bluuebunny/crossref_metadata_2025_split huggingface dataset:
742. “Troponin Leaks” in Patients with Acute Respiratory Viral Infections Enrolled in SUPERNOVA: A Marker of Worse Clinical Outcomes
Authors: Ruiz Ernesto , Lengi Bashir , Gray Tiffany , Mushtaq Mahwish , Musher Daniel , Rodriguez-Barradas Maria 
Published: November 2018

Abstract

Background
Cardiac troponin I (cTnI) is a specific marker of cardiac muscular injury. Many patients hospitalized with acute respiratory illness (ARI) have elevated cTnI levels but do not meet EKG criteria for an acute ischemic cardiac event. Troponin leaks could be due to demand ischemia or acute inflammation of the myocardium. We hypothesized that patients with viral ARI and elevated cTnI have worse cardiopulmonary outcomes than those with viral ARI and normal cTnI.

Methods
From November 11, 2016–September 30, 2017 nasopharyngeal swabs from patients enrolled in SUPERNOVA ARI Study, a CDC/2-VA site, active surveillance platform to evaluate the incidence of viral infection in patients hospitalized with symptoms and/or signs of ARI, were tested using a FilmArray Respiratory Panel. Based on detection of any virus, patients were categorized as positive (vPCR+) or negative (vPCR−). Patient enrolled at the Houston site with cTnI obtained &lt;48 hours of admission were included in the analysis. cTnI above upper limit of normal (&gt;0.03 ng/dL) was defined as elevated. Demographic and clinical data were abstracted from chart review. Outcomes were myocardial infarction (MI) on admission, 30- and 90-day re-admissions due to cardio-respiratory illness and 30- and 90-day all-cause mortality. For the univariable analysis of baseline factors and outcomes we used unpaired t-tests for continuous variables and χ2 or Fisher exact test for categorical variables as appropriate.

Results
Ninety-four of 332 cases were vPCR positive and cTnI levels on admission were available in 86. Demographics and comorbidities were all similar for the high (N = 42) and normal (N = 44) cTnI groups. Compared with normal cTnI group, those with high cTnI had similar 30- and 90-day readmission rates (14% vs. 9%, P = 0.4 and 26% vs. 16%, respectively, P = 0.2). However, 30- and 90-day mortality rates were higher for high cTnI patients (10% vs. 0% and 19% vs. 5%, P &lt; 0.03).

Conclusion
Troponin elevation on patients with a documented viral respiratory infection is associated with higher 30- and 90-day mortality rates. Troponin leaks should not be dismissed as a trivial finding in this group of patients. Further work on its pathogenesis is warranted.

Disclosures
All authors: No reported disclosures.
744. Effectiveness of 23-Valent Pneumococcal Polysaccharide Vaccine and Influenza Vaccine Against Pneumococcal Pneumonia Among Elderly Patients Aged 65 Years and Older in the Republic of Korea: A Case–Control Study
Authors: Kim Jong Hun , Chun Byung Chul , Song Joon Young , Kim Hyo Youl , Bae In-Gyu , Kim Dong-Min , Choi Won Suk , Jeong Y H , Choi Young Hwa , Kang Seong Hui , Yoon Young Kyung , Sohn Jang-Wook , Kim Min-Ja 
Published: November 2018

Abstract

Background
The national immunization program (NIP) of annual influenza vaccination to the elderly population (≥65 years of age) in the Republic of Korea (ROK) has been implemented since 1987. Recently, the 23-valent pneumococcal polysaccharide vaccine (PPV23) through the NIP has been provided to the elderly population in the ROK since May 2013. The aim of this study was to assess PPV23 and influenza vaccine (IV) effectiveness in preventing pneumococcal pneumonia (PP) among elderly patients ≥65 years of age.

Methods
A case–control study using a hospital-based cohort was conducted. Cases of PP including bacteremic PP and nonbacteremic PP were collected from 14 hospitals in the pneumococcal diseases surveillance program from March 2013 to October 2015. Controls matched by age and sex in the same hospital were selected. Demographic, clinical information, and vaccination histories were collected. Previous immunization was categorized into “vaccinated” if a patient had received vaccines as follows: PPV23 (4 weeks to 5 years) and IV (2 weeks to 6 months) prior to the diagnosis of PP for case patients and prior to the hospital admission for control patients. Adjusted odds ratio (OR) was calculated, controlling for underlying medical conditions. Vaccine effectiveness was defined as (1 – OR) × 100.

Results
During the study period, a total of 661 cases (104 bacteremic PP cases and 557 nonbacteremic PP cases) and 661 controls were enrolled for analyses. For overall patients ≥65 years of age, there was no significant vaccine effectiveness against PP. For young elderly patients with 65–74 years, IV alone (1.2%, [95% confidence interval (CI) −95.3% to 50.0%]) and PPV23 alone (21.9%, [95% CI −39.0% to 56.1%]) were not effective. However, significant vaccine effectiveness of PPV23 plus IV against PP was noted (54.4%, [95% CI 6.9–77.7%], P = 0.031). For older elderly patients ≥75 years of age, no significant vaccine effectiveness was observed.

Conclusion
Our study indicates that PPV23 plus IV may be effective in preventing PP among young elderly patients with 65–74 years, suggesting additive benefits of influenza plus PPV23 vaccination. Further studies are required to confirm the persistent additive protective effectiveness.

Disclosures
All authors: No reported disclosures.
766. Migration Flows and Increase of Extrapulmonary Tuberculosis in a Low Prevalence Setting: A Retrospective Analysis in Two Italian Centers
Authors: Compagno Mirko , Campogiani Laura , Coppola Luigi , Sarmati Loredana , Andreoni Massimo , Francisci Daniela , Saraca Lavinia , Baldelli Franco 
Published: November 2018

Abstract

Background
Extrapulmonary tuberculosis (EPTB) represents 25% of Worldwide tuberculosis and it is more commonly associated with immunodepression. The purpose of this study was to determinate the burden of EPTB in a low TB prevalence setting.

Methods
A retrospective evaluation of patients treated for TB at Tor Vergata Hospital and Terni Hospital (Italy) from January 2013 to November 2017 was done. Clinical charts, laboratory tests and radiological findings were reviewed and analysed. Data were elaborated using Yates’ method analysis, Fisher test and Pearson’s chi-square test.

Results
A total of 171 patients were enrolled from 2013 to 2017 in two Italian centers (Rome and Terni); 71% were males, with a mean age of 41.5 years. The number of TB diagnosis increased among the study period (6.6% in 2013 vs. 56% in 2017) and an increase of EPTB (23% in 2013 vs. 44% in 2017) was seen. Most commonly EPTB presented as generalized lymphadenitis (34%), osteomyelitis and spondylodiscitis (28%) and other sites localizations (31%). Statistical analysis revealed a significant correlation between geographical provenience and TB localization (P = 0.004). Extra European immigrants (76% Africans) resulted at higher risk of EPTB (OR 2.31; CI 95% 0.63–8.46), while being Caucasian showed a protective role toward EPTB development (P = 0.001). The risk of EPTB doubled in 2015–2017 respect 2013–2014.

Conclusion
From 2013 to 2017 an increase in TB admissions was documented with a significant higher number of EPTB cases, particularly in extra-European immigrants. The doubled risk in 2015–2017 was likely the consequence of the recent ongoing escalating levels of migration from African countries and may result as an emerging Public Health problem.

Disclosures
All authors: No reported disclosures.
768. Epidemiological and Clinical Profile of Miliary Tuberculosis in Southern of Tunisia
Authors: Jemaa Maissa Ben , Koubaa Makram , Ayed Houda Ben , Marrakchi Chakib , Trigui Maroua , Hammami Fatma , Hmida Mariem Ben , Jemaa Tarak Ben , Dammak Jamel , Jemaa Mounir Ben 
Published: November 2018

Abstract

Background
Miliary tuberculosis (MT) is a severe rare form of tuberculosis (TB). It is often due to lymphohaematogenous dissemination of tubercle bacilli. Although the global incidence of TB has been slowly decreasing with globally conducted program, MT incidence is relatively increasing owing mainly to widespread use of immunosuppressive drugs and HIV/AIDS pandemicity. Few reports were found regarding epidemiological data of MT in developing countries. We aim to evaluate epidemiological characteristics of MT in the region of Sfax Southern Tunisia.

Methods
We conducted a retrospective study of all new cases of MT of all ages between January 1995 and December 2016. Data were collected from the regional register of tuberculosis implanted in the anti-tuberculosis center of Sfax.

Results
We analyzed 22 patients with MT accounting for 0.8 of all cases of tuberculosis. Incidence rates of MT were stable over the 22-year study period. Their median age was of 41 years (IQR= [17–63.5]) and a half of them were females. MT was significantly more common in patients less than 15 years (2.4% vs. 0.7%; OR=3.5; P = 0.04). Six patients (27.3%) had extra-pulmonary locations with lymph nodes (n = 1), meninges (n = 2), bones and joints (n = 1), abdominal cavity (n = 1), and pleura (n = 1). One patient (4.5%) died within 8 months after a confirmed diagnosis. Median duration of treatment was 10 months (IQR = [6–15 months]). The outcome was favorable in 19 cases (86.4%) and three patients received a combined-drug regimen (13.6%).

Conclusion
MT remains a serious form of tuberculosis which may compromise the life-threatening. It was mainly seen in young nonvaccinated children but currently, except among HIV-infected persons, it is more common among older persons who experience more an endogenous reactivation. These findings emphasize the high efficacy of BCG vaccination in developing countries to prevent MT.

Disclosures
All authors: No reported disclosures.
772. Factors Associated With Healthcare Delay of Active Pulmonary Tuberculosis After Hospitalization
Authors: Han Jaijun , Park Se Yoon , Park Jebyung , Lee So Young , Kim Gil Eun , Jeong Yeon Su , Kim Jin Hwa , Lee Eunyoung , Lee Eun Jung , Yu Shi Nae , Kim Tark , Jeon Min Hyok , Choo Eun Ju , Kim Tae Hyong 
Published: November 2018

Abstract

Background
Hospitals are undesirable reservoirs for a respiratory outbreak. Active pulmonary tuberculosis (TB) can be readily transmitted among hospitalized patients. Early recognition of pulmonary TB is an essential priority against transmission. The aim of this study was to evaluate factors associated with delayed identification of pulmonary TB in hospital settings.

Methods
Medical records of newly diagnosed TB patients admitted to a referral hospital from January 2015 through December 2017 were reviewed. Delayed recognition of pulmonary TB was defined as failure to initiate airborne isolation within the first 3 days after admission. We analyzed clinical, microbiological, radiological, and healthcare factors associated with delayed recognition of pulmonary TB. Patients who were not suspected of having active pulmonary TB had no remarks about TB on their initial chest radiograph interpretation by radiologists. Multivariate logistic regression analysis was performed with significant factors included.

Results
A total of 136 patients were analyzed who had positive sputum acid-fast bacilli (AFB) cultures. Of these, 45 (33%) patients were isolated 3 days after admission and had longer days of exposure before isolation (median 9, interquartile range [IQR] 6–14, P &lt; 0.001) in comparison to others (median 0, IQR 0–1). Patients with older age (odds ratio [OR] = 1.04, 95% confidence interval [CI] 1.01–1.08, P = 0.01), patients who were admitted to departments other than infectious diseases or pulmonology (OR = 6.23, 95% CI 2.17–17.89, P = 0.001) and patients who were not suspected of having active pulmonary TB by radiologists (OR = 11.36, 95% CI 4.11–31.39, P &lt; 0.001) were more likely to have delayed recognition of pulmonary TB.

Conclusion
In a country with intermediate TB prevalence, better awareness for pulmonary TB is required for all hospitalized patients who are admitted to departments other than infectious diseases or pulmonology. Although active pulmonary TB is not suspected by a radiologist, sputum AFB smear, and culture are necessary when new lesions are present in chest radiographs.

Disclosures
All authors: No reported disclosures.
775. An Epidemiological Analysis of Patients With Multidrug-Resistant Tuberculosis Among Tibetan Refugees in India
Authors: Desel Tenzin , Tsuda Naonori , Tsundue Tenzin , Lingtsang Rangjung , Topgyal Sonam , Sako Akahito , Yanai Hidekatsu , Sadutshang Tsetan 
Published: November 2018

Abstract

Background
Globally, refugee populations face an increased risk for tuberculosis (TB) due to malnutrition, overcrowding, and poor living conditions. Compared with the general Indian population, Tibetan refugees in India display a higher incidence rate of both TB and multidrug-resistant TB (MDR-TB). The high incidence of MDR-TB in younger population is a serious public health concern.

Methods
We retrospectively reviewed the medical records of patients with MDR-TB treated from January 2010 to December 2013 in Tibetan Delek Hospital, which is the center of TB control among Tibetan refugees. Patients were classified into either new cases (supposed infection by exposure to MDR-TB) or previously treated MDR-TB cases (suspected acquirement of MDR-TB through anti-TB treatment or by MDR-TB exposure after treatment). We compared patients’ age, sex, birthplace, residence type, occupation, contact history, and treatment outcome.

Results
Of 749 patients with TB, we enrolled 134 patients with MDR-TB [median age, 26 (interquartile range: 22–35) years; males, 55%]. The Tibetan ethnicity comprised 96% of the study population, whereas Indians (trans-Himalayan) comprised 4%. The birthplace was Tibet for 22% patients, India for 75%, and Nepal for 2%. New MDR-TB cases were 28% and previously treated MDR-TB cases were 72%. Failure was observed in 42% patients and cured and completed in 54% patients, during their previous TB treatment. The median age was significantly lower in new cases than in previously treated MDR-TB cases (24 vs. 28.5 years; P &lt; 0.01). Tibet was the birthplace of 34% new cases and 18% in previously treated cases (P = 0.04). The residence was of the congregated type in 58% of new cases and 30% in previously treated MDR-TB cases (P = 0.01). The occupation was “student” and “unemployed” in 58% and 8% in new cases and 33% and 24% in previously treated cases, respectively (P = 0.03). Contact history with TB type and treatment outcome were not considerably different, although the rates of cured and completed were high in both new (82%) and previously treated (84%) MDR-TB cases.

Conclusion
This study shows that new MDR-TB correlates with younger age, birth in Tibet, congregated residence, and student occupation. Targeting the above-listed characteristics could be effective in further reducing the MDR-TB transmission among Tibetan refugees in India.

Disclosures
All authors: No reported disclosures.
776. Tuberculosis Screening Among People Living With HIV in Arkansas: A Ryan White Program Evaluation
Authors: Gu Mofan , Patil Naveen , Fischbach Lori , Vance Tiffany , Bedell Charles , Mukasa Leonard 
Published: November 2018

Abstract

Background
The current TB screening practice among people living with HIV in the United States is understudied. In our preliminary study, we found that only 6 (12%) US states recommended TB screening in their HIV guidelines; and only half of the Ryan White Programs capture client TB status. In this ongoing project, we aim to determine the prevalence of TB screening among people living with HIV in Arkansas, inform policy revisions, and ultimately reduce the burden of TB-HIV comorbidity.

Methods
We generated a sample of patients who received Ryan White service during the last grant year (April 1, 2016 to March 31, 2017) from CAREWare (Ryan White client database). We reviewed these patient files in multiple site visits and collected data on TB screening practice. We then performed descriptive analysis and multivariate logistic regression to analyze TB screening patterns in Arkansas.

Results
To date, we reviewed 728 patient records from 22 clinics across Arkansas during a 6-month study period. Three hundred sixty-seven (50%) patients have baseline (HIV diagnosis) TB status. On the basis of the multivariate logistic regression model (adjusting for age, gender, race, and patient residence), TB screening among Ryan White patients vary significantly by clinical regions in Arkansas (P &lt; 0.0001). As compared with the central region, HIV patients in the North Central clinical region are more likely to be screened for TB (OR, 23.28; 95% CI, 5.29, 102.49); and HIV patients in the Northeast clinical region are less likely to be screened (OR, 0.05; 95% CI, 0.01, 0.30).

Conclusion
We observed in Arkansas (1) low adherence to recommendations for TB screening among people living with HIV and (2) insufficient HIV surveillance infrastructure to capture TB status, and (3) geographic variations in TB screening practice among people with HIV, indicating the need for (1) clearer guidelines, (2) stronger TB education among providers, and (3) program collaboration and service integration between TB and HIV. In our next steps, we want to explore further into the regional variations in TB screening among people with HIV, in order to tailor interventions to different geographic regions. We also want to examine changes in TB screening practice after implementation of the new contract, and to determine the optimal frequency of TB screening among people living with HIV.

Disclosures
All authors: No reported disclosures.
782. Risk Factors, Clinical Characteristic, and Treatment Outcomes for Nontuberculous Mycobacterial Disease in Mexico
Authors: Luis Bruno Ali Lopez , Perez-Gutierrez Ma Teresa , Bobadilla-Del-Valle Miriam , Ponce-De-Leon Alfredo , Sifuentes-Osornio José 
Published: November 2018

Abstract

Background
Nontuberculous Mycobacteria (NTM) cause diverse clinical manifestations in multiples clinical setting, and in the past years, there has been an increasing prevalence and variability among geographic regions, this associated with a diversity of hosts and clinical manifestations. We objective was evaluated the clinical and microbiologic characteristic, and the treatment outcomes related to slowly growing mycobacteria (SGM) and rapidly growing mycobacteria (RGM).

Methods
When conducting a retrospective study between January 2001 and December 2017, retrospectively their medical records were reviewed for obtainments of site of isolation or infection, comorbidities or predisponent condition, clinical and radiographic presentation, and treatment outcomes.

Results
A total of 90 patients with isolated of RGM and 87 within SGM were evaluated among these M. avium and M. fortuitum were the most predominant species. HIV infection was the predominat risk factor for SGM infections (P &lt; 0.001); the conditions associated to RGM infections were cancer (P = 0.02787); diabetes mellitus (DM) (P = 0.01418), chronic kidney disease (CKD)(P = 0.04662), use of immunosuppressive medication (P &lt; 0.001), and use of invasive device only were present in the RGM group. In the RGM group, lung infection was the most common site of infection (43%); in the SGM group, the disseminated disease was the most common (54%). The time of treatment was more prolonged in the SGM group (196 vs. 229 days, P = 0.0309). In the RGM group, the rate of cure was higher in the subgroup of Mycobacterial stream infections and disseminated disease (15 vs. 5, P = 0.0146). In the analysis of lung infection who meet the IDSA/ATS criteria were divided into the group with treatment and the group without treatment, the outcomes were not significative in both groups.

Conclusion
The NTM infections are an important cause of disease in patients with chronic conditions such as cancer, immunosuppressive medication, CKD, use of invasive device, and DM. HIV infection persist as the first risk factor for M. avium disseminated disease, the treatment for this latter condition in spite of more prolonged, it had a lower rate of cure. The treatment of lung infections for NTM must be individualized although the IDSA/ATS criteria are met.

Disclosures
All authors: No reported disclosures.
783. Characterization of Non-tuberculous Mycobacteria Isolates in a National Mycobacterial Laboratory in Panama: 2012–2015
Authors: Zavala Sofia , Rosas Samantha , Calvo Arlene , Sosa Nestor , Henostroza German , Rodriguez Ana Belen Arauz 
Published: November 2018

Abstract

Background
Nontuberculous mycobacteria (NTM) are becoming more frequently isolated in microbiology laboratories. There is no standardized diagnosis, treatment, and/or monitoring of patients with NTM disease. We described the experience of the Panama National Mycobacterial Laboratory in isolating NTM in patients suspected to have active tuberculosis in Panama.

Methods
Data registries of the National TB Program Laboratory of Panama between 2012 and 2015 were reviewed. Demographic information, relevant history, sample source, and isolate identified for each specimen obtained at the time of specimen submission was extracted. Identification of mycobacterial species were made using culture and PCR. Data were exported to an Excel workbook and a descriptive analysis was performed using STATA.

Results
A total of 4,545 samples were received during this period. Of these, 288 (6.3%) were not processed. From the remaining 4,257 samples, 705 (16.5%) were negative, 2,783 (65.3%) were positive for M. tuberculosis, and 769 (18%) were confirmed NTM. NTM species identification was achieved in 715 (93%) using PCR. Median age was 55 years (0 – 92); 49.4% were male. The most frequent NTM isolate was M. avium complex in 172 (22.3%) samples, followed by M. fortuitum in 131 (17%). M. chelonae was isolated in 98 (12.7%) samples, M. gordonae in 50 (6.5%), M. scrofulaceum in 20 (2.6%), and M. triviale in 16 (2.0%). NTM isolation steadily rose over the study period with 490 (63.7%) of the samples being from 2015 and 465 (94.5%) of these typified by PCR. Specimens mainly originated from the Panama metropolitan area (88.2%) and were mostly sputum samples (70.8%).

Conclusion
Nontuberculous mycobacteria represented an important proportion of isolates among TB suspects in Panama. The implementation of more sensitive diagnostic techniques is increasing the recovery of NTM. Further evaluation of the clinical significance of these finding is required for appropriate guideline implementation.

Disclosures
G. Henostroza, Aeras: Investigator, Grant recipient.
791. Hyponatremia Incidence and Its Association With Mortality in Patients With Tuberculosis
Authors: Llamas-Lopez Andrea , Vargas Tania , Morales-Garza Luis , Maya Rogelio 
Published: November 2018

Abstract

Background
In 2014, 26,000 new cases of tuberculosis were reported in Mexico. TB infection can cause hyponatremia which has a strong association with mortality. The objective of this study was to determine the association of mortality with hyponatremia in patients with tuberculosis infection.

Methods
Patients were collected from a 2-year period in the Hospital Dr. Bernardo Sepœlveda in Nuevo Leon, Mexico. Inclusion criteria were patients &gt;18 years of age, with positive tuberculosis tests, and sodium and serum glucose values upon admission.
Clinical data from the electronic file were collected and analyzed by descriptive statistics; Student’s t-test and chi-square test were used to compare categorical variables, and Kaplan–Meier to estimate survival curves.

Results
There were 314 patients with suspected TB, 77 patients were included (Table 1).
Mean follow-up was 6.5 ± 7.1 months. Overall mortality rate was 36.3%. Analysis of mortality is presented in Fig 2, and in severe hyponatremia in Figure 3.

Conclusion
Overall mortality was higher than previously reported, but there was no statistical association between hyponatremia and mortality compared with patients with normal sodium, or by severity. Within the limitations of this study, we must consider that 92% of patients were hospitalized patients at the time of diagnosis, implying that they were patients with complications and may be the reason why both mortality and the incidence of hyponatremia were higher.

Disclosures
All authors: No reported disclosures.