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Education ?

Medical School Score
The University of Texas at Galveston (1999)

Awards & Distinctions ?

American Board of Pathology

Affiliations ?

Dr. Muldrew is affiliated with 1 hospitals.

Hospital Affiliations



  • University of Toledo Medical Center
    3000 Arlington Ave, Toledo, OH 43614
    Top 50%
  • Publications & Research

    Dr. Muldrew has contributed to 12 publications.
    Title Cryptococcal Retropharyngeal Abscess.
    Date January 2011
    Journal Travel Medicine and Infectious Disease

    Cryptococcus neoformans is an opportunistic fungal pathogen that causes a variety of diseases in immunosuppressed patients. We describe a patient with sarcoidosis and odynophagia admitted with a large retropharyngeal abscess. Aspiration showed budding yeast and culture identified C. neoformans, confirmed by D2 large subunit rRNA gene sequencing.

    Title Triplex Real-time Polymerase Chain Reaction Assay for Simultaneous Detection of Staphylococcus Aureus and Coagulase-negative Staphylococci and Determination of Methicillin Resistance Directly from Positive Blood Culture Bottles.
    Date May 2010
    Journal Diagnostic Microbiology and Infectious Disease

    We describe here a 1-step, triplex real-time polymerase chain reaction (PCR) assay for the detection and identification of staphylococci directly from signal-positive blood culture bottles containing Gram-positive cocci in clusters (GPCC). The triplex assay targeted and detected tuf, nuc, and mecA genes in a single tube and had a detection limit of 10(5) CFU/mL for each gene target. A total of 341 GPCC-positive blood culture bottles were collected between November 12, 2008, and August 11, 2009. Among them, 230 methicillin-resistant coagulase-negative staphylococci (CoNS), 54 methicillin-susceptible CoNS, 22 methicillin-resistant Staphylococcus aureus, 22 methicillin-susceptible S. aureus, and 13 nonstaphylococci species were identified by conventional methods. The results obtained by triplex assay were in agreement with those of conventional methods for tuf (99.7%), nuc (100.0%), and mecA (99.1%), respectively. The triplex assay was found to have sensitivities of 99.7%, 100%, and 99.2% and specificities of 100%, 100%, and 98.7%, respectively, for the tuf, nuc, and mecA gene targets. The triplex real-time PCR assay accurately detects and identifies staphylococci directly from positive blood cultures without nucleic acid extraction prior to amplification.

    Title Molecular Diagnostics of Infectious Diseases.
    Date June 2009
    Journal Current Opinion in Pediatrics

    The purpose of this article is to review the molecular methods commonly used in medical microbiology as well as to update the clinician as to newer molecular technologies that show promise in the identification of microorganisms as well as evaluation of the presence of virulence factors and antibiotic resistance determinants.

    Title Growth of Adenocarcinoma on Routine Microbiological Media Inoculated with Fluid from a Pleural Effusion in an 82-year-old Female.
    Date April 2009
    Journal Journal of Clinical Microbiology

    We report the first documented case of adenocarcinoma cell growth on routine microbiological media. Pleural fluid culture from an 82-year-old female showed colonies with fried egg appearance on routine microbiological media that were negative for bacterial microorganisms. Stains of the colonies demonstrated clusters of viable neoplastic cells.

    Title Clonal Dissemination of Staphylococcus Epidermidis in an Oncology Ward.
    Date October 2008
    Journal Journal of Clinical Microbiology

    Coagulase-negative staphylococci (CoNS) are the main cause of catheter-related infections, especially among immunosuppressed and neutropenic patients, as well as a source of bacterial contamination in blood cultures. Using biochemical identification and pulsed-field gel electrophoresis (PFGE), we sought to identify possible clonal isolates of bacteremia in patients with central lines in an oncology ward (OW), with comparison to isolates that were recovered by venipuncture from an adult emergency room (ER). A total of 243 CoNS isolates were identified to species level from the OW (126) and ER (117), with Staphylococcus epidermidis isolates being the most common (OW, 79.4%; ER, 45.3%). PFGE demonstrated a predominant clone of S. epidermidis (major subtype A) which was 35.5 times more likely (odds ratio [OR] = 35.5; 95% confidence interval [CI] = 4.7 to 267.0; P < 0.00001) to be present in the OW versus the ER. These (CoNS or major subtype A) isolates were more frequently resistant to gentamicin (OR = 2.83; 95% CI = 1.23 to 6.53; P = 0.016) and less frequently resistant to trimethoprim-sulfamethoxazole (OR = 0.38; 95% CI = 0.18 to 0.80; P = 0.013). Subset analysis of S. epidermidis isolates 2 years after the study period showed the persistence of the clone of major subtype A within the OW. This study demonstrates the presence of a predominant clone among central line isolates from an OW that is not present in CoNS venipuncture isolates from an ER.

    Title Neonatal Meningoencephalitis Caused by Bacillus Cereus.
    Date October 2008
    Journal The Pediatric Infectious Disease Journal

    The classic organisms associated with central nervous system infection in the neonate are herpes simplex, Listeria monocytogenes, Escherichia coli, and Streptococcus agalactiae; we describe an unusual case of neonatal meningoencephalitis caused by Bacillus cereus.

    Title Acute Pyelonephritis Caused by Aerococcus Urinae in a 12-year-old Boy.
    Date September 2008
    Journal The Pediatric Infectious Disease Journal

    Aerococcus urinae are Gram-positive cocci that cause urinary tract infections in adults with underlying genitourinary (GU) tract disease. We report a case of pyelonephritis caused by A. urinae in a 12-year-old boy with a history of pyeloplasty and GU reflux.

    Title Necrotizing Fasciitis from Vibrio Vulnificus in a Patient with Undiagnosed Hepatitis and Cirrhosis.
    Date May 2007
    Journal Journal of Clinical Microbiology

    Necrotizing fasciitis due to Vibrio vulnificus may result in overwhelming sepsis, leading to death in some patients. Significant risk factors for severe disease include preexisting liver disease. We report a case of Vibrio vulnificus necrotizing fasciitis in a patient with previously undiagnosed chronic hepatitis and cirrhosis.

    Title Evaluation of a Digene-recommended Algorithm for Human Papillomavirus Low-positive Results Present in a "retest Zone".
    Date February 2007
    Journal American Journal of Clinical Pathology

    The Digene Hybrid Capture 2 (hc2) high-risk human papillomavirus (HPV) DNA test (Digene, Gaithersburg, MD) is widely used for triage of women with atypical squamous cells of undetermined significance. Results in a "retest zone" (weakly positive tests) are repeated up to 2 times according to the Digene-recommended algorithm.We studied 56 cervical samples in the retest zone. Specimens were tested by a multiplex polymerase chain reaction (PCR)-based genotyping assay, and relevant cytopathologic results were reviewed. Digene results were compared with a reference standard that combined PCR genotyping and cytopathology results. The first repeated Digene assay yielded a sensitivity of 85.2% and a specificity of 62.1% with false-positive and false-negative rates of 40.0% and 15.4%, respectively. The 22 negative samples underwent a second retest and 18 (82%) were negative by the reference standard. The combined first and second retest sensitivity, specificity, and predictive values remained unchanged from the first retest alone.Repeating specimens in the retest zone is necessary, but a second retest does not offer advantages over the first retest.

    Title Molecular Diagnosis of Necrotizing Fasciitis by 16s Rrna Gene Sequencing and Superantigen Gene Detection.
    Date March 2006
    Journal The Journal of Molecular Diagnostics : Jmd

    We report the use of molecular techniques in the diagnosis of a case of culture-negative necrotizing fasciitis occurring in a 32-year-old female with no significant past medical history and who died within 36 hours of admission. Paraffin-embedded tissue sections from the popliteal fossa region obtained at autopsy showed hemorrhage, necrosis, and mild inflammation by hematoxylin and eosin staining. Tissue gram stain showed numerous gram-positive organisms arranged in clusters. The sequences of the first 500 bp of bacterial 16S rRNA gene amplified from the lesion were identical to a Lancefield group A beta-hemolytic Streptococcus pyogenes. Streptococcal pyrogenic exotoxin A and B superantigen genes were detected and an emm type 1 was determined by polymerase chain reaction and sequencing from the lesion. This confirmed the etiology of the patient's rapid deterioration with multisystem organ failure.

    Title Determination of Acetaminophen-protein Adducts in Mouse Liver and Serum and Human Serum After Hepatotoxic Doses of Acetaminophen Using High-performance Liquid Chromatography with Electrochemical Detection.
    Date May 2002
    Journal Drug Metabolism and Disposition: the Biological Fate of Chemicals

    Acetaminophen-induced hepatotoxicity has been attributed to covalent binding of the reactive metabolite N-acetyl-p-benzoquinone imine to cysteine groups on proteins as an acetaminophen-cysteine conjugate. We report a high-performance liquid chromatography with electrochemical detection (HPLC-ECD) assay for the conjugate with increased sensitivity compared with previous methods. Previous methods to quantitate the protein-bound conjugate have used a competitive immunoassay or radiolabeled acetaminophen. With HPLC-ECD, the protein samples are dialyzed and then digested with protease. The acetaminophen-cysteine conjugate is then quantified by HPLC-ECD using tyrosine as an internal reference. The lower limit of detection of the assay is approximately 3 pmol/mg of protein. Acetaminophen protein adducts were detected in liver and serum as early as 15 min after hepatotoxic dosing of acetaminophen to mice. Adducts were also detected in the serum of acetaminophen overdose patients. Analysis of human serum samples for the acetaminophen-cysteine conjugate revealed a positive correlation between acetaminophen-cysteine conjugate concentration and serum aspartate aminotransferase (AST) activity or time. Adducts were detected in the serum of patients even with relatively mild liver injury, as measured by AST and alanine aminotransferase. This assay may be useful in the diagnostic evaluation of patients with hepatotoxicity of an indeterminate etiology for which acetaminophen toxicity is suspect.

    Title Oxidative Stress and Reactive Nitrogen Species Generation During Renal Ischemia.
    Date October 2001
    Journal Toxicological Sciences : an Official Journal of the Society of Toxicology

    Previous evidence suggests that both oxygen radicals and nitric oxide (NO) are important mediators of injury during renal ischemia-reperfusion (I-R) injury. However, the generation of reactive nitrogen species (RNS) has not been evaluated in this model at early time points. The purpose of these studies was to examine the development of oxidant stress and the formation of RNS during I-R injury. Male Sprague-Dawley rats were anesthetized and subjected to 40 min of bilateral renal ischemia followed by 0, 3, or 6 h of reperfusion. Control animals received a sham operation. Plasma urea nitrogen and creatinine levels were monitored as markers of renal injury. Glutathione (GSH) oxidation and 4-hydroxynonenal (4-HNE)-protein adducts were used as markers of oxidant stress. 3-Nitrotyrosine (3-NT) was used as a biomarker of RNS formation. Significant increases in plasma creatinine concentrations and urea nitrogen levels were found following both 3 and 6 h of reperfusion. Increases in GSH oxidation, 4-HNE-protein adduct levels, and 3-NT levels were observed following 40 min of ischemia with no reperfusion. Since these results suggested RNS generation during the 40 min of ischemia, a time course of RNS generation following 0, 5, 10, 20, and 40 min of ischemia was evaluated. Significant increases in 3-NT generation was detected as early as 10 min of ischemia and rose to values nearly 10-fold higher than Control at 40 min of ischemia. No additional increase was observed following reperfusion. The data clearly demonstrate that oxidative stress and RNS generation occur in the kidney during ischemia.

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