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Cenicacelaya Olabarrieta X, Cabello Vallejo M, Morell-Hita JL, Macía-Villa C. Case Report and Literature Review of Parvimonas micra: Difficult-to-Treat Arthritis in Hiding. Healthcare (Basel) 2023; 11:2879. [PMID: 37958023 PMCID: PMC10648561 DOI: 10.3390/healthcare11212879] [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: 09/20/2023] [Revised: 10/27/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023] Open
Abstract
Septic arthritis is a life-threatening rheumatological syndrome that is highly related to a patient's immune status and comorbidities, and although the most common clinical presentation is rapid-onset monoarthritis, it can also appear as subacute or chronic joint swelling. In these cases, differential diagnosis is more challenging, but early diagnosis and treatment is no less urgent to ensure a good global prognosis and the best outcome of the affected joint. Anaerobic microorganisms, such as Parvimonas micra, are an uncommon cause of septic arthritis (less than 5% of cases) but may be the cause of subacute arthritis. Knowledge about Parvimonas micra is important, as it is difficult to culture in the laboratory and generates a synovial fluid with atypical characteristics for septic arthritis so that, if not suspected, its diagnosis can be easily overlooked and underdiagnosed. We present the case of a 76-year-old woman with subacute arthritis of the left knee, describe the difficult diagnosis and treatment of its unexpected cause (Parvimonas micra), and review previously described cases, identifying the possible common comorbidities that may help clinicians easily find and treat this cause of subacute septic arthritis.
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Affiliation(s)
| | | | - José Luis Morell-Hita
- Department of Rheumatology, Ramón y Cajal University Hospital—IRYCIS, 28034 Madrid, Spain; (X.C.O.); (J.L.M.-H.)
| | - Cristina Macía-Villa
- Department of Rheumatology, Ramón y Cajal University Hospital—IRYCIS, 28034 Madrid, Spain; (X.C.O.); (J.L.M.-H.)
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Li Y, Yang J, Wang J, Wei B, Hu L. Pyopneumothorax caused by Parvimonas micra and Prevotella oralis: a case report. World J Emerg Med 2023; 14:488-491. [PMID: 37969220 PMCID: PMC10632756 DOI: 10.5847/wjem.j.1920-8642.2023.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 07/21/2023] [Indexed: 11/17/2023] Open
Affiliation(s)
- Yixuan Li
- Emergency Medicine Clinical Research Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100043, China
| | - Jun Yang
- Emergency Medicine Clinical Research Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100043, China
| | - Junyu Wang
- Emergency Medicine Clinical Research Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100043, China
| | - Bing Wei
- Emergency Medicine Clinical Research Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100043, China
| | - Le Hu
- Emergency Medicine Clinical Research Center, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100043, China
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3
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Native joint infections caused by Parvimonas micra. Anaerobe 2021; 71:102412. [PMID: 34217826 DOI: 10.1016/j.anaerobe.2021.102412] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 11/24/2022]
Abstract
Parvimonas micra is an anaerobic, fastidious, gram positive organism commonly found in the oral cavity and gastrointestinal tract. It has been increasingly reported as the cause of septic arthritis of native joints, often times with delayed diagnosis leading to increased morbidity. Risk factors include immunosuppression, inflammation of the joint, and recent dental procedures or infections. It has been a historically difficult organism to culture. However, the development of and increasing use of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS) has led to increased identification of P. micra. Common antibiotic susceptibilities, as well as data regarding susceptibilities in specific situations, have been reported, but susceptibility testing is required in all cases. Common treatments include clindamycin, penicillin, and metronidazole for six to ten weeks.
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Ryan PM, Morrey BF. Parvimonas micra causing native hip joint septic arthritis. Proc (Bayl Univ Med Cent) 2021; 34:486-488. [PMID: 34219932 DOI: 10.1080/08998280.2021.1906827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Parvimonas micra is a bacterium normal to oral and gastrointestinal flora that has been implicated in cases of discitis, osteomyelitis, and prosthetic joint infections, often involving dental procedures or periodontal disease. It is an extremely rare cause of infection outside of these circumstances. We describe a case of septic arthritis of the native hip joint due to P. micra.
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Affiliation(s)
- Patrick M Ryan
- Department of Orthopedics, Baylor Scott and White Medical Center - Temple, Temple, Texas
| | - Bernard F Morrey
- Department of Orthopedics, UT Health San Antonio, San Antonio, Texas
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Zhang Y, Song P, Zhang R, Yao Y, Shen L, Ma Q, Zhou J, Zhou H. Clinical Characteristics of Chronic Lung Abscess Associated with Parvimonas micra Diagnosed Using Metagenomic Next-Generation Sequencing. Infect Drug Resist 2021; 14:1191-1198. [PMID: 33790589 PMCID: PMC8001108 DOI: 10.2147/idr.s304569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 03/04/2021] [Indexed: 12/16/2022] Open
Abstract
Purpose Parvimonas micra (P. micra) is a Gram-positive anaerobic bacterium distributed in the oral cavity, with a potential to become pathogenic causing lung abscess. Due to the lack of specificity of symptoms and the difficulty in culture, the diagnosis of lung abscess associated with P. micra is delayed. It is essential to elucidate the clinical characteristics of lung abscess associated with P. micra. Methods From January 2019 to July 2020, five patients with chronic lung abscess associated with P. micra diagnosed by pathological biopsy and metagenomic next-generation sequencing (mNGS) were analyzed in this retrospective study. Results Among the five patients, four had a history of smoking, three had periodontitis, and two had a history of drinking. The average course of the disease was 6.5 months. High-density flake-like or mass shadows with irregular boundaries were observed in the chest computed tomography (CT) images of the five patients, and liquefactive necrosis was detected in the middle of the lesions; however, no gas-liquid plane or cavity was noted, making it difficult to distinguish a lung cancer. The pathological biopsy of the five patients showed chronic inflammation of lung tissue, and P. micra was detected by mNGS in the biopsy or bronchoalveolar lavage fluid samples. Two patients were treated with amoxicillin-clavulanate, two had metronidazole, and one had moxifloxacin. Among them, four recovered after receiving antibiotic treatment, and the remaining one underwent surgical resection due to poor antibiotic treatment effect. Conclusion Chronic lung abscess associated with P. micra, common in elderly male smokers with poor oral hygiene, is often diagnosed in a delayed manner and misdiagnosed as lung cancer. The mNGS technology is beneficial to the rapid determination of P. micra.
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Affiliation(s)
- Yaping Zhang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310003, People's Republic of China.,Department of Respiratory and Critical Care Medicine, Shangyu People's Hospital, Shaoxing, Zhejiang, 312300, People's Republic of China
| | - Ping Song
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310003, People's Republic of China.,Department of Critical Care Medicine, Deqing People's Hospital, Huzhou, Zhejiang, 313200, People's Republic of China
| | - Ruhui Zhang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310003, People's Republic of China
| | - Yake Yao
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310003, People's Republic of China
| | - Lisha Shen
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310003, People's Republic of China
| | - Qiang Ma
- Department of Respiratory Diseases, Yuhang Second People's Hospital, Hangzhou, Zhejiang, 311100, People's Republic of China
| | - Jianying Zhou
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310003, People's Republic of China
| | - Hua Zhou
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310003, People's Republic of China
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Ali H, Amir W, Bolick NL. An uncommon case of native joint septic arthritis by Parvimonas micra. Anaerobe 2020; 67:102315. [PMID: 33348083 DOI: 10.1016/j.anaerobe.2020.102315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/06/2020] [Accepted: 12/13/2020] [Indexed: 12/29/2022]
Abstract
Parvimonas micra is an anaerobic, Gram-positive coccus found in the oral cavity and gastrointestinal tract. We report a case of a 77-year-old male with right knee pain after a recent dental procedure and fall. Arthrocentesis was notable for Parvimonas micra which was successfully treated with metronidazole.
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Affiliation(s)
- Hassam Ali
- Department of Internal Medicine, East Carolina University/Vidant Medical Center, Greenville, NC, USA.
| | - Washma Amir
- Department of Internal Medicine, Dow Medical University, Karachi, Pakistan
| | - Nicole L Bolick
- Department of Internal Medicine, East Carolina University/Vidant Medical Center, Greenville, NC, USA
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Randall D, Jee Y, Vanood A, Mayo D. Atypical Presentation of Periprosthetic Joint Infection After Total Knee Arthroplasty due to Parvimonas micra. Arthroplast Today 2020; 6:901-905. [PMID: 33204785 PMCID: PMC7649107 DOI: 10.1016/j.artd.2020.09.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/25/2020] [Accepted: 09/30/2020] [Indexed: 11/18/2022] Open
Abstract
There is limited literature reporting the oral pathogen Parvimonas micra as the causative organism of periprosthetic joint infection. Previous reports demonstrate septic arthritis in native or prosthetic joints due to P. micra in elderly or immunocompromised patients associated with tooth abscess and periodontal disease. Our case report is unique because it describes a healthy individual with recurrent gingivitis developing periprosthetic joint infection after total knee arthroplasty as the result of isolated P. micra. Her clinical symptom presented early and manifested as progressive stiffness only. Timely aspiration resulted in early diagnosis, but the patient still underwent 2-stage revision with a more constrained implant. To prevent the risk of infection by oral pathogens such as P. micra, dental history should be thoroughly investigated, and any lingering periodontal infection should be addressed before any arthroplasty operation.
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Affiliation(s)
- Dustin Randall
- Oakland University William Beaumont School of Medicine, Auburn Hills, MI, USA
| | - Young Jee
- Department of Orthopaedic Surgery, Beaumont Health, Royal Oak, MI, USA
| | - Aimen Vanood
- Oakland University William Beaumont School of Medicine, Auburn Hills, MI, USA
| | - David Mayo
- Department of Orthopaedic Surgery, Beaumont Health, Royal Oak, MI, USA
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Sawai T, Koga S, Ide S, Yoshioka S, Matsuo N, Mukae H. An iliopsoas abscess caused by Parvimonas micra: a case report. J Med Case Rep 2019; 13:47. [PMID: 30819241 PMCID: PMC6396525 DOI: 10.1186/s13256-019-2004-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 02/01/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Parvimonas micra, a Gram-positive anaerobic coccus, is a rare pathogen for psoas abscess. We describe a case of a patient with iliopsoas abscess caused by P. micra. CASE PRESENTATION An 81-year-old Asian man presented to our department with complaints of fever since the preceding day. Abdominal computed tomography revealed the presence of a low-density mass in the right iliopsoas muscle indicative of a psoas abscess. Computed tomography-guided percutaneous drainage of the psoas abscess was performed. Results of organism cultures of the abscess and blood were positive for P. micra. However, our patient had no known primary focus of infection. On the basis of these findings, a primary psoas abscess caused by P. micra was diagnosed, and treatment with ampicillin/sulbactam 1.5 g, administered intravenously every 8 h, was initiated. By day 7, the patient's white blood cell count normalized. By day 20, his C-reactive protein level was decreased to 0.35 mg/dl. CONCLUSION Iliopsoas abscesses caused by anaerobic bacteria are relatively rare, and iliopsoas abscesses caused by P. micra are especially rare. Our patient's case revealed that P. micra can cause iliopsoas abscess. Therefore, clinicians should be aware of the possibility that P. micra may cause iliopsoas abscess.
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Affiliation(s)
- Toyomitsu Sawai
- Department of Respiratory Medicine, Nagasaki Harbor Medical Center, 6-39 Shinchi-machi, Nagasaki, 850-8555 Japan
| | - Satoru Koga
- Department of Respiratory Medicine, Nagasaki Harbor Medical Center, 6-39 Shinchi-machi, Nagasaki, 850-8555 Japan
| | - Shotaro Ide
- Department of Respiratory Medicine, Nagasaki Harbor Medical Center, 6-39 Shinchi-machi, Nagasaki, 850-8555 Japan
| | - Sumako Yoshioka
- Department of Respiratory Medicine, Nagasaki Harbor Medical Center, 6-39 Shinchi-machi, Nagasaki, 850-8555 Japan
| | - Nobuko Matsuo
- Department of Respiratory Medicine, Nagasaki Harbor Medical Center, 6-39 Shinchi-machi, Nagasaki, 850-8555 Japan
| | - Hiroshi Mukae
- Second Department of Internal Medicine, Nagasaki University Hospital, 1-7-1 Sakamoto-machi, Nagasaki, Japan
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Parvimonas micra bacteremia following endoscopic retrograde cholangiopancreatography: A new route of infection. Anaerobe 2018; 54:136-139. [PMID: 30217496 DOI: 10.1016/j.anaerobe.2018.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 09/03/2018] [Accepted: 09/10/2018] [Indexed: 12/20/2022]
Abstract
Parvimonas micra is an anaerobic, Gram-positive coccus belonging to oral, gastrointestinal and genital flora, rarely causing infections in humans. It was mainly deemed to cause bacteremia, septic bone and cerebral infections in patients which have undergone dental procedures or with suboptimal dental hygiene. We report the first case of Parvimonas micra bacteremia following endoscopic retrograde colangiopancreatography performed due to choledocholithiasis in a patient with good oral health. Identification of P. micra was finally performed by Matrix-assisted laser desorption ionization-time of flight mass spectrometry (VITEK MS system, bioMérieux, Marcy l'Étoile, France). All cases reported in english language of Parvimonas micra infections after medical procedure are reviewed in order to alert clinicians about new possible routes of infection of this emerging pathogen.
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Abstract
PURPOSE OF REVIEW Current evidence and accumulated experience for the management of calcium pyrophosphate deposition disease (CPPD) are presented. RECENT FINDINGS Contrary to other rheumatic inflammatory conditions that account for high interest and growing research, advances in treating CPPD are still very limited and mostly derive from those achieved in gout. Once formed, calcium pyrophosphate crystals cannot be dissolved; therefore, management relies on the control of crystal-derived inflammation. Besides classical agents-such as colchicine, glucocorticoids, or NSAIDs-the use of targeted therapies, mostly against interleukin-1, has provided a relevant relief for refractory CPPD patients in recent years. Meanwhile, former enthusiasm about conventional disease-modifying agents such as methotrexate is currently controversial.
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Affiliation(s)
- Mariano Andrés
- Sección de Reumatología, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Hospital General Universitario de Alicante, Pintor Baeza 12, 03010, Alicante, Spain. .,Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, Spain.
| | - Francisca Sivera
- Sección de Reumatología, Hospital General Universitario de Elda, Alicante, Spain
| | - Eliseo Pascual
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain
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Concomitant Parvimonas micra Septic Arthritis and Pseudogout After Total Knee Arthroplasty. J Clin Rheumatol 2018; 25:47-50. [PMID: 29470261 DOI: 10.1097/rhu.0000000000000728] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Sultan AA, Cantrell WA, Khlopas A, Cole C, Piuzzi NS, Sodhi N, Brooks P, Mont MA. Acute septic arthritis of the knee: A rare case report of infection with Parvimonas micra after an intra-articular corticosteroid injection for osteoarthritis. Anaerobe 2018; 51:17-20. [PMID: 29305995 DOI: 10.1016/j.anaerobe.2017.12.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 12/28/2017] [Accepted: 12/31/2017] [Indexed: 11/27/2022]
Abstract
Acute bacterial mono-articular septic arthritis affects most commonly the lower extremity joints in adult population and most commonly caused by Staphylococcus aureus. Various risk factors determine susceptibility to infection including host immunity, medical co-morbidity and joint structural abnormality and other organisms may be involved. Parvimonas micra (P. micra) is among the rare organisms that may be associated with atypical septic arthritis and primarily affects the native knee joint. Only 3 case reports in the literature have reported on pyogenic pyogenic joint infection caused by this organism. We hereby present our experience with a case of knee septic arthritis caused by P. micra in a patient with knee osteoarthritis following a recent intra-articular injection with corticosteroids. In susceptible patients, Intra-articular corticosteroid injection and crystal induced arthritis may propose a potential risk of contracting infection with P. micra.
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Affiliation(s)
- Assem A Sultan
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | | | - Anton Khlopas
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Connor Cole
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Nicolas S Piuzzi
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Nipun Sodhi
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Peter Brooks
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Michael A Mont
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, OH, USA.
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Roy M, Roy AK, Ahmad S. Septic arthritis of knee joint due to Parvimonas micra. BMJ Case Rep 2017; 2017:bcr-2017-221926. [PMID: 29141929 DOI: 10.1136/bcr-2017-221926] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Parvimonas species are anaerobic, Gram-positive cocci that are a constituent of normal oral and gastrointestinal flora. We present a case of right knee joint septic arthritis due to Parvimonas micra in an immunocompromised patient. A 61-year-old male renal and pancreatic transplant recipient on immunosuppressive therapy was admitted to our hospital due to intense pain, joint swelling and inability to move his right knee over the past 9 months. After synovial fluid was drawn, cultures were positive for P. micra, an anaerobic pathogen that is part of the flora of the oral cavity. We report a rare causative pathogen for septic arthritis in an immunocompromised patient.
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Affiliation(s)
- Moni Roy
- Internal Medicine, OSF Saint Francis Medical Center, Peoria, Illinois, USA
| | - Ashish Kumar Roy
- Internal Medicine, OSF Saint Francis Medical Center, Peoria, Illinois, USA
| | - Sharjeel Ahmad
- Internal Medicine, Section of Infectious Diseases, University of Illinois College of Medicine at Peoria, Peoria, Illinois, USA
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