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Liu Z, Wang L, Sun J, Zhang Q, Peng Y, Tang S, Zhang L, Li X, Yu Z, Zhang T. Whole Genome Sequence Analysis of Two Oxacillin-Resistant and mecA-Positive Strains of Staphylococcus haemolyticus Isolated from Ear Swab Samples of Patients with Otitis Media. Infect Drug Resist 2024; 17:1291-1301. [PMID: 38576824 PMCID: PMC10992674 DOI: 10.2147/idr.s455051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 03/15/2024] [Indexed: 04/06/2024] Open
Abstract
Objective Staphylococcus haemolyticus can cause a series of infections including otitis media (OM), and the oxacillin-resistant S. haemolyticus has become a serious health concern. This study aimed to investigate the genomic characteristics of two strains of oxacillin-resistant and mecA-positive S. haemolyticus isolated from the samples of ear swabs from patients with OM and explore their acquired antibiotic resistance genes (ARGs) and the mobile genetic elements (MGEs). Methods Two oxacillin-resistant S. haemolyticus strains, isolated from ear swab samples of patients with OM, underwent antimicrobial susceptibility evaluation, followed by whole-genome sequencing. The acquired ARGs and the MGEs carried by the ARGs, harbored by the genomes of two strains of S. haemolyticus were identified. Results The two strains of oxacillin-resistant S. haemolyticus (strain SH1275 and strain SH9361) both carried the genetic contexts of mecA with high similarity with the SCCmec type V(5C2&5) subtype c. Surprisingly, the chromosomal aminoglycoside resistance gene aac(6')-aph(2") harbored by S. haemolyticus strain SH936 was flanked by two copies of IS256, forming the IS256-element (IS256-GNAT-[aac(6')-aph(2")]-IS256), which was widely present in strains of both Staphylococcus and Enterococcus genus. Furthermore, the two strains of oxacillin-resistant and MDR S. haemolyticus were found to harbor antimicrobial resistance plasmids, including one 26.9-kb plasmid (pSH1275-2) containing msr(A)-mph(C)) and qacA, one mobilizable plasmid pSH1275-3 harboring vga(A)LC, one plasmid (pSH9361-1) carrying erm(C), and one plasmid (pSH9361-2) carrying qacJ. Conclusion The systematic analysis of whole-genome sequences provided insights into the mobile genetic elements responsible for multi-drug resistance in these two strains of oxacillin-resistant and mecA-positive S. haemolyticus, which will assist clinicians in devising precise, personalized, and clinical therapeutic strategies for treating otitis media caused by multi-drug resistant S. haemolyticus.
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Affiliation(s)
- Zhao Liu
- Department of Otolaryngology, Zhuhai Hospital Affiliated with Jinan University (Zhuhai People’s Hospital), Zhuhai, People’s Republic of China
| | - Ling Wang
- Department of Obstetrics, Zhuhai Hospital Affiliated with Jinan University (Zhuhai People’s Hospital), Zhuhai, 519000, People’s Republic of China
| | - Jiabing Sun
- Department of Otolaryngology, Zhuhai Hospital Affiliated with Jinan University (Zhuhai People’s Hospital), Zhuhai, People’s Republic of China
| | - Qinghuan Zhang
- Department of Clinical Laboratory, Zhuhai Hospital Affiliated with Jinan University (Zhuhai People’s Hospital), Zhuhai, 519000, People’s Republic of China
| | - Yue Peng
- Department of Otolaryngology, Zhuhai Hospital Affiliated with Jinan University (Zhuhai People’s Hospital), Zhuhai, People’s Republic of China
| | - Susu Tang
- Department of Otolaryngology, Zhuhai Hospital Affiliated with Jinan University (Zhuhai People’s Hospital), Zhuhai, People’s Republic of China
| | - Limei Zhang
- Guangdong Provincial Key Laboratory of Tumor Interventional Diagnosis and Treatment, Zhuhai Hospital Affiliated with Jinan University (Zhuhai People’s Hospital), Zhuhai, People’s Republic of China
| | - Xiaobin Li
- Guangdong Provincial Key Laboratory of Tumor Interventional Diagnosis and Treatment, Zhuhai Hospital Affiliated with Jinan University (Zhuhai People’s Hospital), Zhuhai, People’s Republic of China
- Zhuhai Precision Medical Center, Zhuhai Hospital Affiliated with Jinan University (Zhuhai People’s Hospital), Zhuhai, People’s Republic of China
| | - Zhijian Yu
- Department of Otolaryngology, Zhuhai Hospital Affiliated with Jinan University (Zhuhai People’s Hospital), Zhuhai, People’s Republic of China
| | - Tao Zhang
- Department of Otolaryngology, The First Affiliated Hospital of Jinan University, Guangzhou, People’s Republic of China
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Król J, Wanecka A, Twardoń J, Florek M, Marynowska M, Banaszkiewicz S, Kaczmarek-Pieńczewska A, Pląskowska E, Brodala M, Chwirot W, Korzeniowska-Kowal A, De Buck J. Staphylococcus borealis - A newly identified pathogen of bovine mammary glands. Vet Microbiol 2023; 286:109876. [PMID: 37776630 DOI: 10.1016/j.vetmic.2023.109876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 09/04/2023] [Accepted: 09/11/2023] [Indexed: 10/02/2023]
Abstract
Twelve Staphylococcus borealis strains, isolated in Canada and Poland from milk of cows with intramammary infections, were characterized phenotypically (biochemical reactions on ID 32 STAPH and Biolog Phenotype MicroArrays™ PM1 and PM2A, ability of biofilm production) and genotypically (random amplified polymorphic DNA). In addition, a genomic comparison was done with S. borealis strains of human and porcine origin using the multilocus sequence typing (MLST) technique. The bovine isolates showed a high degree of phenotypic and genotypic diversity, however, they could be differentiated from human strains by the negative test for urease (found in all but one bovine isolate examined with ID 32 STAPH) and positive reaction for D-galactose (on Biolog phenotype microarray PM1) and D-lactose (on both commercial systems). The MLST method, utilizing six concatenated genes of the total length of ∼2930 bp, revealed that bovine strains (irrespective of the country of origin) show a distinctly greater degree of mutual relationship than to the strains of human and porcine origin, suggesting that S. borealis has evolved independently in these hosts. In conclusion, bovine-specific S. borealis can be involved in intramammary infections in cattle.
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Affiliation(s)
- Jarosław Król
- Department of Pathology, Wroclaw University of Environmental and Life Sciences, Faculty of Veterinary Medicine, St. Norwida 31, 50-375 Wrocław, Poland.
| | - Anna Wanecka
- Department of Pathology, Wroclaw University of Environmental and Life Sciences, Faculty of Veterinary Medicine, St. Norwida 31, 50-375 Wrocław, Poland
| | - Jan Twardoń
- Department of Reproduction and Clinic of Farm Animals, Wroclaw University of Environmental and Life Sciences, Faculty of Veterinary Medicine, Pl. Grunwaldzki 49, 50-366 Wrocław, Poland
| | - Magdalena Florek
- Department of Pathology, Wroclaw University of Environmental and Life Sciences, Faculty of Veterinary Medicine, St. Norwida 31, 50-375 Wrocław, Poland
| | - Maja Marynowska
- Department of Pathology, Wroclaw University of Environmental and Life Sciences, Faculty of Veterinary Medicine, St. Norwida 31, 50-375 Wrocław, Poland
| | - Sylwia Banaszkiewicz
- Department of Food Hygiene and Consumer Health Protection, Wroclaw University of Environmental and Life Sciences, Faculty of Veterinary Medicine, St. Norwida 31, 50-375 Wrocław, Poland
| | - Agata Kaczmarek-Pieńczewska
- Department of Plant Protection, Division of Plant Pathology and Mycology, Wroclaw University of Environmental and Life Sciences, Pl. Grunwaldzki 24a, 50-363 Wrocław, Poland
| | - Elżbieta Pląskowska
- Department of Plant Protection, Division of Plant Pathology and Mycology, Wroclaw University of Environmental and Life Sciences, Pl. Grunwaldzki 24a, 50-363 Wrocław, Poland
| | - Maria Brodala
- Student of the Faculty of Veterinary Medicine, University of Environmental and Life Sciences, Wrocław, Poland
| | - Wojciech Chwirot
- Student of the Faculty of Veterinary Medicine, University of Environmental and Life Sciences, Wrocław, Poland
| | - Agnieszka Korzeniowska-Kowal
- Department of Immunology of Infectious Diseases, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, St. Weigla 12, 53-114 Wrocław, Poland
| | - Jeroen De Buck
- Faculty of Veterinary Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary T2N 4N1, Alberta, Canada
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Ocloo R, Newton-Foot M, Ziebuhr W, Whitelaw AC. Molecular epidemiology and antibiotic resistance of staphylococci other than Staphylococcus aureus in children in Cape Town, South Africa. Front Microbiol 2023; 14:1239666. [PMID: 37601359 PMCID: PMC10437061 DOI: 10.3389/fmicb.2023.1239666] [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: 06/13/2023] [Accepted: 07/11/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction Staphylococci other than Staphylococcus aureus (SOSA) have emerged as significant pathogens in healthcare settings, particularly among patients with indwelling devices and immunocompromised individuals. Staphylococcus epidermidis, Staphylococcus haemolyticus and Staphylococcus hominis are the most common commensal SOSA species and are implicated in infections such as endocarditis and bacteremia. SOSA infections in neonates and children have been reported globally. Recent increases in antibiotic resistance and virulence among SOSA strains in clinical settings have highlighted the need to describe the reservoirs of SOSA to enable monitoring of these emerging pathogens. Methods Stool samples were collected from 150 healthy children from Cape Town communities between 2017 and 2020. Staphylococci were isolated, identified using mass-spectrometry, and antimicrobial susceptibility testing and Illumina whole genome sequencing were performed. Results Among the participants, 50 (33.3%) were colonized by SOSA, with S. haemolyticus (n = 38; 25.3%) being the most common, followed by S. hominis (n = 5; 3.3%) and Mammalicoccus sciuri (n = 5; 3.3%). Out of the 77 initially isolated S. haemolyticus strains, 23 were identified as Staphylococcus borealis through whole genome sequencing. All S. haemolyticus isolates (n = 49) were methicillin resistant, with 65.3% (n = 32) harbouring mecA. In S. haemolyticus, SCCmec type VIII(4A) was detected in 42.0% of ST9 isolates while non-mecA methicillin resistant S. haemolyticus isolates were mostly ST49 (41.1%). Additionally, 16 (50.0%) S. haemolyticus strains contained non-typeable SCCmec elements. Discussion High rates of methicillin resistance were identified among colonizing SOSA in Cape Town, increasing the risk of transmission to clinical settings. This study also identified a new species, S. borealis, for the first time in Africa.
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Affiliation(s)
- Remous Ocloo
- Division of Medical Microbiology and Immunology, Department of Pathology, Stellenbosch University, Stellenbosch, South Africa
| | - Mae Newton-Foot
- Division of Medical Microbiology and Immunology, Department of Pathology, Stellenbosch University, Stellenbosch, South Africa
- National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
| | - Wilma Ziebuhr
- Institute of Molecular Infection Biology, University of Wuerzburg, Wuerzburg, Germany
| | - Andrew Christopher Whitelaw
- Division of Medical Microbiology and Immunology, Department of Pathology, Stellenbosch University, Stellenbosch, South Africa
- National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
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Shoaib M, Xu J, Meng X, Wu Z, Hou X, He Z, Shang R, Zhang H, Pu W. Molecular epidemiology and characterization of antimicrobial-resistant Staphylococcus haemolyticus strains isolated from dairy cattle milk in Northwest, China. Front Cell Infect Microbiol 2023; 13:1183390. [PMID: 37265496 PMCID: PMC10230075 DOI: 10.3389/fcimb.2023.1183390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 04/27/2023] [Indexed: 06/03/2023] Open
Abstract
Introduction Non-aureus Staphylococcus (NAS) species are currently the most commonly identified microbial agents causing sub-clinical infections of the udder and are also deemed as opportunistic pathogens of clinical mastitis in dairy cattle. More than 10 NAS species have been identified and studied but little is known about S. haemolyticus in accordance with dairy mastitis. The present study focused on the molecular epidemiology and genotypic characterization of S. haemolyticus isolated from dairy cattle milk in Northwest, China. Methods In this study, a total of 356 milk samples were collected from large dairy farms in three provinces in Northwest, China. The bacterial isolation and presumptive identification were done by microbiological and biochemical methods following the molecular confirmation by 16S rRNA gene sequencing. The antimicrobial susceptibility testing (AST) was done by Kirby-Bauer disk diffusion assay and antibiotic-resistance genes (ARGs) were identified by PCR. The phylogenetic grouping and sequence typing was done by Pulsed Field Gel Electrophoresis (PFGE) and Multi-Locus Sequence Typing (MLST) respectively. Results In total, 39/356 (11.0%) were identified as positive for S. haemolyticus. The overall prevalence of other Staphylococcus species was noted to be 39.6% (141/356), while the species distribution was as follows: S. aureus 14.9%, S. sciuri 10.4%, S. saprophyticus 7.6%, S. chromogenes 4.2%, S. simulans 1.4%, and S. epidermidis 1.1%. The antimicrobial susceptibility of 39 S. haemolyticus strains exhibited higher resistance to erythromycin (92.3%) followed by trimethoprim-sulfamethoxazole (51.3%), ciprofloxacin (43.6%), florfenicol (30.8%), cefoxitin (28.2%), and gentamicin (23.1%). All of the S. haemolyticus strains were susceptible to tetracycline, vancomycin, and linezolid. The overall percentage of multi-drug resistant (MDR) S. haemolyticus strains was noted to be 46.15% (18/39). Among ARGs, mphC was identified as predominant (82.05%), followed by ermB (33.33%), floR (30.77%), gyrA (30.77%), sul1 (28.21%), ermA (23.08%), aadD (12.82%), grlA (12.82%), aacA-aphD (10.26%), sul2 (10.26%), dfrA (7.69%), and dfrG (5.13%). The PFGE categorized 39 S. haemolyticus strains into A-H phylogenetic groups while the MLST categorized strains into eight STs with ST8 being the most predominant while other STs identified were ST3, ST11, ST22, ST32, ST19, ST16, and ST7. Conclusion These findings provided new insights into our understanding of the epidemiology and genetic characteristics of S. haemolyticus in dairy farms to inform interventions limiting the spread of AMR in dairy production.
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Affiliation(s)
- Muhammad Shoaib
- Key Laboratory of New Animal Drug Project, Gansu Province/Key Laboratory of Veterinary Pharmaceutical Development, Ministry of Agriculture and Rural Affairs, Lanzhou Institute of Husbandry and Pharmaceutical Sciences of Chinese Academy of Agricultural Sciences (CAAS), Lanzhou, China
| | - Jie Xu
- Key Laboratory of New Animal Drug Project, Gansu Province/Key Laboratory of Veterinary Pharmaceutical Development, Ministry of Agriculture and Rural Affairs, Lanzhou Institute of Husbandry and Pharmaceutical Sciences of Chinese Academy of Agricultural Sciences (CAAS), Lanzhou, China
| | - Xiaoqin Meng
- Lanzhou Center for Animal Disease Control and Prevention, Lanzhou, China
| | - Zhongyong Wu
- Key Laboratory of New Animal Drug Project, Gansu Province/Key Laboratory of Veterinary Pharmaceutical Development, Ministry of Agriculture and Rural Affairs, Lanzhou Institute of Husbandry and Pharmaceutical Sciences of Chinese Academy of Agricultural Sciences (CAAS), Lanzhou, China
| | - Xiao Hou
- Key Laboratory of New Animal Drug Project, Gansu Province/Key Laboratory of Veterinary Pharmaceutical Development, Ministry of Agriculture and Rural Affairs, Lanzhou Institute of Husbandry and Pharmaceutical Sciences of Chinese Academy of Agricultural Sciences (CAAS), Lanzhou, China
| | - Zhuolin He
- Key Laboratory of New Animal Drug Project, Gansu Province/Key Laboratory of Veterinary Pharmaceutical Development, Ministry of Agriculture and Rural Affairs, Lanzhou Institute of Husbandry and Pharmaceutical Sciences of Chinese Academy of Agricultural Sciences (CAAS), Lanzhou, China
| | - Ruofeng Shang
- Key Laboratory of New Animal Drug Project, Gansu Province/Key Laboratory of Veterinary Pharmaceutical Development, Ministry of Agriculture and Rural Affairs, Lanzhou Institute of Husbandry and Pharmaceutical Sciences of Chinese Academy of Agricultural Sciences (CAAS), Lanzhou, China
| | - Hongjuan Zhang
- Key Laboratory of New Animal Drug Project, Gansu Province/Key Laboratory of Veterinary Pharmaceutical Development, Ministry of Agriculture and Rural Affairs, Lanzhou Institute of Husbandry and Pharmaceutical Sciences of Chinese Academy of Agricultural Sciences (CAAS), Lanzhou, China
| | - Wanxia Pu
- Key Laboratory of New Animal Drug Project, Gansu Province/Key Laboratory of Veterinary Pharmaceutical Development, Ministry of Agriculture and Rural Affairs, Lanzhou Institute of Husbandry and Pharmaceutical Sciences of Chinese Academy of Agricultural Sciences (CAAS), Lanzhou, China
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Lin LC, Chang SC, Ou YH, Liu TP, Lu JJ. Clonal Spreading of ST42 Staphylococcus haemolyticus Strains Occurs Possibly Due to fusB and tetK Resistant Genes and Capsule-Related Genes. Int J Mol Sci 2023; 24:ijms24076198. [PMID: 37047168 PMCID: PMC10094739 DOI: 10.3390/ijms24076198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/16/2023] [Accepted: 03/17/2023] [Indexed: 03/29/2023] Open
Abstract
Multi-drug resistant Staphylococcus haemolyticus is a frequent nosocomial invasive bacteremia pathogen in hospitals. Our previous analysis showed one of the predominant strains, ST42 originated from ST3, had only one multilocus sequence typing (MLST) variation among seven loci in SH1431; yet no significant differences in biofilm formation observed between ST42 and ST3, suggesting that other factors influence clonal lineage change. Whole genome sequencing was conducted on two isolates from ST42 and ST3 to find phenotypic and genotypic variations, and these variations were further validated in 140 clinical isolates. The fusidic acid- and tetracycline-resistant genes (fusB and tetK) were found only in CGMH-SH51 (ST42). Further investigation revealed consistent resistant genotypes in all isolates, with 46% and 70% of ST42 containing fusB and tetK, respectively. In contrast, only 23% and 4.2% ST3 contained these two genes, respectively. The phenotypic analysis also showed that ST42 isolates were highly resistant to fusidic acid (47%) and tetracycline (70%), compared with ST3 (23% and 4%, respectively). Along with drug-resistant genes, three capsule-related genes were found in higher percentage distributions in ST42 than in ST3 isolates. Our findings indicate that ST42 could become endemic in Taiwan, further constitutive surveillance is required to prevent the spread of this bacterium.
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Qin M, Chen P, Deng B, He R, Wu Y, Yang Y, Deng W, Ding X, Yang F, Xie C, Yang Y, Tian GB. The Emergence of a Multidrug-Resistant and Pathogenic ST42 Lineage of Staphylococcus haemolyticus from a Hospital in China. Microbiol Spectr 2022; 10:e0234221. [PMID: 35579464 PMCID: PMC9241665 DOI: 10.1128/spectrum.02342-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 04/08/2022] [Indexed: 11/20/2022] Open
Abstract
Staphylococcus haemolyticus is an opportunistic pathogen associated with hospital-acquired infections. However, the genetic diversity of S. haemolyticus among the patients and the hospital environment is largely unknown. Here, we isolated 311 S. haemolyticus strains from different sampling sites of patients and hospital environment. Genomic analysis showed that ST42 is an emerging clone widely disseminated in the hospital. S. haemolyticus ST42 strains exhibited decreased susceptibilities for multiple antibiotics compared with other STs and carried significantly more antibiotic resistance genes (ARGs). Furthermore, ST42 strains harbored more virulence genes per isolate than in other STs, and the capsular biosynthesis genes capDEFG were more prevalent in ST42 strains. Using the Galleria mellonella infection model, we demonstrated that ST42 strains are highly virulent compared with non-ST42 strains. Taken together, our data identified an emerging ST42 clone of S. haemolyticus with aggregated ARGs and virulence determinants in the hospital, representing a significant health threat in terms of both disease and treatment. IMPORTANCES. haemolyticus is an emerging opportunistic pathogen with a high burden of antimicrobial resistance. We performed molecular epidemiological analysis of S. haemolyticus that was isolated from a hospital, and found that the phylogenetic lineages are diverse accompanied by a dominant epidemic clonal lineage ST42. We demonstrated that S. haemolyticus ST42 strains have been disseminated among patients and the hospital environment. The data provide mechanistic insight and indicate that S. haemolyticus ST42 strains are multidrug-resistance and virulent clones via accumulating more ARGs and virulence genes.
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Affiliation(s)
- Mingyang Qin
- School of Basic Medical Sciences, Xinxiang Medical University, Xinxiang, China
| | - Ping Chen
- School of Basic Medical Sciences, Xinxiang Medical University, Xinxiang, China
| | - Baoguo Deng
- School of Basic Medical Sciences, Xinxiang Medical University, Xinxiang, China
| | - Ruowen He
- Department of Microbiology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Tropical Diseases Control (Sun Yat-sen University), Ministry of Education, Guangzhou, China
| | - Yiping Wu
- Department of Microbiology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Tropical Diseases Control (Sun Yat-sen University), Ministry of Education, Guangzhou, China
| | - Yanxian Yang
- Department of Microbiology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Tropical Diseases Control (Sun Yat-sen University), Ministry of Education, Guangzhou, China
| | - Wenbin Deng
- School of Pharmaceutical Sciences (Shenzhen), Sun Yat-sen University, Guangzhou, China
| | - Xin Ding
- State Key Laboratory of Oncology in South China, Guangzhou, China
| | - Fan Yang
- School of Basic Medical Sciences, Xinxiang Medical University, Xinxiang, China
| | - Chuanbo Xie
- Cancer Prevention Center, Sun Yat-sen University Cancer Center, Guangzhou, China
- State Key Laboratory of Oncology in South China, Guangzhou, China
- Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yongqiang Yang
- Department of Microbiology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Tropical Diseases Control (Sun Yat-sen University), Ministry of Education, Guangzhou, China
- School of Pharmaceutical Sciences (Shenzhen), Sun Yat-sen University, Guangzhou, China
| | - Guo-Bao Tian
- Department of Microbiology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
- Key Laboratory of Tropical Diseases Control (Sun Yat-sen University), Ministry of Education, Guangzhou, China
- School of Medicine, Xizang Minzu University, Xianyang, Shaanxi, China
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