Purpose: To determine whether clinician-led immunization education with immediate onsite vaccinat... more Purpose: To determine whether clinician-led immunization education with immediate onsite vaccination availability will increase pneumococcal immunizations during specialty care. Methods: We designed a controlled before and after QI project quasi-experimental design to retrospectively evaluate the QI effectiveness. The QI setting included two clinics. Clinic #1 was a part of the county hospital system and offered comprehensive care. Clinic #2 was a university clinic that hosted a private practice and a dermatology resident continuity clinic. 201 patients with planned or existing immunosuppressive medication regimens attending an initial or follow-up dermatology visit participated in the study. The intervention included clinician provided verbal immunization recommendations. Patients were then given the opportunity for immediate immunization. The main measure of outcome was pneumococcal immunization status after QI intervention. Results: Our analysis included 201 patients with planned...
Introduction: Immunosuppressive therapies increase risk of infections 2-fold when compared to nai... more Introduction: Immunosuppressive therapies increase risk of infections 2-fold when compared to naive individuals; however, an observational study found that only 4% of patients with psoriasis who were on or planned to start immunosuppressive therapy were immunized with pneumococcus. Factors positively influencing vaccination uptake include having vaccines available same day in clinic and education about vaccines. Negative influences include no recommendation from the treating clinician and no insurance. Failure to vaccinate occurs by overlooking indication and an uncertainty as to who is responsible for vaccination. Since the early 2000’s, vaccinations have been offered in pharmacies. This could result in additional confusion regarding vaccination responsibility. As a result of not being immunized, patients on immunosuppressive medications experience higher rates of preventable infections. We observed that many of our patients’ immunizations were incomplete and sought to increase imm...
Comedones occur when an overproliferation of keratinocytes blocks sebum secretion in a pilosebace... more Comedones occur when an overproliferation of keratinocytes blocks sebum secretion in a pilosebaceous duct. Comedones have multiple possible etiologies and contributing factors. While comedones are common to acne, they are also seen in occupational exposures and are associated with certain syndromes. We describe a particularly rare case of comedones at the perianus that is not associated with any known exposure or disease and is a rare incidental finding.
Granuloma gluteale infantum is a rare pediatric dermatological disorder of uncertain etiology. Su... more Granuloma gluteale infantum is a rare pediatric dermatological disorder of uncertain etiology. Suggested causes include fluorinated corticosteroids, , and irritant contact dermatitis. We present the case of a 3-year-old boy with recurrent episodes of granuloma gluteale infantum which resolved with treatment of his fecal overflow incontinence. As each recurrence correlated with a relapse of overflow incontinence, in this case the cause was irritant contact dermatitis from the liquid stool. This is the first reported case of recurrent granuloma gluteale infantum.
Leishmaniasis is recognized as an endemic human disease in Africa, the Middle East, Asia, and Sou... more Leishmaniasis is recognized as an endemic human disease in Africa, the Middle East, Asia, and South America. Yet despite case reports of endemic human leishmaniasis in the United States, and well-documented occurrences of disease in various animal vectors and reservoirs, the endemicity of leishmaniasis in North America has not yet been established. Moreover, leishmaniasis is not a federally reportable disease in the United States. Clinical awareness of endemic disease therefore remains low, with North American physicians considering leishmaniasis a tropical disease. To assess the endemicity of human leishmaniasis in the United States. This cross-sectional multicenter observational study reviewed cases of human leishmaniasis occurring in the United States from 2007 through 2017. Previously diagnosed, deidentified cases of leishmaniasis were reported by the institutions of the authors and acknowledged contributors, as well as the Texas Department of State Health Services. Cases of lei...
Annals of the American Thoracic Society, Jan 28, 2018
More information on risk factors for death from tuberculosis in the United States could help redu... more More information on risk factors for death from tuberculosis in the United States could help reduce the tuberculosis mortality rate, which has remained steady for over a decade. Objective(s) To identify risk factors for tuberculosis-related death in adults. We performed a retrospective study of 1,304 adults with tuberculosis who died before treatment completion and 1,039 frequency-matched controls who completed tuberculosis treatment in 2005-2006 in thirteen states reporting 65% of U.S. tuberculosis cases. We used in-depth record abstractions and a standard algorithm to classify deaths in persons with tuberculosis as tuberculosis-related or not. We then compared these classifications to causes of death as coded in death certificates. We used multivariable logistic regression to calculate adjusted odds ratios (aOR) for predictors of tuberculosis-related death among adults compared with those who completed tuberculosis treatment. Of 1,304 adult deaths, 942 (72%) were tuberculosis-rela...
Purpose: To determine whether clinician-led immunization education with immediate onsite vaccinat... more Purpose: To determine whether clinician-led immunization education with immediate onsite vaccination availability will increase pneumococcal immunizations during specialty care. Methods: We designed a controlled before and after QI project quasi-experimental design to retrospectively evaluate the QI effectiveness. The QI setting included two clinics. Clinic #1 was a part of the county hospital system and offered comprehensive care. Clinic #2 was a university clinic that hosted a private practice and a dermatology resident continuity clinic. 201 patients with planned or existing immunosuppressive medication regimens attending an initial or follow-up dermatology visit participated in the study. The intervention included clinician provided verbal immunization recommendations. Patients were then given the opportunity for immediate immunization. The main measure of outcome was pneumococcal immunization status after QI intervention. Results: Our analysis included 201 patients with planned...
Introduction: Immunosuppressive therapies increase risk of infections 2-fold when compared to nai... more Introduction: Immunosuppressive therapies increase risk of infections 2-fold when compared to naive individuals; however, an observational study found that only 4% of patients with psoriasis who were on or planned to start immunosuppressive therapy were immunized with pneumococcus. Factors positively influencing vaccination uptake include having vaccines available same day in clinic and education about vaccines. Negative influences include no recommendation from the treating clinician and no insurance. Failure to vaccinate occurs by overlooking indication and an uncertainty as to who is responsible for vaccination. Since the early 2000’s, vaccinations have been offered in pharmacies. This could result in additional confusion regarding vaccination responsibility. As a result of not being immunized, patients on immunosuppressive medications experience higher rates of preventable infections. We observed that many of our patients’ immunizations were incomplete and sought to increase imm...
Comedones occur when an overproliferation of keratinocytes blocks sebum secretion in a pilosebace... more Comedones occur when an overproliferation of keratinocytes blocks sebum secretion in a pilosebaceous duct. Comedones have multiple possible etiologies and contributing factors. While comedones are common to acne, they are also seen in occupational exposures and are associated with certain syndromes. We describe a particularly rare case of comedones at the perianus that is not associated with any known exposure or disease and is a rare incidental finding.
Granuloma gluteale infantum is a rare pediatric dermatological disorder of uncertain etiology. Su... more Granuloma gluteale infantum is a rare pediatric dermatological disorder of uncertain etiology. Suggested causes include fluorinated corticosteroids, , and irritant contact dermatitis. We present the case of a 3-year-old boy with recurrent episodes of granuloma gluteale infantum which resolved with treatment of his fecal overflow incontinence. As each recurrence correlated with a relapse of overflow incontinence, in this case the cause was irritant contact dermatitis from the liquid stool. This is the first reported case of recurrent granuloma gluteale infantum.
Leishmaniasis is recognized as an endemic human disease in Africa, the Middle East, Asia, and Sou... more Leishmaniasis is recognized as an endemic human disease in Africa, the Middle East, Asia, and South America. Yet despite case reports of endemic human leishmaniasis in the United States, and well-documented occurrences of disease in various animal vectors and reservoirs, the endemicity of leishmaniasis in North America has not yet been established. Moreover, leishmaniasis is not a federally reportable disease in the United States. Clinical awareness of endemic disease therefore remains low, with North American physicians considering leishmaniasis a tropical disease. To assess the endemicity of human leishmaniasis in the United States. This cross-sectional multicenter observational study reviewed cases of human leishmaniasis occurring in the United States from 2007 through 2017. Previously diagnosed, deidentified cases of leishmaniasis were reported by the institutions of the authors and acknowledged contributors, as well as the Texas Department of State Health Services. Cases of lei...
Annals of the American Thoracic Society, Jan 28, 2018
More information on risk factors for death from tuberculosis in the United States could help redu... more More information on risk factors for death from tuberculosis in the United States could help reduce the tuberculosis mortality rate, which has remained steady for over a decade. Objective(s) To identify risk factors for tuberculosis-related death in adults. We performed a retrospective study of 1,304 adults with tuberculosis who died before treatment completion and 1,039 frequency-matched controls who completed tuberculosis treatment in 2005-2006 in thirteen states reporting 65% of U.S. tuberculosis cases. We used in-depth record abstractions and a standard algorithm to classify deaths in persons with tuberculosis as tuberculosis-related or not. We then compared these classifications to causes of death as coded in death certificates. We used multivariable logistic regression to calculate adjusted odds ratios (aOR) for predictors of tuberculosis-related death among adults compared with those who completed tuberculosis treatment. Of 1,304 adult deaths, 942 (72%) were tuberculosis-rela...
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