<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2307-3349</journal-id>
<journal-title><![CDATA[Revista de salud publica del Paraguay]]></journal-title>
<abbrev-journal-title><![CDATA[Rev. salud publica Parag.]]></abbrev-journal-title>
<issn>2307-3349</issn>
<publisher>
<publisher-name><![CDATA[INSTITUTO NACIONAL DE SALUD - MSP Y BS]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2307-33492024000100015</article-id>
<article-id pub-id-type="doi">10.18004/rspp.2024.abr.03</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Persistencia de signos y síntomas a los 6 meses posinfección por chikungunya en pacientes de un hospital público en Paraguay]]></article-title>
<article-title xml:lang="en"><![CDATA[Persistence of signs and symptoms 6 months after chikungunya infection in patients from a Public Hospital in Paraguay]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Viveros]]></surname>
<given-names><![CDATA[Guiomar]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[González Vázquez]]></surname>
<given-names><![CDATA[Gloria]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Méndez]]></surname>
<given-names><![CDATA[Julieta]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Galeano]]></surname>
<given-names><![CDATA[Deisy]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidad Nacional de Caaguazú Facultad de Ciencias de la Salud ]]></institution>
<addr-line><![CDATA[Caaguazú ]]></addr-line>
<country>Paraguay</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>04</month>
<year>2024</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>04</month>
<year>2024</year>
</pub-date>
<volume>14</volume>
<numero>1</numero>
<fpage>15</fpage>
<lpage>22</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_arttext&amp;pid=S2307-33492024000100015&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_abstract&amp;pid=S2307-33492024000100015&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_pdf&amp;pid=S2307-33492024000100015&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[RESUMEN  Introducción: El virus chikungunya (CHIKV) causa una enfermedad con manifestaciones agudas bien documentadas, pero existen pocos datos sobre la persistencia de síntomas y secuelas a largo plazo.  Objetivos:  Evaluar la persistencia de signos, síntomas y factores asociados en pacientes con infección por CHIKV en un seguimiento de 6 meses posinfección.  Materiales y métodos:  Estudio de cohorte ambispectivo que incluyó casos confirmados de CHIKV notificados en abril de 2023 en Coronel Oviedo, Paraguay. Se realizaron entrevistas al mes, a los tres meses y a los 6 meses posinfección. Se analizaron características demográficas, comorbilidades, manifestaciones reumáticas y sintomáticas.  Resultados:  Ingresaron 333 participantes, completando seguimiento a 6 meses 170 pacientes. A los 6 meses persistieron: dolor de espalda (61.2%), artritis (57.1%), cefalea (54.1%), fatiga (51.2%), mialgia (49.4%), debilidad (47.6%), depresión (45.9%) y artralgia (45.9%). La persistencia de artritis (OR 7.54; p=0.008) y mialgia (OR 3.24; p=0.031) a 6 meses fue mayor en el grupo de 36-45 años.  Conclusiones:  Alta persistencia de síntomas musculoesqueléticos y fatiga hasta 6 meses posinfección, con tendencia decreciente, pero exacerbación de depresión. Edad entre 36-45 años asociada a mayor persistencia. Se requieren protocolos de seguimiento integral, investigar mecanismos fisiopatológicos y fortalecer prevención, dado el impacto individual y socioeconómico de la enfermedad.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[ABSTRACT  Introduction:  Chikungunya virus (CHIKV) causes a disease with well-documented acute manifestations, but there is limited data on the persistence of symptoms and long-term sequelae.  Objectives:  To evaluate the persistence of signs, symptoms, and associated factors in patients with CHIKV infection during a 6-month post-infection follow-up.  Material and Methods:  An ambispective cohort study that included confirmed cases of CHIKV reported in April 2023 in Coronel Oviedo, Paraguay. Interviews were conducted at 1, 3 and 6 months post-infection. Demographic characteristics, comorbidities, rheumatic, and symptomatic manifestations were analyzed.  Results:  333 participants were enrolled, with 170 patients completing the 6-month follow-up. At 6 months, the following symptoms persisted: back pain (61.2%), arthritis (57.1%), headache (54.1%), fatigue (51.2%), myalgia (49.4%), weakness (47.6%), depression (45.9%), and arthralgia (45.9%). The persistence of arthritis (OR 7.54, p=0.008) and myalgia (OR 3.24, p=0.031) at 6 months was higher in the 36-45 age group.  Conclusions:  High persistence of musculoskeletal symptoms and fatigue up to 6 months post-infection, with a decreasing trend but exacerbation of depression. Age between 36-45 years was associated with greater persistence. Comprehensive follow-up protocols, investigation of pathophysiological mechanisms, and strengthening prevention are required, given the individual and socioeconomic impact of the disease.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[virus chikungunya]]></kwd>
<kwd lng="es"><![CDATA[dolor musculoesquelético]]></kwd>
<kwd lng="es"><![CDATA[estudios de seguimiento]]></kwd>
<kwd lng="en"><![CDATA[chikungunya virus]]></kwd>
<kwd lng="en"><![CDATA[musculoskeletal pain]]></kwd>
<kwd lng="en"><![CDATA[follow-up studies]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Côrtes]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Lira]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Prates-Syed]]></surname>
<given-names><![CDATA[W]]></given-names>
</name>
<name>
<surname><![CDATA[Dinis Silva]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Vuitika]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Cabral-Miranda]]></surname>
<given-names><![CDATA[W]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Integrated control strategies for dengue, Zika, and CHIKV virus infections]]></article-title>
<source><![CDATA[Front Immunol]]></source>
<year>2023</year>
<volume>14</volume>
<page-range>1281667</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Sissoko]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Malvy]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Ezzedine]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Renault]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Moscetti]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Ledrans]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Post-epidemic CHIKV disease on Reunion Island: course of rheumatic manifestations and associated factors over a 15-month period]]></article-title>
<source><![CDATA[PLoS Negl Trop Dis]]></source>
<year>2009</year>
<volume>3</volume>
<numero>3</numero>
<issue>3</issue>
</nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Lloves Schenone]]></surname>
<given-names><![CDATA[NM]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Artralgias persistentes luego de infección por virus CHIKV]]></article-title>
<source><![CDATA[Rev Argent Reumatol]]></source>
<year>2022</year>
<volume>33</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>248-53</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="">
<collab>World Health Organization</collab>
<source><![CDATA[CHIKV fact sheet]]></source>
<year>2016</year>
</nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Suhrbier]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Rheumatic manifestations of CHIKV: emerging concepts and interventions]]></article-title>
<source><![CDATA[Nat Rev Rheumatol]]></source>
<year>2019</year>
<volume>15</volume>
<numero>10</numero>
<issue>10</issue>
<page-range>597-611</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Garay-Morán]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Román-Pedroza]]></surname>
<given-names><![CDATA[JF]]></given-names>
</name>
<name>
<surname><![CDATA[López-Martínez]]></surname>
<given-names><![CDATA[I]]></given-names>
</name>
<name>
<surname><![CDATA[Rodríguez-Martínez]]></surname>
<given-names><![CDATA[JC]]></given-names>
</name>
<name>
<surname><![CDATA[Ruiz-Matus]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Kuri-Morales]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Caracterización clínica y epidemiológica de fiebre CHIKV en México]]></article-title>
<source><![CDATA[Rev Panam Salud Pública]]></source>
<year>2017</year>
<volume>41</volume>
</nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Benavides Melo]]></surname>
<given-names><![CDATA[JA]]></given-names>
</name>
<name>
<surname><![CDATA[Montenegro Coral]]></surname>
<given-names><![CDATA[FA]]></given-names>
</name>
<name>
<surname><![CDATA[Rojas Caraballo]]></surname>
<given-names><![CDATA[JV]]></given-names>
</name>
<name>
<surname><![CDATA[Lucero Coral]]></surname>
<given-names><![CDATA[NJ]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Caracterización sociodemográfica y clínica de pacientes diagnosticados con dengue y CHIKV en Nariño, Colombia]]></article-title>
<source><![CDATA[Rev Cubana Med Trop]]></source>
<year>2021</year>
<volume>73</volume>
<numero>1</numero>
<issue>1</issue>
</nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="book">
<collab>Pan American Health Organization</collab>
<source><![CDATA[Preparedness and response for CHIKV virus: introduction in the Americas]]></source>
<year>2014</year>
<publisher-name><![CDATA[PAHO]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Weaver]]></surname>
<given-names><![CDATA[SC]]></given-names>
</name>
<name>
<surname><![CDATA[Forrester]]></surname>
<given-names><![CDATA[NL]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[CHIKV Evolutionary history and recent epidemic spread]]></article-title>
<source><![CDATA[Antiviral Res]]></source>
<year>2015</year>
<volume>120</volume>
<page-range>32-9</page-range></nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Staples]]></surname>
<given-names><![CDATA[JE]]></given-names>
</name>
<name>
<surname><![CDATA[Breiman]]></surname>
<given-names><![CDATA[RF]]></given-names>
</name>
<name>
<surname><![CDATA[Powers]]></surname>
<given-names><![CDATA[AM]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[CHIKV fever an epidemiological review of a re-emerging infectious disease]]></article-title>
<source><![CDATA[Clin Infect Dis Off Publ Infect Dis Soc Am]]></source>
<year>2009</year>
<volume>49</volume>
<numero>6</numero>
<issue>6</issue>
<page-range>942-8</page-range></nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Villamil-Gómez]]></surname>
<given-names><![CDATA[WE]]></given-names>
</name>
<name>
<surname><![CDATA[González-Camargo]]></surname>
<given-names><![CDATA[O]]></given-names>
</name>
<name>
<surname><![CDATA[Rodríguez-Ayubi]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Zapata-Serpa]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Rodríguez-Morales]]></surname>
<given-names><![CDATA[AJ]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Dengue, CHIKV and Zika co-infection in a patient from Colombia]]></article-title>
<source><![CDATA[J Infect Public Health]]></source>
<year>2016</year>
<volume>9</volume>
<numero>5</numero>
<issue>5</issue>
<page-range>684-6</page-range></nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Mateo]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Roure]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Artritis crónica en la infección por virus de Chikunguña]]></article-title>
<source><![CDATA[Reumatol Clínica]]></source>
<year>2019</year>
<volume>15</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>113-6</page-range></nlm-citation>
</ref>
<ref id="B13">
<label>13</label><nlm-citation citation-type="">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Castro-Domínguez]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Salman-Monte]]></surname>
<given-names><![CDATA[TC]]></given-names>
</name>
<name>
<surname><![CDATA[Ojeda]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Corzo]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Carrión-Barberá]]></surname>
<given-names><![CDATA[I]]></given-names>
</name>
<name>
<surname><![CDATA[García-Duitama]]></surname>
<given-names><![CDATA[IC]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Artritis erosiva por virus CHIKV, caso y revisión de la literatura]]></article-title>
<source><![CDATA[Reumatol Clínica]]></source>
<year>2019</year>
<volume>15</volume>
<numero>6</numero>
<issue>6</issue>
<page-range>e119-21</page-range></nlm-citation>
</ref>
<ref id="B14">
<label>14</label><nlm-citation citation-type="">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Losanto]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Riquelme-Granada]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Yinde]]></surname>
<given-names><![CDATA[Y]]></given-names>
</name>
<name>
<surname><![CDATA[Duarte]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Giménez]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Ojeda]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Articular compromise after CHIKV fever in a second tier hospital during the 2015 epidemic. Asunción, Paraguay]]></article-title>
<source><![CDATA[Rev Paraguaya Reumatol]]></source>
<year>2017</year>
<volume>3</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>56-9</page-range></nlm-citation>
</ref>
<ref id="B15">
<label>15</label><nlm-citation citation-type="">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Rodriguez-Morales]]></surname>
<given-names><![CDATA[AJ]]></given-names>
</name>
<name>
<surname><![CDATA[Gil-Restrepo]]></surname>
<given-names><![CDATA[AF]]></given-names>
</name>
<name>
<surname><![CDATA[Ramírez-Jaramillo]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
<name>
<surname><![CDATA[Montoya-Arias]]></surname>
<given-names><![CDATA[CP]]></given-names>
</name>
<name>
<surname><![CDATA[Acevedo-Mendoza]]></surname>
<given-names><![CDATA[WF]]></given-names>
</name>
<name>
<surname><![CDATA[Bedoya-Arias]]></surname>
<given-names><![CDATA[JE]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Post-CHIKV chronic inflammatory rheumatism: results from a retrospective follow-up study of 283 adult and child cases in La Virginia, Risaralda, Colombia]]></article-title>
<source><![CDATA[F1000Research]]></source>
<year>2016</year>
<volume>5</volume>
<numero>360</numero>
<issue>360</issue>
</nlm-citation>
</ref>
<ref id="B16">
<label>16</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Rodríguez-Morales]]></surname>
<given-names><![CDATA[AJ]]></given-names>
</name>
<name>
<surname><![CDATA[Cardona-Ospina]]></surname>
<given-names><![CDATA[JA]]></given-names>
</name>
<name>
<surname><![CDATA[Urbano-Garzón]]></surname>
<given-names><![CDATA[SF]]></given-names>
</name>
<name>
<surname><![CDATA[Hurtado-Zapata]]></surname>
<given-names><![CDATA[JS]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Prevalence of Post-CHIKV Infection Chronic Inflammatory Arthritis A Systematic Review and Meta-Analysis]]></article-title>
<source><![CDATA[Arthritis Care Res]]></source>
<year>2016</year>
<volume>68</volume>
<numero>12</numero>
<issue>12</issue>
<page-range>1849-58</page-range></nlm-citation>
</ref>
<ref id="B17">
<label>17</label><nlm-citation citation-type="">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Argüello Gordillo]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Gallego Torres]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[M]]></surname>
<given-names><![CDATA[Villena Galarza]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Fiebre CHIKV Manifestaciones reumatológicas]]></article-title>
<source><![CDATA[Rev Cuba Reumatol]]></source>
<year>2017</year>
<volume>19</volume>
<numero>^s3 Supp. 1</numero>
<issue>^s3 Supp. 1</issue>
<supplement>3 Supp. 1</supplement>
<page-range>182-8</page-range></nlm-citation>
</ref>
<ref id="B18">
<label>18</label><nlm-citation citation-type="">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Arredondo Bruce]]></surname>
<given-names><![CDATA[AE]]></given-names>
</name>
<name>
<surname><![CDATA[Guerrero Jiménez]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[de Quezada López]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Santana Gutiérrez]]></surname>
<given-names><![CDATA[O]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Presencia y diseminación del Dengue, CHIKV y otras arbovirosis en las Américas]]></article-title>
<source><![CDATA[Rev Médica Electrónica]]></source>
<year>2019</year>
<volume>41</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>423-34</page-range></nlm-citation>
</ref>
<ref id="B19">
<label>19</label><nlm-citation citation-type="">
<collab>The Translational Research Consortia (TRC) for Chikungunya Virus in India</collab>
<article-title xml:lang=""><![CDATA[Current Status of CHIKV in India]]></article-title>
<source><![CDATA[Front Microbiol]]></source>
<year>2021</year>
<volume>12</volume>
<page-range>695173</page-range></nlm-citation>
</ref>
<ref id="B20">
<label>20</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Vairo]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Haider]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Kock]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Ntoumi]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Ippolito]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Zumla]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[CHIKV epidemiology, pathogenesis, clinical features, management, and prevention]]></article-title>
<source><![CDATA[Infect Dis Clin North Am]]></source>
<year>2019</year>
<volume>33</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>1003-25</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
