Division of Infectious Diseases

Happy International Women’s Day! Meet the Women Faculty of UNMC ID

March 8, International Women’s Day, was created as a day to recognize the women’s rights movements around the world. This year’s theme is #PressforProgress, fueled by ongoing global activism and advocacy for women’s rights in all facets of life.

In an age where more women than men are enrolled in US medical schools, and 52% of adult Infectious Disease Fellows are women,  young aspiring female doctors may look to the composition of faculty in their desired specialty as an indication of their likelihood to “fit in” with that specialty.  UNMC ID is a division that embodies #PressforProgress. Of 21 Faculty members within our division, 12 are women, and we are proud of every one of them.

Meet the Women Faculty of UNMC ID:

Dr. Sara Hurtado Bares, MD is an Assistant Professor of Medicine and Associate Director of the Specialty Care Clinic which serves our patients living with HIV. Her primary research and clinical interests lie with HIV prevention, and she is currently principal investigator of several studies looking at delivery of HIV pre-exposure prophylaxis to high-risk patients. Dr. Bares is also passionate about medical education; she is the director of the HIV track of the UNMC College of Medicine Enhanced Medical Education Tracks Course and co-directs the medical student microbiology/infectious disease courses called Defenses & Invaders with Dr. Andrea Zimmer.

Dr. Kelly Cawcutt, MD is an Assistant Professor of Medicine and Associate Medical Director of Infection Control and Epidemiology.  She is also a board-certified Critical Care Physician, and regularly attends on the ICU services at UNMC. Dr. Cawcutt is also creator and co-administrator of the UNMC ID Social Media platforms with Dr. Jasmine Marcelin, and recently published a commentary on the value of Social Media in academic medicine.

Dr. Razan El-Ramahi, MBBS is an Assistant Professor of Medicine.  Her clinical and research interests include infections in Oncology/Immunocompromised patients. She also attends on the inpatient Oncology Infectious Disease service and sees patients in the General Infectious Diseases clinic.

Dr. Diana Florescu, MD is an Associate Professor of Medicine. Dr. Florescu’s clinical and research interests include infections in solid organ transplant recipients. She attends on the inpatient Transplant Infectious Diseases service and is regularly involved in teaching residents and fellows.

Dr. Alison Freifeld, MD is a Professor of Medicine. Her clinical and research expertise lies in the Oncology/Immunocompromised patients, and she is the founder and Director of the Oncology Infectious Disease Service at UNMC. Dr. Freifeld is internationally known in her field and has published/edited several books, countless peer-reviewed publications, including authoring the Clinical Practice Guidelines for Management of Febrile Neutropenia. Dr. Freifeld sees immunocompromised patients with infections in the outpatient clinic, and works closely with oncologists at UNMC.

Dr. Andrea Green Hines, MD is an Assistant Professor in the departments of Internal Medicine and Pediatrics, and Medical Director of the Antimicrobial Stewardship Program at Children’s Hospital & Medical Center. Dr. Green Hines is also the Program Director of the Pediatric Infectious Diseases Fellowship Program at UNMC. Her clinical practice comprises both adult and pediatric medicine. She attends on the Oncology Infectious Diseases and Pediatric Infectious Diseases services at UNMC and the Pediatric Infectious Disease Service at Children’s Hospital & Medical Center. Her research interests include antimicrobial stewardship in pediatric populations.

Dr. Angela Hewlett, MD is an Associate Professor of Medicine and Associate director of Infection Control and Epidemiology. Dr. Hewlett is also the Medical Director of the Nebraska Biocontainment Unit which was selected to care for Americans affected by the recent Ebola epidemic in West Africa. Her work with the BCU allows her to collaborate with the Department of Justice and Department of Health and Human Services to ensure that personnel are always trained to be ready for any possible global health threat. Dr. Hewlett also has an interest in Orthopedic Infectious Diseases, which comprises much of her outpatient clinical practice. She attends on the inpatient General Infectious Disease service, and is an adviser for the medical student ID interest group on campus.

Dr. Jasmine Riviere Marcelin, MD is an Assistant Professor of Medicine and Associate Medical Director of the Nebraska Medicine Antimicrobial Stewardship Program. Her clinical and research interests include HIV treatment and prevention and Antimicrobial Stewardship.  She is passionate about medical education and co-directs the HIV track of the UNMC College of Medicine Enhanced Medical Education Tracks Course with Dr. Sara Bares.  She is also co-adminstrator of the UNMC ID Social Media platforms with Dr. Kelly Cawcutt and is passionate about improving diversity in medicine.

Dr. Kari Neemann, MD is an Assistant Professor in the departments of Medicine and Pediatrics. Like Dr. Green Hines, Dr. Neemann’s clinical practice comprises both adult and pediatric medicine. She attends on the Oncology Infectious Diseases and Pediatric Infectious Diseases services at UNMC and the Pediatric Infectious Disease Service at Children’s Hospital & Medical Center. Her research interests include infections in children and in adults with cancer.

Dr. Kimberly Scarsi, PharmD is an Associate Professor of Pharmacy. Her clinical practice is as an HIV pharmacist at the Specialty Care center. She also facilitates the Infectious Disease sections of the School of Pharmacy, and precepts the ambulatory clinic rotation for pharmacy students. Dr. Scarsi’s  primary research focus is on pharmacologic studies of treatments for HIV, focusing on women living with HIV and treating co-infections with HIV/TB, and she collaborates with Dr. Swindells and Dr. Bares on many local, multi-center and multinational research projects.

Dr. Susan Swindells, MBBS is a Professor of Medicine and Director of the Specialty Care Clinic which serves our patients living with HIV. She was honored as a Distinguished Scientist at UNMC in 2011, and in 2013 received the UNMC Innovation, Development and Engagement Award (IDEA) award. Her clinical and research interests include treatment of persons living with HIV and persons co-infected with HIV and Tuberculosis.  Dr. Swindells is on the writing group for the Department of Health & Human Services HIV guidelines as an HIV/TB co-infection content expert, and the Principal Investigator on a multinational study recently presented at the Conference on Retroviruses and Opportunistic Infections (CROI) that showed 1 month of treatment for latent TB infection is as effective as 9 months of treatment in persons living with HIV.

Dr. Andrea Zimmer, MD is an Assistant Professor of Medicine. Her clinical and research interests include infections in Oncology/Immunocompromised patients. She attends on the inpatient Oncology Infectious Disease service and sees immunocompromised patients with infections in the outpatient clinic also. Dr. Zimmer is also involved with medical education and co-directs the medical student microbiology/infectious disease courses called Defenses and Invaders with Dr. Sara Bares.

Join us today on #InternationalWomensDay and everyday as we #PressforProgress and celebrate these women who are invaluable assets to our Faculty and Division. Learn more about the UNMC Division of Infectious Diseases here.


 

New Staff Spotlight – Danny Schroeder, PharmD

Tell us about the position you are starting:  I have recently started my role at Nebraska Medicine Bellevue as an Antimicrobial Stewardship pharmacist. I reach out to physicians at Nebraska Medicine Bellevue to discuss antibiotic therapy and try to obtain the best and safest therapy for our patients here. In addition, I work with Dr. Jasmine Marcelin in this role, she helps guide me with her expertise on some of Bellevue’s more complicated patients.

Tell us about your background:  I was born and raised in Omaha, Nebraska. I completed my pre-pharmacy studies at the University of Nebraska at Lincoln and came back to Omaha and obtained my PharmD in 2012 at the University of Nebraska Medical Center College of Pharmacy. I started at Nebraska Medicine Bellevue right after I graduated in 2012 as a casual pharmacist and started my full time position at Bellevue in early 2013.

Why UNMC? I obtained my PharmD at UNMC so I already knew how great of an organization UNMC is. I knew once I graduated that if I had a chance to get a position at UNMC I would take it. Everyone I know that works for the organization is happy working here and I enjoy working with all of the staff from UNMC as well. I also have an interest in teaching so working at an academic institution can help me pursue that interest.

What about ID makes you excited?  As I have been working at Nebraska Medicine Bellevue I found that the patients that have interested me most have been patients with infections. Progress notes from ID attending physicians have always been my favorite notes to read because it is fascinating to me how they go about figuring out what is wrong with their patients. I am excited to join the detective crew and do my part to help tackle these cases. In addition, I feel like I learn something new in the ID realm every day, there are advancements and new therapies introduced often and I am always eager to learn new treatment mechanisms.

Tell us something interesting about yourself UNRELATED to medicine: I really enjoy having a good beer. My wife and I traveled to Germany in 2016 and we attended an Oktoberfest celebration in Stuttgart. I also enjoy outdoor activities like hiking and disc golf. Lastly, I am a dog person, my wife and I have two Shih Tzus and they take up a lot of our time!

 

Danny Schroeder is joining the Nebraska Medicine Antimicrobial Stewardship Program (ASP) Team as an ASP Pharmacist primarily located at our Bellevue campus. We are pleased to have the opportunity to add this ASP complement to our Bellevue campus – Danny has been a great asset to the team.

CROI 2018 – The Official UNMC ID Guide of Where We Will Be!

CROI 2018 is here and we want to be sure YOU know where to find us in Boston. Below is the list of faculty presentations and posters from our Division. Come visit us at CROI – We would LOVE to meet you! Find us on Twitter @UNMC_ID ; #UNMCID

Content courtesy of Kim Scarsi, Sue Swindells and the entire HIV group at UNMC ID

Oral presentations:

Monday March 5 2018, 11:15am (in Oral Abstract O-02 ART: New Data and new insights, Auditorium) 

Abstract 27: COMPARATIVE LYMPHOID TISSUE PHARMACOKINETICS (PK) OF INTEGRASE INHIBITORS (INSTI) 

Courtney V. Fletcher, Ann Thorkelson, Lee Winchester, Timothy Mykris, Jon Weinhold, Kayla Campbell, Jodi Anderson, Jacob Zulk, Puleng Moshele, Timothy Schacker

*****

Monday March 5 2018, 11:40 AM to 11:50 AM (in Oral Abstract O-03: ADVANCES IN TB AND CRYPTOCOCCAL MENINGITIS TREATMENT AND PREVENTION, Ballroom C)

Late-Breaker Abstract 37LB: ONE MONTH OF RIFAPENTINE/ISONIAZID TO PREVENT TB IN PEOPLE WITH HIV: BRIEF-TB/A5279 

Susan Swindells, Ritesh Ramchandani, Amita Gupta, Constance A. Benson, Jorge T. Leon-Cruz, Ayotunde Omoz-Oarhe, Marc Antoine Jean Juste, Javier R. Lama, Javier A. Valencia, Sharlaa Badal-Faesen, Laura E. Moran, Courtney V. Fletcher, Eric Nuermberger, Richard E. Chaisson (presenter)

*****

Monday March 5 2018, 1:30pm (in Themed Discussion TD-02, Room 304-306, “Clinical Pharmacology of HIV-TB coinfection”)

Abstract 455: EFAVIRENZ PHARMACOKINETICS IN HIV/TB COINFECTED PERSONS RECEIVING RIFAPENTINE

Anthony Podany, Erin Sizemore, Michael Chen, Neil A. Martinson, Rodney Dawson, Sharlaa Badal-Faesen, Sachiko Miyahara, Ekaterina Kurbatova, William C. Whitworth, Richard E. Chaisson, Susan E. Dorman, Payam Nahid, Kelly Dooley, Susan Swindells, for the AIDS Clinical Trials Group & Tuberculosis Trials Consortium A5349 / Study 31 Team

*****

Wednesday March 7 2018, 11:30am (in the Oral Abstract session O-12, Ballroom C “Critical Issues in women’s health and early treatment of pediatric HIV infection”)

Abstract 141: VAGINAL CONTRACEPTIVE HORMONE EXPOSURE PROFOUNDLY ALTERED BY EFV- AND ATV/R-BASED ART

Kimberly K. Scarsi, Yoninah S. Cramer, David Gingrich, Susan L. Rosenkranz, Francesca Aweeka, Robert Coombs, Carmen D. Zorrilla, Kristine Coughlin, Laura E. Moran, Baiba Berzins, Catherine Godfrey, Susan E. Cohn, for the AIDS Clinical Trials Group A5316 Study Team

*****

Poster Presentations:

Monday March 5 2018, 2:30-4pm (Poster P-F1 ANTIRETROVIRAL, ANTITUBERCULAR, AND ANTIMALARIAL PHARMACOKINETICS Poster Hall D)

Abstract 455: EFAVIRENZ PHARMACOKINETICS IN HIV/TB COINFECTED PERSONS RECEIVING RIFAPENTINE

Anthony Podany, Erin Sizemore, Michael Chen, Neil A. Martinson, Rodney Dawson, Sharlaa Badal-Faesen, Sachiko Miyahara, Ekaterina Kurbatova, William C. Whitworth, Richard E. Chaisson, Susan E. Dorman, Payam Nahid, Kelly Dooley, Susan Swindells, for the AIDS Clinical Trials Group & Tuberculosis Trials Consortium A5349 / Study 31 Team

*****

Tuesday March 6 2019, 2:30-4pm: (Poster P-F3 ANTIRETROVIRAL PHARMACOKINETICS, PHARMACOGENETICS, AND DRUG INTERACTIONS, Poster Hall D)

Abstract 466:  CYP2B6 VARIANTS ALTER ETONOGESTREL PHARMACOKINETICS WHEN COMBINED WITH EFAVIRENZ

Megan Neary, Catherine Chappell, Kimberly K. Scarsi, Shadia Nakalema, Joshua Matovu, Sharon L. Achilles, Beatrice A. Chen, Marco Siccardi, Andrew Owen, Mohammed Lamorde

See you there!


 

Stewardship-driven Ertapenem Restriction: Can Reduced Utilization Affect the Antibiogram?

In this article review we learn about the impact of a large-scale, multi-institutional Antimicrobial Stewardship Intervention on significantly reducing the overall use of ertapenem without subsequent downstream effect on carbapenem-resistant Enterobacteriaceae (CRE) non-susceptibility patterns.

Delgado A, Gawrys GW, Duhon BM, Lee GC (2017). Impact of an Antimicrobial Stewardship Initiative on Ertapenem Use and Carbapenem Susceptibilities at Four Community Hospitals. J Infect Dis Ther 5: 341. doi:10.4172/2332-0877.1000341

Ertapenem has no activity against Pseudomonas spp. isolates, and although there is a theoretical risk of increasing carbapenem resistant Pseudomonas spp. isolates with ertapenem use, clinical studies have demonstrated that this is not the case.  Nevertheless, ertapenem use can potentially select for CRE, and there remains clinical value in minimizing its use.

The authors conducted a retrospective pre-post quality improvement study designed to reduce ertapenem usage, hoping to also demonstrate an effect in the prevalence of resistant Pseudomonas spp. and Enterobacteriaceae as a result of this intervention.  The multifaceted stewardship intervention was largely educational, but was supported by modification of electronic orders and providing audit-feedback opportunities to high frequency prescribers. They also included as a counter measure, evaluation of use of other alternative antimicrobials.

Copyright: © 2017 Delgado A, et al. Click to enlarge

They were successful in significantly reducing ertapenem utilization by 60% with mean days of therapy (DOT) per 1000 adjusted patient days declining from 17.6 to 7.0, p<0.001. There was a decrease in overall antibiotic use but as expected, ceftriaxone and fluoroquinolones were highly utilized and increased around October 2014 (3 months after electronic alert restricting ertapenem).  They reported stability of carbapenem use as a class.  They only reviewed Pseudomonas aeruginosa, Escherichia coli and Klebsiella pneumoniae isolates; so potential effect on other Enterobacteriaceae could not be assessed. There was no change in % of P. aeruginosa non-susceptibility to carbapenems, however the average incidence of carbapenem non-susceptible P. aeruginosa isolates per 10,000 adjusted patient days decreased from 4.9 to 3.7 (p=0.03). There were no changes in % or average incidence of carbapenem non-susceptible E. coli or K. pneumoniae.

Copyright: © 2017 Delgado A, et al. Click to enlarge.

The authors achieved the goal of reduced ertapenem usage from 18.3 to 5.1 DOT, but did not show an associated change in carbapenem non-susceptible organisms. Furthermore, their overall carbapenem use was stable (though appears to have slightly trended upwards on the graph) despite significant ertapenem utilization reductions; without a breakdown of individual carbapenem use, it is impossible to know if there was a concordant increase in imipinem/meropenem use to account for this.  Antibiotic shortages occurred during the study period, which unfortunately adds a confounder to the overall reduction of antibiotic utilization, as well as overall carbapenem utilization. – could these shortages have caused an increase in meropenem use? Additionally, limited (though number not specified)  carbapenem non-susceptible isolates at baseline makes it difficult to draw conclusions about effect of the intervention on the antibiogram. However, it demonstrates well that a multifaceted intervention can have significant impact on antibiotic utilization.


 

Pharm to Exam Table – Trimethroprim/Sulfamethoxazole for Nocardiosis

Pharm to Exam Table: Clinical Pharmacology/Antibiotic Updates – Trimethroprim/Sulfamethoxazole for Nocardiosis

Nocardia is an aerobic, gram-positive bacterium commonly found in soil, decomposing vegetation, fresh water, and salt water. Nocardia is typically considered an opportunistic pathogen, but there have been several cases of nocardiosis occurring in immunocompetent hosts. Patients that are most at risk of developing nocardiosis are those with malignancies, human immunodeficiency virus (HIV), solid-organ and hematopoietic stem cell transplants, and long-term use of cell depleting medications such as corticosteroids. Nocardia infections most commonly present as a pulmonary infection, but may also include central nervous system involvement and skin abscesses. Nocardiosis usually requires a long course of treatment and traditionally, trimethoprim/sulfamethoxazole (TMP/SMX) has been the drug of choice.

Although there are numerous case reports available about the treatment of Nocardia infections, the lack of randomized controlled trials hinder the ability to make concise recommendations on drug dosing and treatment duration. Regardless of the site of infection, high dose TMP/SMX (800mg/160mg) given twice a day seems to be the most effective for eradicating Nocardia infections. The duration of treatment varies based on the location of the infection. Pulmonary infections should be treated for at least 3 months upon hospital discharge. Extending that duration to 6 months may also be appropriate if the patient is not responding as quickly or abscesses are still present on the CT exam at follow-up. Brain infections should be treated for at least 12 months upon hospital discharge. Cutaneous infections should be treated for at least 2 months. As with any of these infections, patients should be started on treatment as soon as Nocardia infections are identified. One area of variability is the amount of time patients are treated while inpatient because it will take each patient a different amount of time to become stable enough to discharge. The impact of the variation of overall treatment duration still remains unknown in the treatment of Nocardia. These recommendations are based on individual case studies and while they can be applied to other similar cases, it is important to take into account that additional agents may need to be added or substituted if susceptibility testing demonstrates resistance to TMP/SMX.

References

  1. Wilson JW. Nocardiosis: Updates and Clinical Overview. Mayo Clinic Proceedings. 2012 April; 87(4); 403-407.
  2. Valdezate S, Garrido N, Carrasco G, Medina-Pascual M, Villalon P, Navarro A, et al. Epidemiology and susceptibility to antimicrobial agents of the main Nocardia species in Spain. Journal of Antimicrobial Chemotherapy. 15 Dec 2016; 72: 754-761.
  3. Galacho- Harriero A, Delgado-Lopez P, Ortega-Lafont M, Martin-Alonso J, Catilla-Diez J, et al. Nocardia farcinica Brain Abscess: Report of 3 Cases. World Neurosurgery. 18 July 2017.
  4. Sharrif M, Gunasekaran J. Pulmonary Nocardiosis: Review of Cases and an Update. Canadian Respiratory Journal. 9 November 2015.
  5. Zhu, N, Zhu, Y, Wang Y, Dong S. Pulmonary and cutaneous infection caused by Nocardia farcinica in a patient with nephrotic syndrome. Medicine. 16 May 2017; 96:24(e7211).

Content Courtesy Patricia Malinowski Burch, University of Nebraska Medical Center Pharmacy Student

Thank A Resident Day 2018 has ARRIVED

We recently posted about Resident Awareness Week in Canada and we are THRILLED to support this new initiative today.

Nebraska Medicine, UNMC and The Gold Humanism Honor Society are excited to celebrate all Residents today on Thank a Resident Day. Thank a Resident Day offers faculty and students the chance to show their gratitude to the unsung teachers of their medical school clerkship, the house-staff. 

While Residency is an important stage in medical training, it is also a period of peak burn out. Physician burnout affects more than half of U.S. doctors. Burnout is characterized by three symptoms; exhaustion, cynicism or dehumanization, and sense of ineffectiveness and lack of accomplishment. Thank a Resident Day is meant to Celebrate Residents and Explore their Resiliency. This is a medical-student led activity that will provide residents with resiliency-promoting physical and social activities as well as show support for their efforts.

A simple, but heart-felt, thank you may carry a larger impact than any of us realize. Please take a moment today to personally thank a resident. 

 

Here in the ID world, we would like to extend a particular thanks to our residents here in ALL specialties at UNMC. Thank you for EVERYTHING you do to help prevent and treat infections in the community and here in the hospital. We need your help every day in preventing the spread of disease, in antimicrobial stewardship and in providing the best possible care for our patients.


 

Honoring Black Women and Men Physician Leaders in Infectious Diseases

African Americans account for only 6% of newly minted doctors graduating from medical school in the USA. Within our specialty of Infectious Diseases, only 3% of ID physician members of the Infectious Diseases Society of America (IDSA) self-report as Black/African American. Many of these physicians make it their career goals to provide care for and advance clinical research pertaining to People of Color, often underrepresented in clinical trials and underserved in clinical practice.

In honor of Black History Month, let us recognize and honor Black Women and Men Physician Leaders who have and continue to advance our specialty.

Dr. William Augustus Hinton (1883-1959) was a microbiologist, and would be considered an Infectious Diseases Physician before the field of Infectious Diseases existed as a separate specialty. The son of two former freed slaves, Dr. Hinton graduated with honors from Harvard Medical College in 1912; by 1915 he had become the lab director for the Massachusetts State Department of Health. He went on to become the first African American to be appointed Professor at Harvard Medical School. His contributions to the field of Infectious Diseases were primarily regarding diagnosis and treatment of syphilis, which he worked on in his lab after being denied a medical internship due to his race. He developed a diagnostic test for syphilis called the Hinton test, a precipitation assay that was the most accurate of its time (later replaced by the RPR). He founded a school for women laboratory technicians, leading to countless job opportunities for hundreds of women. In 1936, Dr. Hinton was the first African American to publish a medical textbook: Syphilis and Its Treatment. Dr. Hinton’s legacy has been honored by the creation of the American Society of Microbiology William A Hinton Research Training Award dedicated toward research training of underrepresented minorities in microbiology.

Incidentally, his daughter, Dr. Jane Hinton (1919-2003) [photo not available] was one of the beneficiaries of Dr. Hinton’s Medical Laboratory Techniques course.  Before becoming one of the first African American woman veterinarians, she worked in Harvard laboratories to co-develop the Mueller-Hinton agar, which is still used today for antibiotic susceptibility testing. Infectious diseases doctors know that our jobs would be infinitely more difficult without antibiotic susceptibility testing.

There are over thirty-six million people worldwide living with HIV, twenty-five million of whom reside in African countries.  In the United States, 1.1 million people are living with HIV, and although African Americans make up only 12% of the entire US population, they account for 44% of the persons living with HIV in the USA. The doctors highlighted next have dedicated their lives to studying and caring for persons living with HIV. 

Drs. N’Galy Bosenge and Kapita Bila Minlangu were passionate doctors from Zaire (now known as the Democratic Republic of Congo), who led the charge towards understanding the HIV/AIDS epidemic in Africa. In 1984, Drs. N’Galy and Kapita were the Zairean co-leaders of Projet SIDA (Project AIDS), along with American ID physician scientist Dr. Jonathan Mann and other contributions from Belgian epidemiologists, the Centers for Disease Control and Prevention, and World Health Organization. Much of what we know about HIV/AIDS today can be traced back to early epidemiological studies and clinical research conducted at one hospital in Kinshasa.

Dr. N’Galy Bosenge led research and advocated for change in practices increasing risk for HIV transmission, particularly blood transfusions. Dr. N’Galy died tragically in a car accident in 1989, and for his early work in understanding HIV and establishing Projet SIDA, Dr. N’Galy is honored annually along with Dr. Mann at the Conference on Retroviruses and Opportunistic Infections (CROI) with the N’Galy-Mann lectureship.

Dr. Kapita Bila Minlangu has been credited as perhaps “one of the first African [doctors] to recognize the disease”, identifying individuals who he thought clinically were infected, so that the American/Belgian researchers could perform tests to confirm the diagnosis based on absence of T-helper cells.  These key observations led to the 1984 publication of data in The Lancet proving that HIV/AIDS was NOT a disease of gay men only, and that heterosexuals of all genders were susceptible to infection. Projet SIDA was discontinued abruptly in 1991 due to civil war in the country, but its impact on our understanding of HIV is still relevant today.

Dr. Kimberly Smith MD, MPH once referred to herself as “a trouble maker”.  Those three words tell a story about Dr. Smith spending her life advocating for women and children living with HIV (traditionally underrepresented in clinical studies), being a voice for those who cannot speak for themselves.  Dr. Smith’s invaluable contribution to the world of Infectious Diseases through research addressing gender and racial disparities among people living with HIV is evident by countless published papers on the topic. She has demonstrated her dedication to the community by her years of engagement in Chicago as a clinician.  Dr. Smith was awarded the Black AIDS Institute “Heroes in the Struggle” Award in 2008, the Thurgood Marshall College Fund Award of Excellence in Medicine in 2011, and in that same year, the HIV Medical Association (HIVMA) Clinical Educator Award. Dr. Smith is now the head of Global Research and Medical Strategy at ViiV Healthcare, the only pharmaceutical company 100% dedicated to providing treatment options for persons living with HIV. As head of this group, Dr. Smith has committed to including more women in clinical trials in order to improve the treatment of women living with HIV.

Adaora Adimora, MD, MPH, FIDSA, FACP: When asked for suggestions about names of African American ID physicians who have impacted our field, Dr. Adaora Adimora’s name was invariably on everyone’s list. She is a Professor of Medicine & Epidemiology at University of North Carolina. Dr. Adimora has been caring for persons living with HIV since the disease was first starting to be recognized, and her passion for caring for this patient population has not wavered. Her research career has identified socioeconomic and racial disparities in HIV infection and management, as well as other sexually transmitted diseases. She has been a leader in both research and clinical care of women living with HIV, who are often underrepresented in clinical research and prevention initiatives. Her commitment to HIV and clinical/research impact is internationally known. She was the program director of the Fogarty AIDS International Training and Research program at University of North Carolina from its inception in 1998, providing opportunities in HIV/AIDS for researchers from China, Cameroon and Malawi. A member of the US Department of Health and Human Services Antiretroviral Treatment Guidelines Panel, she was an instrumental author in multiple iterations of the Sexually Transmitted Infections Guidelines.  In 2014, she was appointed to President Obama’s Advisory Council on HIV/AIDS. In the same year, she was Chair of the HIV Medical Association (HIVMA).  In 2009 Dr. Adimora was named to the Root’s its inaugural list of The Root 100, an annual list of “the most influential African Americans ages 25-45…honoring the innovators, the leaders, the public figures and game changers whose work from the past year is breaking down barriers and paving the way for the next generation”.

Editorial note: This is obviously not an exhaustive list, but an introduction: As inspiring as these stories are, there are many others out there that are just as exceptional, and still others whose stories have yet to be told. Follow us on twitter @unmc_id to learn about them!

Acknowledgements: Many thanks to Drs. Wendy Armstrong and Igho Ofotokun, who shared some insights into African Americans who have influenced our field of Infectious Diseases. Other sources are included in hyperlinks throughout the post.

Image Sources:
Dr. Hinton: http://kentakepage.com/william-a-hinton-the-first-african-american-to-author-a-medical-textbook/ 
Drs. N’Galy and Kapita:  http://www.medizinisches-coaching.net/artikel/medical_coaching/projet-sida-kinshasa.html
Dr. Smith:  http://www.telegraph.co.uk/education/stem-awards/healthcare/working-on-a-cure-for-hiv/
Dr. Adimora: https://www.med.unc.edu/infdis/about/faculty/adaora-adimora-md


 

Whitney Knuth, NP on “Why I Love ID”

Why I Love ID: 

“I love the detective work we get to do on a daily basis and the unpredictability each day brings.  The field is a constant challenge, with no two days being the same.  I specifically love working with our oncology patients and their families and the interpersonal relationships we are privileged to establish.  There is no better reward or satisfaction when we are able to find the missing piece of the puzzle and in return, help the patient get better and be able to again focus on their oncologic treatments.”

 

-Whitney Knuth, NP

Learn more about the UNMC ID Division here.


 

Reflections on a year of blogging

On February 14, 2017, led by our Division’s own Social Media Maven Dr. Kelly Cawcutt, we launched our UNMC Infectious Diseases Blog with a welcome post. 365 days, 134 posts, and almost 14,000 views later, we are still here! We have introduced our faculty, shared thoughts on why ID is special to us, recruited for and filled open positions (including 2 amazing fellowship matches), celebrated faculty/staff achievements and involvement in medical education, commented on conference proceedings and dived into important themes like Antimicrobial Stewardship and HIV Awareness.

Here are further thoughts from Dr. Cawcutt and Dr. Rupp on the blog and it’s impact.

When we first started the blog, it was because so many of our colleagues, current and future trainees, and patients are on social media now. Our medical journals, national organizations and world-renowned experts are posting, commenting and bringing academic medicine into a realm that is both approachable and searchable, by anyone and everyone. We wanted to create an online presence to share all of the amazing work being done in our Division, provide expertise, and networking opportunities in the conversations surrounding Infectious Diseases, Antimicrobial Stewardship, Infection Control and training the next generations of medical practitioners. Gone are the days of the proverbial “ivory towers” and inaccessible experts. Thank you all for contributing, following, subscribing and sharing. Without all of you, this blog would not still remain today. – Dr. Kelly Cawcutt, MD, MS 

 

Happy Birthday ID Blog! – Dr. Mark Rupp MD (Professor of Medicine and UNMC ID Division Chief)

One year ago, with leadership supplied by Dr. Kelly Cawcutt, the UNMC ID Blog was launched.  It has been a terrific success with a large number of regular followers.  In the fall of 2017, we further expanded our social media presence by posting to Twitter.

Why is UNMC ID stepping into social media?  Several reasons:

  • UNMC ID is full of talented people who are doing terrific things and we want folks to be aware of who we are and what we do. Social media is just one way to get the message out. 
  • We hope that by expanding our reach and touching more people, we will increase awareness of UNMC ID, resulting in a greater number of persons who “catch the ID fever” and go into ID as a profession.
  • We hope the blog increases awareness of studies and projects that we are conducting, resulting in increased participation by patients who need cutting-edge treatments and collaboration with colleagues who can carry the work forward.
  • On a broader level, the UNMC blog increases knowledge of science in general, and microbiology and ID in particular.
  • In this era of “fake news”, “alternative facts”, and “talking-head experts”, we hope our readers learn to trust the UNMC ID Blog as a place to get reliable information on ID issues that are important in our own locale from our own local experts.

Thank you for your support over the last 12 months, and continued support as we forge ahead. We have a lot planned for the coming months, so stay tuned for new themes, journal article commentaries, and follow us on twitter @unmc_id.


 

cDFS y JTbVT hAc

Calamities of Kissing – Happy Valentine’s Day from UNMC ID

It’s almost Valentine’s day, and in honor of the one day of the year commercially dedicated to L’Amour, we thought would be fun to talk about some of the Infectious Diseases associated with “kissing”.

Infectious Mononucleosis or “Mono” is an illness most commonly caused by a herpesvirus called Epstein Barr Virus (EBV).  Mono is characterized by a constellation of non-specific symptoms including sore throat, fatigue, muscle pains, fever, headache and lymphadenopathy (swollen lymph nodes).  It is transmitted through exchange of body fluids like saliva, semen, blood, etc.

Mono is diagnosed clinically, and sometimes with additional serologic testing which can identify EBV as the specific cause of Mono. A recent case of Mono is likely if a person has antibodies to the viral capsid antigen (VCA) in the absence of EBV nuclear antigen (EBNA) antibodies. The monospot (heterophile antibody) test relies on a patient’s serum ability to agglutinate sheep blood red blood cells, but is not very sensitive and may miss cases of Mono.

There is no recommended treatment for Mono other than symptomatic therapy.  Patients diagnosed with Mono are usually advised to avoid body fluid contact with others, avoid sharing personal items such as toothbrushes. Additionally, because of enlargement of the spleen, patients diagnosed with Mono are typically advised to avoid contact sports for 6-8 weeks after diagnosis, as they would be at higher risk for splenic rupture as a result of rough contact.

  • Did you know that Kissing Ulcers can be caused by several sexually transmitted diseases?

Kissing ulcers refer to symmetrical ulcerated lesions occurring in folds of skin. It is thought that they are formed as a result of the ulcer on one side of the skin fold auto-infecting the other side after prolonged contact. This can be seen on the lips, labia or penis. This is not specific to one particular infection, and can occur with infections due to syphilis (caused by Treponema pallidum), genital herpes (caused by herpes simplex virus), chancroid (caused by Haemophilus ducreyi), lymphogranuloma venereum (caused by Chlamydia trachomatis L1-3 serotypes).

Chagas Disease is caused by Trypanosoma cruzi, a protozoan parasite transmitted to humans by triatomine bugs, also known as reduvid bugs, vampire bugs or kissing bugs. The bugs are called kissing bugs because they typically bite near the mouth or eyes. The bites are painless and although the bugs take blood meals during bites, T. cruzi is actually transmitted when the insect defecates near the site of the bite.

Chagas Disease is endemic in South America, and is generally asymptomatic.  If symptoms do occur in the acute stage of infection, they can consist of fever, lymphadenopathy, myocarditis (inflammation of heart muscles), and liver/spleen enlargement.  Years after infection, the chronic stage of Chagas disease can include enlargement of the esophagus and colon, weight loss, and the most serious complication of infection is cardiomyopathy.

In the acute stage of Chagas Disease, blood smears can identify various forms of the parasite. In the chronic stage (or in cases of solid organ transplant or transfusion-related infections), serologic testing (antibodies) or molecular testing (PCR) is necessary to make the diagnosis.  Treatment for Chagas Disease generally involves a consultation with the Centers for Disease Control and Prevention, as the antiparasitics (nifurtimox and benznidazole) are not readily available.

Of course, this list is not exhaustive. I’m sure there are other Infectious Disease syndromes that are associated with the word “kiss”. If you know others that were not mentioned, feel free to add a comment!

Happy Valentine’s Day!