A Framework for Outpatient Infusion of Antispike Monoclonal Antibodies to High-Risk Patients with Mild-to-Moderate Coronavirus Disease-19: The Mayo Clinic Model.

The administration of spike monoclonal antibody treatment to patients with mild to moderate COVID-19 is very challenging. This article summarizes essential components and processes in establishing an effective spike monoclonal antibody infusion program. Rapid identification of a dedicated physical infrastructure was essential to circumvent the logistical challenges of caring for infectious patients while maintaining compliance with regulations and ensuring the safety of our personnel and other patients. Our partnerships and collaborations among multiple different specialties and disciplines enabled contributions from personnel with specific expertise in medicine, nursing, pharmacy, infection prevention and control, electronic health record (EHR) informatics, compliance, legal, medical ethics, engineering, administration, and other critical areas. Clear communication and a culture in which all roles are welcomed at the planning and operational tables are critical to the rapid development and refinement needed to adapt and thrive in providing this time-sensitive beneficial therapy. Our partnerships with leaders and providers outside our institutions, including those who care for underserved populations, have promoted equity in the access of monoclonal antibodies in our regions. Strong support from institutional leadership facilitated expedited action when needed, from a physical, personnel, and system infrastructure standpoint. Our ongoing real-time assessment and monitoring of our clinical program allowed us to improve and optimize our processes to ensure that the needs of our patients with COVID-19 in the outpatient setting are met.

Gram-negative Diplococcal Respiratory Infections.

Human respiratory tract infections caused by gram- negative diplococci continue to remain significant issues in health care. Although not addressed as frequently as the classical diplococcal pneumonia, the gram-positive Streptococcus pneumoniae (the pneumococcus), infections due to Neisseria meningitidis (the meningococcus), and Moraxella catarrhalis (formerly called both Neisseria catarrhalis and Branhamella catarrhalis) are addressed here including their microbiology, respiratory tract manifestations, antimicrobial treatment, and potential prevention with immunization.

The environment as a significant cofactor for multiply resistant nosocomial infections.

The role of antimicrobial agent control in the war against the development of resistance is not the only issue in this conflict. In this article, the role the environment plays in the spread of pathogens is discussed.

Inhalational Anthrax.

Until recently, inhalational anthrax was a medical curiosity in both the Western medical literature and clinical practice. The post-September 11, 2001 outbreak of this disease in the eastern United States that spread through the mail, however, instantly changed the appreciation of this disease and the appreciation of biological terrorism/warfare in general. The microbiology, epidemiology, clinical, and therapeutic/preventative aspects of this entity, classically known as "wool sorter's disease" are highlighted in this review.

Chemical terrorism: a primer for 2002.

Agents of chemical warfare have inflicted mass casualties on military and civilian personnel. Although not yet deployed on populations in the United States, stockpiles exist in countries that view the United States with enmity. There are four groups of such agents. The inhalants, chlorine and phosgene, were the earliest such weapons. Cyanide gases, because of their volatility, exert their lethal consequences in enclosed spaces. The vesicants and nerve agents, currently the most successful agents of chemical mass destruction, are the major focus of this overview. Mustard, the prototype of the vesicants, and its sulfur and nitrogen analogues are aerosolized liquids that linger on victims, incapacitating through their effects on the skin, eye, and respiratory tract. Mortality is low, but morbidity is substantial and mass casualties strain health care resources. Nerve agents, by contrast, are designed to kill. All, including Tabun, Sarin, Soman, and VX, are organophosphates that inactivate acetylcholinesterase. Widespread manifestations of peripheral and central neuronal dysfunction can be fatal without timely administration of antidotes. Decontamination, axiomatic in the management of agents of chemical warfare, is outlined, and therapeutic strategies are summarized in the light of current understanding.

Bioterrorism: a primer for 2002.

The often anticipated, sometimes dismissed, threat of biological terrorism became a reality in the United States in the fall of 2001 with cases of cutaneous and inhalation anthrax. As the public health sector is rapidly focusing on enhancing awareness and preparedness, this overview is intended as a primer for clinicians. The more probable events, their most prominent characteristics, and currently available management strategies are summarized. The biowarfare characteristics of plague, tularemia and botulism are summarized. The more problematic anthrax and smallpox are presented in greater detail. Epidemiological clues to a biological attack are outlined with reference to the recent literature.

Active immunisation against human tick-borne diseases.

With the development and licensure of a recombinant vaccine for the tick-borne infection Lyme disease, more attention has been paid to other vaccines that have been used or are being developed for the prevention of other tick-borne infections. This review highlights vaccine information for Lyme borreliosis, tick-borne encephalitis (TBE), Rocky Mountain spotted fever, tularaemia, Query (Q) fever, Kyasanur Forest disease (KFD) and tick paralysis. Additionally, discussion on the use of immunisation against the tick itself is included which not only can decrease veterinary tick burdens but may also decrease the transmission of arthropod-transmitted diseases.

Vaccines for Category A bioterrorism diseases.

Vaccination programmes are very successful as a preventive strategy against many infectious diseases which have had a major impact on human morbidity and mortality. One of these diseases, smallpox, has been eliminated as a natural infection. The recent concern about biological attacks has turned attention to the use of an immunisation programme to prevent infection with what are considered the most significant potentially harmful biowarfare pathogens. This review puts into perspective the available information on current immunisation and newer vaccine options for anthrax, smallpox, tularaemia, plague and botulism.

Pulmonary Manifestations of Bioterrorism.

Along with smallpox, inhalation anthrax and pneumonic plague are among the diseases most likely to be spread by biowarfare, either from a rogue nation or terrorist group. Neither anthrax nor plague has been seen by many pulmonary (or any other) physicians in the United States. This article summarizes these two diseases as pulmonary manifestations of bioterrorism and discusses the possibility of avian influenza as a potential respiratory pathogen in biowarfare. It is hoped that phyisicians will need to know this information only as an academic exercise and not because of a clinical circumstance.