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Faúndez F, Iñiguez G, Fehrmann-Cartes K. Detection of Escherichia coli O157H7 and Campylobacter jejuni in Bovine Carcasses in Two Slaughterhouses in Bio-Bío District, Chile. Foodborne Pathog Dis 2024; 21:409-415. [PMID: 38568114 DOI: 10.1089/fpd.2023.0137] [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] [Indexed: 07/11/2024] Open
Abstract
Escherichia coli O157:H7 (E. coli O157:H7) and Campylobacter jejuni (C. jejuni) are pathogenic microorganisms that can cause severe clinical symptoms in humans and are associated with bovine meat consumption. Specific monitoring for E. coli O157: H7 or C. jejuni in meat is not mandatory under Chilean regulations. In this study, we analyzed 544 samples for the detection of both microorganisms, obtained from 272 bovine carcasses (280 kg average) at two slaughterhouses in the Bio-Bío District, Chile. Sampling was carried out at post-shower of carcasses and after channel passage through the cold chamber. Eleven samples were found to be positive for E. coli O157:H7 (4.0%) using microbiological and biochemical detection techniques and were subjected to a multiplex PCR to detect fliC and rfbE genes. Six samples (2.2%) were also found to be positive for the pathogenicity genes stx1, stx2, and eaeA. Twenty-two carcasses (8.0%) were found to be positive for C. jejuni using microbiological and biochemical detection techniques, but no sample with amplified mapA gene was found.
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Affiliation(s)
- Felipe Faúndez
- Facultad de Medicina Veterinaria y Agronomía, Universidad de Las Américas, Concepción, Chile
| | - Gonzalo Iñiguez
- Facultad de Medicina Veterinaria y Agronomía, Universidad de Las Américas, Concepción, Chile
| | - Karen Fehrmann-Cartes
- Facultad de Medicina Veterinaria y Agronomía, Universidad de Las Américas, Concepción, Chile
- Núcleo de Investigaciones Aplicadas en Ciencias Veterinarias y Agronómicas, Universidad de Las Américas, Concepción, Chile
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Benedetti G, Holm Hansen C, Tølbøll Svendsen A, Grimstrup Joensen K, Sørensen G, Engsbro AL, Torpdahl M, Møller Nielsen E, Ethelberg S. The effect of changing diagnostic method from culture to PCR on the number of episodes of human campylobacteriosis in Denmark: a retrospective study (2015-2022). Microbiol Spectr 2024; 12:e0341823. [PMID: 38063356 PMCID: PMC10783023 DOI: 10.1128/spectrum.03418-23] [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: 09/22/2023] [Accepted: 11/13/2023] [Indexed: 01/13/2024] Open
Abstract
IMPORTANCE This study is important because it shows the potential epidemiological silence associated with the use of culture as the primary diagnostic method for the laboratory identification of human campylobacteriosis. Also, we show how polymerase chain reaction methods are associated with a systematic increase in the number of human campylobacteriosis episodes as reported by routine disease surveillance. These findings are operationally relevant and have public health implications because they tell how crucial it is to consider changes in diagnostic methods, e.g., in the epidemiological analysis of historical data and in the interpretation of future data in light of the past. We also believe that this study highlights how the synergy between microbiology and epidemiology is essential for disease surveillance.
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Affiliation(s)
- Guido Benedetti
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Christian Holm Hansen
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Anna Tølbøll Svendsen
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
- Department of Medicine, Zealand University Hospital, Køge, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Gitte Sørensen
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Anne Line Engsbro
- Department of Clinical Microbiology, Zealand University Hospital, Slagelse, Denmark
- Hvidovre University Hospital, Hvidovre, Denmark
| | - Mia Torpdahl
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Eva Møller Nielsen
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Steen Ethelberg
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
- Department of Public Health, Global Health Section, University of Copenhagen, Copenhagen, Denmark
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Chen Y, Hu Y, Lu X. An Integrated Paper Microfluidic Device Based on Isothermal Amplification for Simple Sample-to-Answer Detection of Campylobacter jejuni. Appl Environ Microbiol 2023; 89:e0069523. [PMID: 37382522 PMCID: PMC10370333 DOI: 10.1128/aem.00695-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 06/03/2023] [Indexed: 06/30/2023] Open
Abstract
Campylobacter jejuni is recognized as the most common species in the genus Campylobacter that causes foodborne diseases. The main reservoirs harboring C. jejuni are poultry products, which are associated with most illnesses, creating a demand for effective detection methods to achieve point-of-need diagnostics. We developed an easy-to-use, hybrid paper/polymer-based microfluidic device that integrates paper-based DNA extraction, isothermal nucleic acid amplification, and lateral flow detection. Overall, the recombinase polymerase amplification (RPA) reaction was completed in 20 min and demonstrated 100% specificity to C. jejuni, including 2 reference strains and 6 wild strains isolated from the agroecosystem, 9 other Campylobacter subspecies strains, and 11 non-Campylobacter strains. The limit of detection (LOD) was 46 CFU/mL with DNA extracted on the cellulose paper. The sensitivity was reduced to 460 CFU/mL on the integrated hybrid paper/polymer-based microfluidic device. This device could detect C. jejuni spiked at concentrations ranging from 101 to 102 CFU/g in chicken meat after an enrichment of 5 to 10 h. For C. jejuni levels of >102 CFU/g, it managed to confirm positive results immediately, without bacterial enrichment. RPA reagents and primers remained stable on the paper platform at 22°C for 12 h. After lyophilization and storage on paper, the RPA reaction showed consistent sensitivity for 3 days, and the LOD was reduced to 103 CFU/mL when storage was extended to 25 days. The use of this hybrid paper/polymer-based microfluidic device enabled detection of Campylobacter in foods with high specificity and sensitivity, demonstrating its potential as a reliable point-of-need diagnostic platform for on-site conditions due to its low cost, portability, and simplicity. IMPORTANCE The global health and economic burden of Campylobacter prompts the development of novel detection techniques that can be implemented in resource-limited and on-site settings. This study described point-of-need identification of C. jejuni using a hybrid paper/polymer-based microfluidic device that is easy to operate. This device had high specificity and sensitivity toward C. jejuni and significantly reduced the total analysis time compared to conventional culture-based methods. Nucleic acid extraction was simplified from intensive pipetting to a paper dipstick, making it more convenient for use in the field as a promising tool for future routine surveillance and outbreak investigation.
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Affiliation(s)
- Yunxuan Chen
- Food, Nutrition and Health Program, Faculty of Land and Food Systems, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Yaxi Hu
- Food, Nutrition and Health Program, Faculty of Land and Food Systems, The University of British Columbia, Vancouver, British Columbia, Canada
- Food Science Program, Department of Chemistry, Carleton University, Ottawa, Ontario, Canada
| | - Xiaonan Lu
- Food, Nutrition and Health Program, Faculty of Land and Food Systems, The University of British Columbia, Vancouver, British Columbia, Canada
- Department of Food Science and Agricultural Chemistry, McGill University Macdonald Campus, Quebec, Canada
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McDougall F, Power M. Occurrence of Salmonella enterica in grey-headed flying foxes from New South Wales. Aust Vet J 2021; 99:517-521. [PMID: 34490611 DOI: 10.1111/avj.13116] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 07/30/2021] [Accepted: 08/12/2021] [Indexed: 11/30/2022]
Abstract
Salmonella enterica and Campylobacter jejuni are significant foodborne zoonotic pathogens causing gastroenteritis in humans. Domestic animals are commonly implicated as reservoirs of S. enterica and C. jejuni, but both are also detected in wild animals. Salmonella enterica serovar Typhimurium is the most common cause of human salmonellosis in Australia; however, Salmonella enterica serovar Wangata is associated with sporadic human outbreaks in New South Wales and wild animals may be a potential reservoir. To determine if wild grey-headed flying foxes (GHFF; Pteropus poliocephalus) are reservoirs of Salmonella and Campylobacter, faecal samples were collected from three GHFF colonies in New South Wales and cultured for the presence of Salmonella and Campylobacter. One Salmonella isolate was cultured from 254 GHFF faecal samples (0.39%). Whole genome sequencing was used to genetically characterise the Salmonella isolate and perform phylogenetic analysis. The GHFF isolate was determined to be Salmonella Typhimurium ST19. The GHFF isolate carried a virulence plasmid and other virulence factors, but did not exhibit antimicrobial resistance. Phylogenetic analysis determined that the GHFF isolate was most closely related to a cluster of six isolates: four from human salmonellosis cases in Queensland and two from Australian livestock. Neither Campylobacter nor Salmonella Wangata were cultured from the 254 GHFF faecal samples. This study concluded that wild GHFF in New South Wales are not major reservoirs for Salmonella, and the zoonotic risks associated with S. enterica carriage by urban GHFF are low for the general public.
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Affiliation(s)
- F McDougall
- Department of Biological Sciences, Macquarie University, Sydney, New South Wales, 2109, Australia
| | - M Power
- Department of Biological Sciences, Macquarie University, Sydney, New South Wales, 2109, Australia
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El Baaboua A, El Maadoudi M, Bouyahya A, Kounnoun A, Bougtaib H, Belmehdi O, Senhaji NS, Abrini J. Prevalence and antimicrobial profiling of Campylobacter spp. isolated from meats, animal, and human feces in Northern of Morocco. Int J Food Microbiol 2021; 349:109202. [PMID: 33991875 DOI: 10.1016/j.ijfoodmicro.2021.109202] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 03/26/2021] [Accepted: 04/13/2021] [Indexed: 01/20/2023]
Abstract
The present work was carried out to understand the occurrence and antimicrobial susceptibility of Campylobacter spp., in various samples in Northern of Morocco. For this purpose, a random sampling was undertaken from butcher shops, traditional markets, and slaughterhouse. First, the research of Campylobacter was performed according to the Moroccan standard NM ISO: 10272-1 (2008). Second, the isolates were identified by biochemical tests and real time PCR. After the biochemical and molecular identification of suspected colonies, a disk diffusion method was executed to determine the sensitivity of Campylobacter spp. against 18 antibiotics. The results showed a moderate prevalence of Campylobacter species (130/466) recovered mainly on the Campylobacter blood base agar, where C. coli (108/130) were more prevalent comparable to C. jejuni (22/130) in poultry and cattle meat, raw milk, cloacal and surface swabs, and stool of patient suffering from diarrhea. The findings supported also the sensitivity of multiplex qPCR to detect Campylobacter strains compared to Moroccan standard NM ISO: 10272-1 (2008). Among our isolates, C. jejuni were the most susceptible strain toward colistin, florfenicol, gentamicin, streptomycin, and erythromycin. Nonetheless, the presence of multidrug Campylobacter resistant strains was highly observed in C. jejuni isolated, particularly, from broiler chickens toward the antibiotic classes of cephalosporin, penicillin, monobactam, quinolone, fluoroquinolone, sulfamide, as well as tetracycline. This may be due to common use of these drugs in veterinary medicine and farms as growth factor, which limits the usefulness of these molecules. Hence, the study highlights the importance of resistance profile monitoring of these pathogens in Northern of Morocco, in order to develop appropriate control measures and to reduce the emergence of multidrug-resistant strains.
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Affiliation(s)
- Aicha El Baaboua
- Biology and Health Laboratory, Biotechnology and Applied Microbiology Team, Department of Biology, Faculty of Science, Abdelmalek-Essaadi University, Tetouan, Morocco; Regional Laboratory for Analysis and Research, National Office for Food Safety, Tangier, Morocco.
| | - Mohamed El Maadoudi
- Regional Laboratory for Analysis and Research, National Office for Food Safety, Tangier, Morocco
| | - Abdelhakim Bouyahya
- Laboratory of Human Pathology Biology, Faculty of Sciences, Genomic Center of Human Pathology, Mohammed V University in Rabat, Morocco.
| | - Ayoub Kounnoun
- Regional Laboratory for Analysis and Research, National Office for Food Safety, Tangier, Morocco; Laboratory of Applied Biology and Pathology, Department of Biology, Faculty of Science, Abdelmalek-Essaadi University, Tetouan, Morocco
| | - Hajar Bougtaib
- Regional Laboratory for Analysis and Research, National Office for Food Safety, Tangier, Morocco; Laboratory of Applied Biology and Pathology, Department of Biology, Faculty of Science, Abdelmalek-Essaadi University, Tetouan, Morocco
| | - Omar Belmehdi
- Biology and Health Laboratory, Biotechnology and Applied Microbiology Team, Department of Biology, Faculty of Science, Abdelmalek-Essaadi University, Tetouan, Morocco
| | - Nadia Skali Senhaji
- Biology and Health Laboratory, Biotechnology and Applied Microbiology Team, Department of Biology, Faculty of Science, Abdelmalek-Essaadi University, Tetouan, Morocco
| | - Jamal Abrini
- Biology and Health Laboratory, Biotechnology and Applied Microbiology Team, Department of Biology, Faculty of Science, Abdelmalek-Essaadi University, Tetouan, Morocco
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Hlashwayo DF, Sigaúque B, Noormahomed EV, Afonso SMS, Mandomando IM, Bila CG. A systematic review and meta-analysis reveal that Campylobacter spp. and antibiotic resistance are widespread in humans in sub-Saharan Africa. PLoS One 2021; 16:e0245951. [PMID: 33503068 PMCID: PMC7840040 DOI: 10.1371/journal.pone.0245951] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 01/11/2021] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Campylobacter spp. are zoonotic bacteria that cause gastroenteritis in humans worldwide, whose main symptom is diarrhea. In certain cases, extra intestinal manifestations may occur, such as Guillain Barré syndrome. The bacteria cause severe diarrhea mostly in children and in immunocompromised individuals. This review aims to address the prevalence of Campylobacter spp. in humans in sub-Saharan Africa. It also aims to understand the impact of HIV in the prevalence, as well as to report data on antibiotic resistance and propose research priorities. METHODS We followed PRISMA guidelines to find studies on the occurrence of Campylobacter spp. in humans in all countries from sub-Saharan Africa. Studies published between 2000 and 2020 were searched in PubMed, Cochrane Library, CINAHL, African Index Medicus, African Journals Online, Google Scholar and Science Direct. We have conducted a random-effect meta-analysis and calculated the proportion of resistant isolates to different antibiotics. RESULTS AND DISCUSSION We found 77 studies that described such occurrence in humans in 20 out of 53 sub-Saharan African countries. Campylobacter jejuni was the most prevalent species. Pooled prevalence was 9.9% (CI: 8.4%-11.6%). No major variations within the different sub-regions were found. Most studies reported Campylobacter spp. as the cause of diarrhea, mainly in children. Some studies reported the bacteria as a possible etiologic agent of acute flaccid paralysis and urinary tract infection. Campylobacter spp. presented a higher pooled prevalence in HIV infected patients, although not statistically significant. High proportions of resistant strains were reported for many antibiotics, including erythromycin and tetracycline. CONCLUSION Campylobacter spp. occur in sub-Saharan Africa, although information is scarce or inexistent for many countries. Research priorities should include investigation of the understudied species; extra intestinal manifestations; the impact of HIV infection and associated risk factors. Control strategies should be reinforced to contain the spread of this pathogen and drug resistance.
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Affiliation(s)
- Delfina F. Hlashwayo
- Department of Biological Sciences, Faculty of Sciences, Eduardo Mondlane University, Maputo, Mozambique
- Faculty of Veterinary Science, Eduardo Mondlane University, Maputo, Mozambique
| | - Betuel Sigaúque
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Emília V. Noormahomed
- Department of Microbiology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
- Infectious Disease Division, Department of Medicine, University of California, San Diego, San Diego, CA, United States of America
- Mozambique Institute for Health Education and Research (MIHER), Maputo, Mozambique
| | - Sónia M. S. Afonso
- Faculty of Veterinary Science, Eduardo Mondlane University, Maputo, Mozambique
| | - Inácio M. Mandomando
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- Instituto Nacional de Saúde (INS), Ministério da Saúde, Marracuene, Mozambique
| | - Custódio G. Bila
- Faculty of Veterinary Science, Eduardo Mondlane University, Maputo, Mozambique
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First Report of aacC5-aadA7Δ4 Gene Cassette Array and Phage Tail Tape Measure Protein on Class 1 Integrons of Campylobacter Species Isolated from Animal and Human Sources in Egypt. Animals (Basel) 2020; 10:ani10112067. [PMID: 33171625 PMCID: PMC7695199 DOI: 10.3390/ani10112067] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/01/2020] [Accepted: 11/02/2020] [Indexed: 11/28/2022] Open
Abstract
Simple Summary Campylobacter species are among the major causes of bacterial foodborne infections. Here, we investigate, for the first time, class 1 integrons and associated gene cassettes among pan drug-resistant (PDR), extensively drug-resistant (XDR), and multidrug-resistant (MDR) Campylobacter species isolated from livestock animals and humans in Egypt. Our results revealed alarming PDR (2.55%) and inordinate XDR (68.94%) and MDR (28.5%) Campylobacter isolates. None of the examined isolates were pan-susceptible. The existence of a novel gene cassette array, namely aacC5-aadA7Δ4 and a putative phage tail tape measure protein on class 1 integrons of Campylobacter species is the most highlighted novelty of the current study. Evidence from this study showed the possibility of Campylobacter–bacteriophage interactions as well as treatment failure in animals and humans due to horizontal gene transfer mediated by class 1 integrons. Abstract Campylobacter species are common commensals in the gastrointestinal tract of livestock animals; thus, animal-to-human transmission occurs frequently. We investigated for the first time, class 1 integrons and associated gene cassettes among pan drug-resistant (PDR), extensively drug-resistant (XDR), and multidrug-resistant (MDR) Campylobacter species isolated from livestock animals and humans in Egypt. Campylobacter species were detected in 58.11% of the analyzed chicken samples represented as 67.53% Campylobacter jejuni(C. jejuni) and 32.47% Campylobacter coli (C. coli). C. jejuni isolates were reported in 51.42%, 74.28%, and 66.67% of examined minced meat, raw milk, and human stool samples, respectively. Variable antimicrobial resistance phenotypes; PDR (2.55%), XDR (68.94%), and MDR (28.5%) campylobacters were reported. Molecular analysis revealed that 97.36% of examined campylobacters were integrase gene-positive; all harbored the class 1 integrons, except one possessed an empty integron structure. DNA sequence analysis revealed the predominance of aadA (81.08%) and dfrA (67.56%) alleles accounting for resistance to aminoglycosides and trimethoprim, respectively. This is the first report of aacC5-aadA7Δ4 gene cassette array and a putative phage tail tape measure protein on class 1 integrons of Campylobacter isolates. Evidence from this study showed the possibility of Campylobacter–bacteriophage interactions and treatment failure in animals and humans due to horizontal gene transfer mediated by class 1 integrons.
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Multi-metal resistance and potential of Alcaligenes sp. MMA for the removal of heavy metals. SN APPLIED SCIENCES 2020. [DOI: 10.1007/s42452-020-03583-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Kingsbury JM, Soboleva TK. Evaluation of culture-based and molecular detection methods for Campylobacter in New Zealand raw cows' milk. J Appl Microbiol 2020; 130:478-492. [PMID: 32725959 DOI: 10.1111/jam.14798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 01/23/2023]
Abstract
AIMS This study evaluated the performance of a commercial molecular detection method (mericon Campylobacter triple kit real-time/quantitative (q)PCR) and a selective plating medium (R&F Campylobacter jejuni/Campylobacter coli Chromogenic Plating Medium (CCPM)) against a culture-based reference method (ISO 10272-1:2017 detection procedure B) for the detection of Campylobacter from raw milk enrichment broths. METHODS AND RESULTS New Zealand raw cows' milk and Ultra-High Temperature-processed milk samples were inoculated with 50, 125 and 500 colony forming units of C. jejuni and C. coli cocktail per analytical unit. Samples were tested for Campylobacter after 0, 24- and 48 h refrigeration. ISO 10272-1:2017 proved to be a sensitive detection method (77/80 positive samples); detection only failed for some milk samples tested 48 h postinoculation. CCPM was as effective as Cefoperazone Charcoal Deoxycholate Agar for selective plating of Campylobacter raw milk enrichments (78/80 positive samples). However, the qPCR detected Campylobacter in only 42/80 samples and qPCR reaction inhibition was observed. CONCLUSIONS The ISO 10272-1:2017 method was a more sensitive method for Campylobacter detection from raw milk than the mericon Campylobacter triple kit qPCR, and CCPM was a useful complementary medium to mCCDA where one of these media is required by the standard. SIGNIFICANCE AND IMPACT OF THE STUDY In regions where testing is required or recommended, optimized methods for Campylobacter detection from raw milk will reduce risk to the raw milk consumer. Although molecular methods are generally touted as a rapid alternative to culture, issues with inhibition due to matrix components mean that culture-based methods might provide the most sensitive option for Campylobacter detection in raw milk. Findings also emphasize the importance of minimizing the time between milk collection and testing for Campylobacter.
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Affiliation(s)
- J M Kingsbury
- Institute of Environmental Science and Research, Christchurch, New Zealand
| | - T K Soboleva
- New Zealand Food Safety, Ministry for Primary Industries, Wellington, New Zealand
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Barakat AMA, El-Razik KAA, Elfadaly HA, Rabie NS, Sadek SAS, Almuzaini AM. Prevalence, molecular detection, and virulence gene profiles of Campylobacter species in humans and foods of animal origin. Vet World 2020; 13:1430-1438. [PMID: 32848321 PMCID: PMC7429388 DOI: 10.14202/vetworld.2020.1430-1438] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 05/29/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND AIM Campylobacteriosis is one of the most well-characterized bacterial foodborne infections worldwide that arise chiefly due to the consumption of foods of animal origin such as poultry, milk, and their products. The disease is caused by numerous species within the genus Campylobacter, but Campylobacter jejuni is the most commonly isolated species from established cases of human campylobacteriosis. This study was conducted to determine the prevalence and virulence of Campylobacter isolates from human, chicken, and milk and milk products in Egypt. MATERIALS AND METHODS A total of 1299 samples (547 chicken intestine and liver, 647 milk and milk products, and 105 human stool) were collected and microbiologically investigated, confirmed by multiplex polymerase chain reaction (PCR) targeting the 23S rRNA, hipO, and glyA genes specific for Campylobacter spp., C. jejuni, and Campylobacter Coli, respectively, followed by virulence genes (Campylobacter adhesion to fibronectin F [cadF] and cdtB) detection using PCR. RESULTS About 38.09%, 37.84%, and 8.5% of human stool, chicken, and milk and milk product samples, respectively, were bacteriologically positive, with a total of 302 Campylobacter isolates. All isolates were molecularly confirmed as Campylobacter spp. (100%) where 285 isolates (94.37%) were identified as C. jejuni and 17 isolates (5.62%) as C. coli. Regarding the virulence pattern, all isolates (100%) carried cadF gene while cytolethal distending toxin B gene was definite in 284/302 isolates (94%), concisely, 282/285 (98.94%) C. jejuni isolates, and in 2/17 (11.76%) C. coli isolates. CONCLUSION The widespread presence of these highly virulent Campylobacter, especially C. jejuni, proofs the urgent need for the implementation of stringent control, public health, and food protection strategies to protect consumers from this zoonotic pathogen. The availability of information about pathogen virulence will enable enhanced local policy drafting by food safety and public health officials.
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Affiliation(s)
| | | | - Hassan A. Elfadaly
- Department of Zoonotic Diseases, National Research Centre, Dokki, Giza, Egypt
| | - Nagwa S. Rabie
- Department of Poultry Diseases, National Research Centre, Dokki, Giza, Egypt
| | - Sabry A. S. Sadek
- Department of Zoonotic Diseases, National Research Centre, Dokki, Giza, Egypt
| | - Abdulaziz M. Almuzaini
- Department of Veterinary Medicine, College of Agriculture and Veterinary Medicine, Qassim University, Buraydah, Saudi Arabia
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11
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Sodhi KK, Kumar M, Balan B, Dhaulaniya AS, Singh DK. Isolation and characterization of amoxicillin-resistant bacteria and amoxicillin-induced alteration in its protein profiling and RNA yield. Arch Microbiol 2019; 202:225-232. [PMID: 31598755 DOI: 10.1007/s00203-019-01737-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 09/06/2019] [Accepted: 09/24/2019] [Indexed: 11/26/2022]
Abstract
Amoxicillin-resistant bacteria were isolated using selective enrichment procedure. The morphological, biochemical and molecular characterization based on 16S rRNA gene sequencing and phylogenetic analysis of the bacterial strain WA5 confirmed that the strain belongs to the genus Stenotrophomonas. The bacteria were named as Stenotrophomonas sp. strain WA5 (MK110499). Substantial growth was seen in M9 minimal media supplemented with 5 mg L-1 of amoxicillin as a sole source of carbon and energy. RNA yield was also observed to be decreased in the presence of amoxicillin. Amoxicillin (5 mg L-1)-induced alteration is seen on bacterial protein profile and unique polypeptide bands were seen to be induced in the presence of amoxicillin, the bands were subjected to trypsin digestion, and LC-MS/MS analysis showed that the bands belong to the family of DNA-dependent RNA polymerase subunit β (rpoC). Plasmid DNA isolation indicated the presence of antibiotic-resistant genes being harboured by the plasmid.
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Affiliation(s)
- Kushneet Kaur Sodhi
- Soil Microbial Ecology and Environmental Toxicology Laboratory, Department of Zoology, University of Delhi, Delhi, 110007, India
| | - Mohit Kumar
- Soil Microbial Ecology and Environmental Toxicology Laboratory, Department of Zoology, University of Delhi, Delhi, 110007, India
| | - Biji Balan
- Soil Microbial Ecology and Environmental Toxicology Laboratory, Department of Zoology, University of Delhi, Delhi, 110007, India
| | - Amit Singh Dhaulaniya
- Soil Microbial Ecology and Environmental Toxicology Laboratory, Department of Zoology, University of Delhi, Delhi, 110007, India
| | - Dileep Kumar Singh
- Soil Microbial Ecology and Environmental Toxicology Laboratory, Department of Zoology, University of Delhi, Delhi, 110007, India.
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A sensitive gold-nanorods-based nanobiosensor for specific detection of Campylobacter jejuni and Campylobacter coli. J Nanobiotechnology 2019; 17:43. [PMID: 30914053 PMCID: PMC6434641 DOI: 10.1186/s12951-019-0476-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 03/13/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Campylobacteriosis is a zoonotic infectious disease that can be mostly undiagnosed or unreported due to fastidious Campylobacter species. The aim of this study was to develop a simple, sensitive, and quick assay for the detection of Campylobacter spp. and taking advantage of the great sensitivity of gold nanorods (GNRs) to trace changes in the local environment and interparticle distance. METHODS Characterized GNRs were modified by specific ssDNA probes of cadF gene. First, the biosensor was evaluated using recombinant plasmid (pTG19-T/cadF) and synthetic single-stranded 95 bp gene, followed by a collection of the extracted DNAs of the stool samples. The sensing strategy was compared by culture, PCR, and real-time PCR. RESULTS AND DISCUSSION Analysis of 283 specimens showed successful detection of Campylobacter spp. in 44 cases (16%), which was comparable to culture (7%), PCR (15%), and real-time PCR (18%). In comparison with real-time PCR, the sensitivity of the biosensor was reported 88%, while the specificity test for all assays was the same (100%). However, it was not able to detect Campylobacter in 6 positive clinical samples, as compared to real-time PCR. The limit of detection was calculated to be the same for the biosensor and real-time PCR (102 copy number/mL). CONCLUSIONS Taking high speed and simplicity of this assay into consideration, the plasmonic nanobiosensor could pave the way in designing a new generation of diagnostic kits for detection of C. jejuni and C. coli species in clinical laboratories.
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Molecular characterisation of Salmonella enterica serovar Typhimurium and Campylobacter jejuni faecal carriage by captured rangeland goats. Small Rumin Res 2018. [DOI: 10.1016/j.smallrumres.2017.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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14
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Premarathne JMKJK, Anuar AS, Thung TY, Satharasinghe DA, Jambari NN, Abdul-Mutalib NA, Huat JTY, Basri DF, Rukayadi Y, Nakaguchi Y, Nishibuchi M, Radu S. Prevalence and Antibiotic Resistance against Tetracycline in Campylobacter jejuni and C. coli in Cattle and Beef Meat from Selangor, Malaysia. Front Microbiol 2017; 8:2254. [PMID: 29255448 PMCID: PMC5722848 DOI: 10.3389/fmicb.2017.02254] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 10/31/2017] [Indexed: 01/28/2023] Open
Abstract
Campylobacter is a major foodborne pathogen frequently associated with human bacterial gastroenteritis in the world. This study was conducted to determine the prevalence and antibiotic resistance of Campylobacter spp. in the beef food system in Malaysia. A total of 340 samples consisting of cattle feces (n = 100), beef (n = 120) from wet markets and beef (n = 120) from hypermarkets were analyzed for Campylobacter spp. The overall prevalence of Campylobacter was 17.4%, consisting of 33% in cattle fecal samples, 14.2% in raw beef from wet market and 7.5% in raw beef from the hypermarket. The multiplex-polymerase chain reaction (PCR) identified 55% of the strains as C. jejuni, 26% as C. coli, and 19% as other Campylobacter spp. A high percentage of Campylobacter spp. were resistant to tetracycline (76.9%) and ampicillin (69.2%), whilst low resistance was exhibited to chloramphenicol (7.6%). The MAR Index of Campylobacter isolates from this study ranged from 0.09 to 0.73. The present study indicates the potential public health risk associated with the beef food system, hence stringent surveillance, regulatory measures, and appropriate interventions are required to minimize Campylobacter contamination and prudent antibiotic usage that can ensure consumer safety.
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Affiliation(s)
- Jayasekara M. K. J. K. Premarathne
- Faculty of Food Science and Technology, Food Safety Research Center, Universiti Putra Malaysia, Seri Kembangan, Malaysia
- Department of Livestock and Avian Science, Faculty of Livestock, Fisheries and Nutrition, Wayamba University of Sri Lanka, Kuliyapitiya, Sri Lanka
| | - Aimi S. Anuar
- Faculty of Food Science and Technology, Food Safety Research Center, Universiti Putra Malaysia, Seri Kembangan, Malaysia
| | - Tze Young Thung
- Faculty of Food Science and Technology, Food Safety Research Center, Universiti Putra Malaysia, Seri Kembangan, Malaysia
| | - Dilan A. Satharasinghe
- Institute of Bio Science, Universiti Putra Malaysia, Seri Kembangan, Malaysia
- Department of Basic Veterinary Science, Faculty of Veterinary Medicine and Animal Science, University of Peradeniya, Peradeniya, Sri Lanka
| | - Nuzul Noorahya Jambari
- Food Safety Research Center (FOSREC), Faculty of Food Science and Technology, Universiti Putra Malaysia, Seri Kembangan, Malaysia
| | - Noor-Azira Abdul-Mutalib
- Food Safety Research Center (FOSREC), Faculty of Food Science and Technology, Universiti Putra Malaysia, Seri Kembangan, Malaysia
| | - John Tang Yew Huat
- Faculty of Food Technology, Universiti Sultan Zainal Abidin, Kuala Terengganu, Malaysia
| | - Dayang F. Basri
- Faculty of Health Sciences, School of Diagnostic and Applied Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Yaya Rukayadi
- Faculty of Food Science and Technology, Food Safety Research Center, Universiti Putra Malaysia, Seri Kembangan, Malaysia
| | | | | | - Son Radu
- Faculty of Food Science and Technology, Food Safety Research Center, Universiti Putra Malaysia, Seri Kembangan, Malaysia
- Laboratory of Food Safety and Food Integrity, Institute of Tropical Agriculture and Food Security, Universiti Putra Malaysia, Seri Kembangan, Malaysia
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Ramachandran N, Ramlal S, Batra HV. Confirmed identification and toxin profiling of Campylobacter jejuni using a thermostabilized multiplex PCR formulation. APMIS 2017; 125:641-649. [PMID: 28574617 DOI: 10.1111/apm.12700] [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: 12/06/2016] [Accepted: 02/27/2017] [Indexed: 11/28/2022]
Abstract
Cytolethal distending toxin (CDT) producing Campylobacter jejuni species are one of the leading causes of human gastroenteritis worldwide. The main intent of the study was to develop a multiplex PCR assay for the confirmed identification and toxin profiling of C. jejuni. The genes targeted were rpo B as genus specific, hip O for species; cdt A, cdt B, cdt C encoding respective subunit proteins of CDT with Internal Amplification Control (IAC). To enhance its application as a pre-mixed ready-to-use format, the master mix of developed mPCR was dried by lyophilization and stability was assessed. Thermostabilized reagents showed stability of 1.5 months at room-temperature and upto six months at 4 °C without any loss of functionality. The assay was evaluated on a number of presumptive Campylobacter isolates along with biochemical tests. Results obtained indicated the accurate identification of C. jejuni by developed mPCR format in contrast to misconception associated with biochemical assays. The assay was also tested on spiked samples for its real-time utility. Altogether, the room-temperature storable and ready-to- use mPCR format developed in this study could be preferred for rapid detection and confirmed identification of toxigenic strains of C. jejuni in place of conventional biochemical assays.
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Affiliation(s)
- Nitya Ramachandran
- Microbiology Division, Defence Food Research Laboratory, Mysore, Karnataka, India
| | - Shylaja Ramlal
- Microbiology Division, Defence Food Research Laboratory, Mysore, Karnataka, India
| | - Harsh Vardhan Batra
- Microbiology Division, Defence Food Research Laboratory, Mysore, Karnataka, India
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Comparison of the Detection Limits of the Culture and PCR Methods for the Detection of Clostridium difficile, Clostridium perfringens, Campylobacter jejuni, and Yersinia enterocolitica in Human Stool. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2016. [DOI: 10.5812/pedinfect.38888] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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17
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Comparative Analysis of Cultural and PCR Based Assays for Detection of Campylobacter spp. in Human Stool Samples. ACTA ACUST UNITED AC 2015. [DOI: 10.1007/s40011-015-0565-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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18
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Modi S, Brahmbhatt MN, Chatur YA, Nayak JB. Prevalence of Campylobacter species in milk and milk products, their virulence gene profile and anti-bio gram. Vet World 2015; 8:1-8. [PMID: 27046986 PMCID: PMC4777796 DOI: 10.14202/vetworld.2015.1-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 11/22/2014] [Accepted: 11/29/2014] [Indexed: 11/16/2022] Open
Abstract
Aim: During the last decades, number of food poisoning cases due to Campylobacter occurred, immensely. After poultry, raw milk acts as a second main source of Campylobacter. Therefore, the present study was undertaken to detect the prevalence of Campylobacters in milk and milk products and to know the antibiotic sensitivity and virulence gene profile of Campylobacter spp. in Anand city, Gujarat, India. Material and Methods: A total of 240 samples (85 buffalo milk, 65 cow milk, 30 cheese, 30 ice-cream and 30 paneer) were collected from the different collection points in Anand city. The samples were processed by microbiological culture method, and presumptive isolates were further confirmed by genus and species-specific polymerase chain reaction using previously reported primer. The isolates were further subjected to antibiotic susceptibility assay and virulence gene detection. Result: Campylobacter species were detected in 7 (2.91%) raw milk samples whereas none of the milk product was positive. All the isolate identified were Campylobacter jejuni. Most of the isolates showed resistance against nalidixic acid, ciprofloxacin, and tetracyclin. All the isolates have three virulence genes cadF, cdtB and flgR whereas only one isolate was positive for iamA gene and 6 isolates were positive for fla gene. Conclusion: The presence of Campylobacter in raw milk indicates that raw milk consumption is hazardous for human being and proper pasteurization of milk and adaptation of hygienic condition will be necessary to protect the consumer from this zoonotic pathogen.
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Affiliation(s)
- Shivani Modi
- Department of Veterinary Public Health and Epidemiology, College of Veterinary Science & Animal Husbandry, Anand Agricultural University, Anand, Gujarat, India
| | - M N Brahmbhatt
- Department of Veterinary Public Health and Epidemiology, College of Veterinary Science & Animal Husbandry, Anand Agricultural University, Anand, Gujarat, India
| | - Y A Chatur
- Department of Veterinary Public Health and Epidemiology, College of Veterinary Science & Animal Husbandry, Anand Agricultural University, Anand, Gujarat, India
| | - J B Nayak
- Department of Veterinary Public Health and Epidemiology, College of Veterinary Science & Animal Husbandry, Anand Agricultural University, Anand, Gujarat, India
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Pallavi, Kumar A. Prevalence and antibiotic resistance pattern of Campylobacter species in foods of animal origin. Vet World 2014. [DOI: 10.14202/vetworld.2014.681-684] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Fontanot M, Iacumin L, Cecchini F, Comi G, Manzano M. Rapid detection and differentiation of important Campylobacter spp. in poultry samples by dot blot and PCR. Food Microbiol 2014; 43:28-34. [PMID: 24929879 DOI: 10.1016/j.fm.2014.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 04/29/2014] [Accepted: 05/01/2014] [Indexed: 10/25/2022]
Abstract
The detection of Campylobacter, the most commonly reported cause of foodborne gastroenteritis in the European Union, is very important for human health. The most commonly recognised risk factor for infection is the handling and/or consumption of undercooked poultry meat. The methods typically applied to evaluate the presence/absence of Campylobacter in food samples are direct plating and/or enrichment culture based on the Horizontal Method for Detection and Enumeration of Campylobacter spp. (ISO 10272-1B: 2006) and PCR. Molecular methods also allow for the detection of cells that are viable but cannot be cultivated on agar media and that decrease the time required for species identification. The current study proposes the use of two molecular methods for species identification: dot blot and PCR. The dot blot method had a sensitivity of 25 ng for detection of DNA extracted from a pure culture using a digoxigenin-labelled probe for hybridisation; the target DNA was extracted from the enrichment broth at 24 h. PCR was performed using a pair of sensitive and specific primers for the detection of Campylobacter jejuni and Campylobacter coli after 24 h of enrichment in Preston broth. The initial samples were contaminated by 5 × 10 C. jejuni cells/g and 1.5 × 10(2)C. coli cells/g, thus the number of cells present in the enrichment broth at 0 h was 1 or 3 cell/g, respectively.
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Affiliation(s)
- Marco Fontanot
- Department of Food Science, University of Udine, Via Sondrio 2/A, 33100 Udine, Italy
| | - Lucilla Iacumin
- Department of Food Science, University of Udine, Via Sondrio 2/A, 33100 Udine, Italy
| | - Francesca Cecchini
- Department of Food Science, University of Udine, Via Sondrio 2/A, 33100 Udine, Italy
| | - Giuseppe Comi
- Department of Food Science, University of Udine, Via Sondrio 2/A, 33100 Udine, Italy
| | - Marisa Manzano
- Department of Food Science, University of Udine, Via Sondrio 2/A, 33100 Udine, Italy.
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Quetz JDS, Lima IFN, Havt A, Prata MMG, Cavalcante PA, Medeiros PHQS, Cid DAC, Moraes ML, Rey LC, Soares AM, Mota RMS, Weigl BH, Guerrant RL, Lima AAM. Campylobacter jejuni infection and virulence-associated genes in children with moderate to severe diarrhoea admitted to emergency rooms in northeastern Brazil. J Med Microbiol 2011; 61:507-513. [PMID: 22174372 DOI: 10.1099/jmm.0.040600-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Campylobacter is an important cause of foodborne gastroenteritis. We determined the occurrence of Campylobacter jejuni and Campylobacter coli, using culture-based methods and PCRs targeting virulence-associated genes (VAGs) among children aged ≤14 years who were treated for diarrhoea at emergency rooms in northeastern Brazil. Genomic DNA was extracted directly from stool samples collected from 366 children. A questionnaire was also applied to qualify the clinical conditions presented by each child at the time of admission. C. jejuni and C. coli were detected in 16.4 % (60/366) and 1.4 % (5/366) of the diarrhoeal samples, respectively, by PCR, a much higher proportion than that detected by conventional methods. C. jejuni VAGs were detected in the following proportions of hipO-positive samples: ciaB, 95 % (57/60); dnaJ, 86.7 % (52/60); racR, 98.3 % (59/60); flaA, 80 % (48/60); pldA, 45 % (27/60); cdtABC, 95 % (57/60); and pVir 0 % (0/60). Particular symptoms, such as blood in faeces, vomiting, fever, and/or abdominal pain, were not associated with detection of C. jejuni nor were they associated with any particular VAG or combination of VAGs (P>0.05). C. jejuni and its VAGs were detected in a substantial proportion of the children admitted. Further efforts shall be directed towards elucidating whether these genetic factors or their expressed proteins play a role in Campylobacter pathogenesis.
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Affiliation(s)
- Josiane da S Quetz
- Institute of Biomedicine for Brazilian Semi-Arid/Clinical Research Unit, Federal University of Ceara, Fortaleza, CE 60430-270, Brazil
| | - Ila F N Lima
- Institute of Biomedicine for Brazilian Semi-Arid/Clinical Research Unit, Federal University of Ceara, Fortaleza, CE 60430-270, Brazil
| | - Alexandre Havt
- Institute of Biomedicine for Brazilian Semi-Arid/Clinical Research Unit, Federal University of Ceara, Fortaleza, CE 60430-270, Brazil
| | - Mara M G Prata
- Institute of Biomedicine for Brazilian Semi-Arid/Clinical Research Unit, Federal University of Ceara, Fortaleza, CE 60430-270, Brazil
| | - Paloma A Cavalcante
- Institute of Biomedicine for Brazilian Semi-Arid/Clinical Research Unit, Federal University of Ceara, Fortaleza, CE 60430-270, Brazil
| | - Pedro H Q S Medeiros
- Institute of Biomedicine for Brazilian Semi-Arid/Clinical Research Unit, Federal University of Ceara, Fortaleza, CE 60430-270, Brazil
| | - David A C Cid
- Institute of Biomedicine for Brazilian Semi-Arid/Clinical Research Unit, Federal University of Ceara, Fortaleza, CE 60430-270, Brazil
| | - Milena L Moraes
- Institute of Biomedicine for Brazilian Semi-Arid/Clinical Research Unit, Federal University of Ceara, Fortaleza, CE 60430-270, Brazil
| | - Luís Carlos Rey
- Institute of Biomedicine for Brazilian Semi-Arid/Clinical Research Unit, Federal University of Ceara, Fortaleza, CE 60430-270, Brazil
| | - Alberto M Soares
- Institute of Biomedicine for Brazilian Semi-Arid/Clinical Research Unit, Federal University of Ceara, Fortaleza, CE 60430-270, Brazil
| | - Rosa M S Mota
- Science Center/Unit of Statistics, Federal University of Ceara, Fortaleza, CE 60455-760, Brazil
| | - Bernhard H Weigl
- Program for Appropriate Technology in Health (PATH), Seattle, Washington, WA 98107, USA
| | - Richard L Guerrant
- Center for Global Health, University of Virginia, Charlottesville, VA 22908, USA
| | - Aldo A M Lima
- Institute of Biomedicine for Brazilian Semi-Arid/Clinical Research Unit, Federal University of Ceara, Fortaleza, CE 60430-270, Brazil
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