1
|
Amato M, Santonocito S, Bruno MT, Polizzi A, Mastroianni A, Chaurasia A, Isola G. Oral and periodontal manifestation related during human papilloma virus infections: Update on early prognostic factors. Heliyon 2024; 10:e31061. [PMID: 38813162 PMCID: PMC11133762 DOI: 10.1016/j.heliyon.2024.e31061] [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: 02/07/2024] [Revised: 04/11/2024] [Accepted: 05/09/2024] [Indexed: 05/31/2024] Open
Abstract
Human Papilloma Virus (HPV) is considered one of the most common sexually transmitted infections and has been shown to play an important role in the pathogenesis of squamous cell carcinomas (SCC) of the cervix and head and neck. Manifestations of HPV infections can be manifold, ranging from asymptomatic infections to benign or potentially malignant lesions to intraepithelial neoplasms and invasive carcinomas. The heterogeneity of clinical manifestations from HPV infection depends on the interactions between the viral agent and the host, a direct consequence of the ability on the part of HPV is to remain silent and to evade and convey the action of the host immune system. The oral mucosa represents one of the tissues for which HPV has a distinct tropism and is frequently affected by infection. While much information is available on the role that HPV infection plays in the development of SCC in the oral cavity, there is less information on asymptomatic infections and benign HPV-induced oral lesions. Therefore, the purpose of this review is to analyze, in light of current knowledge, the early clinical and bio-humoral prognostic features related to the risk of HPV malignant transformation, focusing on subclinical conditions, benign lesions, and the correlation between oral infection and infection in other districts. The data show that the main risk associated with HPV infection is related to malignant transformation of lesions. Although HPV-driven OPSCC is associated with a better prognosis than non-HPV-driven OPSCC, primary prevention and early detection of the infection and affected genotype are essential to reduce the risk of malignant neoplastic complications and improve the prognosis.
Collapse
Affiliation(s)
- Mariacristina Amato
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, AOU "Policlinico-San Marco", Via S. Sofia 78, 95124, Catania, Italy
| | - Simona Santonocito
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, AOU "Policlinico-San Marco", Via S. Sofia 78, 95124, Catania, Italy
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, 98100 Messina, Italy
| | - Maria Teresa Bruno
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, AOU "Policlinico-San Marco", Via S. Sofia 78, 95124, Catania, Italy
- Research Center of “Human Papilloma Virus” University of Catania, AOU "Policlinico-San Marco", Via S. Sofia 78, 95124, Catania, Italy
| | - Alessandro Polizzi
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, AOU "Policlinico-San Marco", Via S. Sofia 78, 95124, Catania, Italy
| | - Alessandro Mastroianni
- Dentistry Unit, Department of Clinical Sciences and Translational Medicine, University of Tor Vergata, 00133, Rome, Italy
| | - Akhilanand Chaurasia
- Department of Oral Medicine & Radiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Gaetano Isola
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, AOU "Policlinico-San Marco", Via S. Sofia 78, 95124, Catania, Italy
- Research Center of “Human Papilloma Virus” University of Catania, AOU "Policlinico-San Marco", Via S. Sofia 78, 95124, Catania, Italy
| |
Collapse
|
2
|
Bruno MT, Caruso G, Torrisi E, Grimaldi R, Abate B, Luciani FS, Basile S, Panella MM. The Impact of Diagnosis of Human Papillomavirus (HPV) Infection and Electrosurgical Excision Procedure (LEEP) for Cervical Intraepithelial Neoplasia 3 (CIN3) on Women's Sexual Lives. Diagnostics (Basel) 2024; 14:911. [PMID: 38732325 PMCID: PMC11083130 DOI: 10.3390/diagnostics14090911] [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: 02/16/2024] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
The aim of the study was to assess sexual health in women who underwent Loop Electrosurgical Excisional Procedure (LEEP) for the treatment of cervical intraepithelial neoplasia 3 (CIN 3). One hundred thirty-one women were enrolled, and the Female Sexual Function Index (FSFI) questionnaire was administered before LEEP and 6 months after the procedure. In almost all of the participants, data revealed a statistically significant worsening in sexual quality of life after LEEP. Therefore, clinicians should be aware of these possible negative effects on sexual behavior, and provide women with appropriate, wide-ranging, and detailed counseling. The data obtained in the present study should help to plan appropriate counseling from communicating HPV diagnosis and medical treatment to CIN3 surgical procedure.
Collapse
Affiliation(s)
- Maria Teresa Bruno
- Department of General Surgery and Medical-Surgical Specialties, Gynecological Clinic, University of Catania, 95123 Catania, Italy (E.T.); (R.G.)
- Multidisciplinary Research Center in Papillomavirus Pathology, University of Catania, 95123 Catania, Italy
| | - Giuseppe Caruso
- Department of General Surgery and Medical-Surgical Specialties, Gynecological Clinic, University of Catania, 95123 Catania, Italy (E.T.); (R.G.)
| | - Elena Torrisi
- Department of General Surgery and Medical-Surgical Specialties, Gynecological Clinic, University of Catania, 95123 Catania, Italy (E.T.); (R.G.)
| | - Raffaela Grimaldi
- Department of General Surgery and Medical-Surgical Specialties, Gynecological Clinic, University of Catania, 95123 Catania, Italy (E.T.); (R.G.)
| | - Biagio Abate
- Department of General Surgery and Medical-Surgical Specialties, Gynecological Clinic, University of Catania, 95123 Catania, Italy (E.T.); (R.G.)
| | - Francesco Saverio Luciani
- Methods and Models Department for the Economy, Territory and Finance, La Sapienza University of Rome, 00185 Rome, Italy;
| | - Susanna Basile
- Psychologist and Clinical Sexologist, 95123 Catania, Italy;
| | - Marco Marzio Panella
- Department of General Surgery and Medical-Surgical Specialties, Gynecological Clinic, University of Catania, 95123 Catania, Italy (E.T.); (R.G.)
- Multidisciplinary Research Center in Papillomavirus Pathology, University of Catania, 95123 Catania, Italy
| |
Collapse
|
3
|
Dellino M, Pinto G, D’Amato A, Barbara F, Di Gennaro F, Saracino A, Laganà AS, Vimercati A, Malvasi A, Malvasi VM, Cicinelli E, Vitagliano A, Cascardi E, Pinto V. Analogies between HPV Behavior in Oral and Vaginal Cavity: Narrative Review on the Current Evidence in the Literature. J Clin Med 2024; 13:1429. [PMID: 38592283 PMCID: PMC10932293 DOI: 10.3390/jcm13051429] [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: 12/28/2023] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 04/10/2024] Open
Abstract
Human genital papilloma virus infection is the most prevalent sexually transmitted infection in the world. It is estimated that more than 75% of sexually active women contract this infection in their lifetime. In 80% of young women, there is the clearance of the virus within 18-24 months. In developed countries, oral squamous cell carcinoma (OSCC) is now the most frequent human papilloma virus (HPV)-related cancer, having surpassed cervical cancer, and it is predicted that by 2030 most squamous cell carcinomas will be the HPV-related rather than non-HPV-related form. However, there are currently no screening programs for oral cavity infection. While the natural history of HPV infection in the cervix is well known, in the oropharynx, it is not entirely clear. Furthermore, the prevalence of HPV in the oropharynx is unknown. Published studies have found wide-ranging prevalence estimates of 2.6% to 50%. There are also conflicting results regarding the percentage of women presenting the same type of HPV at two mucosal sites, ranging from 0 to 60%. Additionally, the question arises as to whether oral infection can develop from genital HPV infection, through oral and genital contact or by self-inoculation, or whether it should be considered an independent event. However, there is still no consensus on these topics, nor on the relationship between genital and oral HPV infections. Therefore, this literature review aims to evaluate whether there is evidence of a connection between oral and cervical HPV, while also endorsing the usefulness of the screening of oral infection in patients with high-risk cervical HPV as a means of facilitating the diagnosis and early management of HPV-related oral lesions. Finally, this review emphasizes the recommendation for the use of the HPV vaccines in primary prevention in the male and female population as the most effective means of successfully counteracting the increasing incidence of OSCC to date.
Collapse
Affiliation(s)
- Miriam Dellino
- 1st Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine, University of Bari, 70124 Bari, Italy; (M.D.); (A.V.); (A.M.); (E.C.); (A.V.); (V.P.)
| | - Grazia Pinto
- Dentistry Unit, Department of Interdisciplinary Medicine, University of Bari Medical School, 70124 Bari, Italy;
| | - Antonio D’Amato
- 1st Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine, University of Bari, 70124 Bari, Italy; (M.D.); (A.V.); (A.M.); (E.C.); (A.V.); (V.P.)
| | - Francesco Barbara
- Unit of Otolaryngology, Department of Ophtalmology and Otolaryngology, University of Bari, 70124 Bari, Italy;
| | - Francesco Di Gennaro
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area, Polyclinic of Bari, University Hospital Polyclinic, University of Bari, Piazza Giulio Cesare n. 11, 70124 Bari, Italy; (F.D.G.); (A.S.)
| | - Annalisa Saracino
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area, Polyclinic of Bari, University Hospital Polyclinic, University of Bari, Piazza Giulio Cesare n. 11, 70124 Bari, Italy; (F.D.G.); (A.S.)
| | - Antonio Simone Laganà
- Unit of Obstetrics and Gynecology, “Paolo Giaccone” Hospital, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy;
| | - Antonella Vimercati
- 1st Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine, University of Bari, 70124 Bari, Italy; (M.D.); (A.V.); (A.M.); (E.C.); (A.V.); (V.P.)
| | - Antonio Malvasi
- 1st Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine, University of Bari, 70124 Bari, Italy; (M.D.); (A.V.); (A.M.); (E.C.); (A.V.); (V.P.)
| | | | - Ettore Cicinelli
- 1st Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine, University of Bari, 70124 Bari, Italy; (M.D.); (A.V.); (A.M.); (E.C.); (A.V.); (V.P.)
| | - Amerigo Vitagliano
- 1st Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine, University of Bari, 70124 Bari, Italy; (M.D.); (A.V.); (A.M.); (E.C.); (A.V.); (V.P.)
| | - Eliano Cascardi
- Pathology Unit, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari, Piazza Giulio Cesare 11, 70121 Bari, Italy;
| | - Vincenzo Pinto
- 1st Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine, University of Bari, 70124 Bari, Italy; (M.D.); (A.V.); (A.M.); (E.C.); (A.V.); (V.P.)
| |
Collapse
|
4
|
Bruno MT, Valenti G, Ruggeri Z, Incognito GG, Coretti P, Montana GD, Panella MM, Mereu L. Correlation of the HPV 16 Genotype Persistence in Women Undergoing LEEP for CIN3 with the Risk of CIN2+ Relapses in the First 18 Months of Follow-Up: A Multicenter Retrospective Study. Diagnostics (Basel) 2024; 14:509. [PMID: 38472983 DOI: 10.3390/diagnostics14050509] [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: 01/31/2024] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024] Open
Abstract
OBJECTIVE Specific hr-HPV genotypes have different natural histories and different oncogenic capacity. This study aimed to investigate the risk of CIN2+ recurrence of the individual genotypes and evaluate how the duration of HPV persistence influences the risk of developing recurrent 16 cervical dysplasia of high grade (CIN2+). METHODS Data from patients with persistent HPV infection after primary conization were retrospectively extracted. Kaplan-Meier proportional hazards models were used to evaluate associations between the duration of HPV persistence and the risk of developing recurrent CIN2+. Kruskal-Wallis testing with Dunn's multiple comparison test was used to test whether there was a statistically significant difference in the time to development of tumor recurrences between different genotypes. RESULTS Overall, 333 patients met the inclusion criteria. In 285 cases the HPV infection was persistent, in 48 cases (18%) it was transient, i.e., different genotypes after LEEP. Overall were diagnosed 39 relapses (13.7%), 79.5% (31/39 cases) were due to genotype 16, 20.5% (8/39) were linked to the other genotypes. Persistence of genotype 16 showed a 7-fold increased risk of developing a CIN2+ relapse, OR = 7.08 (95%CI: 3.12-16.08). Furthermore, the majority of relapses (38/39) occurred within 24 months of persistence with a cut-off represented by 18 months (p = 0.001) in which the relapse rate is maximum and the most frequently found genotype was the 16th with 31 (79.5%) cases of recurrence. Kruskal-Wallis test with Dunn's multiple comparisons has shown statistically significant difference in the time of development of CIN2 relapses among HPV16 and other genotypes. (p < 0.05). Kaplan-meier analysis has shown statistically significant difference between the time to CIN2+ relapse onset in patients with HPV 16 infection and patients with other hrHPV genotypes. (p < 0.05) Conclusions: the study results suggest that persistent HPV infection after LEEP with the same HR genotype present before surgery represents one of the most important predictive factors of the risk of CIN2+ recurrence. The persistence of HPV16 for the first 18 months strongly correlates with the risk of developing a CIN2+ recurrence.
Collapse
Affiliation(s)
- Maria Teresa Bruno
- Gynecology and Obstetrics Unit, Department of General Surgery and Medical-Surgical Specialty, Rodolico University Hospital, University of Catania, 95123 Catania, Italy
- Multidisciplinary Research Center in Papillomavirus Pathology, Chirmed, University of Catania, 95123 Catania, Italy
| | - Gaetano Valenti
- Multidisciplinary Research Center in Papillomavirus Pathology, Chirmed, University of Catania, 95123 Catania, Italy
- Humanitas, Gynaecologic Oncology Unit, 95125 Catania, Italy
| | - Zaira Ruggeri
- Cervical Cancer Screening Unit, Level II, ASP Messina, 98123 Messina, Italy
| | - Giosuè Giordano Incognito
- Gynecology and Obstetrics Unit, Department of General Surgery and Medical-Surgical Specialty, Rodolico University Hospital, University of Catania, 95123 Catania, Italy
| | - Paola Coretti
- Gynecology and Obstetrics Unit, Department of General Surgery and Medical-Surgical Specialty, Rodolico University Hospital, University of Catania, 95123 Catania, Italy
| | - Giuseppe Dario Montana
- Gynecology and Obstetrics Unit, Department of General Surgery and Medical-Surgical Specialty, Rodolico University Hospital, University of Catania, 95123 Catania, Italy
| | - Marco Marzio Panella
- Gynecology and Obstetrics Unit, Department of General Surgery and Medical-Surgical Specialty, Rodolico University Hospital, University of Catania, 95123 Catania, Italy
- Multidisciplinary Research Center in Papillomavirus Pathology, Chirmed, University of Catania, 95123 Catania, Italy
| | - Liliana Mereu
- Gynecology and Obstetrics Unit, Department of General Surgery and Medical-Surgical Specialty, Rodolico University Hospital, University of Catania, 95123 Catania, Italy
| |
Collapse
|
5
|
Džundová MN, Sehnal B, Zikán M, Kocián R, Dubová O, Hubka P, Dostálek L, Kabele P, Brtnický T, Slama J. Risk Factors for the Anal and Oral Human Papillomavirus (HPV) Infections among Women with Severe Cervical Lesions: A Prospective Case-Control Study. Biomedicines 2023; 11:3183. [PMID: 38137404 PMCID: PMC10741157 DOI: 10.3390/biomedicines11123183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 11/25/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023] Open
Abstract
The carcinogenicity of HPV infection in the anogenital and oropharyngeal regions is broadly accepted. The aim of the study was to define risk factors for anal and oral HPV infections in high-risk patients with biopsy-proven severe cervical lesions (CIN2+). Altogether immunocompetent 473 females with CIN2+ were categorized into the study group and another 245 women into the control group. The strongest risk factor for anal HPV infection was the presence of cervical HPV infection (p < 0.001). Furthermore, ten or more lifetime sexual partners (p = 0.013), a sexual non-coital contact with the anal area (p < 0.001), and actively practicing anal-penetrative intercourse (p < 0.001) were significantly associated with anal HPV. A history of genital warts in the woman (p = 0.010) and the presence of genital warts in the male partner (p = 0.029) were found statistically significant for the risk of oral HPV infection. Our data suggest that the presence of HPV infection, especially high-risk genotypes, in one anatomical site poses the greatest risk for HPV infection in another anatomical site. The cervix is the main reservoir of infection, but the risk factors for anal and oral HPV infections are dissimilar according to different anatomical distances and more complex routes of transmission.
Collapse
Affiliation(s)
- Monika Nipčová Džundová
- Department of Gynecology and Obstetrics, Bulovka University Hospital, 1st Faculty of Medicine, Charles University, 18081 Prague, Czech Republic; (M.N.D.); (M.Z.); (O.D.); (P.H.); (P.K.); (T.B.)
| | - Borek Sehnal
- Department of Gynecology and Obstetrics, Bulovka University Hospital, 1st Faculty of Medicine, Charles University, 18081 Prague, Czech Republic; (M.N.D.); (M.Z.); (O.D.); (P.H.); (P.K.); (T.B.)
| | - Michal Zikán
- Department of Gynecology and Obstetrics, Bulovka University Hospital, 1st Faculty of Medicine, Charles University, 18081 Prague, Czech Republic; (M.N.D.); (M.Z.); (O.D.); (P.H.); (P.K.); (T.B.)
| | - Roman Kocián
- Department of Gynecology, Obstetrics and Neonatology, General University Hospital, 1st Faculty of Medicine, Charles University, 12808 Prague, Czech Republic; (R.K.); (L.D.); (J.S.)
| | - Olga Dubová
- Department of Gynecology and Obstetrics, Bulovka University Hospital, 1st Faculty of Medicine, Charles University, 18081 Prague, Czech Republic; (M.N.D.); (M.Z.); (O.D.); (P.H.); (P.K.); (T.B.)
| | - Petr Hubka
- Department of Gynecology and Obstetrics, Bulovka University Hospital, 1st Faculty of Medicine, Charles University, 18081 Prague, Czech Republic; (M.N.D.); (M.Z.); (O.D.); (P.H.); (P.K.); (T.B.)
| | - Lukáš Dostálek
- Department of Gynecology, Obstetrics and Neonatology, General University Hospital, 1st Faculty of Medicine, Charles University, 12808 Prague, Czech Republic; (R.K.); (L.D.); (J.S.)
| | - Pavel Kabele
- Department of Gynecology and Obstetrics, Bulovka University Hospital, 1st Faculty of Medicine, Charles University, 18081 Prague, Czech Republic; (M.N.D.); (M.Z.); (O.D.); (P.H.); (P.K.); (T.B.)
| | - Tomáš Brtnický
- Department of Gynecology and Obstetrics, Bulovka University Hospital, 1st Faculty of Medicine, Charles University, 18081 Prague, Czech Republic; (M.N.D.); (M.Z.); (O.D.); (P.H.); (P.K.); (T.B.)
| | - Jiri Slama
- Department of Gynecology, Obstetrics and Neonatology, General University Hospital, 1st Faculty of Medicine, Charles University, 12808 Prague, Czech Republic; (R.K.); (L.D.); (J.S.)
| |
Collapse
|
6
|
Buttà M, Serra N, Panzarella V, Fasciana TMA, Campisi G, Capra G. Orogenital Human Papillomavirus Infection and Vaccines: A Survey of High- and Low-Risk Genotypes Not Included in Vaccines. Vaccines (Basel) 2023; 11:1466. [PMID: 37766142 PMCID: PMC10535452 DOI: 10.3390/vaccines11091466] [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: 08/12/2023] [Revised: 09/02/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
Knowledge of human papillomavirus transmission from the genital tract to the oral mucosa remains unsatisfactory, with poor and often inconsistent literature results. The increase in HPV-associated oral malignancies prompts further analysis of the simultaneous detection of the virus in the two anatomical areas and on the identification of genotypes to be included in future vaccines. Therefore, in this retrospective study, we evaluated orogenital HPV concurrence, hrHPV, lrHPV and type-concordance in 337 samples, as well as the prevalence of the most common genotypes not included in HPV vaccines. Concurrence was found in 12.5% (31/248) of cases, hr-concordance in 61.3% (19/31) and lr-concordance in 12.9% (4/31). Finally, type-concordance was found in 32.3% (10/31) of concurrent infections. Regarding the identification of non-vaccine genotypes, the significantly prevalent genotypes in the anogenital area were HPV66 (12.6%, p < 0.0001), HPV53 (11.1%, p < 0.0001), HPV51 (8.7%, p < 0.0001), HPV42 (8.2%, p < 0.0001) and HPV68 (5.6%, p = 0.0034) in women and HPV66 (14.6%, p = 0.0058), HPV42 (12.2%, p = 0.0428), HPV51 (12.2%, p = 0.0428), HPV53 (12.2%, p = 0.0428), HPV70 (12.2%, p = 0.0428) and HPV73 (12.2%, p = 0.0428) in men. Considering the results of our study, we recommend including the high-risk genotypes HPV51, HPV68, HPV53 and HPV66 in future HPV vaccine formulations.
Collapse
Affiliation(s)
- Michela Buttà
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE) “G. D’Alessandro”, University of Palermo, 90133 Palermo, Italy; (M.B.); (T.M.A.F.)
- Department of Surgical, Oncological and Oral Sciences (Dichirons), University of Palermo, 90133 Palermo, Italy; (V.P.); (G.C.)
| | - Nicola Serra
- Department of Public Health, University Federico II of Naples, 80138 Napoli, Italy;
| | - Vera Panzarella
- Department of Surgical, Oncological and Oral Sciences (Dichirons), University of Palermo, 90133 Palermo, Italy; (V.P.); (G.C.)
| | - Teresa Maria Assunta Fasciana
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE) “G. D’Alessandro”, University of Palermo, 90133 Palermo, Italy; (M.B.); (T.M.A.F.)
- Microbiology and Virology Unit, Polyclinic Hospital “P. Giaccone”, 90133 Palermo, Italy
| | - Giuseppina Campisi
- Department of Surgical, Oncological and Oral Sciences (Dichirons), University of Palermo, 90133 Palermo, Italy; (V.P.); (G.C.)
- Oral Medicine with Dentistry for Fragile Patients Unit, Polyclinic Hospital “P. Giaccone”, 90133 Palermo, Italy
| | - Giuseppina Capra
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE) “G. D’Alessandro”, University of Palermo, 90133 Palermo, Italy; (M.B.); (T.M.A.F.)
- Microbiology and Virology Unit, Polyclinic Hospital “P. Giaccone”, 90133 Palermo, Italy
| |
Collapse
|