bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Etiologies and Clinical Characteristics of Patients Hospitalized with an Acute Febrile Illness and Central Nervous System Sydromes in Indonesia
Authors: Aman Abu Tholib , Gasem Muhammad Hussein , Tjitra Emiliana , Alisjahbana Bachti , Kosasih Herman , Merati Ketut Tuti , Arif Mansyur , Karyana Muhammad , Sudarmono Pratiwi , Suharto Suharto , Lisdawati Vivi , Neal Aaron , Siddiqui Sophia 
Published: October 2017

Abstract

Background
Acute febrile illness is a common reason for hospitalization in many developing countries, including Indonesia. While patients can often be categorized and managed based on clinical presentations, diagnostic capacity in these countries remains limited, leading to poor patient outcomes. For patients with central nervous system (CNS) infections, identifying the underlying etiologies is particularly important to prevent lifelong neurological complications and death.

Methods
As part of a study conducted at 8 top-referral hospitals across Indonesia from 2013 to 2016, 114 of 1,486 enrolled subjects presented with an acute fever and a CNS syndrome. To identify the etiologies and clinical manifestations of these infections, as well as the management of febrile patients at the hospitals, demographic and clinical data were collected at enrollment, and blood samples were collected for diagnostic testing at enrollment, once during days 14–28, and at 3 months after enrollment.

Results
Subject ages ranged from 1 to 63.2 years old (median of 4.9 years old), and underlying diseases were reported in 35 (30.7%) subjects. Standard-of-care, molecular, and serological testing identified pathogens in 56 (49.1%) cases, as detailed in the table. Of the 19 subjects who died, 18 presented with decreased consciousness and 5 were infected with Rickettsia typhi, which was clinically misdiagnosed in each case.

Conclusion
The findings from this study will improve the diagnosis and treatment of patients presenting with CNS syndromes in Indonesia. Additionally, the discovery of misdiagnosed, fatal etiologies highlights the general need for greater diagnostic testing capacity to aid clinicians and inform public health policy makers.

Disclosures
All authors: No reported disclosures.
Long-term Outcomes of Acute Aseptic Encephalitis In Adults - a Single Center Study
Authors: Kusulja Marija , Santini Marija , Papic Neven 
Published: October 2017

Abstract

Background
Encephalitis is a heterogeneous syndrome associated with significant mortality and neurophysiological sequelae. The etiology is identified in only 20–50% of cases, and long-term outcomes of survivors are underinvestigated, especially in patients with unknown etiology. The aim of this study was to describe long-term outcomes of patients with aseptic encephalitis of various etiologies.

Methods
The study population consisted of a retrospectively identified cohort of consecutive adult patients diagnosed with viral and etiologically undiagnosed encephalitis during a 24-month period (2014-2015) at the University Hospital for Infectious Diseases Zagreb, Croatia. Clinical, laboratory data and short-term outcomes were collected from medical records, and long-term outcomes were assessed by telephone interviews and quantified through modified Rankin scores (mRS).

Results
A total of 90 patients were identified (57.7% female; 51.5 ± 17.4 years). Viral etiology was identified in 20 (22.2%) patients: herpes simplex virus (HSV-1, 8.9%), varicella-zoster virus (VZV, 6.7%), Tick-borne encephalitis (TBE, 4.4%) and enteroviruses (2.2%). Postinfectious meningoencephalitis was suspected in 14 (15.6%) patients, and 56 (62.2%) had unknown etiology. Elevated CSF WBC was present in 77 patients (mean of 169.3 ± 279.4/mm3) and all but 6 had elevated CSF proteins (1.23 ± 0.88 g/L). Convulsions occurred more frequently in HSV-1 (37.5%) and in unknown etiology group (15.7%). GOS&lt;3 was noted in 50% of HSV, 33% of VZV, 25% of TBE and 24% of unknown group patients during hospitalization. Mechanical ventilation was necessary in 17.1% of patients with unknown and 23.5% with viral etiology for the mean duration of 1.8 ± 6.7 and 3.2 ± 6.3 days, respectively. The mean length of stay was 23.2 ± 18.5 days. In-hospital mortality was 7.8%. Among 64 survivors who were available for follow-up interviews (mean follow-up of 28.6 ± 6.8 months), 73.1% with unknown and 90.9% with viral etiology had favorable outcomes (mRS 0–1); 4 (6.25%) had moderate (mRS 3) and 3 (4.6%) had severe neuropsychological deficits (mRS 4-5).

Conclusion
Although the etiology of aseptic encephalitis is often unknown, long-term outcomes are favorable in the majority of patients.

Disclosures
All authors: No reported disclosures.
Establishing Models of Herpes Simplex Virus Type 2 Superinfection of Herpes Simplex Virus Type 1 Seropositive Mice to Test The Efficacy of a Novel Vaccine
Authors: Ramsey Natalie , Jacobs William , Herold Betsy C 
Published: October 2017

Abstract

Background
Multiple subunit vaccines that elicit neutralizing antibodies (nAbs) against the immunodominant HSV-2 glycoproteins D and/or B (gD and gB) were advanced into the clinic after demonstrating protection against disease in animal models. However, although the vaccines elicited nAbs in seronegative and boosted nAb titers in HSV-1 seropositive (HSV-1+) participants, none prevented HSV-2 infection suggesting that nAbs alone are not sufficient. The results also indicate that current animal models are not predictive of clinical trial outcomes. We recently engineered a candidate single cycle vaccine strain deleted in gD (ΔgD-2) and showed that it elicits high titer non-neutralizing Abs that provide complete protection against HSV-1 or HSV-2. The Abs passively protect naïve mice and activate the Fc receptor to induce antibody-dependent cell mediated cytotoxicity (ADCC). We hypothesize that ΔgD-2 will protect HSV-1+ individuals from HSV-2 because it elicits a different type of immune response. To test this hypothesis, we established a model of HSV-2 superinfection in HSV-1+ mice.

Methods
We infected mice by corneal scarification with serial dilutions of a clinical strain of HSV-1 (Bx31.1) to identify a sublethal dose associated with seroconversion. We then superinfected mice on the skin with HSV-2 and monitored for disease. The presence of virus in dorsal root ganglia (DRG), the site of HSV latency, was determined by quantitative PCR.

Results
Corneal infection with 10^4 PFU of HSV-1 resulted in disease in 18/29 (62%) mice and 13/18 survived. Seroconversion was documented in 9/13 survivors. Surviving mice were superinfected 2 weeks post-recovery with HSV-2. All of the mice developed signs of disease, but only 2/9 who were HSV-1+ died compared with 4/4 seronegative mice (P = 0.02, Fisher exact test). HSV-2 DNA was detected in the DRG of 12/13 mice.

Conclusion
Sublethal HSV-1 corneal disease provides partial protection against HSV-2 superinfection and provides a model to test vaccine efficacy. We speculate that superinfection boosts preexisting nAb titers, a response consistent with immune repertoire freeze, but that ΔgD-2, because it elicits ADCC Abs, will overcome repertoire freeze and provide greater protection against HSV-2 superinfection.

Disclosures
W. Jacobs, X-vax: Grant Investigator, Research grant and Research support. B. C. Herold, X-vax: Grant Investigator, Research grant and Research support.
Study to Address Threats of Acute Respiratory Infections among Congregate Military Populations (ATARI)
Authors: Coles Christian , Chen Wei-Ju , Milzman Jacqueline Owens , Grigorenko Elena , Robinson Scott , Jones Carol , Moreno Nicole , Burgess Timothy , Malone Leslie 
Published: October 2017

Abstract

Background
More than 90% of active duty personnel receive influenza vaccinations yearly. Despite high coverage, influenza-like illnesses (ILI) remain a frequent cause of missed duty and hospitalizations, particularly in U.S. military recruits. More research is needed on the epidemiology and etiology of ILI to reduce the burden of respiratory infections in congregated military settings.

Methods
We conducted a prospective cohort study to assess ILI patterns among US Army recruits in a 9-week basic combat training course at Ft. Benning, GA. Demographic data, vaccination history, and information on recent illness were collected at enrollment in January 2017. Participants were divided into two platoons with staggered biweekly visit schedules. Visits occurred from reception through training, with nasal swabs and symptom surveys (all visits) and blood draws (weeks 8 and 9). Nasal specimens were used to detect clinical and colonizing pathogens using the Diatherix TEM-PCR Respiratory Panel.

Results
A total of 90 recruits were enrolled in the study. Twelve recruits were lost due to training attrition in the first week of the study. The participants were male and the mean age was 23 yo (SD 4.9). There were 10 (13%) cases of ILI reported among the 78 remaining participants, 6 in week 1, 3 in week 2 and 1 in week 9. The most frequently detected pathogens in the 10 symptomatic cases were coronavirus (5, 50%), rhinovirus (4, 40%), other enterovirus (3, 30%), and influenza A (2, 20%). Pathogen co-detections were common, 8 out 10 cases were associated with 2 pathogens, representing 7 unique combinations. While rhinovirus and coronavirus were most common among asymptomatic trainees, 10% had detectable influenza A. Detection of multiple pathogens was common in the first two weeks of training (50% among those who had viral detection). The study is still in progress.

Conclusion
Symptomatic ILI was associated with coronavirus, rhinovirus, and enterovirus, in addition to influenza in the early weeks of training. Coronavirus and rhinovirus also circulated widely among healthy recruits, along with influenza. The findings will inform ILI control strategies for congregated military trainees.

Disclosures
E. Grigorenko, Diatherix Laboratories: Employee, Salary.L. Malone, Diatherix Laboratories: Employee, Salary.
Human Coronavirus (HCoV) Infection Among Adults in Cleveland, Ohio: An Increasingly Recognized Respiratory Pathogen
Authors: Kanwar Anubhav , Selvaraju Suresh , Esper Frank 
Published: October 2017

Abstract

Background
Human Coronaviruses (CoV) have been long recognized as a common cause of respiratory tract disease including severe respiratory tract illness, yet there are few recent studies characterizing disease among adults in the United States. Here, we describe CoV infections and clinical characteristics among adults (&gt;18 years) presenting with respiratory illness in Cleveland, Ohio.

Methods
Between February 1, 2016 and April 30, 2017, 2949 nasopharyngeal swab specimens were analyzed by NxTAG Respiratory Pathogen Panel in adults presenting with respiratory illness at MetroHealth Medical Center. Clinical data were collected on adults whose samples screened positive for CoV-HKU1, CoV-OC43, CoV-229E or CoV-NL63.

Results
Coronaviruses were detected in 192 (6.5%) adults including 105 (3.5%) OC43, 67 (2.3%) 229E, 13 (0.4%) HKU1 and 7 (0.2%) NL63. The majority of adults with coronavirus infection were females (66.2%) with a median age of 53 years. Common comorbidities included smoking (40.0%), asthma (38.0%), COPD (35.4%), and inhaled corticosteroid use (28.6%). Eighty-five (46.4%) required admission to the hospital. Common presenting symptoms included shortness of breath (42.7%) and cough (31.0%) whereas fever was uncommon (12.5%). Gastrointestinal symptoms were more common in HKU1 and NL63 infected adults. Seventy-three percent of coronavirus disease occurred between the months of January and March. Despite the recognition of coronavirus infection, 70 (36.5%) received antibiotics for their disease.

Conclusion
This study provides needed insight into clinical characteristics and severity associated with coronavirus infection in adults. Coronavirus infection should be considered in differential diagnosis of respiratory tract illness in adults including those that require hospitalization, have a history of smoking and have pulmonary comorbidities.

Disclosures
All authors: No reported disclosures.
Active Surveillance to Quantify the Burden of Norovirus in a U.S. Veterans Affairs (VA) Patient Population, Houston, 2015–2016
Authors: Kambhampati Anita , Vargas Blanca , Mushtaq Mahwish , Browne Hannah , Perregaux Sara , Grytdal Scott , Atmar Robert L , Vinje Jan , Parashar Umesh D , Hall Aron J , Cardemil Cristina V , Lopman Benjamin , Rodriguez-Barradas Maria C 
Published: October 2017

Abstract

Background
Norovirus is the leading cause of acute gastroenteritis (AGE) outbreaks in the United States; however, little data exist on the burden of endemic norovirus disease among adults. Robust estimates of the norovirus disease burden among US adults are needed to inform assessment of potential norovirus vaccines, which are currently in development.

Methods
We conducted active surveillance for AGE at the Michael E. DeBakey Veteran’s Affairs (VA) Medical Center, where approximately 104,000 unique patients were served in 2016. Cases were defined as veterans with symptoms of AGE (≥3 loose stools, ≥2 vomiting episodes, or ≥1 episodes of both loose stool and vomiting, within 24 hours) occurring in the previous 10 days, who presented to the emergency department or outpatient clinics (outpatients), or were admitted to the hospital (inpatients). Patients without AGE symptoms in the prior 14 days were enrolled as controls. Demographic data and illness characteristics were collected from enrolled subjects, and stool samples were collected and tested using the FilmArray gastrointestinal panel. Norovirus positives were confirmed by real-time RT-PCR and genotyped after sequencing of conventional PCR products.

Results
From November 1, 2015–November 30, 2016, 130 inpatient and 85 outpatient AGE cases, along with 20 inpatient and 37 outpatient controls, were enrolled and provided a stool specimen. Among cases, 201 (93%) were male, and 94 (44%) were ≥65 years; median duration of illness was 3 days (range, 1–10 days). Norovirus was detected in 12 (9%) inpatient and 15 (18%) outpatient cases; norovirus was not detected in any controls. Incidence of norovirus-associated hospitalization was 15/100,000 population, and was similar in hospitalized cases aged &lt;65 years (14/100,000) and ≥65 years (15/100,000). Of 22 norovirus positive specimens genotyped, 13 (59%) were GII.4 Sydney.

Conclusion
This robust, active surveillance platform employed screening and enrollment of patients in a VA population meeting a standardized AGE case definition, as well as asymptomatic controls. Data from this study highlight the burden of norovirus in adults and importance of a norovirus vaccine.

Disclosures
R. L. Atmar, Takeda Vaccines, Inc.: Research Support, Research support. B. Lopman, HHS/NIH/NIAID: Grant Investigator, Grant recipient. Bill & Melinda Gates Foundation: Grant Investigator, Grant recipient.
Epidemiology and Clinical Outcomes of Respiratory Viral Infections at a Single Tertiary Centre in Alberta, Canada
Authors: Teale Alastair , Zapernick Lori , Taylor Geoffrey , Smith Stephanie 
Published: October 2017

Abstract

Background
Respiratory viral infections (RVI) are commonly seen in hospitalized patients. While many studies have examined outcomes with influenza, fewer studies have examined outcomes of community and hospital acquired infections of other respiratory viruses.

Methods
Data were prospectively collected from adult (age&gt;17 years) inpatients with a positive result from respiratory viral multiplex panel testing during consecutive viral respiratory seasons from November 2014 to April 2017 at our facility. Ambulatory patients were excluded. Clinical outcomes including ICU admission requiring intubation, overall mortality and respiratory virus infection-related mortality was assessed at 30 days post infection.

Results
A total of 731 inpatients with positive results were identified. Influenza A was the most commonly detected virus (44%) followed by respiratory syncytial virus (RSV)(14%) and rhinovirus/enterovirus (13%). Rates of RSV and human metapneumovirus infections displayed significant yearly variability. There were no significant differences in rates of ICU admission requiring intubation (16.8% vs. 14.3% P = 0.35) between infections caused by influenza A and B and other respiratory viruses. In addition, mortality related to respiratory infections between these groups was also similar (5.7% Influenza vs. 4.5% non-Influenza P = 0.46). Ninety-five (15%) of identified patients had hospital acquired respiratory viral infections. Influenza A was the most commonly isolated hospital acquired infection (39%). Rates of ICU admission requiring intubation (22.6% vs. 14.6%, P = 0.06) and respiratory infection-related mortality (7.4% vs. 4.8%, P = 0.14) were higher in hospital acquired RVI but did not meet statistical significance. Less than half (45%) of all patients testing positive for influenza received antiviral treatment (oseltamivir). Respiratory infection-related mortality was not significantly different between those who were treated and those who were not treated (5.5% vs. 4.4%, P = 0.64).

Conclusion
While influenza remains the most common community and hospital acquired respiratory viral infection in inpatients at our facility, half of infections were attributed to other respiratory viruses and these resulted in similar rates of serious outcomes including ICU admission and mortality.

Disclosures
All authors: No reported disclosures.
Factors for Hospitalizations and Neurologic Complications in Zika Virus Infection in the Department of Veterans Affairs (VA)
Authors: Schirmer Patricia , Wendelboe Aaron , Lucero-Obusan Cynthia , Ryono Russell , Oda Gina , Winters Mark , Saavedra Sonia , Martinez Mirsonia , Holodniy Mark 
Published: October 2017

Abstract

Background
Zika virus (ZIKV) is an important flavivirus, but severity of infection is poorly described in adults. We investigated factors associated with hospitalization and neurologic complications as measures of severity.

Methods
ZIKV cases from December 1, 2015 to October 31, 2016 were identified from clinical samples tested in VA, state and commercial laboratories, and patients were followed until 3/31/2017. ZIKV positive patients (RT-PCR or screening IgM positive confirmed by a plaque-reduction neutralization test [PRNT] IgM positive for ZIKV alone or including dengue virus) were reviewed for demographic and clinical factors. Logistic regression analysis was performed to evaluate factors associated with 1) hospitalization and 2) neurologic complications in VA ZIKV positive patients.

Results
736 of 1,538 (48%) patients tested were ZIKV positive; 655 (89%) were male and 683 (93%) were diagnosed at the VA Caribbean Healthcare System (VACHCS). In total, 94 (13%) were hospitalized with 91 (12%) at VACHCS. 19 (3%) patients, all at VACHCS, died from any cause after ZIKV diagnosis. Hospitalization was more likely with increased age, co-morbidities, neurologic symptoms, thrombocytopenia, or preadmission glucocorticoid use, and less likely if rash was present (Table 1). Hospitalization, prior cerebrovascular disease and dementia were associated with neurologic complications.

Conclusion
Older Veterans with multiple comorbidities or presenting with neurologic symptoms were more likely to be hospitalized after ZIKV infection, and those with a prior history of cerebrovascular disease and dementia were at increased risk for neurological complications.

Disclosures
All authors: No reported disclosures.
Clinical and Laboratoy Characteristics of Parvovirus B19 Infection During 2013/2014 Outbreak in Zagreb, Croatia
Authors: Ajdukovic Mia , Pejic Lucija , Papic Neven , Vince Adriana 
Published: October 2017

Abstract

Background
Human Parvovirus B19 (HPV-B19) occurs worldwide and causes mild, acute exanthematous disease that occurs in a form of cyclic local epidemics. The aim of this study was to analyze clinical features and complication rates of acute HPV-B19 infection in different age groups.

Methods
We retrospectively reviewed the charts of 718 consecutive patients clinicaly diagnosed with acute HPV-B19 infection who visited outpatient department at the University Hospital for Infectious Diseases in Zagreb, Croatia during 2013–2014 outbreak. In 212 patients (of 298 tested) diagnosis was confirmed by positive IgM antibodies and/or HPV-B19 DNA in peripheral blood.

Results
Outbreak started in June 2013 and had a peak in April 2014, with highest prevalence in schoolchildren. There were no difference in clinical presentation or laboratory findings between clinicaly and serologicaly diagnosed patients. Biphasic presentation, fever, myalgia, arthralgia, headache and peripheral edema were more frequent in adults, but „slapped cheeks” was found predominantly in children. Complications were more common in adults, most commonly hematological disordes (mild anemia, thrombocytopenia and leukopenia), vasculitis, hepatitis and aseptic meningitis. There were no deaths in our cohort.

Conclusion
Parvovirus B19 infection has different clinical presentation, laboratory findings and complications in children and adults. Since the diversity of the clinical manifestations in adults may be misleading, the infection in adults should be suspected when disease is prevalent in children.

Disclosures
`All authors: No reported disclosures.
Human Papillomavirus (HPV) Knowledge, Vaccine Acceptability and Acceptability of Text Message Reminders for Vaccine Doses in Adolescents Presenting to an Urban Emergency Department (ED)
Authors: Allison Waridibo E , Rubin Ada , Levine Deborah 
Published: October 2017

Abstract

Background
HPV vaccination has been shown to reduce the incidence of high grade cervical abnormalities in girls under 18 years old and the incidence of genital warts in young men and women under 21 years old. HPV vaccine uptake in the US is low. The 2012 National Immunization Survey–Teen indicated that of girls and boys aged 13–17 years, 33.4% and 6.8% respectively had completed the three dose HPV vaccine. It has been suggested that opportunities for HPV vaccination in less traditional health care settings and using reminder and recall systems may improve HPV vaccine uptake.

Methods
Adolescents aged 13–18 years old were recruited prospectively from two pediatric EDs in New York City. Recruited patients took part in a researcher-administered questionnaire based on the validated Carolina HPV Attitudes and Beliefs Scale. Demographic information was also collected. Patients were recruited between 8 am and 8 pm and approached consecutively within 4-hour time blocks. Standard descriptive statistics were used to summarize response data.

Results
Between September 21, 2016 and May 31, 2017, 117 adolescents were interviewed (70 females, 47 males). 76 (65%) had never had their parent or anyone else talk to them about the HPV vaccine. 71 (61%) of adolescents knew the HPV vaccine was not for girls only. 83 (71%) thought that the HPV vaccine was safe. Only 10 (8.5%) of participants thought they were too young to get the vaccine. 35 (30%) answered “yes” when asked if they had ever had sex but only 14 (12%) thought that the HPV vaccine was only for people who are sexually active. 83 (71%) of adolescents would agree, if their parent agreed, to have the HPV vaccine in the ED on the day they were interviewed. 104 (89%) of interviewed adolescents had a mobile phone and 88 (75%) stated they would have no problem with receiving a text message reminder for a vaccine shot.

Conclusion
Adolescents find it acceptable to receive HPV vaccination in these EDs and text message reminders for subsequent vaccine doses. Exploration of initial HPV vaccination of unvaccinated adolescents in the ED, with follow up doses in more traditional clinic settings aided by text message reminders warrants further investigation. Though a challenging care environment, the ED should not be ignored as a potential site for public health interventions such as HPV vaccination in adolescents.

Disclosures
All authors: No reported disclosures.