Jeannette Guarner

Centers for Disease Control and Prevention, Атланта, Michigan, United States

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Publications (189)

  • Jeannette Guarner · Cassandra Street · Margaret Matlock · [...] · Francoise Brierre
    [Show abstract] [Hide abstract] ABSTRACT: Background: Consolidation of laboratories has left many hospitals and satellite laboratories with minimal microbiologic testing. In many hospitals and satellite laboratories, Gram stains on primary specimens are still performed despite difficultly in maintaining proficiency. Methods: To maintain Gram stain proficiency at a community 450-bed hospital with an active emergency room we designed bimonthly challenges that require reporting Gram staining and morphology of different organisms. The challenges consist of five specimens prepared by the reference microbiology laboratory from cultures and primary specimens. Twenty to 23 medical laboratory scientists participate reading the challenges. Results from the challenges are discussed with each medical laboratory scientists. In addition, printed images from the challenges are presented at huddle to add microbiology knowledge. Results: On the first three challenges, Gram staining was read correctly in 71%-77% of the time while morphology 53%-66%. In the last six challenges correct answers for Gram stain were 77%-99% while morphology 73%-96%. Conclusions: We observed statistically significant improvement when reading Gram stains by providing frequent challenges to medical laboratory scientists. The clinical importance of Gram stain results is emphasized during huddle presentations increasing knowledge and motivation to perform the test for patients.
    Article · Sep 2016 · Clinical Chemistry and Laboratory Medicine
  • Jeannette Guarner · Ann M. Winkler · Lisa Flowers · [...] · Jennifer Goedken
    [Show abstract] [Hide abstract] ABSTRACT: Objectives To describe the creation, implementation, and evaluation of a case-based, interdisciplinary course that highlights laboratory principles for students who have selected a career in obstetrics and gynecology. Methods We developed four case-based modules with questions that emphasize laboratory principles required to establish a diagnosis and treat and monitor each case-based scenario. The cases were offered as a 4-hour elective course during the medical school capstone. A clinician and a clinical pathologist pair facilitated the case discussions with groups of six to nine medical students during 2 consecutive years. Pre- and postknowledge quizzes were given to the students. In addition, a structured evaluation of the course was performed. Results Twenty-two students participated in the courses. Most found the format effective and the information useful. There was a significant increase in their related knowledge as established by pre- and posttesting. Conclusions Case-based discussions gave learners a better understanding of the function and complexity of the clinical laboratories, and multidisciplinary facilitation highlighted the value of interacting with laboratory professionals to enhance clinical care.
    Article · Aug 2016 · American Journal of Clinical Pathology
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    Lee F. Schroeder · Jeannette Guarner · Ali Elbireer · [...] · Timothy K. Amukele
    [Show abstract] [Hide abstract] ABSTRACT: Many diagnostic tests are required for fulfilling the health care needs of populations. A Model List of Essential Diagnostics could play a global health policy role similar to that of the Model List of Essential Medicines maintained by the World Health Organization.
    Full-text Article · Jun 2016 · New England Journal of Medicine
  • Jeannette Guarner · Silvia M. Niño
    [Show abstract] [Hide abstract] ABSTRACT: The ubiquity of devices connected to the internet has exploded allowing for easy dissemination of information. Many teachers from kindergarten to universities use the information obtained online or post material they want their students to access. Online media readily places at our fingertips articles, books, videos, and games. The public in general also gathers health information from the internet. The following review will explore what has been published regarding microbiology education and learning online and the use of electronic media by microbiologists for scientific purposes.
    Article · Mar 2016 · Journal of Clinical Microbiology
  • [Show abstract] [Hide abstract] ABSTRACT: Objectives: Free-living amoebas are exceedingly rare causes of cutaneous infections and present unique diagnostic and therapeutic challenges. We describe a case of disseminated acanthamoebiasis with cutaneous manifestations and summarize additional diagnostic, prognostic, and therapeutic highlights.Methods: A 58-year-old man with relapsed chronic lymphocytic leukemia had several weeks of progressive, painful ulcerations on the forehead, arms, abdomen, and thighs. A biopsy was performed for histopathologic evaluation.Results: The biopsy specimen showed inflammatory infiltrate with abscess formation involving the epidermis, dermis, and subcutis. Scattered cells showed nuclei with a prominent central karyosome, dispersed chromatin, and either abundant foamy basophilic cytoplasm or two well-demarcated cytoplasmic walls. Acanthamoeba species was confirmed by polymerase chain reaction from the formalin-fixed, paraffin-embedded tissue.Conclusions: Cutaneous lesions from acanthamoebiasis are exceptionally rare but should be included in the differential diagnosis of necrotic cutaneous lesions in immunocompromised patients. Although infrequently encountered, pathologists need to be aware of the morphologic features of free-living amoebas. Immunohistochemical and molecular studies can confirm the diagnosis. Multiagent treatment regimens, when initiated empirically, have been more successful than single-agent regimens, but infections involving the central nervous system are almost universally fatal.
    Article · Jan 2016 · American Journal of Clinical Pathology
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    [Show abstract] [Hide abstract] ABSTRACT: Background. The 2014–2015 Ebola epidemic in West Africa had global impact beyond the primarily affected countries of Guinea, Liberia, and Sierra Leone. Other countries, including the United States, encountered numerous patients who arrived from highly affected countries with fever or other signs or symptoms consistent with Ebola virus disease (EVD). Methods. We describe our experience evaluating 25 travelers who met the US Centers for Disease Control and Prevention case definition for a person under investigation (PUI) for EVD from July 20, 2014 to January 28, 2015. All patients were triaged and evaluated under the guidance of institutional protocols to the emergency department, outpatient tropical medicine clinic, or Emory's Ebola treatment unit. Strict attention to infection control and early involvement of public health authorities guided the safe evaluation of these patients. Results. None were diagnosed with EVD. Respiratory illnesses were common, and 8 (32%) PUI were confirmed to have influenza. Four patients (16%) were diagnosed with potentially life-threatening infections or conditions, including 3 with Plasmodium falciparum malaria and 1 with diabetic ketoacidosis. Conclusions. In addition to preparing for potential patients with EVD, Ebola assessment centers should consider other life-threatening conditions requiring urgent treatment, and travelers to affected countries should be strongly advised to seek pretravel counseling. Furthermore, attention to infection control in all aspects of PUI evaluation is paramount and has presented unique challenges. Lessons learned from our evaluation of potential patients with EVD can help inform preparations for future outbreaks of highly pathogenic communicable diseases.
    Full-text Article · Jan 2016 · Open Forum Infectious Diseases
  • Jeannette Guarner · Hannah K Dolan · Lisa Cole
    Article · Sep 2015 · American Journal of Clinical Pathology
  • Carlos Del Rio · Jeannette Guarner
    [Show abstract] [Hide abstract] ABSTRACT: The 2014 Ebola virus disease outbreak in West Africa has been the largest in recorded history. During this Ebola epidemic, the media has focused much attention to the magnitude of the problem in West Africa but has also overplayed the potential for an Ebola virus pandemic as patients have been transported for treatment to the United States and Europe causing panic and paranoia in the population. Knowledge of the epidemiology, pathogenesis, clinical presentation, treatment, and prevention of this infection will allow a better understanding of the disease and decrease irrational fear of spread.
    Article · Sep 2015 · Transactions of the American Clinical and Climatological Association
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    Jeannette Guarner · Heather Jost · Allan Pillay · [...] · Kimberly Workowski
    [Show abstract] [Hide abstract] ABSTRACT: We evaluated the use of treponemal serum tests in cerebrospinal fluid (CSF) to diagnose neurosyphilis since CSF-Venereal Disease Research Laboratory (VDRL) is specific but lacks sensitivity. We tested CSF specimens using the following treponemal serum tests: INNO-LIA, Treponema pallidum particle agglutination (TP-PA), Trep-Sure, and Maxi-Syph. The reference standard to calculate sensitivity and specificity was having two or more reactive/positive tests on CSF. The reference standard group included 11 cases that fulfilled the definition of neurosyphilis (reactive CSF-VDRL plus symptoms) and three cases that did not fulfill the definition: two cases had neurologic symptoms but a nonreactive CSF-VDRL, and one had several positive CSF syphilis tests (reactive VDRL and positive treponemal and syphilis polymerase chain reaction) but no history (referred sample). Controls included 18 patients in whom a CSF-VDRL was performed the same week as patients in the reference group. The sensitivity was 85.7% (12/14) for CSF-VDRL, 92.9% (13/14) for Trep-Sure, 100% (10/10) for Maxi-Syph, 92.3% (12/13) for INNO-LIA, and 83.3% (10/12) for TP-PA. Specificity was 100% for all tests. Treponemal serum tests performed on CSF were useful in identifying two patients with nonreactive CSF-VDRL. Copyright© by the American Society for Clinical Pathology.
    Full-text Article · Apr 2015 · American Journal of Clinical Pathology
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    Jeannette Guarner · Drucilla Roberts · Ann Nelson · Michael L. Wilson
    Full-text Article · Apr 2015
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    [Show abstract] [Hide abstract] ABSTRACT: A better understanding of second-line drug (SLD) pharmacokinetics including cavitary penetration may help optimize SLD dosing. Patients with pulmonary MDR-TB undergoing adjunctive surgery were enrolled in Tbilisi, Georgia. Serum was obtained at 0, 1, 4, and 8 hours and at time of cavitary removal to measure levofloxacin concentrations. After surgery, microdialysis was performed using the ex vivo cavity and levofloxacin concentrations were measured in collected dialysate fluid. Noncompartmental analysis was performed and a cavitary to serum levofloxacin concentration ratio was calculated. Twelve patients received levofloxacin for a median of 373 days before surgery; median dose 11.8 mg/kg. The median serum levofloxacin Cmax was 6.5 μg/ml and was < 2μg/ml in 3 (25%) patients. Among 11 patients with complete data, the median cavitary concentration of levofloxacin was 4.36 μg/ml (range 0.46-8.82). The median cavitary-serum levofloxacin ratio was 1.33 (range 0.63-2.36) and 7 patients (64%) had a ratio > 1. There was a significant correlation between serum and cavitary concentrations (R=0.71, p=0.01) CONCLUSIONS: Levofloxacin had excellent penetration into chronic cavitary TB lesions and there was good correlation between serum and cavitary concentrations. Optimizing serum concentrations will help ensure optimal cavitary concentrations of levofloxacin, which may enhance treatment outcomes. Copyright © 2015, American Society for Microbiology. All Rights Reserved.
    Full-text Article · Mar 2015 · Antimicrobial Agents and Chemotherapy
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    Jeannette Guarner · Timothy Amukele · Meheretu Mehari · [...] · Carlos Del Rio
    [Show abstract] [Hide abstract] ABSTRACT: To describe a 4-day laboratory medicine course for clinicians given at Addis Ababa University, Ethiopia, designed to improve the use of laboratory-based diagnoses. Each day was dedicated to one of the following topics: hematology, blood bank/transfusion medicine and coagulation, chemistry, and microbiology. The course included lectures, case-based learning, laboratory tours, and interactive computer case-based homework. The same 12-question knowledge quiz was given before and after the course. Twenty-eight participants took the quiz before and 21 after completing the course. The average score was 5.28 (range, 2-10) for the initial quiz and 8.09 (range, 4-11) for the second quiz (P = .0001). Two of 12 and 8 of 12 questions were answered correctly by more than 60% of trainees on the initial and second quiz, respectively. Knowledge and awareness of the role of the laboratory increased after participation in the course. Understanding of laboratory medicine principles by clinicians will likely improve use of laboratory services and build capacity in Africa. Copyright© by the American Society for Clinical Pathology.
    Full-text Article · Mar 2015 · American Journal of Clinical Pathology
  • Jeannette Guarner
    [Show abstract] [Hide abstract] ABSTRACT: The objective of this chapter is to present an atlas of histopathological findings of some of the major Neglected Tropical Diseases that continue to pose a substantial burden of disease in Latin America and the Caribbean.
    Chapter · Jan 2015
  • Laleh Ehsani · Sujan C Reddy · Mario Mosunjac · [...] · Jeannette Guarner
    [Show abstract] [Hide abstract] ABSTRACT: Mycobacterium kansasii is a photochromogenic, slow-growing mycobacterium species that can cause pulmonary infection in patients with predisposing lung diseases, as well as extrapulmonary or disseminated disease in immunosuppressed patients. We describe a patient with a myelodysplastic syndrome, disseminated M kansasii infection, and ruptured aortic aneurysm. He had a recent diagnosis of mycobacterium cavitary lung lesions and was transferred to our facility for possible surgical intervention of an aortic aneurysm. Few hours after admission, the patient suddenly collapsed and died despite resuscitation efforts. A complete autopsy was performed and showed ruptured ascending aortic pseudoaneurysm with hemopericardium, disseminated necrotizing and nonnecrotizing granulomas with acid-fast bacilli in the aortic wall, lungs, heart, liver, spleen, and kidneys. Further genetic studies were consistent with monocytopenia and mycobacterial infection syndrome. Copyright © 2014 Elsevier Inc. All rights reserved.
    Article · Nov 2014 · Human pathology
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    Jeannette Guarner · Eileen M Burd · Colleen S Kraft · [...] · Carlos Del Rio
    [Show abstract] [Hide abstract] ABSTRACT: Microbiology rounds are an integral part of infectious disease consultation service. During microbiology rounds, we highlight microbiology principles using vignettes. We created case-based, interactive, microbiology online modules similar to the vignettes presented during microbiology rounds. Since internal medicine residents rotating on our infectious disease elective have limited time to participate in rounds and learn microbiology, our objective was to evaluate the use of the microbiology online modules by internal medicine residents. We asked residents to complete 10 of 25 online modules during their infectious disease elective. We evaluated which modules they chose and the change in their knowledge level. Forty-six internal medicine residents completed assessments given before and after accessing the modules with an average of 11/20 (range, 6 to 19) and 16/20 (range, 9 to 20) correct questions, respectively (average improvement, 5 questions; P = 0.0001). The modules accessed by more than 30 residents included those related to Clostridium difficile, anaerobes, Candida spp., Streptococcus pneumoniae, influenza, Mycobacterium tuberculosis, and Neisseria meningitidis. We demonstrated improved microbiology knowledge after completion of the online modules. This improvement may not be solely attributed to completing the online modules, as fellows and faculty may have provided additional microbiology education during the rotation.
    Full-text Article · Nov 2014 · Journal of Clinical Microbiology
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    Jeannette Guarner · Kenneth Fleming
    Full-text Article · Oct 2014 · American Journal of Clinical Pathology
  • Jeannette Guarner
    Article · Oct 2014 · American Journal of Clinical Pathology
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    Full-text Article · Aug 2014 · Annals of internal medicine
  • Jeannette Guarner
    [Show abstract] [Hide abstract] ABSTRACT: The role pathology plays in establishing or excluding infectious diseases has been established. However, as the practice of pathology has become subspecialized, there is not enough infectious disease specimen volume to have a pathologist dedicated full time to this crosscutting subspecialty. So, what are the myths and realities of a practicing infectious disease pathologist in the hospital setting? Infectious disease clinicians tend to consult pathologists when there are questions regarding terminology used in pathology reports; when there is the need to perform additional studies on formalin-fixed, paraffin-embedded tissues; and when there is an interest in seeing biopsies or resections obtained from patients and in obtaining photographs for presentations. Pathologists consult infectious disease pathologists when there is a need to review diverse inflammatory reactions; for identification of fungi, parasites, or unknown structures; to define the need to use special stains and other techniques in order to identify organisms in tissues that have been formalin fixed; and to help with terminology to be used in reports. This review explores in more detail why and how these consultations occur.
    Article · Jun 2014 · Clinical Infectious Diseases
  • Jeannette Guarner · Carlos del Rio
    Article · May 2014 · American Journal of Clinical Pathology

Publication Stats

9k Citations

Institutions

  • 2010
    • Centers for Disease Control and Prevention
      Атланта, Michigan, United States
  • 2001-2006
    • Stanford University
      • • Department of Statistics
      • • Department of Medicine
      Palo Alto, California, United States
  • 2004
    • University of New Mexico Hospitals
      Albuquerque, New Mexico, United States
  • 2003
    • University of Malaya
      Kuala Lumpor, Kuala Lumpur, Malaysia
  • 1997
    • Instituto Nacional de Cancerología - Mexico
      Ciudad de México, The Federal District, Mexico