1
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Guo L, Tran J, Sun DI, Newton JS, D'Amiano NM, Lai J, Cohen B. Management of tinea capitis in infants and children in the United States: A national survey of pediatric dermatologists. Pediatr Dermatol 2024; 41:263-265. [PMID: 38342578 DOI: 10.1111/pde.15544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 01/13/2024] [Indexed: 02/13/2024]
Abstract
This study aimed to evaluate the current management of tinea capitis in the United States, specifically focusing on patients aged 0-2 months, 2 months to 2 years, and 2 years to 18 years. An online survey, distributed through the Pediatric Dermatology Research Alliance and the Society of Pediatric Dermatology, revealed the following preferences: fluconazole for those under 2 months, griseofulvin for those aged 2 months to 2 years, and terbinafine for those aged 2 years and older. There exists inter-provider variation in tinea capitis treatment regimens within the pediatric dermatology community.
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Affiliation(s)
- Lily Guo
- Chicago Medical School, Rosalind Franklin University, North Chicago, Illinois, USA
| | | | - Dingyuan Iris Sun
- Stritch School of Medicine, Loyola University, Maywood, Illinois, USA
| | - Jazmin Starr Newton
- Sanford School of Medicine, University of South Dakota, Vermillion, South Dakota, USA
| | - Nina M D'Amiano
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jonathan Lai
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Bernard Cohen
- Department of Pediatrics and Dermatology, Johns Hopkins University, Baltimore, Maryland, USA
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2
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Contin CG, Carvalho GDSM, Valinoto GCJ, Mayor SAS, Veasey JV. Tinea capitis: observations and clinical approach in a pediatric population of 99 cases. An Bras Dermatol 2024; 99:279-283. [PMID: 37985304 PMCID: PMC10943283 DOI: 10.1016/j.abd.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/26/2023] [Accepted: 03/04/2023] [Indexed: 11/22/2023] Open
Affiliation(s)
- Carolina Gonçalves Contin
- Dermatology Clinic, Irmandade da Santa Casa de Misericórdia de São Paulo, Hospital Central, São Paulo, SP, Brazil
| | | | | | | | - John Verrinder Veasey
- Dermatology Clinic, Irmandade da Santa Casa de Misericórdia de São Paulo, Hospital Central, São Paulo, SP, Brazil
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3
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Gold JAW, Benedict K, Lockhart SR, Lipner SR. Epidemiology of tinea capitis causative species: An analysis of fungal culture results from a major United States national commercial laboratory. J Am Acad Dermatol 2023; 89:382-384. [PMID: 37003477 PMCID: PMC10691499 DOI: 10.1016/j.jaad.2023.03.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/16/2023] [Accepted: 03/21/2023] [Indexed: 04/03/2023]
Affiliation(s)
- Jeremy A W Gold
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Kaitlin Benedict
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shawn R Lockhart
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine, New York, New York
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4
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Galili E, Goldsmith T, Khanimov I, Arbel C, Sharvit S, Lyakhovitsky A, Shemer A, Barzilai A, Astman N. Tinea capitis caused by Trichophyton tonsurans among adults: Clinical characteristics and treatment response. Mycoses 2023; 66:144-149. [PMID: 36219520 DOI: 10.1111/myc.13536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/30/2022] [Accepted: 10/08/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Trichophyton tonsurans tinea capitis has become a growing epidemiological concern. Yet, its clinical manifestations and treatment response, specifically among adults, have only been described among small sample size studies. OBJECTIVE To assess clinical manifestations and treatment outcome of T. tonsurans tinea capitis among adults. PATIENTS AND METHODS A retrospective cohort study was carried out among 111 adults with T. tonsurans tinea capitis. Diagnosis was confirmed by fungal culture or polymerase chain reaction. Examinees' demographics, disease characteristics and treatment response were measured. The risk factors for the treatment failure were evaluated. RESULTS The mean age was 20.1 years (±3.1), with men (98.2%) outnumbering women. The follow-up lasted 12.2 months (±5.6). The majority of T. tonsurans tinea capitis was seen in the occipital area (87.6%). In 78.9% of the cases, the scalp manifestation was non-inflammatory (scaly plaques and papules:76.1% and seborrhoea-like: 2.8%). 21.1% of cases presented with inflammatory tinea capitis (21.1%; Kerion: 10.1% and pustular: 11%). Concomitant involvement of other than scalp areas was common: tinea corporis was seen in 38.7% of the cases; tinea faciei and barbae in 24.3%; nape and anterior neck in 76.6% and 2.7% of the cases, respectively. An adequate treatment course with oral terbinafine resulted in 83.2% clinical cure rate. Treatment failure was significantly associated with concomitant tinea corporis (odds ratio 3.9; 95% confidence interval 1.3-12.1, p-Value< .02). CONCLUSION The most common clinical presentation of T. tonsurans tinea capitis included occipital scaly plaques and papules with concomitant non-scalp lesions. Oral terbinafine was found to be highly effective. Concomitant tinea corporis increased the risk for treatment failure.
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Affiliation(s)
- Eran Galili
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tomer Goldsmith
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Israel Khanimov
- Israel Defense Forces Medical Corps, Tel Hashomer, Ramat Gan, Israel.,Division of Dermatology, Rabin Medical Center, Petah Tikva, Israel
| | - Chen Arbel
- Israel Defense Forces Medical Corps, Tel Hashomer, Ramat Gan, Israel
| | - Sharon Sharvit
- Israel Defense Forces Medical Corps, Tel Hashomer, Ramat Gan, Israel
| | - Anna Lyakhovitsky
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avner Shemer
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviv Barzilai
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nadav Astman
- Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Israel Defense Forces Medical Corps, Tel Hashomer, Ramat Gan, Israel
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5
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Maruani A, Barbarot S, Gangneux JP, Caseris M, Moreau C, Brun S, Botterel F, Menotti J, Toubiana J, Chouchana L, Beylot-Barry M, Dupin N, Guillot B, Chosidow O. Management of tinea capitis in children following the withdrawal of griseofulvin from the French market: A fast-track algorithm proposed by the Center of Evidence of the French Society of Dermatology. Ann Dermatol Venereol 2022; 149:238-240. [PMID: 36229261 DOI: 10.1016/j.annder.2022.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/07/2022] [Accepted: 07/12/2022] [Indexed: 11/06/2022]
Affiliation(s)
- A Maruani
- Universités de Tours et Nantes, Inserm 1246-SPHERE, CHRU de Tours, service de dermatologie, unité de dermatologie pédiatrique, 37000 Tours, France; Centre de Preuves en Dermatologie, Société Française de Dermatologie Pédiatrique, Société Française de Dermatologie, France.
| | - S Barbarot
- Centre de Preuves en Dermatologie, Société Française de Dermatologie Pédiatrique, Société Française de Dermatologie, France; Nantes Université, Servie de Dermatologie, CHU Nantes, UMR 1280 PhAN, INRAE, F-44000 Nantes, France
| | - J P Gangneux
- Service de Parasitologie-Mycologie, CHU de Rennes, Univ Rennes, Inserm, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F35000 Rennes, France; Société Française de Mycologie Médicale, France
| | - M Caseris
- Infectiologie mobile, Hôpital Robert Debré, AP-HP, 75019 Paris, France; Groupe de Pathologie Infectieuse Pédiatrique de la Société Française de Pédiatrie, France
| | - C Moreau
- Service Pharmacie, Hôpital Robert-Debré (AP-HP), 75019 Paris, France
| | - S Brun
- Service de Parasitologie-Mycologie, Hôpital Avicenne, AP-HP, Université Sorbonne Paris Nord, Bobigny, France; Société Française de Mycologie Médicale, France
| | - F Botterel
- Unité de Parasitologie - Mycologie, Département de Prévention, diagnostic et traitement des infections, CHU de Créteil, AP-HP, Université Paris Est Créteil, Créteil, France; Société Française de Mycologie Médicale, France
| | - J Menotti
- Service de Parasitologie et Mycologie Médicale, Institut des Agents Infectieux, Hospices Civils de Lyon / Université Lyon 1, Lyon, France; Société Française de Mycologie Médicale, France
| | - J Toubiana
- Service de pédiatrie générale et maladies infectieuses, Hôpital Necker Enfants malades, AP-HP, Université de Paris, Paris, France
| | - L Chouchana
- Centre Régional de Pharmacovigilance, Service de Pharmacologie, EA 7323 Pharmacologie et Evaluation des Thérapeutiques chez l'enfant et la femme enceinte, Hôpital Cochin, AP-HP, Université de Paris, Paris, France; Société Française de Pharmacologie et Thérapeutique, France
| | - M Beylot-Barry
- Service de Dermatologie, CHU de Bordeaux, INSERM U1312, Bordeaux, France; Centre de Preuves en Dermatologie, Société Française de Dermatologie, France
| | - N Dupin
- Centre de Preuves en Dermatologie, Société Française de Dermatologie, France; Service de dermatologie Hôpital Cochin AP-HP, Paris, France
| | - B Guillot
- Université de Montpellier, Montpellier, France
| | - O Chosidow
- Service de Dermatologie, Hôpitaux Universitaires Henri-Mondor, AP-HP, Créteil, France; Universités de Tours et Nantes, Inserm 1246-SPHERE, France; Centre de Preuves en Dermatologie, GrIDIST Groupe Infectiologie Dermatologique, ISD-SIDA, Société Française de Dermatologie, Paris, France
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Shemer A, Lyakhovitsky A, Kaplan B, Kassem R, Daniel R, Caspi T, Galili E. Diagnostic approach to tinea capitis with kerion: A retrospective study. Pediatr Dermatol 2022; 39:708-712. [PMID: 35510777 DOI: 10.1111/pde.15021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 04/10/2022] [Accepted: 04/11/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Kerion is an inflammatory type of tinea capitis manifesting as boggy crusted nodules. Diagnosis of kerion is often challenging due to high rates of false-negative mycological samples. METHODS A retrospective study among children with kerion, prior to antifungal treatment, was conducted to assess rates of false-negative mycological samples. Specimens for direct microscopy and fungal culture were collected at baseline and after administration of an oral antibiotic course, with or without an oral steroid course. Kerion was categorized as highly inflammatory when a painful, moist scalp nodule with spontaneous purulent discharge or exuberant crust was present, or mildly inflammatory when an erythematous, dry scalp nodule was seen. RESULTS Twenty-three children (mean age 7.9 ± 3.0 years) were included in the study. Trichophyton tonsurans was the most common species isolated (69.6%). Highly inflammatory kerions were significantly more likely to be culture negative before treatment than mildly inflammatory kerions (80% vs. 16.7%, p < .01). Non-inflammatory tinea capitis lesions (n = 13) were culture positive in all cases. Following a combined oral antibiotic and steroid course given to most highly inflammatory kerions (n = 11/13), higher rates of positive fungal cultures were found compared to baseline (90.9% vs. 18.2%, p < .01). CONCLUSION High rates of negative fungal cultures were found only in highly inflammatory kerion. Sampling a highly inflammatory kerion after a combined oral antibiotic and steroid course improved rates of positive fungal cultures. In addition, sampling of non-inflammatory tinea capitis lesions (when present in addition to the kerion) had the highest culture sensitivity.
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Affiliation(s)
- Avner Shemer
- Department of Dermatology, Sheba Medical Center, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anna Lyakhovitsky
- Department of Dermatology, Sheba Medical Center, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Baruch Kaplan
- Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Riad Kassem
- Department of Dermatology, Sheba Medical Center, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ralph Daniel
- University of Mississippi Medical Center, Jackson, Mississippi, USA.,University of Alabama, Birmingham, Alabama, USA
| | - Tomm Caspi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Loewenstein Rehabilitation Hospital, Raanana, Israel
| | - Eran Galili
- Department of Dermatology, Sheba Medical Center, Ramat-Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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7
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Gupta AK, Friedlander SF, Simkovich AJ. Tinea capitis: An update. Pediatr Dermatol 2022; 39:167-172. [PMID: 35075666 DOI: 10.1111/pde.14925] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/05/2022] [Accepted: 01/08/2022] [Indexed: 11/26/2022]
Abstract
Tinea capitis is an important superficial infection and affects children globally. A literature review was conducted to identify recent findings and the current understanding of this fungal infection. Here, we highlight updates on important aspects of tinea capitis including advances in dermatophyte detection and diagnosis and comparing these new methods to more traditional techniques. Additionally, aspects of treating tinea capitis are discussed, including the importance of mycological confirmation and current means of treatment, and the treatment of asymptomatic carriers are reviewed. This review also examines the subject of laboratory monitoring of patients undergoing treatment with systemic antifungals; we discuss the opinions of prominent researchers and currently accepted guidelines. Lastly, we provide answers to several common questions that practitioners may encounter when treating a child with tinea capitis.
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Affiliation(s)
- Aditya K Gupta
- Division of Dermatology, Department of Medicine, University of Toronto School of Medicine, Toronto, Ontario, Canada.,Mediprobe Research Inc., London, Ontario, Canada
| | - Sheila Fallon Friedlander
- Department of Dermatology, University of California School of Medicine, San Diego, California, USA.,Department of Dermatology, Scripps Clinic, San Diego, California, USA
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8
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Shemer A, Gupta AK, Galili E, Daniel R, Kassem R, Farhi R, Grunwald H, Bamimore MA. Management of tinea capitis in Israel: A comparative study. Pediatr Dermatol 2021; 38:806-811. [PMID: 33998709 DOI: 10.1111/pde.14572] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Tinea capitis is a common fungal infection in Israel, most commonly caused by the dermatophyte Trichophyton tonsurans. OBJECTIVES To investigate the effectiveness of oral antifungal monotherapy in producing clinical or complete cure. We also evaluated the impact of topical therapy (bifonazole 1% shampoo and/or betamethasone valerate 0.1% solution), prior to oral treatment, on patients' likelihood of clinical or complete cure. METHODS A retrospective chart review was conducted. Patients with mycologically confirmed tinea capitis were treated with one of four regimens: (1) terbinafine (greater than 40 kg: 250 mg/day, 20 to 40 kg: 125 mg/day, less than 20 kg: 62.5 mg/day), (2) itraconazole 5 mg/kg daily, (3) fluconazole 6 mg/kg daily, or (4) griseofulvin 20 mg/kg daily. We used generalized linear models (GLM) to determine whether there was a significant association between the odds of cure and choice of treatment. RESULTS The causative species was Trichophyton tonsurans in all but 6 cases that grew T violaceum. For pediatric patients, the odds of having complete or clinical cure within 6 weeks was greater if they used terbinafine compared to itraconazole, fluconazole, or griseofulvin (odds ratio [OR] = 9.06, P = .047). The likelihood of complete or clinical cure within 8 weeks of oral therapy was lower if topical steroids were previously used compared to if topical antifungals were used prior to systemic treatment (OR = 0.29, P = .046). CONCLUSIONS Our findings substantiate prior literature demonstrating that terbinafine is non-inferior to griseofulvin, itraconazole, and fluconazole in the therapy of pediatric tinea capitis caused by T tonsurans.
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Affiliation(s)
- Avner Shemer
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aditya K Gupta
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Mediprobe Research Inc., London, ON, Canada.,Division of Dermatology, Department of Medicine, University of Toronto School of Medicine, Toronto, ON, Canada
| | - Eran Galili
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ralph Daniel
- University of Mississippi Medical Center and University of Alabama, Birmingham, AL, USA
| | - Riad Kassem
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Renata Farhi
- Hospital Nossa Senhora da Saude, University Fundação Tecnico Educacional Souza Marques, Rio de Janeiro, Brazil
| | - Hadas Grunwald
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Chiriac A, Birsan C, Mares M, Wollina U. [Kerion Celsi due to Microsporum canis infection]. Hautarzt 2021; 72:855-859. [PMID: 33884438 DOI: 10.1007/s00105-021-04817-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 11/26/2022]
Abstract
Tinea capitis is seen world-wide among children up to 12 years. The most severe type is Kerion Celsi with painful abscesses and lymphadenopathy. We report on an 11-year-old boy with Kerion Celsi, who was initially treated using antibiotics under the common misdiagnosis of a bacterial infection. Mycological investigations could identify Microsporum canis. The patient was treated orally with griseofulvin, which resulted in complete mycological remission after 8 weeks. Cicatrical alopecia, however, could not be prevented. Purulent infections of the scalp should lead to early mycological diagnostics in children.
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Affiliation(s)
- A Chiriac
- Department of Dermatology, Nicolina Medical Center, Iași, Rumänien
- Department of Dermatology, Apollonia University, Iași, Rumänien
- P. Poni Institute of Macromolecular Chemistry, Romanian Academy, Iași, Rumänien
| | - C Birsan
- Department of Dermatology, Apollonia University, Iași, Rumänien
| | - M Mares
- Laboratory of Antimicrobial Chemotherapy, Ion Ionescu de la Brad University, Iași, Rumänien
| | - Uwe Wollina
- Klinik für Dermatologie und Allergologie, Städtisches Klinikum Dresden, Friedrichstr. 41, 01067, Dresden, Deutschland.
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Nenoff P, Kunz M, Weißer M, Viehweger A, Krüger C, Uhrlaß S. Kerion Celsi durch Trichophyton mentagrophytes Genotyp III* bei einem 2-jährigen Kind - erfolgreiche Therapie mit Terbinafin. J Dtsch Dermatol Ges 2021; 19 Suppl 1:1-4. [PMID: 33835661 DOI: 10.1111/ddg.14478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Manfred Kunz
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig AöR und Medizinische Fakultät der Universität Leipzig, Philipp-Rosenthal-Straße 23, Leipzig, 04103
| | - Margit Weißer
- Klinik und Poliklinik für Kinderchirurgie, Universitätsklinikum Leipzig AöR und Medizinische Fakultät der Universität Leipzig, Liebigstr. 20a, Haus 6, Leipzig, 04103
| | - Adrian Viehweger
- Institut für Medizinische Mikrobiologie und Infektionsepidemiologie, Liebigstraße 21, Haus C, Leipzig, 04103
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