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Pajer HB, Asher AM, Gelinne A, Northam W, van Duin D, Quinsey CS. Impact of Surgical and Medical Treatment on Survival of Patients with Cerebral Aspergillosis: Systematic Review of the Literature. World Neurosurg 2021; 149:244-248.e13. [PMID: 33482411 DOI: 10.1016/j.wneu.2021.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 01/10/2021] [Accepted: 01/10/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Cerebral aspergillosis carries a high mortality. Rapid diagnosis and treatment can increase survival, but symptoms and imaging findings are nonspecific. The literature on cerebral aspergillosis consists mostly of case reports and case series and lacks large-scale review of data. METHODS We performed a review of the literature using PubMed in March 2019. We recorded the year of publication, age and sex of patients, neurosurgical involvement, the antifungals administered, use of intrathecal antifungals, and the outcome of patients. The relationships among variables were tested using bivariant statics and linear regression. RESULTS A total of 324 studies met the eligibility criteria, and 198 studies including 248 patients were included. Surgical resection (odds ratio [OR], 0.45; 95% confidence interval [CI], 0.25-0.80; P < 0.01) and administration of voriconazole (OR, 0.32; 95% CI, 0.18-0.55; P < 0.001) or itraconazole (OR, 0.36; 95% CI, 0.16-0.72; P < 0.001) were shown to be significantly associated with survival. CONCLUSIONS Given the significant survival benefits for patients who received voriconazole and surgical intervention, we suggest early antifungal medical treatment and resection.
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Affiliation(s)
- Hengameh B Pajer
- Campbell University School of Osteopathic Medicine, Buis Creek, North Carolina, USA
| | - Anthony M Asher
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Aaron Gelinne
- Department of Neurosurgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Weston Northam
- Department of Neurosurgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - David van Duin
- Department of Infectious Disease, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Carolyn S Quinsey
- Department of Neurosurgery, University of North Carolina, Chapel Hill, North Carolina, USA.
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Khalid S, -Rahman FAU, Abbass A, Aldarondo S, Abusaada K. Pseudomembranous aspergillar tracheobronchitis in a non-neutropenic critically ill patient in the intensive care unit. J Community Hosp Intern Med Perspect 2017. [PMID: 28634525 PMCID: PMC5463668 DOI: 10.1080/20009666.2017.1287840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Invasive aspergillosis is an important cause of morbidity and mortality among immunocompromised patients. Prolonged neutropenia is the most common risk factor. It has rarely been reported to occur in non-neutropenic critically ill patients in the intensive care unit setting. Mortality rate in this group has been reported to be as high as 92%. We report a case of tracheobronchial aspergillosis in a non-neutropenic critically ill patient to highlight the fact that critically ill patients admitted in the intensive care unit can develop opportunistic infections such as invasive aspergillosis even in the absence of classic risk factors and prior history of immunosuppression. Early diagnosis and prompt initiation of antifungal therapy may improve the outcome and decrease mortality rate.
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Affiliation(s)
- Sameen Khalid
- Internal Medicine Department, Florida Hospital, Orlando, FL, USA
| | | | - Aamer Abbass
- Internal Medicine Department, Florida Hospital, Orlando, FL, USA
| | | | - Khalid Abusaada
- Internal Medicine Department, Florida Hospital, Orlando, FL, USA
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Santana-Ramírez A, Esparza-Gutiérrez SV, Avila-Rodríguez P, Jiménez-Gómez JE, Vélez-Gómez E, Bañuelos-Gallo D. Aspergillosis of the central nervous system in a previously healthy patient that simulated Creutzfeldt-Jakob disease. Surg Neurol Int 2016; 7:S940-S946. [PMID: 28031987 PMCID: PMC5180434 DOI: 10.4103/2152-7806.195230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 07/25/2016] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The presence of Aspergillus in the central nervous system (CNS) is rare in immunocompetent patients but not in immunocompromised patients who may have a more common infection. This article describes a case of an adult immunocompetent patient with a diagnosis of cerebral aspergillosis and with a clinical process of rapidly progressive dementia which simulated a Creutzfeldt-Jakob syndrome. CASE DESCRIPTION A 34-year-old adult was previously healthy and had no medical history of any significance. The patient had suffered only facial trauma 8 months before admission. One month prior to admission, he showed rapidly progressing changes in his behavior and higher mental functions. He was admitted to the emergency room with an occipital headache with 2 months of history. By the time he arrived, he suffered from total disability and was prostrate. He was diagnosed with meningeal and demential syndrome in the process of being studied. After starting the diagnostic approach by investigating cerebrospinal fluid, a magnetic resonance of the skull, an electroencephalogram, a brain biopsy was indicated. The histopathological study reported the presence of the hyphae characteristics of Aspergillus. The patient died 7 days after the diagnosis. CONCLUSION Cerebral aspergillosis is a common aggressive disease in immunosuppressed patients. However, the disease is rare in individuals with respected immunity and in individuals with neurological impairment and a rapid and progressive deterioration of mental functions. The suspected diagnosis should always be considered given its poor prognosis and the encouraging efficacy of antifungal treatment administered in a timely manner.
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Affiliation(s)
- Adrián Santana-Ramírez
- Department of Neurosurgery, Hospital Civil de Guadalajara Dr. Juan I Menchaca, Guadalajara, Jalisco, Mexico
| | - Sergio V Esparza-Gutiérrez
- Department of Neurosurgery, Hospital Civil de Guadalajara Dr. Juan I Menchaca, Guadalajara, Jalisco, Mexico
| | - Pedro Avila-Rodríguez
- Department of Neurosurgery, Hospital Civil de Guadalajara Dr. Juan I Menchaca, Guadalajara, Jalisco, Mexico
| | - J Eugenio Jiménez-Gómez
- Department of Internal Medicine, Hospital Civil de Guadalajara Dr. Juan I Menchaca, Guadalajara, Jalisco, Mexico
| | - Ezequiel Vélez-Gómez
- Department of Pathology, Hospital Civil de Guadalajara Dr. Juan I Menchaca, Guadalajara, Jalisco, Mexico
| | - David Bañuelos-Gallo
- Department of Neuroradiology, Hospital Civil de Guadalajara Dr. Juan I Menchaca, Guadalajara, Jalisco, Mexico
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Abstract
Invasive aspergillosis, an infection most frequently induced by Aspergillus fumigatus and Aspergillus flavus, typically occurs in immunocompromised patients and is usually transmitted through inhalation of Aspergillus spores. As the lungs are by far the most common site involved in invasive aspergillosis and invasive aspergillosis in immunocompetent hosts is very rare, there have been a few case reports of extra-pulmonary, disseminated invasive aspergillosis in immunocompetent persons. Herein, we report a case of an adult, male, immunocompetent patient with disseminated invasive aspergillosis that successively spread from the right adrenal gland to the left hepatic lobe. The patient was successfully treated through surgical excisions of his adrenal and hepatic masses followed by voriconazole therapy. To our knowledge, this is the first case report of invasive aspergillosis affecting the adrenal glands.
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Affiliation(s)
- Liyu Chen
- From the Center for Infectious Diseases, West China Hospital, Sichuan University , Chengdu , China
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5
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Infektionen. NEUROINTENSIV 2015. [PMCID: PMC7175474 DOI: 10.1007/978-3-662-46500-4_32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In diesem Kapitel werden zunächst die für die Neurointensivmedizin wesentlichen bakteriellen Infektionen (Meningitis, spinale und Hirnabszesse, Spondylodiszitis, septisch-embolische Herdenzephalitis) abgehandelt, die trotz gezielt eingesetzter Antibiotika und neurochirurgischer Therapieoptionen noch mit einer erheblichen Morbidität und Mortalität behaftet sind. Besonderheiten wie neurovaskuläre Komplikationen, die Tuberkulose des Nervensystems, Neuroborreliose, Neurosyphilis und opportunistische Infektionen bei Immunsuppressionszuständen finden hierbei besondere Berücksichtigung. Der zweite Teil dieses Kapitels behandelt akute und chronische Virusinfektionen des ZNS sowie in einem gesonderten Abschnitt die HIVInfektion und HIV-assoziierte Krankheitsbilder sowie Parasitosen und Pilzinfektionen, die in Industrieländern seit Einführung der HAART bei HIV zwar eher seltener, aber mit zunehmender Globalisierung auch in unseren Breiten immer noch anzutreffen sind.
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Chen L, Liu Y, Wang W, Liu K. WITHDRAWN: Adrenal and hepatic aspergillosis in an immunocompetent patient: A case report. IDCases 2014. [DOI: 10.1016/j.idcr.2014.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Mearelli F, Occhipinti A, Altamura N, Fernandes G, Pivetti G, Chendi E, Spalluti A, Mamolo L, Casarsa C, Biolo G. Invasive filamentous fungus infection with secondary cerebral vasculitis in a patient with no obvious immune suppression. Int J Infect Dis 2013; 19:91-2. [PMID: 24275049 DOI: 10.1016/j.ijid.2013.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 10/01/2013] [Accepted: 10/05/2013] [Indexed: 11/25/2022] Open
Abstract
Invasive mold infections represent an emerging and important diagnostic challenge, especially in immunocompetent patients when microscopy and cultures of the biological fluids remain negative. A central nervous system localization is not common and the clinical presentation is aspecific.
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Affiliation(s)
- Filippo Mearelli
- Clinica Medica Generale e Terapia Medica, Department of Medical, Surgical and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Cattinara Trieste, Italy.
| | - Alessandro Occhipinti
- Clinica Medica Generale e Terapia Medica, Department of Medical, Surgical and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Cattinara Trieste, Italy
| | - Nicola Altamura
- Clinica Medica Generale e Terapia Medica, Department of Medical, Surgical and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Cattinara Trieste, Italy
| | - Giovanni Fernandes
- Clinica Medica Generale e Terapia Medica, Department of Medical, Surgical and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Cattinara Trieste, Italy
| | - Giulia Pivetti
- Clinica Medica Generale e Terapia Medica, Department of Medical, Surgical and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Cattinara Trieste, Italy
| | - Enrico Chendi
- Clinica Medica Generale e Terapia Medica, Department of Medical, Surgical and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Cattinara Trieste, Italy
| | - AnnaLisa Spalluti
- Clinica Medica Generale e Terapia Medica, Department of Medical, Surgical and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Cattinara Trieste, Italy
| | - Lorenza Mamolo
- Clinica Medica Generale e Terapia Medica, Department of Medical, Surgical and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Cattinara Trieste, Italy
| | - Chiara Casarsa
- Clinica Medica Generale e Terapia Medica, Department of Medical, Surgical and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Cattinara Trieste, Italy
| | - Gianni Biolo
- Clinica Medica Generale e Terapia Medica, Department of Medical, Surgical and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Cattinara Trieste, Italy
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A review of the mechanism of injury and treatment approaches for illness resulting from exposure to water-damaged buildings, mold, and mycotoxins. ScientificWorldJournal 2013; 2013:767482. [PMID: 23710148 PMCID: PMC3654247 DOI: 10.1155/2013/767482] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 02/10/2013] [Indexed: 12/21/2022] Open
Abstract
Physicians are increasingly being asked to diagnose and treat people made ill by exposure to water-damaged environments, mold, and mycotoxins. In addition to avoidance of further exposure to these environments and to items contaminated by these environments, a number of approaches have been used to help persons affected by exposure to restore their health. Illness results from a combination of factors present in water-damaged indoor environments including, mold spores and hyphal fragments, mycotoxins, bacteria, bacterial endotoxins, and cell wall components as well as other factors. Mechanisms of illness include inflammation, oxidative stress, toxicity, infection, allergy, and irritant effects of exposure. This paper reviews the scientific literature as it relates to commonly used treatments such as glutathione, antioxidants, antifungals, and sequestering agents such as Cholestyramine, charcoal, clay and chlorella, antioxidants, probiotics, and induced sweating.
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Infektionen. NEUROINTENSIV 2012. [PMCID: PMC7123678 DOI: 10.1007/978-3-642-16911-3_32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Trotz Weiterentwicklung moderner Antibiotika in den letzten Jahren sind die Letalitätszahlen der bakteriellen (eitrigen) Meningitis weiterhin hoch; Überlebende haben häufig neurologische Residuen. Die ungünstigen klinischen Verläufe der bakteriellen Meningitis sind meist Folge intrakranieller Komplikationen, wie z. B. eines generalisierten Hirnödems, einer zerebrovaskulären arteriellen oder venösen Beteiligung oder eines Hydrozephalus.
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Schwartz S, Reisman A, Troke PF. The efficacy of voriconazole in the treatment of 192 fungal central nervous system infections: a retrospective analysis. Infection 2011; 39:201-10. [PMID: 21512792 DOI: 10.1007/s15010-011-0108-6] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Accepted: 03/29/2011] [Indexed: 10/18/2022]
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11
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Yan B, Wu X, Zhou D. Invasive intracranial aspergillosis in an immunocompetent patient after dental extraction. ACTA ACUST UNITED AC 2010; 43:156-8. [PMID: 21047191 DOI: 10.3109/00365548.2010.527858] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Invasive intracranial aspergillosis in immunocompetent patients remains a rarity. We report such a case in a male who developed symptoms after a dental extraction. Attention should be paid to atypical central nervous system symptoms after dental procedures; early diagnosis and management are of great importance to improve outcomes.
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Affiliation(s)
- Bo Yan
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
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12
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Generalized Lymphadenopathy Secondary to an Invasive Fungal Infection in an Apparently Healthy Patient. Am J Med Sci 2010; 340:84-8. [DOI: 10.1097/maj.0b013e3181df7ff8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cerebral Vasculitis Caused by Aspergillus Simulating Ischemic Stroke in an Immunocompetent Patient. J Emerg Med 2010; 38:597-600. [DOI: 10.1016/j.jemermed.2007.09.062] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2007] [Revised: 09/14/2007] [Accepted: 09/16/2007] [Indexed: 11/17/2022]
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Thrasher JD, Crawley S. The biocontaminants and complexity of damp indoor spaces: more than what meets the eyes. Toxicol Ind Health 2009; 25:583-615. [DOI: 10.1177/0748233709348386] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Nine types of biocontaminants in damp indoor environments from microbial growth are discussed: (1) indicator molds; (2) Gram negative and positive bacteria; (3) microbial particulates; (4) mycotoxins; (5) volatile organic compounds, both microbial (MVOCs) and non-microbial (VOCs); (6) proteins; (7) galactomannans; (8) 1-3-β-D-glucans (glucans) and (9) lipopolysaccharides (LPS — endotoxins). When mold species exceed those outdoors contamination is deduced. Gram negative bacterial endotoxins, LPS in indoor environments, synergize with mycotoxins. The gram positive Bacillus species, Actinomycetes (Streptomyces, Nocardia and Mycobacterium), produce exotoxins. The Actinomycetes are associated with hypersensitivity pneumonitis, lung and invasive infections. Mycobacterial mycobacterium infections not from M. tuberculosis are increasing in immunocompetent individuals. In animal models, LPS enhance the toxicity of roridin A, satratoxins G and aflatoxin B1 to damage the olfactory epithelium, tract and bulbs (roridin A, satratoxin G) and liver (aflatoxin B1). Aflatoxin B1 and probably trichothecenes are transported along the olfactory tract to the temporal lobe. Co-cultured Streptomyces californicus and Stachybotrys chartarum produce a cytotoxin similar to doxorubicin and actinomycin D (chemotherapeutic agents). Trichothecenes, aflatoxins, gliotoxin and other mycotoxins are found in dust, bulk samples, air and ventilation systems of infested buildings. Macrocyclic trichothecenes are present in airborne particles <2 μm. Trichothecenes and stachylysin are present in the sera of individuals exposed to S. chartarum in contaminated indoor environments. Haemolysins are produced by S. chartarum, Memnoniella echinata and several species of Aspergillus and Penicillium. Galactomannans, glucans and LPS are upper and lower respiratory tract irritants. Gliotoxin, an immunosuppressive mycotoxin, was identified in the lung secretions and sera of cancer patients with aspergillosis produced by A. fumigatus, A. terreus, A. niger and A. flavus.
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Abstract
This review summarizes the health aspects of the medically important fungal genus Aspergillus. The morphology and systematics of the genus are explained as well as its biogeography. Major mycotoxins, the aspergilli that produce them, affected crops, and symptoms of the toxicoses are summarized, as are the major mycoses caused by aspergilli. The current status of the relationship between Aspergillus in the indoor environment and health issues are discussed.
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Affiliation(s)
- Maren A Klich
- USDA, ARS, Southern Regional Research Center, New Orleans, LA 70124, USA.
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Domergue V, Orlandini V, Begueret H, Couprie B, Huerre M, Tunon de Lara M, Beylot-Barry M, Doutre MS. Aspergillose cutanée, pulmonaire et osseuse chez un malade ayant un lupus érythémateux cutané subaigu sans déficit immunitaire associé. Ann Dermatol Venereol 2008; 135:217-21. [DOI: 10.1016/j.annder.2007.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2006] [Accepted: 04/13/2007] [Indexed: 11/29/2022]
Affiliation(s)
- V Domergue
- Service de dermatologie, hôpital Haut-Lévêque, CHU de Bordeaux, 1, avenue de Magellan, 33604 Pessac cedex, France
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Ho TV, Zalpour A, D'Amico C, Niangar ML, Gentle B, Mante M, Valdres R, Watson A, Grover T. Treatment of Aspergillosis in an Immunocompetent Patient: A Multidisciplinary Approach. Clin J Oncol Nurs 2007; 11:942-8. [DOI: 10.1188/cjon.07.942-948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Blot SI, Vandewoude KH. Invasive aspergillosis in immunocompetent patients. South Med J 2007; 99:1398. [PMID: 17233201 DOI: 10.1097/01.smj.0000251440.27396.a7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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