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Eslami A, Alimoghadam S, Khoshravesh S, Shirani M, Alimoghadam R, Alavi Darazam I. Mpox vaccination and treatment: a systematic review. J Chemother 2024; 36:85-109. [PMID: 38069596 DOI: 10.1080/1120009x.2023.2289270] [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: 03/17/2023] [Accepted: 11/27/2023] [Indexed: 02/01/2024]
Abstract
The Human monkeypox virus (mpox) belongs to the Poxviridae family, characterized by double-stranded DNA. A 2022 outbreak, notably prevalent among men who have sex with men, was confirmed by the World Health Organization. To understand shifting prevalence patterns and clinical manifestations, we conducted a systematic review of recent animal and human studies. We comprehensively searched PubMed, Scopus, Web of Science, Cochrane Library, and Clinicaltrials.gov, reviewing 69 relevant articles from 4,342 screened records. Our analysis highlights Modified Vaccinia Ankara - Bavarian Nordic (MVA-BN)'s potential, though efficacy concerns exist. Tecovirimat emerged as a prominent antiviral in the recent outbreak. However, limited evidence underscores the imperative for further clinical trials in understanding and managing monkeypox.
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Affiliation(s)
- Arvin Eslami
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | | | - Mahsa Shirani
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Ilad Alavi Darazam
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Infectious Diseases, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Ramírez-Soto MC, Arroyo-Hernández H. Monkeypox virus infections in low-risk groups during the 2022-23 global outbreak: An analysis of the WHO global report. LE INFEZIONI IN MEDICINA 2024; 32:12-19. [PMID: 38456029 PMCID: PMC10917560 DOI: 10.53854/liim-3201-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/31/2024] [Indexed: 03/09/2024]
Abstract
Introduction In the 2022-23 Mpox outbreak, cases also occurred in children, adolescents, and adults aged 50 years and older, for whom the risk of transmission is low and whose epidemiological characteristics are less known, compared to high-risk groups such as young adults. Here we describe the epidemiological characteristics of Mpox in children, adolescents and adults aged 50 years and older in the global Mpox outbreak. Methods A retrospective study on laboratory-confirmed surveillance data of Mpox cases reported to World Health Organization (WHO) was conducted. Case data from WHO's 2022-23 Mpox Outbreak: Global Trends from 1 January 2022 to 1 September 2023 was used for our analysis. We included cases reported by WHO with data on age (children [range, 0 to 9 years], adolescents [range, 10 to 17 years], adults 50 to 59 years, and adults 60 years and older), gender, WHO region, hospital admission, and intensive care unit admission. Results Until September 01, 2023, data from 89,752 cases of Mpox have been reported to WHO. Of all the reported cases, 1124 (1.3%), 6296 (7.0%) and 1501 (1.6%) were children and adolescents, adults aged 50-59 years, and adults aged 60 years or older, respectively, and the proportion varied among WHO regions. There was a high proportion of cases among population aged 0-17 years, adolescents (256 [66.3%]) from the region of the Americas and girls aged 0-9 years [127 (46.7%)] from the African region. Men aged 50-59 years (3495 [57.2%] vs. 2553 [41.8%] cases from the region of the Americas and the European region, respectively) and men aged 60-69 years (639 [60.0%] vs. 607 [48.4%] from the region of the Americas and the European region) were most affected, compared to other age groups and women. Among children, adolescents, and adults aged 50 years or older, a low proportion of cases developed some complications and required hospital admission, and some cases were admitted to the intensive care unit. Conclusions Epidemiological evidence of Mpox in these low-risk groups highlights the risk of wider community transmission. Therefore, while efforts continue to control the global outbreak of Mpox in high-risk groups, it is also necessary to ensure that these low-risk groups have access to timely health care and vaccination.
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Affiliation(s)
| | - Hugo Arroyo-Hernández
- Instituto de Investigaciones en Ciencias Biomédicas, Universidad Ricardo Palma. Lima, Peru
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Amer FA, Nofal HA, Gebriel MG, Bedawy AM, Allam AA, Khalil HES, Elahmady M, Nofal H, Saeed MA, Shaltout SW, Behiry A, Attia O, Bahgat SM, Ali AA, Ahmed FM, Abdelrahman AM, Hammad NM. Grasping knowledge, attitude, and perception towards monkeypox among healthcare workers and medical students: an Egyptian cross-sectional study. Front Cell Infect Microbiol 2024; 14:1339352. [PMID: 38410721 PMCID: PMC10895011 DOI: 10.3389/fcimb.2024.1339352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/24/2024] [Indexed: 02/28/2024] Open
Abstract
Background Monkeypox (Mpox) is a re-emerging infectious disease representing a new global challenge. It poses a substantial threat to countries, particularly those with a low number of cases. Due to its popularity as a tourist destination and its proximity to many African refugees, Egypt is potentially at risk of Mpox importation. Therefore, effective disease management necessitates healthcare workers (HCWs) to possess adept knowledge, along with a positive attitude and behavior. The study aimed to assess the knowledge, attitude, and perception of Egyptian HCWs and medical students towards human Mpox. Methods The present cross-sectional study data was collected from participants between October and December 2022 via a questionnaire. The questionnaire comprised 31 questions in the knowledge section, 11 questions in the attitude section, and 14 in the perception section. Results The present study involved a total of 1,034 HCWs and medical students. It was found that 55.3% of the participants demonstrated adequate knowledge about Mpox, whereas 44.5% and 39.8% of the respondents exhibited favorable attitudes and perceptions towards the disease, respectively. Binary logistic regression analysis revealed that adequate knowledge was significantly observed in ages older than 40 years (p < 0.001), married participants (p < 0.001), and doctors (p < 0.001). The positive attitude was significantly observed among the male sex (p = 0.045), urban residents (p = 0.002), and nurses (p = 0.002). Conversely, married participants (p = 0.013), doctors (p < 0.001), and individuals employed in pharmacy and laboratory departments (p < 0.001) experienced an increase in positive perception. Conclusion Knowledge, attitude, and perception towards Mpox among Egyptian HCWs and medical students exhibit suboptimal levels. Addressing these gaps is crucial to controlling and effectively preventing disease transmission.
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Affiliation(s)
- Fatma A. Amer
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
- Viral Infection Working Group of International Society of Antimicrobial Chemotherapy (VIWG/ISAC), London, United Kingdom
| | - Hanaa A. Nofal
- Department of Public Health and Community Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Manar G. Gebriel
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Aya M. Bedawy
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ayman A. Allam
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Hend E. S. Khalil
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
- Microbiology and Immunology, Qatar Armed Forces Hospital, Doha, Qatar
| | - Mohammed Elahmady
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
- Microbiology, Al Ahli Hospital, Doha, Qatar
| | - Hagar Nofal
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Maysaa A. Saeed
- Viral Infection Working Group of International Society of Antimicrobial Chemotherapy (VIWG/ISAC), London, United Kingdom
- Department of Tropical Medicine, Zagazig University, Zagazig, Egypt
| | | | - Ahmed Behiry
- Department of Tropical Medicine, Zagazig University, Zagazig, Egypt
| | - Osama Attia
- Department of Internal Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | - Ahmed A. Ali
- Department of Pediatrics, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Fatma Mohammed Ahmed
- Department of Community Health Nursing, Faculty of Nursing, Zagazig University, Zagazig, Egypt
| | | | - Noha M. Hammad
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
- Viral Infection Working Group of International Society of Antimicrobial Chemotherapy (VIWG/ISAC), London, United Kingdom
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Baldovin T, Girolametto G, Geppini R, Bordignon M, Alaibac M. Preventing and fighting stigma: a lesson from the first Mpox in Veneto region of Northeast Italy-A case report. Front Public Health 2023; 11:1141742. [PMID: 37275485 PMCID: PMC10235756 DOI: 10.3389/fpubh.2023.1141742] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/13/2023] [Indexed: 06/07/2023] Open
Abstract
Since the 1970s, human monkeypox (Mpox) has been referred to as a zoonotic endemic disease of specific regions of Africa until early 2022, when a worldwide epidemic outbreak developed. There are many hypotheses on how Mpox could spread to non-endemic regions; the dominant theory is that it spread from the UK and Spain among men who have sex with men (MSM). Therefore, the first clinical case in the Veneto region (Northeast of Italy) was analyzed-which represented a typical case report of the ongoing outbreak-with lesions located mainly in the areas associated with sexual behaviors (genital and oral). This case report highlights the new challenges of Mpox, as it seems to differ from the previous classic manifestation. Indeed, although the patient achieved restitution ad integrum of lesions and complete recovery from the disease, it is deemed necessary to offer communication strategies to involve a heterogeneous audience based on different risks of exposure but without stigmatizing attitudes, avoiding the mistakes made with HIV. The need for broad public involvement is demonstrated by identifying Mpox even in "anomalous cases." Stigma could be an obstacle in engaging patients in proper care and in getting honest answers while contact tracing, as happened in our patient's case; thus, WHO recently renamed monkeypox as Mpox. Abnormal outbreaks in non-endemic countries, with no causal links, must become a warning signal for governments and health policies to design national plans for managing unexpected outbreaks. For an effective public health response, health institutions must communicate effectively, focus on changes and prevention measures, and formulate a plan based on equity and inclusion of the most vulnerable groups.
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Affiliation(s)
- Tatjana Baldovin
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Hygiene and Public Health, University of Padua, Padua, Italy
| | - Gloria Girolametto
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Hygiene and Public Health, University of Padua, Padua, Italy
| | - Ruggero Geppini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Hygiene and Public Health, University of Padua, Padua, Italy
| | | | - Mauro Alaibac
- Unit of Dermatology, University of Padua, Padua, Italy
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Amer F, Khalifa HES, Elahmady M, ElBadawy NE, Zahran WA, Abdelnasser M, Rodríguez-Morales AJ, Wegdan AA, Tash RME. Monkeypox: Risks and Approaches to Prevention. J Infect Public Health 2023; 16:901-910. [PMID: 37062165 PMCID: PMC10074767 DOI: 10.1016/j.jiph.2023.04.001] [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: 10/14/2022] [Revised: 03/24/2023] [Accepted: 04/02/2023] [Indexed: 04/08/2023] Open
Abstract
Since early May 2022, an outbreak due to Mpox virus (formerly called monkeypox) has occurred in many countries around the world. On July 23, the World Health Organization declared the outbreak ‘Public Health Emergency of International Concern’. In order to combat the outbreak, it is important to have effective infection prevention and control plans. The first step is to qualitatively and quantitatively determine the risks of infections, followed by the design and implementation of infection prevention and control measures. Mpox is transmitted through direct, indirect, and prolonged contact, through sexual transmission, and via the respiratory route. Men who have sex with men are identified as the most vulnerable population. Home pet-raisers, and health care workers are at risk of catching the disease. The outcome of infection is catastrophic among the elderly, immunocompromised individuals, pregnant female and children. The spillover to animals is of great concern. It is important to communicate the risks and have community engagement in the control of this outbreak. The availability of vaccines will add to the capability of containing the outbreak. It is critical to prevent the virus from spreading further. Hence, we review the recent findings on the risk management of Mpox along with the preventive strategies.
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Affiliation(s)
- Fatma Amer
- Medical Microbiology and Immunology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt; Executive Committee member International Society for Antimicrobial Chemotherapy (ISAC); Viral Infection Working Group/International Society for Antimicrobial Chemotherapy (ISAC).
| | - Hend E S Khalifa
- Medical Microbiology and Immunology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt; Microbiology and Immunology, Qatar Armed Forces Hospital, Qatar
| | - Mohammed Elahmady
- Medical Microbiology and Immunology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt; Microbiology laboratory, Al Ahli Hospital, Doha, Qatar
| | - Nissreen E ElBadawy
- Medical Microbiology and Immunology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Wafaa Ahmed Zahran
- Medical Microbiology and Immunology Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Moustafa Abdelnasser
- Microbiology and Immunology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Alfonso J Rodríguez-Morales
- Faculty of Health Sciences, Universidad Científica del Sur, Lima 15067, Peru; Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut 1102, Lebanon
| | - Ahmed A Wegdan
- Microbiology and Immunology Department, Faculty of Medicine, El-Fayoum University, El-Fayoum, Egypt
| | - Rehab M Elsaid Tash
- Medical Microbiology and Immunology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt; Viral Infection Working Group/International Society for Antimicrobial Chemotherapy (ISAC)
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Wong L, Gonzales-Zamora JA, Beauchamps L, Henry Z, Lichtenberger P. Clinical presentation of Monkeypox among people living with HIV in South Florida: a case series. LE INFEZIONI IN MEDICINA 2022; 30:610-618. [PMID: 36482948 PMCID: PMC9715005 DOI: 10.53854/liim-3004-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 11/03/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Monkeypox, historically a zoonotic disease caused by monkeypox virus, is a new global health emergency. Since May 2022, dozens of non-endemic countries have seen new cases with rapid spread. Generally a self-limited disease, there are vulnerable populations, in which severe or deadly illness can occur. There is limited data on immunocompromised patients in this outbreak, particularly on people living with HIV, who are disproportionately affected. METHODS We reported seven cases of monkeypox in people living with HIV in South Florida, USA. Relevant demographic, epidemiologic and clinical data were described. RESULTS All the patients were men, identified as gay or bisexual, and were on combination antiretroviral therapy (cART) for HIV. Six of the seven had CD4 counts more than 200 cells/mm3 (one unknown level), and one of the seven had detectable HIV viral load. Six had sexual or intimate contact with asymptomatic partners prior to development of symptoms. Two were hospitalized, one for proctitis and one for an increasing number of lesions. Six had disseminated lesions and one had localized perianal lesions and all had 5-25 total number of lesions. Five received tecovirimat with resolution of lesions in 2-14 days and all were doing well at the time of the present report. Close contacts received the Jynneos vaccine which was well tolerated. CONCLUSIONS Our case series described monkeypox in people living with HIV and have noted atypical symptoms (lack of fever and more notable anogenital lesions) and relatively mild course as described in HIV seronegative patients. We stress the importance of early detection and isolation as well as vaccination to contacts, which has been well tolerated. In our case series, we are unable to estimate the effectiveness of tecovirimat given the limited number of patients, but all our patients had lesions that resolved within two weeks of rash onset and had no side effects reported.
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Affiliation(s)
- Lena Wong
- Infectious Disease Division, Department of Medicine, University of Miami Miller School of Medicine, Miami,
USA
| | - Jose A. Gonzales-Zamora
- Infectious Disease Division, Department of Medicine, University of Miami Miller School of Medicine, Miami,
USA,Peruvian American Medical Society (PAMS), Albuquerque,
USA
| | - Laura Beauchamps
- Infectious Disease Division, Department of Medicine, University of Miami Miller School of Medicine, Miami,
USA
| | | | - Paola Lichtenberger
- Infectious Disease Division, Department of Medicine, University of Miami Miller School of Medicine, Miami,
USA,Department of Infectious Disease, Miami Veterans Affair Health Care Center, Miami,
USA
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Guarducci G, Porchia BR, Lorenzini C, Nante N. Overview of case definitions and contact tracing indications in the 2022 monkeypox outbreak. LE INFEZIONI IN MEDICINA 2022; 31:13-19. [PMID: 36908385 PMCID: PMC9994831 DOI: 10.53854/liim-3101-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/28/2023] [Indexed: 03/07/2023]
Abstract
Background In 2022, a new outbreak of the Mpox virus occurred outside of Africa, its usual endemic area. The virus was detected in European, American, Asian, and Oceanian countries where Mpox is uncommon or had not been reported previously and where the spread was rapid. The study aims to compare the case definition and the indications for contact tracing in case of Mpox infection among the World Health Organization (WHO), the European Centre for Disease Prevention and Control (ECDC), and four European Countries. Methods From August 2022 to November 2022, we conducted research, first on the WHO and ECDC official websites and then on the official websites of the Ministry of Health or National Health Agencies of four European Countries (Italy, France, Spain, and Portugal). All reports found were compared to enlighten the differences in the definition of the case and indications for contact tracing. Results The WHO divides the case definition into four categories: suspected, probable, confirmed, and discarded, while the ECDC divides cases into confirmed and probable. The ECDC defines contact as close and others, while the WHO divides it into high, medium, and minimal risk. The four countries analyzed show heterogeneity in both the case definitions and the indications for contact tracing. Conclusions Our analysis revealed heterogeneity in the case definition between the WHO and ECDC. Different countries followed different indications or have given their indications for both the case definition and contact tracing indications. Harmonization strengthens public health preparedness and response and creates unified communication.
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Affiliation(s)
- Giovanni Guarducci
- Post Graduate School of Public Health, University of Siena, Siena, Italy
| | | | - Carlotta Lorenzini
- Post Graduate School of Public Health, University of Siena, Siena, Italy
| | - Nicola Nante
- Post Graduate School of Public Health, University of Siena, Siena, Italy.,Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
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Ciccarese G, Di Biagio A, Drago F, Mastrolonardo M, Pipoli A, Lo Caputo S, Serviddio G, Santantonio T, Parodi A. Monkeypox virus infection mimicking primary syphilis. LE INFEZIONI IN MEDICINA 2022; 31:113-115. [PMID: 36908381 PMCID: PMC9994820 DOI: 10.53854/liim-3101-16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 01/10/2023] [Indexed: 03/07/2023]
Abstract
In our case series of monkeypox (MPX) virus infected patients, one had a single genital ulcer as the only cutaneous manifestation of the infection. Physical examination revealed a single, rounded ulcer of the shaft penis characterized by pinkish raised, infiltrated borders and a crusty yellowish bottom associated with bilateral inguinal lymphadenopathies. Serology for Treponema pallidum infection and a complete screening for sexually transmitted infections (STIs) resulted negative except for the detection of Staphylococcus aureus at the cultural examination and MPX DNA at the ulcer bottom. The patient's general conditions were good therefore he remained isolated at home for 3 weeks after the diagnosis. At one month follow up, he presented only a depressed pinkish skin scars on the site of the previous ulcer. The clinical presentation of this patient could easily be misdiagnosed with other sexually transmitted infections (STIs), especially with primary syphilis. MPX infection should be considered in the differential diagnosis of STIs, also in patients with weak and localized manifestations.
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Affiliation(s)
- Giulia Ciccarese
- Unit of Dermatology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Antonio Di Biagio
- Infectious Diseases Unit, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy.,Department of Health Sciences, University of Genova, Genova, Italy
| | - Francesco Drago
- Unit of Dermatology, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Mario Mastrolonardo
- Unit of Dermatology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Antonietta Pipoli
- Clinic of Infectious Diseases, Department of Clinical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Sergio Lo Caputo
- Clinic of Infectious Diseases, Department of Clinical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Gaetano Serviddio
- C.U.R.E. (University Centre for Liver Disease Research and Treatment), Liver Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Teresa Santantonio
- Clinic of Infectious Diseases, Department of Clinical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Aurora Parodi
- Unit of Dermatology, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
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