Brian Blackburn

All Publications

• Case Report: Relapsing Leptospirosis in an Immunocompromised Host. The American journal of tropical medicine and hygiene Prasad, R., Narsana, N. K., Ajayi, A. A., Wang, H., Patel, J., Ho, D. Y., Banaei, N., Blackburn, B. G. 2023

  Abstract

  Leptospirosis is typically a self-limited febrile illness; when it occurs, meningitis usually develops early in the course. Here, we describe a patient who had engaged in freshwater activities in Kauai that was immunocompromised due to a history of mantle cell lymphoma, autologous hematopoietic cell transplant, and hypogammaglobulinemia. He developed leptospiral meningoencephalitis 11 weeks after illness onset and persistently detectable Leptospira DNA in blood and cerebrospinal fluid along with ongoing clinical illness, despite appropriate treatment.

  View details for DOI 10.4269/ajtmh.23-0111

  View details for PubMedID 37604468

• Inclusion, Diversity, Access, and Equity in Infectious Diseases Fellowship Training: Tools for Program Directors. Open forum infectious diseases Luther, V. P., Barsoumian, A. E., Konold, V. J., Vijayan, T., Balba, G., Benson, C., Blackburn, B., Cariello, P., Perloff, S., Razonable, R., Acharya, K., Azar, M. M., Bhanot, N., Blyth, D., Butt, S., Casanas, B., Chow, B., Cleveland, K., Cutrell, J. B., Doshi, S., Finkel, D., Graber, C. J., Hazra, A., Hochberg, N. S., James, S. H., Kaltsas, A., Kodiyanplakkal, R. P., Lee, M., Marcos, L., Mena Lora, A. J., Moore, C. C., Nnedu, O., Osorio, G., Paras, M. L., Reece, R., Salas, N. M., Sanasi-Bhola, K., Schultz, S., Serpa, J. A., Shnekendorf, R., Weisenberg, S., Wooten, D., Zuckerman, R. A., Melia, M., Chirch, L. M. 2023; 10 (6): ofad289

  Abstract

  The Infectious Diseases Society of America (IDSA) has set clear priorities in recent years to promote inclusion, diversity, access, and equity (IDA&E) in infectious disease (ID) clinical practice, medical education, and research. The IDSA IDA&E Task Force was launched in 2018 to ensure implementation of these principles. The IDSA Training Program Directors Committee met in 2021 and discussed IDA&E best practices as they pertain to the education of ID fellows. Committee members sought to develop specific goals and strategies related to recruitment, clinical training, didactics, and faculty development. This article represents a presentation of ideas brought forth at the meeting in those spheres and is meant to serve as a reference document for ID training program directors seeking guidance in this area.

  View details for DOI 10.1093/ofid/ofad289

  View details for PubMedID 37397270

• Virtual Recruitment Is Here to Stay: A Survey of ID Fellowship Program Directors and Matched Applicants Regarding Their 2020 Virtual Recruitment Experiences. Open forum infectious diseases Rockney, D., Benson, C. A., Blackburn, B. G., Chirch, L. M., Konold, V. J., Luther, V. P., Razonable, R. R., Tackett, S., Melia, M. T. 2021; 8 (8): ofab383

  Abstract

  Background: Graduate Medical Education training programs transitioned to all-virtual recruitment in 2020. Limited data have been published regarding the consequences of this transition. We aimed to understand (1) infectious diseases (ID) fellowship programs' recruitment efforts and the effect of virtual recruitment on application and interview numbers and (2) the number of programs to which matched applicants applied and interviewed and applicants' perspectives on virtual recruitment.Methods: In 2020-2021, we surveyed all US ID fellowship program directors (PDs) and matched applicants. Descriptive data analysis was performed on quantitative survey items. Free-text responses were analyzed through a quantitative content analysis approach.Results: The PD response rate was 68/158 (43%); the applicant response rate was at least 23% (85/365). PDs reported a 27% increase in mean number of applications received and a 45% increase in mean number of applicants interviewed compared with the previous year. Applicants especially valued the online program structure information, PD program overview videos, didactic and curriculum content, and fellow testimonials and profiles. Most applicants preferred interviews lasting no more than 40 minutes and interview days lasting no more than 5 hours. Nearly all (60/64, 94%) PDs adequately learned about candidates; most (48/64, 75%) felt unable to showcase their program as well as when in-person. Most PDs (54/64, 84%) and applicants (56/73, 77%) want an option for virtual recruitment.Conclusions: Virtual recruitment enabled programs to accommodate more applicants and highlighted applicants' preferences for programs' augmented online presences and time-limited interview days. Most programs and applicants want an option for virtual interviews.

  View details for DOI 10.1093/ofid/ofab383

  View details for PubMedID 34395715

• Reactivation of Chagas Disease in a Patient With an Autoimmune Rheumatic Disease: Case Report and Review of the Literature. Open forum infectious diseases Czech, M. M., Nayak, A. K., Subramanian, K. n., Suarez, J. F., Ferguson, J. n., Jacobson, K. B., Montgomery, S. P., Chang, M. n., Bae, G. H., Raghavan, S. S., Wang, H. n., Miranti, E. n., Budvytiene, I. n., Shoor, S. M., Banaei, N. n., Rieger, K. n., Deresinski, S. n., Holubar, M. n., Blackburn, B. G. 2021; 8 (2): ofaa642

  Abstract

  Reactivation of Chagas disease has been described in immunosuppressed patients, but there is a paucity of literature describing reactivation in patients on immunosuppressive therapies for the treatment of autoimmune rheumatic diseases. We describe a case of Chagas disease reactivation in a woman taking azathioprine and prednisone for limited cutaneous systemic sclerosis (lcSSc). Reactivation manifested as indurated and erythematous cutaneous nodules. Sequencing of a skin biopsy specimen confirmed the diagnosis of Chagas disease. She was treated with benznidazole with clinical improvement in the cutaneous lesions. However, her clinical course was complicated and included disseminated CMV disease and subsequent septic shock due to bacteremia. Our case and review of the literature highlight that screening for Chagas disease should be strongly considered for patients who will undergo immunosuppression for treatment of autoimmune disease if epidemiologically indicated.

  View details for DOI 10.1093/ofid/ofaa642

  View details for PubMedID 33575423

  View details for PubMedCentralID PMC7863873

• Concurrent Trypanosoma cruzi and Cytomegalovirus Reactivation in an Immunosuppressed Patient With Limited Cutaneous Systemic Sclerosis. The American Journal of dermatopathology Chang, M. S., Bae, G. H., Almazan, T., Raghavan, S. S., Wang, J. Y., Czech, M. M., Wang, H., Banaei, N., Blackburn, B. G., Novoa, R. A., Rieger, K. E. 2020

  Abstract

  Chagas disease, a multisystem infection caused by the protozoan Trypanosoma cruzi, is primarily found in Latin America. In recent years, prevalence has increased in the United States, where reactivation is the most common clinical scenario. Here, we describe cutaneous reactivation of T. cruzi in a patient with limited cutaneous systemic sclerosis on immunosuppression therapy who simultaneously presented with cytomegalovirus reactivation. Histopathology showed parasitized histiocytes in the superficial and deep dermis. Occasional epidermal keratinocytes were also parasitized, and rare organisms were also seen in the walls of blood vessels. Also noted were viral cytopathic changes within the vascular endothelium, and immunostaining confirmed cytomegalovirus. In this report, we describe the difference in cutaneous findings between reactivated and acute Chagas disease, and we also review the histopathologic features that help distinguish T.cruzi from other intracellular organisms.

  View details for DOI 10.1097/DAD.0000000000001842

  View details for PubMedID 33201010

• Use of Remdesivir for Pregnant Patients with Severe Novel 2019 Coronavirus Disease. American journal of obstetrics and gynecology Igbinosa, I., Miller, S., Bianco, K., Nelson, J., Kappagoda, S., Blackburn, B. G., Grant, P., Subramanian, A., Lyell, D., El-Sayed, Y., Aziz, N. 2020

  View details for DOI 10.1016/j.ajog.2020.08.001

  View details for PubMedID 32771381

• The Struggling Infectious Diseases Fellow: Remediation Challenges and Opportunities. Open forum infectious diseases Melia, M. T., Paez, A., Reid, G., Chirch, L. M., Luther, V. P., Blackburn, B. G., Perez, F., Abdoler, E., Kaul, D. R., Rehm, S., Harik, N., Barsoumian, A., Person, A. K., Yun, H., Beckham, J. D., Boruchoff, S., Cariello, P. F., Cutrell, J. B., Graber, C. J., Lee, D. H., Maziarz, E., Paras, M. L., Razonable, R. R., Ressner, R., Chen, A., Chow, B., Escota, G., Herc, E., Johnson, A., Maves, R. C., Nnedu, O., Clauss, H., Kulkarni, P., Pottinger, P. S., Serpa, J. A., Bhowmick, T., Bittner, M., Wooten, D., Casanas, B., Shnekendorf, R., Blumberg, E. A. 2020; 7 (3): ofaa058

  Abstract

  Remediation of struggling learners is a challenge faced by all educators. In recognition of this reality, and in light of contemporary challenges facing infectious diseases (ID) fellowship program directors, the Infectious Diseases Society of America Training Program Directors' Committee focused the 2018 National Fellowship Program Directors' Meeting at IDWeek on "Remediation of the Struggling Fellow." Small group discussions addressed 7 core topics, including feedback and evaluations, performance management and remediation, knowledge deficits, fellow well-being, efficiency and time management, teaching skills, and career development. This manuscript synthesizes those discussions around a competency-based framework to provide program directors and other educators with a roadmap for addressing common contemporary remediation challenges.

  View details for DOI 10.1093/ofid/ofaa058

  View details for PubMedID 32166097

• Free Living Amebae Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases Koshy, A., Blackburn, B. G., Singh, U. Elsevier. 2020; 9: 3287–98
• Tuberculosis and Parasitic Infections of the Genitourinary Tract Campbell-Walsh-Wein Urology Chang, A. H., Blackburn, B. G., Hsieh, M. H. Elsevier. 2020; 12: 1305–37
• Compassionate Use of Remdesivir in Pregnant Women with Severe Covid-19. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America Burwick, R. M., Yawetz, S. n., Stephenson, K. E., Collier, A. Y., Sen, P. n., Blackburn, B. G., Kojic, E. M., Hirshberg, A. n., Suarez, J. F., Sobieszczyk, M. E., Marks, K. M., Mazur, S. n., Big, C. n., Manuel, O. n., Morlin, G. n., Rose, S. J., Naqvi, M. n., Goldfarb, I. T., DeZure, A. n., Telep, L. n., Tan, S. K., Zhao, Y. n., Hahambis, T. n., Hindman, J. n., Chokkalingam, A. P., Carter, C. n., Das, M. n., Osinusi, A. O., Brainard, D. M., Varughese, T. A., Kovalenko, O. n., Sims, M. D., Desai, S. n., Swamy, G. n., Sheffield, J. S., Zash, R. n., Short, W. R. 2020

  Abstract

  Remdesivir is efficacious for severe COVID-19 in adults, but data in pregnant women are limited. We describe outcomes in the first 86 pregnant women with severe COVID-19 who were treated with remdesivir.Reported data span March 21 to June 16, 2020 for hospitalized pregnant women with PCR-confirmed SARS-CoV-2 infection and room air oxygen saturation ≤94% whose clinicians requested remdesivir through the compassionate use program. The intended remdesivir treatment course was 10 days (200mg on Day 1, followed by 100mg for Days 2-10, given intravenously).Nineteen of 86 women delivered before their first dose and were reclassified as immediate "postpartum" (median postpartum day=1; range 0-3). At baseline, 40% of pregnant women (median gestational age 28 weeks) required invasive ventilation, in contrast to 95% of postpartum women (median gestational age at delivery 30 weeks). By Day 28 of follow-up, the level of oxygen requirement decreased in 96% and 89% of pregnant and postpartum women, respectively. Among pregnant women, 93% of those on mechanical ventilation were extubated, 93% recovered, and 90% were discharged. Among postpartum women, 89% were extubated, 89% recovered, and 84% were discharged. Remdesivir was well tolerated, with a low incidence of serious adverse events (16%). Most adverse events were related to pregnancy and underlying disease; most laboratory abnormalities were Grades 1 or 2. There was one maternal death attributed to underlying disease and no neonatal deaths.Among 86 pregnant and postpartum women with severe COVID-19 who received compassionate use remdesivir, recovery rates were high, with a low rate of serious adverse events.

  View details for DOI 10.1093/cid/ciaa1466

  View details for PubMedID 33031500

• Pathogenic Intestinal Parasites in Transplant Recipients Emerging Transplant Infections Rosser, J. I., Blackburn, B. G. Springer. 2020; 1: 1–55

  View details for DOI 10.1007/978-3-030-01751-4_57-1

• Diagnosis of Chagasic Encephalitis by Sequencing of 28S rRNA Gene EMERGING INFECTIOUS DISEASES Multani, A., Meer, A., Smith, D. S., Kheraj, M. N., Plowey, E. D., Blackburn, B. G. 2019; 25 (7): 1370–72

  Abstract

  We report a case of chagasic encephalitis diagnosed by 28S rRNA sequencing. The diagnosis of chagasic encephalitis is challenging, given the broad differential diagnosis for central nervous system lesions in immunocompromised patients and low sensitivity of traditional diagnostics. Sequencing should be part of the diagnostic armamentarium for potential chagasic encephalitis.

  View details for DOI 10.3201/eid2507.180285

  View details for Web of Science ID 000473775400014

  View details for PubMedID 31211674

  View details for PubMedCentralID PMC6590746

• Soil-Transmitted Helminths: Ascaris, Trichuris, and Hookworm Infections In: Selendy J (ed.) Water and Sanitation Related Diseases and the Environment: Challenges, Interventions and Preventive Measures Yu, A. T., Blackburn, B. G. Wiley Blackwell. 2019; 2nd: 95–110
• Parasitic Infections in Transplant Patients: Toxoplasmosis, Strongyloidiasis, and Other Parasites Principles and Practice of Transplant Infectious Diseases Blackburn, B. G., Montoya, J. G. edited by Safdar, A. Springer-Verlag. 2019; 1: 775–92

  View details for DOI 10.1007/978-1-4939-9034-4

• Role of Toxoplasma IgA as part of a Reference Panel for the Diagnosis of Acute Toxoplasmosis During Pregnancy. Journal of clinical microbiology Olariu, T. R., Blackburn, B. G., Press, C., Talucod, J., Remington, J. S., Montoya, J. G. 2018

  Abstract

  This study evaluated the usefulness of adding the Toxoplasma gondii IgA antibody ELISA test to the serologic panel of tests done for the diagnosis of acute toxoplasmosis in pregnant women in a reference laboratory in the United States. We conducted a retrospective study of 690 consecutive pregnant women with positive T. gondii IgG antibody test results who also had T. gondii IgA and IgM antibody tests performed. Patients were defined as acutely or chronically infected with T. gondii based on a panel of serologic tests performed at the Palo Alto Medical Foundation - Toxoplasma Serology Laboratory (PAMF-TSL). Among the 81 women who were positive by T. gondii IgA antibody ELISA testing, 61 (75.3%) were acutely infected with T. gondii, while of the 547 who were negative by IgA testing, only 24 (4.4%) were acutely infected (p<0.001). Among the 71 women who were positive by both IgA and IgM antibody tests, 61 (85.9%) were acutely infected, compared to 24 (19.2%) of the 125 women who were positive by only the IgM ELISA (p<0.001). These results demonstrate that pregnant women with T. gondii IgA antibodies are more likely to have had a recent infection with T. gondii compared to pregnant women without T. gondii IgA antibodies. Toxoplasma IgA antibody testing can therefore improve the accuracy of a serologic panel for the diagnosis of acute toxoplasmosis during pregnancy. Physicians who ordered testing only for T. gondii IgG and IgM should also request additional testing for IgA and IgG avidity, if both IgG and IgM are positive. This further testing should be ideally performed in a reference laboratory.

  View details for PubMedID 30463899

• Central Nervous System Infections Scientific American Critical Care of the Surgical Patient Finley Caulfield, A., Blackburn, B. G. Hamilton (ON): Decker Intellectual Properties. 2017; 1: 1–23

  View details for DOI 10.2310/7800.8036

• Serious Bacterial Infections Acquired During Treatment for Purported Chronic Lyme Disease – United States Morbid Mortal Weekly Report Marzec, N., Nelson, C., Waldron, P., Blackburn, B., Hosain, S., Greenhow, T., Green, G., Lomen-Hoerth, C., Golden, M., Mead, P. 2017; 66: 607-9
• Tuberculosis and Parasitic Infections of the Genitourinary Tract Campbell-Walsh Urology Chang, A., Blackburn, B., MH, H. Elsevier. 2016; 11: 421–46
• First case of infectious endocarditis caused by Parvimonas micra. Anaerobe Gomez, C. A., Gerber, D. A., Zambrano, E., Banaei, N., Deresinski, S., Blackburn, B. G. 2015; 36: 53-55

  Abstract

  P. micra is an anaerobic Gram-positive cocci, and a known commensal organism of the human oral cavity and gastrointestinal tract. Although it has been classically described in association with endodontic disease and peritonsillar infection, recent reports have highlighted the role of P. micra as the primary pathogen in the setting of invasive infections. In its most recent taxonomic classification, P. micra has never been reported causing infectious endocarditis in humans. Here, we describe a 71 year-old man who developed severe native valve endocarditis complicated by aortic valvular destruction and perivalvular abscess, requiring emergent surgical intervention. Molecular sequencing enabled identification of P. micra.

  View details for DOI 10.1016/j.anaerobe.2015.10.007

  View details for PubMedID 26485192

• Comparison of community-wide, integrated mass drug administration strategies for schistosomiasis and soil-transmitted helminthiasis: a cost-effectiveness modelling study. The Lancet. Global health Lo, N. C., Bogoch, I. I., Blackburn, B. G., Raso, G., N'Goran, E. K., Coulibaly, J. T., Becker, S. L., Abrams, H. B., Utzinger, J., Andrews, J. R. 2015; 3 (10): e629-38

  Abstract

  More than 1·5 billion people are affected by schistosomiasis or soil-transmitted helminthiasis. WHO's recommendations for mass drug administration (MDA) against these parasitic infections emphasise treatment of school-aged children, using separate treatment guidelines for these two helminthiases groups. We aimed to evaluate the cost-effectiveness of expanding integrated MDA to the entire community in four settings in Côte d'Ivoire.We extended previously published, dynamic, age-structured models of helminthiases transmission to simulate costs and disability averted with integrated MDA (of praziquantel and albendazole) for schistosomiasis and soil-transmitted helminthiasis. We calibrated the model to data for prevalence and intensity of species-specific helminth infection from surveys undertaken in four communities in Côte d'Ivoire between March, 1997, and September, 2010. We simulated a 15-year treatment programme with 75% coverage in only school-aged children; school-aged children and preschool-aged children; adults; and the entire community. Treatment costs were estimated at US$0·74 for school-aged children and $1·74 for preschool-aged children and adults. The incremental cost-effectiveness ratio (ICER) was calculated in 2014 US dollars per disability-adjusted life-year (DALY) averted.Expanded community-wide treatment was highly cost effective compared with treatment of only school-aged children (ICER $167 per DALY averted) and WHO guidelines (ICER $127 per DALY averted), and remained highly cost effective even if treatment costs for preschool-aged children and adults were ten times greater than those for school-aged children. Community-wide treatment remained highly cost effective even when elimination of helminth infections was not achieved. These findings were robust across the four diverse communities in Côte d'Ivoire, only one of which would have received annual MDA for both schistosomiasis and soil-transmitted helminthiasis under the latest WHO guidelines. Treatment every 6 months was also highly cost effective in three out of four communities.Integrated, community-wide MDA programmes for schistosomiasis and soil-transmitted helminthiasis can be highly cost effective, even in communities with low disease burden in any helminth group. These results support an urgent need to re-evaluate current global guidelines for helminthiases control programmes to include community-wide treatment, increased treatment frequency, and consideration for lowered prevalence thresholds for integrated treatment.Stanford University Medical Scholars Programme, Mount Sinai Hospital-University Health Network AMO Innovation Fund.

  View details for DOI 10.1016/S2214-109X(15)00047-9

  View details for PubMedID 26385302

• Free Living Amebae Mandell, Bennett, and Dolin's Principles and Practice of Infectious Diseases Koshy, A., Blackburn, B. G., Singh, U. Elsevier Saunders. 2015; 8: 3059–69
• Comparison of community-wide, integrated mass drug administration strategies for schistosomiasis and soil-transmitted helminthiasis: a cost-effectiveness modelling study Lancet Global Health Lo, N. C., Bogoch, I. I., Blackburn, B. G., Raso, G., N’Goran, E. K., Coulibaly, J. T., Becker, S. L., Abrams, H. B., Utzinger, J., Andrews, J. R. 2015: e629-38

  Abstract

  More than 1·5 billion people are affected by schistosomiasis or soil-transmitted helminthiasis. WHO's recommendations for mass drug administration (MDA) against these parasitic infections emphasise treatment of school-aged children, using separate treatment guidelines for these two helminthiases groups. We aimed to evaluate the cost-effectiveness of expanding integrated MDA to the entire community in four settings in Côte d'Ivoire.We extended previously published, dynamic, age-structured models of helminthiases transmission to simulate costs and disability averted with integrated MDA (of praziquantel and albendazole) for schistosomiasis and soil-transmitted helminthiasis. We calibrated the model to data for prevalence and intensity of species-specific helminth infection from surveys undertaken in four communities in Côte d'Ivoire between March, 1997, and September, 2010. We simulated a 15-year treatment programme with 75% coverage in only school-aged children; school-aged children and preschool-aged children; adults; and the entire community. Treatment costs were estimated at US$0·74 for school-aged children and $1·74 for preschool-aged children and adults. The incremental cost-effectiveness ratio (ICER) was calculated in 2014 US dollars per disability-adjusted life-year (DALY) averted.Expanded community-wide treatment was highly cost effective compared with treatment of only school-aged children (ICER $167 per DALY averted) and WHO guidelines (ICER $127 per DALY averted), and remained highly cost effective even if treatment costs for preschool-aged children and adults were ten times greater than those for school-aged children. Community-wide treatment remained highly cost effective even when elimination of helminth infections was not achieved. These findings were robust across the four diverse communities in Côte d'Ivoire, only one of which would have received annual MDA for both schistosomiasis and soil-transmitted helminthiasis under the latest WHO guidelines. Treatment every 6 months was also highly cost effective in three out of four communities.Integrated, community-wide MDA programmes for schistosomiasis and soil-transmitted helminthiasis can be highly cost effective, even in communities with low disease burden in any helminth group. These results support an urgent need to re-evaluate current global guidelines for helminthiases control programmes to include community-wide treatment, increased treatment frequency, and consideration for lowered prevalence thresholds for integrated treatment.Stanford University Medical Scholars Programme, Mount Sinai Hospital-University Health Network AMO Innovation Fund.

  View details for DOI 10.1016/S2214-109X(15)00047-9

• Micro-Loans, Insecticide-Treated Bednets, and Malaria: Evidence from a Randomized Controlled Trial in Orissa, India. The American economic review Tarozzi, A., Mahajan, A., Blackburn, B., Kopf, D., Krishnan, L., Yoong, J. 2014; 104 (7): 1909-41

  Abstract

  We describe findings from the first large-scale cluster randomized controlled trial in a developing country that evaluates the uptake of a health-protecting technology, insecticide-treated bednets (ITNs), through micro-consumer loans, as compared to free distribution and control conditions. Despite a relatively high price, 52 percent of sample households purchased ITNs, highlighting the role of liquidity constraints in explaining earlier low adoption rates. We find mixed evidence of improvements in malaria indices. We interpret the results and their implications within the debate about cost sharing, sustainability and liquidity constraints in public health initiatives in developing countries.

  View details for PubMedID 29533566

• Insecticide-Treated Bednets and Malaria Control: Strategies, Implementation, and Outcome The Global Challenge of Malaria: Lessons of the Past and Future Prospects HV, F., E, M., BG, B. edited by FM, S. G., R, B. World Scientific Press. 2014; 1st: 143–87
• Eosinophilic Meningitis Attributable to Angiostrongylus cantonensis Infection in Hawaii: Clinical Characteristics and Potential Exposures AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE Hochberg, N. S., Blackburn, B. G., Park, S. Y., Sejvar, J. J., Effler, P. V., Herwaldt, B. L. 2011; 85 (4): 685-690

  Abstract

  The most common infectious cause of eosinophilic meningitis is Angiostrongylus cantonensis, which is transmitted largely by consumption of snails/slugs. We previously identified cases of angiostrongyliasis that occurred in Hawaii from 2001 to 2005; the highest incidence was on the island of Hawaii. We now report symptoms, laboratory parameters, and exposures. Eighteen patients were evaluated; 94% had headache, and 65% had sensory symptoms (paresthesia, hyperesthesia, and/or numbness). These symptoms lasted a median of 17 and 55 days, respectively. Three persons recalled finding a slug in their food/drink. Case-patients on the island of Hawaii were more likely than case-patients on other islands to consume raw homegrown produce in a typical week (89% versus 0%, P < 0.001) and to see snails/slugs on produce (56% versus 0%, P = 0.03). Residents and travelers should be aware of the potential risks of eating uncooked produce in Hawaii, especially if it is from the island of Hawaii and locally grown.

  View details for DOI 10.4269/ajtmh.2011.11-0322

  View details for Web of Science ID 000295898900021

  View details for PubMedID 21976573

  View details for PubMedCentralID PMC3183778

• Antiparasitic Therapy MAYO CLINIC PROCEEDINGS Kappagoda, S., Singh, U., Blackburn, B. G. 2011; 86 (6): 561-583

  Abstract

  Parasitic diseases affect more than 2 billion people globally and cause substantial morbidity and mortality, particularly among the world's poorest people. This overview focuses on the treatment of the major protozoan and helminth infections in humans. Recent developments in antiparasitic therapy include the expansion of artemisinin-based therapies for malaria, new drugs for soil-transmitted helminths and intestinal protozoa, expansion of the indications for antiparasitic drug treatment in patients with Chagas disease, and the use of combination therapy for leishmaniasis and human African trypanosomiasis.

  View details for DOI 10.4065/mcp.2011.0203

  View details for Web of Science ID 000291288400012

  View details for PubMedID 21628620

  View details for PubMedCentralID PMC3104918

• West Nile virus encephalitis acquired via liver transplantation and clinical response to intravenous immunoglobulin: case report and review of the literature. Transpl Infect Dis Rhee C, Eaton EF, Concepcion W, Blackburn BG. 2011; 13: 312-7
• Soil-Transmitted Helminths: Ascaris, Trichuris, and Hookworm Infections In: Selendy J (ed.) Water and Sanitation Related Diseases and the Environment: Challenges, Interventions and Preventive Measures, 1st Ed. Blackburn BG, Barry M 2011: 81-93
• High Prevalence of Wuchereria bancrofti Infection As Detected by Immunochromatographic Card Testing in Five Districts of Orissa, India, Previously Considered to be Non-Endemic Trans R Soc Trop Med Hyg Foo PK, Tarozzi A, Mahajan A, Yoong J, Krishnan L, Kopf D, Blackburn BG 2011; 105: 109-14
• Parasitic Infections in Cancer Patients: Toxoplasmosis, Strongyloidiasis, and Other Parasites In: Safdar A, ed. Principles and Practice of Cancer Infectious Diseases, Current Clinical Oncology Series. 1st ed. Blackburn BG, Montoya JG 2011; 1: 469-80
• Free Living Amebae. In: Mandell G, Bennett JE, Dolin R, eds., Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, 7th ed. Koshy, A., Blackburn, B. G., Singh, U. 2010; 7: 3427-3436
• Travel Medicine In: Bope ET, Rakel RE, Kellerman RD (eds). Conn's Current Therapy 2010. Chary A, Singh U, Blackburn BG 2010; 62: 155-68
• Commitment Mechanisms and Compliance with Health-Protecting Behavior: Preliminary Evidence from Orissa, India 121st Annual Meeting of the American-Economic-Association Tarozzi, A., Mahajan, A., Yoong, J., Blackburn, B. AMER ECONOMIC ASSOC. 2009: 231–35

  View details for DOI 10.1257/aer.99.2.231

  View details for Web of Science ID 000266458300039

• Commitment Mechanisms and Compliance with Health-Protecting Behavior: Preliminary Evidence from Orissa, India. The American economic review Tarozzi, A., Mahajan, A., Yoong, J., Blackburn, B. 2009; 99 (2): 231-5

  View details for PubMedID 29505218

• Review of Travel Medicine, 2nd Ed. Keystone JS, Kozarsky PE, Freedman DO, Nothdurft HO, Connor BA (eds) Clin Infect Dis Barry M, Blackburn BG 2009; 49: 1461
• Gram Negative Rods, Gram Positive Organisms, and Pneumonia chapters Practical Guide to the Care of the Surgical Patient (in press) Pang PS, Blackburn BG, Eckburg PB 2009; 1st Ed: 92-7, 98-100, 102-5
• Severe Encephalomyelitis in an Immunocompetent Adult with Chromosomally Integrated Human Herpesvirus 6 and Clinical Response to Treatment with Foscarnet plus Ganciclovir Clin Infect Dis Troy SB, Blackburn BG, Yeom K, Finley Caulfield AK, Bhangoo MS, Montoya JG 2008; 47: e93-6
• Schistosomiasis Health Information for International Travel 2008 (The Yellow Book) Maguire J, Blackburn B, Montgomery S 2007: 297-301
• High prevalence and presumptive treatment of schistosomiasis and strongyloidiasis among African refugees Clin Infect Dis Blackburn BG*, Posey DL*, Weinberg M, Flagg EW, Ortega L, Wilson M, Secor WE, Sanders-Lewis K, Won K, Maguire JH 2007; 45: 1310-15
• Distribution of Eosinophilic Meningitis Cases Attributable to Angiostrongylus cantonensis, Hawaii Emerg Infect Dis Hochberg NS, Park SY, Blackburn BG, Sejvar JJ, Gaynor K, Chung H, Leniek K, Herwaldt BL, Effler PV 2007; 13: 1675-1680
• Full recovery from Baylisascaris procyonis eosinophilic meningitis Emerg Infec Dis Pai PJ, Blackburn BG, Kazacos KR, Warrier RP, Begue RE 2007; 13 (6): 928-930
• Microarray detection of human parainfluenzavirus 4 infection associated with respiratory failure in an immunocompetent adult CLINICAL INFECTIOUS DISEASES Chiu, C. Y., Rouskin, S., Koshy, A., Urisman, A., Fischer, K., Yagi, S., Schnurr, D., Eckburg, P. B., Tompkins, L. S., Blackburn, B. G., Merker, J. D., Patterson, B. K., Ganem, D., DeRisi, J. L. 2006; 43 (8): E71-E76

  Abstract

  A pan-viral DNA microarray, the Virochip (University of California, San Francisco), was used to detect human parainfluenzavirus 4 (HPIV-4) infection in an immunocompetent adult presenting with a life-threatening acute respiratory illness. The virus was identified in an endotracheal aspirate specimen, and the microarray results were confirmed by specific polymerase chain reaction and serological analysis for HPIV-4. Conventional clinical laboratory testing using an extensive panel of microbiological tests failed to yield a diagnosis. This case suggests that the potential severity of disease caused by HPIV-4 in adults may be greater than previously appreciated and illustrates the clinical utility of a microarray for broad-based viral pathogen screening.

  View details for Web of Science ID 000240666200029

  View details for PubMedID 16983602

• Successful integration of insecticide-treated bed net distribution with mass drug administration in Central Nigeria AMERICAN JOURNAL OF TROPICAL MEDICINE AND HYGIENE Blackburn, B. G., Eigege, A., Gotau, H., Gerlong, G., Miri, E., Hawley, W. A., Mathieu, E., Richards, F. 2006; 75 (4): 650-655

  Abstract

  In Africa anopheline mosquitoes transmit malaria and lymphatic filariasis (LF); insecticide-treated bed nets significantly reduce transmission of both. Insecticide-treated bed net provision to children under 5 (U5) and pregnant women (PW) is a major goal of malaria control initiatives, but use in Africa remains low because of cost and logistics. We therefore integrated insecticide-treated bed net distribution with the 2004 LF/onchocerciasis mass drug administration (MDA) program in Central Nigeria. Community volunteers distributed 38,600 insecticide-treated bed nets, while simultaneously treating 150,800 persons with ivermectin/albendazole (compared with 135,600 in 2003). This was subsequently assessed with a 30-cluster survey. Among surveyed households containing U5/PW, 80% (95% CI, 72-87%) owned > or = 1 insecticide-treated bed net, a 9-fold increase from 2003. This first linkage of insecticide-treated bed net distribution with mass drug administration resulted in substantial improvement in insecticide-treated bed net ownership and usage, without adversely affecting mass drug administration coverage. Such integration allowed two programs to share resources while realizing mutual benefit, and is one model for rapidly improving insecticide-treated bed net coverage objectives.

  View details for Web of Science ID 000241214100013

  View details for PubMedID 17038688

• Urban lymphatic filariasis in central Nigeria ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY Terranella, A., Eigiege, A., Gontor, I., Dagwa, P., Damishi, S., Miri, E., Blackburn, B., McFarland, D., Zingeser, J., Jinadu, M. Y., Richards, F. O. 2006; 100 (2): 163-172

  Abstract

  Wuchereria bancrofti and the other mosquito-borne parasites that cause human lymphatic filariasis (LF) infect over 120 million people world-wide. Global efforts are underway to stop transmission of the parasites, using annual, single-dose mass drug administrations (MDA) to all at-risk populations. Although most MDA to date have been in rural settings, they are also recommended in urban areas of transmission. It remains unclear whether there is significant urban transmission in West Africa, however, and the need for urban MDA in this region therefore remains a matter of debate.Clinic-based surveillance, for the clinical manifestations of LF, has now been used to identify areas of urban transmission of W. bancrofti in Jos, the major urban population centre of Plateau state, Nigeria. The eight clinics investigated were all located in slum areas, close to vector breeding sites, and were therefore considered to serve at-risk populations. Over a 1-month period, selected providers in these clinics sought hydrocele, lymphoedema, elephantiasis, or acute adenolymphangitis among the patients seeking treatment. The consenting patients who were suspected clinical cases of LF, and a cohort of patients suspected to be cases of onchocerciasis, were tested for W. bancrofti antigenaemia. All the patients were asked a series of questions in an attempt to determine if those found antigenaemic could only have been infected in an urban area. During the study, 30 suspected clinical cases of LF were detected and 18 of these (including two patients who were found to be antigenaemic) lived in urban areas. Of the 98 patients with exclusively urban exposure who were tested for filarial antigenaemia, six (6.1%) were found antigenaemic. Clinic-based surveillance appears to be a useful tool for determining if there is W. bancrofti transmission in an urban setting.

  View details for DOI 10.1179/136485906X86266

  View details for Web of Science ID 000236031200008

  View details for PubMedID 16492364

• Schistosomiasis and Strongyloidiasis chapters The Red Book Blackburn B 2006; 27th Ed.: 587-88; 629-631
• Outbreak of Cryptosporidiosis Associated with Consumption of Ozonated Apple Cider Emerg Infec Dis Blackburn BG, Mazurek J, Hlavsa M, Park J, Tillapaw M, Parrish M, Salehi E, Franks W, Koch E, Smith F, Xiao L, Arrowood M, Hill V, da Silva A, Jones J 2006; 12: 684-686
• Emergency survey methods in acute cryptosporidiosis outbreak EMERGING INFECTIOUS DISEASES Fox, L. M., Ocfemia, M. C., Hunt, D. C., Blackburn, B. G., Neises, D., Kent, W. K., Beach, M. J., Pezzino, G. 2005; 11 (5): 729-731

  Abstract

  In August 2003, a communitywide outbreak of cryptosporidiosis occurred in Kansas. We conducted a case-control study to assess risk factors associated with Cryptosporidium infection by using the telephone survey infrastructure of the Behavioral Risk Factor Surveillance System. Using existing state-based infrastructure provides an innovative means for investigating acute outbreaks.

  View details for Web of Science ID 000228683000017

  View details for PubMedID 15890130

• Schistosomiasis Health Information for International Travel 2005-2006 (The Yellow Book) Blackburn B, Maguire J 2005: 266-270
• Surveillance for waterborne-disease outbreaks associated with recreational water--United States, 2001-2002. Morbidity and mortality weekly report. Surveillance summaries (Washington, D.C. : 2002) Yoder, J. S., Blackburn, B. G., Craun, G. F., Hill, V., Levy, D. A., Chen, N., Lee, S. H., Calderon, R. L., Beach, M. J. 2004; 53 (8): 1-22

  Abstract

  Since 1971, CDC, the U.S. Environmental Protection Agency, and the Council of State and Territorial Epidemiologists have maintained a collaborative surveillance system for collecting and periodically reporting data related to occurrences and causes of waterborne-disease outbreaks (WBDOs) related to drinking water; tabulation of recreational water-associated outbreaks was added to the surveillance system in 1978. This surveillance system is the primary source of data concerning the scope and effects of waterborne disease outbreaks on persons in the United States.This summary includes data on WBDOs associated with recreational water that occurred during January 2001-December 2002 and on a previously unreported outbreak that occurred during 1998.Public health departments in the states, territories, localities, and the Freely Associated States are primarily responsible for detecting and investigating WBDOs and voluntarily reporting them to CDC on a standard form. The surveillance system includes data for outbreaks associated with both drinking water and recreational water; only outbreaks associated with recreational water are reported in this summary.During 2001-2002, a total of 65 WBDOs associated with recreational water were reported by 23 states. These 65 outbreaks caused illness among an estimated 2,536 persons; 61 persons were hospitalized, eight of whom died. This is the largest number of recreational water-associated outbreaks to occur since reporting began in 1978; the number of recreational water-associated outbreaks has increased significantly during this period (p<0.01). Of these 65 outbreaks, 30 (46.2%) involved gastroenteritis. The etiologic agent was identified in 23 (76.7%) of these 30 outbreaks; 18 (60.0%) of the 30 were associated with swimming or wading pools. Eight (12.3%) of the 65 recreational water-associated disease outbreaks were attributed to single cases of primary amebic meningoencephalitis caused by Naegleria fowleri; all eight cases were fatal and were associated with swimming in a lake (n = seven; 87.5%) or river (n = one; 12.5%). Of the 65 outbreaks, 21 (32.3%) involved dermatitis; 20 (95.2%) of these 21 outbreaks were associated with spas or pools. In addition, one outbreak of Pontiac fever associated with a spa was reported to CDC. Four (6.1%) of the 65 outbreaks involved acute respiratory illness associated with chemical exposure at pools.The 30 outbreaks involving gastroenteritis comprised the largest proportion of recreational water-associated outbreaks during this reporting period. These outbreaks were associated most frequently with Cryptosporidium (50.0%) in treated water venues and with toxigenic Escherichia coli (25.0%) and norovirus (25.0%) in freshwater venues. The increase in the number of outbreaks since 1993 could reflect improved surveillance and reporting at the local and state level, a true increase in the number of WBDOs, or a combination of these factors.CDC uses surveillance data to identify the etiologic agents, types of aquatics venues, water-treatment systems, and deficiencies associated with outbreaks and to evaluate the adequacy of efforts (e.g., regulations and public awareness activities) for providing safe recreational water. Surveillance data are also used to establish public health prevention priorities, which might lead to improved water-quality regulations at the local, state, and federal levels.

  View details for PubMedID 15499306