Division of Infectious Diseases

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!


 

Going Global – Supporting UNMC & Los Chavalitos in Nicaragua

Dr. Florescu will be joining an upcoming medical service trip to Los Chavalitos clinic in Managua, Nicaragua, sponsored by UNMC’s Student Alliance for Global Health.

Los Chavalitos Clinic is the outreach of APUSAN, a Spanish acronym meaning “Association of Pediatricians United for the Health of the Children.”  APUSAN was founded by a small group of ambitious young Nicaraguan medical residents in the early 1990s.  The doctors, who saw a multitude of children in advanced stages of diarrhea in the emergency departments of the hospital where they worked, knew that diarrhea can be prevented and should not be a major cause of childhood death, as it was in Nicaragua (and in many underdeveloped countries).  They knew that education of the parents was the key to prevention and they formed APUSAN, a legal corporation in Nicaragua.  However, they had no funding to put their dreams of preventive measures into action.  Through unpredictable, but fortuitous circumstances,  UNO social work professor on sabbatical in Nicaragua, learned of the aspirations of the APUSAN physicians and engaged her Rotary Club back in Omaha to support the mission of the Nicaraguan MDs.  One of the Rotary members brought the cause to his Omaha church, Countryside Community Church.  Subsequently, between the active support of the district Rotary Clubs and Countryside Community Church, a small structure in an impoverished Managua community was purchased and Los Chavalitos (“little kids”) Clinic opened in 1994.  From the beginning, and to this day, the front of the building has both the Rotary Club emblem on it and the words “Countryside Community Church” emblazoned on it.  It is truly an “Omaha” product in the heart of this Nicaraguan capitol city, Managua.  There is no government funding and the clinic provides primarily free care, with a small proportion of patients paying on a sliding scale.  Private donations sustain the clinic on an ongoing basis.

UNMC began sending individual student volunteers to work at Los Chavalitos in 1995 and the first SAGH-sponsored medical service trip took place in Nicaragua in 1996, with 13 participants.  UNMC has offered the service trips to Nicaragua annually since 2000.  The SAGH medical service trips, which also take place in Jamaica and a Native American Reservation, have grown in student participation since the first trip.  Twenty-two years there will be 41 UNMC students in Nicaragua participating in one-week SAGH medical service trips.  Of these 41 students, nine of them will be based in Managua, volunteering under the auspices of the Los Chavalitos medical director.  Every day the group will go into the neighborhoods served by Los Chavalitos and establish “puestos” (posts) in one of these communities – perhaps the home of a community leader, a school, or a church, and provide immunization services to the community members, and will also offer vitamin A, anti-parasite pills, and fluoride treatments.  The presence of the UNMC group is well-publicized in advance, so that the community members can plan to take advantage of the free services offered, which have been approved by the Nicaraguan Ministry of Health (and it is the government who provides the vaccines that the group uses).  Four of the student members are physical therapy students, who will spend part of their time serving in other sites with a geriatric population and severely handicapped children.

The UNMC students (from medicine, nursing, pharmacy and allied health) volunteering through Los Chavalitos typically serve up to 1000 patients during their service week.  All of these activities take place in community locations (not on the clinic premises), which eliminates the need for client transportation (requiring both time and money) to receive valuable services.  The student participants see/experience first-hand the living conditions of a poor population and have ample opportunity to directly interact with the local personnel.  It is a valuable lesson in cross-cultural communication and demonstrates the value of serving the under-served.

To donate to help fund the upcoming SAGH Nicaragua medical service trip (to help defray trip expenses):  cash or check (payable to SAGH/UNMC and put SAGH Nicaragua on the bottom left corner of the check.  Please send to the attention of Sara Pirtle at campus zip 5700, or mail to the address below.

To donate to directly assist Los Chavalitos with their community outreach and clinical services, cash or check payable to SAGH/UNMC and note “Los Chavalitos” on the bottom left corner of the check.  Please send to the attention of Sara Pirtle at campus zip 5700, or mail to the address below.

 

985700 Nebraska Medical Center

Omaha, NE  68198-5700

 

Content courtesy of Sara E. Pirtle, MBA

IHME Program Manager

SAGH Advisor

402 559 2924

www.unmc.edu/ihme


 

#ResidentAwarenessWeek – Thank You to ALL residents around the world

This week marks resident awareness week in Canada.

Why are we talking about a week celebrated by our colleagues to the North?

First, because as I first came across this trending on Twitter (#residentawarenessweek), I was excited and wanted to find a similar week to celebrate our US residents. I do not recall such a week in the past, but I was sure I was wrong and just missed it in my sleep-deprived years of residency. Sadly, I have yet to find such a week on a US calendar. Perhaps I am not looking in the right places. Perhaps I am using the wrong search terms. Or perhaps, we need to follow the lead of our Canadian friends and start a week celebrating all of the hard work our residents do every year.

So, today, in honor of the Canadian Resident Awareness Week, I want to extend a note of deep gratitude from the UNMC ID Division, and as a faculty physician, to our resident colleagues who truly help keep the wheels of medicine turning.

Residents are critical for providing excellent care to our patients, but how often do we truly say ‘thank you’? How often do we express gratitude for the hard work of any of our colleagues? Gratitude has been associated with decreased stress in healthcare practitioners and associated with overall wellbeing. A simple, but heart-felt, thank you may carry a larger impact than any of us realize. So, with that…

To the resident who is exhausted and overwhelmed, thank you for putting the needs of you patients and team first.

To the resident who covered service for a sick colleague, thank you for keeping both our patients and colleagues healthier by your service today.

To the resident who feels like they are not good enough, thank you for showing up everyday and continuing to forge ahead. The road is not easy, it is ok to ask for help. Success is not in knowing everything, it is about developing the competence to know when you need help and to get it.

To the resident who is teaching all of us on rounds, thank you for your initiative and know you are bringing value to the entire team.

To the resident who had to break bad news, thank you for for your support and care for that patient and family.

To the resident toiling on research on nights and weekends, thank you for working to improve medical practices.

To the resident dreaming of leadership roles, keep dreaming! You are the future leaders – thank you for your future innovations.

To the resident who wants to quit, know you are not alone. Thank you for carrying the emotional toll of medicine, but now it is time to ask for help carrying that burden. Please talk to someone, seek mentorship and help. Thank you for your bravery in doing so.

To all of the residents working around the clock in hospitals, emergency rooms and clinics, thank you for being part of this healthcare team. Thank you for your dedication, your blood, sweat and tears. We need you, we appreciate you even if we are not always expressing this as often as we should, and we are grateful for you.

Thank you!

And thank you Canada for your initiative this week.


 

Plazomicin: Will it be the future of MDRO treatment?

Today at our UNMC Infectious Disease Research Conference, Dr. Kelly Cawcutt’s presentation included details on Plazomicin, a new antibiotic recently granted FDA Breakthrough Therapy Designation,  aimed at treating multi-drug resistant organisms (MDROs).

Antibiotic resistance continues to be a clinical problem. The CDC Antibiotic Threat Report has estimated 2 million infections with antibiotic resistant organisms and 23,000 deaths, with antibiotic resistant organisms estimated to cost up to 20 billion healthcare dollars.

Hospital Acquired Pneumonia (HAP) is one of the most common diagnoses in the intensive care unit (ICU), and many are ventilator associated pneumonia (VAP). Given the significant antibiotic exposure experienced in ICUs, it is no surprise that the number of MDROs causing HAP/VAP has increased.

Despite known concern for increased incidence/prevalence of MDROs, there are relatively few new or re-purposed antibiotics in development. Further complicating the situation, often when new drugs are developed, they are usually restricted, to attempt to conserve them for totally drug resistant organisms in severely ill patients. Nevertheless, new drugs still need to be developed.

Plazomicin is a next generation aminoglycoside/neoglycoside targeting MDROs with similar spectrum of activity to gentamicin and amikacin. It is bactericidal, with concentration-dependent killing and is administered intravenously once daily.  Aminoglycosides have been known to cause some significant adverse drug effects including nephrotoxicity and ototoxicity. Plazomicin is unique in that compared with the other aminoglycosides, these adverse effects are reduced, and there are low risks of drug-drug interactions.

Dr. Cawcutt shared brief data about two phase 3 clinical trials fast tracked by the FDA looking at effectiveness of plazomicin to currently used antimicrobials.

The EPIC trial:  (Evaluating plazomicin in cUTI). This trial evaluated the use of plazomicin vs. meropenem  for the treatment of complicated enterobacteriaciae urinary tract infections and acute pyelonephritis. This study showed that plazomicin was superior to meropenem for microbial eradication on a test of cure (81.7%-70%), and that there were fewer relapses (1.8% vs 7.9%).

The CARE trial: (Combating Antibiotic Resistant Enterobacteriaceae). This was an open label trial of plazomicin vs colistin (combined with either meropenem or tigecycline) looking at mortality and safety with use of plazomicin. They showed a reduction of mortality or significant disease (as a composite endpoint) (23.5% with plazomicin vs 50% with colistin).  Additionally, the all-cause mortality was reduced with plazomicin (11.8% vs 40%).

Finally, Dr. Cawcutt discussed future research opportunities surrounding the utilization of plazomicin for critically ill patients to assess further potential clinical uses among this high risk, high morbidity and mortality patient population.


 

Dr. El-Ramahi on “Why I Love ID”

Why I Love ID:

“I love ID because it is an exciting field and every day brings interesting cases and unique challenges. It is a field where I have a chance to form strong doctor-patient relationship since we spend a lot of time talking to the patient and as a group, we do ask a lot of questions! It is also gratifying to see patients’ health improve after you cure their infection(s) which happens in the majority of the cases we treat. “

-Dr. El-Ramahi

 

See more about the UNMC ID Division here.


 

I Am Woman, Hear Me Roar…In Infectious Diseases and More!

February 3 is National Women Physicians Day. This day was chosen to celebrate Women Physicians in honor of Dr. Elizabeth Blackwell’s birthday. Dr. Blackwell was the first woman to matriculate at a US medical school, and her acceptance in 1847 was initially a joke. In those times, medicine was very much a man’s world, but the joke was on them because, after graduating in 1849, Dr. Blackwell, her sister Dr. Emily Blackwell and Dr. Marie Zakrzewska began providing training opportunities for other women physicians when they created the New York Infirmary for Women and Children in 1857. Since then, women have made some strides in medicine and have made significant contributions to the science, changing the way we practice medicine today; but as a society we have not celebrated these women as often as we should, and there are still important gains to be made with respect to equality in compensation, academic promotion and recognition.

Within our specialty of Infectious Diseases (ID), 36% of IDSA members, 45% of PIDS and SHEA members and 52% of adult (ID) trainees are women, but do these women know of the women who blazed the trail for them?  In honor of National Women Physicians Day, here is a short look at some women in the field of ID/microbiology who changed our specialty. The women featured here were not clinicians (because 1. Infectious Diseases did not exist as a specialty at that time, and 2. It was still difficult for women to actually become physicians at that time) but within our specialty, they were the ones who tossed the first stones to shatter the glass ceiling, and should be lauded for their contributions to the way we practice medicine today.

 

 They are some of the giants on whose shoulders we ALL stand. 

 

Alice C Evans, MS (1881-1975) Photo Credit: National Photo Company Collection, restored by Adam Cuerden – This image is available from the United States Library of Congress’s Prints and Photographs division under the digital ID npcc.30943.

Alice Evans was a trailblazer.  After obtaining a Bachelor of Science in bacteriology from Cornell University in 1909, she was the first woman to obtain a scholarship and Masters of Science in bacteriology from the University of Wisconsin-Madison in 1910. She had a farming background, having been raised on a farm in Pennsylvania, and subsequently became the first female scientist at the United States Department of Agriculture (USDA). She focused her work on unpasteurized milk and was the first to hypothesize that brucellosis could be transmitted by drinking unpasteurized cow’s milk.  Though she did not have a doctoral degree, her work was published in the Journal of Infectious Diseases in 1918 and subsequently confirmed. This data was instrumental in the efforts leading up to development of milk pasteurization and subsequent reduction in cases of brucellosis reported in the United States.  In 1928 she was honored as the first female president of the society of American Bacteriologists (now American Society for Microbiology – ASM), and after retiring in 1945, she took it upon herself to empower young women that they too could pursue careers in science and academia. She was awarded an honorary degree in medicine by the Women’s Medical College of Pennsylvania in 1934 and inducted into the National Women’s Hall of Fame in 1993.

Dr. Rebecca Lancefield, PhD (1895-1981) Photo Credit: http://www.inventricity.com/rebecca-lancefield-microbiologist

 

Dr. Rebecca Lancefield was a microbiologist who helped to develop testing to differentiate between various hemolytic streptococci (Lancefield classifications). She received her PhD from Columbia University in immunology and bacteriology. She subsequently went on to work at the Rockerfeller Institute, and continued to advance the field with respect to study of streptococci, and their association with rheumatic fever.  In 1943 Dr. Lancefield became the second female president of ASM, and for her work in studying rheumatic heart disease, she received American Heart Association Achievement Award in 1964, and was one of few women at the time elected to the prestigious National Academy of Sciences.  Rockerfeller University has now dedicated the Rebecca C Lancefield Professorship to honor exemplary women in science at that institution.

Dr. Gladys Hobby, PhD (1910-1993)
Photo Credit: Jean Thomas http://femilogue.blogspot.com/2012/11/gladys-hobby.html

Dr. Gladys Hobby was a microbiologist who played a key role in the development of antibiotics we use today.  She grew up in New York City, and earned a PhD in bacteriology from Columbia University. Penicillin was discovered by Dr. Alexander Flemming in 1928, and several years later, during World War II, there was a need for readily available antibiotics to treat war-related infections.  Dr. Hobby and her team at Columbia were among the first to begin human clinical trials of penicillin in 1941, and after proving that it was beneficial in eradicating bacterial infections, collaboration with Pfizer (pharmaceutical company) allowed for mass production of the antibiotic for clinical use. Without penicillin, many of the medical/surgical advances we take for granted today (like organ or stem cell transplantation) would not be possible. In 1972, Dr. Hobby founded the scientific journal Antimicrobial Agents and Chemotherapy, which is still publishing papers today. 

 

Editorial note: This is obviously not an exhaustive list, but an introduction to some of the early trailblazers in our field; there are many more women both living and deceased who have contributed to the success of Infectious Diseases, and future posts will continue to celebrate others. 

Acknowledgements: Many thanks to Drs. Wendy Armstrong, Judy Aberg, Angela Caliendo, Jeanne Marrazzo, Ada Adimora, Shanta Zimmer, and Erin Bonura, who shared some insights into women who have influenced our field of Infectious Diseases.


 

Can Social Media Revolutionize Academic Medicine?

As we approach our first anniversary in the blogosphere, it was fitting that our very own Dr. Kelly Cawcutt was invited to write a commentary on  a recent publication in the journal Infection Control & Hospital Epidemiology that explored the use of Twitter messaging at four major Infectious Diseases/Infection Control conferences worldwide.

Dr. Cawcutt’s commentary, entitled Twitter Me This—Can Social Media Revolutionize Academic Medicine? was published in December 2017 in Infection Control & Hospital Epidemiology.   The articles reviewed the influence of Twitter on increasing public engagement in academic conferences, particularly in spreading the reach and impact of the conferences beyond just the attendees.

Our @unmc_id twitter account went live last fall at #IDweek2017, and we’ve been having a ball tweeting and retweeting. We were very active in the #USAAW2017 for the #beantibioticsaware campaign, and plan to continue ramping up our online presence.

Gone are the days where acquisition of medical knowledge was limited to hard copy journals, and if you missed a conference you missed the action altogether.  Today, in the era of online access journals, Twitter, Facebook and podcasts, we can be at every conference, anywhere in the world;  stay updated on current hot topics, and use hashtags to connect with others who have similar interests.

So can Social Media revolutionize Academic Medicine?

YES.

It’s time to join the revolution of #unmcid. Follow us on Twitter @unmc_id, and subscribe to our blog for more updates!


 

Dr. Marcelin on “Why I Love ID”

Why I Love ID:

“The patients I encounter as an Infectious Diseases specialist are so fascinating. Because we are interested in all aspects of a patient’s history, ID docs get to learn some cool things from their patients. I once had a patient who trained animals for show competitions, and another who taught me how to polka! I love the fact that we still get opportunities to build lasting relationships as we journey with patients, but also have the ability to truly cure disease through antibiotics. Finally, I love ID because it is a routine part of our day to be educators (of patients, trainees, nurses, etc), and the best way to fall in love with something more is to talk about it all the time!”

– Dr. Marcelin

See more about Dr. Marcelin and the UNMC ID Division here.


 

Erin Van Surksum, PA on “Why I Love ID”

Why I Love ID – 

“I love ID because it is never boring. There are so many microorganisms that can cause infection, so many medications we can use to treat, so many side effects to monitor, and so many factors that play a role in patient’s developing these infections. No wonder there are so many sub-specialties within ID!”

-Erin Van Surksum, PA with Transplant Infectious Diseases

See more about UNMC ID here.


 

UNMC ID Division Retirement Announcement

The UNMC Division of Infectious Diseases extends our best wishes to Elaine Litton, who retired from the University on January 5th. Elaine has been valued member of the Division of Infectious Diseases with 13 years of service as our Division Administrative Assistant.

The Division hosted a Retirement Tea for Elaine on January 5th 2018. It was well attended as several came to celebrate Elaine’s service and wish her well as she begins this new chapter in her life.

Good luck Elaine, thank you for your service!


 

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