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1.
J Emerg Nurs ; 48(5): 583-585, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35963786

RESUMO

Rat bite fever is an acute illness caused by bacteria from rodents. In the United States, rat bite fever is considered rare; however, actual incidence is unknown because of lack of mandatory disease reporting requirements. Risk of development of rat bite fever after being bitten by a rat is approximately 10%. Early treatment is imperative as death is a potential complication. The following case study demonstrates the gravity of the syndrome.


Assuntos
Mordeduras e Picadas , Febre por Mordedura de Rato , Streptobacillus , Mordeduras e Picadas/complicações , Serviço Hospitalar de Emergência , Humanos , Febre por Mordedura de Rato/complicações , Febre por Mordedura de Rato/diagnóstico , Febre por Mordedura de Rato/tratamento farmacológico
2.
J Microbiol Methods ; 199: 106525, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35738493

RESUMO

Streptobacillus (S.) moniliformis is the most important pathogen causing rat bite fever (RBF) worldwide. This zoonotic pathogen is understudied mainly due to difficulties in culturing S. moniliformis as a fastidious microorganism. Therefore, advances in molecular detection techniques are highly needed, especially with regard to the widespread availability of real-time quantitative (q) PCR in laboratories. In this study, we aimed to develop a qPCR for the identification of Streptobacillus species and quantification of S. moniliformis in clinical samples, especially those derived from tissue samples of animal origin. We optimized a previously described PCR protocol in order to develop a qPCR, which can detect different Streptobacillus species with high specificity and is simultaneously able to quantitate S. moniliformis in different clinical matrices. The qPCR exhibited a limit of detection (LOD) of 21 copies/reaction representing ~4-5 streptobacilli, while the limit of quantification (LOQ) was 2.1 × 103 copies/reaction. It was also more sensitive than conventional PCR by two orders of magnitude and proved to have a substantial agreement (Kappa 0.74) compared to it with a superior detection rate in 374 samples from wild rats, laboratory rats and animals from holdings of wild-trapped rats. To conclude, the qPCR described in this study is an important molecular tool that is able to quantify S. moniliformis in tissue samples of animal origin. It represents a suitable tool for future establishment and evaluation of other molecular assays that are highly needed for a better understanding of epidemiology and pathophysiology of RBF. In experimental studies, it will also be useful for titration purposes since the quantification of the organism using classical plate counting technique is problematic and inaccurate.


Assuntos
Febre por Mordedura de Rato , Streptobacillus , Animais , Técnicas de Amplificação de Ácido Nucleico , Febre por Mordedura de Rato/diagnóstico , Febre por Mordedura de Rato/etiologia , Ratos , Reação em Cadeia da Polimerase em Tempo Real , Streptobacillus/genética
3.
Emerg Infect Dis ; 28(4): 886-888, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35318927

RESUMO

To determine the source of Streptobacillus notomytis bacteremia in a woman in Japan with signs of rat-bite fever, we examined rat feces from her home. After culture and PCR failed to identify the causative organism in the feces, next-generation sequencing detected Streptobacillus spp., illustrating this procedure's value for identifying causative environmental organisms.


Assuntos
Bacteriemia , Febre por Mordedura de Rato , Streptobacillus , Animais , Bacteriemia/diagnóstico , Fezes , Feminino , Humanos , Febre por Mordedura de Rato/diagnóstico , Febre por Mordedura de Rato/tratamento farmacológico , Ratos
6.
FEMS Microbiol Lett ; 368(21-24)2021 12 21.
Artigo em Inglês | MEDLINE | ID: mdl-34910142

RESUMO

Almost all major classes of bacteria are surrounded by a peptidoglycan cell wall, which is a crucial target for antibiotics. It is now understood that many bacteria can tolerate loss of the cell wall provided that they are in an isotonic environment. Furthermore, in some cases the cells can continue to proliferate in a state known as the L-form. L-form proliferation occurs by an unusual blebbing or tubulation mechanism that is completely independent of the normally essential division machine or cell wall synthetic enzymes, and is resistant to cell wall-active antibiotics. However, the growth is limited by reactive oxygen species generated by the respiratory chain pathway. In this work, we examined the walled to L-form transition in a pathogenic Gram-negative bacterium, Streptobacillus moniliformis, which naturally lacks the respiratory chain pathway, under aerobic conditions. L-form-like cells often emerged spontaneously, but proliferation was not observed unless the cells were treated with cell wall-active antibiotics. Time-lapse imaging revealed that cell division of S. moniliformis L-forms involves unusual membrane dynamics with an apparent imbalance between outer membrane and cytoplasmic volume growth. The results suggest that outer membrane expansion may be an important general factor for L-form proliferation of diderm bacteria.


Assuntos
Formas L , Antibacterianos/farmacologia , Membrana Externa Bacteriana/efeitos dos fármacos , Membrana Externa Bacteriana/metabolismo , Proliferação de Células/fisiologia , Parede Celular/efeitos dos fármacos , Parede Celular/metabolismo , Citoplasma/metabolismo , Formas L/fisiologia , Streptobacillus/efeitos dos fármacos , Streptobacillus/crescimento & desenvolvimento
7.
Emerg Infect Dis ; 27(12): 3198-3199, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34808096

RESUMO

Streptobacillus moniliformis is a pleomorphic, fastidious gram-negative bacillus that colonizes rodent respiratory tracts and causes rat-bite fever in humans. Rat-bite fever is associated with septic arthritis, usually monoarticular or pauciarticular. We report a rare case of polyarticular septic arthritis caused by S. moniliformis; the disease was initially misdiagnosed as inflammatory arthritis.


Assuntos
Artrite Infecciosa , Febre por Mordedura de Rato , Streptobacillus , Animais , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/tratamento farmacológico , Humanos , Febre por Mordedura de Rato/diagnóstico , Febre por Mordedura de Rato/tratamento farmacológico , Ratos
8.
BMC Infect Dis ; 21(1): 1017, 2021 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-34583654

RESUMO

BACKGROUND: Only three other cases of rat bite fever caused by Streptobacillus notomytis in humans have been reported since this species was identified in 2015. Data specific to the differences in clinical features and geographic distribution between S. notomytis infection and S. moniliformis infection are scarce. All previous cases of human S. notomytis infection were reported from Japan. This is the first case of S. notomytis infection reported from outside of Japan. CASE PRESENTATION: A 72-year-old Thai woman was admitted to Siriraj Hospital (Bangkok, Thailand)-Thailand's largest university-based national tertiary referral center-in August 2020 with fever, myalgia, and polyarthralgia for 3 days, and gradually decreased consciousness for the past 1 day. Physical examination and laboratory investigations revealed septic arthritis of both knee joints, meningitis, and hepatitis. She was initially misdiagnosed as rheumatoid arthritis in the elderly since the initial investigations were unable to detect a causative pathogen. However, S. notomytis infection was later confirmed by polymerase chain reaction amplification of a part of the 16S rRNA gene and sequencing from synovial fluid. Her clinical course was also complicated by spondylodiscitis and epidural abscess caused by S. notomytis, which was detected from tissue biopsy. Therefore, rat bite fever in this patient manifested as meningitis, septic polyarthritis, hepatitis, and spondylodiscitis. The patient was treated with intravenous ceftriaxone then switched to oral amoxicillin with complete recovery. CONCLUSIONS: The clinical manifestations of S. notomytis infection are similar to those demonstrated in S. moniliformis infection. This case also showed that arthritis caused by S. notomytis mimics rheumatoid arthritis, and that meningitis and spondylodiscitis are potential coexisting complications that can be found in S. notomytis infection.


Assuntos
Artrite Infecciosa , Discite , Meningite , Febre por Mordedura de Rato , Streptobacillus , Idoso , Animais , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/tratamento farmacológico , Discite/diagnóstico , Discite/tratamento farmacológico , Feminino , Humanos , RNA Ribossômico 16S/genética , Febre por Mordedura de Rato/diagnóstico , Febre por Mordedura de Rato/tratamento farmacológico , Ratos , Streptobacillus/genética , Tailândia
9.
J Dtsch Dermatol Ges ; 19(9): 1283-1287, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34323361

RESUMO

Rats can transmit Streptobacillus moniliformis, which may cause rat-bite fever (RBF), a rare and potentially lethal zoonosis. Fastidious in vitro growth and unspecific symptoms, including fever, arthralgia, and polymorphous skin lesions, complicate the diagnosis. Rat-bite fever follows exposure to contaminated bodily fluids of infected rodents; however, reports on Streptobacillus moniliformis-related infections are few so far. A female patient presented with painful hemorrhagic pustules and purpuric lesions on hands and feet. She developed fever and migratory polyarthralgia. Blood culture yielded growth with Streptobacillus moniliformis. The patient owned rats and handled contaminated rat feces and urine, making this the most likely etiology of infection. We report a case of RBF due to Streptobacillus moniliformis in a rat handling-patient. Difficulties in clinical and microbiological diagnosis highlight the need for a thorough and complete history-taking and a greater understanding of this rare infectious disease.


Assuntos
Exantema , Febre por Mordedura de Rato , Streptobacillus , Animais , Feminino , Humanos , Pessoa de Meia-Idade , Febre por Mordedura de Rato/diagnóstico , Febre por Mordedura de Rato/tratamento farmacológico , Ratos , Zoonoses
10.
Pediatr Infect Dis J ; 40(11): e439-e442, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34260491

RESUMO

Rat bite fever is a systemic illness most commonly caused by Streptobacillus moniliformis that is classically characterized by fever, rash and migratory polyarthritis. Here, we highlight the highly variable clinical presentations of rat bite fever in children and the importance of maintaining a high degree of suspicion so appropriate treatment can be promptly initiated.


Assuntos
Gerenciamento Clínico , Febre por Mordedura de Rato/diagnóstico , Streptobacillus/patogenicidade , Adolescente , Animais , Artrite Infecciosa/microbiologia , Criança , Pré-Escolar , Exantema/microbiologia , Feminino , Febre/microbiologia , Humanos , Lactente , Recém-Nascido , Masculino , Febre por Mordedura de Rato/complicações , Febre por Mordedura de Rato/microbiologia , Ratos , Estudos Retrospectivos
11.
Yale J Biol Med ; 94(2): 217-226, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34211343

RESUMO

Rat-bite fever is an over-looked, global zoonotic disease that has a mortality rate of up to 13%, if untreated. Historically, this rat-borne disease has been attributed to one of two causative agents, Streptobacillus moniliformis or Spirillum minus. Given the confirmed presence of multiple invasive Rattus host species, high rat densities in urban, informal human settlements and increasing reports of rat bites in South Africa, we undertook a retrospective assessment of Streptobacillus in rats sampled from 16 urban sites, in Gauteng, the smallest but most populous Province in South Africa. Using a multi-gene PCR-sequencing approach, we confirmed Streptobacillus presence in 50.9% of oral swabs from three rat species and the presence of two Streptobacillus species, viz. S. moniliformis and S. notomytis. The two members of the cryptic Rattus rattus species complex (R. rattus and R. tanezumi), which are morphologically indistinguishable from each other, had markedly different colonization rates. Whereas 48.6% of rats from this species complex were Streptobacillus-positive, only 32.3% of Rattus tanezumi were positive compared to 61.5% R. rattus. Rattus norvegicus had an intermediate prevalence of 55.6%. Phylogenetic analysis of four gene regions (16S rRNA, gyrB, groEL, recA) identified two discrete lineages; S. moniliformis occurred exclusively in R. norvegicus, and S. notomytis was restricted to the two members of the R. rattus species complex; this represents the first report of Streptobacillus in R. tanezumi. These results highlight a largely overlooked zoonotic threat posed by invasive rats and confirm the presence of two discrete and potentially host-specific Streptobacillus lineages in South Africa.


Assuntos
Febre por Mordedura de Rato , Streptobacillus , Animais , Espécies Introduzidas , Filogenia , Prevalência , RNA Ribossômico 16S/genética , Ratos , Estudos Retrospectivos , África do Sul/epidemiologia , Streptobacillus/genética
12.
BMC Infect Dis ; 21(1): 479, 2021 May 26.
Artigo em Inglês | MEDLINE | ID: mdl-34039283

RESUMO

BACKGROUND: Rat bite fever (RBF) is a rare systemic febrile illness transmitted by rats. Streptobacillus moniliformis is a pleomorphic Gram-negative bacillus which is the usual etiologic organism for rat bite fever in the United States. CASE PRESENTATION: Here we present a case of rat bite fever complicated by vertebral osteomyelitis and discitis. The patient revealed an exposure history of being bitten by pet rats. The patient's symptoms dramatically improved with a six-week course of cephalexin therapy. CONCLUSIONS: It is important to obtain a thorough zoonotic exposure history and maintain rat bite fever in the differential when considering potential causes of discitis and osteomyelitis.


Assuntos
Discite/etiologia , Osteomielite/etiologia , Febre por Mordedura de Rato/complicações , Animais , Animais Domésticos , Antibacterianos/administração & dosagem , Mordeduras e Picadas/complicações , Cefalexina/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Febre por Mordedura de Rato/diagnóstico , Febre por Mordedura de Rato/tratamento farmacológico , Ratos , Streptobacillus/efeitos dos fármacos , Streptobacillus/isolamento & purificação , Resultado do Tratamento
13.
Lab Med ; 52(6): 536-549, 2021 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-33693831

RESUMO

Rat bite fever and Haverhill fever are often difficult to diagnose in a clinical setting. This difficulty results in part from clinicians and laboratory professionals not being able to reliably recover the causative agent Streptobacillus moniliformis using culture-based methods. After utilizing an automated continuous-monitoring blood culture bottle system, we showed that the organism can be reliably cultured when a blood volume inoculum of 10 mL is used. Further, we showed that when the above recommendation is followed, sodium polyanethole sulfonate (up to a concentration of 0.05% w/v) in commercially purchased blood culture bottle formulations seems to be inactivated, allowing for the growth and detection of S. moniliformis. Herein, we offer data and methods used to overcome these clinical limitations. This is a comprehensive study of the historical collection of S. moniliformis isolates maintained by our facility and believed to be the largest of its kind to date.


Assuntos
Streptobacillus , Animais , Automação Laboratorial , Hemocultura , Febre por Mordedura de Rato , Ratos , Estudos Retrospectivos
14.
Diagn Microbiol Infect Dis ; 100(2): 115335, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33618204

RESUMO

Rat bite fever (RBF) caused by Streptobacillus moniliformis has been described as a diagnostic challenge. While it has a favorable prognosis with treatment, timely diagnosis is hindered by the lack of culture-free identification methods. Here we present a multiplex real-time PCR assay that detects the zoonotic Streptobacillus spp. as well as differentiate the primary causative agent of RBF, Streptobacillus moniliformis. The performance of this assay was evaluated using mock clinical specimens for blood, serum, and urine. Analytical sensitivity was determined to be 3-4 genome equivalents (GE)/µl for the zoonotic Streptobacillus spp. target, and 1-2 GE/µl for the S. moniliformis specific target. The assay correctly detected only the intended targets with no cross-reactivity identified. The pathogen was detected in all spiked matrices and not detected in the negative non-spiked specimens. This rapid diagnostic assay may permit quicker diagnosis of RBF patients.


Assuntos
Zoonoses Bacterianas/microbiologia , Febre por Mordedura de Rato/microbiologia , Reação em Cadeia da Polimerase em Tempo Real/métodos , Streptobacillus/classificação , Streptobacillus/isolamento & purificação , Animais , Clonagem Molecular , Humanos , Reprodutibilidade dos Testes , Especificidade da Espécie
15.
Clin Infect Dis ; 72(10): 1826-1829, 2021 05 18.
Artigo em Inglês | MEDLINE | ID: mdl-32658299

RESUMO

Rat bite fever (RBF) is predominantly caused by Streptobacillus moniliformis. We report a human infection with Streptobacillus felis. Clinical presentation was consistent with RBF, but serologic testing was negative for S moniliformis. Eventually, S felis-specific sequences were detected in skin lesions of the patient and in the oropharynx of local cats.


Assuntos
Febre por Mordedura de Rato , Streptobacillus , Animais , Gatos , Humanos , Masculino , Orofaringe , Febre por Mordedura de Rato/diagnóstico , Febre por Mordedura de Rato/tratamento farmacológico
16.
J Transl Med ; 18(1): 421, 2020 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-33167991

RESUMO

BACKGROUND: Heavy tobacco smoking, a hallmark feature of lung cancer, is drastically predominant in Middle Eastern populations. The precise links between nicotine dependence and the functional contribution of the oral microbiota remain unknown in these populations. METHODS: We evaluated the composition and functional capabilities of oral microbiota with relation to cigarette smoking in 105 adults through shotgun metagenomics using buccal swabs. RESULTS: The oral microbiota composition in our study subjects was dominated by the phyla Firmicutes, Proteobacteria, Actinobacteria, and Bacteroidetes, in addition to the genera Prevotella and Veillonella, similar to previously described westernized cohorts. Furthermore, the smoker's oral microbiota represented a significant abundance of Veillonella dispar, Leptotrichia spp. and Prevotella pleuritidis when compared to non-smokers. Within the smoking groups, differential relative abundance testing unveiled relative abundance of Streptobacillus hongkongensis, Fusobacterium massiliense, Prevotella bivia in high nicotine dependent compared to low nicotine dependent profiles based on Fagerström Test for Nicotine Dependence. Functional profiling showed marked differences between smokers and non-smokers. Smokers exhibited an enrichment of Tricarballylate utilization and Lactate racemization when compared to the non-smokers. According to their nicotine dependence, enrichment of Xanthosine utilization, p-Aminobenzoyl-Glutamate utilization, and multidrug efflux pump in Campylobacter jejuni biosynthesis modules were detected in the high nicotine dependent group. CONCLUSIONS: These compositional and functional differences may provide critical insight on how variations in the oral microbiota could predispose to respiratory illnesses and smoke cessation relapse in cigarette smokers. In particular, the observed enrichment of Fusobacterium and Prevotella in the oral microbiota possibly suggests an intriguing linkage to gut and lung cancers.


Assuntos
Fumar Cigarros , Microbiota , Produtos do Tabaco , Adulto , Fusobacterium , Humanos , Recidiva Local de Neoplasia , Prevotella , Fumaça , Streptobacillus , Veillonella
17.
Am J Case Rep ; 21: e925647, 2020 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-33038206

RESUMO

BACKGROUND Rat bite fever (RBF) is a rare but fatal zoonotic disease caused by infections with various bacteria, which are transmitted from rats or other rodents. Only a few patients worldwide are diagnosed with RBF annually. RBF can be fatal if left untreated, with a mortality rate of about 10% in patients with severe RBF. CASE REPORT A case 37-year-old previously healthy man presented to the emergency department with acute gastroenteritis, sepsis and multi-organ failure requiring ventilatory support. He was later diagnosed with RBF due to Streptobacillus moniliformis. He recovered rapidly after administration of intravenous penicillin G and was discharged from the hospital 10 days later. CONCLUSIONS This report describes a patient with RBF and multi-organ involvement requiring ventilatory support. He was successfully treated with intravenous penicillin G. To our knowledge, this is the first report of a patient from Qatar with RBF.


Assuntos
Febre por Mordedura de Rato , Sepse , Streptobacillus , Animais , Humanos , Masculino , Catar , Febre por Mordedura de Rato/diagnóstico , Febre por Mordedura de Rato/tratamento farmacológico , Ratos
18.
Mod Rheumatol Case Rep ; 4(1): 95-98, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-33086954

RESUMO

Rat-bite fever (RBF) is characterized by fever, rash and arthritis, mainly caused by Streptobacillus moniliformis. We present a case of inflammatory erosive polyarthritis with sepsis caused by Streptobacillus notomytis, a novel species isolated from S. moniliformis. A 67-year-old man presented with fever, purpura and peripheral arthritis. After blood cultures were performed, loxoprofen administration was initiated. Arthritis partially improved, but left first metatarsophalangeal (MTP) arthritis persisted. A gram-negative rod was detected in the blood culture, and meropenem administration was started that improved arthritis. Ultrasonography and computed tomography revealed bone erosion in the left first MTP joint, leading to the diagnosis of septic arthritis. 16S rRNA gene sequence analysis revealed that this strain was S. notomytis. Further questioning revealed the patient may have had contact with rats. It is essential to consider Streptobacillus infection in the differential diagnosis of erosive polyarthritis.


Assuntos
Artrite/diagnóstico , Artrite/etiologia , Febre por Mordedura de Rato/complicações , Febre por Mordedura de Rato/microbiologia , Sepse/complicações , Sepse/microbiologia , Streptobacillus , Idoso , Humanos , Masculino , RNA Ribossômico 16S/genética , Febre por Mordedura de Rato/diagnóstico , Febre por Mordedura de Rato/transmissão , Sepse/diagnóstico , Análise de Sequência de DNA , Streptobacillus/efeitos dos fármacos , Streptobacillus/genética
19.
Tidsskr Nor Laegeforen ; 140(13)2020 09 29.
Artigo em Inglês, Norueguês | MEDLINE | ID: mdl-32998485

RESUMO

BACKGROUND: Fever in combination with a rash is a presentation regularly seen in medicine. The causes clinicians must consider include infections, medications, autoimmune diseases. CASE PRESENTATION: A previously healthy young woman presented with a 3 to 4 day history of fever, headache and a maculopapular rash that also affected her palms. She was in a stable condition and was admitted for observation and further investigations without initiating antibiotic treatment. During the next two days her condition improved spontaneously, and her symptoms were initially interpreted as a viral infection. On day 3, blood cultures taken on the day of admission came back positive for Streptobacillus moniliformis, the causative agent of rat-bite fever. A more detailed patient history was taken, and the patient reported that she had several pet rats and one of them had given her some superficial scratches a few days before she fell ill. INTERPRETATION: Rats and other rodents are often colonised by Streptobacillus moniliformis in their oropharynx. Many people keep such animals as pets, and it is important to be aware of this disease as a differential diagnosis when a patient presents with fever and rash. Untreated, the disease might have a fatal course and the treatment of choice, penicillin, is usually easily available.


Assuntos
Exantema , Febre por Mordedura de Rato , Streptobacillus , Animais , Exantema/diagnóstico , Exantema/etiologia , Feminino , Cefaleia/diagnóstico , Cefaleia/etiologia , Humanos , Febre por Mordedura de Rato/complicações , Febre por Mordedura de Rato/diagnóstico , Febre por Mordedura de Rato/tratamento farmacológico , Ratos
20.
Pediatr Infect Dis J ; 39(12): 1131-1133, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32868746

RESUMO

Rat-bite fever caused by Streptobacillus moniliformis is a rare infection that may be fatal. An adolescent male presented with multiorgan failure, negative blood cultures and Gram-negative rods in blood smear. S. moniliformis was identified by 16S ribosomal RNA gene sequencing from the blood. He developed systemic hyperinflammatory syndrome resembling hemophagocytic lymphohistiocytosis, for which immune-globulins and steroids were added to the antibiotic regimen and he rapidly recovered.


Assuntos
Ceftriaxona/uso terapêutico , Dexametasona/uso terapêutico , Imunoglobulinas Intravenosas/uso terapêutico , Linfo-Histiocitose Hemofagocítica/patologia , Febre por Mordedura de Rato/diagnóstico , Streptobacillus/isolamento & purificação , Adolescente , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/uso terapêutico , Ceftriaxona/administração & dosagem , Dexametasona/administração & dosagem , Doxiciclina/administração & dosagem , Doxiciclina/uso terapêutico , Humanos , Linfo-Histiocitose Hemofagocítica/tratamento farmacológico , Masculino , Febre por Mordedura de Rato/complicações , Febre por Mordedura de Rato/microbiologia
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