bluuebunny/crossref_metadata_2025_split huggingface dataset:
1809. Seroprevalence of Tick-borne Diseases including Alpha-gal Allergy and Associations with Musculoskelatal Symptoms in a Population-based Cohort in Central North Carolina
Authors: Zychowski Diana , Alvarez Carolina , Rodgers Haley Abernathy , Giandomenico Dana , Boyce Ross M , Nelson Amanda E , Commins Scott 
Published: November 2023

Abstract

Background
The incidence of ehrlichiosis, spotted fever rickettsioses (SFR), and Alpha-gal syndrome (AGS) is high in North Carolina (NC). Post-infectious sequelae secondary to ehrlichiosis or SFR are uncommon, however patients often attribute persistent musculoskeletal symptoms, including arthralgia, to prior tick-borne exposure. It is uncertain if these symptoms represent long-term complications from SFR or ehrlichiosis, or non-anaphylactic AGS via the development of IgE to galactose alpha-1,3-galactose (alpha-gal IgE). Utilizing a population-based cohort, we sought to examine the potential association between prior exposure to Ehrlichia, Rickettsia and alpha-gal, and chronic musculoskeletal symptoms.

Methods
A total of 488 Individuals from the 2017–2018 Johnston County Osteoarthritis study – a longitudinal, probability-based cohort – completed questionnaires regarding health status and environmental exposures, underwent physical assessment, and had serological testing for Rickettsia, Ehrlichia chaffeensis, and alpha-gal IgE. Multivariable models were used to estimate associations of interest for this cross-sectional study.

Results
The overall weighted point prevalence for Ehrlichia IgG was 8.6% (95% CI: 5.9–11.3%), Rickettsia IgG was 17.1% (95% CI: 12.6–21.5), and alpha-gal IgE &gt; 0.1 IU/mL was 19.6% (95% CI: 15.3–23.8) in Johnston County, NC. Only one individual had antibodies to Rickettsia, Ehrlichia, and alpha-gal IgE &gt; 0.1 IU/mL. Forty percent of participants had detectable alpha-gal IgE &gt; 0 IU/mL, while only 2.5% self-reported a diagnosis of alpha-gal allergy to red meat. Only alpha-gal IgE was associated with knee pain, aching and stiffness (PAS) (IDR 1.3, 95% CI: 1.09-1.56). Antibodies to Rickettsia, Ehrlichia, and alpha-gal were not associated with symptomatic radiographic knee osteoarthritis (OA).

Conclusion
Despite only 17% of individuals recalling a tick bite in the past 5 years, 52% had either i) alpha-gal IgE &gt; 0 IU/mL; ii) positive Rickettsia IgG antibodies; and/or iii) positive Ehrlichia IgG antibodies, together, suggesting high levels of tick exposure. Positive Ehrlichia or Rickettsia tick-borne serologies did not predict OA or PAS within this population. Further investigation into extraintestinal manifestations of AGS is needed.

Disclosures
Scott Commins, MD, PhD, Genentech: Advisor/Consultant|Revivicor: Grant/Research Support|Up to Date: Honoraria
1810. Noma (Cancrum oris): World Health Organisation's latest neglected tropical disease?
Authors: Braimah Ramat O , Butali Azeez , Mossey Peter , Wendy Thompson , Taiwo Abdurrazaq , Coker Modupe , Bala Mujtaba , Ibikunle Adebayo , Abdullah Shafiu , Bello Abubakar 
Published: November 2023

Abstract

Background
Noma, also known as cancrum oris, necrotizing ulcerative stomatitis or gangrenous stomatitis, is a rapidly progressive and often fatal infection of the mouth and face. This disease predominantly affects children between the ages of 2 and 6 years old in poorly developed countries around the world where adequate nutrition, sanitation and cleanliness are lacking. Northwest Nigeria has a particularly high prevalence of the Noma.
Noma starts as gum disease and, without effective treatment (including antibiotics), around 90% die within two weeks and as such noma eminently fits the definition of a neglected tropical disease (NTD). The World Health Organization (WHO) has described 5-stages of the disease to include: Stage 1 (Acute Necrotizing Ulcerative Gingivitis), Stage 2 (Edematous), Stage 3 (Gangrenous), Stage 4 (Scarring) and Stage 5 (Late sequelae).
Stage 1 noma - Acute necrotizing ulcerative gingivitis (necrotizing periodontal disease)
Stage 1 noma - Acute necrotizing ulcerative gingivitis (necrotizing periodontal disease)

Stage 2 noma – Edema

Methods
This study describes the patients who presented at hospitals in Sokoto, Nigeria between 2014 and 2022. Data were collected at Usmanu Danfodiyo University Teaching Hospital, Noma Children’s Hospital and State Specialist Hospital. The data are supplemented with exemplar images of cases which presented in each stage of noma.
Stage 3 noma - Gangrenous
Stage 4 noma – Scarring

Results
Since 2014, a total of 1,147 patients have been admitted. 165 (14.4%) patients presented with Stage 1 noma and were enrolled in the Ambulatory Therapeutic Feeding Centre (ATFC) (Figure 1). 125 (10.9%) patients presented with Stage 2 or 3 noma(see Figure 2)and were admitted to Inpatient Therapeutic Feeding Centres (ITFC). 845 (73.7%) patients presented with Stage 4 or 5 noma (see Figure 3) had various surgical interventions.
One case of twins both presenting with noma was seen. One presented with Stage 3 noma and the other was in Stage 4 . Just 11 (1.0%) cases were adults, all of whom presented with Stage 3 noma.
Stage 5 noma – late sequelae

Conclusion
Noma represents a major health inequality and has a relatively high prevalence in Nigeria. While previous studies have identified possible risk factors, there is a paucity of knowledge about the etio-pathogenesis, prevention and treatment of each phase. The designation of noma as a neglected tropical disease would focus attention on the condition and would release funding for further research to address these knowledge gaps.

Disclosures
All Authors: No reported disclosures
1813. A Retrospective Review of the Safety and Efficacy of Dalbavancin at Ireland's Largest Acute Medical Hospital
Authors: Conlon Peter , Bannan Ciaran , Kelly Mary , Williamson Claire 
Published: November 2023

Abstract

Background
Dalbavancin is second-generation lipoglycopeptide antibiotic. It is licensed in Ireland and the United States for the management of acute skin and soft tissue infections. International colleagues report treatment success in its use for patients who are unable to stay in the hospital for prolonged periods and not suitable for OPAT [1]. We reviewed the use of Dalbavancin at St James's Hospital Dublin, which is the largest hospital in Ireland with over 700 acute beds. We are located in Dublin’s inner city which experiences significant socio-economic deprivation.

Methods
We used the electronic patient records at St James's Hospital to capture all uses of Dalbavancin from August 2018 to September 2022.
We established baseline demographics, indication, microbiological characteristics if there was oversight by ID/micro, safety, and treatment outcomes.

Results
&lt; We identified 23 patients who met the inclusion criteria
Base demographic:
The most common indication was endovascular infection (35%) and skin and soft tissue infection (35%). (Figure 1)
Most patients were not bacteremic. Staph aureus was the most common organism identified on blood culture (figure 2)
322 hospital bed were saved which equates to 257,600 euro
0 patients had an adverse drug reaction
100% of cases were discussed with micro or ID

Conclusion
Dalbavancin is a safe and effective drug. It is another tool that can be used when caring for patients who are experiencing unstable housing and challenging social circumstances. Our experience has found 0 adverse events, 69% of patients experienced treatment success (this increases to 88.8% if we exclude those lost to follow up). This is an important finding considering on 17% of indications were considered ‘on label’.
Dalbavancin can save money on hospital beds and also reduces non-recyclable plastic associated with repeated doses of IV antibiotics.

Disclosures
All Authors: No reported disclosures
1814. Retrospective Study of Skin and Soft Tissue Actinomycosis in an Urban Pediatric Academic Medical Center
Authors: Demirhan Salih , Orner Erika , Szymczak Wendy , Lee Philip J , Aldrich Margaret 
Published: November 2023

Abstract

Background
Actinomyces species are known colonizers of human mucosal surfaces but are rarely associated with disease in immunocompetent hosts. Pediatrics studies are limited to case reports. This retrospective study aims to describe the characteristics of skin and soft tissue actinomycosis (SSTA) and the frequency and risk factors of recurrence in pediatric patients.

Methods
We conducted this study of patients aged ≤21 years with Actinomyces growth in abscess cultures obtained under sterile conditions between January 2019 and December 2022 (Figure 1). Patient demographics were collected using the EMR, and all patients had at least a one-year follow-up period in which to ascertain recurrence.

Results
One hundred four patients met inclusion criteria; median age 19 (IQR 17-20) years, 68.3% female, 46.2% Black and 47.1% Hispanic. Body mass index (BMI) was &gt; 25 in 59.8% of patients. Actinomyces turicensis (n=47) was the most commonly isolated subspecies and 71.2% of Actinomyces cultures were monobacterial. Clindamycin and trimethoprim-sulfamethoxazole were the most commonly used antibiotics. Only 7 patients had consultation with pediatric infectious diseases. Patients who had a prior abscess at the same anatomic site made up 29.8% of the study cohort and 33.7% had documented recurrence after the first SSTA episode, within median 10 (IQR 6-16) months after initial episode (Figure 2 and Table 1). Monobacterial culture growth (85.7% vs 63.8%, p=0.02), patients with BMI &gt;25 (75% vs 52.6%, p=0.04) and patients with prior abscess in the same area (51.4% vs 18.8%, p=0001) were significantly higher in patients with recurrent actinomycosis (Table 2). In univariate analysis, monobacterial growth (OR= 3.4, 95% CI 1.2-9.9), BMI &gt;25 (OR=2.7, 95% CI=1.1-7.0) and prior abscess (OR=4.6, 95% CI=1.9-11.2) were associated with increased odds of recurrence.

Conclusion
Our findings suggest that patients with SSTA were generally adolescents with elevated BMI. Monobacterial culture growth, BMI &gt;25, and prior abscess in the same area were significantly associated with recurrence. High recurrence rate, suboptimal antibiotic utilization and very low rates of consultation with infectious diseases suggest that providers should be informed and updated regarding this rare but difficult to treat infection.

Disclosures
All Authors: No reported disclosures
1822. Assessing Trusted Sources and its Impact on Healthcare Accessibility for Safe Return to K-12 Schools in an Underserved Population
Authors: Agha Humza , Shelley Jamee T , Reyes Sydney A , Reyes Summer M , Walsh Tyler , Watterson Tremayne , Torres Ana V , Bonty Brittany T , Evans Christina , Prater Jasmine , Hayes Samantha , Malone Sara , Lai Albert , Fritz Stephanie A , Newland Jason , Neidich Julie A , Lackey Ian T 
Published: November 2023

Abstract

Background
Participants of a COVID-19 school-based testing program in predominantly Black schools were asked to complete the NIH’s Common Data Elements (CDE) survey to help understand the demographic and social determinants of health of our testing population. The objective of this study was to assess if those completing the CDEs were reflective of our overall testing participants and to identify the trusted sources of these individuals

Methods
All testing participants were offered the opportunity to complete a 150 question CDE survey after being enrolled in the testing portion of the study. Descriptive statistics described race/ethnicity, socioeconomic status, and vaccination status. Geospatial mapping utilizing addresses of participants was used to assess social vulnerability index among testing and CDE participants. Response options for trusted COVID19 source questions were given in a 5-point Likert scale, with answers ranging from “A great deal,” to “Not at all.”

Results
A total of 477 CDE surveys were submitted among 2581 participants. When comparing the total participant population with the CDE respondent population, we see disparate numbers among Black and White participants (Fig. 1). Additionally, those completing CDEs were in lower SVIs (Fig. 2). Analysis of trusted sources for COVID19 information showed that 80% of White CDE respondents trusted their doctor/healthcare provider “a great deal,” as compared to 26% indicating “not at all” for Faith Leader. 51% of Black CDE respondents trust their doctor/healthcare provider “a great deal,” as compared to 25% indicating “not at all,” for the US Government. (Fig. 3)
Testing population vs. CDE population by race
This graph shows our overall testing population and CDE population by race.
Mapping testing population vs. CDE population SVI
The addresses of our overall testing population and our CDE population were geospatially mapped against CDC's 2018 Social Vulnerability Index (SVI).
CDE trusted COVID19 sources by Race
Responses from our testing population that completed CDEs based on trusted sources

Conclusion
CDE respondents did not reflect our testing participants. Additionally, the most trusted sources among the population completing the CDEs were doctors/healthcare providers, and not as much faith leaders. While these data are important, they do not reflect the testing participants in our underserved community and need to be interpreted with caution. Use of CDEs are important but care needs to be taken when reporting the results.

Disclosures
Albert Lai, PhD, Johnson & Johnson: Stocks/Bonds Jason Newland, MD, Moderna: Grant/Research Support|Pfizer: Grant/Research Support
1827. Patients with Serious Injection Related Infections (SIRI) have Limited Access to Community-based Infection Prevention and Treatment in Alabama
Authors: Bradford William , Gagnon Kelly , Bassler John R , Eaton Ellen 
Published: November 2023

Abstract

Background
The University of Alabama at Birmingham Hospital (UABH) provides a large percentage of tertiary care for Alabamians, including treatment of serious injection-related infections (SIRI). Because patients with SIRI frequently utilize our hospital and emergency department, we hypothesized that persons who inject drugs (PWID) in AL have limited access to community-based infection prevention and treatment, including addiction and harm reduction services, that is associated with their rural residence.

Sociodemographics, healthcare utilization, infection type, and substance use outcomes of participants.

Methods
We conducted a retrospective cohort study of patients hospitalized with SIRI at University of Alabama at Birmingham (UAB) Hospital (2016 to 2021). We queried sociodemographics, healthcare utilization, infection, and substance use outcomes (table 1). We used a standardized telephone survey, to identify and characterize the community services for PWID in AL. We then categorized the distance between self-reported residence, using zip code, and two locations: UAB hospital and community services. Using geospatial mapping, we then evaluated patients’ driving distances to these sites.

Results
A total of 383 patients with SIRI met inclusion criteria (table 1). We identified 98 sites providing community services (HIV, harm reduction, addiction) for PWID in AL. Patients residing in a community at intermediate distance from UAB (defined as 15-50 miles) had the most limited access to services. They were also significantly more likely to be white, uninsured, rural, have an established diagnosis of opioid use disorder (OUD).

Conclusion
For patients with SIRI receiving care at UAB Hospital, the proximity of their residence to UAB was associated with access to community services, with those 15 to 50 miles away being most limited. Although this group has access to care when hospitalized, the results highlight the lack of community care available in their hometowns. Clinicians should anticipate this gap in care and arrange for telehealth and other accessible options; integrated infection and addiction telehealth services may help bridge this care gap. More research is needed to understand how the residence of PWID may impact post-hospital ID and addiction outcomes.

Disclosures
Ellen Eaton, MD, MPH, Gilead: Grant/Research Support|Gilead: Honoraria
1843. Exploring Cisgender Women's HIV Pre-Exposure Prophylaxis (PrEP) Needs and Preferences Across Settings: the Roles of Social-Structural Factors
Authors: Kerrigan Deanna , Yonamine Kimi , O’Rourke Allison , Karver Tahilin Sanchez , Davis Wendy W , Metzner Aimee A , Oglesby Alan , Garris Cindy , Scott Rachel , Moriarty Patricia , Taggart Tamara , Barrington Clare , Gomez Hoisex , Perez Martha , Donastorg Yeycy 
Published: November 2023

Abstract

Background
Cisgender women (CGW) account for 48% of new HIV infections globally and 18% of new HIV infections in the United States (US) but comprise only 8% of daily oral PrEP users in the US. Social-structural factors including stigma, gender norms, and medical provider bias have been linked to daily oral PrEP inequities among CGW. These factors influencing PrEP utilization merit further attention as additional options emerge, including long-acting (LA) injectable PrEP.

Methods
PrEP preferences, barriers, and facilitators to uptake were explored through 60 in-depth interviews with CGW with indications for PrEP (n=40), and HIV and reproductive healthcare providers (HCPs) (n=20) in Washington, DC, US and Santo Domingo, Dominican Republic (DR) in 2021 and 2022 (Table 1). CGW in the DR were female sex workers (FSW), while those in DC were seeking reproductive health services. Thematic content analysis was employed.

Results
Participants noted low awareness of PrEP, particularly LA PrEP, among CGW across settings and indicated this may be in part due to ongoing emphasis on PrEP for men who have sex with men and transgender women compared to CGW. In DC and the DR, PrEP was often seen as a potential empowerment tool by CGW to address social-structural constraints, gender-related pressures and responsibilities, and inequitable partner dynamics. The perceived need for and preferences regarding daily oral vs. LA injectable PrEP was mixed among CGW in DC due to varied self-assessment regarding PrEP as a priority and some CGW’s comfort with pill taking. LA PrEP was described by some CGW as a means to improve adherence and reduce stigma associated with pill taking. FSW in the DR were particularly interested in LA PrEP as they found it more compatible with their work. Suggested facilitators of PrEP uptake noted across settings included financial and logistical support (transport, childcare) and HCP training on CGW’s PrEP needs.

Conclusion
Tailored CGW-centered awareness campaigns and sensitivity training for HCPs related to PrEP options for CGW are needed. Access to LA PrEP for FSW is critical given the disproportionate impact of HIV on this community and their work-related PrEP preferences. Interventions must address social-structural factors among CGW to support equitable PrEP uptake.

Disclosures
Aimee A. Metzner, PharmD, AAHIVP, ViiV Healthcare: Full-time employee (salary/benefits/etc.)|ViiV Healthcare: Stocks/Bonds Alan Oglesby, MPH, GlaxoSmithKline: Employment|GlaxoSmithKline: Stocks/Bonds Cindy Garris, MS, GSK: Stocks/Bonds|ViiV Healthcare: Employee Rachel Scott, MD,MPH,FACOG, Gilead Science: Grant/Research Support|ViiV/GSK: Grant/Research Support
1846. Quality of Life Impairment and Difficulty to Work Associated with Post-COVID Syndrome: A Cross-Sectional Study
Authors: Kochuparambil Jose J , Raju Jomel 
Published: November 2023

Abstract

Background
Following SARS-CoV-2 virus infection, patients may suffer from long-lasting symptoms regardless of disease severity. Preliminary results show limitations in health-related quality of life (HRQoL). The aim of this study is to evaluate the change in the quality of life of COVID-19-infected patients depending on the duration of the infection and the accumulation of symptoms.

Methods
The study population consisted of patients (18–65 years) presenting to the Post-COVID outpatient clinic of the tertiary care hospital in India, between March and October 2022. The HRQoL was assessed by the use of the RehabNeQ and the SF-36. Data analysis was descriptive with frequencies, means, and/or percentages. In addition, a univariate analysis of variance was performed to show the dependence of physical and psychological HRQoL on specific factors. This was finally tested for significance at an alpha level of 5%.

Results
Data from 318 patients were analyzed, most of whom had 3–6 months of infection (56%) and 5–10 symptoms persisted (60.4%). Both mental (MCS) and physical sum score (PCS) of HRQoL of the COVID-19 infected population were significantly lower than those of the normal population without a history of COVID-19 infection (p &lt; .001). The number of remaining symptoms (MCS p = .0034, PCS p = .000) as well as the perceived ability to work (MCS p = .007, PCS p = .000), influenced the HRQoL.

Conclusion
The HRQoL of patients with Post-COVID-syndrome is still reduced months after infection and so is their occupational performance. In particular, the number of symptoms could have an influence on this deficit, which would need to be further investigated. Further research is needed to detect other factors influencing HRQoL and to implement appropriate therapeutic interventions.

Disclosures
All Authors: No reported disclosures
1847. A mixed methods approach to understanding the perceived risk of COVID-19 and vaccination perceptions among people living with HIV in Nebraska
Authors: Labisi Titilola , Fadul Nada , New-Aaron Moses , Coleman Jason , Podany Anthony , King Keyonna 
Published: November 2023

Abstract

Background
Despite COVID-19 vaccine benefits, some people with HIV (PWH) might be unvaccinated. Also, whether PWH may have increased risk of severe COVID-19 outcomes due to immunosuppression remain inconclusive. Thus, understanding the perceived risk (PR) of COVID-19 and vaccine perceptions is critical for reduced COVID-19 complication risk and vaccine uptake. We applied a mixed methods approach to understand the PR of COVID-19 and perception of vaccines among PWH.

Methods
We recruited participants from University of Nebraska Medical Center HIV clinic. Eligible criteria included 1) ≥19 years; 2) Nebraska resident; 3) English Language proficiency; 4) HIV diagnosis. Participants (N=100) completed an electronic survey. We operationalized PR using the fear of COVID-19 scale scores. Quantitative data analyses included descriptive statistics, logistic regression and negative binomial. Participants (N=19) were purposefully selected for qualitative phase and completed a semi-structured one-on-one interview. Qualitative data were analyzed using open-ended coding and thematic analysis.

Results
Overall, perceived risk of COVID-19 was moderate (mean 15.3, SD: 7.0) out of 35. Eighty-five percent reported receiving ≥1 vaccine dose and 31% reported a history of COVID-19. Participants aged 19-30 years compared to 31-50 years were less likely to have high perceived COVID-19 risk scores (p= 0.02, RR: 0.70, CI: 0.53-0.93). Similarly, age group 19-30 years was more likely to report COVID-19 infection history (p= 0.03, OR: 1.83, CI: 0.04 – 0.68). The qualitative data reveal that participants’ PR waned over time. However, those with high PR expressed fear of severe COVID-19 complications. Vaccine perceptions were mixed, with lack of trust in the vaccines as main reason for hesitancy. Though not medically confirmed, 4 out of 19 participants interviewed believed they had adverse effects post-COVID-19 vaccination, including stroke, blood clots, and hives.

Conclusion
Our data suggest below national vaccination status among PWH and lack of vaccine trust might be a reason for low vaccination status. Also, younger PWH may have lower PR and higher COVID-19 risk than older PWH. We recommend further research on vaccination uptake, HIV-COVID-19 vaccine interactions, and long-term effects of COVID-19 among PWH.

Disclosures
All Authors: No reported disclosures