bluuebunny/crossref_metadata_2025_split huggingface dataset:
710. Comparison of Initial CXR to CT in Patients (pts) with Hematologic Malignancy (HEM) and Documented Symptomatic Pulmonary Mucormycosis (PM)
Authors: Franklin Alexander , Axell-House Dierdre B , Spallone Amy , Tarrand Jeffery , Kontoyiannis Dimitrios P 
Published: December 2021

Abstract

Background
There is a spectrum of pulmonary disease burden in pts with HEM and PM. There have not been any data comparing the sensitivity and findings of initial Chest X-Ray (CXR) and chest CT in these pts.

Methods
We compared the findings of the initial CXR and CT in all pts with proven or probable PM via EORTC/MSG criteria. We included only pts who had pulmonary symptoms and who had both CXR and CT within 5 days of each other and within seven days of symptom onset or date of culture at MD Anderson Cancer Center from April 2000 and April 2020. We collected data regarding demographics, status of HEM, clinical presentation, frequency and findings of BAL and imaging findings, mold-active prophylaxis and treatment regimens, and mortality. CXR findings were classified as normal or abnormal, and if abnormal sub-classified as mass-like/consolidative, nodular, cavitary or heterogenous/non-specific. CT findings were classified in a similar manner.

Results
We Identified such 39 pts with PM who had both CXR and CT within 5 d. All pts had positive CT. Five pts (13%) had a negative CXR. The majority of pts 28 (72%) were neutropenic (neutrophil count &lt; 500). The most common CXR findings were consolidation or mass-like lesions (56%), followed by patchy, heterogenous or non-specific findings (33%) and nodules (13%). Only 3% had cavitary lesions. Similarly, consolidation or mass-like lesions were the most common finding on CT (69%), followed by nodular lesions with or without ground glass halos (56%). Cavitary lesions and/or reverse halo sign (RHS) were common (31%) on CT. Patients with normal CXR vs those with abnormal CXR were comparable in all clinical parameters we collected. The median survival from time of symptoms onset for all pts was 45 days. There was a trend for lower 42 day mortality in pts with normal CXR (20% vs 47%, P=.253).

Conclusion
A negative CXR does not preclude PM, especially in neutropenic pts. A CT is recommended for better sensitivity and although there was concordance in CXR with CT findings in some chest abnormalities (mass, consolidation), CT more commonly revealed nodules and signs highly suggestive of PM such as RHS. Although small numbers precluded a robust comparison, it is possible that HEM pts with PM and negative initial CXR have better prognosis, perhaps reflecting a lower burden of pulmonary involvement

Disclosures
Dimitrios P. Kontoyiannis, MD, Astellas (Consultant)Cidara Therapeutics (Advisor or Review Panel member)Gilead Sciences (Consultant, Grant/Research Support, Other Financial or Material Support, Honoraria)
712. Neurocysticercosis at a Large Academic Center in the USA
Authors: Ramanathan Maya , Cordova Leopoldo , Bertran-Lopez Jovanna , Lichtenberger Paola , Lichtenberger Paola 
Published: December 2021

Abstract

Background
Neurocysticercosis (NCC) is a parasitic infection that results from the ingestion of eggs from the adult tapeworm Taenia solium that develops when cysticercoids migrate into the central nervous system. In addition, this infection has been found to affect over 50 million individuals worldwide. In the United States, NCC mainly affects immigrants from Latin America, where the disease is endemic with seroprevalence rates ranging from 5% to 11%. Most data regarding NCC in the United States comes from hospital reports from California and Texas. We are undertaking this study to determine the differences seen in a higher Latin American and Haitian population compared to a previously seen predominantly Mexican population. In this retrospective review, we characterized the population diagnosed with NCC at one large tertiary medical center in South Florida, University of Miami Hospital.

Methods
This retrospective chart review included adult patients from January 2009 to December 2019 with the admission or discharge diagnosis of neurocysticercosis (ICD 10 Code B 69.0 Neurocysticercosis and CPT code 86682 Cysticercosis). We extracted data on demographics, clinical symptoms, recurrence, treatment, resolution and follow up.

Results
Forty-seven patients were analyzed to completion. Most of the cases were seen in Hispanics 72.3 % and from Central America 40.4%. The most common symptom was headache 53.2% followed by seizures 42.6%. Normal physical exam was noted in 93.6% of the cases. Most of the cases have 1-10 lesions (98%), located in the brain parenchyma (75%). Serum serology, CSF antibody or stool studies were not obtained in around 90% of the cases. Treatment was indicated in 70.2% of cases and recurrence was low at 17.0%. Refer to Tables 1-5 for full results.
Figure 1. Demographics and Clinical Symptoms

Figure 2. History and Imaging

Figure 3. Laboratory Evidence and Follow up

Conclusion
NCC is a neglected tropical disease which is preventable. Our study noted that the majority of the affected population were immigrants that had been in the US for more than 10 years and came from central America and the Caribbean. With appropriate treatment, most of the symptoms and CNS lesions resolved, with a low mortality. Public health efforts to identify and treat the tapeworm carrier could be improved to allow for public health follow-up of cases. Although not yet considered endemic in Florida, we hope to bring awareness in this state.

Disclosures
All Authors: No reported disclosures
714. Invasive Fungal Infection Caused by Curvularia Species in a Patient with Intranasal Drug Use: A Case Report
Authors: Kulla Bakri , Pham Jason , Johnson McKenna 
Published: December 2021

Abstract

Background
Invasive fungal infections (IFIs) are uncommon infections that account for approximately 27.2/100,000 cases per year in the United States. One form of IFI is chronic invasive fungal sinusitis (CIFS). If untreated, invasion into neighboring structures may cause altered mental status, seizures, strokes, proptosis, and intracranial complications.

Case Report
An afebrile 43-year-old female with a history of polysubstance abuse presented to the ED due to altered mental status, left sided facial droop, right sided hemiparesis, and slurred speech. The patient was somnolent but arousable to stimuli and appeared acutely ill. The patient’s mother reported a history of cocaine abuse, which was confirmed on urine toxicology. A CT head and neck with contrast revealed subacute basal ganglia lacunar infarcts and a left sphenoid opacity with scattered hyperintensities and erosive changes [Figure 2]. One month prior, she had been diagnosed with a left superior pole kidney mass and a left-sided enlarged periaortic lymph node containing multiple noncaseating granulomas and GMS stains positive for fungal hyphae [Figure 1].
The patient underwent nasal endoscopy with tissue biopsy. Tissue showed necrotizing invasive fungal sinusitis with granuloma formation and foreign-body giant cell reaction. Fungal speciation of the tissue culture showed Curvularia species was placed on IV voriconazole. While the infection stabilized, her neurologic deficits did not significantly improve. She was discharged to inpatient rehabilitation.
Figure 1. Coronal and axial view of left upper pole kidney mass with perinephric fat stranding.

Figure 2. MRI brain CTA Head and Neck with contrast in axial plane showing multifocal infarcts likely represent complications of fungal basilar meningitis secondary to the left sphenoid sinus disease. Imaging also shows irregular erosive change at the anterior aspect of the sella turcica, through the planum sphenoidale, and bony defect of the sphenoid sinus.

Methods
Results

Conclusion
Intranasal use of cocaine causes vasoconstriction to elicit sinonasal tissue ischemia. With extended use, chronic mucosal inflammation can occur that can result in sinonasal osteocartilaginous necrosis and potential for infection. CIFS is infrequently diagnosed and its indolent nature with progression over weeks or months can make diagnosis and treatment difficult. The most frequent fungal species identified are the Aspergillus species, but Curvularia species have been found as well. CT and MRI scanning can be suggestive, but are not sufficiently specific or sensitive. The main forms of interventional modalities include surgical debridement and antifungal therapy to maximize survival

Disclosures
All Authors: No reported disclosures
715. Evaluation of Four Chromogenic Selective Media for the Isolation of Candida auris
Authors: Phee Lynette , Kwang Lee Ling , Ng Tong Yong 
Published: December 2021

Abstract

Background
Candida auris is an emerging healthcare-associated multi-drug resistant pathogen able to cause severe invasive infections. Public health agencies have emphasized the need for active surveillance of C. auris to enable prompt infection control measures in healthcare institutions. Four commercially available chromogenic selective media were evaluated for the isolation of C. auris in this study.

Methods
Four chromogenic selective media (Brilliance Candida (BC), CHROMagar Candida (CC), CHROMagar Candida Plus (CCP) and chromID Candida (CAN2)) were evaluated with 52 fungal and 20 bacterial strains. Isolates were identified with Vitek matrix-assisted laser desorption/ionization mass spectrometry (MS). 1 µL spots of broth subcultures of each organism were inoculated onto chromogenic media and incubated as per manufacturer’s instructions. Plates were read at 24, 36 and 48 hours. Sabouraud Dextrose agar (fungi) or blood agar (bacteria) were inoculated to obtain viable counts. All reads were categorized into color groups. Sensitivity and specificity were determined based on phenotypic characteristics after 48h of incubation. Additionally, spots of serially diluted C. auris type strain CDC B11903 were assessed for expression of the expected C. auris phenotype at 36, 48 and 72 h. Probit regression model (R version 3.6.3) was used to estimate limit of detection (LOD) for each medium at each time-point.

Results
A minimum of 36h incubation (optimally &gt; 48 h) was required for observation of distinct color and colony morphology. CCP performed best overall, with 100% sensitivity and 96% specificity. Sensitivity was 100% across all 4 media, but specificity was reduced (BC – 66%, CAN2 – 83%, CC – 81%). The lowest LOD was observed with CCP at 4 colony-forming units (CFU). See figure 1 for details.
Figure 1. Comparison of limit of detection for C. auris by type of chromogenic selective media across various time-points.

Conclusion
Rapid isolation and accurate identification of C. auris from samples, including those from non-sterile sites, are crucial for the management of C. auris infections and in curtailing nosocomial transmission. Chromogenic media are simple to use, inexpensive and scalable; ideal for routine diagnostics and high volume screening samples. Of the 4 media evaluated, CCP is best suited to screen for C. auris, with subsequent confirmation of identification using MS or genotypic methods.

Disclosures
Lynette Phee, MD PhD, Creative Life Science Co. Ltd (Creative Media Plate) (Other Financial or Material Support, Provided some of the CHROMagar Candida and CHROMagar Candida Plus plates free-of-charge for evaluation purposes.)Fort Richard Laboratories (Other Financial or Material Support, Provided some of the CHROMagar Candida Plus plates free-of-charge for evaluation purposes.)
716. Characterization of Azole Susceptibility Profiles of Aspergillus spp. Isolates Obtained From Immunocompromised Patients in Cali, Colombia
Authors: Rosso Fernando 
Published: December 2021

Abstract

Background
Aspergillus spp. are opportunistic filamentous fungi causing a spectrum of diseases described aspergillosis. Aspergillosis is treated with triazole antifungals of second-generation, mostly voriconazole or itraconazole, which inhibit the ergosterol synthesis, an important component of the fungal membrane. However, the efficacy of these drugs has been affected by the presence of resistance found in different Aspergillus spp. species, as a mutations in CYP51 gene We describe the azole susceptibility profiles of Aspergillus spp., isolated from clinical samples in a hospital in Cali, Colombia.

Methods
A total of 63 Aspergillus spp. clinical isolates were identified at a phenotypic and protein level through matrix-assisted laser ionization (MALDI-TOF-MS), susceptibility profiles against voriconazole and itraconazole were subsequently characterized. Following the guidelines for susceptibility determination issued by EUCAST, 96-well plates were prepared with the azole antifungals itraconazole (ITZ) and voriconazole(VCZ), using concentrations ranging from 0.06 to 32 mg/L. Each well was then inoculated with 100μL of the fungal inoculum previously diluted in distilled water and 20% tween adjusted to a concentration of 0.5 on the Mcfarland scale. The plates were incubated at 37 °C and readings were taken after 48 hours of incubation.

Results
A total of 63 clinical isolates of Aspergillus spp were collected, of these 44% corresponded to isolates of A. fumigatus, 25% A. flavus/oryzae, 18% A. niger, 5% A. parasiticus, 3% A. terreus and 3% A. versicolor. In vitro characterization of the susceptibility profiles revealed variable phenotypes, with a predominance of susceptible strains for the two antifungals tested, however, of the total isolates, 8% (5/63) were resistant to itraconazole (ITZ), and 6% (4/63) to voriconazole (VRZ).
Figure 1. Distribution or Frequency of Aspergillus spp. Species and Their Resistance Profiles

Conclusion
Azole resistance was low 6-8% . Susceptibility profiles of the strains isolated from clinical samples is important to carry out an accurate identification of each one of the agents involved in infections caused by Aspergillus spp in order to differentiate common species from cryptic ones, since these have increasingly acquired importance at the clinical level,.

Disclosures
All Authors: No reported disclosures
718. Posaconazole Versus Standard of Care for Treatment of Invasive Mold Infections
Authors: Idusuyi Ann-Marie , McCoy Christopher , Gold Howard 
Published: December 2021

Abstract

Background
Invasive mold infections (IMIs) including Aspergillus spp. are a significant cause of morbidity and mortality in immunocompromised patients. Voriconazole is recommended as first line treatment for primary IA. Liposomal amphotericin B and isavuconazole are also recommended alternative therapies. Posaconazole has activity against mold species including those not covered by voriconazole, is available as an IV and oral formulation with a distinct adverse effect profile making it a potential effective alternative for treatment. This study investigated the clinical outcomes of treatment of invasive mold infections (IMIs) with posaconazole compared to standard of care (voriconazole, isavuconazole, liposomal amphotericin B).

Methods
A retrospective, single center, cohort study was completed to evaluate patients with IMIs treated with posaconazole versus those treated with standard of care therapy. Medication orders for posaconazole or standard of care therapy between January 2012 and December 2020 were identified from a clinical data repository. Only patients with antifungal orders with a listed indication for “treatment of fungal infection” were included. Data collected for each group included baseline demographics, underlying conditions, site of infection, type of mold, therapeutic drug monitoring and classification of IMI.

Results
A total of 120 patients met inclusion criteria, with 35 patients in the posaconazole group and 85 patients in the SOC group. Baseline characteristics were similar except for increased severe neutropenia in the posaconazole group (p&lt; 0.0001), more probable IMIs in the SOC group (p=0.009) and more possible IMIs in the posaconazole group (p=0.043). In the posaconazole group 37.1% (13/35) of patients were treatment experienced vs. 29.4% (25/85) of patients in the SOC group. More patients achieved a complete/partial response in the SOC group compared to the posaconazole group (p=0.0001) and more patients experienced treatment failure in the posaconazole group (p=0.01). A higher proportion of patients experienced adverse effects in the SOC group compared to the posaconazole group (p=0.0001).

Conclusion
Posaconazole was not as effective as SOC in treating invasive mold infections but patients experienced comparatively fewer adverse events.

Disclosures
All Authors: No reported disclosures
719. Susceptibility Testing of Oteseconazole (VT-1161) Against Clinical Isolates from Phase 3 Clinical Studies in Subjects with Recurrent Vulvovaginal Candidiasis
Authors: Ghannoum Mahmoud , Degenhardt Thorsten , Person Karen , Brand Stephen 
Published: December 2021

Abstract

Background
Oteseconazole (VT-1161) is a novel, investigational oral therapy that is currently under FDA review for the treatment of recurrent vulvovaginal candidiasis (RVVC). Susceptibility testing was performed on all viable clinical isolates collected from three Phase 3 studies to determine the susceptibility of causative pathogens to oteseconazole versus the current treatment standard of care, fluconazole.

Methods
Vaginal cultures were obtained at screening and at all subsequent study visits throughout the duration of the studies (approx. 48 Weeks) and submitted to a central mycology laboratory for fungal species identification and storage. Susceptibility testing was conducted in accordance with the CLSI Reference Method for Broth Dilution Antifungal Susceptibility Testing of Yeast M27-Ed4.

Results
Candida albicans was identified as the primary causative pathogen in 87% of women with RVVC presenting with an acute infection, followed by C. glabrata (8%). Other non-albicans species including; C. parapsilosis, C. tropicalis, C. krusei, C. dubliniensis, C. kefyr and Saccharomyces cerevisiae were responsible for &lt; 1% of infections. A total of 1910 isolates were collected. The MIC range, MIC50 and MIC90 values against all isolates for oteseconazole were ≤ 0.0005 to &gt; 0.25, 0.002 and 0.06 µg/mL, respectively. In comparison, the MIC range, MIC50 and MIC90 values for fluconazole were, ≤ 0.06 to &gt; 32, 0.25 and 8 µg/mL respectively. The MIC range, MIC50 and MIC90 values against all C.glabrata isolates for oteseconazole were 0.002 to &gt; 0.25, 0.03 and 0.125 µg/mL, respectively. In comparison, the MIC range, MIC50 and MIC90 values for fluconazole were, ≤ 0.06 to 32, 2 and 8 µg/mL respectively.

Conclusion
Oteseconazole demonstrated very low MIC values against most Candida strains, including fluconazole resistant isolates, aligning with clinical study outcomes. Oteseconazole MICs against C. glabrata strains were approximately 6-fold lower than fluconazole.

Disclosures
Mahmoud Ghannoum, PhD, Mycovia Pharmaceuticals (Grant/Research Support, Research Grant or Support) Thorsten Degenhardt, Ph.D, Mycovia Pharmaceuticals (Employee, Shareholder) Karen Person, M.S., Mycovia Pharmaceuticals, Inc. (Employee)Mycovia Pharmaceuticals, Inc. (Employee) Stephen Brand, Ph.D, Mycovia Pharmaceuticals (Employee)
720. Efficacy of Nifurtimox + Eflornithine in the Treatment of African Trypanosomiasis. Systematic Review
Authors: Hidalgo Jessica , Tirupathi Raghavendra , Ortiz Juan Fernando , Fabara Stephanie P , Reddy Dinesh , Rabaan Ali A , Al-Tawfiq Jaffar A 
Published: December 2021

Abstract

Background
Sleeping sickness is an infectious disease transmitted mainly by the Trypanosoma Brucei, with the tsetse fly as a vector. The condition has two stages: The hemolymphatic and the meningo-encephalitic stage. The second stage is caused mainly by the Trypanosoma Brucei Gambiense. The treatment of the second stage has changed from melarsoprol, eflornithine, to now nifurtimox-eflornithine (NECT). This systematic review will focus on the efficacy and the toxicity of the medication.

Methods
We use PRISMA and MOOSE protocol for this review. On figure 1, we detail the methodology used for the extraction of information from the systematic review. To assess the study's bias, we used Cochrane Collaboration’s tool for risk assessment of the clinical trials and the Robins I tool for the observational studies.

Results
We collected four clinical trials and two observational studies after an extensive search. Three clinical trials showed that NECT was non-inferior to eflornithine with the following cure rates (NECT VS eflornithine): 1) 96.3% vs. 94.1% ; 2) 90.9% vs. 88.9%; 3) 91.6% vs. 96.5%. An additional clinical trial revealed that the proportion of patient discharge from the hospital was 98.4% (619/629); 95% CI [97.1%; 99.1%]). The two observational studies discussed the pharmacovigilance of the drug and toxicity related to NECT. In one study, patients treated with NECT, 589 (86%) experienced at least one adverse effect (AE) during treatment, and 70 (10.2%) experience serious AE. On average, children experienced fewer AEs than adults. In the other study at least one AE was described in 1043 patients (60.1%), and Serious AE was reported in 19 patients (1.1% of treated), leading to nine deaths (case fatality rate of 0.5%). The major limitations of the studies were the lack of blinding because most of them were open-label. Also, there was heterogenicity in the definition of the outcomes in the observational studies.
PRISMA Flow Chart

Conclusion
NECT is not inferior to eflornithine, and the proportion of patients discharged from the hospital alive showed favorable results. The observational studies revealed a high frequency of AE. However, NECT is more convenient and safe than Eflornithine and Melarsoprol.

Disclosures
All Authors: No reported disclosures