Michael Freedman

All Publications

• Estimated Burden of Coccidioidomycosis. JAMA network open Williams, S. L., Benedict, K., Jackson, B. R., Rajeev, M., Cooksey, G., Ruberto, I., Williamson, T., Sunenshine, R. H., Osborn, B., Oltean, H. N., Reik, R. R., Freedman, M. S., Spec, A., Carey, A., Schwartz, I. S., Medina-Garcia, L., Bahr, N. C., Kuran, R., Heidari, A., Thompson, G. R., Johnson, R., Galgiani, J. N., Chiller, T., Toda, M. 2025; 8 (6): e2513572

  Abstract

  Importance: Coccidioidomycosis is an underrecognized fungal infection that can cause serious illness and constitutes a considerable public health burden. The number of cases is likely substantially higher than the nationally reported total, as surveillance does not capture patients who do not seek medical care or who are undiagnosed or misdiagnosed. Coccidioidomycosis is not reportable in all states, and cases not reported to public health entities are likewise missed. A systematic estimate of coccidioidomycosis burden is needed to raise awareness and inform public health interventions and policy.Objective: To assess the annual burden of symptomatic coccidioidomycosis in the US.Design, Setting, and Participants: This cross-sectional study developed models incorporating coccidioidomycosis cases reported to the National Notifiable Diseases Surveillance System from January 1 to December 31, 2019, as model inputs. Multipliers from US public health surveillance accounted for factors including health care-seeking behavior, underdiagnosis, underreporting, and in-hospital mortality. Multiplier values were sourced from a combination of literature review and expert opinion. Regional estimates were generated using endemicity levels categorized as high (Arizona and California), low (Nevada, New Mexico, Texas, Utah, and Washington), or unknown (all other states and Washington, DC). Data were accrued from January 1, 2022, to July 1, 2024, and analyzed from October 1, 2022, to September 1, 2024.Exposure: Coccidioidomycosis reported to public health surveillance entities.Main Outcomes and Measures: Models estimated annual incident symptomatic coccidioidomycosis cases, hospitalizations, and deaths nationally and regionally in the US.Results: A nationwide total of 273 000 (95% credible interval [CrI], 206 000-360 000) incident symptomatic coccidioidomycosis cases were estimated in 2019. High-endemic states accounted for the highest burden (125 000 [95% CrI, 94 000-165 000] cases), followed by states of unknown endemicity (103 000 [95% CrI, 66 000-155 000] cases) and low-endemic states (46 000 [95% CrI, 31 000-65 000] cases). Nationally, models estimated 23 000 annual hospitalizations (95% CrI, 18 000-28 000) and 900 annual deaths (95% CrI, 700-1100) associated with coccidioidomycosis.Conclusions and Relevance: In this cross-sectional study, the estimated national burden of symptomatic coccidioidomycosis in 2019 was 10 to 18 times higher than the number of cases reported through national surveillance. Better awareness, diagnostic testing practices, and reporting are needed to improve patient outcomes and enhance our understanding of coccidioidomycosis epidemiology.

  View details for DOI 10.1001/jamanetworkopen.2025.13572

  View details for PubMedID 40459889

• SEVERE OR MILD TRANSCRIPTOMIC SCORE IS CONSERVED IN INFECTIOUS AND NONINFECTIOUS CRITICAL ILLNESS Ganesan, A., Moore, A., Zheng, H., Freedman, M., Rogers, A., Khatri, P. LIPPINCOTT WILLIAMS & WILKINS. 2025

  View details for DOI 10.1097/01.ccm.0001102860.15139.82

  View details for Web of Science ID 001411620600048

• 42-gene Severe-or-Mild (SOM) gene expression signature is conserved across viral and bacterial infections and originates from developing neutrophils Moore, A., Freedman, M., Zheng, H., Ganesan, A., Rogers, A., Khatri, P. AMER ASSOC IMMUNOLOGISTS. 2024

  View details for DOI 10.4049/jimmunol.212.supp.0635.5089

  View details for Web of Science ID 001368989500047

• Infant in extremis: respiratory failure secondary to lower airway infantile hemangioma. BMC pediatrics MacDougall, M. S., Afzal, S. Y., Freedman, M. S., Han, P. 2022; 22 (1): 744

  Abstract

  Infantile hemangiomas (IHs) are vascular tumors that commonly affect infants and usually regress spontaneously or can be easily treated as an outpatient with topical beta-blockers. However, IHs that present in the airway may cause life-threatening symptoms due to airway obstruction or risk of bleeding. Here we present the first documented case of an infant with rapid deterioration and acute respiratory failure secondary to a lower airway hemangioma.This 3-month-old male initially presented in respiratory distress with symptoms consistent with a viral respiratory infection, however showed no clinical improvement with standard therapies. An urgent CT scan revealed a mass occluding the right mainstem bronchus. Upon transfer to a tertiary care facility, he developed acute respiratory failure requiring emergent intubation and single lung ventilation. The availability of multiple subspecialists allowed for stabilization of a critically ill child, expedited diagnosis, and ultimately initiation of life-saving treatment with beta blockers. After 17 total hospital days, he was extubated successfully and discharged home in good condition.While IH is a rare cause of infantile respiratory distress, we present multiple pearls for the general pediatrician for management of IHs of the airway.

  View details for DOI 10.1186/s12887-022-03821-1

  View details for PubMedID 36581920

• Initial emergency department vital signs may predict PICU admission in pediatric patients presenting with asthma exacerbation. The Journal of asthma : official journal of the Association for the Care of Asthma Freedman, M. S., Forno, E. 2022: 1-13

  Abstract

  OBJECTIVE: Severe asthma exacerbations account for a large share of asthma morbidity, mortality, and costs. Here, we aim to identify early predictive factors associated with pediatric intensive care unit (PICU) admission.METHODS: We performed a retrospective observational study of 5,185 emergency department (ED) encounters at a large children's hospital, including 86 (1.7%) resulting in PICU admission between 10/1/2015 and 8/7/2018 with ICD9/ICD10 codes for "asthma," "bronchospasm," or "wheezing". Vital signs and demographic information were obtained from EHR data and analyzed for each encounter. Predictive factors were identified using adjusted regression models, and our primary outcome was PICU admission.RESULTS: Higher mean heart rates (HR) and respiratory rates (RR) and lower SpO2 within the first hour of ED presentation were independently associated with PICU admission. Odds of PICU admission increased 70% for each 10-beats/minute higher HR, 125% for each 10-breaths/minute higher RR, and 34% for each 5% lower SpO2. A binary predictive index using 1-hour vitals yielded OR 13.4 (95%CI 8.1-22.1) for PICU admission, area under the receiver operator characteristic curve (AUROC) 0.84 and overall accuracy of 80.1%. Results were largely unchanged (AUROC 0.84-0.88) after adjusting for surrogates of asthma severity and initial ED management. In combination with a secondary standardized clinical asthma distress score, positive predictive value increased by seven-fold (6.1% to 46%).CONCLUSIONS: A predictive index using HR, RR and SpO2 within the first hour of ED presentation accurately predicted PICU admission in this cohort. Automated vital signs trend analysis may help identify vulnerable patients quickly upon presentation.

  View details for DOI 10.1080/02770903.2022.2111686

  View details for PubMedID 35943201

• The association of flavored milk consumption with milk and energy intake, and obesity: A systematic review PREVENTIVE MEDICINE Patel, A. I., Moghadam, S., Freedman, M., Hazari, A., Fang, M., Allen, I. E. 2018; 111: 151–62

  Abstract

  Taxes on sugary drinks are being implemented to prevent chronic diseases. Sugar-sweetened milk has been exempt from such policies because of its nutritional value. This systematic review sought to examine whether flavored milk consumption was associated with milk and energy intake, and obesity among children. A search of PubMed, EMBASE, Cochrane, CINAHL, Web of Science, Cochrane Central Register of Controlled Trials and the grey literature was conducted for peer-reviewed publications published before June 6, 2016 that met the following criteria: 1) English-language publications 2) studies of children ages 1 to 18 years, 3) controlled experimental, cohort, case-control, systematic reviews, or meta-analysis studies 4) dependent variable: flavored milk consumption 5) independent variable: weight, weight gain, weight change, body mass index, metabolic syndrome, waist circumference, cholesterol, triglycerides, blood pressure, serum glucose, calories, sugar, or milk consumed. Of 3978 studies identified, 13 met inclusion criteria. Ten studies were experimental and three were longitudinal cohort studies. Eleven studies found that flavored milk increased overall milk intake, five of seven studies that examined energy intake showed that flavored milk increased energy intake, and one of three studies that assessed obesity outcomes demonstrated an increase in weight gain with flavored milk consumption. Only one study was a randomized controlled trial, most studies had high bias, and over half were industry-funded or did not disclose funding. Although flavoring milk may increase milk intake, added sugars may promote increased energy intake. More data regarding flavored milk's impact on health is needed to inform its role in sugary drink policies.

  View details for PubMedID 29501475