Chapter 40 : Viral Infections in Transplant Recipients

MyBook is a cheap paperback edition of the original book and will be sold at uniform, low price.

Preview this chapter:
Zoom in

Viral Infections in Transplant Recipients, Page 1 of 2

| /docserver/preview/fulltext/10.1128/9781555816834/9781555814977_Chap40-1.gif /docserver/preview/fulltext/10.1128/9781555816834/9781555814977_Chap40-2.gif


This chapter discusses the role of nucleic acid tests in the diagnosis and management of herpes simplex virus (HSV), varicella-zoster virus (VZV), human herpesvirus 6 (HHV-6), cytomegalovirus (CMV), Epstein-Barr virus (EBV), BK virus (BKV), parvovirus (erythrovirus) B19, and adenovirus in hematopoietic and solid-organ transplant recipients. HSV most commonly causes reactivation of oral or genital mucocutaneous lesions in transplant recipients. The majority of transplant recipients are VZV seropositive pretransplantation, and at risk for VZV reactivation, most commonly in the form of zoster. Due to the severity of primary VZV infection in transplant recipients, solid-organ transplant candidates should be screened for antibody to VZV prior to transplantation, and consideration should be given to administration of the varicella vaccine prior to transplantation to solid-organ transplant candidates who have no history of prior VZV disease and are VZV seronegative. To complicate the matter, some pediatric liver and heart transplant recipients may exhibit chronic high EBV viral loads. Molecular diagnostics play a paramount role in the diagnosis and management of transplant recipients with infections caused by viruses. These methods have greatly enhanced diagnosis of viral infections due to the increase in speed and sensitivity compared to traditional antigen detection or culture methods. In addition, routine monitoring of transplant recipients for CMV, EBV, and BKV viremia using these methods has become the standard of care at many transplant centers, and this monitoring has facilitated earlier clinical interventions that have dramatically reduced morbidity caused by these viruses.

Citation: Patel R, Nolte F. 2011. Viral Infections in Transplant Recipients, p 631-640. In Persing D, Tenover F, Tang Y, Nolte F, Hayden R, van Belkum A (ed), Molecular Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555816834.ch40

Key Concept Ranking

Lower Respiratory Tract Infections
Upper Respiratory Tract Infections
Highlighted Text: Show | Hide
Loading full text...

Full text loading...


1. Aalto, S. M.,, E. Juvonen,, J. Tarkkanen,, L. Volin,, H. Haario,, T. Ruutu, and, K. Hedman. 2007. Epstein-Barr viral load and disease prediction in a large cohort of allogeneic stem cell transplant recipients. Clin. Infect. Dis. 45:13051309.
2. Aberham, C.,, C. Pendl,, P. Gross,, G. Zerlauth, and, M. Gessner. 2001. A quantitative, internally controlled realtime PCR assay for the detection of parvovirus B19 DNA. J. Virol. Methods 92:183191.
3. Arness, T.,, R. Pedersen,, R. Dierkhising,, W. Kremers, and, R. Patel. 2008. Varicella zoster virus-associated disease in adult kidney transplant recipients: incidence and risk-factor analysis. Transpl. Infect. Dis. 10:260268.
4. Arthurs, S. K.,, A. J. Eid,, R. A. Pedersen,, R. A. Dierkhising,, W. K. Kremers,, R. Patel, and, R. R. Razonable. 2007. Delayed-onset primary cytomegalovirus disease after liver transplantation. Liver Transpl. 13:17031709.
5. Arthurs, S. K.,, A. J. Eid,, R. A. Pedersen,, W. K. Kremers,, F. G. Cosio,, R. Patel, and, R. R. Razonable. 2008. Delayed-onset primary cytomegalovirus disease and the risk of allograft failure and mortality after kidney transplantation. Clin. Infect. Dis. 46:840846.
6. Bakker, N. A.,, E. A. Verschuuren,, N. J. Veeger,, W. van der Bij,, G. W. van Imhoff,, C. G. Kallenberg, and, B. G. Hepkema. 2008. Quantification of Epstein-Barr virus-DNA load in lung transplant recipients: a comparison of plasma versus whole blood. J. Heart Lung Transplant. 27:710.
7. Bingler, M. A.,, B. Feingold,, S. A. Miller,, E. Quivers,, M. G. Michaels,, M. Green,, R. M. Wadowsky,, D. T. Rowe, and, S. A. Webber. 2008. Chronic high Epstein-Barr viral load state and risk for late-onset posttransplant lymphoproliferative disease/lymphoma in children. Am. J. Transplant. 8:442445.
8. Bogdanovic, G.,, P. Priftakis,, B. Taemmeraes,, A. Gustafsson,, T. Flaegstad,, J. Winiarski, and, T. Dalianis. 1998. Primary BK virus (BKV) infection due to possible BKV transmission during bone marrow transplantation is not the major cause of hemorrhagic cystitis in transplanted children. Pediatr. Transplant. 2:288293.
9. Brennan, D. C.,, I. Agha,, D. L. Bohl,, M. A. Schnitzler,, K. L. Hardinger,, M. Lockwood,, S. Torrence,, R. Schuessler,, T. Roby,, M. Gaudreault-Keener, and, G. A. Storch. 2005. Incidence of BK with tacrolimus versus cyclosporine and impact of preemptive immunosuppression reduction. Am. J. Transplant. 5:582594.
10. Bressollette-Bodin, C.,, M. Coste-Burel,, M. Hourmant,, V. Sebille,, E. Andre-Garnier, and, B. M. Imbert-Marcille. 2005. A prospective longitudinal study of BK virus infection in 104 renal transplant recipients. Am. J. Transplant. 5:19261933.
11. Brown, K. E.,, S. M. Anderson, and, N. S. Young. 1993. Erythrocyte P antigen: cellular receptor for B19 parvovirus. Science 262:114117.
12. Buller, R. S.,, and G. Storch. 2004. Evaluation of a realtime PCR assay using the LightCycler system for detection of parvovirus B19 DNA. J. Clin. Microbiol. 42:33263328.
13. Cavallo, R.,, C. Merlino,, D. Re,, C. Bollero,, M. Bergallo,, D. Lembo,, T. Musso,, G. Leonardi,, G. P. Segoloni, and, A. N. Ponzi. 2003. B19 virus infection in renal transplant recipients. J. Clin. Virol. 26:361368.
14. Chan, P. K.,, K. W. Ip,, S. Y. Shiu,, E. K. Chiu,, M. P. Wong, and, K. Y. Yuen. 1994. Association between polyomaviruria and microscopic haematuria in bone marrow transplant recipients. J. Infect. 29:139146.
15. Chen, Y.,, P. M. Sharp,, M. Fowkes,, O. Kocher,, J. T. Joseph, and, I. J. Koralnik. 2004. Analysis of 15 novel full-length BK virus sequences from three individuals: evidence of a high intra-strain genetic diversity. J. Gen. Virol. 85:26512663.
16. Cirocco, R.,, M. Markou,, A. Rosen,, L. Goldsmith,, G. Cianco,, D. Roth,, W. Kupin,, G. Burke,, V. Esquenazi,, A. Tzakis, and, J. Miller. 2001. Polyomavirus PCR monitoring in renal transplant recipients: detection in blood is associated with higher creatinine values. Transplant. Proc. 33:18051807.
17. Claas, E. C.,, M. W. Schilham,, C. S. de Brouwer,, P. Hubacek,, M. Echavarria,, A. C. Lankester,, M. J. van Tol, and, A. C. Kroes. 2005. Internally controlled realtime PCR monitoring of adenovirus DNA load in serum or plasma of transplant recipients. J. Clin. Microbiol. 43:17381744.
18. Cottler-Fox, M.,, M. Lynch,, H. J. Deeg, and, L. G. Koss. 1989. Human polyomavirus: lack of relationship of viruria to prolonged or severe hemorrhagic cystitis after bone marrow transplant. Bone Marrow Transplant. 4:279282.
19. Ding, R.,, M. Medeiros,, D. Dadhania,, T. Muthukumar,, D. Kracker,, J. M. Kong,, S. R. Epstein,, V. K. Sharma,, S. V. Seshan,, B. Li, and, M. Suthanthiran. 2002. Non-invasive diagnosis of BK virus nephritis by measurement of messenger RNA for BK virus VP1 in urine. Transplantation 74:987994.
20. Drachenberg, R. C.,, C. B. Drachenberg,, J. C. Papadimitriou,, E. Ramos,, J. C. Fink,, R. Wali,, M. R. Weir,, C. B. Cangro,, D. K. Klassen,, A. Khaled,, R. Cunningham, and, S. T. Bartlett. 2001. Morphological spectrum of polyoma virus disease in renal allografts: diagnostic accuracy of urine cytology. Am. J. Transplant. 1:373381.
21. Ebner, K.,, M. Suda,, F. Watzinger, and, T. Lion. 2005. Molecular detection and quantitative analysis of the entire spectrum of human adenoviruses by a two-reaction real-time PCR assay. J. Clin. Microbiol. 43:30493053.
22. Eid, A. J.,, R. A. Brown,, R. Patel, and, R. R. Razonable. 2006. Parvovirus B19 infection after transplantation: a review of 98 cases. Clin. Infect. Dis. 43:4048.
23. Flomenberg, P.,, J. Babbitt,, W. R. Drobyski,, R. C. Ash,, D. R. Carrigan,, G. V. Sedmak,, T. McAuliffe,, B. Camitta,, M. M. Horowitz,, N. Bunin, et al. 1994. Increasing incidence of adenovirus disease in bone marrow transplant recipients. J. Infect. Dis. 169:775781.
24. Garcia-Martinez, J.,, L. Folgueira,, R. Delgado,, S. Hernando,, C. Prieto,, J. M. Aguado, and, J. R. Otero. 2008. Viral monitoring and successful treatment of a ganciclovirresistant cytomegalovirus infection in a heart transplant recipient. Transpl. Infect. Dis. 10:123128.
25. Gardner, S. D.,, A. M. Field,, D. V. Coleman, and, B. Hulme. 1971. New human papovavirus (B.K.) isolated from urine after renal transplantation. Lancet 1:12531257.
26. Garrigue, I.,, A. Doussau,, J. Asselineau,, H. Bricout,, L. Couzi,, C. Rio,, P. Merville,, H. Fleury,, M. E. Lafon, and, R. Thiebaut. 2008. Prediction of cytomegalovirus (CMV) plasma load from evaluation of CMV whole-blood load in samples from renal transplant recipients. J. Clin. Microbiol. 46:493498.
27. Gerna, G.,, F. Baldanti,, M. Torsellini,, L. Minoli,, M. Vigano,, T. Oggionnis,, T. Rampino,, B. Castiglioni,, A. Goglio,, M. Colledan,, C. Mammana,, F. Nozza, and, L. Daniele. 2007. Evaluation of cytomegalovirus DNAaemia versus pp65-antigenaemia cutoff for guiding preemptive therapy in transplant recipients: a randomized study. Antivir. Ther. 12:6372.
28. Gerna, G.,, D. Lilleri,, D. Caldera,, M. Furione,, L. Zenone Bragotti, and, E. P. Alessandrino. 2008. Validation of a DNAemia cutoff for preemptive therapy of cytomegalovirus infection in adult hematopoietic stem cell transplant recipients. Bone Marrow Transplant. 41:873879.
29. Goudsmit, J.,, P. Wertheim-van Dillen,, A. van Strien, and, J. van der Noordaa. 1982. The role of BK virus in acute respiratory tract disease and the presence of BKV DNA in tonsils. J. Med. Virol. 10:9199.
30. Green, M.,, K. Soltys,, D. T. Rowe,, S. A. Webber, and, G. Mazareigos. 2009. Chronic high Epstein-Barr viral load carriage in pediatric liver transplant recipients. Pediatr. Transplant. 13:319323.
31. Greenfield, H. M.,, M. I. Gharib,, A. J. Turner,, M. Guiver,, T. Carr,, A. M. Will, and, R. F. Wynn. 2006. The impact of monitoring Epstein-Barr virus PCR in paediatric bone marrow transplant patients: can it successfully predict outcome and guide intervention? Pediatr. Blood Cancer 47:200205.
32. Gulley, M. L.,, and W. Tang. 2008. Laboratory assays for Epstein-Barr virus-related disease. J. Mol. Diagn. 10:279292.
33. Hanson, K. E.,, L. B. Reller,, J. Kurtzberg,, M. Horwitz,, G. Long, and, B. D. Alexander. 2007. Comparison of the Digene Hybrid Capture System Cytomegalovirus (CMV) DNA (version 2.0), Roche CMV UL54 analyte-specific reagent, and QIAGEN RealArt CMV LightCycler PCR reagent tests using AcroMetrix OptiQuant CMV DNA quantification panels and specimens from allogeneicstemcell transplant recipients. J. Clin. Microbiol. 45:19721973.
34. Harder, T. C.,, M. Hufnagel,, K. Zahn,, K. Beutel,, H. J. Schmitt,, U. Ullmann, and, P. Rautenberg. 2001. New LightCycler PCR for rapid and sensitive quantification of parvovirus B19 DNA guides therapeutic decision-making in relapsing infections. J. Clin. Microbiol. 39:44134419.
35. Hirsch, H. H.,, D. C. Brennan,, C. B. Drachenberg,, F. Ginevri,, J. Gordon,, A. P. Limaye,, M. J. Mihatsch,, V. Nickeleit,, E. Ramos,, P. Randhawa,, R. Shapiro,, J. Steiger,, M. Suthanthiran, and, J. Trofe. 2005. Polyomavirus-associated nephropathy in renal transplantation: interdisciplinary analyses and recommendations. Transplantation 79:12771286.
36. Hirsch, H. H.,, W. Knowles,, M. Dickenmann,, J. Passweg,, T. Klimkait,, M. J. Mihatsch, and, J. Steiger. 2002. Prospective study of polyomavirus type BK replication and nephropathy in renal-transplant recipients. N. Engl. J. Med. 347:488496.
37. Hirsch, H. H.,, M. Mohaupt, and, T. Klimkait. 2001. Prospective monitoring of BK virus load after discontinuing sirolimus treatment in a renal transplant patient with BK virus nephropathy. J. Infect. Dis. 184:14941495; author reply 1495–1496.
38. Hirsch, H. H.,, and J. Steiger. 2003. Polyomavirus BK. Lancet Infect. Dis. 3:611623.
39. Hoffman, N. G.,, L. Cook,, E. E. Atienza,, A. P. Limaye, and, K. R. Jerome. 2008. Marked variability of BK virus load measurement using quantitative real-time PCR among commonly used assays. J. Clin. Microbiol. 46:26712680.
40. Hokynar, K.,, J. Brunstein,, M. Soderlund-Venermo,, O. Kiviluoto,, E. K. Partio,, Y. Konttinen, and, K. Hedman. 2000. Integrity and full coding sequence of B19 virus DNA persisting in human synovial tissue. J. Gen. Virol. 81:10171025.
41. Ison, M. G. 2006. Adenovirus infections in transplant recipients. Clin. Infect. Dis. 43:331339.
42. Jordan, J.,, B. Tiangco,, J. Kiss, and, W. Koch. 1998. Human parvovirus B19: prevalence of viral DNA in volunteer blood donors and clinical outcomes of transfusion recipients. Vox Sang. 75:97102.
43. Ki, C. S.,, I. S. Kim,, J. W. Kim,, N. Y. Lee,, S. H. Kim,, K. W. Lee,, S. J. Kim,, J. W. Joh,, W. S. Huh, and, H. Y. Oh. 2005. Incidence and clinical significance of human parvovirus B19 infection in kidney transplant recipients. Clin. Transplant. 19:751755.
44. Kim, D. H.,, H. Messner,, M. Minden,, V. Gupta,, J. Kuruvilla,, J. Wright, and, J. Lipton. 2008. Factors influencing varicella zoster virus infection after allogeneic peripheral blood stem cell transplantation: low-dose acyclovir prophylaxis and pre-transplant diagnosis of lymphoproliferative disorders. Transpl. Infect. Dis. 10:9098.
45. Kinch, A.,, G. Oberg,, J. Arvidson,, K. I. Falk,, A. Linde, and, K. Pauksens. 2007. Post-transplant lymphoproliferative disease and other Epstein-Barr virus diseases in allogeneic haematopoietic stem cell transplantation after introduction of monitoring of viral load by polymerase chain reaction. Scand. J. Infect. Dis. 39:235244.
46. Leruez-Ville, M.,, V. Minard,, F. Lacaille,, A. Buzyn,, E. Abachin,, S. Blanche,, F. Freymuth, and, C. Rouzioux. 2004. Real-time blood plasma polymerase chain reaction for management of disseminated adenovirus infection. Clin. Infect. Dis. 38:4552.
47. Leung, A. Y.,, C. K. Suen,, A. K. Lie,, R. H. Liang,, K. Y. Yuen, and, Y. L. Kwong. 2001. Quantification of polyoma BK viruria in hemorrhagic cystitis complicating bone marrow transplantation. Blood 98:19711978.
48. Liefeldt, L.,, A. Plentz,, B. Klempa,, O. Kershaw,, A. S. Endres,, U. Raab,, H. H. Neumayer,, H. Meisel, and, S. Modrow. 2005. Recurrent high level parvovirus B19/ genotype 2 viremia in a renal transplant recipient analyzed by real-time PCR for simultaneous detection of genotypes 1 to 3. J. Med. Virol. 75:161169.
49. Limaye, A. P.,, K. R. Jerome,, C. S. Kuhr,, J. Ferrenberg,, M. L. Huang,, C. L. Davis,, L. Corey, and, C. L. Marsh. 2001. Quantitation of BK virus load in serum for the diagnosis of BK virus-associated nephropathy in renal transplant recipients. J. Infect. Dis. 183:16691672.
50. Meerbach, A.,, P. Wutzler,, R. Hafer,, F. Zintl, and, B. Gruhn. 2008. Monitoring of Epstein-Barr virus load after hematopoietic stem cell transplantation for early intervention in post-transplant lymphoproliferative disease. J. Med. Virol. 80:441454.
51. Neild, G.,, M. Anderson,, S. Hawes, and, B. T. Colvin. 1986. Parvovirus infection after renal transplant. Lancet 2:12261227.
52. Nickeleit, V.,, T. Klimkait,, I. F. Binet,, P. Dalquen,, V. Del Zenero,, G. Thiel,, M. J. Mihatsch, and, H. H. Hirsch. 2000. Testing for polyomavirus type BK DNA in plasma to identify renal-allograft recipients with viral nephropathy. N. Engl. J. Med. 342:13091315.
53. Nishimoto, Y.,, T. Takasaka,, M. Hasegawa,, H. Y. Zheng,, Q. Chen,, C. Sugimoto,, T. Kitamura, and, Y. Yogo. 2006. Evolution of BK virus based on complete genome data. J. Mol. Evol. 63:341352.
54. Priftakis, P.,, G. Bogdanovic,, P. Kokhaei,, H. Mellstedt, and, T. Dalianis. 2003. BK virus (BKV) quantification in urine samples of bone marrow transplanted patients is helpful for diagnosis of hemorrhagic cystitis, although wide individual variations exist. J. Clin. Virol. 26:7177.
55. Purighalla, R.,, R. Shapiro,, J. McCauley, and, P. Randhawa. 1995. BK virus infection in a kidney allograft diagnosed by needle biopsy. Am. J. Kidney Dis. 26:671673.
56. Ramos, E.,, C. B. Drachenberg,, J. C. Papadimitriou,, O. Hamze,, J. C. Fink,, D. K. Klassen,, R. C. Drachenberg,, A. Wiland,, R. Wali,, C. B. Cangro,, E. Schweitzer,, S. T. Bartlett, and, M. R. Weir. 2002. Clinical course of polyoma virus nephropathy in 67 renal transplant patients. J. Am. Soc. Nephrol. 13:21452151.
57. Ramos, E.,, C. B. Drachenberg,, M. Portocarrero,, R. Wali,, D. K. Klassen,, J. C. Fink,, A. Farney,, H. Hirsch,, J. C. Papadimitriou,, C. B. Cangro,, M. R. Weir, and, S. T. Bartlett. 2002. BK virus nephropathy diagnosis and treatment: experience at the University of Maryland Renal Transplant Program. Clin. Transpl. 2002:143153.
58. Randhawa, P.,, A. Ho,, R. Shapiro,, A. Vats,, P. Swalsky,, S. Finkelstein,, J. Uhrmacher, and, K. Weck. 2004. Correlates of quantitative measurement of BK polyomavirus (BKV) DNA with clinical course of BKV infection in renal transplant patients. J. Clin. Microbiol. 42:11761180.
59. Reploeg, M. D.,, G. A. Storch, and, D. B. Clifford. 2001. BK virus: a clinical review. Clin. Infect. Dis. 33:191202.
60. Rodriguez, J.,, K. Casper,, G. Smallwood,, A. Stieber,, C. Fasola,, J. Lehneman, and, T. Heffron. 2007. Resistance to combined ganciclovir and foscarnet therapy in a liver transplant recipient with possible dual-strain cytomegalovirus coinfection. Liver Transpl. 13:13961400.
61. Rux, J. J.,, P. R. Kuser, and, R. M. Burnett. 2003. Structural and phylogenetic analysis of adenovirus hexons by use of high-resolution X-ray crystallographic, molecular modeling, and sequence-based methods. J. Virol. 77:95539566.
62. Schilham, M. W.,, E. C. Claas,, W. van Zaane,, B. Heemskerk,, J. M. Vossen,, A. C. Lankester,, R. E. Toes,, M. Echavarria,, A. C. Kroes, and, M. J. van Tol. 2002. High levels of adenovirus DNA in serum correlate with fatal outcome of adenovirus infection in children after allogeneic stem-cell transplantation. Clin. Infect. Dis. 35:526532.
63. Scott-Taylor, T. H.,, and G. W. Hammond. 1992. Conserved sequences of the adenovirus genome for detection of all human adenovirus types by hybridization. J. Clin. Microbiol. 30:17031710.
64. Sencer, S. F.,, R. J. Haake, and, D. J. Weisdorf. 1993. Hemorrhagic cystitis after bone marrow transplantation. Risk factors and complications. Transplantation 56:875879.
65. Servant, A.,, S. Laperche,, F. Lallemand,, V. Marinho,, G. De Saint Maur,, J. F. Meritet, and, A. Garbarg-Chenon. 2002. Genetic diversity within human erythroviruses: identification of three genotypes. J. Virol. 76:91249134.
66. Sharma, P. M.,, G. Gupta,, A. Vats,, R. Shapiro, and, P. Randhawa. 2006. Phylogenetic analysis of polyomavirus BK sequences. J. Virol. 80:88698879.
67. Suparno, C.,, D. W. Milligan,, P. A. Moss, and, V. Mautner. 2004. Adenovirus infections in stem cell transplant recipients: recent developments in understanding of pathogenesis, diagnosis and management. Leuk. Lymphoma 45:873885.
68. Tong, C. Y.,, R. Hilton,, E. M. MacMahon,, L. Brown,, P. Pantelidis,, I. L. Chrystie,, I. M. Kidd,, M. F. Tungekar, and, J. M. Pattison. 2004. Monitoring the progress of BK virus associated nephropathy in renal transplant recipients. Nephrol. Dial. Transplant. 19:25982605.
69. Toyoda, M.,, A. Moudgil,, B. A. Warady,, D. P. Puliyanda, and, S. C. Jordan. 2008. Clinical significance of peripheral blood Epstein-Barr viral load monitoring using polymerase chain reaction in renal transplant recipients. Pediatr. Transplant. 12:778784.
70. Vats, A.,, R. Shapiro,, P. Singh Randhawa,, V. Scantlebury,, A. Tuzuner,, M. Saxena,, M. L. Moritz,, T. J. Beattie,, T. Gonwa,, M. D. Green, and, D. Ellis. 2003. Quantitative viral load monitoring and cidofovir therapy for the management of BK virus-associated nephropathy in children and adults. Transplantation 75:105112.
71. Weinstock, D. M.,, M. Boeckh, and, K. A. Sepkowitz. 2006. Postexposure prophylaxis against varicella zoster virus infection among hematopoietic stem cell transplant recipients. Biol. Blood Marrow Transplant. 12:10961097.
72. Yang, C. C.,, D. D. Hurd,, L. D. Case, and, D. G. Assimos. 1994. Hemorrhagic cystitis in bone marrow transplantation. Urology 44:322328.
73. Zolnourian, Z. R.,, M. D. Curran,, B. K. Rima,, P. V. Coyle,, H. J. O’Neill, and, D. Middleton. 2000. Parvovirus B19 in kidney transplant patients. Transplantation 69:21982202.


Generic image for table

Infections associated with adenovirus subgroups and serotypes

Citation: Patel R, Nolte F. 2011. Viral Infections in Transplant Recipients, p 631-640. In Persing D, Tenover F, Tang Y, Nolte F, Hayden R, van Belkum A (ed), Molecular Microbiology. ASM Press, Washington, DC. doi: 10.1128/9781555816834.ch40

This is a required field
Please enter a valid email address
Please check the format of the address you have entered.
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error