P. Cariello

University of Utah

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Giorgio Emanuele Polistina

Ospedale Monaldi

M. Saporiti

Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda

Paola Castellotti

Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda

Antonio Del Giudice

Casa Sollievo della Sofferenza

Darcy Wooten

Washington University in St. Louis

Alice E Barsoumian

Joint Base San Antonio

Vera Luther

Wake Forest University

Beata Casańas

University of South Florida

José A. Serpa

The University of Texas at Tyler

Annunziata De Rosa

Ospedale D. Cotugno

Cooperative Institutions

University of Utah

Office of Infectious Diseases

Centers for Disease Control and Prevention

University of Naples Federico II

Universidade Federal do Rio de Janeiro

Cornell University

University of Washington

New York Proton Center

Communities In Schools of Orange County

Huntsman Cancer Institute

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Nocardia thyroiditis after allogeneic hematopoietic cell transplantation

Leukemia & lymphoma/Leukemia and lymphoma (2019)

James Dane Osborn P. Cariello Esteban Peña Catherine J. Lee

Nocardiosis is an uncommon opportunistic infection in patients who have undergone an allogeneic hematopoietic cell transplantation (allo-HCT). Primary pulmonary infection is the most common present...

10.1080/10428194.2019.1702181

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Citations (3)

1908. Development of an Electronic Health Record Generated Alert for Prophylaxis Against Pneumocystis Jirovecii Pneumonia in the Setting of High-Dose Steroids

Open Forum Infectious Diseases (2018)

Noopur Goyal Eric Gaskill Stephanie A. Sanders Kencee Graves Russell J Benefield

Pneumocystis jirovecii pneumonia (PJP) is an opportunistic infection associated with high dose steroid use in non-HIV patients. Many patients on high dose steroids (>20 mg prednisone equivalents for 28 days or longer), developed PJP within a month of steroid use. This study aims to develop an electronic alert for providers to consider PJP prophylaxis for patients discharged on high-dose steroids. Cases were obtained from the University of Utah Enterprise Data Warehouse between October 2014 and September 2017. A retrospective, manual chart review evaluated adults 18 years of age or older, with an inpatient PJP diagnosis made via direct fluorescent antibody or PCR. Patients with PJP due to HIV were excluded. Steroid dose and duration one month prior to diagnosis of PJP were evaluated. After retrospective analysis, via a multidisciplinary team, a best practice advisory (BPA) alert was created to flag providers to consider PJP prophylaxis at discharge, with consideration of creatinine levels and allergy profile to guide drug choices. The alert was trailed in a silent mode from January to April 2018 without provider notification so it could be modified to prevent inappropriate firing. The alert was approved for live use by the Clinical Decision Support Committee and is now active in the University of Utah Epic system as of April 10, 2018. In retrospective analysis, of 94 non-HIV patients diagnosed with PJP, 31/94 (33%) cases were in the setting of high dose steroids. 7/31 (23%) cases were exclusively with high dose steroids, while 24/31 (77%) cases were in combination with chemotherapy or other immune modulating agents. Data from the silent BPA from February to April 2018 demonstrated 23 cases triggered the alert, all of which were determined to be appropriate by chart review. Since live use, the BPA has fired 15 times, of which 14 cases met criteria for prophylaxis and 4/14 (29%) resulted in prophylaxis on discharge. Chart review identified high dose steroids as a target for a quality improvement intervention, which led to development of a BPA. Data indicates room for improvement on discharge with prophylaxis. Goals include reducing morbidity, mortality and cost associated with PJP, as well as educating providers regarding the need for prophylaxis. All authors: No reported disclosures.

Medical record

10.1093/ofid/ofy210.1564

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Novel coronavirus 2019 (COVID‐19): Emergence and implications for emergency care

Journal of the American College of Emergency Physicians Open (2020)

Jane Yee Lucy Unger Frank J. Zadravecz P. Cariello Allan Seibert

Abstract A novel coronavirus (COVID‐19) causing acute illness with severe symptoms has been isolated in Wuhan, Hubei Province, China. Since its emergence, cases have been found worldwide, reminiscent of severe acute respiratory syndrome and Middle East respiratory syndrome outbreaks over the past 2 decades. Current understanding of this epidemic remains limited due to its rapid development and available data. While occurrence outside mainland China remains low, the likelihood of increasing cases globally continues to rise. Given this potential, it is imperative that emergency clinicians understand the preliminary data behind the dynamics of this disease, recognize possible presentations of patients, and understand proposed treatment modalities.

Coronavirus

2019-20 coronavirus outbreak

Modalities

China mainland

Pandemic

10.1002/emp2.12034

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Citations (79)

Biliary Strongyloides stercoralis With Cholecystitis and Extensive Portal Vein Thrombosis

Open Forum Infectious Diseases (2017)

Laura Filkins David C. Gaston Blaine A. Mathison Timothy M. Smith Marc Roger Couturier

Abstract We report the rare finding of Strongyloides stercoralis rhabditiform larvae in biliary fluid, here associated with cholecystitis and near total portal vein thrombosis. The role of S. stercoralis leading to atypical clinical presentations and difficulty diagnosing strongyloidiasis in such patients with appropriate geographic exposure is discussed.

Strongyloides stercoralis

Portal vein thrombosis

Strongyloidiasis

10.1093/ofid/ofx217

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Citations (3)

SWITCHING ROLES: A RARE CASE OF MILIARY TB YEARS AFTER PULMONARY NTM DISEASE

CHEST Journal (2020)

Paola Castellotti M. Saporiti Maurizio Ferrarese Giorgio Emanuele Polistina P. Cariello

Rifabutin

Sputum culture

Productive Cough

10.1016/j.chest.2020.05.096

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PULMONARY TUBERCULOSIS PRE XDR AND LUNG CANCER: DOUBLE TROUBLE

CHEST Journal (2020)

Giorgio Emanuele Polistina P. Cariello Annunziata De Rosa Paola Castellotti M. Saporiti

10.1016/j.chest.2020.05.065

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Cavitary lung metastasis as relapse of prostate cancer

Respiratory Medicine Case Reports (2019)

Giorgio Emanuele Polistina Alessandro Matarese P. Cariello Danila Caroppo Alessandro Sanduzzi

Prostate cancer is the most common non-cutaneous malignancy diagnosed in men. It usually metastasizes to bone as osteoblastic lesions on radiographs and regional lymph nodes, and uncommonly to lung, liver and brain. Metastatic prostate cancer recurrence after definitive local therapy can occur in any tissue. The role of fine needle aspiration cytology (FNAC) for diagnosis of metastatic malignancies is well established in literature. We describe a 74 years old male, previously treated for localized prostate cancer, admitted to our Department after total body computed tomography revealed multiple irregular lung lesions some of which had an excavated appearance.

10.1016/j.rmcr.2019.100973

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Citations (6)

[Local use of hydrocortisone & neomycin in the prevention & therapy of fissures of the nipple].

PubMed (1957)

P. Cariello

Neomycin

Source

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2109. Liposomal Amphotericin B-associated Nephrotoxicity in Obese and Non-obese Patients

Open Forum Infectious Diseases (2019)

Brandon Tritle Л. С. Петерсон Jared Olson Emily C. Benefield P. Cariello

Abstract Background Liposomal amphotericin B (L-amb) is an important antifungal agent which exhibits significant rates of dose-dependent nephrotoxicity. Animal studies demonstrate only small amounts of L-amb distribute into adipose tissue and obese animals show greater risk of nephrotoxicity with L-amb administration. This study aims to determine whether obese patients are at a higher risk of nephrotoxicity with weight-based doses of L-amb. Methods We performed a multi-center, retrospective cohort study of nephrotoxicity with L-amb in obese (BMI > 30) and non-obese adult patients at University of Utah Health and Intermountain Healthcare from January 1, 2014 through December 31, 2018. Our primary outcome was the rate of nephrotoxicity as determined by AKIN criteria. Patients receiving at least one dose of L-amb were identified for inclusion. Patients were excluded if they were already on a renal replacement at the time of L-amb initiation or they received L-amb prior to admission. Results We included 221 patients, 47 (21%) were obese and 174 (79%) were non-obese. Median total body weight was 109 kg in obese patients compared with 70 kg in non-obese patients. Dosage based on ideal body weight was higher in the obese group (median 6.9 mg/kg vs. 4.9 mg/kg). Obese patients were significantly more likely to experience acute kidney injury (AKI) than non-obese patients (55% vs. 37%, P = 0.03). Patients who experienced nephrotoxicity received a higher average daily dose than those who did not (365 mg vs. 333 mg, P = 0.03), had a higher median cumulative dose (3,130 mg vs. 1,700 mg, P < 0.001), and had a higher median total body weight (79.6 kg vs. 71.9 kg, P = 0.04.). Additionally, daily dose normalized to total body weight was not associated with AKI (median 4.7 mg/kg in patients with AKI vs. 4.8 mg/kg in patients without AKI, P = 0.86). However, daily dose normalized to ideal body weight was associated with AKI (median 5.5 mg/kg in patients with AKI vs. 4.9 mg/kg in patients without AKI, P = 0.02). Conclusion We identified a higher rate of nephrotoxicity among obese patients receiving L-amb compared with non-obese patients. These data suggest that dosing L-amb based on total body weight places obese patients at a higher risk of nephrotoxicity. This should be considered when assessing the risks and benefits of this dosing strategy in obese patients. Disclosures All authors: No reported disclosures.

Nephrotoxicity

Renal replacement therapy

10.1093/ofid/ofz360.1789

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Safety and tolerability of clofazimine as salvage therapy for atypical mycobacterial infection in solid organ transplant recipients

Transplant Infectious Disease (2015)

P. Cariello E.J. Kwak R. Abdel‐Massih F. Silveira

Abstract Background The treatment of Mycobacterium avium complex ( MAC ) requires prolonged, multidrug therapy, which is often not well tolerated. In solid organ transplant ( SOT ) recipients, drug–drug interactions complicate treatment further. Failure or intolerance requires the use of salvage regimens, and clofazimine is one of the drugs that can be used. No data are available on the safety and tolerability of clofazimine for the treatment of MAC in SOT recipients. Methods Retrospective review of all SOT recipients treated for MAC infection with clofazimine at a large transplant center between 2006 and 2013. Results Five SOT recipients received clofazimine as salvage therapy. Transplanted organs were lungs in 3 patients, and kidney and liver in 1 patient each. Infection was diagnosed at a median of 22 months (range 4–57) post transplant. Sites of infection were the lungs in 2 patients, and septic arthritis, mesenteric, and disseminated disease in 1 patient each. All patients received standard anti‐ MAC therapy for a median of 26 weeks (range 18–45) before starting clofazimine. Indications for use of clofazimine included a lack of response to previous therapy (3 patients), and poor tolerance of other regimens (3 patients). All patients received at least 2 additional drugs besides clofazimine. Median duration of clofazimine‐containing regimen was 8 months (range 2–18). Clofazimine was discontinued because of gastrointestinal intolerance in 1 of the 5 patients. The most common adverse event from clofazimine was skin discoloration, in 60% of patients. No hepatotoxicity or hematologic toxicity occurred. Microbiological clearance and resolution of clinical disease was documented in 2 of 5 patients; and 2 of the 5 patients died of other causes while on therapy. Conclusions Clofazimine appears safe and may be considered as a salvage therapeutic option in SOT recipients with MAC infection who are intolerant or unresponsive to standard therapy. The small sample size does not allow conclusions regarding efficacy.

Clofazimine

Tolerability

Regimen

Salvage therapy

10.1111/tid.12340

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Citations (35)