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Çocuklarda COVID-19 sonrası streptokokal tonsillofarenjit sıklığındaki değişiklikler

Year 2024, Volume: 15 Issue: 1, 110 - 116, 28.03.2024
https://doi.org/10.18663/tjcl.1440105

Abstract

Amaç: Koronavirus hastalığı 2019 (COVID-19) pandemisi öncesi ve sonrasında Streptococcus pyogenes (GAS) tonsillofarenjit sıklığında yaşanan değişikliklere ilişkin kapsamlı veriler yetersizdir. Bu çalışmada, COVID-19 dönemi öncesi, sırası ve sonrasında çocuklarda GAS sıklığında meydana gelen değişiklikleri incelemeyi amaçlanmıştır.
Gereç ve Yöntemler: Bu retrospektif çalışmaya, Haziran 2018 ile Haziran 2023 tarihleri arasında klinik bulgularla bakteriyel tonsillofarenjit ön tanısı alan 13,061 çocuk hasta dahil edildi. Tüm hastalara Strep A antijen testi yapılmış ve boğaz sürüntü örnekleri toplanmıştır. Hastalar, hastaneye başvuru tarihlerine göre üç gruba ayrıldı: Grup 1, COVID-19 pandemisi öncesi dönem (1 Ocak 2018 - 10 Mart 2020); Grup 2, COVID-19 pandemisi sırasında sıkı önlemlerin uygulandığı dönem (11 Mart 2020 - 30 Haziran 2021); ve Grup 3, COVID-19 pandemisi önlemlerinin kaldırıldığı dönem (1 Temmuz 2021 - 30 Haziran 2023).
Bulgular: Tüm popülasyonda GAS prevalansı %23.2 (n=3024) idi. Gruplar arasında, Grup 3 en yüksek GAS sıklığına sahipken, bunu Grup 1 ve ardından Grup 2 izledi (Grup 1: %18.1, Grup 2: %6.0, Grup 3: %29.6, p < 0.001). COVID-19 pandemisine karşı katı önlemlerin alındığı dönemde, COVID-19 öncesi döneme kıyasla GAS sıklığında önemli bir azalma gözlemlendi. Ancak, COVID-19 ile ilişkili kısıtlamaların gevşetilmesiyle, özellikle 2022'nin son çeyreği ve 2023 ilkbaharında, GAS sıklığında belirgin bir artış saptandı.
Sonuçlar: Çocuklarda, GAS sıklığı COVID-19 izolasyon önlemleriyle önemli ölçüde azaldı. Ancak, bu izolasyon önlemlerinin gevşetilmesinin ardından ani bir artış gözlemlendi.

Ethical Statement

The study was performed in accordance with the Declaration of Helsinki, and was approved by the Hisar Intercontinental Hospital Ethics Committee (Date: 22.09.2023, Decision No: 23-48).

Project Number

Decision No: 23-48, Date: 22.09.2023

References

  • Mustafa Z, Ghaffari M. Diagnostic methods, clinical guidelines, and antibiotic treatment for Group A Streptococcal Pharyngitis: A narrative review. Front Cell Infect Microbiol. 2020;10:563627.
  • Shaikh N, Leonard E, Martin JM. Prevalence of streptococcal pharyngitis and streptococcal carriage in children: a meta-analysis. Pediatrics. 2010;126:e557-564.
  • Walker MJ, Barnett TC, McArthur JD, et al. Disease manifestations and pathogenic mechanisms of Group A Streptococcus. Clin Microbiol Rev. 2014;27:264-301.
  • Smith KL, Hughes R, Myrex P. Tonsillitis and tonsilloliths: Diagnosis and management. Am Fam Physician. 2023;107:35-41.
  • Avire NJ, Whiley H, Ross K. A Review of Streptococcus pyogenes: Public health risk factors, prevention and control. Pathogens. 2021;10:248.
  • Windfuhr JP, Toepfner N, Steffen G, Waldfahrer F, Berner R. Clinical practice guideline: Tonsillitis I. Diagnostics and nonsurgical management. Eur Arch Otorhinolaryngol. 2016;273:973-987.
  • Herrera AL, Huber VC, Chaussee MS. The association between invasive Group A Streptococcal diseases and viral respiratory tract infections. Front Microbiol. 2016;7:342.
  • Morens DM, Fauci AS. The 1918 influenza pandemic: insights for the 21st century. J Infect Dis. 2007;195:1018-1028.
  • Zakikhany K, Degail MA, Lamagni T, et al. Increase in invasive Streptococcus pyogenes and Streptococcus pneumoniae infections in England, December 2010 to January 2011. Euro Surveill. 2011;16:19785.
  • Jean C, Louie JK, Glaser CA, et al. Invasive Group A streptococcal infection concurrent with 2009 H1N1 influenza. Clin Infect Dis. 2010;50:e59-62.
  • Prasad N, Rhodes J, Deng L, et al. Changes in the incidence of invasive bacterial disease during the COVID-19 pandemic in the United States, 2014-2020. J Infect Dis. 2023;227:907-916.
  • Cobo-Vazquez E, Aguilera-Alonso D, Carrasco-Colom J, Calvo C, Saavedra-Lozano JPed GASnWG. Increasing incidence and severity of invasive Group A streptococcal disease in Spanish children in 2019-2022. Lancet Reg Health Eur. 2023;27:100597.
  • Abo YN, Oliver J, McMinn A, et al. Increase in invasive Group A Streptococcal disease among Australian children coinciding with northern hemisphere surges. Lancet Reg Health West Pac. 2023;41:100873.
  • WHO. Increased incidence of scarlet fever and invasive Group A Streptococcus infection – multi-country. 15 December 2022 [cited 2024 15 January]; Available from: https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON429.
  • Johannesen TB, Munkstrup C, Edslev SM, et al. Increase in invasive Group A Streptococcal infections and emergence of novel, rapidly expanding sub-lineage of the virulent Streptococcus pyogenes M1 clone, Denmark, 2023. Euro Surveill. 2023;28:2300291.
  • van der Putten BCL, Vlaminckx BJM, de Gier B, Freudenburg-de Graaf W, van Sorge NM. Group A Streptococcal meningitis with the M1UK variant in the Netherlands. JAMA. 2023;329:1791-1792.
  • Shulman ST, Bisno AL, Clegg HW, et al. Clinical practice guideline for the diagnosis and management of Group A Streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis. 2012;55:1279-1282.
  • Solvik UO, Boija EE, Ekvall S, et al. Performance and user-friendliness of the rapid antigen detection tests QuickVue Dipstick Strep A test and DIAQUICK Strep A Blue Dipstick for pharyngotonsillitis caused by Streptococcus pyogenes in primary health care. Eur J Clin Microbiol Infect Dis. 2021;40:549-558.
  • Barlas G, Ozturk H, Pehlivanturk G, Aydin S. Turkey's response to COVID-19 pandemic: strategy and key actions. Turk J Med Sci. 2021;51:3150-3156.
  • Ilhan MN, Tuzun H, Kilic R, Yildirim N. Nonpharmaceutical interventions in Turkey and worldwide during COVID-19 pandemic. Turk J Med Sci. 2021;51:3207-3214.
  • Sidell D, Shapiro NL. Acute tonsillitis. Infect Disord Drug Targets. 2012;12:271-276.
  • Yilmaz F, Karabay O, Ince NK, Ekerbicer H, Kocoglu E. [Effectiveness of rapid antigen test with throat gargle in detecting Group A beta-hemolytic streptococci]. Kulak Burun Bogaz Ihtis Derg. 2008;18:280-283.
  • Candan ED, Neslihan İ, Taner A. Factors affecting the incidence of Group A Β-Hemolytic Streptococci isolated from throat culture. Hacettepe Journal of Biology and Chemistry. 2022;50:25-30.
  • Yücel S, Güdücüoğlu H, Parlak M, Bayram Y. The frequency of Group A Beta-Hemolytic Streptococci (AGBHS) growing in throat cultures by years. Van Sağlık Bilimleri Dergisi. 2021;14:258-263.
  • Ozkaya-Parlakay A, Uysal M, Kara A. Group A Streptococcal tonsillopharyngitis burden in a tertiary Turkish hospital. Turk J Pediatr. 2012;54:474-477.
  • Furuncuoğlu Y, Başar M, Alici Ö, Bayiz Ü. The incidence of Group A Beta Hemolytic Streptococci in patients with acute exudative tonsilitis in Istanbul a 14-year period. Journal of Istanbul Faculty of Medicine. 2016;79:16-18.
  • Boyanton BLJ, Snowden JN, Frenner RA, Rosenbaum ER, Young HLKennedy JL. SARS-CoV-2 infection mitigation strategies concomitantly reduce Group A Streptococcus pharyngitis. Clin Pediatr (Phila). 2023;62:683-687.
  • Flores-Perez P, Gerig N, Cabrera-Lopez MI, et al. Acute bronchiolitis during the COVID-19 pandemic. Enferm Infecc Microbiol Clin (Engl Ed). 2022;40:572-575.
  • Cohen JF, Rybak A, Werner A, et al. Surveillance of noninvasive group A Streptococcus infections in French ambulatory pediatrics before and during the COVID-19 pandemic: a prospective multicenter study from 2018-2022. Int J Infect Dis. 2023;134:135-141.
  • Rybak A, Levy C, Angoulvant F, et al. Association of nonpharmaceutical interventions during the COVID-19 pandemic with invasive pneumococcal disease, pneumococcal carriage, and respiratory viral infections among children in France. JAMA Netw Open. 2022;5:e2218959.
  • Mangioni D, Fox V, Saltini P, et al. Increase in invasive Group A Streptococcal infections in Milan, Italy: A genomic and clinical characterization. Front Microbiol. 2023;14:1287522.
  • Wolters M, Berinson B, Degel-Brossmann N, et al. Population of invasive Group A streptococci isolates from a German tertiary care center is dominated by the hypertoxigenic virulent M1(UK) genotype. Infection. 2023. Epub ahead of print. doi: 10.1007/s15010-023-02137-1.
  • Cohen R, Ashman M, Taha MK, et al. Pediatric Infectious Disease Group (GPIP) position paper on the immune debt of the COVID-19 pandemic in childhood, how can we fill the immunity gap? Infect Dis Now. 2021;51:418-423.
  • Lu Q, Yu D, Yang Y. Group A Streptococcus is still at large. J Clin Med. 2023;12:2739.
  • Wrenn K, Blomquist PB, Inzoungou-Massanga C, et al. Surge of lower respiratory tract Group A Streptococcal infections in England in winter 2022: Epidemiology and clinical profile. Lancet. 2023;402:93.
  • Guy R, Henderson KL, Coelho J, et al. Increase in invasive group A streptococcal infection notifications, England, 2022. Euro Surveill. 2023;28:2200942.
  • Kennis M, Tagawa A, Kung VM, et al. Seasonal variations and risk factors of Streptococcus pyogenes infection: a multicenter research network study. Ther Adv Infect Dis. 2022;9:20499361221132101.
  • Lamagni TL, Darenberg J, Luca-Harari B, et al. Epidemiology of severe Streptococcus pyogenes disease in Europe. J Clin Microbiol. 2008;46:2359-2367.
  • Taylor A, Whittaker E. The changing epidemiology of respiratory viruses in children during the COVID-19 pandemic: A Canary in a COVID time. Pediatr Infect Dis J. 2022;41:e46-48.
  • Mponponsuo K, Church DL, Lu SJ, et al. Age and sex-specific incidence rates of Group A Streptococcal pharyngitis between 2010 and 2018: a population-based study. Future Microbiol. 2021;16:1053-1062.
  • Yildiz I, Gonullu E, Soysal A, Oner CN, Karabocuoglu M. The epidemiology of influenza virus infection and Group A Streptococcal pharyngitis in children between 2011 and 2018 in an outpatient pediatric clinic. Cureus. 2023;15:e33492.

Variations in the frequency of streptococcal tonsillopharyngitis among children after COVID-19

Year 2024, Volume: 15 Issue: 1, 110 - 116, 28.03.2024
https://doi.org/10.18663/tjcl.1440105

Abstract

Aim: Comprehensive data on the variations in the frequency of Streptococcus pyogenes (GAS) tonsillopharyngitis before
and after the Coronavirus disease 2019 (COVID-19) pandemic are still insufficient. This study aimed to investigate the changes in the frequency of GAS in children before, during, and after the COVID-19 period.
Material and Methods: This retrospective study included 13,061 patients diagnosed with a pre-diagnosis of bacterial tonsillopharyngitis based on clinical findings, between June 2018 and June 2023. All patients were administered the Strep A antigen test, and throat swab samples were collected. Patients were divided into three groups based on their hospital admission dates. Group 1, pre-COVID-19 pandemic period (1 January 2018 – 10 March 2020); Group 2, during the COVID-19 pandemic when strict measures were enforced (11 March 2020 – 30 June 2021); and Group 3, the period after the lifting of COVID-19 pandemic measures (1 July 2021 – 30 June 2023).
Results: The prevalence of GAS in the entire population was 23.2% (n=3024). Among the groups, Group 3 had the highest ratio of GAS cases, followed by Group 1, and then Group 2 (Group 1: 18.1%, Group 2: 6.0%, Group 3: 29.6%, p < 0.001). During the period characterized by stringent measures against the COVID-19 pandemic, a significant reduction in the frequency of GAS was observed in comparison to the pre-COVID-19 era. However, with the relaxation of COVID-19-related restrictions, particularly in the last quarter of 2022 and the spring of 2023, there was a marked increase in the frequency of GAS. Conclusion: In children, the frequency of GAS significantly decreases with COVID-19 isolation measures. However, a rebound increase is observed following the relaxation of these isolation measures.

Ethical Statement

Çalışma Helsinki Bildirgesi'ne uygun olarak yapıldı ve Hisar Hospital Intercontinental Etik Kurulu tarafından onaylandı (Tarih: 22.09.2023, Karar No: 23-48).

Project Number

Decision No: 23-48, Date: 22.09.2023

References

  • Mustafa Z, Ghaffari M. Diagnostic methods, clinical guidelines, and antibiotic treatment for Group A Streptococcal Pharyngitis: A narrative review. Front Cell Infect Microbiol. 2020;10:563627.
  • Shaikh N, Leonard E, Martin JM. Prevalence of streptococcal pharyngitis and streptococcal carriage in children: a meta-analysis. Pediatrics. 2010;126:e557-564.
  • Walker MJ, Barnett TC, McArthur JD, et al. Disease manifestations and pathogenic mechanisms of Group A Streptococcus. Clin Microbiol Rev. 2014;27:264-301.
  • Smith KL, Hughes R, Myrex P. Tonsillitis and tonsilloliths: Diagnosis and management. Am Fam Physician. 2023;107:35-41.
  • Avire NJ, Whiley H, Ross K. A Review of Streptococcus pyogenes: Public health risk factors, prevention and control. Pathogens. 2021;10:248.
  • Windfuhr JP, Toepfner N, Steffen G, Waldfahrer F, Berner R. Clinical practice guideline: Tonsillitis I. Diagnostics and nonsurgical management. Eur Arch Otorhinolaryngol. 2016;273:973-987.
  • Herrera AL, Huber VC, Chaussee MS. The association between invasive Group A Streptococcal diseases and viral respiratory tract infections. Front Microbiol. 2016;7:342.
  • Morens DM, Fauci AS. The 1918 influenza pandemic: insights for the 21st century. J Infect Dis. 2007;195:1018-1028.
  • Zakikhany K, Degail MA, Lamagni T, et al. Increase in invasive Streptococcus pyogenes and Streptococcus pneumoniae infections in England, December 2010 to January 2011. Euro Surveill. 2011;16:19785.
  • Jean C, Louie JK, Glaser CA, et al. Invasive Group A streptococcal infection concurrent with 2009 H1N1 influenza. Clin Infect Dis. 2010;50:e59-62.
  • Prasad N, Rhodes J, Deng L, et al. Changes in the incidence of invasive bacterial disease during the COVID-19 pandemic in the United States, 2014-2020. J Infect Dis. 2023;227:907-916.
  • Cobo-Vazquez E, Aguilera-Alonso D, Carrasco-Colom J, Calvo C, Saavedra-Lozano JPed GASnWG. Increasing incidence and severity of invasive Group A streptococcal disease in Spanish children in 2019-2022. Lancet Reg Health Eur. 2023;27:100597.
  • Abo YN, Oliver J, McMinn A, et al. Increase in invasive Group A Streptococcal disease among Australian children coinciding with northern hemisphere surges. Lancet Reg Health West Pac. 2023;41:100873.
  • WHO. Increased incidence of scarlet fever and invasive Group A Streptococcus infection – multi-country. 15 December 2022 [cited 2024 15 January]; Available from: https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON429.
  • Johannesen TB, Munkstrup C, Edslev SM, et al. Increase in invasive Group A Streptococcal infections and emergence of novel, rapidly expanding sub-lineage of the virulent Streptococcus pyogenes M1 clone, Denmark, 2023. Euro Surveill. 2023;28:2300291.
  • van der Putten BCL, Vlaminckx BJM, de Gier B, Freudenburg-de Graaf W, van Sorge NM. Group A Streptococcal meningitis with the M1UK variant in the Netherlands. JAMA. 2023;329:1791-1792.
  • Shulman ST, Bisno AL, Clegg HW, et al. Clinical practice guideline for the diagnosis and management of Group A Streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis. 2012;55:1279-1282.
  • Solvik UO, Boija EE, Ekvall S, et al. Performance and user-friendliness of the rapid antigen detection tests QuickVue Dipstick Strep A test and DIAQUICK Strep A Blue Dipstick for pharyngotonsillitis caused by Streptococcus pyogenes in primary health care. Eur J Clin Microbiol Infect Dis. 2021;40:549-558.
  • Barlas G, Ozturk H, Pehlivanturk G, Aydin S. Turkey's response to COVID-19 pandemic: strategy and key actions. Turk J Med Sci. 2021;51:3150-3156.
  • Ilhan MN, Tuzun H, Kilic R, Yildirim N. Nonpharmaceutical interventions in Turkey and worldwide during COVID-19 pandemic. Turk J Med Sci. 2021;51:3207-3214.
  • Sidell D, Shapiro NL. Acute tonsillitis. Infect Disord Drug Targets. 2012;12:271-276.
  • Yilmaz F, Karabay O, Ince NK, Ekerbicer H, Kocoglu E. [Effectiveness of rapid antigen test with throat gargle in detecting Group A beta-hemolytic streptococci]. Kulak Burun Bogaz Ihtis Derg. 2008;18:280-283.
  • Candan ED, Neslihan İ, Taner A. Factors affecting the incidence of Group A Β-Hemolytic Streptococci isolated from throat culture. Hacettepe Journal of Biology and Chemistry. 2022;50:25-30.
  • Yücel S, Güdücüoğlu H, Parlak M, Bayram Y. The frequency of Group A Beta-Hemolytic Streptococci (AGBHS) growing in throat cultures by years. Van Sağlık Bilimleri Dergisi. 2021;14:258-263.
  • Ozkaya-Parlakay A, Uysal M, Kara A. Group A Streptococcal tonsillopharyngitis burden in a tertiary Turkish hospital. Turk J Pediatr. 2012;54:474-477.
  • Furuncuoğlu Y, Başar M, Alici Ö, Bayiz Ü. The incidence of Group A Beta Hemolytic Streptococci in patients with acute exudative tonsilitis in Istanbul a 14-year period. Journal of Istanbul Faculty of Medicine. 2016;79:16-18.
  • Boyanton BLJ, Snowden JN, Frenner RA, Rosenbaum ER, Young HLKennedy JL. SARS-CoV-2 infection mitigation strategies concomitantly reduce Group A Streptococcus pharyngitis. Clin Pediatr (Phila). 2023;62:683-687.
  • Flores-Perez P, Gerig N, Cabrera-Lopez MI, et al. Acute bronchiolitis during the COVID-19 pandemic. Enferm Infecc Microbiol Clin (Engl Ed). 2022;40:572-575.
  • Cohen JF, Rybak A, Werner A, et al. Surveillance of noninvasive group A Streptococcus infections in French ambulatory pediatrics before and during the COVID-19 pandemic: a prospective multicenter study from 2018-2022. Int J Infect Dis. 2023;134:135-141.
  • Rybak A, Levy C, Angoulvant F, et al. Association of nonpharmaceutical interventions during the COVID-19 pandemic with invasive pneumococcal disease, pneumococcal carriage, and respiratory viral infections among children in France. JAMA Netw Open. 2022;5:e2218959.
  • Mangioni D, Fox V, Saltini P, et al. Increase in invasive Group A Streptococcal infections in Milan, Italy: A genomic and clinical characterization. Front Microbiol. 2023;14:1287522.
  • Wolters M, Berinson B, Degel-Brossmann N, et al. Population of invasive Group A streptococci isolates from a German tertiary care center is dominated by the hypertoxigenic virulent M1(UK) genotype. Infection. 2023. Epub ahead of print. doi: 10.1007/s15010-023-02137-1.
  • Cohen R, Ashman M, Taha MK, et al. Pediatric Infectious Disease Group (GPIP) position paper on the immune debt of the COVID-19 pandemic in childhood, how can we fill the immunity gap? Infect Dis Now. 2021;51:418-423.
  • Lu Q, Yu D, Yang Y. Group A Streptococcus is still at large. J Clin Med. 2023;12:2739.
  • Wrenn K, Blomquist PB, Inzoungou-Massanga C, et al. Surge of lower respiratory tract Group A Streptococcal infections in England in winter 2022: Epidemiology and clinical profile. Lancet. 2023;402:93.
  • Guy R, Henderson KL, Coelho J, et al. Increase in invasive group A streptococcal infection notifications, England, 2022. Euro Surveill. 2023;28:2200942.
  • Kennis M, Tagawa A, Kung VM, et al. Seasonal variations and risk factors of Streptococcus pyogenes infection: a multicenter research network study. Ther Adv Infect Dis. 2022;9:20499361221132101.
  • Lamagni TL, Darenberg J, Luca-Harari B, et al. Epidemiology of severe Streptococcus pyogenes disease in Europe. J Clin Microbiol. 2008;46:2359-2367.
  • Taylor A, Whittaker E. The changing epidemiology of respiratory viruses in children during the COVID-19 pandemic: A Canary in a COVID time. Pediatr Infect Dis J. 2022;41:e46-48.
  • Mponponsuo K, Church DL, Lu SJ, et al. Age and sex-specific incidence rates of Group A Streptococcal pharyngitis between 2010 and 2018: a population-based study. Future Microbiol. 2021;16:1053-1062.
  • Yildiz I, Gonullu E, Soysal A, Oner CN, Karabocuoglu M. The epidemiology of influenza virus infection and Group A Streptococcal pharyngitis in children between 2011 and 2018 in an outpatient pediatric clinic. Cureus. 2023;15:e33492.
There are 41 citations in total.

Details

Primary Language Turkish
Subjects Pediatric Infectious Diseases
Journal Section Research Article
Authors

Yunus Nas 0009-0003-5012-1222

Süveyda Gözüküçük 0009-0006-9830-0790

Project Number Decision No: 23-48, Date: 22.09.2023
Publication Date March 28, 2024
Submission Date February 20, 2024
Acceptance Date March 25, 2024
Published in Issue Year 2024 Volume: 15 Issue: 1

Cite

APA Nas, Y., & Gözüküçük, S. (2024). Variations in the frequency of streptococcal tonsillopharyngitis among children after COVID-19. Turkish Journal of Clinics and Laboratory, 15(1), 110-116. https://doi.org/10.18663/tjcl.1440105
AMA Nas Y, Gözüküçük S. Variations in the frequency of streptococcal tonsillopharyngitis among children after COVID-19. TJCL. March 2024;15(1):110-116. doi:10.18663/tjcl.1440105
Chicago Nas, Yunus, and Süveyda Gözüküçük. “Variations in the Frequency of Streptococcal Tonsillopharyngitis Among Children After COVID-19”. Turkish Journal of Clinics and Laboratory 15, no. 1 (March 2024): 110-16. https://doi.org/10.18663/tjcl.1440105.
EndNote Nas Y, Gözüküçük S (March 1, 2024) Variations in the frequency of streptococcal tonsillopharyngitis among children after COVID-19. Turkish Journal of Clinics and Laboratory 15 1 110–116.
IEEE Y. Nas and S. Gözüküçük, “Variations in the frequency of streptococcal tonsillopharyngitis among children after COVID-19”, TJCL, vol. 15, no. 1, pp. 110–116, 2024, doi: 10.18663/tjcl.1440105.
ISNAD Nas, Yunus - Gözüküçük, Süveyda. “Variations in the Frequency of Streptococcal Tonsillopharyngitis Among Children After COVID-19”. Turkish Journal of Clinics and Laboratory 15/1 (March 2024), 110-116. https://doi.org/10.18663/tjcl.1440105.
JAMA Nas Y, Gözüküçük S. Variations in the frequency of streptococcal tonsillopharyngitis among children after COVID-19. TJCL. 2024;15:110–116.
MLA Nas, Yunus and Süveyda Gözüküçük. “Variations in the Frequency of Streptococcal Tonsillopharyngitis Among Children After COVID-19”. Turkish Journal of Clinics and Laboratory, vol. 15, no. 1, 2024, pp. 110-6, doi:10.18663/tjcl.1440105.
Vancouver Nas Y, Gözüküçük S. Variations in the frequency of streptococcal tonsillopharyngitis among children after COVID-19. TJCL. 2024;15(1):110-6.


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