Parkway, CA, United States
Parkway, CA, United States

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Moonan P.K.,Centers for Disease Control and Prevention | Teeter L.D.,Methodist Hospital Research Institute | Salcedo K.,Center for Infectious Diseases | Ghosh S.,Centers for Disease Control and Prevention | And 2 more authors.
The Lancet Infectious Diseases | Year: 2013

Background: Multidrug-resistant (MDR) tuberculosis is a potential threat to tuberculosis elimination, but the extent of MDR tuberculosis disease in the USA that is attributable to transmission within the country is unknown. We assessed transmission of MDR tuberculosis and potential contributing factors in the USA. Methods: In a cross-sectional study, clinical, demographic, epidemiological, and Mycobacterium tuberculosis genotype data were obtained during routine surveillance of all verified cases of MDR tuberculosis reported from eight states in the USA (California from Jan 1, 2007, to Dec 31, 2009; Texas from Jan 1, 2007, to March 31, 2009; and the states of Colorado, Maryland, Massachusetts, New York, Tennessee, and Washington from Jan 1, 2007 to Dec 31, 2008). In-depth interviews and health-record abstraction were done for all who consented to ascertain potential interpersonal connections. Findings: 168 cases of MDR tuberculosis were reported in the eight states during our study period. 92 individuals (55%) consented to in-depth interview. 20 (22%) of these individuals developed MDR tuberculosis as a result of transmission in the USA; a source case was identified for eight of them (9%). 20 individuals (22%) had imported active tuberculosis (ie, culture-confirmed disease within 3 months of entry into the USA). 38 (41%) were deemed to have reactivation of disease, of whom 14 (15%) had a known previous episode of tuberculosis outside the USA. Five individuals (5%) had documented treatment of a previous episode in the USA, and so were deemed to have relapsed. For nine cases (10%), insufficient evidence was available to definitively classify reason for presentation. Interpretation: About a fifth of cases of MDR tuberculosis in the USA can be linked to transmission within the country. Many individuals acquire MDR tuberculosis before entry into the USA. MDR tuberculosis needs to be diagnosed rapidly to reduce potential infectious periods, and clinicians should consider latent tuberculosis infection treatment-tailored to the results of drug susceptibility testing of the putative source case-for exposed individuals. © 2013 Elsevier Ltd.


Lowenthal P.,Center for Infectious Diseases | Barry P.M.,Center for Infectious Diseases | Flood J.,Center for Infectious Diseases
Pediatric Infectious Disease Journal | Year: 2016

Background: Since 2007, immigration applicants 2-14 years old with a tuberculin skin test (TST) ≥10 mm and an otherwise negative evaluation for tuberculosis (TB) are assigned a classification for TB infection and instructed to seek domestic evaluation upon arrival in the US in accordance with Centers for Disease Control and Prevention instructions. We examined the characteristics and outcome of domestic evaluation of immigrant children who arrived in California with a positive TST on preimmigration examination to inform the preimmigration TB screening process. Methods: Retrospective analysis of the characteristics and results of domestic evaluation of immigrants 2-14 years old who arrived in California with a classification for TB infection during October 1, 2008-September 30, 2013 was performed. TB disease was determined by matching preimmigration records with the California TB registry. Results: Among a total of 12,544 immigrant children included, 7786 (62%) were evaluated for TB postentry. Of these, 5243 (67%) were tested with TST or interferon gamma release assay (IGRA), and 2371 (45%) had a positive test. Of those tested with IGRA (n = 4035), 914 (23%) were positive. The proportion with positive IGRA increased significantly with age (years): 2-4 (11%), 5-9 (19%), 10-14 (28%), P < 0.0001; was lowest among arrivers from China (6%) and highest among arrivers from Mexico (48%). Nine children (0.07%) had TB disease within 5 years after arrival. Conclusions: The majority of immigrant children with a positive preimmigration TST tested negative for TB infection on domestic evaluation using TST or IGRA. Inclusion of IGRA in preimmigration TB screening is likely to reduce subsequent testing, treatment and cost of evaluations among immigrant children to the US. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.


Chow J.M.,Center for Infectious Diseases
Sexually Transmitted Diseases | Year: 2012

The passage of the landmark United States (US) Patient Protection and Affordable Care Act (ACA) of 2010 has placed a new emphasis on prevention services, including increased access, coverage, and improved quality of care. In this legislation, chlamydia screening qualifies along with other preventive services (The Patient Protection and Affordable Care Act, P.H. 111-148, March 2010, §2,713) as an essential health service benefit by virtue of having an "A" rating ("strongly recommended") from the US Preventive Services Task Force. However, along with this important commitment of public health resources comes accountability by demonstrating outcomes and results. It should not come as a surprise that in the current era of unprecedented government budget reductions, there is a compelling need for evidence-based prioritization and impact assessment. Funding agencies increasingly need health program data to show the impact of investment in preventive services, and chlamydia screening is no exception. However, measuring the population-level impact of chlamydia screening expansion in the US since the 1980s has been problematic; conflicting data on screening uptake, chlamydia burden, and adverse reproductive outcomes, including pelvic inflammatory disease (PID) and tubal factor infertility, have all been challenging to interpret, despite compelling epidemiologic evidence supporting intervention. © 2012 American Sexually Transmitted Diseases Association All rights reserved.


Banada P.P.,Center for Infectious Diseases | Koshy R.,Center for Infectious Diseases | Alland D.,Center for Infectious Diseases
Journal of Clinical Microbiology | Year: 2013

We have developed a novel blood lysis-centrifugation approach for highly sensitive Mycobacterium tuberculosis detection in large volumes of blood with the Xpert MTB/RIF assay. One through 20 ml of blood was spiked with 0.25 to 10 CFU/ml of theM. tuberculosis surrogateM. bovis BCG. Multiple replicates of each sample were processed by a new lysis-centrifugation method and tested with the Xpert MTB/RIF assay. The assay was very sensitive with increased blood volumes. In the 20-ml samples, BCG was detected in blood spiked with 10, 5, 1, and 0.25 CFU/ml 100, 100, 83, and 57% of the time, respectively, compared to 100, 66, 18, and 18%, of the time, respectively, in 1-ml blood samples. Assay sensitivity was influenced by the type of anticoagulant used, with acid-citrate-dextrose solution B (ACD-B) providing the best results. A limit of detection of 10 CFU/ml was established with BCG spiked into ACD-B-treated blood, and 92, 36, and 33% of the samples with 5, 1, and 0.5 CFU/ml, respectively, were assay positive. The lysis buffer was stable both at room temperature and at 4°C for 2 months. The assay was tested with blood stored for 8 days without a change in sensitivity as measured by cycle threshold. This new assay format extends the capability of the Xpert MTB/RIF test, enabling up to 20 ml of blood to be tested rapidly for the presence of M. tuberculosis. This approach may be a useful method to detect extrapulmonary tuberculosis and the risk of death in immunocompromised patients. © 2013, American Society for Microbiology.


Walter N.D.,University of Colorado at Denver | Painter J.,Centers for Disease Control and Prevention | Lowenthal P.,Center for Infectious Diseases | Flood J.,Center for Infectious Diseases | And 2 more authors.
American Journal of Respiratory and Critical Care Medicine | Year: 2014

Rationale: Current guidelines limit latent tuberculosis infection (LTBI) evaluation to persons in the United States less than or equal to 5 years based on the assumption that high TB rates among recent entrants are attributable to high LTBI reactivation risk, which declines over time. We hypothesized that high postarrival TB rates may instead be caused by imported active TB. Objectives: Estimate reactivation and imported TB in an immigrant cohort. Methods: We linked preimmigration records from a cohort of California-bound Filipino immigrants during 2001-2010 with subsequent TB reports. TB was likely LTBI reactivation if the immigrant had no evidence of active TB at preimmigration examination, likely imported if preimmigration radiograph was abnormal and TB was reported less than or equal to 6 months after arrival, and likely reactivation of inactive TB if radiograph was abnormal but TB was reported more than 6 months after arrival. Measurements and Main Results: Among 123,114 immigrants, 793 TB cases were reported. Within 1 year of preimmigration examination, 85% of TB was imported; 6 and 9% were reactivation of LTBI and inactive TB, respectively. Conversely, during Years 2-9 after U.S. entry, 76 and 24% were reactivation of LTBI and inactive TB, respectively. The rate of LTBI reactivation (32 per 100,000) did not decline during Years 1-9. Conclusions: High postarrival TB rates were caused by detection of imported TB through active postarrival surveillance. Among immigrants without active TB at baseline, reported TB did not decline over 9 years, indicating sustained high risk of LTBI reactivation. Revised guidelines should support LTBI screening and treatment more than 5 years after U.S. arrival. Copyright © 2014 by the American Thoracic Society.


Jackson A.,Center for Infectious Diseases | Van Der Horst C.,Center for Infectious Diseases
Current HIV/AIDS Reports | Year: 2012

Cryptococcal meningitis (CM) remains a major cause of morbidity and mortality among immunocompromised patients, especially in areas of high HIV prevalence, although it can also cause disease in the apparently immunocompetent. Improving the management of HIV-associated CM is important to ensure that patients can survive to benefit from increasing access to ART. In this review we focus on recent advances in prevention, diagnosis, and treatment of CM. © 2012 Springer Science+Business Media, LLC.


Bauer H.M.,Center for Infectious Diseases | Wright G.,Center for Infectious Diseases | Chow J.,Center for Infectious Diseases
American Journal of Public Health | Year: 2012

Because of the rapid development of genital warts (GW) after infection, monitoring GW trends may provide early evidence of population-level human papillomavirus (HPV) vaccine effectiveness. Trends in GW diagnoses were assessed using public family planning administrative data. Between 2007 and 2010, among females younger than 21 years, these diagnoses decreased 35% from 0.94% to 0.61% (P trend < .001). Decreases were also observed among males younger than 21 years (19%); and among females and males ages 21-25 (10% and 11%, respectively). The diagnoses stabilized or increased among older age groups. HPV vaccine may be preventing GW among young people.


Zhang Y.,Center for Infectious Diseases | Romanov G.,Center for Infectious Diseases | Bliska J.B.,Center for Infectious Diseases
Infection and Immunity | Year: 2011

Yersinia pseudotuberculosis is a Gram-negative bacterial pathogen. Virulence in Y. pseudotuberculosis requires the plasmid-encoded Ysc type III secretion system (T3SS), which functions to translocate a set of effectors called Yops into infected host cells. The effectors function to antagonize phagocytosis (e.g., YopH) or to induce apoptosis (YopJ) in macrophages infected with Y. pseudotuberculosis. Additionally, when antiphagocytosis is incomplete and Y. pseudotuberculosis is internalized by macrophages, the bacterium can survive in phagosomes. Previous studies have shown that delivery of effectors into host cells occurs efficiently when Yersinia is extracellular. However, it is not clear whether the T3SS can be utilized by intracellular Y. pseudotuberculosis to translocate Yops. This possibility was investigated here using Y. pseudotuberculosis strains that express YopJ or YopH under the control of an inducible promoter. Bone marrow-derived murine macrophages were infected with these strains under conditions that prevented the survival of extracellular bacteria. Effector translocation was detected by measuring apoptosis or the activities of Yop-β-lactamase fusion proteins. Results showed that macrophages underwent apoptosis when YopJ expression was induced prior to phagocytosis, confirming that delivery of this effector prior to or during uptake is sufficient to cause cell death. However, macrophages also underwent apoptosis when YopJ was ectopically expressed after phagocytosis; furthermore, expression of the translocator YopB from intracellular bacteria also resulted in increased cell death. Analysis by microscopy showed that translocation of ectopically expressed YopH- or YopJ-β-lactamase fusions could be correlated with the presence of viable Y. pseudotuberculosis in macrophages. Collectively, our results suggest that the Ysc T3SS of Y. pseudotuberculosis can function within macrophage phagosomes to translocate Yops into the host cytosol. © 2011, American Society for Microbiology.


Pollini R.A.,University of California at San Diego | Blanco E.,University of California at San Diego | Crump C.,Center for Infectious Diseases | Zuniga M.L.,University of California at San Diego
AIDS Patient Care and STDs | Year: 2011

Timely treatment of HIV infection is a public health priority, yet many HIV-positive persons delay treatment initiation. We conducted a community-based study comparing HIV-positive persons who received an HIV diagnosis at least 3 months ago but had not initiated care (n=100) with a reference population of HIV-positive persons currently in care (n=115) to identify potential barriers to treatment initiation. Study participants were mostly male (78.0%), and persons of color (54.9% Latino, 26.3% black), with median age 37.8 years. Median time since HIV diagnosis was 3.7 years. Univariate analysis revealed that those never in care differed substantially from those currently in care with regard to sociodemographics; HIV testing and counseling experiences; perceived barriers to care; and knowledge, attitudes, and beliefs regarding HIV. Factors independently associated with never initiating HIV care were younger age (adjusted odds ratio [AOR]=0.93; 95% confidence interval [CI]: 0.88, 0.99), shorter time since diagnosis (AOR=0.87; 95% CI: 0.77, 0.98), lacking insurance (AOR=0.11; 95% CI: 0.03, 0.35), not knowing someone with HIV/AIDS (AOR=0.09; 95% CI: 0.03, 0.30) not disclosing HIV status (AOR=0.13; 95% CI: 0.02, 0.70), not receiving help making an HIV care appointment after diagnosis (AOR=0.04; 95% CI: 0.01, 0.14), and not wanting to think about being HIV positive (AOR=3.57; 95% CI: 1.22, 10.46). Our findings suggest that isolation and stigma remain significant barriers to initiating HIV care in populations consisting primarily of persons of color, and that direct linkages to HIV care at the time of diagnosis are critical to promoting timely care initiation in these populations. © Copyright 2011, Mary Ann Liebert, Inc.


Padgett K.A.,Center for Infectious Diseases | Bonilla D.L.,Center for Infectious Diseases
Ticks and Tick-borne Diseases | Year: 2011

Risk of exposure to nymphal Ixodes pacificus Cooley and Kohls ticks was investigated at 7 picnic areas in Tilden Regional Park, a heavily used recreation area of over 2000 acres in northwestern California, east of San Francisco Bay. Wooden picnic tables, tree trunks, logs, leaf litter, surrounding vegetation, and rock walls were checked for ticks using standard 1-m2 flannel tick flags at biweekly intervals from March to August 2008. Results indicate that nymphal I. pacificus were commonly found on wooden picnic tables and other wooden materials, such as tree trunks and logs, at an equal proportion to those found in leaf litter. Nymphal I. pacificus in picnic areas peaked in April, with a secondary peak in early June. Five of 170 (2.9%) nymphal I. pacificus collected at picnic sites were positive for Borrelia spirochetes, of which 3 (1.8%) were identified as B. burgdorferi sensu stricto using molecular techniques. In addition, a nymphal I. auritulus collected from a rock wall in a picnic area tested positive for a mixture of B. burgdorferi and B. bissettii; this tick species feeds exclusively on birds. This study indicates a moderate risk of acquiring a nymphal tick at Tilden Park picnic areas, but due to the low B. burgdorferi infection prevalence, the risk of acquiring Lyme disease appears to be low. © 2011.

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