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Publisher: Oxford University Press   (Total: 396 journals)

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Showing 1 - 200 of 396 Journals sorted alphabetically
ACS Symposium Series     Full-text available via subscription   (SJR: 0.189, CiteScore: 0)
Acta Biochimica et Biophysica Sinica     Hybrid Journal   (Followers: 5, SJR: 0.79, CiteScore: 2)
Adaptation     Hybrid Journal   (Followers: 9, SJR: 0.143, CiteScore: 0)
Advances in Nutrition     Hybrid Journal   (Followers: 50, SJR: 2.196, CiteScore: 5)
Aesthetic Surgery J.     Hybrid Journal   (Followers: 6, SJR: 1.434, CiteScore: 1)
African Affairs     Hybrid Journal   (Followers: 65, SJR: 1.869, CiteScore: 2)
Age and Ageing     Hybrid Journal   (Followers: 90, SJR: 1.989, CiteScore: 4)
Alcohol and Alcoholism     Hybrid Journal   (Followers: 18, SJR: 1.376, CiteScore: 3)
American Entomologist     Full-text available via subscription   (Followers: 7)
American Historical Review     Hybrid Journal   (Followers: 156, SJR: 0.467, CiteScore: 1)
American J. of Agricultural Economics     Hybrid Journal   (Followers: 42, SJR: 2.113, CiteScore: 3)
American J. of Clinical Nutrition     Hybrid Journal   (Followers: 156, SJR: 3.438, CiteScore: 6)
American J. of Epidemiology     Hybrid Journal   (Followers: 177, SJR: 2.713, CiteScore: 3)
American J. of Hypertension     Hybrid Journal   (Followers: 25, SJR: 1.322, CiteScore: 3)
American J. of Jurisprudence     Hybrid Journal   (Followers: 19, SJR: 0.281, CiteScore: 1)
American J. of Legal History     Full-text available via subscription   (Followers: 8, SJR: 0.116, CiteScore: 0)
American Law and Economics Review     Hybrid Journal   (Followers: 27, SJR: 1.053, CiteScore: 1)
American Literary History     Hybrid Journal   (Followers: 16, SJR: 0.391, CiteScore: 0)
Analysis     Hybrid Journal   (Followers: 22, SJR: 1.038, CiteScore: 1)
Animal Frontiers     Hybrid Journal   (Followers: 1)
Annals of Behavioral Medicine     Hybrid Journal   (Followers: 15, SJR: 1.423, CiteScore: 3)
Annals of Botany     Hybrid Journal   (Followers: 36, SJR: 1.721, CiteScore: 4)
Annals of Oncology     Hybrid Journal   (Followers: 45, SJR: 5.599, CiteScore: 9)
Annals of the Entomological Society of America     Full-text available via subscription   (Followers: 10, SJR: 0.722, CiteScore: 1)
Annals of Work Exposures and Health     Hybrid Journal   (Followers: 32, SJR: 0.728, CiteScore: 2)
AoB Plants     Open Access   (Followers: 4, SJR: 1.28, CiteScore: 3)
Applied Economic Perspectives and Policy     Hybrid Journal   (Followers: 18, SJR: 0.858, CiteScore: 2)
Applied Linguistics     Hybrid Journal   (Followers: 56, SJR: 2.987, CiteScore: 3)
Applied Mathematics Research eXpress     Hybrid Journal   (Followers: 1, SJR: 1.241, CiteScore: 1)
Arbitration Intl.     Full-text available via subscription   (Followers: 20)
Arbitration Law Reports and Review     Hybrid Journal   (Followers: 14)
Archives of Clinical Neuropsychology     Hybrid Journal   (Followers: 30, SJR: 0.731, CiteScore: 2)
Aristotelian Society Supplementary Volume     Hybrid Journal   (Followers: 3)
Arthropod Management Tests     Hybrid Journal   (Followers: 2)
Astronomy & Geophysics     Hybrid Journal   (Followers: 43, SJR: 0.146, CiteScore: 0)
Behavioral Ecology     Hybrid Journal   (Followers: 52, SJR: 1.871, CiteScore: 3)
Bioinformatics     Hybrid Journal   (Followers: 309, SJR: 6.14, CiteScore: 8)
Biology Methods and Protocols     Hybrid Journal  
Biology of Reproduction     Full-text available via subscription   (Followers: 9, SJR: 1.446, CiteScore: 3)
Biometrika     Hybrid Journal   (Followers: 20, SJR: 3.485, CiteScore: 2)
BioScience     Hybrid Journal   (Followers: 29, SJR: 2.754, CiteScore: 4)
Bioscience Horizons : The National Undergraduate Research J.     Open Access   (Followers: 1, SJR: 0.146, CiteScore: 0)
Biostatistics     Hybrid Journal   (Followers: 17, SJR: 1.553, CiteScore: 2)
BJA : British J. of Anaesthesia     Hybrid Journal   (Followers: 167, SJR: 2.115, CiteScore: 3)
BJA Education     Hybrid Journal   (Followers: 64)
Brain     Hybrid Journal   (Followers: 68, SJR: 5.858, CiteScore: 7)
Briefings in Bioinformatics     Hybrid Journal   (Followers: 49, SJR: 2.505, CiteScore: 5)
Briefings in Functional Genomics     Hybrid Journal   (Followers: 3, SJR: 2.15, CiteScore: 3)
British J. for the Philosophy of Science     Hybrid Journal   (Followers: 35, SJR: 2.161, CiteScore: 2)
British J. of Aesthetics     Hybrid Journal   (Followers: 25, SJR: 0.508, CiteScore: 1)
British J. of Criminology     Hybrid Journal   (Followers: 587, SJR: 1.828, CiteScore: 3)
British J. of Social Work     Hybrid Journal   (Followers: 87, SJR: 1.019, CiteScore: 2)
British Medical Bulletin     Hybrid Journal   (Followers: 6, SJR: 1.355, CiteScore: 3)
British Yearbook of Intl. Law     Hybrid Journal   (Followers: 32)
Bulletin of the London Mathematical Society     Hybrid Journal   (Followers: 4, SJR: 1.376, CiteScore: 1)
Cambridge J. of Economics     Hybrid Journal   (Followers: 64, SJR: 0.764, CiteScore: 2)
Cambridge J. of Regions, Economy and Society     Hybrid Journal   (Followers: 11, SJR: 2.438, CiteScore: 4)
Cambridge Quarterly     Hybrid Journal   (Followers: 9, SJR: 0.104, CiteScore: 0)
Capital Markets Law J.     Hybrid Journal   (Followers: 2, SJR: 0.222, CiteScore: 0)
Carcinogenesis     Hybrid Journal   (Followers: 2, SJR: 2.135, CiteScore: 5)
Cardiovascular Research     Hybrid Journal   (Followers: 14, SJR: 3.002, CiteScore: 5)
Cerebral Cortex     Hybrid Journal   (Followers: 45, SJR: 3.892, CiteScore: 6)
CESifo Economic Studies     Hybrid Journal   (Followers: 17, SJR: 0.483, CiteScore: 1)
Chemical Senses     Hybrid Journal   (Followers: 1, SJR: 1.42, CiteScore: 3)
Children and Schools     Hybrid Journal   (Followers: 5, SJR: 0.246, CiteScore: 0)
Chinese J. of Comparative Law     Hybrid Journal   (Followers: 4, SJR: 0.412, CiteScore: 0)
Chinese J. of Intl. Law     Hybrid Journal   (Followers: 23, SJR: 0.329, CiteScore: 0)
Chinese J. of Intl. Politics     Hybrid Journal   (Followers: 10, SJR: 1.392, CiteScore: 2)
Christian Bioethics: Non-Ecumenical Studies in Medical Morality     Hybrid Journal   (Followers: 10, SJR: 0.183, CiteScore: 0)
Classical Receptions J.     Hybrid Journal   (Followers: 27, SJR: 0.123, CiteScore: 0)
Clean Energy     Open Access   (Followers: 1)
Clinical Infectious Diseases     Hybrid Journal   (Followers: 66, SJR: 5.051, CiteScore: 5)
Clinical Kidney J.     Open Access   (Followers: 3, SJR: 1.163, CiteScore: 2)
Communication Theory     Hybrid Journal   (Followers: 23, SJR: 2.424, CiteScore: 3)
Communication, Culture & Critique     Hybrid Journal   (Followers: 27, SJR: 0.222, CiteScore: 1)
Community Development J.     Hybrid Journal   (Followers: 27, SJR: 0.268, CiteScore: 1)
Computer J.     Hybrid Journal   (Followers: 9, SJR: 0.319, CiteScore: 1)
Conservation Physiology     Open Access   (Followers: 2, SJR: 1.818, CiteScore: 3)
Contemporary Women's Writing     Hybrid Journal   (Followers: 9, SJR: 0.121, CiteScore: 0)
Contributions to Political Economy     Hybrid Journal   (Followers: 5, SJR: 0.906, CiteScore: 1)
Critical Values     Full-text available via subscription  
Current Developments in Nutrition     Open Access   (Followers: 2)
Current Legal Problems     Hybrid Journal   (Followers: 29)
Current Zoology     Full-text available via subscription   (Followers: 2, SJR: 1.164, CiteScore: 2)
Database : The J. of Biological Databases and Curation     Open Access   (Followers: 8, SJR: 1.791, CiteScore: 3)
Digital Scholarship in the Humanities     Hybrid Journal   (Followers: 14, SJR: 0.259, CiteScore: 1)
Diplomatic History     Hybrid Journal   (Followers: 20, SJR: 0.45, CiteScore: 1)
DNA Research     Open Access   (Followers: 5, SJR: 2.866, CiteScore: 6)
Dynamics and Statistics of the Climate System     Open Access   (Followers: 4)
Early Music     Hybrid Journal   (Followers: 16, SJR: 0.139, CiteScore: 0)
Economic Policy     Hybrid Journal   (Followers: 42, SJR: 3.584, CiteScore: 3)
ELT J.     Hybrid Journal   (Followers: 24, SJR: 0.942, CiteScore: 1)
English Historical Review     Hybrid Journal   (Followers: 54, SJR: 0.612, CiteScore: 1)
English: J. of the English Association     Hybrid Journal   (Followers: 14, SJR: 0.1, CiteScore: 0)
Environmental Entomology     Full-text available via subscription   (Followers: 11, SJR: 0.818, CiteScore: 2)
Environmental Epigenetics     Open Access   (Followers: 3)
Environmental History     Hybrid Journal   (Followers: 27, SJR: 0.408, CiteScore: 1)
EP-Europace     Hybrid Journal   (Followers: 2, SJR: 2.748, CiteScore: 4)
Epidemiologic Reviews     Hybrid Journal   (Followers: 9, SJR: 4.505, CiteScore: 8)
ESHRE Monographs     Hybrid Journal  
Essays in Criticism     Hybrid Journal   (Followers: 17, SJR: 0.113, CiteScore: 0)
European Heart J.     Hybrid Journal   (Followers: 57, SJR: 9.315, CiteScore: 9)
European Heart J. - Cardiovascular Imaging     Hybrid Journal   (Followers: 9, SJR: 3.625, CiteScore: 3)
European Heart J. - Cardiovascular Pharmacotherapy     Full-text available via subscription   (Followers: 1)
European Heart J. - Quality of Care and Clinical Outcomes     Hybrid Journal  
European Heart J. : Case Reports     Open Access  
European Heart J. Supplements     Hybrid Journal   (Followers: 8, SJR: 0.223, CiteScore: 0)
European J. of Cardio-Thoracic Surgery     Hybrid Journal   (Followers: 9, SJR: 1.681, CiteScore: 2)
European J. of Intl. Law     Hybrid Journal   (Followers: 188, SJR: 0.694, CiteScore: 1)
European J. of Orthodontics     Hybrid Journal   (Followers: 4, SJR: 1.279, CiteScore: 2)
European J. of Public Health     Hybrid Journal   (Followers: 20, SJR: 1.36, CiteScore: 2)
European Review of Agricultural Economics     Hybrid Journal   (Followers: 10, SJR: 1.172, CiteScore: 2)
European Review of Economic History     Hybrid Journal   (Followers: 30, SJR: 0.702, CiteScore: 1)
European Sociological Review     Hybrid Journal   (Followers: 42, SJR: 2.728, CiteScore: 3)
Evolution, Medicine, and Public Health     Open Access   (Followers: 11)
Family Practice     Hybrid Journal   (Followers: 16, SJR: 1.018, CiteScore: 2)
Fems Microbiology Ecology     Hybrid Journal   (Followers: 12, SJR: 1.492, CiteScore: 4)
Fems Microbiology Letters     Hybrid Journal   (Followers: 26, SJR: 0.79, CiteScore: 2)
Fems Microbiology Reviews     Hybrid Journal   (Followers: 30, SJR: 7.063, CiteScore: 13)
Fems Yeast Research     Hybrid Journal   (Followers: 14, SJR: 1.308, CiteScore: 3)
Food Quality and Safety     Open Access   (Followers: 1)
Foreign Policy Analysis     Hybrid Journal   (Followers: 24, SJR: 1.425, CiteScore: 1)
Forest Science     Hybrid Journal   (Followers: 7, SJR: 0.89, CiteScore: 2)
Forestry: An Intl. J. of Forest Research     Hybrid Journal   (Followers: 16, SJR: 1.133, CiteScore: 3)
Forum for Modern Language Studies     Hybrid Journal   (Followers: 6, SJR: 0.104, CiteScore: 0)
French History     Hybrid Journal   (Followers: 33, SJR: 0.118, CiteScore: 0)
French Studies     Hybrid Journal   (Followers: 20, SJR: 0.148, CiteScore: 0)
French Studies Bulletin     Hybrid Journal   (Followers: 10, SJR: 0.152, CiteScore: 0)
Gastroenterology Report     Open Access   (Followers: 2)
Genome Biology and Evolution     Open Access   (Followers: 13, SJR: 2.578, CiteScore: 4)
Geophysical J. Intl.     Hybrid Journal   (Followers: 35, SJR: 1.506, CiteScore: 3)
German History     Hybrid Journal   (Followers: 23, SJR: 0.161, CiteScore: 0)
GigaScience     Open Access   (Followers: 4, SJR: 5.022, CiteScore: 7)
Global Summitry     Hybrid Journal   (Followers: 1)
Glycobiology     Hybrid Journal   (Followers: 13, SJR: 1.493, CiteScore: 3)
Health and Social Work     Hybrid Journal   (Followers: 56, SJR: 0.388, CiteScore: 1)
Health Education Research     Hybrid Journal   (Followers: 15, SJR: 0.854, CiteScore: 2)
Health Policy and Planning     Hybrid Journal   (Followers: 25, SJR: 1.512, CiteScore: 2)
Health Promotion Intl.     Hybrid Journal   (Followers: 22, SJR: 0.812, CiteScore: 2)
History Workshop J.     Hybrid Journal   (Followers: 31, SJR: 1.278, CiteScore: 1)
Holocaust and Genocide Studies     Hybrid Journal   (Followers: 28, SJR: 0.105, CiteScore: 0)
Human Communication Research     Hybrid Journal   (Followers: 14, SJR: 2.146, CiteScore: 3)
Human Molecular Genetics     Hybrid Journal   (Followers: 8, SJR: 3.555, CiteScore: 5)
Human Reproduction     Hybrid Journal   (Followers: 71, SJR: 2.643, CiteScore: 5)
Human Reproduction Open     Open Access  
Human Reproduction Update     Hybrid Journal   (Followers: 18, SJR: 5.317, CiteScore: 10)
Human Rights Law Review     Hybrid Journal   (Followers: 58, SJR: 0.756, CiteScore: 1)
ICES J. of Marine Science: J. du Conseil     Hybrid Journal   (Followers: 53, SJR: 1.591, CiteScore: 3)
ICSID Review     Hybrid Journal   (Followers: 11)
ILAR J.     Hybrid Journal   (Followers: 2, SJR: 1.732, CiteScore: 4)
IMA J. of Applied Mathematics     Hybrid Journal   (SJR: 0.679, CiteScore: 1)
IMA J. of Management Mathematics     Hybrid Journal   (SJR: 0.538, CiteScore: 1)
IMA J. of Mathematical Control and Information     Hybrid Journal   (Followers: 2, SJR: 0.496, CiteScore: 1)
IMA J. of Numerical Analysis - advance access     Hybrid Journal   (SJR: 1.987, CiteScore: 2)
Industrial and Corporate Change     Hybrid Journal   (Followers: 10, SJR: 1.792, CiteScore: 2)
Industrial Law J.     Hybrid Journal   (Followers: 36, SJR: 0.249, CiteScore: 1)
Inflammatory Bowel Diseases     Hybrid Journal   (Followers: 44, SJR: 2.511, CiteScore: 4)
Information and Inference     Free  
Integrative and Comparative Biology     Hybrid Journal   (Followers: 8, SJR: 1.319, CiteScore: 2)
Interacting with Computers     Hybrid Journal   (Followers: 11, SJR: 0.292, CiteScore: 1)
Interactive CardioVascular and Thoracic Surgery     Hybrid Journal   (Followers: 7, SJR: 0.762, CiteScore: 1)
Intl. Affairs     Hybrid Journal   (Followers: 62, SJR: 1.505, CiteScore: 3)
Intl. Data Privacy Law     Hybrid Journal   (Followers: 25)
Intl. Health     Hybrid Journal   (Followers: 6, SJR: 0.851, CiteScore: 2)
Intl. Immunology     Hybrid Journal   (Followers: 3, SJR: 2.167, CiteScore: 4)
Intl. J. for Quality in Health Care     Hybrid Journal   (Followers: 36, SJR: 1.348, CiteScore: 2)
Intl. J. of Constitutional Law     Hybrid Journal   (Followers: 64, SJR: 0.601, CiteScore: 1)
Intl. J. of Epidemiology     Hybrid Journal   (Followers: 239, SJR: 3.969, CiteScore: 5)
Intl. J. of Law and Information Technology     Hybrid Journal   (Followers: 5, SJR: 0.202, CiteScore: 1)
Intl. J. of Law, Policy and the Family     Hybrid Journal   (Followers: 24, SJR: 0.223, CiteScore: 1)
Intl. J. of Lexicography     Hybrid Journal   (Followers: 9, SJR: 0.285, CiteScore: 1)
Intl. J. of Low-Carbon Technologies     Open Access   (Followers: 1, SJR: 0.403, CiteScore: 1)
Intl. J. of Neuropsychopharmacology     Open Access   (Followers: 3, SJR: 1.808, CiteScore: 4)
Intl. J. of Public Opinion Research     Hybrid Journal   (Followers: 11, SJR: 1.545, CiteScore: 1)
Intl. J. of Refugee Law     Hybrid Journal   (Followers: 38, SJR: 0.389, CiteScore: 1)
Intl. J. of Transitional Justice     Hybrid Journal   (Followers: 11, SJR: 0.724, CiteScore: 2)
Intl. Mathematics Research Notices     Hybrid Journal   (Followers: 1, SJR: 2.168, CiteScore: 1)
Intl. Political Sociology     Hybrid Journal   (Followers: 39, SJR: 1.465, CiteScore: 3)
Intl. Relations of the Asia-Pacific     Hybrid Journal   (Followers: 23, SJR: 0.401, CiteScore: 1)
Intl. Studies Perspectives     Hybrid Journal   (Followers: 9, SJR: 0.983, CiteScore: 1)
Intl. Studies Quarterly     Hybrid Journal   (Followers: 47, SJR: 2.581, CiteScore: 2)
Intl. Studies Review     Hybrid Journal   (Followers: 25, SJR: 1.201, CiteScore: 1)
ISLE: Interdisciplinary Studies in Literature and Environment     Hybrid Journal   (Followers: 2, SJR: 0.15, CiteScore: 0)
ITNOW     Hybrid Journal   (Followers: 1, SJR: 0.103, CiteScore: 0)
J. of African Economies     Hybrid Journal   (Followers: 17, SJR: 0.533, CiteScore: 1)
J. of American History     Hybrid Journal   (Followers: 46, SJR: 0.297, CiteScore: 1)
J. of Analytical Toxicology     Hybrid Journal   (Followers: 14, SJR: 1.065, CiteScore: 2)
J. of Antimicrobial Chemotherapy     Hybrid Journal   (Followers: 15, SJR: 2.419, CiteScore: 4)
J. of Antitrust Enforcement     Hybrid Journal   (Followers: 1)
J. of Applied Poultry Research     Hybrid Journal   (Followers: 5, SJR: 0.585, CiteScore: 1)
J. of Biochemistry     Hybrid Journal   (Followers: 41, SJR: 1.226, CiteScore: 2)
J. of Burn Care & Research     Hybrid Journal   (Followers: 10, SJR: 0.768, CiteScore: 2)
J. of Chromatographic Science     Hybrid Journal   (Followers: 18, SJR: 0.36, CiteScore: 1)
J. of Church and State     Hybrid Journal   (Followers: 11, SJR: 0.139, CiteScore: 0)
J. of Communication     Hybrid Journal   (Followers: 54, SJR: 4.411, CiteScore: 5)
J. of Competition Law and Economics     Hybrid Journal   (Followers: 36, SJR: 0.33, CiteScore: 0)
J. of Complex Networks     Hybrid Journal   (Followers: 2, SJR: 1.05, CiteScore: 4)
J. of Computer-Mediated Communication     Open Access   (Followers: 29, SJR: 2.961, CiteScore: 6)
J. of Conflict and Security Law     Hybrid Journal   (Followers: 12, SJR: 0.402, CiteScore: 0)
J. of Consumer Research     Full-text available via subscription   (Followers: 46, SJR: 5.856, CiteScore: 5)

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Journal Cover
Clinical Infectious Diseases
Journal Prestige (SJR): 5.051
Citation Impact (citeScore): 5
Number of Followers: 66  
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1058-4838 - ISSN (Online) 1537-6591
Published by Oxford University Press Homepage  [396 journals]
  • In the Literature
    • PubDate: Tue, 13 Nov 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy832
      Issue No: Vol. 67, No. 11 (2018)
  • News
    • PubDate: Tue, 13 Nov 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy785
      Issue No: Vol. 67, No. 11 (2018)
  • Outcomes of Patients Lost to Follow-up in African Antiretroviral Therapy
           Programs: Individual Patient Data Meta-analysis
    • Authors: Chammartin F; Zürcher K, Keiser O, et al.
      Pages: 1643 - 1652
      Abstract: BackgroundLow retention on combination antiretroviral therapy (cART) has emerged as a threat to the Joint United Nations Programme on human immunodeficiency virus (HIV)/AIDS (UNAIDS) 90-90-90 targets. We examined outcomes of patients who started cART but were subsequently lost to follow-up (LTFU) in African treatment programs.MethodsThis was a systematic review and individual patient data meta-analysis of studies that traced patients who were LTFU. Outcomes were analyzed using cumulative incidence functions and proportional hazards models for the competing risks of (i) death, (ii) alive but stopped cART, (iii) silent transfer to other clinics, and (iv) retention on cART.ResultsNine studies contributed data on 7377 patients who started cART and were subsequently LTFU in sub-Saharan Africa. The median CD4 count at the start of cART was 129 cells/μL. At 4 years after the last clinic visit, 21.8% (95% confidence interval [CI], 20.8%–22.7%) were known to have died, 22.6% (95% CI, 21.6%–23.6%) were alive but had stopped cART, 14.8% (95% CI, 14.0%–15.6%) had transferred to another clinic, 9.2% (95% CI, 8.5%–9.8%) were retained on cART, and 31.6% (95% CI, 30.6%–32.7%) could not been found. Mortality was associated with male sex, more advanced disease, and shorter cART duration; stopping cART with less advanced disease andlonger cART duration; and silent transfer with female sex and less advanced disease.ConclusionsMortality in patients LTFU must be considered for unbiased assessments of program outcomes and UNAIDS targets in sub-Saharan Africa. Immediate start of cART and early tracing of patients LTFU should be priorities.
      PubDate: Fri, 08 Jun 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy347
      Issue No: Vol. 67, No. 11 (2018)
  • Transmission of Mycobacterium tuberculosis From Patients Who Are Nucleic
           Acid Amplification Test Negative
    • Authors: Xie Y; Cronin W, Proschan M, et al.
      Pages: 1653 - 1659
      Abstract: BackgroundAmong adults with signs and symptoms of pulmonary tuberculosis (TB), recognition of transmissible TB has implications for airborne infection isolation and public health activities. Sputum smear–negative TB patients account for around one-fifth of tuberculosis transmission. The tuberculosis transmission risk of TB patients with negative results on nucleic acid amplification test (NAAT) of respiratory specimens has not been established. We sought to estimate the tuberculosis transmission risk of NAAT-negative TB patients.MethodsWe retrospectively reviewed Maryland TB program data collected from 2004 to 2009, during which time NAAT using the Mycobacterium Tuberculosis Direct Test (MTD) was performed routinely. Patients with sputum Mycobacterium tuberculosis (M.tb) isolates having matching genotypes were assigned to clusters. Transmission sequence was approximated by collection order of individuals’ first culture-positive specimens. Minimum transmission risks of NAAT (MTD)-negative TB patients and of smear-negative TB patients were estimated based on individuals’ positions within clusters.ResultsAmong 809 patients with culture-confirmed TB, M.tb genotypes were available for 782 (96.7%). For NAA-negative TB patients, the minimum transmission risk estimate was 5.1% (95% CI 0–11.4). For smear-negative TB patients, the minimum transmission risk estimate was 11.2% (95% CI 7.2–15.3).ConclusionsMinimum transmission risk of NAAT-negative TB patients was lower than that of smear-negative TB patients. However, transmission risk of NAA-negative TB patients appears to not be negligible.
      PubDate: Tue, 24 Apr 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy365
      Issue No: Vol. 67, No. 11 (2018)
  • Epidemiology and Risk Factors for Cryptosporidiosis in Children From 8
           Low-income Sites: Results From the MAL-ED Study
    • Authors: Korpe P; Valencia C, Haque R, et al.
      Pages: 1660 - 1669
      Abstract: BackgroundCryptosporidium species are enteric protozoa that cause significant morbidity and mortality in children worldwide. We characterized the epidemiology of Cryptosporidium in children from 8 resource-limited sites in Africa, Asia, and South America.MethodsChildren were enrolled within 17 days of birth and followed twice weekly for 24 months. Diarrheal and monthly surveillance stool samples were tested for Cryptosporidium by enzyme-linked immunosorbent assay. Socioeconomic data were collected by survey, and anthropometry was measured monthly.ResultsSixty-five percent (962/1486) of children had a Cryptosporidium infection and 54% (802/1486) had at least 1 Cryptosporidium-associated diarrheal episode. Cryptosporidium diarrhea was more likely to be associated with dehydration (16.5% vs 8.3%, P < .01). Rates of Cryptosporidium diarrhea were highest in the Peru (10.9%) and Pakistan (9.2%) sites. In multivariable regression analysis, overcrowding at home was a significant risk factor for infection in the Bangladesh site (odds ratio, 2.3 [95% confidence interval {CI}, 1.2–4.6]). Multiple linear regression demonstrated a decreased length-for-age z score at 24 months in Cryptosporidium-positive children in the India (β = –.26 [95% CI, –.51 to –.01]) and Bangladesh (β = –.20 [95% CI, –.44 to .05]) sites.ConclusionsThis multicountry cohort study confirmed the association of Cryptosporidium infection with stunting in 2 South Asian sites, highlighting the significance of cryptosporidiosis as a risk factor for poor growth. We observed that the rate, age of onset, and number of repeat infections varied per site; future interventions should be targeted per region to maximize success.
      PubDate: Thu, 26 Apr 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy355
      Issue No: Vol. 67, No. 11 (2018)
  • Large-scale Artemisinin–Piperaquine Mass Drug Administration With or
           Without Primaquine Dramatically Reduces Malaria in a Highly Endemic Region
           of Africa
    • Authors: Deng C; Huang B, Wang Q, et al.
      Pages: 1670 - 1676
      Abstract: BackgroundMass drug administration (MDA), with or without low-dose primaquine (PMQLD), is being considered for malaria elimination programs. The potential of PMQLD to block malaria transmission by mosquitoes must be balanced against liabilities of its use.MethodsArtemisinin–piperaquine (AP), with or without PMQLD, was administered in 3 monthly rounds across Anjouan Island, Union of Comoros. Plasmodium falciparum malaria rates, mortality, parasitemias, adverse events, and PfK13 Kelch-propeller gene polymorphisms were evaluated.ResultsCoverage of 85 to 93% of the Anjouan population was achieved with AP plus PMQLD (AP+PMQLD) in 2 districts (population 97164) and with AP alone in 5 districts (224471). Between the months of April–September in both 2012 and 2013, average monthly malaria hospital rates per 100000 people fell from 310.8 to 2.06 in the AP+PMQLD population (ratio 2.06/310.8 = 0.66%; 95% CI: 0.02%, 3.62%; P = .00007) and from 412.1 to 2.60 in the AP population (ratio 0.63%; 95% CI: 0.11%, 1.93%; P < .00001). Effectiveness of AP+PMQLD was 0.9908 (95% CI: 0.9053, 0.9991), while effectiveness of AP alone was 0.9913 (95% CI: 0.9657, 0.9978). Both regimens were well tolerated, without severe adverse events. Analysis of 52 malaria samples after MDA showed no evidence for selection of PfK13 Kelch-propeller mutations.ConclusionsSteep reductions of malaria cases were achieved by 3 monthly rounds of either AP+PMQLD or AP alone, suggesting potential for highly successful MDA without PMQLD in epidemiological settings such as those on Anjouan. A major challenge is to sustain and expand the public health benefits of malaria reductions by MDA.
      PubDate: Tue, 24 Apr 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy364
      Issue No: Vol. 67, No. 11 (2018)
  • Benchmarking Inpatient Antimicrobial Use: A Comparison of Risk-Adjusted
           Observed-to-Expected Ratios
    • Authors: Yu K; Moisan E, Tartof S, et al.
      Pages: 1677 - 1685
      Abstract: BackgroundIncreasing antibiotic resistance has made benchmarking appropriate inpatient antibiotic use a worldwide priority supported by expert societies and regulatory bodies; however, standard risk adjustment for fair interfacility comparison has been elusive. We describe a risk-adjusted antibiotic exposure ratio that may help facilitate assessment of antimicrobial use.MethodsThis was a retrospective cohort study of 2.7 million admissions evaluating a wide array of potential explanatory variables for correlation with expected antibiotic consumption in a 2-step approach using recursive partitioning and Poisson regression. Observed-to-expected ratios of risk-adjusted antibiotic use were calculated. Three models of varying complexity were compared: (1) a complex ratio consisting of all available antibiotic use risk factors in a hierarchical model; (2) a simplified antimicrobial stewardship program (ASP) ratio using common facility and encounter factors in a single-level model; and (3) a facility ratio using only broad hospital characteristics.ResultsDiagnosis-related groups, infection present on admission, patient class, and unit type were the major predictors of expected antibiotic use. Aside from a history of gram-positive resistance in the prior 12 months for anti–methicillin-resistant Staphylococcus aureus drugs, additional clinical and comorbid history information did not improve the model. The simplified ASP ratio demonstrated higher Pearson correlation (R2 = 0.97–0.99) to the complex ratio than the facility ratio (R2 = 0.57–0.85) and provided clinical explanations when discordant.ConclusionsThe simplified ASP ratio is derived from a parsimonious model that incorporates disease burden through patient-level risk adjustment and better informs stewardship assessment. This may allow for improved comparison of antibiotic use between healthcare facilities.
      PubDate: Tue, 24 Apr 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy354
      Issue No: Vol. 67, No. 11 (2018)
  • The Fog May be Lifting Around Antibiotic Use Metrics and Interfacility
    • Authors: Fridkin S.
      Pages: 1686 - 1687
      Abstract: (See the Major Article by Yu et al on pages 1677–85.)
      PubDate: Tue, 24 Apr 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy359
      Issue No: Vol. 67, No. 11 (2018)
  • Clinical Impact of a Multiplex Gastrointestinal Polymerase Chain Reaction
           Panel in Patients With Acute Gastroenteritis
    • Authors: Cybulski R; Jr, Bateman A, Bourassa L, et al.
      Pages: 1688 - 1696
      Abstract: BackgroundMolecular syndromic diagnostic panels can enhance pathogen identification in the approximately 2–4 billion episodes of acute gastroenteritis that occur annually worldwide. However, the clinical utility of these panels has not been established.MethodsWe conducted a prospective, multi-center study to investigate the impact of the BioFire FilmArray Gastrointestinal polymerase chain reaction panel on clinical diagnosis and decision-making, and compared the clinical acuity of patients with positive results obtained exclusively with the FilmArray with those detected by conventional stool culture. A total of 1887 consecutive fecal specimens were tested in parallel by FilmArray and stool culture. Laboratory and medical records were reviewed to determine rates of detection, turnaround times, clinical features, and the nature and timing of clinical decisions.ResultsFilmArray detected pathogens in 35.3% of specimens, compared to 6.0% for culture. Median time from collection to result was 18 hours for FilmArray and 47 hours for culture. Median time from collection to initiation of antimicrobial therapy was 22 hours for FilmArray and 72 hours for culture. Patients diagnosed by FilmArray were more likely to receive targeted rather than empirical therapy, compared to those diagnosed by culture (P = .0148). Positive Shiga-like toxin-producing E. coli results were reported 47 hours faster with FilmArray and facilitated discontinuation of empirical antimicrobials. Patients diagnosed exclusively by FilmArray had clinical characteristics similar to those identified by culture.ConclusionsFilmArray markedly improved clinical sensitivity in patients with acute diarrhea, identified cases with clinical acuity comparable to those identified by culture, and enabled clinicians to make more timely and targeted therapeutic decisions.
      PubDate: Wed, 25 Apr 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy357
      Issue No: Vol. 67, No. 11 (2018)
  • Longitudinal Trajectories of Brain Volume and Cortical Thickness in
           Treated and Untreated Primary Human Immunodeficiency Virus Infection
    • Authors: Sanford R; Ances B, Meyerhoff D, et al.
      Pages: 1697 - 1704
      Abstract: BackgroundHuman immunodeficiency virus (HIV) penetrates the brain in early infection. We used neuroimaging to longitudinally examine the impact of HIV and combination antiretroviral therapy (cART) on the brain in treated and untreated HIV-infected participants, starting in primary HIV infection (PHI).MethodsSixty-five participants, enrolled during PHI, underwent longitudinal magnetic resonance imaging, 30 of whom commenced cART during follow-up. Cross-sectional data from 16 patients with chronic HIV infection (CHI) and 19 HIV-uninfected participants were included for comparison. Brain volume and cortical thickness were estimated using tensor-based morphometry and cortical modeling, respectively. Mixed-effects models longitudinally mapped structural brain changes before and after cART. The relationship between brain morphometry estimates and blood and cerebrospinal fluid (CSF) biomarkers were also tested. Region-of-interest analyses were performed to compare brain morphometry estimates between the groups.ResultsPrior to cART, longer duration of untreated infection in PHI correlated with volume loss in the thalamus, caudate, and cerebellum, and with cortical thinning in the frontal and temporal lobes and cingulate cortex. After cART, no further volume loss was observed. However, small increases of cortical thickness in the frontal and temporal lobe correlated with longer cART duration. No correlations were observed with blood or CSF measures. The PHI group did not have different brain morphometric measures compared to the HIV-uninfected group, but had larger volumes in the thalamus, caudate, putamen, and cortical gray matter compared with CHI participants.ConclusionsSubcortical atrophy and cortical thinning occur during untreated infection but may be arrested by cART. These findings emphasize the importance of early cART.
      PubDate: Tue, 24 Apr 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy362
      Issue No: Vol. 67, No. 11 (2018)
  • Urine Antigen Detection as an Aid to Diagnose Invasive Aspergillosis
    • Authors: Marr K; Datta K, Mehta S, et al.
      Pages: 1705 - 1711
      Abstract: BackgroundEstablishing rapid diagnoses of invasive aspergillosis (IA) is a priority tests that detect galactomannan and β-d-glucan are available, but are technically cumbersome and rely on invasive sampling (blood or bronchoalveolar lavage).MethodsWe optimized a lateral flow dipstick assay using the galactofuranose-specific monoclonal antibody (mAb476), which recognizes urine antigens after Aspergillus fumigatus pulmonary infection in animals. Urine samples were obtained from a cohort of 78 subjects undergoing evaluation for suspected invasive fungal infections, and stored frozen until testing. Urine was processed by centrifugation through desalting columns and exposed to dipsticks. Reviewers blinded to clinical diagnoses graded results. Western blots were performed on urine samples from 2 subjects to characterize mAb476-reactive antigens.ResultsPer-patient sensitivity and specificity for diagnosis of proven or probable IA in the overall cohort was 80% (95% confidence interval [CI], 61.4%–92.3%) and 92% (95% CI, 74%–99%), respectively. In the subgroup with cancer, sensitivity was 89.5% (95% CI, 66.7%–98.7%) and specificity was 90.9% (95% CI, 58.7%–99.8%); among all others, sensitivity and specificity were 63.6% (95% CI, 30.8%–89.1%) and 92.9% (95% CI, 66.1%–99.8%), respectively. Eliminating lung transplant recipients with airway disease increased sensitivity in the noncancer cohort (85.7% [95% CI, 42.1%–99.6%]). Semiquantitative urine assay results correlated with serum galactomannan indices. Western blots demonstrated mAb476-reactive antigens in urine from cases, ranging between 26 kDa and 35 kDa in size.ConclusionsUrine testing using mAb476 may be used as an aid to diagnose IA in high-risk patients.
      PubDate: Thu, 19 Apr 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy326
      Issue No: Vol. 67, No. 11 (2018)
  • Safety and Immunogenicity of Zoster Vaccine Live in Human Immunodeficiency
           Virus–Infected Adults With CD4+ Cell Counts >200 Cells/mL
           Virologically Suppressed on Antiretroviral Therapy
    • Authors: Benson C; Andersen J, Macatangay B, et al.
      Pages: 1712 - 1719
      Abstract: BackgroundHerpes zoster (HZ) risk is increased in human immunodeficiency virus (HIV)–infected persons. Live attenuated zoster vaccine (ZV) reduces HZ incidence and severity in adults; safety and immunogenicity data in HIV-infected adults are limited.MethodsWe conducted a randomized, double-blind, placebo-controlled trial in HIV-infected adults virally suppressed on antiretroviral therapy (ART). Participants, stratified by CD4+ count (200–349 or ≥350 cells/µL), were randomized 3:1 to receive ZV or placebo on day 0 and week 6. The primary endpoint was serious adverse event or grade 3/4 signs/symptoms within 6 weeks after each dose. Immunogenicity (varicella zoster virus [VZV]–specific glycoprotein enzyme-linked immunosorbent assay and interferon-γ enzyme-linked immunospot assay responses) was assessed at 6 and 12 weeks postvaccination.ResultsOf 395 participants (296 ZV vs 99 placebo), 84% were male, 47% white, 29% black, and 22% Hispanic; median age was 49 years. Safety endpoints occurred in 15 ZV and 2 placebo recipients (5.1% [95% confidence interval {CI}, 2.9%–8.2%] vs 2.1% [95% CI, .3%–7.3%]; P = .26). Injection site reactions occurred in 42% of ZV (95% CI, 36.3%–47.9%) vs 12.4% of placebo recipients (95% CI, 6.6%–20.6%) (P < .001). Week 12 median natural log VZV antibody titer was higher for ZV (6.30 [Q1, Q3, 5.64, 6.96]) vs placebo (5.48 [Q1, Q3, 4.63, 6.44]; P < .001) overall and in the high CD4+ stratum (P = .003). VZV antibody titers were similar after 1 or 2 ZV doses. Polymerase chain reaction–confirmed HZ occurred in 2 participants (1 ZV; 1 placebo); none was vaccine strain related.ConclusionsTwo doses of ZV in HIV-infected adults suppressed on ART with CD4+ counts ≥200 cells/µL were safe and immunogenic.Clinical Trials RegistrationNCT00851786.
      PubDate: Mon, 26 Mar 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy242
      Issue No: Vol. 67, No. 11 (2018)
  • Colonization With Levofloxacin-resistant Extended-spectrum
           β-Lactamase-producing Enterobacteriaceae and Risk of Bacteremia in
           Hematopoietic Stem Cell Transplant Recipients
    • Authors: Satlin M; Chavda K, Baker T, et al.
      Pages: 1720 - 1728
      Abstract: BackgroundBacteremia caused by extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae (ESBL-E) is associated with inadequate empirical therapy and substantial mortality in neutropenic patients. Strategies are needed to identify neutropenic patients at high risk of these infections.MethodsFrom April 2014 to September 2016, we collected perianal swabs, both at admission and weekly thereafter, from patients undergoing hematopoietic stem cell transplantation (HSCT). Patients received prophylactic levofloxacin while neutropenic. Swabs were plated onto selective agar, colonies were identified and underwent antimicrobial susceptibility testing, and phenotypic ESBL testing and polymerase chain reaction for β-lactamase genes were performed on ceftriaxone-resistant Enterobacteriaceae. We then determined the prevalence of pre-transplant ESBL-E colonization and risk of ESBL-E bacteremia. Colonizing and bloodstream isolates from patients with ESBL-E bacteremia underwent multilocus sequence typing and pulsed-field gel electrophoresis.ResultsWe analyzed 312 patients, including 212 allogeneic and 100 autologous HSCT recipients. Ten percent (31/312) of patients had pre-transplant ESBL-E colonization. Susceptibility rates of colonizing ESBL-E were: levofloxacin, 25%; cefepime, 9%; piperacillin-tazobactam, 84%; and meropenem, 97%. Of 31 patients colonized with ESBL-E pre-transplant, 10 (32%) developed ESBL-E bacteremia during their transplant admission, compared to 1 (0.4%) of 281 patients not colonized with ESBL-E (P < .001). All bloodstream ESBL-E were levofloxacin-resistant and colonizing and bloodstream isolates from individual patients had identical genotypic profiles.ConclusionsHSCT recipients who are colonized with levofloxacin-resistant ESBL-E pre-transplant and receive levofloxacin prophylaxis have high rates of bacteremia from their colonizing strain during neutropenia. Assessing for ESBL-E colonization in neutropenic patients could lead to optimization of empirical antibacterial therapy.
      PubDate: Thu, 26 Apr 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy363
      Issue No: Vol. 67, No. 11 (2018)
  • Spectrum of Enterovirus Serotypes Causing Uncomplicated Hand, Foot, and
           Mouth Disease and Enteroviral Diagnostic Yield of Different Clinical
    • Authors: Gao L; Zou G, Liao Q, et al.
      Pages: 1729 - 1735
      Abstract: BackgroundHand, foot, and mouth disease (HFMD) represents a substantial disease burden in the Western Pacific region. We investigated the spectrum of causative enteroviruses of HFMD, and evaluated different clinical samples’ diagnostic yield for enteroviruses.MethodsWe enrolled pediatric patients hospitalized for HFMD among 6 hospitals in Anhua County, Hunan Province, China between October 2013 and September 2016. Throat swabs and stool samples (or rectal swabs) were collected to detect the enterovirus serotypes by real-time reverse-transcription polymerase chain reaction (PCR) or nested PCR.ResultsAmong the 2836 patients, only 1 developed severe illness. Seventeen serotypes were identified in 2401 patients (85%), with the most frequently detected being CV-A16 (29% [814]), CV-A6 (28% [784]), EV-A71 (17% [491]), CV-A10 (4% [114]), and CV-A4 (2% [53]). Children were younger in CV-A6, CV-A10, and CV-A4 infections (median, 12 months; interquartile range [IQR], 12–24 months) than EV-A71 and CV-A16 infections (median, 24 months; IQR, 12–36 months; P < .05). The predominant enterovirus serotype shifted between CV-A16 and CV-A6 during the 3 years. Stool had a higher diagnostic yield (89%) than rectal (77%) and throat swabs (74%). Detection rates reached 93% when testing stools followed by throat swabs if stools were negative, and 89% when testing rectal swabs followed by throat swabs if rectal swabs were negative.ConclusionsOur results provide a virological benchmark for future surveillance and diagnostics. Continuous comprehensive virological surveillance is essential, especially after implementation of the EV-A71 vaccine in China, to monitor serotype replacement and the vaccine’s impact.
      PubDate: Tue, 24 Apr 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy341
      Issue No: Vol. 67, No. 11 (2018)
  • The Effect of Antibiotic Selection Pressure on the Nasopharyngeal
           Macrolide Resistome: A Cluster-randomized Trial
    • Authors: Keenan J; Chin S, Amza A, et al.
      Pages: 1736 - 1742
      Abstract: BackgroundFrequent use of antibiotics is thought to create selection pressure by clearing susceptible bacteria and allowing resistant bacteria to spread in a community. A cluster-randomized trial comparing 2 different frequencies of mass azithromycin distributions for trachoma provided a convenient experiment for determining the causal relationship between antibiotic consumption and antibiotic resistance.MethodsTwenty-four communities were randomized to either annual or biannual mass azithromycin distributions for trachoma. Randomization was stratified on health catchment area and trachoma prevalence. Swabs were processed for the genetic macrolide resistance determinants ermB and mefA/E in a masked fashion from a random sample of 120 preschool children before treatment and another 120 children after 2 years of mass antibiotics.ResultsMacrolide resistance determinants were similar in the 12 annually and 12 biannually treated communities before treatment, with a median prevalence among preschool children of 20% (interquartile range [IQR], 10%–40%) in each group. By 24 months, macrolide resistance determinants were found more commonly in the biannually treated communities (median, 60% [IQR, 50%–80%]) than the annually treated communities (median, 40% [IQR, 20%–40%]; P < .001). Adjusting for baseline, the 24-month prevalence of macrolide resistance determinants in the biannual group was 29.4% higher than that of the annual group (95% confidence interval, 10.5%–56.7%).ConclusionsThis randomized trial used direct genetic methods to confirm the causal relationship of community antibiotic consumption and antibiotic resistance. Communities randomized to less frequent use of antibiotics had a significantly lower prevalence of genetic antibiotic resistance determinants.Clinical Trials RegistrationNCT00792922.
      PubDate: Fri, 20 Apr 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy339
      Issue No: Vol. 67, No. 11 (2018)
  • Intermediate Susceptibility Dose-Dependent Breakpoints For High-Dose
           Rifampin, Isoniazid, and Pyrazinamide Treatment in Multidrug-Resistant
           Tuberculosis Programs
    • Authors: Zuur M; Pasipanodya J, van Soolingen D, et al.
      Pages: 1743 - 1749
      Abstract: BackgroundBacterial susceptibility is categorized as susceptible, intermediate-susceptible dose-dependent (ISDD), and resistant. The strategy is to use higher doses of first-line agents in the ISDD category, thereby preserving the use of these drugs. This system has not been applied to antituberculosis drugs. Pharmacokinetic/pharmacodynamic (PK/PD) target exposures, in tandem with Monte Carlo experiments, recently identified susceptibility breakpoints of 0.0312 mg/L for isoniazid, 0.0625 mg/L for rifampin, and 50 mg/L for pyrazinamide. These have been confirmed in clinical studies.MethodsTarget attainment studies were carried out using Monte Carlo experiments to investigate whether rifampin, isoniazid, and pyrazinamide dose increases would achieve the PK/PD target in >90% of 10000 patients with tuberculosis caused by bacteria, revealing minimum inhibitory concentrations (MICs) between the proposed and the traditional breakpoints.ResultsWe found that an isoniazid dose of 900 mg/day identified a new ISDD MIC range of 0.0312–0.25 mg/L and resistance at MIC ≥0.5 mg/L. Rifampin 1800 mg/day would result in an ISDD of 0.0625–0.25 mg/L and resistance at MIC ≥0.5 mg/L. At a dose of pyrazinamide 4 g/day, the ISDD MIC range was 37.5–50 mg/L and resistance at MIC ≥100 mg/L. Based on MIC distributions, 93% (isoniazid), 78% (rifampin), and 27% (pyrazinamide) of isolates would be within the ISDD range.ConclusionsDrug susceptibility testing at 2 concentrations delineating the ISDD range, and subsequently using higher doses, could prevent switching to a more toxic second-line treatment. Confirmatory clinical studies would provide evidence to change treatment guidelines.
      PubDate: Tue, 24 Apr 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy346
      Issue No: Vol. 67, No. 11 (2018)
  • Risk Factors and Incidence of Syphilis in Human Immunodeficiency Virus
           (HIV)–Infected Persons: The HIV Outpatient Study, 1999–2015
    • Authors: Novak R; Ghanem A, Hart R, et al.
      Pages: 1750 - 1759
      Abstract: BackgroundSince 2000, the incidence of syphilis has been increasing, especially among gay, bisexual, and other men who have sex with men (MSM) in the United States. We assessed temporal trends and associated risk factors for newly diagnosed syphilis infections among human immunodeficiency virus (HIV)–infected patients during a 16-year period.MethodsWe analyzed data from the HIV Outpatient Study (HOPS) cohort participants at 10 US HIV clinics during 1999–2015. New syphilis cases were defined based on laboratory parameters and clinical diagnoses. We performed Cox proportional hazards regression analyses of sociodemographic, clinical, and behavioral risk factors for new syphilis infections.ResultsWe studied 6888 HIV-infected participants; 641 had 1 or more new syphilis diagnoses during a median follow-up of 5.2 years. Most participants were male (78%), aged 31–50 years, and 57% were MSM. The overall incidence was 1.8 (95% confidence interval [CI], 1.6–1.9) per 100 person-years (PY) and it increased from 0.4 (95% CI, .2–.8) to 2.2 (95% CI, 1.4–3.5) per 100 PY during 1999–2015. In multivariable analyses adjusting for calendar year, risk factors for syphilis included age 18–30 years (hazard ratio [HR], 1.3 [95% CI, 1.1–1.6]) vs 31–40 years, being MSM (HR, 3.1 [95% CI, 2.4–4.1]) vs heterosexual male, and being non-Hispanic black (HR, 1.6 [95% CI, 1.4–1.9]) vs non-Hispanic white.ConclusionsThe increases in the syphilis incidence rate through 2015 reflect ongoing sexual risk and highlight the need for enhanced prevention interventions among HIV-infected patients in care.
      PubDate: Tue, 24 Apr 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy348
      Issue No: Vol. 67, No. 11 (2018)
  • Differences in Transmission and Disease Severity Between 2 Successive
           Waves of Chikungunya
    • Authors: Gordon A; Gresh L, Ojeda S, et al.
      Pages: 1760 - 1767
      Abstract: BackgroundChikungunya, an arboviral disease, caused massive epidemics in Central and South America in 2014–2016. In a prospective pediatric cohort study, we examined the introduction of chikungunya in a naive population and investigated transmission and clinical characteristics.MethodsChildren presenting to the study health center with a chikungunya-like illness or undifferentiated fever were tested for chikungunya virus (CHIKV) infection by reverse transcriptase-polymerase chain reaction (RT-PCR) and serological assays. Inapparent CHIKV infections in the intervening year were determined by seroconversion in healthy blood samples collected annually.ResultsA total of 4353 children participated in the cohort study from March 2014 to February 2016 during the 2 epidemic waves of chikungunya. A total of 539 cases of chikungunya were documented, for an incidence rate of 80.2 cases per 1000 person-years (95% confidence interval [CI]: 73.7, 87.2); and a total of 893 CHIKV infections were documented, for an incidence rate of 137.1 infections per 1000 person-years (95% CI: 128.4, 146.4). The seroprevalence of anti-CHIKV antibodies increased linearly with age, with seroprevalence of >45% in 14-year-old children at the end of Epidemic 2. Symptom presentation varied between the epidemics, with Epidemic 2 exhibiting both a higher symptomatic-to-inapparent ratio (1:1.20 in Epidemic 1 vs. 1:0.65 in Epidemic 2) and more severe clinical presentation among cases. The mean reproduction number was also greater in Epidemic 2 than in Epidemic 1.ConclusionsThe intensity of transmission and severity of clinical presentation varied between the 2 epidemics, with higher transmission intensity associated with greater disease severity.
      PubDate: Wed, 25 Apr 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy356
      Issue No: Vol. 67, No. 11 (2018)
  • Multiple Class I and Class II Haemophilus ducreyi Strains Cause Cutaneous
           Ulcers in Children on an Endemic Island
    • Authors: Grant J; González-Beiras C, Amick K, et al.
      Pages: 1768 - 1774
      Abstract: BackgroundTogether with Treponema pallidum subspecies pertenue, Haemophilus ducreyi is a major cause of exudative cutaneous ulcers (CUs) in children. For H. ducreyi, both class I and class II strains, asymptomatic colonization, and environmental reservoirs have been found in endemic regions, but the epidemiology of this infection is unknown.MethodsBased on published whole-genome sequences of H. ducreyi CU strains, a single-locus typing system was developed and applied to H. ducreyi–positive CU samples obtained prior to, 1 year after, and 2 years after the initiation of a mass drug administration campaign to eradicate CU on Lihir Island in Papua New Guinea. DNA from the CU samples was amplified with class I and class II dsrA-specific primers and sequenced; the samples were classified into dsrA types, which were geospatially mapped. Selection pressure analysis was performed on the dsrA sequences.ResultsThirty-seven samples contained class I sequences, 27 contained class II sequences, and 13 contained both. There were 5 class I and 4 class II types circulating on the island; 3 types accounted for approximately 87% of the strains. The composition and geospatial distribution of the types varied little over time and there was no evidence of selection pressure.ConclusionsMultiple strains of H. ducreyi cause CU on an endemic island and coinfections are common. In contrast to recent findings with T. pallidum pertenue, strain composition is not affected by antibiotic pressure, consistent with environmental reservoirs of H. ducreyi. Such reservoirs must be addressed to achieve eradication of H. ducreyi.
      PubDate: Fri, 20 Apr 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy343
      Issue No: Vol. 67, No. 11 (2018)
  • Two Birds, One Stone: Two Unusual Causes of Diarrhea in a
           Nonimmunocompromised Human Immunodeficiency Virus–Infected Patient
    • Authors: Tornero C; Frutos J, Orta N, et al.
      Pages: 1775 - 1776
      Abstract: A 46-year-old white homosexual man was diagnosed with human immunodeficiency virus (HIV) infection 6 years ago, following successfully treated secondary syphilis. Baseline blood tests showed a CD4&#x002B; count of 490 cells/mL (43%) and a plasma HIV RNA load of 43 000 copies/mL. Since then, correct antiretroviral therapy had been maintained (currently with Genvoya), with full virological suppression and a CD4&#x002B; count of >600 cells/mL.
      PubDate: Tue, 13 Nov 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy282
      Issue No: Vol. 67, No. 11 (2018)
  • Clinical and Cardiac Safety of Long-term Levofloxacin in Children Treated
           for Multidrug-resistant Tuberculosis
    • Authors: Garcia-Prats A; Draper H, Finlayson H, et al.
      Pages: 1777 - 1780
      Abstract: Safety concerns persist for long-term pediatric fluoroquinolone use. Seventy children (median age, 2.1 years) treated with levofloxacin 10–20 mg/kg once daily for multidrug-resistant tuberculosis (median observation time, 11.8 months) had few musculoskeletal events, no levofloxacin-attributed serious adverse events, and no Fridericia-corrected QT interval >450 ms. Long-term levofloxacin was safe and well tolerated.
      PubDate: Wed, 16 May 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy416
      Issue No: Vol. 67, No. 11 (2018)
  • Detection and Isolation of Clostridium difficile Asymptomatic Carriers
           During Clostridium difficile Infection Outbreaks: An Exploratory Study
    • Authors: Paquet-Bolduc B; Gervais P, Roussy J, et al.
      Pages: 1781 - 1783
      Abstract: During 4 Clostridium difficile infection outbreaks, unit-wide screening of 114 patients led to detection and isolation of 15 (13%) C. difficile asymptomatic carriers. Carriage prevalence varied between outbreaks, from 0% to 29% (P = .004). Isolating carriers was not associated with significantly shorter outbreak durations, compared with historical controls.
      PubDate: Wed, 16 May 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy425
      Issue No: Vol. 67, No. 11 (2018)
  • Risk Factors for Group A Streptococcus Colonization During an Outbreak
           Among People Experiencing Homelessness in Anchorage, Alaska, 2017
    • Authors: Adebanjo T; Mosites E, Van Beneden C, et al.
      Pages: 1784 - 1787
      Abstract: We identified risk factors for any emm type group A streptococcal (GAS) colonization while investigating an invasive emm26.3 GAS outbreak among people experiencing homelessness in Alaska. Risk factors included upper extremity skin breakdown, sleeping outdoors, sharing blankets, and infrequent tooth brushing. Our results may help guide control efforts in future outbreaks.
      PubDate: Fri, 18 May 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy429
      Issue No: Vol. 67, No. 11 (2018)
  • Hantavirus Cardiopulmonary Syndrome Due to Imported Andes Hantavirus
           Infection in Switzerland: A Multidisciplinary Challenge, Two Cases and a
           Literature Review
    • Authors: Kuenzli A; Marschall J, Schefold J, et al.
      Pages: 1788 - 1795
      Abstract: Two travellers returning from South America were diagnosed with Andes hantavirus infection, the only member of the Hantaviridae family known to be transmitted from person to person. We describe the clinical course and therapeutic and infection control measures. While both patients showed high viral load (VL) and shedding over several months, 1 patient recovered within 1 week from severe respiratory illness that required noninvasive ventilation, whereas the second patient developed severe hantavirus cardiopulmonary syndrome that required extracorporeal membrane oxygenation for 27 days. The clinical course in the latter patient was complicated by severe disseminated intravascular coagulopathy with diffuse hemorrhage that necessitated mass transfusions, as well as by multiple organ failure, including the need for renal replacement therapy. Results of VL in blood, respiratory secretions, and semen for the first 9 months of follow-up are reported. To our knowledge, these are the first cases of Andes hantavirus infection detected in Europe.
      PubDate: Tue, 22 May 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy443
      Issue No: Vol. 67, No. 11 (2018)
  • Diagnosis and Treatment of Neurocysticercosis: Issues That Need to Be
    • Authors: Garg R; Malhotra H, Pandey S.
      Pages: 1796 - 1797
      Abstract: To the Editor—We read with interest the guidelines on diagnosis and treatment of neurocysticercosis [1]. We wish to highlight few points that are lacking in these guidelines.
      PubDate: Tue, 22 May 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy434
      Issue No: Vol. 67, No. 11 (2018)
  • Antiparasitic Dosing Discrepancy in the 2017 Neurocysticercosis Guidelines
    • Authors: Smith E; Marks G, Hirai-Yang A, et al.
      Pages: 1797 - 1797
      Abstract: To the Editor—With much anticipation, we have reviewed the recently published Infectious Diseases Society of America (IDSA) and American Society of Tropical Medicine and Hygiene 2017 guidelines for the diagnosis and treatment of neurocysticercosis [1]. We applaud the publication of the first IDSA guidelines dedicated to the management of this disease; however, we would like to note a dosing discrepancy encountered in one of the tables in that publication [1, p. e63].
      PubDate: Tue, 22 May 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy435
      Issue No: Vol. 67, No. 11 (2018)
  • Pregnancy Screening and Monitoring of Albendazole Therapy for
    • Authors: Persichino J; Miller L.
      Pages: 1797 - 1798
      Abstract: To the Editor—We read with great interest the first guidelines from the Infectious Diseases Society of America and the American Society of Tropical Medicine and Hygiene on the diagnosis and treatment of neurocysticercosis, by White et al [1]. We applaud the authors’ obviously challenging efforts to develop recommendations for an infection that has few trial data from which to draw guidelines.
      PubDate: Tue, 22 May 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy436
      Issue No: Vol. 67, No. 11 (2018)
  • Reply to Garg et al, Smith et al, and Persichino and Miller
    • Authors: White A; Jr, Coyle C, Rajshekhar V, et al.
      Pages: 1798 - 1798
      Abstract: To the Editor—We thank Garg and colleagues for their letter [1]. Two randomized trials compared albendazole and combination therapy with simultaneous praziquantel and albendazole [2, 3]. In both cases, the radiologic response was better with combination therapy only in patients with >2 viable parenchymal cysts but not in those with ≤2 cysts. These trials were the basis for the distinction in treatment of viable parenchymal disease distinguishing patients with 1 or 2 parenchymal cysts form those with ≥3 parenchymal cysts or viable parenchymal cysticercosis. However, neither of these trials included patients with >20 cysticerci.
      PubDate: Tue, 22 May 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy437
      Issue No: Vol. 67, No. 11 (2018)
  • Bacterial Cocktail to Treat Clostridium difficile Infection: Primum Non
    • Authors: Million M; Lagier J, Chaudet H, et al.
      Pages: 1799 - 1799
      Abstract: To the Editor—We read with great interest the recent work of Dubberke et al evaluating—in a randomized, placebo-controlled clinical trial—the efficacy and safety of a cocktail of bacteria (RBX2660) to treat recurrent Clostridium difficile infections (CDI) [1]. However, we believe that the authors’ conclusion that “RBX2660 was safe” is not supported by the data presented.
      PubDate: Mon, 06 Aug 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy459
      Issue No: Vol. 67, No. 11 (2018)
  • Reply to Million et al
    • Authors: Dubberke E; Blount K, Gerding D.
      Pages: 1799 - 1800
      Abstract: To the Editor—We appreciate the comments by Million et al regarding the safety of RBX2660 [1]. We also agree Clostridium difficile infection (CDI) is associated with significant morbidity and mortality. CDI afflicts the sickest and frailest of our patients, with increases in hospital and nursing home admissions and mortality that persist at least 6 months after the initial episode [2]. This is especially true for patients with recurrent CDI. At 6 months after an initial episode of CDI, Olsen et al found that 36.3% of patients with recurrent CDI had died, compared to 25.7% of patients with a single episode, for a hazard ratio of 1.33 (95% confidence interval 1.12–1.58) on multivariable analysis [3]. As shocking as these objective data are, they only scratch the surface in regards to how devastating recurrent CDI can be to quality of life [2, 4].
      PubDate: Mon, 06 Aug 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy460
      Issue No: Vol. 67, No. 11 (2018)
  • Nutritionally Variant Streptococci Infective Endocarditis: A Different
    • Authors: García-Granja P; López J, Vilacosta I, et al.
      Pages: 1800 - 1801
      Abstract: To the Editor—We have read with great interest the article by Tellez et al [1] regarding infective endocarditis (IE) due to Abiotrophia and Granulicatella species (GA-IE). Simultaneously, we did another systematic review of this entity from 2000 to 2017 and found 73 cases. Although the article by Tellez et al summarizes the main features of GA-IE, we think that it would be interesting for the readers to access the information of each individual case; therefore, we have built up a table with this information (Supplemental Table 1Supplemental Table 1).
      PubDate: Mon, 21 May 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy444
      Issue No: Vol. 67, No. 11 (2018)
  • Reply to Garcia-Granja et al
    • Authors: Ambrosioni J; Tellez A, Hernandez-Meneses M, et al.
      Pages: 1801 - 1801
      Abstract: To the Editor—We thank Dr. García-Granja et al [1] for their interest in our work and for their review of the literature. Despite references not being provided in their letter, we were able to conclude that approximately 80% of cases are the same as we report in our article (provided as a Supplementary table) [2]. We would, however, like to point out that when referring to the 72.7% of periannular complications in our article, it is only the institutional cases (with a probable bias, because our institution is reference for cardiac surgery for infective endocarditis for 9 other smaller centers) and not the whole series (28.9%).
      PubDate: Mon, 21 May 2018 00:00:00 GMT
      DOI: 10.1093/cid/ciy446
      Issue No: Vol. 67, No. 11 (2018)
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