scholarly journals Prognosis of EBV Infection in Children with Tonsillitis

2021 ◽  
pp. 100-108
Author(s):  
Reza Erfanian ◽  
Saeed Sohrabpour
Keyword(s):  
Immune Function ◽  
Adverse Reactions ◽  
Control Group ◽  
Case Group ◽  
Inflammatory Factor ◽  
Barr Virus ◽  
Ebv Infection ◽  
Before And After ◽  
Epstein Barr

Aims: Determining the prognosis of Epstein-Barr virus (EBV) infection with in children with tonsillitis. Methods: Totally 102 children with chronic tonsillitis admitted to our hospital between January 2017 and March 2019 were selected. Among them, 52 children with EBV infection were assigned to a case group, and the other 50 without EBV infection to a control group. All children were given targeted therapy. Then the two groups were compared in efficacy, defervescence time, alleviation time of tonsillar enlargement and pharyngalgia after therapy, immune function-associated indexes and inflammatory factor-associated indexes before and after therapy, incidence of adverse reactions during therapy, and recurrence times during therapy and 1-year follow-up. Results: Compared with the case group, the control group showed notably better efficacy, experienced notably shorter alleviation time of tonsillar enlargement and pharyngalgia, and presented better improvement in immune function and inflammation (all P<0.05). Additionally, the two groups were not greatly different in the incidence of adverse reactions (P>0.05), while the control group experienced notably less times of recurrence during therapy and 1-year follow-up (P<0.05). Conclusion: EBV infection will compromise the efficacy on children with tonsillitis and take its toll on their prognosis, so it is imperative to adopt a targeted and individualized therapeutic regimen for children with both diseases.

scholarly journals Cognitive–behavioural therapy combined with music therapy for chronic fatigue following Epstein-Barr virus infection in adolescents: a feasibility study

2020 ◽  
Vol 4 (1) ◽  
pp. e000620 ◽  
Author(s):  
Sadaf Malik ◽  
Tarjei Tørre Asprusten ◽  
Maria Pedersen ◽  
Julie Mangersnes ◽  
Gro Trondalen ◽  
...  
Keyword(s):  
Music Therapy ◽  
Intervention Group ◽  
Chronic Fatigue ◽  
Behavioural Therapy ◽  
Control Group ◽  
Barr Virus ◽  
Cognitive Behavioural ◽  
Epstein Barr ◽  
Harmful Effects

​BackgroundCognitive–behavioural therapy (CBT) is effective in chronic fatigue syndrome. However, CBT has not been investigated in postinfectious chronic fatigue (CF), nor is it known whether addition of therapeutic elements from other disciplines might be feasible. We studied the feasibility of a combined CBT and music therapy intervention for CF following Epstein-Barr virus (EBV) infection in adolescents.​MethodsAdolescents (12–20 years old) participating in a postinfectious cohort study who developed CF 6 months after an acute EBV infection were eligible for the present feasibility study. A combined CBT and music therapy programme (10 therapy sessions and related homework) was compared with care as usual in a randomised controlled design. Therapists and participants were blinded to outcome evaluation. Endpoints included physical activity (steps/day), symptom scores, recovery rate and possible harmful effects, but the study was underpowered regarding efficacy. Total follow-up time was 15 months.​ResultsA total of 43 individuals with postinfectious CF were included (21 intervention group, 22 control group). Seven individuals left the study during the first 3 months, leaving 15 in the intervention group and 21 in the control group at 3 months’ follow-up. No harmful effects were recorded, and compliance with appointment was high. In intention-to-treat analyses, number of steps/day tended to decrease (difference=−1158, 95% CI −2642 to 325), whereas postexertional malaise tended to improve (difference=−0.4, 95% CI −0.9 to 0.1) in the intervention group at 3 months. At 15 months’ follow-up, there was a trend towards higher recovery rate in the intervention group (62% vs 37%).​ConclusionAn intervention study of combined CBT and music therapy in postinfectious CF is feasible, and appears acceptable to the participants. The tendencies towards positive effects on patients’ symptoms and recovery might justify a full-scale clinical trial.​Trial registration numberNCT02499302.

Epstein–Barr virus and regulatory T cells in Egyptian paediatric patients with acute B lymphoblastic leukaemia

2016 ◽  
Vol 70 (2) ◽  
pp. 120-125 ◽  
Author(s):  
Mohamed E Ateyah ◽  
Mona E Hashem ◽  
Mohamed Abdelsalam
Keyword(s):  
Lymphoblastic Leukaemia ◽  
Epstein Barr Virus ◽  
Acute Infection ◽  
Treg Cells ◽  
Control Group ◽  
Healthy Children ◽  
Barr Virus ◽  
Ebv Infection ◽  
High Incidence ◽  
Epstein Barr

ObjectiveAcute B lymphoblastic leukaemia (B-ALL) is the most common type of childhood malignancy worldwide but little is known of its origin. Recently, many studies showed both a high incidence of Epstein–Barr virus (EBV) infection and high levels of CD4+CD25+Foxp3+(Treg cells) in children with B-ALL. In our study, we investigated the possible relationship between EBV infection and the onset of B-ALL, and its relation to expression of CD4+, CD25high+Foxp3+ T regulatory cells.Subject and methodsWe analysed expression and mean fluorescence intensity (MFI) of Treg cells in peripheral blood of 45 children with B-ALL and in 40 apparently healthy children as a control, using flow cytometry. Serum anti-EBV viral capsid antigen (VCA) IgG, anti-EBV nuclear antigen (EBNA) IgG (for latent infection) and anti-EBV VCA IgM (for acute infection) were investigated using ELISA.ResultsAnalysis of the Treg cells population in patients and controls revealed that expression of CD4+ CD25high+ T lymphocytes was higher in patients than in controls (mean±SD 15.7±4.1 and 10.61±2.6 in patients and controls, respectively, and MFI of Foxp3 was 30.1±7.1 and 16.7±3.7 in patients and controls, respectively (p<0.001)). There was a high incidence of latent EBV infection in patients (31%) compared with controls (10%) while the incidence of acute infection was 12% in patients and 0% in the control group. To study the role of latent EBV infection in the pathogenesis of acute B-ALL, OR was calculated (OR=4.06, coefficient index 1.2–13.6).ConclusionsThese findings suggest a possible role for Treg cells and EBV in the pathogenesis of B-ALL. Further studies are needed on the possible mechanisms of tumour genesis related to Treg cells and EBV in children with B-ALL.

scholarly journals EBV Infection Unmasking a Choledochal Cyst in an Infant

2019 ◽  
Vol 2019 ◽  
pp. 1-3
Author(s):  
Hassan El Khatib ◽  
Batoul Kawtharany ◽  
Diyaa Mohammad ◽  
Mohammad Siblini ◽  
Nahida El-Rifai
Keyword(s):  
Choledochal Cyst ◽  
Stone Formation ◽  
Liver Function Tests ◽  
Gamma Glutamyl Transferase ◽  
Barr Virus ◽  
Ebv Infection ◽  
Hepatic Involvement ◽  
Epstein Barr ◽  
Glutamyl Transferase

Hepatic involvement is common in acute Epstein–Barr virus (EBV) infection in children. It usually manifests as a transitory elevation of transaminases in up to 80% to 90% of patients, and they normalize by 2 to 6 weeks. A cholestatic pattern with elevated gamma-glutamyl transferase (γGT) and alkaline phosphatase (ALP) is common, in up to 60% in young adults. However, jaundice is very rare occurring in only 5% of pediatric patients. We report here an 8-month-old female with EBV infection who developed obstructive jaundice 2 weeks after the initial infection. Radiologic investigations were compatible with choledochal cyst type IVa complicated by stone formation in the common bile duct. In case of clinical exacerbation or nonamelioration of liver function tests in EVB infection, another diagnosis should be addressed. This highlights the importance of close follow-up in these patients in order not to miss a serious underlying condition such as choledochal malformation.

scholarly journals Epstein–Barr Virus Prevalence at Diagnosis and Seroconversion during Follow-Up in Pediatric Inflammatory Bowel Disease

2021 ◽  
Vol 10 (21) ◽  
pp. 5187
Author(s):  
Jennifer Bachmann ◽  
Giang Le Thi ◽  
Annecarin Brückner ◽  
Anna-Lena Kalteis ◽  
Tobias Schwerd ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Hemophagocytic Lymphohistiocytosis ◽  
Epstein Barr Virus ◽  
Barr Virus ◽  
Ebv Infection ◽  
Increased Risk ◽  
Inflammatory Bowel ◽  
Epstein Barr

Primary Epstein–Barr virus infection in pediatric patients with inflammatory bowel disease during immunomodulation with thiopurines has been associated with increased risk for malignancies or hemophagocytic lymphohistiocytosis. We determined Epstein–Barr virus (EBV) seroprevalence at inflammatory bowel disease (IBD) diagnosis and seroconversion during follow-up in a large single center cohort of children with IBD. EBV serology results and patient characteristics were retrospectively retrieved from the hospital documentation system. EBV seronegative patients at IBD diagnosis were prospectively retested. We report on IBD patients with symptomatic active EBV infection and a complicated disease course, and those diagnosed with malignancy with respect to EBV status and drug exposure. Of 402 patients, 194 (48%) had available EBV serology results at time of IBD diagnosis at a median of 12 years (IQR 9–14 years). Thereof, 102 (53%) were EBV-positive. Of 92 EBV-negative patients, 66 were retested and 17% showed a seroconversion at a mean follow-up time of 4.3 years (SD 3 years). Three children treated with azathioprine experienced acute clinically relevant EBV infection 2, 2.5, and 4 years after IBD diagnosis, two developed signs of hemophagocytic lymphohistiocytosis. Three cases of malignancy occurred in the cohort, though none seemed to be triggered by EBV. In conclusion, almost 50% of pediatric IBD patients were EBV-naïve following diagnosis and may be at increased risk to develop severe EBV infection during immunosuppressive therapy, potentially associated with complications such as hemophagocytic lymphohistiocytosis or malignancy.

scholarly journals EPIDEMIOLOGY AND CLINICAL CHARACTERISTICS OF HENOCH-SCHÖNLEIN PURPURA ASSOCIATED WITH EPSTEIN-BARR VIRUS INFECTION

2021 ◽  
Vol 13 (1) ◽  
pp. e2021064
Author(s):  
Hongbo Hu ◽  
Jiangang Wu ◽  
Ying Cheng ◽  
Jian jun Li
Keyword(s):  
Abdominal Pain ◽  
Clinical Characteristics ◽  
Epstein Barr Virus ◽  
Control Group ◽  
Infection Group ◽  
Barr Virus ◽  
Ebv Infection ◽  
Healthy Control ◽  
Epstein Barr ◽  
Schonlein Purpura

Introduction: Henoch-Schönlein purpura (HSP) is an immune-mediated vasculitis, and the formation of immune complexes may be triggered by exposure to Epstein-Barr virus (EBV) infection. Methods: We performed a five-year case-control study to evaluate the epidemiology and clinical characteristics of HSP associated with EBV infection. Results: The incidence of EBV-triggered HSP was 4.2%, while EBV infection in children with HSP was 0.9%; The EBV-triggered HSP cases had a significantly higher frequency of abdominal pain than the MP-triggered HSP group (χ2 = 8.024, p = 0.005); Significant differences were observed in the duration of abdominal pain (Z = -1.935, p = 0.027) between the two groups; C3 (t = 9.709, p < 0.001), IgA (t = 20.39, p < 0.001) and IgG (t = 6.407, p < 0.001) were significantly increased in the EBV infection group than those in the healthy control group. Notably, significantly higher proportion of CD19 (t = 6.773, p < 0.001) and lower proportion of CD56 (t = 11.13, p < 0.001) was found in EBV infection group compared with healthy control group. The IgA level was higher than that of the non-infectious group (t = 2.162, p = 0.032), but their CD4/CD8 ratio (t = 10.070, p < 0.001) and CD56 proportion (t = 2.096, p = 0.037) were significantly lower. Conclusions: Both cellular and humoral immunity were involved in the pathogenesis of EBV-triggered HSP, leading to increased production of inflammatory mediators and immunoglobulins. Those events may cause or promote the development of systemic vessel vasculitis.

Manifestation and prognostic value of EBV serology in nasal/nasopharyngeal T and NK-cell lymphomas

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 7596-7596
Author(s):  
Y. Zhang ◽  
Y. Huang ◽  
J. Xiao ◽  
Y. Xia ◽  
T. Lu ◽  
...  
Keyword(s):  
Prognostic Value ◽  
Nk Cell ◽  
Cell Lymphoma ◽  
Poor Prognostic Factor ◽  
Barr Virus ◽  
Ebv Infection ◽  
Kaplan Meier ◽  
Ann Arbor ◽  
Epstein Barr

7596 Background: Extranodal nasal type T and NK-cell lymphoma is highly associated with the Epstein-Barr virus (EBV) infection which is usually found in tumor cells, but the serum manifestation of EBV and its prognostic value remains unclear. Methods: 151 patients with nasal/nasopharyngeal T and NK-cell lymphomas were reviewed, the diagnoses of which were confirmed by histology and immunohistochemistry from Jan, 1992 to Nov, 2004. In 40 patients, which included 30 males and 10 females and aged 24 to 73(median 46) years old, analyses were performed of serum titers of antibodies against virus-capsid antigen (VCA-IgA) and early antigen (EA-IgA) with immunoenzyme assay, and antibody against EBV DNAase (EDAb), with immunoradiological method. Positive criteria were identified as VCA-IgA ≥ 1: 10, EA-IgA≥ 1: 10, and EDAb ≥ 30%. Clinically, 87.5% of the 40 patients were staged as Ann Arbor I and II diseases. Most patients underwent combined chemo and radiotherapy. Results: Median follow-up time for survived patients was 17(6–136) months. Median survival time for the overall patients were 12 months. Highest serum VCA-IgA, EA-IgA, and EDAb levels were 1: 1280, 1: 40, and 86% respectively. Positive rates of the three parameters were 60%, 15%, and 50% respectively. 30 patients(75%) had at least one positive parameter. Positve EA-IgA was negatively correlated with survival (p=0.0245) in Kaplan-Meier analysis, neither positive VCA-IgA or elevated EDAb level showed significant correlation with survival (p=0.134 and 0.405 ). Conclusions: Most patients with nasal/nasopharyngeal T and NK-cell lymphomas showed serum evidences of EBV infection, higher EA-IgA level can be a poor prognostic factor for survival. The importance of EBV serology in patients with nasal/nasopharyngeal T and NK-cell Lymphoma deserves further investigation. No significant financial relationships to disclose.

scholarly journals Antibody-Mediated Immune Subset Depletion Modulates the Immune Response in a Rabbit (Oryctolagus cuniculus) Model of Epstein-Barr Virus Infection

2020 ◽  
Vol 70 (5) ◽  
pp. 312-322
Author(s):  
Andrea J Osborne ◽  
Hannah M Atkins ◽  
Karla K Balogh ◽  
Sarah A Brendle ◽  
Debra A Shearer ◽  
...  
Keyword(s):  
T Cell ◽  
Animal Models ◽  
Epstein Barr Virus ◽  
Clinical Signs ◽  
Control Group ◽  
Epstein Barr Virus Infection ◽  
Barr Virus ◽  
Ebv Infection ◽  
Cell Antibody ◽  
Epstein Barr

Epstein-Barr Virus (EBV) is a γ-herpesvirus which infects over 90% of the adult human population. Most notably, this virus causes infectious mononucleosis but it is also associated with cancers such as Hodgkin and Burkitt lymphoma. EBV is a species-specific virus and has been studied in many animal models, including nonhuman primates, guinea pigs, humanized mice, and tree shrews. However, none of these animal models are considered the "gold standard" for EBV research. Recently, rabbits have emerged as a viable alternative model, as they are susceptible to EBV infection. In addition, the EBV infection progresses after immune suppression with cyclosporine A (CsA), modeling the reactivation of EBV after latency. We sought to refine this model for acute or active EBV infections by performing antibody-mediated depletion of certain immune subsets in rabbits. Fourteen 16 to 20-wk old, NZW rabbits were intravenously inoculated with EBV and concurrently treated with either anti-CD4 T-cell antibody, anti-pan-T-cell antibody (anti CD45), CSA, or, as a control, anti-HPV antibody. Rabbits that received the depleting antibodies were treated with CsA 3 times at a dose of 15 mg/kg SC once per day for 4 d starting at the time of EBV inoculation then the dose was increased to 20 mg/kg SC twice weekly for 2 wk. Weights, temperatures, and clinical signs were monitored, and rabbits were anesthetized once weekly for blood collection. When compared with the control group, anti-CD4-treated rabbits had fewer clinical signs and displayed higher levels of viral DNA via qPCR in splenocytes; however, flow cytometry results showed only a partial depletion of CD4 T-cells. Treatment with anti-pan-T-cell antibody did not result in noticeable T-cell depletion. These data suggest the EBV-infected rabbit is a promising model for testing antiviral medications and prophylactic vaccines for EBV.

scholarly journals Efficacy of Etimicin Sulfate Combined with Cefotaxime Sodium in the Treatment of Patients with Septic Shock and Effect on Serum Inflammatory Factor Levels and Immune Function

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Songqiang Pang ◽  
Yao Song ◽  
Jinqiang Yang ◽  
Sen Li ◽  
Yaqiang He ◽  
...  
Keyword(s):  
Septic Shock ◽  
Mechanical Ventilation ◽  
Immune Function ◽  
Research Group ◽  
Adverse Reactions ◽  
Control Group ◽  
Inflammatory Factor ◽  
Ventilation Time ◽  
Tnf Α ◽  
Mechanical Ventilation Time

Objective. To explore the effect of etimicin sulfate combined with cefotaxime sodium and cefotaxime sodium alone in the treatment of patients with septic shock and the effect on serum inflammatory factor levels and immune function. Methods. Total of 95 patients with septic shock who were treated in our hospital from March 2018 to July 2020 were collected as the subjects of this study. Among them, 44 patients who received cefotaxime sodium treatment and were included in the control group, and 51 patients who received etimicin sulfate combined with cefotaxime sodium treatment were included in the research group. The levels of serum IL-6 (interleukin-6), PCT (procalcitonin), TNF-α (tumor necrosis factor-α), CD3+ (cluster of differentiation 3+), CD4+, CD4+/CD8+, FIB (fibrinogen), and PT (prothrombin time), APTT (activated partial thromboplastin time) time before and after treatment, and the treatment effects, mechanical ventilation time, hospitalization time, and incidence of adverse reactions between the two groups were compared. Results. The total effective rate of treatment in the research group (90.20%) was higher than the control group (72.73%) ( p < 0.05 ). After treatment, the serum levels of IL-6, PCT, and TNF-α, FIB, CD3+, CD4+, CD4+/CD8+, and PT and APTT time in the two groups of patients have improved significantly ( p < 0.05 ). Compared with the control group, the research group’s IL-6, PCT, TNF-α levels, PT, and APTT decreased more, and FIB, CD3+, CD4+, and CD4+/CD8+ levels increased more ( p < 0.05 ). The mechanical ventilation time and hospital stay of the research group were significantly shorter than the control group ( p < 0.05 ). There was no significant difference between the total incidence of adverse reactions in the research group (15.69%) and the control group (9.09%) ( p > 0.05 ). Conclusion. Compared with cefotaxime sodium alone, the treatment of etimicin sulfate combined with cefotaxime sodium is more effective in improving the coagulation function and cellular immune function of patients with septic shock, reducing the level of serum inflammatory factors, and having higher clinical treatment effective.

scholarly journals Limited Utility of Serology and Heterophile Test in the Early Diagnosis of Epstein–Barr Virus Mononucleosis in a Child after Renal Transplantation

Medicines ◽  
2020 ◽  
Vol 7 (4) ◽  
pp. 21
Author(s):  
Alexandra Byrne ◽  
Rachel Bush ◽  
Felicia Johns ◽  
Kiran Upadhyay
Keyword(s):  
Early Diagnosis ◽  
Epstein Barr Virus ◽  
Antibody Test ◽  
Nuclear Antigen ◽  
Heterophile Antibody ◽  
Barr Virus ◽  
Ebv Infection ◽  
Limited Role ◽  
Epstein Barr

Background: Epstein–Barr virus (EBV) infection is associated with significant morbidity and mortality in renal transplant (RT) recipients. The spectrum of illness ranges from infectious mononucleosis (IM) to post-transplant lymphoproliferative disorder (PTLD). In association with clinical signs and symptoms, virus-specific serology and heterophile antibody tests are widely used in confirming the diagnosis of IM in the general population. However, these tests may have a limited role in immunosuppressed RT recipients from seropositive donor, especially in children who were EBV-seronegative prior to the transplant. The aim of this study is to evaluate the utility of these tests in the early diagnosis of IM in this subset of patients. Methods: This is a case study with a review of literature. Results: Here, we present a 14-year-old male with hemophilia B who presented with fever, fatigue, sore throat, palatal petechial rash, exudative tonsillitis and cervical lymphadenopathy 3 months post-RT. He was EBV seronegative prior to RT and received a deceased donor kidney transplant from a seropositive donor. Induction was done with Thymoglobulin and maintenance immunosuppression consisted of tacrolimus and mycophenolate. Initial heterophile antibody test (monospot) was negative, but became positive at 5 months and remained positive at 9 months follow-up post-RT. EBV viral capsid antigens (VCA) IgM and IgG, early antigen (EA) and nuclear antigen (EBNA) were all negative at the time of presentation. VCA IgM and IgG both became positive at 5 months and peaked at 9 months follow-up, however the EA and EBNA remained negative. EBV viral load as measured by polymerase chain reaction (PCR) was negative for the first 3 months post-RT but became positive at presentation, peaked at 6 months and started declining thereafter. Peripheral blood smear examination showed no absolute and atypical lymphocytosis. Cytomegalovirus PCR in the blood and throat culture for streptococcus were negative. There was no splenomegaly. He was managed conservatively with intravenous fluids, bed rest, antipyretics and reduction of immunosuppression. Conclusions: EBV serological markers have a limited role in the early diagnosis of EBV-IM following RT in prior seronegative children. Initial heterophile antibody test may also be negative, and hence a repeat test may be necessary. Once becoming positive, the VCA IgM may remain persistently elevated for prolonged duration. In addition to the suppressed cellular immunity secondary to immunosuppression, humoral response to viral infections is also delayed in transplant recipients, especially in the early transplant period. Hence, routine monitoring with PCR is superior to serology in diagnosing IM early and monitoring the EBV infection post-RT for timely evaluation and management.

scholarly journals Molecular Detection of Epstein–Barr Virus, Human Herpes Virus 6, Cytomegalovirus, and Hepatitis B Virus in Patients with Multiple Sclerosis

2020 ◽  
Vol 12 (3) ◽  
pp. 171-177
Author(s):  
Mohsen Asouri ◽  
Mohammad Ali Sahraian ◽  
Morteza Karimpoor ◽  
Sadegh Fattahi ◽  
Nima Motamed ◽  
...  
Keyword(s):  
Epstein Barr Virus ◽  
Control Group ◽  
Case Group ◽  
Control Groups ◽  
Barr Virus ◽  
Human Herpes Virus ◽  
B Virus ◽  
Human Herpes Virus 6 ◽  
Epstein Barr ◽  
And Control

BACKGROUND Multiple sclerosis (MS) is a chronic disease with significant morbidity. A wide spectrum of risk factors has been suggested that triggers the development of MS. Among them, several viral infections have been implicated to play a role in MS pathogenesis. We aimed to evaluate the relationship between viral diseases, including Epstein–Barr virus (EBV), human herpes virus 6 (HHV-6), cytomegalovirus (CMV), and hepatitis B virus (HBV) and MS in the present case-control study. METHODS About 100 patients with confirmed MS and age- and sex-matched individuals were selected as case and control groups, respectively. The patients were randomly selected from individuals diagnosed by neurologists based on the clinical signs and symptoms and imaging procedures. RESULTS More than 100 patients with MS and patients who were referred for other causes were analyzed for the presence of DNA of EBV, HHV6, CMV, and HBV separately. 9.37% of the control group had a positive test for the DNA of EBV in a real-time polymerase chain reaction (PCR), while the frequency of positive test result was zero in the case group (p = 0.0012). HBV DNA was not detected in both the case and control groups. The prevalence of CMV was 0.88 and zero in the control and case groups, respectively (p = 0.3410). For HHV6, 9.73 % of the control group had a positive result, while this test was positive in 5.88% of the patients with MS (p = 0.2959). CONCLUSION We detected a significantly higher number of individuals with DNA of EBV in their blood among the control group compared with the case group. In conclusion, the results suggest a surprisingly adverse association between MS and EBV, and no association was found between the presence of DNA of HBV, CMV, and HHV6 and MS.

Sign in / Sign up

Export Citation Format

Share Document