bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-123. Unlocking Synergy: Exploring Combination Therapies in Whipple's Disease for Enhanced Clinical Efficacy
Authors: Ghneim Hiyam , Haj Ebrahimi Hashem , Charles Reema , Farid Tahsin 
Published: January 2025

Abstract

Background
Whipple's disease (WD) is a rare chronic multisystemic infection that primarily affects the gastrointestinal tract. There are no FDA-approved treatments for WD. Standard treatment involves prolonged antibiotic regimens that can be controversial, especially in cases of relapse or neurological involvement. This study uses CURE ID, an online case reporting platform, to investigate WD cases in the literature, analyze combination therapies currently being used, and identify strategies that improve patient outcomes.Figure 1:Geographic Distribution of Whipple’s Disease Cases

Methods
We identified WD cases on PubMed and Embase reported between 2019-2024 using relevant keywords, MeSH terms, and Emtree terms. Rayyan.ai was used to screen articles following a PRISMA protocol. Out of 271 identified cases, 84 met inclusion criteria. They were added to CURE ID via the case report form. The aggregated WD data was then analyzed.Figure 2:Age Distribution of Whipple’s Disease Patients

Results
74/84 patients improved or recovered (Table1). Figure 1 displays that most cases originated in Europe and North America, followed by a minority in Asia and South America. WD predominantly occurred in males (61/84) and most cases occurred in middle-aged patients (Figure 2). Most cases were associated with favorable outcomes (Table 1). As shown in Figure 3, the most used antibiotic combination was ceftriaxone and TMP-SMX and was associated with the best outcome followed by doxycycline and hydroxychloroquine. Corticosteroids were added in 4 patients to prevent the formation of Immune Reconstitution Inflammatory Syndrome (IRIS), and all cases were associated with a positive result.Figure 3:Outcome of the most frequently used treatment regimens

Conclusion
There appears to be a geographic clustering of WD cases as well as higher incidence in males. This needs to be investigated further for explanations for this correlation. It was noted that the majority of the cases occurred in immunocompromised patients. We aim to investigate this further in a full manuscript. The standard treatment of WD is using combination therapy with ceftriaxone and TMP-SMX and this was associated with favorable outcomes. Interestingly, the combination of doxycycline and hydroxychloroquine also emerged as a successful alternative in cases where the preferred combination was not tolerated or failed. We aim to further explore the mechanism of this combination and establish it as a standard alternative regimen.Table 1:Composite table of patient outcomes and frequency of drugs used.

Disclosures
All Authors: No reported disclosures
P-144. The Introduction of Antimicrobial Prescription Guidance and Patient Education for a Medical Brigade to Honduras
Authors: Anderson Moira , Zerbini Gabriella , Abdallah Danielle G , James Amy M 
Published: January 2025

Abstract

Background
Antimicrobial resistance is a global problem that requires active interventions to combat. Misusage of antimicrobials contributes to the development of multi-drug resistant organisms that can be fatal. Many can be purchased over the counter in countries outside of the US, and medical brigades often provide a source of these drugs. PODEMOS is a medical brigade partnered with The Ohio State University College of Medicine and travels to Honduras twice yearly. Since this brigade prescribes antimicrobials for a variety of disease states, this project aimed to create guidelines on antimicrobial usage and community education materials to ensure that PODEMOS is not contributing to further resistance.
Patient Education Antimicrobial Resistance
This flyer was distributed to patients on the PODEMOS medical brigade to educate the community on antimicrobial resistance.

Methods
First, current literature on antimicrobial resistance was reviewed to understand the scope of the problem in Central America. Data was collected on antimicrobial consumption and community education within Honduras and surrounding area. Secondly, common infectious diseases encountered during the PODEMOS medical brigades were identified and the current drug formulary was reviewed in comparison to current treatment guidelines on UpToDate.
Medical Brigade Treatment Guidelines
The image shows a portion of the guidelines that were created for PODEMOS medical brigades, with this example being for upper respiratory infections.

Results
Results of our initial literature review indicated that there is no current standard of tracking antimicrobial usage in Honduras. There is also limited awareness and education on antimicrobial resistance. There were 16 common infectious disease states encountered on PODEMOS brigades which were used as basis for creating guidelines for students and providers on future brigades. These included information on clinical diagnosis, treatment protocols, and medication safety. Also, the drug formulary for PODEMOS was updated to include two antimicrobials that will lessen contribution to drug resistance. Lastly, a flyer was created with information to educate the community on antimicrobial resistance.

Conclusion
Guidance for the proper usage of antimicrobials is paramount in combating drug resistance. By creating treatment protocols and patient education materials, this project aimed to prevent contribution to antimicrobial resistance and improve the care of patients on future PODEMOS medical brigades. Prospectively, data will be collected on usage of these guidelines and patient understanding of antimicrobial resistance.

Disclosures
All Authors: No reported disclosures
P-156. Global burden of mortality and antimicrobial resistance of pathogens associated with peritoneal and intraabdominal infection in 2019: A Benchmarking Global Analysis
Authors: Hirapara Ishita , Enemuo Nkechi , Vala Lovekumar , Maddineni Kavya , Nandania Parthkumar , Markandu Keethanshan , Modi Dhruvi , Dineshbhai Desai Hardik 
Published: January 2025

Abstract

Background
Peritoneal and abdominal infections (PAI) are among the most serious complications in the clinical setting, often leading to significant morbidity and mortality worldwide. These infections, which can stem from a variety of pathogens, are further complicated by the increasing threat of antimicrobial resistance (AMR).
Deaths per 100k both associated with and attributable to bacterial antimicrobial resistance by pathogen Peritoneal & abdominal infection, Global, Age-standardized, Both sexes, 2019

Methods
Using Global Burden of Disease (GBD) AMR 2019 methodology, we estimated the number of deaths and the disability-adjusted life years (DALYs) globally attributable to and associated with AMR of pathogens associated with PAI in 2019.
DALYs per 100k both associated with and attributable to bacterial antimicrobial resistance by pathogen Peritoneal & abdominal infection, Global, Age-standardized, Both sexes, 2019

Results
The data reveals that in 2019, E. coli was the leading cause of AMR-associated deaths in the context of PAI, with an estimated 289,206 deaths (95% uncertainty interval [UI]: 187,670-423,363), followed by S. aureus with 169,222 deaths (95% UI: 105,231-252,817). Among the countries studied, Romania reported the highest mortality rate from E. coli associated with PAI at 8.45 per 100,000 population, followed closely by Bulgaria at 7.99, while the United States recorded a lower rate of 5.17. Additionally, the highest number of deaths linked to AMR overall was observed with E. coli (252,952 deaths), followed by K. pneumoniae (123,158), S. aureus (115,616), and E. faecium (107,226) in 2019.
Total DALYs per 100k by pathogen Peritoneal & abdominal infection, Global, Age-standardized, Both sexes, 2019

Conclusion
The findings of this study underscore the urgent need for enhanced public health measures to combat the escalating threat of antimicrobial resistance (AMR) associated with peritoneal and abdominal infections. Public health stakeholders must prioritize the development and implementation of robust surveillance systems, promote rational use of antibiotics, and invest in research to discover new antimicrobial agents. From a clinician's perspective, there is a critical need for adherence to stringent infection control practices, timely and accurate diagnosis, and tailored treatment strategies to effectively manage these infections and mitigate the burden of AMR. Together, these actions are essential for improving patient outcomes and curbing the global rise in antibiotic-resistant pathogens.
Total deaths per 100k by pathogen Peritoneal & abdominal infection, Global, Age-standardized, Both sexes, 2019

Disclosures
All Authors: No reported disclosures
P-163. Efficacy of Wolbachia-mediated sterility to suppress dengue
Authors: Tao Lim Jue 
Published: January 2025

Abstract

Background
Vector control remains the primary means to mitigate the spread of dengue. Matings between male Aedes aegypti mosquitoes infected with the wAlbB strain of Wolbachia and wildtype females yield non-viable eggs (Wolbachia-Aedes). We evaluated the efficacy of Wolbachia-Aedes to suppress dengue incidence. We present data comprising a field trial of 607,872 residents over 5 years.

Methods
We utilized the synthetic control method and trial emulation approach to evaluate large-scale field trials in Singapore involving the deployment of Wolbachia-Aedes for dengue control via vector population suppression, from epidemiological week (EW) 27, 2018, to EW 26, 2022. We selected two large towns (Yishun and Tampines) to adopt an expanding release strategy and two smaller towns (Bukit Batok and Choa Chu Kang) to adopt a targeted-release approach. All intervention and control locations practised the same baseline dengue control protocol. The main outcome was weekly dengue incidence rate caused by any dengue virus serotype (in the case of the synthetic control method) and risk of being test positive for dengue (when using the trial emulation approach). We used incidence data collected by the Singapore Ministry of Health as well as a nationally representative dengue test positive/negative database to assess the efficacy of the interventions, To compare interventions, we used the synthetic control method or constrained randomization protocols to generate appropriate counterfactuals for the intervention towns selected from a combination of 30 control towns from EW 1, 2014 to EW 26, 2022.

Results
Our study comprised an at-risk population of 607 872 individuals living in intervention sites and 3 894 544 individuals living in control sites. Interventions demonstrated up to 77⋅28% (121/156, 95% CI 75⋅81–78⋅58) intervention efficacy despite incomplete coverage across all towns. Intervention efficacies increased as release coverage increased across all intervention sites. Secondary analysis showed that these intervention effects were replicated across all age groups and both sexes for intervention sites.

Conclusion
Wolbachia-mediated incompatible insect technique can strengthen dengue control in tropical cities, where dengue burden is the greatest.

Disclosures
All Authors: No reported disclosures
P-164. Comparing long-term cardiovascular, neuropsychiatric, and autoimmune complications following dengue infection versus SARS-CoV-2 infection
Authors: Tao Lim Jue 
Published: January 2025

Abstract

Background
While persistence of chronic symptoms following dengue infection has been documented in small prospective cohorts, population-based studies are limited. The post-acute risk of new-incident multi-systemic complications following dengue infection was evaluated and contrasted against that following SARS-CoV-2 infection in a multi-ethnic adult Asian population

Methods
National testing and healthcare claims databases in Singapore were utilised to build a retrospective population-based adult cohort with laboratory-confirmed infection during overlapping waves of SARS-CoV-2 and dengue transmission (1 Jul 2021-31 Oct 2022). Risks of new-incident cardiovascular/neuropsychiatric/autoimmune complications 31-300 days post-dengue infection, contrasted with SARS-CoV-2 infection were estimated using Cox regression with overlap weights. Risks were reported in terms of adjusted-hazard-ratio (aHR) and excess-burden (EB) per-1000-persons.

Results
11,960 dengue-infected individuals and 1,265,329 contemporaneous COVID-19 cases were included; the majority had mild initial infection not requiring hospitalisation. Amongst dengue-infected individuals, there was 50% (aHR=1.50 [1.25–1.81]) increased risk of any sequelae (EB=1.51[1.40-4.42]), with 90% (aHR=1.90 [1.44–2.52]) increased risk of cardiovascular sequelae (EB=1.64[0.09-3.37]). Specifically, increased risk of ischemic-heart-disease (aHR=1.88[1.31-2.70]), other cardiac disorders (aHR=2.87[1.74-4.74]) and thrombotic disorders (aHR=4.56[2.37-8.75]) was noted. Elevated risk of individual neurological sequelae, including cerebrovascular disorders (aHR=2.05[1.29-3.25]) and cognition/memory disorders (aHR=2.31[1.40-3.84]) was observed in dengue-infected individuals compared to COVID-19 cases. Elevated risks of post-acute sequelae in dengue survivors were observed when contrasted against COVID-19 survivors infected during Delta/Omicron predominance, as well as across vaccination strata.

Conclusion
Increased risk of post-acute cardiovascular/neurological complications was observed in dengue survivors, when contrasted against COVID-19 survivors infected during Delta/Omicron predominance.

Disclosures
All Authors: No reported disclosures
P-174. Burden, Epidemiology, and Clinical Characteristics of Leptospirosis within the Military Health System
Authors: Graf Patrick J , Chu Xiuping , Davies Julian , Hickey Patrick , Blyth Dana M 
Published: January 2025

Abstract

Background
Leptospirosis (Lepto) remains underreported due to diagnostic limitations. Military personnel are considered high risk due to deployments in endemic locations and exposure in contaminated training sites. We analyzed the frequency, epidemiology, and clinical characteristics of lepto diagnoses in the Military Health System (MHS).Figure 1Leptospirosis Lab and Clinical Case Definitions and Criteria

Methods
Potential MHS lepto diagnoses were identified by lepto-specific ICD-9/10 codes or positive lepto laboratory tests between 1/1/2013-1/1/2022. Potential cases underwent chart review, were classified per CDC case definitions (Figure 1), and compared for clinical and lab findings.Figure 2Flowchart for Identification of Leptospirosis Cases

Results
Of 297 identified potential lepto cases, there were 11 confirmed, 134 probable, and 53 possible cases on chart review (Figure 2) of whom 77% (153/198) were hospitalized and one died (Table 1). Cases were confirmed via microscopic agglutination test (MAT, 6/11), blood culture (3/11), MAT and blood culture (1/11), and urine PCR (1/11) (Table 2). Of cases with demographic data, 89% were male (176/197) and 82% (162/197) were service members, with 16% (31/197) retired, dependents, or civilians. Of those with documented exposures, 52% (88/169) were recreational, and an additional 5 cases non-occupational (cumulatively 55%, 93/169). Fresh water exposures were common and more likely in confirmed/probable cases, with 67 associated with jungle warfare training in Okinawa. Of note, 44% of all cases (87/198) were diagnosed in those living in endemic areas without occupational exposure or deployment/travel. Japan (86/198), Guam (55/198), and Hawaii (22/198) were the most common areas of exposure. Confirmed cases were most likely to be exposed and diagnosed in Hawaii.Table 1Clinical Characteristics of Confirmed, Probable, and Possible Leptospirosis Cases

Conclusion
Lepto remains a common diagnosis within the MHS, especially among service members and in endemic areas. Despite classic teaching, a significant proportion of MHS cases occur in patients living in endemic areas without occupational or deployment exposures. This highlights lepto as a continual threat and burden on systems in endemic areas in addition to the classically recognized military exposures. Furthermore, despite a substantial amount of possible and probable cases, there remain few confirmed cases.Table 2Laboratory Testing of Confirmed, Probable, and Possible Leptospirosis

Disclosures
All Authors: No reported disclosures
P-177. Contemporary Clinical Characteristics and Outcomes of Leprosy— a Multicenter Network Analysis
Authors: Kaplan Samantha R , Henao Martínez Andrés F , Bliss Masson , Olivo Freites Christian , Agudelo Higuita Nelson I , Marcos Luis A , Ramirez-Garcia Edgar A , Casapia Martin , Mohareb Amir , Avanzi Charlotte , Chastain Daniel B , Franco-Paredes Carlos 
Published: January 2025

Abstract

Background
Leprosy, also known as Hansen's disease, is a chronic infectious disease caused primarily by Mycobacterium leprae, endemic to tropical countries. In 2022, WHO registered 165,459 cases of leprosy. We lack more contemporary clinical descriptions and outcomes of the disease. Understanding its clinical characteristics is essential for improving diagnosis, treatment, and patient outcomes. We aim to describe the clinical manifestations and outcomes associated with leprosy using a "real-world" database.
US Map of the proportion of captured cases by region

Methods
We queried TriNetX, a global research network database (https://trinetx.com/), to identify patients with Leprosy by ICD-10 code. We captured demographics, comorbidities, clinical manifestations, treatments, and outcomes within 1 year.
Clinical characteristics and outcomes of leprosy patients by region

Results
We captured 1,237 patients, with 965 (78%) originating from the US health system. The mean age was 48, and most were women (60.4%). US patients were predominantly from the South and West (Figure 1) and were predominantly White, Native Hawaiian, or Asian (table 1). The most common clinical manifestations included neuralgia, rash, neuropathy, and malaise. Blindness, corneal abrasions, and burns were present among 2-3% of US patients. Orchitis, iritis, and the Lucio phenomena were relatively uncommon. Rifampin, dapsone, and minocycline were most commonly used. However, significant geographical differences were noted in treatment regimens. Notably, clofazimine use was minimal. Steroids were used in 60% of cases, with a higher prevalence in US-based patients. Other immunosuppressants were uncommon, although methotrexate use was more frequent internationally. TB co-infection was 2%. The overall 1-year mortality was 24.3%.
Clinical characteristics and outcomes of leprosy patients by region

Conclusion
Women from the southern and western US were the most significantly affected demographic groups. Severe complications like blindness, corneal abrasions, and burns, though less frequent, underscore the potential impact on quality of life. The presence of conditions like TB co-infection and the use of steroids in treatment point to the need for comprehensive preventive care strategies. With an overall 1-year mortality of 24.3%, our findings stress the importance of early diagnosis and treatment to improve outcomes and reduce mortality rates.
Clinical characteristics and outcomes of leprosy patients by region

Disclosures
All Authors: No reported disclosures
P-178. Crotalic snakebites accidents: the clinical and epidemiological profile of patients treated at toxicology unit of a reference center in Brazil
Authors: Schulthais Chagas Victor , Da Silveira Luciana Reis , Rocha Valle Lucas , Freitas Ribeiro Aloisio Joaquim , da Silva Rosa Patryk Marques , Baroni Neves João Victor , Marcolino Milena S 
Published: January 2025

Abstract

Background
In Brazil, about 30,000 snakebites accidents are reported every year. Crotalus durissus is responsible for 9% of the cases. This study aimed to assess the clinical, epidemiological and laboratory profile of victims of crotalic accidents treated at a major toxicological reference in Brazil and the incidence of clinical complications.

Methods
Retrospective cohort study that analyzed medical records from victims of crotalic accidents treated at the Toxicology Unity of the reference center between January/2011 and December/2022. Suspected crotalic accidents with lack of clinical and laboratory diagnosis were excluded. Multivariate logistic regression was performed to evaluate the association between the severity of crotalic accidents with its factors, reported as odds ratio (OR) and 95% confidence intervals.

Results
From 411 patients included (median age 40 years, interquartile range [IQR] 23–56), 79.8% were men, 70.0% pardo, 74.0% of the accidents happened in rural areas and 77.6% of the bites were in lower limbs. Overall, 29.0% were late-admitted to the hospital ( &gt;6 hours after the accident. Accidents were more frequent in summer (63.3%). Median hospital length of stay was 3 days (IQR 2-4). From those who had local manifestations (90.3%), pain was the most frequent symptom (80.5%). Regarding patients who had systemic manifestations (74.0%), neuroparalytic were the most frequent (66.7%), followed by myotoxic and hemolytic (37.8%), vagal (20.4%) and renal (17.3%). Four deaths were reported (1.0%). Age &gt; 50 years (OR 1.85 [95% CI 1.11-3.11]), non-identification of the snake (OR 4.24 [95% CI 2.07-8.97]) and &gt;6h until medical admission (OR 4.23 [CI 95% 2.55-7.12]) were associated with severe cases.

Conclusion
The results show the importance of the adequate and early management of crotalic accidents focusing on the main manifestations. The establishment of epidemiological, clinical and laboratory profiles related to severe cases is also important to help understand the socio demographic characteristics of the patients.

Disclosures
All Authors: No reported disclosures