Melanie Ann Kiener

All Publications

• Short Report: Low Rate of Asymptomatic Dengue Infection Detected in Coastal Kenya Using Pooled Polymerase Chain Reaction Testing. The American journal of tropical medicine and hygiene Kiener, M., Shayegh, N., Nyathi, S. V., Ndenga, B. A., Mutuku, F. M., LaBeaud, A. D. 2024

  Abstract

  Asymptomatic dengue virus (DENV) infections have important public health implications but are challenging to identify. We performed a cross-sectional study of reverse transcription quantitative polymerase chain reaction on pooled sera of asymptomatic individuals from the south coast of Kenya at two time periods to identify cases of asymptomatic viremia. Among 2,460 samples tested in pools of 9 or 10, we found only one positive case (0.04% incidence). Although pooling of samples has the potential to be a cost-effective and time-efficient method for asymptomatic DENV detection, mass cross-sectional pooled testing may not provide accurate data on rates of asymptomatic infection, likely owing to a decrease in the sensitivity with pooling of samples, a short period of viremia, or testing in the absence of an outbreak.

  View details for DOI 10.4269/ajtmh.23-0650

  View details for PubMedID 38471167

• Low infectivity among asymptomatic patients with a positive severe acute respiratory coronavirus virus 2 (SARS-CoV-2) admission test at a tertiary care center, 2020-2022. Infection control and hospital epidemiology Tayyar, R., Kiener, M. A., Liang, J. W., Contreras, G., Rodriguez-Nava, G., Zimmet, A. N., Contag, C. A., Srinivasan, K., McIntyre, K., Subramanian, A., Shepard, J., Tompkins, L. S., Pinsky, B. A., Salinas, J. L. 2023: 1-3

  Abstract

  We used a strand-specific RT-qPCR to evaluate viral replication as a surrogate for infectiousness among 242 asymptomatic inpatients with a positive severe acute respiratory coronavirus virus 2 (SARS-CoV-2) admission test. Only 21 patients (9%) had detectable SARS-CoV-2 minus-strand RNA. Because most patients were found to be noninfectious, our findings support the suspension of asymptomatic admission testing.

  View details for DOI 10.1017/ice.2023.210

  View details for PubMedID 37746805

• Use of a severe acute respiratory coronavirus virus 2 (SARS-CoV-2) strand-specific assay to evaluate for prolonged viral replication >20 days from illness onset. Infection control and hospital epidemiology Ferguson, J. D., Tayyar, R., Contreras, G., Kiener, M., Zimmet, A. N., Contag, C. A., Rodriguez Nava, G., Tompkins, L. S., Shepard, J., Rosenthal, A., Subramanian, A. K., Pinsky, B. A., Salinas, J. L. 2023: 1-3

  Abstract

  Severe acute respiratory coronavirus virus 2 (SARS-CoV-2) real-time reverse-transcription polymerase chain reaction (rRT-PCR) strand-specific assay can be used to identify active SARS-CoV-2 viral replication. We describe the characteristics of 337 hospitalized patients with at least 1 minus-strand SARS-CoV-2 assay performed >20 days after illness onset. This test is a novel tool to identify high-risk hospitalized patients with prolonged SARS-CoV-2 replication.

  View details for DOI 10.1017/ice.2023.105

  View details for PubMedID 37381726

• Factors Associated with Chikungunya Infection among Pregnant Women in Grenada, West Indies. The American journal of tropical medicine and hygiene Kiener, M., Cudjoe, N., Evans, R., Mapp-Alexander, V., Tariq, A., Macpherson, C., Noel, T., Gerardin, P., Waechter, R., LaBeaud, A. D. 2023

  Abstract

  Neonates are vulnerable to vector-borne diseases given the potential for mother-to-child congenital transmission. To determine factors associated with chikungunya virus (CHIKV) infection among pregnant women in Grenada, West Indies, a retrospective cohort study enrolled women who were pregnant during the 2014 CHIKV epidemic. In all, 520/688 women (75.5%) were CHIKV IgG positive. Low incomes, use of pit latrines, lack of home window screens, and subjective reporting of frequent mosquito bites were associated with increased risk of CHIKV infection in bivariate analyses. In the multivariate modified Poisson regression model, low income (adjusted relative risk [aRR]: 1.05 [95% CI: 1.01-1.10]) and frequent mosquito bites (aRR: 1.05 [95% CI: 1.01-1.10]) were linked to increased infection risk. In Grenada, markers of low socioeconomic status are associated with CHIKV infection among pregnant women. Given that Grenada will continue to face vector-borne outbreaks, interventions dedicated to improving living conditions of the most disadvantaged will help reduce the incidence of arboviral infections.

  View details for DOI 10.4269/ajtmh.23-0157

  View details for PubMedID 37253436

• Fever and a rash: measles: a re-emerging epidemic POSTGRADUATE MEDICAL JOURNAL Gallahue, F., Duncan, A., Frank, M. 2019; 95 (1127): 511-512

  View details for DOI 10.1136/postgradmedj-2019-136850

  View details for Web of Science ID 000488246000014

  View details for PubMedID 31324727

• Long-term Follow-up Reveals High Posttreatment Mortality Rate Among Patients With Extensively Drug-Resistant Tuberculosis in the Country of Georgia OPEN FORUM INFECTIOUS DISEASES Frank, M., Adamashvili, N., Lomtadze, N., Kokbreidze, E., Avaliani, Z., Kempker, R. R., Blumberg, H. M. 2019; 6 (4): ofz152

  Abstract

  Given very limited data, we assessed the long-term outcomes among patients with extensively drug-resistant (XDR) tuberculosis (TB).A retrospective population-based cohort study was performed in patients with XDR-TB diagnosed during 2011-2013 in the country of Georgia. Data were abstracted from the National TB Program, medical charts, interviews, and the national Georgian death registry.Among 111 patients starting treatment for XDR-TB, 59 (53.2%) had newly diagnosed tuberculosis, and 3 (2.9%) had human immunodeficiency virus (HIV) coinfection. The median length of follow-up from diagnosis of XDR-TB to death or the end of study was 53.9 months (interquartile range, 27.2-66.3 months). End-of-treatment outcomes were available for 106 patients; 35 (33.0%) had a favorable outcome, and 71 (67.0%) had an unfavorable outcome, including death in 16 (15.1%). An additional 20 patients died after cessation of initial treatment, increasing the overall mortality rate to 34.0%. In multivariable analysis, an unfavorable initial end-of-treatment outcome was associated with posttreatment death (adjusted odds ratio, 14.41; 95% confidence interval, 1.78-117.13).The overall mortality rate and specifically the posttreatment mortality rate were high among patients with XDR-TB. Patients with an unfavorable end-of-treatment outcome had an increased risk of death during follow-up. Our findings highlight the need for improved adherence, better-tolerated and shorter therapies, and enhanced posttreatment surveillance among patients treated for XDR-TB.

  View details for DOI 10.1093/ofid/ofz152

  View details for Web of Science ID 000474844200049

  View details for PubMedID 31041349

  View details for PubMedCentralID PMC6483133

• Factors Associated with High-Grade Anal Intraepithelial Lesion in HIV-Positive Men in a Southern US City AIDS RESEARCH AND HUMAN RETROVIRUSES Frank, M., Lahiri, C. D., Minh Ly Nguyen, Mehta, C., Mosunjac, M., Flowers, L. 2018; 34 (7): 598-602

  Abstract

  The incidence of anal cancer is increased in HIV-infected patients compared with the general population. Risk factors associated with the anal cancer precursor, high-grade squamous intraepithelial lesion (HSIL), have not been extensively studied in an urban black population with late-stage HIV disease. We performed a retrospective chart review of HIV-infected men at the Grady Ponce de Leon Center HIV Clinic (Atlanta, GA) referred for high-resolution anoscopy (HRA), a procedure where anal tissue is examined under magnification and abnormal areas are biopsied. Between December 2013 and September 2015, 147 men underwent HRA: 72% were black, and 94% were men who have sex with men. CD4 count closest to time of HRA was a median 325 cells/mm3 (interquartile range 203-473), and 69% had an undetectable HIV viral load. Ninety-four percent had abnormal anal cytology [80% atypical squamous cells of undetermined significance/low-grade squamous intraepithelial lesion (LSIL) and 20% atypical squamous cells, cannot exclude HSIL/HSIL], and 97% had abnormal histology (35% LSIL, 65% HSIL). Statistically significant variables associated with HSIL included number of biopsies [odds ratio (OR) 1.55, 95% confidence interval (CI) 1.13-2.14] and having ≥1 high-grade anal cytology in the last 12 months (OR 3.76, 95% CI 1.38-10.23). No significant association was found between HSIL and CD4, HIV viral load, or recent sexually transmitted infection. In this population, the burden of anal HSIL was extremely high, regardless of most recent anal cytology result. In newly diagnosed HIV-infected men with no history of anal cancer screening, performing HRA as primary anal cancer screening instead of cytology appears to be a viable option.

  View details for DOI 10.1089/aid.2018.0008

  View details for Web of Science ID 000431371400001

  View details for PubMedID 29607650

  View details for PubMedCentralID PMC6025845

• Decreased monocyte activation with daily acyclovir use in HIV-1/HSV-2 coinfected women SEXUALLY TRANSMITTED INFECTIONS Redd, A. D., Newell, K., Patel, E. U., Nalugoda, F., Ssebbowa, P., Kalibbala, S., Frank, M. A., Tobian, A. R., Gray, R. H., Quinn, T. C., Serwadda, D., Reynolds, S. J. 2015; 91 (7): 485-488

  Abstract

  Several clinical trials have demonstrated that daily treatment of HIV-infected individuals with the antiherpes drug acyclovir slightly decreases HIV-1 viral load and slows disease progression. This study examines if this slowing in clinical progression is a direct cause of the decrease in viral load or an indirect effect of lower immune activation due to lower levels of herpetic reactivation.Women who participated in a randomised clinical trial of daily acyclovir use (n=301) were monitored every 6 months for changes in immune activation. Soluble CD14 (sCD14), a marker for monocyte activation, and C-reactive protein (CRP), a marker for general immune activation, were measured by ELISA.Initial levels of sCD14 and CRP were not predictive of HIV disease progression when controlling for initial CD4+ cell count and HIV viral load. sCD14 levels, but not CRP, decreased in the acyclovir treatment arm at a significantly faster rate than the placebo group, which was independent of changes in HIV viral load and CD4+ cell count in a multivariant mixed-effects model (p=0.039). However, the magnitude of this decrease was relatively small with a total estimated decrease of sCD14 of 15% of initial levels.These data suggest that decreased monocyte activation may play a minor role in the ability of daily acyclovir use to slow HIV disease progression.NCT00405821.

  View details for DOI 10.1136/sextrans-2014-051867

  View details for Web of Science ID 000363474100008

  View details for PubMedID 25904747

• Prevalence and Factors Associated with Herpes Simplex Virus Type 2 Infection in Patients Attending a Baltimore City Emergency Department PLOS ONE Patel, E. U., Frank, M. A., Hsieh, Y., Rothman, R. E., Baker, A. O., Kraus, C. K., Shahan, J., Gaydos, C. A., Kelen, G. D., Quinn, T. C., Laeyendecker, O. 2014; 9 (7): e102422

  Abstract

  Herpes simplex virus type 2 (HSV-2) is a common sexually transmitted disease, but there is limited data on its epidemiology among urban populations. The urban Emergency Department (ED) is a potential venue for surveillance as it predominantly serves an inner city minority population. We evaluate the seroprevalence and factors associated with HSV-2 infection among patients attending the Johns Hopkins Hospital Adult Emergency Department (JHH ED).An identity unlinked-serosurvey was conducted between 6/2007 and 9/2007 in the JHH ED; sera were tested by the Focus HerpeSelect ELISA. Prevalence risk ratios (PRR) were used to determine factors associated with HSV-2 infection.Of 3,408 serum samples, 1,853 (54.4%) were seropositive for HSV-2. Females (adjPRR  = 1.47, 95% CI 1.38-1.56), non-Hispanic blacks (adjPRR  = 2.03, 95% CI 1.82-2.27), single (adjPRR  = 1.15, 95% CI 1.07-1.25), divorced (adjPRR  = 1.28, 95% CI 1.15-1.41), and unemployed patients (adjPRR  = 1.13, 95% CI 1.05-1.21) had significantly higher rates of HSV-2 infection. Though certain zip codes had significantly higher seroprevalence of HSV-2, this effect was completely attenuated when controlling for age and gender.Seroprevalence of HSV-2 in the JHH ED was higher than U.S. national estimates; however, factors associated with HSV-2 infection were similar. The high seroprevalence of HSV-2 in this urban ED highlights the need for targeted testing and treatment. Cross-sectional serosurveys in the urban ED may help to examine the epidemiology of HSV-2.

  View details for DOI 10.1371/journal.pone.0102422

  View details for Web of Science ID 000339615200058

  View details for PubMedID 25036862

  View details for PubMedCentralID PMC4103852