bluuebunny/crossref_metadata_2025_split huggingface dataset:
739. Middle East Respiratory Syndrome Coronavirus Infection Profile in Qatar: A 7-Year Retrospective Study
Authors: Elmaki Nada , Abid Fatma Ben , Farag Elmubasher , Alsoub Hussam , Ghazouani Hafedh Ghazouani , Saleh Mulham Mohed , Dousa Khalid M , Al-Khal Abdullatif , Hashim Samar Mahmoud A , Al- Maslamani Muna 
Published: November 2018

Abstract

Background
A deadly zoonotic Middle East respiratory syndrome coronavirus (MERS-CoV) had emerged over the last 7 years in the Arabian Peninsula. As of February 28, 2018, 2,182 cases of MERS-CoV infection (with 779 deaths) in 27 countries were reported to WHO worldwide. The objectives of this study were to identify the clinical and epidemiological characteristics of MERS-CoV infection as well as determine its clinical outcome.

Methods
This was a retrospective-observational study of all laboratory confirmed cases of MERS-CoV infection conducted at the main seven hospitals in the State of Qatar from January, 2012 to April 2018. We used the Fast Track diagnostics real-time reverse-transcription polymerase chain reaction (rRT-PCR), targeting the upE and ORF1a genes respectively. Demographics, clinical information, potential contacts and probable risk factors were collected and analyzed by standard statistical methods.

Results
The mean annual incidence was 1.7 per 100,0000 person-years. Among the 24 confirmed cases of of MERS-CoV, males constituted the vast majority of cases (23 males) with a median age of 52 years (range 22–74). Fifty percent of the cases were Qatari and 42% reside in the same region. 67% of the cases had contact with camels, and 21% had contact with MERS-CoV-infected patient. Thirty-eight had travel history within 2 weeks of symptoms onset to the Kingdom of Saudi Arabia. Fifty percent were smokers and 42% had comorbidities.
The median symptoms duration was 4.5 days. Most of the patient presented with flu-like symptoms, were fever was the most common presentation, followed by cough, SOB, diarrhea, abdominal pain and headache, 96%, 83%, 33%, 8%, 8% and 4%, respectively. All patients were admitted to a tertiary hospital with a median hospital stay 41 days (8–97). Forty-five percent patients developed severe sepsis with multi-organ failure and needed ICU admission. Fifty percent patients developed acute kidney injury, 29% patients were on hemodialysis and 16% needed extra-corporeal membrane oxygenation. Thirty-three percent patients died. The rest of patients had recovered from the infection and discharged home. Among those who died all had one or more comorbidities.

Conclusion
MERS-CoV infection is a rare infection in the State of Qatar, seen in both Qataris and expatriates with and without travel history. The infection in patients with comorbidities carries high mortality.

Disclosures
All authors: No reported disclosures.
741. Impact of Adenovirus Co-detections on Illness Severity
Authors: Probst Varvara , Piya Bhinnata , Stewart Laura , Gerber Susan , Rha Brian , Yu Joana , Das Suman , Campbell Angela P , Williams John V , Halasa Natasha B 
Published: November 2018

Abstract

Background
Human adenovirus (AdV) is a common pathogen among children with acute respiratory illnesses (ARI) and is often associated with co-detection with other respiratory viral pathogens. We sought to compare demographic and clinical characteristics in children with ARI who had single-AdV vs. AdV-co-detection with other viruses.

Methods
Children &lt;18 years with fever and/or ARI were enrolled in Vanderbilt Children’s Hospital inpatient setting from 2015 to 2018 and emergency department from 2016 to 2018. Interviews were conducted using standardized case report forms. Nose and throat swab specimens were collected and tested by RT-qPCR for common respiratory pathogens (AdV, RSV, HRV, hMPV, PIV1–4 and Influenza).

Results
Of 2,740 ARI cases, 174 were positive for AdV [88 (51%) single detection], with 53% male, 47% White, 36% Black, 30% Hispanic and median age of 17.2 months. Co-detected pathogens in AdV-positive specimens were RSV(15%), HRV(14%), influenza(5%), PIV1(1%), PIV2(0.6%), PIV3(1.7%), and PIV4(0.6%), hMPV(3%), &gt;1 co-pathogens(9%). Subjects with single-AdV detection were more likely to have an underlying medical condition (42% vs. 24%, P &lt; 0.05). Table 1 compares clinical presentation and severity of single-AdV and AdV-co-detection cases.

Conclusion
Patients with single-AdV detection were less likely to present with ARI symptoms and require oxygen, but were more likely to have underlying medical conditions compared with AdV-co-detection. Further studies to type AdV isolates will help elucidate the role of specific adenovirus types associated with co-detections and illness severity and inform epidemiological information for future vaccine initiatives.

Disclosures
J. V. Williams, Quidel: Board Member, Consulting fee. GlaxoSmithKline: Consultant, Consulting fee. N. B. Halasa, sanofi pasteur: Investigator, Research support. GSK: Consultant, Consulting fee. Moderna: Consultant, Consulting fee.
753. Screening for Latent Mycobacterium tuberculosis Infection (LTBI): A Clinical Conundrum of Public Health Concern
Authors: Bricker Lauren , Brock Jeff , Tippett Jan , Rice Casey , Wittmer Jason , Crippen Alicia , Vemuri Ravi 
Published: November 2018

Abstract

Background
Tumor necrosis factor (TNF)-α inhibitors increase the risk of reactivating LTBI, hence screening is crucial prior to starting therapy. There is a lack of evidence to support a preferred screening regimen in this population, and either tuberculin skin tests (TST) or interferon-γ release assays (IGRAs) are acceptable. Although difficult to assess, the sensitivity of IGRAs and TST are similar (80–95%), while IGRAs are considered to be more specific.

Methods
A 48-year-old White female in rural Iowa with a 30-year history of Crohn’s disease was evaluated for TNF inhibitor therapy. She had no known risk factors for LTBI and was screened using an IGRA which yielded an indeterminate result. A repeat IGRA and a two-step TST were both negative. Subsequently, adalimumab was initiated. Adalimumab was discontinued after 9 months due to progression of Crohn’s, and the patient underwent bowel surgery at a California hospital. Her course was complicated by bilateral pleural effusions requiring thoracentesis twice.

Results
The patient presented 1 month later with upper lobe infiltrative changes and mediastinal adenopathy. A third IGRA was performed and was non-reactive. A bronchoscopy with biopsy was then performed. The next day her dyspnea, cough and fevers worsened. She was admitted to an Iowa hospital where she was immediately put in airborne precautions. Her bronchoalveolar lavage acid-fast bacilli (AFB) smear was 4+, and an induced sputum showed 3+ AFB. Standard TB treatment was initiated. At least 59 patients (17 immunocompromised) and five employees in a private office and 13 employees at the Iowa hospital were exposed, in addition to an unknown number in California.

Conclusion
Although rare, there appears to be a risk for patients on TNF inhibitors who have multiple negative screening tests to become infected with TB. It is unclear whether this represents reactivation of undetected LTBI or new infection, although new TB cases are less likely in rural Iowa where the incidence is 1.53 per 100,000. Patients should be counseled to report any pulmonary symptoms to providers. As demonstrated by this case, airborne precautions should be implemented as soon as possible if clinical suspicion of TB is high despite negative screening tests to reduce exposure to others.

Disclosures
All authors: No reported disclosures.
757. Community Prevalence of Bacteriologically Confirmed Pulmonary Tuberculosis: A 7-Year Retrospective Study
Authors: Sethuraman Nandini , Thirunarayan M a , Subbulakshmi R , Lakshmisree V , Balasubramanian Udhaya 
Published: November 2018

Abstract

Background
It is estimated that about 40% of the Indian population is infected with Mycobacterium tuberculosis (TB), the vast majority of whom have latent TB. However, asymptomatic pulmonary carriage of the TB bacteria contributes to sustenance of the disease in the community and subsequent transmission. The present study was carried out to see the prevalence of culture positive pulmonary tuberculosis in apparently asymptomatic individuals from the community.

Methods
The study population consisted of individuals wishing to migrate to the USA/UK/Canada/Australia and submitting for the mandatory health check prior to obtaining the Visa. Chest X-ray was the initial screening test for diagnosis of tuberculosis. Individuals with any X-ray abnormalities were directed to submit three sputum samples for microscopy and culture which was done on automated culture systems (BacTALERT and MGIT). First-line drug susceptibility (INH, Rifampicin, Pyrazinamide, Ethambutol, Streptomycin) testing data were retrieved wherever available. Data were obtained for a period of 7 years from August 2010 to July 2017.

Results
A total of 140,499 individuals presented for the health check. Of these, 1,002 (0.7%) were further investigated using sputum microscopy and culture based on chest X-ray findings. Of these, 42 (0.4%) individuals were sputum culture positive for Mycobacterium tuberculosis. Except two, none had any respiratory complaints. Eleven (27.5%) of them were smear positive for acid fast bacilli. Most of the patients (30%) belonged to the age group of 18–25 years. Eighty-four percent had no prior history of tuberculosis or treatment for TB. Fifty-nine percent isolates were sensitive to all first-line drugs (Isoniazid, rifampicin, pyrazinamide, ethambutol and streptomycin). Twenty-seven percent were resistant to pyrazinamide alone. Fourteen percent were resistant to more than one first-line drug. There were no cases of multidrug resistance.

Conclusion
This is a unique large-scale study which assesses prevalence of culture positive pulmonary tuberculosis in the urban Indian community. It stresses the need for more stringent public health measures to curb transmission of the disease in such a high endemic region such as India.

Disclosures
All authors: No reported disclosures.
758. Tuberculosis Recurrence in New York City: A Retrospective Study
Authors: McPherson Tristan , Trieu Lisa , Meissner Jeanne Sullivan , Ahuja Shama , Burzynski Joseph 
Published: November 2018

Abstract

Background
Tuberculosis (TB) recurrence has been difficult to determine due to diverse definitions. Without knowledge of recurrence rates or associated risk factors, patients with highest likelihood of recurrence may not be identified, contributing to continued morbidity and disease transmission. We aimed to determine the recurrence rate for TB cases, associated clinical findings and patient characteristics.

Methods
We conducted a retrospective study evaluating 7,755 New York City TB cases from 2005 to 2014 for recurrence after appropriate treatment completion through 2017. Demographic, clinical, drug susceptibility testing (DST), and genotype data were collected during routine care. Adjusted odds ratios (aOR) were calculated to estimate associated risk factors for recurrence.

Results
A total of 73 cases were identified with ≥ one recurrence, a rate of 0.9%. Median time to recurrence after treatment was 516 days (IQR 165–1,256). In univariate analysis, pulmonary or combination of pulmonary and extrapulmonary disease, human immunodeficiency virus (HIV) infection, culture positive disease, alcohol abuse, intravenous drug use, and homelessness in the 12 months prior to diagnosis were associated with recurrence (P &lt; 0.05). In adjusted analysis, HIV infection (aOR 2.04 95% CI 1.13–3.67), pulmonary disease (aOR 9.03 95% CI 2.19–37.12), and having both pulmonary and extrapulmonary disease (aOR 17.19 95% CI 4.0–74.0) were independently associated with recurrence. Of 67 cases with positive culture and DST, 10 had additional drug resistance and 14 had new disease sites. Among 36 cases with complete genotyping information, data suggested relapse in 27 (75%) cases and re-infection in two (5.5%). Re-infection could not be ruled out in seven (19%) cases.

Conclusion
The recurrence rate for this period was lower than expected compared with other studies. HIV infection continues to be associated with recurrence despite availability of effective antiviral medication. Those with pulmonary or disseminated TB were more likely to have recurrence compared with only extrapulmonary TB. A notable number of recurrent cases demonstrated new drug resistance or disease manifestations, which should be considered in later treatment regimens and follow-up evaluation.

Disclosures
All authors: No reported disclosures.
760. The Diversity of Mycobacterium tuberculosis in India Is Underestimated and Underreported
Authors: Poonawala Husain , Verma Amit , Kumar Narender 
Published: November 2018

Abstract

Background
The seven lineages of Mycobacterium tuberculosis differ in virulence, transmissibility, drug resistance, and immune responses. We reviewed spoligotype data published from India to determine the distribution and diversity of TB lineages in India.

Methods
Spoligoytpe patterns were extracted from studies published from India and compared against the SpolSimilarity database to determine Spoligotype International Type (SIT) number, sub-lineage and lineage. Minimum spanning trees (MSTs) were created with Phyloviz.

Results
Thirty-four studies list 1,473 spoligotypes containing 8,242 isolates (Table 1), with 6,733 isolates belonging to 472 SITs. Of the remaining 1,001 patterns (1,509 isolates), 351 patterns (491 isolates) match orphans, while 650 patterns (1,018 isolates) are unreported; these 1,509 isolates could potentially form 532 new SITs and 469 orphans. The most common SITs are SIT11 (Lineage 1; 1,218 isolates, 14.78%), SIT26 (Lineage 3; 982,11.91%) and SIT1 (Lineage 2; 618, 7.5%). Figure 1 demonstrates regional differences in lineage distribution. Figure 2 is an MST of all isolates by lineage (“not assigned” are known SITs with no lineage and “unknowns” are previously unreported patterns). Figure 3 is an MST by superfamily, “others” referring to patterns with no known superfamily.

Conclusion
Lineages 1 and 3 dominate in India, in contrast to lineages 2 and 4 prevalent worldwide. The 1,473 SITs reflect the significant diversity of M. tuberculosis in India; the 1,001 orphan and previously unreported patterns suggest this diversity is underestimated. Understanding M. tuberculosis diversity is necessary for clinical and public health interventions to control India’s TB epidemic.

Disclosures
All authors: No reported disclosures.
762. Sex Differences in the Epidemiology of Tuberculosis in Tunisia
Authors: Jemaa Maissa Ben , Koubaa Makram , Ayed Houda Ben , Marrakchi Chakib , Trigui Maroua , Dammak Jamel , Jemaa Mounir Ben 
Published: November 2018

Abstract

Background
According to WHO, many more men than women are diagnosed with tuberculosis (TB) and die from it globally. In light of this fact, examining the gender differences among patients with TB is important to institute effective prevention, coverage and treatment. We aim to study sex differences in the epidemiology and clinical specificities of TB.

Methods
We conducted a retrospective study of patients with TB, of all ages between January 1995 and December 2016. Data were collected from the regional register of tuberculosis implanted at the anti tuberculosis center ATC of Sfax, Southern Sfax.

Results
We recorded 2,771 new cases of TB. Sex ratio was 1.2. Pulmonary Tuberculosis (PT) represented 40.5% of all cases of TB (n = 1,121) and was 2.5 times more frequent in men than women (50.3% vs. 28.7%; P &lt; 0.001). The sex ratio for extra-pulmonary tuberculosis (EPT) was 0.83. Lymph node and abdominal TB were significantly more frequent in women with respectively 52.5% (vs. 37.4%; P &lt; 0.001) and 12.6% (vs. 9.1%; P = 0.025). Pleural and urogenital TB were significantly more common in men (20.3% vs. 8.9%; P &lt; 0.001 and 13.4% vs. 9.8%; P = 0.023 respectively). We did not found any gender differences in other EPT forms. Between 1995 and 2016, overall TB (P = 0.001; rho = 0.64), EPT (P = 0.02; rho = 0.63) and PT (P = 0.03; rho = 0.46) cases were increasingly notified in women while they were stable in men. Death rates were significantly more important in men (3.5 vs. 2.1; P = 0.02). Women experienced recovery more frequently (89.2% vs. 86.7%; P = 0.04) and duration of treatment was significantly higher in women (9 months vs. 8 months; P &lt; 0.001).

Conclusion
Our study highlighted sex differences of TB in the region of Sfax with a higher burden and morbidity in men. National TB programs should actively focus in these results with more routine diagnostic and screening.

Disclosures
All authors: No reported disclosures.
769. An Outbreak of Multidrug-Resistant Tuberculosis, Minnesota 2016–2017
Authors: Desilva Malini , Moore Nora , Thai Dzung , Grimm Mary Beth , Sabuwala Nadya , Brueshaber Milayna , Gordon Sarah , Andersen Laura , Hall Victoria , Buuck Sean , Hickman Cynthia , Stinebaugh Katie , Silk Benjamin , Raz Kayla , Talarico Sarah , Wortham Jonathan , Kingdon Elisabeth , Pistulka Gina , Guerard Krissie , Cowan Lauren , Posey James E , Snippes Vagnone Paula M , McCullough Joel , Tsukayama Dean , Mody Rajal K , Ehresmann Kristen 
Published: November 2018

Abstract

Background
Multidrug-resistant tuberculosis (MDR TB) is more difficult to treat and outcomes are worse than for drug-susceptible TB disease. MDR TB cases in Minnesota increased from zero in 2015 to nine in 2016. Case investigations suggested an outbreak. We describe the public health response, challenges of contact investigations (CIs), and ongoing management of contacts.

Methods
CDC performed whole-genome sequencing (WGS) to evaluate relatedness of MDR TB isolates. We conducted CIs for infectious cases. We created outbreak specific guidelines for screening and management of contacts, and partnered with various agencies to increase MDR TB awareness.

Results
WGS results were consistent with an MDR TB outbreak that included 10 cases (70% pulmonary) as of April 2018. Limited provider awareness about TB contributed to delayed diagnoses. CIs identified 588 contacts; 8.7% (n = 51) of contacts had previously documented positive TB infection test results, and 14% (n = 74) were newly positive for TB infection (median age: 72 years). Eight cases were epidemiologically linked to one Hmong adult day center. Sixty-two contacts started a fluoroquinolone for latent MDR TB infection. Contacts who declined treatment began a 2-year clinical monitoring program.

Conclusion
In this outbreak, delayed diagnoses resulted in long infectious periods and hundreds of contacts. WGS results were consistent with recent transmission. We discovered adult day centers are an overlooked congregate setting. CIs were complicated by limited public health funding and high underlying TB infection prevalence in the affected community. Increased community and provider awareness and intensified screening of contacts resulted in additional case finding and prevention interventions.

Disclosures
All authors: No reported disclosures.
770. Multi-Drug-Resistant Tuberculosis Cases in Arkansas in 2017: A Tale of Two Threats
Authors: Weldon Emily , Patil Naveen , Voyles Jan , Chai Sandra , Majors Marsha , Mukasa Leonard 
Published: November 2018

Abstract

Background
Multi-drug-resistant tuberculosis (MDR-TB) is a threat to TB elimination strategies worldwide. From 1998 to 2016, six cases of MDR-TB were reported in Arkansas. In 2017 alone, three cases were detected. We sought to describe the characteristics of these cases to inform our MDR-TB prevention strategy in AR.

Methods
The surveillance database identified three MDR-TB cases in 2017. A detailed review was done to define the demographics, clinical presentation, and laboratory reports relating to drug susceptibility testing (DST), including molecular detection of drug resistance (MDDR). A search was done in the Genotyping database for genotype patterns of the patient isolates.

Results
All three cases were born outside the United States and developed active disease after arrival in AR. Case 1, age 52, was born in the Marshall Islands, arrived in 2016, and had a history of Type 2 diabetes. He developed MDR-TB in February 2017. Case 2, age 42, was born in Mexico, arrived over 20 years ago, and was HIV positive. He developed TB in July 2016 with a pan-sensitive organism and completed an intermittent treatment regimen. A second TB episode with matching genotype but different drug sensitivities occurred in April 2017, less than 4 months after treatment completion, and was considered treatment failure. Case 3, age 56, was born in the Philippines, arrived in 1990, and was reportedly treated for latent TB infection in 1993 with 6 months of isoniazid. She visited the Philippines April–May 2017 and developed MDR-TB in October 2017. Her isolate was in cluster with a case in Oklahoma who came from Mexico in 2006 and was admitted in an AR hospital with a pan-sensitive organism. There are no epidemiological links between the two cases; only one isolate in each case. Because both isolates were identified in AR State TB laboratory, a complex contamination has been considered with no definite resolution at this time.

Conclusion
MDR-TB, due to both primary and secondary drug resistance, remains a threat in AR. Cooperation and communication between all levels of healthcare are crucial to avoid delayed diagnosis of MDR-TB. Timely DST via technologies like GeneXpert and MDDR service at CDC is critical. Consultation from Centers of Excellence is vital in the treatment of MDR-TB complicated by diabetes and HIV. Whole-genome sequencing could provide clarity in the cluster with discordant DST patterns.

Disclosures
All authors: No reported disclosures.
771. Drug Resistance Tuberculosis (DR-TB), Comorbidities and Risk Factors Identified in a Prospective Multicenter Cohort Study in Indonesia
Authors: Burhan Erlina , Wibisono Banteng , Indah Retna , Sajinadiyasa Gede Ketut , Riyanto Bambang , Kusmiati Tutik , Susanto Nugroho 
Published: November 2018

Abstract

Background
The numbers of patients with drug resistance TB (DR-TB) increased annually by over 20% globally in the last decade. However, data on the prevalence of DR-TB in Indonesia are limited. The objective of this study to estimate the proportion of DR-TB in new and previously treated TB cases, and to identify comorbidities and risk factors.

Methods
This study has been conducted at seven hospitals throughout Indonesia since March 2017. Clinically TB patients ≥18-year-old were enrolled and followed until 6 months after treatment completed. Demography and clinical data were recorded; sputum, blood, urine, and PBMC were collected at several time points. AFB smear, sputum culture, Xpert MTB/RIF, and drug sensitivity tests were performed. Drug resistance TB is determined by Xpert MTB/RIF.

Results
Of 151 enrolled patients, 103 (68%) were confirmed M. tuberculosis by Xpert MTB/RIF, and 47 (46%) were confirmed rifampicin resistance. The distribution of DR-TB in each study site is shown in Figure 1. Among those with comorbidities (38%), comorbidity with diabetes (based on HbA1c level and diabetes history), HIV, and cancer was 9%, 26%, and 7%. Demography, nutrition status, contact and treatment history, and comorbidities are shown in Table 1. DR-TB primary infection contributes to 23% of DR-TB cases. Biomarkers that may predict treatment failure and TB-genotyping are underway.

Conclusion
The proportion of DR-TB in both new and previously treated patients in our cohort was significantly higher than the estimated number from the WHO and Ministry of Health. TB is a serious threat for public health and mitigation plan must be implemented at all levels.

Disclosures
All authors: No reported disclosures.