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  1. Article: Updates and Opinions in Diagnosis and Treatment of

    Malhotra, Sanchi / Mohandas, Sindhu

    Current treatment options in pediatrics

    2021  Volume 7, Issue 4, Page(s) 203–216

    Abstract: Purpose of review: Clostridiodes difficile: Recent findings: Use of fidaxomicin for CDI in pediatrics has been shown to be to be non-inferior to vancomycin and is associated with higher global cure rates and decreased risk of recurrence. Fecal ... ...

    Abstract Purpose of review: Clostridiodes difficile
    Recent findings: Use of fidaxomicin for CDI in pediatrics has been shown to be to be non-inferior to vancomycin and is associated with higher global cure rates and decreased risk of recurrence. Fecal microbiota transplant is a successful emerging therapy with cure rates of up to 90%, though safety alerts should be noted. Diagnostic laboratory testing for
    Summary: The diagnosis and treatment of
    Language English
    Publishing date 2021-12-04
    Publishing country Switzerland
    Document type Journal Article ; Review
    ISSN 2198-6088
    ISSN 2198-6088
    DOI 10.1007/s40746-021-00232-9
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  2. Article ; Online: Viral persistence, reactivation, and mechanisms of long COVID.

    Chen, Benjamin / Julg, Boris / Mohandas, Sindhu / Bradfute, Steven B

    eLife

    2023  Volume 12

    Abstract: The COVID-19 global pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has infected hundreds of millions of individuals. Following COVID-19 infection, a subset can develop a wide range of chronic symptoms ... ...

    Abstract The COVID-19 global pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has infected hundreds of millions of individuals. Following COVID-19 infection, a subset can develop a wide range of chronic symptoms affecting diverse organ systems referred to as post-acute sequelae of SARS-CoV-2 infection (PASC), also known as long COVID. A National Institutes of Health-sponsored initiative, RECOVER: Researching COVID to Enhance Recovery, has sought to understand the basis of long COVID in a large cohort. Given the range of symptoms that occur in long COVID, the mechanisms that may underlie these diverse symptoms may also be diverse. In this review, we focus on the emerging literature supporting the role(s) that viral persistence or reactivation of viruses may play in PASC. Persistence of SARS-CoV-2 RNA or antigens is reported in some organs, yet the mechanism by which they do so and how they may be associated with pathogenic immune responses is unclear. Understanding the mechanisms of persistence of RNA, antigen or other reactivated viruses and how they may relate to specific inflammatory responses that drive symptoms of PASC may provide a rationale for treatment.
    MeSH term(s) United States ; Humans ; Post-Acute COVID-19 Syndrome ; COVID-19 ; RNA, Viral ; SARS-CoV-2 ; Disease Progression
    Chemical Substances RNA, Viral
    Language English
    Publishing date 2023-05-04
    Publishing country England
    Document type Review ; Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 2687154-3
    ISSN 2050-084X ; 2050-084X
    ISSN (online) 2050-084X
    ISSN 2050-084X
    DOI 10.7554/eLife.86015
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  3. Article ; Online: Beyond the Bacterial Microbiome: Virome of Human Milk and Effects on the Developing Infant.

    Mohandas, Sindhu / Pannaraj, Pia S

    Nestle Nutrition Institute workshop series

    2020  Volume 94, Page(s) 86–93

    Abstract: Human milk microbes play an important role in infant health and disease. Emerging evidence shows that human milk viruses are also transmitted from the mother to the infant via breastfeeding. These viruses include eukaryotic viruses, bacterium-infecting ... ...

    Abstract Human milk microbes play an important role in infant health and disease. Emerging evidence shows that human milk viruses are also transmitted from the mother to the infant via breastfeeding. These viruses include eukaryotic viruses, bacterium-infecting viruses called bacteriophages, and other viral particles. Human milk viruses are instrumental in shaping the infant gut virome and microbiome. Eukaryotic DNA and RNA viruses contribute to pathogenic challenges and protection. Bacteriophages have the ability to kill bacteria or supply them with potentially beneficial gene functions, thereby shaping the microbiome. The early infant virome is dominated by bacteriophages that likely contribute to a highly dynamic microbiome in the early life. There is a critical window of early childhood growth with rapid maturation of metabolic, endocrine, neural, and immune pathways. The colonization of microbes in the infant body during this time plays an important role in the establishment and maturation of these pathways. The virome transmitted via breastfeeding may also be particularly important at these critical time points of immune development. More longitudinal studies of mother-infant pairs will help to better define the human milk virome and their functional impact on the development of the growing infant.
    MeSH term(s) Bacteria/genetics ; Child, Preschool ; Female ; Gastrointestinal Microbiome ; Humans ; Infant ; Microbiota ; Milk, Human/virology ; Virome
    Language English
    Publishing date 2020-03-20
    Publishing country Switzerland
    Document type Journal Article ; Review
    ISSN 1664-2155
    ISSN (online) 1664-2155
    DOI 10.1159/000504997
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  4. Article ; Online: Expanding the Differential for Alternative Diagnoses in the Workup of Multisystem Inflammatory Syndrome in Children.

    Kaneta, Kelli / Malhotra, Sanchi / Szmuszkovicz, Jacqueline / Mohandas, Sindhu / White, Sarah / Wu, Susan

    The Pediatric infectious disease journal

    2023  Volume 42, Issue 7, Page(s) 590–593

    Abstract: Background: Multisystem inflammatory syndrome in children (MIS-C) is a rare inflammatory syndrome associated with SARS-CoV-2 infection. Children are increasingly admitted for MIS-C evaluation, but instead found to have alternative diagnoses.: Methods!# ...

    Abstract Background: Multisystem inflammatory syndrome in children (MIS-C) is a rare inflammatory syndrome associated with SARS-CoV-2 infection. Children are increasingly admitted for MIS-C evaluation, but instead found to have alternative diagnoses.
    Methods: Retrospective study of all pediatric patients <21 years of age hospitalized between August 1, 2020, and July 31, 2021, with clinical concern for MIS-C at the time of presentation were identified through use of an institutional computerized MIS-C order entry set. Final diagnoses were then collected through primary review of the medical record from the time of initial presentation through 1-month postdischarge.
    Results: Of 359 cases identified through the MIS-C order entry set, 126 (35.1%) met criteria for MIS-C, 28 had Kawasaki Disease (KD) (7.8%), and 11 cases met criteria for both MIS-C and KD (3.1%), leaving 194 (54.0%) patients ruled out and categorized as "MIS-C mimickers." Infectious diagnoses were the most common MIS-C mimickers (78.9%). Of the infectious etiologies, bacterial (51.0%) and viral (52.3%) etiologies were seen with similar frequency.
    Conclusions: We describe MIS-C mimickers spanning multiple subspecialties, with infectious etiologies predominating, which can aid clinicians in the consideration of diagnostic testing, with the goal of achieving timely and accurate diagnoses.
    MeSH term(s) Child ; Humans ; COVID-19/diagnosis ; SARS-CoV-2 ; Retrospective Studies ; Aftercare ; Patient Discharge ; Systemic Inflammatory Response Syndrome/diagnosis ; Mucocutaneous Lymph Node Syndrome/diagnosis
    Language English
    Publishing date 2023-03-10
    Publishing country United States
    Document type Journal Article
    ZDB-ID 392481-6
    ISSN 1532-0987 ; 0891-3668
    ISSN (online) 1532-0987
    ISSN 0891-3668
    DOI 10.1097/INF.0000000000003903
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    Zs.A 1852: Show issues Location:
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  5. Article ; Online: The importance of patient-partnered research in addressing long COVID: Takeaways for biomedical research study design from the RECOVER Initiative's Mechanistic Pathways taskforce.

    Kim, C / Chen, Benjamin / Mohandas, Sindhu / Rehman, Jalees / Sherif, Zaki A / Coombs, K

    eLife

    2023  Volume 12

    Abstract: The NIH-funded RECOVER study is collecting clinical data on patients who experience a SARS-CoV-2 infection. As patient representatives of the RECOVER Initiative's Mechanistic Pathways task force, we offer our perspectives on patient motivations for ... ...

    Abstract The NIH-funded RECOVER study is collecting clinical data on patients who experience a SARS-CoV-2 infection. As patient representatives of the RECOVER Initiative's Mechanistic Pathways task force, we offer our perspectives on patient motivations for partnering with researchers to obtain results from mechanistic studies. We emphasize the challenges of balancing urgency with scientific rigor. We recognize the importance of such partnerships in addressing post-acute sequelae of SARS-CoV-2 infection (PASC), which includes 'long COVID,' through contrasting objective and subjective narratives. Long COVID's prevalence served as a call to action for patients like us to become actively involved in efforts to understand our condition. Patient-centered and patient-partnered research informs the balance between urgency and robust mechanistic research. Results from collaborating on protocol design, diverse patient inclusion, and awareness of community concerns establish a new precedent in biomedical research study design. With a public health matter as pressing as the long-term complications that can emerge after SARS-CoV-2 infection, considerate and equitable stakeholder involvement is essential to guiding seminal research. Discussions in the RECOVER Mechanistic Pathways task force gave rise to this commentary as well as other review articles on the current scientific understanding of PASC mechanisms.
    MeSH term(s) Humans ; Post-Acute COVID-19 Syndrome ; COVID-19 ; SARS-CoV-2 ; Disease Progression ; Biomedical Research
    Language English
    Publishing date 2023-09-22
    Publishing country England
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S.
    ZDB-ID 2687154-3
    ISSN 2050-084X ; 2050-084X
    ISSN (online) 2050-084X
    ISSN 2050-084X
    DOI 10.7554/eLife.86043
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  6. Article: Isavuconazole Pharmacokinetics and Pharmacodynamics in Children.

    Elhence, Hirsh / Mongkolrattanothai, Kanokporn / Mohandas, Sindhu / Neely, Michael N

    Pharmaceutics

    2022  Volume 15, Issue 1

    Abstract: Isavuconazole is a broad-spectrum azole anti-fungal not yet approved in children. We conducted a retrospective, single-center review of isavuconazole use and routine therapeutic drug monitoring in pediatric patients, extracting demographic, dosing, ... ...

    Abstract Isavuconazole is a broad-spectrum azole anti-fungal not yet approved in children. We conducted a retrospective, single-center review of isavuconazole use and routine therapeutic drug monitoring in pediatric patients, extracting demographic, dosing, concentration, mortality and hepatoxicity data. We constructed a nonparametric population model using Pmetrics. Of 26 patients, 19 (73%) were male. The mean (SD) age and weight were 12.7 (5.5) years and 50.9 (26.8) kg. Eighty percent received between 9.7 and 10.6 mg/kg per dose. Ten (38%) subjects had proven fungal disease and eight (31%) had probable disease, mostly with Candida and Aspergillus spp. The predicted steady-state isavuconazole concentrations in our patients were similar to previous reports in children and adults, and simulations with the proposed dosing of 10 mg/kg/dose every 8 h for 2 days followed by once daily maintenance matched effective adult exposures. Attributable mortality (5 of 11 deaths) was associated with steady-state daily AUC < 60 mg∗h/L and higher AST/ALT with trough concentrations > 5 mg/L. Neither dose nor trough alone correlated well with AUC, but AUC can be estimated with one sample 10 h after the first maintenance dose or a trough concentration, if combined with a Bayesian approach or a peak and trough without a Bayesian approach.
    Language English
    Publishing date 2022-12-26
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2527217-2
    ISSN 1999-4923
    ISSN 1999-4923
    DOI 10.3390/pharmaceutics15010075
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  7. Article ; Online: The Brief Case: Vaccine strain herpes zoster ophthalmicus and meningoencephalitis in an immunocompetent child.

    Rand, Katherine / He, Kaidi / Dien Bard, Jennifer / Braskett, Melinda / Mohandas, Sindhu

    Journal of clinical microbiology

    2023  Volume 61, Issue 8, Page(s) e0071422

    MeSH term(s) Humans ; Child ; Herpes Zoster Ophthalmicus/diagnosis ; Herpes Zoster Ophthalmicus/drug therapy ; Meningoencephalitis/diagnosis
    Language English
    Publishing date 2023-08-23
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 390499-4
    ISSN 1098-660X ; 0095-1137
    ISSN (online) 1098-660X
    ISSN 0095-1137
    DOI 10.1128/jcm.00714-22
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    Zs.A 1188: Show issues Location:
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  8. Article ; Online: Lung mass and neurogenic hyperventilation as a presentation of disseminated tuberculosis.

    Yousif, Deena / Zipkin, Ronen / Ward, Sally / Mohandas, Sindhu

    Pediatric pulmonology

    2021  Volume 56, Issue 7, Page(s) 2379–2380

    MeSH term(s) Humans ; Hyperventilation/complications ; Lung/diagnostic imaging ; Tomography, X-Ray Computed ; Tuberculosis, Miliary
    Language English
    Publishing date 2021-04-18
    Publishing country United States
    Document type Letter
    ZDB-ID 632784-9
    ISSN 1099-0496 ; 8755-6863
    ISSN (online) 1099-0496
    ISSN 8755-6863
    DOI 10.1002/ppul.25411
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    Zs.A 2143: Show issues Location:
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  9. Article ; Online: Impact of COVID-19 Pandemic on Pediatric Infectious Disease Telehealth Practices in North America.

    Kalyoussef, Sabah / Hakim, Amin / Kumar, Ambuj / Fanella, Sergio / Mohandas, Sindhu / Gaviria-Agudelo, Claudia

    Journal of the Pediatric Infectious Diseases Society

    2022  Volume 12, Issue 1, Page(s) 21–28

    Abstract: Background: The coronavirus disease 2019 (COVID-19) pandemic has driven a significant increase in the use of telehealth (TH) but little is published about changes in TH usage by pediatric infectious disease (PID) providers. We assessed their pre- and ... ...

    Abstract Background: The coronavirus disease 2019 (COVID-19) pandemic has driven a significant increase in the use of telehealth (TH) but little is published about changes in TH usage by pediatric infectious disease (PID) providers. We assessed their pre- and intra-pandemic TH usage and experience.
    Methods: The Pediatric Infectious Diseases Society Telehealth Work Group surveyed PID specialists in the United States and Canada from 6 December 2020 until 26 February 2021. Data collected included TH modalities, barriers, and satisfaction.
    Results: The survey response rate was 11.3% (288 of 2,550 PID clinicians) with 243 (96% of 253 analysis-eligible responses) managing children only. Women accounted for 62.1% (n = 157), 51.4% (130) of respondents devoted 50-99% of their time to direct patient care, and 93.3% (236) were located in the United States. The greatest increase in TH usage during the pandemic was in synchronous provider-patient communications (3.9-fold increase). During the pandemic, provider-provider TH increased by less than 10%, comfort with TH usage doubled from 42% to 91%, and satisfaction grew from 74% to 93.3% with different aspects of TH. The top challenge was incomplete or no physical examination (182, 71.9%). Multivariate analysis showed that pre-pandemic TH usage and lack of barriers, but not reimbursement, were significantly associated with higher intra-pandemic usage. EMR-integrated TH was associated with significantly higher usage and satisfaction. Over 70% of respondents anticipate continuing TH usage after the pandemic.
    Conclusions: There was high intra-pandemic usage of, and increased comfort and satisfaction with telehealth by PID specialists. Our data help inform post-pandemic TH expectations and strategies.
    MeSH term(s) Child ; Humans ; Female ; United States/epidemiology ; COVID-19/epidemiology ; Pandemics ; Telemedicine ; Communicable Diseases ; North America/epidemiology
    Language English
    Publishing date 2022-11-01
    Publishing country England
    Document type Journal Article
    ZDB-ID 2668791-4
    ISSN 2048-7207 ; 2048-7193
    ISSN (online) 2048-7207
    ISSN 2048-7193
    DOI 10.1093/jpids/piac111
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  10. Article ; Online: Pediatric Reactive Arthritis Due to

    Rand, Katherine / Yau, Ji-Ting / He, Kaidi / Mohandas, Sindhu / Reyhan, Iris / Gutierrez, Yvonne

    Clinical pediatrics

    2022  Volume 61, Issue 9, Page(s) 649–653

    MeSH term(s) Arthritis, Reactive/diagnosis ; Arthritis, Reactive/drug therapy ; Arthritis, Reactive/etiology ; Child ; Clostridioides difficile ; Clostridium Infections/complications ; Clostridium Infections/diagnosis ; Clostridium Infections/drug therapy ; Humans
    Language English
    Publishing date 2022-06-08
    Publishing country United States
    Document type Journal Article
    ZDB-ID 207678-0
    ISSN 1938-2707 ; 0009-9228
    ISSN (online) 1938-2707
    ISSN 0009-9228
    DOI 10.1177/00099228221098977
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