Scholars@Duke
Megan Elizabeth Reller

Megan Elizabeth Reller

Associate Professor of Medicine
Medicine, Infectious Diseases
megan.reller@duke.edu
178 Hanes Hse, Box 102359, Durham, NC 27710

Selected Publications

Patterns of care-seeking for postpartum symptoms in urban Karachi, Pakistan: implications for intervention design.

Journal Article Reprod Health · April 16, 2025 BACKGROUND: In Pakistan, the maternal mortality rate is 186/100,000 live births, with postpartum (PP) or maternal sepsis being the third leading cause of maternal deaths. Delays in early identification and timely management of PP sepsis are associated with ... Full text Link to item Cite

Viral Acute Lower Respiratory Tract Infections (ALRI) in Rural Bangladeshi Children Prior to the COVID-19 Pandemic.

Journal Article Influenza Other Respir Viruses · December 2024 BACKGROUND: Acute lower respiratory tract infections (ALRIs) remain the leading infectious cause of death among children < 5 years, with viruses contributing to a large proportion of cases. Little is known about the epidemiology and etiology of viral ALRI ... Full text Link to item Cite

Emerging Tick-borne Infections in the Upper Midwest and Northeast United States Among Patients With Suspected Anaplasmosis.

Journal Article Open Forum Infect Dis · April 2024 BACKGROUND: Emerging tick-transmitted illnesses are increasingly recognized in the United States (US). To identify multiple potential tick-borne pathogens in patients from the Upper Midwest and Northeast US with suspected anaplasmosis, we used state-of-the ... Full text Link to item Cite

Ehrlichiosis and Anaplasmosis

Chapter · January 1, 2024 Full text Cite

Q Fever (Coxiella burnetii)

Chapter · January 1, 2024 Full text Cite

Introduction

Chapter · January 1, 2024 Full text Cite

Host-response transcriptional biomarkers accurately discriminate bacterial and viral infections of global relevance.

Journal Article Sci Rep · December 18, 2023 Diagnostic limitations challenge management of clinically indistinguishable acute infectious illness globally. Gene expression classification models show great promise distinguishing causes of fever. We generated transcriptional data for a 294-participant ... Full text Link to item Cite

RADx-UP Testing Core: Access to COVID-19 Diagnostics in Community-Engaged Research with Underserved Populations.

Journal Article J Clin Microbiol · August 23, 2023 Research on the COVID-19 pandemic revealed a disproportionate burden of COVID-19 infection and death among underserved populations and exposed low rates of SARS-CoV-2 testing in these communities. A landmark National Institutes of Health (NIH) funding init ... Full text Open Access Link to item Cite

Use of Structured Electronic Health Records Data Elements for the Development of Computable Phenotypes to Identify Potential Adverse Events Associated with Intravenous Immunoglobulin Infusion.

Journal Article Drug Saf · March 2023 INTRODUCTION: Detection of adverse reactions to drugs and biologic agents is an important component of regulatory approval and post-market safety evaluation. Real-world data, including insurance claims and electronic health records data, are increasingly u ... Full text Link to item Cite

Ehrlichia, Anaplasma, and related intracellular bacteria

Chapter · June 3, 2022 Members of the genus Ehrlichia and Anaplasma are now recognized to be important human pathogens. They are obligate intracellular bacteria currently placed in the Proteobacteria phylum ( Alphaproteobacteria ), order Rickettsiales , and family Anaplasmatacea ... Full text Cite

Salmonella Species

Chapter · January 1, 2022 Full text Cite

The Host Response to Viral Infections Reveals Common and Virus-Specific Signatures in the Peripheral Blood.

Journal Article Front Immunol · 2021 Viruses cause a wide spectrum of clinical disease, the majority being acute respiratory infections (ARI). In most cases, ARI symptoms are similar for different viruses although severity can be variable. The objective of this study was to understand the sha ... Full text Open Access Link to item Cite

Effectiveness of the 10-valent pneumococcal conjugate vaccine against radiographic pneumonia among children in rural Bangladesh: A case-control study.

Journal Article Vaccine · September 2020 BackgroundPneumococcal conjugate vaccine (PCV) effectiveness against radiographic pneumonia in South Asia is unknown. Bangladesh introduced PCV10 in 2015 using a three dose primary series (3 + 0). We sought to measure PCV10 effectiveness for two o ... Full text Cite

Optimization and Evaluation of a Multiplex Quantitative PCR Assay for Detection of Nucleic Acids in Human Blood Samples from Patients with Spotted Fever Rickettsiosis, Typhus Rickettsiosis, Scrub Typhus, Monocytic Ehrlichiosis, and Granulocytic Anaplasmosis.

Journal Article J Clin Microbiol · August 24, 2020 Spotted fever group rickettsioses (SFGR), typhus group rickettsioses (TGR), scrub typhus (caused by Orientia tsutsugamushi), ehrlichiosis, and anaplasmosis often present as undifferentiated fever but are not treated by agents (penicillins and cephalosporin ... Full text Link to item Cite

Rickettsioses as Major Etiologies of Unrecognized Acute Febrile Illness, Sabah, East Malaysia.

Journal Article Emerg Infect Dis · July 2020 Orientia tsutsugamushi, spotted fever group rickettsioses, and typhus group rickettsioses (TGR) are reemerging causes of acute febrile illness (AFI) in Southeast Asia. To further delineate extent, we enrolled patients >4 weeks of age with nonmalarial AFI i ... Full text Link to item Cite

Geospatial analysis of dengue emergence in rural areas in the Southern Province of Sri Lanka.

Conference Trans R Soc Trop Med Hyg · June 1, 2020 BACKGROUND: Dengue is a major cause of acute febrile illness in Sri Lanka. Dengue has historically been considered an urban disease. In 2012-2013, we documented that acute dengue was surprisingly associated with self-reported rural residence in the Souther ... Full text Link to item Cite

Previously Derived Host Gene Expression Classifiers Identify Bacterial and Viral Etiologies of Acute Febrile Respiratory Illness in a South Asian Population.

Journal Article Open Forum Infect Dis · June 2020 BACKGROUND: Pathogen-based diagnostics for acute respiratory infection (ARI) have limited ability to detect etiology of illness. We previously showed that peripheral blood-based host gene expression classifiers accurately identify bacterial and viral ARI i ... Full text Open Access Link to item Cite

Respiratory Viral Infection: An Underappreciated Cause of Acute Febrile Illness Admissions in Southern Sri Lanka.

Journal Article Am J Trop Med Hyg · March 2019 The contribution of respiratory viruses to acute febrile illness (AFI) burden is poorly characterized. We describe the prevalence, seasonality, and clinical features of respiratory viral infection among AFI admissions in Sri Lanka. We enrolled AFI patients ... Full text Link to item Cite

Chest radiograph reading panel performance in a Bangladesh pneumococcal vaccine effectiveness study.

Journal Article BMJ Open Respir Res · 2019 INTRODUCTION: To evaluate WHO chest radiograph interpretation processes during a pneumococcal vaccine effectiveness study of children aged 3-35 months with suspected pneumonia in Sylhet, Bangladesh. METHODS: Eight physicians masked to all data were standar ... Full text Link to item Cite

Evaluation of the WHO 2009 classification for diagnosis of acute dengue in a large cohort of adults and children in Sri Lanka during a dengue-1 epidemic.

Journal Article PLoS Negl Trop Dis · February 2018 BACKGROUND: Dengue is a leading cause of fever and mimics other acute febrile illnesses (AFI). In 2009, the World Health Organization (WHO) revised criteria for clinical diagnosis of dengue. METHODOLOGY/PRINCIPAL FINDINGS: The new WHO 2009 classification o ... Full text Link to item Cite

Development and Clinical Validation of a Multiplex Real-Time Quantitative PCR Assay for Human Infection by Anaplasma phagocytophilum and Ehrlichia chaffeensis.

Journal Article Trop Med Infect Dis · January 29, 2018 BACKGROUND: Human granulocytic anaplasmosis (HGA), caused by Anaplasma phagocytophilum, and human monocytic ehrlichiosis (HME), caused by Ehrlichia chaffeensis, often present as undifferentiated fever but are not treated by typical empiric regimens for acu ... Full text Link to item Cite

Estimated seroprevalence of Anaplasma spp. and spotted fever group Rickettsia exposure among herders and livestock in Mongolia.

Journal Article Acta Trop · January 2018 BACKGROUND: To better understand the epidemiology of tick-borne disease in Mongolia, a comprehensive seroprevalence study was conducted investigating exposure to Anaplasma spp. and spotted fever group (SFG) Rickettsia spp. in nomadic herders and their live ... Full text Link to item Cite

Burden and Seasonality of Viral Acute Respiratory Tract Infections among Outpatients in Southern Sri Lanka.

Journal Article Am J Trop Med Hyg · July 2017 In tropical and subtropical settings, the epidemiology of viral acute respiratory tract infections varies widely between countries. We determined the etiology, seasonality, and clinical presentation of viral acute respiratory tract infections among outpati ... Full text Link to item Cite

Analysis of Dengue Serotype 4 in Sri Lanka during the 2012-2013 Dengue Epidemic.

Journal Article Am J Trop Med Hyg · July 2017 The four serotypes of dengue virus (DENV-1, -2, -3, and -4) have had a rapidly expanding geographic range and are now endemic in over 100 tropical and subtropical countries. Sri Lanka has experienced periodic dengue outbreaks since the 1960s, but since 198 ... Full text Link to item Cite

Salmonella Species

Chapter · June 21, 2017 Full text Cite

First Identification and Description of Rickettsioses and Q Fever as Causes of Acute Febrile Illness in Nicaragua.

Journal Article PLoS Negl Trop Dis · December 2016 BACKGROUND: Rickettsial infections and Q fever present similarly to other acute febrile illnesses, but are infrequently diagnosed because of limited diagnostic tools. Despite sporadic reports, rickettsial infections and Q fever have not been prospectively ... Full text Link to item Cite

Emergence of Epidemic Dengue-1 Virus in the Southern Province of Sri Lanka.

Journal Article PLoS Negl Trop Dis · October 2016 BACKGROUND: Dengue is a frequent cause of acute febrile illness with an expanding global distribution. Since the 1960s, dengue in Sri Lanka has been documented primarily along the heavily urbanized western coast with periodic shifting of serotypes. Outbrea ... Full text Open Access Link to item Cite

Unsuspected Dengue as a Cause of Acute Febrile Illness in Children and Adults in Western Nicaragua.

Journal Article PLoS Negl Trop Dis · October 2016 BACKGROUND: Dengue is an emerging infectious disease of global significance. Suspected dengue, especially in children in Nicaragua's heavily-urbanized capital of Managua, has been well documented, but unsuspected dengue among children and adults with undif ... Full text Link to item Cite

Use of Peptide-Based Enzyme-Linked Immunosorbent Assay followed by Immunofluorescence Assay To Document Ehrlichia chaffeensis as a Cause of Febrile Illness in Nicaragua.

Journal Article J Clin Microbiol · June 2016 Ehrlichia chaffeensis, the etiologic agent of human monocytic ehrlichiosis (HME), has been extensively studied as a cause of acute febrile illness and an emerging tick-borne zoonosis in the United States. Limited data suggest its presence in other regions, ... Full text Link to item Cite

Diagnostic methods to determine microbiology of postpartum endometritis in South Asia: laboratory methods protocol used in the Postpartum Sepsis Study: a prospective cohort study.

Journal Article Reprod Health · February 25, 2016 BACKGROUND: The South Asian region has the second highest risk of maternal death in the world. To prevent maternal deaths due to sepsis and to decrease the maternal mortality ratio as per the World Health Organization Millenium Development Goals, a better ... Full text Link to item Cite

The development and evaluation of a community-based clinical diagnosis tool and treatment regimen for postpartum sepsis in Bangladesh and Pakistan.

Journal Article Reprod Health · February 25, 2016 BACKGROUND: Postpartum sepsis accounts for most maternal deaths between three and seven days postpartum, when most mothers, even those who deliver in facilities, are at home. Case fatality rates for untreated women are very high. Newborns of ill women have ... Full text Link to item Cite

Use of Rapid Influenza Testing to Reduce Antibiotic Prescriptions Among Outpatients with Influenza-Like Illness in Southern Sri Lanka.

Journal Article Am J Trop Med Hyg · November 2015 Acute respiratory tract infections (ARTIs) are a common reason for unnecessary antibiotic prescriptions worldwide. Our objective was to determine if providing access to rapid influenza test results could reduce antibiotic prescriptions for ARTIs in a resou ... Full text Link to item Cite

An under-recognized influenza epidemic identified by rapid influenza testing, southern Sri Lanka, 2013.

Journal Article Am J Trop Med Hyg · May 2015 Influenza accounts for a large burden of acute respiratory tract infections in high-income countries; data from lower-income settings are limited due to lack of confirmatory testing. Consecutive outpatients presenting to the largest tertiary care hospital ... Full text Link to item Cite

Detection of pathogen-specific antibodies by loop-mediated isothermal amplification.

Journal Article Clin Vaccine Immunol · April 2015 Loop-mediated isothermal amplification (LAMP) is a method for enzymatically replicating DNA that has great utility for clinical diagnosis at the point of care (POC), given its high sensitivity, specificity, speed, and technical requirements (isothermal con ... Full text Link to item Cite

Ehrlichia, Anaplasma, and Related Intracellular Bacteria

Chapter · January 1, 2015 Members of the genera Ehrlichia and Anaplasma are now recognized to be important human pathogens. Ehrlichia and Anaplasma species infect bone marrow-derived cells, such as granulocytes, monocytes, erythrocytes, and platelets, of humans and other mammals. E ... Full text Cite

Unsuspected leptospirosis is a cause of acute febrile illness in Nicaragua.

Journal Article PLoS Negl Trop Dis · July 2014 BACKGROUND: Epidemic severe leptospirosis was recognized in Nicaragua in 1995, but unrecognized epidemic and endemic disease remains unstudied. METHODOLOGY/PRINCIPAL FINDINGS: To determine the burden of and risk factors associated with symptomatic leptospi ... Full text Link to item Cite

Respiratory syncytial virus and seasonal influenza cause similar illnesses in children with sickle cell disease.

Journal Article Pediatr Blood Cancer · May 2014 BACKGROUND: Respiratory syncytial virus (RSV) is a cause of acute chest syndrome (ACS) in sickle cell disease (SCD), but its clinical course and acute complications have not been well characterized. We compared RSV to seasonal influenza infections in child ... Full text Link to item Cite

Multiplex 5' nuclease quantitative real-time PCR for clinical diagnosis of malaria and species-level identification and epidemiologic evaluation of malaria-causing parasites, including Plasmodium knowlesi.

Journal Article J Clin Microbiol · September 2013 Molecular diagnosis of malaria offers many potential advantages over microscopy, including identification of malaria to the species level in an era with few experienced microscopists. We developed high-throughput multiplex 5' nuclease quantitative PCR (qPC ... Full text Link to item Cite

Chikungunya as a cause of acute febrile illness in southern Sri Lanka.

Journal Article PLoS One · 2013 BACKGROUND: Chikungunya virus (CHIKV) re-emerged in Sri Lanka in late 2006 after a 40-year hiatus. We sought to identify and characterize acute chikungunya infection (CHIK) in patients presenting with acute undifferentiated febrile illness in unstudied rur ... Full text Open Access Link to item Cite

Unsuspected rickettsioses among patients with acute febrile illness, Sri Lanka, 2007.

Journal Article Emerg Infect Dis · May 2012 We studied rickettsioses in southern Sri Lanka. Of 883 febrile patients with paired serum samples, 156 (17.7%) had acute rickettsioses; rickettsioses were unsuspected at presentation. Additionally, 342 (38.7%) had exposure to spotted fever and/or typhus gr ... Full text Link to item Cite

Molecular detection and analysis of spotted fever group Rickettsia in patients with fever and rash at a tertiary care centre in Tamil Nadu, India.

Journal Article Pathog Glob Health · March 2012 BACKGROUND: Detection of specific targets by PCR is used to confirm a diagnosis of spotted fever, but serological tests are still widely used. In this prospective study, nested PCR was performed on skin biopsy specimens to confirm the diagnosis of spotted ... Full text Link to item Cite

Unsuspected dengue and acute febrile illness in rural and semi-urban southern Sri Lanka.

Journal Article Emerg Infect Dis · February 2012 Dengue virus (DENV), a globally emerging cause of undifferentiated fever, has been documented in the heavily urbanized western coast of Sri Lanka since the 1960s. New areas of Sri Lanka are now being affected, and the reported number and severity of cases ... Full text Link to item Cite

Salmonella Species

Chapter · January 1, 2012 Full text Cite

Prevalence and density-related concordance of three diagnostic tests for malaria in a region of Tanzania with hypoendemic malaria.

Journal Article J Clin Microbiol · November 2011 Accurate malaria diagnosis has dual roles in identification of symptomatic persons for effective malaria treatment and also enumeration of asymptomatic persons who contribute to the epidemiologic determinants of transmission. Three currently used diagnosti ... Full text Link to item Cite

Leptospirosis as frequent cause of acute febrile illness in southern Sri Lanka.

Journal Article Emerg Infect Dis · September 2011 To determine the proportion of fevers caused by leptospirosis, we obtained serum specimens and epidemiologic and clinical data from patients in Galle, Sri Lanka, March-October 2007. Immunoglobulin M ELISA was performed on paired serum specimens to diagnose ... Full text Link to item Cite

Multiplex 5' nuclease-quantitative PCR for diagnosis of relapsing fever in a large Tanzanian cohort.

Journal Article J Clin Microbiol · September 2011 Relapsing fever (RF) is caused by tick- and louse-borne Borrelia spp., is characterized by recurrent fever, and is often misdiagnosed as malaria. Because of submicroscopic bacteremia, microscopy can be insensitive between febrile bouts. We designed a multi ... Full text Link to item Cite

Severe pandemic H1N1 and seasonal influenza in children and young adults with sickle cell disease.

Journal Article Blood · November 4, 2010 Influenza causes excess morbidity in sickle cell disease (SCD). H1N1 pandemic influenza has been severe in children. To compare H1N1 with seasonal influenza in SCD (patients younger than 22), we reviewed medical records (1993-2009). We identified 123 cases ... Full text Link to item Cite

Comparison of two rapid assays for Clostridium difficile Common antigen and a C difficile toxin A/B assay with the cell culture neutralization assay.

Journal Article Am J Clin Pathol · January 2010 We compared 3 rapid assays for Clostridium difficile with a cell culture cytotoxicity neutralization assay (CCNA). Of 600 stool samples, 46 were positive for toxigenic C difficile. Both rapid common antigen assays were highly sensitive (91.3%-100%) and, th ... Full text Link to item Cite

Vibrio cholerae (Cholera)

Chapter · January 1, 2009 Full text Cite

Salmonella Species

Chapter · January 1, 2009 Full text Cite

Controlled evaluation of Bactec Peds Plus/F and Bactec lytic/10 anaerobic/F media for isolation of Salmonella enterica serovars typhi and paratyphi A from blood.

Journal Article J Clin Microbiol · January 2009 We compared anaerobic lytic (AL) and pediatric aerobic resin-containing (Peds Plus/F) blood culture media for the isolation of Salmonella enterica serotype Typhi or Paratyphi A from children. The yields from AL and Peds Plus/F media were the same with equa ... Full text Link to item Cite

Excess salmonellosis in women in the United States: 1968-2000.

Journal Article Epidemiol Infect · August 2008 We describe recent epidemiological changes in salmonellosis. Linking 1968-2000 National Salmonella Surveillance System to census data, we calculated population-based age- and sex-stratified rates of non-urinary salmonellosis for the top 30 non-typhoidal se ... Full text Link to item Cite

A 41-year-old woman from Cameroon with infertility.

Journal Article Clin Infect Dis · July 1, 2008 Full text Link to item Cite

A 41-year-old woman from Cameroon with infertility

Journal Article Clinical Infectious Diseases · July 1, 2008 Full text Cite

Use of peptide nucleic acid-fluorescence in situ hybridization for definitive, rapid identification of five common Candida species.

Journal Article J Clin Microbiol · November 2007 We investigated a 2.5-h peptide nucleic acid-fluorescence in situ hybridization (PNA-FISH) assay with five Candida species-specific probes to identify Candida colonies and compared it to standard 2-h to 5-day phenotypic identification methods. Suspensions ... Full text Link to item Cite

Yield of stool culture with isolate toxin testing versus a two-step algorithm including stool toxin testing for detection of toxigenic Clostridium difficile.

Journal Article J Clin Microbiol · November 2007 We examined the incremental yield of stool culture (with toxin testing on isolates) versus our two-step algorithm for optimal detection of toxigenic Clostridium difficile. Per the two-step algorithm, stools were screened for C. difficile-associated glutama ... Full text Link to item Cite

Wound botulism acquired in the Amazonian rain forest of Ecuador.

Journal Article Am J Trop Med Hyg · April 2006 Wound botulism results from colonization of a contaminated wound by Clostridium botulinum and the anaerobic in situ production of a potent neurotoxin. Between 1943, when wound botulism was first recognized, and 1990, 47 laboratory-confirmed cases, mostly t ... Link to item Cite

A large, multiple-restaurant outbreak of infection with Shigella flexneri serotype 2a traced to tomatoes.

Journal Article Clin Infect Dis · January 15, 2006 BACKGROUND: Foodborne outbreaks of Shigella infection are uncommon and tomatoes are an unusual vehicle. We describe a large, multiple-restaurant outbreak of Shigella flexneri serotype 2a infection that was associated with tomatoes. METHODS: We conducted na ... Full text Link to item Cite

An outbreak of foodborne botulism associated with food sold at a salvage store in Texas.

Journal Article Clin Infect Dis · December 1, 2003 Foodborne botulism is caused by potent neurotoxins of Clostridium botulinum. We investigated a large outbreak of foodborne botulism among church supper attendees in Texas. We conducted a cohort study of attendees and investigated the salvage store that sol ... Full text Link to item Cite

An outbreak of Escherichia coli O157 infection following exposure to a contaminated building.

Journal Article JAMA · November 26, 2003 CONTEXT: Infection with Escherichia coli O157 causes an estimated 70 000 diarrheal illnesses per year in the United States and can result in hemolytic-uremic syndrome and death. Environmental contamination with E coli O157 may be a public health problem. O ... Full text Link to item Cite

A randomized controlled trial of household-based flocculant-disinfectant drinking water treatment for diarrhea prevention in rural Guatemala.

Journal Article Am J Trop Med Hyg · October 2003 We conducted a study to determine if use of a new flocculant-disinfectant home water treatment reduced diarrhea. We randomly assigned 492 rural Guatemalan households to five different water treatment groups: flocculant-disinfectant, flocculant-disinfectant ... Link to item Cite

Sexual transmission of typhoid fever: a multistate outbreak among men who have sex with men.

Journal Article Clin Infect Dis · July 1, 2003 In August 2000, the Ohio Department of Health reported a cluster of men with typhoid fever who denied having traveled abroad. To determine the cause and the extent of the outbreak, an epidemiological investigation was initiated in which 7 persons in Ohio, ... Full text Link to item Cite

Malaria Surveillance - United States, 1994

Journal Article Morbidity and Mortality Weekly Report · October 17, 1997 Problem/Condition: Malaria is caused by infection with one of four species of Plasmodium (i.e., P. falciparum, P. vivax, P. ovale, and P. malariae), which are transmitted by the bite of an infective female Anopheles sp. mosquito. Most malarial infections i ... Cite