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Published in: BMC Infectious Diseases 1/2021

Open Access 01-12-2021 | Expectoration | Research article

Direct detection of Corynebacterium striatum, Corynebacterium propinquum, and Corynebacterium simulans in sputum samples by high-resolution melt curve analysis

Authors: Shuai Xu, Xiaotong Qiu, Xuexin Hou, Haijian Zhou, Dongke Chen, Xuebing Wang, Lichao Han, Dan Li, Lina Sun, Xingzhao Ji, Minghui Li, Jingshan Zhang, Mengtong Li, Zhenjun Li

Published in: BMC Infectious Diseases | Issue 1/2021

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Abstract

Background

Pulmonary infections caused by non-diphtheriae corynebacteria are increasing. However, rapid identification of Corynebacterium species poses a challenge due to the low genetic variation within the genus.

Methods

Three reference strains and 99 clinical isolates were used in this study. A qPCR followed by high-resolution melting (HRM) targeting ssrA was performed to simultaneously identify C. striatum, C. propinquum and C. simulans. To further evaluate this assay’s performance, 88 clinical sputum samples were tested by HRM and the detection results were compared with those of the traditional culture method and multiple cross-displacement amplification (MCDA) assay.

Results

The melting curve produced by a pair of universal primers generated species-specific HRM curve profiles and could distinguish the three target species from other related bacteria. The limit of detection of HRM assay for DNA from the three purified Corynebacterium species was 100 fg. Compared with the culture method, HRM detected 22 additional positive specimens, representing a 23.9% relative increase in detection rate. The HRM assay had 98.4% (95% confidence interval [CI], 90.5–99.9%) sensitivity and 100% (95% CI, 82.8–100%) specificity. Additionally, 95.5% concordance between HRM and MCDA (κ = 0.89 [95% CI, 0.79–0.99]) was noted.

Conclusions

The HRM assay was a simple, rapid, sensitive, and specific diagnostic tool for detecting C. striatum, C. propinquum, and C. simulans, with the potential to contribute to early diagnosis, epidemiological surveillance, and rapid response to outbreak.
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Literature
1.
go back to reference Neemuchwala A, Soares D, Ravirajan V, Marchand-Austin A, Kus JV, Patel SN. In vitro antibiotic susceptibility pattern of non-diphtheriae Corynebacterium isolates in Ontario, Canada, from 2011 to 2016. Antimicrob Agents Chemother. 2018;62:e01776.CrossRef Neemuchwala A, Soares D, Ravirajan V, Marchand-Austin A, Kus JV, Patel SN. In vitro antibiotic susceptibility pattern of non-diphtheriae Corynebacterium isolates in Ontario, Canada, from 2011 to 2016. Antimicrob Agents Chemother. 2018;62:e01776.CrossRef
2.
go back to reference Verroken A, Bauraing C, Deplano A, Bogaerts P, Huang D, Wauters G, et al. Epidemiological investigation of a nosocomial outbreak of multidrug-resistant Corynebacterium striatum at one Belgian university hospital. Clin Microbiol Infect. 2014;20:44.CrossRef Verroken A, Bauraing C, Deplano A, Bogaerts P, Huang D, Wauters G, et al. Epidemiological investigation of a nosocomial outbreak of multidrug-resistant Corynebacterium striatum at one Belgian university hospital. Clin Microbiol Infect. 2014;20:44.CrossRef
3.
go back to reference Wang J, Wang Y, Du X, Cui J, Wang K, Zhang L, et al. Rapid transmission of multidrug-resistant Corynebacterium striatum among susceptible patients in a tertiary hospital in China. J Infect Dev Ctries. 2016;10:1299.CrossRef Wang J, Wang Y, Du X, Cui J, Wang K, Zhang L, et al. Rapid transmission of multidrug-resistant Corynebacterium striatum among susceptible patients in a tertiary hospital in China. J Infect Dev Ctries. 2016;10:1299.CrossRef
4.
go back to reference Renom F, Garau M, Rubi M, Ramis F, Galmes A, Soriano JB. Nosocomial outbreak of Corynebacterium striatum infection in patients with chronic obstructive pulmonary disease. J Clin Microbiol. 2017;45:2064.CrossRef Renom F, Garau M, Rubi M, Ramis F, Galmes A, Soriano JB. Nosocomial outbreak of Corynebacterium striatum infection in patients with chronic obstructive pulmonary disease. J Clin Microbiol. 2017;45:2064.CrossRef
5.
go back to reference Nhan TX, Parienti JJ, Badiou G, Leclercq R, Cattoir V. Microbiological investigation and clinical significance of Corynebacterium spp in respiratory specimens. Diagn Microbiol Infect Dis. 2012;74:236.CrossRef Nhan TX, Parienti JJ, Badiou G, Leclercq R, Cattoir V. Microbiological investigation and clinical significance of Corynebacterium spp in respiratory specimens. Diagn Microbiol Infect Dis. 2012;74:236.CrossRef
6.
go back to reference Díez-Aguilar M, Ruiz-Garbajosa P, Fernández-Olmos A, Guisado P, Campo R, Quereda C, et al. Non-diphtheriae Corynebacterium species: an emerging respiratory pathogen. Eur J Clin Microbiol Infect Dis. 2013;32:769.CrossRef Díez-Aguilar M, Ruiz-Garbajosa P, Fernández-Olmos A, Guisado P, Campo R, Quereda C, et al. Non-diphtheriae Corynebacterium species: an emerging respiratory pathogen. Eur J Clin Microbiol Infect Dis. 2013;32:769.CrossRef
7.
go back to reference Hahn WO, Werth BJ, Butler-Wu SM, Rakita RM. Multidrug-resistant Corynebacterium striatum associated with increased use of parenteral antimicrobial drugs. Emerg Infect Dis. 2016;22(11):1908–14. Hahn WO, Werth BJ, Butler-Wu SM, Rakita RM. Multidrug-resistant Corynebacterium striatum associated with increased use of parenteral antimicrobial drugs. Emerg Infect Dis. 2016;22(11):1908–14.
8.
go back to reference McMullen AR, Anderson N, Wallace MA, Shupe A, Burnham C-AD. When good bugs go bad: epidemiology and antimicrobial resistance profiles of Corynebacterium striatum, an emerging multidrug-resistant, Opportunistic Pathogen. Antimicrob Agents Chemother. 2017;61:e01111.CrossRef McMullen AR, Anderson N, Wallace MA, Shupe A, Burnham C-AD. When good bugs go bad: epidemiology and antimicrobial resistance profiles of Corynebacterium striatum, an emerging multidrug-resistant, Opportunistic Pathogen. Antimicrob Agents Chemother. 2017;61:e01111.CrossRef
9.
go back to reference Alibi S, Ferjani A, Boukadida J, Cano ME, Fernandez-Martinez M, Martinez-Martinez L, et al. Occurrence of Corynebacterium striatum as an emerging antibiotic-resistant nosocomial pathogen in a Tunisian hospital. Sci Rep. 2017;7:9704.CrossRef Alibi S, Ferjani A, Boukadida J, Cano ME, Fernandez-Martinez M, Martinez-Martinez L, et al. Occurrence of Corynebacterium striatum as an emerging antibiotic-resistant nosocomial pathogen in a Tunisian hospital. Sci Rep. 2017;7:9704.CrossRef
10.
go back to reference Campanile F, Carretto E, Barbarini D, Grigis A, Falcone M, Goglio A, et al. Clonal multidrug-resistant Corynebacterium striatum strains, Italy. Emerg Infect Dis. 2009;15:75.CrossRef Campanile F, Carretto E, Barbarini D, Grigis A, Falcone M, Goglio A, et al. Clonal multidrug-resistant Corynebacterium striatum strains, Italy. Emerg Infect Dis. 2009;15:75.CrossRef
11.
go back to reference Hinic V, Lang C, Weisser M, Straub C, Frei R, Goldenberger D. Corynebacterium tuberculostearicum: a potentially misidentified and multiresistant Corynebacterium species isolated from clinical specimens. J Clin Microbiol. 2012;50:2561.CrossRef Hinic V, Lang C, Weisser M, Straub C, Frei R, Goldenberger D. Corynebacterium tuberculostearicum: a potentially misidentified and multiresistant Corynebacterium species isolated from clinical specimens. J Clin Microbiol. 2012;50:2561.CrossRef
12.
go back to reference Santos AS, Ramos RT, Silva A, Hirata R, Mattos-Guaraldi AL, Meyer R, et al. Searching whole genome sequences for biochemical identification features of emerging and reemerging pathogenic Corynebacterium species. Funct Integr Genomics. 2018;18:593.CrossRef Santos AS, Ramos RT, Silva A, Hirata R, Mattos-Guaraldi AL, Meyer R, et al. Searching whole genome sequences for biochemical identification features of emerging and reemerging pathogenic Corynebacterium species. Funct Integr Genomics. 2018;18:593.CrossRef
13.
go back to reference Alibi S, Ferjani A, Gaillot O, Marzouk M, Courcol R, Boukadida J. Identification of clinically relevant Corynebacterium strains by Api Coryne, MALDI-TOF-mass spectrometry and molecular approaches. Pathol Biol. 2015;63:153.CrossRef Alibi S, Ferjani A, Gaillot O, Marzouk M, Courcol R, Boukadida J. Identification of clinically relevant Corynebacterium strains by Api Coryne, MALDI-TOF-mass spectrometry and molecular approaches. Pathol Biol. 2015;63:153.CrossRef
14.
go back to reference Bernard K. The genus Corynebacterium and other medically relevant coryneform-like bacteria. J Clin Microbiol. 2012;50:3152.CrossRef Bernard K. The genus Corynebacterium and other medically relevant coryneform-like bacteria. J Clin Microbiol. 2012;50:3152.CrossRef
15.
go back to reference Khamis A, Raoult D, La Scola B. Comparison between rpoB and 16S rRNA gene sequencing for molecular identification of 168 clinical isolates of Corynebacterium. J Clin Microbiol. 2005;43:1934.CrossRef Khamis A, Raoult D, La Scola B. Comparison between rpoB and 16S rRNA gene sequencing for molecular identification of 168 clinical isolates of Corynebacterium. J Clin Microbiol. 2005;43:1934.CrossRef
16.
go back to reference Khamis A, Raoult D, La Scola B. rpoB gene sequencing for identification of Corynebacterium species. J Clin Microbiol. 2004;42:3925.CrossRef Khamis A, Raoult D, La Scola B. rpoB gene sequencing for identification of Corynebacterium species. J Clin Microbiol. 2004;42:3925.CrossRef
17.
go back to reference Santos CS, Ramos JN, Vieira VV, Pinheiro CS, Meyer R, Alcantara-Neves NM, et al. Efficient differentiation of Corynebacterium striatum, Corynebacterium amycolatum and Corynebacterium xerosis clinical isolates by multiplex PCR using novel species-specific primers. J Microbiol Methods. 2017;142:33.CrossRef Santos CS, Ramos JN, Vieira VV, Pinheiro CS, Meyer R, Alcantara-Neves NM, et al. Efficient differentiation of Corynebacterium striatum, Corynebacterium amycolatum and Corynebacterium xerosis clinical isolates by multiplex PCR using novel species-specific primers. J Microbiol Methods. 2017;142:33.CrossRef
18.
go back to reference Reed GH, Kent JO, Wittwer CT. High-resolution DNA melting analysis for simple and efficient molecular diagnostics. Pharmacogenomics. 2007;8:597.CrossRef Reed GH, Kent JO, Wittwer CT. High-resolution DNA melting analysis for simple and efficient molecular diagnostics. Pharmacogenomics. 2007;8:597.CrossRef
19.
go back to reference Talmi-Frank D, Nasereddin A, Schnur LF, Schonian G, Toz SO, Jaffe CL, et al. Detection and identification of old world Leishmania by high resolution melt analysis. Plos Negl Trop Dis. 2010;4:e581.CrossRef Talmi-Frank D, Nasereddin A, Schnur LF, Schonian G, Toz SO, Jaffe CL, et al. Detection and identification of old world Leishmania by high resolution melt analysis. Plos Negl Trop Dis. 2010;4:e581.CrossRef
20.
go back to reference Papavasileiou A, Madesis PB, Karaoglanidis GS. Identification and differentiation of Monilinia species causing Brown rot of pome and stone fruit using high-resolution melting (HRM) analysis. Phytopathology. 2016;106:1055.CrossRef Papavasileiou A, Madesis PB, Karaoglanidis GS. Identification and differentiation of Monilinia species causing Brown rot of pome and stone fruit using high-resolution melting (HRM) analysis. Phytopathology. 2016;106:1055.CrossRef
21.
go back to reference Winchell JM, Wolff BJ, Tiller R, Bowen MD, Hoffmaster AR. Rapid identification and discrimination of Brucella isolates by use of real-time PCR and high-resolution melt analysis. J Clin Microbiol. 2010;48:697.CrossRef Winchell JM, Wolff BJ, Tiller R, Bowen MD, Hoffmaster AR. Rapid identification and discrimination of Brucella isolates by use of real-time PCR and high-resolution melt analysis. J Clin Microbiol. 2010;48:697.CrossRef
22.
go back to reference Khosravi AD, Hashemzadeh M, Hashemi Shahraki A, Teimoori A. Differential identification of Mycobacterial species using high-resolution melting analysis. Front Microbiol. 2017;8:2045.CrossRef Khosravi AD, Hashemzadeh M, Hashemi Shahraki A, Teimoori A. Differential identification of Mycobacterial species using high-resolution melting analysis. Front Microbiol. 2017;8:2045.CrossRef
23.
go back to reference Sun Y, Cheng Y, Lin P, Zhang H, Yi L, Tong M, et al. Simultaneous detection and differentiation of Canine parvovirus and Feline parvovirus by high resolution melting analysis. BMC Vet Res. 2019;15:141.CrossRef Sun Y, Cheng Y, Lin P, Zhang H, Yi L, Tong M, et al. Simultaneous detection and differentiation of Canine parvovirus and Feline parvovirus by high resolution melting analysis. BMC Vet Res. 2019;15:141.CrossRef
24.
go back to reference Schonhuber W, Le Bourhis G, Tremblay J, Amann R, Kulakauskas S. Utilization of tmRNA sequences for bacterial identification. BMC Microbiol. 2001;1:20.CrossRef Schonhuber W, Le Bourhis G, Tremblay J, Amann R, Kulakauskas S. Utilization of tmRNA sequences for bacterial identification. BMC Microbiol. 2001;1:20.CrossRef
25.
go back to reference Qiu X, Chen D, Wang X, Zhou H, Hou X, Zhang J, et al. A novel isothermal amplification-based method for detection of Corynebacterium striatum. J Microbiol Methods. 2019;164:105675.CrossRef Qiu X, Chen D, Wang X, Zhou H, Hou X, Zhang J, et al. A novel isothermal amplification-based method for detection of Corynebacterium striatum. J Microbiol Methods. 2019;164:105675.CrossRef
26.
go back to reference Zhao F, Niu L, Yan L, Nong J, Wang C, Jing W, et al. Establishment and application of multiple cross displacement amplification coupled with lateral flow biosensor (MCDA-LFB) for visual and rapid detection of Candida albicans in clinical samples. Front Cell Infect Microbiol. 2019;9:102.CrossRef Zhao F, Niu L, Yan L, Nong J, Wang C, Jing W, et al. Establishment and application of multiple cross displacement amplification coupled with lateral flow biosensor (MCDA-LFB) for visual and rapid detection of Candida albicans in clinical samples. Front Cell Infect Microbiol. 2019;9:102.CrossRef
27.
go back to reference Watson PF, Petrie A. Method agreement analysis: a review of correct methodology. Theriogenology. 2010;73:1167.CrossRef Watson PF, Petrie A. Method agreement analysis: a review of correct methodology. Theriogenology. 2010;73:1167.CrossRef
28.
go back to reference Shin JH, Pride DT. Comparison of three nucleic acid amplification tests and culture for detection of group B Streptococcus from enrichment broth. J Clin Microbiol. 2019;57:e01958.CrossRef Shin JH, Pride DT. Comparison of three nucleic acid amplification tests and culture for detection of group B Streptococcus from enrichment broth. J Clin Microbiol. 2019;57:e01958.CrossRef
29.
go back to reference Goodrich JS, Miller MB. Comparison of culture and 2 real-time polymerase chain reaction assays to detect group B Streptococcus during antepartum screening. Diagn Microbiol Infect Dis. 2007;59:17.CrossRef Goodrich JS, Miller MB. Comparison of culture and 2 real-time polymerase chain reaction assays to detect group B Streptococcus during antepartum screening. Diagn Microbiol Infect Dis. 2007;59:17.CrossRef
30.
go back to reference Miller SA, Deak E, Humphries R. Comparison of the AmpliVue, BD max system, and illumigene molecular assays for detection of group B Streptococcus in antenatal screening specimens. J Clin Microbiol. 2015;53:1938.CrossRef Miller SA, Deak E, Humphries R. Comparison of the AmpliVue, BD max system, and illumigene molecular assays for detection of group B Streptococcus in antenatal screening specimens. J Clin Microbiol. 2015;53:1938.CrossRef
31.
go back to reference Baio PVP, Mota HF, Freitas AD, Gomes DLR, Ramos JN, Sant’Anna LO, et al. Clonal multidrug-resistant Corynebacterium striatum within a nosocomial environment, Rio de Janeiro, Brazil. Mem Inst Oswaldo Cruz. 2013;108:23.CrossRef Baio PVP, Mota HF, Freitas AD, Gomes DLR, Ramos JN, Sant’Anna LO, et al. Clonal multidrug-resistant Corynebacterium striatum within a nosocomial environment, Rio de Janeiro, Brazil. Mem Inst Oswaldo Cruz. 2013;108:23.CrossRef
32.
go back to reference Boltin D, Katzir M, Bugoslavsky V, Yalashvili I, Brosh-Nissimov T, Fried M, et al. Corynebacterium striatum—a classic pathogen eluding diagnosis. Eur J Intern Med. 2009;20:e49.CrossRef Boltin D, Katzir M, Bugoslavsky V, Yalashvili I, Brosh-Nissimov T, Fried M, et al. Corynebacterium striatum—a classic pathogen eluding diagnosis. Eur J Intern Med. 2009;20:e49.CrossRef
33.
go back to reference Alatoom AA, Cazanave CJ, Cunningham SA, Ihde SM, Patel R. Identification of non-diphtheriae Corynebacterium by use of matrix-assisted laser desorption ionization-time of flight mass spectrometry. J Clin Microbiol. 2012;50:160.CrossRef Alatoom AA, Cazanave CJ, Cunningham SA, Ihde SM, Patel R. Identification of non-diphtheriae Corynebacterium by use of matrix-assisted laser desorption ionization-time of flight mass spectrometry. J Clin Microbiol. 2012;50:160.CrossRef
34.
go back to reference Gomila M, Renom F, Gallegos M del C, Garau M, Guerrero D, Soriano JB, et al. Identification and diversity of multiresistant Corynebacterium striatum clinical isolates by MALDI-TOF mass spectrometry and by a multigene sequencing approach. BMC Microbiol 2012;12:52. Gomila M, Renom F, Gallegos M del C, Garau M, Guerrero D, Soriano JB, et al. Identification and diversity of multiresistant Corynebacterium striatum clinical isolates by MALDI-TOF mass spectrometry and by a multigene sequencing approach. BMC Microbiol 2012;12:52.
35.
go back to reference Los-Arcos I, Len O, Martin-Gomez MT, Baroja A, Berastegui C, Deu M, et al. Clinical characteristics and outcome of lung transplant recipients with respiratory isolation of Corynebacterium spp. J Clin Microbiol. 2018;56. Los-Arcos I, Len O, Martin-Gomez MT, Baroja A, Berastegui C, Deu M, et al. Clinical characteristics and outcome of lung transplant recipients with respiratory isolation of Corynebacterium spp. J Clin Microbiol. 2018;56.
36.
go back to reference Wattiau P, Janssens M, Wauters G. Corynebacterium simulans sp. nov., a non-lipophilic, fermentative Corynebacterium. Int J Syst Evol Microbiol. 2000;50:347–53.CrossRef Wattiau P, Janssens M, Wauters G. Corynebacterium simulans sp. nov., a non-lipophilic, fermentative Corynebacterium. Int J Syst Evol Microbiol. 2000;50:347–53.CrossRef
37.
go back to reference Wang Y, Li H, Wang Y, Li H, Luo L, Xu J, et al. Development of multiple cross displacement amplification label-based gold nanoparticles lateral flow biosensor for detection of Listeria monocytogenes. Int J Nanomedicine. 2017;12:473–86. Wang Y, Li H, Wang Y, Li H, Luo L, Xu J, et al. Development of multiple cross displacement amplification label-based gold nanoparticles lateral flow biosensor for detection of Listeria monocytogenes. Int J Nanomedicine. 2017;12:473–86.
38.
go back to reference Prats-Sánchez I, Soler-Sempere MJ, Sánchez-Hellín V. Chronic obstructive pulmonary disease exacerbation by Corynebacterium propinquum. Arch Bronconeumol. 2015;51:154–5.CrossRef Prats-Sánchez I, Soler-Sempere MJ, Sánchez-Hellín V. Chronic obstructive pulmonary disease exacerbation by Corynebacterium propinquum. Arch Bronconeumol. 2015;51:154–5.CrossRef
39.
go back to reference Malkoçoğlu G, Gencer H, Kaya A, Dalgıç N, Bulut ME, Aktaş E. Corynebacterium propinquum bronchopneumonia in a child with ataxia telangiectasia. TurkJPediatr. 2016;58:558.CrossRef Malkoçoğlu G, Gencer H, Kaya A, Dalgıç N, Bulut ME, Aktaş E. Corynebacterium propinquum bronchopneumonia in a child with ataxia telangiectasia. TurkJPediatr. 2016;58:558.CrossRef
40.
go back to reference Shariff M, Aditi A, Beri K. Corynebacterium striatum: an emerging respiratory pathogen. J Infect Dev Ctries. 2018;12:581–6.CrossRef Shariff M, Aditi A, Beri K. Corynebacterium striatum: an emerging respiratory pathogen. J Infect Dev Ctries. 2018;12:581–6.CrossRef
41.
go back to reference Iaria C, Stassi G, Costa GB, Biondo C, Gerace E, Noto A, et al. Outbreak of multi-resistant Corynebacterium striatum infection in an Italian general intensive care unit. J Hosp Infect. 2007;67:102.CrossRef Iaria C, Stassi G, Costa GB, Biondo C, Gerace E, Noto A, et al. Outbreak of multi-resistant Corynebacterium striatum infection in an Italian general intensive care unit. J Hosp Infect. 2007;67:102.CrossRef
42.
go back to reference Nagassar RP, Nicholson AM, Williams W, Bridgelal-Nagassar RJ. Diphtheroids as a cause of endocarditis in a haemodialysis patient. BMJ Case Rep. 2012;8:bcr1020114894. Nagassar RP, Nicholson AM, Williams W, Bridgelal-Nagassar RJ. Diphtheroids as a cause of endocarditis in a haemodialysis patient. BMJ Case Rep. 2012;8:bcr1020114894.
43.
go back to reference Cazanave C, Greenwood-Quaintance KE, Hanssen AD, Patel R. Corynebacterium prosthetic joint infection. J Clin Microbiol. 2012;50:1518–23.CrossRef Cazanave C, Greenwood-Quaintance KE, Hanssen AD, Patel R. Corynebacterium prosthetic joint infection. J Clin Microbiol. 2012;50:1518–23.CrossRef
44.
go back to reference Ogasawara M, Matsuhisa T, Kondo T, Oshima R, Sugiura F, Niwa T. Pyogenic spondylitis with acute course caused by Corynebacterium simulans. J Infect Chemother. 2020;26:294–7.CrossRef Ogasawara M, Matsuhisa T, Kondo T, Oshima R, Sugiura F, Niwa T. Pyogenic spondylitis with acute course caused by Corynebacterium simulans. J Infect Chemother. 2020;26:294–7.CrossRef
45.
go back to reference Mandviwala T, Shinde R, Kalra A, Sobel JD, Akins RA. High-throughput identification and quantification of Candida species using high resolution derivative melt analysis of panfungal amplicons. J Mol Diagn. 2010;12:91.CrossRef Mandviwala T, Shinde R, Kalra A, Sobel JD, Akins RA. High-throughput identification and quantification of Candida species using high resolution derivative melt analysis of panfungal amplicons. J Mol Diagn. 2010;12:91.CrossRef
Metadata
Title
Direct detection of Corynebacterium striatum, Corynebacterium propinquum, and Corynebacterium simulans in sputum samples by high-resolution melt curve analysis
Authors
Shuai Xu
Xiaotong Qiu
Xuexin Hou
Haijian Zhou
Dongke Chen
Xuebing Wang
Lichao Han
Dan Li
Lina Sun
Xingzhao Ji
Minghui Li
Jingshan Zhang
Mengtong Li
Zhenjun Li
Publication date
01-12-2021
Publisher
BioMed Central
Keyword
Expectoration
Published in
BMC Infectious Diseases / Issue 1/2021
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/s12879-020-05633-z

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