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Mansour R, El-Dakdouki MH, Mina S. Phylogenetic group distribution and antibiotic resistance of Escherichia coli isolates in aquatic environments of a highly populated area. AIMS Microbiol 2024; 10:340-362. [PMID: 38919712 PMCID: PMC11194619 DOI: 10.3934/microbiol.2024018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 04/21/2024] [Accepted: 04/28/2024] [Indexed: 06/27/2024] Open
Abstract
Background Extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae including Escherichia coli (E. coli), are recognized as a global public health threat due to their multidrug-resistant (MDR) phenotypes and their rapid dissemination in aquatic environments. Nevertheless, studies investigating the prevalence and antimicrobial resistance (AMR) profile of ESBL-producing E. coli in Lebanese surface water are limited. Objective This study aimed to assess the physicochemical properties and microbial contamination load and to determine the distribution of AMR patterns of ESBL-producing E. coli in surface water samples from different sites in the North Governorate of Lebanon. Methods Water samples were collected from 25 major sites in North Lebanon. These samples were analyzed for the presence of total coliforms, E. coli, and fecal enterococci. Phenotypic and genetic characterizations were then performed for E. coli isolates to determine their resistance patterns and phylogenetic groups. Results Fifty-six samples out of 100 samples were positive for ESBL-producing E. coli, mostly harboring blaCTX-M (40/56, 71%) including blaCTX-M-15 (33/40, 82%), blaTEM gene (36/56, 64%), blaSHV (20/56, 36%), and blaOXA (16/56, 29%) including blaOXA-48 gene (11/16, 69%). Most ESBL-producing E. coli isolates belonged to the extra-intestinal pathogenic phylogroup B2 (40/56, 71.4%) while 10/56 (17.9%) belonged to the commensal phylogroup A. Conclusion Our results highlight the need to implement effective water monitoring strategies to control transmission of ESBL-producing E. coli in surface water and thus reduce the burden on human and animal health.
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Affiliation(s)
- Rosette Mansour
- Department of Biological Sciences, Faculty of Sciences, Beirut Arab University, P.O. Box 11-5020, Riad El Solh 11072809, Beirut, Lebanon
| | - Mohammad H. El-Dakdouki
- Department of Chemistry, Faculty of Sciences, Beirut Arab University, P.O. Box 11-5020, Riad El Solh 11072809, Beirut, Lebanon
| | - Sara Mina
- Department of Medical Laboratory Sciences, Faculty of Health Sciences, Beirut Arab University, P.O. Box 11-5020, Riad El Solh 11072809, Beirut, Lebanon
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2
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Gargano V, Gambino D, Oddo AM, Pizzo M, Sucato A, Cammilleri G, La Russa F, Di Pasquale ML, Parisi MG, Cassata G, Giangrosso G. Scolopax rusticola Carrying Enterobacterales Harboring Antibiotic Resistance Genes. Antibiotics (Basel) 2024; 13:234. [PMID: 38534669 DOI: 10.3390/antibiotics13030234] [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: 01/30/2024] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 03/28/2024] Open
Abstract
The Eurasian woodcock (Scolopax rusticola) belongs to those bird species that make systematic migratory flights in spring and autumn in search of favorable breeding and wintering areas. These specimens arrive in the Mediterranean Area from northeastern European countries during the autumn season. The purpose of this study was to assess whether woodcocks can carry antibiotic resistance genes (ARGs) along their migratory routes. Although the role of migratory birds in the spread of some zoonotic diseases (of viral and bacterial etiology) has been elucidated, the role of these animals in the spread of antibiotic resistance has not yet been clarified. In this study, we analyzed the presence of beta-lactam antibiotic resistance genes. The study was conducted on 69 strains from 60 cloacal swabs belonging to an equal number of animals shot during the 2022-2023 hunting season in Sicily, Italy. An antibiogram was performed on all strains using the microdilution method (MIC) and beta-lactam resistance genes were investigated. The strains tested showed no phenotypic resistance to any of the 13 antibiotics tested; however, four isolates of Enterobacter cloacae and three of Klebsiella oxytoca were found to carry the blaIMP-70, blaVIM-35, blaNDM-5 and blaOXA-1 genes. Our results confirm the importance of monitoring antimicrobial resistance among migratory animals capable of long-distance bacteria spread.
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Affiliation(s)
- Valeria Gargano
- Istituto Zooprofilattico Sperimentale della Sicilia, 90129 Palermo, Italy
| | - Delia Gambino
- Istituto Zooprofilattico Sperimentale della Sicilia, 90129 Palermo, Italy
| | | | | | | | - Gaetano Cammilleri
- Istituto Zooprofilattico Sperimentale della Sicilia, 90129 Palermo, Italy
| | - Francesco La Russa
- Istituto Zooprofilattico Sperimentale della Sicilia, 90129 Palermo, Italy
| | | | - Maria Giovanna Parisi
- Marine Immunobiology Laboratory, Dipartimento di Scienze della Terra e del Mare, University of Palermo, 90100 Palermo, Italy
| | - Giovanni Cassata
- Istituto Zooprofilattico Sperimentale della Sicilia, 90129 Palermo, Italy
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3
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Klementova S, Poncarova M. Selected widely prescribed pharmaceuticals: toxicity of the drugs and the products of their photochemical degradation to aquatic organisms. J Appl Biomed 2024; 22:1-11. [PMID: 38505965 DOI: 10.32725/jab.2024.007] [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: 07/19/2023] [Accepted: 03/01/2024] [Indexed: 03/21/2024] Open
Abstract
Cholesterol-lowering drugs, antidiabetics, antiarrhythmics, antidepressants, and antibiotics belong to the most prescribed drugs worldwide. Because of the manufacture, excretion, and improper disposal of leftover drugs, the drugs enter waste waters and, subsequently, surface waters. They have been detected in surface waters all over the world, from concentrations of ng/l to concentrations several orders of magnitude higher. Since pharmaceuticals are designed to be both biologically and chemically stable, photochemical degradation by sun radiation represents a way of transformation in the natural environment. This review provides a survey of how selected drugs of the above-mentioned classes affect aquatic organisms of different trophic level. The emphasis is on the harmful effects of phototransformation products, an area of scientific investigation that has only attracted attention in the past few years, revealing the surprising fact that products of photochemical degradation might be even more toxic to aquatic organisms than the parent drugs.
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Affiliation(s)
- Sarka Klementova
- University of South Bohemia, Faculty of Science, Department of Chemistry, Ceske Budejovice, Czech Republic
| | - Martina Poncarova
- University of South Bohemia, Faculty of Science, Department of Chemistry, Ceske Budejovice, Czech Republic
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4
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Cho S, Hiott LM, Read QD, Damashek J, Westrich J, Edwards M, Seim RF, Glinski DA, Bateman McDonald JM, Ottesen EA, Lipp EK, Henderson WM, Jackson CR, Frye JG. Distribution of Antibiotic Resistance in a Mixed-Use Watershed and the Impact of Wastewater Treatment Plants on Antibiotic Resistance in Surface Water. Antibiotics (Basel) 2023; 12:1586. [PMID: 37998788 PMCID: PMC10668835 DOI: 10.3390/antibiotics12111586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/28/2023] [Accepted: 10/31/2023] [Indexed: 11/25/2023] Open
Abstract
The aquatic environment has been recognized as a source of antibiotic resistance (AR) that factors into the One Health approach to combat AR. To provide much needed data on AR in the environment, a comprehensive survey of antibiotic-resistant bacteria (ARB), antibiotic resistance genes (ARGs), and antibiotic residues was conducted in a mixed-use watershed and wastewater treatment plants (WWTPs) within the watershed to evaluate these contaminants in surface water. A culture-based approach was used to determine prevalence and diversity of ARB in surface water. Low levels of AR Salmonella (9.6%) and Escherichia coli (6.5%) were detected, while all Enterococcus were resistant to at least one tested antibiotic. Fewer than 20% of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae (17.3%) and carbapenem-resistant Enterobacteriaceae (CRE) (7.7%) were recovered. Six ARGs were detected using qPCR, primarily the erythromycin-resistance gene, ermB. Of the 26 antibiotics measured, almost all water samples (98.7%) had detectable levels of antibiotics. Analysis of wastewater samples from three WWTPs showed that WWTPs did not completely remove AR contaminants. ARGs and antibiotics were detected in all the WWTP effluent discharges, indicating that WWTPs are the source of AR contaminants in receiving water. However, no significant difference in ARGs and antibiotics between the upstream and downstream water suggests that there are other sources of AR contamination. The widespread occurrence and abundance of medically important antibiotics, bacteria resistant to antibiotics used for human and veterinary purposes, and the genes associated with resistance to these antibiotics, may potentially pose risks to the local populations exposed to these water sources.
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Affiliation(s)
- Sohyun Cho
- Poultry Microbiological Safety and Processing Research Unit, Agricultural Research Service, U.S. Department of Agriculture, Athens, GA 30605, USA; (S.C.); (L.M.H.); (C.R.J.)
- Oak Ridge Institute for Science and Education, Oak Ridge, TN 37830, USA;
| | - Lari M. Hiott
- Poultry Microbiological Safety and Processing Research Unit, Agricultural Research Service, U.S. Department of Agriculture, Athens, GA 30605, USA; (S.C.); (L.M.H.); (C.R.J.)
| | - Quentin D. Read
- Agricultural Research Service, U.S. Department of Agriculture, Southeast Area, Raleigh, NC 27606, USA;
| | - Julian Damashek
- Department of Biology, Utica University, Utica, NY 13502, USA;
- Department of Microbiology, University of Georgia, Athens, GA 30602, USA; (J.W.); (E.A.O.)
| | - Jason Westrich
- Department of Microbiology, University of Georgia, Athens, GA 30602, USA; (J.W.); (E.A.O.)
| | - Martinique Edwards
- Department of Environmental Health Science, University of Georgia, Athens, GA 30602, USA; (M.E.); (E.K.L.)
| | - Roland F. Seim
- Oak Ridge Institute for Science and Education, Oak Ridge, TN 37830, USA;
- Center for Environmental Measurement and Modeling, Office of Research and Development, U.S. Environmental Protection Agency, Athens, GA 30605, USA; (D.A.G.); (W.M.H.)
| | - Donna A. Glinski
- Center for Environmental Measurement and Modeling, Office of Research and Development, U.S. Environmental Protection Agency, Athens, GA 30605, USA; (D.A.G.); (W.M.H.)
| | - Jacob M. Bateman McDonald
- Lewis F. Rogers Institute for Environmental and Spatial Analysis, University of North Georgia, Oakwood, GA 30566, USA;
| | - Elizabeth A. Ottesen
- Department of Microbiology, University of Georgia, Athens, GA 30602, USA; (J.W.); (E.A.O.)
| | - Erin K. Lipp
- Department of Environmental Health Science, University of Georgia, Athens, GA 30602, USA; (M.E.); (E.K.L.)
| | - William Matthew Henderson
- Center for Environmental Measurement and Modeling, Office of Research and Development, U.S. Environmental Protection Agency, Athens, GA 30605, USA; (D.A.G.); (W.M.H.)
| | - Charlene R. Jackson
- Poultry Microbiological Safety and Processing Research Unit, Agricultural Research Service, U.S. Department of Agriculture, Athens, GA 30605, USA; (S.C.); (L.M.H.); (C.R.J.)
| | - Jonathan G. Frye
- Poultry Microbiological Safety and Processing Research Unit, Agricultural Research Service, U.S. Department of Agriculture, Athens, GA 30605, USA; (S.C.); (L.M.H.); (C.R.J.)
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Ndlovu T, Kgosietsile L, Motshwarakgole P, Ndlovu SI. Evaluation of Potential Factors Influencing the Dissemination of Multidrug-Resistant Klebsiella pneumoniae and Alternative Treatment Strategies. Trop Med Infect Dis 2023; 8:381. [PMID: 37624319 PMCID: PMC10459473 DOI: 10.3390/tropicalmed8080381] [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: 06/08/2023] [Revised: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 08/26/2023] Open
Abstract
The increasing reports of multidrug-resistant Klebsiella pneumoniae have emerged as a public health concern, raising questions about the potential routes for the evolution and dissemination of the pathogenic K. pneumoniae into environmental reservoirs. Potential drivers of the increased incidence of antimicrobial-resistant environmental K. pneumoniae include the eminent global climatic variations as a direct or indirect effect of human activities. The ability of microorganisms to adapt and grow at an exponential rate facilitates the distribution of environmental strains with acquired resistant mutations into water systems, vegetation, and soil which are major intersection points with animals and humans. The bacterial pathogen, K. pneumoniae, is one of the critical-priority pathogens listed by the World Health Organization, mostly associated with hospital-acquired infections. However, the increasing prevalence of pathogenic environmental strains with similar characteristics to clinical-antibiotic-resistant K. pneumoniae isolates is concerning. Considering the eminent impact of global climatic variations in the spread and dissemination of multidrug-resistant bacteria, in this review, we closely assess factors influencing the dissemination of this pathogen resulting in increased interaction with the environment, human beings, and animals. We also look at the recent developments in rapid detection techniques as part of the response measures to improve surveillance and preparedness for potential outbreaks. Furthermore, we discuss alternative treatment strategies that include secondary metabolites such as biosurfactants and plant extracts with high antimicrobial properties.
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Affiliation(s)
- Thando Ndlovu
- Department of Biological Sciences, Faculty of Science, University of Botswana, Private Bag UB, Gaborone 0022, Botswana; (L.K.); (P.M.)
| | - Lebang Kgosietsile
- Department of Biological Sciences, Faculty of Science, University of Botswana, Private Bag UB, Gaborone 0022, Botswana; (L.K.); (P.M.)
| | - Pako Motshwarakgole
- Department of Biological Sciences, Faculty of Science, University of Botswana, Private Bag UB, Gaborone 0022, Botswana; (L.K.); (P.M.)
| | - Sizwe I. Ndlovu
- Department of Biotechnology and Food Technology, Doornfontein Campus, University of Johannesburg, Johannesburg 2028, South Africa;
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Ekakoro JE, Guptill LF, Hendrix GK, Dorsey L, Ruple A. Antimicrobial Susceptibility of Bacteria Isolated from Freshwater Mussels in the Wildcat Creek Watershed, Indiana, United States. Antibiotics (Basel) 2023; 12:antibiotics12040728. [PMID: 37107090 PMCID: PMC10135199 DOI: 10.3390/antibiotics12040728] [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: 02/23/2023] [Revised: 04/03/2023] [Accepted: 04/07/2023] [Indexed: 04/29/2023] Open
Abstract
Antimicrobial resistance (AMR) is a global health crisis that threatens the health of humans and animals. The spread of resistance among species may occur through our shared environment. Prevention of AMR requires integrated monitoring systems, and these systems must account for the presence of AMR in the environment in order to be effective. The purpose of this study was to establish and pilot a set of procedures for utilizing freshwater mussels as a means of surveillance for microbes with AMR in Indiana waterways. One hundred and eighty freshwater mussels were sampled from three sites along the Wildcat Creek watershed in north-central Indiana. Specimens were evaluated for the presence of ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter species), Escherichia coli, Campylobacter, and Salmonella species, and the isolates were tested for antimicrobial resistance. A total of 24 bacterial isolates were obtained from tissue homogenates of freshwater mussels collected at a site directly downstream from Kokomo, Indiana. Of these, 17 were Enterobacter spp., five were Escherichia coli, one was Pseudomonas aeruginosa, and one was Klebsiella pneumoniae. All isolates were resistant to three or more antimicrobial drug classes. Further work is necessary to determine the source of the bacterial species found in the mussels.
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Affiliation(s)
- John E Ekakoro
- Department of Public and Ecosystem Health, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA
| | - Lynn F Guptill
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN 47907, USA
| | - G Kenitra Hendrix
- Department of Comparative Pathobiology/Indiana Animal Disease Diagnostic Laboratory, College of Veterinary Medicine, Purdue University, West Lafayette, IN 47907, USA
| | - Lauren Dorsey
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN 47907, USA
| | - Audrey Ruple
- Department of Population Health Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA 24061, USA
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7
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Magnano San Lio R, Favara G, Maugeri A, Barchitta M, Agodi A. How Antimicrobial Resistance Is Linked to Climate Change: An Overview of Two Intertwined Global Challenges. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20031681. [PMID: 36767043 PMCID: PMC9914631 DOI: 10.3390/ijerph20031681] [Citation(s) in RCA: 186] [Impact Index Per Article: 186.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 05/13/2023]
Abstract
Globally, antimicrobial resistance (AMR) and climate change (CC) are two of the top health emergencies, and can be considered as two interlinked public health priorities. The complex commonalities between AMR and CC should be deeply investigated in a One Health perspective. Here, we provided an overview of the current knowledge about the relationship between AMR and CC. Overall, the studies included pointed out the need for applying a systemic approach to planetary health. Firstly, CC increasingly brings humans and animals into contact, leading to outbreaks of zoonotic and vector-borne diseases with pandemic potential. Although it is well-established that antimicrobial use in human, animal and environmental sectors is one of the main drivers of AMR, the COVID-19 pandemic is exacerbating the current scenario, by influencing the use of antibiotics, personal protective equipment, and biocides. This also results in higher concentrations of contaminants (e.g., microplastics) in natural water bodies, which cannot be completely removed from wastewater treatment plants, and which could sustain the AMR spread. Our overview underlined the lack of studies on the direct relationship between AMR and CC, and encouraged further research to investigate the multiple aspects involved, and its effect on human health.
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Emery B, Fullerton H, Bossak B. Resistance on the rise: Assessment of antibiotic-resistant indicator organisms in Shem Creek, Charleston, South Carolina. DIALOGUES IN HEALTH 2022; 1:100063. [PMID: 38515911 PMCID: PMC10953939 DOI: 10.1016/j.dialog.2022.100063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 10/19/2022] [Accepted: 10/23/2022] [Indexed: 03/23/2024]
Abstract
Shem Creek is a Charleston waterway well-known for numerous recreational activities such as paddle boarding, fishing, and kayaking. However, Charleston WaterKeepers, a local organization, has consistently found high levels of coliform bacteria within Shem Creek. With antibiotic prescription rates surging and coastal flooding becoming an increasing concern, antibiotic resistant bacteria (ARBs) have become both a public health and environmental risk. ARBs can lead to the spread of antibiotic-resistant infections (ARIs) within populations. Precipitation influences bacterial concentrations in a body of water. Immediately after rainfall, the levels of bacteria rise tremendously. Runoff from livestock, sewage, and hospitals are known to contribute to the development of ARBs in bodies of water. Consistent water testing is essential to preventing the risk and spread of ARIs and determining what additional factors contribute to the development of ARBs in an aquatic environment. This pilot study found that precipitation was directly associated with the levels of bacteria found within Shem Creek and validated that ARBs are present within local waterways in Charleston, South Carolina.
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Affiliation(s)
- Brooke Emery
- Department of Health and Human Performance, College of Charleston, Charleston, SC, USA
| | | | - Brian Bossak
- Department of Health and Human Performance, College of Charleston, Charleston, SC, USA
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Jeamsripong S, Thaotumpitak V, Anuntawirun S, Roongrojmongkhon N, Atwill ER, Hinthong W. Molecular Epidemiology of Antimicrobial Resistance and Virulence Profiles of Escherichia coli, Salmonella spp., and Vibrio spp. Isolated from Coastal Seawater for Aquaculture. Antibiotics (Basel) 2022; 11:antibiotics11121688. [PMID: 36551345 PMCID: PMC9774326 DOI: 10.3390/antibiotics11121688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/19/2022] [Accepted: 11/21/2022] [Indexed: 11/24/2022] Open
Abstract
The occurrence of waterborne antimicrobial-resistant (AMR) bacteria in areas of high-density oyster cultivation is an ongoing environmental and public health threat given the popularity of shellfish consumption, water-related human recreation throughout coastal Thailand, and the geographical expansion of Thailand's shellfish industry. This study characterized the association of phenotypic and genotypic AMR, including extended-spectrum β-lactamase (ESBL) production, and virulence genes isolated from waterborne Escherichia coli (E. coli) (n = 84), Salmonella enterica (S. enterica) subsp. enterica (n = 12), Vibrio parahaemolyticus (V. parahaemolyticus) (n = 249), and Vibrio cholerae (V. cholerae) (n = 39) from Thailand's coastal aquaculture regions. All Salmonella (100.0%) and half of V. cholerae (51.3%) isolates harbored their unique virulence gene, invA and ompW, respectively. The majority of isolates of V. parahaemolyticus and E. coli, ~25% of S. enterica subsp. enterica, and ~12% of V. cholerae, exhibited phenotypic AMR to multiple antimicrobials, with 8.9% of all coastal water isolates exhibiting multidrug resistance (MDR). Taken together, we recommend that coastal water quality surveillance programs include monitoring for bacterial AMR for food safety and recreational water exposure to water for Thailand's coastal water resources.
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Affiliation(s)
- Saharuetai Jeamsripong
- Research Unit in Microbial Food Safety and Antimicrobial Resistance, Department of Veterinary Public Health, Faculty of Veterinary Science, Chulalongkorn University, Bangkok 10330, Thailand
- Department of Veterinary Public Health, Faculty of Veterinary Science, Chulalongkorn University, Bangkok 10330, Thailand
- Correspondence: ; Tel.: +662-218-9579
| | - Varangkana Thaotumpitak
- Research Unit in Microbial Food Safety and Antimicrobial Resistance, Department of Veterinary Public Health, Faculty of Veterinary Science, Chulalongkorn University, Bangkok 10330, Thailand
- Department of Veterinary Public Health, Faculty of Veterinary Science, Chulalongkorn University, Bangkok 10330, Thailand
| | - Saran Anuntawirun
- Department of Veterinary Public Health, Faculty of Veterinary Science, Chulalongkorn University, Bangkok 10330, Thailand
| | - Nawaphorn Roongrojmongkhon
- Department of Veterinary Public Health, Faculty of Veterinary Science, Chulalongkorn University, Bangkok 10330, Thailand
| | - Edward R. Atwill
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California-Davis, Davis, CA 95616, USA
| | - Woranich Hinthong
- Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok 10210, Thailand
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