Jake Scott, MD

All Publications

• Updated Evidence for Covid-19, RSV, and Influenza Vaccines for 2025-2026. The New England journal of medicine Scott, J., Abers, M. S., Marwah, H. K., McCann, N. C., Meyerowitz, E. A., Richterman, A., Fleming, D. F., Holmes, E. J., Moat, L. E., Redepenning, S. G., Smith, E. A., Stoddart, C. J., Sundaram, M. E., Ulrich, A. K., Alba, C., Anderson, C. J., Arpey, M. K., Borre, E., Ladines-Lim, J., Mehr, A. J., Rich, K., Watts, C., Basta, N. E., Jarolimova, J., Walensky, R. P., Dugdale, C. M. 2025

  Abstract

  Changes in the vaccine advisory process in the United States have disrupted immunization guidance, which reinforces the need for independent evidence review to inform decisions regarding immunization for respiratory viruses during the 2025-2026 season.We conducted a systematic review of U.S.-licensed immunizations against coronavirus disease 2019 (Covid-19), respiratory syncytial virus (RSV), and influenza. We searched databases on PubMed/MEDLINE, Embase, and Web of Science for updates of the most recent review by the Advisory Committee on Immunization Practices (ACIP) Evidence-to-Recommendations for each disease, which was performed during the 2023-2024 period. Outcomes included vaccine efficacy and effectiveness against hospitalization, other clinical end points, and safety.Of 17,263 identified references, 511 studies met the inclusion criteria. Covid-19 mRNA vaccines against the XBB.1.5 subvariant had pooled vaccine effectiveness against hospitalization of 46% (95% confidence interval [CI], 34 to 55; from cohort studies) and 50% (95% CI, 43 to 57; from case-control studies) among adults and 37% (95% CI, 29 to 44) among immunocompromised adults. In a case-control study, vaccines against the KP.2 subvariant showed an effectiveness of 68% (95% CI, 42 to 82). Maternal RSV vaccination (for infant protection), nirsevimab for infants, and RSV vaccines in adults who were 60 years of age or older showed vaccine effectiveness of 68% or more against hospitalization. Influenza vaccination had a pooled vaccine effectiveness of 48% (95% CI, 39 to 55) in adults between the ages of 18 and 64 years and 67% (95% CI, 58 to 75) in children against hospitalization. Safety profiles were consistent with previous evaluations. The diagnosis of myocarditis associated with Covid-19 vaccines occurred at rates of 1.3 to 3.1 per 100,000 doses in male adolescents, with lower risk associated with longer dosing intervals. The RSVPreF vaccine was associated with 18.2 excess cases of Guillain-Barré syndrome per million doses in older adults; a significant association with preterm birth was not observed when the vaccine was administered at 32 to 36 weeks' gestation.Ongoing peer-reviewed evidence supports the safety and effectiveness of immunizations against Covid-19, RSV, and influenza during the 2025-2026 season. (Funded by the Center for Infectious Disease Research and Policy and the Alumbra Innovations Foundation.).

  View details for DOI 10.1056/NEJMsa2514268

  View details for PubMedID 41160817

• Olfactory Dysfunction After SARS-CoV-2 Infection in the RECOVER Adult Cohort. JAMA network open Horwitz, L. I., Becker, J. H., Huang, W., Akintonwa, T., Hornig-Rohan, M. M., Maranga, G., Adams, D. R., Albers, M. W., Ayache, M., Berry, J., Brim, H., Bryan, T. W., Charney, A. W., Clark, R. A., Cortez, M. M., D'Anza, B., Davis, H., Donohue, S. E., Erdmann, N., Flaherman, V., Fong, T. G., Frontera, J. A., Goldberg, M. P., Goldman, J. D., Harkins, M. S., Hodder, S. L., Jacoby, V. L., Jagannathan, P., Jia, X., Kelly, J. D., Krishnan, J. A., Kumar, A., Laiyemo, A. O., Levitan, E. B., Martin, J. N., McCaffrey, K. M., McComsey, G. A., Metz, T. D., Murthy, G., Nguyen, H., Okumura, M., Parry, S., Parthasarathy, S., Patterson, T. F., Peluso, M. J., Sorochinsky, C., Walker, T., Wiegand, S. L., Wiley, Z., Wisnivesky, J., Ashktorab, H., Foulkes, A., Lee-Iannotti, J. K. 2025; 8 (9): e2533815

  Abstract

  Olfactory dysfunction is common after SARS-CoV-2 infection and has been associated with cognitive loss in other conditions. Formal testing is needed to characterize the presence, severity, and patterns of olfactory dysfunction.To characterize long-term olfactory dysfunction after SARS-CoV-2 infection.This prospective cohort study included adults enrolled in the Researching COVID to Enhance Recovery (RECOVER)-Adult study. All those with and a random sample of those without self-reported change or loss in smell or taste were offered olfactory testing, performed at 83 sites in 35 US states and territories. Participants included 2956 enrollees with prior infection (1393 with and 1563 without self-reported change or loss) and 569 without prior infection (9 with and 560 without self-reported change or loss in taste) who underwent olfactory testing a mean (SD) of 671.6 (417.8) days after the index date. Data were collected from October 29, 2021, to June 6, 2025.SARS-CoV-2 infection.Olfactory function, as defined by age- and sex-standardized performance on the University of Pennsylvania Smell Identification Test (UPSIT), a well-validated test comprising 40 unique odors.The study included 3525 participants with a mean (SD) age of 47.6 (15.2) years; of 3520 with data available, 2548 (72.4%) were female or intersex. Among 1393 infected participants with self-reported change or loss, 1111 (79.8%) had hyposmia on the UPSIT, including 321 (23.0%) with severe microsmia or anosmia. Among 1563 infected participants without self-reported change or loss, 1031 (66.0%) had hyposmia, including 128 (8.2%) with severe microsmia or anosmia. Participants with prior infection and self-reported change or loss scored at the 16th age- and sex-standardized UPSIT percentile, compared with the 23rd and 28th percentiles for those without self-reported change or loss with and without prior known infection, respectively. Younger women had scores corresponding to lower mean age- and sex-standardized percentiles. Among participants who self-reported change or loss in smell, those with abnormal UPSIT scores more often reported cognitive problems (742 of 1111 [66.8%]) than those with normal UPSIT scores (179 of 282 [63.5%]).In this cohort study of RECOVER-Adult participants, self-reported change or loss in smell or taste was an accurate signal of verified hyposmia, but a high rate of hyposmia among those with no reported change or loss was also observed. Formal smell testing may be considered in those with prior SARS-CoV-2 infection to diagnose occult hyposmia and counsel patients about risks.

  View details for DOI 10.1001/jamanetworkopen.2025.33815

  View details for PubMedID 40996759

• Metformin and Time to Sustained Recovery in Adults With COVID-19: The ACTIV-6 Randomized Clinical Trial. JAMA internal medicine Bramante, C. T., Stewart, T. G., Boulware, D. R., McCarthy, M. W., Gao, Y., Rothman, R. L., Mourad, A., Thicklin, F., Cohen, J. B., Garcia Del Sol, I. T., Ruiz-Unger, J., Shah, N. S., Mehta, M., Cardona, O. Q., Scott, J., Ginde, A. A., Castro, M., Jayaweera, D., Sulkowski, M., Gentile, N., McTigue, K., Felker, G. M., Collins, S., Dunsmore, S. E., Adam, S. J., Lindsell, C. J., Hernandez, A. F., Naggie, S., Accelerating COVID-19 Therapeutic Interventions and Vaccines-6 Study Group and Investigators, DeLong, A., Wilder, R., Hanna, G., Fraser, R., Ward, M., Weaver, S., McAdams, M. P., Korzekwinski, K., Oyelakin, M., Dockery, S., Adkins, R., Crow, M., Light, S., Morris, R., Nowell, E., Wells, K., Herbert, A., Stone, A., Heavlin, H., Brown, L., Brunson, S., Harding, T., Harrington, A., Beauchaine, M., Lindblom, K., Burns, A., Mourad, A., Hamm, M. E., Phillips, K. T., Vasey, A., Edwards, T., Nelson, D., Merritt, G., Nguyen, J., Denson, J., Arnold, J., Aamodt, D., Clark, D., Collins, J., Collins, S., Dixon, S., Gao, Y., Graves, J., Grindstaff, J., Harrell, F., Lai, J., Liao, V., Lopez, I., Manis, E., Mankowski, K., Marlin, J., Merkel, A., Nwosu, S., Obregon, S., Orozco, D., Prato, N., Rohde, M., Shirey-Rice, J., Vermillion, K., Smith, J., Tan, H., Vance, M., Weir, M., Bianchi, R., Premas, J., Gupta, M., Karawan, G., Lima, S., Ziomek, C., Arena, J., DeAlmeida, S., Malik, A., Bryce, J., Swint, S., Tiffany, B., Tanner, C., Sahelian, A., George-Adebayo, C., Adebayo, A., Ronan, T., Woods, A., Gallegos, C., Flys, T., Sloan, O., Olofintuyi, A., Samraj, J., Samraj, J., Averett, A., Slandzicki, A., Wallan, J., Vogel, C., Munoz, S., Kavtaradze, D., Watson, C., Singleton, D., Sevier, M., Rivon, M., Rao, S., Cantu, L., Krishna, A., Daugherty, H., Kerr, B., Evans, K., Spees, R., Marta, M., Amir, D., Collazo, J., Dolor, R., Vergara, L., Jordan, J., Burruss, V., Hurst, T., Rebolledo Esteinou, P. A., Ofotokun, I., Zhang, C., Traenkner, J., Atha, M. M., James, V., Rogers, M., Oragwu, C., Oguego, N., Pillai, R., Gabriel, A., Ghaly, E., Michal, M., Hassanien, G., Ismail, S., Samir, Y., Meltzer, A., Heidish, R. S., Loganathan, A., Brehaut, S., Roche, A., Koppinger, N., Baez, J., Pagan, I., Abdelsayed, D., Aziz, M., Robinson, P., Lozinski, G., Nguyen, J., Griffin, A., Morris, M., Love, N., Mattox, B., Martin, R., Pardue, V., Rowland, T., Reyes, L., Bacallao, N., Cienki, J., Yuan, Y., Li, J., Szeto, J., Stelmash, L., Mekhael, S., Morales Castillo, L., Gutierrez, A., Prieto, S., Amon, A., Barbera, A., Bugajski, A., Wills, W., Jacklin, K., Lamb, D., Harper, A., Stout, E., Griffin, M., Clark, N., Barsanti-Sekhar, M., Carbrera-Mendez, C., Evans, M. R., Maria, J., Raymond, O., Summers, J., Turner, T., Lenert, L., Panaccione, E., Miller, C., Wiley, H., Chan, A., Khizer, S., Adeyemi, O., Ning Chi, W., Chen, J., Morton-Jost, M., Castex, J., Quirch, A., Belani, H., Machicado, R., Bjornsson, B., Olivo, J., Maldonado, M., Vecchiarelli, A., Gaytan-Alvarez, D., Cherukuri, V., Alicic, R., Lambert, A. A., Urbat, C., Baxter, J., Cooper, A., Linn, D., Fisher, L., Patel, V., Patel, Y., Talati, R., Patel, P., Ellison, L., Roman, A., Harrison, J., Moy, J., Naquiallah, D., Shah, B., Jagannathan, P., Singh, U., O'Donnell, A., Jazayeri, Y., Gupta, A., Chandrasekar, N., Curtis, C., White, B., Dockery, M., Fortt, T., Fortt, A., Wilson, J., Marcelin, J., Farlow, B., Grady, C., Richwine, R., Pazier, P., Michelson, E., Watts, S., Kariyawasam, D., Rodriguez, L., Luis Garcia, J., Manresa, I., Achong, A. A., Garcia, M. C., Mahadevan, A., VandeWeerd, C., Lowenkron, J., Sappington, E., Roberts, M., Wang, J., Adams, M., Ding, X., Co, M., D'Andrea, M., Lim, S., Young, M., Wilson, M., Eastin, C., Cheathem, A., Nadeem, A., Walters, C., Powers-Fletcher, M., Brown, D., Miller, D., Mukunzi, S., Isache, C., Bowman, J., Martin, D., Duran, B., Schwasinger-Schmidt, T., Ast, A., Cornejo, A., Archer, A., Almanzar, M., Motel, V., Pullen, M., Bhat, N., Parra, D., Urbina, E., Arriaza, S., Sekikawa, A., Klawson, E., Weiland, N., Ostrosky-Zeichner, L., Patel, B., Umana, V., Nielsen, L., Grimes, C. Z., Patterson, T. F., Soileau, B. T., Jackson, P. E., Haughey, H. M., Vaidya-Tank, B., Gould, C., Goyal, P., Pangburn, H., Michalowski, L., Williamson, J., Wortham, B., Abbott, R., Umana, U., Alleyne, C., Witting, B., Armas, E., Perez Landaburo, R. O., De La Cruz, M., Ballmajo, M., Alvarez, J. 2025

  Abstract

  Importance: The effect of metformin on reducing symptom duration among outpatient adults with COVID-19 has not been studied.Objective: To assess metformin compared with placebo for symptom resolution during acute infection with SARS-CoV-2.Design, Setting, and Participants: The Accelerating COVID-19 Therapeutic Interventions and Vaccines platform evaluated repurposed medications for mild to moderate COVID-19. Between September 19, 2023, and May 1, 2024, participants 30 years or older with confirmed SARS-CoV-2 infection and 2 or more COVID-19 symptoms for 7 days or less were included at 90 US sites.Interventions: Participants were randomized to receive metformin (titrated to 1500 mg, daily) or placebo for 14 days.Main Outcomes and Measures: The primary outcome was time to sustained recovery (3 consecutive days without COVID-19 symptoms) within 28 days of receiving the study drug. Secondary outcomes included time to clinic visit, emergency department (ED) visit, hospitalization, or death. Safety events of interest were hypoglycemia and lactic acidosis.Results: Among 2991 participants who were randomized and received study drug, the median age was 47 (IQR, 38-58) years; 1895 (63.4%) were female, 25 (0.8%) were American Indian of Alaska Native, 77 (2.6%) were Asian, 350 (11.7%) were Black, African American, or African, 1392 (46.5%) identified as Hispanic or Latino, 8 (0.3%) were Native Hawaiian or other Pacific Islander, 2395 (80.1%) were White, and 2044 (68.3%) reported 2 or more doses of a SARS-CoV-2 vaccine. Among 1443 (48.2%) participants who received metformin and 1548 (51.8%) who received placebo, differences in time to sustained recovery were not observed (adjusted hazard ratio, 0.96; 95% credible interval [CrI], 0.89-1.03; P for efficacy=.11). The median time to sustained recovery was 9 days (95% CI, 9-10) for metformin and 10 days (95% CI, 9-10) for placebo. No deaths were reported; 103 participants reported clinic visits, ED visits, or hospitalization: 54 in the metformin group and 49 in the placebo group (hazard ratio, 1.25; 95% CrI, 0.82-1.78; P for efficacy=.13). Overall, 35 (1.2%) reported ED visits or hospitalization (1.1% in the metformin and 1.3% in the placebo group). Seven participants who received metformin and 3 who received placebo experienced a serious adverse event over 180 days. There were 4 episodes of participant-reported hypoglycemia in the placebo group and 2 in the metformin group.Conclusions and Relevance: In this randomized clinical trial, metformin was not shown to shorten the time to symptom resolution in low-risk adults with COVID-19. The median days to symptom resolution was numerically but not significantly lower for metformin. Safety was not a limitation in the study population.Trial Registration: ClinicalTrials.gov Identifier: NCT04885530.

  View details for DOI 10.1001/jamainternmed.2025.2570

  View details for PubMedID 40658388

• Evaluation of Procalcitonin-Guided Algorithm for Antibiotic Use in Lower Respiratory Tract Infections Nguyen, A. K., Lu, B., Scott, J. OXFORD UNIV PRESS INC. 2025: S909

  View details for Web of Science ID 001430246002213

• Sex Differences in Long COVID. JAMA network open Shah, D. P., Thaweethai, T., Karlson, E. W., Bonilla, H., Horne, B. D., Mullington, J. M., Wisnivesky, J. P., Hornig, M., Shinnick, D. J., Klein, J. D., Erdmann, N. B., Brosnahan, S. B., Lee-Iannotti, J. K., Metz, T. D., Maughan, C., Ofotokun, I., Reeder, H. T., Stiles, L. E., Shaukat, A., Hess, R., Ashktorab, H., Bartram, L., Bassett, I. V., Becker, J. H., Brim, H., Charney, A. W., Chopra, T., Clifton, R. G., Deeks, S. G., Erlandson, K. M., Fierer, D. S., Flaherman, V. J., Fonseca, V., Gander, J. C., Hodder, S. L., Jacoby, V. L., Kotini-Shah, P., Krishnan, J. A., Kumar, A., Levy, B. D., Lieberman, D., Lin, J. J., Martin, J. N., McComsey, G. A., Moukabary, T., Okumura, M. J., Peluso, M. J., Rosen, C. J., Saade, G., Shah, P. K., Sherif, Z. A., Taylor, B. S., Tuttle, K. R., Urdaneta, A. E., Wallick, J. A., Wiley, Z., Zhang, D., Horwitz, L. I., Foulkes, A. S., Singer, N. G. 2025; 8 (1): e2455430

  Abstract

  A substantial number of individuals worldwide experience long COVID, or post-COVID condition. Other postviral and autoimmune conditions have a female predominance, but whether the same is true for long COVID, especially within different subgroups, is uncertain.To evaluate sex differences in the risk of developing long COVID among adults with SARS-CoV-2 infection.This cohort study used data from the National Institutes of Health (NIH) Researching COVID to Enhance Recovery (RECOVER)-Adult cohort, which consists of individuals enrolled in and prospectively followed up at 83 sites in 33 US states plus Washington, DC, and Puerto Rico. Data were examined from all participants enrolled between October 29, 2021, and July 5, 2024, who had a qualifying study visit 6 months or more after their initial SARS-CoV-2 infection.Self-reported sex (male, female) assigned at birth.Development of long COVID, measured using a self-reported symptom-based questionnaire and scoring guideline at the first study visit that occurred at least 6 months after infection. Propensity score matching was used to estimate risk ratios (RRs) and risk differences (95% CIs). The full model included demographic and clinical characteristics and social determinants of health, and the reduced model included only age, race, and ethnicity.Among 12 276 participants who had experienced SARS-CoV-2 infection (8969 [73%] female; mean [SD] age at infection, 46 [15] years), female sex was associated with higher risk of long COVID in the primary full (RR, 1.31; 95% CI, 1.06-1.62) and reduced (RR, 1.44; 95% CI, 1.17-1.77) models. This finding was observed across all age groups except 18 to 39 years (RR, 1.04; 95% CI, 0.72-1.49). Female sex was associated with significantly higher overall long COVID risk when the analysis was restricted to nonpregnant participants (RR, 1.50; 95%: CI, 1.27-1.77). Among participants aged 40 to 54 years, the risk ratio was 1.42 (95% CI, 0.99-2.03) in menopausal female participants and 1.45 (95% CI, 1.15-1.83) in nonmenopausal female participants compared with male participants.In this prospective cohort study of the NIH RECOVER-Adult cohort, female sex was associated with an increased risk of long COVID compared with male sex, and this association was age, pregnancy, and menopausal status dependent. These findings highlight the need to identify biological mechanisms contributing to sex specificity to facilitate risk stratification, targeted drug development, and improved management of long COVID.

  View details for DOI 10.1001/jamanetworkopen.2024.55430

  View details for PubMedID 39841477

  View details for PubMedCentralID PMC11755195

• 2024 Update of the RECOVER-Adult Long COVID Research Index. JAMA Geng, L. N., Erlandson, K. M., Hornig, M., Letts, R., Selvaggi, C., Ashktorab, H., Atieh, O., Bartram, L., Brim, H., Brosnahan, S. B., Brown, J., Castro, M., Charney, A., Chen, P., Deeks, S. G., Erdmann, N., Flaherman, V. J., Ghamloush, M. A., Goepfert, P., Goldman, J. D., Han, J. E., Hess, R., Hirshberg, E., Hoover, S. E., Katz, S. D., Kelly, J. D., Klein, J. D., Krishnan, J. A., Lee-Iannotti, J., Levitan, E. B., Marconi, V. C., Metz, T. D., Modes, M. E., Nikolich, J. Ž., Novak, R. M., Ofotokun, I., Okumura, M. J., Parthasarathy, S., Patterson, T. F., Peluso, M. J., Poppas, A., Quintero Cardona, O., Scott, J., Shellito, J., Sherif, Z. A., Singer, N. G., Taylor, B. S., Thaweethai, T., Verduzco-Gutierrez, M., Wisnivesky, J., McComsey, G. A., Horwitz, L. I., Foulkes, A. S. 2024

  Abstract

  Classification of persons with long COVID (LC) or post-COVID-19 condition must encompass the complexity and heterogeneity of the condition. Iterative refinement of the classification index for research is needed to incorporate newly available data as the field rapidly evolves.To update the 2023 research index for adults with LC using additional participant data from the Researching COVID to Enhance Recovery (RECOVER-Adult) study and an expanded symptom list based on input from patient communities.Prospective, observational cohort study including adults 18 years or older with or without known prior SARS-CoV-2 infection who were enrolled at 83 sites in the US and Puerto Rico. Included participants had at least 1 study visit taking place 4.5 months after first SARS-CoV-2 infection or later, and not within 30 days of a reinfection. The study visits took place between October 2021 and March 2024.SARS-CoV-2 infection.Presence of LC and participant-reported symptoms.A total of 13 647 participants (11 743 with known SARS-CoV-2 infection and 1904 without known prior SARS-CoV-2 infection; median age, 45 years [IQR, 34-69 years]; and 73% were female) were included. Using the least absolute shrinkage and selection operator analysis regression approach from the 2023 model, symptoms contributing to the updated 2024 index included postexertional malaise, fatigue, brain fog, dizziness, palpitations, change in smell or taste, thirst, chronic cough, chest pain, shortness of breath, and sleep apnea. For the 2024 LC research index, the optimal threshold to identify participants with highly symptomatic LC was a score of 11 or greater. The 2024 index classified 20% of participants with known prior SARS-CoV-2 infection and 4% of those without known prior SARS-CoV-2 infection as having likely LC (vs 21% and 5%, respectively, using the 2023 index) and 39% of participants with known prior SARS-CoV-2 infection as having possible LC, which is a new category for the 2024 model. Cluster analysis identified 5 LC subtypes that tracked quality-of-life measures.The 2024 LC research index for adults builds on the 2023 index with additional data and symptoms to help researchers classify symptomatic LC and its symptom subtypes. Continued future refinement of the index will be needed as the understanding of LC evolves.

  View details for DOI 10.1001/jama.2024.24184

  View details for PubMedID 39693079

• 2024 Update of the RECOVER-Adult Long COVID Research Index JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Geng, L. N., Erlandson, K. M., Hornig, M., Letts, R., Selvaggi, C., Ashktorab, H., Atieh, O., Bartram, L., Brim, H., Brosnahan, S. B., Brown, J., Castro, M., Charney, A., Chen, P., Deeks, S. G., Erdmann, N., Flaherman, V. J., Ghamloush, M. A., Goepfert, P., Goldman, J. D., Han, J. E., Hess, R., Hirshberg, E., Hoover, S. E., Katz, S. D., Kelly, J., Klein, J. D., Krishnan, J. A., Lee-Iannotti, J., Levitan, E. B., Marconi, V. C., Metz, T. D., Modes, M. E., Nikolich, J. Z., Novak, R. M., Ofotokun, I., Okumura, M. J., Parthasarathy, S., Patterson, T. F., Peluso, M. J., Poppas, A., Cardona, O., Scott, J., Shellito, J., Sherif, Z. A., Singer, N. G., Taylor, B. S., Thaweethai, T., Verduzco-Gutierrez, M., Wisnivesky, J., McComsey, G. A., Horwitz, L. I., Foulkes, A. S., RECOVER Consortium 2024

  Abstract

  Classification of persons with long COVID (LC) or post-COVID-19 condition must encompass the complexity and heterogeneity of the condition. Iterative refinement of the classification index for research is needed to incorporate newly available data as the field rapidly evolves.To update the 2023 research index for adults with LC using additional participant data from the Researching COVID to Enhance Recovery (RECOVER-Adult) study and an expanded symptom list based on input from patient communities.Prospective, observational cohort study including adults 18 years or older with or without known prior SARS-CoV-2 infection who were enrolled at 83 sites in the US and Puerto Rico. Included participants had at least 1 study visit taking place 4.5 months after first SARS-CoV-2 infection or later, and not within 30 days of a reinfection. The study visits took place between October 2021 and March 2024.SARS-CoV-2 infection.Presence of LC and participant-reported symptoms.A total of 13 647 participants (11 743 with known SARS-CoV-2 infection and 1904 without known prior SARS-CoV-2 infection; median age, 45 years [IQR, 34-69 years]; and 73% were female) were included. Using the least absolute shrinkage and selection operator analysis regression approach from the 2023 model, symptoms contributing to the updated 2024 index included postexertional malaise, fatigue, brain fog, dizziness, palpitations, change in smell or taste, thirst, chronic cough, chest pain, shortness of breath, and sleep apnea. For the 2024 LC research index, the optimal threshold to identify participants with highly symptomatic LC was a score of 11 or greater. The 2024 index classified 20% of participants with known prior SARS-CoV-2 infection and 4% of those without known prior SARS-CoV-2 infection as having likely LC (vs 21% and 5%, respectively, using the 2023 index) and 39% of participants with known prior SARS-CoV-2 infection as having possible LC, which is a new category for the 2024 model. Cluster analysis identified 5 LC subtypes that tracked quality-of-life measures.The 2024 LC research index for adults builds on the 2023 index with additional data and symptoms to help researchers classify symptomatic LC and its symptom subtypes. Continued future refinement of the index will be needed as the understanding of LC evolves.

  View details for DOI 10.1001/jama.2024.11370

  View details for Web of Science ID 001381236900001

  View details for PubMedID 39693079

• Time to Sustained Recovery Among Outpatients With COVID-19 Receiving Montelukast vs Placebo: The ACTIV-6 Randomized Clinical Trial. JAMA network open Rothman, R. L., Stewart, T. G., Mourad, A., Boulware, D. R., McCarthy, M. W., Thicklin, F., Garcia Del Sol, I. T., Garcia, J. L., Bramante, C. T., Shah, N. S., Singh, U., Williamson, J. C., Rebolledo, P. A., Jagannathan, P., Schwasinger-Schmidt, T., Ginde, A. A., Castro, M., Jayaweera, D., Sulkowski, M., Gentile, N., McTigue, K., Felker, G. M., DeLong, A., Wilder, R., Collins, S., Dunsmore, S. E., Adam, S. J., Hanna, G. J., Shenkman, E., Hernandez, A. F., Naggie, S., Lindsell, C. J., Accelerating COVID-19 Therapeutic Interventions and Vaccines-6 Study Group and Investigators, Hanna, G., Fraser, R., Ward, M., Gamboa Jackson, J., McAdams, M. P., Vail, J., Korzekwinski, K., Oyelakin, M., Chopp, J., Randle, D., Dockery, S., Adkins, R., Crow, M., Nowell, E., Wells, K., Herbert, A., Stone, A., Heavlin, H., Brown, L., Harding, T., Harrington, A., Beauchaine, M., Lindblom, K., Burns, A., Aamodt, D., Collins, J., Dixon, S., Gao, Y., Graves, J., Grindstaff, J., Harrell, F., Lai, J., Liao, V., Lopez, I., Manis, E., Mankowski, K., Marlin, J., Merkel, A., Nwosu, S., Obregon, S., Orozco, D., Prato, N., Rhode, M., Shirey-Rice, J., Vermillion, K., Smith, J., Tan, H., Vance, M., Weir, M., Bianchi, R., Premas, J., Gupta, M., Karawan, G., Lima, S., Ziomek, C., Arena, J., DeAlmeida, S., Malik, A., Bryce, J., Swint, S., Ramin, S., Nataraj, J., Deider, J., Cruz, R., Ramirez, A. M., Henault, L., Marcus, J., Southwell, A., Jacques, G., Sexton, C., Tiffany, B., Tanner, C., Sahelian, A., George-Adebayo, C., Adebayo, A., Zapatero, J., Clement, J., Ronan, T., Woods, A., Gallegos, C., Flys, T., Sloan, O., Olofintuyi, A., Samraj, J., Vasbinder, A., Averett, A., Slandzicki, A., Wallen, J., Vogel, C., Munoz, S., Kavtaradze, D., Watson, C., Singleton, D., Sevier, M., Rivon, M., Del Pilar, A., Spangler, A., Rao, S., Cantu, L., Krishna, A., Daugherty, H., Kerr, B., Evans, K., Spees, R., Marta, M., Dolor, R., Vergara, L., Jordan, J., Burruss, V., Hurst, T., Ofotokun, I., Zhang, C., Traenkner, J., Atha, M. M., Prabhu, R., Klicka, K., Lightfeather, A., James, V., Rogers, M., Oragwu, C., Oguego, N., Pillai, R., Gabriel, A., Ghaly, E., Michal, M., Vasquez, M., Mamon, A., Sheets, M., Hassanien, G., Ismail, S., Samir, Y., Meltzer, A., Shahamatdar, S., Heidish, R. S., Loganathan, A., Brehaut, S., Roche, A., Mehta, M., Koppinger, N., Baez, J., Pagan, I., Abdelsayed, D., Aziz, M., Robinson, P., Lozinski, G., Nguyen, J., Griffin, A., Morris, M., Love, N., Mattox, B., Martin, R., Pardue, V., Rowland, T., Ruiz-Unger, J., Reyes, L., Zamora, Y., Bacallao, N., Cienki, J., Cohen, J., Yuan, Y., Li, J., Szeto, J., Stelmash, L., Mekhael, S., Morales Castillo, L., Gutierrez, A., Prieto, S., Amon, A., Barbera, A., Bugajski, A., Willis, W., Jacklin, K., Lamb, D., Harper, A., Stout, E., Griffin, M., Pyram-Bernard, N., Quintero, A., Clark, N., Barsanti-Sekhar, M., Carbrera-Mendez, C., Evans, M. R., Adhami, E., Carillo, G., Maria, J., Paudel, D., Raymond, O., Summers, J., Turner, T., Lenert, L., Panaccione, E., Szwast, E., Reynolds, A., Abdulghani, A., Vasoya, P., Miller, C., Wiley, H., Chan, A., Khizer, S., Adeyemi, O., Chi, W. N., Chen, J., Morton-Jost, M., Castex, J., Quirch, A., Belani, H., Machicado, R., Bjornsson, B., Olivo, J., Maldonado, M., Vecchiarelli, A., Gaytan-Alvarez, D., Cherukuri, V., Alicic, R., Lambert, A. A., Urbat, C., Baxter, J., Cooper, A., Linn, D., Fisher, L., Patel, V., Talati, R., Patel, P., Ellison, L., Roman, A., Harrison, J., Moy, J., Naquiallah, D., Shah, B., Quintero, O., Scott, J., Jazayeri, Y., O'Donnell, A., Pathak, D., Gupta, A., Chandrasekar, N., Curtis, C., White, B., Dockery, M., Fortt, T., Fortt, A., Jones-Ince, I., McKee, A., Wilson, J., Marcelin, J., Farlow, B., Grady, C., Richwine, R., Pazier, P., Michelson, E., Watts, S., Kariyawasam, D., Rodriguez, L., Manresa, I., Achong, A. A., Garcia, M. C., Khetpal, S., Posey, F., Mahadevan, A., Gnoni, M., Van de Weerd, C., Lowenkron, J., Sappington, E., Roberts, M., Wang, J., Adams, M., Ding, X., Co, M., D'Andrea, M., Lim, S., Swink, W., Bozant, E., Young, M., Wilson, M., Eastin, C., Cheathem, A., Nadeem, A., Walters, C., Powers-Fletcher, M., Brown, D., Miller, D., Mukunzi, S., Manning, B., Terry-White, M., Crizaldo, M. C., Isache, C., Bowman, J., Callaghan-Brown, A., Martin, D., Ast, A., Duran, B., Cornejo, A., Archer, A., Almanzar, M., Motel, V., Pullen, M., Anderson, B., Bhat, N., Parra, D., Campora, P., Robinson, M., Seithel, M., Kendrick, L., Helming, D., Pollock, K., Sekikawa, A., Klawson, E., Arnold, J., Weiland, N., Ostrosky-Zeichner, L., Patel, B., Umana, V., Nielsen, L., Grimes, C. Z., Patterson, T. F., Tragus, R., Soileau, B. T., Heath, T., Hinjosa, E., Gutierrez, C., Jackson, P. E., Hallowell, C., Haughey, H. M., Vaidya-Tank, B., Gould, C., Goyal, P., Sommers, S., Pangburn, H., Jones, C., Michalowski, L., Wortham, B., Abbott, R., Umana, U., Alleyne, C., Witting, B., Armas, E., Perez Landaburo, R. O., De La Cruz, M., Ballmajo, M., Alvarez, J. 2024; 7 (10): e2439332

  Abstract

  Importance: The effect of montelukast in reducing symptom duration among outpatients with mild to moderate COVID-19 is uncertain.Objective: To assess the effectiveness of montelukast compared with placebo in treating outpatients with mild to moderate COVID-19.Design, Setting, and Participants: This randomized clinical trial (Accelerating COVID-19 Therapeutic Interventions and Vaccines [ACTIV]-6) was conducted from January 27 through June 23, 2023, during the circulation of Omicron subvariants. Participants aged 30 years or older with confirmed SARS-CoV-2 infection and 2 or more acute COVID-19 symptoms for less than 7 days were included across 104 US sites.Interventions: Participants were randomized 1:1 to receive montelukast, 10 mg once daily, or matched placebo for 14 days.Main Outcomes and Measures: The primary outcome was time to sustained recovery (defined as ≥3 consecutive days without symptoms). Secondary outcomes included time to death; time to hospitalization or death; a composite of health care utilization events (hospitalization, urgent care clinic visit, emergency department visit, or death); COVID-19 clinical progression scale score; and difference in mean time unwell. A modified intention-to-treat approach was used for the analysis.Results: Among 1250 participants who were randomized and received the study drug or placebo, the median age was 53 years (IQR, 42-62 years), 753 (60.2%) were female, and 704 (56.3%) reported receiving 2 or more doses of a SARS-CoV-2 vaccine. Among 628 participants who received montelukast and 622 who received placebo, differences in time to sustained recovery were not observed (adjusted hazard ratio [AHR], 1.02; 95% credible interval [CrI], 0.92-1.12; P=.63 for efficacy). Unadjusted median time to sustained recovery was 10 days (95% CI, 10-11 days) in both groups. No deaths occurred, and hospitalizations were reported for 2 participants (0.3%) in each group; the composite of health care utilization events was reported for 18 participants (2.9%) in the montelukast group and 18 (2.9%) in the placebo group (AHR, 1.01; 95% CrI, 0.45-1.84; P=.48 for efficacy). Five participants (0.4%) experienced serious adverse events (3 [0.5%] in the montelukast group and 2 [0.3%] in the placebo group).Conclusions and Relevance: In this randomized clinical trial of outpatients with mild to moderate COVID-19, treatment with montelukast did not reduce duration of COVID-19 symptoms. These findings do not support the use of montelukast for the treatment of mild to moderate COVID-19.Trial Registration: ClinicalTrials.gov Identifier: NCT04885530.

  View details for DOI 10.1001/jamanetworkopen.2024.39332

  View details for PubMedID 39422912

• Revisiting Diagnostics: ESR and CRP: It's Time to Stop the Zombie Tests. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases Spellberg, B., Nielsen, T. B., Phillips, M. C., Ghanem, B., Boyles, T., Jegorović, B., Footer, B., Mah, J. K., Lieu, A., Scott, J., Wald-Dickler, N., Lee, T. C., McDonald, E. G. 2024

  View details for DOI 10.1016/j.cmi.2024.08.017

  View details for PubMedID 39209263

• Differentiation of Prior SARS-CoV-2 Infection and Postacute Sequelae by Standard Clinical Laboratory Measurements in the RECOVER Cohort. Annals of internal medicine Erlandson, K. M., Geng, L. N., Selvaggi, C. A., Thaweethai, T., Chen, P., Erdmann, N. B., Goldman, J. D., Henrich, T. J., Hornig, M., Karlson, E. W., Katz, S. D., Kim, C., Cribbs, S. K., Laiyemo, A. O., Letts, R., Lin, J. Y., Marathe, J., Parthasarathy, S., Patterson, T. F., Taylor, B. D., Duffy, E. R., Haack, M., Julg, B., Maranga, G., Hernandez, C., Singer, N. G., Han, J., Pemu, P., Brim, H., Ashktorab, H., Charney, A. W., Wisnivesky, J., Lin, J. J., Chu, H. Y., Go, M., Singh, U., Levitan, E. B., Goepfert, P. A., Nikolich, J. Ž., Hsu, H., Peluso, M. J., Kelly, J. D., Okumura, M. J., Flaherman, V. J., Quigley, J. G., Krishnan, J. A., Scholand, M. B., Hess, R., Metz, T. D., Costantine, M. M., Rouse, D. J., Taylor, B. S., Goldberg, M. P., Marshall, G. D., Wood, J., Warren, D., Horwitz, L., Foulkes, A. S., McComsey, G. A. 2024

  Abstract

  There are currently no validated clinical biomarkers of postacute sequelae of SARS-CoV-2 infection (PASC).To investigate clinical laboratory markers of SARS-CoV-2 and PASC.Propensity score-weighted linear regression models were fitted to evaluate differences in mean laboratory measures by prior infection and PASC index (≥12 vs. 0). (ClinicalTrials.gov: NCT05172024).83 enrolling sites.RECOVER-Adult cohort participants with or without SARS-CoV-2 infection with a study visit and laboratory measures 6 months after the index date (or at enrollment if >6 months after the index date). Participants were excluded if the 6-month visit occurred within 30 days of reinfection.Participants completed questionnaires and standard clinical laboratory tests.Among 10 094 participants, 8746 had prior SARS-CoV-2 infection, 1348 were uninfected, 1880 had a PASC index of 12 or higher, and 3351 had a PASC index of zero. After propensity score adjustment, participants with prior infection had a lower mean platelet count (265.9 × 109 cells/L [95% CI, 264.5 to 267.4 × 109 cells/L]) than participants without known prior infection (275.2 × 109 cells/L [CI, 268.5 to 282.0 × 109 cells/L]), as well as higher mean hemoglobin A1c (HbA1c) level (5.58% [CI, 5.56% to 5.60%] vs. 5.46% [CI, 5.40% to 5.51%]) and urinary albumin-creatinine ratio (81.9 mg/g [CI, 67.5 to 96.2 mg/g] vs. 43.0 mg/g [CI, 25.4 to 60.6 mg/g]), although differences were of modest clinical significance. The difference in HbA1c levels was attenuated after participants with preexisting diabetes were excluded. Among participants with prior infection, no meaningful differences in mean laboratory values were found between those with a PASC index of 12 or higher and those with a PASC index of zero.Whether differences in laboratory markers represent consequences of or risk factors for SARS-CoV-2 infection could not be determined.Overall, no evidence was found that any of the 25 routine clinical laboratory values assessed in this study could serve as a clinically useful biomarker of PASC.National Institutes of Health.

  View details for DOI 10.7326/M24-0737

  View details for PubMedID 39133923

• Prevalence of Emergent Dolutegravir Resistance Mutations in People Living with HIV: A Rapid Scoping Review. Viruses Chu, C., Tao, K., Kouamou, V., Avalos, A., Scott, J., Grant, P. M., Rhee, S. Y., McCluskey, S. M., Jordan, M. R., Morgan, R. L., Shafer, R. W. 2024; 16 (3)

  Abstract

  Dolutegravir (DTG) is a cornerstone of global antiretroviral (ARV) therapy (ART) due to its high efficacy and favorable tolerability. However, limited data exist regarding the risk of emergent integrase strand transfer inhibitor (INSTI) drug-resistance mutations (DRMs) in individuals receiving DTG-containing ART.We performed a PubMed search using the term "Dolutegravir", last updated 18 December 2023, to estimate the prevalence of VF with emergent INSTI DRMs in people living with HIV (PLWH) without previous VF on an INSTI who received DTG-containing ART.Of 2131 retrieved records, 43 clinical trials, 39 cohorts, and 6 cross-sectional studies provided data across 6 clinical scenarios based on ART history, virological status, and co-administered ARVs: (1) ART-naïve PLWH receiving DTG plus two NRTIs; (2) ART-naïve PLWH receiving DTG plus lamivudine; (3) ART-experienced PLWH with VF on a previous regimen receiving DTG plus two NRTIs; (4) ART-experienced PLWH with virological suppression receiving DTG plus two NRTIs; (5) ART-experienced PLWH with virological suppression receiving DTG and a second ARV; and (6) ART-experienced PLWH with virological suppression receiving DTG monotherapy. The median proportion of PLWH in clinical trials with emergent INSTI DRMs was 1.5% for scenario 3 and 3.4% for scenario 6. In the remaining four trial scenarios, VF prevalence with emergent INSTI DRMs was ≤0.1%. Data from cohort studies minimally influenced prevalence estimates from clinical trials, whereas cross-sectional studies yielded prevalence data lacking denominator details.In clinical trials, the prevalence of VF with emergent INSTI DRMs in PLWH receiving DTG-containing regimens has been low. Novel approaches are required to assess VF prevalence with emergent INSTI DRMs in PLWH receiving DTG in real-world settings.

  View details for DOI 10.3390/v16030399

  View details for PubMedID 38543764

  View details for PubMedCentralID PMC10975848

• Clinical course and management of COVID-19 in the era of widespread population immunity. Nature reviews. Microbiology Meyerowitz, E. A., Scott, J., Richterman, A., Male, V., Cevik, M. 2023

  Abstract

  The clinical implications of COVID-19 have changed since SARS-CoV-2 first emerged in humans. The current high levels of population immunity, due to prior infection and/or vaccination, have been associated with a vastly decreased overall risk of severe disease. Some people, particularly those with immunocompromising conditions, remain at risk for severe outcomes. Through the course of the pandemic, variants with somewhat different symptom profiles from the original SARS-CoV-2 virus have emerged. The management of COVID-19 has also changed since 2020, with the increasing availability of evidence-based treatments in two main classes: antivirals and immunomodulators. Selecting the appropriate treatment(s) for patients with COVID-19 requires a deep understanding of the evidence and an awareness of the limitations of applying data that have been largely based on immune-naive populations to patients today who most likely have vaccine-derived and/or infection-derived immunity. In this Review, we provide a summary of the clinical manifestations and approaches to caring for adult patients with COVID-19 in the era of vaccine availability and the dominance of the Omicron subvariants, with a focus on the management of COVID-19 in different patient groups, including immunocompromised, pregnant, vaccinated and unvaccinated patients.

  View details for DOI 10.1038/s41579-023-01001-1

  View details for PubMedID 38114838

  View details for PubMedCentralID 10208005

• Higher-Dose Fluvoxamine and Time to Sustained Recovery in Outpatients With COVID-19: The ACTIV-6 Randomized Clinical Trial. JAMA Stewart, T. G., Rebolledo, P. A., Mourad, A., Lindsell, C. J., Boulware, D. R., McCarthy, M. W., Thicklin, F., Garcia Del Sol, I. T., Bramante, C. T., Lenert, L. A., Lim, S., Williamson, J. C., Cardona, O. Q., Scott, J., Schwasinger-Schmidt, T., Ginde, A. A., Castro, M., Jayaweera, D., Sulkowski, M., Gentile, N., McTigue, K., Felker, G. M., DeLong, A., Wilder, R., Rothman, R. L., Collins, S., Dunsmore, S. E., Adam, S. J., Hanna, G. J., Shenkman, E., Hernandez, A. F., Naggie, S. 2023

  Abstract

  The effect of higher-dose fluvoxamine in reducing symptom duration among outpatients with mild to moderate COVID-19 remains uncertain.To assess the effectiveness of fluvoxamine, 100 mg twice daily, compared with placebo, for treating mild to moderate COVID-19.The ACTIV-6 platform randomized clinical trial aims to evaluate repurposed medications for mild to moderate COVID-19. Between August 25, 2022, and January 20, 2023, a total of 1175 participants were enrolled at 103 US sites for evaluating fluvoxamine; participants were 30 years or older with confirmed SARS-CoV-2 infection and at least 2 acute COVID-19 symptoms for 7 days or less.Participants were randomized to receive fluvoxamine, 50 mg twice daily on day 1 followed by 100 mg twice daily for 12 additional days (n = 601), or placebo (n = 607).The primary outcome was time to sustained recovery (defined as at least 3 consecutive days without symptoms). Secondary outcomes included time to death; time to hospitalization or death; a composite of hospitalization, urgent care visit, emergency department visit, or death; COVID-19 clinical progression scale score; and difference in mean time unwell. Follow-up occurred through day 28.Among 1208 participants who were randomized and received the study drug, the median (IQR) age was 50 (40-60) years, 65.8% were women, 45.5% identified as Hispanic/Latino, and 76.8% reported receiving at least 2 doses of a SARS-CoV-2 vaccine. Among 589 participants who received fluvoxamine and 586 who received placebo included in the primary analysis, differences in time to sustained recovery were not observed (adjusted hazard ratio [HR], 0.99 [95% credible interval, 0.89-1.09]; P for efficacy = .40]). Additionally, unadjusted median time to sustained recovery was 10 (95% CI, 10-11) days in both the intervention and placebo groups. No deaths were reported. Thirty-five participants reported health care use events (a priori defined as death, hospitalization, or emergency department/urgent care visit): 14 in the fluvoxamine group compared with 21 in the placebo group (HR, 0.69 [95% credible interval, 0.27-1.21]; P for efficacy = .86) There were 7 serious adverse events in 6 participants (2 with fluvoxamine and 4 with placebo) but no deaths.Among outpatients with mild to moderate COVID-19, treatment with fluvoxamine does not reduce duration of COVID-19 symptoms.ClinicalTrials.gov Identifier: NCT04885530.

  View details for DOI 10.1001/jama.2023.23363

  View details for PubMedID 37976072

• Use of biomarkers to individualize antimicrobial therapy duration: a narrative review. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases Scott, J., Deresinski, S. 2022

  Abstract

  BACKGROUND: Reducing the overuse of antimicrobials is imperative for the sake of minimizing antimicrobial-associated adverse effects, optimizing resource utilization, and curtailing the rise in multidrug-resistant organisms. Biomarkers reflect host responses to infection and may assist with minimizing unnecessary antimicrobial usage.OBJECTIVES: To review the literature pertaining to the performance of biomarkers specifically used to guide the duration of antimicrobial therapy (AMT).SOURCES: Randomized controlled trials (RCTs), observational studies, and meta-analyses assessing biomarker-guided approaches to AMT decision-making and their impact on duration of therapy were reviewed.CONTENT: Several RCTs and real-world observational studies have shown that a procalcitonin (PCT)-guided strategy can help clinicians individualize the duration of AMT, particularly for non-critically ill patients hospitalized with suspected respiratory tract infections when using a PCT cutoff of <0.25 mug/L and critically ill patients with respiratory tract infections or undifferentiated sepsis when using a PCT cutoff of <0.5 mug/L or ≥80% decline in peak level. C-reactive protein (CRP) is a non-specific marker of inflammation that may also assist with earlier discontinuation of AMT, though data are limited. Hematological biomarkers are prone to variance between individuals and are often influenced by medications and non-infectious conditions, making them less reliable for the purposes of AMT decision-making. Novel biomarkers, such as multi-protein signatures and host gene expression tests, have shown promise as tools to better differentiate between bacterial and non-bacterial infections; clinical studies are needed to determine whether they can be used to help optimize the duration of AMT.IMPLICATIONS: Studies have demonstrated that PCT, when utilized appropriately, can help guide clinicians to individualize and often reduce the duration of AMT, especially for patients hospitalized with respiratory tract infections and intensive care unit (ICU) patients with suspected respiratory tract infections or sepsis. The impact of utilizing other biomarkers is less clear and requires further study.

  View details for DOI 10.1016/j.cmi.2022.08.026

  View details for PubMedID 36096429

• Covid-19 vaccines, immunity, and boosters. BMJ (Clinical research ed.) Richterman, A., Scott, J., Cevik, M. 1800; 375: n3105

  View details for DOI 10.1136/bmj.n3105

  View details for PubMedID 34930779

• Covid-19 vaccination: evidence of waning immunity is overstated British Medical Journal Scott, J., Richterman, A., Cevik, M. 2021

  View details for DOI 10.1136/bmj.n2320

• Characteristics and outcomes of coronavirus disease patients under nonsurge conditions, northern California, USA, March–April 2020 Emerging Infectious Diseases Ferguson, J., Rosser, J., Quintero, O., Scott, J., Subramanian, A., Gumma, M., Rogers, A., Kappagoda, S. 2020

  Abstract

  Limited data are available on the clinical presentation and outcomes of coronavirus disease (COVID-19) patients in the United States hospitalized under normal-caseload or nonsurge conditions. We retrospectively studied 72 consecutive adult patients hospitalized with COVID-19 in 2 hospitals in the San Francisco Bay area, California, USA, during March 13-April 11, 2020. The death rate for all hospitalized COVID-19 patients was 8.3%, and median length of hospitalization was 7.5 days. Of the 21 (29% of total) intensive care unit patients, 3 (14.3% died); median length of intensive care unit stay was 12 days. Of the 72 patients, 43 (59.7%) had underlying cardiovascular disease and 19 (26.4%) had underlying pulmonary disease. In this study, death rates were lower than those reported from regions of the United States experiencing a high volume of COVID-19 patients.

  View details for DOI 10.3201/eid2608.201776

• Recurrent Multifocal Mycoplasma orale Infection in an Immunocompromised Patient: A Case Report and Review. Case reports in infectious diseases Ketchersid, J., Scott, J., Lew, T., Banaei, N., Kappagoda, S. 2020; 2020: 8852115

  Abstract

  A young woman with mixed connective tissue disease complicated by erosive arthritis, secondary hypogammaglobulinemia due to rituximab, and a history of many infectious complications developed multiple nonhealing wounds, polyarticular joint pain, and leukocytosis. Radiographic studies demonstrated multiple scattered areas of osteomyelitis and complex abscesses. Purulent fluid drained from multiple sites did not yield a microbiologic diagnosis by standard culture technique, but Mycoplasma orale was ultimately identified using 16S ribosomal RNA gene amplification and sequencing. We describe this unique case and review the literature.

  View details for DOI 10.1155/2020/8852115

  View details for PubMedID 32850161

• Treatment optimization for HIV/HCV co-infected patients. Therapeutic advances in infectious disease Scott, J. A., Chew, K. W. 2017; 4 (1): 18-36

  Abstract

  Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infections affect millions of persons around the globe and cause profound morbidity and mortality. A major intersection exists between these two epidemics, with HCV infection being more common in persons with HIV than in the general population, largely due to shared routes of transmission. HCV co-infection increases risk for liver- and non-liver-related morbidity and mortality, making HCV treatment a priority in HIV co-infected persons, but the treatment of HCV in co-infected patients has been daunting for multiple reasons. Until recently, HCV treatment has frequently been deferred due to the low rates of cure, significant adverse effects, burdensome duration of therapy and drug-drug interactions with HIV antiretroviral medications. Untreated HCV has resulted in significant health consequences for the millions of those infected and has led to multiple downstream impacts on our healthcare systems around the world. The development of a remarkable number of new HCV direct-acting agents (DAAs) that are significantly more efficacious and tolerable than the previous interferon-based regimens has transformed this important field of medicine, with the potential to dramatically reduce the burden of infection and improve health outcomes in this population. This review will summarize the epidemiology and clinical impact of HIV/HCV co-infection and current approaches to the treatment of HCV in HIV/HCV co-infected patients.

  View details for DOI 10.1177/2049936116681279

  View details for PubMedID 28357062

• Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome in Older Adults. Clinics in geriatric medicine Scott, J., Goetz, M. B. 2016; 32 (3): 571-83

  Abstract

  Improved survival with combination antiretroviral therapy has led to a dramatic increase in the number of human immunodeficiency virus (HIV)-infected individuals 50 years of age or older such that by 2020 more than 50% of HIV-infected persons in the United States will be above this age. Recent studies confirm that antiretroviral therapy should be offered to all HIV-infected patients regardless of age, symptoms, CD4+ cell count, or HIV viral load. However, when compared with HIV-uninfected populations, even with suppression of measurable HIV replication, older individuals are at greater risk for cardiovascular disease, malignancies, liver disease, and other comorbidities.

  View details for DOI 10.1016/j.cger.2016.02.010

  View details for PubMedID 27394024

• Maternal decidual macrophages inhibit NK cell killing of invasive cytotrophoblasts during human pregnancy. Biology of reproduction Co, E. C., Gormley, M., Kapidzic, M., Rosen, D. B., Scott, M. A., Stolp, H. A., McMaster, M., Lanier, L. L., Bárcena, A., Fisher, S. J. 2013; 88 (6): 155

  Abstract

  Human pregnancy is an immunological paradox. Semiallogeneic (fetal) placental cells (extravillous cytotrophoblasts [CTBs]) invade the uterine lining (decidua), which contains a unique decidual natural killer (dNK) cell population, identified by the cell surface phenotype CD56(bright) CD16(-) CD3(-) and CD14(+) CD206(+) macrophages (dMac). Previous reports suggested that human dNK cells are not a threat to the fetoplacental unit because they are anergic. In contrast, here we showed that purified and exogenously stimulated dNK cells are capable killers of cellular targets, including semiallogeneic CTBs. However, dMacs in the decidual leukocyte (DL) population restrained dNK killing through a transforming growth factor beta1 (TGF-beta1)-dependent mechanism. Our findings support a new model whereby dNK cells, capable of killing CTBs, are prevented from doing so by neighboring macrophages, thus protecting the fetal cells from NK cell attack. We speculate that this mechanism would inhibit dNK cell-mediated killing, even under conditions where high levels of cytokines may stimulate dNK cells, which could pose a threat to the developing placenta.

  View details for DOI 10.1095/biolreprod.112.099465

  View details for PubMedID 23553431

  View details for PubMedCentralID PMC4070869