Epidemiology in horses involves the study of the distribution and determinants of health-related states and events in equine populations. It encompasses the investigation of patterns, causes, and effects of diseases and health conditions within horse populations. This field of study aims to identify risk factors for disease and targets for preventive healthcare. Key components of equine epidemiology include disease surveillance, outbreak investigation, and the study of disease dynamics within herds or regions. Research in this area often focuses on infectious diseases, zoonotic diseases, and the impact of environmental factors on equine health. This page compiles peer-reviewed research studies and scholarly articles that explore various aspects of epidemiology in horses, including disease prevalence, transmission pathways, and strategies for disease prevention and control.
Timoney PJ, McCollum WH, Roberts AW, McDonald MJ.Clinical cases of equine arteritis virus infection have not been diagnosed in Kentucky since 1984, and there has been no indication that any of the horses involved in the 1984 epizootic have since been responsible for spread of the disease to horses in other states or other countries. Cases of abortion caused by naturally acquired infection with this virus have not been confirmed in 1984 or 1985. Neither field nor vaccine strains of equine arteritis virus have been shown to induce teratologic abnormalities or the carrier state in foals born to infected or vaccinated mares. The carrier stallion...
Mayhew IG, Ferguson HO.A group of 834 Thoroughbred horses was surveyed on four central Florida farms for clinical and epidemiologic features of anhidrosis. In addition, comparative analysis was made of serum thyroxine, serum electrolytes, and fractional urinary electrolyte excretion ratios. An overall disease prevalence of 6.12% was observed. Training horses and nonpregnant broodmares had a predilection for the disease. Adolescent horses were infrequently affected. There was no correlation with sex or color. Comparative clinical signs, related to thermoregulatory compromise, included tachypnea and hyperthermia. Long...
McLean RG, Calisher CH, Parham GL.Blood samples collected in September and November 1980 from 87 horses in southwestern Michigan were examined for virus isolation and for plaque-reduction neutralizing antibody against selected arboviruses. Cache Valley virus was isolated from the blood of a clinically normal horse in St Joseph County in September. The age-specific antibody prevalence for Cache Valley virus indicated enzootic transmission in the study area. The high antibody prevalence and the lack of age-specific antibody prevalence indicated sporadic, but intense, exposure to Jamestown Canyon virus. Low prevalences of antibod...
Edwards JF, Yedloutschnig RJ, Dardiri AH, Callis JJ.Virus isolation was attempted from 262 field samples of vesicular material collected during the outbreaks of vesicular exanthema of swine in the U.S.A. from 1952-54. Using primary swine kidney culture, viral cytopathogenic agents were isolated from 76.3% of the samples. However, an overall recovery rate of 82.1% was obtained after samples negative in tissue culture were inoculated intradermally in susceptible swine. All vesicular exanthema of swine virus isolates were identified as serotype B51 using complement fixation and serum neutralization tests. Two isolates did not react with antisera t...
Anderson RA, Gallaway WJ.The capillary tube precipitin test was used to determine the host utilization patterns of Culiseta inornata in southwestern Manitoba. Ruminant blood was identified in 83.3% and equine blood in 15.8% of 1,036 positively reacting blood-meals. Human, swine and avian blood accounted for 0.9% of these blood-meals and mixed blood-meals accounted for 1.5% of the total. Culiseta inornata preferentially fed on large mammals, and selection between cattle and horses reflected the relative abundance of these two hosts rather than a specific preference for either one.
Hall BG, Faunce W.The genes for utilization of cellobiose are normally cryptic in both laboratory strains and natural isolates of Escherichia coli. A survey of natural isolates of E. coli reveals that functional genes for cellobiose utilization, while rare, are present. The fraction of E. coli that utilized cellobiose ranged from less than 0.01% in human fecal samples to 7% in fecal samples obtained from horses. Samples obtained from sheep, cows, dogs, and pigs contained 0.1 to 0.5% cellobiose-positive E. coli. Neither the previously identified cel genes nor the bgl genes from E. coli K-12 were expressed during...
The Journal of heredityMay 1, 1987
Volume 78, Issue 3 171-177 doi: 10.1093/oxfordjournals.jhered.a110351
Leone NC, Shupe JL, Gardner EJ, Millar EA, Olson AE, Phillips EC.Hereditary multiple exostosis (HME), a bone tumor first described by Virchow, has been studied over a period of 15 years on a comparative basis. The horse, an excellent biomedical model for this physically deforming multiple bone tumor in man, has been utilized in this study. The etiology, hereditary pattern, potential for malignancy and other aspects of this strange affliction need additional clarification. This in-depth study of 261 individuals from 144 families was compared with that of 55 horses bearing the HME trait, selectively bred and studied over the same period. Important information...
Schwink K.A retrospective review of 41 cases of equine ocular squamous cell carcinoma with follow up information for 33 horses is presented. An apparent prevalence in heavy horse breeds was identified. Age and sex distribution were similar to those previously reported. High recurrence (42.4 per cent) and low metastasis (6 per cent) rates were seen. Initial tumour location, primary treatment used, or patient case history had no apparent influence on final outcome. The willingness of owners to pursue with continuous treatment correlated with a high degree of success.
Broström H, Larsson A, Troedsson M.A survey of allergic dermatitis (sweet itch) in Sweden contained information on 441 Icelandic horses. Results of a questionnaire indicated that approximately 15 per cent of the country's Icelandic horses suffered from the disease. The prevalence of allergic dermatitis was significantly higher among horses imported from Iceland (26.2 per cent) compared to that of Swedish-born animals (6.7 per cent). In addition, horses born in Iceland were significantly more severely affected than horses born in Sweden. The risk of allergic dermatitis in Sweden appeared to be more than six times higher for hors...
Snyder JR, Pascoe JR, Hirsh DC.Positive cultures were obtained from 60 equine orthopedic cases during a 12 year period (1974-1985). These cases consisted of 34 long or cuboidal bone fractures, 13 arthrotomy/arthroscopy procedures for removal or internal fixation of a fracture, 7 proximal splint bone fractures, and 6 facial or mandibular fractures. Excluding the 13 arthrotomies, only 10 (21%) of the 47 were open fractures. Multiple organisms were isolated from 36 cases (20 long or cuboidal bone fractures, 7 splint bone fractures, 5 mandibular fractures, and 4 intra-articular fractures). Of the 142 isolates, 35 (24%) were mem...
Browning GF, Studdert MJ.The genomes of 51 isolates of slowly cytopathic equine herpesviruses were examined by digestion with restriction endonucleases. Forty-seven of the isolates showed considerable fragment pattern heterogeneity although common fragments were evident, especially when any two isolates were compared or when they were digested with SalI. Fifteen of the 47 viruses, selected for their diverse fragment patterns, showed a high degree of homology in Southern blot hybridization. In contrast, four viruses, representing three epidemiologically distinct isolations, shared few, if any, comigrating fragments wit...
Lloyd K, Hintz HF, Wheat JD, Schryver HF.Many cases of enteroliths were reported in the nineteenth century but the number greatly decreased in the early twentieth century. However, in recent years the number of cases in certain parts of the United States such as California has greatly increased. The reasons for the increase are obscure. The intake of nitrogen, magnesium and phosphorus (the primary components of enteroliths) from water and food is likely to be a factor. Arabians may be more likely to develop enteroliths than horses of other breeds. A nidus such as a small stone is needed because a nidus has been found in every enterol...
Hirsh DC, Jang SS.Rational choice of an antimicrobial agent requires that the condition for which the drug is prescribed contain an infectious agent and, if so, knowledge of the susceptibility of the microorganism to antimicrobial drugs. Unfortunately, most infectious conditions necessitate the use of an antimicrobic drug before data from the microbiology laboratory are available. The data presented are meant to serve as a guide in the choice of antimicrobic drugs for treatment of infectious processes of the horse before knowledge of the nature of the microorganism isolated as well as its susceptibility to anti...
Payne SL, Salinovich O, Nauman SM, Issel CJ, Montelaro RC.Comparisons of peptide and oligonucleotide maps of glycoproteins and RNA from nine isolates of equine infectious anemia virus (EIAV) that were generated during parallel infections of two Shetland ponies revealed that each isolate was structurally unique. Each EIAV isolate contained a unique subset of variant peptides, oligonucleotides, or both, indicating that structural variation in EIAV is a random and noncumulative process and that a large spectrum of possible EIAV variants can be generated in infected animals.
Cabañes FJ, Abarca L, Bragulat MR, Calvo MA.The ability of 17 strains of Epidermophyton to perforate hair in vitro using the Ajello & Georg's test procedure and a modification of Lu's method has been studied. Following the Ajello & Georg's test procedure only E. stockdaleae perforated hair. Sporadically some strains of E. floccosum perforated horse hair. We noted as well unusual perforations originated from inside to outside of the hair. By the other technique, all strains, excepting E. floccosum var. nigricans in child hair, perforated hair. E. floccosum showed these perforations later than E. stockdaleae.
Foil LD, Klei TR, Miller RI, Church GE, Foil CS, French DD, Smith JN.Seasonal changes in density and spatial distribution of Onchocerca cervicalis microfilariae were studied in ventral-midline skin of 15 infected pony mares in southern Louisiana. Triple running mean analysis of data over a 13-mo period indicated that a distinct pattern exists in total microfilariae population density and in microfilariae occurrence in different levels of the dermis. Microfilariae density reaches peak levels in the spring followed by a 58% decrease in the summer, a 19% increase in the fall, and a decrease to the lowest numbers in the winter. Microfilariae were found in all level...
Boldur I, Cohen A, Tamarin-Landau R, Sompolinsky D.The lungs of 139 calves presented for autopsy and 29 healthy slaughtered calves were examined for Legionella by culture and by direct immunofluorescence (DIF) with fluorescein-conjugated antisera. About 17% of the cadaver lungs and 4% of lungs from slaughtered animals were positive by DIF. Legionella organisms were only isolated from the lungs of two cadavers (L. pneumophila, serogroup 1). In a prevalence study of antibodies to Legionella in domestic and wild animals of various species, titers of greater than or equal to 64 were demonstrated by indirect immunofluorescence in sera of 10% of dai...
Grabatin M, Fux R, Zablotski Y, Goehring LS, Witte TS.Contagious equine metritis (CEM) is caused by Taylorella equigenitalis. It is a venereal disease that is detected in some breeds more than others and can cause temporary infertility with substantial costs for regular testing, sanitation and retesting. There was a perceived increase in T. equigenitalis-positive cases in Icelandic intact males where natural cover is common. Objective: We aimed to investigate the prevalence of T. equigenitalis in Icelandic intact males and compare to draught horse and Haflinger intact males. We hypothesised that prevalence of T. equigenitalis is higher in Iceland...
Gonzalez-Obando J, Zuluaga-Cabrera A, Moreno I, Úsuga J, Ciuderis K, Forero JE, Diaz A, Rojas-Arbeláez C, Hernández-Ortiz JP, Ruiz-Saenz J.Equine influenza is a viral disease caused by the equine influenza virus (EIV), and according to the WOAH, it is mandatory to report these infections. In Latin America and Colombia, EIV risk factors have not been analyzed. The objective of this research is to perform an epidemiological and molecular analysis of the EIV in horses with respiratory symptoms from 2020 to 2023 in Colombia. Molecular EIV detection was performed using RT-qPCR and nanopore sequencing. A risk analysis was also performed via the GEE method. A total of 188 equines with EIV respiratory symptoms were recruited. The positiv...
Tong P, Yang E, Liu B, Tian S, Suo Y, Pan J, Dang Y, Palidan N, Jia C, Kuang L, Xie J.Varicellovirus equidalpha1 (formerly Equid alphaherpesvirus 1, EqAHV-1) is among the most important viruses responsible for respiratory disease outbreaks among horses throughout the world. No reports to date have detailed the association between EqAHV-1 and respiratory disease among horses in China. This study described one such outbreak among a population of horses in north Xinjiang that occurred from April 2021 - May 2023. Results: qPCR revealed that EqAHV-1 was detectable in all samples and this virus was identified as a possible source of respiratory disease, although a limited subset of t...
Equine influenza (EI) is a highly contagious viral disease of equids characterized by pyrexia and respiratory signs. Like other influenza A viruses, antigenic drift or shift could lead to a vaccine-induced immunity breakdown if vaccine strains are not updated. The aim of this study was to genetically characterize EIV strains circulating in Italy, detected in PCR-positive samples collected from suspected cases, especially in the absence of formal active surveillance. Methods: Between February and April 2019, blood samples and nasal swabs collected from each of the 20 symptomatic horses from Nor...
Molini U, Franzo G, de Villiers L, van Zyl L, de Villiers M, Khaiseb S, Busch F, Knauf S, Dietze K, Eiden M.The present study investigated the seropositivity rate of Hepatitis E virus (HEV) in domestic and working animals in Namibia, which included dogs, cats, horses, and donkeys. HEV poses a growing threat as a significant cause of human hepatitis globally and has several genotypes of varying zoonotic potential. As epidemiological data on the seroprevalence of HEV in Namibia is scarce, a serosurvey was conducted on archived serum samples of 374 dogs, 238 cats, 98 horses, and 60 donkeys collected between 2018 and 2022 from different regions, to assess the potential of these animals as sources of HEV...
Yuen NKY, Harrison JJ, Wang ASW, McMahon IE, Habarugira G, Coyle MP, Bielefeldt-Ohmann H.An incursion and outbreak of Japanese encephalitis virus (JEV) was reported in Australia in 2021 and 2022, respectively. There was speculation that JEV may have been circulating in Australia unknowingly prior to the detection. In this study, we determined sero-prevalence and transmission of West Nile virus (WNV), Murray Valley encephalitis virus (MVEV) and JEV, prior to and post JEV incursion in a sentinel equine population in south-east Queensland (SEQ), Australia, using blocking ELISAs (screening test) and virus neutralisation test (confirmatory). Serum samples collected between 2018 and 202...
Cutarelli A, De Falco F, Serpe F, Izzo S, Fusco G, Catoi C, Roperto S.BPV1, BPV2, BPV13, and BPV14 are all genotypes of bovine delta papillomaviruses (δPV), of which the first three cause infections in horses and are associated with equine sarcoids. However, BPV14 infection has never been reported in equine species. In this study, we examined 58 fresh and thawed commercial semen samples from healthy stallions. In 34 (58.6%), bovine δPV DNA was detected and quantified using droplet digital polymerase chain reaction (ddPCR). Real time quantitative PCR (qPCR) was able to identify bovine δPV DNA in 5 samples (8.6%). Of the BPV-infected semen samples, 15 were posi...
Costa MVD, Rodrigues GD, Lima HIL, Krolow TK, Krüger RF.Tabanidae (Diptera), popularly known as horse flies, is an important vector group. This is the first study to ascertain the abundance and diversity of horse flies in horses at the cerrado biome of the state of Tocantins, Brazil. Collecting took place in typical Cerrado, and sampling occurred in the dry and rainy seasons. The horseflies were collected from horses using an entomological net. A total of 249 individuals were collected and spread over 25 species. The prevalent species were Stypommisa aripuana (25.8%) and Catachlorops rufescens (6.4%), in the dry period, and Fidena lissorhina (22.5%...
Ichikawa Y, Borjigin L, Enkhtuul B, Khurtsbaatar O, Aoshima K, Kobayashi A, Batbaatar V, Kimura T.Glanders, a highly contagious and often fatal disease affecting equids, is caused by Burkholderia mallei. Although sporadic cases of equine glanders have recently been documented in Mongolia, genome sequencing and molecular studies of the bacteria within this region are lacking. This study provided the first molecular characterization of B. mallei isolated from four native Mongolian horses from two different provinces in 2019 and 2022 by applying whole-genome sequencing with two SNP types (previously developed genotyping with 15 SNP markers that provide global coverage of the B. mallei populat...
Muroni G, Serra E, Biggio GP, Sanna D, Cherchi R, Taras A, Appino S, Foxi C, Masala G, Loi F, Chisu V.The members of the family are important pathogens that infect a wide range of vertebrate hosts, including humans. Among them, , historically considered as an avian agent, has recently been identified in livestock, primarily sheep and cattle, but also in horses, with the infection being linked to reproductive disorders, such as abortion, absorption of embryos, stillbirth, and the birth of weak foals. Much less is known about chlamydial infections in the Sardinian equine population. This study aimed to identify the chlamydial diversity in genital samples from asymptomatic Sardinian horses. Howe...
de Martinis C, Cardillo L, Pesce F, Viscardi M, Cozzolino L, Paradiso R, Cavallo S, De Ascentis M, Goffredo M, Monaco F, Savini G, D'Orilia F....West Nile virus (WNV) is the most widespread arbovirus worldwide, responsible for severe neurological symptoms in humans as well as in horses and birds. The main reservoir and amplifier of the virus are birds, and migratory birds seem to have a key role in the introduction and spread of WNV during their migratory routes. WNV lineage 1 (L1) has been missing in Italy for almost 10 years, only to reappear in 2020 in two dead raptor birds in southern Italy. The present study reports the first equine outbreak in the Campania region. A 7-year-old horse died because of worsening neurological signs ...
Legg KA, Cochrane DJ, Gee EK, Rogers CW.To identify descriptors associated with success in apprentice jockeys and to determine optimum numbers of jockeys for safer race riding. Methods: Retrospective cohort study. Methods: Incidence-rates for jockey falls and success (wins per 1,000 race-starts), time and number of races spent at different apprentice levels were calculated for 807 apprentice and professional jockeys over 19 years of Thoroughbred flat racing in New Zealand (n = 524,551 race-starts). Survival analysis was used to compare career progression for jockeys that fell and those that did not, and individual seasonal fal...
Onasanya AE, El-Hage C, Diaz-Méndez A, Vaz PK, Legione AR, Devlin JM, Hartley CA.Equid gammaherpesvirus 5 (EHV5) is closely related to equid gammaherpesvirus 2 (EHV2). Detection of EHV5 is frequent in horse populations worldwide, but it is often without a clear and significant clinical impact. Infection in horses can often present as subclinical disease; however, it has been associated with respiratory disease, including equine multinodular pulmonary fibrosis (EMPF). Genetic heterogeneity within small regions of the EHV5 glycoprotein B (gB) sequences have been reported and multiple genotypes of this virus have been identified within individual horses, but full genome seque...
The Western equine encephalitis virus is transmitted between mosquitoes and wild birds. Mosquitoes spread the virus to horses and human populations, causing severe encephalitis and death. The most recent large outbreak occurred in South America from November 2023 to April 2024. We identified and genetically characterized Uruguayan strains during this outbreak to understand their evolutionary trends and rapid expansion. We obtained genomes from 15 strains using a novel multiplex PCR assay combined with next-generation Illumina sequencing. The phylogenetic analysis revealed that viruses from Uru...
Sellali S, Lafri I, Ayhan N, Medrouh B, Messahel NE, Lafri M, Charrel R, Bitam I.Toscana virus is a sandfly-borne human pathogen belonging to Phlebovirus genus into Phenuiviridae family. It is emerging in north Africa posing a complex threat to public health. TOSV is heavily affecting sandfly-exposed people in northern Algeria. A larger distribution has recently been stated in Algeria by using dog sera. Dog exposure to TOSV was repeatedly identified in north Algeria, with 4.56% lately detected to possess respective neutralizing antibodies. However, evidence for TOSV has only been observed in dogs among various species of domestic animals. Therefore, we attempted to assess ...
Matsumura R, Bannai H, Nemoto M, Higa Y, Kai I, Sasaki T, Futami K, Yoshikawa A, Fujita R, Hino M, Nagata K, Kuwata R, Kaku Y, Kobayashi D....Getah virus (GETV), belonging to the genus Alphavirus within the family Togaviridae, is a mosquito-borne virus that causes fever, rash, edema in horses, fatalities, and pregnancy disorders in pigs. It has caused occasional outbreaks in horse populations in Japan, China, and India, and the endemic areas are gradually expanding, particularly in Asia and Oceania. In this study, we isolated a new GETV strain from Culex tritaeniorhynchus mosquitoes collected in Nagasaki Prefecture, Japan, in 2022. Phylogenetic analysis demonstrated that this new strain, 22IH8, was more closely related to previous C...
Daugaliyeva A, Daugaliyeva S, Abutalip A, Adambayeva A, Kydyr N, Peletto S.Brucellosis is one of the most common zoonotic infectious diseases of animals. The causative agent of brucellosis is a highly conserved bacterium of the genus Brucella, which includes 14 species with minor genetic changes. Our work aimed to study the epidemiological and molecular characteristics of Brucella strains circulating in Kazakhstan, including the study of polymorphisms in critical virulence genes using single nucleotide polymorphism (SNP) analysis based on whole genome sequencing (WGS). A total of 21 Brucella isolates obtained in 2023-2024 from cattle, sheep and goats, horses, camels,...
Zeng W, Kairat Z, Awulibieer M, Abylay S, Serik K, Yang M, Wang Y, Hazihan W.Tick-borne pathogens (TBPs) are a global public health issue. However, there have been few reports on the prevalence of piroplasms, , and in Kazakhstan. To understand the distribution of piroplasms, , and pathogens carried by ticks in Kazakhstan, a total of 10,461 ticks were collected from natural hosts (e.g., cattle, sheep, and horses) in six oblasts in eastern, southern, and western Kazakhstan between 2022 and 2024. After morphological identification, 272 representative ticks were further used for species-level detection and partial genotyping analysis of TBPs. Two species ( and ), four ...
Munirah M, Wahyuni S, Wahid I, Hamid F.In Indonesia, malaria incidence is at a high rate despite maximum preventive efforts. Therefore, this study aims to determine the possibility of a reservoir among domestic animals in malaria-endemic areas. Animal blood was collected using EDTA tubes, then smeared and stained with Giemsa for microscopic identification. About 10 μl of blood was dropped on to a filter paper to capture DNA. Nested PCR was used for parasite molecular detection, while species were identified using the sequenced DNA. A total of 208 and 62 animal blood samples were collected from Gaura village, West Sumba and Fak...
Nambuya S, Kalinda C, Vudriko P, Adriko M, Phiri M, Mindu T, Wagaba D, Mugisha L.Fascioliasis is a zoonotic disease of public health and economic importance. It is caused by trematodes species Fasciola hepatica, and Fasciola gigantica. The parasites infest the liver particularly the bile ducts, and cause harm to the host. The economic loss to both dairy and meat industry is attributed to emaciation, reduction in milk production, death, infertility, and losses to liver condemnation. However, fascioliasis remains poorly studied and limited data is available to guide appropriate interventions especially in low- and middle-income countries. This paper aimed to review the preva...
Luong T, Tran MH, Pham BU, Metrailer MC, Pham VK, Nguyen HL, Pham TL, Tran TMH, Pham QT, Hoang TTH, Blackburn JK.Anthrax, a widespread zoonosis in low and middle-income countries with low disease awareness and insufficient livestock vaccination coverage, has been known in Lao Cai Province in northern Vietnam for years before its apparent absence in 2009, which requires investigation as this infection is frequently reported from neighbouring provinces and countries. We aimed to describe the seasonal patterns of anthrax (1991-2008), compare livestock anthrax vaccine coverage to disease occurrence (1991- 2022), and delineate the high-risk areas to inform local disease surveillance in the province. We illust...
Yuen NKY, Bielefeldt-Ohmann H, Coyle MP, Henning J.Ross River virus (RRV), the most medically and economically important arbovirus in Australia, has been the most prevalent arbovirus infections in humans for many years. Infected humans and horses often suffer similar clinical symptoms. We conducted a prospective longitudinal study over a 3.5-year period to investigate the exposure dynamics of RRV in three foal cohorts (n = 32) born in a subtropical region of South East Queensland, Australia, between 2020 and 2022. RRV-specific seroconversion was detected in 56% (n = 18) of foals with a median time to seroconversion, after waning of materna...
Romiti F, Scicluna MT, Censi F, Micarelli F, Puccica S, Carvelli A, Sala MG, Del Lesto I, Casini R, De Liberato C, Tofani S.West Nile (WNV) and Usutu (USUV) viruses co-circulated in a region of Central Italy (Lazio) in 2018, as evidenced by the detection of WNV in the nervous tissues of symptomatic horses and USUV in blood donors and mosquito pools. To assess whether these viruses were endemic in the region, we analysed: 1) diapausing Culex pipiens mosquitoes collected during the winter seasons 2022-2023 and 2023-2024, 2) Cx. pipiens mosquitoes collected during the adult activity period from April to November in 2022 and 2023 across 4 provinces, and 3) sera from 52 horses and tissues from 537 birds. Field-collected...
Dieste-Pérez L, Holstege MMC, de Jong JE, Heuvelink AE.The resistance of species to azoles in human medicine is gaining increasing attention, and the role of animals and agricultural practices in this issue is becoming a significant source of concern. To gain better insights into the occurrence of azole resistance in spp. isolates from animals, a systematic literature review was conducted. Searches were conducted in the PubMed and Scopus databases for articles addressing azole resistance in spp. isolates from both animals and their immediate environments, published between 2013 and 2024. Descriptive clinical cases were analyzed separately from ...
