Speakers at Conference


The following people will be speaking at the conference during demonstration times. Steve C. Buckingham speaks Tuesday afternoon/evening.  Angela L. Myers will be speaking Friday morning.





M.D., M.A.
Associate Professor

·         Article: Managing Rocky Mountain spotted fever.
Timothy D Minniear, Steven C Buckingham
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ABSTRACT: Rocky Mountain spotted fever is caused by the tick-borne bacterium Rickettsia rickettsii. Symptoms range from moderate illness to severe illness, including cardiovascular compromise, coma and death. The disease is prevalent in most of the USA, especially during warmer months. The trademark presentation is fever and rash with a history of tick bite, although tick exposure is unappreciated in over a third of cases. Other signature symptoms include headache and abdominal pain. The antibiotic therapy of choice for R. rickettsii infection is doxycycline. Preventive measures for Rocky Mountain spotted fever and other tick-borne diseases include: wearing long-sleeved, light colored clothing; checking for tick attachment and removing attached ticks promptly; applying topical insect repellent; and treating clothing with permethrin.
Expert Review of Anticancer Therapy 11/2009; 7(9):1131-7. DOI:10.1586/eri.09.94 · 3.22 Impact Factor
·         Article: Human monocytic Ehrlichiosis in children
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ABSTRACT: Human monocytic ehrlichiosis (HME) is a tick-borne illness caused by Ehrlichia chaffeensis. Data about disease in children have been largely derived from case reports or small case series. A retrospective review of all medical and laboratory records from 6 sites located in the "tick belt" of the Southeastern United States was carried out. Demographic, history and laboratory data were abstracted from the identified medical records of patients. Bivariate statistical comparisons were performed using Fisher exact test or Wilcoxon rank sum tests. Common clinical signs and symptoms of patients with HME (n = 32) included fever (100%), headache (69%), myalgia (69%), rash (66%), nausea/vomiting (56%), altered mental status (50%) and lymphadenopathy (47%). Only 48% had a complaint of fever, headache and rash. Common laboratory abnormalities included thrombocytopenia (94%), elevated aspartate aminotransferase (90%), elevated alanine aminotransferase (74%), hypoalbuminemia (65%), lymphopenia (57%), leukopenia (56%) and hyponatremia (55%). The median number of days of illness before the initiation of antirickettsial therapy was 6. Patients who received sulfonamides before starting doxycycline therapy developed a rash, were admitted to the hospital, and started doxycycline at a later date. Twenty-two percent of patients were admitted to the intensive care unit with 12.5% of patients requiring ventilatory and blood pressure support. Although HME has been recognized among children for almost 20 years, there is only a limited knowledge about its clinical course. Even among physicians practicing in endemic regions, few cases are diagnosed each year. More work is needed to understand the true burden of disease and the natural history among asymptomatically and symptomatically infected children.
The Pediatric Infectious Disease Journal 07/2007; 26(6):475-9. DOI:10.1097/INF.0b013e318042b66c · 3.14 Impact Factor

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ABSTRACT: To describe the clinical characteristics and course of children with laboratory-diagnosed Rocky Mountain spotted fever (RMSF) and to identify clinical findings independently associated with adverse outcomes of death or discharge with neurologic deficits. Retrospective chart review of 92 patients at six institutions in the southeastern and southcentral United States from 1990 to 2002. Statistical analyses used descriptive statistics and multiple logistic regression. Children with RMSF presented to study institutions after a median of 6 days of symptoms, which most commonly included fever (98%), rash (97%), nausea and/or vomiting (73%), and headache (61%); no other symptom or sign was present in >50% of children. Only 49% reported antecedent tick bites. Platelet counts were <150,000/mm3 in 59% of children, and serum sodium concentrations were <135 mEq/dL in 52%. Although 86% sought medical care before admission, only 4 patients received anti-rickettsial therapy during this time. Three patients died, and 13 survivors had neurologic deficits at discharge. Coma and need for inotropic support and intravenous fluid boluses were independently associated with adverse outcomes. Children with RMSF generally present with fever and rash. Delays in diagnosis and initiation of appropriate therapy are unacceptably common. Prognosis is guarded in those with hemodynamic instability or neurologic compromise at initiation of therapy.
The Journal of pediatrics 03/2007; 150(2):180-4, 184.e1. DOI:10.1016/j.jpeds.2006.11.023 · 4.02 Impact Factor
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ABSTRACT: Tickborne rickettsial diseases (TBRD) continue to cause severe illness and death in otherwise healthy adults and children, despite the availability of low cost, effective antimicrobial therapy. The greatest challenge to clinicians is the difficult diagnostic dilemma posed by these infections early in their clinical course, when antibiotic therapy is most effective. Early signs and symptoms of these illnesses are notoriously nonspecific or mimic benign viral illnesses, making diagnosis difficult. In October 2004, CDC's Viral and Rickettsial Zoonoses Branch, in consultation with 11 clinical and academic specialists of Rocky Mountain spotted fever, human granulocytotropic anaplasmosis, and human monocytotropic ehrlichiosis, developed guidelines to address the need for a consolidated source for the diagnosis and management of TBRD. The preparers focused on the practical aspects of epidemiology, clinical assessment, treatment, and laboratory diagnosis of TBRD. This report will assist clinicians and other health-care and public health professionals to 1) recognize epidemiologic features and clinical manifestations of TBRD, 2) develop a differential diagnosis that includes and ranks TBRD, 3) understand that the recommendations for doxycycline are the treatment of choice for both adults and children, 4) understand that early empiric antibiotic therapy can prevent severe morbidity and death, and 5) report suspect or confirmed cases of TBRD to local public health authorities to assist them with control measures and public health education efforts.
MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control 04/2006; 55(RR-4):1-27.
·         Article: Tick-Borne Infections in Children
Steven C Buckingham
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ABSTRACT: Ticks can transmit bacterial, protozoal, and viral infections to humans. Specific therapy is available for several of these infections. Doxycycline is the antimicrobial treatment of choice for all patients, regardless of age, with Rocky Mountain spotted fever, human monocytic ehrlichiosis, or human granulocytic ehrlichiosis. Chloramphenicol has been used to treat these infections in children but is demonstrably inferior to doxycycline. In patients with Mediterranean spotted fever, doxycycline, chloramphenicol, and newer macrolides all appear to be effective therapies. Therapy of Lyme disease depends on the age of the child and stage of the disease. For early localized disease, amoxicillin (for those aged <8 years) or doxycycline (for those aged ≥8 years) is effective. Doxycycline, penicillin V (phenoxymethylpenicillin) or penicillin G (benzylpenicillin) preparations, and erythromycin are all effective treatments for tick-borne relapsing fever. Hospitalized patients with tularemia should receive gentamicin or streptomycin. Doxycycline and ciprofloxacin have each been investigated for the treatment of tularemia in outpatients; however, these agents do not yet have established roles in the treatment of this disease in children. Combination therapy with clindamycin and quinine is preferred for children with babesiosis; the combination of azithromycin and atovaquone also appears promising. Ribavirin has been recently shown to markedly improve survival in patients with Crimean-Congo hemorrhagic fever. The role of antiviral therapy in the treatment of other tick-borne viral infections, including other hemorrhagic fevers and tick-borne encephalitis, is not yet defined.
Paediatric Drugs 01/2005; 7(3):163-176. DOI:10.2165/00148581-200507030-00003 · 1.72 Impact Factor
Steven C Buckingham
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ABSTRACT: Ticks can transmit bacterial, protozoal, and viral infections to humans. Specific therapy is available for several of these infections. Doxycycline is the antimicrobial treatment of choice for all patients, regardless of age, with Rocky Mountain spotted fever, human monocytic ehrlichiosis, or human granulocytic ehrlichiosis. Chloramphenicol has been used to treat these infections in children but is demonstrably inferior to doxycycline. In patients with Mediterranean spotted fever, doxycycline, chloramphenicol, and newer macrolides all appear to be effective therapies. Therapy of Lyme disease depends on the age of the child and stage of the disease. For early localized disease, amoxicillin (for those aged <8 years) or doxycycline (for those aged >/=8 years) is effective. Doxycycline, penicillin V (phenoxymethylpenicillin) or penicillin G (benzylpenicillin) preparations, and erythromycin are all effective treatments for tick-borne relapsing fever. Hospitalized patients with tularemia should receive gentamicin or streptomycin. Doxycycline and ciprofloxacin have each been investigated for the treatment of tularemia in outpatients; however, these agents do not yet have established roles in the treatment of this disease in children. Combination therapy with clindamycin and quinine is preferred for children with babesiosis; the combination of azithromycin and atovaquone also appears promising. Ribavirin has been recently shown to markedly improve survival in patients with Crimean-Congo hemorrhagic fever. The role of antiviral therapy in the treatment of other tick-borne viral infections, including other hemorrhagic fevers and tick-borne encephalitis, is not yet defined.
Paediatric Drugs 01/2005; 7(3):163-76. · 1.72 Impact Factor
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ABSTRACT: The reported annual incidence of Rocky Mountain spotted fever in the United States is 2.2 per million, but studies have suggested that human infection with Rickettsia rickettsii may be more common. This study estimated the prevalence of antibodies reactive to R rickettsii among children living in the southeastern and south central United States. Approximately 300 specimens were obtained from children at each of 7 pediatric referral centers (N = 1999). Serum was tested for R rickettsii antibodies by means of indirect immunofluorescence antibody assay. Three different cutoff titers (>or=64, >or=128, and >or=256) represented increasing levels of stringency to define positive specimens. Overall, 12.0% of children had R rickettsii antibody titers of at least 64; 7.3%, at least 128; and 4.3%, at least 256. Strong relationships were seen between increasing age and seroprevalence at each cutoff titer. Remarkably, 6.4% of children aged 13 to 17 years had titers of at least 256. Age-adjusted seroprevalence rates at titers of at least 64 varied from 21.9% in Little Rock, Ark, to 3.5% in Louisville, Ky. At titers of at least 256, seroprevalence ranged from 7.7% in Nashville, Tenn, to 1.8% in Winston-Salem, NC. Only site and age group were strong predictors of seropositivity; a weak association was seen with nonurban residence. To our knowledge, this is the largest serosurvey of rickettsial infection in children in the United States. Within the limitations of the immunofluorescence antibody assay, these data suggest that infections with R rickettsii or antigenically related spotted-fever group rickettsiae may be common and subclinical. The results also have implications for the interpretation of single immunofluorescence antibody assay titers in children with suspected Rocky Mountain spotted fever.
Archives of Pediatrics and Adolescent Medicine 05/2003; 157(5):443-8. DOI:10.1001/archpedi.157.5.443 · 4.25 Impact Factor
Steven C Buckingham
Pediatric Annals 04/2002; 31(3):163-8. DOI:10.3928/0090-4481-20020301-06 · 0.29 Impact Factor
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ABSTRACT: The reported annual incidence of human monocytic ehrlichiosis, which is due to infection with Ehrlichia chaffeensis, is as high as 5.5 per million in some states, but serosurveys suggest much higher infection rates in some populations. To estimate the prevalence of E chaffeensis infection among children aged 1 to 17 years living in the southeast and south-central United States. Cross-sectional serosurvey. Seven academic pediatric medical centers in the southeastern and south-central United States. Nineteen hundred ninety-nine children (approximately 300 at each center) having their blood drawn for any reason. The presence of antibody at 2 different cutoff titers to E chaffeensis, as detected by indirect immunofluorescence assay. Overall, 250 children (13%) had E chaffeensis antibody titers of 1:80 or higher and 61 (3%) had titers of 1:160 or higher. Age-adjusted seroprevalence rates varied widely between sites. At 1:80 or higher, the highest rate was in Winston-Salem, NC (22%), and the lowest was in Louisville, Ky (2%). At 1:160 or higher, the highest rate was in Kansas City, Mo (9%), and the lowest was in Oklahoma City, Okla (<1%). In univariate analyses, no associations were found between seroprevalence at either cutoff value and sex, race, source of specimen, or residence demographics. However, age was a significant predictor of seroprevalence at both cutoff values. In multiple logistic regression analysis, study site and age remained strong predictors of seroprevalence, but living in a nonurban ZIP code was not significantly related. Infection with E chaffeensis, or related ehrlichiae, may be more common in children than previously recognized.
Archives of Pediatrics and Adolescent Medicine 03/2002; 156(2):166-70. · 4.25 Impact Factor

Pediatric Research 04/1999; 45(4). DOI:10.1203/00006450-199904020-00996 · 2.84 Impact Factor



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Angela L. Myers, MD, MPH






BIOGRAPHICAL SKETCH
Angela L. Myers Pediatric Infectious Diseases

INSTITUTION DEGREE FIELD OF STUDY
University of Missouri-Kansas City School of Medicine
Pediatric Residency – Children’s Mercy Hospitals and Clinics
Pediatric Infectious Diseases Fellowship –
Children’s Mercy Hospitals and Clinics
Master in Public Health – Kansas University
School of Medicine
BA/MD
Certified
Certified
MPH
Medicine
Residency, Pediatrics
Fellowship, Pediatric
Infectious Diseases
Public Health
Area of Scholarly Interest:
Vaccine Acceptance for Childhood Vaccines
Influenza Vaccine Acceptance in Health Care Workers
Acceptance of Adult Vaccines
Adverse Drug Reactions

Professional Experience:
2013 - Present Children’s Mercy Hospital, Associate Professor of Pediatrics, University
of Missouri-Kansas City School of Medicine, Kansas City, Missouri
2008 - Present Children’s Mercy Hospital, Assistant Professor of Pediatrics, University
of Missouri-Kansas City School of Medicine, Kansas City, Missouri
Board Certification and Professional Organization Membership:
Certified American Board of Pediatrics 2014
Member International Society of Travel Medicine 2011 - Present
Member Association of Pediatric Program Directors 2010 - Present
Member Society for Healthcare Epidemiology of America 2008 - Present
Fellow American Academy of Pediatrics 2004 - Present
Member Pediatric Infectious Disease Society 2004 - Present
Member Infectious Disease Society of America 2004 - Present
Professional and Community Service (Previous 5 Years):
Member Grant Review Panel for Clinical Scholars Awards 2012 – 2013
Member Planning Committee for Clinical Advances in Pediatrics 2012 - Present
Member Resident Competency Committee 2010 - Present
Member Pediatric Infectious Disease Program Directors
Committee 2010 - Present
Director Director of Pediatric Infectious Disease Fellowship 2010 - Present
Member Graduate Medical Education Council 2010 - Present
Associate Associate Director Pediatric Infectious Disease
Fellowship 2009 - 2010
Docent School of Medicine Year 1 Medical Students 2009 - Present
Honors and Awards (Previous 5 Years):
Educational Academic Development 2012 - 2013
American Academy of Pediatrics-Infectious Diseases Editorial Board (PREP-ID) 2012 - Present
Association of Pediatric Program Directors Leadership in
Golden Apple Mercy Mentor-Selected by a Graduating Resident 2012
Le Bien Visiting Professorship-Provides Funds for NIH Immunology Expert 2012

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