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1.
Medicine (Baltimore) ; 100(18): e25706, 2021 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-33950953

RESUMO

ABSTRACT: Enteroviruses is a group of positive single-stranded RNA viruses ubiquitous in the environment, which is a causative agent of epidemic diseases in children and infants. But data on neonates are still limited. The present study aimed to describe the clinical characteristics of enterovirus infection in neonates and arise the awareness of this disease to general public.Between March 2018 and September 2019, data from all of the neonates diagnosed with enterovirus infection were collected and analyzed from neonatal intensive care unit of Zhangzhou Hospital in Fujian, China.A total of 23 neonates were enrolled. All of them presented with fever (100%), and some with rashes (39.1%). The incidence of aseptic meningitis was high (91.3%), but only a small proportion (28.6%) presented with cerebrospinal fluid (CSF) leukocytosis. The positive value for nucleic acid detection in CSF was significantly higher than throat swab (91.3% vs 43.5%, P = .007). Five of the infected neonates presented with aseptic meningitis (23.8%) underwent brain magnetic resonance imaging examination and no craniocerebral injuries were found. Subsequent follow-ups were performed in 15 of them (71.4%) and no neurological sequelae was found.Aseptic meningitis is a common type of enterovirus infection in neonates with a benign course. Nucleic acid detection of CSF has an important diagnostic value. Febrile neonates would be suggested to screen for enterovirus infection in addition to complete septic workup. An unnecessary initiation or earlier cessation of antibiotics could be considered in enterovirus infection, but that indications still need further studies to guarantee the safety.


Assuntos
Infecções por Enterovirus/epidemiologia , Enterovirus/isolamento & purificação , Febre/epidemiologia , Meningite Asséptica/epidemiologia , Meningite Viral/epidemiologia , Encéfalo/diagnóstico por imagem , China/epidemiologia , Enterovirus/genética , Infecções por Enterovirus/líquido cefalorraquidiano , Infecções por Enterovirus/diagnóstico , Infecções por Enterovirus/virologia , Exantema/líquido cefalorraquidiano , Exantema/diagnóstico , Exantema/epidemiologia , Exantema/virologia , Feminino , Febre/líquido cefalorraquidiano , Febre/diagnóstico , Febre/virologia , Humanos , Incidência , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Imageamento por Ressonância Magnética , Masculino , Meningite Asséptica/líquido cefalorraquidiano , Meningite Asséptica/diagnóstico , Meningite Asséptica/virologia , Meningite Viral/líquido cefalorraquidiano , Meningite Viral/diagnóstico , Meningite Viral/virologia , Faringe/virologia , RNA Viral/líquido cefalorraquidiano , RNA Viral/isolamento & purificação , Estudos Retrospectivos , Dermatopatias Virais/líquido cefalorraquidiano , Dermatopatias Virais/epidemiologia , Dermatopatias Virais/virologia
2.
Clin Dermatol ; 39(1): 12-22, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33972039

RESUMO

A wide range of cutaneous signs are attributed to COVID-19 infection. This retrospective study assesses the presence and impact of dermatologic manifestations related to the spread of COVID-19 in Lombardy, the geographic district with the first outbreak in Italy. A cohort of 345 patients with laboratory confirmed COVID-19 was collected from February 1, 2020 to May 31, 2020. Cutaneous signs and dermatologic diagnoses were recorded on admission, and during the course of the disease. Of the 345 patients included in the study, 52 (15%) had new-onset dermatologic conditions related to COVID-19. We observed seven major cutaneous clinical patterns, merged under 3 main groups: Exanthems, vascular lesions, and other cutaneous manifestations. Each subset was detailed with prevalence, age, duration, prognosis, and histology. Cutaneous findings can lead to suspect COVID-19 infection and identify potentially contagious cases with indolent course.


Assuntos
/complicações , Dermatopatias/epidemiologia , Dermatopatias/virologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Pérnio/patologia , Pérnio/virologia , Criança , Eritema Multiforme/virologia , Exantema/virologia , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Estudos Retrospectivos , Dermatopatias/patologia , Dermatopatias Vasculares/virologia , Urticária/virologia , Adulto Jovem
3.
Clin Dermatol ; 39(1): 149-162, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33972045

RESUMO

Skin is one of target organs affected by the novel coronavirus SARS-CoV-2, and in response to the current COVID-19 pandemic, a fast body of literature has emerged on related cutaneous manifestations. Current perspective is that the skin is not only a bystander of the general cytokines storm with thrombophilic multiorgan injury, but it is directly affected by the epithelial tropism of the virus, as confirmed by the detection of SARS-CoV-2 in endothelial cells and epithelial cells of epidermis and eccrine glands. In contrast with the abundance of epidemiologic and clinical reports, histopathologic characterization of skin manifestations is limited. Without an adequate clinicopathologic correlation, nosology of clinically similar conditions is confusing, and effective association with COVID-19 remains presumptive. Several patients with different types of skin lesions, including the most specific acral chilblains-like lesions, showed negative results at SARS-CoV-2 nasopharyngeal and serologic sampling. The aim of this review is to provide an overview of what has currently been reported worldwide, with a particular emphasis on microscopic patterns of the skin manifestations in patients exposed to or affected by COVID-19. Substantial breakthroughs may occur in the near future from more skin biopsies, improvement of immunohistochemistry studies, RNA detection of SARS-CoV-2 strain by real-time polymerase chain reaction-based assay, and electron microscopic studies.


Assuntos
/complicações , Dermatopatias/patologia , Dermatopatias/virologia , Pele/patologia , Pérnio/patologia , Pérnio/virologia , Eritema Multiforme/patologia , Eritema Multiforme/virologia , Exantema/patologia , Exantema/virologia , Humanos , Necrose/virologia , Púrpura/patologia , Púrpura/virologia , Síndrome de Resposta Inflamatória Sistêmica/complicações , Urticária/patologia , Urticária/virologia
4.
Orv Hetil ; 162(16): 602-607, 2021 04 07.
Artigo em Húngaro | MEDLINE | ID: mdl-33830937

RESUMO

Összefoglaló. Újabb megfigyelések szerint a SARS-CoV-2-fertozést követoen gyermekekben a paediatric inflammatory multisystem syndrome (PIMS) elnevezésu, sokkállapottal szövodött Kawasaki-megbetegedéshez hasonlító, többszervi elégtelenségnek megfelelo tünetegyüttes alakulhat ki. A gyermekek többségében ilyenkor a direkt víruskimutatás már sikertelen, azonban a SARS-CoV-2 ellen képzodött antitest igazolhatja a diagnózist. Dolgozatunk célja az egyik elso hazai eset ismertetése. Egy 15 éves fiú került gyermek intenzív osztályos felvételre több napon át észlelt magas láz, kesztyu-, zokniszeru exanthema, conjunctivitis, többszervi elégtelenség, szeptikus sokk tüneteivel, akut gyulladásra utaló laboratóriumi eltérésekkel és diffúz hasi panaszokkal. Felvételét megelozoen néhány héttel SARS-CoV-2-fertozésen esett át. Felvételekor a direkt víruskimutatás sikertelen volt, ám a SARS-CoV-2 elleni antitest vizsgálata pozitív lett. Komplex intenzív terápia mellett állapota stabilizálódott. Az irodalmi ajánlásoknak megfeleloen immunglobulin-, acetilszalicilsav- és szteroidkezelésben részesítettük, melynek hatására állapota maradványtünetek nélkül rendezodött. A növekvo esetszámú gyermekkori SARS-CoV-2-fertozés mellett egyre gyakrabban várható a SARS-CoV-2-fertozést követo, a Kawasaki-betegség tüneteire emlékezteto PIMS kialakulása. Gyermekekben súlyos szeptikus állapot és többszervi elégtelenség esetén gondolni kell a PIMS lehetoségére, mely esetenként intenzív osztályos ellátást és célzott terápiát igényel. Legjobb tudomásunk szerint a leírásra került beteg a Magyarországon diagnosztizált egyik legkorábbi eset. Orv Hetil. 2021; 162(16): 602-607. Summary. Recently following SARS-CoV-2 infection, a new, multisystem disease (paediatric inflammatory multisystem syndrome, PIMS) with fever was recognized in children with shock and multiorgan failure. On of the first Hungarian cases will be described. A 15-year-old boy was admitted to the Paediatric Intensive Care Unit with persistent high fever, diffuse abdominal pain, septic shock, multiple organ failure, gloves- and socks-shaped cutan exanthema, conjunctivitis and laboratory signs of inflammation. Some weeks preceding his admission, symptoms of mild SARS-CoV-2 infection were revealed. At admission, the SARS-CoV-2 PCR and antigen tests were negative, however, the presence of IgG antibody was shown. Following complex supportive intensive care along with internationally recommended immunoglobulin, aspirin and steroid treatment, the patient was completely cured without any sequalae. In children after SARS-CoV-2 infection, PIMS could occur mimicking Kawasaki syndrome. At this time, in children virus PCR or antigen tests are usually negative already, but the presence of SARS-CoV-2 antibody could prove the preceding disease. Due to the increasing number of SARS-CoV-2 infections, the occurrence of post-SARS-CoV-2 PIMS in childhood is expected to increase. For paediatric patients, in case of severe septic state and multiple organ failure, PIMS should be also considered, which may require intensive care and targeted therapy. As far as we know, the described case is one of the earliest cases of PIMS in Hungary. Orv Hetil. 2021; 162(16): 602-607.


Assuntos
Dor Abdominal/etiologia , Febre/etiologia , Imunoglobulina G/sangue , Síndrome de Resposta Inflamatória Sistêmica , Adolescente , /virologia , Conjuntivite/virologia , Exantema/virologia , Hospitalização , Humanos , Hungria , Inflamação/virologia , Unidades de Terapia Intensiva Pediátrica , Masculino , Insuficiência de Múltiplos Órgãos/virologia , Choque Séptico/virologia , Síndrome de Resposta Inflamatória Sistêmica/sangue , Síndrome de Resposta Inflamatória Sistêmica/virologia
5.
Saudi Med J ; 42(5): 579, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33896791
6.
Am J Case Rep ; 22: e929489, 2021 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-33743006

RESUMO

BACKGROUND The damage caused by the severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) has been extensive. Pregnant women are a group requiring special attention in medicine given the anatomical and physiological changes that occur during pregnancy. Skin rash is commonly associated with pregnancy, with the most common form of an erythematous maculopapular rash being pruritic urticarial papules and plaques of pregnancy. Skin rash is also an increasingly reported initial presentation in patients with coronavirus disease 2019 (COVID-19), due to infection with SARS-CoV-2. CASE REPORT A 34-year-old woman with a diamniotic dichorionic twin pregnancy presented with clinical picture characterized by dermatological manifestations, namely an erythematous and papular skin rash associated with SARS-CoV-2 infection. A real-time reverse transcription-polymerase chain reaction (GeneFinder) test was positive for SARS-CoV-2 detection. CONCLUSIONS Ten months after the onset of this pandemic, there is no conclusive evidence indicating that pregnant women represent a sector more or less vulnerable to severe forms of COVID-19 than the general population. This report has highlighted the importance of performing a reliable diagnostic test for SARS-CoV-2 infection in patients who present with a skin rash, particularly pregnant women.


Assuntos
/diagnóstico , Eritema/virologia , Exantema/virologia , Complicações Infecciosas na Gravidez/diagnóstico , Adulto , Feminino , Humanos , Gravidez , Complicações Infecciosas na Gravidez/virologia , Gravidez de Gêmeos
7.
BMJ Case Rep ; 14(3)2021 Mar 25.
Artigo em Inglês | MEDLINE | ID: mdl-33766974

RESUMO

A 54-year-old woman presented with pruritic rash and hives of 3 days' duration followed by shortness of breath for 1 day. SARS-CoV-2 PCR test for COVID-19 was positive. Cutaneous manifestations of COVID-19 include acral lesions, urticarial rash, erythematous maculopapular rash, vascular rashes and vesicular rash. The cutaneous manifestations are mostly described as self-limiting. Urticarial rashes are not reported as the initial presentation symptom of COVID-19 infection but mostly noted to occur at the same time or after the onset of non-cutaneous symptoms. Management of cutaneous manifestations of COVID-19 affecting quality of life has not been well studied. Antihistamine therapy is the primary recommended therapy. Role of antiviral therapy for severe cases of rash needs to be further assessed.


Assuntos
/complicações , Exantema/virologia , Urticária/virologia , Antivirais/uso terapêutico , Fibrilação Atrial/complicações , Exantema/patologia , Exantema/terapia , Feminino , Antagonistas dos Receptores Histamínicos/uso terapêutico , Humanos , Hipertensão Pulmonar/complicações , Pessoa de Meia-Idade , Obesidade/complicações , Insuficiência Renal Crônica/complicações , Pele/patologia , Apneia Obstrutiva do Sono/complicações , Resultado do Tratamento , Urticária/patologia , Urticária/terapia
9.
Rheumatol Int ; 41(6): 1021-1036, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33774723

RESUMO

Anti-Melanoma Differentiation-Associated gene 5 (MDA-5) Dermatomyositis (MDA5, DM) is a recently identified subtype of myositis characteristically associated with Rapidly Progressive Interstitial Lung Disease (RP-ILD) and unique cutaneous features. We reviewed PubMed, SCOPUS and Web of Science databases and selected 87 relevant articles after screening 1485 search results, aiming to gain a better understanding of the pathophysiology, clinical features, diagnosis, and treatment approaches of anti-MDA-5 DM described in the literature. The etiopathogenesis is speculatively linked to an unidentified viral trigger on the background of genetic predisposition culminating in an acquired type I interferonopathy. The clinical phenotype is highly varied in different ethnicities, with new clinical features having been recently described, expanding the spectrum of cases that should raise the suspicion of anti-MDA-5 DM. Unfortunately, the diagnosis is frequently missed despite excessive mortality, calling for wider awareness of suspect symptoms. RP ILD is the major determinant of survival, treatment being largely based on observational studies with recent insights into aggressive combined immunosuppression at the outset.


Assuntos
Dermatomiosite/diagnóstico , Dermatomiosite/terapia , /diagnóstico , Dermatomiosite/epidemiologia , Dermatomiosite/virologia , Progressão da Doença , Exantema/diagnóstico , Exantema/etiologia , Exantema/virologia , Feminino , Humanos , Helicase IFIH1 Induzida por Interferon , Doenças Pulmonares Intersticiais/diagnóstico , Doenças Pulmonares Intersticiais/etiologia , Doenças Pulmonares Intersticiais/virologia , Masculino , Prevalência
10.
Sao Paulo Med J ; 139(2): 186-189, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33566880

RESUMO

CONTEXT: Various skin manifestations have been reported in coronavirus disease. It may be difficult to determine the etiology of these lesions in view of the increased frequency of handwashing during the pandemic, along with occurrences of irritant contact dermatitis and allergic contact dermatitis due to disinfectant use; usage of herbal medicine and supplements to strengthen the immune system; and urticarial or maculopapular drug eruptions due to COVID-19 treatment. The variety of associated skin manifestations seen with COVID-19 makes it challenging to identify virus-specific skin manifestations. Petechiae, purpura, acrocyanosis and necrotic and non-necrotic purpura, which can be considered as manifestations of vascular involvement on the skin, have been reported. CASE REPORT: Here, we report a case of eruptive cherry angiomas, which was thought to have developed due to COVID-19, with a papulovesicular rash on distal extremities that progressed over time to reticular purpura. CONCLUSION: The case presented had a papulovesicular rash at the onset, which evolved to retiform purpura, and eruptive cherry angiomas were observed. It should be kept in mind that dermatological signs may vary in patients with COVID-19.


Assuntos
/complicações , Exantema/virologia , Hemangioma/virologia , Púrpura/virologia , Dermatopatias Virais/virologia , Pele/virologia , /tratamento farmacológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pele/efeitos dos fármacos , Pele/patologia , Dermatopatias Virais/diagnóstico , Dermatopatias Virais/terapia , Resultado do Tratamento
11.
Pediatr Dermatol ; 38(2): 455-457, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33410205

RESUMO

The novel coronavirus SARS-CoV-2 has been associated with a variety of dermatologic manifestations, often the predominant finding in otherwise asymptomatic or oligosymptomatic patients. Urticarial eruption is one example, but few cases have been reported among pediatric patients. We present a case of acute urticaria in a 6-month-old boy preceding other COVID-19 symptoms. The suspicion of a possible COVID-19-associated cutaneous manifestation prompted timely testing and diagnosis of SARS-CoV-2 infection.


Assuntos
/diagnóstico , Exantema , Urticária , /complicações , Exantema/diagnóstico , Exantema/virologia , Humanos , Lactente , Masculino , Urticária/diagnóstico , Urticária/virologia
12.
J Am Acad Dermatol ; 84(4): 946-952, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33359476

RESUMO

BACKGROUND: Limited information exists on mucocutaneous disease and its relation to course of COVID-19. OBJECTIVE: To estimate prevalence of mucocutaneous findings, characterize morphologic patterns, and describe relationship to course in hospitalized adults with COVID-19. METHODS: Prospective cohort study at 2 tertiary hospitals (Northwell Health) between May 11, 2020 and June 15, 2020. RESULTS: Among 296 hospitalized adults with COVID-19, 35 (11.8%) had at least 1 disease-related eruption. Patterns included ulcer (13/35, 37.1%), purpura (9/35, 25.7%), necrosis (5/35, 14.3%), nonspecific erythema (4/35, 11.4%), morbilliform eruption (4/35, 11.4%), pernio-like lesions (4/35, 11.4%), and vesicles (1/35, 2.9%). Patterns also showed anatomic site specificity. A greater proportion of patients with mucocutaneous findings used mechanical ventilation (61% vs 30%), used vasopressors (77% vs 33%), initiated dialysis (31% vs 9%), had thrombosis (17% vs 11%), and had in-hospital mortality (34% vs 12%) compared with those without mucocutaneous findings. Patients with mucocutaneous disease were more likely to use mechanical ventilation (adjusted prevalence ratio, 1.98; 95% confidence interval, 1.37-2.86); P < .001). Differences for other outcomes were attenuated after covariate adjustment and did not reach statistical significance. LIMITATIONS: Skin biopsies were not performed. CONCLUSIONS: Distinct mucocutaneous patterns were identified in hospitalized adults with COVID-19. Mucocutaneous disease may be linked to more severe clinical course.


Assuntos
/complicações , Dermatopatias/virologia , Pele/patologia , Injúria Renal Aguda/terapia , Injúria Renal Aguda/virologia , Idoso , Vesícula/virologia , Pérnio/virologia , Eritema/virologia , Exantema/virologia , Feminino , Mortalidade Hospitalar , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Membrana Mucosa , Necrose/virologia , Estudos Prospectivos , Púrpura/virologia , Diálise Renal , Respiração Artificial , Úlcera Cutânea/virologia , Trombose/virologia , Vasoconstritores/uso terapêutico
16.
Rev Soc Bras Med Trop ; 53: e20200533, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32935788

RESUMO

Coronavirus disease (COVID-19) is caused by SARS-CoV-2 and has spread rapidly and caused a global pandemic. Knowledge about clinical and laboratory manifestations in the pediatric population is necessary to guide and monitor such patients. A 3-year-old female patient diagnosed with COVID-19 presented with high fever. After defervescence, she experienced a maculopapular rash that worsened by the sixth day of the disease with self-limited evolution without relevant laboratory changes. The identification of rashes in children with COVID-19 is an unusual and important condition that must be recognized in view of the high transmissibility shown.


Assuntos
Infecções por Coronavirus/diagnóstico , Exantema/virologia , Pneumonia Viral/diagnóstico , Pré-Escolar , Infecções por Coronavirus/complicações , Feminino , Humanos , Pandemias , Pneumonia Viral/complicações
17.
Pediatr. aten. prim ; 22(87): 295-303, jul.-sept. 2020. ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-194301

RESUMO

Un nuevo coronavirus llamado coronavirus 2 del síndrome respiratorio agudo severo (SARS-CoV-2), causante de una pandemia global, afecta a la población pediátrica con unas características clínicas diferentes a las de los adultos. Las lesiones dermatológicas acroisquémicas que se pueden asociar, se manifiestan más en pacientes jóvenes sin cuadro respiratorio. Se presentan tres casos clínicos con estudios analíticos, que incluyen determinación de anticuerpos neutralizantes por inmunocromatografía. En ninguno de los casos se ha podido demostrar la participación del SARS-CoV-2 como agente implicado. El término de "acroisquemia aguda en el niño en tiempos de COVID-19" parece ser el término más adecuado hasta tener un mayor conocimiento del cuadro


A new coronavirus called coronavirus 2 of severe acute respiratory syndrome (SARSCoV-2), causing a global pandemic, affects the pediatric population with some characteristics different from those of adults. The acro-ischemic dermatological lesions that can be associated, are manifested more in young patients without respiratory symptoms. Three clinical cases with analytical studies that include neutralizing antibody determinations by immunochromatography are presented. In none of these cases the SARS-CoV-2 appears to be an involved agent. The term "acute acro-ischemia in the child in the times of the Covid-19" seems to be the best term until there is a better understanding of the disease


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Infecções por Coronavirus/diagnóstico , Acrodermatite/virologia , Isquemia/virologia , Dermatopatias Vasculares/virologia , Dermatopatias Virais/diagnóstico , Infecções por Coronavirus/epidemiologia , Síndrome Respiratória Aguda Grave/epidemiologia , Vírus da SARS/patogenicidade , Cuidado da Criança/métodos , Pandemias/estatística & dados numéricos , Atenção Primária à Saúde/organização & administração , Exantema/virologia
19.
J Am Acad Dermatol ; 83(6): 1738-1748, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32777318

RESUMO

The new coronavirus, severe acute respiratory syndrome coronavirus 2, is associated with a wide variety of cutaneous manifestations. Although new skin manifestations caused by COVID-19 are continuously being described, other cutaneous entities should also be considered in the differential diagnosis, including adverse cutaneous reactions to drugs used in the treatment of COVID-19 infections. The aim of this review is to provide dermatologists with an overview of the cutaneous adverse effects associated with the most frequently prescribed drugs in patients with COVID-19. The skin reactions of antimalarials (chloroquine and hydroxychloroquine), antivirals (lopinavir/ritonavir, ribavirin with or without interferon, oseltamivir, remdesivir, favipiravir, and darunavir), and treatments for complications (imatinib, tocilizumab, anakinra, immunoglobulins, corticosteroids, colchicine and low molecular weight heparins) are analyzed. Information regarding possible skin reactions, their frequency, management, and key points for differential diagnosis are presented.


Assuntos
Infecções por Coronavirus/tratamento farmacológico , Erupção por Droga/diagnóstico , Pneumonia Viral/tratamento farmacológico , Antimaláricos/efeitos adversos , Antivirais/efeitos adversos , Betacoronavirus/imunologia , Betacoronavirus/patogenicidade , Colchicina/efeitos adversos , Infecções por Coronavirus/complicações , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/virologia , Diagnóstico Diferencial , Erupção por Droga/etiologia , Quimioterapia Combinada/efeitos adversos , Quimioterapia Combinada/métodos , Exantema/diagnóstico , Exantema/imunologia , Exantema/virologia , Glucocorticoides/efeitos adversos , Humanos , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/imunologia , Pneumonia Viral/virologia , Urticária/diagnóstico , Urticária/imunologia , Urticária/virologia
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