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Rayamajhee B, Williams NLR, Siboni N, Rodgers K, Willcox M, Henriquez FL, Seymour JR, Potts J, Johnson C, Scanes P, Carnt N. Identification and quantification of Acanthamoeba spp. within seawater at four coastal lagoons on the east coast of Australia. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 901:165862. [PMID: 37541500 DOI: 10.1016/j.scitotenv.2023.165862] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 07/08/2023] [Accepted: 07/26/2023] [Indexed: 08/06/2023]
Abstract
Acanthamoeba is an opportunistic free-living heterotrophic protist that is the most predominant amoeba in diverse ecological habitats. Acanthamoeba causes amoebic keratitis (AK), a painful and potentially blinding corneal infection. Major risk factors for AK have been linked to non-optimal contact lens hygiene practices and Acanthamoeba contamination of domestic and recreational water. This study investigated the incidence and seasonal variation of Acanthamoeba spp. within coastal lagoons located on the eastern coast of Australia and then examined the association between Acanthamoeba and water abiotic factors and bacterial species within the water. Water samples were collected from four intermittently closed and open lagoons (ICOLLs) (Wamberal, Terrigal, Avoca and Cockrone) every month between August 2019 to July 2020 except March and April. qPCR was used to target the Acanthamoeba 18S rRNA gene, validated by Sanger sequencing. Water abiotic factors were measured in situ using a multiprobe metre and 16S rRNA sequencing (V3-V4) was performed to characterise bacterial community composition. Network analysis was used to gauge putative associations between Acanthamoeba incidence and bacterial amplicon sequence variants (ASVs). Among 206 water samples analysed, 79 (38.3%) were Acanthamoeba positive and Acanthamoeba level was significantly higher in summer compared with winter, spring, or autumn (p = 0.008). More than 50% (23/45) water samples of Terrigal were positive for Acanthamoeba which is a highly urbanised area with extensive recreational activities while about 32% (16/49) samples were positive from Cockrone that is the least impacted lagoon by urban development. All sequenced strains belonged to the pathogenic genotype T4 clade except two which were of genotype clades T2 and T5. Water turbidity, temperature, intl1 gene concentration, and dissolved O2 were significantly associated with Acanthamoeba incidence (p < 0.05). The ASVs level of cyanobacteria, Pseudomonas spp., Candidatus spp., and marine bacteria of the Actinobacteria phylum and Acanthamoeba 18S rRNA genes were positively correlated (Pearson's r ≥ 0.14). The presence of Acanthamoeba spp. in all lagoons, except Wamberal, was associated with significant differences in the composition of bacterial communities (beta diversity). The results of this study suggest that coastal lagoons, particularly those in urbanised regions with extensive water recreational activities, may pose an elevated risk to human health due to the relatively high incidence of pathogenic Acanthamoeba in the summer. These findings underscore the importance of educating the public about the rare yet devastating impact of AK on vision and quality of life, highlighting the need for collaborative efforts between public health officials and educators to promote awareness and preventive measures, especially focusing lagoons residents and travellers.
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Affiliation(s)
- Binod Rayamajhee
- School of Optometry and Vision Science, Faculty of Medicine and Health, UNSW, Sydney, Australia.
| | - Nathan L R Williams
- Climate Change Cluster, Faculty of Science, University of Technology Sydney, Sydney, Australia
| | - Nachshon Siboni
- Climate Change Cluster, Faculty of Science, University of Technology Sydney, Sydney, Australia
| | - Kiri Rodgers
- Institute of Biomedical and Environmental Health Research, School of Health and Life Sciences, University of the West of Scotland, Blantyre, South Lanarkshire, G72 0LH, Scotland, UK
| | - Mark Willcox
- School of Optometry and Vision Science, Faculty of Medicine and Health, UNSW, Sydney, Australia
| | - Fiona L Henriquez
- Institute of Biomedical and Environmental Health Research, School of Health and Life Sciences, University of the West of Scotland, Blantyre, South Lanarkshire, G72 0LH, Scotland, UK
| | - Justin R Seymour
- Climate Change Cluster, Faculty of Science, University of Technology Sydney, Sydney, Australia
| | - Jaimie Potts
- Estuaries and Catchments Team, Waters Wetland Coastal Science Branch, NSW Department of Planning, Industry and Environment, Lidcombe, NSW 2141, Australia
| | - Colin Johnson
- Estuaries and Catchments Team, Waters Wetland Coastal Science Branch, NSW Department of Planning, Industry and Environment, Lidcombe, NSW 2141, Australia
| | - Peter Scanes
- Estuaries and Catchments Team, Waters Wetland Coastal Science Branch, NSW Department of Planning, Industry and Environment, Lidcombe, NSW 2141, Australia
| | - Nicole Carnt
- School of Optometry and Vision Science, Faculty of Medicine and Health, UNSW, Sydney, Australia
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Fatemi M, Niyyati M, Rouhani S, Karamati SA, Mirjalali H, Karanis P. Contamination of fresh vegetables in municipal stores with pathogenic Acanthamoeba genotypes; a public health concern. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2023; 33:1010-1021. [PMID: 35443833 DOI: 10.1080/09603123.2022.2067328] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 04/12/2022] [Indexed: 05/23/2023]
Abstract
Acanthamoeba spp. cause keratitis and encephalitis, and are a proper carrier of foodborne pathogens. A total of 70 samples including garden cress, chives, mint, parsley, and basil were collected. Samples were cultured onto a 2% non-nutrient agar medium. The cultures were analyzed using morphological and molecular techniques. In total, 18 (25.7%) out of 70 samples were positive including garden cress 10/22 (45.45%), chives 3/12 (25%), mint 2/13 (15.38%), basil 2/13 (15.38%), and parsley 1/10 (10%). The diagnostic fragment 3 was successfully sequenced in 15 samples and represented 11 (73.3%) T4, three (20%) T5, and one T9 genotypes. In addition, three, two, and one strains, belonging to the genotypes T4, T5, and T9 were ranked highly pathogenic. This is the first study reporting contamination of the most commonly consumed fresh vegetables with pathogenic Acanthamoeba genotypes. Our findings signify the public health concerns due the contamination of vegetables in municipal public markets.
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Affiliation(s)
- Marziye Fatemi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Medical Parasitology and Mycology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Niyyati
- Department of Medical Parasitology and Mycology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soheila Rouhani
- Department of Medical Parasitology and Mycology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Ahmad Karamati
- Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamed Mirjalali
- Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Panagiotis Karanis
- University of Cologne, Medical Faculty and University Hospital, Cologne 50931, Germany
- Department of Basic and Clinical Sciences, Nicosia University Medical School, Nicosia, Cyprus
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Salazar-Ardiles C, Asserella-Rebollo L, Andrade DC. Free-Living Amoebas in Extreme Environments: The True Survival in our Planet. BIOMED RESEARCH INTERNATIONAL 2022; 2022:2359883. [PMID: 36303587 PMCID: PMC9596261 DOI: 10.1155/2022/2359883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/08/2022] [Indexed: 12/03/2022]
Abstract
Free-living amoebas (FLAs) are microorganisms, unicellular protozoa widely distributed in nature and present in different environments, such as water or soil; they are maintained in ecosystems and play a fundamental role in the biological control of bacteria, other protozoa, and mushrooms. In particular circumstances, some can reach humans or animals, promoting several health complications. Notably, FLAs are characterized by a robust capacity to survive in extreme environments. However, currently, there is no updated information on the existence and distribution of this protozoan in inhospitable places. Undoubtedly, the cellular physiology of these protozoan microorganisms is very particular. They can resist and live in extreme environments due to their encysting capacity and tolerance to different osmolarities, temperatures, and other environmental factors, which give them excellent adaptative resistance. In this review, we summarized the most relevant evidence related to FLAs and the possible mechanism, which could explain their adaptative capacity to several extreme environments.
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Affiliation(s)
- Camila Salazar-Ardiles
- Research Center in High Altitude Medicine and Physiology, Biomedical Department, Faculty of Health Science, University of Antofagasta, Antofagasta, Chile
| | | | - David C. Andrade
- Research Center in High Altitude Medicine and Physiology, Biomedical Department, Faculty of Health Science, University of Antofagasta, Antofagasta, Chile
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Elseadawy R, Abbas I, Al-Araby M, Abu-Elwafa S. Occurrence and molecular characterization of Acanthamoeba, Naegleria fowleri and Blastocystis in water samples from various sources in Egypt. Acta Trop 2022; 237:106733. [DOI: 10.1016/j.actatropica.2022.106733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 10/25/2022] [Accepted: 10/25/2022] [Indexed: 11/26/2022]
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Dirim Erdogan D, Aykur M, Selvi Gunel N, Palamar M, Barut Selver O, Ozel B, Yagci A, Gunduz C, Dagci H. The Risk Factors and Clinical Features of Acanthamoeba Keratitis: First Time Detection of Acanthamoeba T5 Genotype from Keratitis Patients in Turkey. Acta Parasitol 2022; 67:1384-1392. [PMID: 35864410 DOI: 10.1007/s11686-022-00596-4] [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: 03/16/2022] [Accepted: 07/07/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE The primary aim of this study is to investigate Acanthamoeba in clinical samples of keratitis cases (n = 60), in contact lens (CL) and lens care solutions of asymptomatic CL users (n = 41), and to identify the genotypes in positive samples. The secondary aim is to assess the risk factors and clinical features of Acanthamoeba keratitis (AK) patients. METHODS All samples from patients and asymptomatic CL users were examined by microscopy and inoculated in non-nutrient agar plates. PCR was performed using the DNA isolated from corneal scrapings, CL and lens care solution samples. Positive DNA samples were sequenced to determine the genotype of Acanthamoeba. RESULTS In none of the samples, Acanthamoeba was identified by microscopy, while Acanthamoeba was detected in a patient with keratitis by culture method. However, Acanthamoeba was detected in 11.66% (7/60) of the keratitis patients by PCR. The genotypes of these isolates detected by sequencing were T4 (4), and T5 (3). Acanthamoeba was detected in none of the samples of asymptomatic CL users by any of the three methods. CONCLUSION To best of our knowledge, this is the first study to detect T5 genotype in AK patients from Turkey. In addition, the CL use was found to be an important risk factor for AK.
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Affiliation(s)
- Derya Dirim Erdogan
- Department of Parasitology, Faculty of Medicine, Ege University, Bornova, 35100, Izmir, Turkey.
| | - Mehmet Aykur
- Department of Parasitology, Faculty of Medicine, Ege University, Bornova, 35100, Izmir, Turkey.,Department of Parasitology, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey
| | - Nur Selvi Gunel
- Department of Medical Biology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Melis Palamar
- Department of Ophthalmology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Ozlem Barut Selver
- Department of Ophthalmology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Buket Ozel
- Department of Medical Biology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Ayse Yagci
- Department of Ophthalmology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Cumhur Gunduz
- Department of Medical Biology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Hande Dagci
- Department of Parasitology, Faculty of Medicine, Ege University, Bornova, 35100, Izmir, Turkey
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Karaman U, Koloren Z, Karanis P. Survey and first report of Acanthamoeba T4 genotype in natural spring water resources in the Black Sea, Turkey. JOURNAL OF WATER AND HEALTH 2022; 20:193-204. [PMID: 35100167 DOI: 10.2166/wh.2021.250] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Infection with Acanthamoeba spp. may result in granulomatous amoebic encephalitis and Acanthamoeba keratitis. Water is an important habitat where Acanthamoeba species thrive. Therefore, studying the occurrence of this free-living amoeba in water sources will help understand the infection dynamics. The aim of the study was to survey and report on the presence of Acanthamoeba spp. in water resources from the Ordu and Giresun provinces in Black Sea. Acanthamoeba spp. was found in 1/17 natural spring water samples from Ordu and in 2/18 from Giresun. Acanthamoeba species were not detected in any of the investigated tap water samples. Sequencing of the (SSU) rDNA gene resulted in the identification of haplotype I (Acanthamoeba genotype: KJ094684). T4 (8.6%) was the only isolated genotype in both Ordu and Giresun provinces. This is the first report of Acanthamoeba T4 genotype in natural spring water resources in the Black Sea. The occurrence of Acanthamoeba species in natural spring water sources should be considered as a potential risk for human infection, especially to high-risk populations.
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Affiliation(s)
- Ulku Karaman
- Faculty of Medicine, Department of Parasitology, University of Ordu, Ordu, Turkey
| | - Zeynep Koloren
- Department of Molecular Biology and Genetics, Faculty of Arts and Sciences, University of Ordu, Ordu, Turkey E-mail:
| | - Panagiotis Karanis
- Medical Faculty and University Hospital, University of Cologne, 50937 Cologne, Cologne, Germany; Department of Basic and Clinical Sciences, University of Nicosia Medical School, Institute of Anatomy, Nicosia, Cyprus
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Molecular identification and phylogenetic analysis of free-living amoeba (Naegleria and Acanthamoeba) from treated and untreated drinking water. GENE REPORTS 2021. [DOI: 10.1016/j.genrep.2021.101328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Eftekhari-Kenzerki R, Solhjoo K, Babaei Z, Rezanezhad H, Abolghazi A, Taghipour A. High occurrence of Acanthamoeba spp. in the water samples of public swimming pools from Kerman Province, Iran. JOURNAL OF WATER AND HEALTH 2021; 19:864-871. [PMID: 34665778 DOI: 10.2166/wh.2021.162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Acanthamoeba spp. is a free-living amoeba that can cause major infections in humans, including keratitis and granulomatous encephalitis. Thus, water resources play an important role in transmitting Acanthamoeba spp. infection to humans. The purpose of this study was to investigate the presence of Acanthamoeba spp. in public swimming pools from three cities of Kerman Province, southeastern Iran. Eighty water samples of 20 public indoor swimming pools were taken from Kerman, Jiroft, and Kahnauj cities. Water temperature (°C), pH, and free chlorine concentration (ppm) were measured. Filtration and cultivation were applied on non-nutrient agar medium. The polymerase chain reaction was applied by using the genus-specific primers (JDP1 and JDP2) on positive samples; these primers can amplify the 423-551 bp fragment. Eighteen of the 20 swimming pools (including 32/80; 40% samples) were contaminated with Acanthamoeba spp. All swimming pools of Jiroft and Kahnauj and 88.2% of swimming pools in Kerman were contaminated. As such, all 32 Acanthamoeba isolates were amplified using the JDP primer pairs. Two genotypes, T3 and T4, were also identified. The present research is the first to report Acanthamoeba spp. in public swimming pools from Kerman Province. Due to high occurrence of this protozoan, it is recommended to use warning signs around swimming pools to create awareness of this infection.
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Affiliation(s)
- Raheleh Eftekhari-Kenzerki
- Department of Medical Parasitology and Mycology, School of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran E-mail:
| | - Kavous Solhjoo
- Department of Medical Parasitology and Mycology, School of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran E-mail: ; Zoonoses Research Center, School of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Zahra Babaei
- Leishmaniasis Research Center, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Hassan Rezanezhad
- Department of Medical Parasitology and Mycology, School of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran E-mail: ; Zoonoses Research Center, School of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Ahmad Abolghazi
- Department of Medical Parasitology and Mycology, School of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran E-mail:
| | - Ali Taghipour
- Zoonoses Research Center, School of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran
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Aykur M, Dagci H. Evaluation of molecular characterization and phylogeny for quantification of Acanthamoeba and Naegleria fowleri in various water sources, Turkey. PLoS One 2021; 16:e0256659. [PMID: 34437614 PMCID: PMC8389491 DOI: 10.1371/journal.pone.0256659] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/11/2021] [Indexed: 01/02/2023] Open
Abstract
Free-living amoeba (FLA) is widely distributed in the natural environment. Since these amoebae are widely found in various waters, they pose an important public health problem. The aim of this study was to detect the presence of Acanthamoeba, B. mandrillaris, and N. fowleri in various water resources by qPCR in Izmir, Turkey. A total of (n = 27) 18.24% Acanthamoeba and (n = 4) 2.7% N. fowleri positives were detected in six different water sources using qPCR with ITS regions (ITS1) specific primers. The resulting concentrations varied in various water samples for Acanthamoeba in the range of 3.2x105-1.4x102 plasmid copies/l and for N. fowleri in the range of 8x103-11x102 plasmid copies/l. The highest concentration of Acanthamoeba and N. fowleri was found in seawater and damp samples respectively. All 27 Acanthamoeba isolates were identified in genotype level based on the 18S rRNA gene as T4 (51.85%), T5 (22.22%), T2 (14.81%) and T15 (11.11%). The four positive N. fowleri isolate was confirmed by sequencing the ITS1, ITS2 and 5.8S rRNA regions using specific primers. Four N. fowleri isolates were genotyped (three isolate as type 2 and one isolate as type 5) and detected for the first time from water sources in Turkey. Acanthamoeba and N. fowleri genotypes found in many natural environments are straightly related to human populations to have pathogenic potentials that may pose a risk to human health. Public health professionals should raise awareness on this issue, and public awareness education should be provided by the assistance of civil authorities. To the best of our knowledge, this is the first study on the quantitative detection and distribution of Acanthamoeba and N. fowleri genotypes in various water sources in Turkey.
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Affiliation(s)
- Mehmet Aykur
- Department of Parasitology, Faculty of Medicine, Tokat Gaziosmanpasa University Tokat, Tokat, Turkey
- Department of Parasitology, Faculty of Medicine, Ege University, Bornova, İzmir, Turkey
- * E-mail:
| | - Hande Dagci
- Department of Parasitology, Faculty of Medicine, Ege University, Bornova, İzmir, Turkey
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Reyes-Batlle M, Díaz FJ, Sifaoui I, Rodríguez-Expósito R, Rizo-Liendo A, Piñero JE, Lorenzo-Morales J. Free living amoebae isolation in irrigation waters and soils of an insular arid agroecosystem. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 753:141833. [PMID: 33207478 DOI: 10.1016/j.scitotenv.2020.141833] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/18/2020] [Accepted: 08/18/2020] [Indexed: 06/11/2023]
Abstract
The use of freshwater in agricultural systems represents a high percentage of total water consumption worldwide. Therefore, alternative sources of water for irrigation will need to be developed, particularly in arid and semi-arid areas, in order to meet the growing demand for food in the future. The use of recycled wastewater (RWW), brackish water (BW) or desalinated brackish water (DBW) are among the different non-conventional water resources proposed. However, it is necessary to evaluate the health risks for humans and animals associated with the microbiological load of these waters. Protozoa such as free-living amoebae (FLA) are considered an emerging group of opportunistic pathogens capable to cause several diseases in humans (e.g. cutaneous and ocular infections, lung, bone or adrenal gland conditions or fatal encephalitis). In the present study we evaluate FLA presence in three different irrigation water qualities (RWW, BW and DBW) and its survival in irrigated agricultural soils of an extremely arid insular ecosystem (Fuerteventura, Canary Islands, Spain). Samples were cultured on 2% Non-Nutrient Agar (NNA) plates covered with a thin layer of heat killed E. coli and checked daily for the presence of FLA. According to the prevalence of FLA, Vermamoeba vermiformis (53,8%), Acanthamoeba spp. (30,8%), Vahlkampfia avara (7,7%) and Naegleria australiensis (7,7%) were detected in the analysed water samples, while Acanthamoeba (83,3%), Cercozoa spp. (8,3%) and Vahlkampfia orchilla (8,3%) were isolated in irrigated soils. Only Acanthamoeba strains were isolated in no irrigated soils used as control, evidencing the capability of these protozoa to resist environmental harsh conditions. Additionally, all analysed water sources and the irrigated soils presented growth of several pathogenic bacteria. Therefore, the coexistence in water and soils of pathogenic bacteria and FLA, can mean an increased risk of infection in agroecosystems.
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Affiliation(s)
- María Reyes-Batlle
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna, Spain / Departamento de Obstetricia y Ginecología, Pediatría, Medicina Preventiva y Salud Pública, Toxicología, Medicina Legal y Forense y Parasitología. Universidad De La Laguna, La Laguna, Tenerife, 38203 Islas Canarias, Spain; Red de Investigación Colaborativa en Enfermedades Tropicales (RICET), Spain.
| | - Francisco J Díaz
- Department of Animal Biology, Soil Science and Geology, University of La Laguna, Spain
| | - Ines Sifaoui
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna, Spain / Departamento de Obstetricia y Ginecología, Pediatría, Medicina Preventiva y Salud Pública, Toxicología, Medicina Legal y Forense y Parasitología. Universidad De La Laguna, La Laguna, Tenerife, 38203 Islas Canarias, Spain; Red de Investigación Colaborativa en Enfermedades Tropicales (RICET), Spain
| | - Rubén Rodríguez-Expósito
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna, Spain / Departamento de Obstetricia y Ginecología, Pediatría, Medicina Preventiva y Salud Pública, Toxicología, Medicina Legal y Forense y Parasitología. Universidad De La Laguna, La Laguna, Tenerife, 38203 Islas Canarias, Spain; Red de Investigación Colaborativa en Enfermedades Tropicales (RICET), Spain
| | - Aitor Rizo-Liendo
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna, Spain / Departamento de Obstetricia y Ginecología, Pediatría, Medicina Preventiva y Salud Pública, Toxicología, Medicina Legal y Forense y Parasitología. Universidad De La Laguna, La Laguna, Tenerife, 38203 Islas Canarias, Spain; Red de Investigación Colaborativa en Enfermedades Tropicales (RICET), Spain
| | - José E Piñero
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna, Spain / Departamento de Obstetricia y Ginecología, Pediatría, Medicina Preventiva y Salud Pública, Toxicología, Medicina Legal y Forense y Parasitología. Universidad De La Laguna, La Laguna, Tenerife, 38203 Islas Canarias, Spain; Red de Investigación Colaborativa en Enfermedades Tropicales (RICET), Spain
| | - Jacob Lorenzo-Morales
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna, Spain / Departamento de Obstetricia y Ginecología, Pediatría, Medicina Preventiva y Salud Pública, Toxicología, Medicina Legal y Forense y Parasitología. Universidad De La Laguna, La Laguna, Tenerife, 38203 Islas Canarias, Spain; Red de Investigación Colaborativa en Enfermedades Tropicales (RICET), Spain
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