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Indari O, Ghosh S, Bal AS, James A, Garg M, Mishra A, Karmodiya K, Jha HC. Awakening the sleeping giant: Epstein-Barr virus reactivation by biological agents. Pathog Dis 2024; 82:ftae002. [PMID: 38281067 PMCID: PMC10901609 DOI: 10.1093/femspd/ftae002] [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] [Received: 03/27/2023] [Revised: 01/16/2024] [Accepted: 01/25/2024] [Indexed: 01/29/2024] Open
Abstract
Epstein-Barr virus (EBV) may cause harm in immunocompromised conditions or on stress stimuli. Various chemical agents have been utilized to induce the lytic cycle in EBV-infected cells. However, apart from chemical agents and external stress stimuli, certain infectious agents may reactivate the EBV. In addition, the acute infection of other pathogens may provide suitable conditions for EBV to thrive more and planting the roots for EBV-associated pathologies. Various bacteria such as periodontal pathogens like Aggregatibacter, Helicobacter pylori, etc. have shown to induce EBV reactivation either by triggering host cells directly or indirectly. Viruses such as Human simplex virus-1 (HSV) induce EBV reactivation by HSV US3 kinase while other viruses such as HIV, hepatitis virus, and even novel SARS-CoV-2 have also been reported to cause EBV reactivation. The eukaryotic pathogens such as Plasmodium falciparum and Aspergillus flavus can also reactivate EBV either by surface protein interaction or as an impact of aflatoxin, respectively. To highlight the underexplored niche of EBV reactivation by biological agents, we have comprehensively presented the related information in this review. This may help to shedding the light on the research gaps as well as to unveil yet unexplored mechanisms of EBV reactivation.
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Affiliation(s)
- Omkar Indari
- Infection Bioengineering Group, Department of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Simrol Campus, Simrol, Indore 453552, India
- Department of Immunology, St. Jude Children's Research Hospital, Memphis, TN 38105, United States
| | - Subhrojyoti Ghosh
- Infection Bioengineering Group, Department of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Simrol Campus, Simrol, Indore 453552, India
| | - Adhiraj Singh Bal
- Infection Bioengineering Group, Department of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Simrol Campus, Simrol, Indore 453552, India
| | - Ajay James
- Infection Bioengineering Group, Department of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Simrol Campus, Simrol, Indore 453552, India
| | - Mehek Garg
- Infection Bioengineering Group, Department of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Simrol Campus, Simrol, Indore 453552, India
| | - Amit Mishra
- Cellular and Molecular Neurobiology Unit, Indian Institute of Technology Jodhpur, Jodhpur 342037, India
| | - Krishanpal Karmodiya
- Indian Institute of Science Education and Research (IISER), Dr. Homi Bhabha Road, Pune 411008, India
| | - Hem Chandra Jha
- Infection Bioengineering Group, Department of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Simrol Campus, Simrol, Indore 453552, India
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Janković M, Knežević A, Todorović M, Đunić I, Mihaljević B, Soldatović I, Protić J, Miković N, Stoiljković V, Jovanović T. Cytomegalovirus infection may be oncoprotective against neoplasms of B-lymphocyte lineage: single-institution experience and survey of global evidence. Virol J 2022; 19:155. [PMID: 36171605 PMCID: PMC9520857 DOI: 10.1186/s12985-022-01884-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 09/16/2022] [Indexed: 11/23/2022] Open
Abstract
Background Although cytomegalovirus (CMV) is not considered tumorigenic, there is evidence for its oncomodulatory effects and association with hematological neoplasms. Conversely, a number of experimental and clinical studies suggest its putative anti-tumour effect. We investigated the potential connection between chronic CMV infection in patients with B-lymphocyte (B-cell) malignancies in a retrospective single-center study and extracted relevant data on CMV prevalences and the incidences of B-cell cancers the world over. Methods In the clinical single-center study, prevalence of chronic CMV infection was compared between patients with B-cell leukemia/lymphoma and the healthy controls. Also, global data on CMV seroprevalences and the corresponding country-specific incidences of B- lineage neoplasms worldwide were investigated for potential correlations. Results Significantly higher CMV seropositivity was observed in control subjects than in patients with B-cell malignancies (p = 0.035). Moreover, an unexpected seroepidemiological evidence of highly significant inverse relationship between country-specific CMV prevalence and the annual incidence of B-cell neoplasms was noted across the populations worldwide (ρ = −0.625, p < 0.001). Conclusions We try to draw attention to an unreported interplay between CMV infection and B-cell lymphomagenesis in adults. A large-scale survey across > 70 countries disclosed a link between CMV and B-cell neoplasms. Our evidence hints at an antagonistic effect of chronic CMV infection against B-lymphoproliferation.
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Affiliation(s)
- Marko Janković
- Institute of Microbiology and Immunology, Department of Virology, Faculty of Medicine, University of Belgrade, dr Subotića 1, Belgrade, 11000, Republic of Serbia.
| | - Aleksandra Knežević
- Institute of Microbiology and Immunology, Department of Virology, Faculty of Medicine, University of Belgrade, dr Subotića 1, Belgrade, 11000, Republic of Serbia
| | - Milena Todorović
- Clinic for Hematology, Faculty of Medicine, University Clinical Centre of Serbia, University of Belgrade, dr Koste Todorovića 2, Belgrade, 11000, Republic of Serbia
| | - Irena Đunić
- Clinic for Hematology, Faculty of Medicine, University Clinical Centre of Serbia, University of Belgrade, dr Koste Todorovića 2, Belgrade, 11000, Republic of Serbia
| | - Biljana Mihaljević
- Clinic for Hematology, Faculty of Medicine, University Clinical Centre of Serbia, University of Belgrade, dr Koste Todorovića 2, Belgrade, 11000, Republic of Serbia
| | - Ivan Soldatović
- Institute of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, dr Subotića 15, Belgrade, 11000, Republic of Serbia
| | - Jelena Protić
- Institute of Virology, Vaccines, and Sera "Torlak",, Vojvode Stepe 458, Belgrade, 11152, Republic of Serbia
| | - Nevenka Miković
- Institute of Virology, Vaccines, and Sera "Torlak",, Vojvode Stepe 458, Belgrade, 11152, Republic of Serbia
| | - Vera Stoiljković
- Institute of Virology, Vaccines, and Sera "Torlak",, Vojvode Stepe 458, Belgrade, 11152, Republic of Serbia
| | - Tanja Jovanović
- Institute of Microbiology and Immunology, Department of Virology, Faculty of Medicine, University of Belgrade, dr Subotića 1, Belgrade, 11000, Republic of Serbia
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Deng W, Xu Y, Yuan X. Clinical features and prognosis of acute lymphoblastic leukemia in children with Epstein-Barr virus infection. Transl Pediatr 2022; 11:642-650. [PMID: 35685069 PMCID: PMC9173871 DOI: 10.21037/tp-22-146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/07/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Acute lymphoblastic leukemia (ALL) is one of the most common malignant diseases of the hematopoietic system in children. Although the etiology of ALL is unknown, it has been reported that it may be associated with Epstein-Barr virus (EBV) infection. The aim of this study was to analyze the impact of EBV infection on the clinical features and prognosis of childhood ALL. METHODS A total of 162 children with ALL admitted to Heilongjiang Provincial Hospital from January 2018 to December 2020 were selected for this stud, and were divided into 2 groups, infected group and non-infected group, according to whether they had EBV infection. Differences in clinical characteristics between the 2 groups were analyzed by χ2 or t-test. The impact of EBV infection on the prognosis of children was analyzed by Kaplan-Meier survival and Cox regression analysis. RESULTS The 2 groups were statistically significantly different (P<0.05) according to comparison of characteristics such as first symptoms, karyotype, immunophenotyping, clinical risk, whether secondary infection occurred during chemotherapy, and lymphocyte subsets. Logistic regression results suggested that first symptoms, karyotype, immunophenotyping, clinical risk, the presence of secondary infection during chemotherapy, and lymphocyte subsets were independently associated with EBV infection in children with ALL (P<0.05). The complete remission rate at 46 days after chemotherapy, event-free survival (EFS), overall survival (OS), and survival rate were lower in the infected group than non-infected group, and the complete remission recurrence rate was higher than non-infected group (P<0.05). The EBV DNA levels were statistically lower in the good prognosis group (1.07±0.25×103 copies/L) than poor prognosis group (8.86±1.14 ×103 copies/L) (P<0.01). The area under the curve (AUC) for EBV to predict prognosis in children with ALL was 0.921, sensitivity and sensitivity were 86.57%, 80.16%. CONCLUSIONS Infection with EBV is associated with first symptoms, karyotype, immunophenotyping, clinical risk, secondary infection during chemotherapy, and lymphocyte subpopulation index levels in children with ALL, and children with EBV infection have a reduced clinical remission rate and poor prognosis. Therefore, the detection of EBV DNA is clinically important for assessing the prognosis of their disease.
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Affiliation(s)
- Wei Deng
- Department of Pediatric General Internal Medicine, Gansu Provincial Maternity and Child-Care Hospital, Lanzhou, China
| | - Yating Xu
- Department of Pediatrics, Huai'an Hospital of Huai'an City, Huai'an, China
| | - Xunling Yuan
- Department of Pediatrics, Heilongjiang Provincial Hospital, Harbin, China
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Hemophagocytic syndrome due to Epstein-Barr virus and cytomegalovirus coinfection in a patient on adalimumab. J Infect Chemother 2022; 28:823-827. [DOI: 10.1016/j.jiac.2022.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/09/2022] [Accepted: 01/23/2022] [Indexed: 11/20/2022]
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Metwally SA, Abo-Shadi MA, Abdel Fattah NF, Barakat AB, Rabee OA, Osman AM, Helal AM, Hashem T, Moneer MM, Chehadeh W, Loutfy SA. Presence of HPV, EBV and HMTV Viruses Among Egyptian Breast Cancer Women: Molecular Detection and Clinical Relevance. Infect Drug Resist 2021; 14:2327-2339. [PMID: 34188499 PMCID: PMC8236253 DOI: 10.2147/idr.s313219] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 05/07/2021] [Indexed: 12/20/2022] Open
Abstract
Background Oncogenic viruses, their possible association with breast cancer (BC) and effect on its clinical course are interesting issue. The present study evaluates the presence of human papillomavirus (HPV), EpsteinBarr virus (EBV), and human mammary tumor virus (HMTV) in BC and their relation with clinico-pathological characteristics. Patients and Methods This study was conducted on 80 Egyptian women with BC and 30 control women without known oncological disease. Forty formalin-fixed paraffin-embedded (FFPE) tissues, forty fresh tissue samples, and white blood cells (WBCs) of BC patients and WBCs of controls were subjected to a qualitative polymerase chain reaction (PCR). Quantitative real-time PCR was used to measure viral loads in fresh tissues of BC. The result was correlated with clinico-pathological characteristics of BC. Results HPV was detected in 33 (41.25%), EBV in 30 (37.5%) and HMTV in 33 (41.25%) BC patients. None of the control women was positive for HPV or EBV while HMTV was detected in 7 (23.3%). Among 40 BC WBCs specimens, HPV/HMTV were found together in 25%, followed by EBV/HMTV in 2.5% and EBV/HPV in 2.5%. However, the three viruses (HPV/EBV/HMTV) were found together in only 5%. In the 40 fresh BC tissues, the three viruses were found together in 12 (30%), EBV/HMTV in 7 (17.5%), HPV/HMTV in 4 (10%), and HPV/EBV in 4 (10%). EBV, HMTV, or multiple viral infections were associated with younger age of BC women. HPV, EBV, and HMTV median loads in fresh tissues were 4.8×103 copies/μL, 6.3×103 copies/μL, and 97 copies/μL, respectively. Conclusion WBCs could be a more suitable specimen instead of fresh tissue for HMTV detection in BC patients to avoid invasive procedures. The presence of HPV, EBV, and HMTV together in Egyptian women with BC was significantly associated with younger age.
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Affiliation(s)
- Shimaa A Metwally
- Microbiology & Immunology Department, Faculty of Pharmacy for Girls, Al-Azhar University, Cairo, Egypt
| | - Maha A Abo-Shadi
- Microbiology & Immunology Department, Faculty of Pharmacy for Girls, Al-Azhar University, Cairo, Egypt
| | - Nasra F Abdel Fattah
- Virology and Immunology Unit, Cancer Biology Department, National Cancer Institute (NCI), Cairo University, Cairo, Egypt
| | - Ahmed B Barakat
- Microbiology Department, Faculty of Science, Ain Shams University, Cairo, Egypt
| | - Omar A Rabee
- Microbiology Department, Faculty of Science, Ain Shams University, Cairo, Egypt
| | - Ahmed M Osman
- Virology and Immunology Unit, Cancer Biology Department, National Cancer Institute (NCI), Cairo University, Cairo, Egypt
| | - Amany M Helal
- Medical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Tarek Hashem
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Manar M Moneer
- Cancer Epidemiology and Biostatistics Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Wassim Chehadeh
- Department of Microbiology, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
| | - Samah A Loutfy
- Virology and Immunology Unit, Cancer Biology Department, National Cancer Institute (NCI), Cairo University, Cairo, Egypt.,Nanotechnology Research Center, British University in Egypt (BUE), Cairo, Egypt
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de Melo Silva J, Pinheiro-Silva R, Dhyani A, Pontes GS. Cytomegalovirus and Epstein-Barr Infections: Prevalence and Impact on Patients with Hematological Diseases. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1627824. [PMID: 33163531 PMCID: PMC7605947 DOI: 10.1155/2020/1627824] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 12/14/2022]
Abstract
Cytomegalovirus (CMV) and Epstein-Barr virus (EBV) infections are widely distributed throughout the world. EBV is linked to various hematological and autoimmune disorders whereas CMV might play important role in the progression of chronic hematological diseases, such as hemoglobinopathies, lymphomas, myelomas, hemophilia, and aplastic and sickle cell anemia. Both viruses produce a viral homolog of human interleukin-10 that can cause general suppression of immune response, increasing susceptibility to other infections. These viruses can remain latent in the host cells and be reactivated when the host immune system is compromised. Studies showing the impact of CMV and EBV infections on hematological disorders are scarce and unclear in the context of coinfection. This review intends to present the biology, prevalence, and impact of CMV and EBV infections in patients with hematological diseases.
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Affiliation(s)
- Jean de Melo Silva
- Programa de Pós-graduação em Hematologia, Universidade do Estado do Amazonas, Manaus-Amazonas, Brazil
| | - Renato Pinheiro-Silva
- Programa de Pós-graduação em Hematologia, Universidade do Estado do Amazonas, Manaus-Amazonas, Brazil
| | - Anamika Dhyani
- Programa de Pós-graduação em Hematologia, Universidade do Estado do Amazonas, Manaus-Amazonas, Brazil
| | - Gemilson Soares Pontes
- Programa de Pós-graduação em Hematologia, Universidade do Estado do Amazonas, Manaus-Amazonas, Brazil
- Laboratório de Virologia e Imunologia, Coordenação Sociedade, Ambiente e Saúde, Instituto Nacional de Pesquisas da Amazônia (INPA), Manaus-Amazonas, Brazil
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Li SQ, Liu J, Zhang J, Wang XL, Chen D, Wang Y, Xu YM, Huang B, Lin J, Li J, Wang XZ. Transcriptome profiling reveals the high incidence of hnRNPA1 exon 8 inclusion in chronic myeloid leukemia. J Adv Res 2020; 24:301-310. [PMID: 32405436 PMCID: PMC7210475 DOI: 10.1016/j.jare.2020.04.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/08/2020] [Accepted: 04/25/2020] [Indexed: 01/30/2023] Open
Abstract
Chronic myeloid leukemia (CML) is a malignancy that evolves through a multi-step process. Alternative splicing of several genes has been linked to the progression of the disease, but involvement of alternations in splicing profiles has not been reported. RNA-seq of peripheral blood mononuclear cell (PBMC) samples characterized the differentially expressed and spliced transcripts in five CML chronic phase (CP) and five blast phase (BP) patients, and five healthy controls. Global splicing alteration analysis detected 6474 altered splicing events altered between CML and healthy samples, including many of the previously reported splicing variants and showing a more profound altered splicing deregulation in BP samples. Functional clustering of differentially spliced genes in CP revealed a preferred enrichment relating to cell signaling, while the spliceosome pathway was most overrepresented in BP samples. One differentially spliced spliceosome gene hnRNPA1 showed two splice isoforms; the longer isoform contained exon 8 was preferentially expressed in the BP patients, and the short one excluding exon 8 was specific to healthy controls. Our findings suggested that alternative splicing deregulation played a central role during the progression of CML from CP to BP, and the longer isoform of hnRNPA1 might represent a diagnostic marker and therapeutic target for CML.
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Affiliation(s)
- Shu-Qi Li
- Jiangxi Province Key Laboratory of Laboratory Medicine, Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, No.1 Min De Road, Nanchang 330006, China
| | - Jing Liu
- Jiangxi Province Key Laboratory of Laboratory Medicine, Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, No.1 Min De Road, Nanchang 330006, China
| | - Jing Zhang
- Jiangxi Province Key Laboratory of Laboratory Medicine, Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, No.1 Min De Road, Nanchang 330006, China
| | - Xue-Lian Wang
- Center for Genome Analysis, ABLife Inc., Wuhan 430075, China
| | - Dong Chen
- Center for Genome Analysis, ABLife Inc., Wuhan 430075, China
| | - Yan Wang
- Jiangxi Province Key Laboratory of Laboratory Medicine, Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, No.1 Min De Road, Nanchang 330006, China
| | - Yan-Mei Xu
- Jiangxi Province Key Laboratory of Laboratory Medicine, Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, No.1 Min De Road, Nanchang 330006, China
| | - Bo Huang
- Jiangxi Province Key Laboratory of Laboratory Medicine, Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, No.1 Min De Road, Nanchang 330006, China
| | - Jin Lin
- Jiangxi Province Key Laboratory of Laboratory Medicine, Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, No.1 Min De Road, Nanchang 330006, China
| | - Jing Li
- Department of Clinical Laboratory, The First Affiliated Hospital of Nanchang University, No.17 Yong Wai Road, Nanchang 330006, China
| | - Xiao-Zhong Wang
- Jiangxi Province Key Laboratory of Laboratory Medicine, Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, No.1 Min De Road, Nanchang 330006, China
- Corresponding author.
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Ozturk V, Yikilmaz AS, Kilicarslan A, Bakanay SM, Akinci S, Dilek İ. The Triple Positivity for EBV, PD-1, and PD-L1 Identifies a Very High Risk Classical Hodgkin Lymphoma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 20:e375-e381. [PMID: 32295735 DOI: 10.1016/j.clml.2019.11.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 11/10/2019] [Accepted: 11/28/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND The programmed death receptor (PD-1) and ligand (PD-L1) pathway act by suppressing the antitumor response in chronic Hodgkin lymphoma (cHL). In this study, we aimed to investigate the effect of PD-1, PD-L1, and Epstein-Barr virus (EBV) positivity on prognosis at the initial diagnosis of cHL. MATERIAL AND METHODS Thirty-six patients with cHL were retrospectively analyzed. PD-L1 staining was performed for RS cells and tumor microenvironment in the biopsy materials of cases. The presence of EBV was investigated by EBER (EBV-encoded RNA) method in tumor cell. P < .05 was accepted as significant. RESULTS The presence of advanced-stage disease, B symptoms, intermediate or high-risk international prognostic index (IPS), and extranodal involvement were found to be related to both PD-L1 positivity and EBV positivity in RS cells. PD-L1 positivity in RS cells was also associated with EBV positivity. There were 6 (16.7%) triple-positive (EBV+, RS-PD-L1+, mic-PD-1+) patients. All of these patients had advanced-stage disease, B symptoms at the time of diagnosis, and intermediate-high IPS score, and 4 of 6 patients had extranodal involvement. This group also had significantly shortened overall survival compared with others (38.4 months vs. 67.9 months P = .024). CONCLUSION Our data suggest that there is correlation between PD-L1 positivity and EBV positivity in tumor RS cells that are also associated with extranodal involvement, intermediate and high IPS score, presence of B symptoms, and advanced-stage disease. In addition, we identified a group of triple-positive (EBV+, RS-PD-L1+, mic-PD-1+) cHL patients who have a very high-risk disease.
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Affiliation(s)
- Vedia Ozturk
- Department of Pathology, Yıldırım Beyazıt University, Ankara, Turkey
| | | | - Aydan Kilicarslan
- Department of Pathology, Yıldırım Beyazıt University, Ankara, Turkey
| | - Sule Mine Bakanay
- Department of Hematology, Yıldırım Beyazıt University, Ankara, Turkey
| | - Sema Akinci
- Department of Hematology, Yıldırım Beyazıt University, Ankara, Turkey
| | - İmdat Dilek
- Department of Hematology, Yıldırım Beyazıt University, Ankara, Turkey
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Fattahi S, Nikbakhsh N, Taheri H, Ghadami E, Kosari-Monfared M, Amirbozorgi G, Asouri M, Pilehchian-Langroudi M, Ranaee M, Samadani AA, Paryan M, Akhavan-Niaki H. Prevalence of multiple infections and the risk of gastric adenocarcinoma development at earlier age. Diagn Microbiol Infect Dis 2018; 92:62-68. [DOI: 10.1016/j.diagmicrobio.2018.04.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 04/24/2018] [Accepted: 04/30/2018] [Indexed: 02/07/2023]
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