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Article ; Online: Cytomegalovirus Cell-mediated Immunity Assays in Pediatric Transplantation.

Otto, William R / Vora, Surabhi B / Dulek, Daniel E

Journal of the Pediatric Infectious Diseases Society

2024 Volume 13, Issue Supplement_1, Page(s) S22–S30

Abstract: Cytomegalovirus (CMV) is a significant cause of morbidity and mortality in pediatric transplantation. However, currently utilized CMV prevention paradigms have limitations, leading to research aimed at novel strategies for mitigation of CMV infection. ... ...

Abstract	Cytomegalovirus (CMV) is a significant cause of morbidity and mortality in pediatric transplantation. However, currently utilized CMV prevention paradigms have limitations, leading to research aimed at novel strategies for mitigation of CMV infection. Cell-mediated immunity (CMI) is crucial in controlling CMV infection and the use of CMV-specific CMI assays to guide prevention and treatment of CMV infection in both solid organ transplant and hematopoietic cell transplant recipients shows great promise. In this article, we review the immune response to CMV infection to highlight the rationale for CMI assays, describe available commercial assays and strategies for their use, and summarize relevant literature regarding the use of CMI assays in transplant recipients.
MeSH term(s)	Humans ; Child ; Cytomegalovirus ; Hematopoietic Stem Cell Transplantation/adverse effects ; Cytomegalovirus Infections ; Organ Transplantation ; Immunity, Cellular ; Antiviral Agents/therapeutic use
Chemical Substances	Antiviral Agents
Language	English
Publishing date	2024-02-28
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/piae005
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Article ; Online: The Impact of an Emergency Department Bruising Pathway on Disparities in Child Abuse Evaluation.

Crumm, Caitlin E / Brown, Emily C B / Vora, Surabhi B / Lowry, Sarah / Schlatter, Adrienne / Rutman, Lori E

Pediatric emergency care

2023 Volume 39, Issue 8, Page(s) 580–585

Abstract: Objectives: Previous research has shown racial, ethnic, and socioeconomic disparities in provider medical evaluations and reporting to child protective services (CPS) and law enforcement (LE) for cases of suspected child physical abuse. Our hospital ... ...

Abstract	Objectives: Previous research has shown racial, ethnic, and socioeconomic disparities in provider medical evaluations and reporting to child protective services (CPS) and law enforcement (LE) for cases of suspected child physical abuse. Our hospital standardized evaluation and reporting of high-risk bruising using a clinical pathway. We aimed to assess whether standardization impacted disparity. Methods: We performed a retrospective observational study including children evaluated in the emergency department who had a social work consult for concern for child abuse or neglect between June 2012 and December 2019. From this group, we identified children with high-risk bruising. We compared outcomes (receipt of skeletal survey, CPS report, or LE report) before and after implementation of a standard bruising evaluation pathway to determine how the intervention changed practice among various racial, ethnic, and socioeconomic groups. Results: During the study period, 2129 children presented to the ED and received a social work consult for child abuse or neglect. Of these, 333 had high-risk bruising. Children without private insurance had a higher risk of having a CPS (adjusted relative risk, 1.32; 95% confidence interval, 1.09-1.60) or LE (adjusted relative risk, 1.48; 95% confidence interval, 1.11-1.97) report prepathway, but not after pathway implementation. No significant associations were seen for race or ethnicity. Conclusions: A standardized clinical pathway for identification and evaluation of high-risk bruising may help to decrease socioeconomic disparities in reporting high-risk bruising. Larger studies are needed to fully evaluate disparities in assessment and reporting of child abuse.
MeSH term(s)	Child ; Humans ; Child Abuse/diagnosis ; Contusions/diagnosis ; Emergency Service, Hospital ; Risk ; Social Work
Language	English
Publishing date	2023-07-01
Publishing country	United States
Document type	Observational Study ; Journal Article
ZDB-ID	632588-9
ISSN	1535-1815 ; 0749-5161
ISSN (online)	1535-1815
ISSN	0749-5161
DOI	10.1097/PEC.0000000000002998
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Zs.A 2083: Show issues

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Article ; Online: Neonatal Herpes Simplex Virus Infection: Epidemiology and Outcomes in the Modern Era.

Melvin, Ann J / Mohan, Kathleen M / Vora, Surabhi B / Selke, Stacy / Sullivan, Erin / Wald, Anna

Journal of the Pediatric Infectious Diseases Society

2021 Volume 11, Issue 3, Page(s) 94–101

Abstract: Background: Over the past several decades, there have been advances in diagnosis and treatment of neonatal herpes simplex virus (HSV) disease. There has been no recent comprehensive evaluation of the impact of these advances on the management and ... ...

Abstract	Background: Over the past several decades, there have been advances in diagnosis and treatment of neonatal herpes simplex virus (HSV) disease. There has been no recent comprehensive evaluation of the impact of these advances on the management and outcomes for neonates with HSV. Methods: Clinical data for initial presentation, treatment, and outcomes were abstracted from medical records of neonates with HSV treated at Seattle Children's Hospital between 1980 and 2016. Results: One hundred thirty infants with a diagnosis of neonatal HSV were identified. Between 1980 and 2016, high-dose acyclovir treatment for neonatal HSV infection increased from 0% to close to 95%, with subsequent decrease in overall HSV-related mortality from 20.9% to 5.6%. However, even among infants treated with high-dose acyclovir, mortality was 40.9% for infants with disseminated (DIS) disease, and only 55% of infants with central nervous system (CNS) disease were without obvious neurologic abnormalities at 24 months. Over the study period, the time between initial symptoms and diagnosis decreased. Skin recurrences were more common with HSV-2 than HSV-1 (80% vs 55%; P = .02) and in infants with lesions at initial diagnosis (76% vs 47%; P = .02). Conclusion: Changes in the standard of care for management of neonatal HSV disease have led to improvements in timeliness of diagnosis and outcome but mortality in infants with DIS disease and neurologic morbidity in infants with CNS disease remain high. Future research should focus on prevention of perinatal infection and subsequent recurrences.
MeSH term(s)	Acyclovir/therapeutic use ; Antiviral Agents/therapeutic use ; Child ; Female ; Herpes Simplex/diagnosis ; Herpes Simplex/drug therapy ; Herpes Simplex/epidemiology ; Humans ; Infant ; Infant, Newborn ; Pregnancy ; Pregnancy Complications, Infectious/diagnosis ; Pregnancy Complications, Infectious/drug therapy ; Pregnancy Complications, Infectious/epidemiology
Chemical Substances	Antiviral Agents ; Acyclovir (X4HES1O11F)
Language	English
Publishing date	2021-12-10
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/piab105
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Article ; Online: Monoclonal Antibody and Antiviral Therapy for Mild-to-Moderate COVID-19 in Pediatric Patients.

Vora, Surabhi B / Englund, Janet A / Trehan, Indi / Waghmare, Alpana / Kong, Ada / Adler, Amanda / Zerr, Danielle M

The Pediatric infectious disease journal

2022 Volume 42, Issue 1, Page(s) 32–34

Abstract: Multiple antiviral and monoclonal antibody therapies are now available for mild-moderate COVID-19 in high-risk patients ≥12 years of age. However, data for the use of these agents in children is limited. We reviewed 94 pediatric patients for whom early ... ...

Abstract	Multiple antiviral and monoclonal antibody therapies are now available for mild-moderate COVID-19 in high-risk patients ≥12 years of age. However, data for the use of these agents in children is limited. We reviewed 94 pediatric patients for whom early therapy was requested since the emergence of the Omicron variant and describe patient characteristics, treatment logistics and associated short-term events.
MeSH term(s)	Child ; Humans ; Antibodies, Monoclonal/therapeutic use ; Antiviral Agents/therapeutic use ; COVID-19 ; SARS-CoV-2
Chemical Substances	Antibodies, Monoclonal ; Antiviral Agents
Language	English
Publishing date	2022-10-21
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.0000000000003740
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Zs.A 1852: Show issues

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Article ; Online: Improving Care for Children with Bloody Diarrhea at Risk for Hemolytic Uremic Syndrome.

Burns, Carson S / Rubin, Jason / Sardesai, Tara / Klein, Eileen J / Vora, Surabhi B / Kearney, Ryan / Rutman, Lori

Pediatric quality & safety

2022 Volume 7, Issue 1, Page(s) e517

Abstract: Introduction: Children with infectious bloody diarrhea are at an increased risk for developing hemolytic uremic syndrome (HUS). Early intervention may improve outcomes. This study evaluated the impact of a clinical pathway designed to identify those at ... ...

Abstract	Introduction: Children with infectious bloody diarrhea are at an increased risk for developing hemolytic uremic syndrome (HUS). Early intervention may improve outcomes. This study evaluated the impact of a clinical pathway designed to identify those at risk for HUS, guide initial management, and provide decision support regarding patient disposition. Methods: We performed a retrospective cohort study of children 4 months to 19 years of age who presented with the acute onset of bloody diarrhea or other HUS risk factors to the pediatric emergency department (ED) from September 2015 through July 2020. A rapid stool polymerase chain reaction (PCR) test became available in May 2017. The clinical pathway was implemented in January 2018. We used Fisher's exact tests and statistical process control charts to analyze patient- and system-level changes following pathway implementation. Results: Three hundred five patients were included. Postimplementation, stool PCR use increased (78%-91%), hospitalization decreased (49%-30%), and mean total charges decreased ($7715-$6797). There were increases in length of stay (226-288 minutes) and charges ($2651-$3524) for patients discharged from the ED. All changes met rules for special cause variation. There was no change in early IV fluid administration, inpatient length of stay, ED return visits, hospital readmissions, or patients with Shiga toxin-producing Conclusions: For children presenting to the ED with bloody diarrhea, introduction of a rapid stool PCR test and clinical pathway correlated with decreased hospitalizations and overall costs without adverse clinical outcomes.
Language	English
Publishing date	2022-01-21
Publishing country	United States
Document type	Journal Article
ISSN	2472-0054
ISSN (online)	2472-0054
DOI	10.1097/pq9.0000000000000517
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Article ; Online: Cytomegalovirus in immunocompromised children.

Vora, Surabhi B / Englund, Janet A

Current opinion in infectious diseases

2015 Volume 28, Issue 4, Page(s) 323–329

Abstract: Purpose of review: The purpose of this study is to explore the latest developments in the risk factors, prevention and treatment of cytomegalovirus (CMV) infection in immunocompromised children, including those with congenital immunodeficiency or ... ...

Abstract	Purpose of review: The purpose of this study is to explore the latest developments in the risk factors, prevention and treatment of cytomegalovirus (CMV) infection in immunocompromised children, including those with congenital immunodeficiency or iatrogenic immune suppression related to solid organ transplantation (SOT) or haematopoietic cell transplantation (HCT). Recent findings: CMV viral load measurements now have international standards, allowing for more reliable comparison across sites and within individuals. Preemptive and prophylactic therapy with routine CMV monitoring in transplant patients has yielded significant reduction in CMV morbidity and mortality in these patients. The majority of U.S. states have adopted routine newborn screening for severe combined immunodeficiency (SCID). Viral infections, including CMV, are a major obstacle preventing optimal curative transplantation in these patients. Several new antiviral agents are currently being investigated for CMV infection in immunocompromised patients. Knowledge on CMV drug resistance in children is emerging and requires further study. Summary: Conditions that diminish cell-mediated immunity impact the development of CMV infection and disease. These conditions include certain congenital immunodeficiencies and SOT and HCT. Infants identified as having SCID should be screened for CMV risk factors. A preemptive or prophylactic strategy should be chosen for CMV management in children who are high risk posttransplantation. In those who develop disease, viral loads should be monitored and resistance testing considered if response is not deemed adequate. Oral valganciclovir is being used as an alternative to ganciclovir in children, although pharmacokinetic data are limited. Other oral antiviral agents under development are promising future options for paediatric CMV therapy.
MeSH term(s)	Adolescent ; Antiviral Agents/therapeutic use ; Chemoprevention/methods ; Child ; Child, Preschool ; Cytomegalovirus Infections/diagnosis ; Cytomegalovirus Infections/epidemiology ; Humans ; Immunocompromised Host ; Infant ; Infant, Newborn ; Risk Factors ; Viral Load/methods ; Viral Load/standards
Chemical Substances	Antiviral Agents
Language	English
Publishing date	2015-08
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	645085-4
ISSN	1473-6527 ; 1535-3877 ; 0951-7375 ; 1355-834X
ISSN (online)	1473-6527 ; 1535-3877
ISSN	0951-7375 ; 1355-834X
DOI	10.1097/QCO.0000000000000174
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Zs.A 2462: Show issues

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bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
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ab Jg. 2022: Lesesaal (EG)

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Article ; Online: Adverse pregnancy outcomes after in vitro fertilization due to undiagnosed urogenital tuberculosis and proposed screening algorithm for patients from tuberculosis-endemic countries.

McLaughlin, Stephanie E / Vora, Surabhi B / Church, E Chandler / Spitters, Christopher / Thyer, Angela / LaCourse, Sylvia / Herndon, Christopher N

F&S reports

2022 Volume 3, Issue 3, Page(s) 285–291

Abstract: Objective: To report 2 cases of adverse pregnancy outcomes due to delayed diagnosis of urogenital tuberculosis and propose a screening algorithm for patients from tuberculosis-endemic countries.: Design: Case report.: Setting: Academic medical ... ...

Abstract	Objective: To report 2 cases of adverse pregnancy outcomes due to delayed diagnosis of urogenital tuberculosis and propose a screening algorithm for patients from tuberculosis-endemic countries. Design: Case report. Setting: Academic medical center. Patients: Two patients with delayed diagnosis of urogenital tuberculosis leading to a fetal loss and a preterm delivery of an infant with congenital tuberculosis. Interventions: Endometrial biopsy, acid-fast bacilli culture of urine, and endometrium. Main outcome measures: Pregnancy outcomes. Results: Fetal loss at 19 weeks and preterm delivery of an infant with congenital tuberculosis before urogenital tuberculosis treatment. Conclusions: Patients who are at risk of urogenital tuberculosis should be screened in advance of infertility treatment to potentially prevent adverse pregnancy outcomes.
Language	English
Publishing date	2022-08-05
Publishing country	United States
Document type	Journal Article
ISSN	2666-3341
ISSN (online)	2666-3341
DOI	10.1016/j.xfre.2022.07.008
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Article: Infectious Complications Following CD19 Chimeric Antigen Receptor T-cell Therapy for Children, Adolescents, and Young Adults.

Vora, Surabhi B / Waghmare, Alpana / Englund, Janet A / Qu, Pingping / Gardner, Rebecca A / Hill, Joshua A

Open forum infectious diseases

2020 Volume 7, Issue 5, Page(s) ofaa121

Abstract: Background: Infectious complications of chimeric antigen receptor (CAR) T-cell immunotherapy in children and young adults have not been well described.: Methods: Medical records of patients ≤26 years old receiving CD19 CAR T-cell infusion (CTI) at a ... ...

Abstract	Background: Infectious complications of chimeric antigen receptor (CAR) T-cell immunotherapy in children and young adults have not been well described. Methods: Medical records of patients ≤26 years old receiving CD19 CAR T-cell infusion (CTI) at a single institution between 2014 and 2017 were reviewed. The number of infections per 100 days-at-risk (infection density) in the 90 days preceding and 0-28 and 29-90 days after CTI was calculated. Poisson regression and Cox analyses were utilized to identify risk factors for infections. Results: Eighty-three patients received CTI during the study period. Most patients (98%) had refractory or relapsed acute lymphoblastic leukemia (ALL). Infections occurred in 54% of patients in the 90 days before CTI (infection density, 1.23) and in 40% of patients in the first 28 days following CTI (infection density, 2.89). Infection density decreased to 0.55 in the 29-90 days post-CTI. Most infections were bacteremias (39%) or respiratory viral infections (43%). Pre-CTI risk factors associated with infection included prior hematopoietic cell transplantation (HCT), immunoglobulin G (IgG) level <400 mg/dL, and lymphodepletion other than cyclophosphamide plus fludarabine; post-CTI risk factors included higher-severity CRS and IgG <400 mg/dL. Conclusions: Infection rates in children and young adults receiving CD19 CAR T-cell therapy increase in the first month and then decline. Understanding types and timing of infections and contributing risk factors may help inform prophylactic and monitoring strategies. Specific attention should be given to patients with prior HCT, severe hypogammaglobulinemia, and severe CRS.
Keywords	covid19
Language	English
Publishing date	2020-04-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	2757767-3
ISSN	2328-8957
ISSN	2328-8957
DOI	10.1093/ofid/ofaa121
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Article ; Online: Renal Toxicity in Pediatric Patients Receiving Cidofovir for the Treatment of Adenovirus Infection.

Vora, Surabhi B / Brothers, Adam W / Englund, Janet A

Journal of the Pediatric Infectious Diseases Society

2017 Volume 6, Issue 4, Page(s) 399–402

Abstract: Treatment options for adenovirus infection in immunocompromised children are limited. Nephrotoxicity has been associated with cidofovir use, but the rate of cidofovir-associated nephrotoxicity in pediatric patients is unclear. In a retrospective review ... ...

Abstract	Treatment options for adenovirus infection in immunocompromised children are limited. Nephrotoxicity has been associated with cidofovir use, but the rate of cidofovir-associated nephrotoxicity in pediatric patients is unclear. In a retrospective review of patients with adenovirus infection treated with cidofovir, neonates (n = 5) had higher viral loads and shorter times to renal insufficiency than older children (n = 24). Higher weekly doses of cidofovir were associated with greater increases in creatinine levels. Of 29 courses of cidofovir, 9 were complicated by acute kidney injury; in these children, mortality was high. Cidofovir dosing in children needs to be optimized, and other therapeutic alternatives should be developed.
MeSH term(s)	Acute Kidney Injury/chemically induced ; Adenovirus Infections, Human/drug therapy ; Adolescent ; Antiviral Agents/adverse effects ; Antiviral Agents/therapeutic use ; Child ; Child, Preschool ; Cytosine/adverse effects ; Cytosine/analogs & derivatives ; Cytosine/therapeutic use ; Humans ; Infant ; Infant, Newborn ; Organophosphonates/adverse effects ; Organophosphonates/therapeutic use ; Retrospective Studies ; Young Adult
Chemical Substances	Antiviral Agents ; Organophosphonates ; Cytosine (8J337D1HZY) ; cidofovir (JIL713Q00N)
Language	English
Publishing date	2017-11-24
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/pix011
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Article ; Online: Antiviral combination therapy for cytomegalovirus infection in high-risk infants.

Vora, Surabhi B / Brothers, Adam W / Waghmare, Alpana / Englund, Janet A

Antiviral therapy

2018 Volume 23, Issue 6, Page(s) 505–511

Abstract: Background: Cytomegalovirus (CMV) infection is a major risk factor for mortality in infants with severe combined immunodeficiency (SCID) and other profound immune defects. Specific antiviral therapy must be initiated early and aggressively because of ... ...

Abstract	Background: Cytomegalovirus (CMV) infection is a major risk factor for mortality in infants with severe combined immunodeficiency (SCID) and other profound immune defects. Specific antiviral therapy must be initiated early and aggressively because of the potential for antiviral resistance, rapid dissemination and poor transplant outcomes. Combination antiviral therapy is routinely administered for some viral infections, but the value of this approach for the treatment of CMV is unclear. Here we explore a strategy of initial combination therapy for high-risk infants with CMV infection. Methods: We reviewed medical records of infants ≤6 months of age hospitalized between 2007-2015 who received ganciclovir (GCV) or foscarnet (FOS) monotherapy or initial combination GCV + FOS for CMV disease. The combination therapy group consisted of severely immunocompromised infants being considered for haematopoietic cell transplantation (HCT). Results: Four patients received initial combination antiviral therapy and 26 patients received initial monotherapy during the study period. Combination antiviral recipients demonstrated initial improvement in viraemia and two of three who continued with this therapy survived the infection. Clinically significant resistance mutations did not emerge. Toxicity was common; neutropenia, thrombocytopenia and electrolyte abnormalities were the most frequent adverse events in both groups. Creatinine elevation was uncommon in both groups. Conclusions: Combination GCV + FOS therapy may be a safe alternative to monotherapy in high-risk infants, especially those who are pre-transplant with primary immune deficiency syndromes and high viral loads.
MeSH term(s)	Antiviral Agents/therapeutic use ; Cytomegalovirus/drug effects ; Cytomegalovirus/immunology ; Cytomegalovirus/pathogenicity ; Cytomegalovirus Infections/drug therapy ; Cytomegalovirus Infections/immunology ; Cytomegalovirus Infections/mortality ; Cytomegalovirus Infections/virology ; Drug Therapy, Combination ; Female ; Foscarnet/therapeutic use ; Ganciclovir/therapeutic use ; Hematopoietic Stem Cell Transplantation ; Humans ; Immunocompromised Host ; Infant ; Infant, Newborn ; Male ; Retrospective Studies ; Risk Factors ; Severe Combined Immunodeficiency/immunology ; Severe Combined Immunodeficiency/mortality ; Severe Combined Immunodeficiency/therapy ; Severe Combined Immunodeficiency/virology ; Survival Analysis ; Viral Load/drug effects ; Viremia/drug therapy ; Viremia/immunology ; Viremia/mortality ; Viremia/virology
Chemical Substances	Antiviral Agents ; Foscarnet (364P9RVW4X) ; Ganciclovir (P9G3CKZ4P5)
Language	English
Publishing date	2018-05-22
Publishing country	England
Document type	Journal Article
ZDB-ID	1339842-8
ISSN	2040-2058 ; 1359-6535
ISSN (online)	2040-2058
ISSN	1359-6535
DOI	10.3851/IMP3238
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