Browsing by Author "Mayhew, Jonathan A."

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    Cytomegalovirus reactivation and acute and chronic complications in children with cerebral malaria: a prospective cohort study
    (Springer Nature, 2025-02-17) Mayhew, Jonathan A.; Witten, Andrew J.; Bond, Caitlin A.; Opoka, Robert O.; Bangirana, Paul; Conroy, Andrea L.; Hernandez‑Alvarado, Nelmary; Schleiss, Mark R.; John, Chandy C.; Pediatrics, School of Medicine
    Background: Virus co-infection or reactivation may modify the host response during cerebral malaria. Cytomegalovirus (CMV) DNAemia has been associated with increased morbidity and mortality in adults with sepsis; however, the impact of CMV DNAemia on adverse outcomes in children with cerebral malaria is unknown. Methods: Clinical, physiological, and neurocognitive outcomes were compared in children aged 18 months to 12 years with cerebral malaria (N = 242) based on the presence or absence of CMV DNAemia 24 h after admission. The primary study outcome was subsequent in-hospital mortality. Secondary outcomes included the presence of acute kidney injury, neurocognitive impairment over a 2-year follow-up, and chronic kidney disease at the 1-year follow-up. Markers of platelet and endothelial cell activation and oxidative and nitrosative stress were measured to characterize the mechanisms by which CMV DNAemia might contribute to pathogenesis. Results: CMV DNAemia was present in 33 children with cerebral malaria (13.6%) 24 h after admission. CMV DNAemia was not significantly associated with mortality in this study. Children with CMV-DNAemia had a higher prevalence of acute kidney injury than those without CMV-DNAemia (59.4% vs. 38.6%, p = 0.03). There was no difference in the prevalence of chronic kidney disease or long-term neurocognitive impairment based on the presence of DNAemia. CMV DNAemia was associated with elevated plasma levels of P-selectin, angiopoietin-1, asymmetric dimethylarginine, and platelet counts. Conclusions: In children with cerebral malaria, CMV DNAemia is associated with acute kidney injury but not in-hospital mortality, chronic kidney disease, or long-term neurocognitive impairment.
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    Post-Artesunate Delayed Hemolysis in Pediatric Malaria Patients in the United States
    (Oxford University Press, 2024) Sundararaman, Sesh A.; Hanze Villavicencio, Karen L.; Roper, Brianne; Wang, Ziyi; Davis, Amy K. F.; Mayhew, Jonathan A.; Wang, Michelle L.; Tang, Nina L.; Soma, Vijaya L.; Shust, Gail F.; Feeney, Margaret E.; Trehan, Indi; Weatherhead, Jill E.; John, Chandy C.; Gerber, Jeffrey S.; Odom John, Audrey R.; Pediatrics, School of Medicine
    Post-artesunate delayed hemolysis (PADH) occurred in 6 of 24 children treated with artesunate for severe malaria in the United States; however, severe hemolysis requiring hospitalization or transfusion was rare. In children in the United States treated with artesunate, counseling, and symptom monitoring may be preferred to weekly laboratory surveillance for PADH.
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    Recurrent Serratia marcescens osteomyelitis eight years after a contaminated open fracture: a case report and review of the literature
    (AME, 2024) Mayhew, Jonathan A.; Christenson, John C.; Alali, Muayad; Pediatrics, School of Medicine
    Background: Serratia marcescens (S. marcescens) is an unusual cause of osteomyelitis. Infection may develop following open trauma, intravenous drug abuse, or in the presence of hardware, but osteoarticular infections outside of this context are atypical in the absence of immunodeficiency. Rarely, a chronic indolent infection may develop after open trauma with disease recurrence years after the initial injury. Case description: We present the case of a 16-year-old male with extensive left lower extremity osteomyelitis secondary to S. marcescens eight years after an open fracture to this leg was complicated by an infection with the same organism. Suboptimal therapy of his initial infection may have contributed to persistent, latent disease before recurrence years later. Evaluation for immunodeficiency was negative and he responded well to ciprofloxacin antibiotic therapy. Conclusions: S. marcescens infection may complicate open fractures, and, if not adequately treated, a chronic, indolent infection may result, with disease recurrence years later. We stress the importance of adequate therapy for infectious complications following open fractures and discuss virulence factors of S. marcescens that may allow this organism to evade the immune system and survive subclinically within a host. The optimal therapy of S. marcescens osteomyelitis is not established and further studies are needed to best guide the therapeutic approach.