Publications by authors named "Hesham Awadh"

7 Publications

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Management of enterococcal central line-associated bloodstream infections in patients with cancer.

BMC Infect Dis 2021 Jul 5;21(1):643. Epub 2021 Jul 5.

Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1460, Houston, TX, 77030, USA.

Objective: Enterococcus species are the third most common organisms causing central line-associated bloodstream infections (CLABSIs). The management of enterococcal CLABSI, including the need for and timing of catheter removal, is not well defined. We therefore conducted this study to determine the optimal management of enterococcal CLABSI in cancer patients.

Methods: We reviewed data for 542 patients diagnosed with Enterococcus bacteremia between September 2011 to December 2018. After excluding patients without an indwelling central venous catheter (CVC), polymicrobial bacteremia or with CVC placement less than 48 h from bacteremia onset we classified the remaining 397 patients into 3 groups: Group 1 (G1) consisted of patients with CLABSI with mucosal barrier injury (MBI), Group 2 (G2) included patients with either catheter-related bloodstream infection (CRBSI) as defined in 2009 Clinical Practice Guidelines for the Diagnosis and Management of Intravascular Catheter-Related Infection by the Infectious Diseases Society of America (IDSA) or CLABSI without MBI, and Group 3 (G3) consisted of patients who did not meet the CDC criteria for CLABSI. The impact of early (< 3 days after bacteremia onset) and late (3-7 days) CVC removal was compared. The composite primary outcome included absence of microbiologic recurrence, 90-day infection-related mortality, and 90-day infection-related complications.

Results: Among patients in G2, CVC removal within 3 days of bacteremia onset was associated with a trend towards a better overall outcome than those whose CVCs were removed later between days 3 to 7 (success rate 88% vs 63%). However, those who had CVCs retained beyond 7 days had a similar successful outcome than those who had CVC removal < 3 days (92% vs. 88%). In G1, catheter retention (removal > 7 days) was associated with a better success rates than catheter removal between 3 and 7 days (93% vs. 67%, p = 0.003). In non-CLABSI cases (G3), CVC retention (withdrawal > 7 days) was significantly associated with a higher success rates compared to early CVC removal (< 3 days) (90% vs. 64%, p = 0.006).

Conclusion: Catheter management in patients with enterococcal bacteremia is challenging. When CVC removal is clinically indicated in patients with enterococcal CLABSI, earlier removal in less than 3 days may be associated with better outcomes. Based on our data, we cannot make firm conclusions about whether earlier removal (< 3 days) could be associated with better outcomes in patients with Enterococcal CLABSI whose CVC withdrawal is clinically indicated. In contrast, it seemed that catheter retention was associated to higher success outcome rates. Therefore, future studies are needed to clearly assess this aspect.
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http://dx.doi.org/10.1186/s12879-021-06328-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8256598PMC
July 2021

Insights into SARS-CoV-2 Persistence and Its Relevance.

Viruses 2021 05 29;13(6). Epub 2021 May 29.

Department of Internal Medicine, Marshall University Joan C. Edwards School of Medicine, Huntington, WV 25701, USA.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), continues to wreak havoc, threatening the public health services and imposing economic collapse worldwide. Tailoring public health responses to the SARS-CoV-2 pandemic depends on understanding the mechanism of viral replication, disease pathogenesis, accurately identifying acute infections, and mapping the spreading risk of hotspots across the globe. However, effective identification and isolation of persons with asymptomatic and mild SARS-CoV-2 infections remain the major obstacles to efforts in controlling the SARS-CoV-2 spread and hence the pandemic. Understanding the mechanism of persistent viral shedding, reinfection, and the post-acute sequalae of SARS-CoV-2 infection (PASC) is crucial in our efforts to combat the pandemic and provide better care and rehabilitation to survivors. Here, we present a living literature review (January 2020 through 15 March 2021) on SARS-CoV-2 viral persistence, reinfection, and PASC. We also highlight potential areas of research to uncover putative links between viral persistence, intra-host evolution, host immune status, and protective immunity to guide and direct future basic science and clinical research priorities.
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http://dx.doi.org/10.3390/v13061025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8228265PMC
May 2021

Measles or Not Measles? That Is the Question!

Open Forum Infect Dis 2020 Aug 22;7(8):ofaa311. Epub 2020 Jul 22.

Department of Internal Medicine, Division of Infectious Diseases, The University of Texas Health Science Center, McGovern Medical School, Houston, Texas, USA.

We present a diagnostically challenging case of a patient who presented with fever and rash during a measles outbreak. The diagnosis was complicated by the interpretation of the results of serological tests, which resulted in implementation of major preventive measures in the hospital. The patient was later confirmed to have murine typhus.
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http://dx.doi.org/10.1093/ofid/ofaa311DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7423290PMC
August 2020

Disseminated cytomegalovirus infection with bilateral adrenal pseudotumors masquerading as recurrent hematologic malignancy.

Infection 2020 Jun 6;48(3):477-481. Epub 2020 Mar 6.

Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.

Background: Mass-like lesions are an uncommon presentation of cytomegalovirus (CMV) disease.

Case: We report on a case of disseminated CMV disease with bilateral adrenal pseudotumors in a patient with a history of acute leukemia in remission.

Conclusion: In the settings of advanced cancer therapy and organ transplantation, a high index of suspicion for CMV should be maintained for mass-like disease.
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http://dx.doi.org/10.1007/s15010-020-01404-9DOI Listing
June 2020

Pneumonia due to a Rare Pathogen: , Subspecies .

Case Rep Infect Dis 2017 15;2017:3969682. Epub 2017 Aug 15.

Pulmonology Department, Marshall University Joan C. Edwards School of Medicine, Huntington WV, USA.

, subspecies , is a gram-negative rod recently implicated as an emerging cause of infection in both immunosuppressed and immunocompetent populations. Few cases are reported in literature involving multiple body systems. Diagnosis depends on cultures of appropriate specimens, and management usually is by administration of appropriate antibiotics (usually agents with antipseudomonal activity). We report a rare case of pneumonia due to infection with this organism, in a patient with preexisting bronchiectasis secondary to chronic aspiration.
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http://dx.doi.org/10.1155/2017/3969682DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5574223PMC
August 2017

Complete Esophageal Obstruction after Endoscopic Variceal Band Ligation in a Patient with a Sliding Hiatal Hernia.

ACG Case Rep J 2017 18;4:e8. Epub 2017 Jan 18.

Department of Gastroenterology, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV.

Complete esophageal obstruction is a rare complication of endoscopic variceal banding, with only 6 cases in the English literature since the introduction of endoscopic variceal banding in 1986. We report a case of complete esophageal obstruction following esophageal banding due to entrapment of part of a sliding hiatal hernia. To our knowledge, our case is one of few with esophageal obstruction post-banding, and the first associated with a hiatal hernia. We recommend caution when performing esophageal banding on patients with a hiatal hernia.
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http://dx.doi.org/10.14309/crj.2017.8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5247629PMC
January 2017

Bacteremia with an Unusual Pathogen: .

Case Rep Infect Dis 2016 11;2016:5167874. Epub 2016 Oct 11.

Department of Infectious Diseases, MUSOM, Huntington, WV, USA.

is an infrequently encountered cause of infection in humans. It is a member of the rapidly growing mycobacteria family. It predominately afflicts those with a compromised immune status and a chronically indwelling vascular access. Isolation of this organism is challenging yet the advent of 16s ribosomal sequencing paved the way for more sensitive detection. No treatment guidelines are available and treatment largely depends on the experience of the treating physician and nature of the isolate. We report a case of bacteremia in an immune competent host, with a chronically placed peripherally inserted central catheter (PICC line).
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http://dx.doi.org/10.1155/2016/5167874DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5078649PMC
October 2016
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