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Campero LM, Basso W, Moré G, Fiorani F, Hecker YP, Echaide I, Cantón GJ, Cirone KM, Campero CM, Venturini MC, Moore DP. Neosporosis in Argentina: Past, present and future perspectives. Vet Parasitol Reg Stud Reports 2023; 41:100882. [PMID: 37208088 DOI: 10.1016/j.vprsr.2023.100882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 04/20/2023] [Indexed: 05/21/2023]
Abstract
Neosporosis, caused by the protozoan Neospora caninum, was first diagnosed in Argentinean cattle in the 90's. With a national bovine stock of approximately 53 million head, the cattle industry is socially and economically relevant. Severe economic losses have been estimated at US$ 33 and 12 million annually in dairy and beef cattle, respectively. Approximately 9% of bovine abortions in the Buenos Aires province are caused by N. caninum. In 2001, the first isolation of N. caninum oocysts from feces of a naturally infected dog was performed in Argentina and named as NC-6 Argentina. Further strains were isolated from cattle (NC-Argentina LP1, NC-Argentina LP2) and axis deer (Axis axis, NC-Axis). Epidemiological studies revealed a high distribution of Neospora-infections not only in dairy but also in beef cattle, with seroprevalence rates of 16.6-88.8% and 0-73%, respectively. Several experimental infection studies in cattle have been carried out, as well as attempts to develop effective vaccines to avoid Neospora-abortions and transmission. However, no vaccine has proven successful for its use in daily practice. Reduction of seroprevalence, vertical transmission and Neospora-related abortions have been achieved in dairy farms by the use of selective breeding strategies and embryo transfer. Neospora-infections have been also detected in goats, sheep, deer, water buffaloes (Bubalus bubalis) and gray foxes (Lycalopex griseus). Moreover, Neospora-related reproductive losses were reported in small ruminants and deer species and could be more frequent than previously thought. Even though diagnostic methods have been improved during the last decades, control of neosporosis is still not optimal. The development of new strategies including new antiprotozoal drugs and vaccines is highly needed. This paper reviews the information from the previous 28 years of research of N. caninum in Argentina, including seroprevalence and epidemiological studies, available diagnostic techniques, experimental reproduction, immunization strategies, isolations and control measures in domestic and non-domestic animals from Argentina.
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Affiliation(s)
- L M Campero
- National Scientific and Technical Research Council (CONICET), Godoy Cruz, 2290, C1033AAJ Buenos Aires, Argentina; Institute of Innovation for Agricultural Production and Sustainable Development (IPADS Balcarce), Ruta 226, km 73.5, 7620 Balcarce, Argentina
| | - W Basso
- Institute of Parasitology, Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern, Länggassstrasse 122, CH-3012 Bern, Switzerland
| | - G Moré
- National Scientific and Technical Research Council (CONICET), Godoy Cruz, 2290, C1033AAJ Buenos Aires, Argentina; Institute of Parasitology, Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern, Länggassstrasse 122, CH-3012 Bern, Switzerland
| | - F Fiorani
- National Scientific and Technical Research Council (CONICET), Godoy Cruz, 2290, C1033AAJ Buenos Aires, Argentina; Institute of Innovation for Agricultural Production and Sustainable Development (IPADS Balcarce), Ruta 226, km 73.5, 7620 Balcarce, Argentina; Faculty of Agrarian Sciences, National University of Mar del Plata (UNMdP), Ruta 226, km 73.5, 7620 Balcarce, Argentina
| | - Y P Hecker
- National Scientific and Technical Research Council (CONICET), Godoy Cruz, 2290, C1033AAJ Buenos Aires, Argentina; Institute of Innovation for Agricultural Production and Sustainable Development (IPADS Balcarce), Ruta 226, km 73.5, 7620 Balcarce, Argentina; SALUVET, Animal Health Department, Faculty of Veterinary Sciences, Complutense University of Madrid, 28040 Madrid, Spain
| | - I Echaide
- National Institute of Agricultural Technology, INTA E.E.A, Rafaela, Argentina
| | - G J Cantón
- National Institute of Agricultural Technology, INTA E.E.A Balcarce, Ruta 226, km 73.5, 7620 Balcarce, Argentina
| | - K M Cirone
- Faculty of Agrarian Sciences, National University of Mar del Plata (UNMdP), Ruta 226, km 73.5, 7620 Balcarce, Argentina; National Institute of Agricultural Technology, INTA E.E.A Balcarce, Ruta 226, km 73.5, 7620 Balcarce, Argentina
| | - C M Campero
- National Institute of Agricultural Technology, INTA E.E.A Balcarce, Ruta 226, km 73.5, 7620 Balcarce, Argentina
| | - M C Venturini
- Immunoparasitology Laboratory, Veterinary Sciences Faculty, National University of La Plata, 60 and 118 s/n, 1900 La Plata, Argentina
| | - D P Moore
- National Scientific and Technical Research Council (CONICET), Godoy Cruz, 2290, C1033AAJ Buenos Aires, Argentina; Institute of Innovation for Agricultural Production and Sustainable Development (IPADS Balcarce), Ruta 226, km 73.5, 7620 Balcarce, Argentina; Faculty of Agrarian Sciences, National University of Mar del Plata (UNMdP), Ruta 226, km 73.5, 7620 Balcarce, Argentina.
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Basso W, Holenweger F, Schares G, Müller N, Campero LM, Ardüser F, Moore-Jones G, Frey CF, Zanolari P. Toxoplasma gondii and Neospora caninum infections in sheep and goats in Switzerland: Seroprevalence and occurrence in aborted foetuses. Food Waterborne Parasitol 2022; 28:e00176. [PMID: 36039091 PMCID: PMC9418186 DOI: 10.1016/j.fawpar.2022.e00176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/04/2022] [Accepted: 08/11/2022] [Indexed: 11/24/2022] Open
Abstract
Toxoplasma gondii and Neospora caninum infections are important causes of abortion in ruminants. Besides, meat from T. gondii infected animals represent a major infection source for humans. The occurrence of these protozoan parasites in Switzerland was investigated both, in a nationwide cross-sectional serological survey, and by molecular methods in aborted sheep and goat foetuses. A total of 653 sheep from 143 farms and 748 goats from 164 farms were tested by commercial ELISAs and inconclusive results were defined by immunoblot. Besides, a risk factor analysis for seropositivity was performed. The observed seroprevalences for T. gondii in sheep and goats were 66.3% and 50.5% at the animal level, and 90.9% and 81.1% at the farm level, respectively. For N. caninum, the detected seroprevalences in sheep and goats were 0.8% and 0.9% at the animal level, and 2.8% and 1.8% at the farm level, respectively. Older small ruminants, and sheep (vs. goats) had a higher risk of being seropositive to T. gondii. Alpine grazing in summer was identified as a protective factor for seropositivity to T. gondii in both animal species. Toxoplasma gondii and N. caninum DNA were detected in 6.1% and 2.4% (n = 82), and in 6.8% and 1.4% (n = 73) of the tested ovine and caprine foetuses, respectively. These results suggest the involvement of these parasites in abortions and reveal a high prevalence of T. gondii and lower prevalence of N. caninum infections in small ruminants in Switzerland. They also suggest that consumption of undercooked meat from T. gondii infected sheep and goats may represent a risk for public health. Toxoplasma gondii infections are very frequent in Swiss small ruminants. Meat from infected small ruminants represents a source for T. gondii human infection. Sheep have a higher risk of T. gondii seropositivity than goats. Neospora caninum seroprevalences in Swiss sheep and goats are very low. T. gondii and N. caninum were detected in ovine and caprine abortions in Switzerland. T. gondii and N. caninum should be considered in diagnosis of small ruminant abortion.
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Affiliation(s)
- Walter Basso
- Institute of Parasitology, Vetsuisse-Faculty, University of Bern, Länggassstrasse 122, 3012 Bern, Switzerland
| | - Fabienne Holenweger
- Institute of Parasitology, Vetsuisse-Faculty, University of Bern, Länggassstrasse 122, 3012 Bern, Switzerland.,Clinic for Ruminants, Vetsuisse-Faculty, University of Bern, Bremgartenstrasse 109a, 3012 Bern, Switzerland
| | - Gereon Schares
- Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Institute of Epidemiology, Südufer 10, 17493 Greifswald-Insel Riems, Germany
| | - Norbert Müller
- Institute of Parasitology, Vetsuisse-Faculty, University of Bern, Länggassstrasse 122, 3012 Bern, Switzerland
| | - Lucía M Campero
- Institute of Parasitology, Vetsuisse-Faculty, University of Bern, Länggassstrasse 122, 3012 Bern, Switzerland.,Immunoparasitology Laboratory, Faculty of Veterinary Sciences, National University of La Plata, 60 y 118, 1900 La Plata, Argentina.,National Scientific and Technical Research Council (CONICET), Argentina
| | - Flurin Ardüser
- Clinic for Ruminants, Vetsuisse-Faculty, University of Bern, Bremgartenstrasse 109a, 3012 Bern, Switzerland
| | - Gaia Moore-Jones
- Institute for Fish and Wildlife Health (FIWI), Vetsuisse-Faculty, University of Bern, Längassstrasse 122, 3012, Bern, Switzerland
| | - Caroline F Frey
- Institute of Parasitology, Vetsuisse-Faculty, University of Bern, Länggassstrasse 122, 3012 Bern, Switzerland
| | - Patrik Zanolari
- Clinic for Ruminants, Vetsuisse-Faculty, University of Bern, Bremgartenstrasse 109a, 3012 Bern, Switzerland
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Benavides J, González-Warleta M, Arteche-Villasol N, Pérez V, Mezo M, Gutiérrez-Expósito D. Ovine Neosporosis: The Current Global Situation. Animals (Basel) 2022; 12:ani12162074. [PMID: 36009665 PMCID: PMC9405361 DOI: 10.3390/ani12162074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/17/2022] [Accepted: 08/10/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary This review summarizes the current global situation of Neospora caninum infection in sheep by referring to all of the available descriptions of natural ovine neosporosis to date, focusing on epidemiology, clinical signs, lesions, and diagnosis. The data suggest that ovine neosporosis is more prevalent than currently thought, that it has increased in the last few decades, and that it should now be considered in the differential diagnosis when investigating abortion in sheep. Abstract In the past 20 years, Neospora caninum infection in sheep has been reported in at least 31 countries worldwide from all sheep-rearing continents (Europe, Asia, the Americas, Africa, and Oceania), and its role as an abortifacient agent is becoming more evident. Most studies of ovine neosporosis have focused on its epidemiology, based primarily on serological analysis, with only a few studies investigating the actual presence of the parasite by PCR and/or IHC. Individual seroprevalence rates were highly variable between countries, and even between regions within the same country, ranging from 0.0% to 67.4% positive. Furthermore, most of the studies were not directly comparable due to differences in experimental designs, sample sizes, husbandry systems, ecological factors, and serological tests (e.g., IFAT, ELISA, MAT, Western blot). The latter, along with the scarcity of studies on the relevance of N. caninum as an abortifacient agent, may bias the perception of the importance of this disease. This review summarizes the situation of N. caninum infection in sheep using all available published studies describing natural ovine neosporosis. The epidemiology shows that ovine neosporosis is found worldwide, and it poses a relevant risk to the sustainability of sheep flocks.
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Affiliation(s)
- Julio Benavides
- Instituto de Ganadería de Montaña, CSIC-University of Leon, Grulleros, 24346 León, Spain
| | - Marta González-Warleta
- Centro de Investigaciones Agrarias de Mabegondo, Parasitology Laboratory, Axencia Galega da Calidade Alimentaria (AGACAL)-Xunta de Galicia, Ctra, Betanzos a Mesón do Vento km 7, Abegondo, 15318 A Coruña, Spain
| | - Noive Arteche-Villasol
- Instituto de Ganadería de Montaña, CSIC-University of Leon, Grulleros, 24346 León, Spain
- Animal Health Department, Faculty of Veterinary, University of Leon, Campus de Vegazana s/n, 24071 León, Spain
| | - Valentín Pérez
- Instituto de Ganadería de Montaña, CSIC-University of Leon, Grulleros, 24346 León, Spain
- Animal Health Department, Faculty of Veterinary, University of Leon, Campus de Vegazana s/n, 24071 León, Spain
| | - Mercedes Mezo
- Centro de Investigaciones Agrarias de Mabegondo, Parasitology Laboratory, Axencia Galega da Calidade Alimentaria (AGACAL)-Xunta de Galicia, Ctra, Betanzos a Mesón do Vento km 7, Abegondo, 15318 A Coruña, Spain
| | - Daniel Gutiérrez-Expósito
- Instituto de Ganadería de Montaña, CSIC-University of Leon, Grulleros, 24346 León, Spain
- Animal Health Department, Faculty of Veterinary, University of Leon, Campus de Vegazana s/n, 24071 León, Spain
- Correspondence:
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Dorsch MA, Francia ME, Tana LR, González FC, Cabrera A, Calleros L, Sanguinetti M, Barcellos M, Zarantonelli L, Ciuffo C, Maya L, Castells M, Mirazo S, da Silva Silveira C, Rabaza A, Caffarena RD, Doncel Díaz B, Aráoz V, Matto C, Armendano JI, Salada S, Fraga M, Fierro S, Giannitti F. Diagnostic Investigation of 100 Cases of Abortion in Sheep in Uruguay: 2015–2021. Front Vet Sci 2022; 9:904786. [PMID: 35664842 PMCID: PMC9161216 DOI: 10.3389/fvets.2022.904786] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 04/13/2022] [Indexed: 11/13/2022] Open
Abstract
The aim of this work was to identify causes of abortion through laboratory investigations in sheep flocks in Uruguay. One hundred cases of abortion, comprising 58 fetuses, 36 fetuses with their placentas, and 6 placentas were investigated in 2015–2021. Cases were subjected to gross and microscopic pathologic examinations, and microbiological and serological testing for the identification of causes of abortion, including protozoal, bacterial, and viral pathogens. An etiologic diagnosis was determined in 46 (46%) cases, including 33 (33%) cases caused by infectious pathogens, as determined by the detection of a pathogen along with the identification of fetoplacental lesions attributable to the detected pathogen. Twenty-seven cases (27%) were caused by Toxoplasma gondii, 5 (5%) by Campylobacter fetus subspecies fetus, and 1 (1%) by an unidentified species of Campylobacter. Fourteen cases (14%) had inflammatory and/or necrotizing fetoplacental lesions compatible with an infectious etiology. Although the cause for these lesions was not clearly identified, T. gondii was detected in 4 of these cases, opportunistic bacteria (Bacillus licheniformis, Streptococcus sp.) were isolated in 2 cases, and bovine viral diarrhea virus 1 subtype i (BVDV-1i) was detected in another. Campylobacter jejuni was identified in 1 (1%) severely autolyzed, mummified fetus. BVDV-2b was identified incidentally in one fetus with an etiologic diagnosis of toxoplasmosis. Microscopic agglutination test revealed antibodies against ≥1 Leptospira serovars in 15/63 (23.8%) fetuses; however, Leptospira was not identified by a combination of qPCR, culture, fluorescent antibody testing nor immunohistochemistry. Neospora caninum, Chlamydia abortus, Chlamydia pecorum, Coxiella burnetii and border disease virus were not detected in any of the analyzed cases. Death was attributed to dystocia in 13 (13%) fetuses delivered by 8 sheep, mostly from one highly prolific flock. Congenital malformations including inferior prognathism, a focal hepatic cyst, and enterohepatic agenesis were identified in one fetus each, the latter being the only one considered incompatible with postnatal life. Toxoplasmosis, campylobacteriosis and dystocia were the main identified causes of fetal losses. Despite the relatively low overall success rate in establishing an etiologic diagnosis, a systematic laboratory workup in cases of abortion is of value to identify their causes and enables zoonotic pathogens surveillance.
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Affiliation(s)
- Matías A. Dorsch
- Plataforma de Investigación en Salud Animal, Instituto Nacional de Investigación Agropecuaria (INIA), Estación Experimental La Estanzuela, Colonia, Uruguay
| | - María E. Francia
- Laboratorio de Biología de Apicomplejos, Instituto Pasteur de Montevideo, Montevideo, Uruguay
- Departamento de Parasitología y Micología, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Leandro R. Tana
- Laboratorio de Biología de Apicomplejos, Instituto Pasteur de Montevideo, Montevideo, Uruguay
| | - Fabiana C. González
- Laboratorio de Biología de Apicomplejos, Instituto Pasteur de Montevideo, Montevideo, Uruguay
| | - Andrés Cabrera
- Laboratorio de Interacciones Hospedero-Patógeno, Instituto Pasteur de Montevideo, Montevideo, Uruguay
- Unidad de Microbiología, Departamento de Patobiología, Facultad de Veterinaria, Universidad de la República, Montevideo, Uruguay
| | - Lucía Calleros
- Sección de Genética Evolutiva, Facultad de Ciencias, Universidad de la República, Montevideo, Uruguay
| | - Margarita Sanguinetti
- Sección de Genética Evolutiva, Facultad de Ciencias, Universidad de la República, Montevideo, Uruguay
| | - Maila Barcellos
- Sección de Genética Evolutiva, Facultad de Ciencias, Universidad de la República, Montevideo, Uruguay
| | - Leticia Zarantonelli
- Unidad Mixta Instituto Pasteur de Montevideo e Instituto Nacional de Investigación Agropecuaria (UMPI), Montevideo, Uruguay
| | - Camila Ciuffo
- Unidad Mixta Instituto Pasteur de Montevideo e Instituto Nacional de Investigación Agropecuaria (UMPI), Montevideo, Uruguay
| | - Leticia Maya
- Laboratorio de Virología Molecular, Departamento de Ciencias Biológicas, Centro Universitario Regional (CENUR) Litoral Norte, Universidad de la República, Salto, Uruguay
| | - Matías Castells
- Laboratorio de Virología Molecular, Departamento de Ciencias Biológicas, Centro Universitario Regional (CENUR) Litoral Norte, Universidad de la República, Salto, Uruguay
| | - Santiago Mirazo
- Laboratorio de Virología, Facultad de Ciencias, Universidad de la República, Montevideo, Uruguay
- Departamento de Bacteriología y Virología, Instituto de Higiene, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Caroline da Silva Silveira
- Plataforma de Investigación en Salud Animal, Instituto Nacional de Investigación Agropecuaria (INIA), Estación Experimental La Estanzuela, Colonia, Uruguay
| | - Ana Rabaza
- Plataforma de Investigación en Salud Animal, Instituto Nacional de Investigación Agropecuaria (INIA), Estación Experimental La Estanzuela, Colonia, Uruguay
| | - Rubén D. Caffarena
- Plataforma de Investigación en Salud Animal, Instituto Nacional de Investigación Agropecuaria (INIA), Estación Experimental La Estanzuela, Colonia, Uruguay
- Unidad Académica Salud de los Rumiantes, Departamento de Producción Animal, Facultad de Veterinaria, Universidad de la República, Montevideo, Uruguay
| | - Benjamín Doncel Díaz
- Plataforma de Investigación en Salud Animal, Instituto Nacional de Investigación Agropecuaria (INIA), Estación Experimental La Estanzuela, Colonia, Uruguay
- Laboratorio de Patología Veterinaria, Facultad de Medicina Veterinaria y de Zootecnia, Universidad Nacional de Colombia, Sede Bogotá, Bogotá, Colombia
| | - Virginia Aráoz
- Plataforma de Investigación en Salud Animal, Instituto Nacional de Investigación Agropecuaria (INIA), Estación Experimental La Estanzuela, Colonia, Uruguay
| | - Carolina Matto
- Laboratorio Regional Noroeste, División de Laboratorios Veterinarios (DILAVE) Miguel C. Rubino, Ministerio de Ganadería, Agricultura y Pesca (MGAP), Paysandú, Uruguay
| | - Joaquín I. Armendano
- Facultad de Ciencias Veterinarias, Universidad Nacional del Centro de la Provincia de Buenos Aires (UNCPBA), Tandil, Argentina
| | - Sofía Salada
- Secretariado Uruguayo de la Lana (SUL), Montevideo, Uruguay
| | - Martín Fraga
- Plataforma de Investigación en Salud Animal, Instituto Nacional de Investigación Agropecuaria (INIA), Estación Experimental La Estanzuela, Colonia, Uruguay
| | - Sergio Fierro
- Secretariado Uruguayo de la Lana (SUL), Montevideo, Uruguay
| | - Federico Giannitti
- Plataforma de Investigación en Salud Animal, Instituto Nacional de Investigación Agropecuaria (INIA), Estación Experimental La Estanzuela, Colonia, Uruguay
- *Correspondence: Federico Giannitti
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Nayeri T, Sarvi S, Moosazadeh M, Daryani A. The Global Prevalence of Neospora caninum Infection in Sheep and Goats That Had an Abortion and Aborted Fetuses: A Systematic Review and Meta-Analysis. Front Vet Sci 2022; 9:870904. [PMID: 35558895 PMCID: PMC9090472 DOI: 10.3389/fvets.2022.870904] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/23/2022] [Indexed: 12/02/2022] Open
Abstract
Neospora caninum (N. caninum) can be a potential factor causing a significant rate of miscarriages in small ruminants (sheep and goats) worldwide. Therefore, the present study aimed to determine the global status of N. caninum in sheep and goats that had an abortion and aborted fetuses. Five English databases (PubMed, ScienceDirect, Web of Science, Scopus, and ProQuest) were searched for relevant scientific articles published from their inception until November 4, 2021. Finally, 21 studies conducted on sheep (1,671 aborted fetuses and 935 abortive sheep) and 10 studies on goats (130 aborted fetuses and 80 abortive goats) were included for the final meta-analysis. A random-effects meta-analysis model was used to estimate the pooled prevalence with 95% confidence intervals (CIs). Moreover, sensitivity analysis, publication bias test, and quality assessment were performed in this study. The pooled prevalence of N. caninum in aborted fetuses of sheep and goats globally was estimated to be 15% (95% CI: 9-21%) and 7% (95% CI: 2-12%) using molecular methods. Besides, the seroprevalence of N. caninum was estimated to be 17% for aborted fetuses of sheep. The overall prevalence rate of N. caninum infection in sheep that had an abortion was 3%. The present results show a relatively high prevalence of N. caninum infection in sheep that had an abortion and aborted fetuses compared to goats. Therefore, further studies using different diagnostic techniques to more accurately estimate the rate of infection in sheep and goats may help provide adequate control measures and strategies to reduce the rate of abortion in sheep and goats and reduce economic damage to the livestock industry. This study was registered at the International Prospective Register of Systematic Reviews (PROSPERO; code: CRD42020216694).
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Affiliation(s)
- Tooran Nayeri
- Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Parasitology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
- Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
| | - Shahabeddin Sarvi
- Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Parasitology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahmood Moosazadeh
- Gastrointestinal Cancer Research Center, Non-communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ahmad Daryani
- Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Parasitology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
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