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Demolder F, De Bontridder S, Hanon S. Katayama syndrome disguised as eosinophilic asthma with acute systemic symptoms and pulmonary nodules. Respir Med Case Rep 2024; 50:102032. [PMID: 38737518 PMCID: PMC11087229 DOI: 10.1016/j.rmcr.2024.102032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 04/25/2024] [Accepted: 04/27/2024] [Indexed: 05/14/2024] Open
Abstract
Background Katayama syndrome is an acute manifestation of schistosomiasis, a parasitic infection that manifests itself through a hypersensitivity reaction to migrating larvae and early egg deposition. Left undiagnosed and untreated, acute schistosomiasis can develop into chronic schistosomiasis which can lead to debilitating morbidity such as pulmonary hypertension. This case highlights that Katayama syndrome can also been seen in regions where the parasite is not endemic, as it occurs in travelers returning from endemic regions or in immigrants. Case presentation We describe the case of a 26-year-old asthmatic male, who presented with systemic symptoms including fever, myalgia, night sweats as well as gastro-intestinal and pulmonary complaints since five days. At presentation, there was a raised blood eosinophil count and nodular lesions were seen on computed tomography. After considering diagnoses such as tuberculosis, vasculitis and hypereosinophilic syndrome, it was repeated history taking that revealed that the patient had suffered from swimmer's itch during a stay in Guinea. A stool sample showed microscopic presence of Schistosoma mansoni eggs, confirming the diagnosis of Katayama syndrome. The patient was treated with tapered corticosteroids to suppress the hypersensitivity reaction and praziquantel was added to cure the parasitic infection. This led to a complete resolution of the patients' symptoms and radiological abnormalities. Negative stool samples confirmed the eradication of the schistosomes. Conclusions Swimmer's itch and Katayama syndrome are manifestations of acute schistosomiasis. It is important to recognize the syndrome, because early diagnosis and adequate treatment can prevent chronic disease and significant morbidity.
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Affiliation(s)
- Femke Demolder
- Respiratory Division, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090, Jette, Belgium
| | - Samuel De Bontridder
- Respiratory Division, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090, Jette, Belgium
- Department of Pulmonology, Regional Hospital Heilig Hart Leuven, Naamsestraat 105, 3000, Leuven, Belgium
- Department of Respiratory Medicine, CUB Hôpital Erasme, Université Libre de Bruxelles, 808 Route de Lennik, 1070, Brussels, Belgium
| | - Shane Hanon
- Respiratory Division, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090, Jette, Belgium
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Camprubí-Ferrer D, Romero L, Van Esbroeck M, Wammes LJ, Almuedo-Riera A, Rodriguez-Valero N, Balerdi-Sarasola L, Hoekstra PT, Subirà C, Valls ME, Micalessi I, Corstjens P, Cortes-Serra N, Huyse T, Benegas M, Álvarez-Martínez MJ, Muñoz J, van Lieshout L. Improving the diagnosis and management of acute schistosomiasis with antibody, antigen and molecular techniques: lessons from a cluster of six travellers. J Travel Med 2021; 28:6316243. [PMID: 34230958 DOI: 10.1093/jtm/taab101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 06/18/2021] [Accepted: 06/29/2021] [Indexed: 11/12/2022]
Abstract
Different diagnostic tests were evaluated in a cluster of six European travellers with acute schistosomiasis (AS) acquired in Mozambique. Adult worm and soluble egg antibodies, circulating anodic antigen (CAA) and DNA detection allowed early confirmation of AS. CAA permitted monitoring treatment response and Sm1-7 polymerase chain reaction allowed identification of Schistosoma mansoni complex.
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Affiliation(s)
| | - Lucía Romero
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona 08036, Spain
| | - Marjan Van Esbroeck
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp 2000, Belgium
| | - Linda J Wammes
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, 2333 ZA, The Netherlands
| | - Alex Almuedo-Riera
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona 08036, Spain
| | | | | | - Pytsje T Hoekstra
- Department of Parasitology, Leiden University Medical Center, Leiden, 2333 ZA, The Netherlands
| | - Carme Subirà
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona 08036, Spain
| | | | - Isabel Micalessi
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp 2000, Belgium
| | - Paul Corstjens
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, 2333 ZA, The Netherlands
| | - Nuria Cortes-Serra
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona 08036, Spain
| | - Tine Huyse
- Department of Biology, Royal Museum for Central Africa, Tervuren 3080, Belgium
| | - Mariana Benegas
- Radiology Department, Hospital Clínic Barcelona, Barcelona 08036, Spain
| | | | - Jose Muñoz
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona 08036, Spain
| | - Lisette van Lieshout
- Department of Parasitology, Leiden University Medical Center, Leiden, 2333 ZA, The Netherlands
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3
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Rabinowicz S, Leshem E, Schwartz E. Acute schistosomiasis in paediatric travellers and comparison with their companion adults. J Travel Med 2021; 28:6062386. [PMID: 33398348 DOI: 10.1093/jtm/taaa238] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Schistosomiasis in non-immune travellers can cause acute schistosomiasis, a multi-systemic hypersensitivity reaction. Little is known regarding acute schistosomiasis in children. We describe acute schistosomiasis in paediatric travellers and compare them with adult travellers. METHODS A retrospective study of paediatric travellers (0-18 years old) diagnosed with schistosomiasis at Sheba Medical Center. Patients' findings are compared with those of adult travellers from the same travel groups. RESULTS in total, 18 children and 24 adults from five different trips to Tanzania, Uganda, Nigeria and Laos were infected (90% of the exposed travellers). The median bathing time of the infected children was 30 min (interquartile range (IQR) 15-30 min). The most common presentations were respiratory symptoms in 13 (72%), eosinophilia in 13 (72%) and fever in 11 (61%). Acute illness included a median of 2.5 symptoms. Three children required hospitalization and three were asymptomatic. Fatigue was significantly less common in children compared with similarly exposed adults (33% vs 71%, P = 0.03). Rates of hospitalization and steroid treatment were similar. The median eosinophil count in children was 1045 cells/μl (IQR 625-2575), lower than adults [2900 cells/μl (IQR 1170-4584)], P = 0.02. CONCLUSIONS Children may develop acute schistosomiasis following short exposure to contaminated freshwater, demonstrating a high infection rate. Severity seems to be similar to adults, although children report fatigue less commonly and show lower eosinophil counts. The disease should be suspected in children with multi-systemic illness and in asymptomatic children with relevant travel history.
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Affiliation(s)
- Shira Rabinowicz
- Paediatric Neurology Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eyal Leshem
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,The Center for Travel Medicine and Tropical Diseases, Sheba Medical Center, Ramat Gan, Israel
| | - Eli Schwartz
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,The Center for Travel Medicine and Tropical Diseases, Sheba Medical Center, Ramat Gan, Israel
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4
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Li YF, Lin DD. [Role of acute schistosomiasis control in facilitating the progress towards schistosomiasis elimination]. Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi 2019; 31:596-598. [PMID: 32064801 DOI: 10.16250/j.32.1374.2019195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Acute schistosomiasis is a clinical type of schistosomiasis with severe symptoms. The number of acute schistosomiasis cases is not only a sensitive indicator to assess the endemic situation and control effects, but also an important indicator to define schistosomiasis outbreaks and evaluate the achievements of infection control or transmission control. Acute schistosomiasis control is therefore of great significance to achieve the goal of schistosomiasis elimination in China. This paper analyzes the features and causes of acute schistosomiasis, and proposes some suggestions for future acute schistosomiasis control in China.
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Affiliation(s)
- Y F Li
- Jiangxi Provincial Key Laboratory of Schistosomiasis Control and Prevention, Jiangxi Provincial Institute of Parasitic Diseases, Nanchang 330000, China
| | - D D Lin
- Jiangxi Provincial Key Laboratory of Schistosomiasis Control and Prevention, Jiangxi Provincial Institute of Parasitic Diseases, Nanchang 330000, China
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5
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Fei Y, Jian-Gang Z, Xiao-Lang L, Cheng-Kui D. [Pulmonary ectopic lesion of acute schistosomiasis: a report of two cases]. Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi 2017; 29:534-536. [PMID: 29508602 DOI: 10.16250/j.32.1374.2016230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This paper reports the diagnosis and treatment of 2 cases of acute schistosomiasis with ectopic lesion in the lung. It suggests that in schistosomiasis endemic areas, if the patients with the contact history of infested water have the symptom of fever, while the effects of anti-infection and the corresponding treatments are not good, the clinician should consider acute schistosomiasis.
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Affiliation(s)
- Y Fei
- Department of Digestive Medicine, Second People's Hospital of Liangshan Prefecture, Sichuan Province, Xichang 615000, China
| | - Z Jian-Gang
- Department of Digestive Medicine, Second People's Hospital of Liangshan Prefecture, Sichuan Province, Xichang 615000, China
| | - L Xiao-Lang
- Department of Digestive Medicine, Second People's Hospital of Liangshan Prefecture, Sichuan Province, Xichang 615000, China
| | - D Cheng-Kui
- Department of Digestive Medicine, Second People's Hospital of Liangshan Prefecture, Sichuan Province, Xichang 615000, China
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6
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Liang-Jun W, You-Bin W, Zhao-Gang X. [Analysis of antibody titer value of IHA in 135 acute schistosomiasis patients]. Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi 2017; 29:222-224. [PMID: 29469332 DOI: 10.16250/j.32.1374.2016259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To analyze the antibody titer value of indirect haemagglutination test (IHA) in 135 confirmed acute schistosomiasis patients, so as to provide the evidence for improving the diagnosis and treatment of acute schistosomiasis. METHODS A total of 135 acute schistosomiasis inpatients were selected from 2001 to 2006. They all received the IHA antibody titer detection, and the correlation among the age, incubation period, and hospitalization days was calculated. RESULTS The antibody titers of IHA were higher than 1:320 in all the cases. The percentages of 1:640, 1:1 280, 1:2 560, 1:5 120 and 1:10 240 were 1.48%, 28.15%, 35.56%, 20.00%, and 14.81% respectively. The mean age was (47.70 ± 14.58) years, average incubation period was (38.03 ± 4.59) days and mean hospital stay time was (15.08 ± 3.79) days. The antibody titer value had no correlation with the age distribution (r = 0.109, P > 0.05). There was a negatively correlation between the antibody titer value and incubation period, (r = -0.558, P <0.01), there was a positive correlation between the antibody titer value and hospitalization time (r = 0.791, P < 0.01), and there were significant differences among different groups (F = 17.07, 64.53, both P < 0.01). CONCLUSIONS The antibody titer of acute schistosomiasis cases detected by IHA is 1:640 and above. There is no correlation between the antibody titer value and age, but the antibody titer value is higher, the incubation period is shorter and hospitalization time is longer.
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Affiliation(s)
- Wen Liang-Jun
- Gong'an County Specialist Hospital of Schistosomiasis, Hubei Province, Gong'an 434300, China
| | - Wang You-Bin
- Institute of Schistosomiasis Prevention and Control, Gong'an Municipal Center for Disease Control and Prevention, Hubei Province, China
| | - Xu Zhao-Gang
- Institute of Schistosomiasis Prevention and Control, Gong'an Municipal Center for Disease Control and Prevention, Hubei Province, China
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Zhang Y, Wang Y, Jiang Y, Pan W, Liu H, Yin J, Shen Y, Cao J. T follicular helper cells in patients with acute schistosomiasis. Parasit Vectors 2016; 9:321. [PMID: 27266984 PMCID: PMC4895967 DOI: 10.1186/s13071-016-1602-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 05/20/2016] [Indexed: 11/24/2022] Open
Abstract
Background The role of T follicular helper (Tfh) cells in schistosome infection is not fully defined. In a previous study, a higher frequency of circulating PD-1+CXCR5+CD4+ Tfh cells was observed in patients with chronic schistosomiasis relative to healthy controls (HCs) and it correlated positively with the level of soluble egg antigen (SEA) specific antibodies in serum. However, the function of Tfh cells in patients with acute schistosomiasis remains elusive; this was investigated in the present study. Methods The frequency of circulating Tfh cells and the expression of inducible T cell co-stimulator (ICOS), programmed cell death 1 (PD-1) and B cell subsets were analyzed in 12 patients with acute schistosomiasis and 10 HCs by flow cytometry. The expression of Bcl6, c-Maf and IL-21 mRNA were detected by quantitative real-time reverse transcriptase PCR (qRT-PCR). The concentration of serum IL-21 and IgG specific to Schistosoma japonicum antigen were then determined by enzyme linked immunosorbent assay (ELISA). Correlations between PD-1+CXCR5+CD4+ Tfh cells, memory B cells and IgG specific to S. japonicum were analyzed by Spearman’s rank correlation. Results The frequency of PD-1+CXCR5+CD4+ Tfh and memory B cells was increased in acute schistosomiasis patients relative to HCs. Moreover, the levels of IL-21 in serum and the expression of IL-21 mRNA were higher in acute schistosomiasis patients. However, there was no significant correlation between PD-1+CXCR5+CD4+ Tfh cells, memory B cells and IgG specific to S. japonicum antigen in patients with acute schistosomiasis. Conclusions PD-1+CXCR5+CD4+ Tfh cells in peripheral blood are involved in the immune response of patients with acute schistosomiasis. Understanding the immunological mechanism is helpful for the development of vaccination strategies to control schistosomiasis.
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Affiliation(s)
- Yumei Zhang
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, 200025, China.,Key Laboratory of Parasite and Vector Biology, MOH, Shanghai, 200025, China.,National Center for International Research on Tropical Diseases, Shanghai, 200025, China.,WHO Collaborating Center for Tropical Diseases, Shanghai, 200025, China.,Department of Pathogenic Biology, Binzhou Medical University, Yantai, 264003, Shandong, China
| | - Yanjuan Wang
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, 200025, China. .,Key Laboratory of Parasite and Vector Biology, MOH, Shanghai, 200025, China. .,National Center for International Research on Tropical Diseases, Shanghai, 200025, China. .,WHO Collaborating Center for Tropical Diseases, Shanghai, 200025, China.
| | - Yanyan Jiang
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, 200025, China.,Key Laboratory of Parasite and Vector Biology, MOH, Shanghai, 200025, China.,National Center for International Research on Tropical Diseases, Shanghai, 200025, China.,WHO Collaborating Center for Tropical Diseases, Shanghai, 200025, China
| | - Wei Pan
- Department of Pathogenic Biology and Immunity, Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China
| | - Hua Liu
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, 200025, China.,Key Laboratory of Parasite and Vector Biology, MOH, Shanghai, 200025, China.,National Center for International Research on Tropical Diseases, Shanghai, 200025, China.,WHO Collaborating Center for Tropical Diseases, Shanghai, 200025, China
| | - Jianhai Yin
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, 200025, China.,Key Laboratory of Parasite and Vector Biology, MOH, Shanghai, 200025, China.,National Center for International Research on Tropical Diseases, Shanghai, 200025, China.,WHO Collaborating Center for Tropical Diseases, Shanghai, 200025, China
| | - Yujuan Shen
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, 200025, China.,Key Laboratory of Parasite and Vector Biology, MOH, Shanghai, 200025, China.,National Center for International Research on Tropical Diseases, Shanghai, 200025, China.,WHO Collaborating Center for Tropical Diseases, Shanghai, 200025, China
| | - Jianping Cao
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, 200025, China. .,Key Laboratory of Parasite and Vector Biology, MOH, Shanghai, 200025, China. .,National Center for International Research on Tropical Diseases, Shanghai, 200025, China. .,WHO Collaborating Center for Tropical Diseases, Shanghai, 200025, China.
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Schwartz E, Rosenthal E, Bank I. Gamma delta T cells in non-immune patients during primary schistosomal infection. Immun Inflamm Dis 2014; 2:56-61. [PMID: 25400925 PMCID: PMC4220667 DOI: 10.1002/iid3.18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 03/05/2014] [Accepted: 03/26/2014] [Indexed: 12/30/2022]
Abstract
The mevalonate pathway is critical for the survival of Schistosoma. γδ T cells, a small subset of peripheral blood (PB) T cells, recognize low molecular weight phosphorylated antigens in the mevalonate pathway, which drive their expansion to exert protective and immunoregulatory effects. To evaluate their role in schistosomiasis, we measured γδ T cells in the PB of non-immune travelers who contracted Schistosoma hematobium or Schistosoma mansoni in Africa. The maximal level of γδ T-cells following infection was 5.78 ± 2.19% of the total T cells, versus 3.72 ± 3.15% in 16 healthy controls [P = 0.09] with no difference between S. hematobium and S. mansoni in this regard. However, among the nine patients in the cohort who presented with acute schistosomiasis syndrome (AS), the level (3.5 ± 1.9%) was significantly lower than in those who did not (8.6 ± 6.4%, P < 0.05), both before and after therapy. Furthermore, γδ T cells increased significantly in response to praziquantel therapy. In a patient with marked expansion of γδ T cells, most expressed the Vδ2 gene segment, a hallmark of cells responding to cognate antigens in the mevalonate pathways of the parasite or the human host. These results suggest an immunoregulatory role of antigen responsive γδ T cells in the clinical manifestations of early schistosomal infection.
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Affiliation(s)
- Eli Schwartz
- The Center for Geographical Medicine & Tropical Diseases, Chaim Sheba Medical Center Tel Hashomer, 52621, Israel
| | - Etti Rosenthal
- Institute of Hematology, Chaim Sheba Medical Center Ramat Gan, Israel
| | - Ilan Bank
- Department of Medicine F and Laboratory for Immunoregulation, Chaim Sheba Medical Center Ramat Gan, Israel
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9
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Abstract
Acute pulmonary schistosomiasis affects non-immune individuals returning from endemic areas. Pathogenesis is not well understood. We report a case of acute pulmonary schistosomiasis in which lung biopsy was done 10 weeks after exposure and it identified the presence of schistosomal ovum surrounded by granuloma.
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Affiliation(s)
- Sa Baharoon
- Department of Medicine, Infectious Diseases Division, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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