Publisher: Oxford University Press   (Total: 409 journals)

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Showing 1 - 200 of 409 Journals sorted alphabetically
ACS Symposium Series     Full-text available via subscription   (Followers: 3, 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: 57, SJR: 2.196, CiteScore: 5)
Aesthetic Surgery J.     Hybrid Journal   (Followers: 6, SJR: 1.434, CiteScore: 1)
Aesthetic Surgery J. Open Forum     Open Access  
African Affairs     Hybrid Journal   (Followers: 70, SJR: 1.869, CiteScore: 2)
Age and Ageing     Hybrid Journal   (Followers: 94, SJR: 1.989, CiteScore: 4)
Alcohol and Alcoholism     Hybrid Journal   (Followers: 19, SJR: 1.376, CiteScore: 3)
American Entomologist     Hybrid Journal   (Followers: 8)
American Historical Review     Hybrid Journal   (Followers: 204, SJR: 0.467, CiteScore: 1)
American J. of Agricultural Economics     Hybrid Journal   (Followers: 47, SJR: 2.113, CiteScore: 3)
American J. of Clinical Nutrition     Hybrid Journal   (Followers: 208, SJR: 3.438, CiteScore: 6)
American J. of Epidemiology     Hybrid Journal   (Followers: 211, SJR: 2.713, CiteScore: 3)
American J. of Health-System Pharmacy     Full-text available via subscription   (Followers: 60, SJR: 0.595, CiteScore: 1)
American J. of Hypertension     Hybrid Journal   (Followers: 28, 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: 10, SJR: 0.116, CiteScore: 0)
American Law and Economics Review     Hybrid Journal   (Followers: 29, SJR: 1.053, CiteScore: 1)
American Literary History     Hybrid Journal   (Followers: 18, SJR: 0.391, CiteScore: 0)
Analysis     Hybrid Journal   (Followers: 24, SJR: 1.038, CiteScore: 1)
Animal Frontiers     Hybrid Journal   (Followers: 2)
Annals of Behavioral Medicine     Hybrid Journal   (Followers: 15, SJR: 1.423, CiteScore: 3)
Annals of Botany     Hybrid Journal   (Followers: 37, SJR: 1.721, CiteScore: 4)
Annals of Oncology     Hybrid Journal   (Followers: 57, SJR: 5.599, CiteScore: 9)
Annals of the Entomological Society of America     Full-text available via subscription   (Followers: 11, SJR: 0.722, CiteScore: 1)
Annals of Work Exposures and Health     Hybrid Journal   (Followers: 36, SJR: 0.728, CiteScore: 2)
Antibody Therapeutics     Open Access  
AoB Plants     Open Access   (Followers: 4, SJR: 1.28, CiteScore: 3)
Applied Economic Perspectives and Policy     Hybrid Journal   (Followers: 16, SJR: 0.858, CiteScore: 2)
Applied Linguistics     Hybrid Journal   (Followers: 59, 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: 22)
Arbitration Law Reports and Review     Hybrid Journal   (Followers: 14)
Archives of Clinical Neuropsychology     Hybrid Journal   (Followers: 31, SJR: 0.731, CiteScore: 2)
Aristotelian Society Supplementary Volume     Hybrid Journal   (Followers: 2)
Arthropod Management Tests     Hybrid Journal   (Followers: 2)
Astronomy & Geophysics     Hybrid Journal   (Followers: 45, SJR: 0.146, CiteScore: 0)
Behavioral Ecology     Hybrid Journal   (Followers: 55, SJR: 1.871, CiteScore: 3)
Bioinformatics     Hybrid Journal   (Followers: 380, SJR: 6.14, CiteScore: 8)
Biology Methods and Protocols     Hybrid Journal  
Biology of Reproduction     Full-text available via subscription   (Followers: 10, SJR: 1.446, CiteScore: 3)
Biometrika     Hybrid Journal   (Followers: 20, SJR: 3.485, CiteScore: 2)
BioScience     Hybrid Journal   (Followers: 30, SJR: 2.754, CiteScore: 4)
Bioscience Horizons : The National Undergraduate Research J.     Open Access   (Followers: 3, SJR: 0.146, CiteScore: 0)
Biostatistics     Hybrid Journal   (Followers: 17, SJR: 1.553, CiteScore: 2)
BJA : British J. of Anaesthesia     Hybrid Journal   (Followers: 207, SJR: 2.115, CiteScore: 3)
BJA Education     Hybrid Journal   (Followers: 67)
Brain     Hybrid Journal   (Followers: 74, SJR: 5.858, CiteScore: 7)
Briefings in Bioinformatics     Hybrid Journal   (Followers: 52, 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: 40, SJR: 2.161, CiteScore: 2)
British J. of Aesthetics     Hybrid Journal   (Followers: 24, SJR: 0.508, CiteScore: 1)
British J. of Criminology     Hybrid Journal   (Followers: 618, SJR: 1.828, CiteScore: 3)
British J. of Social Work     Hybrid Journal   (Followers: 88, 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: 35)
Bulletin of the London Mathematical Society     Hybrid Journal   (Followers: 3, SJR: 1.376, CiteScore: 1)
Cambridge J. of Economics     Hybrid Journal   (Followers: 71, SJR: 0.764, CiteScore: 2)
Cambridge J. of Regions, Economy and Society     Hybrid Journal   (Followers: 12, SJR: 2.438, CiteScore: 4)
Cambridge Quarterly     Hybrid Journal   (Followers: 10, 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: 15, SJR: 3.002, CiteScore: 5)
Cerebral Cortex     Hybrid Journal   (Followers: 54, SJR: 3.892, CiteScore: 6)
CESifo Economic Studies     Hybrid Journal   (Followers: 24, SJR: 0.483, CiteScore: 1)
Chemical Senses     Hybrid Journal   (Followers: 1, SJR: 1.42, CiteScore: 3)
Children and Schools     Hybrid Journal   (Followers: 7, SJR: 0.246, CiteScore: 0)
Chinese J. of Comparative Law     Hybrid Journal   (Followers: 5, SJR: 0.412, CiteScore: 0)
Chinese J. of Intl. Law     Hybrid Journal   (Followers: 24, SJR: 0.329, CiteScore: 0)
Chinese J. of Intl. Politics     Hybrid Journal   (Followers: 11, 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: 29, SJR: 0.123, CiteScore: 0)
Clean Energy     Open Access   (Followers: 1)
Clinical Infectious Diseases     Hybrid Journal   (Followers: 77, SJR: 5.051, CiteScore: 5)
Communication Theory     Hybrid Journal   (Followers: 26, SJR: 2.424, CiteScore: 3)
Communication, Culture & Critique     Hybrid Journal   (Followers: 28, 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: 3, SJR: 1.818, CiteScore: 3)
Contemporary Women's Writing     Hybrid Journal   (Followers: 11, SJR: 0.121, CiteScore: 0)
Contributions to Political Economy     Hybrid Journal   (Followers: 6, SJR: 0.906, CiteScore: 1)
Critical Values     Full-text available via subscription  
Current Developments in Nutrition     Open Access   (Followers: 5)
Current Legal Problems     Hybrid Journal   (Followers: 29)
Current Zoology     Full-text available via subscription   (Followers: 4, SJR: 1.164, CiteScore: 2)
Database : The J. of Biological Databases and Curation     Open Access   (Followers: 9, SJR: 1.791, CiteScore: 3)
Digital Scholarship in the Humanities     Hybrid Journal   (Followers: 14, SJR: 0.259, CiteScore: 1)
Diplomatic History     Hybrid Journal   (Followers: 24, 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: 17, SJR: 0.139, CiteScore: 0)
Econometrics J.     Hybrid Journal   (Followers: 33, SJR: 2.926, CiteScore: 1)
Economic J.     Hybrid Journal   (Followers: 118, SJR: 5.161, CiteScore: 3)
Economic Policy     Hybrid Journal   (Followers: 48, SJR: 3.584, CiteScore: 3)
ELT J.     Hybrid Journal   (Followers: 25, SJR: 0.942, CiteScore: 1)
English Historical Review     Hybrid Journal   (Followers: 57, SJR: 0.612, CiteScore: 1)
English: J. of the English Association     Hybrid Journal   (Followers: 21, SJR: 0.1, CiteScore: 0)
Environmental Entomology     Full-text available via subscription   (Followers: 12, SJR: 0.818, CiteScore: 2)
Environmental Epigenetics     Open Access   (Followers: 2)
Environmental History     Hybrid Journal   (Followers: 26, SJR: 0.408, CiteScore: 1)
EP-Europace     Hybrid Journal   (Followers: 3, 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: 22, SJR: 0.113, CiteScore: 0)
European Heart J.     Hybrid Journal   (Followers: 67, SJR: 9.315, CiteScore: 9)
European Heart J. - Cardiovascular Imaging     Hybrid Journal   (Followers: 10, SJR: 3.625, CiteScore: 3)
European Heart J. - Cardiovascular Pharmacotherapy     Full-text available via subscription   (Followers: 3)
European Heart J. - Quality of Care and Clinical Outcomes     Hybrid Journal  
European Heart J. : Case Reports     Open Access   (Followers: 1)
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: 222, SJR: 0.694, CiteScore: 1)
European J. of Orthodontics     Hybrid Journal   (Followers: 5, SJR: 1.279, CiteScore: 2)
European J. of Public Health     Hybrid Journal   (Followers: 21, 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: 44, SJR: 2.728, CiteScore: 3)
Evolution, Medicine, and Public Health     Open Access   (Followers: 12)
Family Practice     Hybrid Journal   (Followers: 15, SJR: 1.018, CiteScore: 2)
Fems Microbiology Ecology     Hybrid Journal   (Followers: 19, SJR: 1.492, CiteScore: 4)
Fems Microbiology Letters     Hybrid Journal   (Followers: 29, SJR: 0.79, CiteScore: 2)
Fems Microbiology Reviews     Hybrid Journal   (Followers: 38, 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: 25, SJR: 1.425, CiteScore: 1)
Forest Science     Hybrid Journal   (Followers: 8, 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: 35, SJR: 0.118, CiteScore: 0)
French Studies     Hybrid Journal   (Followers: 21, SJR: 0.148, CiteScore: 0)
French Studies Bulletin     Hybrid Journal   (Followers: 10, SJR: 0.152, CiteScore: 0)
Gastroenterology Report     Open Access   (Followers: 3)
Genome Biology and Evolution     Open Access   (Followers: 17, SJR: 2.578, CiteScore: 4)
Geophysical J. Intl.     Hybrid Journal   (Followers: 38, SJR: 1.506, CiteScore: 3)
German History     Hybrid Journal   (Followers: 24, SJR: 0.161, CiteScore: 0)
GigaScience     Open Access   (Followers: 6, SJR: 5.022, CiteScore: 7)
Global Summitry     Hybrid Journal   (Followers: 1)
Glycobiology     Hybrid Journal   (Followers: 12, SJR: 1.493, CiteScore: 3)
Health and Social Work     Hybrid Journal   (Followers: 60, 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: 23, SJR: 0.812, CiteScore: 2)
History Workshop J.     Hybrid Journal   (Followers: 33, SJR: 1.278, CiteScore: 1)
Holocaust and Genocide Studies     Hybrid Journal   (Followers: 30, SJR: 0.105, CiteScore: 0)
Human Communication Research     Hybrid Journal   (Followers: 15, SJR: 2.146, CiteScore: 3)
Human Molecular Genetics     Hybrid Journal   (Followers: 11, SJR: 3.555, CiteScore: 5)
Human Reproduction     Hybrid Journal   (Followers: 74, SJR: 2.643, CiteScore: 5)
Human Reproduction Open     Open Access   (Followers: 1)
Human Reproduction Update     Hybrid Journal   (Followers: 19, SJR: 5.317, CiteScore: 10)
Human Rights Law Review     Hybrid Journal   (Followers: 65, SJR: 0.756, CiteScore: 1)
ICES J. of Marine Science: J. du Conseil     Hybrid Journal   (Followers: 59, SJR: 1.591, CiteScore: 3)
ICSID Review : Foreign Investment Law J.     Hybrid Journal   (Followers: 12)
ILAR J.     Hybrid Journal   (Followers: 3, 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: 44, SJR: 0.249, CiteScore: 1)
Inflammatory Bowel Diseases     Hybrid Journal   (Followers: 45, SJR: 2.511, CiteScore: 4)
Information and Inference     Free  
Innovation in Aging     Open Access   (Followers: 1)
Insect Systematics and Diversity     Hybrid Journal  
Integrative and Comparative Biology     Hybrid Journal   (Followers: 10, SJR: 1.319, CiteScore: 2)
Integrative Biology     Full-text available via subscription   (Followers: 5, SJR: 1.36, CiteScore: 3)
Integrative Organismal Biology     Open Access  
Interacting with Computers     Hybrid Journal   (Followers: 10, SJR: 0.292, CiteScore: 1)
Interactive CardioVascular and Thoracic Surgery     Hybrid Journal   (Followers: 7, SJR: 0.762, CiteScore: 1)
Intl. Affairs     Hybrid Journal   (Followers: 69, SJR: 1.505, CiteScore: 3)
Intl. Data Privacy Law     Hybrid Journal   (Followers: 26)
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: 37, SJR: 1.348, CiteScore: 2)
Intl. J. of Constitutional Law     Hybrid Journal   (Followers: 62, SJR: 0.601, CiteScore: 1)
Intl. J. of Epidemiology     Hybrid Journal   (Followers: 279, 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: 25, 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: 39, SJR: 0.389, CiteScore: 1)
Intl. J. of Transitional Justice     Hybrid Journal   (Followers: 14, SJR: 0.724, CiteScore: 2)
Intl. Mathematics Research Notices     Hybrid Journal   (Followers: 1, SJR: 2.168, CiteScore: 1)
Intl. Political Sociology     Hybrid Journal   (Followers: 41, SJR: 1.465, CiteScore: 3)
Intl. Relations of the Asia-Pacific     Hybrid Journal   (Followers: 24, SJR: 0.401, CiteScore: 1)
Intl. Studies Perspectives     Hybrid Journal   (Followers: 9, SJR: 0.983, CiteScore: 1)
Intl. Studies Quarterly     Hybrid Journal   (Followers: 55, SJR: 2.581, CiteScore: 2)
Intl. Studies Review     Hybrid Journal   (Followers: 24, 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: 18, SJR: 0.533, CiteScore: 1)
J. of American History     Hybrid Journal   (Followers: 50, 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: 16, 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: 43, SJR: 1.226, CiteScore: 2)
J. of Breast Imaging     Full-text available via subscription   (Followers: 2)

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Similar Journals
Journal Cover
Clinical Infectious Diseases
Journal Prestige (SJR): 5.051
Citation Impact (citeScore): 5
Number of Followers: 77  
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1058-4838 - ISSN (Online) 1537-6591
Published by Oxford University Press Homepage  [409 journals]
  • In the Literature
    • PubDate: Thu, 16 Jan 2020 00:00:00 GMT
      DOI: 10.1093/cid/ciz1073
      Issue No: Vol. 70, No. 3 (2020)
  • News
    • PubDate: Thu, 16 Jan 2020 00:00:00 GMT
      DOI: 10.1093/cid/ciz1057
      Issue No: Vol. 70, No. 3 (2020)
  • A 67-year-old Man With Recurrent Multifocal Cellulitis
    • Authors: Rauseo A; La Starza B, Hendrix M, et al.
      Pages: 531 - 534
      Abstract: A 67-year-old Caucasian man, an avid traveler with a history of hypertension, depression, and previous morbid obesity treated with bariatric surgery, presented with low-grade fever and recurrent left-ankle painful rash (Figure 1A). The patient noted the first episode 2 months prior to presentation when he presented with a poorly defined painful erythematous patch over his left ankle and leukocytosis. He was treated with cefazolin for suspected cellulitis and discharged on cephalexin with partial improvement. Infectious workup, including blood cultures, echocardiogram, and x-ray, was negative. Over the next few weeks he developed similar discrete episodes with new, noncontiguous rashes to other body parts, such as the abdomen, left shoulder (Figure 1B), right gluteal region, right elbow, and left knee that spontaneously resolved within a few days, sometimes without antibiotic treatment. A partial response to antihistamines, leg elevation, and doxycycline was noted, but rash and pain worsened with a short trial of steroids after initial improvement. Two days prior to admission, he again developed left-ankle painful erythematous rash spreading up to his knee, associated with fever. He had an extensive travel history with trips to China, India, South Asia, Canada, and Brazil in the last decade. Five months previously he had visited Hong Kong where he had a diarrheal illness consisting of 4–5 loose but not watery stools for 2 days that self-resolved. Three months previously he visited Morocco where he rode a camel. He lives in Missouri and has retired but volunteers with refugees hailing from the developing world receiving treatment for tuberculosis. He is a former sushi chef and eats raw seafood often. On presentation, he was febrile to 38.3°C but otherwise had stable vital signs. Laboratory data revealed leukocytosis (12 300 cells/μL) and elevated erythrocyte sedimentation rate (49 mm/h) and C-reactive protein (103 mg/L). Blood cultures were collected, and the patient was started on vancomycin and cefepime. Rheumatologic testing was negative, as was testing for syphilis, human immunodeficiency virus, tuberculosis, and Lyme disease. Left lower extremity computed tomography showed superficial soft tissue edema without osteomyelitis or abscess. Echocardiogram showed normal ventricular function without vegetations. Skin biopsy revealed sparse perivascular and interstitial inflammatory infiltrate consistent with cellulitis with negative tissue bacterial cultures. The aerobic bottle from 2 sets of blood cultures obtained on the day of admission yielded a pathogen whose microscopic features are shown in Figures 2 and 3.
      PubDate: Thu, 16 Jan 2020 00:00:00 GMT
      DOI: 10.1093/cid/ciz315
      Issue No: Vol. 70, No. 3 (2020)
  • Plasmodium knowlesi Malaria in Sabah, Malaysia, 2015–2017: Ongoing
           Increase in Incidence Despite Near-elimination of the Human-only
           Plasmodium Species
    • Authors: Cooper D; Rajahram G, William T, et al.
      Pages: 361 - 367
      Abstract: AbstractBackgroundMalaysia aims to eliminate malaria by 2020. However, while cases of Plasmodium falciparum and Plasmodium vivax have decreased substantially, the incidence of zoonotic malaria from Plasmodium knowlesi continues to increase, presenting a major challenge to regional malaria control efforts. Here we report incidence of all Plasmodium species in Sabah, including zoonotic P. knowlesi, during 2015–2017.MethodsMicroscopy-based malaria notification data and polymerase chain reaction (PCR) results were obtained from the Sabah Department of Health and State Public Health Laboratory, respectively, from January 2015 to December 2017. From January 2016 this was complemented by a statewide prospective hospital surveillance study. Databases were matched, and species was determined by PCR, or microscopy if PCR was not available.ResultsA total of 3867 malaria cases were recorded between 2015 and 2017, with PCR performed in 93%. Using PCR results, and microscopy if PCR was unavailable, P. knowlesi accounted for 817 (80%), 677 (88%), and 2030 (98%) malaria cases in 2015, 2016, and 2017, respectively. P. falciparum accounted for 110 (11%), 45 (6%), and 23 (1%) cases and P. vivax accounted for 61 (6%), 17 (2%), and 8 (0.4%) cases, respectively. Of those with P. knowlesi, the median age was 35 (interquartile range: 24–47) years, and 85% were male.ConclusionsMalaysia is approaching elimination of the human-only Plasmodium species. However, the ongoing increase in P. knowlesi incidence presents a major challenge to malaria control and warrants increased focus on knowlesi-specific prevention activities. Wider molecular surveillance in surrounding countries is required.
      PubDate: Tue, 19 Mar 2019 00:00:00 GMT
      DOI: 10.1093/cid/ciz237
      Issue No: Vol. 70, No. 3 (2019)
  • Is the Epidemiology of Plasmodium knowlesi Changing, and What Does This
           Mean for Malaria Control in Southeast Asia'
    • Authors: Karunajeewa H; Berman J.
      Pages: 368 - 369
      Abstract: Plasmodium knowlesiSabahepidemiology
      PubDate: Tue, 19 Mar 2019 00:00:00 GMT
      DOI: 10.1093/cid/ciz238
      Issue No: Vol. 70, No. 3 (2019)
  • Changes in US Outpatient Antibiotic Prescriptions From 2011–2016
    • Authors: King L; Bartoces M, Fleming-Dutra K, et al.
      Pages: 370 - 377
      Abstract: AbstractBackgroundWhile antibiotics are life-saving drugs, their use is not without risk, including adverse events and antibiotic resistance. The majority of US antibiotic prescriptions are prescribed in outpatient settings, making outpatient antibiotic prescribing an important antibiotic stewardship target. The primary objective of this study was to describe trends in US outpatient oral antibiotic prescriptions from 2011–2016.MethodsWe estimated annual oral antibiotic prescription rates using national prescription dispensing count data from IQVIA Xponent, divided by census estimates for 2011–2016. We calculated the ratio of broad- to narrow-spectrum prescriptions by dividing broad-spectrum prescription rates by narrow-spectrum prescription rates. We used Poisson models to estimate prevalence rate ratios, comparing 2011 and 2016 antibiotic prescription rates, and linear models to evaluate temporal trends throughout the study period.ResultsOral antibiotic prescription rates decreased 5%, from 877 prescriptions per 1000 persons in 2011 to 836 per 1000 persons in 2016. During this period, rates of prescriptions dispensed to children decreased 13%, while adult rates increased 2%. The ratio of broad- to narrow-spectrum antibiotics decreased from 1.62 in 2011 to 1.49 in 2016, driven by decreases in macrolides and fluoroquinolones. The proportion of prescriptions written by nurse practitioners and physician assistants increased during the study period; in 2016, these providers prescribed over one-quarter of all antibiotic prescriptions.ConclusionsOutpatient antibiotic prescription rates, especially of broad-spectrum agents, have decreased in recent years. Clinicians who prescribe to adults, including nurse practitioners and physician assistants, are important targets for antibiotic stewardship.
      PubDate: Sat, 16 Mar 2019 00:00:00 GMT
      DOI: 10.1093/cid/ciz225
      Issue No: Vol. 70, No. 3 (2019)
  • Outpatient Antibiotic Prescribing in the United States: Are Pediatricians
           Leading the Way'
    • Authors: Gerber J.
      Pages: 378 - 379
      Abstract: antibiotic stewardshiprespiratory tract infection
      PubDate: Mon, 18 Mar 2019 00:00:00 GMT
      DOI: 10.1093/cid/ciz230
      Issue No: Vol. 70, No. 3 (2019)
  • Maternal Vaccination in Argentina: Tetanus, Diphtheria, and Acellular
           Pertussis Vaccine Effectiveness During Pregnancy in Preventing Pertussis
           in Infants <2 Months of Age
    • Authors: Romanin V; Acosta A, Juarez M, et al.
      Pages: 380 - 387
      Abstract: AbstractBackgroundIn 2011, Argentina experienced its highest pertussis incidence and mortality rates of the last decade; 60% of deaths were among infants aged <2 months. In response, a dose of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine was recommended for all pregnant women at ≥20 weeks of gestation. Although recent studies suggest that maternal Tdap vaccination is effective at preventing infant disease, no data have come from low- or middle-income countries, nor from ones using whole-cell pertussis vaccines for primary immunization.MethodsWe conducted a matched case-control evaluation to assess the effectiveness of maternal Tdap vaccination in preventing pertussis among infants aged <2 months in Argentina. Pertussis case patients identified from September 2012 to March 2016 at 6 hospital sites and confirmed by polymerase chain reaction testing were included. Five randomly selected controls were matched to each case patient by hospital site and mother’s health district. We used multivariable conditional logistic regression to calculate odds ratios (ORs). Vaccine effectiveness (VE) was estimated as (1 – OR) × 100%.ResultsSeventy-one case patients and 300 controls were included in the analysis. Forty-nine percent of case patients and 78% of controls had mothers who were vaccinated during pregnancy. Overall Tdap VE was estimated at 80.7% (95% confidence interval, 52.1%–92.2%). We found similar VE whether Tdap was administered during the second or third trimester.ConclusionsTdap vaccination during pregnancy is effective in preventing pertussis in infants aged <2 months in Argentina, with similar effectiveness whether administered during the second or third trimester of pregnancy.
      PubDate: Sat, 16 Mar 2019 00:00:00 GMT
      DOI: 10.1093/cid/ciz217
      Issue No: Vol. 70, No. 3 (2019)
  • Modeling Regional Transmission and Containment of a Healthcare-associated
           Multidrug-resistant Organism
    • Authors: Paul P; Slayton R, Kallen A, et al.
      Pages: 388 - 394
      Abstract: AbstractBackgroundThe Centers for Disease Control and Prevention (CDC) recently published interim guidance for a public health response to contain novel or targeted multidrug-resistant organisms (MDROs). We assessed the impact of implementing the strategy in a US state using a mathematical model.MethodsWe used a deterministic compartmental model, parametrized via a novel analysis of carbapenem-resistant Enterobacteriaceae data reported to the National Healthcare Safety Network and patient transfer data from the Centers for Medicare and Medicaid Services. The simulations assumed that after the importation of the MDRO and its initial detection by clinical culture at an index hospital, fortnightly prevalence surveys for colonization and additional infection control interventions were implemented at the index facility; similar surveys were then also implemented at those facilities known to be connected most strongly to it as measured by patient transfer data; and prevalence surveys were discontinued after 2 consecutive negative surveys.ResultsIf additional infection-control interventions are assumed to lead to a 20% reduction in transmissibility in intervention facilities, prevalent case count in the state 3 years after importation would be reduced by 76% (interquartile range: 73–77%). During the third year, these additional infection-control measures would be applied in facilities accounting for 42% (37–46%) of inpatient days.ConclusionsCDC guidance for containing MDROs, when used in combination with information on transfer of patients among hospitals, is predicted to be effective, enabling targeted and efficient use of prevention resources during an outbreak response. Even modestly effective infection-control measures may lead to a substantial reduction in transmission events.
      PubDate: Thu, 28 Mar 2019 00:00:00 GMT
      DOI: 10.1093/cid/ciz248
      Issue No: Vol. 70, No. 3 (2019)
  • Better Virological Outcomes Among People Living With Human
           Immunodeficiency Virus (HIV) Initiating Early Antiretroviral Treatment
           (CD4 Counts ≥500 Cells/µL) in the HIV Prevention Trials Network 071
           (PopART) Trial in South Africa
    • Authors: Fatti G; , Grimwood A, et al.
      Pages: 395 - 403
      Abstract: AbstractBackgroundThere have been concerns about reduced adherence and human immunodeficiency virus (HIV) virological suppression (VS) among clinically well people initiating antiretroviral therapy (ART) with high pre-ART CD4 cell counts. We compared virological outcomes by pre-ART CD4 count, where universal ART initiation was provided in the HIV Prevention Trials Network 071 (PopART) trial in South Africa prior to routine national and international implementation.MethodsThis prospective cohort study included adults initiating ART at facilities providing universal ART since January 2014. VS (<400 copies/mL), confirmed virological failure (VF) (2 consecutive viral loads >1000 copies/mL), and viral rebound were compared between participants in strata of baseline CD4 cell count.ResultsThe sample included 1901 participants. VS was ≥94% among participants with baseline CD4 count ≥500 cells/µL at all 6-month intervals to 30 months. The risk of an elevated viral load (≥400 copies/mL) was independently lower among participants with baseline CD4 count ≥500 cells/µL (3.3%) compared to those with CD4 count 200–499 cells/µL (9.2%) between months 18 and 30 (adjusted relative risk, 0.30 [95% confidence interval, .12–.74]; P = .010). The incidence rate of VF was 7.0, 2.0, and 0.5 per 100 person-years among participants with baseline CD4 count <200, 200–499, and ≥500 cells/µL, respectively (P < .0001). VF was independently lower among participants with baseline CD4 count ≥500 cells/µL (adjusted hazard ratio [aHR], 0.23; P = .045) and 3-fold higher among those with baseline CD4 count <200 cells/µL (aHR, 3.49; P < .0001).ConclusionsDespite previous concerns, participants initiating ART with CD4 counts ≥500 cells/µL had very good virological outcomes, being better than those with CD4 counts 200–499 cells/µL.Clinical Trials RegistrationNCT01900977.
      PubDate: Sat, 16 Mar 2019 00:00:00 GMT
      DOI: 10.1093/cid/ciz214
      Issue No: Vol. 70, No. 3 (2019)
  • Prevalence and Clinical Outcomes of Poor Immune Response Despite
           Virologically Suppressive Antiretroviral Therapy Among Children and
           Adolescents With Human Immunodeficiency Virus in Europe and Thailand:
           Cohort Study
    • Pages: 404 - 415
      Abstract: AbstractBackgroundIn human immunodeficiency virus (HIV)–positive adults, low CD4 cell counts despite fully suppressed HIV-1 RNA on antiretroviral therapy (ART) have been associated with increased risk of morbidity and mortality. We assessed the prevalence and outcomes of poor immune response (PIR) in children receiving suppressive ART.MethodsSixteen cohorts from the European Pregnancy and Paediatric HIV Cohort Collaboration (EPPICC) contributed data. Children <18 years at ART initiation, with sustained viral suppression (VS) (≤400 copies/mL) for ≥1 year were included. The prevalence of PIR (defined as World Health Organization advanced/severe immunosuppression for age) at 1 year of VS was described. Factors associated with PIR were assessed using logistic regression. Rates of acquired immunodeficiency syndrome (AIDS) or death on suppressive ART were calculated by PIR status.ResultsOf 2318 children included, median age was 6.4 years and 68% had advanced/severe immunosuppression at ART initiation. At 1 year of VS, 12% had PIR. In multivariable analysis, PIR was associated with older age and worse immunological stage at ART start, hepatitis B coinfection, and residing in Thailand (all P ≤ .03). Rates of AIDS/death (95% confidence interval) per 100 000 person-years were 1052 (547, 2022) among PIR versus 261 (166, 409) among immune responders; rate ratio of 4.04 (1.83, 8.92; P < .001).ConclusionsOne in eight children in our cohort experienced PIR despite sustained VS. While the overall rate of AIDS/death was low, children with PIR had a 4-fold increase in risk of event as compared with immune responders.
      PubDate: Thu, 28 Mar 2019 00:00:00 GMT
      DOI: 10.1093/cid/ciz253
      Issue No: Vol. 70, No. 3 (2019)
  • Clusters of Sexual Behavior in Human Immunodeficiency Virus–positive Men
           Who Have Sex With Men Reveal Highly Dissimilar Time Trends
    • Authors: Salazar-Vizcaya L; Kusejko K, Schmidt A, et al.
      Pages: 416 - 424
      Abstract: AbstractBackgroundSeparately addressing specific groups of people who share patterns of behavioral change might increase the impact of behavioral interventions to prevent transmission of sexually transmitted infections. We propose a method based on machine learning to assist the identification of such groups among men who have sex with men (MSM).MethodsBy means of unsupervised learning, we inferred “behavioral clusters” based on the recognition of similarities and differences in longitudinal patterns of condomless anal intercourse with nonsteady partners (nsCAI) in the HIV Cohort Study over the last 18 years. We then used supervised learning to investigate whether sociodemographic variables could predict cluster membership.ResultsWe identified 4 behavioral clusters. The largest behavioral cluster (cluster 1) contained 53% of the study population and displayed the most stable behavior. Cluster 3 (17% of the study population) displayed consistently increasing nsCAI. Sociodemographic variables were predictive for both of these clusters. The other 2 clusters displayed more drastic changes: nsCAI frequency in cluster 2 (20% of the study population) was initially similar to that in cluster 3 but accelerated in 2010. Cluster 4 (10% of the study population) had significantly lower estimates of nsCAI than all other clusters until 2017, when it increased drastically, reaching 85% by the end of the study period.ConclusionsWe identified highly dissimilar behavioral patterns across behavioral clusters, including drastic, atypical changes. The patterns suggest that the overall increase in the frequency of nsCAI is largely attributable to 2 clusters, accounting for a third of the population.
      PubDate: Fri, 15 Mar 2019 00:00:00 GMT
      DOI: 10.1093/cid/ciz208
      Issue No: Vol. 70, No. 3 (2019)
  • Feasibility of Identifying Household Contacts of Rifampin-and
           Multidrug-resistant Tuberculosis Cases at High Risk of Progression to
           Tuberculosis Disease
    • Authors: Gupta A; , Swindells S, et al.
      Pages: 425 - 435
      Abstract: AbstractBackgroundWe assessed multidrug-resistant tuberculosis (MDR-TB) cases and their household contacts (HHCs) to inform the development of an interventional clinical trial.MethodsWe conducted a cross-sectional study of adult MDR-TB cases and their HHCs in 8 countries with high TB burdens. HHCs underwent symptom screenings, chest radiographies, sputum TB bacteriologies, TB infection (TBI) testing (tuberculin skin test [TST] and interferon gamma release assay [IGRA]), and human immunodeficiency virus (HIV) testing.ResultsFrom October 2015 to April 2016, 1016 HHCs from 284 MDR-TB cases were enrolled. At diagnosis, 69% of MDR-TB cases were positive for acid-fast bacilli sputum smears and 43% had cavitary disease; at study entry, 35% remained smear positive after a median MDR-TB treatment duration of 8.8 weeks. There were 9 HHCs that were diagnosed with TB prior to entry and excluded. Of the remaining 1007 HHCs, 41% were male and the median age was 25 years. There were 121 (12%) HHCs that had new cases of TB identified: 17 (2%) were confirmed, 33 (3%) probable, and 71 (7%) possible TB cases. The TBI prevalence (defined as either TST or IGRA positivity) was 72% and varied by age, test used, and country. Of 1007 HHCs, 775 (77%) were considered high-risk per these mutually exclusive groups: 102 (10%) were aged <5 years; 63 (6%) were aged ≥5 and were infected with HIV; and 610 (61%) were aged ≥5 years, were negative for HIV or had an unknown HIV status, and were TBI positive. Only 21 (2%) HHCs were on preventive therapy.ConclusionsThe majority of HHCs in these high-burden countries were at high risk of TB disease and infection, yet few were receiving routine preventive therapy. Trials of novel, preventive therapies are urgently needed to inform treatment policy and practice.
      PubDate: Thu, 28 Mar 2019 00:00:00 GMT
      DOI: 10.1093/cid/ciz235
      Issue No: Vol. 70, No. 3 (2019)
  • Willingness to Take Multidrug-resistant Tuberculosis (MDR-TB) Preventive
           Therapy Among Adult and Adolescent Household Contacts of MDR-TB Index
           Cases: An International Multisite Cross-sectional Study
    • Authors: Suryavanshi N; , Murrill M, et al.
      Pages: 436 - 445
      Abstract: AbstractBackgroundHousehold contacts (HHCs) of individuals with multidrug-resistant tuberculosis (MDR-TB) are at high risk of infection and subsequent disease. There is limited evidence on the willingness of MDR-TB HHCs to take MDR-TB preventive therapy (MDR TPT) to decrease their risk of TB disease.MethodsIn this cross-sectional study of HHCs of MDR-TB and rifampicin-resistant tuberculosis (RR-TB) index cases from 16 clinical research sites in 8 countries, enrollees were interviewed to assess willingness to take a hypothetical, newly developed MDR TPT if offered. To identify factors associated with willingness to take MDR TPT, a marginal logistic model was fitted using generalized estimating equations to account for household-level clustering.ResultsFrom 278 MDR-TB/RR-TB index case households, 743 HHCs were enrolled; the median age of HHCs was 33 (interquartile range, 22–49) years, and 62% were women. HHC willingness to take hypothetical MDR TPT was high (79%) and remained high even with the potential for mild side effects (70%). Increased willingness was significantly associated with current employment or schooling (adjusted odds ratio [aOR], 1.83 [95% confidence interval {CI}, 1.07–3.13]), appropriate TB-related knowledge (aOR, 2.22 [95% CI, 1.23–3.99]), confidence in taking MDR TPT (aOR, 7.16 [95% CI, 3.33–15.42]), and being comfortable telling others about taking MDR TPT (aOR, 2.29 [95% CI, 1.29–4.06]).ConclusionsThe high percentage of HHCs of MDR-TB/RR-TB index cases willing to take hypothetical MDR TPT provides important evidence for the potential uptake of effective MDR TPT when implemented. Identified HHC-level variables associated with willingness may inform education and counseling efforts to increase HHC confidence in and uptake of MDR TPT.
      PubDate: Thu, 28 Mar 2019 00:00:00 GMT
      DOI: 10.1093/cid/ciz254
      Issue No: Vol. 70, No. 3 (2019)
  • Changes in Invasive Pneumococcal Disease Spectrum After 13-Valent
           Pneumococcal Conjugate Vaccine Implementation
    • Authors: Levy C; Varon E, Ouldali N, et al.
      Pages: 446 - 454
      Abstract: AbstractBackgroundPneumococcal conjugate vaccine (PCV) implementation has led to a sharp decrease in invasive pneumococcal disease (IPD) due to the reduction in PCV serotypes. We aimed to describe the changes in the spectrum of IPD and its clinical presentations after 13-valent PCV (PCV13) implementation.MethodsThis prospective, hospital-based, active surveillance involved 130 pediatric wards and microbiology departments throughout France. We analyzed IPD cases from 2011 to 2016 for which a pneumococcal isolate was sent to the National Reference Center for Pneumococci for serotyping. Clinical data recorded were medical history, vaccination status, type of IPD, clinical features, and short-term evolution.ResultsAmong 1082 IPD cases, we observed a 35.3% decrease (95% confidence interval, 29.2%–41.8%]) and the median age shifted from 38.3 months to 23.7 months (P = .007). The change in IPD type was mostly due to a reduction in bacteremic pneumonia frequency (from 42.1% to 19.1%; P < .001). Among the emerging non-PCV13 types (NVTs), those known to have the highest disease potential (8, 12F, 24F, and 33F) were isolated more frequently in patients without underlying conditions and were able to induce all IPD clinical presentations including bacteremic pneumonia. Conversely, serotypes with lower disease potential (15A, 15BC, 16F, and 23B) were rarely isolated from bacteremic pneumonia cases and were particularly involved in IPD in patients with underlying conditions (35.8%).ConclusionsBesides the decrease in IPD after 7-valent, then 13-valent PCV implementation, the spectrum of the remaining IPD cases showed significant changes, with substantial discrepancies across NVTs implicated in terms of clinical features and underlying conditions.
      PubDate: Thu, 14 Mar 2019 00:00:00 GMT
      DOI: 10.1093/cid/ciz221
      Issue No: Vol. 70, No. 3 (2019)
  • Interacting, Nonspecific, Immunological Effects of Bacille
           Calmette-Guérin and Tetanus-diphtheria-pertussis Inactivated Polio
           Vaccinations: An Explorative, Randomized Trial
    • Authors: Blok B; de Bree L, Diavatopoulos D, et al.
      Pages: 455 - 463
      Abstract: AbstractBackgroundCertain vaccines, such as Bacille Calmette-Guérin (BCG), have nonspecific effects, which modulate innate immune responses and lead to protection against mortality from unrelated infections (trained immunity). In contrast, in spite of the disease-specific effects, an enhanced overall mortality has been described after diphtheria-tetanus-pertussis (DTP) vaccination in females. This randomized trial aimed to investigate the nonspecific immunological effects of BCG and DTP-containing vaccines on the immune response to unrelated pathogens.MethodsWe randomized 75 healthy, female, adult volunteers to receive either BCG, followed by a booster dose of tetanus-diphtheria-pertussis inactivated polio vaccine (Tdap) 3 months later; BCG and Tdap combined; or Tdap followed by BCG 3 months later. Blood was collected before vaccination, as well as at 1 day, 4 days, 2 weeks, and 3 months after the first vaccination(s), plus 2 weeks after the second vaccination. Ex vivo leukocyte responses to unrelated stimuli and pathogens were assessed.ResultsTdap vaccination led to short-term potentiation and long-term repression of monocyte-derived cytokine responses, and short-term as well as long-term repression of T-cell reactivity to unrelated pathogens. BCG led to short-term and long-term potentiation of monocyte-derived cytokine responses. When given together with Tdap or after Tdap, BCG abrogated the immunosuppressive effects of Tdap vaccination.ConclusionsTdap induces immunotolerance to unrelated antigens, which is partially restored by concurrent or subsequent BCG vaccination. These data indicate that the modulation of heterologous immune responses is induced by vaccination with Tdap and BCG, and more studies are warranted to investigate whether this is involved in the nonspecific effects of vaccines on mortality.Clinical Trials RegistrationNCT02771782.
      PubDate: Thu, 28 Mar 2019 00:00:00 GMT
      DOI: 10.1093/cid/ciz246
      Issue No: Vol. 70, No. 3 (2019)
  • Active Targeted Surveillance to Identify Sites of Emergence of Hantavirus
    • Authors: Kim W; No J, Lee D, et al.
      Pages: 464 - 473
      Abstract: AbstractBackgroundEndemic outbreaks of hantaviruses pose a critical public health threat worldwide. Hantaan orthohantavirus (HTNV) causes hemorrhagic fever with renal syndrome (HFRS) in humans. Using comparative genomic analyses of partial and nearly complete sequences of HTNV from humans and rodents, we were able to localize, with limitations, the putative infection locations for HFRS patients. Partial sequences might not reflect precise phylogenetic positions over the whole-genome sequences; finer granularity of rodent sampling reflects more precisely the circulation of strains.MethodsFive HFRS specimens were collected. Epidemiological surveys were conducted with the patients during hospitalization. We conducted active surveillance at suspected HFRS outbreak areas. We performed multiplex polymerase chain reaction–based next-generation sequencing to obtain the genomic sequence of HTNV from patients and rodents. The phylogeny of human- and rodent-derived HTNV was generated using the maximum likelihood method. For phylogeographic analyses, the tracing of HTNV genomes from HFRS patients was defined on the bases of epidemiological interviews, phylogenetic patterns of the viruses, and geographic locations of HTNV-positive rodents.ResultsThe phylogeographic analyses demonstrated genetic clusters of HTNV strains from clinical specimens, with HTNV circulating in rodents at suspected sites of patient infections.ConclusionsThis study demonstrates a major shift in molecular epidemiological surveillance of HTNV. Active targeted surveillance was performed at sites of suspected infections, allowing the high-resolution phylogeographic analysis to reveal the site of emergence of HTNV. We posit that this novel approach will make it possible to identify infectious sources, perform disease risk assessment, and implement preparedness against vector-borne viruses.
      PubDate: Wed, 20 Mar 2019 00:00:00 GMT
      DOI: 10.1093/cid/ciz234
      Issue No: Vol. 70, No. 3 (2019)
  • Association Between Normothermia at the End of Surgery and Postoperative
           Complications Following Orthopedic Surgery
    • Authors: Yamada K; Nakajima K, Nakamoto H, et al.
      Pages: 474 - 482
      Abstract: AbstractBackgroundMaintaining perioperative normothermia is recommended by recent guidelines for the prevention of surgical site infections (SSIs). However, the majority of supporting data originates outside the field of orthopaedic surgery.MethodsThe effect of normothermia was explored using the prospectively collected data of consecutive patients who underwent single-site surgery in 7 tertiary referral hospitals between November 2013 and July 2016. SSIs, urinary tract infections (UTIs), respiratory tract infections (RTIs), cardiac and cerebral events (CCE), and all-cause mortality rates within 30 days after surgery were compared between patients with normothermia (body temperature ≥36°C) and those with hypothermia (<36°C) at the end of surgery, after closure. Multivariable adjusted and inverse-probability weighted regression analyses were performed.ResultsThe final cohort included 8841 patients. Of these, 11.4% (n = 1008) were hypothermic. More than 96% were evaluated in person by the physicians. After adjusting for multiple covariates, normothermia was not significantly associated with SSIs (adjusted odds ratio [aOR] 1.18, 95% confidence interval [CI] 0.59–2.33), UTIs (aOR 1.14, 95% CI 0.66–1.95), RTIs (aOR 0.60, 95% CI 0.31–1.19), or CCE (aOR 0.53, 95% CI 0.26–1.09). In contrast, normothermia was associated with a lower risk of 30-day mortality (aOR 0.26, 95% CI 0.11–0.64; P < .01; weighted hazard ratio 0.21, 95% CI 0.07–0.68; P = .002). In a subgroup analysis, normothermia was associated with reduced mortality in all types of surgical procedures.ConclusionsWhereas our findings suggest no clear association with SSI risks following orthopedic surgery, our study supports maintaining perioperative normothermia, as it is associated with reduced 30-day mortality.
      PubDate: Wed, 13 Mar 2019 00:00:00 GMT
      DOI: 10.1093/cid/ciz213
      Issue No: Vol. 70, No. 3 (2019)
  • Longitudinal Changes in Spirometry in South African Adolescents
           Perinatally Infected With Human Immunodeficiency Virus Who Are Receiving
           Antiretroviral Therapy
    • Authors: Githinji L; Gray D, Hlengwa S, et al.
      Pages: 483 - 490
      Abstract: AbstractBackgroundDespite increased access to highly active antiretroviral therapy (HAART), lung disease remains common in human immunodeficiency virus (HIV)–infected (HIV+) adolescents. There is limited information on changes in lung function over time in perinatally HIV+ adolescents on HAART. The objective was to investigate the progression of spirometry findings over 2 years in HIV+ adolescents on HAART in a prospective cohort, the Cape Town Adolescent Antiretroviral Cohort (CTAAC).MethodsHIV+ adolescents aged 9–14 years, with at least 6 months of HAART, and a comparator group of healthy HIV-uninfected (HIV–), age-matched controls were enrolled in CTAAC. Spirometry and bronchodilator testing were done at baseline, 12 months, and 24 months. Mixed-effect models were used to compute longitudinal changes in lung function.ResultsFive hundred fifteen HIV+ adolescents, mean age 12 (standard deviation [SD], 1.6) years, 50.4% male, and 110 HIV– adolescents, mean age 11.8 (SD, 1.8) years, 45.6% male, were tested at baseline; 477 (93%) HIV+ and 102 (93%) HIV– adolescents at 12 months; and 473 (92%) HIV+ and 97 (88%) HIV– adolescents at 24 months. Only 5.4% of the HIV+ adolescents had HIV viral load >10 000 copies/mL at baseline. Forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were lower in the HIV+ compared to the HIV– adolescents and tracked with no deterioration or catch-up over 2 years. Previous pulmonary tuberculosis (PTB) or lower respiratory tract infection (LRTI) was significantly associated with reduced FEV1 and FVC (P < .05 for both).ConclusionsHIV+ adolescents had lower lung function over 2 years than HIV– adolescents. This study highlights the need for lung function surveillance and prevention of LRTIs and PTB in HIV+ adolescents.
      PubDate: Tue, 02 Apr 2019 00:00:00 GMT
      DOI: 10.1093/cid/ciz255
      Issue No: Vol. 70, No. 3 (2019)
  • Longitudinally Evaluating the Lung Function of Children in Low- and
           Middle-income Countries: It’s About Time
    • Authors: McCollum E.
      Pages: 491 - 492
      Abstract: (See the Major Article by Githinji et al on pages 483–90.)
      PubDate: Thu, 28 Mar 2019 00:00:00 GMT
      DOI: 10.1093/cid/ciz260
      Issue No: Vol. 70, No. 3 (2019)
  • Understanding the Importance of Contact Heterogeneity and Variable
           Infectiousness in the Dynamics of a Large Norovirus Outbreak
    • Authors: Zelner J; Adams C, Havumaki J, et al.
      Pages: 493 - 500
      Abstract: AbstractBackgroundLarge norovirus (NoV) outbreaks are explosive in nature and vary widely in final size and duration, suggesting that superspreading combined with heterogeneous contact may explain these dynamics. Modeling tools that can capture heterogeneity in infectiousness and contact are important for NoV outbreak prevention and control, yet they remain limited.MethodsData from a large NoV outbreak at a Dutch scout jamboree, which resulted in illness among 326 (of 4500 total) individuals from 7 separate camps, were used to examine the contributions of individual variation in infectiousness and clustered contact patterns to the transmission dynamics. A Bayesian hierarchical model of heterogeneous, clustered outbreak transmission was applied to represent (1) between-individual heterogeneity in infectiousness and (2) heterogeneous patterns of contact.ResultsWe found wide heterogeneity in infectiousness across individuals, suggestive of superspreading. Nearly 50% of individual infectiousness was concentrated in the individual’s subcamp of residence, with the remainder distributed over other subcamps. This suggests a source-and-sink dynamic in which subcamps with greater average infectiousness fed cases to those with a lower transmission rate. Although the per capita transmission rate within camps was significantly greater than that between camps, the large pool of susceptible individuals across camps enabled similar numbers of secondary cases generated between versus within camps.ConclusionsThe consideration of clustered transmission and heterogeneous infectiousness is important for understanding NoV transmission dynamics. Models including these mechanisms may be useful for providing early warning and guiding outbreak response.
      PubDate: Mon, 18 Mar 2019 00:00:00 GMT
      DOI: 10.1093/cid/ciz220
      Issue No: Vol. 70, No. 3 (2019)
  • Antiretroviral Adherence, Elevated Viral Load, and Drug Resistance
           Mutations in Human Immunodeficiency Virus–infected Women Initiating
           Treatment in Pregnancy: A Nested Case-control Study
    • Authors: Myer L; Redd A, Mukonda E, et al.
      Pages: 501 - 508
      Abstract: AbstractBackgroundElevated viral load (VL) early after antiretroviral therapy (ART) initiation appears frequently in pregnant and postpartum women living with human immunodeficiency virus; however the relative contributions of pre-ART drug resistance mutations (DRMs) vs nonadherence in the etiology of elevated VL are unknown.MethodsWithin a cohort of women initiating ART during pregnancy in Cape Town, South Africa, we compared women with elevated VL after initial suppression (cases, n = 80) incidence-density matched to women who maintained suppression over time (controls, n = 87). Groups were compared on pre-ART DRMs and detection of antiretrovirals in stored plasma.ResultsThe prevalence of pre-ART DRMs was 10% in cases and 5% in controls (adjusted odds ratio [aOR], 1.53 [95% confidence interval {CI}, .4–5.9]); all mutations were to nonnucleoside reverse transcriptase inhibitors. At the time of elevated VL, 19% of cases had antiretrovirals detected in plasma, compared with 87% of controls who were suppressed at a matched time point (aOR, 131.43 [95% CI, 32.8–527.4]). Based on these findings, we estimate that <10% of all elevated VL in the cohort may be attributable to pre-ART DRMs vs >90% attributable to ART nonadherence.ConclusionsDRMs account for a small proportion of all elevated VL among women occurring in the 12 months after ART initiation during pregnancy in this setting, with nonadherence appearing to drive most episodes of elevated VL. Alongside the drive for access to more robust antiretroviral agents in resource-limited settings, there is an ongoing need for effective strategies to support ART adherence in this patient population.
      PubDate: Sat, 16 Mar 2019 00:00:00 GMT
      DOI: 10.1093/cid/ciz209
      Issue No: Vol. 70, No. 3 (2019)
  • Emergency Department Visits due to Scabies in the United States: A
           Retrospective Analysis of a Nationally Representative Emergency Department
    • Authors: Tripathi R; Knusel K, Ezaldein H, et al.
      Pages: 509 - 517
      Abstract: AbstractBackgroundLimited information exists regarding the burden of emergency department (ED) visits due to scabies in the United States. The goal of this study was to provide population-level estimates regarding scabies visits to American EDs.MethodsThis study was a retrospective analysis of the nationally representative National Emergency Department Sample from 2013 to 2015. Outcomes included adjusted odds for scabies ED visits, adjusted odds for inpatient admission due to scabies in the ED scabies population, predictors for cost of care, and seasonal/regional variation in cost and prevalence of scabies ED visits.ResultsOur patient population included 416 017 218 ED visits from 2013 to 2015, of which 356 267 were due to scabies (prevalence = 85.7 per 100 000 ED visits). The average annual expenditure for scabies ED visits was $67 125 780.36. The average cost of care for a scabies ED visit was $750.91 (±17.41). Patients visiting the ED for scabies were most likely to be male children from lower income quartiles and were most likely to present to the ED on weekdays in the fall, controlling for all other factors. Scabies ED patients that were male, older, insured by Medicare, from the highest income quartile, and from the Midwest/West were most likely to be admitted as inpatients. Older, higher income, Medicare patients in large Northeastern metropolitan cities had the greatest cost of care.ConclusionThis study provides comprehensive nationally representative estimates of the burden of scabies ED visits on the American healthcare system. These findings are important for developing targeted interventions to decrease the incidence and burden of scabies in American EDs.
      PubDate: Fri, 15 Mar 2019 00:00:00 GMT
      DOI: 10.1093/cid/ciz207
      Issue No: Vol. 70, No. 3 (2019)
  • A Second Case of Human Conjunctival Infestation With Thelazia gulosa and a
           Review of T. gulosa in North America
    • Authors: Bradbury R; Gustafson D, Sapp S, et al.
      Pages: 518 - 520
      Abstract: AbstractWe describe a second case of human infection caused by Thelazia gulosa (the cattle eye worm), likely acquired in California. For epidemiologic purposes, it is important to identify all Thelazia recovered from humans in North America to the species level.
      PubDate: Tue, 22 Oct 2019 00:00:00 GMT
      DOI: 10.1093/cid/ciz469
      Issue No: Vol. 70, No. 3 (2019)
  • One-year Mortality Outcomes From the Advancing Cryptococcal Meningitis
    • Authors: Kanyama C; Molloy S, Chan A, et al.
      Pages: 521 - 524
      Abstract: AbstractIn Malawi, 236 participants from the Advancing Cryptococcal Meningitis Treatment for Africa trial were followed for 12 months. The trial outcomes reported at 10 weeks were sustained to 1 year. One-week amphotericin B plus flucytosine was associated with the lowest 1 year mortality (27.5% [95% confidence interval, 16.3 to 44.1]).
      PubDate: Sat, 01 Jun 2019 00:00:00 GMT
      DOI: 10.1093/cid/ciz454
      Issue No: Vol. 70, No. 3 (2019)
  • Gut Resistome After Oral Antibiotics in Preschool Children in Burkina
           Faso: A Randomized, Controlled Trial
    • Authors: Oldenburg C; Hinterwirth A, Sié A, et al.
      Pages: 525 - 527
      Abstract: AbstractWe evaluated the effect of systemic antibiotics (azithromycin, amoxicillin, cotrimoxazole, or placebo) on the gut resistome in children aged 6 to 59 months. Azithromycin and cotrimoxazole led to an increase in macrolide and sulfonamide resistance determinants. Resistome expansion can be induced with a single course of antibiotics.
      PubDate: Fri, 31 May 2019 00:00:00 GMT
      DOI: 10.1093/cid/ciz455
      Issue No: Vol. 70, No. 3 (2019)
  • A First Unexplained Invasive Encapsulated Bacterial Infection in Young
           Adults Associated With High Mortality and Readmission Rates
    • Authors: Jackson N; Sutton T, Bedford L, et al.
      Pages: 528 - 530
      Abstract: AbstractWe find that patients <40 years old with a first invasive encapsulated bacterial infection have a high likelihood of death or readmission within 23 months. It is imperative to highlight them for immunological screening and initiate prophylactic interventions and treatment.
      PubDate: Mon, 03 Jun 2019 00:00:00 GMT
      DOI: 10.1093/cid/ciz470
      Issue No: Vol. 70, No. 3 (2019)
  • To Succeed, One Health Must Win Animal Agriculture’s Stronger
    • Authors: Gray G; Mazet J.
      Pages: 535 - 537
      Abstract: AbstractThe One Health approach has received widespread international endorsements from professional, academic, and governmental organizations as the way forward in tackling complex interdisciplinary problems, such as emerging zoonotic diseases, antimicrobial resistance, and food safety. Yet conspicuously absent from US One Health training or research activities are the animal agricultural industries. Their absence is likely due to multiple factors, including the lack of appreciation for their potential problem-solving roles, as well as the industries’ business-oriented fears that such engagement could cause them to suffer economic damage. As demands on the swine, poultry, egg, beef, and dairy production industries are closely linked to the above-mentioned complex problems, we must find new, nonthreatening ways to better engage and win animal agriculture’s collaboration into One Health training and research partnerships for successful health problem solving. Without animal agricultural industries’ improved cooperation, One Health’s efforts to control these complex problems are not likely to succeed.
      PubDate: Fri, 06 Sep 2019 00:00:00 GMT
      DOI: 10.1093/cid/ciz729
      Issue No: Vol. 70, No. 3 (2019)
  • Procalcitonin to Distinguish Viral From Bacterial Pneumonia: A Systematic
           Review and Meta-analysis
    • Authors: Kamat I; Ramachandran V, Eswaran H, et al.
      Pages: 538 - 542
      Abstract: AbstractBecause of the diverse etiologies of community-acquired pneumonia (CAP) and the limitations of current diagnostic modalities, serum procalcitonin levels have been proposed as a novel tool to guide antibiotic therapy. Outcome data from procalcitonin-guided therapy trials have shown similar mortality, but the essential question is whether the sensitivity and specificity of procalcitonin levels enable the practitioner to distinguish bacterial pneumonia, which requires antibiotic therapy, from viral pneumonia, which does not. In this meta-analysis of 12 studies in 2408 patients with CAP that included etiologic diagnoses and sufficient data to enable analysis, the sensitivity and specificity of serum procalcitonin were 0.55 (95% confidence interval [CI], .37–.71; I2 = 95.5%) and 0.76 (95% CI, .62–.86; I2 = 94.1%), respectively. Thus, a procalcitonin level is unlikely to provide reliable evidence either to mandate administration of antibiotics or to enable withholding such treatment in patients with CAP.
      PubDate: Tue, 25 Jun 2019 00:00:00 GMT
      DOI: 10.1093/cid/ciz545
      Issue No: Vol. 70, No. 3 (2019)
  • Setting-based Prioritization for Birth Cohort Hepatitis C Virus Testing in
           the United States
    • Authors: MacDonald B; Chu T, Stewart R, et al.
      Pages: 543 - 544
      Abstract: To the Editor—We read with interest the study by Patel et al [1], in which they used 2013–2017 National Health Interview Survey (NHIS) data to assess hepatitis C virus (HCV) testing coverage for the 1945–1965 birth cohort in the United States. The authors reported that HCV testing for this birth cohort was low, with a peak of only 17% in 2017. An overall improvement in HCV testing is needed, and a settings-based perspective may be useful for guiding interventions [2].
      PubDate: Fri, 24 May 2019 00:00:00 GMT
      DOI: 10.1093/cid/ciz440
      Issue No: Vol. 70, No. 3 (2019)
  • Reply to MacDonald et al
    • Authors: Patel E; Mehta S, Boon D, et al.
      Pages: 544 - 545
      Abstract: To the Editor—We appreciate Dr MacDonald and colleagues’ [1] interest in our study [2] describing the limited coverage of hepatitis C virus (HCV) testing in the noninstitutionalized US civilian population, even among Baby Boomers, for whom there is a 1-time HCV testing recommendation. Our study was conducted using data from the 2013–2017 National Health Interview Survey. Using the same data source, the authors make an important point that, even in 2017, there were missed opportunities for HCV testing [1]. In particular, the authors highlight that 78% of untested Baby Boomers interacted with a primary care provider in the past year. We agree with MacDonald et al [1] that interventions to improve the uptake of HCV testing recommendations should be implemented in primary care settings (eg, provider and patient education programs, in combination with targeted electronic medical record best practice alerts for providers [3]).
      PubDate: Fri, 24 May 2019 00:00:00 GMT
      DOI: 10.1093/cid/ciz441
      Issue No: Vol. 70, No. 3 (2019)
  • Tuberculosis and Dysglycemia
    • Authors: Yates T; Barr D.
      Pages: 545 - 545
      Abstract: To the Editor—In our opinion, the extent to which dysglycemia is causally associated with tuberculosis (TB) remains unanswered. Ugarte-Gil and colleagues, with no control group, cannot answer that question [1]. We note that the prevalence of diabetes in, for example, their South African TB patients is not dissimilar to that reported in the general population of South Africans aged >30 years [2]. In fairness, their TB cohort is at the lower end of this age distribution.
      PubDate: Fri, 24 May 2019 00:00:00 GMT
      DOI: 10.1093/cid/ciz433
      Issue No: Vol. 70, No. 3 (2019)
  • Reply to Yates and Barr
    • Authors: Ugarte-Gil C; Pearson F, Moore D, et al.
      Pages: 545 - 546
      Abstract: To the Editor—We thank Drs Yates and Barr for their valuable comments. In our article [1], we were not attempting to assess the extent to which dysglycemia is causally associated with tuberculosis (TB). A number of prospective studies exist, among a body of evidence, supporting probabilistic causation between diabetes mellitus (DM) and TB [2, 3]. Rather, the aim of our study was to identify age-adjusted prevalence and clinical characteristics of DM and intermediate hyperglycemia among those with newly diagnosed TB across 4 TB-endemic settings. In our South African population, the prevalence of DM (10.9% [95% confidence interval, 7%–14.9%]) was the lowest across all 4 study sites. However, as the smallest site, uncertainty around this estimate is greatest and the prevalence estimate was shown to increase after age standardization.
      PubDate: Fri, 24 May 2019 00:00:00 GMT
      DOI: 10.1093/cid/ciz434
      Issue No: Vol. 70, No. 3 (2019)
  • Prediction Model Needs More Improvements Before Clinical Application
    • Authors: Chen H; Song Y, Liu K.
      Pages: 546 - 547
      Abstract: To the Editor—We read with interest the impressive study by Hong et al [1] that developed a new clinical prediction model of aminoglycoside (AG)-induced hearing loss among patients initiating drug-resistant tuberculosis (DR-TB) treatment. The results showed reasonable discrimination (area under curve [AUC] = 0.71) and calibration (χ2[8] = 6.10; P = .636) in the development cohort, and satisfied discrimination (AUC = 0.81) and calibration (χ2[8] = 6.48; P = .593) in the validation (ultrahigh-frequency hearing loss) cohort. According to these results, we agree that the authors built a simple model for the identification of patients with DR-TB who are at the highest risk of developing AG-induced ototoxicity. However, we think this model should be improved before its clinical application.
      PubDate: Wed, 29 May 2019 00:00:00 GMT
      DOI: 10.1093/cid/ciz446
      Issue No: Vol. 70, No. 3 (2019)
  • Reply to Chen, Song, and Liu
    • Authors: Hong H; Dowdy D.
      Pages: 547 - 548
      Abstract: To the Editor—Chen and colleagues [1] suggest that our prediction model of hearing loss among patients receiving aminoglycosides for the treatment of multidrug-resistant tuberculosis (MDR-TB) [2] should undergo validation in other cohorts, achieve a higher level of accuracy, and undergo additional analyses prior to clinical application. We agree with this assessment, but would like to clarify these concerns further.
      PubDate: Wed, 29 May 2019 00:00:00 GMT
      DOI: 10.1093/cid/ciz447
      Issue No: Vol. 70, No. 3 (2019)
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