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Grimm J, Krickl J, Beck A, Nell J, Bergmann M, Tappe D, Grüner B, Barth TFE, Brehm K. Establishing and evaluation of a polymerase chain reaction for the detection of Echinococcus multilocularis in human tissue. PLoS Negl Trop Dis 2021; 15:e0009155. [PMID: 33630840 PMCID: PMC7906421 DOI: 10.1371/journal.pntd.0009155] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 01/19/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Alveolar echinococcosis (AE) is caused by metacestode larva of the tapeworm Echinococcus multilocularis. AE diagnostics currently rely on imaging techniques supported by serology, but unequivocal detection of AE is difficult. Although polymerase chain reaction (PCR)-based methods to detect tapeworm DNA in biopsies have been suggested for several species, no validated protocol adhering to accepted guidelines has so far been presented for AE diagnostics. We herein established a PCR protocol for metacestode biopsies and technically evaluated the method using isolated parasite DNA and cells, biopsies of clinically relevant material, and formalin fixed paraffin-embedded (FFPE) human tissue blocks. We compared the results with an immunochemical (IHC) approach using the monoclonal antibody Em2G11 specific for the antigen Em2 of E. mulitlocularis. METHODOLOGY/PRINCIPAL FINDINGS Based on tapeworm 12S rDNA sequences we established and validated a PCR protocol for robust detection of as little as 50 parasite cells per specimen and report 127 cases of positive identification of Echinococcus species in samples from humans and animals. For further validation, we analyzed 45 liver, heart, brain, and soft tissue samples as well as cytological probes of aspirates of FFPE-material from 18 patients with clinically confirmed AE. Of each patient we analyzed (i) fully viable lesions with laminated layer; (ii) tissue with mAbEm2G11-positive small particles of E. multilocularis (spems); (iii) mAbEm2G11-negative tissue adjacent to the main lesion; and (iv) lymph node tissue with mAbEm2G11-positive spems. To identify the areas for the PCR-based approach, we performed IHC-staining with the monoclonal antibody Em2G11. Micro-dissected tissue of these areas was then used for PCR-analysis. 9 of 15 analyzed samples with viable E. multilocularis lesions with laminated layer were positive by PCR. Of this group, all samples preserved for less than 6 years (6/6) were tested positive. 11 of 15 samples of spems and 7 of 9 samples of the control group mAbEm2G11-negative tissue were negative by PCR. We further show that all probes from lymph nodes with spems are PCR negative. CONCLUSIONS/SIGNIFICANCE We present a sensitive PCR method for the detection of E. multilocularis in human tissue, particularly in fresh biopsy material and tissue blocks stored for less than 5 years. While the diagnostic sensitivity of material containing only spems was higher using IHC, PCR detection was possible in IHC negative liver tissue and in patients with negative serology. Our results support the view that spems do not contain parasitic DNA or viable cells of the parasite. spems thus most probably do not directly contribute to metastasis formation during AE.
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Affiliation(s)
| | - Julian Krickl
- Consultant Laboratory for Echinococcosis, Institute for Hygiene and Microbiology, University of Wuerzburg, Wuerzburg, Germany
| | - Annika Beck
- Institute of Pathology, University of Ulm, Ulm, Germany
| | - Juliane Nell
- Institute of Pathology, University of Ulm, Ulm, Germany
| | - Monika Bergmann
- Consultant Laboratory for Echinococcosis, Institute for Hygiene and Microbiology, University of Wuerzburg, Wuerzburg, Germany
| | - Dennis Tappe
- Consultant Laboratory for Echinococcosis, Institute for Hygiene and Microbiology, University of Wuerzburg, Wuerzburg, Germany
| | - Beate Grüner
- Division of Infectious Diseases, University Hospital and Medical Center, Ulm, Germany
| | | | - Klaus Brehm
- Consultant Laboratory for Echinococcosis, Institute for Hygiene and Microbiology, University of Wuerzburg, Wuerzburg, Germany
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Khan A, Ahmed H, Khan H, Simsek S, Kilinc SG, Kesik HK, Yayi G, Celik F, Afzal MS, Budke CM. First report of Echinococcus canadensis (G6/G7) by sequence analysis from the Khyber Pakhtunkhwa province of Pakistan. Acta Trop 2020; 209:105559. [PMID: 32473988 DOI: 10.1016/j.actatropica.2020.105559] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 05/16/2020] [Accepted: 05/24/2020] [Indexed: 12/14/2022]
Abstract
Cystic echinococcosis (CE) is a zoonotic parasitic disease that can result in human and animal health problems globally. Although the disease is known to be endemic in Asia and the Middle East, there are few epidemiological studies on CE in Pakistan. The purpose of the present study was to identify the Echinococcus granulosus sensu lato species and genotypes contributing to human CE cases in the Khyber Pakhtunkhwa (KPK) province of Pakistan. A total of fifty-six formalin fixed paraffin embedded (FFPE) CE cyst samples of human origin were collected from the Pathology Department, Rehman Medical Institute (RMI), KPK for the years 2012-2017. Cyst samples came from the liver (26/56; 46.4%), lungs (3/56; 5.3%), spleen (3/56; 5.3%), pelvis (1/56; 1.8%), breast (1/56; 1.8%), and thigh (1/56; 1.8%). The organ location for 21 of the cysts was not recorded. World Health Organization-Informal Working Group on Echinococcosis (WHO-IWGE) ultrasound-based cyst staging was available for 17 of the 26 (65.4%) hepatic cysts. Five of these cysts (29.4%) were CE3 (transitional), nine (52.9%) were CE4 (inactive), and three (17.6%) were CE5 (inactive). Most of the cysts were obtained from CE patients that were ethnically Afghan Pashtuns (44/56; 78.6%), while 12.5% (7/56) were from patients that were Pakistani Pashtuns. The majority (41/56; 73.2%) of patients reported having close interactions with dogs. Using 12SrRNA primers, 33 cyst samples were identified as being caused by E. granulosus sensu stricto (s.s.). Mitochondrially encoded cytochrome C oxidase 1 (mt-CO1) was evaluated for the remaining 23 samples. PCR product was obtained from six of these 23 samples. Of these six samples, one was identified as Echinococcus canadensis (G6/7). Haplotype analysis showed high haplotype and low nucleotide diversity for the mt-CO1 gene. There were 26 polymorphic sites for the mt-CO1 sequence, of which 65.3% (17/26) were parsimony informative. The E. canadensis mt-CO1 haplotype network consisted of 11 haplotypes, with a main central haplotype. In conclusion, it appears that E. granulosus s.s. and E. canadensis (G6/7) are circulating in the northwestern region of Pakistan. Further molecular epidemiological studies are needed to explore the local genetic diversity of the parasite.
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Affiliation(s)
- Aisha Khan
- Department of Biosciences, COMSATS University Islamabad (CUI), Park Road, Chakh Shahzad, Islamabad, Pakistan
| | - Haroon Ahmed
- Department of Biosciences, COMSATS University Islamabad (CUI), Park Road, Chakh Shahzad, Islamabad, Pakistan.
| | - Huma Khan
- Department of Biosciences, COMSATS University Islamabad (CUI), Park Road, Chakh Shahzad, Islamabad, Pakistan
| | - Sami Simsek
- Department of Parasitology, Faculty of Veterinary Medicine, University of Firat, 23119, Elazig, Turkey
| | - Seyma Gunyakti Kilinc
- Department of Parasitology, Faculty of Veterinary Medicine, University of Firat, 23119, Elazig, Turkey; Department of Parasitology, Faculty of Veterinary Medicine, Bingol University, Bingol, Turkey
| | - Harun Kaya Kesik
- Department of Parasitology, Faculty of Veterinary Medicine, Bingol University, Bingol, Turkey
| | - Guan Yayi
- Center for Global Health, National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Key Laboratory of Parasite and Vector Biology, Ministry of Health, WHO Collaborating Center of Tropical Diseases, National Center for International Researches on Tropical Diseases, Ministry of Science and Technology, 207 Ruijin Er Lu, Shanghai 200025, China
| | - Figen Celik
- Department of Parasitology, Faculty of Veterinary Medicine, University of Firat, 23119, Elazig, Turkey
| | - Muhammad Sohail Afzal
- Department of Life Sciences, School of Science, University of Management and Technology (UMT), Lahore, 54770, Pakistan
| | - Christine M Budke
- Department of Veterinary Integrative Biosciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, Texas, United States of America
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Efficacy of novel albendazole salt formulations against secondary cystic echinococcosis in experimentally infected mice. Parasitology 2020; 147:1425-1432. [PMID: 32729453 DOI: 10.1017/s0031182020001225] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In this study, we evaluated the efficacy, expressed as a mean weight decrease of the whole echinococcal cyst mass, of novel benzimidazole salt formulations in a murine Echinococcus granulosus infection model. BALB/c mice were intraperitoneally infected with protoscoleces of E. granulosus (genotype G1). At 9 months post-infection, treatment with albendazole (ABZ), ricobendazole (RBZ) salt formulations, and RBZ enantiomer salts (R)-(+)-RBZ-Na and (S)-(-)-RBZ-Na formulations were initiated. Drugs were orally applied by gavage at 10 mg kg-1 body weight per day during 30 days. Experimental treatments with benzimidazole sodium salts resulted in a significant reduction of the weight of cysts compared to conventional ABZ treatment, except for the (S)-(-)-RBZ-Na enantiomer formulation. Scanning electron microscopy and histological inspection revealed that treatments impacted not only the structural integrity of the parasite tissue in the germinal layer, but also induced alterations in the laminated layer. Overall, these results demonstrate the improved efficacy of benzimidazole salt formulations compared to conventional ABZ treatment in experimental murine cystic echinococcosis.
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M'rad S, Chaabane-Banaoues R, Lahmar I, Oumaima H, Mezhoud H, Babba H, Oudni-M'rad M. Parasitological Contamination of Vegetables Sold in Tunisian Retail Markets with Helminth Eggs and Protozoan Cysts. J Food Prot 2020; 83:1104-1109. [PMID: 32074629 DOI: 10.4315/jfp-19-559] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 02/14/2020] [Indexed: 01/24/2023]
Abstract
ABSTRACT Foodborne diseases continue to represent an important threat to public health in many parts of the world and are particularly widespread in developing countries. They are essentially acquired through an oro-fecal route via the consumption of uncooked fruits and vegetables. This study evaluated the parasitological contamination of vegetables for sale to humans in Tunisian retail markets. A total of 240 samples of fresh vegetables were examined for helminth eggs and protozoan cysts and oocysts (collectively, (oo)cysts) contamination. The parasitic elements (helminth eggs and protozoan (oo)cysts) were concentrated by sucrose flotation and identified by microscopic examination. The molecular identification of Echinococcus granulosus eggs was carried out using PCR. Helminth eggs and protozoan (oo)cysts eggs were found in 12.5% of the unwashed vegetables, and the most common parasites observed in vegetables were coccidian oocysts (4.1%), Toxocara spp. (2.5%), hookworm (2.1%), and Taenia spp. (1.25%) eggs, followed by Pseudolimax butschlii (1.6%) and Entamoeba coli (1.6%) protozoan cysts. Furthermore, parasite contamination differed significantly from one city to another. Taeniid eggs were identified by PCR as E. granulosus sensu stricto (s.s.) (genotype G1). To our knowledge, this study highlights for the first time in Tunisia that fresh vegetables for sale in markets are contaminated with helminths and protozoan cysts, which are potentially pathogenic for humans. The control of these pathogens is in part a question of sanitary education, especially for retail vendors, and in part of improvement in hygiene measures throughout the food production chain, from the field to the consumer. HIGHLIGHTS
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Affiliation(s)
- Selim M'rad
- Faculty of Pharmacy, Laboratory of Medical and Molecular Parasitology-Mycology (LP3M), LR12ES08, University of Monastir, 5000 Monastir, Tunisia
| | - Raja Chaabane-Banaoues
- Faculty of Pharmacy, Laboratory of Medical and Molecular Parasitology-Mycology (LP3M), LR12ES08, University of Monastir, 5000 Monastir, Tunisia
| | - Ibtissem Lahmar
- Faculty of Pharmacy, Laboratory of Medical and Molecular Parasitology-Mycology (LP3M), LR12ES08, University of Monastir, 5000 Monastir, Tunisia
| | - Hamza Oumaima
- Faculty of Pharmacy, Laboratory of Medical and Molecular Parasitology-Mycology (LP3M), LR12ES08, University of Monastir, 5000 Monastir, Tunisia
| | - Habib Mezhoud
- Faculty of Pharmacy, Laboratory of Medical and Molecular Parasitology-Mycology (LP3M), LR12ES08, University of Monastir, 5000 Monastir, Tunisia
| | - Hamouda Babba
- Faculty of Pharmacy, Laboratory of Medical and Molecular Parasitology-Mycology (LP3M), LR12ES08, University of Monastir, 5000 Monastir, Tunisia.,Laboratory of Parasitology-Mycology, EPS F. Bourguiba, 5000 Monastir, Tunisia
| | - Myriam Oudni-M'rad
- Faculty of Pharmacy, Laboratory of Medical and Molecular Parasitology-Mycology (LP3M), LR12ES08, University of Monastir, 5000 Monastir, Tunisia
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Comparison of various methods for DNA extraction from human isolated paraffin-embedded hydatid cyst samples. J Parasit Dis 2020; 44:613-617. [PMID: 32801514 DOI: 10.1007/s12639-020-01236-2] [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: 03/30/2020] [Accepted: 06/17/2020] [Indexed: 10/24/2022] Open
Abstract
Successful molecular research with reliable results depends on achieving significant and uniform amounts of genomic DNA from the parasite as the first and most basic step. Therefore, selection of an appropriate method that minimizes damage to the DNA of the parasite, is very important. In this study, we are going to describe a method that can extract DNA from human isolated paraffin-embedded hydatid cysts with a high quality and quantity. Formalin fixed and Paraffin-embedded hydatid cyst samples isolated from human lung and archived in the pathology laboratory were used for this purpose. Several sections of the paraffin blocks were prepared with 5 micron thickness and DNA were extracted by three different methods including; modified boiling, commercial kit and the method described by Larissa A. Pikor et al. The obtained DNA were evaluated by Nanodrop in terms of the yield of DNA and possible contaminations. To compare the quality of DNA prepared, cox1 region was amplified using specific primers. It was found that the DNA extracted by modified boiling had the lowest rate of contamination and the best electrophoretic band on the gel, compared to other two performed methods. Considering the findings of this study, this simple and high throughput DNA extraction method with high yield and quality can be recommended for extraction of DNA from formalin fixed and paraffin-embedded hydatid cysts.
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Hizem A, M’rad S, Oudni-M’rad M, Mezhoud H, Ben Jannet H, Flamini G, Ghedira K, Babba H. In vitro scolicidal activity of Thymus capitatus Hoff. et Link. essential oil on Echinococcus granulosus protoscoleces. JOURNAL OF ESSENTIAL OIL RESEARCH 2020. [DOI: 10.1080/10412905.2019.1711212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Amani Hizem
- Université de Monastir, Faculté de Pharmacie de Monastir, LP3M: Laboratoire de Parasitologie-Mycologie Médicale et Moléculaire, LR 12ES08, Monastir, Tunisie
| | - Selim M’rad
- Université de Monastir, Faculté de Pharmacie de Monastir, LP3M: Laboratoire de Parasitologie-Mycologie Médicale et Moléculaire, LR 12ES08, Monastir, Tunisie
| | - Myriam Oudni-M’rad
- Université de Monastir, Faculté de Pharmacie de Monastir, LP3M: Laboratoire de Parasitologie-Mycologie Médicale et Moléculaire, LR 12ES08, Monastir, Tunisie
| | - Habib Mezhoud
- Université de Monastir, Faculté de Pharmacie de Monastir, LP3M: Laboratoire de Parasitologie-Mycologie Médicale et Moléculaire, LR 12ES08, Monastir, Tunisie
| | - Hichem Ben Jannet
- Laboratoire de Chimie Hétérocyclique, Produits Naturels et Réactivité, Equipe: Chimie Médicinale et Produits Naturels, Faculté des Sciences de Monastir, Université de Monastir, Monastir, Tunisie
| | - Guido Flamini
- Dipartimento di Farmacia, Università di Pisa, Pisa, Italy
- Centro Interdipartimentale di Ricerca “Nutraceutica e Alimentazione per la Salute” Nutrafood, University of Pisa, Pisa, Italy
| | - Kamel Ghedira
- Unité des Substances naturelles bioactives et biotechnologie, UR17 ES49, Faculté de Pharmacie de Monastir, Université de Monastir, Monastir, Tunisie
| | - Hamouda Babba
- Université de Monastir, Faculté de Pharmacie de Monastir, LP3M: Laboratoire de Parasitologie-Mycologie Médicale et Moléculaire, LR 12ES08, Monastir, Tunisie
- Laboratoire B, Centre de maternité EPS F. Bourguiba, Monastir, Tunisie
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Abedi B, Maghsood AH, Khansarinejad B, Fallah M, Matini M, Gholami S, Pagheh AS, Ghasemikhah R. Genotyping of Echinococcus granulosus isolates from livestock based on mitochondrial cox1 gene, in the Markazi province, Iran. J Parasit Dis 2019; 43:592-596. [PMID: 31749529 DOI: 10.1007/s12639-019-01132-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 06/05/2019] [Indexed: 11/26/2022] Open
Abstract
Hydatidosisis a parasitic disease caused by the larval stage of Echinococcus granulosus with different genotypes, and major complications in vital organs such as liver, lungs and, brain. Also, this parasite can infect animals and cause economic damages. Recently, some investigations indicated that the genetic variation of the parasite affects the antigenic, immunogenic and pathogenic features. Therefore, present study conducted to genotyping of the E. granulosus larva based on mitochondrial cox1 gene in livestock in the endemic areas of Markazi province, Iran. In this study, 49 hydatid cysts samples collected from 36 sheep, 11 goats and 2 cattle from different slaughterhouses of Markazi province in central part of Iran, 2017. The mitochondrial cox1 gene was amplified and genotyping were accomplished using sequence analysis. The sequencing analysis indicated that the main genotype G1 (61%) and G3 (37%) were identified. Also, one of the samples shows similarity with the G2 (2%) genotype. The results showed the statistically significant differences between the genotypes in different livestock (P < 0.05). This study indicated that the main genotypes of E. granulosus in Markazi province are G1 and G3 which are related to dog/sheep strain. Therefore, parasite control in dogs and sheep can reduce the risk of transmission of infection to humans.
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Affiliation(s)
- Behnam Abedi
- 1Department of Medical Parasitology and Mycology, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Amir Hossein Maghsood
- 1Department of Medical Parasitology and Mycology, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Behzad Khansarinejad
- 2Department of Medical Microbiology, Arak University of Medical Sciences, Arāk, Iran
| | - Mohammad Fallah
- 1Department of Medical Parasitology and Mycology, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Matini
- 1Department of Medical Parasitology and Mycology, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Shirzad Gholami
- 3Department of Parasitology, Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Abdol Sattar Pagheh
- 3Department of Parasitology, Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Reza Ghasemikhah
- 4Department of Medical Parasitology and Mycology, Arak University of Medical Sciences, Arāk, Iran
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Chaâbane-Banaoues R, Oudni-M'rad M, M'rad S, Amani H, Mezhoud H, Babba H. A novel PCR-RFLP assay for molecular characterization of Echinococcus granulosus sensu lato and closely related species in developing countries. Parasitol Res 2016; 115:3817-24. [PMID: 27225001 DOI: 10.1007/s00436-016-5143-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 05/19/2016] [Indexed: 11/30/2022]
Abstract
Cystic echinococcosis, due to Echinococcus granulosus sensu lato (s. l.), currently affects three million people, especially in low-income countries and results in high livestock production loss. DNA-based methods demonstrated genetic variability of E. granulosus s. l., and five species were recognized to belong to the complex, including E. granulosus sensu stricto (s.s) (genotypes G1-G3), Echinococcus equinus (genotype G4), Echinococcus ortleppi (genotype G5), Echinococcus canadensis (genotypes G6-G10), and the lion strain Echinococcus felidis. The characterization of Echinococcus species responsible for human and animal echinococcosis is crucial to adapt the preventive measures against this parasitic disease. The sequencing approach is the gold standard for genotyping assays. Unfortunately, developing countries do not often have access to these techniques. Based on in silico RFLP tools, we described an accurate PCR-RFLP method for Echinococcus spp. characterization. The double digestion with the HaeIII and HinfI restriction enzymes of the PCR product from nad1 gene (1071 bp) led to a clear discrimination between E. granulosus s. l. and most closely related species (Echinococcus shiquicus and Echinococcus multilocularis).Molecular procedures and phylogenetic analysis confirmed the efficiency and the reproducibility of this simple and fast PCR-RFLP method. This technique is proved useful for fresh/unfixed and FF-PET tissues and enables large-scale molecular epidemiological screening in developing countries.
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Affiliation(s)
- Raja Chaâbane-Banaoues
- LP3M: Laboratory of Medical and Molecular Parasitology-Mycology, LR 12ES08, Faculty of Pharmacy, University of Monastir, 1 rue Avicenne, 5000, Monastir, Tunisia
| | - Myriam Oudni-M'rad
- LP3M: Laboratory of Medical and Molecular Parasitology-Mycology, LR 12ES08, Faculty of Pharmacy, University of Monastir, 1 rue Avicenne, 5000, Monastir, Tunisia.
| | - Selim M'rad
- LP3M: Laboratory of Medical and Molecular Parasitology-Mycology, LR 12ES08, Faculty of Pharmacy, University of Monastir, 1 rue Avicenne, 5000, Monastir, Tunisia
| | - Hizem Amani
- LP3M: Laboratory of Medical and Molecular Parasitology-Mycology, LR 12ES08, Faculty of Pharmacy, University of Monastir, 1 rue Avicenne, 5000, Monastir, Tunisia
| | - Habib Mezhoud
- LP3M: Laboratory of Medical and Molecular Parasitology-Mycology, LR 12ES08, Faculty of Pharmacy, University of Monastir, 1 rue Avicenne, 5000, Monastir, Tunisia
| | - Hamouda Babba
- LP3M: Laboratory of Medical and Molecular Parasitology-Mycology, LR 12ES08, Faculty of Pharmacy, University of Monastir, 1 rue Avicenne, 5000, Monastir, Tunisia
- Laboratory of Parasitology-Mycology, F. Bourguiba Teaching Hospital, 5000, Monastir, Tunisia
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