The National Foundation for Infectious Diseases (NFID) recently announced the recipients of its postdoctoral fellowships for the 1998-99 season. The purpose of the fellowships is to encourage physicians to train as specialists and to conduct research in infectious diseases.

Committees comprised of senior investigators chose the individuals listed below. NFID will provide them with a monetary stipend to conduct their proposed research.

NFID offers the fellowships in support of its mission to support research into the causes, cures, and prevention of infectious diseases; to encourage and sponsor public and professional education programs; and to aid in the prevention of infectious diseases.

Committees comprised of senior investigators chose the individuals listed below. NFID will provide them with a monetary stipend to conduct their proposed research.

Kieren A. Marr, MD, is the recipient of the 1998 John P. Utz Postdoctoral Fellowship in Medical Mycology, which is co-sponsored by NFID and Pfizer Inc.

This award is named in honor of John P. Utz, MD, president emeritus of NFID. Dr. Utz served as dean of the Georgetown University School of Medicine, was chief of immunology and infectious diseases at the Medical College of Virginia, and prior to that was chief of the infectious disease service at the National Institutes of Health. A well-known and respected physician, Dr. Utz, now retired, devoted his efforts to mycology.

Dr. Marr will focus her research on fungal infections in patients undergoing bone marrow transplants (BMT). The severe immune deficiency caused by BMT places patients at high risk for developing invasive infections with the yeast, Candida albicans.

In order to avoid invasive candidiasis, patients with severe immune deficiency are given fluconazole prophylaxis, explained Dr. Marr. "Unfortunately, resistance to this drug has been recognized in C. albicanscausing infections in patients immunosuppressed with HIV, and more recently, in patients undergoing BMT or receiving therapy for cancer," said Dr. Marr. Her current goals are to determine the extent of the drug resistance in yeasts infecting BMT patients and to determine the mechanism by which C. albicans becomes resistant to fluconazole in BMT patients.

Dr. Marr will conduct her research at the Fred Hutchinson Cancer Research Center in Seattle, WA. Her mentor will be Lawrence Corey, MD, professor of laboratory medicine and medicine, and head of the program in infectious diseases.

Dr. Marr is currently a third-year fellow at the University of Washington. She completed her residency and internship at Duke University Medical Center and received her medical degree from the Hahnemann University School of Medicine in Philadelphia, PA.

The 1998 Postdoctoral Fellowship in Emerging Infectious Diseases has been awarded to Richard S. Witzig, MD. Co-sponsored by NFID, the Centers for Disease Control and Prevention (CDC), and Merck & Co., Inc., the fellowship allows Dr. Witzig the opportunity to develop expertise in the areas of emerging infectious diseases and epidemiology through assignment to CDC's National Center for Infectious Diseases (NCID).

While at CDC, Dr. Witzig will participate in the analysis and reporting of the national burden of infectious diseases, as well as the potential threats of emerging infectious diseases. In conjunction with his work at CDC, Dr. Witzig will have the opportunity to participate in training courses in such fields as epidemiology, statistics, and computer science.

Dr. Witzig has a professional interest in tropical public health. He has done field work in Peru in tuberculosis, malaria, and other primary health care projects.

"Emerging infectious diseases (EIDs) are unique to distinct geographical areas, but have wider importance with increasing international trade and travel," said Dr. Witzig. "Some EIDs in Peru have already entered the United States, and others have importance in tourism zones," he said.

"At the CDC, I will participate in the analysis of EID trends in the United States, while keeping active my interest in tropical EIDs and their threat to the American population."

Robert W. Pinner, MD, special assistant for surveillance, NCID, CDC, will serve as Dr. Witzig's mentor during his research year.

Prior to accepting this fellowship, Dr. Witzig was an associate in the Department of International Health at the Johns Hopkins School of Public Health. He received his medical degree from the St. GeorgeÌs University School of Medicine, Grenada, WI, and earned an MPH degree from the Harvard School of Public Health.

With his award of the 1998 Postdoctoral Fellowship in Nosocomial Infection Research and Training, sponsored by NFID and Hoechst Marion Roussel, Inc., James D. Whitehouse, MD, will study the adverse quality of life, excess length of hospital stay, and extra costs attributed to surgical site infections following orthopedic surgery.

Nosocomial infections prolong hospital stays, increase re-hospitalization rates, and significantly increase health care costs. According to Dr. Whitehouse, orthopedic operations account for a substantial proportion of inpatient surgical procedures at Duke University Medical Center. He further pointed out that while it is expected that orthopedic surgery will restore a patientÌs function, infections following such surgery can be catastrophic, leading to long term complications.

"An infection which develops after an elective artificial joint replacement can require removal of the artificial joint and several weeks of antibiotic treatment, followed by a second surgery to place another artificial joint. Some patients may remain in the hospital or nursing home for four-to-six weeks for antibiotic treatment."

Few studies that have addressed the impact of surgical site infections on a patientÌs quality of life following orthopedic procedure, all have been conducted at large tertiary care hospitals. Dr. WhitehouseÌs research project will compare patients who did and did not develop such infections at a community hospital and a university hospital. Dr. Whitehorse is hopeful that he will provide useful information for both patients and physicians making decisions about surgery and for hospital administrators determining the allocation of resources toward preventing these infections.

Daniel J. Sexton, MD, professor of medicine in the division of infectious diseases at Duke University Medical Center in Durham, will serve as Dr. Whitehouse's mentor during his research year.

Dr. Whitehouse graduated cum laude from the Emory University School of Medicine and will receive his masterÌs degree in clinical research in 1999 from Duke University School of Medicine.

Sean P. Elliott, MD, will seek to clarify the role of endothelial cell injury in hemolytic uremic syndrome (HUS) during his research year as recipient of the 1998 Fellowship in Infectious Diseases, co-sponsored by NFID and Glaxo Wellcome Inc.

HUS, which is characterized by diffuse injury to the endothelium (a thin layer of cells that line internal body cavities), most commonly results from exposure to bacterial toxins known as Shiga toxins (ST). These toxins are generally released by such bacteria as E. coli 0157:H7. These toxins bind to glycolipids on the endothelial cell surface, are internalized, inhibit protein synthesis, and ultimately cause cell death.

The precise contribution of endothelial cell glycolipids in the pathogenesis of HUS has been difficult to study since genetic tools have not been available for manipulating glycolipid synthesis. In preliminary research, using a model system that he had recently helped develop and characterize, Dr. Elliott demonstrated in vitro that cells transfected with cDNA encoding Forssman synthetase (FS), an enzyme that modifies Shiga toxin (ST) receptor glycolipids, are highly resistant to ST, yet continue to express a glycolipid toxin receptor.

"I will seek to identify and characterize this receptor and its contribution to toxin resistance," Dr. Elliott said. He will also try to determine whether altered glycolipid synthesis results in ST-resistance and prevention of ST-associated injury. "[Such a determination will] provide insight into the pathogenesis of HUS and suggest therapeutic interventions and preventive measures for the disease," notes Dr. Elliott.

Working in the Division of Pediatrics at the Washington University School of MedicineÌs St. Louis ChildrenÌs Hospital, Dr. Elliott will conduct research with his mentor, David B. Haslam, MD. Dr. Haslam is an assistant professor in the Department of Pediatrics and Molecular Microbiology.

Dr. Elliott received his medical degree from Columbia University College of Physicians and Surgeons and completed his residency at Children's Memorial Hospital, Northwestern University.