Author
Luciana Borio
Other affiliations:Â National Institutes of Health, Johns Hopkins University
Bio: Luciana Borio is an academic researcher from University of Pittsburgh. The author has contributed to research in topics: Vaccination & Public health. The author has an hindex of 14, co-authored 23 publications receiving 1496 citations. Previous affiliations of Luciana Borio include National Institutes of Health & Johns Hopkins University.
Topics:Â Vaccination, Public health, Transatlantic relations, Preparedness, Monkeypox
Papers
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Johns Hopkins University1, University of Texas at Austin2, United States Army Medical Research Institute of Infectious Diseases3, Centers for Disease Control and Prevention4, University of New Mexico5, Food and Drug Administration6, United States Department of Health and Human Services7, National Institutes of Health8, Nuclear Threat Initiative9, New York State Department of Health10, University of Minnesota11
TL;DR: Weapons disseminating a number of HFVs could cause an outbreak of an undifferentiated febrile illness 2 to 21 days later, associated with clinical manifestations that could include rash, hemorrhagic diathesis, and shock.
Abstract: ObjectiveTo develop consensus-based recommendations for measures to be taken
by medical and public health professionals if hemorrhagic fever viruses (HFVs)
are used as biological weapons against a civilian populationParticipantsThe Working Group on Civilian Biodefense included 26 representatives
from academic medical centers, public health, military services, governmental
agencies, and other emergency management institutionsEvidenceMEDLINE was searched from January 1966 to January 2002 Retrieved references,
relevant material published prior to 1966, and additional sources identified
by participants were reviewedConsensus ProcessThree formal drafts of the statement that synthesized information obtained
in the evidence-gathering process were reviewed by the working group Each
draft incorporated comments and judgments of the members All members approved
the final draftConclusionsWeapons disseminating a number of HFVs could cause an outbreak of an
undifferentiated febrile illness 2 to 21 days later, associated with clinical
manifestations that could include rash, hemorrhagic diathesis, and shock
The mode of transmission and clinical course would vary depending on the specific
pathogen Diagnosis may be delayed given clinicians' unfamiliarity with these
diseases, heterogeneous clinical presentation within an infected cohort, and
lack of widely available diagnostic tests Initiation of ribavirin therapy
in the early phases of illness may be useful in treatment of some of these
viruses, although extensive experience is lacking There are no licensed vaccines
to treat the diseases caused by HFVs
661Â citations
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TL;DR: Clinicians have an urgent need for prompt communication of vital epidemiologic information that could focus their diagnostic evaluation, and rapid diagnostic assays to distinguish more common infectious processes from agents of bioterrorism also could improve management strategies.
Abstract: On October 9, 2001, a letter containing anthrax spores was mailed from
New Jersey to Washington, DC. The letter was processed at a major postal facility
in Washington, DC, and opened in the Senate's Hart Office Building on October
15. Between October 19 and October 26, there were 5 cases of inhalational
anthrax among postal workers who were employed at that major facility or who
handled bulk mail originating from that facility. The cases of 2 postal workers
who died of inhalational anthrax are reported here. Both patients had nonspecific
prodromal illnesses. One patient developed predominantly gastrointestinal
symptoms, including nausea, vomiting, and abdominal pain. The other patient
had a "flulike" illness associated with myalgias and malaise. Both patients
ultimately developed dyspnea, retrosternal chest pressure, and respiratory
failure requiring mechanical ventilation. Leukocytosis and hemoconcentration
were noted in both cases prior to death. Both patients had evidence of mediastinitis
and extensive pulmonary infiltrates late in their course of illness. The durations
of illness were 7 days and 5 days from onset of symptoms to death; both patients
died within 24 hours of hospitalization. Without a clinician's high index
of suspicion, the diagnosis of inhalational anthrax is difficult during nonspecific
prodromal illness. Clinicians have an urgent need for prompt communication
of vital epidemiologic information that could focus their diagnostic evaluation.
Rapid diagnostic assays to distinguish more common infectious processes from
agents of bioterrorism also could improve management strategies.
174Â citations
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TL;DR: This study reinforces the hypothesis that mutations in the DHPS gene are likely involved in the development of sulfa resistance in P. carinii and suggests that there is less selective pressure on DHFR than on DHPS.
Abstract: Recent studies of the human Pneumocystis carinii dihydropteroate synthase (DHPS) gene suggest that P. carinii is developing resistance to sulfamethoxazole (SMX) and dapsone. To explore whether P. carinii is also developing resistance to trimethoprim (TMP), the human P. carinii dihydrofolate reductase (DHFR) gene was cloned, DHFR and DHPS genes in 37 P. carinii isolates from 35 patients were sequenced, and the relationship between TMP-SMX or dapsone use and gene mutations was analyzed. The DHFR gene sequences were identical in all isolates except 1 with a synonymous substitution. In contrast, the DHPS gene sequences showed mutations in 16 of the 37 isolates; prior sulfa/sulfone prophylaxis was associated with the presence of these mutations (P<.001). In addition to suggesting that there is less selective pressure on DHFR than on DHPS, this study reinforces the hypothesis that mutations in the DHPS gene are likely involved in the development of sulfa resistance in P. carinii.
171Â citations
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TL;DR: Clinicians are provided with clinically relevant information about the diagnosis and management of anthrax.
Abstract: From 3 October 2001 through 16 November 2001, in the United States, there were 18 confirmed cases of inhalational and cutaneous anthrax, an additional 4 suspected cases of cutaneous anthrax, and 5 deaths due to inhalational anthrax. Although the number of cases was relatively small, this experience brought bioterrorism and its potential to sharp focus as thousands of people began receiving prophylactic antibiotics after possible exposure to anthrax spores. These events have resulted in a substantial impact on the health care system, including the rewriting of pneumonia guidelines, new emphasis on identification of microbial etiology, substantial infusion of funds for bioterrorism-related research, and a sudden mandate for regional disaster and public health planning. This article provides clinicians with clinically relevant information about the diagnosis and management of anthrax.
123Â citations
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TL;DR: The window for controlling monkeypox is closing and a well-funded global plan for containment is needed.
Abstract: On July 23, 2022, World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus, PhD, declared the current monkeypox outbreak a Public Health EmergencyofInternationalConcern(PHEIC),overridingthe WHO Emergency Committee, which decided 6-9 against recommending a PHEIC.1 That decision was justified, with cases in more than 70 countries, most of which are nonendemic,manywithnoclearepidemiological linksandmilder nonspecific clinical presentation. The window for controlling monkeypox is closing and a well-funded global plan for containment is needed.
99Â citations
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3,097Â citations
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TL;DR: The ability of hospital ventilation systems to filter Aspergillus and other fungi following a building implosion and the impact of bedside design and furnishing on nosocomial infections are investigated.
2,632Â citations
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TL;DR: The majority of cases in the SARS outbreak in the greater Toronto area were related to hospital exposure, and several features of the clinical presentation will be useful in raising the suspicion of SARS.
Abstract: ContextSevere acute respiratory syndrome (SARS) is an emerging infectious disease
that first manifested in humans in China in November 2002 and has subsequently
spread worldwide.ObjectivesTo describe the clinical characteristics and short-term outcomes of
SARS in the first large group of patients in North America; to describe how
these patients were treated and the variables associated with poor outcome.Design, Setting, and PatientsRetrospective case series involving 144 adult patients admitted to 10
academic and community hospitals in the greater Toronto, Ontario, area between
March 7 and April 10, 2003, with a diagnosis of suspected or probable SARS.
Patients were included if they had fever, a known exposure to SARS, and respiratory
symptoms or infiltrates observed on chest radiograph. Patients were excluded
if an alternative diagnosis was determined.Main Outcome MeasuresLocation of exposure to SARS; features of the history, physical examination,
and laboratory tests at admission to the hospital; and 21-day outcomes such
as death or intensive care unit (ICU) admission with or without mechanical
ventilation.ResultsOf the 144 patients, 111 (77%) were exposed to SARS in the hospital
setting. Features of the clinical examination most commonly found in these
patients at admission were self-reported fever (99%), documented elevated
temperature (85%), nonproductive cough (69%), myalgia (49%), and dyspnea (42%).
Common laboratory features included elevated lactate dehydrogenase (87%),
hypocalcemia (60%), and lymphopenia (54%). Only 2% of patients had rhinorrhea.
A total of 126 patients (88%) were treated with ribavirin, although its use
was associated with significant toxicity, including hemolysis (in 76%) and
decrease in hemoglobin of 2 g/dL (in 49%). Twenty-nine patients (20%) were
admitted to the ICU with or without mechanical ventilation, and 8 patients
died (21-day mortality, 6.5%; 95% confidence interval [CI], 1.9%-11.8%). Multivariable
analysis showed that the presence of diabetes (relative risk [RR], 3.1; 95%
CI, 1.4-7.2; P = .01) or other comorbid conditions
(RR, 2.5; 95% CI, 1.1-5.8; P = .03) were independently
associated with poor outcome (death, ICU admission, or mechanical ventilation).ConclusionsThe majority of cases in the SARS outbreak in the greater Toronto area
were related to hospital exposure. In the event that contact history becomes
unreliable, several features of the clinical presentation will be useful in
raising the suspicion of SARS. Although SARS is associated with significant
morbidity and mortality, especially in patients with diabetes or other comorbid
conditions, the vast majority (93.5%) of patients in our cohort survived.Published online May 6, 2003 (doi:10.1001/jama.289.21.JOC30885).
1,269Â citations
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TL;DR: SARS appears to be of viral origin, with patterns suggesting droplet or contact transmission, and the role of human metapneumovirus, a novel coronavirus, or both requires further investigation.
Abstract: background Severe acute respiratory syndrome (SARS) is a condition of unknown cause that has recently been recognized in patients in Asia, North America, and Europe. This report summarizes the initial epidemiologic findings, clinical description, and diagnostic findings that followed the identification of SARS in Canada. methods SARS was first identified in Canada in early March 2003. We collected epidemiologic, clinical, and diagnostic data from each of the first 10 cases prospectively as they were identified. Specimens from all cases were sent to local, provincial, national, and international laboratories for studies to identify an etiologic agent. results The patients ranged from 24 to 78 years old; 60 percent were men. Transmission occurred only after close contact. The most common presenting symptoms were fever (in 100 percent of cases) and malaise (in 70 percent), followed by nonproductive cough (in 100 percent) and dyspnea (in 80 percent) associated with infiltrates on chest radiography (in 100 percent). Lymphopenia (in 89 percent of those for whom data were available), elevated lactate dehydrogenase levels (in 80 percent), elevated aspartate aminotransferase levels (in 78 percent), and elevated creatinine kinase levels (in 56 percent) were common. Empirical therapy most commonly included antibiotics, oseltamivir, and intravenous ribavirin. Mechanical ventilation was required in five patients. Three patients died, and five have had clinical improvement. The results of laboratory investigations were negative or not clinically significant except for the amplification of human metapneumovirus from respiratory specimens from five of nine patients and the isolation and amplification of a novel coronavirus from five of nine patients. In four cases both pathogens were isolated. conclusions SARS is a condition associated with substantial morbidity and mortality. It appears to be of viral origin, with patterns suggesting droplet or contact transmission. The role of human metapneumovirus, a novel coronavirus, or both requires further investigation.
1,125Â citations
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TL;DR: Crimean-Congo haemorrhagic fever (CCHF) is an often fatal viral infection described in about 30 countries, and it has the most extensive geographic distribution of the medically important tickborne viral diseases, closely approximating the known global distribution of Hyalomma spp ticks.
Abstract: Crimean-Congo haemorrhagic fever (CCHF) is an often fatal viral infection described in about 30 countries, and it has the most extensive geographic distribution of the medically important tickborne viral diseases, closely approximating the known global distribution of Hyalomma spp ticks. Human beings become infected through tick bites, by crushing infected ticks, after contact with a patient with CCHF during the acute phase of infection, or by contact with blood or tissues from viraemic livestock. Clinical features commonly show a dramatic progression characterised by haemorrhage, myalgia, and fever. The levels of liver enzymes, creatinine phosphokinase, and lactate dehydrogenase are raised, and bleeding markers are prolonged. Infection of the endothelium has a major pathogenic role. Besides direct infection of the endothelium, indirect damage by viral factors or virus-mediated host-derived soluble factors that cause endothelial activations and dysfunction are thought to occur. In diagnosis, enzyme-linked immunoassay and real-time reverse transcriptase PCR are used. Early diagnosis is critical for patient therapy and prevention of potential nosocomial infections. Supportive therapy is the most essential part of case management. Recent studies suggest that ribavirin is effective against CCHF, although definitive studies are not available. Health-care workers have a serious risk of infection, particularly during care of patients with haemorrhages from the nose, mouth, gums, vagina, and injection sites. Simple barrier precautions have been reported to be effective.
982Â citations