Isabella Rosa-Cunha

Mycobacterium abscessus infection in solid organ transplant recipients: report of three cases and review of the literature

Abstract: Mycobacterium abscessus is an ubiquitous organism found in the environment. This rapidly growing mycobacterium infrequently causes disease in humans; however, in immunocompromised hosts, disease can range from localized cutaneous lesions to disseminated infection. The organism is resistant to most antimycobacterial drugs and therapy can be limited by drug interactions. The exact incidence of M. abscessus infection among solid organ transplant (SOT) recipients is unknown; data are only available from previously reported cases in the literature. We describe 3 cases of M. abscessus infection in SOT recipients diagnosed within a 5‐month period. One of the cases followed multi‐visceral transplantation, the first such case to be reported in the literature. An epidemiological investigation did not reveal significant commonalities among the cases, and pulsed‐field gel electrophoresis of genomic DNA of the case isolates confirmed their non‐identity. All cases improved with antibiotic therapy, most notably with the new glycylcycline, tigecycline, along with surgical intervention in 2 of the cases. In addition, we review features and characteristics of M. abscessus infections in recipients of SOT reported in the literature from 1992 to 2008 and summarize some selected therapeutic concerns and issues related to treatment.

Description of a Pilot Anal Pap Smear Screening Program Among Individuals Attending a Veteran's Affairs HIV Clinic

Despite the higher risk of anal cancer among HIV-infected individuals currently there are no national or international guidelines for anal dysplasia screening. We assessed acceptance and feasibility of screening for anal intraepithelial neoplasia (AIN), the rate of abnormalities, and relationship between the presence of AIN and a history of receptive anal intercourse. Eighty-two percent of HIV-patients approached during routine clinic visit agreed to participate in the study with anal Pap smear collection; 53% had abnormal cytology results and among those undergoing high-resolution anoscopy with biopsy, 55% had high-grade AIN, including 2 cases of carcinoma in situ. Anal cytology was well accepted and it was feasible to be incorporated into HIV primary care practice. Abnormal cytology was not significantly associated with history of anal intercourse (p = 0.767). The high rate of abnormal results reinforces the need for further evaluation of the role of systematic anal Pap smear screening for HIV patients.

HPV in HIV-Infected Women: Implications for Primary Prevention

Background: There is growing evidence that human immunodeficiency virus (HIV)-infected women might have a different human papillomavirus (HPV) type distribution in cervical dysplasia specimens as compared to the general population. This has implications for primary prevention. Objective: We aimed to obtain preliminary data on the HPV genotypes prevalent in histological samples of HIV-infected women with cervical intraepithelial neoplasia (CIN) 3/CIS of the cervix in Miami, FL, USA. Methods: Retrospective data were collected on HIV-infected women referred to the University of Miami-Jackson Memorial Hospital colposcopy clinic between years 2000 and 2008. The histology slides of CIN 3/CIS biopsies underwent pathological review and sections were cut from these archived specimens for HPV DNA extraction. HPV genotyping was then performed using the GeneSquare™ HPV genotyping assay. We report on our first set of 23 samples. Results: Eight high-risk HPV types were detected. Types in decreasing order of frequency were 16, 35, 45, 52, 59, 31, 58, and 56. Most cases had multiple infections. HPV type 16 was the most common (45%) followed by HPV-35 and -45 with equal frequency (40%). No samples contained HPV-18. Conclusion: Our preliminary results suggest that cervical dysplasia specimens of HIV-infected women more likely (55%) contain non-16 and -18 high-risk HPV types. We show that this held true for histologically confirmed severe dysplasia and carcinoma-in situ. Epidemiological studies guide vaccine development, therefore HPV type prevalence in CIS and invasive cervical cancer among HIV-infected women should be more rigorously explored to ensure that this highly vulnerable population receives appropriate primary prevention.

A case of subcutaneous Mycoleptodiscus indicus infection in a liver transplant recipient successfully treated with antifungal therapy.

Abstract: Mycoleptodiscus indicus, a dematiaceous mold, occurs on the leaves of a number of different host plants and has been only recently described as a cause of human infection. Immunosuppressed individuals are at risk for developing infections with opportunistic fungal pathogens, which are a major cause of morbidity and mortality in this population. In addition, the treatment of infections caused by these fungi is frequently challenging. We report a case of M. indicus subcutaneous infection in a 51‐year‐old man with human immunodeficiency virus and hepatitis C co‐infection, who had a liver transplant. He developed skin nodules with a sporotrichoid lymphangitic distribution. Histopathology demonstrated unusual fungal elements with angioinvasion. Mycology cultures isolated a dematiaceous mold with the characteristic curved hyaline conidia of M. indicus. Initial treatment involved a combination of amphotericin B lipid complex and voriconazole, followed by monotherapy with voriconazole. The subcutaneous lesions resolved completely after 4 months of antifungal therapy.

Increase in Lymphogranuloma Venereum Cases in South Florida

The purpose of the study was to evaluate the clinic prevalence and clinical characteristics of patients with LGV since 2007 when active clinic surveillance started. We review all the reports of rectal Chlamydia trachomatis and LGV testing of those samples. Chlamydia trachomatis LGV DNA was detected by Nucleic Acid Amplification/ompA gene sequencing. Medical records of all patients with LGV were reviewed. Prevalence of rectal CT among tested individuals was relatively stable during the study period: 2007 (15%), 2008 (15%), 2009 (12%) and 2010 (14%). Eight cases of LGV were identified during the study period, one in 2009 and seven in 2010. All individuals were male and all except one had sex with only men. Most of them were also infected with HIV (62.5%). We concluded that this is the first report of LGV cases in South Florida and shows a rapid increase in the number of cases in the last year.

Pharyngeal Gonorrhea and Chlamydial Infections in Men who have Sex with Men, a Hidden Threat to the HIV Epidemic

Abstract: Background : Pharyngeal infections with gonorrhea (GC) and chlamydia (CT) can be missed if screened only by routine methods of urethral or urine specimens and may increase the risk of sexually transmitted infections and HIV acquisition and transmission. The prevalence of pharyngeal GC and CT in men who have sex with men (MSM) has been reported as 5.3-9.2% and 1.4-1.9% respectively. The objective of this study is to determine the rates of pharyngeal GC and CT infections in MSM in the Miami Dade Health Department (MDHD) STD clinic. Methods : Routine screening for pharyngeal GC and CT infections in MSM was implemented in the MDHD STD clinic in October 2011 using APTIMA Combo 2 Assay®. Validation studies were performed in the Florida Department of Health Laboratories prior to implementation of the test. Retrospective review of medical records of individuals tested for pharyngeal GC/CT from October 2011 to March 2012 was performed. Results from urine and rectal GC/CT testing done at the same time from the same individuals were also reviewed. Results : A total of 475 pharyngeal swabs were performed. Fifty-two (10.9%) were positive for GC and 13 (2.7%) were positive for CT. Among the individuals with GC pharyngeal infection, 21 (52.5%) had a positive GC rectal test and 14 (28%) a positive urine test. Among the individuals with CT pharyngeal infection, 3 (30%) had a positive CT rectal test and 1 (7.7%) a positive urine test. Conclusions : The prevalence of pharyngeal GC/CT in MSM in the MDHD STD clinic is higher than what has been previously reported in other centers. The discrepancy between pharyngeal, rectal, and urine tests emphasizes the importance of extragenital testing in the MSM population.

P3-S3.01 Anal Pap smear screening among drug users living with HIV in Miami, Florida

Background Human papillomavirus (HPV) is associated with anal cancer. Human immunodeficiency virus (HIV) infection and cocaine use are associated with increased risk for HPV infection and associated diseases, but little is known about anal dysplasia among HIV-infected drug users. The objective of our study was to assess the rate of abnormal anal Pap smears among drug users living with HIV in Miami, Florida. Methods Project HOPE (Hospital is an Opportunity for Prevention and Engagement) is a two-site study conducted in Miami and Atlanta to evaluate the efficacy of a brief prevention intervention for HIV-positive crack cocaine users recruited from two inner-city hospitals during their inpatient stays. At the Miami site, anal Pap smears from women and men (n=46) were collected. Results The study population was 95% Black, the mean age was 47, 63% were female (29/46), 35% heterosexual males (16/46) and 2% men who have sex with men (MSM) (1/46). Approximately half of the participants did not complete high school, 50% were on antiretroviral therapy and 50% had been diagnosed with HIV for more than 14 years. The median CD4 cell count was 198. Overall 69.5% (32/46) of anal Pap smears were abnormal; 69% of women (20/29) and 70.5% of men (12/17) had abnormal Pap smear. Conclusions These preliminary data suggest that abnormal anal Pap smears are common in drug users living with HIV in Miami and highlight the need for further studies on prevention and screening of anal dysplasia and cancer in this population.