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Article ; Online: Daily Fevers, Pancytopenia, and Elevated Transaminase Levels in a 5-month-old Boy.

McKissic, Devin A / Lee, Winston / Weinberg, Jason B / Stillwell, Terri

2022 Volume 43, Issue 12, Page(s) 717–720

MeSH term(s)	Male ; Humans ; Infant ; Pancytopenia/etiology ; Fever/etiology ; Transaminases
Chemical Substances	Transaminases (EC 2.6.1.-)
Language	English
Publishing date	2022-08-31
Publishing country	United States
Document type	Journal Article
ZDB-ID	774515-1
ISSN	1526-3347 ; 0191-9601
ISSN (online)	1526-3347
ISSN	0191-9601
DOI	10.1542/pir.2021-004969
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Article ; Online: Laying the Groundwork for a Fulfilling Career in Pediatric Infectious Diseases: The Transition From Fellowship to Faculty.

Kushner, Lauren E / Ristagno, Elizabeth H / Dong, Sara W / Konold, Victoria J L / Fatemi, Yasaman / Stillwell, Terri L / Wohrley, Julie D / Sattler, Matthew M / Kalu, Ibukunoluwa C / Boguniewicz, Juri

Journal of the Pediatric Infectious Diseases Society

2023 Volume 12, Issue 12, Page(s) 627–633

Abstract: There are limited resources for guidance on the transition from fellowship into a new faculty role in pediatric infectious diseases. This review aims to address this gap and provides a framework for a successful transition that is composed of four ... ...

Abstract	There are limited resources for guidance on the transition from fellowship into a new faculty role in pediatric infectious diseases. This review aims to address this gap and provides a framework for a successful transition that is composed of four essential pillars-(1) stepping into your role, (2) finding your niche, (3) building your network, and (4) self-care-all of which are supported by strong mentorship/sponsorship and continual realignment with one's personal mission statement. In addition to providing general principles and guidance, this review also outlines specific steps that a junior faculty member can take to expand their influence and build a successful, fulfilling career in pediatric infectious diseases.
MeSH term(s)	Child ; Humans ; Fellowships and Scholarships ; Career Choice ; Faculty ; Mentors ; Communicable Diseases
Language	English
Publishing date	2023-10-09
Publishing country	England
Document type	Review ; Journal Article
ZDB-ID	2668791-4
ISSN	2048-7207 ; 2048-7193
ISSN (online)	2048-7207
ISSN	2048-7193
DOI	10.1093/jpids/piad079
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Article ; Online: ACR Appropriateness Criteria® Central Venous Access Device and Site Selection.

Massouh, Alan / Kwan, Sharon W / Fidelman, Nicholas / Higgins, Mikhail / Abujudeh, Hani / Charalel, Resmi A / Guimaraes, Marcelo S / Gupta, Amit / Lam, Alexander / Majdalany, Bill S / Patel, Parag J / Stadtlander, Kevin S / Stillwell, Terri / Teo, Elrond Y L / Tong, Ricky T / Kapoor, Baljendra S

Journal of the American College of Radiology : JACR

2023 Volume 20, Issue 5S, Page(s) S3–S19

Abstract: The use of central venous access devices is ubiquitous in both inpatient and outpatient settings, whether for critical care, oncology, hemodialysis, parenteral nutrition, or diagnostic purposes. Radiology has a well-established role in the placement of ... ...

Abstract	The use of central venous access devices is ubiquitous in both inpatient and outpatient settings, whether for critical care, oncology, hemodialysis, parenteral nutrition, or diagnostic purposes. Radiology has a well-established role in the placement of these devices due to demonstrated benefits of radiologic placement in multiple clinical settings. A wide variety of devices are available for central venous access and optimal device selection is a common clinical challenge. Central venous access devices may be nontunneled, tunneled, or implantable. They may be centrally or peripherally inserted by way of veins in the neck, extremities, or elsewhere. Each device and access site presents specific risks that should be considered in each clinical scenario to minimize the risk of harm. The risk of infection and mechanical injury should be minimized in all patients. In hemodialysis patients, preservation of future access is an additional important consideration. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
MeSH term(s)	Humans ; United States ; Societies, Medical ; Evidence-Based Medicine ; Extremities ; Diagnostic Imaging/methods ; Radiology
Language	English
Publishing date	2023-02-24
Publishing country	United States
Document type	Practice Guideline ; Journal Article
ZDB-ID	2274861-1
ISSN	1558-349X ; 1546-1440
ISSN (online)	1558-349X
ISSN	1546-1440
DOI	10.1016/j.jacr.2023.02.021
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Article ; Online: Not just vegetations: focal myocardial changes in patients with fungal infections.

Cresalia, Nicole M / Owens, Sonal T / Stillwell, Terri L / Norris, Mark D / Yu, Sunkyung / Retzloff, Lauren / Ensing, Gregory J

Cardiology in the young

2020 Volume 31, Issue 2, Page(s) 199–204

Abstract: Background: Fungal endocarditis classically involves dense heterogenous vegetations. However, several patients with fungal infections were noted to have myocardial changes ranging from focal brightening to nodular thickening of chordae or papillary ... ...

Abstract	Background: Fungal endocarditis classically involves dense heterogenous vegetations. However, several patients with fungal infections were noted to have myocardial changes ranging from focal brightening to nodular thickening of chordae or papillary muscles. This study evaluates whether these findings are associated with fungal infections. Methods: In a retrospective case-control study, paediatric inpatients with fungal infections (positive blood, urine, or catheter tip culture) in a 5-year period were matched 1:1 to inpatients without positive fungal cultures. Echocardiograms were scored on a 5-point scale by two independent readers for presence of myocardial brightenings, nodular thickenings, and vegetations. Clinical data were compared. Results: Of 67 fungal cases, positive culture sites included blood (n = 44), vascular catheter tip (n = 7), and urine (n = 29); several had multiple positive sites. "Positive" echo findings (score ≥ 2+) were more frequent in the Fungal Group (33 versus 18%, p = 0.04). Fungal Group patients with "positive" versus "negative" echo findings had similar proportion of bacterial infections. Among fungal cases, those with "positive" echo findings had longer hospital length of stay than cases with "negative" echos (median 58 versus 40 days, p = 0.03) but no difference in intensive care unit admission, extracorporeal membranous oxygenation support, or mortality. Conclusions: Myocardial and papillary muscle brightening with nodular thickening on echocardiogram appear to be associated with fungal infections. There may be prognostic implications of these findings as patients with "positive" echo have longer length of stay. Further studies are needed to better understand the mechanism and temporal progression of these changes and determine the prognostic value of this scoring system.
MeSH term(s)	Case-Control Studies ; Child ; Endocarditis/diagnosis ; Heart Valve Diseases ; Humans ; Mycoses/diagnosis ; Retrospective Studies
Language	English
Publishing date	2020-11-13
Publishing country	England
Document type	Journal Article
ZDB-ID	1078466-4
ISSN	1467-1107 ; 1047-9511
ISSN (online)	1467-1107
ISSN	1047-9511
DOI	10.1017/S1047951120003674
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Article ; Online: Neonatal Adenovirus Infection Complicated by Hemophagocytic Lymphohistiocytosis Syndrome.

Censoplano, Nina / Gorga, Stephen / Waldeck, Kate / Stillwell, Terri / Rabah-Hammad, Raja / Flori, Heidi

Pediatrics

2018 Volume 141, Issue Suppl 5, Page(s) S475–S480

Abstract: Two infants with disseminated adenoviral infections are described. Both these infants had a similar clinical course and were also diagnosed with secondary hemophagocytic lymphohistiocytosis (HLH). Previous reports of immunocompromised adults with ... ...

Abstract	Two infants with disseminated adenoviral infections are described. Both these infants had a similar clinical course and were also diagnosed with secondary hemophagocytic lymphohistiocytosis (HLH). Previous reports of immunocompromised adults with adenovirus-associated HLH are in the literature; however, this is the first report that we are aware of with this pathology occurring in infants. These cases are used to demonstrate the importance of thinking about HLH in patients who are diagnosed with adenovirus and exhibit prolonged fevers that are unresponsive to antimicrobial agents with hepatosplenomegaly and cytopenias.
MeSH term(s)	Adenoviridae Infections/complications ; Adenoviridae Infections/diagnosis ; Adenoviridae Infections/drug therapy ; Adenoviridae Infections/immunology ; Antiviral Agents/therapeutic use ; Cidofovir/therapeutic use ; Dexamethasone/analogs & derivatives ; Dexamethasone/therapeutic use ; Female ; Glucocorticoids/therapeutic use ; Humans ; Immunocompromised Host ; Infant, Newborn ; Lymphohistiocytosis, Hemophagocytic/complications ; Lymphohistiocytosis, Hemophagocytic/diagnosis ; Lymphohistiocytosis, Hemophagocytic/drug therapy ; Lymphohistiocytosis, Hemophagocytic/immunology ; Methylprednisolone/therapeutic use ; Mucocutaneous Lymph Node Syndrome/complications ; Mucocutaneous Lymph Node Syndrome/diagnosis ; Mucocutaneous Lymph Node Syndrome/drug therapy ; Mucocutaneous Lymph Node Syndrome/immunology
Chemical Substances	Antiviral Agents ; Glucocorticoids ; dexamethasone 21-phosphate (2BP70L44PR) ; Dexamethasone (7S5I7G3JQL) ; Cidofovir (JIL713Q00N) ; Methylprednisolone (X4W7ZR7023)
Language	English
Publishing date	2018-03-13
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	207677-9
ISSN	1098-4275 ; 0031-4005
ISSN (online)	1098-4275
ISSN	0031-4005
DOI	10.1542/peds.2017-2061
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Article ; Online: What Transmission Precautions Best Control Influenza Spread in a Hospital?

Blanco, Natalia / Eisenberg, Marisa C / Stillwell, Terri / Foxman, Betsy

American journal of epidemiology

2016 Volume 183, Issue 11, Page(s) 1045–1054

Abstract: Influenza is a significant problem within hospitals, leading to extended hospital stays, excess morbidity and mortality, and economic loss. Prevention and control strategies are generally "bundled"; therefore, the individual effects of particular ... ...

Abstract	Influenza is a significant problem within hospitals, leading to extended hospital stays, excess morbidity and mortality, and economic loss. Prevention and control strategies are generally "bundled"; therefore, the individual effects of particular strategies and the value of combined strategies cannot be determined directly, making it difficult to discern the optimal strategy. To quantify the individual and joint effectiveness of several known influenza infection control measures used in general hospitals, we simulated influenza transmission at a hypothetical hospital in Ann Arbor, Michigan, during a 1-year seasonal epidemic (June 2012-June 2013), using a susceptible-exposed-infected-recovered (SEIR) compartmental model. The hospital population comprised patients and health-care workers, interacting with its larger community population. Parameter ranges and values were determined from the literature (both national and local to Ann Arbor) and took into account coverage levels and effects of vaccination. The most effective individual strategies, based on percent reduction of cases, were: hand-washing (11%-27%), health-care worker vaccination (6%-19%), prevaccination of patients (4%-17%), patient isolation (5%-16%), antiviral treatment (4%-14%), and use of face masks (3%-10%). Use of all strategies together with ideal levels of compliance could potentially halve the number of observed hospital cases of influenza; under a more realistic scenario, an almost 40% reduction could be achieved. A multifaceted approach is imperative to control and prevent nosocomial influenza in health-care settings.
MeSH term(s)	Antiviral Agents/administration & dosage ; Computer Simulation ; Cross Infection/prevention & control ; Disease Outbreaks/prevention & control ; Hand Disinfection ; Health Personnel ; Humans ; Infection Control/methods ; Infection Control/organization & administration ; Influenza Vaccines/administration & dosage ; Influenza, Human/prevention & control ; Influenza, Human/transmission ; Masks/utilization ; Michigan ; Models, Theoretical ; Patient Isolation/organization & administration ; Patients
Chemical Substances	Antiviral Agents ; Influenza Vaccines
Language	English
Publishing date	2016-06-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	2937-3
ISSN	1476-6256 ; 0002-9262
ISSN (online)	1476-6256
ISSN	0002-9262
DOI	10.1093/aje/kwv293
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Article ; Online: A multi-disciplinary, comprehensive approach to management of children with heterotaxy.

Saba, Thomas G / Geddes, Gabrielle C / Ware, Stephanie M / Schidlow, David N / Del Nido, Pedro J / Rubalcava, Nathan S / Gadepalli, Samir K / Stillwell, Terri / Griffiths, Anne / Bennett Murphy, Laura M / Barber, Andrew T / Leigh, Margaret W / Sabin, Necia / Shapiro, Adam J

Orphanet journal of rare diseases

2022 Volume 17, Issue 1, Page(s) 351

Abstract: Heterotaxy (HTX) is a rare condition of abnormal thoraco-abdominal organ arrangement across the left-right axis of the body. The pathogenesis of HTX includes a derangement of the complex signaling at the left-right organizer early in embryogenesis ... ...

Abstract	Heterotaxy (HTX) is a rare condition of abnormal thoraco-abdominal organ arrangement across the left-right axis of the body. The pathogenesis of HTX includes a derangement of the complex signaling at the left-right organizer early in embryogenesis involving motile and non-motile cilia. It can be inherited as a single-gene disorder, a phenotypic feature of a known genetic syndrome or without any clear genetic etiology. Most patients with HTX have complex cardiovascular malformations requiring surgical intervention. Surgical risks are relatively high due to several serious comorbidities often seen in patients with HTX. Asplenia or functional hyposplenism significantly increase the risk for sepsis and therefore require antimicrobial prophylaxis and immediate medical attention with fever. Intestinal rotation abnormalities are common among patients with HTX, although volvulus is rare and surgical correction carries substantial risk. While routine screening for intestinal malrotation is not recommended, providers and families should promptly address symptoms concerning for volvulus and biliary atresia, another serious morbidity more common among patients with HTX. Many patients with HTX have chronic lung disease and should be screened for primary ciliary dyskinesia, a condition of respiratory cilia impairment leading to bronchiectasis. Mental health and neurodevelopmental conditions need to be carefully considered among this population of patients living with a substantial medical burden. Optimal care of children with HTX requires a cohesive team of primary care providers and experienced subspecialists collaborating to provide compassionate, standardized and evidence-based care. In this statement, subspecialty experts experienced in HTX care and research collaborated to provide expert- and evidence-based suggestions addressing the numerous medical issues affecting children living with HTX.
MeSH term(s)	Anti-Bacterial Agents ; Bronchiectasis ; Child ; Humans ; Intestinal Volvulus
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2022-09-09
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2225857-7
ISSN	1750-1172 ; 1750-1172
ISSN (online)	1750-1172
ISSN	1750-1172
DOI	10.1186/s13023-022-02515-2
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Article ; Online: In Vitro

Caverly, Lindsay J / Spilker, Theodore / Kalikin, Linda M / Stillwell, Terri / Young, Carol / Huang, David B / LiPuma, John J

Antimicrobial agents and chemotherapy

2019 Volume 64, Issue 1

Abstract: We tested ... ...

Abstract	We tested the
MeSH term(s)	Achromobacter/drug effects ; Anti-Bacterial Agents/pharmacology ; Boronic Acids/pharmacology ; Burkholderia/drug effects ; Cystic Fibrosis/microbiology ; Humans ; Meropenem/pharmacology ; Microbial Sensitivity Tests ; Piperacillin/pharmacology ; Pseudomonas aeruginosa/drug effects ; Stenotrophomonas/drug effects ; Stenotrophomonas maltophilia/drug effects ; Tazobactam/pharmacology ; beta-Lactamase Inhibitors/pharmacology
Chemical Substances	Anti-Bacterial Agents ; Boronic Acids ; beta-Lactamase Inhibitors ; vaborbactam (1C75676F8V) ; Meropenem (FV9J3JU8B1) ; Tazobactam (SE10G96M8W) ; Piperacillin (X00B0D5O0E)
Language	English
Publishing date	2019-12-20
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	217602-6
ISSN	1098-6596 ; 0066-4804
ISSN (online)	1098-6596
ISSN	0066-4804
DOI	10.1128/AAC.01595-19
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Article ; Online: Enterovirus D68 infection induces IL-17-dependent neutrophilic airway inflammation and hyperresponsiveness.

Rajput, Charu / Han, Mingyuan / Bentley, J Kelley / Lei, Jing / Ishikawa, Tomoko / Wu, Qian / Hinde, Joanna L / Callear, Amy P / Stillwell, Terri L / Jackson, William T / Martin, Emily T / Hershenson, Marc B

JCI insight

2018 Volume 3, Issue 16

Abstract: Enterovirus D68 (EV-D68) shares biologic features with rhinovirus (RV). In 2014, a nationwide outbreak of EV-D68 was associated with severe asthma-like symptoms. We sought to develop a mouse model of EV-D68 infection and determine the mechanisms ... ...

Abstract	Enterovirus D68 (EV-D68) shares biologic features with rhinovirus (RV). In 2014, a nationwide outbreak of EV-D68 was associated with severe asthma-like symptoms. We sought to develop a mouse model of EV-D68 infection and determine the mechanisms underlying airway disease. BALB/c mice were inoculated intranasally with EV-D68 (2014 isolate), RV-A1B, or sham, alone or in combination with anti-IL-17A or house dust mite (HDM) treatment. Like RV-A1B, lung EV-D68 viral RNA peaked 12 hours after infection. EV-D68 induced airway inflammation, expression of cytokines (TNF-α, IL-6, IL-12b, IL-17A, CXCL1, CXCL2, CXCL10, and CCL2), and airway hyperresponsiveness, which were suppressed by anti-IL-17A antibody. Neutrophilic inflammation and airway responsiveness were significantly higher after EV-D68 compared with RV-A1B infection. Flow cytometry showed increased lineage-, NKp46-, RORγt+ IL-17+ILC3s and γδ T cells in the lungs of EV-D68-treated mice compared with those in RV-treated mice. EV-D68 infection of HDM-exposed mice induced additive or synergistic increases in BAL neutrophils and eosinophils and expression of IL-17, CCL11, IL-5, and Muc5AC. Finally, patients from the 2014 epidemic period with EV-D68 showed significantly higher nasopharyngeal IL-17 mRNA levels compared with patients with RV-A infection. EV-D68 infection induces IL-17-dependent airway inflammation and hyperresponsiveness, which is greater than that generated by RV-A1B, consistent with the clinical picture of severe asthma-like symptoms.
MeSH term(s)	Allergens/administration & dosage ; Allergens/immunology ; Animals ; Asthma/immunology ; Asthma/pathology ; Asthma/virology ; Bronchoalveolar Lavage Fluid/cytology ; Bronchoalveolar Lavage Fluid/immunology ; Cell Line, Tumor ; Child ; Child, Preschool ; Disease Models, Animal ; Enterovirus/immunology ; Enterovirus/isolation & purification ; Enterovirus D, Human/immunology ; Enterovirus D, Human/isolation & purification ; Enterovirus Infections/immunology ; Enterovirus Infections/pathology ; Enterovirus Infections/virology ; Female ; Humans ; Infant ; Infant, Newborn ; Interleukin-17/antagonists & inhibitors ; Interleukin-17/genetics ; Interleukin-17/immunology ; Interleukin-17/metabolism ; Lung/cytology ; Lung/pathology ; Male ; Mice ; Nasopharynx/immunology ; Nasopharynx/pathology ; Nasopharynx/virology ; Neutrophils/drug effects ; Neutrophils/immunology ; Neutrophils/metabolism ; Pyroglyphidae/immunology ; RNA, Messenger/metabolism
Chemical Substances	Allergens ; IL17A protein, human ; Il17a protein, mouse ; Interleukin-17 ; RNA, Messenger
Language	English
Publishing date	2018-08-23
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ISSN	2379-3708
ISSN (online)	2379-3708
DOI	10.1172/jci.insight.121882
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Article ; Online: Outbreak of KPC-3 Producing Carbapenem-Resistant Klebsiella pneumoniae in a US Pediatric Hospital.

Stillwell, Terri / Green, Michael / Barbadora, Karen / Ferrelli, Juliet G / Roberts, Terri L / Weissman, Scott J / Nowalk, Andrew

Journal of the Pediatric Infectious Diseases Society

2015 Volume 4, Issue 4, Page(s) 330–338

Abstract: Background: The increase in carbapenem-resistant Enterobacteriaceae (CRE) infections is a critical public health issue. We recently experienced the largest single-center pediatric outbreak of carbapenem-resistant Klebsiella pneumoniae (CRKP) at our ... ...

Abstract	Background: The increase in carbapenem-resistant Enterobacteriaceae (CRE) infections is a critical public health issue. We recently experienced the largest single-center pediatric outbreak of carbapenem-resistant Klebsiella pneumoniae (CRKP) at our hospital. The objective of this study was to describe the molecular epidemiology of this outbreak before and after infection-prevention interventions. Methods: All positive cultures and associated clinical conditions were reviewed to determine whether health care-associated infections (HAIs) exist. HAIs were defined using Centers for Disease Control and Prevention guidelines. CRKP isolates were collected and screened for the presence of β-lactamase genes. Strain relatedness of CRKP isolates was determined by field-inversion gel electrophoresis (FIGE) and multilocus sequence typing (MLST). Polymerase chain reaction (PCR) amplification and sequencing of blaTEM, blaSHV, and blaKPC genes were performed on representative isolates. Results: During March-July 2010, 18 CRKP isolates were recovered from 15 unique patients. Six isolates were considered HAIs; all were central-line-associated bloodstream infections. All isolates testing positive by PCR for blaKPC were found to carry KPC-3 in transposon Tn4401 isotype "b." FIGE revealed 2 prevalent patterns (accounting for 10 and 3 CRKP isolates, respectively) that MLST demonstrated to consist entirely of strains from ST730; the remaining FIGE types corresponded to ST14, ST15, and ST1559 (a single-locus variant of ST730), with these alternate backgrounds appearing later in the outbreak. New CRKP cases decreased after the implementation of infection-control interventions. All isolates were ciprofloxacin sensitive. Conclusions: Molecular analyses document the introduction of a KPC-3-producing CRKP clone into our hospital setting, though some isolates appear to have other mechanisms of carbapenem resistance. The transition to a polyclonal epidemiology suggests that the initial outbreak was due to nosocomial spread of a single ST730 clone, while latter isolates may have been secondary to the introduction of a blaKPC-3/Tn4401 isotype "b"-containing plasmid into other K pneumoniae strain backgrounds versus new carbapenemase-producing bacteria.
MeSH term(s)	Adolescent ; Anti-Bacterial Agents/pharmacology ; Carbapenems/pharmacology ; Child ; Child, Preschool ; Cross Infection/epidemiology ; Disease Outbreaks ; Drug Resistance, Bacterial ; Female ; Hospitals, Pediatric ; Humans ; Infant ; Klebsiella Infections/drug therapy ; Klebsiella Infections/epidemiology ; Klebsiella pneumoniae/classification ; Klebsiella pneumoniae/drug effects ; Male ; Multilocus Sequence Typing ; Polymerase Chain Reaction ; United States ; beta-Lactamases
Chemical Substances	Anti-Bacterial Agents ; Carbapenems ; beta-Lactamases (EC 3.5.2.6)
Language	English
Publishing date	2015-12
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/piu080
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