Scholars@Duke
Manuela Carugati

Manuela Carugati

Adjunct Associate Professor in the Department of Medicine
Medicine, Infectious Diseases
manuela.carugati@duke.edu
148 Hanes House, 315 Trent Dr, Durham, NC 27710
148 Hanes House, 315 Trent Drive, Durham, NC 27710

Scholarly Works - Journal articles

Population Structure of Escherichia coli Isolated From the Human Bloodstream, Human and Animal Feces, and the Environment in Northern Tanzania.

Journal article J Infect Dis · January 17, 2026 BACKGROUND: Extraintestinal pathogenic Escherichia coli (ExPEC) are a leading cause of human bloodstream infections (BSIs) in sub-Saharan Africa, yet few studies have characterized African strains implicated in BSI or explored their potential reservoirs. M ... Full text Link to item Cite

Assessing blood culture appropriateness in solid organ transplant recipients: a diagnostic stewardship approach.

Journal article Infect Control Hosp Epidemiol · December 2025 OBJECTIVE: Diagnostic stewardship of blood culture utilization is important to mitigate the risks associated with unnecessary culturing. Although blood culture algorithms have been studied previously, there is a lack of data on their application among soli ... Full text Open Access Link to item Cite

Application of plasma cell-free metagenomic next-generation sequencing for the identification of Aspergillus fumigatus donor-derived infections among solid organ transplant recipients.

Journal article Med Mycol Case Rep · December 2025 A cluster of Aspergillus fumigatus donor-derived infections (DDI) was rapidly diagnosed using plasma metagenomic next-generation sequencing (mNGS) among solid organ transplant recipients. The heart recipient, experiencing marginal hemodynamics, underwent a ... Full text Link to item Cite

Disseminated cutaneous blastomycosis in a liver transplant recipient: A case report.

Journal article Med Mycol Case Rep · December 2025 Blastomyces dermatitidis, a dimorphic fungal infection endemic to North America, is typically associated with pulmonary disease, but may also disseminate. We report the case of a 54-year-old female liver transplant recipient who developed blastomycosis wit ... Full text Link to item Cite

Epidemiologic and Genomic Characterization of an Outbreak of Rift Valley Fever Among Humans and Dairy Cattle in Northern Tanzania.

Journal article J Infect Dis · August 14, 2025 BACKGROUND: A periurban outbreak of Rift Valley fever virus (RVFV) among dairy cattle from May through August 2018 in northern Tanzania was detected through testing samples from prospective livestock abortion surveillance. We sought to identify concurrent ... Full text Link to item Cite

Invasive surgical site infections after lung transplantation: contemporary risk factors and associated clinical outcomes.

Journal article JHLT Open · August 2025 BACKGROUND: Invasive primary surgical site infections (IP-SSI) complicate lung transplant (LT) surgery. Identification of IP-SSI risk factors is critical to IP-SSI prevention. METHODS: This single-center retrospective cohort study of adult patients who und ... Full text Open Access Link to item Cite

A change of heart: Limitations of National Healthcare Safety Network (NHSN) and Society of Thoracic Surgeons (STS) surveillance strategies in identifying surgical site infections after heart transplant surgery.

Journal article Am J Infect Control · July 2025 Surgical site infections (SSI) surveillance after heart transplantation is critical for preventing SSI. We analyzed the accuracy of 3 SSI surveillance systems: National-Healthcare-Safety-Network (NHSN), Society-of-Thoracic-Surgeons (STS), and detailed manu ... Full text Link to item Cite

The tell-tale hearts: Donor-derived invasive fungal infections among orthotopic heart transplant recipients.

Journal article Med Mycol Case Rep · June 2025 Donor-derived invasive fungal infections among solid organ transplant recipients are rare but sometimes devastating events associated with notable morbidity and mortality. Here we describe two donor-derived fungal infections - one Candida parapsilosis comp ... Full text Link to item Cite

HOPE in every breath and heartbeat: Understanding transplant eligibility, access barriers, and clinical outcomes in thoracic transplantation in persons with HIV.

Journal article JHLT Open · May 2025 BACKGROUND: Persons with human immunodeficiency virus (PWH) are living longer, leading to increased end-organ disease from chronic illness. Organ transplantation improves survival in patients with end-organ disease yet remains a constrained resource due to ... Full text Link to item Cite

TaqMan Array Card real-time polymerase chain reaction panel to detect pathogens in whole blood of febrile inpatients in northern Tanzania, 2016-2019.

Journal article Trop Med Int Health · March 2025 BACKGROUND: Acute febrile illness is a common reason for seeking healthcare in low- and middle-income countries. We describe the diagnostic utility of a TaqMan Array Card (TAC) real-time polymerase chain reaction (PCR) panel for pathogen detection in paedi ... Full text Link to item Cite

Bacillus Calmette-Guerin (BCG) infections following intravesical BCG immunotherapy: a systematic review protocol.

Journal article Syst Rev · January 22, 2025 BACKGROUND: Although intravesical Bacillus Calmette-Guerin (BCG) immunotherapy usually exhibits a favorable safety profile, it can lead to the development of BCG infections, both localized and disseminated. Understanding of BCG infections following intrave ... Full text Open Access Link to item Cite

Epidemiology of Infections in Lung Transplant Recipients Treated With Belatacept.

Journal article Transpl Infect Dis · 2025 BACKGROUND: Belatacept is a costimulatory blocker that can be used to prevent and treat rejection in lung transplant recipients (LuTRs). The epidemiology of infections in belatacept-treated LuTRs has not been systematically evaluated. METHODS: We performed ... Full text Link to item Cite

Risk Factors for Invasive Surgical Site Infections Among Adult Single Liver Transplant Recipients at Duke University Hospital in the Period 2015-2020.

Journal article Transplant Direct · December 2024 BACKGROUND: Invasive primary surgical site infections (IP-SSI) are a severe complication of liver transplant surgery. Identification of risk factors for IP-SSI is critical to IP-SSI prevention. METHODS: All adult single liver transplants performed at Duke ... Full text Open Access Link to item Cite

Late surgical site infections among solid organ transplant recipients: an unrecognized clinical entity.

Journal article Infect Control Hosp Epidemiol · October 2024 This study identified 26 late invasive primary surgical site infection (IP-SSI) within 4-12 months of transplantation among 2073 SOT recipients at Duke University Hospital over the period 2015-2019. Thoracic organ transplants accounted for 25 late IP-SSI. ... Full text Link to item Cite

Real-World Experience With Maribavir for Treatment of Cytomegalovirus Infection in High-Risk Solid Organ Transplant Recipients.

Journal article Open Forum Infect Dis · July 2024 We evaluated use of maribavir (MBV) for treatment of 15 episodes of refractory/resistant cytomegalovirus infection in 13 solid organ transplant recipients. Treatment failure due to treatment-emergent MBV resistance or early virological recurrence after MBV ... Full text Link to item Cite

Limitations of antifungal prophylaxis in preventing invasive Candida surgical site infections after liver transplant surgery.

Journal article Antimicrob Agents Chemother · March 6, 2024 Invasive primary Candida surgical site infections (IP-SSIs) are a common complication of liver transplantation, and targeted antifungal prophylaxis is an efficient strategy to limit their occurrence. We performed a retrospective single-center cohort study ... Full text Link to item Cite

Global distribution of Leptospira serovar isolations and detections from animal host species: A systematic review and online database.

Journal article Trop Med Int Health · March 2024 OBJECTIVES: Leptospira, the spirochaete causing leptospirosis, can be classified into >250 antigenically distinct serovars. Although knowledge of the animal host species and geographic distribution of Leptospira serovars is critical to understand the human ... Full text Link to item Cite

Prevalence and risk factors for human leptospirosis at a hospital serving a pastoralist community, Endulen, Tanzania.

Journal article PLoS Negl Trop Dis · December 2023 BACKGROUND: Leptospirosis is suspected to be a major cause of illness in rural Tanzania associated with close contact with livestock. We sought to determine leptospirosis prevalence, identify infecting Leptospira serogroups, and investigate risk factors fo ... Full text Open Access Link to item Cite

Global distribution of Leptospira serovar isolations and detections from animal host species: a systematic review and online database.

Journal article medRxiv · October 3, 2023 OBJECTIVES: Leptospira, the spirochaete causing leptospirosis, can be classified into >250 antigenically distinct serovars. Although knowledge of the animal host species and geographic distribution of Leptospira serovars is critical to understand the human ... Full text Open Access Link to item Cite

Antibacterial Utilization for Febrile Illnesses and Laboratory-Confirmed Bloodstream Infections in Northern Tanzania.

Journal article Open Forum Infect Dis · August 2023 BACKGROUND: We describe antibacterial use in light of microbiology data and treatment guidelines for common febrile syndromes in Moshi, Tanzania. METHODS: We compared data from 2 hospital-based prospective cohort studies, cohort 1 (2011-2014) and cohort 2 ... Full text Open Access Link to item Cite

'One Health´ approach to end zoonotic TB.

Journal article Int J Tuberc Lung Dis · February 1, 2023 Mycobacterium bovis has a wide host range causing TB in animals, both in wildlife and cattle (bovine TB bTB), and in humans (zoonotic TB zTB). The real burden of bovine and zoonotic TB (b/zTB) remains unknown due to diagnostic challenges. Although progress ... Full text Open Access Link to item Cite

Epidemiology of surgical site infections after solid organ transplants in the period 2015-2019: A single-center retrospective cohort study.

Journal article Am J Transplant · December 2022 Surgical site infections (SSI) are severe complications of solid organ transplant (SOT). This retrospective study assessed the epidemiology of and outcomes associated with invasive primary SSI (IP-SSI) occurring within 3 months of transplantation in adult ... Full text Open Access Link to item Cite

Performance of Xpert Ultra nasopharyngeal swab for identification of tuberculosis deaths in northern Tanzania.

Journal article Clin Microbiol Infect · August 2022 OBJECTIVE: Numerous tuberculosis (TB) deaths remain undetected in low-resource endemic settings. With autopsy-confirmed tuberculosis as our standard, we assessed the diagnostic performance of Xpert MTB/RIF Ultra (Ultra; Cepheid) on nasopharyngeal specimens ... Full text Open Access Link to item Cite

Facility-based disease surveillance and Bayesian hierarchical modeling to estimate endemic typhoid fever incidence, Kilimanjaro Region, Tanzania, 2007-2018.

Journal article PLoS Negl Trop Dis · July 2022 Growing evidence suggests considerable variation in endemic typhoid fever incidence at some locations over time, yet few settings have multi-year incidence estimates to inform typhoid control measures. We sought to describe a decade of typhoid fever incide ... Full text Open Access Link to item Cite

Incidence Estimates of Acute Q Fever and Spotted Fever Group Rickettsioses, Kilimanjaro, Tanzania, from 2007 to 2008 and from 2012 to 2014.

Journal article Am J Trop Med Hyg · December 20, 2021 Q fever and spotted fever group rickettsioses (SFGR) are common causes of severe febrile illness in northern Tanzania. Incidence estimates are needed to characterize the disease burden. Using hybrid surveillance-coupling case-finding at two referral hospit ... Full text Open Access Link to item Cite

Trends in fever case management for febrile inpatients in a low malaria incidence setting of Tanzania.

Journal article Trop Med Int Health · December 2021 OBJECTIVES: In 2010, WHO published guidelines emphasising parasitological confirmation of malaria before treatment. We present data on changes in fever case management in a low malaria transmission setting of northern Tanzania after 2010. METHODS: We compa ... Full text Open Access Link to item Cite

Performance Assessment of the Universal Vital Assessment Score vs Other Illness Severity Scores for Predicting Risk of In-Hospital Death Among Adult Febrile Inpatients in Northern Tanzania, 2016-2019.

Journal article JAMA Netw Open · December 1, 2021 IMPORTANCE: Severity scores are used to improve triage of hospitalized patients in high-income settings, but the scores may not translate well to low- and middle-income settings such as sub-Saharan Africa. OBJECTIVE: To assess the performance of the Univer ... Full text Open Access Link to item Cite

Aspiration Risk Factors, Microbiology, and Empiric Antibiotics for Patients Hospitalized With Community-Acquired Pneumonia.

Journal article Chest · January 2021 BACKGROUND: Aspiration community-acquired pneumonia (ACAP) and community-acquired pneumonia (CAP) in patients with aspiration risk factors (AspRFs) are infections associated with anaerobes, but limited evidence suggests their pathogenic role. RESEARCH QUES ... Full text Open Access Link to item Cite

Investigation of Melioidosis Using Blood Culture and Indirect Hemagglutination Assay Serology among Patients with Fever, Northern Tanzania.

Journal article Am J Trop Med Hyg · December 2020 Prediction models indicate that melioidosis may be common in parts of East Africa, but there are few empiric data. We evaluated the prevalence of melioidosis among patients presenting with fever to hospitals in Tanzania. Patients with fever were enrolled a ... Full text Open Access Link to item Cite

Fatal respiratory infection due to ST308 VIM-1-producing Pseudomonas aeruginosa in a lung transplant recipient: case report and review of the literature.

Journal article BMC Infect Dis · August 26, 2020 BACKGROUND: Data regarding the prevalence of metallo-β-lactamases (MBLs) among Pseudomonas aeruginosa isolates in cystic fibrosis patients are scarce. Furthermore, there is limited knowledge on the effect of MBL production on patient outcomes. Here we desc ... Full text Open Access Link to item Cite

Bacterial etiology of community-acquired pneumonia in immunocompetent hospitalized patients and appropriateness of empirical treatment recommendations: an international point-prevalence study.

Journal article Eur J Clin Microbiol Infect Dis · August 2020 An accurate knowledge of the epidemiology of community-acquired pneumonia (CAP) is key for selecting appropriate antimicrobial treatments. Very few etiological studies assessed the appropriateness of empiric guideline recommendations at a multinational lev ... Full text Open Access Link to item Cite

Interleukin-1 receptor antagonist anakinra in association with remdesivir in severe COVID-19: A case report.

Journal article Int J Infect Dis · August 2020 We report the first successful treatment with the IL-1 receptor antagonist anakinra, in association with the most promising and available antiviral therapy, of a severe case of novel coronavirus disease 2019 (COVID-19). We describe the diagnosis, clinical ... Full text Open Access Link to item Cite

A prospective study of Escherichia coli bloodstream infection among adolescents and adults in northern Tanzania.

Journal article Trans R Soc Trop Med Hyg · May 7, 2020 BACKGROUND: Characterization of the epidemiology of Escherichia coli bloodstream infection (BSI) in sub-Saharan Africa is lacking. We studied patients with E. coli BSI in northern Tanzania to describe host risk factors for infection and to describe the ant ... Full text Open Access Link to item Cite

Challenges in the Diagnosis and Management of Bacterial Lung Infections in Solid Organ Recipients: A Narrative Review.

Journal article Int J Mol Sci · February 12, 2020 Respiratory infections pose a significant threat to the success of solid organ transplantation, and the diagnosis and management of these infections are challenging. The current narrative review addressed some of these challenges, based on evidence from th ... Full text Open Access Link to item Cite

Zoonotic causes of febrile illness in malaria endemic countries: a systematic review.

Journal article Lancet Infect Dis · February 2020 Fever is one of the most common reasons for seeking health care globally and most human pathogens are zoonotic. We conducted a systematic review to describe the occurrence and distribution of zoonotic causes of human febrile illness reported in malaria end ... Full text Open Access Link to item Cite

International prevalence and risk factors evaluation for drug-resistant Streptococcus pneumoniae pneumonia.

Journal article J Infect · October 2019 OBJECTIVE: Streptococcus pneumoniae is the most frequent bacterial pathogen isolated in subjects with Community-acquired pneumonia (CAP) worldwide. Limited data are available regarding the current global burden and risk factors associated with drug-resista ... Full text Open Access Link to item Cite

Fever, bacterial zoonoses, and One Health in sub-Saharan Africa.

Journal article Clin Med (Lond) · September 2019 Although often underappreciated, a number of bacterial zoonoses are endemic in Africa. Of these, brucellosis, leptospirosis, Q fever, and rickettsioses are responsible for a substantial proportion of febrile illness among patients seeking hospital care. In ... Full text Open Access Link to item Cite

The hidden hypothesis: A disseminated tuberculosis case.

Journal article Int J Infect Dis · August 2019 CASE PRESENTATION: 77-year-old former smoker admitted because of fatigue and abdominal distention. Past medical history positive for two previous hospitalizations for pericardial and pleural effusions (no diagnosis achieved). At admission erythrocyte sedim ... Full text Open Access Link to item Cite

Prevalence and Etiology of Community-acquired Pneumonia in Immunocompromised Patients.

Journal article Clin Infect Dis · April 24, 2019 BACKGROUND: The correct management of immunocompromised patients with pneumonia is debated. We evaluated the prevalence, risk factors, and characteristics of immunocompromised patients coming from the community with pneumonia. METHODS: We conducted a secon ... Full text Open Access Link to item Cite

Methicillin-resistant Staphylococcus aureus: an overview of basic and clinical research.

Journal article Nat Rev Microbiol · April 2019 Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most successful modern pathogens. The same organism that lives as a commensal and is transmitted in both health-care and community settings is also a leading cause of bacteraemia, endocarditi ... Full text Open Access Link to item Cite

An international perspective on hospitalized patients with viral community-acquired pneumonia.

Journal article Eur J Intern Med · February 2019 BACKGROUND: Who should be tested for viruses in patients with community acquired pneumonia (CAP), prevalence and risk factors for viral CAP are still debated. We evaluated the frequency of viral testing, virus prevalence, risk factors and treatment coverag ... Full text Open Access Link to item Cite

Management of Acute Respiratory Failure Due to Community-Acquired Pneumonia: A Systematic Review.

Journal article Med Sci (Basel) · January 14, 2019 Community-acquired pneumonia (CAP) is a leading cause of mortality worldwide. CAP mortality is driven by the development of sepsis and acute respiratory failure (ARF). We performed a systematic review of the available English literature published in the pe ... Full text Open Access Link to item Cite

Microbiological testing of adults hospitalised with community-acquired pneumonia: an international study.

Journal article ERJ Open Res · October 2018 This study aimed to describe real-life microbiological testing of adults hospitalised with community-acquired pneumonia (CAP) and to assess concordance with the 2007 Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) and 2011 Eur ... Full text Open Access Link to item Cite

Effect of Algorithm-Based Therapy vs Usual Care on Clinical Success and Serious Adverse Events in Patients with Staphylococcal Bacteremia: A Randomized Clinical Trial.

Journal article JAMA · September 25, 2018 IMPORTANCE: The appropriate duration of antibiotics for staphylococcal bacteremia is unknown. OBJECTIVE: To test whether an algorithm that defines treatment duration for staphylococcal bacteremia vs standard of care provides noninferior efficacy without in ... Full text Open Access Link to item Cite

Burden and risk factors for Pseudomonas aeruginosa community-acquired pneumonia: a multinational point prevalence study of hospitalised patients.

Journal article Eur Respir J · August 2018 Pseudomonas aeruginosa is a challenging bacterium to treat due to its intrinsic resistance to the antibiotics used most frequently in patients with community-acquired pneumonia (CAP). Data about the global burden and risk factors associated with P. aerugin ... Full text Open Access Link to item Cite

Incidence of human brucellosis in the Kilimanjaro Region of Tanzania in the periods 2007-2008 and 2012-2014.

Journal article Trans R Soc Trop Med Hyg · March 1, 2018 BACKGROUND: Brucellosis causes substantial morbidity among humans and their livestock. There are few robust estimates of the incidence of brucellosis in sub-Saharan Africa. Using cases identified through sentinel hospital surveillance and health care utili ... Full text Open Access Link to item Cite

Influence of vancomycin minimum inhibitory concentration on the outcome of methicillin-susceptible Staphylococcus aureus left-sided infective endocarditis treated with antistaphylococcal β-lactam antibiotics: a prospective cohort study by the International Collaboration on Endocarditis.

Journal article Clin Microbiol Infect · August 2017 OBJECTIVES: Left-sided methicillin-susceptible Staphylococcus aureus (MSSA) endocarditis treated with cloxacillin has a poorer prognosis when the vancomycin minimum inhibitory concentration (MIC) is ≥1.5 mg/L. We aimed to validate this using the Internatio ... Full text Open Access Link to item Cite

Individualizing duration of antibiotic therapy in community-acquired pneumonia.

Journal article Pulm Pharmacol Ther · August 2017 International experts suggest tailoring antibiotic duration in community-acquired pneumonia (CAP) according to patients' characteristics. We aimed to assess the effectiveness of an individualized approach to antibiotic duration based on time in which CAP p ... Full text Open Access Link to item Cite

Global initiative for meticillin-resistant Staphylococcus aureus pneumonia (GLIMP): an international, observational cohort study.

Journal article Lancet Infect Dis · December 2016 BACKGROUND: Antibiotic resistance is a major global health problem and pathogens such as meticillin-resistant Staphylococcus aureus (MRSA) have become of particular concern in the management of lower respiratory tract infections. However, few data are avai ... Full text Open Access Link to item Cite

Antistaphylococcal β-Lactams versus Vancomycin for Treatment of Infective Endocarditis Due to Methicillin-Susceptible Coagulase-Negative Staphylococci: a Prospective Cohort Study from the International Collaboration on Endocarditis.

Journal article Antimicrob Agents Chemother · October 2016 The phenotypic expression of methicillin resistance among coagulase-negative staphylococci (CoNS) is heterogeneous regardless of the presence of the mecA gene. The potential discordance between phenotypic and genotypic results has led to the use of vancomy ... Full text Open Access Link to item Cite

Exogenous reinfection of tuberculosis in a low-burden area.

Journal article Infection · December 2015 PURPOSE: Recurrence of tuberculosis (TB) can be the consequence of relapse or exogenous reinfection. The study aimed to assess the factors associated with exogenous TB reinfection. METHODS: Prospective cohort study based on the TB database, maintained at t ... Full text Open Access Link to item Cite

De-escalation therapy among bacteraemic patients with community-acquired pneumonia.

Journal article Clin Microbiol Infect · October 2015 There is no evidence supporting the use of de-escalation therapy (DET) among patients with community-acquired pneumonia (CAP). We assessed the outcomes associated with DET among bacteraemic CAP patients. We performed a secondary analysis of the Community-A ... Full text Open Access Link to item Cite

How to choose the duration of antibiotic therapy in patients with pneumonia.

Journal article Curr Opin Infect Dis · April 2015 PURPOSE OF REVIEW: The appropriate duration of antimicrobial treatment in patients with pneumonia remains a matter of controversy. The purpose of this article is to review different approaches that have been used to determine the duration of antimicrobial ... Full text Open Access Link to item Cite

A new predictive model for an improved respiratory isolation strategy in HIV-infected patients with PTB.

Journal article Int J Tuberc Lung Dis · July 2014 SETTING: Luigi Sacco Hospital, Milan, Italy, 1 January 2000-31 December 2010. OBJECTIVES: To develop a predictive score for identifying human immunodeficiency virus (HIV) infected patients with pulmonary tuberculosis (PTB). DESIGN: Retrospective study base ... Full text Open Access Link to item Cite

Mycobacterium tuberculosis Beijing family: analysis of the epidemiological and clinical factors associated with an emerging lineage in the urban area of Milan.

Journal article Infect Genet Evol · July 2014 The Mycobacterium tuberculosis Beijing genotype raises major concern because of global spreading, hyper-virulence and association with multi-drug resistance (MDR). The aims of the study were to evaluate role of Beijing family in the epidemiological setting ... Full text Open Access Link to item Cite

High-dose daptomycin therapy for left-sided infective endocarditis: a prospective study from the international collaboration on endocarditis.

Journal article Antimicrob Agents Chemother · December 2013 The use of daptomycin in Gram-positive left-sided infective endocarditis (IE) has significantly increased. The purpose of this study was to assess the influence of high-dose daptomycin on the outcome of left-sided IE due to Gram-positive pathogens. This wa ... Full text Open Access Link to item Cite

Systemic lupus erythematosus and HIV infection: a whimsical relationship. Reports of two cases and review of the literature.

Journal article Clin Rheumatol · September 2013 UNLABELLED: Systemic lupus erythematosus (SLE) is rarely reported in association with HIV infection. We describe two unpredictable cases and provide a review of the literature. Retrospective analysis of the medical records of two HIV-infected patients diag ... Full text Open Access Link to item Cite

Influence of Hospitalization upon Diagnosis on the Risk of Tuberculosis Clustering.

Journal article Mediterr J Hematol Infect Dis · 2013 SETTING: Culture-positive tuberculosis (TB) diagnosed in the metropolitan area of Milan (Italy) over a 5-year period (1995-1999). OBJECTIVE: To assess the impact of short-course hospitalization upon diagnosis on the overall risk of TB clustering. DESIGN: R ... Full text Open Access Link to item Cite