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Showing 1 - 200 of 370 Journals sorted alphabetically
Acta Biochimica et Biophysica Sinica     Hybrid Journal   (Followers: 6, SJR: 0.881, h-index: 38)
Adaptation     Hybrid Journal   (Followers: 8, SJR: 0.111, h-index: 4)
Aesthetic Surgery J.     Hybrid Journal   (Followers: 6, SJR: 1.538, h-index: 35)
African Affairs     Hybrid Journal   (Followers: 59, SJR: 1.512, h-index: 46)
Age and Ageing     Hybrid Journal   (Followers: 85, SJR: 1.611, h-index: 107)
Alcohol and Alcoholism     Hybrid Journal   (Followers: 17, SJR: 0.935, h-index: 80)
American Entomologist     Full-text available via subscription   (Followers: 6)
American Historical Review     Hybrid Journal   (Followers: 137, SJR: 0.652, h-index: 43)
American J. of Agricultural Economics     Hybrid Journal   (Followers: 40, SJR: 1.441, h-index: 77)
American J. of Epidemiology     Hybrid Journal   (Followers: 171, SJR: 3.047, h-index: 201)
American J. of Hypertension     Hybrid Journal   (Followers: 23, SJR: 1.397, h-index: 111)
American J. of Jurisprudence     Hybrid Journal   (Followers: 17)
American J. of Legal History     Full-text available via subscription   (Followers: 6, SJR: 0.151, h-index: 7)
American Law and Economics Review     Hybrid Journal   (Followers: 25, SJR: 0.824, h-index: 23)
American Literary History     Hybrid Journal   (Followers: 12, SJR: 0.185, h-index: 22)
Analysis     Hybrid Journal   (Followers: 23)
Annals of Botany     Hybrid Journal   (Followers: 36, SJR: 1.912, h-index: 124)
Annals of Occupational Hygiene     Hybrid Journal   (Followers: 28, SJR: 0.837, h-index: 57)
Annals of Oncology     Hybrid Journal   (Followers: 49, SJR: 4.362, h-index: 173)
Annals of the Entomological Society of America     Full-text available via subscription   (Followers: 8, SJR: 0.642, h-index: 53)
Annals of Work Exposures and Health     Hybrid Journal  
AoB Plants     Open Access   (Followers: 4, SJR: 0.78, h-index: 10)
Applied Economic Perspectives and Policy     Hybrid Journal   (Followers: 19, SJR: 0.884, h-index: 31)
Applied Linguistics     Hybrid Journal   (Followers: 51, SJR: 1.749, h-index: 63)
Applied Mathematics Research eXpress     Hybrid Journal   (Followers: 1, SJR: 0.779, h-index: 11)
Arbitration Intl.     Full-text available via subscription   (Followers: 20)
Arbitration Law Reports and Review     Hybrid Journal   (Followers: 13)
Archives of Clinical Neuropsychology     Hybrid Journal   (Followers: 26, SJR: 0.96, h-index: 71)
Aristotelian Society Supplementary Volume     Hybrid Journal   (Followers: 2, SJR: 0.102, h-index: 20)
Arthropod Management Tests     Hybrid Journal   (Followers: 2)
Astronomy & Geophysics     Hybrid Journal   (Followers: 47, SJR: 0.144, h-index: 15)
Behavioral Ecology     Hybrid Journal   (Followers: 50, SJR: 1.698, h-index: 92)
Bioinformatics     Hybrid Journal   (Followers: 310, SJR: 4.643, h-index: 271)
Biology Methods and Protocols     Hybrid Journal  
Biology of Reproduction     Full-text available via subscription   (Followers: 9, SJR: 1.646, h-index: 149)
Biometrika     Hybrid Journal   (Followers: 19, SJR: 2.801, h-index: 90)
BioScience     Hybrid Journal   (Followers: 30, SJR: 2.374, h-index: 154)
Bioscience Horizons : The National Undergraduate Research J.     Open Access   (Followers: 1, SJR: 0.213, h-index: 9)
Biostatistics     Hybrid Journal   (Followers: 16, SJR: 1.955, h-index: 55)
BJA : British J. of Anaesthesia     Hybrid Journal   (Followers: 149, SJR: 2.314, h-index: 133)
BJA Education     Hybrid Journal   (Followers: 64, SJR: 0.272, h-index: 20)
Brain     Hybrid Journal   (Followers: 61, SJR: 6.097, h-index: 264)
Briefings in Bioinformatics     Hybrid Journal   (Followers: 45, SJR: 4.086, h-index: 73)
Briefings in Functional Genomics     Hybrid Journal   (Followers: 4, SJR: 1.771, h-index: 50)
British J. for the Philosophy of Science     Hybrid Journal   (Followers: 34, SJR: 1.267, h-index: 38)
British J. of Aesthetics     Hybrid Journal   (Followers: 26, SJR: 0.217, h-index: 18)
British J. of Criminology     Hybrid Journal   (Followers: 528, SJR: 1.373, h-index: 62)
British J. of Social Work     Hybrid Journal   (Followers: 83, SJR: 0.771, h-index: 53)
British Medical Bulletin     Hybrid Journal   (Followers: 7, SJR: 1.391, h-index: 84)
British Yearbook of Intl. Law     Hybrid Journal   (Followers: 27)
Bulletin of the London Mathematical Society     Hybrid Journal   (Followers: 3, SJR: 1.474, h-index: 31)
Cambridge J. of Economics     Hybrid Journal   (Followers: 58, SJR: 0.957, h-index: 59)
Cambridge J. of Regions, Economy and Society     Hybrid Journal   (Followers: 11, SJR: 1.067, h-index: 22)
Cambridge Quarterly     Hybrid Journal   (Followers: 11, SJR: 0.1, h-index: 7)
Capital Markets Law J.     Hybrid Journal   (Followers: 1)
Carcinogenesis     Hybrid Journal   (Followers: 2, SJR: 2.439, h-index: 167)
Cardiovascular Research     Hybrid Journal   (Followers: 12, SJR: 2.897, h-index: 175)
Cerebral Cortex     Hybrid Journal   (Followers: 41, SJR: 4.827, h-index: 192)
CESifo Economic Studies     Hybrid Journal   (Followers: 16, SJR: 0.501, h-index: 19)
Chemical Senses     Hybrid Journal   (Followers: 1, SJR: 1.436, h-index: 76)
Children and Schools     Hybrid Journal   (Followers: 6, SJR: 0.211, h-index: 18)
Chinese J. of Comparative Law     Hybrid Journal   (Followers: 3)
Chinese J. of Intl. Law     Hybrid Journal   (Followers: 21, SJR: 0.737, h-index: 11)
Chinese J. of Intl. Politics     Hybrid Journal   (Followers: 9, SJR: 1.238, h-index: 15)
Christian Bioethics: Non-Ecumenical Studies in Medical Morality     Hybrid Journal   (Followers: 11, SJR: 0.191, h-index: 8)
Classical Receptions J.     Hybrid Journal   (Followers: 24, SJR: 0.1, h-index: 3)
Clinical Infectious Diseases     Hybrid Journal   (Followers: 59, SJR: 4.742, h-index: 261)
Clinical Kidney J.     Open Access   (Followers: 4, SJR: 0.338, h-index: 19)
Community Development J.     Hybrid Journal   (Followers: 24, SJR: 0.47, h-index: 28)
Computer J.     Hybrid Journal   (Followers: 7, SJR: 0.371, h-index: 47)
Conservation Physiology     Open Access   (Followers: 2)
Contemporary Women's Writing     Hybrid Journal   (Followers: 11, SJR: 0.111, h-index: 3)
Contributions to Political Economy     Hybrid Journal   (Followers: 5, SJR: 0.313, h-index: 10)
Critical Values     Full-text available via subscription  
Current Legal Problems     Hybrid Journal   (Followers: 26)
Current Zoology     Full-text available via subscription   (SJR: 0.999, h-index: 20)
Database : The J. of Biological Databases and Curation     Open Access   (Followers: 11, SJR: 1.068, h-index: 24)
Digital Scholarship in the Humanities     Hybrid Journal   (Followers: 12)
Diplomatic History     Hybrid Journal   (Followers: 19, SJR: 0.296, h-index: 22)
DNA Research     Open Access   (Followers: 4, SJR: 2.42, h-index: 77)
Dynamics and Statistics of the Climate System     Open Access   (Followers: 3)
Early Music     Hybrid Journal   (Followers: 15, SJR: 0.124, h-index: 11)
Economic Policy     Hybrid Journal   (Followers: 63, SJR: 2.052, h-index: 52)
ELT J.     Hybrid Journal   (Followers: 25, SJR: 1.26, h-index: 23)
English Historical Review     Hybrid Journal   (Followers: 51, SJR: 0.311, h-index: 10)
English: J. of the English Association     Hybrid Journal   (Followers: 13, SJR: 0.144, h-index: 3)
Environmental Entomology     Full-text available via subscription   (Followers: 11, SJR: 0.791, h-index: 66)
Environmental Epigenetics     Open Access   (Followers: 1)
Environmental History     Hybrid Journal   (Followers: 26, SJR: 0.197, h-index: 25)
EP-Europace     Hybrid Journal   (Followers: 2, SJR: 2.201, h-index: 71)
Epidemiologic Reviews     Hybrid Journal   (Followers: 10, SJR: 3.917, h-index: 81)
ESHRE Monographs     Hybrid Journal  
Essays in Criticism     Hybrid Journal   (Followers: 16, SJR: 0.1, h-index: 6)
European Heart J.     Hybrid Journal   (Followers: 49, SJR: 6.997, h-index: 227)
European Heart J. - Cardiovascular Imaging     Hybrid Journal   (Followers: 8, SJR: 2.044, h-index: 58)
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. Supplements     Hybrid Journal   (Followers: 7, SJR: 0.152, h-index: 31)
European J. of Cardio-Thoracic Surgery     Hybrid Journal   (Followers: 8, SJR: 1.568, h-index: 104)
European J. of Intl. Law     Hybrid Journal   (Followers: 161, SJR: 0.722, h-index: 38)
European J. of Orthodontics     Hybrid Journal   (Followers: 4, SJR: 1.09, h-index: 60)
European J. of Public Health     Hybrid Journal   (Followers: 22, SJR: 1.284, h-index: 64)
European Review of Agricultural Economics     Hybrid Journal   (Followers: 11, SJR: 1.549, h-index: 42)
European Review of Economic History     Hybrid Journal   (Followers: 28, SJR: 0.628, h-index: 24)
European Sociological Review     Hybrid Journal   (Followers: 41, SJR: 2.061, h-index: 53)
Evolution, Medicine, and Public Health     Open Access   (Followers: 11)
Family Practice     Hybrid Journal   (Followers: 11, SJR: 1.048, h-index: 77)
Fems Microbiology Ecology     Hybrid Journal   (Followers: 9, SJR: 1.687, h-index: 115)
Fems Microbiology Letters     Hybrid Journal   (Followers: 20, SJR: 1.126, h-index: 118)
Fems Microbiology Reviews     Hybrid Journal   (Followers: 25, SJR: 7.587, h-index: 150)
Fems Yeast Research     Hybrid Journal   (Followers: 13, SJR: 1.213, h-index: 66)
Foreign Policy Analysis     Hybrid Journal   (Followers: 22, SJR: 0.859, h-index: 10)
Forestry: An Intl. J. of Forest Research     Hybrid Journal   (Followers: 16, SJR: 0.903, h-index: 44)
Forum for Modern Language Studies     Hybrid Journal   (Followers: 6, SJR: 0.108, h-index: 6)
French History     Hybrid Journal   (Followers: 32, SJR: 0.123, h-index: 10)
French Studies     Hybrid Journal   (Followers: 20, SJR: 0.119, h-index: 7)
French Studies Bulletin     Hybrid Journal   (Followers: 10, SJR: 0.102, h-index: 3)
Gastroenterology Report     Open Access   (Followers: 2)
Genome Biology and Evolution     Open Access   (Followers: 10, SJR: 3.22, h-index: 39)
Geophysical J. Intl.     Hybrid Journal   (Followers: 34, SJR: 1.839, h-index: 119)
German History     Hybrid Journal   (Followers: 25, SJR: 0.437, h-index: 13)
GigaScience     Open Access   (Followers: 3)
Global Summitry     Hybrid Journal  
Glycobiology     Hybrid Journal   (Followers: 14, SJR: 1.692, h-index: 101)
Health and Social Work     Hybrid Journal   (Followers: 49, SJR: 0.505, h-index: 40)
Health Education Research     Hybrid Journal   (Followers: 12, SJR: 0.814, h-index: 80)
Health Policy and Planning     Hybrid Journal   (Followers: 20, SJR: 1.628, h-index: 66)
Health Promotion Intl.     Hybrid Journal   (Followers: 21, SJR: 0.664, h-index: 60)
History Workshop J.     Hybrid Journal   (Followers: 27, SJR: 0.313, h-index: 20)
Holocaust and Genocide Studies     Hybrid Journal   (Followers: 24, SJR: 0.115, h-index: 13)
Human Molecular Genetics     Hybrid Journal   (Followers: 9, SJR: 4.288, h-index: 233)
Human Reproduction     Hybrid Journal   (Followers: 79, SJR: 2.271, h-index: 179)
Human Reproduction Update     Hybrid Journal   (Followers: 17, SJR: 4.678, h-index: 128)
Human Rights Law Review     Hybrid Journal   (Followers: 60, SJR: 0.7, h-index: 21)
ICES J. of Marine Science: J. du Conseil     Hybrid Journal   (Followers: 53, SJR: 1.233, h-index: 88)
ICSID Review     Hybrid Journal   (Followers: 10)
ILAR J.     Hybrid Journal   (Followers: 1, SJR: 1.099, h-index: 51)
IMA J. of Applied Mathematics     Hybrid Journal   (SJR: 0.329, h-index: 26)
IMA J. of Management Mathematics     Hybrid Journal   (Followers: 2, SJR: 0.351, h-index: 20)
IMA J. of Mathematical Control and Information     Hybrid Journal   (Followers: 2, SJR: 0.661, h-index: 28)
IMA J. of Numerical Analysis - advance access     Hybrid Journal   (SJR: 2.032, h-index: 44)
Industrial and Corporate Change     Hybrid Journal   (Followers: 8, SJR: 1.37, h-index: 81)
Industrial Law J.     Hybrid Journal   (Followers: 30, SJR: 0.184, h-index: 15)
Information and Inference     Free  
Integrative and Comparative Biology     Hybrid Journal   (Followers: 8, SJR: 1.911, h-index: 90)
Interacting with Computers     Hybrid Journal   (Followers: 10, SJR: 0.529, h-index: 59)
Interactive CardioVascular and Thoracic Surgery     Hybrid Journal   (Followers: 5, SJR: 0.743, h-index: 35)
Intl. Affairs     Hybrid Journal   (Followers: 52, SJR: 1.264, h-index: 53)
Intl. Data Privacy Law     Hybrid Journal   (Followers: 28)
Intl. Health     Hybrid Journal   (Followers: 5, SJR: 0.835, h-index: 15)
Intl. Immunology     Hybrid Journal   (Followers: 3, SJR: 1.613, h-index: 111)
Intl. J. for Quality in Health Care     Hybrid Journal   (Followers: 33, SJR: 1.593, h-index: 69)
Intl. J. of Constitutional Law     Hybrid Journal   (Followers: 60, SJR: 0.613, h-index: 19)
Intl. J. of Epidemiology     Hybrid Journal   (Followers: 147, SJR: 4.381, h-index: 145)
Intl. J. of Law and Information Technology     Hybrid Journal   (Followers: 4, SJR: 0.247, h-index: 8)
Intl. J. of Law, Policy and the Family     Hybrid Journal   (Followers: 29, SJR: 0.307, h-index: 15)
Intl. J. of Lexicography     Hybrid Journal   (Followers: 8, SJR: 0.404, h-index: 18)
Intl. J. of Low-Carbon Technologies     Open Access   (Followers: 1, SJR: 0.457, h-index: 12)
Intl. J. of Neuropsychopharmacology     Open Access   (Followers: 3, SJR: 1.69, h-index: 79)
Intl. J. of Public Opinion Research     Hybrid Journal   (Followers: 9, SJR: 0.906, h-index: 33)
Intl. J. of Refugee Law     Hybrid Journal   (Followers: 33, SJR: 0.231, h-index: 21)
Intl. J. of Transitional Justice     Hybrid Journal   (Followers: 13, SJR: 0.833, h-index: 12)
Intl. Mathematics Research Notices     Hybrid Journal   (Followers: 1, SJR: 2.052, h-index: 42)
Intl. Political Sociology     Hybrid Journal   (Followers: 31, SJR: 1.339, h-index: 19)
Intl. Relations of the Asia-Pacific     Hybrid Journal   (Followers: 18, SJR: 0.539, h-index: 17)
Intl. Studies Perspectives     Hybrid Journal   (Followers: 7, SJR: 0.998, h-index: 28)
Intl. Studies Quarterly     Hybrid Journal   (Followers: 39, SJR: 2.184, h-index: 68)
Intl. Studies Review     Hybrid Journal   (Followers: 18, SJR: 0.783, h-index: 38)
ISLE: Interdisciplinary Studies in Literature and Environment     Hybrid Journal   (Followers: 1, SJR: 0.155, h-index: 4)
ITNOW     Hybrid Journal   (Followers: 2, SJR: 0.102, h-index: 4)
J. of African Economies     Hybrid Journal   (Followers: 15, SJR: 0.647, h-index: 30)
J. of American History     Hybrid Journal   (Followers: 43, SJR: 0.286, h-index: 34)
J. of Analytical Toxicology     Hybrid Journal   (Followers: 13, SJR: 1.038, h-index: 60)
J. of Antimicrobial Chemotherapy     Hybrid Journal   (Followers: 13, SJR: 2.157, h-index: 149)
J. of Antitrust Enforcement     Hybrid Journal   (Followers: 1)
J. of Applied Poultry Research     Hybrid Journal   (Followers: 3, SJR: 0.563, h-index: 43)
J. of Biochemistry     Hybrid Journal   (Followers: 43, SJR: 1.341, h-index: 96)
J. of Chromatographic Science     Hybrid Journal   (Followers: 16, SJR: 0.448, h-index: 42)
J. of Church and State     Hybrid Journal   (Followers: 11, SJR: 0.167, h-index: 11)
J. of Competition Law and Economics     Hybrid Journal   (Followers: 35, SJR: 0.442, h-index: 16)
J. of Complex Networks     Hybrid Journal   (Followers: 1, SJR: 1.165, h-index: 5)
J. of Conflict and Security Law     Hybrid Journal   (Followers: 13, SJR: 0.196, h-index: 15)
J. of Consumer Research     Full-text available via subscription   (Followers: 43, SJR: 4.896, h-index: 121)
J. of Crohn's and Colitis     Hybrid Journal   (Followers: 10, SJR: 1.543, h-index: 37)
J. of Cybersecurity     Hybrid Journal   (Followers: 3)
J. of Deaf Studies and Deaf Education     Hybrid Journal   (Followers: 9, SJR: 0.69, h-index: 36)
J. of Design History     Hybrid Journal   (Followers: 16, SJR: 0.166, h-index: 14)
J. of Economic Entomology     Full-text available via subscription   (Followers: 6, SJR: 0.894, h-index: 76)
J. of Economic Geography     Hybrid Journal   (Followers: 39, SJR: 2.909, h-index: 69)
J. of Environmental Law     Hybrid Journal   (Followers: 23, SJR: 0.457, h-index: 20)
J. of European Competition Law & Practice     Hybrid Journal   (Followers: 19)
J. of Experimental Botany     Hybrid Journal   (Followers: 14, SJR: 2.798, h-index: 163)
J. of Financial Econometrics     Hybrid Journal   (Followers: 23, SJR: 1.314, h-index: 27)
J. of Global Security Studies     Hybrid Journal   (Followers: 3)
J. of Heredity     Hybrid Journal   (Followers: 4, SJR: 1.024, h-index: 76)
J. of Hindu Studies     Hybrid Journal   (Followers: 7, SJR: 0.186, h-index: 3)
J. of Hip Preservation Surgery     Open Access  
J. of Human Rights Practice     Hybrid Journal   (Followers: 20, SJR: 0.399, h-index: 10)
J. of Infectious Diseases     Hybrid Journal   (Followers: 39, SJR: 4, h-index: 209)
J. of Insect Science     Open Access   (Followers: 8, SJR: 0.388, h-index: 31)

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Journal Cover Clinical Infectious Diseases
  [SJR: 4.742]   [H-I: 261]   [59 followers]  Follow
   Hybrid Journal Hybrid journal (It can contain Open Access articles)
   ISSN (Print) 1058-4838 - ISSN (Online) 1537-6591
   Published by Oxford University Press Homepage  [370 journals]
  • In the Literature
    • PubDate: 2017-10-16
      DOI: 10.1093/cid/cix856
      Issue No: Vol. 65, No. 9 (2017)
  • News
    • PubDate: 2017-09-01
      DOI: 10.1093/cid/cix786
      Issue No: Vol. 65, No. 9 (2017)
  • Epidemiology of Pediatric Multidrug-Resistant Tuberculosis in the United
           States, 1993–2014
    • Authors: Smith S; Pratt R, Trieu L, et al.
      Pages: 1437 - 1443
      Abstract: AbstractBackgroundMultidrug-resistant tuberculosis (MDR-TB) is an important global public health threat, but accurate estimates of MDR-TB burden among children are lacking.MethodsWe analyzed demographic, clinical, and laboratory data for newly diagnosed pediatric (age <15 years) TB cases reported to the US National TB Surveillance System during 1993–2014. MDR-TB was defined as culture-confirmed TB disease with resistance to at least isoniazid and rifampicin. To ascertain potential underestimation of pediatric MDR-TB, we surveyed high-burden states for clinically diagnosed cases treated for MDR-TB.ResultsOf 20789 pediatric TB cases, 5162 (24.8%) had bacteriologically confirmed TB. Among 4826 (93.5%) with drug susceptibility testing, 82 (1.7%) had MDR-TB. Most pediatric MDR-TB cases were female (n = 51 [62%]), median age was 5 years (interquartile range, 1–12 years), one-third were Hispanic (n = 28 [34%]), and two-thirds (n = 55 [67%]) were born in the United States. Most cases had additional resistance to ≥1 other first-line drug (n = 66 [81%]) and one-third had resistance to ≥1 second-line drug (24/73 tested). Of 77 who started treatment prior to 2013, 66 (86%) completed treatment and 4 (5%) died. Among the 4 high-TB-burden states/jurisdictions surveyed, there was 42%–55% underestimation of pediatric MDR-TB cases when using only culture-confirmed case definitions.ConclusionsOnly one-quarter of pediatric TB cases had culture-confirmed TB, likely resulting in underestimation of true pediatric MDR-TB burden in the United States using strictly bacteriologic criteria. Better estimates of pediatric MDR-TB burden in the United States are needed and should include clinical diagnoses based on epidemiologic criteria.
      PubDate: 2017-06-19
      DOI: 10.1093/cid/cix561
      Issue No: Vol. 65, No. 9 (2017)
  • Excellent Treatment Outcomes in Children Treated for Tuberculosis Under
           Routine Operational Conditions in Cape Town, South Africa
    • Authors: Osman M; Lee K, Du Preez K, et al.
      Pages: 1444 - 1452
      Abstract: AbstractBackgroundTuberculosis (TB) remains a leading cause of death in children globally. It is recognized that human immunodeficiency virus (HIV) infection increases the risk of developing TB, but our understanding of the impact of HIV on risk of mortality for children treated for TB is limited. We aimed to identify predictors of mortality in children treated for drug-susceptible TB.MethodsA retrospective analysis of all children (<15 years of age) routinely treated between 2005 and 2012 for drug-susceptible TB in Cape Town was conducted using the programmatic electronic TB treatment database. Survival analysis using Cox regression was used to estimate hazard ratios for death. Logistic regression was used to estimate the odds of unfavorable outcomes.ResultsOf 29519 children treated for and notified with TB over the study period, <1% died during TB treatment and 89.5% were cured or completed treatment. The proportion of children with known HIV status increased from 13% in 2005 to 95% in 2012. Children aged <2 years had an increased hazard of death (adjusted hazard ratio [aHR], 3.13; 95% confidence interval [CI], 1.78–5.52) and greater odds of unfavorable outcome (adjusted odds ratio [aOR], 1.44; 95% CI, 1.24–1.66) compared with children aged 10–14 years. HIV-infected children had increased mortality compared to HIV-negative children (aHR, 6.85; 95% CI, 4.60–10.19) and increased odds of unfavorable outcome (aOR, 2.01; 95% CI, 1.81–2.23). Later year of TB treatment was a protective predictor for both mortality and unfavorable outcome.ConclusionsWe demonstrate a dramatic improvement in HIV testing in children with TB over time and excellent overall treatment outcomes. HIV infection and young age were associated with increased risk of death and unfavorable outcome.
      PubDate: 2017-07-05
      DOI: 10.1093/cid/cix602
      Issue No: Vol. 65, No. 9 (2017)
  • Endothelial Nitric Oxide Pathways in the Pathophysiology of Dengue: A
           Prospective Observational Study
    • Authors: Yacoub S; Lam P, Huynh T, et al.
      Pages: 1453 - 1461
      Abstract: AbstractBackgroundDengue can cause increased vascular permeability that may lead to hypovolemic shock. Endothelial dysfunction may underlie this; however, the association of endothelial nitric oxide (NO) pathways with disease severity is unknown.MethodsWe performed a prospective observational study in 2 Vietnamese hospitals, assessing patients presenting early (<72 hours of fever) and patients hospitalized with warning signs or severe dengue. The reactive hyperemic index (RHI), which measures endothelium-dependent vasodilation and is a surrogate marker of endothelial function and NO bioavailability, was evaluated using peripheral artery tonometry (EndoPAT), and plasma levels of l-arginine, arginase-1, and asymmetric dimethylarginine were measured at serial time-points. The main outcome of interest was plasma leakage severity.ResultsThree hundred fourteen patients were enrolled; median age of the participants was 21(interquartile range, 13–30) years. No difference was found in the endothelial parameters between dengue and other febrile illness. Considering dengue patients, the RHI was significantly lower for patients with severe plasma leakage compared to those with no leakage (1.46 vs 2.00; P < .001), over acute time-points, apparent already in the early febrile phase (1.29 vs 1.75; P = .012). RHI correlated negatively with arginase-1 and positively with l-arginine (P = .001).ConclusionsEndothelial dysfunction/NO bioavailability is associated with worse plasma leakage, occurs early in dengue illness and correlates with hypoargininemia and high arginase-1 levels.
      PubDate: 2017-06-29
      DOI: 10.1093/cid/cix567
      Issue No: Vol. 65, No. 9 (2017)
  • Guillain-Barré Syndrome Associated With Zika Virus Infection in
           Martinique in 2016: A Prospective Study
    • Authors: Rozé B; Najioullah F, Fergé J, et al.
      Pages: 1462 - 1468
      Abstract: AbstractBackgroundGuillain-Barré syndrome (GBS) has been reported to be associated with Zika virus (ZIKV) infection in case reports and retrospective studies, mostly on the basis of serological tests, with the problematic cross-reacting antibodies of the Flavivirus genus. Some GBS cases do not exhibit a high level of diagnostic certainty. This prospective study aimed to describe the clinical profiles and the frequency of GBS associated with ZIKV during the ZIKV outbreak in Martinique in 2016.MethodsWe recorded prospective data from GBS meeting levels 1 or 2 of diagnostic certainty for the Brighton Collaboration, with proof of recent ZIKV infection and negative screening for etiologies of GBS.ResultsOf the sample of 34 patients with suspected GBS during the outbreak, 30 had a proven presence of GBS, and 23 had a recent ZIKV infection. The estimated GBS incidence rate ratio (2016 vs 2006–2015) was 4.52 (95% confidence interval, 2.80–7.64; P = .0001). Recent ZIKV infection was confirmed by urine reverse-transcription polymerase chain reaction (RT-PCR) analysis in 17 cases and by serology in 6 cases. Patients, 65% of whom were male, had a median age of 61 years (interquartile range, 56–71 years) and experienced severe GBS. Electrophysiological tests were consistent with the primary demyelinating form of the disease.ConclusionsZIKV infection is usually benign, when symptomatic, but in countries at risk of ZIKV epidemics, adequate intensive care bed capacity is required for management of severe GBS cases. Arbovirus RNA detection by RT-PCR should be part of the management of GBS cases.
      PubDate: 2017-07-20
      DOI: 10.1093/cid/cix588
      Issue No: Vol. 65, No. 9 (2017)
  • Impact of Implementing National Guidelines on Antibiotic Prescriptions for
           Acute Respiratory Tract Infections in Pediatric Emergency Departments: An
           Interrupted Time Series Analysis
    • Authors: Ouldali N; Bellêttre X, Milcent K, et al.
      Pages: 1469 - 1476
      Abstract: AbstractBackgroundMany antibiotics are prescribed inappropriately in pediatric emergency departments (PEDs), but little data are available in these settings about effective interventions based on guidelines that follow the antimicrobial stewardship principle. Our aim was to assess the impact of implementing the 2011 national guidelines on antibiotic prescriptions for acute respiratory tract infection (ARTI) in PEDs.MethodWe conducted a multicentric, quasiexperimental, interrupted time series analysis of prospectively collected electronic data from 7 French PEDs. We included all pediatric patients who visited a participating PED during the study period from November 2009 to October 2014 and were diagnosed with an ARTI. The intervention consisted of local protocol implementation, education sessions, and feedback. The main outcome was the antibiotic prescription rate of discharge prescriptions for ARTI per 1000 PED visits before and after implementation, analyzed using the segmented regression model.ResultsWe included 242534 patients with an ARTI. The intervention was associated with a significant change in slope for the antibiotic prescription rate per 1000 PED visits (–0.4% per 15-day period, P = .04), and the cumulative effect at the end of the study was estimated to be –30.9%, (95% CI [–45.2 to –20.1]), representing 13136 avoided antibiotic prescriptions. The broad-spectrum antibiotic prescription relative percentage decreased dramatically (–62.7%, 95% CI [–92.8; –32.7]) and was replaced by amoxicillin.ConclusionImplementation of the 2011 national French guidelines led to a significant decrease in the antibiotic prescription rate for ARTI and a dramatic drop in broad-spectrum antibiotic prescriptions, in favor of amoxicillin.
      PubDate: 2017-07-05
      DOI: 10.1093/cid/cix590
      Issue No: Vol. 65, No. 9 (2017)
  • Viral Surveillance in Serum Samples From Patients With Acute Liver Failure
           By Metagenomic Next-Generation Sequencing
    • Authors: Somasekar S; Lee D, Rule J, et al.
      Pages: 1477 - 1485
      Abstract: AbstractBackgroundTwelve percent of all acute liver failure (ALF) cases are of unknown origin, often termed indeterminate. A previously unrecognized hepatotropic virus has been suspected as a potential etiologic agent.MethodsWe compared the performance of metagenomic next-generation sequencing (mNGS) with confirmatory nucleic acid testing (NAT) to routine clinical diagnostic testing in detection of known or novel viruses associated with ALF. Serum samples from 204 adult ALF patients collected from 1998 to 2010 as part of a nationwide registry were analyzed. One hundred eighty-seven patients (92%) were classified as indeterminate, while the remaining 17 patients (8%) served as controls, with infections by either hepatitis A virus or hepatitis B virus (HBV), or a noninfectious cause for their ALF.ResultsEight cases of infection from previously unrecognized viral pathogens were detected by mNGS (4 cases of herpes simplex virus type 1, including 1 case of coinfection with HBV, and 1 case each of HBV, parvovirus B19, cytomegalovirus, and human herpesvirus 7). Several missed dual or triple infections were also identified, and assembled viral genomes provided additional information on genotyping and drug resistance mutations. Importantly, no sequences corresponding to novel viruses were detected.ConclusionsThese results suggest that ALF patients should be screened for the presence of uncommon viruses and coinfections, and that most cases of indeterminate ALF in the United States do not appear to be caused by novel viral pathogens. In the future, mNGS testing may be useful for comprehensive diagnosis of viruses associated with ALF, or to exclude infectious etiologies.
      PubDate: 2017-07-19
      DOI: 10.1093/cid/cix596
      Issue No: Vol. 65, No. 9 (2017)
  • Viruses Associated With Unexplained Acute Liver Failure: Next Generation
           Reveals the Last Generation
    • Authors: Fredricks D.
      Pages: 1486 - 1488
      Abstract: hepatitisvirusesliver failuremetagenomics
      PubDate: 2017-07-19
      DOI: 10.1093/cid/cix597
      Issue No: Vol. 65, No. 9 (2017)
  • Characteristics and Clinical Outcome of Lyme Neuroborreliosis in a High
           Endemic Area, 1995–2014: A Retrospective Cohort Study in Denmark
    • Authors: Knudtzen F; Andersen N, Jensen T, et al.
      Pages: 1489 - 1495
      Abstract: AbstractBackgroundDespite a well-described symptomatology, treatment delay and sequelae are common in patients with Lyme neuroborreliosis (LNB). The aim of this study was to contribute to the knowledge about the symptomatology and epidemiology of LNB.MethodsWe conducted a retrospective study of all LNB cases verified by a positive Borrelia intrathecal antibody index test performed at the Department of Microbiology, Odense University Hospital, Denmark, from 1995 through 2014.ResultsThe study included 431 patients; 126 were children. The mean incidence was 4.7 per 100 000 inhabitants per year. The median delay from neurological symptom debut to first hospital contact was 20 days and significantly longer for patients with symptom debut in the winter/early spring. The most common clinical symptoms were painful radiculitis (65.9%), cranial nerve palsy (43.4%), and headache (28.3%). A total of 30.6% were seen in >1 hospital department, and 85.6% were admitted during their course of treatment. Serum Borrelia immunoglobulin M and immunoglobulin G at the time of positive Borrelia intrathecal antibody index test were negative in 67 patients (15.5%). We found a median treatment delay of 24 days, with no improvement in our 20-year study period. Residual symptoms following treatment were found in 28.1% of patients, and risk of residual symptoms was significantly associated with delay from symptom debut to initiation of treatment.ConclusionsThe association between treatment delay and residual symptoms and the lack of improvement in treatment delay during the study period highlight the need for standardized diagnostic routines and a better follow-up for LNB patients. Our findings disprove that all patients with LNB develop positive serum Borrelia antibodies within 6 weeks after infection.
      PubDate: 2017-08-08
      DOI: 10.1093/cid/cix568
      Issue No: Vol. 65, No. 9 (2017)
  • Characterizing Human Immunodeficiency Virus Antiretroviral Therapy
           Interruption and Resulting Disease Progression Using Population-Level Data
           in British Columbia, 1996–2015
    • Authors: Wang L; Min J, Zang X, et al.
      Pages: 1496 - 1503
      Abstract: AbstractBackgroundSuboptimal retention is among the biggest challenges to realize the full benefits of combination antiretroviral therapy (ART). We aimed to describe ART interruption patterns and identify determinants of disease progression while off ART in British Columbia, Canada.MethodsWith population-level data on ART utilization and laboratory testing in British Columbia (1996–2015), we described the timing, frequency, and duration of ART interruptions (a gap of ≥90 days in ART dispensation records). A 4-state continuous-time Markov model was implemented to identify determinants of disease progression during individuals’ first ART interruption episode. Disease progression was measured according to CD4-based state transitions (cells/μL: ≥500 to 200–499; 200–499 to <200; ≥500 to death; 200–499 to death; and <200 to death).ResultsAmong individuals initiating ART, 3129 (38.6%) interrupted ART over a median 8-year follow-up (interquartile range [IQR], 4.3–13.5 years). Those interrupting ART had a median of 1 interruption (IQR, 1.0–3.0), with the first interruption occurring 12.8 (IQR, 4.0–36.1) months after ART initiation, lasting for 7.5 (IQR, 4.1–20.3) months. The proportion of individuals interrupting ART within the first year of ART initiation decreased over time; however, the absolute number of individuals interrupting ART remained high. In a multivariable analysis, age, historical plasma viral load, and ART regimen changes prior to interruption were associated with increased hazard of CD4 decline and death.ConclusionsOur results demonstrate that ART interruptions are common even in a high-resource setting with universal free access to human immunodeficiency virus care. Further efforts are needed to promote ART reengagement and may consider prioritizing individuals with poorer prognostic factors.
      PubDate: 2017-07-01
      DOI: 10.1093/cid/cix570
      Issue No: Vol. 65, No. 9 (2017)
  • Donor-Derived Mycoplasma hominis and an Apparent Cluster of M. hominis
           Cases in Solid Organ Transplant Recipients
    • Authors: Smibert O; Wilson H, Sohail A, et al.
      Pages: 1504 - 1508
      Abstract: AbstractBackgroundInvasive and disseminated Mycoplasma hominis infections are well recognized but uncommon complications in solid organ transplant recipients. In a single center, a cluster of M. hominis infections were identified in lung transplant recipients from the same thoracic intensive care unit (ICU). We sought to determine the source(s) of these infections.MethodsMedical records of the donor and infected transplant recipients were reviewed for clinical characteristics. Clinical specimens underwent routine processing with subculture on Mycoplasma-specific Hayflick agar. Mycoplasma hominis identification was confirmed using sequencing of the 16S ribosomal RNA gene. Mycoplasma hominis isolates were subjected to whole-genome sequencing on the Illumina NextSeq platform.ResultsThree lung transplant recipients presented with invasive M. hominis infections at multiple sites characterized by purulent infections without organisms detected by Gram staining. Each patient had a separate donor; however, pretransplant bronchoalveolar lavage fluid was only available from the donor for patient 1, which subsequently grew M. hominis. Phylo- and pangenomic analyses indicated that the isolates from the donor and the corresponding recipient (patient 1) were closely related and formed a distinct single clade. In contrast, isolates from patients 2 and 3 were unrelated and divergent from one another.ConclusionsMycoplasma hominis should be considered a cause of donor-derived infection. Genomic data suggest donor-to-recipient transmission of M. hominis. Additional patients co-located in the ICU were found to have genetically unrelated M. hominis isolates, excluding patient-to-patient transmission.
      PubDate: 2017-07-05
      DOI: 10.1093/cid/cix601
      Issue No: Vol. 65, No. 9 (2017)
  • Use of a Dual-Antigen Rapid Diagnostic Test to Screen Children for Severe
           Plasmodium falciparum Malaria in a High-Transmission, Resource-Limited
    • Authors: Boyce R; Reyes R, Matte M, et al.
      Pages: 1509 - 1515
      Abstract: AbstractBackgroundIn rural areas, many patients with malaria seek care at peripheral health facilities or community case management programs. While this strategy is effective for the management of uncomplicated malaria, severe malaria necessitates prompt detection and referral to facilities with adequate resources.MethodsIn this prospective, observational cohort study, we assessed the accuracy of a dual-band (histidine-rich protein-2/pan-lactate dehydrogenase [HRP2/pLDH]) rapid diagnostic test (RDT) to differentiate uncomplicated from severe malaria. We included children aged <12 years who presented to a rural clinic in western Uganda with a positive HRP2 or HRP2/pLDH RDT. We estimated the test characteristics of a dual-antigen (HRP2+/pLDH+) band positive RDT compared to World Health Organization–defined clinical and laboratory criteria to detect severe malaria.ResultsA total of 2678 children underwent testing for malaria with an RDT, and 83 (9.0%) satisfied criteria for severe malaria. The sensitivity and specificity of a HRP2+/pLDH+ result for severe malaria was 97.6% (95% confidence interval [CI], 90.8%–99.6%) and 75.6% (95% CI, 73.8%–77.4%), respectively. An HRP2+/pLDH+ result was significantly more sensitive (97.6% vs 68.7%, P < .001) for the detection of severe malaria compared to algorithms that incorporate screening for danger signs.ConclusionsA positive dual-antigen (HRP2/pLDH) RDT has higher sensitivity than the use of clinical manifestations to detect severe malaria, making it a promising tool in the triage of children with malaria in low-resource settings. Additional work is needed to operationalize diagnostic and treatment algorithms that include dual-antigen RDTs to avoid over referral.
      PubDate: 2017-08-24
      DOI: 10.1093/cid/cix592
      Issue No: Vol. 65, No. 9 (2017)
  • Plasmodium malariae in Israeli Travelers: A Nationwide Study
    • Authors: Yavne Y; Leshem E, Paran Y, et al.
      Pages: 1516 - 1522
      Abstract: AbstractBackgroundLittle is known about Plasmodium malariae, a relatively rare cause of malaria in returned travelers. Recently, polymerase chain reaction (PCR) use for malaria diagnosis has enhanced specificity of P. malariae detection. The study objective was to describe the unique aspects of P. malariae diagnosis and clinical course in travelers.MethodsMalaria is a reportable disease in Israel. All PCR-proven P. malariae monoinfections in Israeli travelers between January 2008 and January 2017 were retrieved from the Ministry of Health Reference Parasitology Laboratory. Data regarding method and timing of diagnosis, clinical characteristics, and laboratory testing were collected from patient charts.ResultsEighteen patients with P. malariae were included. All cases were acquired in Africa. During the study period, the relative proportion of P. malariae increased (2%–10% of all malaria cases). Malaria was identified by blood smear in 10 of 18 patients (56%) on admission, and by rapid antigen test in 5 of 18 (29%) patients only, while P. malariae speciation was correctly identified by smear in 2 of 18 (11%) patients. Though all patients reported fever, only 4 of 18 (22%) described a quartan fever course. In 7 of 18 (39%) patients, malaria was contracted despite prophylactic treatment. Five patients had prolonged prepatent periods (median, 55 days), all of whom received prior prophylaxis.ConclusionsThe relative proportion of P. malariae is on the rise. Diagnosis in routine clinical settings is inadequate due to the low sensitivity and specificity of blood smears. PCR should be considered when clinical suspicion is high. Prophylaxis failure, which caused delayed clinical presentation, was documented.
      PubDate: 2017-08-09
      DOI: 10.1093/cid/cix560
      Issue No: Vol. 65, No. 9 (2017)
  • Immune Cross-Opsonization Within emm Clusters Following Group A
           Streptococcus Skin Infection: Broadening the Scope of Type-Specific
    • Authors: Frost H; Laho D, Sanderson-Smith M, et al.
      Pages: 1523 - 1531
      Abstract: AbstractBackgroundGroup A Streptococcus (GAS) skin infections are particularly prevalent in developing nations. The GAS M protein, by which strains are differentiated into >220 different emm types, is immunogenic and elicits protective antibodies. A major obstacle for vaccine development has been the traditional understanding that immunity following infection is restricted to a single emm type. However, recent evidence has led to the hypothesis of immune cross-reactivity between emm types.MethodsWe investigated the human serological response to GAS impetigo in Fijian schoolchildren, focusing on 3 major emm clusters (E4, E6, and D4). Pre- and postinfection sera were assayed by enzyme-linked immunosorbent assay with N-terminal M peptides and bactericidal assays using the infecting-type strain, emm cluster–related strains, and nonrelated strains.ResultsTwenty of the 53 paired sera demonstrated a ≥4-fold increase in antibody titer against the infecting type. When tested against all cluster-related M peptides, we found that 9 of 17 (53%) paired sera had a ≥4-fold increase in antibody titer to cluster-related strains as well. When grouped by cluster, the mean change to cluster-related emm types in E4 and E6 was >4-fold (5.9-fold and 19.5-fold, respectively) but for D4 was 3.8-fold. The 17 paired sera were tested in bactericidal assays against selected cluster-related and nonrelated strains. While the responses were highly variable, numerous instances of cross-reactive killing were observed.ConclusionsThese data demonstrate that M type–specific and cross-reactive immune responses occur following skin infection. The cross-reactive immune responses frequently align with emm clusters, raising new opportunities to design multivalent vaccines with broad coverage.
      PubDate: 2017-07-19
      DOI: 10.1093/cid/cix599
      Issue No: Vol. 65, No. 9 (2017)
  • Burden of Influenza in 4 Ecologically Distinct Regions of Peru: Household
           Active Surveillance of a Community Cohort, 2009–2015
    • Authors: Tinoco Y; Azziz-Baumgartner E, Uyeki T, et al.
      Pages: 1532 - 1541
      Abstract: AbstractBackgroundThere are limited data on the burden of disease posed by influenza in low- and middle-income countries. Furthermore, most estimates of influenza disease burden worldwide rely on passive sentinel surveillance at health clinics and hospitals that lack accurate population denominators.MethodsWe documented influenza incidence, seasonality, health-system utilization with influenza illness, and vaccination coverage through active community-based surveillance in 4 ecologically distinct regions of Peru over 6 years. Approximately 7200 people in 1500 randomly selected households were visited 3 times per week. Naso- and oropharyngeal swabs were collected from persons with influenza-like illness and tested for influenza virus by real-time reverse-transcription polymerase chain reaction.ResultsWe followed participants for 35353 person-years (PY). The overall incidence of influenza was 100 per 1000 PY (95% confidence interval [CI], 97–104) and was highest in children aged 2–4 years (256/1000 PY [95% CI, 236–277]). Seasonal incidence trends were similar across sites, with 61% of annual influenza cases occurring during the austral winter (May–September). Of all participants, 44 per 1000 PY (95% CI, 42–46) sought medical care, 0.7 per 1000 PY (95% CI, 0.4–1.0) were hospitalized, and 1 person died (2.8/100000 PY). Influenza vaccine coverage was 27% among children aged 6–23 months and 26% among persons aged ≥65 years.ConclusionsOur results indicate that 1 in 10 persons develops influenza each year in Peru, with the highest incidence in young children. Active community-based surveillance allows for a better understanding of the true burden and seasonality of disease that is essential to plan the optimal target groups, timing, and cost of national influenza vaccination programs.
      PubDate: 2017-08-09
      DOI: 10.1093/cid/cix565
      Issue No: Vol. 65, No. 9 (2017)
  • Risk of Acute Liver Injury After Statin Initiation by Human
           Immunodeficiency Virus and Chronic Hepatitis C Virus Infection Status
    • Authors: Byrne D; Tate J, Forde K, et al.
      Pages: 1542 - 1550
      Abstract: AbstractBackgroundPatients with human immunodeficiency virus (HIV) and/or chronic hepatitis C virus (HCV) infection may be prescribed statins as treatment for metabolic/cardiovascular disease, but it remains unclear if the risk of acute liver injury (ALI) is increased for statin initiators compared to nonusers in groups classified by HIV/HCV status.MethodsWe conducted a cohort study to compare rates of ALI in statin initiators vs nonusers among 7686 HIV/HCV-coinfected, 8155 HCV-monoinfected, 17739 HIV-monoinfected, and 36604 uninfected persons in the Veterans Aging Cohort Study (2000–2012). We determined development of (1) liver aminotransferases >200 U/L, (2) severe ALI (coagulopathy with hyperbilirubinemia), and (3) death, all within 18 months. Cox regression was used to determine propensity score–adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) of outcomes in statin initiators compared to nonusers across the groups.ResultsAmong HIV/HCV-coinfected patients, statin initiators had lower risks of aminotransferase levels >200 U/L (HR, 0.66 [95% CI, .53–.83]), severe ALI (HR, 0.23 [95% CI, .12–.46]), and death (HR, 0.36 [95% CI, .28–.46]) compared with statin nonusers. In the setting of chronic HCV alone, statin initiators had reduced risks of aminotransferase elevations (HR, 0.57 [95% CI, .45–.72]), severe ALI (HR, 0.15 [95% CI, .06–.37]), and death (HR, 0.42 [95% CI, .32–.54]) than nonusers. Among HIV-monoinfected patients, statin initiators had lower risks of aminotransferase increases (HR, 0.52 [95% CI, .40–.66]), severe ALI (HR, 0.26 [95% CI, .13–.55]), and death (HR, 0.19 [95% CI, .16–.23]) compared with nonusers. Results were similar among uninfected persons.ConclusionsRegardless of HIV and/or chronic HCV status, statin initiators had a lower risk of ALI and death within 18 months compared with statin nonusers.
      PubDate: 2017-08-16
      DOI: 10.1093/cid/cix564
      Issue No: Vol. 65, No. 9 (2017)
  • Plasma But Not Cerebrospinal Fluid Interleukin 7 and Interleukin 5 Levels
           Pre–Antiretroviral Therapy Commencement Predict
           Cryptococcosis-Associated Immune Reconstitution Inflammatory Syndrome
    • Authors: Akilimali N; Chang C, Muema D, et al.
      Pages: 1551 - 1559
      Abstract: AbstractBackgroundPatients with human immunodeficiency virus/AIDS-associated cryptococcal meningitis (CM) frequently experience clinical deterioration, known as cryptococcosis-associated immune reconstitution inflammatory syndrome (C-IRIS), upon initiation of antiretroviral therapy (ART). The immunological mechanisms underlying C-IRIS are incompletely defined and no reliable predictive biomarkers exist. We investigated whether plasma or cerebrospinal fluid (CSF) levels of cytokines and chemokines predicted C-IRIS and are potential predictive biomarkers.MethodsPatients with CM who experienced C-IRIS (N = 27) upon ART initiation were compared to CD4+ T-cell count–matched patients without C-IRIS (N = 27). Plasma and CSF collected pre-ART were assayed for cytokines and chemokines using a 17-plex Luminex kit or enzyme-linked immunosorbent assay. Cox proportional hazards regression and principal component analyses were also performed.ResultsPlasma interleukin (IL) 2, IL-4, IL-5, IL-7, IL-17, interferon-γ, and tumor necrosis factor-α levels were higher in C-IRIS patients compared to controls (all P < .05), with IL-5 and IL-7 significant after Bonferroni-Holm correction. In multivariate Cox proportional hazards regression, high IL-5 (hazard ratio [HR], 5.76 [95% confidence interval {CI}, .77–43.0]; P = .088) and IL-7 (HR, 9.30 [95% CI, 1.96–44.0]; P = .005) were predictive of C-IRIS. Plasma IL-5 (P = .0008) and IL-10 (P = .0089) were lower in those who achieved CSF cryptococcal culture negativity compared to those with positive cultures pre-ART. There were no significant differences in CSF cytokine or chemokine levels between cases and controls.ConclusionsHigh plasma IL-5 and IL-7 levels pre-ART were associated with increased risk of developing C-IRIS. High IL-5 levels may reflect a Th2 environment associated with impaired clearance of cryptococci while high IL-7 levels may reflect IL-7/IL-7R pathway dysfunction in T cells, both of which could be associated with C-IRIS immunopathogenesis.
      PubDate: 2017-07-05
      DOI: 10.1093/cid/cix598
      Issue No: Vol. 65, No. 9 (2017)
  • Outpatient Management of Children With World Health Organization Chest
           Indrawing Pneumonia: Implementation Risks and Proposed Solutions
    • Authors: McCollum E; Ginsburg A.
      Pages: 1560 - 1564
      Abstract: AbstractThis Viewpoints article details our recommendation for the World Health Organization Integrated Management of Childhood Illness guidelines to consider additional referral or daily monitoring criteria for children with chest indrawing pneumonia in low-resource settings. We review chest indrawing physiology in children and relate this to the risk of adverse pneumonia outcomes. We believe there is sufficient evidence to support referring or daily monitoring of children with chest indrawing pneumonia and signs of severe respiratory distress, oxygen saturation <93% (when not at high altitude), moderate malnutrition, or an unknown human immunodeficiency virus (HIV) status in an HIV-endemic setting. Pulse oximetry screening should be routine and performed at the earliest point in the patient care pathway as possible. If outpatient clinics lack capacity to conduct pulse oximetry, nutritional assessment, or HIV testing, then we recommend considering referral to complete the evaluation. When referral is not possible, careful daily monitoring should be performed.
      PubDate: 2017-06-09
      DOI: 10.1093/cid/cix543
      Issue No: Vol. 65, No. 9 (2017)
  • Sepsis National Hospital Inpatient Quality Measure (SEP-1):
           Multistakeholder Work Group Recommendations for Appropriate Antibiotics
           for the Treatment of Sepsis
    • Authors: Septimus E; Coopersmith C, Whittle J, et al.
      Pages: 1565 - 1569
      Abstract: AbstractThe Center for Medicare and Medicaid Services adopted the Early Management Bundle, Severe Sepsis/Septic Shock (SEP-1) performance measure to the Hospital Inpatient Quality Reporting Program in July 2015 to help address the high mortality and high cost associated with sepsis. The SEP-1 performance measure requires, among other critical interventions, timely administration of antibiotics to patients with sepsis or septic shock. The multistakeholder workgroup recognizes the need for SEP-1 but strongly believes that multiple antibiotics listed in the antibiotic tables for SEP-1 are not appropriate and the use of these antibiotics, as called for in the SEP-1 measure, is not in alignment with prudent antimicrobial stewardship. To promote the appropriate use of antimicrobials and combat antimicrobial resistance, the workgroup provides recommendations for appropriate antibiotics for the treatment of sepsis.
      PubDate: 2017-07-14
      DOI: 10.1093/cid/cix603
      Issue No: Vol. 65, No. 9 (2017)
  • Parainfluenza Virus in the Hospitalized Adult
    • Authors: Russell E; Ison M.
      Pages: 1570 - 1576
      Abstract: AbstractParainfluenza virus (PIV) is a negative-sense single-stranded RNA virus in the Paramyxoviridae family. There are 4 serotypes that follow seasonal patterns with varying rates of infection for each serotype. PIV is an established cause of disease and death in the pediatric and immunocompromised populations, and its impact on the hospitalized adult is becoming more apparent with the increased use of multiplex molecular assays in the clinical setting. The clinical presentation of PIV in hospitalized adults varies widely and includes upper respiratory tract infections, severe lower respiratory tract infections, and exacerbations of underlying disease; 0.2%–11.5% of hospitalized patients with pneumonia have been found to have PIV infection. Currently no licensed treatment is available for PIV infection. Ribavirin has been used, but case studies show no impact on mortality rates. DAS181, an inhaled sialidase, is undergoing clinical development for the treatment of PIV in adults and children.
      PubDate: 2017-06-07
      DOI: 10.1093/cid/cix528
      Issue No: Vol. 65, No. 9 (2017)
  • Novel Method Suggests Global Superiority of Short-Duration Antibiotics for
           Intra-abdominal Infections
    • Authors: Celestin A; Odom S, Angelidou K, et al.
      Pages: 1577 - 1579
      Abstract: AbstractDesirability of outcome ranking and response adjusted for duration of antibiotic risk (DOOR/RADAR) are novel and innovative methods of evaluating data in antibiotic trials. We analyzed data from a noninferiority trial of short-course antimicrobial therapy for intra-abdominal infection (STOP-IT), and results suggest global superiority of short-duration therapy for intra-abdominal infections.
      PubDate: 2017-08-28
      DOI: 10.1093/cid/cix569
      Issue No: Vol. 65, No. 9 (2017)
  • A Cool Reception for Desirability of Outcome Ranking (DOOR)/Response
           Adjusted for Duration of Antibiotic Risk (RADAR) in Intra-abdominal
    • Authors: Solomkin J.
      Pages: 1580 - 1581
      Abstract: clinical trial designrandomized controlled trialcomplicated intra-abdominal infectionantimicrobial stewardshipduration of therapyappendicitis
      PubDate: 2017-08-28
      DOI: 10.1093/cid/cix571
      Issue No: Vol. 65, No. 9 (2017)
  • African Tick Bite Fever Treated Successfully With Rifampin in a Patient
           With Doxycycline Intolerance
    • Authors: Strand A; Paddock C, Rinehart A, et al.
      Pages: 1582 - 1584
      Abstract: AbstractAfrican tick bite fever is the most commonly encountered travel-associated rickettsiosis, occurring in as many as 5% of travelers returning from rural subequatorial Africa. This case report illustrates that rifampin represents an effective alternative to doxycycline for treatment of African tick bite fever in some selective situations.
      PubDate: 2017-05-13
      DOI: 10.1093/cid/cix363
      Issue No: Vol. 65, No. 9 (2017)
  • Enhanced Sexually Transmitted Infection Screening for Mycoplasma
           genitalium in Human Immunodeficiency Virus -Infected US Air Force
    • Authors: Hakre S; Casimier R, Danboise B, et al.
      Pages: 1585 - 1588
      Abstract: AbstractThree-site genital and extragenital screening for Mycoplasma genitalium in 102 asymptomatic Air Force members with human immunodeficiency virus (HIV) infection revealed 19 (18.6%) cases of M. genitalium, commonly (58%) in rectal samples. Because M. genitalium is associated with both HIV acquisition and transmission, these findings suggest that it should be included in routine screening of HIV-infected individuals for sexually transmitted infections.
      PubDate: 2017-08-09
      DOI: 10.1093/cid/cix555
      Issue No: Vol. 65, No. 9 (2017)
  • Naked Surgeons' The Debate About What to Wear in the Operating Room
    • Authors: Weinstein R; Bartek M, Verdial F, et al.
      Pages: 1589 - 1592
      Abstract: AbstractThere has been recent controversy regarding recommendations and regulations concerning operating room attire. We performed a nonsystematic literature search regarding operating room attire and surgical site infection (SSI) risk. Much of the literature relies on air sampling and culture of operating room equipment but does not present evidence regarding effect on SSI risk. There is no evidence regarding SSI risk related to operating room attire except for sterile gowns and the use of gloves. Naked surgeons shed fewer bacteria into the operating room environment than ones wearing scrub suits.
      PubDate: 2017-05-29
      DOI: 10.1093/cid/cix498
      Issue No: Vol. 65, No. 9 (2017)
  • 33-Year-Old With Human Immunodeficiency Virus/AIDS and Multiple Skin
    • Pages: 1593 - 1593
      Abstract: (See page 1594 for the Answer to the Photo Quiz)
      PubDate: 2017-10-16
      DOI: 10.1093/cid/cix389
      Issue No: Vol. 65, No. 9 (2017)
  • A 33-Year-Old With Human Immunodeficiency Virus/AIDS and Multiple Skin
    • Authors: Iregui A; Heilman E, Augenbraun M, et al.
      Pages: 1594 - 1594
      Abstract: (See page 1593 for the Photo Quiz)
      PubDate: 2017-10-16
      DOI: 10.1093/cid/cix386
      Issue No: Vol. 65, No. 9 (2017)
  • Optimizing Antimicrobial Utilization: Job of a Steward, or Time for a
    • Authors: Bush L; Kaye D.
      Pages: 1595 - 1595
      Abstract: To the Editor—In the Centers for Disease Control and Prevention’s (CDC) “Announcement: Get Smart About Antibiotics Week” (14–20 November 2016), antibiotic use is the single most important contributing factor to antibiotic resistance in patients [1]. It has been estimated that 30%–50% of all antibiotics prescribed in US acute care hospitals are either unnecessary or inappropriate [2]. Regrettably, the rapid and ongoing rise in antimicrobial resistance is occurring at the same time that the number of new agents being presented to the US Food and Drug Administration for approval has significantly declined. Therefore, we are faced with the question of how best to curtail and hopefully reverse this trend to avoid returning to the “preantibiotic era” of medical practice.
      PubDate: 2017-06-07
      DOI: 10.1093/cid/cix530
      Issue No: Vol. 65, No. 9 (2017)
  • Reply to Bush and Kaye
    • Authors: Kullar R; Goff D, Bauer K, et al.
      Pages: 1596 - 1596
      Abstract: To the Editor—We thank Drs Bush and Kaye [1] for their comments and interest in our article [2]. However, the term “pilot” in their title diminishes the multidisciplinary nature of a successful antimicrobial stewardship program (ASP). In addition, there are several concerns with their statements that should be noted.
      PubDate: 2017-06-07
      DOI: 10.1093/cid/cix531
      Issue No: Vol. 65, No. 9 (2017)
  • Preserving the Health of the Public and Our Specialty
    • Authors: Spellberg B.
      Pages: 1597 - 1597
      Abstract: Walensky et al. tackle one of the most pressing challenges facing our specialty [1]. How do we ensure its future' Two important additions to their salient points are worth considering. First, preserving our specialty is a critical public health imperative, driven by the communicability of infections, which differentiates them from all other medical illnesses. Antibiotics—and only antibiotics among all drugs—are a societal trust [2]. Overuse and misuse by individuals cause harm to everyone else in society. Every time we round on antibiotic stewardship, we are reminded of how critical it is that people specially trained in antibiotic use help preserve these drugs and prevent their misuse. Every time a terrifying new disease emerges into the public consciousness (human immunodeficiency virus, Ebola, West Nile, Zika, myriad bacterial superbugs, resistant fungi, etc.), we are reminded how needed people with our expertise are to preserve the public good. As a specialty, we have not successfully branded ourselves, and have not effectively implanted into the public consciousness the uniqueness and importance of our role in the health of the public. This shouldn’t be “about us”; it should be about serving and preserving the public good. This message should be a focus of all of us as individuals, and of the societies that represent us collectively.
      PubDate: 2017-06-29
      DOI: 10.1093/cid/cix572
      Issue No: Vol. 65, No. 9 (2017)
  • The Future of the Discipline of Infectious Diseases
    • Authors: Fuchs G; III.
      Pages: 1597 - 1598
      Abstract: To the Editor—The invited commentary by Walensky, del Rio, and Armstrong on the analysis and challenges facing the discipline of Infectious Disease is well done, timely, and simultaneously disturbing and unsettling [1]. In my view as an IDSA member and stakeholder, there is at least one addition that might be considered to the possible prescriptions delineated at the end of the commentary. Specifically, systematic advocacy of the discipline of Infectious Diseases directed at policy makers and the public deserves emphasis. In this regard, in addition to the direct inherent health benefits that result from the Infectious Diseases discipline, the direct and indirect cost benefits to the health care system and patients/families (e.g., reduced costly complications, reduced length of stay, reduced loss of salary) need to be further quantified through advanced health economics analyses and subsequently disseminated and promoted. This is relevant and has the potential to be persuasive in the current economic-sensitized environment.
      PubDate: 2017-06-29
      DOI: 10.1093/cid/cix573
      Issue No: Vol. 65, No. 9 (2017)
  • A Call for More Involvement of Infectious Disease Clinicians in the
           Medical Education of the Next Generation of Physicians
    • Authors: Manian F.
      Pages: 1598 - 1598
      Abstract: To the Editor—Walensky et al should be commended for sounding the alarm on the anticipated mismatch between the supply and demand for infectious disease (ID) physicians and potential means of addressing this problem [1].
      PubDate: 2017-06-29
      DOI: 10.1093/cid/cix574
      Issue No: Vol. 65, No. 9 (2017)
  • Reply to Spellberg, Fuchs, and Manian
    • Authors: Walensky R; del Rio C, Armstrong W.
      Pages: 1599 - 1599
      Abstract: We appreciate the endorsement of our piece, “Charting the Future of InfectiousDisease: Anticipating and Addressing theSupply and Demand Mismatch”, in letters from Dr Spellberg, Dr Fuchs, and Dr Manian; we agree further with their comments. Dr Spellberg highlights the importance of our specialty in serving the public as antibiotic stewards and creatively suggests regulatory reform related to prescribing of newly approved antibiotics, as occurs with recently approved expensive agents in other subspecialty fields. Dr Fuchs emphasizes the paucity of research quantifying health benefits and costs (from both a patient and health system perspective) that may be used by Infectious Diseases (ID) specialists in advocacy for our patients and for public health. And Dr Manian underscores the importance of early exposure to the field with trained ID faculty serving as preceptors and mentors through the longitudinal horizon of medical student and residency experiences. Although some of the recommended activities are already underway, we will bring these important suggestions back to the Infectious Diseases Society of America (IDSA) and HIV Medicine Association (HIVMA) leadership and add them to a growing list of action items; we invite continued dialogue through the IDea Exchange Digest ('CommunityKey=0853d0ad-643f-4516-bd91-d43e391a6175&tab=digestviewer).
      PubDate: 2017-06-29
      DOI: 10.1093/cid/cix575
      Issue No: Vol. 65, No. 9 (2017)
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