bluuebunny/crossref_metadata_2025_split huggingface dataset:
1327. The Diagnosis of Subarachnoid Neurocysticercosis Is Often Delayed And Other Findings of a Multicenter Retrospective in the USA
Authors: Guzmán Janitzio J , Herrick Jesica A , Hatlen Timothy , Weatherhead Jill E , Clark Eva , Serpa Jose , Chow Felicia , Allyn Paul R , Wald-Dickler Noah , Rodriguez Jorge M , Bowman Natalie M , Cervantes-Arslanian Anna , Coyle Christina , White A Clinton Clinton , Amusu Senate , Martin Dannae , Duffey Megan M , Larsen Travis , Welford Elliott M , Jenks Jeffrey D , Cowell Anne , Henao Martínez Andrés F , Franco-Paredes Carlos , Mathisen Glenn , Lichtenberger Paola , Bouzigard Rory , Castellino Laila M , O’Connell Elise M 
Published: November 2023

Abstract

Background
Subarachnoid (racemose) neurocysticercosis (SANCC) is an uncommon but severe form of Taenia solium infection. There is limited evidence to guide clinical management of these patients.

Methods
We performed a multicenter retrospective chart review of 15 U.S. sites. A total of 69 subjects with racemose disease were entered.

Results
The most common region of exposure was Mexico (67%) followed by Central America (24%). Median age was 43 years (range 15-76) and 71% were male. Common symptoms at the time of index admission were headache (80%), nausea/vomiting (46%), dizziness (44%), and blurry vision (33%). Cysts were intracranial in 64 (93%) subjects and exclusively intraspinal in 4. One patient had meningitis without visible cystic lesions. Incident admission magnetic resonance imaging (MRI) demonstrated ventriculomegaly in 41 (59%) and focal findings in 9 (13%) including ischemic infarct, subarachnoid hemorrhage, and/or arterial aneurysm. For 55 (80%), SANCC was first diagnosed during the index admission. Of these, 23 (42%) had prior medical visits and substantial delay in diagnosis (i.e. previously seen with hydrocephalus [27%], stroke [5.5%], and/or meningitis [11%], missed diagnostic radiologic features [4%], or inadequate imaging [5.5%]). Of the 69 subjects, 54% underwent a neurosurgical procedure during index admission (cyst removal n=16, EVD/shunt/ventriculostomy n=24). At the time of discharge, 6 (8.6%) patients were not given albendazole and/or praziquantel due to cost or availability. Six months following discharge, &lt; 10% of follow up MRIs demonstrated cyst resolution. Planned treatment course of &lt; 4 weeks at discharge compared to &gt;4 weeks was associated with increased risk for new cyst development on follow up imaging at a median of 3.8 years following discharge (range 2.6 months-8 years). Those with a delayed diagnosis received a significantly longer duration of corticosteroids (median 8 weeks) than those without a delay (median 5 weeks, p=0.047).

Conclusion
The diagnosis of SANCC is often missed, and most patients require neurosurgical intervention. Antiparasitic therapy is suboptimal, especially with regimens developed for parenchymal NCC.

Disclosures
Jeffrey D. Jenks, MD, MPH, Astellas: Grant/Research Support|F2G: Grant/Research Support|Pfizer: Grant/Research Support
1328. Human Parechovirus in Infants: A Case Series
Authors: Robles Tiffany , Gordji Roya , Downey Rachel , Hauger Sarmistha 
Published: November 2023

Abstract

Background
Human parechovirus (HPeV) is a common virus that causes a myriad of clinical presentations ranging from mild symptoms to severe disease. Signs of severe illness include sepsis, seizures, and meningoencephalitis as well as reports of abnormalities seen on brain imaging associated with neurodevelopmental or cognitive delay. Within the last year, there have been increased reports of severe HPeV in neonates.

Methods
This is a single-center, retrospective case series at a children's hospital in Central Texas. Inclusion criteria were patients from birth to 18 years with cerebrospinal (CSF) biofire positive for HPeV from 4/1/2016 to 2/28/2023. A comprehensive review of all CSF biofire tests in this interval was performed to identify the sample population.

Results
Seventeen children were identified and included in the study. Of these, 13 (76%) presented between 4/1/2022 to 6/30/2022. Laboratory findings included leukopenia in 87% of cases and unremarkable CSF in 94% of cases. Thirteen cases exhibited non-specific fussiness. Three infants had electroencephalogram (EEG) performed, for seizure-like activity or persistent fussiness, of which two had mild encephalopathy. While neither had CSF inflammation, brain magnetic resonance imaging (MRI) revealed areas of restricted diffusion. Repeat brain MRI 4 months from initial revealed resolution of restricted diffusion in both; one had sequelae of moderate volume loss.Figure 1:HPeV Frequency
Depicts the number of CSF biofire tests that resulted positive for HPeV by year. There were no cases in 2021 or in 2023 through 2/28/2023. A notable increase in frequency of HPeV is seen in 2022.Figure 2:Age at Presentation in Days
Depicts the age at presentation of each patient who tested positive for HPeV in CSF. The mean age at presentation was 26 days.Figure 3:White Blood Count of Patients with CSF Positive HPeV
Depicts the white blood count (WBC) of patients with positive HPeV on CSF biofire. Of note, two cases of positive HPeV were not included given WBC was not collected. The mean WBC was 6.2.

Conclusion
Our data parallel national trends of increased incidence of HPeV identified in 2022, with a cluster of 13 cases within a 3 month period. Cases were primarily neonates. The majority had non-specific fussiness, but there were cases of extensive neurologic involvement. CSF cell counts were relatively unremarkable, even in patients with encephalopathy. Generalized leukopenia was a common finding, thus may be an indicator of HPeV infection. Importantly, of the two infants with encephalopathy and changes on neuroimaging, one had imaging that remained persistently abnormal and clinically had mild delays in gross and fine motor functioning.

Disclosures
All Authors: No reported disclosures
1329. Clinical Profile and Outcomes of Adults with Meningitis: A Prospective Observational Study from India
Authors: Sukhadiya Pankaj , Gopalakrishnan Maya , Bohra Gopal Krishana , Shukla Kamlakant , Garg M K 
Published: November 2023

Abstract

Background
Meningitis is a highly fatal disease, causing 33,337 deaths/year in India, &gt; 50% of survivors develop sequelae -hearing loss, seizures, and cognitive impairment. Prior studies have been limited to pediatric populations or specific etiology. We explored the clinical profile, outcomes, and mortality risk factors in adult meningitis.Table 1:Previous studies on the prevalence and outcomes of meningitis in India

Methods
Clinically suspected meningitis defined as 2 of 3 features- fever, headache, and focal/global central nervous system (CNS) dysfunction presenting to our centre were included from Mar 21-Sept 22, after consent and ethics approval. Patients were classified as acute/subacute based on the duration of illness of ≤ or &gt; 5 days. Clinical details, Glasgow coma scale (GCS), cerebrospinal fluid parameters, and brain imaging were recorded. Modified Rankin Scale score (mRSS) was calculated at admission, discharge, and at 1 month. Multivariable regression analysis was done to identify mortality and morbidity risk factors.

Results
Of 209 patients enrolled, 154 were diagnosed with meningitis, (57% acute 43% subacute) with viral (40%), tubercular (TBM) (36%), bacterial (12%), and others (12%). Mean age was 48.2 ± 20.5y, male: female ratio 1.6, 24% had the classical triad of fever, headache, and neck stiffness. Abnormal brain imaging was reported in 77%- MRI (97.5%) and CT (60%). Mortality was 29% (n=44) and 30% within TBM. Medical Research Council grade was distributed as grade 3(48%), grade 2 (32%) and grade 1(20%) in TBM. At admission, 44% had mRSS 4 (highest). The highest score at discharge and 1 month were 1 (25%) and 0 (32%) respectively. 105 patients developed complications, 70% CNS, 4% only extra CNS and 26% both; most common being drug induced hepatitis in TBM (n=29). Multivariable regression showed GCS ≤ 10, focal neurological deficits, sepsis at admission, thrombocytopenia (≤ 1,00,000/uL) and HsCRP ≥ 45 mg/dL, were significant mortality predictors, whereas low GCS at presentation predicted morbidity.Figure 1:Frequency of etiology in meningitis patients (n=154)Figure 2:MRS Score at admission, on discharge and at 1 month follow up in meningitis patients (n=154)Table 2:Multivariable analysis: Mortality predictors in meningitis patients (n=154). OR - Odds Ratio CI - Confidence Interval

Conclusion
This is the first Indian study to explore the clinical profile and outcomes in adult meningitis. Viral meningitis was most frequent, while TBM had most fatalities. Our study shows that meningitis mortality is high even at tertiary care facilities in India. This highlights the need for reliable point of care diagnostics and better therapeutics.Table 3:Mortality in enrolled patients with meningitis (n=154)Table 4:Frequency of complications within different meningitis etiologies (n=154)

Disclosures
All Authors: No reported disclosures
1333. Analysis of the Clinical Utility of the Filmarray Meningitis-Encephalitis Panel using a Threshold Cerebrospinal Fluid White Blood Cell Count of &gt; 50
Authors: Webster William , Palavecino Elizabeth , DeWitt Michael E 
Published: November 2023

Abstract

Background
Current diagnostics for meningoencephalitis pose a risk for suboptimal performance characteristics, with a current equipoise surrounding parameters that influence clinical utility of the BioFire FilmArray Meningitis Encephalitis Panel (MEP). The goal of this study is to examine the clinical utility of the MEP when using a cerebrospinal fluid white blood cell count (CSF WBC) threshold of &gt; 50.

Methods
All MEPs performed at Wake Forest Baptist Hospital from March 2016 to September 2022 were retrospectively analyzed to assess clinical utility of the threshold of CSF WBC &gt; 50. The independent variable was CSF WBC greater or less than 50, with the dependent variable being clinical utility, deemed by the investigator. Logistic regression was performed to assess association of CSF WBC with clinical utility. In a secondary analysis, we repeated the regression using CSF WBC as a continuous predictor.

Results
A total of 522 MEPs were analyzed, with 113 (22%) positive and 409 (78%) negative. Positive MEPs were predominantly viruses (65%) followed by bacteria (25%) and fungi (10%). Enterovirus was the most common pathogen detected in 24 (21%) MEPs, seen in Table 1. Among positive MEPs, characteristics associated with high utility were elevated CSF WBC (p=0.038) and older age (p=0.05). Among all MEPs, high utility was seen with increased CSF WBC &gt; 50 (p&lt; 0.001) and positive cultures (p&lt; 0.001). Post hoc analysis of all MEPs revealed a specificity of 0.45, sensitivity of 0.94, PPV of 0.94, and NPV of 0.45 when using culture as the gold standard for bacteria or fungi. 23 (5%) samples were MEP positive and culture negative. Of these, 11 (48%) were MEP positive for Streptococcus pneumoniae. Among positive MEPs, 17 (15%) had WBC &lt; 50. CSF WBC &gt; 50 was associated with high utility with an odds ratio of 16.1 (p&lt; 0.001, CI 9.68-28.1). When treating CSF WBC as a continuous variable, logistic regression revealed a 25% chance that the MEP would have high utility at this threshold, increasing to 50% at a CSF WBC &gt; 310 (Figure 1).
Baseline Characteristics
Table 1
Probability of Clinical Utility as a Function of CSF WBC

Figure 1

Conclusion
Among MEPs ordered for suspicion of meningoencephalitis, the threshold of a CSF WBC &gt; 50 was associated with high utility. Using this threshold to influence pre-test probability may serve as an important parameter to decrease false positive results of the MEP for diagnosis of meningoencephalitis.

Disclosures
All Authors: No reported disclosures
1336. Presence of Antibodies to non-SARS-CoV-2 Associates With Generation of Neutralizing Antibodies to SARS-CoV-2 Following mRNA Vaccination
Authors: Al Hammoud Roukaya , Del Bianco Gabriela P , Somasunderam Anoma , Hernandez Stacy Gomez , Riggs Kaleigh , Hashmi Syed , Murphy James , Heresi Gloria 
Published: November 2023

Abstract

Background
The immunological interplay between SARS-CoV-2 immunization, SARS-CoV-2 infection, and exposure to other human coronaviruses is poorly understood. Therefore, we evaluated the relationship of the humoral immune responses to SARS-CoV-2 and selected other human coronaviruses (HCoVs).

Methods
We enrolled 42 healthcare workers (HCWs) in a Pediatric Department at a medical school in Houston, Texas, during a Delta variant dominance period (2021) of the SARS-CoV-2 pandemic. All had two immunizations with mRNA SARS-CoV-2 vaccines at a median of 7.4 months before sample collection. Using multiplex assays, we tested binding antibodies (Ab) and neutralizing antibodies (NAb) to SARS-CoV-2 and Ab responses to selected non-SARS-CoV-2 HCoVs.

Results
100% had Ab to all components of a SARS-CoV-2 screening panel that comprised receptor-binding protein (RBD), spike 1 (S1), and spike 2 (S2). 13 out of 42 (31%) had Ab to nucleocapsid antigen (N) suggesting previous coronavirus infection of whom 7 (53%) reported a previous PCR-confirmed SARS-CoV-2 infection and had significantly higher Ab response to each of the four screening antigens. (Table 1) Although all volunteers had notable levels of SARS-CoV-2 specific Abs, only 42% had NAb to SARS-CoV-2. Notable findings for volunteers with NAb included a high frequency of NAb to Wild Type (100%), Alpha (72%) and Delta variants (72%). More mRNA-1273 (Moderna) recipients (61%) had NAb than BTN162b2 (Pfizer) (25%) (p-value: 0.041).
83% of volunteers had detectable Ab to at least one of HCoVs. Ab to SARS-CoV-1 is strongly associated with a positive NAb response to SARS-CoV-2 (44% versus 0, p-value 0.001).
Table 1
Demographic and serological profile
Table 2
Comparison between participants with Neutralizing Ab response and those without

Conclusion
Generation of SARS-CoV-2 NAb following mRNA vaccination of HCWs is strongly associated with the presence of Ab to SARS-CoV-1. The source of SARS-CoV-1 Ab in our population is unknown. The nearly 20% prevalence of SARS-CoV-1 Ab exceeds the known prevalence of SARS-CoV-1 infection. There is may be a neutralization relevant shared immunogen between SARS-CoV-1 and SARS-CoV-2.

Disclosures
All Authors: No reported disclosures
1338. Changes in Volume and Diagnoses in a Pediatric Emergency Department during the COVID-19 Pandemic in Northeast Mexico
Authors: Murillo Paulina Blanco , Tamez-Rivera Oscar , Pineda-Magaña Rommy E , Escobedo-Berumen Lucia , Estrada-Mendizabal Ricardo J , Madrazo-Aguirre Katheryne P , Ruelas-Martinez Manuel , Garcia-Lima Maria Guadalupe 
Published: November 2023

Abstract

Background
During the first months of the COVID-19 pandemic, a reduction in the volume of patients who sought care in pediatric emergency departments (ED) was observed. An apparent change in discharge diagnoses was also witnessed. There is scarce evidence about the impact of the pandemic on pediatric emergency departments in Mexico and Latin America.

Methods
We conducted a retrospective observational study at a tertiary care hospital in Mexico. We compared the volume and discharge diagnoses of patients aged 0-16 years admitted to the ED during the COVID-19 pandemic from Dec 2020 to Feb 2021 and during the same 3 months in the previous year (Dec 2019 to Feb 2020). As a secondary objective, we compared the subjects’ demographic characteristics and comorbidities. Chi-square test was performed to compare proportions and Student’s t test to compare the median age of patients between the two periods.

Results
In the pre-pandemic period (Dec 2019 to Feb 2020) there were 1,686 admissions to the ED, compared to 941 during the pandemic period (Dec 2020 to Feb 2021). This represented a 44.1% decrease in pediatric admissions to the ED. Median age in months was higher during the pandemic period (50.8) compared to the previous year (69.8) (Table 1). There was a significant increase in the percentage of patients who had a positive history of comorbidities. The percentage of infectious and respiratory diseases significantly declined during the pandemic period, particularly pneumonia (13.1% vs. 1.9%), bronchiolitis (10.7% vs. 1.3%), and rhinopharyngitis (4.1% vs. 1.3%) (Table 2). There was also an increase in intoxication cases (1.7% vs. 3.4%) and accidents (6.6% vs. 14.7%). The percentage of neonatal, surgical, neurological, rheumatological, and gastrointestinal diseases also increased during the pandemic period.

Conclusion
There was a substantial decrease in the total volume of patients as well as a significant change in discharge diagnoses between the pre-pandemic and pandemic studied periods. This study adds to the scarcity of literature available about the impact of COVID-19 on pediatric EDs in Mexico and Latin America. Further studies regarding medical attention-seeking behavior during the pandemic are crucial to planning for the allocation of health resources in case of future health emergencies.

Disclosures
All Authors: No reported disclosures
1349. Unveiling the Link between COVID-19 and the Gut Microbiome in an Outpatient Cohort with Mild to Moderate Illness
Authors: Comba Isin Y , Mars Ruben A , Dumais Mitchell , Van Gorp Trena , Harrington Jonathan , O’Horo John C , Kashyap Purna C 
Published: November 2023

Abstract

Background
As the acute phase of the COVID-19 pandemic subsides, an increasing number of individuals are recognized as having long COVID, affecting over 65 million people worldwide. Recent studies have suggested a potential link between long COVID and alterations in the gut microbiome. In this study, we examined the gut microbiome of a large outpatient cohort during acute phase of infection, with the ultimate goal of determining predictors of long-term COVID-19 health outcomes.

Methods
We conducted a study of 394 COVID-19 patients with positive SARS-CoV-2 testing from November 2020 to September 2021 at a multi-site healthcare system. Long COVID was defined as the persistence of symptoms for four weeks or more after illness onset. DNA extraction was performed using the MoBio PowerSoil Pro DNA isolation kit. Samples were sequenced using shotgun metagenomics. Stool SARS-CoV-2 RNA was tested using qRT-PCR of the E gene, and stool ELISA was performed for calprotectin levels. Standard biostatistical tools in R (v 4.2.3) were used for statistical analysis.

Results
Of the 394 COVID-19 patients, 84 (21%) had long COVID, with fatigue being the most common persistent symptom (Table 1). No significant differences were seen in age, BMI, and antibiotic use. Those with long COVID were more likely to be female, had higher Charlson's comorbidity scores, more severe index illnesses. However, the two groups had no difference in SARS-CoV-2 stool PCR positivity or stool calprotectin levels (Table 2). Principal coordinate analysis of Bray Curtis dissimilarities revealed that patients with long COVID had a distinct microbial composition compared with those without long COVID during the acute phase of infection (ANOSIM R2= 0.005, P= 0.01). Categorizing patients by number of long COVID symptoms showed significant differences among groups (ANOSIM R2=0.1, P=0.007), mainly between patients with &gt;3 symptoms and those with 0-1 symptoms (Bonferroni, P= 0.018). Alpha diversity was lower in patients with &gt; 3 symptoms, although this was not statistically significant (Shannon diversity, two-way-ANOVA, P=0.051).

Figure 1

Conclusion
Long COVID patients show distinct gut microbial composition during the acute phase of infection, suggesting a potential role in predicting long-term COVID health outcomes.

Disclosures
John C. O'Horo, Sr., MD, MPH, Janssen Pharmaceuticals.: Grant/Research Support|nference: Grant/Research Support Purna C. Kashyap, MD, Intrinsic Medicine: Advisor/Consultant|Novome Biotechnologies: Advisor/Consultant|Pendulum Therapeutics: Advisor/Consultant
1350. Solid Organ Transplantation From COVID Positive Donors: Trends in Utilization, Discard & Long-term Outcomes in the United States
Authors: Dhand Abhay , Okumura Kenji , Ohira Suguru , Lansman Steven , Nishida Seigo 
Published: November 2023

Abstract

Background
Transplantation of organs from COVID positive (COVID+) donors is increasing. The aim of this study was to assess the trends in utilization, discard, and longer-term outcomes in solid organ transplant (SOT) recipients who received organs from COVID+ donors in the United States (US).

Methods
Rates of utilization, discard, and outcomes of SOT from deceased donors with a positive COVID PCR test from respiratory tract between March 2020 and December 2022 were analyzed using the de-identified United Network for Organ Sharing (UNOS) database.

Results
During the study period, 1185 COVID+ donors led to the transplantation of 1249 kidneys, 592 livers, and 168 hearts.
The center-wise acceptance rate for organs from COVID+ donors increased from 2021 to 2022: heart from 31% to 73%, kidney from 53% to 88%, and liver from 53% to 89%.
Discard rates of kidneys from COVID+ donors remained high: left kidney- 29%, right kidney- 32% and were significantly higher than kidney discard rates for COVID negative (COVID-) donors (p &lt; 0.001)
When compared to COVID- donors, COVID+ donors were younger and had a lower median Kidney Donor Profile Index (0.51 vs. 0.54, p = .004), lower median serum creatinine (0.9 vs. 1.05 mg/dl, p&lt; 0.001), similar median serum total bilirubin (0.6 mg/dl, p = .15), and similar left ventricular ejection fraction (60%, p = .84). Six months, one-year and 18-month overall and graft survival were comparable between recipients of COVID+ and COVID- donors (table 1) (figures 1).Table 1:Characteristics and outcomes of solid organ transplantation from COVID+ and COVID- donors
Graft Survival: COVID+ vs. COVID- donors

Conclusion
Utilization of organs from COVID+ donors has improved across various transplant centers in the US. Kidney discard rate from COVID+ donors remain high. Longer-term outcomes of SOT from COVID+ donors are encouraging and are helping to successfully expand the donor pool.

Disclosures
All Authors: No reported disclosures