bluuebunny/crossref_metadata_2025_split huggingface dataset:
1636. Antibiotic Treatment of Human Plague: A Systematic Literature Review of Worldwide Cases, 1937–2016
Authors: Nelson Christina , Fleck-Derderian Shannon , Cooley Katharine , Becksted Heidi , Meaney-Delman Dana , Mead Paul 
Published: October 2019

Abstract

Background
Yersinia pestis remains endemic in countries throughout Africa, Asia, and the Americas and is a tier 1 bioterrorism agent. Antibiotic treatment with aminoglycosides such as streptomycin or gentamicin is effective when initiated early in the course of illness but can have serious side effects. Alternatives such as fluoroquinolones, tetracyclines, and sulfonamides are potentially safer but currently lack robust human data on their efficacy.

Methods
We searched PubMed Central, Medline, Embase, CINAHL, and other databases for articles in any language with terms related to plague, Yersinia pestis, and antibiotics. Articles that contained case-level information on antibiotic treatment and patient outcome were included. We abstracted information related to patient demographics, clinical features of plague, treatment, and survival using a standardized form.

Results
Among 4,874 articles identified and screened, we found 723 published cases of treated plague reported between 1937 and 2016. Fifty-two percent of patients were male; median age was 22 years (range: 8 days-80 years). Cases were most commonly reported from the United States (21%), India (13%), China (11%), Vietnam (10%), and Madagascar (10%). Overall, the case fatality rate was 21%. The majority of patients had primary bubonic (64%), pneumonic (21%), or septicemic (4%) plague, of which survival was 83%, 71%, and 55%, respectively. Among those treated with an aminoglycoside (n = 386, 53%), survival was 86%. Among those treated with a tetracycline (n = 145, 20%), fluoroquinolone (n = 45, 6%), or sulfonamide (n = 311, 43%), survival was 90%, 84%, and 77%, respectively. Survival rates did not substantially differ between patients treated with one vs. two classes of antibiotics (table).

Conclusion
Published cases of treated plague offer an opportunity to evaluate the treatment efficacy of different antibiotic classes. In addition to aminoglycosides, tetracyclines, fluoroquinolones, and sulfonamides appear to be effective for plague treatment, although publication bias and low numbers in certain treatment groups may limit interpretation.

Disclosures
All authors: No reported disclosures.
1645. High Seroprevalence and Seroconversion Rate of Borrelia burgdorferi Infection Among Hispanic/Latino Immigrant Workers in Eastern Suffolk County, New York: A Longitudinal-Based Study
Authors: Vilcarromero Stalin , Nunez Ana M , Vivas Katherine , Russo Julianna , Mahmood Saadia , Wellins Anna-Marie , Lopez-Carrillo Ximena , Xu Yun , Yang Xiaohua , Marcos Luis , Arcan Chrisa , Luft Benjamin J 
Published: October 2019

Abstract

Background
Lyme disease, caused by Borrelia burgdorferi, continues to be the most commonly reported vector-borne disease in the United States (US) affecting the public health and the economy. Suffolk County, New York (NY) has one of the highest incidences in NY State affecting primarily the Hispanic/Latino population working in gardening, landscaping, and agriculture (field workers). However, there is a paucity of research among this population. Thus, the aim of this longitudinal study was to assess the current seroprevalence and seroconversion of the Borrelia burgdorferi infection and its risk factors such as sociodemographic, symptoms, tick encounter, and use of the Fatigue Severity Scale, associated with seropositivity in the Hispanic/Latino immigrant worker population of Eastern Suffolk County.

Methods
Recruitment of participants was based on several towns of this County. Following signed informed consent, participants completed a questionnaire and had their blood drawn. Samples were tested using the conventional 2-tiered serological testing for Borreliosis.

Results
Between June 2016 and October 2018, 660 (83.5%) completed Visit 1; 58.8% of them completed elementary school or less, and 56.7% reported earning = or <$20,000 annually, 344 were field workers, from which, 82.3% and 55.2% were male and from Guatemala, respectively. The overall seroprevalence was 7.2% (48/660) but was significantly higher among gardener/Landscapers (11.5%) having an adjusted odds ratio (OR) = 2.02 with a CI = 1.02–4.03. Another significant risk factor was experiencing fevers after a tick-bite (Adjusted OR: 2.08, CI:1.42–5.63). 2.7% (8/292) seroconverted and were gardener/landscaper.

Conclusion
Several barriers to healthcare access, health literacy, and prevention were identified. Gardening/landscaping has an occupational risk in this population. Efforts to educate about tick-borne infections and preventive methods such as vaccinations are warranted for this population.

Disclosures
All authors: No reported disclosures.
1647. Investigating Parents’ Vaccine Hesitancy in the United Arab Emirates: A Cross-Sectional Survey
Authors: Alsuwaidi Ahmed R , Elbarazi Iffat , Al-Hamad Sania , Alali Asma , Aldhaheri Ruwaya , Sheek-Hussein Mohamud 
Published: October 2019

Abstract

Background
Vaccine hesitancy has been declared by the World Health Organization as a top threat to public health in 2019. It has been studied extensively in the Western world but not so among Arabs. The Parent Attitudes about Childhood Vaccines (PACV) survey is a validated instrument for identifying vaccine-hesitant parents; however, Arabic version is not available. This study aimed to assess the reliability of the PACV survey in Arabic language and to determine the prevalence of vaccine hesitancy among parents in the United Arab Emirates (UAE).

Methods
Forward and backward translation of the PACV in Arabic language was carried out. The reliability of the Arabic-PACV survey was tested among parents with children. The same survey was used to study vaccine hesitancy among parents attending seven primary healthcare centers in Al-Ain city, UAE. Univariate analyses were performed to determine the associations between vaccine hesitancy and socio-demographic characteristics.

Results
The Cronbach’s alpha (a measure of internal consistency reliability) for total Arabic-PACV scores was 0.79. Two hundred and sixty-two participants answered the PACV survey (response rate, 74.9%). The majority were mothers (75.9%) in the age group (18–39 years) and more than half (56.3%) had attended university or higher education. Only 29 parents (11.11%, 95% CI = 7.85–15.5) were found to be vaccine-hesitant (score ≥ 50). Socio-demographic characteristics such as education level, number of children and household income did not have any significant association with vaccine hesitancy. However, when using the question “Have you ever decided not to have your child get a shot for reasons other than illness or allergy?” as a surrogate item for vaccine hesitancy, the variable education was significantly associated to this question. More specifically, participants with lower education (n = 110) were more likely to be vaccine-hesitant compared with those with higher education (n = 147), (OR = 4.50, P = 0.026, 95% CI = 1.3–20.7).

Conclusion
The Arabic-PACV survey could serve as a tool in the evaluation of vaccine hesitancy among parents in UAE and other Arabic-speaking countries. The prevalence of vaccine hesitancy among parents in our community is comparable with other populations.

Disclosures
All authors: No reported disclosures.
1663. Community Engagement for Ebola Prevention in Eastern Democratic Republic of Congo
Authors: Mian Qaasim , Masumbuko Claude Kasereka , Hawkes Michael 
Published: October 2019

Abstract

Background
The second largest outbreak of Ebolavirus in history is currently ongoing in Eastern DRC. The epidemic is characterized by social resistance to foreign-led response teams. Trusted local health practitioners, including medical students, may be valuable social mobilizers in this challenging context.

Methods
We report on a student-led educational campaign to increase community awareness and engagement in EVD control efforts. We evaluated student and community participant satisfaction using standardized questionnaires.

Results
The outreach was conducted in November 2018, involving parades, speeches, branded banners and T-shirts, and interpersonal interactions in public spaces. Key messages, linked to previously identified resistant attitudes, included: “Ebola exists in Butembo,” “Bring infected family members to the Ebola Treatment Unit,” and “Leave burials to the official team.” Medical students (n = 355) and community participants (n = 319) evaluated the outreach campaign. Satisfaction was high: 320 (90%) students agreed that medical students could contribute to the EVD response effort, and 233 (73%) community members agreed that the students had helped them understand Ebola in the area. Lower satisfaction scores were associated with self-reported “resistant” attitudes (e.g., intention to hide infected family member from authorities, ρ = -0.25, P < 0.0001), denial of the existence of Ebola in the area (ρ = -0.17, P = 0.0018), and mistrust of the foreign response team (e.g., belief in mercenary motive, ρ = -0.11, P = 0.042). Higher satisfaction scores were associated with the view that local engagement was critical to ending the epidemic (ρ = +0.13, P = 0.017). Both students (77%) and community members (71%) agreed that they were more motivated to combat Ebola as a result of the outreach, suggesting that the activities fostered empowerment.

Conclusion
Medical students can lead satisfactory community engagement and educational activities during an EVD epidemic. As trusted local health agents, medical students may be valuable allies in building public trust and cooperation in this epidemic complicated by social resistance.

Disclosures
All authors: No reported disclosures.
1666. Community Beliefs about Ebola and Implications for Disease Control in Eastern Democratic Republic of the Congo
Authors: Mian Qaasim , Masumbuko Claude Kasereka , Hawkes Michael 
Published: October 2019

Abstract

Background
The current Ebola epidemic in Eastern Democratic Republic of the Congo (DRC) has surpassed 1,300 cases and 800 deaths. Social resistance is a major barrier to control efforts, and invites an exploration of community beliefs around Ebola and its origins.

Methods
Mixed-methods study, using focus group discussions (FGDs) with key community informants and a 19-item survey questionnaire broadly sampling the outbreak zone.

Results
Between 4 to 17 August, 2018, we conducted 4 FGDs (20 participants) and surveyed 286 community members across Eastern DRC. FGDs revealed a widespread rumor in Mangina early in the epidemic of two twins bewitched by their aunt after eating her cat, who developed bleeding symptoms and triggered the epidemic. However, this myth appeared to dissipate as the epidemic progressed and biomedical transmission became generally accepted (medical syncretism). In our survey, 6% of respondents endorsed supernatural origins of Ebola. This subgroup did not differ from other respondents in terms of knowledge of biomedical modes of transmission or resistant attitudes toward infection control measures, but was more likely to believe that traditional healers could cure Ebola. Wild animals of the forest were recognized as sources of the Ebola virus by 53% of survey respondents. Our findings suggest that skepticism and/or denial of the biomedical discourse, coupled with and mistrust and fear of ETUs may fuel “underground” transmission of Ebola outside western-style medical facilities, as patients seek care from traditional healers, who are ill-equipped to deal with a highly contagious biohazard.

Conclusion
A deeper understanding of beliefs around Ebola origins may illuminate strategies to engage communities in control efforts.

Disclosures
All authors: No reported disclosures.
1672. Imported Enteric Fever in an Ethnically Diverse Area of London
Authors: Gorgui-Naguib Hannah , Aali Adnan , Papineni Padmasayee 
Published: October 2019

Abstract

Background
Typhoid is a leading cause of fever in returning travelers, particularly those visiting friends and relatives in the Indian subcontinent. We reviewed a cohort of patients with enteric fever from our hospitals in North West London, which serves a large Indian resident population.

Methods
Retrospective analysis of electronic laboratory, microbiology and medical records of all patients with blood cultures positive for Salmonella enterica serotypes typhi (S.typhi) or paratyphi (S.paratyphi) A, B and C from January 1, 2016 to December 31, 2018 at London North West University Healthcare NHS Trust. Organisms were cultured on selective media and identified by API 20E (BioMerieux) or MALDI TOF MS (Bruker).

Results
37 blood cultures positive for S.typhi were identified from 26 patients and 37 blood cultures positive for S.paratyphi were identified from 23 patients. The median age was 28 years (range 1–79 years). Infection was more common in males (27/49, 55%) compared with females (22/49, 45%) but this was not statistically significant. Most patients (31/49) had traveled to India. Travel history was not identified for 9 patients. Laboratory results at presentation were available for all patients. Lymphopenia (defined as <1.5 × 109/L) was found in 12/23 (52%) patients with S.paratyphi compared with 10/26 (38%) of those with S. typhi. Thrombocytopenia (defined as <150 × 109/L) was found equally in both groups (22% in S. paratyphi, 27% in S. typhi). Raised alanine transferase (ALT) (defined as >35 IU/L) was seen in 14/23 (61%) in S. paratyphi compared with 19/26 (73%) in S. typhi. Median platelet count was similar in both groups (199 × 109/L in S. paratyphi, 202 × 109/L in S. typhi). Absolute eosinopenia was seen in all patients, consistent with other observational studies. For 3 patients, antibiotic sensitivities were not available. Regarding S. paratyphi cases, 16/21 (76%) were resistant to ciprofloxacin compared with 20/25 (80%) in S. typhi. Azithromycin resistance was seen in 5/46 (11%). All isolates were susceptible to third-generation cephalosporins.

Conclusion
There is a high rate of ciprofloxacin resistance in this cohort of patients with enteric fever, confirming that the use of third-generation cephalosporins and macrolides in travelers to India is most appropriate for treatment.

Disclosures
All authors: No reported disclosures.
1674. Orthopedic Complications of Congenital Zika Syndrome in Brazil
Authors: Nogueira Mendes Neto Nilson , Queiroz Igor T , da S. Maia Jessika T , Zacarkim Marcelo , Labeaud A Desiree , Aronoff David , Fernandes Kalyana , de Alcantara Tabata 
Published: October 2019

Abstract

Background
Congenital Zika Syndrome (CZS) has a broad spectrum of clinical presentations that are still being described. This cohort study aimed to describe the orthopedic complications in children with microcephaly (MCP) related to Zika virus (ZIKV).

Methods
We evaluated 36 children with CZS up to 17 months of age followed at a pediatric rehabilitation center in the northeast of Brazil. Cohort enrollment occurred with children born between January 2015 and May 2016. We assessed their social profiles and orthopedic findings.

Results
Of the 36 cases, 25 were male. All of them lived in rural area. 25 had at least one congenital orthopedic alteration. Hip subluxation was the most common problem detected (n = 15); other lower limb abnormalities included knee subluxation (n = 7), clubfoot (n = 7); congenital vertical talus (n = 4); plano-valgus foot (n = 5). In relation to the upper limbs, 11 children presented with some shoulder and/or elbow abnormality and 16 had some alteration in the hand and/or on the wrist.

Conclusion
Orthopedic problems appear to be common in children with CZS and should be a focus of larger clinical studies. An initial orthopedic assessment may provide a better quality of life by helping children avoid further complications/deformities. Our results emphasize the orthopedic problems associated with CZS and the need to better describe many complications in the natural history of this infection.

Disclosures
All authors: No reported disclosures.
1686. Maternal Knowledge and Perceptions about Routine Immunization in a Slum Area of Pakistan
Authors: Mannan Mustafa Abdul , Mustafa Ghulam 
Published: October 2019

Abstract

Background
To know the baseline coverage and potential obstacles for children vaccination before starting a health awareness program.

Methods
A cross-sectional study on immunization coverage in the slum area of Multan, Pakistan was conducted and a total of 312 mothers were interviewed face to face for Knowledge, Attitudes, and Perceptions (KAP).

Results
Among the children less than 3 years, 33% fully, 46% partially and 21% were not at all immunized. High levels of BCG and OPV zero rates (79%) and low rates of OPV3/DPT3 (48%) and measles (41%) vaccines were found. Majority of the mothers were satisfied with the program. Most of the mothers were aware about the importance of vaccination but were ignorant for the need to complete the schedule. There were many misconceptions and beliefs among the mothers of partial and unimmunized children. The majority were of view that vaccines contain ingredients that will make the children infertile.

Conclusion
There is a need to enhance the maternal knowledge about the vaccine-preventable diseases and importance of completing the immunization schedule. Also the misconception about the vaccines need be specifically addressed.

Disclosures
All authors: No reported disclosures.
1694. Predictors of Septic Shock in Adult Patients with Candidemia: A Single-Center Experience Over 13 Years
Authors: Woong Suh Jin , Yeon Kim Jeong , Seung Chung You , Lee Hojin , Bean Kim Sun , Kyung Yoon Young , Wook Sohn Jang , Ja Kim Min , Hun Kim Jong 
Published: October 2019

Abstract

Background
Although the incidence of candidemia has been increased recently, factors associated with septic shock in adult patients with candidemia have not been well defined. We performed a study to identify septic shock risk factors.

Methods
This retrospective study was conducted among adult patients ≥19 years of age with candidemia who were diagnosed from 2006 to 2018 at a single tertiary care medical center. Clinical data were collected. Patients were excluded if they were noted to have concomitant bacteremia or to have received antifungal treatment <5 days.

Results
After application of the exclusion criteria, 46 patients (25.1%) were classified as having septic shock presentation out of 183 patients. Between the septic shock and non-septic shock patients, there were no differences regarding comorbidities. Variables associated with septic shock in the univariate analysis were non-remission of candidemia [23/46 (67.6%) vs. 100/137 (83.3%) P = 0.044], central venous catheter [41/46 (89.1%) vs. 98/137 (67.9) P = 0.005], hemodialysis [12/46 (26.1%) vs. 15/137 (10.9%) P = 0.012], neutropenia [10/46 (21.7%) vs. 14/137 (10.2%) P = 0.045], and previous hospitalization to the intensive care unit (ICU) [24/46 (52.2%) vs. 47/137 (34.3%) P = 0.031]. The group of other Candida species consisting of [C. guilliermondii, C. haemulonii, C. famata, C. lusitaniae, and unknown] was more common in the septic shock patients (10.9%) than in the non-septic shock patients (1.5%), P = 0.004. The mortality of patients with septic shock was significantly higher than that of patients without septic shock [37/46 (80.4%) vs. 59/137 (43.1%) P < 0.001]. Multivariate analysis showed central venous catheter (odds ratio [OR] 4.00, 95% confidence interval [CI] 1.12 – 14.30, P = 0.033) and abnormal aspartate aminotransferase [AST] (OR 2.76, 95% CI 1.06 – 7.16, P = 0.024) were significantly associated with septic shock. Presence of other Candida species (OR 6.78, 95% CI 0.87 – 53.03, P = 0.068) showed borderline significance.

Conclusion
Our findings suggest that venous catheter and abnormal AST were significant factors associated with septic shock in adult patients with candidemia. Also, candidemia caused by other Candida species may need to be monitored closely for the development of septic shock presentation.

Disclosures
All authors: No reported disclosures.
1702. Prevalence and Risk Factors for Endogenous Fungal Endophthalmitis in Adult Patients with Candidemia at a Tertiary Care Hospital in South Korea Over 13 years
Authors: Hun Kim Jong , Woong Suh Jin , Seung Chung You , Kyung Yoon Young , Wook Sohn Jang , Ja Kim Min 
Published: October 2019

Abstract

Background
Endogenous fungal endophthalmitis is one of the critical complications of candidemia in adult patients. We conducted a study to investigate the prevalence and risk factors for endogenous fungal endophthalmitis in adult patients with candidemia.

Methods
Adult patients ≥19 years with candidemia who underwent ophthalmological examination after the diagnosis of candidemia at a tertiary care hospital in South Korea from 2006 to 2018 were enrolled, and clinical data were collected.

Results
There was a total of 152 adult patients with candidemia who underwent an ophthalmological examination. Endogenous fungal endophthalmitis was found in 29 patients (19.1%). Patients were categorized into two groups (Non-endophthalmitis [NE] and endophthalmitis [E]). Between two groups, there was no significant difference in terms of age, sex, underlying comorbidities. Also, no difference in clinical conditions at the diagnosis of candidemia was noted including concomitant bacteremia, presence of septic shock, receipt of recent surgery, presence of neutropenia, total parenteral nutrition, central venous catheter, urinary catheter, ventilator, dialysis, use of antibiotics, and Candida spp. colonization. However, there was a higher rate of abnormal alanine aminotransferase (ALT) in the E (35.7%) than in the NE (14.8%), P = 0.008. Moreover, the proportion of C. albicans candidemia was higher in the E (65.5%) than in the NE (35.8%), P = 0.003. In contrast, C. parapsilosis candidemia was more common in the NE (27.6%) than in the E (6.9%), P = 0.018. Although there was a trend of higher mortality rate in the E (51.7%) than in the NE (35.0%), no statistical significance was observed, P = 0.095. Multivariate logistic analysis showed C. albicans candidemia (odds ratio [OR] 4.122, 95% confidence interval [CI] 1.653–10.280, P = 0.002) and abnormal ALT (OR 3.839, 95% CI 1.427–10.333, P = 0.008) were significantly associated with E cases.

Conclusion
Endogenous fungal endophthalmitis occurred in 19% of adult patients with candidemia. C. albicans candidemia and abnormal ALT were significantly associated with endophthalmitis. Adult patients with candidemia caused by C. albicans or having abnormal ALT need to be closely monitored for the possibility of endophthalmitis.

Disclosures
All authors: No reported disclosures.