Skip to main content

Advertisement

SpringerLink
Log in

Odontogenic infections in the antibiotic era: approach to diagnosis, management, and prevention

  • Review
  • Published:
Infection Aims and scope Submit manuscript

Abstract

Purpose

The prevalence of odontogenic infections remains one of the highest in the world. If untreated, odontogenic infections can break through the limitation, disseminate to other organs or spaces, and cause high mortality rates. However, it is still difficult to rapidly target limited or disseminated infections in clinical practice. The type of disseminated odontogenic infections and the responsible bacteria have not been described in detail.

Methods

Search databases (e.g., PubMed, MEDLINE, Web of Science, Embase) for reports published from 2018.1 to 2022.9. Use search strategies: (“odontogenic infections” OR “pulpitis” OR “periapical lesions” OR “periodontal diseases”) AND (“disseminated infections” OR “complication”).

Results

Fourteen different types of disseminated odontogenic infections, most of which are polymicrobial infections, can spread through the body either direct or through hematogenous diffusion. Multiple microbial infections can be more invasive in the transmission of infection. Secondary infections are commonly associated with bacteria like Fusobacterium spp., Streptococcus spp., Peptostreptococcus spp., Prevotella spp., and Staphylococcus spp. Antibiotics with broad-spectrum activity are fundamental as first-line antimicrobial agents based on the microorganisms isolated from disseminated infections.

Conclusion

This review elaborates on the epidemiology, microorganisms, risk factors, and dissemination routes, and provides evidence-based opinions on the diagnosis, multidisciplinary management, and prevention of odontogenic infections for dentists and clinicians.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Data availability

The authors confirm that the data supporting the findings of this study are available within its supplementary material.

References

  1. Sittitrai P, Srivanitchapoom C, Reunmakkaew D. Deep neck infection in patients with and without human immunodeficiency virus: a comparison of clinical features, complications, and outcomes. Brit J Oral Max Surg. 2018;56:962–7. https://doi.org/10.1016/j.bjoms.2018.11.004.

    Article  CAS  Google Scholar 

  2. Kitamura S. Anatomy of the fasciae and fascial spaces of the maxillofacial and the anterior neck regions. Anat Sci Int. 2018;93:1–13. https://doi.org/10.1007/s12565-017-0394-x.

    Article  PubMed  Google Scholar 

  3. Velhonoja J, Lääveri M, Soukka T, Irjala H, Kinnunen I. Deep neck space infections: an upward trend and changing characteristics. Eur Arch Oto-rhino-l. 2020;277:863–72. https://doi.org/10.1007/s00405-019-05742-9.

    Article  Google Scholar 

  4. Šutej I, Peroš K, Trkulja V, Rudež I, Barić D, Alajbeg I, et al. The epidemiological and clinical features of odontogenic infective endocarditis. Eur J Clin Microbiol Infect Dis. 2020;39:637–45. https://doi.org/10.1007/s10096-019-03766-x.

    Article  PubMed  Google Scholar 

  5. Escobedo MF, Junquera LM, Megias J, García-San-Narciso L, Fernández MJ, Junquera S. Mediastinitis of odontogenic origin. A serious complication with 80 years of history. Br J Oral Maxillofac Surg. 2021;59:683–9. https://doi.org/10.1016/j.bjoms.2020.09.004.

    Article  CAS  PubMed  Google Scholar 

  6. Ogle OE. Odontogenic infections. Dent Clin N Am. 2017;61:235–52. https://doi.org/10.1016/j.cden.2016.11.004.

    Article  PubMed  Google Scholar 

  7. Li X, Kolltveit KM, Tronstad L, Olsen I. Systemic diseases caused by oral infection. Clin Microbiol Rev. 2000;13:547–58. https://doi.org/10.1128/CMR.13.4.547.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Qian Y, Ge Q, Zuo W, Cheng X, Xing D, Yang J, et al. Maxillofacial space infection experience and risk factors: a retrospective study of 222 cases. Ir J Med Sci. 2021;190:1045–53. https://doi.org/10.1007/s11845-020-02431-z.

    Article  PubMed  Google Scholar 

  9. Chen S, Chin S, Wang Y, Ho C. Factors affecting patients with concurrent deep neck infection and cervical necrotizing fasciitis. Diagnostics. 2022;12:443. https://doi.org/10.3390/diagnostics12020443.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Shin J, Kim S, Lee H, Park ITCT. Changing trends in the clinical characteristics and treatment strategies for odontogenic sinusitis over the past 10 years. Ear Nose Throat J. 2022. https://doi.org/10.1177/01455613221080918.

    Article  PubMed  Google Scholar 

  11. Lou Y, Feng B, Hong H, Ying B, Yu M, Wang H. Skull base sphenoid bone: a potential route of brain abscesses induced by odontogenic infection. J Craniofac Surg. 2021;32:e32–4. https://doi.org/10.1097/SCS.0000000000006861.

    Article  PubMed  Google Scholar 

  12. Kestler M, Muñoz P, Marín M, Goenaga MA, Idígoras Viedma P, de Alarcón A, et al. Endocarditis caused by anaerobic bacteria. Anaerobe. 2017;47:33–8. https://doi.org/10.1016/j.anaerobe.2017.04.002.

    Article  CAS  PubMed  Google Scholar 

  13. Kassebaum NJ, Smith A, Bernabé E, Fleming TD, Reynolds AE, Vos T, et al. Global, regional, and national prevalence, incidence, and disability-adjusted life years for oral conditions for 195 countries, 1990–2015: a systematic analysis for the global burden of diseases, injuries, and risk factors. J Dent Res. 2017;96:380–7. https://doi.org/10.1177/0022034517693566.

    Article  CAS  PubMed  Google Scholar 

  14. James SL, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the global burden of disease study 2017. Lancet. 2018;392:1789–858. https://doi.org/10.1016/S0140-6736(18)32279-7.

    Article  Google Scholar 

  15. Gao L, Xu T, Huang G, Jiang S, Gu Y, Chen F. Oral microbiomes: more and more importance in oral cavity and whole body. Protein Cell. 2018;9:488–500. https://doi.org/10.1007/s13238-018-0548-1.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Keskin C, Demiryürek EÖ, Onuk EE. Pyrosequencing analysis of cryogenically ground samples from primary and secondary/persistent endodontic infections. J Endodont. 2017;43:1309–16. https://doi.org/10.1016/j.joen.2017.03.019.

    Article  Google Scholar 

  17. Siqueira JF, Rôças IN. Present status and future directions: microbiology of endodontic infections. Int Endodontic J. 2022;55:512–30. https://doi.org/10.1111/iej.13677.

    Article  Google Scholar 

  18. Kesim B, Ülger ST, Aslan G, Cudal H, Üstün Y, Küçük MÖ. Amplicon-based next-generation sequencing for comparative analysis of root canal microbiome of teeth with primary and persistent/secondary endodontic infections. Clin Oral Investig. 2023;27:995–1004. https://doi.org/10.1007/s00784-023-04882-x.

    Article  PubMed  Google Scholar 

  19. Ordinola-Zapata R, Costalonga M, Nixdorf D, Dietz M, Schuweiler D, Lima BP, et al. Taxonomic abundance in primary and secondary root canal infections. Int Endod J. 2023;56:278–88. https://doi.org/10.1111/iej.13864.

    Article  PubMed  Google Scholar 

  20. Peng X, Cheng L, You Y, Tang C, Ren B, Li Y, et al. Oral microbiota in human systematic diseases. Int J Oral Sci. 2022;14:14. https://doi.org/10.1038/s41368-022-00163-7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Wisutep P, Kamolvit W, Chongtrakool P, Jitmuang A. Brain abscess mimicking acute stroke syndrome caused by dual Filifactor alocis and Porphyromonas gingivalis infections: a case report. Anaerobe. 2022;75: 102535. https://doi.org/10.1016/j.anaerobe.2022.102535.

    Article  PubMed  Google Scholar 

  22. Lalla E, Papapanou PN. Diabetes mellitus and periodontitis: a tale of two common interrelated diseases. Nat Rev Endocrinol. 2011;7:738–48. https://doi.org/10.1038/nrendo.2011.106.

    Article  CAS  PubMed  Google Scholar 

  23. Mahran H, Hassanein AG, Rizq M. Trends and outcome of aggressive fascial space infections. Surg Infect (Larchmt). 2023;24:475–81. https://doi.org/10.1089/sur.2023.079.

    Article  PubMed  Google Scholar 

  24. Nociti FH, Casati MZ, Duarte PM. Current perspective of the impact of smoking on the progression and treatment of periodontitis. Periodontol. 2000;2015(67):187–210. https://doi.org/10.1111/prd.12063.

    Article  Google Scholar 

  25. Kinane DF, Stathopoulou PG, Papapanou PN. Periodontal diseases. Nat Rev Dis Primers. 2017;3:17038. https://doi.org/10.1038/nrdp.2017.38.

    Article  PubMed  Google Scholar 

  26. Larsen L, Marker CR, Kjeldsen AD, Poulsen FR. Prevalence of hereditary hemorrhagic telangiectasia in patients operated for cerebral abscess: a retrospective cohort analysis. Eur J Clin Microbiol Infect Dis. 2017;36:1975–80. https://doi.org/10.1007/s10096-017-3023-7.

    Article  CAS  PubMed  Google Scholar 

  27. Porto OCL, Silva BSDF, Silva JA, Estrela CRDA, Alencar AHGD, Bueno MDR, et al. CBCT assessment of bone thickness in maxillary and mandibular teeth: an anatomic study. J Appl Oral Sci. 2020;28: e20190148. https://doi.org/10.1590/1678-7757-2019-0148.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Gehrke T, Scherzad A, Hagen R, Hackenberg S. Deep neck infections with and without mediastinal involvement: treatment and outcome in 218 patients. Eur Arch Oto-Rhino-l. 2022;279:1585–92. https://doi.org/10.1007/s00405-021-06945-9.

    Article  Google Scholar 

  29. Hwang CS, Lee H, Hong MP, Kim JH, Kim K. Brain abscess caused by chronic invasive actinomycosis in the nasopharynx. Medicine. 2018;97: e406. https://doi.org/10.1097/MD.0000000000010406.

    Article  Google Scholar 

  30. Lisboa EDCC, Silva WO, Rodrigues RCV, Brum SC, Alves FRF. The connection between brain abscess and odontogenic infections: a systematic review. Arch Oral Biol. 2022;135: 105360. https://doi.org/10.1016/j.archoralbio.2022.105360.

    Article  PubMed  Google Scholar 

  31. Jevon P, Abdelrahman A, Pigadas N. Management of odontogenic infections and sepsis: an update. Br Dent J. 2020;229:363–70. https://doi.org/10.1038/s41415-020-2114-5.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Hajishengallis G, Chavakis T. Local and systemic mechanisms linking periodontal disease and inflammatory comorbidities. Nat Rev Immunol. 2021;21:426–40. https://doi.org/10.1038/s41577-020-00488-6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Ricucci D, Siqueira JF, Abdelsayed RA, Lio SG, Rôças IN. Bacterial invasion of pulp blood vessels in teeth with symptomatic irreversible pulpitis. J Endodont. 2021;47:1854–64. https://doi.org/10.1016/j.joen.2021.09.010.

    Article  Google Scholar 

  34. Yumoto H, Hirota K, Hirao K, Ninomiya M, Murakami K, Fujii H, et al. The pathogenic factors from oral streptococci for systemic diseases. Int J Mol Sci. 2019;20:4571. https://doi.org/10.3390/ijms20184571.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Mtenga AA, Kalyanyama BM, Owibingire SS, Sohal KS, Simon ENM. Cervicofacial necrotizing fasciitis among patients attending the Muhimbili National Hospital, Dar es Salaam Tanzania. BMC Infect Dis. 2019;19:642. https://doi.org/10.1186/s12879-019-4267-x.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Wolf E, Dragicevic M, Fuhrmann M. Alleviation of acute dental pain from localised apical periodontitis: a prospective randomised study comparing two emergency treatment procedures. J Oral Rehabil. 2019;46:120–6. https://doi.org/10.1111/joor.12730.

    Article  CAS  PubMed  Google Scholar 

  37. Schmidt J, Kunderova M, Pilbauerova N, Kapitan M. A review of evidence-based recommendations for pericoronitis management and a systematic review of antibiotic prescribing for pericoronitis among dentists: inappropriate pericoronitis treatment is a critical factor of antibiotic overuse in dentistry. Int J Env Res Pub He. 2021;18:6796. https://doi.org/10.3390/ijerph18136796.

    Article  Google Scholar 

  38. Iwata E, Kusumoto J, Takata N, Furudoi S, Tachibana A, Akashi M. The characteristics of oro-cervical necrotizing fasciitis—comparison with severe cellulitis of oro-cervical region and necrotizing fasciitis of other body regions. PLoS ONE. 2021;16: e260740. https://doi.org/10.1371/journal.pone.0260740.

    Article  CAS  Google Scholar 

  39. Shi H, Yang Z, Li H, Zheng L, Wang B, Zhou Q. Efficacy of needle aspiration in patients with oral-maxillofacial abscesses: a retrospective study of 15 consecutive patients. Am J Otolaryng. 2022;43: 103216. https://doi.org/10.1016/j.amjoto.2021.103216.

    Article  Google Scholar 

  40. Parara E, Krasadakis C, Toursounidis I, Tsekoura K, Mourouzis C, Rallis G. Significant rise in neck infections progressing to descending necrotizing mediastinitis during the COVID-19 pandemic quarantine. J Cranio Maxill Surg. 2021;49:1182–6. https://doi.org/10.1016/j.jcms.2021.06.018.

    Article  Google Scholar 

  41. Wuokko-Landén A, Blomgren K, Suomalainen A, Välimaa HTOC. Odontogenic causes complicating the chronic rhinosinusitis diagnosis. Clin Oral Invest. 2021. https://doi.org/10.1007/s00784-020-03384-4.

    Article  Google Scholar 

  42. Kamalian S, Avery L, Lev MH, Schaefer PW, Curtin HD, Kamalian S. Nontraumatic head and neck emergencies. Radiographics. 2019;39:1808–23. https://doi.org/10.1148/rg.2019190159.

    Article  PubMed  Google Scholar 

  43. Chou P, Hsieh Y, Lin C. Necrotizing fasciitis of the entire head and neck: literature review and case report. Biomed J. 2020;43:94–8. https://doi.org/10.1016/j.bj.2019.08.002.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Hirvonen J, Heikkinen J, Nyman M, Happonen T, Velhonoja J, Irjala H, et al. MRI of acute neck infections: evidence summary and pictorial review. Insights Imaging. 2023;14:5. https://doi.org/10.1186/s13244-022-01347-9.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Babu VR, Ikkurthi S, Perisetty DK, Babu K, Rasool M, Shaik S. A prospective comparison of computed tomography and magnetic resonance imaging as a diagnostic tool for maxillofacial space infections. J Int Soc Prev Community Dent. 2018;8:343–8. https://doi.org/10.4103/jispcd.JISPCD_315_17.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Ghali S, Katti G, Shahbaz S, Chitroda PK, Divakar DD, et al. Fascial space odontogenic infections: ultrasonography as an alternative to magnetic resonance imaging. World J Clin Cases. 2021;9:573–80. https://doi.org/10.12998/wjcc.v9.i3.573.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Sakai T, Sano A, Azuma Y, Koezuka S, Otsuka H, Iyoda A. Streptococcus anginosus group infection as a predictor for the progression of descending necrotizing mediastinitis. Ann Palliat Med. 2021;10:4008. https://doi.org/10.21037/apm-20-2120.

    Article  PubMed  Google Scholar 

  48. Kumari S, Mohanty S, Sharma P, Dabas J, Kohli S, Diana C. Is the routine practice of antibiotic prescription and microbial culture and antibiotic sensitivity testing justified in primary maxillofacial space infection patients? A prospective, randomized clinical study. J Cranio Maxill Surg. 2018;46:446–52. https://doi.org/10.1016/j.jcms.2017.11.026.

    Article  Google Scholar 

  49. Böttger S, Zechel-Gran S, Schmermund D, Streckbein P, Wilbrand J, Knitschke M, et al. Odontogenic cervicofacial necrotizing fasciitis: microbiological characterization and management of four clinical cases. Pathogens. 2022;11:78. https://doi.org/10.3390/pathogens11010078.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Brajkovic D, Zjalić S, Kiralj A. Prognostic factors for descending necrotizing mediastinitis development in deep space neck infections—a retrospective study. Eur Arch Oto-Rhino-Laryngol. 2022;279:2641–9. https://doi.org/10.1007/s00405-021-07081-0.

    Article  Google Scholar 

  51. Segura-Egea JJ, Gould K, Şen BH, Jonasson P, Cotti E, Mazzoni A, et al. Antibiotics in endodontics: a review. Int Endod J. 2017;50:1169–84. https://doi.org/10.1111/iej.12741.

    Article  CAS  PubMed  Google Scholar 

  52. Heim N, Warwas FB, Wiedemeyer V, Wilms CT, Reich RH, Martini M. The role of immediate versus secondary removal of the odontogenic focus in treatment of deep head and neck space infections. A retrospective analysis of 248 patients. Clin Oral Invest. 2019;23:2921–7. https://doi.org/10.1007/s00784-018-02796-7.

    Article  Google Scholar 

  53. Kaneko A, Matsumoto T, Iwabuchi H, Sato J, Wakamura T, Kiyota H, et al. Antimicrobial susceptibility surveillance of bacterial isolates recovered in Japan from odontogenic infections in 2013. J Infect Chemother. 2020;26:882–9. https://doi.org/10.1016/j.jiac.2020.05.019.

    Article  CAS  PubMed  Google Scholar 

  54. Weise H, Naros A, Weise C, Reinert S, Hoefert S. Severe odontogenic infections with septic progress—a constant and increasing challenge: a retrospective analysis. BMC Oral Health. 2019;19:173. https://doi.org/10.1186/s12903-019-0866-6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Vytla S, Gebauer D. Clinical guideline for the management of odontogenic infections in the tertiary setting. Aust Dent J. 2017;62:464–70. https://doi.org/10.1111/adj.12538.

    Article  CAS  PubMed  Google Scholar 

  56. Ausenda F, Jeong N, Arsenault P, Gyurko R, Finkelman M, Dragan IF, et al. The effect of the bass intrasulcular toothbrushing technique on the reduction of gingival inflammation: a randomized clinical trial. J Evid Based Dent Pract. 2019;19:106–14. https://doi.org/10.1016/j.jebdp.2019.01.004.

    Article  PubMed  Google Scholar 

  57. Londero AB, Reiniger A, Tavares R, Ferreira CM, Wikesjö U, Kantorski KZ, et al. Efficacy of dental floss in the management of gingival health: a randomized controlled clinical trial. Clin Oral Investig. 2022;26:5273–80. https://doi.org/10.1007/s00784-022-04495-w.

    Article  PubMed  Google Scholar 

  58. Davidson KW, Barry MJ, Mangione CM, Cabana M, Caughey AB, Davis EM, et al. Screening and interventions to prevent dental caries in children younger than 5 years. JAMA. 2021;326:2172. https://doi.org/10.1001/jama.2021.20007.

    Article  PubMed  Google Scholar 

  59. James P, Worthington HV, Parnell C, Harding M, Lamont T, Cheung A, et al. Chlorhexidine mouthrinse as an adjunctive treatment for gingival health. Cochrane Database Syst Rev. 2017;3:D8676. https://doi.org/10.1002/14651858.CD008676.pub2.

    Article  Google Scholar 

  60. Sakkas A, Weiß C, Ebeling M, Pietzka S, Wilde F, Evers T, et al. Factors Influencing recurrence after surgical treatment of odontogenic maxillary sinusitis: an analysis from the oral and maxillofacial surgery point of view. J Clin Med. 2023. https://doi.org/10.3390/jcm12113670.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

This work was supported by the Key Laboratory of Oral Biomedical Research of Zhejiang Province Foundation (Grant numbers 2021M010 and 2021M004), the Health Science and Technology Program of Zhejiang Province (Grant numbers 2022KY1096), and the National Natural Science Foundation of China (Grant numbers 82001045).

Author information

Author notes

  1. Yiting Lou, Zheyuan Sun and Haiying Ma have contributed equally to this work.

Authors and Affiliations

  1. School of Stomatology, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Stomatology Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang, China

    Yiting Lou, Zheyuan Sun, Haiying Ma, Mouyuan Sun, Qianting Wang, Jingyu Wang, Yu Liu, Mengfei Yu & Huiming Wang

  2. Department of Stomatology, The First Affiliated Hospital of Ningbo University, Ningbo, 315000, Zhejiang, China

    Danna Cao, Qunhao Zhuo & Binbin Ying

  3. Department of Biomedical Sciences, Texas A&M University School of Dentistry, Dallas, TX, USA

    Ran Tao

Authors
  1. Yiting Lou
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zheyuan Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Haiying Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Danna Cao
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mouyuan Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Qianting Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jingyu Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Qunhao Zhuo
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ran Tao
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Binbin Ying
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Yu Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Mengfei Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Huiming Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

YL, ZS, and HM drafted the first and subsequent versions of the review. DC, MS, QW, JW, QZ, and RT searched the literature and managed the data. BY and YL conceived and designed the review. MY and HW revised it critically for important intellectual content.

Corresponding authors

Correspondence to Binbin Ying, Yu Liu or Mengfei Yu.

Ethics declarations

Conflict of interest

No conflicts of interest have been declared.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 95 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lou, Y., Sun, Z., Ma, H. et al. Odontogenic infections in the antibiotic era: approach to diagnosis, management, and prevention. Infection 52, 301–311 (2024). https://doi.org/10.1007/s15010-023-02117-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s15010-023-02117-5

Keywords

Search

Navigation