Internal Medicine; Infectious Disease
I am an attending physician on the Infectious Diseases service at Roswell Park Cancer Institute (RPCI). My clinical duties include inpatient and outpatient consultations at RPCI and on-call duties at Buffalo General Medical Center. In addition to providing clinical care, I teach medical students, residents and fellows in daily rounds and through formal didactic lectures. My primary research interest focuses on the epidemiology, pathogenesis, prevention and treatment of opportunistic infections in patients with hematologic malignancies and recipients of hematopoietic stem cell transplantation. In addition, I study the epidemiology, pathogenesis and transmission of colonization and infection by vancomycin resistant Enterococcus in patients with hematologic malignancies. My long-term goal is to define strategies to prevent transmission, determine virulence and decrease the mortality associated with these infections. Finally, I participate as a site principal investigator in several multicenter clinical trials.
Immunology; Infectious Disease
My patient care and teaching responsibilities are centered at the Veterans Administration hospital where I care for hospitalized patients and maintain an active outpatient clinic. I enjoy teaching medical students and residents in both lecture and small group settings. In addition, my laboratory is open to interested undergraduate, graduate and medical students and residents seeking to gain a research experience. Research interests of my laboratory focus on two key areas of the function of specialized immune cells called macrophages. Our first area of interest concentrates on the immunologic roles of mammalian macrophage gangliosides. Gangliosides are unique molecules that hold diverse regulatory roles as receptors and as mediators of cell differentiation in cells of most species. Our studies encompass ganglioside regulation of macrophage inflammatory responses, ganglioside-associated alterations of the architecture of macrophage cell membranes in HIV-infected individuals, and the function of macrophage gangliosides as receptors for bacterial pathogens and toxins. This work will lead to a better understanding of mechanisms of macrophage activation, to permit manipulation of host immune responses. Our second area of interest centers on the regulation of inflammatory responses of human alveolar macrophages by respiratory bacterial pathogens and bacterial antigens that contribute to the pathogenesis of chronic obstructive pulmonary disease (COPD). Studies encompass defining the repertoire of inflammatory mediators of human alveolar and blood-derived macrophages regulated by bacterial pathogens and characterizing bacteria-regulated immunologic properties of macrophages, in patients with COPD. These investigations into fundamental mechanisms of dysfunctional immune responses of macrophages underlying the progression of COPD are providing the basis for designing novel and more effective therapies.
I provide inpatient infectious disease consultation services at both Erie County Medical Center (ECMC) and Buffalo General Medical Center (BGMC). In addition, I collaborate with the ECMC renal and pancreas transplant team to evaluate and treat infectious complications associated with solid organ transplantation. I feel honored to serve patients who receive a lifesaving organ in order to help live a normal life. Lastly, I see outpatients with various infectious disease problems at the immunodeficiency clinic at ECMC. I enjoy teaching medical students, residents and infectious diseases fellows the principles and practice of infectious diseases. The majority of my teaching is at clinical sites at ECMC and BGMC. However, I also give didactic lectures during specialty conferences and grand rounds. Although the majority of my time is centered on patient care and teaching, I am also involved with clinical research. My role is to identify and recruit patients for a variety of clinical trials designed to assess new modalities for the prevention or treatment of infectious diseases.
Infectious Disease; Infectious Disease; Microbial Pathogenesis; Vitamins and Trace Nutrient
I care for patients who are hospitalized at Erie County Medical Center where I also serve as the hospital epidemiologist addressing infection control. I teach medical students, residents, and fellows in both hospital and classroom settings. In UB’s schools of medicine and dentistry, I teach a variety of topics including microbiology, pharmacology and toxicology, oral biology, and gastrointestinal systems, host defenses, and global health. I also conduct laboratory research on diarrhea-producing strains of E. coli bacteria. My lab focuses on enteropathogenic Escherichia coli (EPEC), Shiga-toxigenic E. coli (STEC, aka EHEC) and enterotoxigenic E. coli (ETEC). We are working on the role of intestinal host defenses such as nitric oxide and on the immune modulatory effects of adenosine. We have discovered that zinc can directly inhibit the virulence of pathogenic bacteria, and we are working on turning these laboratory findings into treatments. In our work on zinc we collaborate with Michael Duffey, PhD, in the Department of Physiology and Biophysics. Recently we have discovered that zinc can inhibit the development of resistance to antibiotics in Escherichia coli and other bacteria. Zinc does this by its ability to inhibit the SOS response, a bacterial stress response triggered by damage to the bacterial DNA. We are collaborating with Dr. Mark Sutton of Biochemistry to better determine the mechanism of zinc in this regard. I am interested in international medicine and global health and participate in an annual medical mission trip to Honduras, a trip in which student volunteers are encouraged to participate. Closer to home, I am a volunteer physician at Good Neighbors Health Center, a free clinic for the underserved on Jefferson Avenue in Buffalo. Resident physicians are encouraged to volunteer, and students may also be able to arrange clinical experiences. I am Co-Medical Director, with Dr. Ryosuke Osawa, of the Erie County TB Clinic. Learning experiences in my laboratory, in infection prevention and hospital epidemiology, or in international health, may be available for motivated students, residents, and fellows.
As an Infectious Disease specialist, I see and evaluate adult patients as part of the Infectious Disease inpatient consultation service at both Buffalo General Medical Center (BGMC) and Erie County Medical Center (ECMC). I enjoy teaching medical students, residents and fellows the principles of Infectious Disease at both ECMC and BGMC. The practice of infectious disease crosses a large variety of specialties from Surgery to Internal Medicine and I believe exposure to this field in training is very important. I appreciate the interdisciplinary aspect of Infectious Diseases and its intersection with global health, microbiology, and epidemiology. The face of the infectious processes seen in Buffalo will continue to change due to the effects of globalization and climate change and I find this especially fascinating.
Infectious Disease; Bioinformatics; Microbial Pathogenesis
My clinical interest work focuses on infectious diseases, particularly those caused by Staphylococcus aureus. I practice medicine at the VA Western New York Healthcare System, where I am Chief of the Infectious Disease Section. The service here treats veterans with a wide variety of infectious diseases, including HIV and hepatitis C. I follow both inpatients and outpatients on this clinical service. Medical students, residents, and fellows evaluate and follow infectious disease consultations with me on the inpatient service. I teach extensively in the Medical School, and serve as Vice Chair for Education in the Department of Medicine. I enjoy working with students throughout the full spectrum of medical education, from first-year medical students to senior fellows in Infectious Disease. My research interests dovetail with my clinical work. I study Staphylococcal infections, particularly complications related to S. aureus bloodstream infections. My laboratory uses advanced molecular biology techniques to identify bacterial virulence factors. In collaboration with Steve Gill at the University of Rochester, we are analyzing three years of clinical data on S. aureus bacteremia in the Buffalo area and sequencing hundreds of bacteremia isolates of S. aureus to identify the genomic architectures associated with more severe complications and those associated with poor clinical outcomes. This work makes use of bioinformatics and database design, techniques that support my ongoing collaborations with other investigators on bioinformatics problems, particularly with Moraxella catarrhalis and Haemophilus influenzae. Prior to my studies in S. aureus, I conducted research on a fascinating pathogen, H. influenzae bio group aegyptius and Brazilian Purpuric Fever. Over that 10-year period my laboratory identified a unique epitope on a surface proteins associated with the disease. We were able to create the only isogenic mutant so far described with this pathogen that is highly refractory to genetic manipulation.
I primarily provide consultations for inpatients at Buffalo General Medical Center (BGMC) and Gates Vascular Institute (GVI). I also provide consultation services at Roswell Park Cancer Institute during on-call weekends. In my clinic at BGMC, I evaluate and treat patients with a variety of infections primarily as a follow-up from recent hospitalization. This allows for continuity of care, a service that is highly appreciated by the medical and surgical services at BGMC and GVI. I enjoy teaching medical students, residents, and fellows on inpatient consultation service at BGMC and GVI; consultations may be called by a medical or a surgical service. Medical services include general internal medicine or one of the medical specialties (cardiology, pulmonary, nephrology, oncology, etc.), neurology, family medicine and rehab medicine. Surgical services include general surgery, colorectal surgery, bariatric surgery, cardiothoracic surgery, orthopedic and hand surgery, vascular surgery, plastic surgery and urology. This spectrum of consultations allows for a broad variety of patients, which provides fellows and residents a diverse intellectual experience during their rotation. I see patients with residents and fellows and discuss cases with them. Also, I provide didactic morning reports to the internal medicine residency program. During my off-service months, I enjoy writing case reports with the medicine residents. I am also the director of the Anti-microbial Stewardship (AMS) program at BGMC and GVI. In this role, and in collaboration with the pharmacy department, I am responsible for providing an overview to the antimicrobial use at these institutions. The aim of the AMS program is to help provide to the different specialties a better understanding of appropriate use of antibiotics and to adjust or de-escalate antibiotics whenever it is deemed appropriate. Our goals are to reduce nosocomial infections like Clostridium difficile, reduce colonization/infection with multi-drug resistant organisms and decrease the length of hospital stay whenever possible.
I am an attending physician on the Infectious Diseases service at Roswell Park Cancer Institute (RPCI). In addition to my clinical duties of inpatient infectious disease consultations, I am the medical director of the Antimicrobial Stewardship Program and the director of Infection Control and Prevention at RPCI. I also enjoy teaching medical students, residents and fellows in daily rounds and through formal didactic lectures. My primary research interest focuses on appropriate use of antimicrobials in "special populations" including oncology patients and other immunosuppressed patients, especially as it relates to antimicrobial and diagnostic stewardship.
Research in my laboratory focuses on nontypeable Haemophilus influenzae and Moraxella catarrhalis, important pathogens in otitis media and lower respiratory tract infections in adults with chronic obstructive pulmonary disease (COPD). A goal of work is to develop vaccine to prevent these infections. To that end, outer membrane proteins have been identified and are being evaluated as potential vaccine antigens. A COPD Study Clinic supported by a grant from the Department of Veteran Affairs has been running continuously since 1994. This prospective study follows adults with COPD during monthly clinic visits during which sputum and serum samples are collected. Bacterial isolates are recovered from sputum and are subjected to molecular typing. These studies are elucidating the dynamics of respiratory tract bacterial colonization. In addition, serum and sputum samples are being studied to learn about systemic and mucosal immune responses to bacterial pathogens.
Internal Medicine; Pulmonary Disease; Infectious Disease
My area of expertise is in infectious diseases in adults and I evaluate and treat adults with all infections, without restriction to a special area, and see patients within the Veterans Affairs hospital system. I act as a consultant for other physicians treating patients who have, or are suspected to have, infectious diseases in hospital settings or outside the hospital. Prior to becoming an infectious disease specialist, I had training and work experience in surgery as well as internal medicine. This exposure has helped me in my current clinical practice since infections occur in patients after surgical procedures. Having a firsthand understanding of what surgeons do allows me to understand the patient’s overall situation better. I teach first- and second-year medical students, primarily in pulmonary, in small group sessions. My research is focused on bacterial infections in patients with chronic obstructive pulmonary disease (emphysema and chronic bronchitis, known also as COPD). I am especially interested in how the host (the human body) reacts to the pathogen (the bacteria), and how differences in the host determine the outcome of the encounter between host and pathogen. Recently, we found that airway epithelial cells from patients with COPD respond to pathogenic bacteria in a manner that is different from healthy, non-COPD people. My goal is to further characterize and understand the cellular mechanisms underlying this aberrant behavior in COPD. I expect this research to open new avenues of therapy specially tailored to intervene in the host-pathogen interaction. Students and fellows have the opportunity to conduct research with me. I collaborate with Sanjay Sethi, MD and Charles Berenson, MD from the department of medicine and with Anders Hakansson, PhD, from the department of microbiology and immunology.
Infectious Disease; Infectious Disease; Microbial Pathogenesis
I am an expert in infectious diseases, and I care for hospitalized patients at the Buffalo VA Medical Center (Buffalo VAMC). I have an active, nationally funded translational research program. My research focuses on Gram-negative bacilli (GNB), including Escherichia coli, Acinetobacter baumannii and a new hypervirulent variant of Klebsiella pneumoniae. These GNB cause infection in nearly every nonintestinal site in the body. The hypervirulent variant of K. pneumoniae is both fascinating and worrisome. Unlike its predecessors, it is capable of causing infection in young, healthy hosts and spreading nearly anywhere in the body from the initial infected site, including the eyes and brain. GNB-caused infections result in the loss of billions of health care dollars, millions of work days and hundreds of thousands of lives each year. GNB are becoming increasingly resistant to antibiotics, including strains that have become resistant to all available antibiotics. Unfortunately, there are virtually no new antimicrobial agents active against highly resistant GNB in the pharmaceutical “pipeline.” To address this formidable clinical challenge, my collaborators and I have increased our understanding of the bacterial factors that are critical for these GNB to cause infection. We use this information to develop vaccines that will prevent infection and antibodies that can be used to treat infection. My UB collaborators include Dr. Campagnari (microbiology), Dr. Gulick (structural biology) and Drs. Elkin and Zola (biomedical informatics). My research also involves identifying potential bacterial drug targets; this information will be used to develop new classes of antibiotics. I intermittently have students in my lab, and I participate in a grant designed to encourage medical students to become physician-scientists. I welcome interested students to contact me about conducting research with me. The Buffalo VAMC is the site of my clinical teaching. I teach first- and second-year medical students in lecture settings and small group sessions, including courses in lung respiration, musculoskeletal, renal and microbiology-immunology. Residents attend my grand rounds; I also teach fellows in all aspects of their training and mentor those who perform their research projects in my lab.
Infectious Disease; Oncology
I care for hospitalized patients and outpatients at Roswell Park Cancer Institute (RPCI), where I am head of Infectious Diseases. My area of clinical expertise relates to infections in patients with cancer and stem cell transplant recipients, and I have served on several national panels that establish guidelines for preventing, diagnosing, and managing infections in these patients. I also have a specific interest in patients with primary phagocytic disorders (e.g., chronic granulomatous disease). RPCI is the site of my clinical teaching. I also teach medical students in lecture settings and in small group sessions in their first and second years, including courses in lung pathophysiology and microbiology-immunology. We intermittently have students in our lab and participate in a grant designed to encourage medical students to become physician-scientists. I mentor residents in their clinical training and in research. I also teach fellows in all aspects of their training and mentor those who perform their research projects in my lab. I have an active, nationally funded translational research program. The major focus of our lab is studying NADPH oxidase as a critical regulator of inflammation and host defense. NADPH oxidase is an emergency host defense pathway that is rapidly activated in response to certain microbial products, and converts molecular oxygen to superoxide anion and downstream reactive oxidant intermediates (ROIs). Chronic granulomatous disease is an inherited disorder of the NADPH oxidase characterized by severe bacterial and fungal infections (e.g., invasive aspergillosis) and by excessive inflammation. In addition to its critical host defense role, our lab, in collaboration with colleagues, found that NADPH oxidase also functions to restrain inflammation by modulating redox-sensitive innate immune pathways. NADPH oxidase also affects T-cell responses, including the balance between Tn17 and regulatory T-cells. We have an NIH grant to further elucidate mechanisms by which NADPH oxidase regulates inflammation. We believe that our work has broad relevance to human diseases associated with inflammation, such as inflammation-induced injury and tumor immunology. Indeed, several of the pathways that NADPH oxidase regulates are important in tumorigenesis and the tumor microenvironment (e.g., NF-kB, Nrf2, IL-17, Tregs), and are potential therapeutic targets. In collaboration with colleagues, we are examining how NADPH oxidase influences tumor immunity.
Infectious Disease; Infectious Disease
My primary patient care activites involve hospitalized patients at the Department of Veterans Affairs Medical Center (VA) in Buffalo. I also have an outpatient clinic at UB’s Student Health Center on the South Campus where I see students for general ambulatory infectious diseases such as skin infections, positive tuberculosis skin tests, etc. I also see students before they travel internationally for care such as immunizations and risk avoidance education and, if needed, for post-travel care and follow-up. I teach first- and second-year medical students in lectures and small group sessions, primarily in the microbiology, respiration, musculoskeletal and reproductive modules. I also teach third- and fourth-year medical students, residents, and fellows on the infectious diseases and internal medicine services at the VA. In addition to patient care and teaching, I have significant roles related to infection prevention and antimicrobial stewardship at two of Buffalo’s major health care systems, and I serve as Hospital Epidemiologist for both. My work includes pandemic and bioterrorism planning activities for these hospital systems as well as the University at Buffalo. These responsibilities require that I collaborate with hospital infection control teams, pharmacists, microbiologists and administrators (particularly the offices of quality management, risk management and patient safety) and with UB’s Student Affairs team. I also interact frequently with local health department staff. Our infection control efforts have been based on the epidemiologic paradigm of hypothesis development, data collection and critical interpretation of the data followed by a rational and directed action plan. This is done for routine infection prevention, outbreak and cluster investigation, healthcare worker safety and antimicrobial stewardship.
Infectious Disease; Internal Medicine - General
I provide infectious diseases consultations for hospitalized patients at the Erie County Medical Center (ECMC). In addition to my inpatient duties, I care for HIV infected patients at the Evergreen Health. HIV infection has become a chronic illness with antiretroviral therapy, and patients with HIV need primary care as well as HIV care. The Evergreen Health offers comprehensive care to these patients and gives me the opportunity to practice primary care for HIV infected patients in addition to my infectious disease practice. I also participate in antiretroviral therapy clinical trials. These studies are crucial in evaluating the effectiveness and safety of new medications and new combination regimens. Patients are screened for eligibility for ongoing trials during their visit, and eligible candidates are enrolled. I enjoy teaching medical students, residents, and fellows, supervising them on crucial skills in infectious diseases: recognizing important physical findings, developing differential diagnosis and selecting appropriate antibiotic treatment. I feel fortunate to be part of their medical training.