This final revision of a previously submitted K 23 grant proposal includes a plan for mentored patient oriented research, using a new protocol shaped by preliminary data, and assures relevant didactic training to expand the candidate's capacity to become an independent investigator in cross-disciplinary clinical research. The clinical research proposal is focused on the aseptic meningoencephalitis syndrome (AMS), a clinical entity comprised of diverse group of etiologies of which some require urgent treatment. Due to lack of effective means in the acute care setting for differentiating patients with an urgent treatable condition from those at low risk for early complications, AMS remains a critical diagnostic challenge. Further, using present diagnostic methods, after standard evaluation nearly 70% of patients remain without an etiological diagnosis. The overall goal of this proposal is to establish a simple and cost-effective algorithm for early diagnosis and effective management of the AMS in patients presenting to the Emergency Department (ED). The primary objective is to derive and validate a clinical predictive index that will identify the subgroup at low risk of having an urgent treatable cause among AMS patients presenting to EDs, using selected New Orleans hospitals. The secondary objectives are: (1) to describe the changing and emerging epidemiology and natural history of the AMS using improved diagnostic methods to identify difficult-to-diagnose viral, rickettsial, mycoplasmal, bacterial, spirochetal, bartonellal, mycobacterial, fungal and parasitic pathogens;(2) to describe the neurocognitive and quality of life outcomes for selective subgroups of AMS;and (3) to correlate neuroimaging with neurocognitive findings in encephalopathic AMS patients who present with altered mental status and/or focal neurological findings. The candidate is committed to a career in clinical investigation of patients with central nervous system infections. To develop his capacity to engage in cross-disciplinary clinical research, his plan includes learning the principles of molecular diagnostics in clinical microbiology, neurocognitive testing and clinical correlations with neuroimaging through formal and informal training in molecular diagnostics, neuropsychology and neuroradiology. In addition, he will complete the NIH funded K30 Clinical Research Curriculum Award Program and obtain a Master's in Clinical Research degree at Tulane University.

Agency
National Institute of Health (NIH)
Institute
National Center for Research Resources (NCRR)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23RR018929-05
Application #
7690911
Study Section
National Center for Research Resources Initial Review Group (RIRG)
Program Officer
Wilde, David B
Project Start
2006-09-01
Project End
2011-07-31
Budget Start
2009-08-01
Budget End
2010-07-31
Support Year
5
Fiscal Year
2009
Total Cost
$120,954
Indirect Cost
Name
University of Texas Health Science Center Houston
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
800771594
City
Houston
State
TX
Country
United States
Zip Code
77225
Shukla, Bhavarth; Aguilera, Elizabeth A; Salazar, Lucrecia et al. (2017) Aseptic meningitis in adults and children: Diagnostic and management challenges. J Clin Virol 94:110-114
Nesher, L; Hadi, C M; Salazar, L et al. (2016) Epidemiology of meningitis with a negative CSF Gram stain: under-utilization of available diagnostic tests. Epidemiol Infect 144:189-97
Hasbun, Rodrigo; Garcia, Melissa N; Kellaway, Judianne et al. (2016) West Nile Virus Retinopathy and Associations with Long Term Neurological and Neurocognitive Sequelae. PLoS One 11:e0148898
Dharmarajan, Lavanya; Salazar, Lucrecia; Hasbun, Rodrigo (2016) Gender Differences in Community-acquired Meningitis in Adults: Clinical Presentations and Prognostic Factors. J Meningitis 1:
SolĂ­s, Natalia; Salazar, Lucrecia; Hasbun, Rodrigo (2016) Anti-NMDA Receptor antibody encephalitis with concomitant detection of Varicella zoster virus. J Clin Virol 83:26-8
Shrikanth, Vandana; Salazar, Lucrecia; Khoury, Nabil et al. (2015) Hypoglycorrhachia in adults with community-acquired meningitis: etiologies and prognostic significance. Int J Infect Dis 39:39-43
Wang, Amy Y; Machicado, Jorge D; Khoury, Nabil T et al. (2014) Community-acquired meningitis in older adults: clinical features, etiology, and prognostic factors. J Am Geriatr Soc 62:2064-70
Castelblanco, Rodrigo Lopez; Lee, MinJae; Hasbun, Rodrigo (2014) Epidemiology of bacterial meningitis in the USA from 1997 to 2010: a population-based observational study. Lancet Infect Dis 14:813-9
Hasbun, Rodrigo; Bijlsma, Merijn; Brouwer, Matthijs C et al. (2013) Risk score for identifying adults with CSF pleocytosis and negative CSF Gram stain at low risk for an urgent treatable cause. J Infect 67:102-10
Khoury, Nabil T; Hossain, Md Monir; Wootton, Susan H et al. (2012) Meningitis with a negative cerebrospinal fluid Gram stain in adults: risk classification for an adverse clinical outcome. Mayo Clin Proc 87:1181-8

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