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Elias E, Savoy HM, Swanson DA, Cohnstaedt LW, Peters DPC, Derner JD, Pelzel‐McCluskey A, Drolet B, Rodriguez L. Landscape dynamics of a vector‐borne disease in the western
US
: How vector–habitat relationships inform disease hotspots. Ecosphere 2022. [DOI: 10.1002/ecs2.4267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Emile Elias
- US Department of Agriculture, Agricultural Research Service Jornada Experimental Range Unit Las Cruces New Mexico USA
| | - Heather M. Savoy
- US Department of Agriculture, Agricultural Research Service, Big Data Initiative and the SCINet Program for Scientific Computing Office of National Programs Beltsville Maryland USA
| | - Dustin A. Swanson
- US Department of Agriculture, Agricultural Research Service, Arthropod‐Borne Animal Diseases Research Unit Center for Grain and Animal Health Research Manhattan Kansas USA
| | - Lee W. Cohnstaedt
- US Department of Agriculture, Agricultural Research Service, Arthropod‐Borne Animal Diseases Research Unit Center for Grain and Animal Health Research Manhattan Kansas USA
| | - Debra P. C. Peters
- US Department of Agriculture, Agricultural Research Service, Big Data Initiative and the SCINet Program for Scientific Computing Office of National Programs Beltsville Maryland USA
| | - Justin D. Derner
- US Department of Agriculture, Agricultural Research Service Rangeland Resources and Systems Research Unit Cheyenne Wyoming USA
| | - Angela Pelzel‐McCluskey
- US Department of Agriculture, Animal and Plant Health Inspection Service Veterinary Services Fort Collins Colorado USA
| | - Barbara Drolet
- US Department of Agriculture, Agricultural Research Service, Arthropod‐Borne Animal Diseases Research Unit Center for Grain and Animal Health Research Manhattan Kansas USA
| | - Luis Rodriguez
- US Department of Agriculture, Agricultural Research Service Foreign Animal Disease Research Unit, Plum Island Animal Disease Center Orient Point New York USA
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Beasley EA, Mahachi KG, Petersen CA. Possibility of Leishmania Transmission via Lutzomyia spp. Sand Flies Within the USA and Implications for Human and Canine Autochthonous Infection. CURRENT TROPICAL MEDICINE REPORTS 2022; 9:160-168. [PMID: 36159745 PMCID: PMC9490703 DOI: 10.1007/s40475-022-00267-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2022] [Indexed: 01/14/2023]
Abstract
Purpose of Review Leishmaniasis is a leading cause of parasitic death, with incidence rising from decreased resources to administer insecticide and anti-leishmanial treatments due to the COVID-19 pandemic. Leishmaniasis is nonendemic in the United States (U.S.), but enzootic canine populations and potentially competent vectors warrant monitoring of autochthonous disease as a fluctuating climate facilitates vector expansion. Recent studies concerning sand fly distribution and vector capacity were assessed for implications of autochthonous transmission within the U.S. Recent Findings Climate change and insecticide resistance provide challenges in sand fly control. While most Leishmania-infected dogs in the U.S. were infected via vertical transmission or were imported, autochthonous vector-borne cases were reported. Autochthonous vector-borne human cases have been reported in four states. Further vaccine research could contribute to infection control. Summary Both cutaneous and visceral leishmaniasis cases in the U.S. are increasingly reported. Prevention measures including vector control and responsible animal breeding are critical to halt this zoonotic disease.
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Affiliation(s)
- Erin A. Beasley
- Department of Epidemiology, College of Public Health, CPHB S429, University of Iowa, 145 N. Riverside Drive, Iowa City, Iowa, USA
- Center for Emerging Infectious Diseases, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Kurayi G. Mahachi
- Department of Epidemiology, College of Public Health, CPHB S429, University of Iowa, 145 N. Riverside Drive, Iowa City, Iowa, USA
- Center for Emerging Infectious Diseases, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Christine A. Petersen
- Department of Epidemiology, College of Public Health, CPHB S429, University of Iowa, 145 N. Riverside Drive, Iowa City, Iowa, USA
- Center for Emerging Infectious Diseases, College of Public Health, University of Iowa, Iowa City, Iowa, USA
- Interdepartmental Immunology Program, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
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Curtin JM, Aronson NE. Leishmaniasis in the United States: Emerging Issues in a Region of Low Endemicity. Microorganisms 2021; 9:578. [PMID: 33799892 PMCID: PMC7998217 DOI: 10.3390/microorganisms9030578] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/08/2021] [Accepted: 03/10/2021] [Indexed: 12/12/2022] Open
Abstract
Leishmaniasis, a chronic and persistent intracellular protozoal infection caused by many different species within the genus Leishmania, is an unfamiliar disease to most North American providers. Clinical presentations may include asymptomatic and symptomatic visceral leishmaniasis (so-called Kala-azar), as well as cutaneous or mucosal disease. Although cutaneous leishmaniasis (caused by Leishmania mexicana in the United States) is endemic in some southwest states, other causes for concern include reactivation of imported visceral leishmaniasis remotely in time from the initial infection, and the possible long-term complications of chronic inflammation from asymptomatic infection. Climate change, the identification of competent vectors and reservoirs, a highly mobile populace, significant population groups with proven exposure history, HIV, and widespread use of immunosuppressive medications and organ transplant all create the potential for increased frequency of leishmaniasis in the U.S. Together, these factors could contribute to leishmaniasis emerging as a health threat in the U.S., including the possibility of sustained autochthonous spread of newly introduced visceral disease. We summarize recent data examining the epidemiology and major risk factors for acquisition of cutaneous and visceral leishmaniasis, with a special focus on implications for the United States, as well as discuss key emerging issues affecting the management of visceral leishmaniasis.
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Affiliation(s)
- John M. Curtin
- Infectious Diseases Service, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
- Infectious Diseases Division, Uniformed Services University, Bethesda, MD 20814, USA;
| | - Naomi E. Aronson
- Infectious Diseases Division, Uniformed Services University, Bethesda, MD 20814, USA;
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Ozanne MV, Brown GD, Toepp AJ, Scorza BM, Oleson JJ, Wilson ME, Petersen CA. Bayesian compartmental models and associated reproductive numbers for an infection with multiple transmission modes. Biometrics 2020; 76:711-721. [PMID: 31785149 PMCID: PMC7673222 DOI: 10.1111/biom.13192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 11/08/2019] [Accepted: 11/14/2019] [Indexed: 01/01/2023]
Abstract
Zoonotic visceral leishmaniasis (ZVL) is a serious neglected tropical disease that is endemic in 98 countries. ZVL is primarily transmitted via a sand fly vector. In the United States, it is enzootic in some canine populations; it is transmitted from infectious mother to pup transplacentally, and vector-borne transmission is absent. This absence affords a unique opportunity to study (1) vertical transmission dynamics in dogs and (2) the importance of vertical transmission in maintaining an infectious reservoir in the presence of a vector. In this paper, we present Bayesian compartmental models and reproductive number formulations to examine (1) and (2), providing a mechanism to plan and evaluate interventions in regions where both transmission modes are present. First, we propose an individual-level susceptible, infectious, removed (SIR) model to study the effect of maternal infection status during pregnancy on pup infection progression. We provide evidence that pups born to diagnostically positive mothers during pregnancy are more likely to become diagnostically positive both earlier in life, and at some point during their lifetime, than those born to diagnostically negative mothers. Second, we propose a population-level SIR model to study the impact of a vertically maintained reservoir on propagating infection in a naive canine population through emergent vector transmission using simulation studies. We also present reproductive numbers to quantify contributions of vertically infected and vector-infected dogs to maintaining infection in the population. We show that a vertically maintained canine reservoir can propagate infection in a theoretical naive population in the presence of a vector.
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Affiliation(s)
- Marie V Ozanne
- Department of Mathematics & Statistics, Mount Holyoke College, South Hadley, Massachusetts
- Department of Biostatistics, University of Iowa College of Public Health, Iowa City, Iowa
| | - Grant D Brown
- Department of Biostatistics, University of Iowa College of Public Health, Iowa City, Iowa
| | - Angela J Toepp
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa
| | - Breanna M Scorza
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa
| | - Jacob J Oleson
- Department of Biostatistics, University of Iowa College of Public Health, Iowa City, Iowa
| | - Mary E Wilson
- Department of Internal Medicine, University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa
- Department of Microbiology, University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa
- Iowa City VA Medical Center, Iowa City, Iowa
| | - Christine A Petersen
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa
- Center for Emerging Infectious Diseases, University of Iowa College of Public Health, Iowa City, Iowa
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Coyner KS, Ward JG. Pathology in Practice. J Am Vet Med Assoc 2020; 254:813-817. [PMID: 30888276 DOI: 10.2460/javma.254.7.813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Toepp AJ, Bennett C, Scott B, Senesac R, Oleson JJ, Petersen CA. Maternal Leishmania infantum infection status has significant impact on leishmaniasis in offspring. PLoS Negl Trop Dis 2019; 13:e0007058. [PMID: 30759078 PMCID: PMC6391032 DOI: 10.1371/journal.pntd.0007058] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 02/26/2019] [Accepted: 12/05/2018] [Indexed: 01/21/2023] Open
Abstract
Visceral Leishmaniasis is a deadly disease caused by Leishmania infantum, endemic in more than 98 countries across the globe. Although the most common means of transmission is via a sand fly vector, there is growing evidence that vertical transmission may be critical for maintaining L. infantum infection within the reservoir, canine, population. Vertical transmission is also an important cause of infant morbidity and mortality particularly in sub-Saharan Africa. While vertical transmission of visceralizing species of Leishmania has been reported around the globe, risk factors associated with this unique means of Leishmania transmission have not been identified therefore interventions regarding this means of transmission have been virtually non-existent. Furthermore, the basic reproductive number, (R0), or number of new L. infantum infections that one infected mother or dam can cause has not been established for vertical transmission, also hampering the ability to assess the impact of this means of transmission within reservoir of human hosts. Canine Leishmaniosis (CanL) is enzootic within a U.S. hunting dog population. CanL is transmitted within this population via transplacental transmission with no reported vector transmission, despite many repeated attempts to find infected sand flies associated with these dogs and kennels. This population with predominantly, if not solely, vertical transmission of L. infantum was used to evaluate the critical risk factors for vertical transmission of Leishmania and establish the R0 of vertical L. infantum infection. Evaluation of 124 animals born to eighteen dams diagnostically positive for infection with L. infantum showed that there was a 13.84x greater chance of being positive for L. infantum within their lifetime if the mother was also positive within her lifetime (RR: 13.84, 95% CI: 3.54-54.20, p-value: <0.0001). The basic reproductive number for vertically transmitted L. infantum within this cohort was 4.12. These results underscore that there is a high risk of L. infantum infection to transmit from mother to offspring. Targeted public health interventions and control efforts that address vertical transmission of L. infantum are necessary in endemic countries to eliminate visceral leishmaniasis.
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Affiliation(s)
- Angela J. Toepp
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, United States of America
- Center for Emerging Infectious Diseases, University of Iowa Research Park, Coralville, Iowa, United States of America
| | - Carolyne Bennett
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, United States of America
- Center for Emerging Infectious Diseases, University of Iowa Research Park, Coralville, Iowa, United States of America
| | - Benjamin Scott
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, United States of America
- Center for Emerging Infectious Diseases, University of Iowa Research Park, Coralville, Iowa, United States of America
| | - Reid Senesac
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, United States of America
- Center for Emerging Infectious Diseases, University of Iowa Research Park, Coralville, Iowa, United States of America
| | - Jacob J. Oleson
- Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa, United States of America
| | - Christine A. Petersen
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, United States of America
- Center for Emerging Infectious Diseases, University of Iowa Research Park, Coralville, Iowa, United States of America
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Swanson DA, Kapaldo NO, Maki E, Carpenter JW, Cohnstaedt LW. Diversity and Abundance of Nonculicid Biting Flies (Diptera) In A Zoo Environment. JOURNAL OF THE AMERICAN MOSQUITO CONTROL ASSOCIATION 2018; 34:265-271. [PMID: 31442142 DOI: 10.2987/18-6761.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The diversity of nonculicid biting flies was surveyed in Sunset Zoo, Manhattan, KS, by carbon dioxide-baited traps. A total of 8,399 nonculicid biting-fly females representing 32 species and 5 families were collected. Twenty-one biting midge (Ceratopogonidae: Culicoides) and 7 black fly (Simuliidae) species were collected, including new state records of 3 Culicoides and 1 simuliid. The species richness of Culicoides and Simuliidae within the zoo represents 72.4% and 41.2%, respectively, of the fauna known to occur in Kansas. Trap type significantly influenced (P < 0.05) collections of the 5 species analyzed, and trapping period affected 3 species. The diversity and abundance of nonculicid biting flies in the zoo as related to animal health and wellness is discussed.
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Toepp AJ, Schaut RG, Scott BD, Mathur D, Berens AJ, Petersen CA. Leishmania incidence and prevalence in U.S. hunting hounds maintained via vertical transmission. Vet Parasitol Reg Stud Reports 2017; 10:75-81. [PMID: 31014604 DOI: 10.1016/j.vprsr.2017.08.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 07/25/2017] [Accepted: 08/17/2017] [Indexed: 11/30/2022]
Abstract
Leishmania is the causative agent of leishmaniasis, a deadly protozoan disease which affects over 1 million people each year. Autochthonous cases of canine leishmaniasis are generally associated with tropical and subtropical climatic zones. However, in 1999, U.S. hunting dogs were found to have leishmaniasis with no history of travel outside the country. Transmission of this disease was found to be primarily vertical. In endemic areas, dogs are a dominant domestic reservoir host for Leishmania infantum. This study evaluated L. infantum infection prevalence and incidence within US dogs tested over a nine-year span (2007-2015). This investigation used both passive and active surveillance, following an initial outbreak investigation by the Centers for Disease Control. L. infantum infection incidence and prevalence over time and across regions were examined to evaluate whether transmission was sufficient to maintain ongoing infection within this population. These studies also established whether this disease is becoming more or less prominent within this reservoir host, dogs. There was no significant difference between prevalence and incidence rates via as measured by passive vs. active surveillance. Although due to fluctuations in sample submission there were significant changes in both incidence and prevalence of L. infantum in US hunting dogs over this nine year span, these differences were not outside of the interquartile range and therefore there is likely to be a steady-state of transmission within U.S. dogs. Based on these findings, if vertical transmission is the primary means of L. infantum spread in U.S. dogs, with appropriate husbandry and infection control procedures, elimination of L. infantum from US dogs could be possible.
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Affiliation(s)
- Angela J Toepp
- College of Public Health, Center for Emerging Infectious Diseases, University of Iowa, Iowa City, IA, USA
| | - Robert G Schaut
- College of Public Health, Center for Emerging Infectious Diseases, University of Iowa, Iowa City, IA, USA
| | - Benjamin D Scott
- College of Public Health, Center for Emerging Infectious Diseases, University of Iowa, Iowa City, IA, USA
| | - Divida Mathur
- Bioinformatics and Computational Biology Lab, Iowa State University, Ames, Iowa, USA
| | - Ali J Berens
- Bioinformatics and Computational Biology Lab, Iowa State University, Ames, Iowa, USA
| | - Christine A Petersen
- College of Public Health, Center for Emerging Infectious Diseases, University of Iowa, Iowa City, IA, USA.
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Neal AT, Ross MS, Schall JJ, Vardo-Zalik AM. Genetic differentiation over a small spatial scale of the sand fly Lutzomyia vexator (Diptera: Psychodidae). Parasit Vectors 2016; 9:550. [PMID: 27756347 PMCID: PMC5070220 DOI: 10.1186/s13071-016-1826-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 10/02/2016] [Indexed: 02/08/2023] Open
Abstract
Background The geographic scale and degree of genetic differentiation for arthropod vectors that transmit parasites play an important role in the distribution, prevalence and coevolution of pathogens of human and wildlife significance. We determined the genetic diversity and population structure of the sand fly Lutzomyia vexator over spatial scales from 0.56 to 3.79 km at a study region in northern California. The study was provoked by observations of differentiation at fine spatial scales of a lizard malaria parasite vectored by Lu. vexator. Methods A microsatellite enrichment/next-generation sequencing protocol was used to identify variable microsatellite loci within the genome of Lu. vexator. Alleles present at these loci were examined in four populations of Lu. vexator in Hopland, CA. Population differentiation was assessed using Fst and D (of Cavalli-Sforza and Edwards), and the program Structure was used to determine the degree of subdivision present. The effective population size for the sand fly populations was also calculated. Results Eight microsatellite markers were characterized and revealed high genetic diversity (uHe = 0.79–0.92, Na = 12–24) and slight but significant differentiation across the fine spatial scale examined (average pairwise D = 0.327; FST = 0.0185 (95 % bootstrapped CI: 0.0102–0.0264). Even though the insects are difficult to capture using standard methods, the estimated population size was thousands per local site. Conclusions The results argue that Lu. vexator at the study sites are abundant and not highly mobile, which may influence the overall transmission dynamics of the lizard malaria parasite, Plasmodium mexicanum, and other parasites transmitted by this species. Electronic supplementary material The online version of this article (doi:10.1186/s13071-016-1826-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Allison T Neal
- Department of Biology, Norwich University, Northfield, VT, 05663, USA
| | - Max S Ross
- Department of Biology, University of Vermont, Burlington, VT, 05401, USA
| | - Jos J Schall
- Department of Biology, University of Vermont, Burlington, VT, 05401, USA
| | - Anne M Vardo-Zalik
- Department of Biology, Pennsylvania State University, York, PA, 17403, USA.
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Schaut RG, Robles-Murguia M, Juelsgaard R, Esch KJ, Bartholomay LC, Ramalho-Ortigao M, Petersen CA. Vectorborne Transmission of Leishmania infantum from Hounds, United States. Emerg Infect Dis 2016; 21:2209-12. [PMID: 26583260 PMCID: PMC4672406 DOI: 10.3201/eid2112.141167] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Leishmaniasis is a zoonotic disease caused by predominantly vectorborne Leishmania spp. In the United States, canine visceral leishmaniasis is common among hounds, and L. infantum vertical transmission among hounds has been confirmed. We found that L. infantum from hounds remains infective in sandflies, underscoring the risk for human exposure by vectorborne transmission.
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Hughes G, Samuels S, Shaikh K, Rasgon J, Vardo-Zalik A. Discrimination of the Plasmodium mexicanum vectors Lutzomyia stewarti and Lutzomyia vexator by a PCR-RFLP assay and Wolbachia infection. JOURNAL OF VECTOR ECOLOGY : JOURNAL OF THE SOCIETY FOR VECTOR ECOLOGY 2014; 39:224-227. [PMID: 24820578 PMCID: PMC4281934 DOI: 10.1111/j.1948-7134.2014.12092.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 01/26/2014] [Indexed: 06/03/2023]
Affiliation(s)
- G.L. Hughes
- The Huck Institutes of The Life Sciences, The Center for Infectious Disease Dynamics and the Department of Entomology, Pennsylvania State University, University Park, PA 16802, U.S.A
| | - S.K. Samuels
- Science Department, The Pennsylvania State University, York, PA 17403, U.S.A
| | - K. Shaikh
- Science Department, The Pennsylvania State University, York, PA 17403, U.S.A
| | - J.L. Rasgon
- The Huck Institutes of The Life Sciences, The Center for Infectious Disease Dynamics and the Department of Entomology, Pennsylvania State University, University Park, PA 16802, U.S.A
| | - A.M. Vardo-Zalik
- The Huck Institutes of The Life Sciences, The Center for Infectious Disease Dynamics and the Department of Entomology, Pennsylvania State University, University Park, PA 16802, U.S.A
- Science Department, The Pennsylvania State University, York, PA 17403, U.S.A
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Douvoyiannis M, Khromachou T, Byers N, Hargreaves J, Murray HW. Cutaneous leishmaniasis in North Dakota. Clin Infect Dis 2014; 59:e73-5. [PMID: 24850800 DOI: 10.1093/cid/ciu386] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
In the United States, autochthonous cutaneous leishmaniasis caused by infection with Leishmania mexicana has been reported from Texas and Oklahoma. Here, we describe a child with 2 new features: cutaneous infection acquired outside of the south-central United States (in North Dakota) and infection caused by Leishmania donovani species complex.
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Affiliation(s)
| | | | - Norman Byers
- Department of Ophthalmology, Altru Health System, Grand Forks, North Dakota Department of Ophthalmology
| | - James Hargreaves
- Division ofInfectious Diseases Division of Infectious Diseases, University of North Dakota School of Medicine, Grand Forks
| | - Henry W Murray
- Division of Infectious Diseases, Weill Cornell Medical College, New York, New York
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