Clinical Focus


  • Infectious Disease
  • Immunocompromised Host Infectious Disease

Academic Appointments


Professional Education


  • Fellowship, Stanford University, Immunocompromised Host Infectious Diseases Fellowship (2017)
  • Board Certification: Infectious Disease, American Board of Internal Medicine (2016)
  • Fellowship:NYU Medical Center/Bellevue Hospital (2016) NY
  • Board Certification: Internal Medicine, American Board of Internal Medicine (2014)
  • Residency:UCLA Medical Center Internal Medicine (2014) CA
  • Medical Education:Boston University School of Medicine (2011) MA

All Publications


  • Echinocandin prophylaxis in patients undergoing haematopoietic cell transplantation and other treatments for haematological malignancies. The Journal of antimicrobial chemotherapy Epstein, D. J., Seo, S. K., Brown, J. M., Papanicolaou, G. A. 2018; 73 (suppl_1): i60–i72

    Abstract

    Antifungal prophylaxis is the standard of care for patients undergoing intensive chemotherapy for haematological malignancy or haematopoietic cell transplantation (HCT). Prophylaxis with azoles reduces invasive fungal infections and may reduce mortality. However, breakthrough infections still occur, and the use of azoles is sometimes complicated by pharmacokinetic variability, drug interactions, adverse events and other issues. Echinocandins are highly active against Candida species, including some organisms resistant to azoles, and have some clinical activity against Aspergillus species as well. Although currently approved echinocandins require daily intravenous administration, the drugs have a favourable safety profile and more predictable pharmacokinetics than mould-active azoles. Clinical data support the efficacy and safety of echinocandins for antifungal prophylaxis in haematology and HCT patients, though data are less robust than for azoles. Notably, sparse evidence exists supporting the use of echinocandins as antifungal prophylaxis for patients with significant graft-versus-host disease (GvHD) after HCT. Two drugs that target (1,3)-β-d-glucan are in development, including an oral glucan synthase inhibitor and an echinocandin with unique pharmacokinetics permitting subcutaneous and weekly administration. Echinocandins are a reasonable alternative to azoles and other agents for antifungal prophylaxis in patients undergoing intensive chemotherapy for haematological malignancy or those receiving HCT, excluding those with significant GvHD.

    View details for DOI 10.1093/jac/dkx450

    View details for PubMedID 29304213

  • Use of Alternative Agents for Prevention of Opportunistic Infections in Heart and Lung Transplant Recipients. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America Epstein, D. J., Benamu, E., Subramanian, A. 2018

    View details for DOI 10.1093/cid/ciy397

    View details for PubMedID 29771330

  • Micafungin Versus Posaconazole Prophylaxis in Acute Leukemia or Myelodysplastic Syndrome: A Randomized Study. The Journal of infection Epstein, D. J., Seo, S. K., Huang, Y. T., Park, J. H., Klimek, V. M., Berman, E., Tallman, M. S., Frattini, M. G., Papanicolaou, G. A. 2018

    Abstract

    To compare the effectiveness and tolerability of micafungin versus posaconazole during chemotherapy-induced neutropenia in acute leukemia (AL) and myelodysplastic syndrome (MDS).Patients with AL or MDS undergoing chemotherapy were randomized to open-label micafungin 100 mg intravenously daily or posaconazole suspension 400 mg orally twice daily until neutrophil recovery, up to 28 days. Patients were followed for 12 weeks. The primary endpoint was prophylaxis failure (premature discontinuation due to infection, intolerance, adverse event, or death). Time to failure and survival were calculated by Kaplan-Meier analysis.From March 2011 to May 2016, 113 patients who received at least 2 doses of prophylaxis were analyzed (58 patients randomized to micafungin and 55 to posaconazole). Prophylaxis failure occurred in 34.5% and 52.7% of patients on micafungin and posaconazole, respectively (P = 0.0118). The median number of days on prophylaxis was 16 [interquartile range (IQR) 12-20] for micafungin and 13 [IQR 6-16] for posaconazole (P = 0.01). Micafungin failures were largely due to antifungal treatment; posaconazole failures were mostly due to gastrointestinal intolerance or adverse effects. IFI incidence and survival were similar between study arms.Our data support micafungin as alternative antifungal prophylaxis in patients with AL and MDS.

    View details for DOI 10.1016/j.jinf.2018.03.015

    View details for PubMedID 29746955

  • The Brief Case: Anaerobiospirillum succiniciproducens Bacteremia and Pyomyositis. Journal of clinical microbiology Epstein, D. J., Ernst, K., Rogers, R., Carmody, E., Aguero-Rosenfeld, M. 2017; 55 (3): 665-669

    View details for DOI 10.1128/JCM.01351-16

    View details for PubMedID 28232502

  • Closing the Brief Case: Anaerobiospirillum succiniciproducens Bacteremia and Pyomyositis. Journal of clinical microbiology Epstein, D. J., Ernst, K., Rogers, R., Carmody, E., Aguero-Rosenfeld, M. 2017; 55 (3): 986-987

    View details for DOI 10.1128/JCM.01358-16

    View details for PubMedID 28232506

  • Toxoplasma Encephalitis in Atypical Hosts at an Academic Cancer Center. Open forum infectious diseases Morjaria, S., Epstein, D. J., Romero, F. A., Taur, Y., Seo, S. K., Papanicolaou, G. A., Hatzoglou, V., Rosenblum, M., Perales, M., Scordo, M., Kaltsas, A. 2016; 3 (2): ofw070-?

    Abstract

    Toxoplasma encephalitis is a well recognized complication of acquired immune deficiency syndrome, solid organ transplantation, and allogeneic hematopoietic stem cell transplantation (HSCT). However, patients with hematologic malignancies not treated with allogeneic HSCT may also develop this condition, which requires high clinical suspicion and consideration for prophylactic therapy.

    View details for DOI 10.1093/ofid/ofw070

    View details for PubMedID 27096140