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Carreras X, Salcedo AS, Ponce-Rosas L, Gonzales-Zamora JA, Diaz N, Alave J. Lemierre-like syndrome after soft tissue infection due to methicillin-resistant Staphylococcus aureus: A case report and literature review. Medicine (Baltimore) 2024; 103:e37006. [PMID: 38363930 PMCID: PMC10869080 DOI: 10.1097/md.0000000000037006] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 12/29/2023] [Indexed: 02/18/2024] Open
Abstract
RATIONALE Lemierre-like syndrome (LLS) is characterized by bacteremia, septic thrombophlebitis of the internal jugular vein, and metastatic abscesses. In contrast to classic Lemierre syndrome, sources of infection are not related to oropharyngeal infections, as are frequent soft tissue infections. In recent years, Staphylococcus aureus has been identified as an emergent pathogen that causes this syndrome. The mortality rate of LLS caused by this pathogen is approximately 16%. Timely diagnosis, antibiotic treatment, and infection control are the cornerstones to treat LLS. Anticoagulant therapy as adjuvant treatment remains controversial. PATIENT CONCERNS A 31-year-old woman from California, United States (US), was admitted to the emergency room with a history of 2 days of fever and severe throbbing pain in the left cervical region. Thorax and neck CT tomography revealed confluent cavities suggestive of septic embolism in the lungs and a filiform thrombus in the lumen of the left internal jugular vein, with moderate swelling of the soft and muscular tissues. Methicillin-resistant Staphylococcus aureus (MRSA) was isolated from the blood culture. DIAGNOSIS The thrombus in the internal jugular vein associated with cellulitis in the neck and multiple cavitary lesions in the lungs support the diagnosis of LLS caused by MRSA with septic embolization. INTERVENTIONS During treatment, the patient received vancomycin IV for 25 days and returned to the US with linezolid orally. In addition, assisted video-thoracoscopy and bilateral mini-thoracotomy with pleural decortication were performed for infectious source control, where 1700cc of purulent pleural fluid was drained. OUTCOMES The patient was discharged with optimal evolution. LESSONS LLS should be suspected in patients with skin and soft tissue infections who develop thrombosis or metastatic infections. MRSA infections should be considered in patients from areas where this pathogen is prevalent.
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Affiliation(s)
- Xosse Carreras
- School of Medicine, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Andrea S. Salcedo
- School of Medicine, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Linda Ponce-Rosas
- Department of Medicine, Hamilton Medical Center, Dalton, GA 30720
- Peruvian American Medical Society, Albuquerque, NM
| | - Jose A. Gonzales-Zamora
- Peruvian American Medical Society, Albuquerque, NM
- Division of Infectious Diseases, Department of Medicine, University of Miami, Miller School of Medicine, FL 33136
| | - Nelson Diaz
- School of Medicine, Universidad Peruana Union, Lima, Peru
- Department of Internal Medicine, Clínica Good Hope, Lima, Peru
| | - Jorge Alave
- School of Medicine, Universidad Peruana Union, Lima, Peru
- Department of Internal Medicine, Clínica Good Hope, Lima, Peru
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Araoz-Salinas JM, Ortiz-Saavedra B, Ponce-Rosas L, Soriano-Moreno DR, Soriano-Moreno AN, Alave J, Gonzales-Zamora JA. Perceptions and Intention to Get Vaccinated against Mpox among the LGBTIQ+ Community during the 2022 Outbreak: A Cross-Sectional Study in Peru. Vaccines (Basel) 2023; 11:vaccines11051008. [PMID: 37243112 DOI: 10.3390/vaccines11051008] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 04/27/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
Vaccination against mpox can control the outbreak by targeting high-risk groups such as the LGBTIQ+ community. The aim of the study was to evaluate the perceptions and intentions to get vaccinated against mpox among the LGBTIQ+ community in Peru. We conducted a cross-sectional study from 1 November 2022 to 17 January 2023 in Peru. We included individuals over 18 years old, belonging to the LGBTIQ+ community, and residing in the departments of Lima and Callao. To evaluate the factors associated with the intention to be vaccinated, we used Poisson regression with robust variance to create a multivariate model. The study comprised 373 individuals who self-identified as members of the LGBTIQ+ community. The participants had a mean age of 31 years (SD ± 9), with 85.0% males and 75.3% reporting to be homosexual men. The majority (88.5%) expressed their intention to receive the vaccine against mpox. Believing that the vaccine is safe was associated with a higher intention to be vaccinated (aPR: 1.24; 95% CI: 1.02 to 1.50; p = 0.028). Our study population showed a high level of mpox vaccination intent. Educational campaigns reinforcing the concept of vaccine safety should be conducted to increase the intention and possibly the vaccination rate in the LGBTIQ+ community.
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Affiliation(s)
| | | | - Linda Ponce-Rosas
- Department of Medicine, Hamilton Medical Center, Dalton, GA 30720, USA
| | - David R Soriano-Moreno
- Unidad de Investigación Clínica y Epidemiológica, Escuela de Medicina, Universidad Peruana Unión, Lima 15464, Peru
| | - Anderson N Soriano-Moreno
- Unidad de Investigación Clínica y Epidemiológica, Escuela de Medicina, Universidad Peruana Unión, Lima 15464, Peru
| | - Jorge Alave
- Departamento de Medicina, Facultad de Medicina, Universidad Peruana Unión, Lima 15464, Peru
- Clinica Good Hope, Lima 15074, Peru
| | - Jose A Gonzales-Zamora
- Peruvian American Medical Society, Albuquerque, NM 87111, USA
- Division of Infectious Diseases, Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
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Gonzales-Zamora JA, Soriano-Moreno D, Ponce-Rosas L, Alarcón Parra MG, Morocho-Alburqueque N, Murrieta-Ruiz V, De-Los-Rios-Pinto A, Soriano-Moreno A, Caira-Chuquineyra B, Ccami-Bernal F, Fernandez-Guzman D, Alave J. 1975. Trends in the parents’ intention to vaccinate their children against COVID-19: A comparative study in Peru. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.1600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
Although COVID-19 vaccination has shown to be clearly beneficial in children and adolescents to reduce hospitalization and potentially transmission, there is still a lot of hesitation among parents due to concerns about vaccine safety and efficacy, especially in children under 12 years of age.
Methods
We conducted a comparative study in Peru to evaluate the trends in parents’ intention to vaccinate their children under 12 years of age against COVID-19, for which an online survey was administered. The survey was distributed through social networks (Facebook, Twitter, etc.), and was applied during two periods: 11/25/2021 to 12/06/2022 (Period 1) and 01/16/2022 to 01/24/2022 (Period 2). We also assessed the factors associated with the intention to vaccinate in each period through crude (cPR) and adjusted prevalence rates (aPR).
Results
During period 1, there were 673 participants (69.7% women). In period 2, we had 1139 respondents (77.7% women). Regarding intention to vaccinate, 83.5% of parents intended to vaccinate their children under 12 years of age during period 1. This percentage was almost the same during period 2 (83.3%). During period 1, the factors associated with a decrease in this intention were to believe that the vaccine was not necessary (aPR 0.65; 95% CI 0.44 – 0.94, p=0.022), that it would not protect (aPR: 0.14; 95% CI 0.03 – 0.63, p=0.011), that it would not be safe (aPR: 0.80; 95% CI 0.70 – 0.92, p=0.001), that it could cause long-term side effects (aPR: 0.92; 95% CI 0.85 – 1.00, p=0.037), and to think it should not be mandatory (aPR: 0.89; 95% CI 0.80-0.99, p=0.038). During period 2, besides the factors identified in period 1, not knowing about COVID-19 infection risk in children (aPR: 0.92; 95% CI 0.85-1.00, p=0.042) was also associated with a decrease in the intention. Living on the highlands or jungle was associated with an increase in the intention in both periods.
Conclusion
A high rate of intention to vaccinate children under 12 years of age was noted among parents in Peru, which was maintained until the end of January of 2022, right before COVID-19 vaccination started for this age group. There was a perception in some parents that the vaccine might not be necessary or safe, leading to a lower intention to vaccinate their children.
Disclosures
All Authors: No reported disclosures.
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Affiliation(s)
- Jose A Gonzales-Zamora
- Infectious Disease Division. University of Miami, Miller School of Medicine. , Miami, Florida
| | - David Soriano-Moreno
- Unidad de Investigación Clínica y Epidemiológica, Escuela de Medicina, Universidad Peruana Unión , Lima, Lima , Peru
| | | | | | | | - Valentina Murrieta-Ruiz
- Facultad de Medicina Humana Rafael Donayre Rojas. Universidad Nacional de la Amazonía Peruana , Iquitos, Loreto , Peru
| | - Abraham De-Los-Rios-Pinto
- Escuela Profesional de Medicina Humana, Universidad Nacional de San Antonio Abad del Cusco , Cusco, Cusco , Peru
| | - Anderson Soriano-Moreno
- Unidad de Investigación Clínica y Epidemiológica, Escuela de Medicina, Universidad Peruana Unión , Lima, Lima , Peru
| | - Brenda Caira-Chuquineyra
- Facultad de Medicina, Universidad Nacional de San Agustín de Arequipa , Arequipa, Arequipa , Peru
| | - Fabricio Ccami-Bernal
- Facultad de Medicina, Universidad Nacional de San Agustín de Arequipa , Arequipa, Arequipa , Peru
| | - Daniel Fernandez-Guzman
- Escuela Profesional de Medicina Humana, Universidad Nacional de San Antonio Abad del Cusco , Cusco, Cusco , Peru
| | - Jorge Alave
- Universidad Peruana Union , Lima, Lima , Peru
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Gonzales-Zamora JA, Ponce-Rosas L, Martinez R. Determinants of public health and interventions to address HIV infection among men who have sex with men in Miami-Dade County, Florida, USA. Infez Med 2022; 30:392-402. [PMID: 36148172 PMCID: PMC9448313 DOI: 10.53854/liim-3003-7] [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] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 07/16/2022] [Indexed: 06/16/2023]
Abstract
Human immunodeficiency virus (HIV) among men who have sex with men (MSM) has been recognized as a public health problem in Miami-Dade County, Florida, USA. This was found to be a significant problem in our need assessment as evidenced by the HIV incidence rate of 28.4 per 100,000 population, which is higher than the average incidence reported for the state of Florida. MSM account for the mostly affected group, reaching 59% of all the new cases. A review of the HIV determinants was conducted using an ecological framework. At the individual level, sexual abuse, alcohol, and drug consumption were identified as determinants of HIV infection in this population. Family rejection was recognized as a determinant at the interpersonal level. Connection to the gay community can function as a protective factor but it can also be possible predictor of HIV infection. Among structural factors, poverty was found to be positively associated with HIV prevalence. Additionally, we highlighted the importance of sexual health education and especially pre-exposure prophylaxis (PrEP) as protective factors. By using systems thinking tools, we designed a causal loop diagram that illustrates visually the recognized determinants of public health. Finally, we presented several studies that evaluate evidence-based interventions to improve the uptake and retention in care of PrEP in MSM. We also described existing interventions implemented in Miami-Dade County, and reported studies that may contribute to the development of new HIV preventive strategies in the future.
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Affiliation(s)
- Jose A. Gonzales-Zamora
- Infectious Diseases Division, Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA
- Peruvian American Medical Society (PAMS), Albuquerque, NM, USA
| | | | - Richard Martinez
- Department of Physical Therapy, University of Miami, Miami, FL, USA
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Ponce-Rosas L, Gonzales-Zamora J, Bertorini TE. Dr. Aníbal Zambrano: un médico peruano con corazón de oro. An Fac med 2022. [DOI: 10.15381/anales.v83i2.21433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
El objetivo del artículo es describir y analizar la trayectoria de vida y las contribuciones humanitarias del Dr. Zambrano, médico egresado de la Escuela de Medicina de San Fernando, quién fue presidente del Centro de Estudiantes de Medicina en una época políticamente álgida en la educación universitaria pública. Emigró a los Estados Unidos en 1970, bajo el contexto de crisis sociopolítica económica en el Perú y en el mundo, donde se convirtió en un renombrado médico internista y cardiólogo del St. Luke’s Hospital. A pesar de su lejanía, mantuvo un lazo estrecho con el Perú organizando múltiples misiones médicas para el beneficio de poblaciones vulnerables, capacitación al personal médico e implementación tecnológica del Hospital Regional de Cajamarca. En 2011 se inauguró el Centro Médico Educativo en Chincha, siendo Zambrano uno de los líderes para su construcción. A pesar de padecer una enfermedad invalidante dedicó hasta los últimos días de su vida a brindar ayuda a los más necesitados. Su trayectoria de vida nos muestra un ejemplo de compromiso con el Perú y de un ejercicio de la medicina comprometida con la solidaridad y el desarrollo de la medicina en su país de origen.
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Gonzales-Zamora JA, Soriano-Moreno DR, Soriano AN, Ponce-Rosas L, De-Los-Rios-Pinto A, Murrieta-Ruiz VT, Morocho-Alburqueque N, Caira-Chuquineyra B, Alave J. Percepciones e intención de los padres de vacunar a sus hijos bajo 12 años de edad contra la COVID-19: estudio transversal en Perú. Rev Chilena Infectol 2022; 39:273-286. [DOI: 10.4067/s0716-10182022000200273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/19/2022] [Indexed: 11/17/2022] Open
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Gonzales-Zamora JA, Ponce-Rosas L, Alave J. [Treatment of chronic hepatitis C in patients with kidney disease: contributions to the Clinical Practice Guideline of the Social Health Insurance of Peru (EsSalud)]. Rev Gastroenterol Peru 2022; 42:141-142. [PMID: 36513363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Jose A Gonzales-Zamora
- Infectious Disease Division, Department of Medicine, Miller School of Medicine, University of Miami. Miami, Florida, Estados Unidos; Peruvian American Medical Society (PAMS). Albuquerque, Nuevo México, Estados Unidos
| | - Linda Ponce-Rosas
- Peruvian American Medical Society (PAMS). Albuquerque, Nuevo México, Estados Unidos
| | - Jorge Alave
- Universidad Peruana Unión. Lima, Perú; Clínica Good Hope. Lima, Perú
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