Cinematic Portrayal of Infectious Disease Outbreaks

Background: Movies are a shared cultural experience. Films likely reflect societal fears, and may provide insight into how the public perceives infectious disease outbreaks. Methods: A search of IMDb.com was conducted in February/March 2020 (updating a 2017 search) using 163 infection-related search terms to identify films with an emphasis on infectious diseases (as assessed by review of plot synopses on IMDb, the American Film Institute database, or Wikipedia) through December 31, 2019. Films featuring an outbreak or pandemic (as defined by the CDC, with the outbreak/pandemic required to be an important component of the story) were then selected. Cultural relevance was defined as 1.) Box office earnings ≥$10 million (adjusted to 2019 dollars) OR 2.) Winner of an Academy Award OR 3.) ≥1 long-gap connections on IMDB (cultural reference to a film ≥25 years after release, e.g. on television). All culturally relevant films were viewed and thematically analyzed. Results: The search yielded 373 infectious disease films, with 142 (38.1%) featuring a human infectious disease outbreak or pandemic. Eighty films were culturally relevant. Conclusion: Outbreak/pandemic films feature recurring themes. The influence such films may have on public compliance with medical recommendations (e.g. social quarantining) should be the subject of future research

The Impact of Maternal Infection on the Neonate

Maternal infection is a common occurrence during pregnancy, with a substantial impact on the infant. Some infections result in impaired development in utero and even death of the fetus. Other infections may be insidious in the mother but result in growth impairment and hearing loss in the infant. A growing body of evidence suggests that even infections such as chorioamnionitis, thought to have no long-term impact on the infant, may alter fetal development. This chapter will review congenital infections and their impact on neonatal outcomes, as well as newer findings suggesting that acute infection may result in adverse changes in the infant. We will explore novel mechanisms of pathogenesis and virulence, as well as areas that continue with ongoing research

Longitudinal Evaluation of Pediatric Residency Didactics Transition from Noon Conference to an Academic Half Day

BACKGROUND: In 2009, the UNM Pediatric Residency transitioned program didactics from noon conference to an academic half day. Immediate evaluation of resident and faculty satisfaction, resident attendance, board exam pass rate and In-Training-Exam (ITE) scores showed improvements with this change. OBJECTIVE: Investigate the longitudinal impact of the academic half day at UNM on resident and faculty satisfaction, resident attendance and clinical knowledge in the form of standardized exam results. METHODS: In this mixed-methods study, surveys regarding satisfaction were conducted of current pediatric residents (n=32) and faculty (n=32) at UNM. To assess clinical knowledge, quantitative measures such as senior resident ITE scores and pediatric board exam pass rate will be evaluated. Finally, focus groups were conducted with pediatric residents and faculty separately to evaluate concepts related to resident autonomy, competence and engagement with the academic half day. RESULTS: Preliminary review of survey data shows 88% and 63% overall satisfaction with the academic half day format from residents and faculty respectively, consistent with 2012 study results. Similar to prior, residents feel that the academic half day does not interfere with clinical education (97%) or patient care duties (83%). Pediatric Board exam pass rate from 2015-2017 is 65% which is similar to pass rates prior to the academic half day. Senior resident ITE scores and resident attendance rates are currently being compiled. Initial review of focus groups shows preference for academic half day in relation to decreasing interruptions to patient care and increase in resident autonomy in clinical areas. CONCLUSIONS: Preliminary data shows sustained overall satisfaction amongst residents and faculty. Board exam pass rates are unchanged, focus groups have identified further areas of intervention including increased resident engagement in didactics

Composition and Similarity of Bovine Rumen Microbiota across Individual Animals

The bovine rumen houses a complex microbiota which is responsible for cattle's remarkable ability to convert indigestible plant mass into food products. Despite this ecosystem's enormous significance for humans, the composition and similarity of bacterial communities across different animals and the possible presence of some bacterial taxa in all animals' rumens have yet to be determined. We characterized the rumen bacterial populations of 16 individual lactating cows using tag amplicon pyrosequencing. Our data showed 51% similarity in bacterial taxa across samples when abundance and occurrence were analyzed using the Bray-Curtis metric. By adding taxon phylogeny to the analysis using a weighted UniFrac metric, the similarity increased to 82%. We also counted 32 genera that are shared by all samples, exhibiting high variability in abundance across samples. Taken together, our results suggest a core microbiome in the bovine rumen. Furthermore, although the bacterial taxa may vary considerably between cow rumens, they appear to be phylogenetically related. This suggests that the functional requirement imposed by the rumen ecological niche selects taxa that potentially share similar genetic features

Atypical causes of bacterial osteoarticular infections in immunocompetent children.

Caring for a child with an osteoarticular infection or considering the possibility of an osteoarticular infection in a child is one of the most common clinical dilemmas encountered by clinicians caring for children. In such a scenario, one most often considers infection with frequently encountered pathogens such as Staphylococcus aureus, Streptococcus pyogenes, Streptococcus pneumoniae or Kingella kingae. A large variety of opportunistic osteoarticular pathogens may be found in the immunosuppressed patient or the postoperative or post-trauma patient, due to breaches in the immune system and nosocomial or post-traumatic exposure to multiple organisms. However, an enlarging spectrum of less commonly encountered bacterial pathogens is also increasingly appreciated in community-acquired osteoarticular infections in otherwise healthy children, particularly in this era of pneumococcal and Haemophilus influenzae serotype B immunization. Given the limitations of culture-based detection methods in osteoarticular infections and the potentially unique therapeutic and diagnostic approaches necessitated by some of these pathogens, an awareness of these infections is necessary for proper detection and management. This review will discuss less commonly encountered bacterial osteoarticular pathogens that may infect otherwise healthy children, with emphasis on the epidemiology, diagnosis and treatment of each

Antibiotic-Induced Neutropenia During Treatment of Hematogenous Osteoarticular Infections in Otherwise Healthy Children.

OBJECTIVES: We studied the frequency and characteristics of antibiotic-induced neutropenia in otherwise healthy children receiving antibiotic therapy for hematogenous osteoarticular infections (OAIs). METHODS: We retrospectively enrolled otherwise healthy children between 1 month and 18 years of age discharged with an OAI from our institution over an 11-year period. An absolute neutrophil count (ANC) ≤1500 cells/μL was defined as neutropenia. We recorded demographic and clinical information, as well as the value and timing of each ANC in relation to changes in antibiotic therapy. A multivariable regression model assessed the contributions of various risk factors. RESULTS: A total of 186 children were enrolled (mean age, 7.6 years; 67.2% boys). β-Lactams represented 61.2% of all prescriptions. During treatment, 61 subjects (32.8%) developed neutropenia (median time to onset, 24 days). An ANC \u3c 500 cells/μL occurred in 7 subjects (3.8%). Neutropenic subjects (mean age, 6.0 years) were significantly younger than those without neutropenia (mean age, 8.5 years) (OR = 0.86; 95% CI: 0.79-0.93; p \u3c 0.001) and received significantly longer courses of total (89.3 vs. 55.8 days) and parenteral (24.6 vs. 19.9 days) antibiotic therapy (OR = 1.01; 95% CI: 1.01-1.02; p = 0.004 and OR = 1.02; 95% CI: 1.01-1.04; p = 0.041, respectively). Recurrent neutropenia occurred in 23.0% of all neutropenic subjects and was significantly more common in those with a longer mean duration of parenteral therapy (OR = 1.05; 95% CI: 1.02-1.09; p = 0.004.). No complications from neutropenia occurred. CONCLUSIONS: Neutropenia was common in our cohort of children receiving prolonged antibiotic therapy for OAIs. Younger age and longer courses of therapy were associated with an increased risk of neutropenia

Safety of Peripherally Inserted Central Catheter Use in Children From Rural Versus Urban Settings Receiving Long-term Parenteral Antimicrobial Therapy.

OBJECTIVES: To determine the safety of peripherally inserted central catheter (PICC) use for delivery of outpatient parenteral antimicrobial therapy (PAT) in children discharged to rural or urban locales. We hypothesized that children from rural settings would experience higher complication rates. PATIENTS AND METHODS: We conducted a retrospective cohort study of children admitted to an academic medical center in the Southwestern United States over 9 years who were discharged with a PICC to complete a course of PAT with follow-up at our institution. To classify rural versus urban residence, we used rural-urban continuum codes from the US Department of Agriculture, the driving time in hours to the nearest trauma center, and the discharging center using Google Maps. RESULTS: In total, 221 children met inclusion criteria (mean age 9.8 years). Osteoarticular infections and cystic fibrosis exacerbations were the most common indications for PICC use (68.8%). The mean driving time to the discharging hospital was significantly longer for those children residing in the most rural regions of the state (3.6 vs 0.8 hours; CONCLUSIONS: In our study, we demonstrate an equivalent safety profile for children in rural and urban settings with PICCs for receipt of outpatient PAT

Suppurative complications of acute hematogenous osteomyelitis in children.

We carried out a case-control study in children with acute hematogenous osteomyelitis (AHO) with and without suppurative complications discharged from our institution over an 11-year period to test the hypothesis that abscess formation was associated with a delayed presentation to care. Of 102 children with AHO, 54 abscesses were documented in 46 patients (25 bone, 29 muscle). A delay in presentation was not associated with abscess formation (6.5 vs. 5.0 days, P=0.26). Overall, 78% of all bone abscesses were visible on initial MRI. Consistent use of MRI at presentation may identify children with suppurative complications of AHO

Nontuberculous mycobacterial adenitis outside of the head and neck region in children: A case report and systematic review of the literature

Nontuberculous mycobacterial (NTM) adenitis of the head and neck region is well-described in healthy children, most commonly presenting under the age of 5 years. Extracervicofacial NTM adenitis is less common. We present a case of NTM inguinal adenitis in a 2-year-old girl, followed by a systematic review of the literature