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.
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