Infectious Diseases Fellow in the Division of Infectious Diseases & Geographic Medicine. Research to benefit underserved populations.
Honors & Awards
Benjamin H. Kean Travel Fellowship in Tropical Medicine, American Society of Tropical Medicine & Hygiene (2014)
Residency, University of Maryland Medical Center, Internal Medicine (2020)
MD, Ben-Gurion University of the Negev Faculty of Health Sciences, The Medical School for International Health (MSIH) (2017)
BA, Cornell University, Anthropology (2012)
Stephen Luby, Postdoctoral Faculty Sponsor
Point-of-Care Ultrasound by Nonexpert Operators Demonstrates High Sensitivity and Specificity in Detecting Gallstones: Data from the Samoa Typhoid Fever Control Program.
The American journal of tropical medicine and hygiene
Approximately 90% of chronic typhoid carriers with persistent Salmonella enterica serovar Typhi (S. Typhi) gallbladder infection have gallstones. In Samoa, where typhoid fever has been endemic for many decades, risk factors predisposing to the development of gallstones are increasing among adults. The Samoa Typhoid Fever Control Program dispatches a "Typhoid Epidemiologic SWAT Team" to perform a household investigation of every blood culture-confirmed case of acute typhoid fever. Investigations include screening household contacts to detect chronic carriers. Following limited training, two nonexpert ultrasound operators performed point-of-care ultrasound (POCUS) on 120 Samoan adults from August to September 2019 to explore the feasibility of POCUS to detect individuals with gallstones during household investigations and community screenings. POCUS scans from 120 Samoan adults in three cohorts (28 food handlers, two typhoid cases and their 18 household contacts, and 72 attendees at an ambulatory clinic) were reviewed by a board-certified radiologist who deemed 96/120 scans (80%) to be interpretable. Compared with the radiologist (gold standard), the nonexpert operators successfully detected 6/7 Samoans with gallstones (85.7% sensitivity) and correctly identified 85/89 without gallstones (95.5% specificity). The proportion (24/120) of uninterpretable scans from this pilot that used minimally trained clinicians (who are neither radiologists nor ultrasound technicians) indicates the need for additional training of POCUS operators. Nevertheless, this pilot feasibility study engenders optimism that in the Samoan setting nonexperts can be trained to use POCUS to diagnose cholelithiasis, thereby helping (along with stool cultures and Vi serology) to identify possible chronic S. Typhi carriers.
View details for DOI 10.4269/ajtmh.21-0973
View details for PubMedID 35008059
SARS-CoV-2 Neutralization Resistance Mutations in Patient with HIV/AIDS, California, USA.
Emerging infectious diseases
2021; 27 (10)
We report persistent severe acute respiratory syndrome coronavirus 2 infection in a patient with HIV/AIDS; the virus developed spike N terminal domain and receptor binding domain neutralization resistance mutations. Our findings suggest that immunocompromised patients can harbor emerging variants of severe acute respiratory syndrome coronavirus 2.
View details for DOI 10.3201/eid2710.211461
View details for PubMedID 34296992
Tenacious Endemic Typhoid Fever in Samoa.
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
2020; 71 (Supplement_2): S120-S126
Typhoid fever has been endemic on the island nation of Samoa (2016 population, 195 979) since the 1960s and has persisted through 2019, despite economic development and improvements in water supply and sanitation.Salmonella enterica serovar Typhi isolates from the 2 hospitals with blood culture capability and matched patient demographic and clinical data from January 2008 through December 2019 were analyzed. Denominators to calculate incidence by island, region, and district came from 2011 and 2016 censuses and from 2017-2019 projections from Samoa's Bureau of Statistics. Data were analyzed to describe typhoid case burden and incidence from 2008 to 2019 by time, place, and person.In sum, 53-193 blood culture-confirmed typhoid cases occurred annually from 2008 to 2019, without apparent seasonality. Typhoid incidence was low among children age < 48 months (17.6-27.8/105), rose progressively in ages 5-9 years (54.0/105), 10-19 years (60.7-63.4/105), and 20-34 years (61.0-79.3/105), and then tapered off; 93.6% of cases occurred among Samoans < 50 years of age. Most typhoid cases and the highest incidence occurred in Northwest Upolu, but Apia Urban Area (served by treated water supplies) also exhibited moderate incidence. The proportion of cases from short-cycle versus long-cycle transmission is unknown. Samoan S. Typhi are pansusceptible to traditional first-line antibiotics. Nevertheless, enhanced surveillance in 2019 detected 4 (2.9%) deaths among 140 cases.Typhoid has been endemic in Samoa in the period 2008-2019. Interventions, including mass vaccination with a Vi-conjugate vaccine coadministered with measles vaccine are planned.
View details for DOI 10.1093/cid/ciaa314
View details for PubMedID 32725232
Miliary pattern on chest imaging as a presentation of EGFR-negative primary lung adenocarcinoma.
BMJ case reports
2019; 12 (5)
A 64-year-old African American man, with a history of prostate adenocarcinoma treated in 2009 and a greater than 50-pack-year tobacco smoking history, presented with 2-3 weeks of non-productive cough, frontal headache and generalised myalgias and arthralgias. CT was positive for diffuse, miliary opacities in bilateral lung fields. He was diagnosed with stage four lung adenocarcinoma, negative for epidermal growth factor receptor (EGFR) gene mutation. The patient was unable to tolerate therapy and passed away approximately 4 months after his diagnosis. Previous case reports and research have suggested an association between EGFR gene mutation and miliary patterned lung metastases in non-small cell lung cancer. This case suggests that the mechanism by which miliary patterned metastases occur is more complex than purely mutation of the EGFR gene. Further study may elucidate novel molecular targets for treatment, especially in patients with rapidly progressive disease such as the patient we describe.
View details for DOI 10.1136/bcr-2018-228534
View details for PubMedID 31151972
Female Anopheles gambiae antennae: increased transcript accumulation of the mosquito-specific odorant-binding-protein OBP2.
Parasites & vectors
2012; 5: 27
New interventions are required to optimally and sustainably control the Anopheles sp. mosquitoes that transmit malaria and filariasis. The mosquito olfactory system is important in host seeking (transmission) and mate finding (reproduction). Understanding olfactory function could lead to development of control strategies based on repelling parasite-carrying mosquitoes or attracting them into a fatal trap.Our initial focus is on odorant binding proteins with differential transcript accumulation between female and male mosquitoes. We report that the odorant binding protein, OBP2 (AGAP003306), had increased expression in the antennae of female vs. male Anopheles gambiae sensu stricto (G3 strain). The increased expression in antennae of females of this gene by quantitative RT-PCR was 4.2 to 32.3 fold in three independent biological replicates and two technical replicate experiments using A. gambiae from two different laboratories. OBP2 is a member of the vast OBP superfamily of insect odorant binding proteins and belongs to the predominantly dipteran clade that includes the Culex oviposition kairomone-binding OBP1. Phylogenetic analysis indicates that its orthologs are present across culicid mosquitoes and are likely to play a conserved role in recognizing a molecule that might be critical for female behavior.OBP2 has increased mRNA transcript accumulation in the antennae of female as compared to male A. gambiae. This molecule and related molecules may play an important role in female mosquito feeding and breeding behavior. This finding may be a step toward providing a foundation for understanding mosquito olfactory requirements and developing control strategies based on reducing mosquito feeding and breeding success.
View details for DOI 10.1186/1756-3305-5-27
View details for PubMedID 22309624
View details for PubMedCentralID PMC3297500
Programmed Cell Death during Malaria Parasite Infection of the Vertebrate Host and Mosquito Vector
Programmed Cell Death in Protozoa
edited by Perez Martin, J.
Springer. 2008: 74–90
View details for DOI 10.1007/978-0-387-76717-8_7
Light deprivation affects larval development and arrestin gene expression in Anopheles stephensi.
Journal of medical entomology
2005; 42 (5): 801-4
The role of light exposure on the final stages of development of Anopheles stephensi larvae to pupae and adult mosquitoes was explored. We demonstrated a significant reduction in the development of adult mosquitoes when larvae were bred in the absence of light compared with the control group bred in alternating 12 h of light and 12 h of dark. To correlate these findings at the molecular level, RNA levels of the visual arrestin gene were examined. Arrestins are an important gene family that play a role in the vectorial capacity of Anopheles and mediate neurotransmission as well as olfactory and visual sensory reception in insects. Semiquantitative polymerase chain reaction showed a reduction in the expression of the visual arrestin gene in pupae that developed from larvae in the absence of light compared with larvae bred under normal conditions.
View details for DOI 10.1093/jmedent/42.5.801
View details for PubMedID 16363162