. In this initial study, a high prevalence of Babesiosis was found. A larger sample size may be needed to better assess the risk of coinfection in this Lyme endemic area.

Disclosures
All authors: No reported disclosures.
1670. Access to Antibiotics Without Prescription for Travelers and Colombian Citizens at Community Pharmacies in Bogotá, Colombia: A Cross-Sectional Study
Authors: Kasbaum Marie , Lizarraga Catalina V , De la Hoz Alejandro , Reyes Jinnethe , Arias Cesar A 
Published: October 2019

Abstract

Background
Antimicrobial-resistant pathogens often emerge in communities where antibiotics are frequently sold without prescriptions. In Colombia, nonprescription sale of antibiotics still occurs despite national regulations. Use of antimicrobials in international travelers has been linked to the rapid dissemination of multidrug-resistant pathogens around the globe. Despite the exponential increase of international visitors to Colombia recently, there is a notable lack of studies investigating the accessibility of antibiotics to foreign travelers without prescriptions in Colombian pharmacies.

Methods
This cross-sectional study compares the access to antibiotics without prescription in community pharmacies between travelers from the United States and local Colombian citizens in Bogotá. Both groups visited 91 pharmacies and conducted trials as covert simulated clients (SCs). The SCs followed a standardized script when interacting with pharmacy personnel, acting as though they were seeking antibiotics for moderate Traveler’s Diarrhea (TD), without a prescription. Data were gathered on the employees’ responses, including the level of “prompting” needed for an employee to offer antibiotics, reasons given to the SCs for refusing to sell antibiotics if no sale was offered, and generic brand of compounds offered.

Results
Antibiotics were offered to the US travelers in 62 (68.13%) pharmacies, and to the Colombian group in 57 (62.64%) pharmacies. The traveler group was significantly more likely than the comparator group to be offered antibiotics without any prompting (P = 0.003). When pharmacy employees refused to sell antibiotics during trials, the traveler group was significantly more likely to be given a clinical reason not to receive antibiotics. Refusal to Colombian citizens was more frequently due legal reasons (P < 0.001).

Conclusion
Antibiotics were accessible without prescriptions at similarly high frequencies, regardless of the customers’ nationality. The US travelers were more likely than the Colombian group to be offered antibiotics without needing to prompt the pharmacist. Additionally, pharmacists were much more likely to deny antibiotics to the Colombian group due to legal reasons, as opposed to clinical reasons for US travelers.

Disclosures
All authors: No reported disclosures.
1681. Assessment of the Impact of Infectious Events in a Cohort of Pediatric Leukemia Patients in the Dominican Republic
Authors: Burns Julianne E , Reyes Pérez Dominga , Li Yimei , Gómez García Wendy , Garcia F Jay , Penélope Gil Jiménez Johanna , Castillo Bueno María , Sánchez Jacqueline , Hunger Stephen P , Deverlis Adriana , Steenhoff Andrew P , Fisher Brian T 
Published: October 2019

Abstract

Background
Infections are a leading cause of morbidity and mortality in children with cancer. Although data are limited, the impact of infection in this population appears to be amplified in low- and middle-income countries. Defining the epidemiology of infection in a specific region is paramount to developing effective interventions. This study aims to define the epidemiology of and outcomes from infection in children with leukemia in the Dominican Republic.

Methods
A retrospective cohort was assembled of children newly diagnosed with leukemia between July 1, 2015 and June 30, 2017 at Hospital Infantil Dr. Robert Reid Cabral in Santo Domingo. Patients were identified from the Pediatric Oncology Network Database and hospital admissions from the Oncology admissions logbook. Medical records and microbiology results were reviewed to identify all inpatient invasive infections. Distance from a child’s home to the hospital was determined using ArcGIS 10.5.1. Infection rates were described in discrete time periods after diagnosis and risk factors for invasive infection were explored using Poisson regression.

Results
The cohort included 68 patients; 54 (79.4%) with acute lymphoblastic leukemia and 14 (20.6%) with acute myeloblastic leukemia. The cohort was 48.5% female, had a median age at diagnosis of 7.3 years (range 1.1–16.6), and a median weight-for-age of 45.5 percentile (range 0–99.9). There were 1.2 invasive infections per 100 days at risk in the first 60 days after diagnosis, 0.8 from > 60–100 days, and 0.4 from > 100–180 days. Gastroenteritis, skin/soft-tissue infection, and pneumonia were most frequent, with bacteremia most common in the first 60 days. In a multivariate Poisson regression model, age ≥10 years (IRR 0.49, 95% CI 0.28–0.85) and distance from the hospital >100 km (IRR 0.34, 95% CI 0.14 – 0.81) were each protective against infection in the first 180 days after diagnosis. During the 2-year period, 8 of 22 (36%) patient deaths were related to infection.

Conclusion
Invasive infections were common and a prominent source of death in this cohort. Interventions aimed at reducing infection should target the first 60 days after diagnosis. Decreased infection incidence among children of older age and farther distance from the hospital were unexpected and warrant further investigation.

Disclosures
All authors: No reported disclosures.
1713. Impact of False-Positive Low-Titer Cryptococcal Antigen Testing
Authors: Bhatt Mahesh , Ribes Julie A , Arora Vaneet , Myint Thein 
Published: October 2019

Abstract

Background
At University of Kentucky (UK) HealthCare, the transition from latex agglutination testing (Remel, Lenexa, KS) to IMMY Cryptococcal Antigen Lateral Flow Assay (CrAg LFA) occurred in September 2016. A few months later, it was noticed that several cryptococcal cases were diagnosed with weak positive test results where the diagnosis could not be confirmed by additional testing. The purpose of this study was to analyze the characteristics of these patients, and to assess the interventions they received based on positive results.

Methods
This was a retrospective study of the patients with positive CrAg LFA treated at UK HealthCare from November to December 2016. Low antigen titers (≤ 1:20) were considered to be false positive if repeat testing with the Remel Cryptococcal Latex assay, IMMY latex and IMMY microwell EIA were negative, cultures and histopathology were negative and there was no clear clinical evidence of infection.

Results
During this 2-month period, CrAg LFA was positive in 12 patients. The diagnosis of cryptococcosis could not be confirmed by additional testing in 9 (75%) individuals. Cirrhosis/liver disease was present in 3 (33.3%) patients, 5 (55.6%) underwent lumber puncture and antifungal therapy was administered in 8 (88.9%) patients (Table 1). CrAg LFA was false positive in 1/2 (50%) HIV, 3/3 (100%) transplant, and 5/7 (71.4%) non-HIV/non-transplant patients (Figure 1). Among the false positives, 4 (44.4%) patients had titer of 1:5, two (22.2%) had 1:20, and the original positive screen was not detected upon titration in 3 (33.3%) other patients. One HIV patient received a complete treatment course for unconfirmed cryptococcal meningitis because an LP could not be performed.

Conclusion
False-positive low CrAg LFA titers led to unnecessary tests, antifungal treatments and prolonged hospitalization in some patients. One-third of these individuals had cirrhosis/liver disease. Other institutions also reported false-positive low CrAg LFA titers. As a result, the company staged a recall of the specific lot and corrected the problem in reagent manufacturing. Low-positive titers using CrAg LFA should be interpreted carefully and further testing should be considered as determined by the clinical situation.

Disclosures
All authors: No reported disclosures.
1721. A Transcriptional Signature of Acute Aspergillus Infection Offers High Diagnostic Accuracy Despite the Presence of Immunosuppression
Authors: Steinbrink Julie M , Zaas Aimee K , Βncourt-Quiroz Marisol , Modliszewski Jennifer L , Corcoran David , McClain Micah T 
Published: October 2019

Abstract

Background
Invasive aspergillosis (IA) is a major cause of critical illness in immunocompromised (IC) patients. However, current fungal testing methods have significant limitations and there is a clear need for new diagnostic options. Disease-specific gene expression patterns in circulating host cells show promise as novel diagnostics; however, it is unknown whether such a “signature” exists for IA. Additionally, there is a need for better understanding of the effect of iatrogenic immunosuppression (present in most cases of IA) on such host response-driven biomarkers.

Methods
Male BALB/c mice were separated into an Aspergillus fumigatus inhalational exposure group and a placebo group. These two groups were each subdivided into three additional sets based on immunocompromised status (no immunosuppression, cyclophosphamide, and corticosteroids) for a total of six experimental groups. Mice were sacrificed 4 days post-infection. Whole blood was assayed for transcriptomic responses via microarray. Bayesian techniques were utilized to develop classifiers of IA and leave one out cross-validation was used to estimate predictive probabilities.

Results
Aspergillus infection triggers a powerful response in non-IC hosts, with 2996 genes differentially expressed between IA and controls. We generated a 146-gene expression classifier able to discriminate between non-IC mice with IA and uninfected non-IC mice with 100% accuracy. However, the presence of immunosuppressive drugs exhibited a strong confounding effect on the transcriptomic classifier that was derived in the absence of immunosuppression. After controlling for the genomic effects of immunosuppressive drugs, we were able to generate a 187-gene classifier with a sensitivity of 100% and specificity of 97% across all IC states.

Conclusion
The host transcriptomic response to IA is robust and highly conserved. Pharmacologic perturbation of the host immune response unsurprisingly has powerful effects on gene expression-based classifier performance and must be taken into account when developing novel diagnostics. When appropriately designed, host-derived peripheral blood transcriptomic responses to IA demonstrate the ability to accurately diagnose Aspergillus infection, even in the presence of immunosuppression.

Disclosures
All authors: No reported disclosures.
1751. The Impact of Prophylactic Systemic Antibiotics (PSA) on Cytomegalovirus (CMV) Infection: A Post-hoc Analysis of a Randomized Controlled Trial (RCT) in Hematopoietic Cell Transplantation (HCT) Recipients
Authors: Zamora Danniel , Xie Hu , Kimball Louise E , Golob Jonathan , Fredericks David , Liu Catherine , Petersen Finn , Leisenring Wendy , Boeckh Michael 
Published: October 2019

Abstract

Background
Prophylactic systemic antibiotics (PSA) during conditioning regimen-induced neutropenia after hematopoietic cell transplantation (HCT) reduce bacteremia but may disrupt the gut microbiota, potentially affecting viral immunity and risk for viral infections. Prior studies suggest a critical role of gut microbiota in the reconstitution of CMV-specific CD8+ T cells and in protection from respiratory viral infections after HCT (J Immunol 2007; 178: 5209; Blood 2018; 131:2978). To identify whether PSA is associated with differences in CMV infection outcomes after HCT, we conducted a post-hoc analysis of CMV infection in the only RCT of PSA exclusively performed in HCT recipients (Infection 1986; 14:115). In that trial, HCT patients received either PSA (ticarcillin/tobramycin/vancomycin or mezlocillin/ceftizoxime) or no systemic antibiotics during neutropenia (absolute neutrophil count <500/mm3).

Methods
A post-hoc analysis was performed of a previously conducted RCT in the pre-antiviral era (1984–1986) at the Fred Hutch. Patients received unscreened blood products and were tested weekly by CMV culture in throat, and disease was evaluated by tissue biopsy or bronchoalveolar lavage. CMV disease was confirmed by chart review. We compared the cumulative incidence of CMV at any site, CMV throat shedding, and CMV disease between randomization groups by day 100 post-transplant, treating death as a competing risk. Overall survival was also compared using Kaplan–Meier method.

Results
119 and 125 allograft recipients were randomized to PSA and no prophylaxis, respectively. Baseline characteristics in both groups were balanced. CMV infection at any site and CMV throat shedding were greater in the PSA group (Figures 1 and 2); CMV disease was numerically reduced in the no PSA group (Figure 3). Overall survival by day 100 was not different between the groups (Figure 4).

Conclusion
CMV infection risk appeared to be increased in recipients of PSA with a significant anaerobic spectrum. While current PSA regimens have narrower spectrum activity, these results provide the rationale to study if changes in gut microbiota play a role in CMV reactivation and adaptive immunity after HCT.

Disclosures
All authors: No reported disclosures.
1756. Role of Human bocavirus Respiratory Tract Infection in Hematopoietic Cell Transplant Recipients
Authors: Ogimi Chikara , Martin Emily T , Xie Hu , Campbell Angela P , Waghmare Alpana , Kuypers Jane , Jerome Keith , Leisenring Wendy , Englund Janet A , Boeckh Michael 
Published: October 2019

Abstract

Background
Limited data exist regarding the impact of human bocavirus (BoV) in hematopoietic cell transplant (HCT) recipients. We examined incidence and disease spectrum of BoV respiratory tract infection (RTI) in HCT recipients.

Methods
In a longitudinal surveillance study of viral RTIs among allogeneic HCT recipients, pre-HCT and weekly post-HCT nasal washes and symptom surveys were collected through day 100, then every 3 months, and whenever respiratory symptoms occurred through 1-year post-HCT. Samples were tested by multiplex semi-quantitative PCR for RSV, parainfluenza virus 1–4, influenza A/B, adenovirus, human metapneumovirus, rhinovirus, coronavirus, and BoV. Plasma samples from BoV+ subjects were analyzed by PCR. In addition, we conducted a retrospective review of HCT recipients with BoV detected in bronchoalveolar lavage or lung biopsy.

Results
Among 469 patients in the prospective cohort, 21 distinct BoV RTIs (3 pre-HCT and 18 post-HCT) were observed by 1-year post-HCT in 19 patients (median 42 years old, range 0–67) without apparent seasonality. BoV was more frequently detected in the latter half of the first 100 days post-HCT (Figure 1). The frequencies of respiratory symptoms in patients with BoV detected did not appear to be higher than those without any virus detected, with the exception of watery eyes (P < 0.01) (Figure 2). Univariable models among patients with BoV RTI post-HCT showed higher peak viral load in nasal samples (P = 0.04) and presence of respiratory copathogens (P = 0.03) were associated with presence of respiratory symptoms; however, BoV detection in plasma was not (P = 0.8). Retrospective review identified 6 allogeneic HCT recipients (range 1–64 years old) with BoV detected in lower respiratory tract specimens [incidence rate of 0.4% (9/2,385) per sample tested]. Although all 6 cases presented with hypoxemia, 4 had significant respiratory copathogens or concomitant conditions that contributed to respiratory compromise. No death was attributed mainly to BoV lower RTI.

Conclusion
BoV is infrequently detected in respiratory tract in HCT recipients. Our studies did not demonstrate convincing evidence that BoV is a significant pathogen in either upper or lower respiratory tracts. Watery eyes were associated with BoV detection.

Disclosures
All authors: No reported disclosures.
1764. Use of Intravesical BCG for Treatment of Bladder Cancer in a Renal Transplant Recipient, with Subsequent Resolution of Chronic BK Viremia
Authors: Kit Chan Yu , Jasmine Chung Shimin , Khor Vincent , Huei Li Gan Valerie , Chen Kenneth , Hwai Liang Loh Alwin , Kee Terence 
Published: October 2019

Abstract

Background
BK virus-induced nephropathy in renal transplantation is well recognized but its oncogenic potential is less appreciated.

Methods
We report a case of high-grade urothelial tumor in a renal transplant recipient with chronic BK viremia in the absence of BK nephropathy successfully treated with intravesical Bacillus Calmette-Guerin (BCG) instillation. Following BCG therapy, there was also spontaneous clearance of BK viremia.

Results
In July 2011, Mr. LYY, a 57-year-old Chinese man with end-stage renal failure secondary to chronic glomerulonephritis underwent uncomplicated deceased donor renal transplantation. One year later, he developed persistent high-level BK viremia despite reduction in immunosuppression. He was also treated with a course of ciprofloxacin from January to October 2013, and intravenous immunoglobulin (IVIG) in February 2013, but high-level BK viremia persisted. In spite of this, his graft function was preserved. He was subsequently placed on BK surveillance alone. Chronic BK viremia persisted for the next 5 years with stable graft function. See Figure 1. In February 2018, an incidental urinary bladder nodule was picked up on computed tomography (CT) scan performed for evaluation of urosepsis. Follow-up flexible cystoscopy in May 2018 showed a 1.5 cm papillary tumor over the left superior bladder wall. Transurethral resection of bladder tumor (TURBT) was performed and histopathological examination revealed high-grade papillary urothelial carcinoma. In addition, the biopsy specimen was stained positive for SV40, suggesting the possible association between chronic BK virus replication in the bladder and oncogenesis. Relook TURBT in July 2018 revealed a persistent erythematous patch over the posterior bladder wall. Given the cystoscopic findings, Mr. LYY received a weekly instillation of intravesical BCG for 6 weeks. He tolerated the intravesical BCG treatment with no local or systemic complications. Interestingly, his serum BK viral loads dropped below lower limits of detection thereafter and continued to remain so for the next 4 months.

Conclusion
We postulate that the intravesical BCG therapy triggered an immune response that targeted not only the tumor but also the BK virus infection, resulting in successful clearance of chronic BK viremia.

Disclosures
All authors: No reported disclosures.
1771. Donor-derived Ureaplasma Infection Increases Mortality in Lung Transplant Recipients
Authors: Roberts Scott C , Bharat Ankit , Kurihara Chitaru , Bhorade Sangeeta M , Ison Michael G 
Published: October 2019

Abstract

Background
Infection with Ureaplasma species has been linked to fatal hyperammonemia syndrome (HS) in lung transplant (LTx) recipients (R). In this retrospective cohort, we sought to characterize the epidemiology of Ureaplasma spp in both candidates and donors and describe outcomes of antimicrobial therapy in preventing and treating HS.

Methods
We performed a retrospective cohort study of patients who received LTx at Northwestern Memorial Hospital from July 2014 to October 2018. Candidate testing for Ureaplasma spp. was performed with urine culture and PCR testing before LTx but after listing. Positive candidates were treated with levofloxacin for 14 days prior to undergoing LTx. Donor testing was performed with bronchoalveolar lavage (BAL) culture and PCR testing at organ implantation. From July 2014 to February 2017 LTxR were treated according to result; from February 2017 to October 2018 LTxR received empiric levofloxacin and azithromycin at the time of LTx until testing returned negative. HS was defined as new-onset altered mental status (AMS) after LTx with ammonia > 100; if no ammonia was tested, LTxR was classified as not developing HS. Summary and comparative statistics were performed using IBM® SPSS Statistics version 25.0.

Results
66 patients who underwent LTx and had candidate screening, donor screening, or both were included. 81.8% (n = 54) of patients had negative screening tests in donor and candidate pre-LTx, 7.5% (n = 5) had positive Ureaplasma spp. testing pre-LTx, and 12.1% (n = 8) had positive donor BAL testing at the time of LTx. One had positive candidate and donor screening (see Table 1). 3 patients developed HS a median of 6 days post-transplant; 2 died with HS as attributed cause. None received empiric therapy. LTxR with confirmed donor-derived infection were more likely to have mortality at 1 year when compared with LTxR with negative testing and candidates with positive testing pre-LTx (P = 0.019). LTxR with donor-derived infection were more likely to have AMS, higher peak ammonia, and require renal replacement therapy, although none reached significance (Table 2).

Conclusion
Donor-derived Ureaplasma spp. in LTxR was associated with increased mortality at one-year. Pre-transplant screening and treatment had no effect on the outcome. There is high concern for donor transmission and we advocate testing in all LTxR.

Disclosures
All authors: No reported disclosures.