bluuebunny/crossref_metadata_2025_split huggingface dataset:
736. Babesia microti: A study of 38 cases
Authors: Kannangara Don , Samia Hoda , Chichili Eiswarya 
Published: January 2021

Abstract

Background
Babesia microti is an intraerythrocytic infection transmitted by Ixodes scapularis in Eastern United States. The same vector transmits Borrelia burgdorferi, Anaplasma phagocytophilum, B miyamotoi and Powassan virus resulting in mixed infections. Spleen involvement, blood abnormalities and abnormal liver functions are common in babesiosis. Here we present the clinical findings of 38 B microti (smear or serology positive) patients.

Methods
We retrospectively evaluated charts of 38 patients, 20 male and 18 female, smear or serology positive for B. microti in our health network from 9 hospitals in Eastern Pennsylvania and one in adjacent Warren county New Jersey.

Results
Eleven had B microti and Lyme co-infections (9 western blot positive, 2 with erythema migrans) and 2 mixed infections with A. phagocytophilum (PCR+). Only 2 gave a history of a tick bite. Fourteen presented with fever. 9 were Babesia smear positive. All 9 smear positive patients had fever, 7 were anemic, 6 leukopenic and 8 had increased liver enzymes. Six out of 14 with fever and 6 out of 9 smear positive patients had low platelet counts. Two with left upper abdominal discomfort likely due to splenic inflammation were initially misdiagnosed as left pyelonephritis. One had splenomegaly. Both had anemia and thrombocytopenia. A patient with a low IGG titer 1:10 for B microti and chronic ITP with a platelet count 102,000 (NL 140-200,000) had a 1 cm splenic artery aneurysm. Four western blot negative patients 2 with joint pain and 2 with radiculopathy were not counted as mixed infections. A Lyme co-infected patient had sinus tachycardia and ST, T changes in the electrocardiogram suggestive of Lyme myocarditis. All mixed infections were treated with a combination of atovaquone, azithromycin and doxycycline, including one patient initially on quinine and clindamycin switched due to side effects.

Conclusion
I.scapularis transmitted mixed infections are not uncommon. The majority were due to B microti and B burgdorferi. Fever was the most common presentation in symptomatic patients. Anemia, leukopenia, thrombocytopenia and elevated liver enzymes were common in smear positive patents. Babesiosis should be suspected in patients presenting with left upper abdominal pain in tick endemic areas. Most did not give a history of a tick bite.

Disclosures
All Authors: No reported disclosures
739. A Two-Center Assessment of Histopathologic Diagnostic Performance for Fungal Organism Identification
Authors: Costales Cristina R , Butler-Wu Susan , She Rosemary 
Published: January 2021

Abstract

Background
Accurate detection and identification of invasive fungal pathogens relies on concordance of several complementary laboratory techniques, including fungal culture, serology, and histopathologic identification. Histopathologic stains such as the Gomori methenamine silver stain (GMS) are used to highlight fungal cell wall in tissue specimens. We sought to determine the diagnostic performance of histopathology fungal stains as compared to fungal culture for diagnosis of invasive fungal tissue infection at tertiary medical centers with dissimilar patient populations.

Methods
We performed a retrospective review of all surgical pathology specimens with reported GMS results and concurrent fungal culture at Keck Medical Center (Keck) and Los Angeles County + USC Medical Center (LAC). Ratios of GMS diagnostic performance were compared using chi-squared analyses, with fungal culture as the gold standard for detection.

Results
Of 1347 LAC surgical pathology specimens stained with GMS to evaluate for fungal infection, 229 (17.0%) had concurrent tissue specimens submitted for fungal culture. Of 1546 Keck GMS-stained surgical pathology specimens, 358 (23.2%) had concurrent tissue for fungal culture. GMS stain performance at LAC showed a sensitivity of 53.7% (95% CI: 37.4-69.3%) and specificity of 90.4% (95% CI: 85.2-94.2%). At Keck, GMS showed a sensitivity of 64.1% (95% CI: 52.4-74.7%), specificity of 88.9% (95% CI: 84.7-92.4%), without significant difference in performance between sites, (p=0.27) and (p=0.62), respectively. Among filamentous fungi, GMS false negative frequency at LAC was 5.3% (10/190) and 4.0% (11/277) at Keck, without significant difference (p=0.51). A subset of pathology reports suggested the fungus genus based on histologic morphology. Of 10 LAC pathology specimens with fungal genus specified, 2 (20.0%) reports gave the incorrect genus and 8/18 (44.4%) reports at Keck gave incorrect genus as per concurrent culture isolate result.
Table 1. Diagnostic performance of GMS histopathology stain on surgical pathology specimens compared to tissue fungal culture at LAC and Keck Medical Centers from July 2015 through December 2018.

Conclusion
GMS stain had low-to-moderate sensitivity when compared to fungal tissue culture. Increased submission of concurrent tissue for fungal culture is likely to improve detection. When genus level identification was attempted, fungal forms were incorrectly identified in about one-third of histopathology specimens.

Disclosures
All Authors: No reported disclosures
741. Antifungal Resistant Candida glabrata Are Most Commonly Colonized in Clostridioides difficile Infection (CDI) Patient Guts in Texas
Authors: Begum Khurshida , Haghighi Farnoosh , Alam M Jahanbgir , Garey Kevin W , Garey Kevin W 
Published: January 2021

Abstract

Background
Candida glabrata is the second most common cause of invasive candidiasis in the United States. The echinocandin class of antifungals, including caspofungin has become the preferred therapy for invasive candidiasis due to C. glabrata and other species demonstrating decreased azole susceptibility. Caspofungin resistance has been uncommon, but reports suggest that the incidence is increasing, particularly among C. glabrata isolates. The dysbiosis associated with Clostridium difficile allows for overgrowth of Candida spp. However, the prevalence of C. glabrata in stool of C. difficile infection (CDI) patients is not well studied. Therefore, our objectives were to investigate the incidence of potentially pathogenic species of C. glabrata in stool samples of CDI patients.

Methods
We collected 1,241 Clostridioides difficile infection (CDI) patient stool samples from two large hospitals in Houston, Texas and enrich the samples in brain heart infusion (BHI) broth at 37C for 48-72 hours and then sub-cultured onto selective HardyChrom Candida agar and incubated at 37C for 48 to 72 hours. Characteristic Candida colonies were stocked in cryovials and kept at -80C for further analyses. Isolates were then identified by multiplex PCR. C. glabrata isolates were screened for caspofungin resistance on Muller-Hinton agar (with 8.0 ug/ml).

Results
Overall, 14.8% (184/1241) samples were culture positive for Candida spp. The predominant species was C. glabrata (9.2 %) followed by C. albicans (2.3%), C. tropicalis (1.6%), C. parapsilosis (1.2%), C. krusei (0.6%) or not speciated (6.9%). The majority of C. glabrata isolates (70.2%; 80/114) were caspofungin resistant.

Conclusion
The results of this study showed that colonization of C. glabrata is common in patients with CDI and could be a source of antifungal-resistant pathogens.

Disclosures
All Authors: No reported disclosures
746. Comparing Hospital Course in Hospitalized Patients Infected with Babesiosis Versus Patients Coinfected with Lyme Disease and Babesiosis
Authors: Spector Rachel , Lum Michael D , Papamanoli Aikaterini , Reardon Kelsey , Garry Evan , Marcos Luis 
Published: January 2021

Abstract

Background
Research is currently lacking on the interplay between Babesiosis and Lyme disease (LD) and how this coinfection may translate into morbidity and mortality. The aim of this study is to compare the clinical features of patients with single-infection with Babesia microti to those co-infected with Borrelia burgdorferi and Babesia microti.

Methods
A retrospective review of all adult patients diagnosed with babesiosis and tested for LD at Stony Brook University Hospital between 2014 and 2019 was performed (n=40). Patients with single babesia infection (Group 1, n=22) were compared to those with Babesia and LD (Group 2, n=18). Babesiosis diagnosis was determined by microscopic visualization of Babesia spp under peripheral blood smear, and confirmed by PCR for B. microti. LD inclusion criteria included a positive screened ELISA test for lyme followed by positive IgM antibody by western blot per CDC criteria (2-3 positive bands). Statistical analysis of the data involved Fisher exact test, Chi-square test, independent t-test, and Wilcoxon rank sum tests. Statistical significance was considered as a p-value less than 0.05.

Results
There was no significant difference in gender, race, and age (p &gt;.75) between both groups as well as comorbidities including hypertension, diabetes, heart conditions, and immunocompromised state (p=1.0). Maximum parasitemia (Group 1: 1.1%, Group 2: 1.7%, p= 0.26) and percentage admitted to the ICU (Group 1: 18.18%, Group 2: 22.22%, p=1.0) were similar among both groups. While lab values on admission including WBC, hemoglobin, platelets, LDH, ALT, and AST did not significantly differ (p &gt;.09), the length of hospital stay in group 2 was significantly longer than group 1 (Group 1: 3.0 days, Group 2: 5.5 days; p=0.03). There was a 0% mortality rate among both groups.
Table 2: Biomarkers of Patients Monoinfected with Babesiosis Versus Patients Coinfected with Babesiosis and Lyme Disease.

Table 1: Demographics of Patients Monoinfected with Babesiosis Versus Patients Coinfected with Babesiosis and Lyme Disease.

Conclusion
It is remarkable that despite no differences in lab values on admission, comorbidities, and demographics, patients with a coinfection had a longer hospital stay than those with only babesiosis. This suggests that having a coinfection with babesiosis and LD may lead to a more severe illness than a single infection with babesiosis.

Disclosures
All Authors: No reported disclosures
747. Diagnostic Performance of Bronchoalveolar Lavage Fluid Galactomannan Assay in Patients with Negative Serum Galactomannan Assay Suspected with Invasive Pulmonary Aspergillosis
Authors: Lim So Yun , Kim Jinyeong , Park Sunghee , Jung Jiwon , Kim Min Jae , Lee Sang-Oh , Choi Sang-Ho , Kim Yang Soo , Kim Sung-Han 
Published: January 2021

Abstract

Background
There are limited data in real clinical practice on the diagnostic value of BAL (bronchoalveolar lavage) fluid galactomannan (GM) assay in patients with suspected invasive pulmonary aspergillosis (IPA) who had negative serum GM results.

Methods
This study was performed at Asan Medical Center, a 2700 bed tertiary-care hospital in Seoul, South Korea between May 2008 and April 2019. All patients with suspected IPA whose serum GM assays revealed negative results and sequentially underwent BAL were enrolled in this study. Patients were classified as proven, probable, possible or not IPA by the revised 2019 EORTC/MSG definition.

Results
A total of 341 patients with suspected IPA including 4 proven IPA, 38 probable IPA, 107 possible IPA, and 192 not IPA were enrolled. Of these 341 patients, 107 (31%) with possible IPA were excluded from the final analysis. Of 42 patients with proven or probable IPA who had initial negative serum GM results, 24 (57%) revealed positive BAL GM results (n=24) or BAL fungal culture (n=8). Among the remaining 18 (43%), 2 (5%) were diagnosed as proven IPA by the histopathologic exam from transbronchial lung biopsy, 6 (14%) as probable IPA by subsequent sputum fungal culture, and 10 (24%) as probable IPA by repeated serum GM assay after BAL. Of 192 patients with not IPA, 14 (7%) revealed positive BAL GM results (n=14) or BAL fungal culture (n=8). The diagnostic performance of various tests is shown in Table 1.
Table 1. Diagnostic performance of various diagnostic tests in patients with suspected IPA who had negative serum GM results

Conclusion
Sequential BAL in patients with suspected IPA who had initial negative serum GM results provided additional diagnostic yield in about half of patients.

Disclosures
All Authors: No reported disclosures
748. Epidemiology and Outcomes of Invasive Fungal Infections Following Civilian Trauma
Authors: Mazi Patrick B , Bochicchio Grant , Bochicchio Kelly M , Liang Stephen , Larson Lindsey , Aldana Jose A , Canas Melissa , Fonseca Ricardo A , Afzal Hussain , Rasane Rohit K , Rincon Javier E , McMullen James M , Zhang Christina X , Powderly William , Spec Andrej 
Published: January 2021

Abstract

Background
Invasive fungal infections (IFI) following traumatic injury are devastating complications that threaten life and limb. In military combat wounds, post-traumatic IFI patients have up to 6 times higher mortality rates and 2.6-5.1 times higher rate of high-level amputations compared to non-IFI patients, though no such data exists for the civilian population. This study is the first cohort to analyze a post-traumatic civilian population for IFI, its epidemiology and outcomes.

Methods
We conducted a single-center retrospective cohort study of all trauma patients over the age of 18 years admitted to a large tertiary referral hospital between 2004 to 2015 who required surgery for their injury and had operative cultures submitted from their wounds. Patient demographics, comorbid conditions, mechanisms of trauma, environmental exposures, and laboratory data were included for analysis. Patients with positive culture for fungus from a site compatible with IFI were considered IFI patients. Data was analyzed using descriptive statistics with p≤0.05 considered significant.

Results
Our cohort includes 1,107 patients that met inclusion criteria. Of these, 120 patients had a positive culture for fungus, 454 patients had a positive culture for bacteria and 533 patients had no positive culture from a site of interest. Basic patient demographics, geographical setting of the trauma, and anatomical site of injury were not significantly associated with having a positive fungal culture. Necrosis was present in 19 (15.8%) IFI vs. 74 (7.5%) non-IFI patients (p=0.002). Soil contamination of a wound was present in 6 (5.0%) IFI vs. 11 (1.1%) non-IFI patients (p=0.001). 55.8% of 120 IFI wounds penetrated below fascial layers compared to 26.7% of 987 non-IFI wounds (p&lt; 0.001).
Presence of IFI increased likelihood of requiring amputation (6.7% vs. 2.7%, p=0.02) and prolonged hospitalization &gt;14 days (77.5% vs. 57.4%, p&lt; 0.001) compared to those without.

Conclusion
IFI significantly increased patient risk for amputation and prolonged hospital length of stay following traumatic injury in a civilian population. Presence of IFI was associated with wounds penetrating below the fascial layer, presence of wound necrosis, and soil contamination of a wound.

Disclosures
Andrej Spec, MD, MSCI, Astellas (Grant/Research Support)Mayne (Consultant)Scynexis (Consultant)
749. Impact of Infectious Disease Consultation in Patients with Candidemia: A Retrospective study, Systematic Literature Review and Meta-analysis
Authors: Kobayashi Takaaki , Marra Alexandre , Schweizer Marin L , Ten Eyck Patrick , Wu Chaorong , Alzunitan Mohammed , Salinas Jorge L , Siegel Marc O , Farmakiotis Dimitrios , Auwaerter Paul , Auwaerter Paul , Healy Heather , Diekema Daniel , Diekema Daniel 
Published: January 2021

Abstract

Background
Morbidity and mortality from candidemia remain unacceptably high. While infectious disease consultation (IDC) is known to lower the mortality from Staphylococcus aureus bacteremia, little is known on the impact of IDC in candidemia.

Methods
We conducted a retrospective observational cohort study of candidemia patients at a large tertiary care hospital between 2015 and 2019. All patients aged ≥18 years with blood cultures positive for Candida species were included. We only included the first episode of candidemia. Exclusion criteria were death or transfer to the palliative care unit within 48 hours from the time cultures became positive. The crude mortality rate was compared between those with IDC and without IDC. Then, we systematically searched five publication-databases through February 2020 and performed a meta-analysis of the impact of IDC on mortality of patients with candidemia. The study protocol has been submitted to the International Prospective Register for Systematic Reviews (PROSPERO) database (ID 156939) on April 2020.

Results
A total of 151 patients at our institution met the inclusion criteria, 129 (85%) of whom received IDC. Thirty-day, and 90-day mortality rates were significantly lower in the IDC group (18% vs 50%, P = .002; 23% vs 50%, P = .0022, respectively). Our systematic literature review returned 216 reports, of which, 13 studies including ours fulfilled the inclusion criteria. Among the 13 studies with a total 3687 patients, IDC was performed in 49% of patients. Mortality numbers were available in 10 studies. Overall mortality was 38.2% with a significant difference in favor of the IDC group (28.4% and 47.6%) with a pooled relative risk of 0.41 [95% Cl 0.35-0.49]. Ophthalmology referral (61%; 790/1279 and 21%; 273/1304, P &lt; 0.001), echocardiogram (54%; 662/1219 and 28%; 369/1296, P &lt; 0.001), and central line removal (78%; 830/1069 and 61%; 686/1116, P &lt; 0.02) were performed more frequently among patients receiving IDC.
Overall mortality

Conclusion
This study is the first systematic literature review and meta-analysis to evaluate the association between IDC and candidemia mortality. IDC was associated with a lower mortality and should be standard of care in all patients with candidemia.

Disclosures
Dimitrios Farmakiotis, MD, Astellas (Grant/Research Support) Paul Auwaerter, Collidion (Consultant)DiaSorin (Consultant)Johnson and Johnson (Shareholder)MicroB-Plex (Research Grant or Support)Shionogi (Consultant) Daniel Diekema, bioMerieux, Inc (Grant/Research Support)JMI Laboratories (Consultant)
752. Management of 20 Patients Diagnosed with Posaconazole-Induced Pseudohyperaldosteronism
Authors: Gintjee Thomas J , Davis Matthew R , Nguyen Minh-Vu Hoang , Young Brian , Odermatt Alex , Thompson George R 
Published: January 2021

Abstract

Background
Posaconazole-induced pseudohyperaldosteronism (PIPH) has been associated with elevated posaconazole serum concentrations. Clinicians are faced with the difficult task of managing patients with PIPH while not compromising the efficacy of antifungal prophylaxis or treatment. Commonly, modifications to posaconazole therapy are utilized in managing PIPH including dosage reduction of posaconazole or therapeutic switch to an alternative antifungal.

Methods
We retrospectively reviewed 20 consecutive adult patients diagnosed with PIPH in this case series. Patient data including blood pressure, electrolytes, endocrine laboratory values, and posaconazole serum concentrations collected before and after therapeutic intervention.

Results
Out of 20 patients included, 17 patients (85%) underwent therapeutic modification with posaconazole dose reduction (N=11) as the most common change. Other modifications included posaconazole discontinuation (N=3), switch to an alternative antifungal (N=2), and addition of spironolactone (N=1). Clinical improvement (a decrease in systolic blood pressure and increase in serum potassium) was observed in 9 of 17 patients (52.9%).
Table 1. Management of Posaconazole-Induced Pseudohyperaldosteronism - p1

Table 1. Management of Posaconazole-Induced Pseudohyperaldosteronism - p2

Table 1. Management of Posaconazole-Induced Pseudohyperaldosteronism - p3

Conclusion
We report our experience with PIPH management, for which there is currently no universally effective strategy. We suggest a stepwise approach for PIPH management, starting with posaconazole dose reduction and repeat assessment of clinical and laboratory parameters. If resolution of PIPH is not achieved, an alternative triazole antifungal or the addition of an aldosterone antagonist are additional potential interventions. Even with this approach, it is possible for PIPH to persist after therapeutic modification. Thus, early diagnosis and continuous, close monitoring of patients is warranted.

Disclosures
All Authors: No reported disclosures
754. Performance Characterization of a Real Time PCR Assay for Pneumocystis jirovecii in Bronchoalveolar Lavage Fluid and Sputum
Authors: Bell Drew T , Koehlinger Jeremy , Schmitt Bryan H 
Published: January 2021

Abstract

Background
Pneumocystis jirovecii pneumonia (PJP) affects immunocompromised patients and contributes significantly to mortality. Outcomes depend on early treatment, making timely and accurate diagnosis critical. Typically, PJP diagnosis is through identification of trophozoite or cyst forms in bronchoalveolar lavage (BAL) fluid or sputum, a labor-intensive and insensitive process. Options for more accessible and sensitive molecular detection are limited. It is known that patients may be colonized, which can cast doubt on the clinical significance of low levels of DNA amplification in qualitative result reporting. In this study, we describe a real time (rt) PCR assay utilizing analyte specific reagent primers targeting the mtLSU gene of P. jirovecii and correlate amplification with morphological PJP identification.

Methods
IUHPL Clinical Microbiology assessed sputum or BAL fluid from 109 patients with clinical concern for PJP microscopically via fungal stains (GMS, calcofluor white). Comparative rtPCR was conducted as follows. First, 2µL of residual specimen or control were mixed with an 8µL combination of rtPCR mastermix, control DNA, and primer pairs (Simplexa). No nucleic acid extraction was performed. Real time PCR was executed and analyzed on the LIAISON MDX (DiaSorin) platform. Qualitative amplification results and cycle threshold (CT) values were correlated with microscopic methods to establish performance. Chart review was performed to assess the clinical impact of this assay.

Results
P. jirovecii was microscopically detected in 26% (29/109) of samples, while 31.1% (34/109) exhibited amplification by rtPCR. Agreement between the two methods was 95.4%; rtPCR demonstrated 100% sensitivity and 93.8% specificity in comparison.

Conclusion
Our results indicate that this assay has exceptional negative predictive value (100%), and therefore may be valuable as a screening test. Considering this data alone, the positive predictive value is lower (85.3%). Further examination of the data, however, revealed that 80% (4/5) of discrepant results demonstrated CT values of &gt;34, while the highest CT for a microscopically positive sample was 31.2. Further clinical correlation may establish a CT cutoff that will reduce false positive and potentially clinically insignificant cases.

Disclosures
All Authors: No reported disclosures