Sean P Elliott

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Journals/Publications

• Elliott, S. P., & Al Mohajer, M. (2018). Knowledge, Attitude and Practice of Blood Culture Contamination - A Multi-Center Study. Journal of Infection Prevention and Hospital Epidemiology.
• Elliott, S. P., Beatty, N., & Klotz, S. A. (2018). Ectoparasite Infestation of a Hospital Due to the Colonization of Nesting Cliff Swallows. Clinical Infectious Diseases.
• Elliott, S. P., Schumacher, D. J., Barnes, M. M., Gibbs, K., & McGreevy, J. (2018). Characteristics of Clinical Competency Committee Members and Review Processes and Their Association with Review Decisions. Academic Medicine.
• Elliott, S. P., Schumacher, D. J., Michelson, C., Poynter, S., Barnes, M. M., & Li, S. T. (2018). Thresholds and Interpretations: How Clinical Competency Committees Identify Pediatric Residents with Performance Concerns. Medical Teacher.
• Cramton, R., Elliott, S. P., Cramer, N., Seserinac, J., Shwaish, N., Franke, H. A., Elliott, S. P., Franke, H. A., Shwaish, N., Seserinac, J., Cramer, N., & Cramton, R. (2017). A QI Project to Improve Resident Satisfaction and Participation in Pediatric Board Examination Review. Academic Pediatrics, 17(5), e14-e15.
• Elliott, S. P. (2011). Congenital cytomegalovirus infection: an overview. Infectious disorders drug targets, 11(5), 432-6.
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  Cytomegalovirus (CMV) remains the most common cause of congenitally-acquired infection in the United States and is a leading infectious cause of sensorineural hearing loss, cognitive delay, and permanent neurologic sequelae. Although most cases of congenital CMV infection are asymptomatic, significant morbidity and mortality exist for symptomatic infants and may also occur in asymptomatic ones. Diagnosis remains relatively straightforward, but treatment options are limited and associated with some toxicity. Efforts at prevention via vaccination, screening, and improved epidemiology deserve high priority to limit the impact of this common infection.
• Klotz, S. A., Ianas, V., & Elliott, S. P. (2011). Cat-scratch Disease. American family physician, 83(2), 152-5.
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  Cat-scratch disease is a common infection that usually presents as tender lymphadenopathy. It should be included in the differential diagnosis of fever of unknown origin and any lymphadenopathy syndrome. Asymptomatic, bacteremic cats with Bartonella henselae in their saliva serve as vectors by biting and clawing the skin. Cat fleas are responsible for horizontal transmission of the disease from cat to cat, and on occasion, arthropod vectors (fleas or ticks) may transmit the disease to humans. Cat-scratch disease is commonly diagnosed in children, but adults can present with it as well. The causative microorganism, B. henselae, is difficult to culture. Diagnosis is most often arrived at by obtaining a history of exposure to cats and a serologic test with high titers (greater than 1:256) of immunoglobulin G antibody to B. henselae. Most cases of cat-scratch disease are self-limited and do not require antibiotic treatment. If an antibiotic is chosen, azithromycin has been shown in one small study to speed recovery. Infrequently, cat-scratch disease may present in a more disseminated form with hepatosplenomegaly or meningoencephalitis, or with bacillary angiomatosis in patients with AIDS.
• Mosbacher, M., Elliott, S. P., Shehab, Z., Pinnas, J. L., Klotz, J. H., & Klotz, S. A. (2010). Cat scratch disease and arthropod vectors: more to it than a scratch?. Journal of the American Board of Family Medicine : JABFM, 23(5), 685-6.
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  Cat scratch disease is a common infection, particularly in children, and clinicians need to be aware of its potential transmission to humans by arthropod vectors such as fleas and ticks in addition to animal bites and scratches. The absence of a vertebrate bite or scratch does not preclude infection with Bartonella henselae.
• Adam, R. D., Elliott, S. P., & Taljanovic, M. S. (2009). The spectrum and presentation of disseminated coccidioidomycosis. The American journal of medicine, 122(8), 770-7.
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  Extrapulmonary dissemination of Coccidioides species is associated with significant morbidity and mortality. The clinical manifestations vary widely according to the host, the severity of illness, and location of dissemination. The morbidity and mortality can be reduced by early recognition and treatment, which in turn depends on understanding the spectrum and presentation of disease.
• Elliott, S. P. (2008). Antimicrobial-resistant pathogens: an emerging pediatric threat. Advances in pediatrics, 55, 329-48.
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  The clinical impact of these three bacterial threats is readily apparent to any who practice pediatrics. The potential virulence of CA-MRSA and MDR pneumococci and the threat of failed antimicrobial options for MDRGN pose enormous challenges now and in the near future. With careful attention to antimicrobial stewardship, however, and knowledge of the clinical and epidemiologic factors of these organisms, one can hope to mitigate the impact on patient care and outcomes while awaiting ongoing discovery of new antimicrobial options. Most important, however, will be careful and thoughtful management of any new antimicrobial products to protect their efficacy for the future.
• Chasin, B. S., Elliott, S. P., & Klotz, S. A. (2007). Medical errors arising from outsourcing laboratory and radiology services. The American journal of medicine, 120(9), 819.e9-11.
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  Document errors and the nuisance factor inherent in the informational exchange that occurs with the outsourcing of laboratory and radiology examinations.
• Elliott, S. P. (2007). Rat bite fever and Streptobacillus moniliformis. Clinical microbiology reviews, 20(1), 13-22.
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  Rat bite fever, caused by Streptobacillus moniliformis, is a systemic illness classically characterized by fever, rigors, and polyarthralgias. If left untreated, it carries a mortality rate of 10%. Unfortunately, its nonspecific initial presentation combined with difficulties in culturing its causative organism produces a significant risk of delay or failure in diagnosis. The increasing popularity of rats and other rodents as pets, together with the risk of invasive or fatal disease, demands increased attention to rat bite fever as a potential diagnosis. The clinical and biological features of rat bite fever and Streptobacillus moniliformis are reviewed, providing some distinguishing features to assist the clinician and microbiologist in diagnosis.
• Villar, R. G., Elliott, S. P., & Davenport, K. M. (2006). Botulism: the many faces of botulinum toxin and its potential for bioterrorism. Infectious disease clinics of North America, 20(2), 313-27, ix.
• Elliott, S. P., Villar, R., & Duncan, B. (2005). Bacteriuria management and urological evaluation of patients with spina bifida and neurogenic bladder: a multicenter survey. The Journal of urology, 173(1), 217-20.
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  We assessed how groups at spina bifida clinics evaluate and manage the urinary tract in patients with spina bifida, neurogenic bladder and bacteriuria.
• Elliott, S. P., & Ellis, S. C. (2004). A bitter pill: attempting change in a pediatric morning report. Pediatrics, 113(2), 243-7.
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  To assess and address participants' dissatisfaction with departmental morning report (MR).
• Freels, L. K., & Elliott, S. P. (2004). Rat bite fever: three case reports and a literature review. Clinical pediatrics, 43(3), 291-5.
• Elliott, S. P., Yu, M., Xu, H., & Haslam, D. B. (2003). Forssman synthetase expression results in diminished shiga toxin susceptibility: a role for glycolipids in determining host-microbe interactions. Infection and immunity, 71(11), 6543-52.
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  Forssman glycolipid (FG), the product of Forssman synthetase (FS), is widely expressed among nonprimate mammalian species. Here, we describe a molecular and genetic relationship between FG expression and Shiga toxin (Stx) susceptibility. We have isolated the FS cDNA from human, canine, and murine cells. Whereas the murine and canine FS genes express a functional enzyme, the human FS cDNA was found to express a protein that lacks FS activity, despite a high degree of sequence identity with the enzymatically active murine and canine FS genes. In order to examine the relationship between FG expression and Stx susceptibility, Vero cells were transfected with the three FS orthologues or a vector control. Complementation with the human FS cDNA had no effect on Stx susceptibility, whereas stable expression of the canine and murine FS resulted in markedly decreased susceptibility to toxin. Among individual cells, an inverse correlation between FG expression and Stx binding was demonstrated. Moreover, only strongly FG-reactive cells were capable of growing in the presence of Stx. These cells were found to have high levels of FG expression and a correspondingly diminished GbO(3) content. We conclude that expression of a functionally active FS modifies Stx receptor glycolipids to FG and results in markedly decreased susceptibility to toxin. We speculate that inactivation of the FS gene during primate evolution may account, at least in part, for the marked susceptibility of human cells to Stx.
• Acharya, V. Z., Talwar, D., & Elliott, S. P. (2001). Enteroviral encephalitis leading to a locked-in state. Journal of child neurology, 16(11), 864-6.
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  Millions of children are infected by enteroviruses each year, usually exhibiting only mild symptoms. Although enteroviruses are a common cause of community-acquired aseptic meningitis, enteroviral meningitis usually has a benign course. We describe a 14-year-old patient with enteroviral meningoencephalitis diagnosed by polymerase chain reaction. Her level of consciousness declined rapidly after hospital admission and resulted in a locked-in state. Although she experienced slow neurologic improvement, residual neurologic deficits remain. Although there is a general awareness of the characteristics of enteroviralencephalitis, this case report is significant in presenting a case of unusual severity and sequelae. To our knowledge, this is the first published report of an enterovirus encephalitis leading to a locked-in-state.
• Elliott, S. P., Yogev, R., & Shulman, S. T. (2001). Staphylococcus lugdunensis: an emerging cause of ventriculoperitoneal shunt infections. Pediatric neurosurgery, 35(3), 128-30.
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  Staphylococcus lugdunensis, a coagulase-negative staphylococcus first described in 1988, has gained recognition as an organism with considerable pathogenic capability in adults. In contrast to the indolent presentation characteristic of other coagulase-negative staphylococci, S. lugdunensis infections resemble the aggressive behavior of Staphylococcus aureus. Although the organism has been isolated from a wide variety of infections in adults, it is a very rare cause of pediatric infections. We describe the first two pediatric patients who developed ventriculoperitoneal shunt infections caused by S. lugdunensis. These cases suggest that coagulase-negative staphylococci should be identified to the species level and that, if S. lugdunensis is identified, greater morbidity compared to that associated with other coagulase-negative staphylococcal shunt infections should be anticipated. A longer course of therapy is recommended for S. lugdunensis infections.
• Wahl, R. A., Shapiro, E., Elliott, S. P., & Binkiewicz, A. I. (2001). Office laboratory procedures, office economics, parenting and parent education, and urinary tract infection. Current opinion in pediatrics, 13(6), 603-15.
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  We once again review four areas of interest to office-based pediatricians: office laboratory procedures, office economics, parenting and patient education, and urinary tract infections. Sean Elliott reviews the current status of the Clinical Laboratories Improvement Amendments (CLIA) and their continuing impact on physician office laboratories. Eve Shapiro reviews office economics, this year focusing on managed care, the physician workforce, practice management, and health care financing for the uninsured. Anna Binkiewicz provides an update on parenting and parent education, with recent reports on nutrition and childhood immunizations. Richard Wahl again reviews recent research on urinary tract infection, discussing voiding physiology, dysfunctional voiding patterns, acute urinary retention, urine collection techniques, diagnosis in young infants, and antibiotic prophylaxis.
• Wahl, R. A., Shapiro, E., Elliott, S. P., & Walter, J. J. (2000). Office laboratory procedures, office economics, parenting and parent education, and urinary tract infection. Current opinion in pediatrics, 12(6), 619-31.
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  We again review four areas of interest to office-based pediatricians: office laboratory procedures, office economics, parenting and patient education, and urinary tract infections. Sean Elliott provides an update on the Clinical Laboratories Improvement Amendments (CLIA) and their impact of office practice. Eve Shapiro reviews office economics, focusing on measuring quality of care, use of performance data, costs of new technologies, and the impact of managed care on the medical marketplace. John Walter offers an update on parenting and parent education, with approaches to counseling families about overuse of antibiotics, teen pregnancy, hyperactivity, violence, and asthma. Richard Wahl reviews the recent research on urinary tract infection, with special attention paid to office diagnosis and management, longitudinal studies of children with urinary tract infections, and the controversy surrounding the American Academy of Pediatrics Task Force on Circumcision report.
• Elliott, S. P., & Mallory, S. B. (1999). Sweet syndrome: an unusual presentation of chronic granulomatous disease in a child. The Pediatric infectious disease journal, 18(6), 568-70.
• Xu, H., Storch, T., Yu, M., Elliott, S. P., & Haslam, D. B. (1999). Characterization of the human Forssman synthetase gene. An evolving association between glycolipid synthesis and host-microbial interactions. The Journal of biological chemistry, 274(41), 29390-8.
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  Differences in glycolipid expression between species contribute to the tropism of many infectious pathogens for their hosts. For example, we demonstrate that cultured human and monkey urinary epithelial cells fail to bind a canine Escherichia coli uropathogenic isolate; however, transfection of these cells with the canine Forssman synthetase (FS) cDNA enables abundant adherence by the same pathogen, indicating that addition of a single sugar residue to a glycolipid receptor has marked effects on microbial attachment. Given the contribution of glycolipids to host-microbial interactions, we sought to determine why human tissues do not express Forssman glycolipid. Query of the GenBank(TM) data base yielded a human sequence with high identity to the canine FS cDNA. Reverse transcription polymerase chain reaction and Northern blotting demonstrated the presence of FS mRNA in all tissues examined. A human FS cDNA was characterized, revealing identities with the canine FS gene of 86 and 83% at the nucleotide and predicted amino acid sequences, respectively. In contrast to the canine FS cDNA, transfection of COS-1 cells with the human FS cDNA resulted in no detectable FS enzyme activity. These results suggest that variability in glycolipid synthesis between species is an important determinant of microbial tropism. Evolutionary pressure from pathogenic organisms may have contributed to diversity in glycolipid expression among species.
• Elliot, S. P., Schmied, R., Gabel, C. A., & Ambron, R. T. (1993). An 83 kDa O-GlcNAc-glycoprotein is found in the axoplasm and nucleus of Aplysia neurons. The Journal of neuroscience : the official journal of the Society for Neuroscience, 13(6), 2424-9.
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  Glycoproteins containing O-linked N-acetylglucosamine (O-GlcNAc) are present in axons of Aplysia neurons (Gabel et al., 1989) and among transcription factors and other proteins in the nucleus of eukaryotic cells (Jackson and Tjian, 1988). A recently discovered pathway in neurons transports proteins through the axon and then into the nucleus (Ambron et al., 1992). If any of the axonal O-GlcNAc glycoproteins use this pathway, then the axon and the nucleus will have these glycoproteins in common. We addressed this issue by using galactosyltransferase and UDP-3H-galactose to label and identify the glycoproteins in three regions of Aplysia neurons: axoplasm, extruded from nerves; nuclei, isolated by manual dissection of single neurons; and cytoplasm, obtained after removal of nuclei. At least 21 glycoproteins were labeled by this procedure; several, at 200, 180, 83, 76, and 66 kDa, from the nucleus and axoplasm comigrated after SDS-PAGE. Radiolabeled galactosyl-N-acetylglucosaminitol was released from the glycoproteins by base/borohydride, thereby verifying the presence of O-GlcNAc. Comparison of the 83 kDa glycoprotein from the nucleus and axoplasm revealed that both were soluble, had multiple O-GlcNAcs, and were bound to WGA. Thus, the 83 kDa constituent is a good candidate to use the axonal transport/nuclear import pathway.

Presentations

• Elliott, S. P., Schumacher, D., King, B., & Bartlett, K. (2017, Summer). Association between Milestone Assignments and Recommended Supervision Categorizations among Clinical Competency Committee Members. International Conference on Residency Education 2017. Quebec City, Quebec, Canada: Royal College of Physicians and Surgeons of Canada.
• Elliott, S. P., Schumacher, D., King, B., & Bartlett, K. (2017, Summer). Concordance of Clinical Competency Committee and Program Director Recommended Supervision Categorization. International Conference on Residency Education 2017. Quebec City, Quebec, Canada: Royal College of Physicians and Surgeons of Canada.
• Elliott, S. P., Schumacher, D., King, B., & Bartlett, K. (2017, Summer). Key Factors for Recommending a Resident May Serve as a Supervisor: A National Study of Clinical Competency Committee Members. International Conference on Residency Education 2017. Quebec City, Quebec, Canada: Royal College of Physicians and Surgeons of Canada.

Poster Presentations

• Elliott, S. P., Cramer, N., Zahedieh, S., Franke, H. A., Seserinac, J., & Cramton, R. (2017, April). ‘Practice Makes Perfect’: A Study Comparing Clustered Vs. Daily Flashcard Review and Medical Knowledge Retention. APPD Spring Meeting. Anaheim, CA: Association of Pediatric Program Directors.
• Elliott, S. P., Franke, H. A., & McClafferty, H. H. (2017, April). Approach to Implementation of a Residency Wellness Series.. APPD Spring Meeting. Anaheim, CA: Association of Pediatric Program Directors.