Open Forum Infectious Diseases

COVID-19 is associated with prolonged hospitalization and a high risk of intubation, which raises concern for bacterial co-infection and antimicrobial resistance. Previous research has shown a wide range of bacterial pneumonia rates for COVID-19 patients in a variety of clinical and demographic settings, but none have compared hospitalized COVID-19 patients to patients testing negative for SARS-CoV-2 in similar care settings. We performed a retrospective cohort study on hospitalized patients wit...

Campylobacter is the leading bacterial cause of gastroenteritis worldwide and its incidence is especially high in low- and middle-income countries (LMIC). Disease epidemiology in LMICs is different compared to high income countries like the USA or in Europe. Children in LMICs commonly have repeated and chronic infections even in the absence of symptoms, which can lead to deficits in early childhood development. In this study, we sequenced and characterized C. jejuni (n=62) from a longitudinal co...

BackgroundLittle is known about the relationship between weight gain during treatment and the subsequent risk of cardiovascular and metabolic (cardiometabolic) diseases. We assessed the relationship between changes in body mass index (BMI) during TB treatment with prevalence post-TB metabolic syndrome, a strong predictor of cardiometabolic diseases. MethodsWe enrolled a prospective cohort of individuals successfully treated for TB disease in Tbilisi, Georgia, from 2019 - 2022. Eligible particip...

BackgroundWithin eight weeks of primary Clostridioides difficile infection (CDI), as many as 30% of patients develop recurrent disease with the associated risks of multiple relapses, morbidity, and economic burden. There are no validated biomarkers predictive of recurrence during primary infection. This study demonstrates the potential of a simple test for identifying hospitalized CDI patients at low risk for disease recurrence. MethodsForty-six hospitalized CDI patients were enrolled at Emory ...

BackgroundOutpatient COVID-19 has been insufficiently characterized. ObjectiveTo determine the progression of disease and subsequent determinants of hospitalization. DesignA prospective outpatient cohort. SettingOutpatients were recruited by phone between April 21 to June 23, 2020 after receiving outpatient or emergency department testing within a large health network in Maryland, USA. ParticipantsOutpatient adults with positive RT-PCR results for SARS-CoV-2. MeasurementsSymptoms, portable ...

ObjectiveTo compare the frequency of replication-competent virologic rebound with and without nirmatrelvir-ritonavir treatment for acute COVID-19. Secondary aims were to estimate the validity of symptoms to detect rebound and the incidence of emergent nirmatrelvir-resistance mutations after rebound. DesignObservational cohort study. SettingMulticenter healthcare system in Boston, Massachusetts. ParticipantsWe enrolled ambulatory adults with a positive COVID-19 test and/or a prescription for n...

BackgroundWe characterized SARS-CoV-2 infections in a densely-populated, majority Latinx San Francisco community six-weeks into the citys shelter-in-place order. MethodsWe offered SARS-CoV-2 reverse transcription-PCR and antibody (Abbott ARCHITECT IgG) testing, regardless of symptoms, to all residents (>4 years) and workers in a San Francisco census tract (population: 5,174) at outdoor, community-mobilized events over four days. We estimated SARS-CoV-2 point prevalence (PCR-positive) and cumula...

BackgroundSome individuals experience prolonged illness after acute COVID-19. We assessed whether pre-infection symptoms affected post-COVID illness duration. MethodsSurvival analysis was performed in adults (n=23,452) with community-managed SARC-CoV-2 infection prospectively self-logging data through the ZOE COVID Symptom Study app, at least weekly, from 8 weeks before to 12 weeks after COVID-19 onset, conditioned on presence vs. absence of baseline symptoms (4-8 weeks before COVID-19). A case...

Background In a phase III clinical trial, casirivimab and imdevimab (CAS+IMD) reduced the composite endpoint of COVID-19-related hospitalizations or all-cause mortality in outpatients at risk of severe disease. This study assessed real-world effectiveness of CAS+IMD. Methods Data from Optum(R) Clinformatics(R) Data Mart (CDM) and IQVIA Pharmetrics Plus (PMTX+) were used to identify patients diagnosed with COVID-19 in ambulatory settings between December 2020 and March 2021 (PMTX+) and June 20...

ImportanceThe novel coronavirus, SARS-CoV-2, is responsible for a world-wide pandemic. While the medical community understands the mode of viral transmission, less is known about how long viral shedding occurs once viral symptoms have resolved. ObjectiveTo determine how long the SARS-CoV-2 remains detectable following self-reporting of viral symptom resolution. DesignA cohort of 86 previously SARS-CoV-2 positive patients were re-tested for proof of viral recovery by nasal swab and nucleic acid...

BackgroundEmerging data on the clinical presentation, diagnostics, and outcomes of patients with COVID-19 have largely been presented as case series. Few studies have compared these clinical features and outcomes of COVID-19 to other acute respiratory illnesses. MethodsWe examined all patients presenting to an emergency department in San Francisco, California between February 3 and March 31, 2020 with an acute respiratory illness who were tested for SARS-CoV-2. We determined COVID-19 status by ...

BackgroundOral nirmatrelvir/ritonavir is a treatment for COVID-19, but whether treatment during the acute phase reduces the risk of developing Long COVID is unknown. MethodsUsing the Covid Citizen Science (CCS) online cohort, we surveyed individuals who reported their first SARS-CoV-2 positive test between March and August 2022 regarding Long COVID symptoms. We excluded those who were pregnant, unvaccinated, hospitalized for COVID-19, or received other antiviral therapy. The primary exposure wa...

BackgroundRespiratory Syncytial Virus (RSV) is the most common cause of bronchiolitis and lower respiratory tract infections in children in their first year of life, disproportionately affecting infants in developing countries. Previous studies have found that the nasopharyngeal microbiome of infants with RSV infection has specific characteristics that correlate with disease severity, including lower biodiversity, perturbations of the microbiota and differences in relative abundance. These studi...

Interferon-{gamma} Release Assays (IGRAs), such as the QuantiFERON-TB Gold Plus (QFTTB) and T-SPOT.TB, are commonly used to detect prior exposure to Mycobacterium tuberculosis complex (Mtb), the causative agent of tuberculosis (TB). IGRA positive (IGRA+) asymptomatic individuals are diagnosed with presumed latent tuberculosis infection (LTBI) and often offered therapy to prevent progression to active disease. However, discordant results during serial or confirmatory IGRA testing pose challenges ...

BackgroundSeroprevalence studies are important tools to estimate the prevalence of prior or recent SARS-CoV-2 infections, identifying hotspots and high-risk groups and informing public health responses to the COVID-19 pandemic. We conducted a city-level seroprevalence study in Holyoke, Massachusetts, USA to estimate the seroprevalence of SARS-CoV-2 antibodies and risk factors for seropositivity. MethodsWe invited inhabitants of 2,000 randomly sampled addresses between November 5 and December 31...

BackgroundProtecting health care workers (HCWs) during the coronavirus disease 2019 (COVID-19) pandemic is essential. Serologic testing can identify HCWs who had minimally symptomatic severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infections that were missed by occupational screening based on daily symptom and temperature checks. Recent studies report conflicting results regarding the impact of occupational factors on SARS-CoV-2 seropositivity amongst HCWs. MethodsThe study popula...

BackgroundAdherence to tuberculosis (TB) treatment is key to optimal health outcomes. Programmatic definitions of treatment success may mask heterogeneity in care engagement patterns that increase risk of unfavorable outcomes. MethodsUsing patient-level medication refill data, latent-class growth modelling was used to identify longitudinal trajectories of care engagement among participants who programmatically achieved treatment success. Logistic regression was conducted to investigate particip...

In July 2021, the Sonoma County Health Department was alerted to three cases of COVID-19 among residents of a homeless shelter in Santa Rosa, California. Among 153 shelter residents, 83 (54%) were fully vaccinated; 71 (86%) vaccinated residents had received the Janssen COVID-19 vaccine and 12 (14%) received an mRNA (Pfizer BioNTech or Moderna) COVID-19 vaccine. Within 1 month, 116 shelter residents (76%) received positive SARS-CoV-2 test results, including 66 fully vaccinated residents and 50 no...

BackgroundSame-day HIV testing and antiretroviral therapy (ART) initiation is being widely implemented. However, the optimal timing of ART among patients with tuberculosis (TB) symptoms is unknown. We hypothesized that same-day treatment would be superior to standard care in this population. Methods and FindingsWe conducted an open-label randomized trial among adults with TB symptoms at initial HIV diagnosis at GHESKIO in Haiti. Participants were randomized in a 1:1 ratio to same-day treatment ...

BackgroundThe coronavirus 2019 (Covid-19) pandemic is a global public health crisis, with over 1.6 million cases and 95,000 deaths worldwide. Data are needed regarding the clinical course of hospitalized patients, particularly in the United States. MethodsDemographic, clinical, and outcomes data for patients admitted to five Mount Sinai Health System hospitals with confirmed Covid-19 between February 27 and April 2, 2020 were identified through institutional electronic health records. We conduc...