No abstract

Introduction: An estimated 2.4 million people in the United States are living with chronic hepatitis C (HCV). Approximately 40% of HCV patients are unaware of their diagnosis. Socioeconomic status and the ongoing opioid crisis are important risk factors for HCV infection. The rates of intravenous and intranasal drug use in California's Central Valley are among the highest in the nation and many are socioeconomically disadvantaged, creating a perfect scenario for HCV propagation. Identification and treatment of HCV is imperative to prevent morbidity and mortality as well as the spread of infection. Methods: A universal HCV screening program was implemented in the internal and family medicine teaching clinics at a large federally qualified health center in the Central Valley. The electronic medical record identifies eligible patients based on current CDC guidelines. Once identified, an automatic prompt alerts the provider and HCV labs (HCV antibody test with reflex to genotype and RNA level) are autopopulated and available to be signed at the end of the visit. Patients with active HCV infection (positive RNA level) are contacted by the designed project coordinator, who facilitates linkage to care to a primary care provider as well as to the provider experienced in treating HCV. Linkage to care is defined as, completion of the first medical appointment. Results: Universal screening was implemented on July 1, 2021. The data here was collected between July 1, 2021 and November 30, 2021. A total of 1152 patients were eligible for screening and 1084 patients completed the screening. Twenty-three patients tested positive for HCV Ab and 11 patients (9 male and 2 female) tested positive for HCV RNA. Most HCV RNA positive patients were Hispanic (36%) and African American (27%). The most common genotype was 1a (45%). Fifty-four percent of HCV RNA positive patients were linked to care. Conclusion: Prior to the implementation of universal screening, only 54% eligible patients were screened in a 12-month period. Based on preliminary data, we screened 94% eligible patients within a 5-month period. In addition, only 31% of HCV patients prior to universal screening were linked to care compared to the 54% linked to care through our initiative. Our project encouraged providers to screen patients which helped identify HCV in the community. Although data collection is ongoing, we suspect this initiative will surpass the total number of patients screened and linked to care compared to previous practices.

abdominal ultrasound showed a hyperechoic focus in the right hepatic lobe corresponding to the findings on CT (Figure 1B). Ultimately, the patient was treated with two weeks of cefepime and metronidazole for her C. perfringens bacteremia with hepatic focus. Her clinical course improved with antimicrobial therapy. Hepatic function tests were within normal limits by the time of discharge. Discussion: C. perfringens causes cytotoxic infection due to its alpha toxin, a lecithinase which breaks down cell membranes leading to cell lysis. Thus, our patient's severe acute anemia is explained in part by hemolysis due to clostridial infection. This organism is an uncommon cause of gas-forming liver abscess. A prior review of 119 cases of patients with gas-forming pyogenic liver abscess found only 8 to be infected with clostridia species. Malignancy and immunosuppression are both risk factors for C. perfringens infection and septicemia, both of which are present in our patient and thus made her more susceptible to clostridial infection. The etiology of her infection was potentially a bacterial translocation from the gastrointestinal tract. Mortality rate in patients with sepsis due to C. perfringens has been previously estimated at 70-100%. Thus, prompt recognition of this clinical syndrome is paramount so that early treatment can be initiated. Early appropriate antimicrobial therapy was essential to this patient's good outcome.[3209] Figure 1. A) A CT scan of the abdomen showing a focus of gas in the right hepatic lobe (arrow). B) An ultrasound of the right upper quadrant showing focus of gas in the right hepatic lobe (arrow).

Figure 1. A. Upper GI endoscopy showing multiple non-bleeding semi-sessile polyps in the stomach. B. Small Bowel Enteroscopy showing angiodysplastic lesions in the small intestine. C. Gastric biopsy showing foveolar hyperplasia and edema of lamina propria, consistent with inflammatory polyp of JPS.