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Investigation of respiratory syncytial virus in children with respiratory tract infection by real-time polymerase chain reaction

Year 2019, Volume: 3 Issue: 10, 754 - 758, 01.10.2019
https://doi.org/10.28982/josam.632224

Abstract

Aim: Respiratory syncytial virus (RSV) is the most common agent of respiratory tract infections (RTIs) in the early stages of life. This study aimed to investigate RSV A/B in children with RTIs by multiplex Polymerase Chain Reaction (PCR) and evaluate the distribution of RSV among age groups, concurrent co-infections, and features of its seasonal distribution. 

Methods: Zero to eighteen-year-old patients whose nasopharyngeal swab samples were analyzed with the pre-diagnosis of RTI between April 2015 - March 2018 were included in this cross-sectional study. RSV A/B and other viruses of the respiratory panel were investigated with the multiplex real-time PCR method. 

Results: Median age of 2707 patients was 1 (age range: 0-18) and 57.4% (1554) of them were male. RSV positivity was found in 14.4% (390). Prevalence of RSV in females and males were 13.6% and 15.5% respectively (P=0.16). The highest RSV rate was 18.1% in those younger than one year. Mixed infection factors were found in 5.4%, the most common ones being RSV and human rhinovirus (1.8%). RSV was mostly seen in December, followed by January and February (P<0.001). 

Conclusion: RSV was found in 14.4% of the pediatric patients with RTI. We found that RSV was more common under the age of 1. In this study, we determined that RSV was commonly seen in winter. Early diagnosis of RSV with real-time PCR plays a crucial role in the prevention of unnecessary use of antibiotics and nosocomial infections. It may also help to implement an effective approach to the prevention, control, and treatment of RTIs during winter when the incidence increases.

Supporting Institution

The authors declared that this study has received no financial support

References

  • 1. Rima B, Collins P, Easton A, Fouchier R, Kurath G, Lamb RA, et al. ICTV Report Consortium. J Gen Virol. 2017;98:2912-3.
  • 2. Falsey AR, Hennessey PA, Formica MA, Cox C, Walsh EE. Respiratory syncytial virus infection in elderly and high-risk adults. N Engl J Med. 2005;352:1749-59.
  • 3. Ruuskanen O, Lahti E, Jennings LC, Murdoch DR. Viral pneumonia. Lancet. 2011;377:1264-75.
  • 4. Weir E, Fisman DN. Respiratory syncytial virus:pervasive yet evasive. CMAJ. 2004;170:191.
  • 5. Stewart DL, Romero JR, Buysman EK, Fernandes AW, Mahadevia PJ. Total healthcare costs in the US for preterm infants with respiratory syncytial virus lower respiratory infection in the first year of life requiring medical attention. Curr Med Res Opin. 2009;25:2795-804.
  • 6. Stein RT, Bont LJ, Zar H, Polack FP, Park C, Claxton A, et al. Respiratory syncytial virus hospitalization and mortality:Systematic review and meta-analysis. Pediatr Pulmonol. 2017;52:556-69.
  • 7. Brüggmann D, Köster C, Klingelhöfer D, Bauer J, Ohlendorf D, Bundschuh M, et al. Respiratory syncytial virus:a systematic scientometric analysis of the global publication output and the gender distribution of publishing authors. BMJ Open. 2017;7:e013615.
  • 8. Scheltema NM, Gentile A, Lucion F, Nokes DJ, Munywoki PK, Madhi SA, et al. Global respiratory syncytial virus-associated mortality in young children (RSV GOLD):a retrospective case series. Lancet Glob Health. 2017;5:e984-e991.
  • 9. Mazur NI, Higgins D, Nunes MC, Melero JA, Langedijk AC, Horsley N, et al. The respiratory syncytial virus vaccine landscape:lessons from the graveyard and promising candidates. Lancet Infect Dis. 2018;18:e295-e311.
  • 10. Stensballe LG, Trautner S, Kofoed PE, Nante E, Hedegaard K, Jensen IP, et al. Comparison of nasopharyngeal aspirate and nasal swab specimens for detection of respiratory syncytial virus in different settings in a developing country. Trop Med Int Health. 2002;7:317-21.
  • 11. Borchers AT, Chang C, Gershwin ME, Gershwin LJ. Respiratory syncytial virus--a comprehensive review. Clin Rev Allergy Immunol. 2013;45:331-79.
  • 12. Walsh EE, Peterson DR, Falsey AR. Risk factors for severe respiratory syncytial virus infection in elderly persons. J Infect Dis. 2004;189:233-8.
  • 13. Rodríguez-Martínez CE, Rodríguez DA, Nino G. Respiratory syncytial virus, adenoviruses, and mixed acute lower respiratory infections in children in a developing country. J Med Virol. 2015;87:774-81.
  • 14. Teck KS, Mac Guad R, Van Rostenberghe AH, Hua GS. Prevalence, risk factors and clinical characteristics of respiratory syncytial virus-associated lower respiratory tract infections in Kelantan, Malaysia. J Med Virol. 2019;91:1608-15.
  • 15. Nair H, Simões EA, Rudan I, Gessner BD, Azziz-Baumgartner E, Zhang JSF, et al. Global and regional burden of hospital admissions for severe acute lower respiratory infections in young children in 2010: A systematic analysis. Lancet. 2013;381:1380-90.
  • 16. Ünüvar E, Yildiz I, Kiliç A, Aslan SS, Çakal B, Toprak S, et al. Viral etiology and symptoms of acute upper respiratory tract infections in children. Turkish Journal of Medical Sciences. 2009;39:29-35.
  • 17. Aktürk H, Sütçü M, Badur S, Törün SH, Çıtak A, Erol OB, et al. Evaluation of epidemiological and clinical features of influenza and other respiratory viruses. Turk Pediatri Ars. 2015;50:217-25.
  • 18. Karakoyun M, Ataoğlu EA, Büyükkayhan D, Elevli M. Solunum yolu enfeksiyonu bulguları ile başvuran 2 yaş altı çocuklarda respiratory syncytial virus enfeksiyonlarının sıklığı ve klinik özellikleri. Online Türk Sağlık Bilimleri Dergisi. 2018;3:56-69.
  • 19. Atilla E, Sahin D, Atilla PA, Dolapci I, Tekeli A, Bozdag SC, et al. Upper respiratory viral infections in patients with haematological malignancies after allogeneic haematopoietic stem cell transplantation:a retrospective study. Antivir Ther. 2018;23:523-7.
  • 20. Aldemir-Kocabaş B, Karbuz A, Pekpak E, Karahan ZC, Dolapçı İ, İnce E, et al. Effects of respiratory viruses on febrile neutropenia attacks in children. Turk J Pediatr. 2017;59:511-9.
  • 21. Tüzüner U, Akkaya O, Özdemir M, Kurtoğlu MG. Prevalence and Concomitancy of Respiratory Viruses in Children with Acute Respiratory Tract Infections. J Pediatr Infect. Dis. 2016;11:001-5.
  • 22. Akçalı S, Yılmaz N, Güler Ö, Şanlidağ T, Anıl M. Alt solunum yolu enfeksiyonu olan çocuklarda solunum yolu viral etkenlerinin sıklığı. Türk Ped Arş. 2013;215-20.
  • 23. Gökçe Ş, Kurugöl Z, Koturoğlu G, Çiçek C, Aslan A. Etiology, Seasonality, and Clinical Features of Viral Respiratory Tract Infections in Children Hospitalized With Acute Bronchiolitis:A Single-Center Study. Glob Pediatr Health. 2017;22;4:2333794X17714378.
  • 24. Janet S, Broad J, Snape MD. Respiratory syncytial virus seasonality and its implications on prevention strategies. Hum Vaccin Immunother. 2018 ;14:234-44.
  • 25. Sommer C, Resch B, Simões EA. Risk factors for severe respiratory syncytial virus lower respiratory tract infection. Open Microbiol J. 2011;5:144-54.
  • 26. Langley GF, Anderson LJ. Epidemiology and prevention of respiratory syncytial virus infections among infants and young children. Pediatr Infect Dis J. 2011;30:510-7.
  • 27. Glezen WP, Taber LH, Frank AL, Kasel JA. Risk of primary infection and reinfection with respiratory syncytial virus. Am J Dis Child. 1986;140:543-6.
  • 28. Henderson FW, Collier AM, Clyde WA Jr, Denny FW. Respiratory-syncytial-virus infections, reinfections and immunity. A prospective, longitudinal study in young children. N Engl J Med. 1979;300:530-4.
  • 29. Munywoki PK, Koech DC, Agoti CN, Kibirige N, Kipkoech J, Cane PA, et al. Influence of age, severity of infection, and co-infection on the duration of respiratory syncytial virus (RSV) shedding. Epidemiol Infect. 2015;143:804-12.
  • 30. Stensballe LG, Devasundaram JK, Simoes EA. Respiratory syncytial virus epidemics:the ups and downs of a seasonal virus. Pediatr Infect Dis J. 2003;22:S21-32.
  • 31. Mullins JA, Lamonte AC, Bresee JS, Anderson LJ. Substantial variability in community respiratory syncytial virus season timing. Pediatr Infect Dis J. 2003;22:857-62.
  • 32. Dawson-Caswell M, Muncie HL Jr. Respiratory syncytial virus infection in children. Am Fam Physician. 2011;83:141-6.
  • 33. Yusuf S, Piedimonte G, Auais A, Demmler G, Krishnan S, Van Caeseele P, et al. The relationship of meteorological conditions to the epidemic activity of respiratory syncytial virus. Epidemiol Infect. 2007;135:1077-90.
  • 34. Çiçek C, Arslan A, Karakuş HS, Yalaz M, Saz EU, Pullukçu H, et al. Prevalence and seasonal distribution of respiratory viruses in patients with acute respiratory tract infections, 2002-2014. Mikrobiyol Bul. 2015;49:188-200.
  • 35. Ture E, Yazar A. Distribution of Respiratory Viral Agents in Patients Being Followed-Up in Our Pediatric Emergency Department. Online Turkish Journal of Health Sciences. 2019;4:94-104.
  • 36. Broberg EK, Waris M, Johansen K, Snacken R, Penttinen P. European Influenza Surveillance Network. Seasonality and geographical spread of respiratory syncytial virus epidemics in 15 European countries, 2010 to 2016. Euro Surveill. 2018;23:1-11.
  • 37. Law BJ, Carbonell-Estrany X, Simoes EA. An update on respiratory syncytial virus epidemiology:a developed country perspective. Respir Med. 2002;96 Suppl B:S1-S7.
  • 38. Simoes EA. Respiratory syncytial virus infection. Lancet. 1999;354:847-52.

Solunum yolu enfeksiyonu olan çocuklarda respiratuvar sinsityal virusun gerçek zamanlı polimeraz zincir reaksiyonu ile araştırılması

Year 2019, Volume: 3 Issue: 10, 754 - 758, 01.10.2019
https://doi.org/10.28982/josam.632224

Abstract

Amaç: Respiratuvar sinsityal virus (RSV), yaşamın ilk yıllarında solunum yolu enfeksiyonlarının (SYE) en sık etkenidir. Bu çalışmada SYE olan çocuklarda RSV A/B’nin multipleks polimeraz zincir reaksiyonu (PCR) ile araştırılması, yaş grupları arasında RSV dağılımı, eşlik eden koenfeksiyonlar ve mevsimsel dağılım özelliklerini değerlendirmeyi amaçladık.

Yöntemler: Bu çalışma çapraz kesitsel olarak planlanmıştır. Çalışmaya Nisan 2015 – Mart 2018 tarihleri arasında, 0-18 yaş arasında 

SYE ön tanısı ile gönderilen nazofaringeal sürüntü örnekleri dahil edildi. Örneklerden nükleik asit ekstraksiyon işlemi, EZ1 Virus Mini Kit V 2.0 (Qiagen, Almanya) ile EZ1 Advanced XL (Qiagen, Almanya) cihazında yapıldı. RSV A/B ve solunum paneline ait diğer viruslar, FTD Respiratory pathogens 21 (Fast-Track Diagnostics, Luxembourg) kiti kullanılarak multipleks real-time PCR yöntemi ile araştırıldı.

Bulgular: Yaş aralığı 0-18 olan 2707 hastanın medyan yaşı 1 idi ve %57,4’ü (1554) erkekti. RSV pozitifliği %14,4’ünde (390) tespit edildi. Kız ve erkeklerde RSV sıklığı sırasıyla %13,6 ve %15,5 idi (P=0,16). En yüksek RSV oranı <1 yaş grubunda %18,1 idi (P<0,001). Mikst etken ile enfeksiyonu %5,4’ünde saptandı. En fazla RSV ve HRV (%1,8) birlikteliği görüldü. RSV en sık Aralık (%27,9), ardından Ocak ve Şubat ayında saptandı (P<0,001). 

Sonuç: SYE olan pediatrik hastaların %14,4’ünde RSV saptadık. RSV’nin 1 yaş altında daha yaygın olduğu tespit ettik. Bu çalışmada, RSV'nin kış mevsiminde sık görülen bir patojen olduğunu belirledik. Real-time PCR ile RSV tanısının erken konulması, gereksiz antibiyotik kullanımının ve nozokomiyal enfeksiyonların önlenmesi açısından önem taşımaktadır. Ayrıca, insidansın arttığı kış mevsimi boyunca SYE’lerin önlenmesi, kontrolü ve tedavisi için etkili bir yaklaşımın uygulanmasına yardımcı olabilecektir.

References

  • 1. Rima B, Collins P, Easton A, Fouchier R, Kurath G, Lamb RA, et al. ICTV Report Consortium. J Gen Virol. 2017;98:2912-3.
  • 2. Falsey AR, Hennessey PA, Formica MA, Cox C, Walsh EE. Respiratory syncytial virus infection in elderly and high-risk adults. N Engl J Med. 2005;352:1749-59.
  • 3. Ruuskanen O, Lahti E, Jennings LC, Murdoch DR. Viral pneumonia. Lancet. 2011;377:1264-75.
  • 4. Weir E, Fisman DN. Respiratory syncytial virus:pervasive yet evasive. CMAJ. 2004;170:191.
  • 5. Stewart DL, Romero JR, Buysman EK, Fernandes AW, Mahadevia PJ. Total healthcare costs in the US for preterm infants with respiratory syncytial virus lower respiratory infection in the first year of life requiring medical attention. Curr Med Res Opin. 2009;25:2795-804.
  • 6. Stein RT, Bont LJ, Zar H, Polack FP, Park C, Claxton A, et al. Respiratory syncytial virus hospitalization and mortality:Systematic review and meta-analysis. Pediatr Pulmonol. 2017;52:556-69.
  • 7. Brüggmann D, Köster C, Klingelhöfer D, Bauer J, Ohlendorf D, Bundschuh M, et al. Respiratory syncytial virus:a systematic scientometric analysis of the global publication output and the gender distribution of publishing authors. BMJ Open. 2017;7:e013615.
  • 8. Scheltema NM, Gentile A, Lucion F, Nokes DJ, Munywoki PK, Madhi SA, et al. Global respiratory syncytial virus-associated mortality in young children (RSV GOLD):a retrospective case series. Lancet Glob Health. 2017;5:e984-e991.
  • 9. Mazur NI, Higgins D, Nunes MC, Melero JA, Langedijk AC, Horsley N, et al. The respiratory syncytial virus vaccine landscape:lessons from the graveyard and promising candidates. Lancet Infect Dis. 2018;18:e295-e311.
  • 10. Stensballe LG, Trautner S, Kofoed PE, Nante E, Hedegaard K, Jensen IP, et al. Comparison of nasopharyngeal aspirate and nasal swab specimens for detection of respiratory syncytial virus in different settings in a developing country. Trop Med Int Health. 2002;7:317-21.
  • 11. Borchers AT, Chang C, Gershwin ME, Gershwin LJ. Respiratory syncytial virus--a comprehensive review. Clin Rev Allergy Immunol. 2013;45:331-79.
  • 12. Walsh EE, Peterson DR, Falsey AR. Risk factors for severe respiratory syncytial virus infection in elderly persons. J Infect Dis. 2004;189:233-8.
  • 13. Rodríguez-Martínez CE, Rodríguez DA, Nino G. Respiratory syncytial virus, adenoviruses, and mixed acute lower respiratory infections in children in a developing country. J Med Virol. 2015;87:774-81.
  • 14. Teck KS, Mac Guad R, Van Rostenberghe AH, Hua GS. Prevalence, risk factors and clinical characteristics of respiratory syncytial virus-associated lower respiratory tract infections in Kelantan, Malaysia. J Med Virol. 2019;91:1608-15.
  • 15. Nair H, Simões EA, Rudan I, Gessner BD, Azziz-Baumgartner E, Zhang JSF, et al. Global and regional burden of hospital admissions for severe acute lower respiratory infections in young children in 2010: A systematic analysis. Lancet. 2013;381:1380-90.
  • 16. Ünüvar E, Yildiz I, Kiliç A, Aslan SS, Çakal B, Toprak S, et al. Viral etiology and symptoms of acute upper respiratory tract infections in children. Turkish Journal of Medical Sciences. 2009;39:29-35.
  • 17. Aktürk H, Sütçü M, Badur S, Törün SH, Çıtak A, Erol OB, et al. Evaluation of epidemiological and clinical features of influenza and other respiratory viruses. Turk Pediatri Ars. 2015;50:217-25.
  • 18. Karakoyun M, Ataoğlu EA, Büyükkayhan D, Elevli M. Solunum yolu enfeksiyonu bulguları ile başvuran 2 yaş altı çocuklarda respiratory syncytial virus enfeksiyonlarının sıklığı ve klinik özellikleri. Online Türk Sağlık Bilimleri Dergisi. 2018;3:56-69.
  • 19. Atilla E, Sahin D, Atilla PA, Dolapci I, Tekeli A, Bozdag SC, et al. Upper respiratory viral infections in patients with haematological malignancies after allogeneic haematopoietic stem cell transplantation:a retrospective study. Antivir Ther. 2018;23:523-7.
  • 20. Aldemir-Kocabaş B, Karbuz A, Pekpak E, Karahan ZC, Dolapçı İ, İnce E, et al. Effects of respiratory viruses on febrile neutropenia attacks in children. Turk J Pediatr. 2017;59:511-9.
  • 21. Tüzüner U, Akkaya O, Özdemir M, Kurtoğlu MG. Prevalence and Concomitancy of Respiratory Viruses in Children with Acute Respiratory Tract Infections. J Pediatr Infect. Dis. 2016;11:001-5.
  • 22. Akçalı S, Yılmaz N, Güler Ö, Şanlidağ T, Anıl M. Alt solunum yolu enfeksiyonu olan çocuklarda solunum yolu viral etkenlerinin sıklığı. Türk Ped Arş. 2013;215-20.
  • 23. Gökçe Ş, Kurugöl Z, Koturoğlu G, Çiçek C, Aslan A. Etiology, Seasonality, and Clinical Features of Viral Respiratory Tract Infections in Children Hospitalized With Acute Bronchiolitis:A Single-Center Study. Glob Pediatr Health. 2017;22;4:2333794X17714378.
  • 24. Janet S, Broad J, Snape MD. Respiratory syncytial virus seasonality and its implications on prevention strategies. Hum Vaccin Immunother. 2018 ;14:234-44.
  • 25. Sommer C, Resch B, Simões EA. Risk factors for severe respiratory syncytial virus lower respiratory tract infection. Open Microbiol J. 2011;5:144-54.
  • 26. Langley GF, Anderson LJ. Epidemiology and prevention of respiratory syncytial virus infections among infants and young children. Pediatr Infect Dis J. 2011;30:510-7.
  • 27. Glezen WP, Taber LH, Frank AL, Kasel JA. Risk of primary infection and reinfection with respiratory syncytial virus. Am J Dis Child. 1986;140:543-6.
  • 28. Henderson FW, Collier AM, Clyde WA Jr, Denny FW. Respiratory-syncytial-virus infections, reinfections and immunity. A prospective, longitudinal study in young children. N Engl J Med. 1979;300:530-4.
  • 29. Munywoki PK, Koech DC, Agoti CN, Kibirige N, Kipkoech J, Cane PA, et al. Influence of age, severity of infection, and co-infection on the duration of respiratory syncytial virus (RSV) shedding. Epidemiol Infect. 2015;143:804-12.
  • 30. Stensballe LG, Devasundaram JK, Simoes EA. Respiratory syncytial virus epidemics:the ups and downs of a seasonal virus. Pediatr Infect Dis J. 2003;22:S21-32.
  • 31. Mullins JA, Lamonte AC, Bresee JS, Anderson LJ. Substantial variability in community respiratory syncytial virus season timing. Pediatr Infect Dis J. 2003;22:857-62.
  • 32. Dawson-Caswell M, Muncie HL Jr. Respiratory syncytial virus infection in children. Am Fam Physician. 2011;83:141-6.
  • 33. Yusuf S, Piedimonte G, Auais A, Demmler G, Krishnan S, Van Caeseele P, et al. The relationship of meteorological conditions to the epidemic activity of respiratory syncytial virus. Epidemiol Infect. 2007;135:1077-90.
  • 34. Çiçek C, Arslan A, Karakuş HS, Yalaz M, Saz EU, Pullukçu H, et al. Prevalence and seasonal distribution of respiratory viruses in patients with acute respiratory tract infections, 2002-2014. Mikrobiyol Bul. 2015;49:188-200.
  • 35. Ture E, Yazar A. Distribution of Respiratory Viral Agents in Patients Being Followed-Up in Our Pediatric Emergency Department. Online Turkish Journal of Health Sciences. 2019;4:94-104.
  • 36. Broberg EK, Waris M, Johansen K, Snacken R, Penttinen P. European Influenza Surveillance Network. Seasonality and geographical spread of respiratory syncytial virus epidemics in 15 European countries, 2010 to 2016. Euro Surveill. 2018;23:1-11.
  • 37. Law BJ, Carbonell-Estrany X, Simoes EA. An update on respiratory syncytial virus epidemiology:a developed country perspective. Respir Med. 2002;96 Suppl B:S1-S7.
  • 38. Simoes EA. Respiratory syncytial virus infection. Lancet. 1999;354:847-52.
There are 38 citations in total.

Details

Primary Language English
Subjects Medical Microbiology
Journal Section Research article
Authors

Ayfer Bakır 0000-0002-9006-5267

Nuran Karabulut This is me 0000-0003-3550-2599

Sema Alaçam 0000-0001-7957-2906

Sevim Meşe 0000-0001-9992-4489

Murat Yaman This is me 0000-0002-3685-0483

Ayper Somer 0000-0002-7827-1113

Ali Ağaçfidan This is me 0000-0002-5470-296X

Publication Date October 1, 2019
Published in Issue Year 2019 Volume: 3 Issue: 10

Cite

APA Bakır, A., Karabulut, N., Alaçam, S., Meşe, S., et al. (2019). Investigation of respiratory syncytial virus in children with respiratory tract infection by real-time polymerase chain reaction. Journal of Surgery and Medicine, 3(10), 754-758. https://doi.org/10.28982/josam.632224
AMA Bakır A, Karabulut N, Alaçam S, Meşe S, Yaman M, Somer A, Ağaçfidan A. Investigation of respiratory syncytial virus in children with respiratory tract infection by real-time polymerase chain reaction. J Surg Med. October 2019;3(10):754-758. doi:10.28982/josam.632224
Chicago Bakır, Ayfer, Nuran Karabulut, Sema Alaçam, Sevim Meşe, Murat Yaman, Ayper Somer, and Ali Ağaçfidan. “Investigation of Respiratory Syncytial Virus in Children With Respiratory Tract Infection by Real-Time Polymerase Chain Reaction”. Journal of Surgery and Medicine 3, no. 10 (October 2019): 754-58. https://doi.org/10.28982/josam.632224.
EndNote Bakır A, Karabulut N, Alaçam S, Meşe S, Yaman M, Somer A, Ağaçfidan A (October 1, 2019) Investigation of respiratory syncytial virus in children with respiratory tract infection by real-time polymerase chain reaction. Journal of Surgery and Medicine 3 10 754–758.
IEEE A. Bakır, “Investigation of respiratory syncytial virus in children with respiratory tract infection by real-time polymerase chain reaction”, J Surg Med, vol. 3, no. 10, pp. 754–758, 2019, doi: 10.28982/josam.632224.
ISNAD Bakır, Ayfer et al. “Investigation of Respiratory Syncytial Virus in Children With Respiratory Tract Infection by Real-Time Polymerase Chain Reaction”. Journal of Surgery and Medicine 3/10 (October 2019), 754-758. https://doi.org/10.28982/josam.632224.
JAMA Bakır A, Karabulut N, Alaçam S, Meşe S, Yaman M, Somer A, Ağaçfidan A. Investigation of respiratory syncytial virus in children with respiratory tract infection by real-time polymerase chain reaction. J Surg Med. 2019;3:754–758.
MLA Bakır, Ayfer et al. “Investigation of Respiratory Syncytial Virus in Children With Respiratory Tract Infection by Real-Time Polymerase Chain Reaction”. Journal of Surgery and Medicine, vol. 3, no. 10, 2019, pp. 754-8, doi:10.28982/josam.632224.
Vancouver Bakır A, Karabulut N, Alaçam S, Meşe S, Yaman M, Somer A, Ağaçfidan A. Investigation of respiratory syncytial virus in children with respiratory tract infection by real-time polymerase chain reaction. J Surg Med. 2019;3(10):754-8.