Tirdad T Zangeneh

Interests

Research

Infections among solid organ transplant recipients, coccidioidomycosis, residency clinical competency and correlation with board passage.

Teaching

Small group clinical based teaching, morning report, flipped classroom teaching, large group lectures, and board review preparation.

Courses

No activities entered.

Scholarly Contributions

Books

• Klotz, S. A., Klotz, S. A., Zangeneh, T. T., & Ramahi, R. A. (2018).

  40 – Bacterial and Miscellaneous Infections of the Liver

  . doi:10.1016/B978-0-323-37591-7.00040-9

Chapters

• Zangeneh, T. T., Al-obaidi, M., & Al-obaidi, M. (2020).

  Evolving Epidemiology of Transplant Infections: Impact of Population Shifts and Climate Change

  . In Emerging Transplant Infections. Springer International Publishing. doi:10.1007/978-3-030-01751-4_4-1
• Zangeneh, T. T., Klotz, S. A., & Traeger, M. S. (2019). Anthrax and other Bacillus species. In Schlossberg's Textbook of Clinical Infectious Disease.
• Zangeneh, T. T., Klotz, S. A., & Ramahi, R. E. (2018).

  40 – Bacterial and Miscellaneous Infections of the Liver

  . In Zakim and Boyer's Hepatology: A Textbook of Liver Disease. doi:10.1016/B978-0-323-37591-7.00040-9
• Zangeneh, T. T., El Ramahi, R., & Klotz, S. A. (2016). Bacterial and Miscellaneous Infections of the Liver. In Hepatology: A Textbook of Liver Disease.
• Zangeneh, T. T., Traeger, M. S., & A, K. S. (2015). Anthrax and other Bacillus species. In Schlossberg’s Textbook of Clinical Infectious Disease.
• Zangeneh, T. T., Traeger, M., Klotz, S. A., & Klotz, S. A. (2015).

  Clinical Infectious Disease: Anthrax and other Bacillus species

  . In Schlossberg's Clinical Infectious Disease (3 edn). Cambridge University Press. doi:10.1017/CBO9781139855952.144

Journals/Publications

• Al-Obaidi, M. M., Gungor, A. B., Murugapandian, S., Thajudeen, B., Mansour, I., Wong, R. C., Tanriover, B., & Zangeneh, T. T. (2023). The Impact of Nirmatrelvir-Ritonavir in Reducing Hospitalizations Among High-Risk Patients With SARS-CoV-2 During the Omicron Predominant Era. The American journal of medicine, 136(6), 577-584.
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  The coronavirus disease 2019 (COVID-19) pandemic has caused significant morbidity and mortality in high-risk populations. Several therapeutics have been developed to reduce the risk of complications related to COVID-19, hospitalizations, and death. In several studies, nirmatrelvir-ritonavir (NR) was reported to reduce the risk of hospitalizations and death. We aimed to evaluate the efficacy of NR in preventing hospitalizations and death during the Omicron predominant period.
• Ibrahim, A., Chattaraj, A., Iqbal, Q., Anjum, A., Rehman, M. E., Aijaz, Z., Nasir, F., Ansar, S., Zangeneh, T. T., & Iftikhar, A. (2023). Pneumonia: A Review of Management in Human Immunodeficiency Virus (HIV) and Non-HIV Immunocompromised Patients. Avicenna journal of medicine, 13(1), 23-34.
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  pneumonia is an opportunistic fungal infection that was mainly associated with pneumonia in patients with advanced human immunodeficiency virus (HIV) disease. There has been a decline in pneumonia incidence in HIV since the introduction of antiretroviral medications. However, its incidence is increasing in non-HIV immunocompromised patients including those with solid organ transplantation, hematopoietic stem cell transplantation, solid organ tumors, autoimmune deficiencies, and primary immunodeficiency disorders. We aim to review and summarize the etiology, epidemiology, clinical presentation, diagnosis, and management of pneumonia in HIV, and non-HIV patients. HIV patients usually have mild-to-severe symptoms, while non-HIV patients present with a rapidly progressing disease. Induced sputum or bronchoalveolar lavage fluid can be used to make a definitive diagnosis of pneumonia. Trimethoprim-sulfamethoxazole is considered to be the first-line drug for treatment and has proven to be highly effective for pneumonia prophylaxis in both HIV and non-HIV patients. Pentamidine, atovaquone, clindamycin, and primaquine are used as second-line agents. While several diagnostic tests, treatments, and prophylactic regimes are available at our disposal, there is need for more research to prevent and manage this disease more effectively.
• Sridhara, S., Gungor, A. B., Erol, H. K., Al-Obaidi, M., Zangeneh, T. T., Bedrick, E. J., Ariyamuthu, V. K., Shetty, A., Qannus, A. A., Mendoza, K., Murugapandian, S., Gupta, G., & Tanriover, B. (2023). Lack of effectiveness of Bebtelovimab monoclonal antibody among high-risk patients with SARS-Cov-2 Omicron during BA.2, BA.2.12.1 and BA.5 subvariants dominated era. PloS one, 18(4), e0279326.
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  Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron subvariants are expected to be resistant to Bebtelovimab (BEB) monoclonal antibody (MAb) and the real-world experience regarding its effectiveness is scarce. This retrospective cohort study reports a data analysis in Banner Healthcare System (a large not-for-profit organization) between 4/5/2022 and 8/1/2022 and included 19,778 Coronavirus disease-19 (COVID-19) positive (by PCR or direct antigen testing) patients who were selected from Cerner-Electronic Health Record after the exclusions criteria were met. The study index date for cohort was determined as the date of BEB MAb administration or the date of the first positive COVID-19 testing. The cohort consist of COVID-19 infected patients who received BEB MAb (N = 1,091) compared to propensity score (PS) matched control (N = 1,091). The primary composite outcome was the incidence of 30-day all-cause hospitalization and/or mortality. All statistical analyses were conducted on the paired (matched) dataset. For the primary composite outcome, the event counts and percentages were reported. Ninety-five percent Clopper-Pearson confidence intervals for percentages were computed. The study cohorts were 1:1 propensity matched without replacement across 26 covariates using an optimal matching algorithm that minimizes the sum of absolute pairwise distance across the matched sample after fitting and using logistic regression as the distance function. The pairs were matched exactly on patient vaccination status, BMI group, age group and diabetes status. Compared to the PS matched control group (2.6%; 95% confidence interval [CI]: 1.7%, 3.7%), BEB MAb use (2.2%; 95% CI: 1.4%, 3.3%) did not significantly reduce the incidence of the primary outcome (p = 0.67). In the subgroup analysis, we observed similar no-difference trends regarding the primary outcomes for the propensity rematched BEB MAb treated and untreated groups, stratified by patient vaccination status, age (
• Zangeneh, T. T., & Al-Obaidi, M. M. (2023). Diagnostic Approach to Coccidioidomycosis in Solid Organ Transplant Recipients. Journal of fungi (Basel, Switzerland), 9(5).
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  Coccidioidomycosis is a fungal infection endemic in the southwestern United States, Mexico, and parts of Central and South America. While coccidioidomycosis is associated with mostly mild infections in the general population, it can lead to devastating infections in immunocompromised patients, including solid organ transplant (SOT) recipients. Early and accurate diagnosis is important in achieving better clinical outcomes in immunocompromised patients. However, the diagnosis of coccidioidomycosis in SOT recipients can be challenging due to the limitations of diagnostic methods including cultures, serology, and other tests in providing a timely and accurate diagnosis. In this review, we will discuss the available diagnostic modalities and approaches when evaluating SOT recipients with coccidioidomycosis, from the use of conventional culture methods to serologic and molecular testing. Additionally, we will discuss the role of early diagnosis in assisting with the administration of effective antifungal therapy to reduce infectious complications. Finally, we will discuss ways to improve the performance of coccidioidomycosis diagnostic methods in SOT recipients with an option for a combined testing approach.
• Zangeneh, T. T., Lainhart, W. D., Wiederhold, N. P., & Al-Obaidi, M. (2023). Coccidioides species antifungal susceptibility testing: Experience from a large healthcare system in the endemic region. Medical Mycology, 61(10). doi:10.1093/mmy/myad104
• Zangeneh, T. T., Lainhart, W. D., Wiederhold, N. P., & Al-Obaidi, M. M. (2023). Coccidioides species antifungal susceptibility testing: Experience from a large healthcare system in the endemic region. Medical mycology, 61(10).
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  The clinical utility of Coccidioides species antifungal susceptibility testing (AST) remains unclear. This study describes the clinical course of eight patients with severe or chronic coccidioidomycosis and subsequent Coccidioides AST. We present the clinical manifestations, antifungal treatment regimens, and clinical outcomes for these patients.
• Al-Obaidi, M., Gungor, A. b., Nematollahi, S., Zangeneh, T. T., Bedrick, E. J., Johnson, K., Nicole, A., Alam, R., Rangan, P., Heise, C. W., ARIYAMUTHU, V. K., Shetty, A., Qannus, A. A., Murugapandian, S., Ayvaci, M., Anand, P. M., & Tanriover, B. (2022).

  Effectiveness of Casirivimab-Imdevimab Monoclonal Antibody Treatment Among High-Risk Patients With Severe Acute Respiratory Syndrome Coronavirus 2 B.1.617.2 (Delta Variant) Infection

  . Open forum infectious diseases.
• Al-Obaidi, M., Gungor, A. b., Nematollahi, S., Zangeneh, T. T., Bedrick, E. J., Johnson, K., Nicole, A., Alam, R., Rangan, P., Heise, C. W., ARIYAMUTHU, V. K., Shetty, A., Qannus, A. A., Murugapandian, S., Ayvaci, M., Anand, P. M., & Tanriover, B. (2022). Effectiveness of Casirivimab-Imdevimab Monoclonal Antibody Treatment Among High-Risk Patients With Severe Acute Respiratory Syndrome Coronavirus 2 B.1.617.2 (Delta Variant) Infection. Open forum infectious diseases.
• Zangeneh, T. T., Afghan, A., Marquez, J., & Al-Obaidi, M. (2023).

  Effect of coccidioidomycosis prophylaxis in selecting non‐ Candida albicans species amongst solid organ transplant recipients in Arizona

  . Mycoses. doi:10.1111/myc.13547
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  Invasive candidiasis carries an increased risk of morbidity and mortality. The rates of non-albicans Candida species (NAC) infections are on the rise secondary to frequent azole antifungal use. NAC incidence and risk amongst solid organ transplant (SOT) recipients in Arizona receiving prolonged azole course for coccidioidomycosis prophylaxis have not been well elucidated.We retrospectively evaluated SOT recipients hospitalised between 2017 and 2021 with a positive Candida spp. culture.There were 66 SOT recipients with 74 hospitalisations and 79 Candida spp. isolates. The median age was 59 (IQR 45-66), 68% were male, 58% were non-Hispanic White, and the most common SOT 38/74 (51%) was a liver transplant. Median time from transplant to the identification of any NAC (infection or colonisation) was significantly shorter, 8 months (IQR 3-78) vs 128 months (IQR 10-282) for Candida albicans isolates, p = .03. Prior use of azoles was significantly higher in NAC-associated post-transplant colonisation and invasive disease hospitalisations (83%) than in those with C. albicans (17%), p < .001. There were 59 hospitalisations with invasive disease, with the majority having NAC isolates of 49 (83%).The universal azole prophylaxis has reduced the incidence of coccidioidomycosis complications amongst SOT recipients in Arizona; however, there is an increased risk of developing NAC colonisation and infections, which can complicate the care of the SOT recipients with invasive candidiasis. Future studies are needed to investigate methods of reducing the risk of NAC infections whilst preventing coccidioidomycosis amongst SOT recipients.
• Al-Obaidi, M., & Zangeneh, T. T. (2021).

  705. Community Acquired Gastrointestinal Infections among Transplant Recipients

  . Open Forum Infectious Diseases, 8(Supplement_1), S453-S453. doi:10.1093/ofid/ofab466.902
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  Abstract Background Community-acquired gastrointestinal (cGI) infections carry a significant risk of mortality and morbidity. Transplant patients are at increased risk of infectious complications. We aimed to study the risks and outcomes of cGI infections in this population. Methods After the institutional review board’s approval, a multi-center retrospective study was conducted. Data was collected from inpatient admission for patients with a history of hematopoietic stem transplantation or solid organ transplantation. Data regarding patient demographics, gastrointestinal polymerase chain reaction (GIPCR), clinical presentation, medications, discharge, and length of stay were collected. Chi-square test was performed to compare categorical data, and student’s t-test and Wilcoxon test were used to compare parametric and non-parametric variables accordingly. Results From 10/01/2017 to 07/14/2020, there were 445 encounters with GIPCR tests ordered. 48% were female, 53% were non-Hispanic White, and the mean age was 58 (SD ±14.6). Of the 445 encounters, 66 had a positive test. 40/66 had kidney transplants. The most common detected organisms were Norovirus (36%), Enteropathogenic E. coli (26%), Campylobacter species (9%), and Enteroaggregative E. coli (9%). The most common symptoms were abdominal pain and diarrhea, with 26% reported an exposure or a recent travel. There was no difference in the mortality rates between positive and negative GIPCR (3% versus 2.4%, p=0.7), during the study period. There was a significant difference in the mean length of stay between positive GIPCR with 7.5 (SD ±10.5) days versus 12.4 (SD ±18.3) days in negative GI PCR, p=0.036. Conclusion The majority of GIPCR tests were negative. Patients with positive GIPCR had shorter length of stay compared to negative GIPCR transplant recipients. There was no difference in mortality between positive and negative GIPCR among transplant patients. Future studies are required to evaluate the impact of cGI infections on transplant patients. Disclosures All Authors: No reported disclosures
• Al-Obaidi, M., Youssefi, B., Bardwell, J., Bouzigard, R., Le, C. H., & Zangeneh, T. T. (2021). A Comparative Analysis of Mucormycosis in Immunosuppressed Hosts Including Patients with Uncontrolled Diabetes in the Southwest United States. The American journal of medicine, 134(9), 1155-1159.
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  Mucormycosis (zygomycosis) is an invasive fungal infection that carries a high risk of morbidity and mortality. Uncontrolled diabetes mellitus and other immunocompromising conditions are risk factors for mucormycosis development. We here describe the differences in characteristics and outcomes of mucormycosis among solid organ transplant, hematological malignancy, and diabetes mellitus groups at our institution.
• Hayes, J. F., Zangeneh, T. T., Obaidi, M. A., Nix, D. E., Hayes, J. F., Zangeneh, T. T., Obaidi, M. A., & Nix, D. E. (2021).

  Fixed Dosing of Amphotericin B in Morbidly Obese Individuals.

  . Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 72(9), e431. doi:10.1093/cid/ciaa1076
• Streling, A. P., Al Obaidi, M. M., Lainhart, W. D., Zangeneh, T., Khan, A., Dinh, A. Q., Hanson, B., Arias, C. A., & Miller, W. R. (2021). Evolution of Cefiderocol Non-Susceptibility in Pseudomonas aeruginosa in a Patient Without Previous Exposure to the Antibiotic. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.
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  We report the emergence of non-susceptibility to cefiderocol from a subpopulation of Pseudomonas aeruginosa recovered from a patient without history of cefiderocol exposure. Whole genome sequencing identified mutations in major iron transport pathways previously associated with cefiderocol uptake. Susceptibility testing should be performed before therapy with siderophore cephalosporins.
• Zangeneh, T., Ayazi, P., Shi, A., Campanella, M. A., & Obaidi, M. A. (2021).

  115. The Utility of (1→3)-β-D-glucan Assay in the Diagnosis of Severe Coccidioidomycosis Infections among Immunocompromised Hosts

  . Open Forum Infectious Diseases, 8(Supplement_1), S70-S70. doi:10.1093/ofid/ofab466.115
• Zangeneh, T., Lainhart, W. D., Streling, A. P., Al Obaidi, M. M., Khan, A., Dinh, A. Q., Hanson, B., Arias, C. A., & Miller, W. R. (2021).

  Evolution of Cefiderocol Non-Susceptibility in Pseudomonas aeruginosa in a Patient Without Previous Exposure to the Antibiotic

  . Clinical Infectious Diseases, 73(11), e4472-e4474. doi:10.1093/cid/ciaa1909
• Adams, M., Bouzigard, R., Al-Obaidi, M., & Zangeneh, T. T. (2020). Perinephric abscess in a renal transplant recipient due to Mycoplasma hominis: Case report and review of the literature. Transplant infectious disease : an official journal of the Transplantation Society, 22(5), e13308.
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  A 42-year-old man presented with nausea, malaise, and pain at his renal graft site 4 months following deceased donor renal transplant. His transplantation had been complicated by urinary leak with delayed wound closure requiring ureteral revision with biologic mesh placement. The initial evaluation in the hospital revealed urinalysis with significant pyuria as well as abdominal CT imaging concerning for abscess formation anterior to the grafted kidney. Interventional radiology (IR) guided drainage of this abscess yielded growth of Enterococcus faecalis treated with intravenous ampicillin/sulbactam. He continued to have pain at his graft site and repeat imaging revealed a persistent abscess despite prolonged antimicrobial therapy. Urine cultures isolated Mycoplasma species. A repeat aspirate of abscess fluid collected and Mycoplasma hominis was identified by molecular test. Patient's symptoms abated and his abscess completely resolved on repeat imaging after completing a course of oral moxifloxacin and doxycycline. His immunosuppression did not require adjustment and the renal graft continued to function well following this therapy. Mycoplasma and Ureaplasma should be considered as a potential etiology for perinephric abscess in renal transplant recipients.
• Bardwell, J., Youseffi, B., Marquez, J., Zangeneh, T. T., & Al-Obaidi, M. (2020). Pulmonary Mucormycosis in a Heart Transplant Patient. The American journal of medicine, 133(9), e524-e525.
• Ellis, K. E., Nawas, G. T., Chan, C., York, L., Fisher, J., Connick, E., & Zangeneh, T. T. (2020). Clinical Outcomes Following the Use of Archived Proviral HIV-1 DNA Genotype to Guide Antiretroviral Therapy Adjustment. Open forum infectious diseases, 7(1), ofz533.
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  Evidence regarding the safety of using proviral HIV-1 DNA genotype (DNA GT) to guide antiretroviral therapy (ART) is limited. We hypothesized that HIV RNA would not increase following ART adjustment guided by DNA GT in a university HIV clinic.
• Florita, C., Zangeneh, T. T., Florita, C., Farran, S., Donovan, F. M., Bardwell, J., & August, J. (2020).

  Infection of Aortic Endograft Caused by Coccidioidomycosis.

  . The American journal of medicine, 133(1), e1-e2. doi:10.1016/j.amjmed.2019.07.013
• Majeed, A., Larriva, M. M., Iftikhar, A., Mushtaq, A., Campbell, P., Nadeem Malik, M., Rafae, A., Zar, M. A., Kamal, A., Lakhani, M., Khalid, N. R., Zangeneh, T. T., & Anwer, F. (2020). A Single-Center Experience and Literature Review of Management Strategies for Infection in Hematopoietic Stem Cell Transplant Patients. Infectious diseases in clinical practice (Baltimore, Md.), 28(1), 10-15.
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  The aim of our study is to evaluate risk factors associated with the development of infection (CDI) in hematopoietic stem cell transplant (HSCT) patients, determine its incidence and report outcomes of CDI in our patient population.
• Malo, J., Holbrook, E., Zangeneh, T., Strawter, C., Oren, E., Robey, I., Erickson, H., Carranza-Chahal, R., Durkin, M., Thompson, C., Hoover, S. E., Ampel, N. M., Wheat, L. J., & Knox, K. S. (2020). Comparison of three anti-coccidioides antibody enzyme immunoassay kits for the diagnosis of coccidioidomycosis. Medical mycology, 58(6), 774-778.
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  Coccidioidomycosis is a common cause of community-acquired pneumonia in endemic areas of the southwestern United States. Clinical presentations range from self-limited disease to severe, disseminated disease. As such, early and accurate diagnosis is essential to ensure appropriate treatment and monitoring. Currently available diagnostic testing has variable accuracy, particularly in certain patient populations, and new tests may offer improved accuracy for the diagnosis of coccidioidomycosis. Serum samples from patients with coccidioidomycosis and controls were tested for immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies using the MVista Coccidioides antibody detection EIA and two commonly used commercial enzyme immunoassay (EIA) kits: the IMMY Omega EIA and the Meridian Premier EIA. The sensitivity of the IgG antibody detection was 87.4% using the MVista test compared to 46.6% for IMMY and 70.9% for Meridian. The sensitivity for IgM antibody detection was 61.2% for the MVista test, 22.3% for IMMY and 29.1% for Meridian. For IgG antibody detection, specificity was 90% for the MVista EIA, 94.6% for IMMY, 96.4% for Meridian. For IgM antibody detection, specificity was 95.3% for the MVista test 98.2% for IMMY and 99.1% for Meridian. The MVista Coccidioides antibody EIA offers improved sensitivity, including among high-risk patient populations, for the detection of IgG and IgM antibodies in comparison to other currently available EIAs.
• Marquez, J. L., Al-obaidi, M., Zangeneh, T. T., Marquez, J., Al-obaidi, M., & Afghan, A. (2020).

  743. Characteristics of Candidemia in a Coccidioidomycosis Endemic Region: The impact of Increased Azole Use in the Selection of Candida species

  . Open Forum Infectious Diseases, 7. doi:10.1093/ofid/ofaa439.933
• Nix, D. E., Hayes, J. F., Al Obaidi, M., & Zangeneh, T. (2020). Fixed Dosing of Amphotericin B in Morbidly Obese Individuals. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.
• Zangeneh, T. T., King, S., Kaur, M., & Fotouhie, A. (2020).

  Unusual Presentations of Coccidioidomycosis in Conjunction With Autoimmune Syndromes: A Literature Review and Case Series.

  . Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases, 26(2), e43-e47. doi:10.1097/rhu.0000000000000825
• Zangeneh, T. T., Marquez, J. L., Al-obaidi, M., & Afghan, A. (2020).

  743. Characteristics of Candidemia in a Coccidioidomycosis Endemic Region: The impact of Increased Azole Use in the Selection of Candida species

  . Open Forum Infectious Diseases, 7(Supplement_1), S419-S420. doi:10.1093/ofid/ofaa439.933
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  Abstract Background The incidence of invasive candidiasis secondary to non-albicans Candida species is on the rise. In Arizona, azoles are used for coccidioidomycosis treatment and prophylaxis in immunosuppressed population. Therefore, we intended to describe the characteristics and outcomes of non-albicans Candidemia in our area. Methods We conducted an IRB approved multicenter study evaluating patients from October 1, 2017 to January 1, 2020. Patient demographics, medical history, procedures, antifungal use, and laboratory data were collected. Episode per patient was included in the statistical analysis. Results In the study period, there were 145 patients with 151 candidemia episodes. For the episode-per-patient, median age was 51 (IQR 37-62), 45% were female, and 86% were Caucasian. 10% had a history of transplantation (40% HSCT and 60% SOT), and 22.5% had a history of cancer. 78% had another concomitant systemic infection. 4/80 (5%) and 12/102 (12%) had infective endocarditis. Only 5 (3.3%) had a history of coccidioidomycosis and 37 (24.5%) had exposure to azole therapy in the prior 3 months. 60% of the candidemia episodes were due to non-albicans Candida species, 27/37 (73%) had a prior history of azole therapy, 12/15 (80%) were transplant recipients, and 23/34 (80%) had cancer. The majority (71%) of patients initially received an echinocandin without a significant difference in mortality. Of all the admission episodes, there were 45/151 (29%) deaths and 7/151 (4.5%) were discharged to hospice. Not removing central catheters was associated with 60% of deaths (P=0.002). Infectious diseases consult was associated with lower mortality (OR 0.25, 95% CI 0.087-0 .70) and higher rates of catheter removal (OR 8, 95% 2.2-29.5). There was no difference in mortality between non-albicans versus albicans Candidemia (28.6% vs. 32%, P=0.7). Conclusion Our study found higher rates of non-albicans Candidemia that are more eminent in transplant recipients and those with prior azole use, but this was not statistically significant. The removal of the central line and ID consultations was associated with a significant reduction in mortality. In Coccidioidomycosis endemic regions, the risk of non-albicans candida infections can be higher with the use of azoles; however, further studies are recommended. Disclosures All Authors: No reported disclosures
• Zangeneh, T., Malo, J., Holbrook, E., Strawter, C., Oren, E., Robey, I., Erickson, H., Carranza-Chahal, R., Durkin, M., Thompson, C., Hoover, S. E., Ampel, N. M., Wheat, L. J., & Knox, K. S. (2020).

  Comparison of three anti-coccidioides antibody enzyme immunoassay kits for the diagnosis of coccidioidomycosis

  . Medical Mycology, 58(6), 774-778. doi:10.1093/mmy/myz125
• Asbury, K., Blair, J. E., August, J., Beatty, N. L., Mi, L., Carey, E. J., Huskey, J. L., LeMond, L. M., & Zangeneh, T. T. (2019). De novo coccidioidomycosis among solid organ transplant recipients 1 or more years after transplant. American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons, 19(9), 2517-2524.
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  Solid organ transplant recipients who contract coccidioidomycosis are at risk for complicated, protracted, disseminated, and severe disease. To date, no studies have described outcomes for patients who develop coccidioidomycosis only after the first posttransplant year. This study was a joint project of Mayo Clinic Hospital, Phoenix, Arizona, and the University of Arizona/Banner University Medical Center, Tucson, Arizona. We retrospectively reviewed electronic health records for patients with a history of solid organ transplant between January 1, 1998, and October 11, 2014, who developed coccidioidomycosis after the first transplant year. We identified 91 patients. Of those, 37/91 (40.7%) had pulmonary coccidioidomycosis (29/37 [78.4%] were symptomatic); and 5/91 (5.5%) had extrapulmonary disease (all were symptomatic). One patient (1.1%) died. Coccidioidomycosis was evident in 2/91 (2.2%) patients within 3 months of antirejection treatment. Many of the patients (51/91 [56.0%]) had asymptomatic coccidioidomycosis, 27 (27.9%) of whom were followed up closely but did not receive antifungal medication and had no sequelae. Although solid organ recipients taking low-level immunosuppression after the first posttransplant year appeared to have less symptomatic, disseminated, or fatal coccidioidal infection than historical cohorts, this remains an important infection with morbidity and mortality even after the first posttransplant year.
• Bardwell, J., August, J., Farran, S., Florita, C., Donovan, F., & Zangeneh, T. T. (2019). Infection of Aortic Endograft Caused by Coccidioidomycosis. The American journal of medicine.
• Habib, S., El Ramahi, R. A., Rosen, S., Farran, S., Shubeilat, J., Walker, C., Casal, M., & Zangeneh, T. (2019). Efficacy of Low Dose Chemoprophylaxis for Coccidioidomycosis Infection in Liver Transplant Recipients. Gastroenterology research, 12(3), 148-156.
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  Coccidioidomycosis (CM) infections among transplant recipients result in significant morbidity and mortality. The goal of our study was to establish the efficacy of low dose (LD) versus standard dose (LD, 50 mg daily) fluconazole in preventing CM infection.
• Zangeneh, T. T., York, L. D., Connick, E., Chan, C. B., Ellis, K. E., Ellis, K. E., Chan, C. B., Connick, E., York, L. D., & Zangeneh, T. T. (2019). Clinical Outcomes Following the Use of Archived Proviral HIV-1 DNA Genotype to Guide Antiretroviral Therapy Adjustment. Open Forum Infectious Disease.
• Korayem, G., Eljaaly, K. O., Matthias, K. R., & Zangeneh, T. T. (2018). Oral Vancomycin Monotherapy versus Combination Therapy in Solid Organ Transplant Recipients with Uncomplicated Clostridium difficile Infection: A retrospective cohort study. Transplantation Proceedings, 50(1), 137-141. doi:10.1016/j.transproceed.2017.11.016
• Zangeneh, T. T. (2018). A 20-year experience with nocardiosis in solid organ transplant (SOT) recipients in the Southwestern United States: A single-center study.. Transpl Infect Dis.
• Zangeneh, T. T. (2018). A rare case of pyogenic pericarditis secondary to Streptococcus constellatus.. BMJ Case Reports.
• Zangeneh, T. T. (2018). Aspergillosis, eosinophilic esophagitis, and allergic rhinitis in signal transducer and activator of transcription 3 haploinsufficiency. J Allergy Clin Immunol.
• Zangeneh, T. T. (2018). Prophylaxis for Hepatitis B Virus Reactivation after Allogeneic Stem Cell Transplantation in the Era of Drug Resistance and Newer Antivirals: A Systematic Review and Meta-Analysis. Biol Blood Marrow Transplant.
• Zangeneh, T. T. (2018). Resistant Cytomegalovirus Infection in Solid-organ Transplantation: Single-center Experience, Literature Review of Risk Factors, and Proposed Preventive Strategies. Transplant Proc.
• Zangeneh, T. T. (2018). Top Questions in the Diagnosis and Treatment of Coccidioidomycosis. Open Forum Infect Dis.
• Zangeneh, T. T. (2018). Unusual Presentations of Coccidioidomycosis in Conjunction With Autoimmune Syndromes: A Literature Review and Case Series. J Clin Rheumatol.
• Zangeneh, T. T., Matthias, K. R., & Korayem, G. B. (2018).

  Recurrence of urinary tract infections and development of urinary-specific antibiogram for kidney transplant recipients.

  . Journal of global antimicrobial resistance, 12, 119-123. doi:10.1016/j.jgar.2017.08.009
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  Urinary tract infection (UTI) recurrence and antimicrobial resistance remain a common problem in kidney transplant recipients. Whilst the use of annual institutional antibiograms may help guide appropriate empirical antibiotic selection, these non-disease specific antibiograms do not always account for patient-specific risk factors or disease-specific resistance patterns. This study determined the frequency of UTI recurrence during the first year after kidney transplantation as well as differences in antimicrobial susceptibility between an institutional antibiogram and the disease-specific antibiogram for patients following kidney transplantation..In this study, adult patients with at least one UTI during an inpatient admission within 1 year post kidney transplantation were evaluated. A disease-specific antibiogram for UTIs in kidney transplant recipients was prepared based on culture results and was compared with the annual institutional antibiograms..Of 299 kidney transplants performed during the study period, 66 subjects meet the study inclusion criteria, of whom 47% had two or more UTIs within the first year after kidney transplant. In comparison with the institutional antibiogram, Escherichia coli isolated from urine samples from kidney transplant recipients were significantly more resistant to trimethoprim/sulfamethoxazole, ceftriaxone, cefepime, ciprofloxacin and gentamicin (P
• Zangeneh, T., Georgescu, A., Iftikhar, A., Majeed, A., Beatty, N., Mushtaq, A., Fisher, J., Gaynor, P., Kim, J. C., Marquez, J. L., & Mora, F. E. (2018).

  A 20-year experience with nocardiosis in solid organ transplant (SOT) recipients in the Southwestern United States: A single-center study

  . Transplant Infectious Disease, 20(4), e12904. doi:10.1111/tid.12904
• Chan, C., York, L., Ellis, K. E., Zangeneh, T. T., Nawas, G. T., & Mar, A. (2017).

  Clinical Outcomes Following the Use of Archived HIV-1 DNA Sequencing to Guide Antiretroviral Therapy Regimen Adjustment and Simplification

  . Open Forum Infectious Diseases, 4(suppl_1), S425-S425. doi:10.1093/ofid/ofx163.1071
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  Abstract Background While favorable new antiretroviral therapy (ART) options are available for HIV disease, the Department of Health and Human Services guidelines recommend against switching suppressive regimens unless there is evidence that the new regimen will be fully active. A new assay analyzes archived HIV pro-viral DNA and can detect resistance mutations when HIV RNA is below the limit of detection, when standard genotyping (GT) is not possible. Small studies have correlated archived DNA GT to historical plasma RNA GT, but there is minimal available data on treatment outcomes when using this assay to determine antiretroviral therapy switch strategies. We evaluated clinical outcomes following ART adjustment based upon results of archived DNA GT testing. Methods A retrospective review of electronic medical records was performed at our medical center from October 2014 to October 2016. Inclusion criteria included age ≥ 18 years, archived DNA GT result available, ART changed after archived GT result, and follow up HIV RNA available after ART switch. Data was collected prior to and after ART switching. McNemar’s test was used for categorical variables and paired t-test for continuous variables. Results A total of 38 patients were included. Most patients were male (89%), Caucasian (66%), had a history of AIDS diagnosis (45%), had HIV for >10 years (74%), and had baseline ART resistance (24% resistant to 1 class, 37% resistant to ≥ 2 classes). Median baseline CD4 was 532 cells/mm3. At baseline, 31 (82%) patients had HIV RNA < 50 copies/mL. Compared with baseline, 35 (92%) patients were undetectable at furthest follow up (P = 0.22). Median time to furthest follow up was 146.5 days (range 12–485). Overall, 36 (95%) patients had at least one undetectable HIV RNA after switching. None of the patients with an initial undetectable HIV RNA became detectable after switching ART. Average number of pills per day and administrations per day decreased from 3.84 to 1.97 (P < 0.001) and 1.47 to 1.05 (P < 0.001) respectively. The number of patients on protease inhibitors (PIs) decreased from 66% to 21% (P < 0.001). Conclusion The use of archived DNA GT to guide ART adjustment may result in maintained viral suppression while allowing for regimens with optimized long-term safety and decreased pill burden. Disclosures All authors: No reported disclosures.
• Donovan, F., Malo, J., Zangeneh, T. T., & Galgiani, J. N. (2017). Top Questions in Diagnosis and Treatment of Coccidioidomycosis. Open Forum Infectious Diseases.
• Florita, C., Georgescu, A., Zangeneh, T. T., Georgescu, A., & Florita, C. (2017).

  Extrapulmonary Nontuberculous Mycobacterial Infections in Southern Arizona

  . Open Forum Infectious Diseases, 4(suppl_1), S670-S670. doi:10.1093/ofid/ofx163.1789
• Galgiani, J. N., Zangeneh, T. T., Donovan, F. M., & Malo, J. (2017).

  Top Questions in the Diagnosis and Treatment of Coccidioidomycosis

  . Open Forum Infectious Diseases, 4(4). doi:10.1093/ofid/ofx197
• Iftikhar, A., Mora, F. E., Georgescu, A., Zangeneh, T. T., Mushtaq, A., Mora, F. E., Marquez, J. L., Majeed, A., Kim, J. C., Georgescu, A., Gaynor, P., & Beatty, N. (2017).

  A 20-Year Experience with Nocardiosis in Solid Organ Transplant (SOT) Recipients in the Southwestern United States: A Single-center Study

  . Open Forum Infectious Diseases, 4(suppl_1), S707-S707. doi:10.1093/ofid/ofx163.1899
• Korayem, G. B., Zangeneh, T. T., & Matthias, K. R. (2017). Urinary Tract Infections Recurrence and Development of Urinary-Specific Antibiogram for Kidney Transplant Recipients. Journal of Global Antimicrobial Resistance. doi:10.1016/j.jgar.2017.08.009
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  Urinary tract infections (UTI) recurrence and antimicrobial resistance remain a common problem in kidney transplant recipients. While the use of annual institutional antibiograms may help guide appropriate empiric antibiotic selection, these non-disease specific antibiograms do not always account for patient-specific risk factors or disease-specific resistance patterns.
• Majeed, A., Iftikhar, A., Zangeneh, T. T., Mushtaq, A., Majeed, A., Lim, M., Larriva, M., Khalid, N., Hassan, N., Hamadani, A. A., & Anwer, F. (2017).

  Clostridium Difficile Infection in Hematopoietic Stem Cell Transplant Patients: A Single-Center experience.

  . Open Forum Infectious Diseases, 4(suppl_1), S390-S390. doi:10.1093/ofid/ofx163.971
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  Abstract Background C. difficile infection (CDI) is the most common cause of nosocomial infections in U.S. and leading cause of gastroenteritis associated death. Incidence of CDI in hematopoietic stem cell transplant (HSCT) patients has been reported between 5.7% to 24.7% during first year after HSCT. Literature review reveals many risk factors i.e., allogenic-HSCT, extremes of age, myeloablative conditioning, prior vancomycin resistance (VRE) colonization, pre-transplant C. difficile colonization, severe mucositis, graft vs. host disease (GVHD), duration and type of antibiotics used, immunosuppression, proton pump inhibitor use and NAP1 C. difficile strain. Methods To study incidence and different variables for CDI, we performed a retrospective review of medical records of adult patients who underwent HSCT between 2013 and 2016 at our center. REDCap database was used to record key variables related to each patient’s HSCT and CDI, keeping in mind HIPPA guidelines. Categorical data were summed up as percentages and counts and numeric data as means, medians, standard deviations and ranges. Results A total of 181 HSCT recipients were included. Incidence of CDI was 10% (18 Patients). Cohort’s most common underlying malignancy was multiple myeloma (35.4%). 70% had autologous HSCT and 30% had allogenic HSCT. Among allogenic transplants, 53% had matched unrelated donor. Peripheral blood was the most common stem cell source (93%). Most common myeloablative conditioning regimen was melphalan (70%). 27% patients were on PPIs. 4% had PEG/NG tube placed and 12% were on TPN. 10% had diabetes mellitus. 5 patients had previous episodes of CDI. 69% developed mucositis. 5% patients developed acute GVHD. 6% had VRE colonization while 66% had no documentation for VRE. Out of positive CDI cases, 17% were NAP1 positive. No episode of ileus or mega colon was documented. Most common treatment regimen were metronidazole 500 mg per orally every 8 hourly (65%) and vancomycin 125 mg per orally four times a day (58.8%). Conclusion This single-center study demonstrates that CDI has 10% incidence in patients undergoing HSCT. Risk factors include neutropenia, high dose chemotherapy, mucosal damage and provision of broad spectrum antibiotic prophylaxis. Data on CDI prophylaxis in these patients is emerging and randomized prospective trials are needed. Disclosures All authors: No reported disclosures.
• Malo, J., Holbrook, E., Zangeneh, T. T., Strawter, C., Oren, E., Robey, I., Erickson, H., Chahal, R., Durkin, M., Thompson, C., Hoover, S. E., Ampel, N., Wheat, L. J., & Knox, K. S. (2017). Enhanced Antibody Detection and Diagnosis of Coccidioidomycosis with the MiraVista IgG and IgM Detection Enzyme. Journal of Clinical Microbiology, 55, 1-9.
• Oren, E., Zangeneh, T., Malo, J., Holbrook, E., Strawter, C., Robey, I., Erickson, H., Chahal, R., Durkin, M., Thompson, C., Hoover, S. E., Ampel, N. M., Wheat, L. J., & Knox, K. S. (2017).

  Enhanced Antibody Detection and Diagnosis of Coccidioidomycosis with the MiraVista IgG and IgM Detection Enzyme Immunoassay

  . Journal of Clinical Microbiology, 55(3), 893-901. doi:10.1128/jcm.01880-16
• Zangeneh, T. T. (2017). A 30-Year Delayed Presentation of Disseminated Histoplasmosis in a Heart Transplant Recipient: Diagnostic Challenges in a Non-Endemic Area. BMJ.
• Zangeneh, T. T. (2017). A rare case of Mycobacterium abscessus subspecies abscessus prosthetic valve endocarditis and the clinical importance of inducible erm(41) gene testing. BMJ Case Reports.
• Zangeneh, T. T. (2017). Intractable cerebral Nocardia mexicana in a GvHD patient successfully treated with linezolid. Bone Marrow Transplant.
• Zangeneh, T. T., Roller, B., Tager, D., & Al Mohajer, M. (2017). Coccidioidal meningitis complicated by central nervous system vasculitis in a patient with leukemia. Med Mycol Case Rep.
• Zangeneh, T. T., Weinreich, M. A., Sugui, J. A., Similuk, M., Oler, A. J., Natarajan, M., Milner, J. D., Lionakis, M. S., Kwon-chung, K. J., Hsu, A. P., & Carr, T. F. (2017).

  De novo STAT3 Mutation in a Patient with Fatal, Treatment-Refractory Sino-orbital Aspergillosis

  . Open Forum Infectious Diseases, 4(suppl_1), S114-S115. doi:10.1093/ofid/ofx163.130
• Bilal, J., Riaz, I. B., Zangeneh, T. T., Riaz, I. B., & Hill, J. L. (2016).

  Intravenous Immunoglobulin-Induced Pulmonary Embolism: It Is Time to Act!

  . American journal of therapeutics, 23(4), e1074-7. doi:10.1097/mjt.0000000000000288
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  Pulmonary embolism (PE) is a common clinical problem affecting 600,000 patients per year in the United States. Although the diagnosis can be easily confirmed by imaging techniques, such as computed tomographic angiography of the chest, the identification of underlying mechanism leading to PE is important for appropriate duration of anticoagulation, and prevention of subsequent episodes. The differential diagnosis of underlying mechanism is broad and must include careful review of medication history. Drug-related thromboembolic disease can be easily missed and may have catastrophic consequences. The identification of the culprit drug is important for prevention of subsequent episodes and choosing appropriate duration of anticoagulation. We report a case of a middle-aged man who developed PE after administration of intravenous immunoglobulin.
• Hassan, K., Turker, T., & Zangeneh, T. T. (2016). Disseminated Sporotrichosis Infections. Case Reports in Plastic Surgery and Hand Surgery.
• Palejwala, S. K., Zangeneh, T. T., Goldstein, S. A., & Lemole, G. M. (2016). An Aggressive Multidisciplinary Approach Reduces Mortality in Rhinocerebral Mucormycosis. Surg Neurol Int. doi:10.4103/2152-7806.182964
• Palejwala, S., Zangeneh, T. T., Goldstein, S., & Lemole, M. G. (2016). Aggressive Multidisciplinary Approach Reduces Mortality in Rhinocerebral Mucormycosis. JNLS-B.
• Zangeneh, T. T. (2016). Polymicrobial Pituitary Abscess Predominately Involving Escherichia coli in the Setting of an Apoplectic Pituitary Prolactinoma. Case Reports in Infectious Diseases.
• Zangeneh, T. T., Wheat, L. J., Thompson, C., Strawter, C., Robey, I. F., Oren, E., Malo, J., Knox, K. S., Hoover, S. E., Holbrook, E. D., Erickson, H., Durkin, M., Chahal, R., & Ampel, N. M. (2016).

  Development of an Improved Antibody Detection EIA for Use in Diagnosis of Coccidioidomycosis.

  . Open Forum Infectious Diseases, 3(suppl_1). doi:10.1093/ofid/ofw172.1254
• Zangeneh, T. T., Yumul, I. K., Urcis, R., Po, J. L., Mahmoud, N., Low, S. W., & Chan, O. (2016).

  Coccidioidomycosis with Pericardial Involvement: Case Report and Literature Review.

  . The American journal of medicine, 129(3), e21-5. doi:10.1016/j.amjmed.2015.11.009
• Bilal, J., Riaz, I. B., Hill, J. L., & Zangeneh, T. T. (2015). Intravenous Immunoglobulin-Induced Pulmonary Embolism: It Is Time to Act!. American journal of therapeutics.
  More info

  Pulmonary embolism (PE) is a common clinical problem affecting 600,000 patients per year in the United States. Although the diagnosis can be easily confirmed by imaging techniques, such as computed tomographic angiography of the chest, the identification of underlying mechanism leading to PE is important for appropriate duration of anticoagulation, and prevention of subsequent episodes. The differential diagnosis of underlying mechanism is broad and must include careful review of medication history. Drug-related thromboembolic disease can be easily missed and may have catastrophic consequences. The identification of the culprit drug is important for prevention of subsequent episodes and choosing appropriate duration of anticoagulation. We report a case of a middle-aged man who developed PE after administration of intravenous immunoglobulin.
• Chan, O., Low, S. W., Urcis, R., Mahmoud, N., Yumul, I. K., Po, J. L., & Zangeneh, T. T. (2015). Coccidioidomycosis with Pericardial Involvement: Case Report and Literature Review. The American journal of medicine.
• Knox, K. S., Zangeneh, T. T., Wheat, L. J., Thompson, C., Strawter, C., Robey, I. F., Oren, E., Malo, J., Knox, K. S., Holbrook, E. D., Erickson, H., Chahal, R., & Ampel, N. M. (2015).

  Development of an Improved Antibody Detection Enzyme Immunoassay for Use in Detection of Coccidioidomycosis

  . Open Forum Infectious Diseases, 2(suppl_1). doi:10.1093/ofid/ofv133.128
• Korayem, G. B., Zangeneh, T. T., & Matthias, K. R. (2018). Urinary Tract Infections Recurrence and Development of Urinary-Specific Antibiogram for Kidney Transplant Recipients. Journal of Global Antimicrobial Resistance, 12, 119-123. doi:10.1016/j.jgar.2017.08.009
  More info

  Urinary tract infections (UTI) recurrence and antimicrobial resistance remain a common problem in kidney transplant recipients. While the use of annual institutional antibiograms may help guide appropriate empiric antibiotic selection, these non-disease specific antibiograms do not always account for patient-specific risk factors or disease-specific resistance patterns.
• Pasha, A. K., Snyder, B. A., Zangeneh, T. T., Thompson, J. L., Sobonya, R. E., & Abidov, A. (2015). A distinctly rare case of candida endocarditis involving the bioprosthetic pulmonary and the Eustachian valve diagnosed on 3D transesophageal echocardiography. Echocardiography (Mount Kisco, N.Y.), 607-9.
• Salameh, A., Bello, N., Becker, J., & Zangeneh, T. (2015). Fatal Granulomatous Amoebic Encephalitis Caused by Acanthamoeba in a Patient With Kidney Transplant: A Case Report. Open forum infectious diseases, 2(3), ofv104.
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  Granulomatous amoebic encephalitis (GAE) due to Acanthamoeba is almost a uniformly fatal infection in immune-compromised hosts despite multidrug combination therapy. We report a case of GAE in a female who received a deceased donor kidney graft. She was treated with a combination of miltefosine, pentamidine, sulfadiazine, fluconazole, flucytosine, and azithromycin.
• Zangeneh, T. T., Malo, J., Luraschi-Monjagatta, C., Hage, C. A., Wheat, L. J., Strawter, C., Klotz, S. A., & Knox, K. S. (2015). Positive (1-3) B-d-glucan and cross reactivity of fungal assays in coccidioidomycosis. Medical mycology, 53(2), 171-3.
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  Fungal antigen testing in immunosuppressed patients has emerged as a powerful diagnostic tool. Some assays are relatively nonspecific, and misinterpretation can have severe clinical consequences. Additionally, when new assays become commercially available it is important to evaluate the potential for cross reactivity. We recently observed several immunosuppressed patients with positive (1→3)-β-D-glucan (BG) who were eventually diagnosed with coccidioidomycosis in the endemic area of Tucson, Arizona. Although the BG assay is known to detect glucans of many fungal pathogens, reports of cross-reactivity with Coccidioides remain sparsely reported. To test the cross-reactivity of fungal antigens in detection assays, serum samples from patients with coccidioidomycosis testing positive for Coccidioides antigen were evaluated for BG. Of 12 samples positive for Coccidioides antigen (≥0.07 ng/ml), 11 (92%) were positive by BG (>80 pg/ml), and of 11 positive for Aspergillus galactomannan, 10 (91%) were positive by BG (>80 pg/ml). We conclude that the BG assay is nonspecific, detecting glucans from many fungal pathogens, including Coccidioides. In the endemic area, a positive BG warrants further specific testing.
• Abidov, A., Sobonya, R. E., Zangeneh, T. T., Pasha, A. K., Snyder, B. A., & Thompson, J. L. (2014).

  A Distinctly Rare Case of Candida Endocarditis Involving the Bioprosthetic Pulmonary and the Eustachian Valve Diagnosed on 3D Transesophageal Echocardiography

  . Echocardiography, 32(3), 607-609. doi:10.1111/echo.12804
• Gheevarghese, J. S., Zangeneh, T. T., & Parthasarathy, S. (2014). Acute respiratory distress syndrome secondary to Mycobacterium abscessus lung infection – a case report. F1000Research, 3, 111. doi:10.12688/f1000research.4108.1
• Satyanarayan, A., Klotz, S., Han, L., Sobonya, R., & Zangeneh, T. T. (2014). Coccidioidomycosis of the genitourinary tract: a case report and discussion. Urology, e30-1.
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  Coccidioides species (Coccidioides immitis and Coccidioides posadasii) are dimorphic fungi endemic to the Southwestern United States. Initial infection ranges from asymptomatic to mild upper respiratory tract symptoms and may disseminate to other organs including the genitourinary tract. Genitourinary complaints may be the initial presenting signs and symptoms among a minority of patients. We report a case of genitourinary coccidioidomycosis and discussion of genitourinary disease with coccidioidomycosis.
• Zangeneh, T. T., Voss, K., Thajudeen, B., & John, S. G. (2014).

  1190: DISSEMINATED FUNGAL INFECTIONS IN A POST CARDIAC TRANSPLANT PATIENT

  . Critical Care Medicine, 42, A1638-A1639. doi:10.1097/01.ccm.0000458657.62531.41
• Gorlitsky, B. R., Zangeneh, T., Fuchs, D., & Cox, C. (2013). Fifty, febrile, and fatigued: high ferritin as a clue in diagnosis. The American journal of medicine, e3-4.
• Poojary, I., Geffre, C., Zangeneh, T. T., & Campion, J. (2013). Medical image of the week: coccidioidomycosis pneumothorax. Southwest J Pulm Crit Care, 7(4), 251-2. doi:http://dx.doi.org/10.13175/swjpcc140-13 PDF
• Rees, H. C., Ianas, V., McCracken, P., Smith, S., Georgescu, A., Zangeneh, T., Mohler, J., & Klotz, S. A. (2013). Measuring frailty in HIV-infected individuals. Identification of frail patients is the first step to amelioration and reversal of frailty. Journal of visualized experiments : JoVE.
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  A simple, validated protocol consisting of a battery of tests is available to identify elderly patients with frailty syndrome. This syndrome of decreased reserve and resistance to stressors increases in incidence with increasing age. In the elderly, frailty may pursue a step-wise loss of function from non-frail to pre-frail to frail. We studied frailty in HIV-infected patients and found that ~20% are frail using the Fried phenotype using stringent criteria developed for the elderly. In HIV infection the syndrome occurs at a younger age. HIV patients were checked for 1) unintentional weight loss; 2) slowness as determined by walking speed; 3) weakness as measured by a grip dynamometer; 4) exhaustion by responses to a depression scale; and 5) low physical activity was determined by assessing kilocalories expended in a week's time. Pre-frailty was present with any two of five criteria and frailty was present if any three of the five criteria were abnormal. The tests take approximately 10-15 min to complete and they can be performed by medical assistants during routine clinic visits. Test results are scored by referring to standard tables. Understanding which of the five components contribute to frailty in an individual patient can allow the clinician to address relevant underlying problems, many of which are not evident in routine HIV clinic visits.
• Salameh, A., Klotz, S. A., & Zangeneh, T. T. (2012). Disseminated Infection Caused by Eggerthella lenta in a Previously Healthy Young Man: A Case Report. Case reports in infectious diseases, 2012, 517637.
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  Anaerobic bacteria are the predominant normal flora of the mucous membranes which may cause life-threatening disseminated infections and are often difficult to culture from infected sites. Eggerthella (previously known as Eubacteria species) is an anaerobic, nonsporulating, nonmotile, Gram-positive rod that is found in the human colon and feces and has been isolated from various other clinical specimens. We report a case of complicated disseminated anaerobic bacterial infection with Eggerthella lenta in a healthy immunocompetent man causing multiple brain abscesses, liver abscesses, necrotizing pneumonia, and osteomyelitis of the left radial bone. He was successfully treated with empiric penicillin G and metronidazole.
• Zangeneh, T. T., Baracco, G., & Al-Tawfiq, J. A. (2011). The Impact of the Conjugate Pneumococcal Vaccines on the Changing Epidemiology of Pneumococcal Infections. Expert Reviews Vaccines.

Presentations

• Zangeneh, T. T. (2018, April). Hepatitis C Standard of Care Management. ACP, Arizona Chapter, Regional Medical Student Journal Club. Tucson, AZ: ACP.
• Zangeneh, T. T. (2018, April). Infections in patients with hematologic malignancies and hematopoietic stem cell transplant recipients. Pulmonary and Critical Care Grand Rounds. BUMC: Division of Pulmonary and Critical Care Medicine.
• Zangeneh, T. T. (2018, April). Infectious Diseases Emergencies in Primary Care. 27th Annual Southwestern Conference on Medicine. Tucson, AZ: Cleveland Clinic and TOMF.
• Zangeneh, T. T. (2018, February). Infectious Diseases in Solid Organ Transplant Recipients, The Organization for Transplant Professionals (NATCO) introductory course for the transplant nurse coordinators. The Organization for Transplant Professionals (NATCO) Meeting. BUMC: NATCO.
• Zangeneh, T. T. (2018, October). Soil and Water-borne Parasites. Global Health Educational Lecture Series. Tucson, AZ: Department of Family Medicine, University of Arizona.
• Zangeneh, T. T. (2018, September). Board Review and Antimicrobial Use in Head and Neck Infections. Board Review. Tucson, AZ: Department of Otolaryngology, University of Arizona.
• Zangeneh, T. T. (2016, April 2016). Development of an Improved Antibody Detection EIA for use in Identification of Coccidioidomycosis. National Coccidioidomycosis Meeting. Fresno, California: Coccidioidomycosis Group.
• Zangeneh, T. T. (2016, May 2016). A novel case of Neuroretinitis secondary to Borrelia hermsii infection. ACP, National Meeting. Washington, DC: ACP.
• Zangeneh, T. T. (2016, November 2016). Early Airborne Isolation and Treatment of Scrofula in a Patient with Possible Pulmonary Involvement. ACP, Arizona Chapter. Phoenix, Arizona: ACP.
• Zangeneh, T. T. (2016, November 2016). Infections in Renal Transplant: More than BK Virus. Arizona Chapter of the ACP. Phoenix, Arizona: ACP.
• Subramaniam, S., Riaz, I. B., Siordia, J. A., Paidy, S. R., Lick, S. D., Zangeneh, T. T., & Abidov, A. (2015, May). Preoperative Intravenous Heparin Challenge Helps Define Optimal Timing of Mitral Valve Surgery in Endocarditis Complicated by Cerebral Emboli: A Case Series. American Association for Thoracic Surgery Mitral Conclave 2015.
• Zangeneh, T. T. (2015, April). HIV Update 2015. 24th Annual Southwestern Conference on Medicine. Tucson, AZ: Tucson Osteopathic Medical Foundation.
• Zangeneh, T. T. (2015, May). Efficacy of Low Dose Chemoprophylaxis for Coccidioidomycosis Infection in Liver Transplantation Recipients. 2015 American Transplant Congress (ATC). Pennsylvania Convention Center.
• Zangeneh, T. T. (2015, October). STI Update and Emerging Infectious Diseases. Southwestern Conference on Medicine Primary Care Update. Tucson, AZ: Tucson Osteopathic Medical Foundation.
• Zangeneh, T. T. (2014, April). Difficult to Diagnose Infectious Diseases as it may pertain to primary care physicians. 23rd Annual Southwestern Conference on Medicine. Tucson, AZ: Tucson Osteopathic Medical Foundation.
• Zangeneh, T. T. (2014, October). Epidemiology of Ebola Virus Disease. Ebola Virus and UAHN Response - An Informational Conference.
• Zangeneh, T. T. (2013, April). HIV Update: “Past, Present, and Future”. AETC Training. Phoenix, AZ: AIDS Education and Training Centers (AETC).
• Zangeneh, T. T. (2013, July). HIV Clinical Update Webinar Series. Texas/Oklahoma AIDS Education and Training.
• Zangeneh, T. T. (2012, August). HIV Update, Treatment, and Integration of Care. Arizona Infectious Disease Training & Exercise, Preliminary Session. Phoenix, AZ.

Poster Presentations

• Zangeneh, T. T. (2023). The performance of bronchoalveolar lavage Aspergillus PCR in solid organ transplantation. American Transplant CongressATC.
• Zangeneh, T. T. (2023, May). Apophysomyces Elegans in Patient Without Underlying Conditions. National ACP meetingACP.
• Zangeneh, T. T. (2023, October). Outcomes of Coccidioidomycosis among patients admitted to the intensive care unit. IDWeekIDSA.
• Zangeneh, T. T. (2023, October). Risk of Clostridioides difficile Infection and Antibiotic Associated Diarrhea in Patients Receiving Outpatient Parenteral Antimicrobial Therapy. IDWeekIDSA.
• Kotagiri, R., Zangeneh, T. T., Albuquerque Ferreira, J. P., Budenski, J., & Brickner, E. (2022, October). Apophysomyces Elegans Mucormycosis in Patient Without Underlying Conditions. ACP AZ Chapter 2022 in Tucson. Tucson: American College of Physicians.
• Zangeneh, T. T. (2021, October). Community Acquired Gastrointestinal Infections among Transplant Recipients. ID Week 2021, IDSA International Conference. Virtual.
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  Invited Poster
• Al-Obaidi, M., & Zangeneh, T. T. (2020, Fall). Characteristics of Candidemia in a Coccidioidomycosis Endemic Region. IDSA - ID Week 2020. Online only: Infectious Diseases Society of America.
• Al-Obaidi, M., Zangeneh, T. T., Bardwell, J., Youseffi, B., Bouzigard, R., & Le, C. (2020, Summer). A Comparative Analysis of Mucormycosis in Solid Organ Transplant Recipients and Other Immunosuppressed Hosts Including Patients with Uncontrolled Diabetes. ATC 2020 Virtual Congress. Online Only: American Transplant Congress.
• Zangeneh, T. T. (2020, June). A Comparative Analysis of Mucormycosis in Solid Organ Transplant Recipients and other Immunosuppressed Hosts Including Patients with Uncontrolled Diabetes. ATC - World Congress 2020 Virtual Meeting. virtual meeting: American Transplant Congress.
• Zangeneh, T. T. (2020, October). Characteristics of Candidemia in a Coccidioidomycosis Endemic Region: The impact of Increase Azole Use in the Selection of Candida species. IDSA International Conference. Virtual Conference: Infectious Diseases Society of America.
• Al-Obaidi, M., Zangeneh, T. T., & Sumaya, F. (2019, June). The Natural History and Time to Seroconversion of CMV in the Era of Post-Transplantation Chemoprophylaxis. American Transplant Congress Annual Meeting. Boston, MA: American Transplant Congress.
• Bouzigard, R., Al-Obaidi, M., Adams, M., Zangeneh, T. T., Adams, M., Zangeneh, T. T., Bouzigard, R., & Al-Obaidi, M. (2019, Oct). Peri-transplant Abscess Due to Mycoplasma hominis. American College of Physicians, Arizona Chapter, Annual Meeting. Tucson, AZ: American College of Physicians, Arizona Chapter.
• Youssefi, B., Al-Obaidi, M., Zangeneh, T. T., Bracamonte, E. R., Kaur, A., Kaur, A., Bracamonte, E. R., Zangeneh, T. T., Youssefi, B., & Al-Obaidi, M. (2019, Oct). Pitfalls in the Diagnosis of Pneumocystis Pneumonia (PCP) by Staining Methods in Respiratory Specimens. American College of Physicians, Arizona Chapter, Annual Meeting. Tucson, AZ: American College of Physicians, Arizona Chapter.
• Youssefi, B., Youssefi, B., Al-Obaidi, M., Bardwell, J. R., Bardwell, J. R., Zangeneh, T. T., Bardwell, J. R., Zangeneh, T. T., Zangeneh, T. T., Youssefi, B., Al-Obaidi, M., & Al-Obaidi, M. (2019, Oct). Invasive Pulmonary Mucormycosis in a Heart Transplant Recipient. American College of Physicians, Arizona Chapter, Annual Meeting. Tucson: American College of Physicians, Arizona Chapter.
• Zangeneh, T. T. (2018, April). Local Art and HIV Perceptions in Tucson’s Hispanic Demographic. University of Arizona Honors Engagement Expo. Tucson, AZ: University of Arizona.
• Zangeneh, T. T. (2018, February). How to Prevent Hepatitis B Reactivation after Allogeneic Stem Cell Transplantation in the Era of Novel Antiviral Drugs: A Systematic Review and Meta-Analysis. ASBMT 2018 Meeting. Salt Lake City, UT: ASBMT.
• Zangeneh, T. T. (2018, June). de novo coccidioidomycosis among remote solid organ transplant recipients at Mayo Clinic Arizona and Banner University Medical Center/University of Arizona. AST World Congress 2018 Meeting. Seattle, WA: AST.
• Zangeneh, T. T. (2018, November). Disseminated Coccidioidomycosis stemming from an Infected Aortic Endograft. Arizona Chapter of the ACP Scientific Meeting. Phoenix, AZ: ACP.
• Zangeneh, T. T. (2018, November). Orbital Cellulitis complicated by MSSA Bacteremia in an Intranasal Drug User. Arizona Chapter of the ACP 2018 Scientific Meeting. Phoenix, AZ: ACP.
• Zangeneh, T. T. (2017, August, 2017). A retrospective review of de novo coccidioidomycosis among remote solid organ transplant recipients at Mayo Clinic Arizona and Banner University Medical Center/University of Arizona,. 7th International Coccidioidomycosis Symposium. Palo Alto, California: Coccidioidomycosis Symposium Group.
• Zangeneh, T. T. (2017, October 2017). A 20-Year Experience with Nocardiosis in Solid Organ Transplant (SOT) Recipients in the Southwestern United States: A Single-Center Study. IDSA International Conference. San Diego, California: IDSA.
• Zangeneh, T. T. (2017, October 2017). Clinical Outcomes Following the Use of Archived HIV-1 DNA Sequencing to Guide Antiretroviral Therapy Regimen Adjustment and Simplification. DSA 2017 Meeting. San Diego, California: IDSA.
• Zangeneh, T. T. (2017, October 2017). Clostridium Difficile Infection in Hematopoietic Stem Cell Transplant Patients: A Single-Center experience. IDSA International Conference. San Diego, California: IDSA.
• Zangeneh, T. T. (2017, October 2017). De novo STAT3 Mutation in a Patient with Fatal, Treatment-Refractory Sino-orbital Aspergillosis. IDSA 2017 Meeting. San Diego, California: IDSA.
• Zangeneh, T. T. (2017, October 2017). Extra-pulmonary Non-tuberculosis mycobacterial infections in Southern Arizona. IDSA 2017 Meeting. San Diego, California: IDSA.
• August, J., Ainapurapu, B. B., & Zangeneh, T. T. (2016, May). Running Out of Sight- Neuroretinitis secondary to Borrelia Hermsii infection. ACP NationalsAmerican College of Physicians National Meeting.
• Holbrook, E. D., Malo, J., Zangeneh, T. T., Strawter, C., Oren, E., Robey, I., Erickson, H., Chahal, R., Durkin, M., Thompson, C., Hoover, S. E., Ampel, N., Wheat, L. J., & Knox, K. S. (2016, Fall). Development of an Improved Antibody Detection EIA for use in Diagnosis of Coccidioidomycosis. ID Week. New Orleans, LA.
• Zangeneh, T. T. (2016, February). Aggressive Multidisciplinary Approach Reduces Mortality in Rhinocerebral Mucormycosis. 26th Annual North American Skull Base Society Meeting. Scottsdale, AZ.
• Zangeneh, T. T. (2016, November 2016). First report of coccidioidomycosis associated with Kikuchi-Fujimoto disease. ACP, Phoenix Chapter. Phoenix, Arizona: ACP.
• Zangeneh, T. T. (2016, November 2016). Sweet syndrome and coccidioidomycosis: a case report. ACP, Arizona Chapter. Phoenix, Arizona: ACP.
• Zangeneh, T. T., & Manjinder, . (2016, November 2016). Association between false positive antineutrophilic cytoplasmic antibodies and pulmonary coccidioidomycosis: first case report. ACP, Arizona Chapter. Phoenix, Arizona: ACP.
• Holbrook, E. D., Zangeneh, T. T., Malo, J., Strawter, C., Oren, E., Robey, I., Erickson, H., Chahal, R., Thompson, C., Ampel, N., Wheat, L. J., & Knox, K. S. (2015, October). Development of an improved antibody detection EIA for use in detection of coccidioidomycosis. ID Week 2015.
• Zangeneh, T. T. (2015, July). Disseminated Nocardia Infection in a Cardiac Transplant Recipient with a Sternotomy Wound Infection Caused by Rhizopus Species. Critical Care Congress. Phoenix, AZ.
• Zangeneh, T. T. (2015, May). Intravenous Immunoglobulin Induced Pulmonary Embolism: It is Time To Act. ACP National Abstract Competitions.
  More info

  Winner: top posters.
• Zangeneh, T. T. (2015, November 2015). Bone Marrow Biopsy in the Rapid Diagnosis of Disseminated Mycobacterium Avium-Intracellulare in a Renal Transplant Recipient. ACP, Arizona Chapter. Tucson, Arizona: ACP.
• Zangeneh, T. T. (2015, November). A case of Invasive Apsergillosis causing a False Positive Histoplasma Urinary Antigen. Arizona Chapter of the ACP. Phoenix, Arizona: ACP.
• Zangeneh, T. T. (2015, November). Intra-abdominal Coccidioidomycosis. Arizona Chapter of the ACP.
• Zangeneh, T. T. (2015, November). Toxic Shock Syndrome related to Intrauterine Device (IUD). Arizona Chapter of the ACP.
• Zangeneh, T. T. (2015, October). Development of an Improved Antibody Detection EIA for use in Detection of Coccidioidomycosis. IDSA National Conference. San Diego, CA.
• Evans-Lomayesva, S., Ferreira, J. P., & Zangeneh, T. T. (2013, December). Rocky Mountain Spotted Fever Among Native Americans in Arizona. American College of Physicians.
• Farran, S., & Zangeneh, T. T. (2013, September). Recurrent Oralabial Herpes associated with sepsis. American College of Physicians.

Creative Productions

• Zangeneh, T. T. (2016. WiRED International article and review of education material for healthcare providers about Zika and its relationship to microcephaly. WiRED InternationalWiRED International.

Other Teaching Materials

• Zangeneh, T. T. (2016. Educational video production regarding Zika Virus Infection for advanced high school science students. NIAID.
• Zangeneh, T. T. (2016. Elder Care A Resource for Interprofessional Providers: Presentation of Common Infections in Older Adults, Portal of Geriatrics Online Education (POGOe). Portal of Geriatrics Online Education (POGOe).

Others

• Zangeneh, T. T. (2014, July). Infectious Disease Blog. Tucson Osteopathic Medicine Association.
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  Newsletter for physicians.
• Zangeneh, T. T. (2014, October). Ebola Preparedness. University of Arizona Press, University of Arizona, School of Journalism.
• Zangeneh, T. T. (2014, October). Ebola Virus and UAHN Response - An Informational Conference. Tucson Channel 13 News.
• Zangeneh, T. T. (2013, December). NIH funded Virtual Clinical Research Center at the University of Arizona.
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  Video interview regarding research work and interests in the area of infectious disease for advanced high school science students.
• Zangeneh, T. T. (2013, September). Hunting the Nightmare Bacteria. PBS Frontline.
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  Participated in this hour-long documentary exposing the reality and complicated story of antibiotic-resistant bacteria around the world.
• Zangeneh, T. T. (2012, August). Dengue Infection: Clinical Presentation, diagnosis, and treatment. The School of Theatre, Film & Television at the University of Arizona.