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Article ; Online: Challenges in Managing Gonorrhea and New Advances in Prevention.

Ewers, Evan C / Curtin, John M / Ganesan, Anuradha

Infectious disease clinics of North America

2023 Volume 37, Issue 2, Page(s) 223–243

Abstract: Gonorrhea is the second most common bacterial sexually transmitted infection in the United States. Rates are increasing, and multiple challenges compound management, including worsening antimicrobial resistance. New therapeutics, enhanced screening and ... ...

Abstract	Gonorrhea is the second most common bacterial sexually transmitted infection in the United States. Rates are increasing, and multiple challenges compound management, including worsening antimicrobial resistance. New therapeutics, enhanced screening and partner notification, and treatment through point-of-care testing and expedited partner therapy, as well as primary prevention efforts provide opportunities for success in combating these trends.
MeSH term(s)	Humans ; United States ; Gonorrhea/diagnosis ; Gonorrhea/drug therapy ; Gonorrhea/prevention & control ; Chlamydia Infections ; Sexual Partners ; Contact Tracing ; Sexually Transmitted Diseases/epidemiology ; Sexually Transmitted Diseases/prevention & control
Language	English
Publishing date	2023-04-25
Publishing country	United States
Document type	Journal Article ; Review ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	1077676-x
ISSN	1557-9824 ; 0891-5520
ISSN (online)	1557-9824
ISSN	0891-5520
DOI	10.1016/j.idc.2023.02.004
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Article ; Online: Fatal septic shock due to disseminated coccidioidomycosis: a case series and review of the literature.

Wisniewski, Piotr / McCool, Isaac / Walsh, John C / Ausman, Chelsea / Edmondson, Jenifer / Perry, Alexandra / Ewers, Evan C / Maves, Ryan C

BMC infectious diseases

2023 Volume 23, Issue 1, Page(s) 430

Abstract: Background: Coccidioidomycosis is a fungal infection endemic to the southwestern United States and regions of Latin America. Disseminated disease occurs in < 1% of cases. Septic shock is even rarer, with high mortality despite therapy. We describe two ... ...

Abstract	Background: Coccidioidomycosis is a fungal infection endemic to the southwestern United States and regions of Latin America. Disseminated disease occurs in < 1% of cases. Septic shock is even rarer, with high mortality despite therapy. We describe two cases of coccidioidal septic shock. Both patients were older men of Filipino ancestry presenting with respiratory failure and vasopressor-dependent shock. Antifungal drugs were initiated after failure to improve with empiric antibiotics; in both, Coccidioides was isolated from respiratory cultures. Despite aggressive care, both patients ultimately died of their infections. We provide a review of the published literature on this topic. Conclusions: Most of the 33 reported cases of coccidioidal septic shock occurred in men (88%) of non-white race and ethnicity (78%). The overall mortality rate was 76%. All survivors received amphotericin B as part of their treatment. Coccidioidomycosis-related septic shock is a rare disease with poor outcomes; delays in diagnosis and treatment are common. Improved diagnostic testing for coccidioidomycosis could enhance recognition of this disease in the future. Although data are limited, early treatment with amphotericin B in cases of coccidioidal septic shock may reduce mortality.
MeSH term(s)	Male ; Humans ; Aged ; Coccidioidomycosis/complications ; Coccidioidomycosis/diagnosis ; Coccidioidomycosis/drug therapy ; Amphotericin B/therapeutic use ; Shock, Septic/diagnosis ; Shock, Septic/etiology ; Shock, Septic/drug therapy ; Antifungal Agents/therapeutic use ; Coccidioides
Chemical Substances	Amphotericin B (7XU7A7DROE) ; Antifungal Agents
Language	English
Publishing date	2023-06-26
Publishing country	England
Document type	Review ; Journal Article
ZDB-ID	2041550-3
ISSN	1471-2334 ; 1471-2334
ISSN (online)	1471-2334
ISSN	1471-2334
DOI	10.1186/s12879-023-08379-6
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Article ; Online: Real World Impact of Remdesivir and Dexamethasone on Clinical Outcomes of Severe Coronavirus Disease 2019 in a Community Hospital.

Larson, Derek T / Ewers, Evan C / Gallagher, Kia M / Mahoney, Alexandra M / Paul, Madison L / Weina, Peter J

Military medicine

2022

Abstract: Background: Evidence has emerged showing potential benefit of Remdesivir and dexamethasone in severe coronavirus disease 2019 (COVID-19) but results from large randomized control trials are conflicting. While initial data for dexamethasone indicated a ... ...

Abstract	Background: Evidence has emerged showing potential benefit of Remdesivir and dexamethasone in severe coronavirus disease 2019 (COVID-19) but results from large randomized control trials are conflicting. While initial data for dexamethasone indicated a mortality benefit, the impact of Remdesivir was best demonstrated in decreased time to recovery. Despite extensive disease burden throughout the world efficacy data of individual interventions is lacking in part due to extensive concurrent use of confounding investigational therapeutics. Materials and methods: We performed a retrospective analysis of the impact of Remdesivir and dexamethasone on real-world outcomes in severe COVID-19. All patients admitted to our community hospital between March 2020 and December 31, 2020 were included, and all patients admitted before national guidelines endorsed Remdesivir and dexamethasone outside of clinical trials were treated with only supportive care and used as historical controls. No other investigational therapeutics were utilized. This study was reviewed and approved by the Fort Belvoir Community Hospital IRB. Results: 58 hospitalized patients met criteria for severe COVID-19 as confirmed by RT-PCR, and 14 (25%) were used as historical controls. Baseline demographics and overall mortality rate (7.1%) did not significantly differ between the groups. The median length of stay was 7 days and 6 days in the historical control group and interventional group, respectively (P = 0.55). Conclusions: We did not observe an appreciable impact on the duration of hospitalization when Remdesivir and dexamethasone were added to supportive care in a community hospital. This study was not sufficiently powered to detect the previously described mortality benefit of dexamethasone.
Language	English
Publishing date	2022-03-12
Publishing country	England
Document type	Journal Article
ZDB-ID	391061-1
ISSN	1930-613X ; 0026-4075
ISSN (online)	1930-613X
ISSN	0026-4075
DOI	10.1093/milmed/usac052
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Article ; Online: The potential danger of eating wild lettuce: a brief review of human rat lungworm infection.

Ewers, Evan C / Anisowicz, Sarah K

Hawai'i journal of medicine & public health : a journal of Asia Pacific Medicine & Public Health

2014 Volume 73, Issue 11 Suppl 2, Page(s) 28–32

Abstract: Angiostrongylus cantonensis, the causative agent of human rat lungworm disease, is the most common cause of eosinophilic meningitis worldwide and is endemic throughout Asia Pacific. It is acquired through the consumption of infected freshwater mollusks ... ...

Abstract	Angiostrongylus cantonensis, the causative agent of human rat lungworm disease, is the most common cause of eosinophilic meningitis worldwide and is endemic throughout Asia Pacific. It is acquired through the consumption of infected freshwater mollusks or contaminated produce. Human angiostrongyliasis is usually a self-limited disease presenting with headache and various neurologic sequelae varying from cranial nerve palsies to radiculitis and/or paresthesias. Fatal cases are rare, and manifest as fulminant meningomyeloencephalitis. The diagnosis is made through the use of clinical history, exam, and laboratory data including peripheral blood counts, cerebrospinal fluid (CSF) examinations, and serologic or molecular diagnostic techniques. Medical therapy is largely focused on symptomatic relief, and includes analgesics, lumbar puncture, and corticosteroids. In resource-limited settings, prevention is key, and the use of analgesics can provide symptomatic relief after infection. Efforts to increase disease awareness have been made in endemic areas, as evidenced by the recent Rat Lungworm Disease Scientific Workshop which was held in Honolulu in 2011. The proceedings of the workshop were published in a supplement to this journal (Hawaii J Med Public Health. Jun 2013;72(6):Supp 2). However, wilderness medicine and travel medicine specialists must also be aware of the disease, how it is contracted, its presentation, and treatment options should they encounter a patient who is in or has returned from an endemic area. This brief review highlights eosinophilic meningitis caused by A. cantonensis, including an example case, an overview of its clinical presentation, treatment options, and prevention.
MeSH term(s)	Angiostrongylus cantonensis/pathogenicity ; Animals ; Child ; Hawaii/epidemiology ; Humans ; Lactuca/microbiology ; Male ; Strongylida Infections/diagnosis ; Strongylida Infections/epidemiology ; Strongylida Infections/etiology ; Strongylida Infections/therapy
Language	English
Publishing date	2014-12-04
Publishing country	United States
Document type	Case Reports ; Journal Article ; Review
ZDB-ID	2653459-9
ISSN	2165-8242 ; 2165-8218
ISSN (online)	2165-8242
ISSN	2165-8218
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Article ; Online: Risk of sexually transmitted infections among U.S. military service members in the setting of HIV pre-exposure prophylaxis use.

Blaylock, Jason M / Ewers, Evan C / Bianchi, Elizabeth J / King, David B / Casimier, Rosemary O / Erazo, Hector / Grieco, Stephen / Lay, Jenny / Peel, Sheila A / Modjarrad, Kayvon / Beckett, Charmagne G / Okulicz, Jason F / Scott, Paul T / Hakre, Shilpa

PloS one

2023 Volume 18, Issue 12, Page(s) e0296054

Abstract: Background: The evidence for an increased incidence of sexually transmitted infections (STIs) among patients utilizing HIV pre-exposure prophylaxis (PrEP) has been inconsistent. We assessed the risk of incident STI while on PrEP compared to periods off ... ...

Abstract	Background: The evidence for an increased incidence of sexually transmitted infections (STIs) among patients utilizing HIV pre-exposure prophylaxis (PrEP) has been inconsistent. We assessed the risk of incident STI while on PrEP compared to periods off PrEP among military service members starting PrEP. Methods: Incidence rates of chlamydia, gonorrhea, syphilis, hepatitis C virus, and HIV were determined among military service members without HIV prescribed daily oral tenofovir disoproxil fumarate and emtricitabine for HIV PrEP from February 1, 2014 through June 10, 2016. Hazard ratios for incident STIs were calculated using an Anderson-Gill recurrent event proportional hazard regression model. Results: Among 755 male service members, 477 (63%) were diagnosed with incident STIs (overall incidence 21.4 per 100 person-years). Male service members had a significantly lower risk of any STIs (adjusted hazard ratio (aHR) 0.21, 95% CI 0.11-0.40) while using PrEP compared to periods off PrEP after adjustment for socio-demographic characteristics, reasons for initiating PrEP, surveillance period prior to PrEP initiation, and the effect of PrEP on site and type of infection in multivariate analysis. However, when stratifying for anatomical site and type of infection, the risk of extragenital gonorrhea infection (pharyngeal NG: aHR 1.84, 95% CI 0.82-4.13, p = 0.30; rectal NG: aHR 1.23, 95% CI 0.60-2.51, p = 1.00) and extragenital CT infection (pharyngeal CT: aHR 2.30, 95% CI 0.46-11.46, p = 0.81; rectal CT: aHR 1.36, 95% CI 0.81-2.31, p = 0.66) was greater on PrEP compared to off PrEP although these values did not reach statistical significance. Conclusions: The data suggest entry into PrEP care reduced the overall risk of STIs following adjustment for anatomical site of STI and treatment. Service members engaged in PrEP services also receive more STI prevention counseling, which might contribute to decreases in STI risk while on PrEP.
MeSH term(s)	Humans ; Male ; Gonorrhea/epidemiology ; Gonorrhea/prevention & control ; Pre-Exposure Prophylaxis ; HIV Infections/epidemiology ; HIV Infections/prevention & control ; Military Personnel ; Homosexuality, Male ; Sexually Transmitted Diseases/epidemiology ; Sexually Transmitted Diseases/prevention & control ; Sexual and Gender Minorities
Language	English
Publishing date	2023-12-28
Publishing country	United States
Document type	Journal Article
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0296054
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Article ; Online: A unique case of adolescent neuroborreliosis presenting with multiple cranial neuritis and cochlear inflammation on magnetic resonance imaging.

Ewers, Evan C / Dennison, David H / Stagliano, David R

Pediatric neurology

2015 Volume 52, Issue 1, Page(s) 107–109

Abstract: Background: Lyme disease is the most common vector-borne disease in the United States and is caused by infection with the spirochete Borrelia burgdorferi. In children, neuroborreliosis usually presents as peripheral facial nerve palsy and lymphocytic ... ...

Abstract	Background: Lyme disease is the most common vector-borne disease in the United States and is caused by infection with the spirochete Borrelia burgdorferi. In children, neuroborreliosis usually presents as peripheral facial nerve palsy and lymphocytic meningitis and only rarely is associated with cranial polyneuritis. Patient description: We present a 15-year-old with tinnitus, hearing loss, and facial nerve palsy in the setting of acute, severe right arm pain and a several week history of malaise and headache. Lumbar puncture was notable for lymphocytic pleocytosis. Serologic testing demonstrated positive Lyme antibody and a positive immunoglobulin M Western blot. Immunofluorescent assay of cerebrospinal fluid was also positive for anti-Lyme immunoglobulin M. Audiologic testing revealed mixed, right-sided hearing loss. Neuroimaging demonstrated cranial polyneuritis and right-sided cochlear inflammation. The patient was treated with parenteral ceftriaxone with resolution of his symptoms at close follow-up. Discussion: Neuroborreliosis with radiculopathy, lymphocytic meningitis, and cranial polyneuritis is a rare presentation of pediatric Lyme disease. Additionally, cochlear inflammation along with cranial nerve VIII inflammation may contribute to hearing loss in patients with neuroborreliosis.
MeSH term(s)	Adolescent ; Anti-Bacterial Agents/therapeutic use ; Ceftriaxone/therapeutic use ; Cochlear Diseases/diagnosis ; Cochlear Diseases/drug therapy ; Cochlear Diseases/pathology ; Cochlear Diseases/physiopathology ; Cranial Nerve Diseases/diagnosis ; Cranial Nerve Diseases/drug therapy ; Cranial Nerve Diseases/pathology ; Cranial Nerve Diseases/physiopathology ; Diagnosis, Differential ; Follow-Up Studies ; Humans ; Lyme Neuroborreliosis/diagnosis ; Lyme Neuroborreliosis/drug therapy ; Lyme Neuroborreliosis/pathology ; Lyme Neuroborreliosis/physiopathology ; Magnetic Resonance Imaging ; Male
Chemical Substances	Anti-Bacterial Agents ; Ceftriaxone (75J73V1629)
Language	English
Publishing date	2015-01
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	639164-3
ISSN	1873-5150 ; 0887-8994
ISSN (online)	1873-5150
ISSN	0887-8994
DOI	10.1016/j.pediatrneurol.2014.10.009
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Article: Concurrent Systemic Chemoimmunotherapy and Sofosbuvir-Based Antiviral Treatment in a Hepatitis C Virus-Infected Patient With Diffuse Large B-Cell Lymphoma.

Ewers, Evan C / Shah, Phalgoon A / Carmichael, Mark G / Ferguson, Tomas M

Open forum infectious diseases

2016 Volume 3, Issue 4, Page(s) ofw223

Abstract: Hepatitis C virus (HCV) infection is associated with the development of non-Hodgkin lymphomas. For aggressive lymphomas, such as diffuse large B-cell lymphoma (DLBCL), treatment of HCV infection is typically deferred in treatment-naive patients until ... ...

Abstract	Hepatitis C virus (HCV) infection is associated with the development of non-Hodgkin lymphomas. For aggressive lymphomas, such as diffuse large B-cell lymphoma (DLBCL), treatment of HCV infection is typically deferred in treatment-naive patients until after completion of lymphoma therapy [1, 2]. We report a case of HCV-associated stage IV DLBCL successfully treated concurrently using chemoimmunotherapy and a sofosbuvir-based antiviral regimen.
Language	English
Publishing date	2016-12-20
Publishing country	United States
Document type	Journal Article
ZDB-ID	2757767-3
ISSN	2328-8957
ISSN	2328-8957
DOI	10.1093/ofid/ofw223
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Article ; Online: Immunoproliferative Small Intestinal Disease Associated with Overwhelming Polymicrobial Gastrointestinal Infection with Transformation to Diffuse Large B-cell Lymphoma.

Ewers, Evan C / Sheffler, Robert L / Wang, James / Ngauy, Viseth

The American journal of tropical medicine and hygiene

2016 Volume 94, Issue 5, Page(s) 1177–1181

Abstract: Immunoproliferative small intestinal disease (IPSID) is an extra-nodal B-cell lymphoma most commonly described in the Mediterranean, Africa, and Asia. It is associated with poverty and poor sanitation, and is rarely encountered in developed countries. A ... ...

Abstract	Immunoproliferative small intestinal disease (IPSID) is an extra-nodal B-cell lymphoma most commonly described in the Mediterranean, Africa, and Asia. It is associated with poverty and poor sanitation, and is rarely encountered in developed countries. A 26-year-old previously healthy, Marshallese male was transferred to our facility with a 6-month history of watery diarrhea, weakness, and cachexia refractory to multiple short courses of oral antibiotics. Stool cultures grew Campylobacter jejuni and Vibrio fluvialis. Endoscopic evaluation showed histologic evidence of Helicobacter pylori gastritis and gross evidence of whipworm infection found in the colon. Mesenteric lymph node biopsy cultures grew Escherichia coli. Histopathology and immunohistochemical stains of the small intestine were consistent with IPSID. He subsequently transformed to diffuse large B-cell lymphoma (DLBCL) with tonsillar involvement despite treatment with rituximab and an extended course of antibiotics. Systemic chemotherapy with six cycles of rituximab, cyclophosphamide, vincristine, doxorubicin, prednisone, and lenalidomide, resulted in remission of his diffuse B cell lymphoma. This case is illustrative of IPSID developing in a previously healthy individual due to overwhelming polymicrobial gastrointestinal infection by C. jejuni and other enteric pathogens with subsequent transformation to an aggressive DLBCL. IPSID should be considered in residents of developing countries presenting with refractory chronic diarrhea, weight loss, and mesenteric lymphadenopathy.
MeSH term(s)	Adult ; Bacteria/classification ; Bacteria/isolation & purification ; Coinfection/complications ; Coinfection/microbiology ; Humans ; Immunoproliferative Small Intestinal Disease/complications ; Lymphoma, Large B-Cell, Diffuse/complications ; Male
Language	English
Publishing date	2016-05-04
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	2942-7
ISSN	1476-1645 ; 0002-9637
ISSN (online)	1476-1645
ISSN	0002-9637
DOI	10.4269/ajtmh.15-0831
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Article ; Online: A machine learning approach identifies distinct early-symptom cluster phenotypes which correlate with hospitalization, failure to return to activities, and prolonged COVID-19 symptoms.

Epsi, Nusrat J / Powers, John H / Lindholm, David A / Mende, Katrin / Malloy, Allison / Ganesan, Anuradha / Huprikar, Nikhil / Lalani, Tahaniyat / Smith, Alfred / Mody, Rupal M / Jones, Milissa U / Bazan, Samantha E / Colombo, Rhonda E / Colombo, Christopher J / Ewers, Evan C / Larson, Derek T / Berjohn, Catherine M / Maldonado, Carlos J / Blair, Paul W /

Chenoweth, Josh / Saunders, David L / Livezey, Jeffrey / Maves, Ryan C / Sanchez Edwards, Margaret / Rozman, Julia S / Simons, Mark P / Tribble, David R / Agan, Brian K / Burgess, Timothy H / Pollett, Simon D

PloS one

2023 Volume 18, Issue 2, Page(s) e0281272

Abstract: Background: Accurate COVID-19 prognosis is a critical aspect of acute and long-term clinical management. We identified discrete clusters of early stage-symptoms which may delineate groups with distinct disease severity phenotypes, including risk of ... ...

Abstract	Background: Accurate COVID-19 prognosis is a critical aspect of acute and long-term clinical management. We identified discrete clusters of early stage-symptoms which may delineate groups with distinct disease severity phenotypes, including risk of developing long-term symptoms and associated inflammatory profiles. Methods: 1,273 SARS-CoV-2 positive U.S. Military Health System beneficiaries with quantitative symptom scores (FLU-PRO Plus) were included in this analysis. We employed machine-learning approaches to identify symptom clusters and compared risk of hospitalization, long-term symptoms, as well as peak CRP and IL-6 concentrations. Results: We identified three distinct clusters of participants based on their FLU-PRO Plus symptoms: cluster 1 ("Nasal cluster") is highly correlated with reporting runny/stuffy nose and sneezing, cluster 2 ("Sensory cluster") is highly correlated with loss of smell or taste, and cluster 3 ("Respiratory/Systemic cluster") is highly correlated with the respiratory (cough, trouble breathing, among others) and systemic (body aches, chills, among others) domain symptoms. Participants in the Respiratory/Systemic cluster were twice as likely as those in the Nasal cluster to have been hospitalized, and 1.5 times as likely to report that they had not returned-to-activities, which remained significant after controlling for confounding covariates (P < 0.01). Respiratory/Systemic and Sensory clusters were more likely to have symptoms at six-months post-symptom-onset (P = 0.03). We observed higher peak CRP and IL-6 in the Respiratory/Systemic cluster (P < 0.01). Conclusions: We identified early symptom profiles potentially associated with hospitalization, return-to-activities, long-term symptoms, and inflammatory profiles. These findings may assist in patient prognosis, including prediction of long COVID risk.
MeSH term(s)	Humans ; COVID-19/epidemiology ; SARS-CoV-2 ; Post-Acute COVID-19 Syndrome ; Interleukin-6 ; Phenotype ; Hospitalization ; Machine Learning
Chemical Substances	Interleukin-6
Language	English
Publishing date	2023-02-09
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S. ; Research Support, N.I.H., Extramural
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0281272
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Article: Decreased Self-reported Physical Fitness Following SARS-CoV-2 Infection and the Impact of Vaccine Boosters in a Cohort Study.

Richard, Stephanie A / Scher, Ann I / Rusiecki, Jennifer / Byrne, Celia / Berjohn, Catherine M / Fries, Anthony C / Lalani, Tahaniyat / Smith, Alfred G / Mody, Rupal M / Ganesan, Anuradha / Huprikar, Nikhil / Colombo, Rhonda E / Colombo, Christopher J / Schofield, Christina / Lindholm, David A / Mende, Katrin / Morris, Michael J / Jones, Milissa U / Flanagan, Ryan /

Larson, Derek T / Ewers, Evan C / Bazan, Samantha E / Saunders, David / Maves, Ryan C / Livezey, Jeffrey / Maldonado, Carlos J / Edwards, Margaret Sanchez / Rozman, Julia S / O'Connell, Robert J / Simons, Mark P / Tribble, David R / Agan, Brian K / Burgess, Timothy H / Pollett, Simon D

Open forum infectious diseases

2023 Volume 10, Issue 12, Page(s) ofad579

Abstract: Background: The long-term effects of coronavirus disease 2019 (COVID-19) on physical fitness are unclear, and the impact of vaccination on that relationship is uncertain.: Methods: We compared survey responses in a 1-year study of US military service ...

Abstract	Background: The long-term effects of coronavirus disease 2019 (COVID-19) on physical fitness are unclear, and the impact of vaccination on that relationship is uncertain. Methods: We compared survey responses in a 1-year study of US military service members with (n = 1923) and without (n = 1591) a history of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We fit Poisson regression models to estimate the association between history of SARS-CoV-2 infection and fitness impairment, adjusting for time since infection, demographics, and baseline health. Results: The participants in this analysis were primarily young adults aged 18-39 years (75%), and 71.5% were male. Participants with a history of SARS-CoV-2 infection were more likely to report difficulty exercising (38.7% vs 18.4%; Conclusions: In this study of generally young, healthy military service members, SARS-CoV-2 infection was associated with lower self-reported fitness and exercise capacity; vaccination and boosting were associated with lower risk of self-reported fitness loss.
Language	English
Publishing date	2023-11-17
Publishing country	United States
Document type	Journal Article
ZDB-ID	2757767-3
ISSN	2328-8957
ISSN	2328-8957
DOI	10.1093/ofid/ofad579
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