bluuebunny/crossref_metadata_2025_split huggingface dataset:
1381. Barriers and Facilitators to Prompt Diagnosis of Tuberculosis in Lima, Peru
Authors: Geadas Carolina , Millones Ana Karina , Acosta Diana , Farroñay Sheyla , Torres Isabel , Jimenez Judith , Lecca Leonid , Yuen Courtney 
Published: November 2023

Abstract

Background
Tuberculosis (TB) infectiousness decreases significantly with only a few days of therapy, but delayed diagnosis often leads to late treatment initiation. We conducted a sequential explanatory mixed-methods study to understand the barriers and facilitators to prompt diagnosis and identify areas for improvement.

Methods
We enrolled 100 adults who started TB therapy in the Carabayllo district of Lima, Peru, between November 2020 and February 2022 and administered a survey about their symptoms and healthcare encounters. We calculated the time from symptom onset to first healthcare visit and to diagnosis. We conducted semi-structured interviews of 26 participants who had a range of delays, investigating their experiences navigating the health system. Interview transcripts were inductively coded for concepts related to diagnostic barriers and facilitators and suggestions for improvement.

Results
Overall, 38% of patients sought care from public facilities and 42% from the private sector. Only 33% reported being diagnosed with TB on their first visit. The median total diagnostic delay was 9 weeks (interquartile range [IQR] 4–22), with a median of 4 weeks (IQR 0–9) before contact with the health system and of 3 weeks (IQR 0–9) after. There was a median of 3 (IQR 2–4) health visits before diagnosis. Several factors contributed to a delayed diagnosis. Many patients attributed their symptoms to an alternative cause or had misconceptions about the disease, and often postponed seeking care. Once they sought care, the vast majority of patients had multiple encounters, sometimes alternating between the public and private sectors. Having a referral document and being seen by a pulmonologist often expedited the diagnosis. Several patients identified a need for more education about the disease through community campaigns and for better access to pulmonologists.
Factors impacting the time to diagnosis of tuberculosis in the Carabayllo district of Lima, Peru

Conclusion
We identified important diagnostic delays related to both patient- and health system-associated factors. Misinformation about TB, poor accessibility of health services, and the need for multiple encounters to obtain diagnostic tests were major factors leading to delays. Better strategies for community education and integration between the public and private sectors should be priorities in the efforts to combat TB.

Disclosures
All Authors: No reported disclosures
1383. Malaria Prophylaxis Use In a Travel Clinic, How Are We Doing?
Authors: Hogan Dennis , Bishburg Eliahu , Suryadevara Madhu 
Published: November 2023

Abstract

Background
Malaria chemoprophylaxis is indicated for travelers going to geographic areas designated as endemic for malaria. Often persons traveling to their native countries where malaria is present consider themselves immune and decline chemoprophylaxis. This study aimed to evaluate malaria chemoprophylaxis utilization in a travel clinic and whether it is correlated with the patient’s native place.

Methods
A retrospective study of patients attending a travel clinic between 2021 to 2023. Data were extracted on demographics, trip destinations, trip duration, and, malaria chemoprophylaxis prescribed. Pharmacies were contacted to verify prescription filling. Patients admitted with malaria were analyzed at the same time period. Comparison between groups was made using a chi-square test. p &lt; 0.05 is considered significant.

Results
One hundred patients were included. Median age 55.5 years (21-80). 62 % (62) were females while 38% were males. There were ninety-four 94 travelers to Africa, 6 to South America, and 1 to Asia. Of the travelers, 44 were US natives while 56 were non-US natives. The median trip duration was 14 and 15 days among US and non-US natives respectively. All 100 patients received prescriptions for malaria prophylaxis: Atovaquone/Proguanil was prescribed to 94, while 6 were given mefloquine. Of the 100 prescriptions, 58 were filled. Of the 44 travelers who were US natives,33/44 (75 %) filled their prescriptions. Among the 56 non-US natives, 25/56 (44 %) filled prescriptions, p -0.002. During the study period, 10 patients (6 females and 4 males) were admitted with a diagnosis of malaria in returning travelers, median age of 54.5 years. The median trip duration was 19 days. All were non-US natives returning from Africa (Nigeria, Ghana, Guinea, and Mali). Only 1/10 patients took mefloquine chemoprophylaxis. All the patients were treated successfully without sequelae.

Conclusion
In our travel clinic malaria chemoprophylaxis was prescribed to all patients as indicated, US native patients filled their prescriptions significantly more than nonnative patients. Malaria in returning travelers was diagnosed exclusively in non-US natives who did not take malaria chemoprophylaxis.

Disclosures
All Authors: No reported disclosures
1384. Verbal Autopsy as a Tool to Identify Probable Cause of Death in People with Acute Febrile Illness in Zambia — January 2020-December 2022
Authors: Hooker Katie R , Kapombe Priscilla , Silver Rachel , Ciuba Chandler , Cheelo Mweene , Moyo Saviour , Mulenga Lloyd , Rao Carol Y , Hines Jonas 
Published: November 2023

Abstract

Background
Acute febrile illness (AFI) surveillance improves a country’s understanding of what diseases are circulating. However, fever as an entry point for patient identification casts a wide net that will likely capture non-infectious causes of AFI. We used mortality surveillance data to examine probable causes of death (CoD) potentially associated with AFI to expand our understanding of febrile illness in Zambia.

Methods
The Zambian Ministry of Health provided verbal autopsy (VA) data from 27 (of 117) districts representing ∼50% of Zambia’s population. The World Health Organization’s standardized tool for VA was used by hospital staff to interview relatives or close associates of deceased persons of all ages on clinical presentation and circumstances prior to death. The InterVA-5 validated computer algorithm provided a CoD. Using questionnaire data, we applied an AFI case definition based on common global AFI surveillance criteria: a febrile person with a fever duration of &lt; 1-14 days and a mild, moderate, or severe fever classification (in lieu of a temperature cutoff). We analyzed the CoDs and SARS-CoV-2 infections among those that met our AFI case definition in R.

Results
From January 2020 to December 2022, 51,751 VAs were conducted on people over 28 days old–14,503 (28%) reported fever prior to death, of which 12,071 (23%) met our AFI case definition. Broadly, we found that 64% of those that met our AFI case definition had an infectious CoD, 32% had a non-communicable CoD, and 4% had other CoDs. Specifically, the most reported CoDs were acute respiratory infection (14%), diarrheal disease (11%), and HIV/AIDS (10%). A positive SARS-CoV-2 test was reported in 965 (8%) persons with AFI versus 1,876 (5%) without AFI (p&lt; 0.001).

Conclusion
AFI-associated deaths were primarily attributable to infectious disease, as identified through VA. AFI is one approach for multi-pathogen surveillance that provides valuable insight into circulating diseases, including SARS-CoV-2, but findings are limited by which pathogens are targeted for testing. Mortality surveillance is a valuable supplementary data source when attempting to understand inconclusive findings in AFI surveillance and aids in a country’s understanding of common causes of febrile illness not captured through AFI surveillance diagnostics.

Disclosures
All Authors: No reported disclosures
1389. Parasitic Diseases Surveillance in Kazakhstan: Incidence Trends and Future Projections
Authors: Kirpicheva Ulyana , Shapiyeva Zhanna 
Published: November 2023

Abstract

Background
The COVID-19 pandemic has had a significant impact on healthcare systems worldwide, leading to a weakening of surveillance for parasitic diseases during quarantine measures in many countries. In 2022, this effect was observed in the Republic of Kazakhstan, where a significant increase in parasitic diseases was reported.

Methods
The prediction of parasitic incidence was carried out based on official statistical data on the incidence of the population of Kazakhstan from 2011 to 2022. Exponential smoothing was used for incidence forecasting with 95% CI. Forecasts were carried out for echinococcosis, opisthorchiasis, ascariasis, enterobiasis, and giardiasis.

Results
In 2022 there was a significant increase in parasitic diseases among the population of the Republic of Kazakhstan, with a total of 9,026 cases registered. Most cases were helminthiasis, accounting for 85% of all cases, while intestinal protozoal invasions accounted for 15%. The most prevalent parasitic diseases were enterobiasis, with an incidence rate of 24.9 per 100,000, followed by giardiasis with a rate of 6.8 per 100,000. Echinococcosis had an incidence rate of 3.9 per 100,000, while ascariasis and opisthorchiasis had rates of 6.4 and 2.5 per 100,000, respectively (Figure 1).
However, the expected incidence rates for parasitic diseases in 2023-2025 are projected to be lower than the long-term average incidence. There will be a significant decrease in the incidence rate of opisthorchiasis and enterobiasis. In 2023, the incidence rate of opisthorchiasis is expected to be 1.45 per 100,000, while the incidence rate of enterobiasis will be 12.1 per 100,000. This trend is projected to continue in 2024-2025 (Table 1).

Conclusion
As negative trends in parasitic diseases are observed, it is crucial to remain vigilant and take proactive measures to prevent the spread of these diseases. Following the results, additional measures were taken in the Republic of Kazakhstan to prevent echinococcosis and opisthorchiasis, such as strengthening the interdepartmental commission and enhancing epidemiological surveillance. It is essential to continue monitoring the situation and take proactive measures to prevent the spread of parasitic diseases.

Disclosures
All Authors: No reported disclosures
1394. Antibiotics Overuse and Cost Analysis among Hospitalized Dengue Virus Infected-Thai Adults.
Authors: Ngamprasertchai Thundon 
Published: November 2023

Abstract

Background
Dengue is a common cause of acute febrile illness, predominantly in Asia which required supportive treatment without antibiotics. The antibiotics overuse leads to antimicrobial resistance threats. This study aimed to determine the use of antibiotics and cost analysis of hospitalized dengue virus infected-Thai adults.

Methods
This retrospective cohort study was conducted in Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Thailand in 2022. All confirmed dengue adults’ cases during 2016-2021 were evaluated by two independent reviewers. Clinical, microbiological characteristics and medical costs per episode were interested outcome. The overuse was defined as inappropriate antibiotics prescription in terms of indications, choices, duration, dosage, or route administration. Factors associated with antibiotics overuse were evaluated using a Poisson regression. Direct medical and non-medical costs per episode also were analysed.

Results
A total of 249 participants were included. More than half were classified as severe or dengue with warning signs upon admission. Nearly 20% were transferred to or admitted at intensive care unit. The cumulative incidence of antibiotics use was 9.3% (95% confidence interval (CI): 8.23–10.47), which majority were empirically given. Of 38.3% among empirical antibiotics given participants showed no definite concurrent bacterial infections. The cumulative incidence of antibiotics overuse was 49.8% (95% CI: 43.42–56.18) mainly thanks to no indications of antibiotics. There was association between disease severity upon admission and antibiotics overuse (p-value 0.014). Median total medical cost was 1,086.6 USD per episode; meanwhile, median cost of antibiotics use was 10.8 USD per episode. There was significant difference of antibiotics cost between overuse and appropriate use (p-value 0.005).

Conclusion
The antibiotics overuse in hospitalized dengue virus infected-Thai adults was high. Doctors in charge should reconsider presumed concurrent bacterial infection before empirical antibiotics administration. Antimicrobial stewardship should be also endorsed in dengue cases or other tropical infectious diseases to control resistance threats and hospitalized medical costs.

Disclosures
All Authors: No reported disclosures
1397. What were the Birth Outcomes of Infants Born to Zika Positive Mothers in Developing Countries?
Authors: Prince Monique A , Orlando Lauren , Prince E’ebony , Fasanmi Abidemi 
Published: November 2023

Abstract

Background
Zika Virus became an emerging health threat in the early 21st century. Epidemics in the Pacific Islands noted flu-like symptoms and complications following human ZIKV infection. However, after a severe outbreak in 2015, Latin American studies reported fetal birth defects with maternal infection but reports in other developing countries where outbreaks occurred were not fully characterized. This study aims to review current reports on birth outcomes associated with maternal ZIKV infection .

Methods
This narrative review evaluated birth outcomes of Zika positive pregnant women. Research articles were found using Google Scholar, PubMed, and MEDLINE. The inclusion criteria were publication between 2012 to 2022, availability as full text in English, categorization as original research, meta-analyses or case reports. Exclusion criteria were studies that were part of a book chapter or encyclopedia and studies that cited results from developed nations. The articles were studied and 20 methodologically sound studies were selected for review, and the data was classified in themes based on birth outcomes.

Results
18 studies reported that infants born to some laboratory-confirmed zika-positive mothers had abnormal birth outcomes after delivery including microcephaly, stillbirth, neurological abnormalities and hearing loss. Maternal ZIKV infection is associated with an increased risk of abnormal birth outcomes in newborns in developing countries. In the countries of studies that did not report abnormal outcomes there may have been a protective factor from previous maternal Dengue Virus (DENV) infection adding protection for their infants.

Conclusion
Overall, there appears a difference in birth outcomes of infants born to mothers infected with ZIKV, however more research is needed on environmental factors and prior arboviral infection as additional factors contributing to these outcomes.

Disclosures
All Authors: No reported disclosures
1400. Geospatial Modeling of the Prevalence of Pediatric Febrile Illness in Uganda
Authors: Ssentongo Paddy , Shah Khush 
Published: November 2023

Abstract

Background
Febrile illness is still one of the major public health problems in Africa. Although it has been recognised as crucial to identify the non-malarial aetiologies and to better understand their spatial distribution, the evidence is still limited. We aim to predict the prevalence of fever cases among children aged under 5 years in Uganda using geostatistical models, whilst exploring the potential association with environmental, nutritional, and socio-demographic factors.

Methods
We analyze household records from the 2016 Demographic and Health Surveys (DHS) conducted in Uganda. We develop a geostatistical Binomial model to predict the prevalence of fever cases among children aged under 5 years in Uganda, accounting for environmental, nutritional, and socio-demographic risk factors obtained from publicly available sources.

Results
The average number of children in each cluster was 20 (interquartile range: 16–25), and the median crude (empirical) febrile illness prevalence for each cluster was 30.4% (interquartile range:13.6–50.0). The model indicates the presence of a strong spatial correlation, predicting a higher prevalence in the eastern and north-eastern regions. The inclusion of some potential risk factors improves the predictive performance of the model. Key environmental, nutritional, and socio-demographic factors strongly associated with febrile illness included

Conclusion
We show that there is extensive within-country spatial variation in children’s febrile illness prevalence in Uganda, whilst indicating the potential association with rainfall, temperature, aridity, poverty, standardized precipitation evapotranspiration index, and anemia. These findings could assist in targeted public health policymaking for fever case management and in hypothesis generation for etiology.

Disclosures
All Authors: No reported disclosures
1402. The Landscape of Infections Caused by Rare Bacterial Pathogens
Authors: Farid Tahsin , Charles Reema , Tumas Keyla , Stone Heather , Tirupathi Raghavendra 
Published: November 2023

Abstract

Background
Rare infectious diseases (RIDs) are a significant source of morbidity and mortality1. Most lack approved treatments and it is difficult to perform comprehensive trials on therapeutic efficacy due to their sporadic nature and distribution in resource limited settings2. Lack of monetary incentives has also discouraged drug development3. RIDs therefore represent an area of high unmet medical need. Here the landscape of rare bacterial infections (RBIs) is reviewed, as a pilot project, to explore the use of real-world data to better inform therapy.
Disclaimers and Affiliations
Table 1: List of Included Rare Bacterial Infections

Methods
A list of bacterial infections was curated by combining reportable infections from health agencies4-7 with the CURE ID8 database of diseases. This list was independently reviewed by two experts in infectious diseases to identify potential RBIs. A literature review identified which of these bacteria met the inclusion criteria: a global incidence of less than or equal to 10,000 cases per year (Figure 1). Data on each RBI that met the inclusion criteria was collected (Table 1) and analyzed.Figure 1.Data Flow Diagram

Results
From the comprehensive list of 163 bacterial infections, 22 met the inclusion criteria. Figure 2 displays the distribution of World Health Organization (WHO) Regions where each RBI has the highest incidence. The most frequent mode of transmission amongst analyzed RBIs was zoonotic (Figure 3). 13 RBIs did not have FDA-approved therapies, but only 2 lacked a standard of care therapy (Table 2). Figure 4 depicts the transmission mode of RBIs according to the WHO region where they are most frequent.Figure 2:Percentage and number of diseases listed in table 1 by highest Incidence occurring per WHO RegionFigure 3:Breakdown of diseases in table 1 by mode of transmissionTable 2:Standard of care availability plotted against FDA approved therapy availability

Conclusion
It was expected that a majority of RIDs would occur through zoonoses while environmental and commensal organisms cause opportunistic infections in the immunocompromised. The majority of zoonoses had worldwide distributions. This does not imply higher incidence, but rather may indicate a lack of sustained endemicity with outbreaks in varied geographic areas when animal to human spillover occurs. Transmission patterns may also relate to socioeconomic conditions, climate change, war/civil unrest, and population growth. The lack of FDA-approved therapies for RIDs stems from the paucity of cases and little financial interest; real-world data may help improve treatment efficacy. This project aims to explore these possibilities and expand to all RIDs.Figure 4:Plot of transmission mode by WHO region
References

Disclosures
All Authors: No reported disclosures
1403. Baseline Electrocardiographic Profile of Patients with Severe Tetanus who developed Dysautonomia in a National Tertiary Hospital for Infectious Diseases
Authors: Edrada Edna , Tulawie Janice de Grace L , Teano Ruel O 
Published: November 2023

Abstract

Background
The main causative agent of Tetanus infection is the bacterium Clostridium tetani, a gram-positive, spore-former obligate anaerobic microorganism. It continues to be an important public health concern in developing countries like the Philippines, even though it is preventable by vaccination. This infection produces a tetanospasmin which cause dysautonomia. The toxin effects on the cardiovascular system have been observed and seem to cause increasing morbidity and mortality. The paucity of literature on the degree of myocardial complications of this toxin in a local health setting geared the investigator to do this research.

Methods
This retrospective included all patients with severe tetanus infections. 325 patient’s records were retrieved. 204 met the inclusion criteria. The research investigator collected the baseline clinico-demographic of patients as to age, sex, body mass index, and presence of co-morbidities. Once collected, the investigator recorded the result of the baseline electrocardiogram of patients. Specifically, this included incidence of bradycardia, tachycardia, arrythmia and other significant electrocardiogram findings. Clinical outcome specifically length of hospital stays, and final clinical status were also determined.

Results
Of the 204 patients included, 90 (44%) developed dysautonomia, while the remaining 114 (56%) did not developed dysautonomia. Most of patients with tetanus infection were males, in the 41 to 60 years of age, married, and had normal body mass index. Comorbidities present were hypertension and diabetes mellitus. Diabetes mellitus increased the risk of dysautonomia. The most common baseline electrocardiogram finding was Sinus tachycardia (63.7%). Other arrythmia and other electrocardiogram finding such as myocardial infarction or ischemia were uncommon in this investigation.

Conclusion
Among the baseline electrocardiogram, finding of Sinus Tachycardia is the only result that is associated with dysautonomia and carries poor clinical outcome. As mention, diabetes mellitus increases the risk of developing dysautonomia. Patients who developed dysautonomia has shorter length of hospital stay and expired.

Disclosures
All Authors: No reported disclosures