About

Dr. Luis A. Marcos is a Professor in Medicine specializing in Infectious Diseases at Stony Brook University. He completed his medical education at Universidad Peruana Cayetano Heredia Programa Academico de Medicina in 2003. His postgraduate training includes a residency in General Medicine at the University of Texas Health Science in 2009 and a fellowship in Infectious Disease at the University of Washington School of Medicine in 2011. Dr. Marcos is board certified in Infectious Disease and Internal Medicine by the American Board of Internal Medicine. His research includes clinical characteristics of chronic infection by Fasciola hepatica in children and studies on the distribution of entero-parasitic infections in rural communities of Peru. He practices at Stony Brook Internists - Infectious Disease locations in Lake Grove and East Setauket, NY.

Research topics

• Medicine
• Internal medicine
• Emergency medicine
• Intensive care medicine
• Biology
• Demography
• Microbiology
• Virology
• Cardiology
• Anesthesia
• Environmental health
• Immunology

Selected publications

• P-177. Contemporary Clinical Characteristics and Outcomes of Leprosy— a Multicenter Network Analysis

  Open Forum Infectious Diseases · 2025-01-29

  articleOpen access

  Abstract Background Leprosy, also known as Hansen's disease, is a chronic infectious disease caused primarily by Mycobacterium leprae, endemic to tropical countries. In 2022, WHO registered 165,459 cases of leprosy. We lack more contemporary clinical descriptions and outcomes of the disease. Understanding its clinical characteristics is essential for improving diagnosis, treatment, and patient outcomes. We aim to describe the clinical manifestations and outcomes associated with leprosy using a "real-world" database. US Map of the proportion of captured cases by region Methods We queried TriNetX, a global research network database (https://trinetx.com/), to identify patients with Leprosy by ICD-10 code. We captured demographics, comorbidities, clinical manifestations, treatments, and outcomes within 1 year. Clinical characteristics and outcomes of leprosy patients by region Results We captured 1,237 patients, with 965 (78%) originating from the US health system. The mean age was 48, and most were women (60.4%). US patients were predominantly from the South and West (Figure 1) and were predominantly White, Native Hawaiian, or Asian (table 1). The most common clinical manifestations included neuralgia, rash, neuropathy, and malaise. Blindness, corneal abrasions, and burns were present among 2-3% of US patients. Orchitis, iritis, and the Lucio phenomena were relatively uncommon. Rifampin, dapsone, and minocycline were most commonly used. However, significant geographical differences were noted in treatment regimens. Notably, clofazimine use was minimal. Steroids were used in 60% of cases, with a higher prevalence in US-based patients. Other immunosuppressants were uncommon, although methotrexate use was more frequent internationally. TB co-infection was 2%. The overall 1-year mortality was 24.3%. Clinical characteristics and outcomes of leprosy patients by region Conclusion Women from the southern and western US were the most significantly affected demographic groups. Severe complications like blindness, corneal abrasions, and burns, though less frequent, underscore the potential impact on quality of life. The presence of conditions like TB co-infection and the use of steroids in treatment point to the need for comprehensive preventive care strategies. With an overall 1-year mortality of 24.3%, our findings stress the importance of early diagnosis and treatment to improve outcomes and reduce mortality rates. Clinical characteristics and outcomes of leprosy patients by region Disclosures All Authors: No reported disclosures

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• Characterization of the clinical features, laboratory findings, and outcomes of human fascioliasis in a global network: a retrospective mutlicenter study

  Therapeutic Advances in Infectious Disease · 2025-07-01

  articleOpen accessSenior authorCorresponding

  Background: , is a neglected tropical disease that has significant medical and veterinary importance. This foodborne zoonotic trematodiases primarily affects poor rural populations in tropical and subtropical areas, where prevalence can be as high as 21%. Objective: This study aims to characterize the clinical features, laboratory findings, and outcomes of fascioliasis in a real-world cohort. Design: Retrospective study. Methods: Patients ⩾ 18 years old diagnosed with fascioliasis were identified from TriNetX, a global federated research network, on October 26, 2024. We used the International Classification of Diseases results to define fascioliasis (ICD-10 code B66.3) for the period 2021-2024. These data include demographics, diagnoses, comorbidities, procedures, clinical laboratory results, and medications. All variables except outcomes were not time-bound to the diagnosis date. Results: In a cohort of 174 predominantly middle-aged, female, and Caucasian patients, we found high rates of essential hypertension, neoplasms, heart disease, liver disease, and sleep disorders. Key symptoms included upper abdominal pain, skin complaints, dyspnea, and malaise/fatigue. Some outcomes were hepatomegaly, cholelithiasis, and cholangitis in 10% of patients, with hepatic cirrhosis being rare. Among hospitalized patients within 3 months of diagnosis, 63% experienced abdominal pain. Of the 13 patients who developed cholangitis or cholelithiasis, most were men, had abdominal pain, nausea/vomiting, dysphagia, and ascites with a history of liver or intrahepatic bile neoplasia. A total of 90-day mortality was low (less than 6%). Triclabendazole was reported in only 6% of these patients. Conclusion: In a large real-world case series of fascioliasis, we found a high frequency of comorbidities and typical gastrointestinal symptoms. The low use of triclabendazole may be due to limited access to the product in certain countries or its omission from the database if prescribed in the outpatient setting. Mortality was very low, but biliary and liver complications warrant characterization through additional prospective clinical studies.

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• Demographic and Clinical Correlates of Discordant QuantiFERON TB Gold Tuberculosis Screening Results in a Low Endemicity Setting

  medRxiv · 2025-09-05

  preprintOpen access

  ), the causative agent of tuberculosis (TB). IGRA positive (IGRA+) asymptomatic individuals are diagnosed with presumed latent tuberculosis infection (LTBI) and often offered therapy to prevent progression to active disease. However, discordant results during serial or confirmatory IGRA testing pose challenges for interpretation and may lead to unnecessary LTBI treatment. We conducted a retrospective study of subjects who received QFTTB testing at Stony Brook Medicine between October 2020 and March 2024, focusing on discordant serial testing, to identify sociodemographic and clinical variables associated with quantitative QFTTB results. Variables measured included age, sex, race, comorbidities, and medication use. A total of 743 subjects were analyzed, including all 436 QFTTB-positive (QFTTB+) cases of 11,641 tests ordered (3.7%), of whom 16 were diagnosed with active TB. A random sample of 307 age-sex-matched QFTTB-negative controls were included. Of 203 subjects undergoing serial QFTTB testing, 170 (83.7%) had concordant results, while 33 (16.3%) showed discordance-23 (69.7%) with reversion and 10 (30.3%) with conversion. Conversions occurred in significantly older subjects (mean age 51.1 ± 15.0 vs. 37.0 ± 15.6, p = 0.025) and over longer intervals (415.1 vs. 91.2 days, p = 0.026). Comorbidities including cardiovascular disease, infections, and diabetes correlated with changes in NIL, TB1, and TB2 values. These findings highlight inconsistencies in QFTTB testing that complicate LTBI management and underscore the importance of confirmatory testing in low-incidence settings. Importance Statement: Reliable interpretation of interferon-γ release assays (IGRAs) is critical for the diagnosis and management of latent tuberculosis infection (LTBI). However, variability in test performance, particularly during serial or confirmatory testing, complicates clinical decision-making and may result in unnecessary treatment. Our study demonstrates that demographic factors, clinical comorbidities, and testing intervals contribute to discordant QuantiFERON-TB Gold Plus (QFTTB) results. These findings underscore the need to integrate epidemiologic risk, clinical history, and repeat testing before initiating therapy, especially in low-incidence regions where the pre-test probability of infection is low. Improved understanding of IGRA variability can strengthen both patient care and research applications, including TB vaccine and biomarker studies.

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• P-1278. Risk Factors Associated with Post-Treatment Lyme Disease Syndrome: A Prospective Cohort Study on Long Island, NY

  Open Forum Infectious Diseases · 2025-01-29

  articleOpen accessSenior author

  Abstract Background Lyme disease (LD) is caused by Borrelia burgdorferi transmitted by the Ixodes scapularis tick. Post-treatment Lyme disease syndrome (PTLDS) refers to a condition in which approximately 10-20% of optimally treated LD patients develop persistent symptoms of unknown pathophysiology. The epidemiological data on PTLDS is limited. This study aims to investigate the underlying risk factors associated with PTLDS.Table 1.Patient characteristics in PTLDS developed and PTLDS negative groups and their associated p-values. Methods This is an ongoing prospective cohort study of 47 adult patients with LD (CDC criteria) who were seen at Stony Brook Medicine in NY since 2021. Demographics, and pertinent epidemiological data, including immunocompromised status, coinfection, diagnosis, past medical history and treatment were collected. Twelve symptoms were assessed using the Visual Analogue Score (VAS) and Fatigue Severity Scores (FSS) at initial presentation and 1, 6- and 12-months post-treatment. PTLDS was defined based on at least one symptom present at 6 months. Continuous variables were described using means and standard deviations; categorical variables were described with frequencies and percentages.Table 2.Symptoms reported by patients at 6 months and average Visual Analogue Scale (VAS) scores for each symptom. Results Out of a total of 47 enrolled patients, 44 (female 31%) patients completed their initial VAS. At 6 months, fatigue had the highest frequency (39%). At the initial presentation, median total symptoms scores were 37 for disseminated Lyme (n=14) and 30.5 for erythema migrans (EM) (n=27). Compared to baseline, VAS total symptom scores decreased at 1 month for the disseminated (n=12, median= 6.5) and EM groups (n=25, median= 3.5). VAS total symptom score decreased at 6 months as well for the disseminated (n=10, median= 5.25) and EM groups (n=20, median=3.25). At each visit, the PTLDS group scored higher on the FSS compared to the No PTLDS group, indicating higher levels of fatigue. In both groups, FSS decreased over time.Table 3:Total symptom score at each visit for erythema migrans versus disseminated. P-value calculated comparing LD syndrome disease at each corresponding time point. Conclusion A trend of higher total symptom score was observed in disseminated patients compared to erythema migrans at 6 months post-treatment. Fatigue was the most common symptom reported and the PTLDS group consistently reported higher fatigue severity compared to the No PTLDS group.Table 4:Fatigue Severity Score (FSS) and Visual Analogue Fatigue Scale (VAFS) at each visit for PTLDS and No PTLDS patients. P-value calculated comparing PTLDS and No PTLDS at each corresponding time point. Disclosures All Authors: No reported disclosures

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• Not your typical hookworm infection—a case report from the Peruvian Amazon and review of the literature

  Therapeutic Advances in Infectious Disease · 2025-05-19

  articleOpen access

  Human hookworm infection is caused by the nematodes Necator americanus , Ancylostoma duodenale , and Ancylostoma ceylanicum . Iron deficiency anemia is the hallmark of chronic, moderate-to-heavy-intensity infections, promoting a vicious poverty cycle. Overt severe and acute life-threatening lower gastrointestinal hemorrhage is an extremely rare manifestation of hookworm infection, as well as finding multiple nematodes attached to the colonic mucosae. This rare hookworm presentation with hematochezia from the colon in a patient living with human immunodeficiency virus highlights the importance of physicians’ awareness of this neglected tropical disease responsible for high morbidity and burden in healthcare systems of endemic regions.

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• A Prospective Cohort Longitudinal Study of Human Acute Babesiosis: Quality of Life and Severity of Symptoms Through 1-Year Follow-up

  Open Forum Infectious Diseases · 2025-10-29

  articleOpen accessSenior author

  Abstract Background Babesiosis, caused by the parasitic blood-borne piroplasm Babesia microti, is emerging in the Northern hemisphere. We aimed to study long-term symptoms of patients with B microti infection in New York. Methods A prospective longitudinal cohort study of human babesiosis was conducted at Stony Brook University Hospital. Inclusion criteria were age ≥18 years with positive blood smear for Babesia spp. Symptoms were assessed in patients at presentation and at 1, 6, and 12 months by 3 validated surveys: a visual analog scale, a quality of life (QOL) questionnaire, and the 36-Item Short Form Survey (SF-36). Results In total, 38 patients with acute B microti infection (26% female; age range, 54–73 years) were enrolled from 2020 to 2022. Compared with baseline, the visual analog scale total symptom scores (with high scores representing worse status) significantly decreased at 6-month follow-up for the immunocompetent (n = 9; P < .001) and immunocompromised groups (n = 6; P < .001). Scores remained significantly higher in the immunocompromised group (ratio, 2.6; P = .045). At 1-year follow-up, the scores in the 2 groups tended to be similar (ratio, 0.9; P = .82). Within QOL concept scores (with low scores representing worse status), physical functioning significantly increased after 6 months of follow-up in both cohorts (immunocompetent, n = 10 [P = .004]; immunocompromised, n = 5 [P = .008]) but was still significantly lower in the immunocompromised group at that time (ratio, 0.7; P < .001). By the 12-month follow-up, physical functioning scores in the 2 groups appeared to converge, though the difference remained borderline significant (ratio, 0.9; P = .06). Conclusions The time to convalescence was similar among patients with babesiosis, though immunocompromised patients tended to have more prolonged symptoms and worsened QOL after babesiosis at 1-year follow-up, compared with immunocompetent patients.

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• P-1859. Immunity against Acute Human Babesiosis and Lyme Disease

  Open Forum Infectious Diseases · 2025-01-29

  articleOpen access

  Abstract Background Babesiosis,a disease caused by Babesia microti (Bm) and transmitted by Ixodes scapularis ticks, has significant morbidity in older and immunocompromised hosts. The natural host response against Bm has not been well-studied. Co-infection with Borrelia burgdorferi (Bb), the etiology of Lyme disease (LD) transmitted by the same deer tick, may impact clinical severity. We aimed to define the immune response to acute human babesiosis and LD in an endemic region in NY, with the hypothesis that specialized innate lymphocytes act early to control primary Bm infection.Figure 1.TNFα cytokine profiling for paired acute and 1-month post-treatment cases of babesiosis, Lyme Disease, and Co-infection.n=6/group. Statistical comparison by Kruskal-Wallis test *p<0.05 Methods Serum and Peripheral Blood Mononuclear Cells (PBMCs) were isolated from a well-characterized human cohort study: acute hospitalized study volunteers with confirmed Bm by peripheral blood microscopy and PCR (n=13), Bb infection by CDC criteria (n=5) or Bm/Bb co-infection (n=5) and compared to paired samples 1-month post-infection or healthy controls (n=12) collected during 2021-2023 at Stony Brook University Hospital, Long Island, NY. PBMCs from babesiosis cases were analyzed by flow cytometry and serum cytokine profiling was performed in mono/co-infected cases to define immune responses over time.Figure 2.IL27 cytokine profiling for paired acute and 1-month post-treatment cases of babesiosis, Lyme Disease, and Co-infection.n=6/group. Statistical comparison by Kruskal-Wallis test *p<0.05 Results Acute monoinfected babesiosis cases demonstrated inflammatory signaling through TNFα and IL27 while IL6, IL21, and IL10 were elevated in Bm and Bb mono/co-infection. Cytokine signatures trended toward resolution one-month post-Bm infection, but were persistently elevated during LD. We also observed persistently elevated CXCL10 and TNFα in LD. Flow cytometry of babesiosis cases vs controls revealed expansion of activated innate lymphocyte subsets including CD8α+ γδ T cells and Natural Killer (NK) cells. In contrast, innate T cells called MAIT cells were activated, but depleted from blood. There was no difference in the frequency of B cells, conventional CD4+/CD8+ T cells, or regulatory T cells during infection.Figure 3.The frequency and activation of γδ T cells in paired acute and 1-month post-treatment cases of babesiosis.n=12 healthy, n=13 babesiosis; Comparisons by Kruskal-Wallis test *p<0.05 **p<0.005 Conclusion This study identifies distinct inflammatory pathways underlying acute human babesiosis and LD and highlights early immune responses of innate lymphocytes during acute Bm infection. Ongoing studies will define the immune mechanisms that control primary Bm infection and will determine how this immunity is modulated by Bb co-infection.Figure 4.MAIT cell frequency and activation in paired acute and 1-month post treatment cases of babesiosis.n=12 healthy, n=13 babesiosis; Comparisons by Kruskal-Wallis test *p<0.05 Disclosures All Authors: No reported disclosures

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• P-1850. Acute <i>Babesia microti</i> Infection in Humans Is Associated With Marked Changes In The Expression Of Peripheral Blood Coding And Noncoding RNA

  Open Forum Infectious Diseases · 2025-01-29

  articleOpen accessSenior author

  Abstract Background Babesiosis is a potentially life-threatening disease transmitted by ticks. However, host and parasite determinants of human babesiosis are completely unknown. In the current study we evaluated the impact of B. microti infection, the primary cause of human babesiosis in the US, on the peripheral blood transcriptome. Figure 1. PCA of top 500 differentially expressed genes. PCA distinguishes Babesia patients at presentation from healthy controls. Methods Patients with confirmed B. microti acute infection were enrolled into a 1-year follow up cohort study at Stony Brook University Hospital, NY. Total RNA was isolated from blood using PaxGene RNA tubes and library preparation performed using Illumina's Stranded Total RNAPrep with Ribo-zero plus kit to remove human ribosomal RNA and globin RNA. 100 M RNA paired end reads were sequenced (2 x 151 bps). Low expression RNAs with less than 10 reads in 17 samples were filtered out prior to identification of differentially expressed genes (DEGs) (p&amp;lt; 0.05).Figure 2.Volcano Plot comparing differential gene and noncoding RNA expression between healthy controls and patients with babesiosis at presentation.Red circles represent genes whose expression are increased or decreased in patients with babesiosis at presentation compared to healthy controls. Blue circles represent genes whose expression are not significantly different. Results The peripheral blood transcriptome from 20 healthy controls was compared to 42 patients at presentation for B. microti infection and 1, 3, 6, 9 and 12 months after treatment for patients who completed the longitudinal protocol after the first visit. A total of 1860 genes or noncoding RNAs were differentially expressed in patients with babesiosis at presentation (V0) compared to healthy controls; 370 were decreased in patients with babesiosis and 1490 were increased (adj p &amp;lt; 0.01; expression fold change &amp;gt;+/- 1.) PCA analysis (Fig 1), and the Volcano Plot (Fig. 2) demonstrate that patients with babesiosis have a distinct peripheral blood gene expression profile compared to healthy control individuals. The heat map of DEGs in Fig. 3 shows the peripheral blood transcriptome in patients with babesiosis largely returned to baseline levels by 1-month post-treatment. The Qiagen IPA Graphical Summary based on DEGs is shown in Figure 4 and highlights activation of diverse immune-mediators, including TNF and interferon families, as well as growth factors, and vascularization pathways in response to B. microti infection.Figure 3.Heat map of differentially expressed genes of patients with babesiosis at presentation (0) and 1, 3, 6, 9 and 12 months post-treatment compared to healthy control individuals.Gene expression in patients with babesiosis is markedly different at presentation but is similar to levels for healthy controls by 1 month post-treatment. Conclusion Infection with B. microti results in marked changes in expression of genes and noncoding RNA in peripheral blood that largely returns to baseline by 1-month post-treatment.Figure 4:Qiagen IPA Graphical Summary of pathways likely increased (orange) or decreased (blue) in patients presenting with babesiosis. Disclosures Paul Arnaboldi, PhD, Biopeptides, Corp: Patent Holder|Biopeptides, Corp: Employee|DiaSorin: Advisor/Consultant

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• <i>Peromyscus leucopus</i> , <i>Mus musculus</i> , and humans have distinct transcriptomic responses to larval <i>Ixodes scapularis</i> bites

  Infection and Immunity · 2025-03-11 · 2 citations

  articleOpen access

  ABSTRACT Ixodes scapularis ticks are an important vector for at least seven tick-borne human pathogens, including a North American Lyme disease spirochete, Borrelia burgdorferi . The ability for these ticks to survive in nature is credited, in part, to their ability to feed on a variety of hosts without triggering an immune response capable of preventing tick feeding. While the ability of nymphal ticks to feed on a variety of hosts has been well documented, the host-parasite interactions between larval I. scapularis and different vertebrate hosts are relatively unexplored. Here we report on the changes in the vertebrate host transcriptome present at the larval tick bite site using the natural I. scapularis host Peromyscus leucopus , a non-natural rodent host, Mus musculus (BALB/c), and humans. We note substantially less evidence of activation of canonical proinflammatory pathways in P. leucopus compared to BALB/c mice and pronounced evidence of inflammation in humans. Pathway enrichment analyses revealed a particularly strong signature of interferon gamma, tumor necrosis factor, and interleukin 1 signaling at the BALB/c and human tick bite sites. We also note that bite sites on BALB/c mice and humans, but not deer mice, show activation of wound-healing pathways. These data provide molecular evidence of the coevolution between larval I. scapularis and P. leucopus and, in addition, expand our overall understanding of I. scapularis feeding.

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• P-2242. Tick-borne Illness Seroprevalence and Meat Allergy (Alpha-Gal Syndrome): A Series of 15 Cases in Long Island, NY

  Open Forum Infectious Diseases · 2025-01-29

  articleOpen accessSenior author

  Abstract Background Alpha-gal syndrome (AGS) is a described meat allergy to an oligosaccharide, galactose-alpha-1,3-galactose (alpha-gal), present on mammalian cells and appears to be associated with the Amblyomma Americanum or lone star tick (LST) bite. Suffolk county, NY has an alarmingly high number of cases of AGS. Immunoglobulin E (IgE)-mediated allergic symptomatology has been reported following ingestion of mammalian meat and its by-products though with variable allergy manifestation. The goal of this pilot study was to identify characteristics and clinical manifestations in a cohort of patients with AGS and try to identify possible risk factors for severe manifestations.Table 1:Demographics, atopy history, alpha-gal IgE, serum total IgE and ratios, tick bite history and tick type, onset of symptoms after tick bite, tick-borne infection in patients identified with AGS, N=15.AGS, Alpha-gal syndrome; LST, Lone star tick; IgE, Immunoglobulin E Methods A retrospective study was performed to identify adult patients referred to Allergy Clinic at the Stony Brook Hospital between 2018 and 2023 with symptoms and laboratory testing consistent with AGS. Demographics, atopy history, alpha-gal IgE and serum total IgE ratios, allergy manifestation, tick type and tick-borne infections were obtained from chart review.Figure 1:Comparison of mean alpha-gal IgE/serum total IgE ratios in patients with anaphylaxis (N=10) and non-anaphylactic (N=5) manifestations to meat consumption. The mean alpha-gal IgE/serum total IgE ratio in the anaphylaxis group was 18.9% and the mean alpha-gal IgE/serum total IgE ratio in the non-anaphylaxis group was 12.3%. There was no statistically significant difference in mean alpha-gal IgE/serum total IgE ratio between the anaphylaxis and non-anaphylaxis groups (p = 0.5). Results We identified 15 adults (mean age: 51 years; male 66.7%; 93% White), with clinical presentation consistent with AGS. Out of the 15 subjects, 9 had history of atopy (60%). All patients reported a history of tick bite, of whom 7 recognized as LST (46.7%). One third of the cases were tested for tick-borne co-infections (n= 10). One met CDC criteria for Lyme disease and 1 had Babesiosis. All patients had elevated alpha-gal IgE/serum total IgE ratio (mean 16.8%, range 2.1-71.4); anaphylaxis group mean ratio was 18.9% versus 12.3% in non-anaphylaxis group (p=0.5). Patients had variability in severity of allergy manifestation: 10 (66.7%) with anaphylaxis, 6 (40%) with skin manifestation, 1 (6.7%) with gastrointestinal symptoms.Figure 2. Overview of allergy manifestation reported by patients; anaphylaxis as per AAAAI criteria, N=15.Gastrointestinal; Skin manifestations i.e. urticaria, angioedema, hives; Other i.e itchy throat, eye swelling; AAAA,: American Academy of Allergy, Asthma &amp; Immunology. Conclusion Observational data suggests that alpha-gal IgE/total IgE ratio may not be related to disease severity, but the sample size was small. Although, most patients in this cohort did not have a documented history of a previous tick-borne illness despite tick exposure, it is important for Infectious Diseases physicians to be aware of AGS, as many patients are referred after tick bites. Further research regarding risk factors for severe disease is warranted to recognize those at greatest risk to prompt more rapid allergy evaluation. Disclosures All Authors: No reported disclosures

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Frequent coauthors

• Angélica Terashima

  Universidad Peruana Cayetano Heredia

  127 shared

• Pushpendra Singh

  National Institute for Research in Tribal Health

  64 shared

• Maria T. Peña

  National Hansen's Disease Program

  64 shared

• W. J. Loughry

  Valdosta State University

  64 shared

• J. Mitchell Lockhart

  Valdosta State University

  64 shared

• David M. Scollard

  National Hansen's Disease Program

  64 shared

• Richard W. Truman

  National Hansen's Disease Program

  64 shared

• Rahul Sharma

  64 shared

Education

• MPH

  Johns Hopkins Bloomberg School of Public Health

  2014