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Lee S, Kim G, Park GM, Jeong J, Jung E, Lee BS, Jo E, Lee S, Yoon H, Jo KW, Kim SH, Lee J. Management of newborns and healthcare workers exposed to isoniazid-resistant congenital tuberculosis in the neonatal intensive care unit. J Hosp Infect 2024; 147:40-46. [PMID: 38432587 DOI: 10.1016/j.jhin.2024.02.012] [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: 11/27/2023] [Revised: 01/25/2024] [Accepted: 02/05/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Management of newborns and healthcare workers (HCWs) exposed to congenital tuberculosis (TB) in the neonatal intensive care unit (NICU) has been reported rarely. AIM To outline a contact investigation process for individuals exposed to congenital TB in the NICU and investigate nosocomial transmission. Additionally, to assess the efficacy and safety of window prophylaxis in exposed newborns. METHODS A baby, born at a gestational age of 28 + 1 weeks, was diagnosed with isoniazid-resistant congenital TB on the 39th day of admission to the level IV NICU. Newborns and HCWs exposed cumulatively for ≥8 h underwent contact investigation and follow-up for a year. FINDINGS Eighty-two newborns underwent contact investigation. All newborns displayed normal chest X-rays, and 42 hospitalized newborns tested negative for acid-fast bacilli stain and Xpert® MTB/RIF assay in their endotracheal sputum or gastric juices. Eighty received window prophylaxis: six of 75 on rifampin experienced mild adverse events, and none of the five on levofloxacin. After 12 weeks, five (6.1%) had a positive tuberculin skin test, all of whom had already received the Bacillus Calmette-Guérin vaccine and tested negative on TB interferon-gamma releasing assay. Of 119 exposed HCWs, three (2.5%) were diagnosed with latent TB infection and completed a four-month rifampin therapy. There was no active TB disease among exposed newborns and HCWs during a one-year follow-up. CONCLUSION Timely diagnosis of congenital TB is crucial for minimizing transmission among exposed neonates and HCWs in the NICU setting. In cases of isoniazid-resistant index patients, even premature newborns may consider the use of rifampin or levofloxacin for window prophylaxis.
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Affiliation(s)
- S Lee
- Department of Paediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - G Kim
- Department of Paediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - G-M Park
- Department of Paediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - J Jeong
- Department of Paediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - E Jung
- Department of Paediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - B S Lee
- Department of Paediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - E Jo
- Office for Infection Control, Asan Medical Center, Seoul, South Korea
| | - S Lee
- Office for Infection Control, Asan Medical Center, Seoul, South Korea
| | - H Yoon
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - K-W Jo
- Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - S-H Kim
- Office for Infection Control, Asan Medical Center, Seoul, South Korea; Department of Infectious Diseases, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - J Lee
- Department of Paediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea; Office for Infection Control, Asan Medical Center, Seoul, South Korea.
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Hu Z, Zeng D, Yang Y, Liu H, Wang A, Li D, Liu M, Feng Y. Pathomorphological characteristics of tuberculous placenta and its clinical implication. Diagn Pathol 2023; 18:128. [PMID: 38031157 PMCID: PMC10685481 DOI: 10.1186/s13000-023-01419-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 11/17/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND The study of pathologic diagnosis of placental TB is rare. The aim of this study is analyzing the pathomorphological characteristics of tuberculosis (TB) placenta during pregnancy and its clinical significance. METHODS Nineteen cases of placental tissue specimens during pregnancy were collected from June 2015 to February 2022 at Shanghai Public Health Clinical Center, the only inpatient center for pregnant women with TB in Shanghai, China. Hematoxylin-eosin staining, acid-fast staining, and molecular testing were applied to analyze them comprehensively in combination with clinical information. RESULTS Among the 19 cases, 7 cases caused intrauterine stillbirth, 3 cases received artificial abortion required by the pregnant woman, the other 9 cases received standard delivery and the infants survived, however, 3 of them were low-weight preterm infants, and another 1 case suffered mild intrauterine asphyxia. The 9 surviving infants were followed-up, of which 3 cases got congenital TB. For pathological characteristics of placental tissues under light microscopy, there were 3 cases of epithelioid granuloma formation, 13 cases of acute fetal membranitis, 4 cases of caseous necrosis, 7 cases of inflammatory necrosis, 10 cases of coagulative necrosis, and 6 cases with small focal calcifications. All placental tissues were positive for acid-fast staining and polymerase chain reaction (PCR). Molecular pathological diagnosis showed that 18 cases were positive for Mycobacterium tuberculosis, with 1 case not having received examination. CONCLUSIONS Combining acid-fast staining and molecular pathological testing is helpful for accurately diagnosing placental TB.
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Affiliation(s)
- Zhidong Hu
- Department of Scientific Research, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Dong Zeng
- Department of Pathology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Yuexiang Yang
- Department of Pathology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Huijun Liu
- Department of Pathology, The Fifth People's Hospital of Puyang, Puyang, Henan Province, China
| | - Ao Wang
- Department of Pathology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Duoduo Li
- Department of Pathology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Min Liu
- Department of Obstetrics and Gynecology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.
| | - Yanling Feng
- Department of Pathology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.
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Diel R, Nienhaus A. Risk of tuberculosis transmission by children to healthcare workers - a comprehensive review. GMS HYGIENE AND INFECTION CONTROL 2023; 18:Doc13. [PMID: 37405249 PMCID: PMC10316281 DOI: 10.3205/dgkh000439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
Background Healthcare workers (HCWs) are at increased risk of becoming infected with M. tuberculosis complex (Mtbc). Objective To assess the magnitude of Mtbc transmission by children under the age of 15 years to HCW. Methods Medline, Google Scholar and Cochrane library were searched to select primary studies in which a child was the presumed index case and exposed HCW were screened for latent TB infection (LTBI). Results Of 4,702 abstracts, 15 original case reports covering 16 children with TB were identified. In sum, 1,395 HCW were contact persons and underwent testing. Ten of the studies reported TST conversion, amounting to 35 (2.9%) of the 1,228 HCW tested. In three of the TST-based and both of the studies that used IGRA testing, conversion was absent. 12 of the 15 studies (80%) reported exposure of HCW in neonatal intensive units (NICUs) to premature infants suffering from congenital pulmonary TB. One study including two infants addressed possible pulmonary Mtbc transmission in a general pediatric ward. Extrapulmonary transmission by aerosolized Mtbc was suggested in two patients, an infant with tuberculous peritonitis and a 12-year-old adolescent with pleurisy, and culture-confirmed only after the child had undergone video-assisted thoracoscopic surgery. Routine use of protective facemasks by HCW before exposure was not mentioned in any of the included studies. Conclusions The results suggest that the risk of Mtbc transmission from children to HCW is low. Particular attention should be paid to infection risk during respiratory manipulations in NICUs. The consistent wearing of facemasks may further reduce the risk of Mtbc transmission.
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Affiliation(s)
- Roland Diel
- Institute for Epidemiology, University Medical Hospital Schleswig-Holstein, Kiel, Germany
- LungClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Albert Nienhaus
- Institute for Health Service Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW), Hamburg, Germany
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Zhang F, Zhang XF, Zhou HY. Clinical characteristics in 26 children with congenital tuberculosis in Central Southern China: a retrospective study. Paediatr Int Child Health 2022; 42:127-132. [PMID: 37587754 DOI: 10.1080/20469047.2023.2246006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 08/04/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Congenital tuberculosis (CTB) is relatively rare and most patients are described in case reports. AIM To investigate the clinical characteristics of CTB in 26 children. METHODS A retrospective analysis of 26 children with CTB from January 2013 to December 2021 in Changsha Central Hospital in Central Southern China was undertaken. RESULTS The median age at onset was 25 days (17-33) and within 4 weeks of age in approximately 73% of cases. Of 24 mothers (including two mothers of twins), 18 (75.0%) were asymptomatic during pregnancy, and four were diagnosed with tuberculosis prenatally. The numbers of tuberculous meningitis, tuberculous encephalitis and liver TB were 17 (65.4%), five (19.2%) and four (15.4%), respectively. The main symptoms were fever (n = 18, 69.2%) and cough (n = 16, 61.5%). Positive rates of T-SPOT.TB, acid-fast bacilli smear, culture of Mycobacterium tuberculosis and GeneXpert MTB/RIF test were, respectively, 84.2% (16/19), 42.3% (11/26), 43.5% (10/23) and 83.3% (5/6). Radiograph or computed tomography demonstrated typical pulmonary tuberculous lesions in all cases and the head magnetic resonance imaging (MRI) showed marked meningeal enhancement or parenchymal lesions in seven cases (26.9%). One case had drug-resistant TB. During follow-up, nine cases had varying degrees of liver injury, and one had delayed growth and development. Eight died and 18 recovered satisfactorily. CONCLUSION Maternal TB status during pregnancy, the epidemiological history, T-SPOT.TB and other TB-related aetiological tests and imaging are important for the early diagnosis and treatment of CTB, and are associated with a favourable outcome. ABBREVIATIONS AFB: acid-fast bacilli; Amk: amikacin; Cs: cycloserine; CT: computed tomography; E: ethambutol; GeneXpert MTB/RIF: GeneXpert Mycobacterium tuberculosis and rifampicin resistance; H: isoniazid; IVF-ET: in-vitro fertilization-embryo transfer; Lzd: linezolid; Mfx: moxifloxacin; MTB: Mycobacterium tuberculosis; mNGS: next generation sequencing; MTB-DNA: Mycobacterium tuberculosis-deoxyribonucleic acid; Pto: protionamide; R: rifampicin; TB: tuberculosis; T-SPOT.TB: spot test of mycobacterium TB infection T-lymphocytes; Z: pyrazinamide.
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Affiliation(s)
- Feng Zhang
- Department of Paediatric Tuberculosis, the Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
| | - Xiao-Fo Zhang
- Department of Paediatric Tuberculosis, the Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
| | - Hai-Yi Zhou
- Department of Paediatric Tuberculosis, the Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
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Matsuda A, Nishizaki N, Abe H, Mizutani A, Niizuma T, Obinata K, Oguma K, Makino S, Ishitate M, Shimizu T. An infant of 26 weeks gestation with congenital miliary tuberculosis complicated by chronic lung disease requiring CPAP was diagnosed on Day 104 of life: congenital tuberculosis was confirmed by detection of calcified ovaries in his mother. Paediatr Int Child Health 2022; 42:72-77. [PMID: 35588163 DOI: 10.1080/20469047.2022.2076030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Early diagnosis of tuberculosis (TB) in infants is important but is commonly missed because the symptoms are often non-specific. CASE PRESENTATION A Nepalese male infant born at 26 weeks gestation and weighing 1227 g (97th centile) was admitted to the neonatal intensive care unit (NICU) immediately after birth for the management of his prematurity. After extubation on Day 8, his oxygen saturation became unstable and he required nasal continuous positive airway pressure with oxygen for 3 months. On Day 104, further detailed evaluation was required because there was no improvement in his respiratory condition. A computed tomography (CT) scan demonstrated scattered miliary nodules in both lung fields. Acid-fast staining for the mycobacteria and TB polymerase chain reaction (PCR) of the sputum obtained directly by laryngeal aspiration confirmed Mycobacterium tuberculosis. On Day 105, he was therefore transferred to a tertiary care hospital for further intensive care. Pathology findings suggested placental involvement with TB owing to chronic endometrial infection. In addition, a maternal abdominal CT scan demonstrated bilateral calcified lesions in the ovaries. He completed antituberculous chemotherapy and was discharged 3 months later. At 18 months of age there are no sequelae and his development is almost normal. None of the infants or medical personnel who were exposed in the NICU developed secondary TB. CONCLUSION In neonates with persistent respiratory distress, neonatologists should consider TB infection as a differential diagnosis. ABBREVIATIONS CLD: chronic lung disease; CRP: C-reactive protein; CT: computed tomography; IGRA: interferon-γ release assay; IVF-ET: in vitro fertilisation-embryo transfer; N-CPAP: nasal continuous positive airway pressure; NICU: neonatal intensive care unit; PCR: polymerase chain reaction; PROM: premature rupture of membranes; TB: tuberculosis; WBC: white blood cells.
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Affiliation(s)
- Akina Matsuda
- Department of Paediatrics, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Naoto Nishizaki
- Department of Paediatrics, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Hanako Abe
- Department of Paediatrics, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Akira Mizutani
- Department of Paediatrics, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Takahiro Niizuma
- Department of Paediatrics, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Kaoru Obinata
- Department of Paediatrics, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Kyoko Oguma
- Department of Obstetrics and Gynaecology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Shintaro Makino
- Department of Obstetrics and Gynaecology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Makoto Ishitate
- Department of Respiratory Diseases, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Toshiaki Shimizu
- Department of Paediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
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Liu L, Wu FY, Zhu CY, Zou HY, Kong RQ, Ma YK, Su D, Song GQ, Zhang Y, Liu KC. Involvement of dopamine signaling pathway in neurodevelopmental toxicity induced by isoniazid in zebrafish. CHEMOSPHERE 2021; 265:129109. [PMID: 33280847 DOI: 10.1016/j.chemosphere.2020.129109] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/02/2020] [Accepted: 11/22/2020] [Indexed: 06/12/2023]
Abstract
AIMS This study evaluated the neurodevelopmental toxicity of isoniazid (INH) in zebrafish embryos and the underlying mechanism. METHODS Zebrafish embryos were exposed to different concentrations (2 mM, 4 mM, 8 mM, 16 mM, 32 mM) INH for 120 hpf. During the exposure period, the percentage of embryo/larva mortality, hatching, and morphological malformation were checked every 24 h until 120 hpf. The development of blood vessels in the brain was observed at 72 hpf and 120 hpf, and behavioral capacity and acridine orange (AO) staining were measured at 120 hpf. Alterations in the mRNA expression of apoptosis and dopamine signaling pathway related genes were assessed by real-time quantitative PCR (qPCR). RESULTS INH considerably inhibited zebrafish embryo hatching and caused zebrafish larval malformation (such as brain malformation, delayed yolk sac absorption, spinal curvature, pericardial edema, and swim bladder defects). High concentration of INH (16 mM, 32 mM) even induced death of zebrafish. In addition, INH exposure markedly restrained the ability of the zebrafish autonomous movement, shortened the length of dopamine neurons and inhibited vascular development in the brain. No obvious apoptotic cells were observed in the control group, whereas considerable numbers of apoptotic cells appeared in the head of INH-treated larvae at 120 hpf. PCR results indicated that INH significantly raised the transcription levels of caspase-3, -8, -9, and bax and significantly decreased bcl-2 and bcl-2/bax in the zebrafish apoptotic signaling pathway. INH also markedly decreased the genes related to dopamine signaling pathway (th1, dat, drd1, drd2a, drd3, and drd4b). CONCLUSIONS Experimental results indicated that INH had obvious neurodevelopmental toxicity in zebrafish. Persistent exposure to INH for 120 h caused apoptosis, decreased dopaminergic gene expression, altered vasculature, and reduced behaviors.
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Affiliation(s)
- Li Liu
- School of Pharmacy, Changzhou University, Changzhou, Jiangsu Province, PR China
| | - Fang-Yan Wu
- School of Pharmacy, Changzhou University, Changzhou, Jiangsu Province, PR China; Biology Institute, Qilu University of Technology (Shandong Academy of Sciences), Jinan, Shandong Province, PR China; Engineering Research Center of Zebrafish Models for Human Diseases and Drug Screening of Shandong Province, Jinan, Shandong Province, PR China
| | - Cheng-Yue Zhu
- Biology Institute, Qilu University of Technology (Shandong Academy of Sciences), Jinan, Shandong Province, PR China; Engineering Research Center of Zebrafish Models for Human Diseases and Drug Screening of Shandong Province, Jinan, Shandong Province, PR China
| | - Hong-Yuan Zou
- Biology Institute, Qilu University of Technology (Shandong Academy of Sciences), Jinan, Shandong Province, PR China; Engineering Research Center of Zebrafish Models for Human Diseases and Drug Screening of Shandong Province, Jinan, Shandong Province, PR China
| | - Rui-Qi Kong
- Biology Institute, Qilu University of Technology (Shandong Academy of Sciences), Jinan, Shandong Province, PR China; Engineering Research Center of Zebrafish Models for Human Diseases and Drug Screening of Shandong Province, Jinan, Shandong Province, PR China
| | - Yu-Kui Ma
- Shandong Academy of Pharmaceutical Sciences, Jinan, Shandong Province, PR China
| | - Dan Su
- Department of Pharmacy, Changzhou No.2 People's Hospital, The Affiliated Hospital of Nanjing Medical University, Changzhou, Jiangsu Province, PR China
| | - Guo-Qiang Song
- School of Pharmacy, Changzhou University, Changzhou, Jiangsu Province, PR China
| | - Yun Zhang
- Biology Institute, Qilu University of Technology (Shandong Academy of Sciences), Jinan, Shandong Province, PR China; Engineering Research Center of Zebrafish Models for Human Diseases and Drug Screening of Shandong Province, Jinan, Shandong Province, PR China.
| | - Ke-Chun Liu
- Biology Institute, Qilu University of Technology (Shandong Academy of Sciences), Jinan, Shandong Province, PR China; Engineering Research Center of Zebrafish Models for Human Diseases and Drug Screening of Shandong Province, Jinan, Shandong Province, PR China.
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Ryu BH, Baek EH, Kim DH, Kim SE, Kim HJ, Cho OH, Hong SI, Do HJ, Park CH. Preterm Twins Born to a Mother with Miliary Tuberculosis: Importance of Early Recognition and Prompt Response in Infection Control to Manage Congenital Tuberculosis Exposure in a Neonatal Intensive Care Unit. Jpn J Infect Dis 2020; 74:97-101. [PMID: 32741929 DOI: 10.7883/yoken.jjid.2020.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Delayed diagnosis of congenital tuberculosis (TB) in the neonatal intensive care unit (NICU) is a serious problem in terms of infection control. Here, we report our preemptive infection control activities implemented after the diagnosis of miliary TB in a mother of preterm twins (index twins, NB1 and NB2) in the NICU. In addition, we reviewed previous case reports of congenital TB exposure in the NICU setting. Immediately after diagnosing miliary TB in the mother, the index twins were isolated before their TB diagnosis and received preemptive anti-TB medication; contact investigations were also conducted. Eventually, NB1 was diagnosed with congenital TB at 29 days of age, and NB2 showed no definite evidence of TB. Through contact investigation, 11 of the 16 exposed infants received isoniazid prophylaxis and no positive tuberculin skin test results were obtained after 3 months. One of the 31 exposed healthcare workers showed new interferon-gamma release assay conversion. Moreover, our case showed a much shorter contagious period compared to that in previous reports (8 versus 17-102 days). This suggests that a high index of suspicion and prompt measures can help prevent congenital TB outbreaks and reduce the burden of infection control activities in the NICU.
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Affiliation(s)
- Byung-Han Ryu
- Department of Infectious Diseases, Gyeongsang National University Changwon Hospital, Republic of Korea
| | - Eun-Hwa Baek
- Infection Control Office, Gyeongsang National University Changwon Hospital, Republic of Korea
| | - Da-Hye Kim
- Infection Control Office, Gyeongsang National University Changwon Hospital, Republic of Korea
| | - Se-Eun Kim
- Infection Control Office, Gyeongsang National University Changwon Hospital, Republic of Korea
| | - Hyun-Ju Kim
- Infection Control Office, Gyeongsang National University Changwon Hospital, Republic of Korea
| | - Oh-Hyun Cho
- Department of Infectious Diseases, Gyeongsang National University Changwon Hospital, Republic of Korea
| | - Sun In Hong
- Department of Infectious Diseases, Gyeongsang National University Changwon Hospital, Republic of Korea
| | - Hyun-Jeong Do
- Department of Pediatrics, Gyeongsang National University Changwon Hospital, Republic of Korea
| | - Chan-Hoo Park
- Department of Pediatrics, Gyeongsang National University Changwon Hospital, Republic of Korea
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