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Guo W, Xue X, Li R, Liang R, Wang Z, Qin J, Duan C, Chen T, Yan X. Epidemiological investigation of Cryptosporidium in children with diarrhea in middle Inner Mongolia, China. Acta Trop 2024; 254:107177. [PMID: 38518835 DOI: 10.1016/j.actatropica.2024.107177] [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: 11/28/2023] [Revised: 02/25/2024] [Accepted: 03/05/2024] [Indexed: 03/24/2024]
Abstract
Cryptosporidia (Cryptosporidium) is a protozoan that is widely parasitic in the intestinal cells of humans and animals, and it is also an important zoonotic parasite. However, there is no epidemiological investigation on Cryptosporidium spp. infection in infants with diarrhea of Inner Mongolia, the largest livestock region in China. To investigate the prevalence of Cryptosporidium, 2435 fresh fecal samples were collected from children with diarrhea in Inner Mongolia Maternal and Child Health Care Hospital. Molecular characterization of Cryptosporidium was carried out based on its 18S rRNA and gp60 gene sequences. The overall prevalence was 12.85% (313/2435), and in Hohhot (12.15%), it was lower than that in the surrounding city (14.87%) (P < 0.05). Moreover, Cryptosporidium was detected in different seasons and sexes. Concerning the age of children with diarrhea, the prevalence of those age groups between 0 and 1 was obviously lower than others, and there were significant differences in the prevalence at different ages (P < 0.001). Analysis of the 18S rRNA gene sequence revealed that all the positive samples were Cryptosporidium parvum, and there were 5 subtypes (IIdA23G3, IIdA24G3, IIdA24G4, IIdA25G3, and IIdA25G4). To the best of our knowledge, the above subtypes have not been reported. Our results provide a relevant basis for control and education on food safety and foodborne illness prevention.
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Affiliation(s)
- Wenhui Guo
- Food Science and Engineering College of Inner Mongolia Agricultural University, Hohhot 010018, China
| | - Xinyu Xue
- Food Science and Engineering College of Inner Mongolia Agricultural University, Hohhot 010018, China
| | - Ruifeng Li
- Department of pediatrics, Inner Mongolia Maternal and Child Health Care Hospital, Hohhot 010020, China
| | - Ru Liang
- Department of pediatrics, Inner Mongolia Maternal and Child Health Care Hospital, Hohhot 010020, China
| | - Zixuan Wang
- Food Science and Engineering College of Inner Mongolia Agricultural University, Hohhot 010018, China
| | - Jiashan Qin
- Food Science and Engineering College of Inner Mongolia Agricultural University, Hohhot 010018, China
| | - Chao Duan
- Food Science and Engineering College of Inner Mongolia Agricultural University, Hohhot 010018, China
| | - Tieyun Chen
- Food Science and Engineering College of Inner Mongolia Agricultural University, Hohhot 010018, China
| | - Xinlei Yan
- Food Science and Engineering College of Inner Mongolia Agricultural University, Hohhot 010018, China.
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Bacchetti R, Connelly L, Browning L, Alexander CL. Changing Molecular Profiles of Human Cryptosporidiosis Cases in Scotland as a Result of the Coronavirus Disease, COVID-19 Pandemic. Br J Biomed Sci 2023; 80:11462. [PMID: 37701073 PMCID: PMC10493326 DOI: 10.3389/bjbs.2023.11462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/02/2023] [Indexed: 09/14/2023]
Abstract
Cryptosporidium, the most frequently reported parasite in Scotland, causes gastrointestinal illness resulting in diarrhoea, nausea and cramps. Two species are responsible for most cases: Cryptosporidium hominis (C. hominis) and Cryptosporidium parvum (C. parvum). Transmission occurs faecal-orally, through ingestion of contaminated food and water, or direct contact with faeces. In 2020, the COVID-19 pandemic led to global restrictions, including national lockdowns to limit viral transmission. Such interventions led to decreased social mixing, and reduced/no local and international travel, which are factors associated with transmission of multiple communicable diseases, including cryptosporidiosis. This report assessed the impact of the pandemic on Scottish cryptosporidiosis cases, and identified changes in circulating molecular variants of Cryptosporidium species. Molecular data generated using real time PCR and GP60 nested-PCR assays on laboratory-confirmed cryptosporidiosis cases reported during 2018-22 were analysed. The Scottish Microbiology Reference Laboratories (SMiRL), Glasgow, received 774 Cryptosporidium-positive faeces during 2018-22, of which 486 samples were successfully subtyped. During this time period, C. hominis (n = 155; 21%) and C. parvum (n = 572; 77%) were the most commonly detected species. The total number of cases during 2020, which was greatly affected by the pandemic, was markedly lower in comparison to case numbers in the 2 years before and after 2020. The most predominant C. hominis family detected prior to 2020 was the Ib family which shifted to the Ie family during 2022. The most common C. parvum variant during 2018-22 was the IIa family, however a rise in the IId family was observed (n = 6 in 2018 to n = 25 in 2022). The dominant C. hominis subtype IbA10G2, which accounted for 71% of C. hominis subtypes in 2018-19 was superseded by three rare subtypes: IeA11G3T3 (n = 15), IdA16 (n = 8) and IbA9G3 (n = 3) by 2022. Frequently reported C. parvum subtypes in 2018-19 were IIaA15G2R1 and IIaA17G1R1, accounting for 59% of total C. parvum subtypes. By 2022, IIaA15G2R1 remained the most common (n = 28), however three unusual subtypes in Scotland emerged: IIdA24G1 (n = 7), IIaA16G3R1 (n = 7) and IIaA15G1R2 (n = 7). Continuous monitoring of Cryptosporidium variants following the pandemic will be essential to explore further changes and emergence of strains with altered virulence.
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Affiliation(s)
- Ross Bacchetti
- Scottish Microbiology Reference Laboratories (Glasgow), Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Lisa Connelly
- Scottish Microbiology Reference Laboratories (Glasgow), Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Lynda Browning
- Clinical and Protecting Health Directorate, Public Health Scotland, Glasgow, United Kingdom
| | - Claire L. Alexander
- Scottish Microbiology Reference Laboratories (Glasgow), Glasgow Royal Infirmary, Glasgow, United Kingdom
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Hayes L, Robinson G, Chalmers RM, Ormerod SJ, Paziewska-Harris A, Chadwick EA, Durance I, Cable J. The occurrence and zoonotic potential of Cryptosporidium species in freshwater biota. Parasit Vectors 2023; 16:209. [PMID: 37344906 PMCID: PMC10283333 DOI: 10.1186/s13071-023-05827-9] [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: 01/20/2023] [Accepted: 05/31/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Protozoan pathogens from the genus Cryptosporidium cause the diarrhoeal disease cryptosporidiosis in humans and animals globally. Freshwater biota could act as potential reservoirs or zoonotic sources of Cryptosporidium infections for livestock and people, but Cryptosporidium occurrence in aquatic biota is largely unexplored. The aim of this study was to investigate the occurrence of Cryptosporidium in a range of freshwater organisms in upland rivers across England and Wales. METHODS Fish were sampled by electrofishing, invertebrate larvae by kick sampling and the otter Lutra lutra and mink Mustela vison through faecal samples collected opportunistically as part of a nation-wide study. PCR targeting the small subunit ribosomal RNA gene was used to detect Cryptosporidium species. RESULTS Cryptosporidium occurred in just 0.8% of all the samples and in none of 73 samples from nine invertebrate genera. Cryptosporidium was detected in two of 2/74 fish samples (2.7%), both salmonids, and in 2/92 otter faecal samples (2.17%), but there were no positive samples in mink (0/24) or the bullhead Cottus gobio (0/16). CONCLUSIONS Low detection rate of human-infective Cryptosporidium species in aquatic fauna indicates they may present a low risk of contamination of some upland freshwaters.
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Affiliation(s)
- Laura Hayes
- School of Biosciences, Cardiff University, Cardiff, CF10 3AX, UK.
| | - Guy Robinson
- Cryptosporidium Reference Unit, Public Health Wales Microbiology, Singleton Hospital, Swansea, SA2 8QA, UK
- Swansea Medical School, Swansea University, Swansea, SA2 8QA, UK
| | - Rachel M Chalmers
- Cryptosporidium Reference Unit, Public Health Wales Microbiology, Singleton Hospital, Swansea, SA2 8QA, UK
- Swansea Medical School, Swansea University, Swansea, SA2 8QA, UK
| | - Steve J Ormerod
- School of Biosciences, Cardiff University, Cardiff, CF10 3AX, UK
| | - Anna Paziewska-Harris
- School of Biosciences, Cardiff University, Cardiff, CF10 3AX, UK
- Lukasiewicz Research Network, PORT Polish Centre for Technology Development, Stablowicka 147, 54-066, Wroclaw, Poland
| | | | - Isabelle Durance
- School of Biosciences, Cardiff University, Cardiff, CF10 3AX, UK
| | - Jo Cable
- School of Biosciences, Cardiff University, Cardiff, CF10 3AX, UK
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Solarczyk P, Wojtkowiak-Giera A, Heddergott M. Migrating Anatidae as Sources of Environmental Contamination with Zoonotic Giardia, Cryptosporidium, Cyclospora and Microsporidia. Pathogens 2023; 12:pathogens12030487. [PMID: 36986409 PMCID: PMC10057910 DOI: 10.3390/pathogens12030487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/14/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
Giardia, Cryptosporidium, Cyclospora, and microsporidia are gastrointestinal pathogens that can cause various disease symptoms in both animals and humans. Numerous studies worldwide have confirmed the presence of these eukaryotic pathogens in nesting and migrating wild geese, ducks, and swans. Migration spreads these zoonotic enteric pathogens to distant locations, which could have public health implications. Soils and water bodies (lakes, ponds, rivers and wetlands) in urban and suburban areas have been shown to be vulnerable to contamination by waterfowl droppings. This review addresses the epidemiology of these enteric pathogens in wild migratory bird species (Anatidae) and some consequences of their spread in the environment. To date, both zoonotic pathogens and genotypes restricted to avian hosts have been found in faecal samples from 21 anatid species worldwide. One of the routes of infection for these zoonotic gastrointestinal micropathogens is the indirect route. For example, shared water bodies (e.g., for drinking or recreational purposes) previously contaminated by birds during the migratory season may facilitate infections of humans through water. However, it is unclear how much wild waterfowl contribute to the transmission of giardiasis, cryptosporidiosis, cyclosporosis, and microsporidiosis in many regions through contaminated environmental sources. Comprehensive epidemiological surveillance based on molecular data on gastrointestinal pathogens is crucial to take measures to control infections in the future.
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Affiliation(s)
- Piotr Solarczyk
- Department of Biology and Medical Parasitology, Poznan University of Medical Sciences, 10 Fredry Street, 61-701 Poznan, Poland
| | - Agnieszka Wojtkowiak-Giera
- Department of Biology and Medical Parasitology, Poznan University of Medical Sciences, 10 Fredry Street, 61-701 Poznan, Poland
| | - Mike Heddergott
- Department of Zoology, Musée National d'Historire Naturelle, 25, Rue Münster, 2160 Luxembourg, Luxembourg
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Masangkay FR, Milanez GD, Dionisio JD, Ormita LAGL, Alvarez AV, Karanis P. Well water sources simultaneous contamination with Cryptosporidium and Acanthamoeba in East-Southeast Asia and Acanthamoeba spp. in biofilms in the Philippines. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 837:155752. [PMID: 35533862 DOI: 10.1016/j.scitotenv.2022.155752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 04/05/2022] [Accepted: 05/02/2022] [Indexed: 06/14/2023]
Abstract
Cryptosporidium is the leading agent of waterborne parasitic protozoan outbreaks and is the second leading cause of infant mortality due to diarrhoea worldwide. Acanthamoeba spp. causes Acanthamoeba keratitis (AK) and a life-threatening condition known as granulomatous amoebic encephalitis (GAE). The present study aimed to assess the water quality of an indigenous and a rural community for waterborne parasitic protozoan contamination. Aquatic samples (n = 22) were processed by filtration of 500 mL portion through a 1.2 μm pore size glass microfiber filter and eluted for light microscopy, culture in non-nutrient agar, and PCR analysis. Overall, 36% (8/22) of the investigated aquatic samples were positive for either Cryptosporidium spp. oocysts (13%; 3/22) or Acanthamoeba spp., (36%; 8/22) or both (13%; 3/22). Cryptosporidium spp. oocysts were detected in 27% (3/11) of wet season samples only while Acanthamoeba spp. were detected in 18% (2/11) and 55% (6/11) of wet and dry season samples, respectively. Subsequently, molecular detection for Acanthamoeba species identified A. lenticulata and A. hatchetti with 98-99% BLAST similarity. This is the first report on the simultaneous contamination of Cryptosporidium and Acanthamoeba in well water sources in East-Southeast Asia, the first detection of Acanthamoeba spp. in biofilms in the Philippines, and the longest viability demonstrated for A. lenticulata in two-year-old water samples stored at room temperature.
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Affiliation(s)
- Frederick R Masangkay
- Department of Medical Technology, Faculty of Pharmacy, University of Santo Tomas, Manila 1008, Philippines.
| | - Giovanni D Milanez
- Department of Medical Technology, Faculty of Pharmacy, University of Santo Tomas, Manila 1008, Philippines
| | - Joseph D Dionisio
- Department of Medical Technology, Far Eastern University-Manila, Manila 1015, Philippines
| | - Luzelle Anne G-L Ormita
- Department of Psychology, Far Eastern University-Manila, Manila 1015, Philippines; Community Extension Services, Far Eastern University-Manila, Manila 1015, Philippines
| | - Abel V Alvarez
- Community Extension Services, Far Eastern University-Manila, Manila 1015, Philippines
| | - Panagiotis Karanis
- University of Cologne, Faculty of Medical and University Hospital Cologne, Cologne 50923, Germany; Medical School, Department of Basic and Clinical Science, University of Nicosia, Nicosia, 2417, Cyprus.
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Jaiswal V, Brar APS, Sandhu BS, Singla LD, Narang D, Leishangthem GD, Kaur P. Comparative evaluation of various diagnostic techniques for detection of Cryptosporidium infection from the faecal samples of diarrhoeic bovine calves. IRANIAN JOURNAL OF VETERINARY RESEARCH 2022; 23:247-254. [PMID: 36425600 PMCID: PMC9681974 DOI: 10.22099/ijvr.2022.42714.6204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/23/2022] [Accepted: 04/19/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Cryptosporidium, an opportunistic, zoonotic, apicomplexan parasite, is one of the most common causes of diarrhea in neonatal bovine calves around the globe. Bovine calves act as a major source of infection by excreting huge numbers of highly resistant oocysts in faeces, which can survive for a long time in extreme environmental conditions. As low as ten oocysts can cause disease and mortality, leading to the requirement of an early and accurate diagnosis for proper and favorable prognosis, management, and control. AIMS The current study was conducted with the objective to evaluate various diagnostic techniques (acid fast staining, negative staining, fluorescent, ELISA, PCR, nested PCR, and qPCR) for the detection of Cryptosporidium in the faecal samples of diarrheic bovine calves. METHODS Two hundred diarrheic faecal samples from bovine calves were collected and subjected to these techniques for Cryptosporidium diagnosis. Results of these were evaluated for diagnostic comparison. RESULTS Out of 200 faecal samples evaluated, 24% (48/200) were detected positive for Cryptosporidium using a combination of two techniques as gold standard criteria. Cohen's kappa value indicated moderate to almost perfect agreement (0.616 to 0.986) among all the techniques used in the present study. Leishman staining showed the lowest sensitivity (54.17%), while nested PCR and qPCR showed the highest sensitivity (97.92%). Diagnostic specificity of all these tests ranged from 98.68 to 100%. CONCLUSION Auramine stain was used for the first time in the bovine calves in India for the detection and diagnostic comparison of Cryptosporidium. It showed strong agreement with the molecular as well as classical diagnostic techniques, and can be used for primary screening for better diagnosis.
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Affiliation(s)
- V. Jaiswal
- Department of Veterinary Pathology, Guru Angad Dev Veterinary and Animal Sciences University (GADVASU), Ludhiana, Punjab, India
| | - A. P. S. Brar
- Department of Veterinary Pathology, Guru Angad Dev Veterinary and Animal Sciences University (GADVASU), Ludhiana, Punjab, India
| | - B. S. Sandhu
- Department of Veterinary Pathology, Guru Angad Dev Veterinary and Animal Sciences University (GADVASU), Ludhiana, Punjab, India
| | - L. D. Singla
- Department of Veterinary Parasitology, Guru Angad Dev Veterinary and Animal Sciences University (GADVASU), Ludhiana, Punjab, India
| | - D. Narang
- Department of Veterinary Microbiology, Guru Angad Dev Veterinary and Animal Sciences University (GADVASU), Ludhiana, Punjab, India
| | - G. D. Leishangthem
- Department of Veterinary Pathology, Guru Angad Dev Veterinary and Animal Sciences University (GADVASU), Ludhiana, Punjab, India
| | - P. Kaur
- MSc in Biochemistry, Department of Veterinary Pathology, Guru Angad Dev Veterinary and Animal Sciences University (GADVASU), Ludhiana, Punjab, India
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Certad G, Viscogliosi E. Editorial for the Special Issue: Epidemiology, Transmission, Cell Biology and Pathogenicity of Cryptosporidium. Microorganisms 2021; 9:microorganisms9030511. [PMID: 33804407 PMCID: PMC7999443 DOI: 10.3390/microorganisms9030511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/25/2021] [Indexed: 11/16/2022] Open
Affiliation(s)
- Gabriela Certad
- University Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019—UMR 9017—CIIL—Centre d’Infection et d’Immunité de Lille, F-59000 Lille, France;
- Délégation à la Recherche Clinique et à l’Innovation, Groupement des Hôpitaux de l’Institut Catholique de Lille, F-59462 Lomme, France
- Correspondence:
| | - Eric Viscogliosi
- University Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019—UMR 9017—CIIL—Centre d’Infection et d’Immunité de Lille, F-59000 Lille, France;
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Conceição A, Almeida L, Macedo L, Mendonça C, Alves L, Ramos R, Carvalho G. Prevalence of infection by Cryptosporidium spp. in calves and associated risk factors in Northeastern Brazil. ARQ BRAS MED VET ZOO 2021. [DOI: 10.1590/1678-4162-12109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Cryptosporidium spp. are zoonotic protozoa, frequently associated with diarrhea in calves, which are responsible for important economic losses. The aim of this study was to assess the prevalence of infection by Cryptosporidium spp. and its associated risk factors among calves raised in a milk production region of Northeastern Brazil. Fecal samples (n = 385) were obtained from young animals (up to ten months old) and evaluated by means of centrifugal fecal sedimentation in formalin-ether followed by the modified Ziehl-Neelsen staining technique. In addition, Odds Ratio (OR) was calculated to evaluate associations between variables and infection by these protozoa. Out of all samples analyzed, 25.7% (99/385) scored positive for the presence of Cryptosporidium spp. Contact with other species (goat and sheep) (OR = 3.33; p = 0.000), use of a semi-intensive rearing system (OR = 1.70; p = 0.024) and absence of hygienic conditions (fecal contamination of food and water) (OR = 1.64; p = 0.029) were considered to be risk factors. Data herein reported shows that the implementation of hygienic-sanitary measures on the farms studied, it is imperative to reduce Cryptosporidium spp. infection and consequently the economic impact caused by this pathogen.
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Affiliation(s)
| | | | - L.O. Macedo
- Universidade Federal Rural de Pernambuco, Brazil
| | | | - L.C. Alves
- Universidade Federal Rural de Pernambuco, Brazil
| | - R.A.N. Ramos
- Universidade Federal do Agreste de Pernambuco, Brazil
| | - G.A. Carvalho
- Universidade Federal do Agreste de Pernambuco, Brazil
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Masangkay FR, Milanez GD, Tsiami A, Hapan FZ, Somsak V, Kotepui M, Tangpong J, Karanis P. Waterborne protozoan pathogens in environmental aquatic biofilms: Implications for water quality assessment strategies. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2020; 259:113903. [PMID: 32023789 DOI: 10.1016/j.envpol.2019.113903] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 12/29/2019] [Accepted: 12/29/2019] [Indexed: 06/10/2023]
Abstract
Biofilms containing pathogenic organisms from the water supply are a potential source of protozoan parasite outbreaks and a significant public health concern. The aim of the present study was to demonstrate the simultaneous and multi-spatial occurrence of waterborne protozoan pathogens (WBPP) in substrate-associated biofilms (SAB) and compare it to surface water (SW) and sediments with bottom water (BW) counterparts using manual filtration and elution from low-volume samples. For scenario purposes, simulated environmental biofilm contamination was created from in-situ grown one-month-old SAB (OM-SAB) that were spiked with Cryptosporidium parvum oocysts. Samples were collected from the largest freshwater reservoirs in Luzon, Philippines and a University Lake in Thailand. A total of 69 samples (23 SAB, 23 SW, and 23 BW) were evaluated using traditional staining techniques for Cryptosporidium, and Immunofluorescence staining for the simultaneous detection of Cryptosporidium and Giardia. WBPP were found in 43% SAB, 39% SW, and 39% BW of the samples tested in the present study with SAB results reflecting SW and BW results. Further highlights were demonstrated in the potential of using low-volume samples for the detection of parasites in source water. Scanning electron microscopy of OM-SAB samples revealed a naturally-associated testate amoeba shell, while Cryptosporidium oocysts spiked samples provided a visual profile of what can be expected from naturally contaminated biofilms. This study provides the first evidence for the simultaneous and multi-spatial occurrence of waterborne protozoan pathogens in low-volume aquatic matrices and further warrants SAB testing along with SW and BW matrices for improved water quality assessment strategies (iWQAS).
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Affiliation(s)
- Frederick R Masangkay
- Biomedical Sciences Program, School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat, 80160, Thailand; Department of Medical Technology, Institute of Arts and Sciences, Far Eastern University Manila, 1015, Philippines.
| | - Giovanni D Milanez
- Biomedical Sciences Program, School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat, 80160, Thailand; Department of Medical Technology, Institute of Arts and Sciences, Far Eastern University Manila, 1015, Philippines.
| | - Amalia Tsiami
- London Geller College of Hospitality and Tourism, University of West London, St Mary's Road, Ealing, London, W5 5RF, United Kingdom.
| | - Freida Z Hapan
- Department of Medical Technology, College of Pharmacy, The Pontifical and Royal University of Santo Tomas, España Blvd, Sampaloc, Manila, 1008, Philippines.
| | - Voravuth Somsak
- Biomedical Sciences Program, School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat, 80160, Thailand.
| | - Manas Kotepui
- Biomedical Sciences Program, School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat, 80160, Thailand.
| | - Jitbanjong Tangpong
- Biomedical Sciences Program, School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat, 80160, Thailand.
| | - Panagiotis Karanis
- Medical Faculty and University Hospital of Cologne, Cologne, 50923, Germany; University of Nicosia Medical School, Nicosia, 2408, Cyprus.
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