Autochthonous and imported giardiasis cases: An analysis of two decades of national surveillance data, Germany, 2002 to 2021

BackgroundGiardia duodenalis is a major cause of gastroenteritis globally, and is the most common food- and waterborne parasitic infection in Europe.AimTo describe the epidemiology of reported acute giardiasis cases in Germany and compare demographic and clinical characteristics between imported and autochthonous cases.MethodsWe conducted a descriptive analysis of giardiasis cases that fulfilled the national case definition and were reported between January 2002 and December 2021. We defined an imported case as having at least one place of exposure abroad in the 3-25 days before symptom onset. We analysed case numbers and incidence by age, sex, month reported and geographic region, both overall and stratified by autochthonous and imported cases.ResultsFrom 2002 to 2021, 72,318 giardiasis cases were reported in Germany, corresponding to a mean annual incidence of 4.4 per 100,000 population. Annual incidence gradually decreased since 2013, declining sharply during the COVID-19 pandemic in 2020-21. Of 69,345 cases reported between 2002 and 2019, 35% were imported. Incidence of autochthonous cases (overall yearly mean: 3.1/100,000) was highest in males and young children (< 5 years); imported cases were predominantly adults aged 20-39 years. We identified seasonal patterns for imported and autochthonous cases.ConclusionsGiardiasis in Germany is typically assumed to be imported. Our data, however, underline the importance of autochthonous giardiasis. Travel advice might reduce imported infections, but prevention strategies for autochthonous infections are less clear. Dietary, behavioural and environmental risk factors need to be further investigated to enhance infection prevention measures for autochthonous giardiasis.

Infectious etiology and indicators of malabsorption or intestinal injury in childhood diarrhea

INTRODUCTION

The multifactorial etiology of gastroenteritis emphasizes the need for different laboratory methods to identify or exclude infectious agents and evaluate the severity of diarrheal disease.

OBJECTIVE

To diagnose the infectious etiology in diarrheic children and to evaluate some fecal markers associated with intestinal integrity.

MATERIALS AND METHODS

The study group comprised 45 children with diarrheal disease, tested for enteropathogens and malabsorption markers, and 76 children whose feces were used for fat evaluation by the traditional and acid steatocrit tests.

RESULTS

We observed acute diarrhea in 80% of the children and persistent diarrhea in 20%. Of the diarrheic individuals analyzed, 40% were positive for enteropathogens, with rotavirus (13.3%) and Giardia duodenalis (11.1%) the most frequently diagnosed. Among the infected patients, occult blood was more evident in those carrying pathogenic bacteria (40%) and enteroviruses (40%), while steatorrhea was observed in infections by the protozoa G. duodenalis (35.7%). Children with diarrhea excreted significantly more lipids in feces than non-diarrheic children, as determined by the traditional (p<0.0003) and acid steatocrit (p<0.0001) methods. Moreover, the acid steatocrit method detected 16.7% more fecal fat than the traditional method.

CONCLUSIONS

Childhood diarrhea can lead to increasingly severe nutrient deficiencies. Steatorrhea is the hallmark of malabsorption, and a stool test, such as the acid steatocrit, can be routinely used as a laboratory tool for the semi-quantitative evaluation of fat malabsorption in diarrheic children.

Dientamoeba fragilis associated with microbiome diversity changes in acute gastroenteritis patients

This study examined the correlation between intestinal protozoans and the bacterial microbiome in faecal samples collected from 463 patients in New Zealand who were diagnosed with gastroenteritis. In comparison to traditional microscopic diagnosis methods, Multiplexed-tandem PCR proved to be more effective in detecting intestinal parasites. Among the identified protozoans, Blastocystis sp. and Dientamoeba fragilis were the most prevalent. Notably, D. fragilis was significantly associated with an increase in the alpha-diversity of host prokaryotic microbes. Although the exact role of Blastocystis sp. and D. fragilis as the primary cause of gastroenteritis remains debatable, our data indicates a substantial correlation between these protozoans and the prokaryote microbiome of their hosts, particularly when compared to other protists or patients with gastroenteritis but no detectable parasitic cause. These findings underscore the significance of comprehending the contributions of intestinal protozoans, specifically D. fragilis, to the development of gastroenteritis and their potential implications for disease management.

PGD2 and CRTH2 counteract Type 2 cytokine-elicited intestinal epithelial responses during helminth infection

Type 2 inflammation is associated with epithelial cell responses, including goblet cell hyperplasia, that promote worm expulsion during intestinal helminth infection. How these epithelial responses are regulated remains incompletely understood. Here, we show that mice deficient in the prostaglandin D2 (PGD2) receptor CRTH2 and mice with CRTH2 deficiency only in nonhematopoietic cells exhibited enhanced worm clearance and intestinal goblet cell hyperplasia following infection with the helminth Nippostrongylus brasiliensis. Small intestinal stem, goblet, and tuft cells expressed CRTH2. CRTH2-deficient small intestinal organoids showed enhanced budding and terminal differentiation to the goblet cell lineage. During helminth infection or in organoids, PGD2 and CRTH2 down-regulated intestinal epithelial Il13ra1 expression and reversed Type 2 cytokine-mediated suppression of epithelial cell proliferation and promotion of goblet cell accumulation. These data show that the PGD2-CRTH2 pathway negatively regulates the Type 2 cytokine-driven epithelial program, revealing a mechanism that can temper the highly inflammatory effects of the anti-helminth response.

Molecular analysis of cryptosporidiosis cases in Western Australia in 2019 and 2020 supports the occurrence of two swimming pool associated outbreaks and reveals the emergence of a rare C. hominis IbA12G3 subtype

Cryptosporidium is an important protozoan parasite and due to its resistance to chlorine is a major cause of swimming pool-associated gastroenteritis outbreaks. The present study combined contact tracing and molecular techniques to analyse cryptosporidiosis cases and outbreaks in Western Australia in 2019 and 2020. In the 2019 outbreak, subtyping at the 60 kDa glycoprotein (gp60) gene identified 89.0% (16/18) of samples were caused by the C. hominis IdA15G1 subtype. Amplicon next generation sequencing (NGS) at the gp60 locus identified five C. hominis IdA15G1 subtype samples that also had C. hominis IdA14 subtype DNA, while multi locus sequence typing (MLST) analysis on a subset (n = 14) of C. hominis samples identified three IdA15G1 samples with a 6 bp insertion at the end of the trinucleotide repeat region of the cp47 gene. In 2020, 88.0% (73/83) of samples typed were caused by the relatively rare C. hominis subtype IbA12G3. Four mixed infections were observed by NGS with three IdA15G1/ IdA14 mixtures and one C. parvum IIaA18G3R1 sample mixed with IIaA16G3R1. No genetic diversity using MLST was detected. Epidemiological and molecular data indicates that the outbreaks in 2019 and 2020 were each potentially from swimming pool point sources and a new C. hominis subtype IbA12G3 is emerging in Australia. The findings of the present study are important for understanding the introduction and transmission of rare Cryptosporidium subtypes to vulnerable populations.

Acute gastroenteritis due to Blastocystis hominis in an adolescent boy

Acute gastroenteritis with persistent vomiting, high degree fever and blood streaking stools often suggests bacterial aetiology in children. Authors report a 13-year-old boy presenting with acute watery diarrhoea with persistent vomiting, fever of 103°F, abdominal cramps and blood streaking stools who failed to show any response to parenteral third-generation cephalosporin for 72 hours. The stool examination revealed numerous cystic and amoeboid forms of Blastocystis hominis Metronidazole was started and the boy promptly responded within 24 hours. There was no recurrence of symptoms then onwards. The case highlights the crucial stool examination in case of acute diarrhoeal disease for rare aetiology.

Anguillulosis: circumstances of infestation and evolution towards the malignant form

INTRODUCTION

Anguillulosis is a ubiquitous digestive parasitosis. Rare in Tunisia, it is due to a round worm, strongyloid stercoralis, whose natural lodging is the duodeno-jejunal mucosa. Its malignant form is rare but it represents a potentially life-threatening disease.

AIM

We report a case of malignant anguillulosis occurring in a context of immunosuppression.

OBSERVATION

The case we report is about a 46-year-old man treated by a long-term corticosteroid therapy for Takayasu disease. He was hospitalized for an acute digestive syndrome. Biopsies were performed but the evolution was rapidly marked by multiorgan failure, sepsis and death of the patient. Histological analysis of the digestive biopsies concluded to an oeso-gastroduodenal anguillulosis.

CONCLUSION

Anguillulosis is a rare parasitosis but it can pose a health problem especially in its malignant form wich can be a life-threatening.

First Evidence of Teladorsagia circumcincta Infection in Sheep from Egypt

Trichostrongylid nematodes are a common cause of gastroenteritis in sheep. Despite its worldwide distribution, Teladorsagia circumcincta has not been included in reports listing the various trichostrongyles infecting sheep from Egypt. Herein, we describe the presence of 2 T. circumcincta haplotypes infecting small ruminants from Egypt. For this study, fresh fecal samples were collected from 340 sheep and 115 goats reared at 5 districts in Dakahlia governorate and its surroundings, Egypt. Trichostrongyle eggs were harvested from the samples, and then subjected to DNA isolation and analysis. Polymerase chain reaction (PCR) amplification was carried out for the second internal transcribed spacer of ribosomal DNA (ITS2 rDNA). Purified PCR products of T. circumcincta were sequenced, and the revealed sequences were subjected to the nucleotide and phylogenetic analysis. A relatively high prevalence of trichostrongyles eggs was identified in sheep (33.2%) and a lower prevalence was found in goats (14.7%). Molecular analysis revealed, for the first time, 2 sheep herds from Egypt that were infected with T. circumcincta. Both infected herds were raised by the Bedouins in rural areas of El Mahalla El Kubra city. No T. circumcincta infections were found in any of the goats. Nucleotide sequence analysis revealed 2 haplotypes (Te1 and Te2) from 7 successfully sequenced samples (5 from the first and 2 from the second herd). Te1 was the major haplotype in both herds, and Te2 was retrieved from a single sample. Phylogenetic analysis displayed that the Te1 haplotype clustered with one from Cyprus, which might have been introduced to Egypt via goats imported from Cyprus due to a program to improve meat and milk production in Egypt. The present results could be beneficial in understanding the epidemiology of T. circumcincta and other trichostrongyles in Egypt, and have implementations in the effective control strategies used in this region.

Analysis of the Cryptosporidium spp. and gp60 subtypes linked to human outbreaks of cryptosporidiosis in England and Wales, 2009 to 2017

BACKGROUND

Cryptosporidium spp. are important causes of gastroenteritis that can be transmitted from humans and animals. We elucidated the distribution of species and gp60 subtypes in human outbreaks classified by transmission vehicle.

METHODS

We used a combined database of national outbreak surveillance and reference unit data to analyse outbreaks by setting, vehicle, season, and linkage with suspected sources.

RESULTS

A total of 178 outbreaks involving 4031 laboratory confirmed cases were identified; 82 (46%) outbreaks involved recreational waters, 74 (42%) animal contact, 4 (2%) environmental contact, 4 (2%) person-to-person spread, 3 (2%) food, 2 (1%) drinking water supplies, and 9 (5%) were of unknown source. The infecting Cryptosporidium sp. was identified in 131 (74%) outbreaks; 69 were C. parvum, 60 C. hominis, and in two outbreaks cases were infected with either species. Animal contact, environmental contact, and food-borne outbreaks were exclusively C. parvum and were mainly in first half of the year. Recreational water outbreaks were predominantly C. hominis and were mainly in the second half of the year. Outbreaks attributed to person-to-person spread were exclusively C. hominis and all occurred in October. Both C. parvum and C. hominis caused drinking waterborne outbreaks. Gp60 subtypes were identified from patients in 48 C. parvum and 38 C. hominis outbreaks, revealing more subtypes among C. parvum (n = 14) than C. hominis (n = 7) outbreaks. Cryptosporidium hominis IbA10G2 predominated (30 outbreaks). Of C. parvum subtypes, IIaA15G2R1 predominated (17 outbreaks), followed by IIaA17G1R1 (12 outbreaks), IIaA19G1R1 (four outbreaks), and other subtypes caused three or fewer outbreaks each. Linkage between cases and suspected sources by gp60 subtype was established in nine animal contact, three swimming pool, and one drinking water outbreak.

CONCLUSIONS

The public health benefit of identifying infecting species and subtypes was twofold: (i) identifying and strengthening epidemiologic links between cases; and (ii) indicating possible exposures and sources to inform outbreak management. Gp60 subtype refined the epidemiological investigations, but a multilocus genotyping scheme would provide further benefit. Characterisation of Cryptosporidium spp. and subtypes needs to shift from predominantly supporting outbreak investigations to becoming nationally systematic.

Impact of Gastrointestinal Panel Implementation on Health Care Utilization and Outcomes

PCR-based multiplex gastrointestinal (GI) pathogen panels have started to replace stool culture and ova and parasite exam as a rapid and accurate means of diagnosing acute gastroenteritis. However, there are limited data on the impact of panel testing on patient outcomes. The objective of this study was to evaluate the management and health care utilization of patients following GI panel compared with conventional stool testing. We performed a retrospective comparative analysis of 9,402 patients who underwent testing with the FilmArray GI panel from March 2015 through May 2017 and 5,986 patients who underwent conventional stool testing from December 2012 through February 2015. GI panel was positive in 2,746 exams (29.2%) compared with 246 exams (4.1%) with conventional testing. Within 30 days following stool testing, compared with patients who received a conventional stool test, patients who received a GI panel were less likely to undergo any endoscopic procedure (8.4% GI panel versus 9.6% stool culture, P = 0.008) or any abdominal radiology (29.4% GI panel versus 31.7%, P = 0.002). Within 14 days following stool testing, patients who received a GI panel were less likely to be prescribed any antibiotic (36.2% GI panel versus 40.9%, P < 0.001). The implementation of multiplex PCR stool testing was associated with a reduction in the utilization of endoscopy, abdominal radiology, and antibiotic prescribing.

Plan ahead to control parasitic gastroenteritis, husk and fluke

This focus article has been prepared by Arthur Otter, deputy lead of the APHA Cattle Expert Group.

Easyscreen™ Enteric Protozoa Assay For the Detection of Intestinal Parasites: A Retrospective Bi-Center Study

Gastroenteritis caused by single or multiple pathogens remains a major diagnostic challenge for the laboratory, as diagnosis is achieved using different techniques with variable sensitivity and specificity. The aim of this study was to evaluate the EasyScreen™ Enteric Protozoa Detection Kit, a multiplex PCR assay for the detection and identification of the 5 most common protozoan parasites in fecal samples. A total of 632 fecal samples, submitted for routine screening to 2 centers in north-eastern Italy, was included in the study. The results of the molecular assay were compared to those of the standard diagnostic procedures, represented by microscopy and immunoassays. Out of 32 samples testing positive by conventional tools, 31 were detected as concordantly positive using the EasyScreen Kit. Additionally, 91 out of 632 samples only tested positive by the molecular test, therefore increasing the positive detection rate by 275%. Finally, the EasyScreen assay detected 14 co-infections compared to 3 co-infections identified by conventional methods. The EasyScreen Kit provided a rapid and sensitive simultaneous identification of the most important diarrhea-causing protozoa that infect humans. Additionally, this molecular assay presents several advantages compared to conventional tools, such as the standardization and near-total automation of the process. Although critical issues related to the employment of molecular assays are still evident, the system is suitable for clinical parasitological diagnosis as long as it is used in association with conventional tools.

Application of a salivary immunoassay in a prospective community study of waterborne infections

Quantifying sporadic waterborne infections in community settings can be challenging. Salivary antibody immunoassays are a promising non-invasive tool that can be used in prospective studies of common infections, especially those involving children. This study was conducted in a Massachusetts city, which uses a microbiologically contaminated river as its water source, during summer-early winter periods before and after construction of a new drinking water treatment plant. Monthly saliva samples (7480 samples from 1170 children and 816 adults) were analyzed for immunoglobulin G (IgG) responses to recombinant proteins of Cryptosporidium, one genogroup I (GI) and two GII noroviruses. Immunoconversion was defined as at least four-fold increase in specific antibody responses between two monthly samples with a post-conversion response above a flexible age-dependent cut-off. Episodes of gastroenteritis (diarrhea or vomiting or cramps) were associated with 3.2 (95% confidence limits 1.1; 9.5) adjusted odds ratio (aOR) of immunoconversion to Cryptosporidium; episodes of combined diarrhea and vomiting symptoms were associated with 3.5 (0.8; 15.0) and 4.6 (1.7; 12.6) aORs of an immunoconversion to GI and GII noroviruses, respectively. Swimming in natural water bodies or chlorinated pools was associated with 2.3 (0.4; 15.4) and 4.9 (1.6; 15.5) aORs of immunoconversion to Cryptosporidium, respectively. In a subset of study participants who did not use home water filters, consumption of at least some amount of non-boiled tap water reported in a monthly recall survey was associated with 11.1 (1.2; 100.0) and 0.6 (0.1; 2.5) aORs of immunoconversion to Cryptosporidium before and after the new water treatment plant construction, respectively. Among individuals who used home water filters, associations between non-boiled tap water consumption and Cryptosporidium immunoconversion were not significant before and after new plant construction with aORs of 0.8 (0.2; 3.3) and 0.3 (0.1; 1.6), respectively. The interaction effect of study phase and non-boiled tap water consumption on Cryptosporidium immunoconversions was statistically significant in the entire study population with aOR of 5.4 (1.1; 25.6). This was the first study that has used a salivary antibody immunoassay to demonstrate significant associations between gastrointestinal symptoms and Cryptosporidium and norovirus infections, and between water-related exposures and Cryptosporidium infections.

Detection of common diarrhea-causing pathogens in Northern Taiwan by multiplex polymerase chain reaction

Conventional methods for identifying gastroenteritis pathogens are time consuming, more likely to result in a false-negative, rely on personnel with diagnostic expertise, and are dependent on the specimen status. Alternatively, molecular diagnostic methods permit the rapid, simultaneous detection of multiple pathogens with high sensitivity and specificity. The present study compared conventional methods with the Luminex xTAG Gastrointestinal Pathogen Panel (xTAG GPP) for the diagnosis of infectious gastroenteritis in northern Taiwan. From July 2015 to April 2016, 217 clinical fecal samples were collected from patients with suspected infectious gastroenteritis. All specimens were tested using conventional diagnostic techniques following physicians' orders as well as with the xTAG GPP. The multiplex polymerase chain reaction (PCR) approach detected significantly more positive samples with bacterial, viral, and/or parasitic infections as compared to conventional analysis (55.8% vs 40.1%, respectively; P < .001). Moreover, multiplex PCR could detect Escherichia coli O157, enterotoxigenic E coli, Shiga-like toxin-producing E coli, Cryptosporidium, and Giardia, which were undetectable by conventional methods. Furthermore, 48 pathogens in 23 patients (10.6%) with coinfections were identified only using the multiplex PCR approach. Of which, 82.6% were from pediatric patients. Because the detection rates using multiplex PCR are higher than conventional methods, and some pediatric pathogens could only be detected by multiplex PCR, this approach may be useful in rapidly diagnosing diarrheal disease in children and facilitating treatment initiation. Further studies are necessary to determine if multiplex PCR improves patient outcomes and reduces costs.

The NICE-GUT trial protocol: a randomised, placebo controlled trial of oral nitazoxanide for the empiric treatment of acute gastroenteritis among Australian Aboriginal children

INTRODUCTION

Diarrhoeal disease is the second leading cause of death in children under 5 years globally, killing 525 000 annually. Australian Aboriginal and Torres Strait Islander (hereafter Aboriginal) children suffer a high burden of disease. Randomised trials in other populations suggest nitazoxanide accelerates recovery for children with Giardia, amoebiasis, Cryptosporidium, Rotavirus and Norovirus gastroenteritis, as well as in cases where no enteropathogens are found.

METHODS AND ANALYSIS

This double blind, 1:1 randomised, placebo controlled trial is investigating the impact of oral nitazoxanide on acute gastroenteritis in hospitalised Australian Aboriginal children aged 3 months to <5 years. Dosing is based on age-based dosing. The primary endpoint is the time to resolution of 'significant illness' defined as the time from randomisation to the time of clinical assessment as medically ready for discharge, or to the time of actual discharge from hospital, whichever occurs first. Secondary endpoints include duration of hospitalisation, symptom severity during the period of significant illness and following treatment, duration of rehydration and drug safety. Patients will be followed for medically significant events for 60 days. Analysis is based on Bayesian inference. Subgroup analysis will occur by pathogen type (bacteria, virus or parasite), rotavirus vaccination status, age and illness severity.

ETHICS AND DISSEMINATION

Ethics approval has been granted by the Central Australian Human Research Ethics Committee (HREC-14-221) and the Human Research Ethics Committee of the Northern Territory Department of Health and Menzies School of Health Research (HREC2014-2172). Study investigators will ensure that the trial is conducted in accordance with the principles of the Declaration of Helsinki. Individual participant consent will be obtained. Results will be disseminated via peer-reviewed publication.

TRIAL REGISTRATION NUMBER

ACTRN12614000381684.

Exposure to Anisakis extracts can induce inflammation on in vitro cultured human colonic cells

Anisakis spp. is a parasitic nematode whose infective third-stage larvae may be found within the flesh of fish species commonly consumed by humans. Thorough cooking or freezing should render the fish safe for consumption; furthermore, marinating solutions containing biocidal agents might have a significant action against Anisakis larvae. Some studies suggest a relationship between some parasitic infections and development of inflammatory bowel disorders, and Anisakis infection might be a risk factor for stomach or colon cancer. The aim of our study was to investigate if crude extracts (CEs) obtained from Anisakis larvae marinated in a solution with added allyl isothiocyanate (ACE-AITC) and frozen, or from frozen only Anisakis larvae (ACE), can induce an inflammatory effect on in vitro differentiated colonic Caco-2 cells exposed or not to LPS. Caco-2 exposure to the two CEs induced a marked COX-2 expression and potentiated LPS-induced COX-2 overexpression, confirming that substances present in Anisakis larvae can induce an inflammatory response in the intestinal epithelium, possibly also exacerbating the effects of other inflammatory stimuli. ACE induced a marked decrease in caspase-3 activation, while AITC-ACE increased its activation. However, LPS-induced caspase-3 activation appeared lower in cells treated with ACE and with the lower concentration of AITC-ACE. Thus, it is evident that Anisakis CEs may affect various cell pathways crucial not only in the inflammatory process but also in cell growth and death. Thus, CEs obtained from nonviable Anisakis larvae retain or are otherwise provided with noxious properties able to induce a strong inflammation response in intestinal epithelial cells. Furthermore, their influence may persist also following pretreatment with the biocidal agent AITC, indicating that the harmful substances contained in crude extracts from Anisakis larvae are resistant to the thermal or biocidal agent treatments.

Agreement between gastrointestinal panel testing and standard microbiology methods for detecting pathogens in suspected infectious gastroenteritis: Test evaluation and meta-analysis in the absence of a reference standard

Objective

Multiplex gastrointestinal pathogen panel (GPP) tests simultaneously identify bacterial, viral and parasitic pathogens from the stool samples of patients with suspected infectious gastroenteritis presenting in hospital or the community. We undertook a systematic review to compare the accuracy of GPP tests with standard microbiology techniques.

Review methods

Searches in Medline, Embase, Web of Science and the Cochrane library were undertaken from inception to January 2016. Eligible studies compared GPP tests with standard microbiology techniques in patients with suspected gastroenteritis. Quality assessment of included studies used tailored QUADAS-2. In the absence of a reference standard we analysed test performance taking GPP tests and standard microbiology techniques in turn as the benchmark test, using random effects meta-analysis of proportions.

Results

No study provided an adequate reference standard with which to compare the test accuracy of GPP and conventional tests. Ten studies informed a meta-analysis of positive and negative agreement. Positive agreement across all pathogens was 0.93 (95% CI 0.90 to 0.96) when conventional methods were the benchmark and 0.68 (95% CI: 0.58 to 0.77) when GPP provided the benchmark. Negative agreement was high in both instances due to the high proportion of negative cases. GPP testing produced a greater number of pathogen-positive findings than conventional testing. It is unclear whether these additional ‘positives’ are clinically important.

Conclusions

GPP testing has the potential to simplify testing and accelerate reporting when compared to conventional microbiology methods. However the impact of GPP testing upon the management, treatment and outcome of patients is poorly understood and further studies are needed to evaluate the health economic impact of GPP testing compared with standard methods.

The review protocol is registered with PROSPERO as CRD42016033320.

Characteristics of child daycare centres associated with clustering of major enteropathogens

Insights into transmission dynamics of enteropathogens in children attending daycare are limited. Here we aimed at identifying daycare centre (DCC) characteristics associated with time-clustered occurrence of enteropathogens in DCC-attending children. For this purpose, we used the KIzSS network, which comprises 43 DCCs that participated in infectious disease surveillance in The Netherlands during February 2010-February 2013. Space-time scan statistics were used to identify clusters of rotavirus, norovirus, astrovirus, Giardia lamblia and Cryptosporidium spp. in a two-dimensional DCC characteristic space constructed using canonical correlation analysis. Logistic regression models were then used to further identify DCC characteristics associated with increased or decreased odds for clustering of enteropathogens. Factors associated with increased odds for enteropathogen clustering in DCCs were having indoor/outdoor paddling pools or sandpits, owning animals, high numbers of attending children, and reporting outbreaks to local health authorities. Factors associated with decreased odds for enteropathogen clustering in DCCs were cleaning child potties in designated waste disposal stations, cleaning vomit with chlorine-based products, daily cleaning of toys, extra cleaning of toys during a suspected outbreak, and excluding children with gastroenteritis. These factors provide targets for reducing the burden of gastrointestinal morbidity associated with time-clustered occurrence of major enteropathogens in DCC attendees.

Frequency of Enteropathogen Detection in Suckling and Weaned Pigs with Diarrhea in Japan

Fecal samples from suckling ( n = 153) and weaned ( n = 116) piglets with diarrhea in Japan were examined for shedding of viral, bacterial, and parasitic pathogens using culture, microscopic, and polymerase chain reaction methods. In suckling piglets, diarrhea was attributed to infection with a single etiologic agent in 60.8% of cases and with combinations of agents in 22.2%. In weaned piglets, diarrhea was attributed to a single etiologic agent in 43.1% and to combinations of agents in 47.4% of cases. Rotavirus was the most prevalent agent in suckling (67.3%) and weaned (65.5%) piglets. The detection of other pathogens was associated with age of the animals examined. Coccidia were predominantly isolated from suckling piglets, whereas Escherichia coli was found predominantly in weaned piglets. Although a relationship was not observed between detection rate of rotavirus and age of piglets, a single group of rotavirus was detected in 87.5% of suckling piglets whereas multiple groups were detected in 51.6% of weaned piglets. The results of this study confirm that diarrhea in piglets can, to a variable degree, be causally associated with multiple agents. Additionally, these results suggest reasons why this syndrome can be difficult to control.

Diarrhea: Initial Evaluation and Treatment in the Emergency Department

Diarrhea generates a wide range of diagnostic considerations and has profound individual and public health significance. The setting and circumstances under which a patient presents with diarrhea drastically influences the concern brought to the encounter. Nausea, vomiting, and diarrhea are often provisionally labeled "gastroenteritis" with appropriate expectant management. In resource-poor countries, the significance of diarrhea is even greater. This review focuses on diarrhea and its initial evaluation and management in the emergency department.

Outbreaks attributed to fresh leafy vegetables, United States, 1973-2012

Leafy vegetables are an essential component of a healthy diet; however, they have been associated with high-profile outbreaks causing severe illnesses. We reviewed leafy vegetable-associated outbreaks reported to the Centers for Disease Control and Prevention between 1973 and 2012. During the study period, 606 leafy vegetable-associated outbreaks, with 20 003 associated illnesses, 1030 hospitalizations, and 19 deaths were reported. On average, leafy vegetable-associated outbreaks were larger than those attributed to other food types. The pathogens that most often caused leafy vegetable-associated outbreaks were norovirus (55% of outbreaks with confirmed aetiology), Shiga toxin-producing Escherichia coli (STEC) (18%), and Salmonella (11%). Most outbreaks were attributed to food prepared in a restaurant or catering facility (85%). An ill food worker was implicated as the source of contamination in 31% of outbreaks. Efforts by local, state, and federal agencies to control leafy vegetable contamination and outbreaks should span from the point of harvest to the point of preparation.

Cryptosporidiosis: A Disease of Tropical and Remote Areas in Australia

Cryptosporidiosis causes gastroenteritis and is transmitted to humans via contaminated water and food, and contact with infected animals and people. We analyse long-term cryptosporidiosis patterns across Australia (2001–2012) and review published Australian studies and jurisdictional health bulletins to identify high risk populations and potential risk factors for disease. Using national data on reported cryptosporidiosis, the average annual rate of reported illness was 12.8 cases per 100 000 population, with cycles of high and low reporting years. Reports of illness peak in summer, similar to other infectious gastrointestinal diseases. States with high livestock densities like New South Wales and Queensland also record a spring peak in illnesses. Children aged less than four years have the highest rates of disease, along with adult females. Rates of reported cryptosporidiosis are highest in the warmer, remote regions and in Aboriginal and Torres Strait Islander populations. Our review of 34 published studies and seven health department reports on cryptosporidiosis in Australia highlights a lack of long term, non-outbreak studies in these regions and populations, with an emphasis on outbreaks and risk factors in urban areas. The high disease rates in remote, tropical and subtropical areas and in Aboriginal and Torres Strait Islander populations underscore the need to develop interventions that target the sources of infection, seasonal exposures and risk factors for cryptosporidiosis in these settings. Spatial epidemiology can provide an evidence base to identify priorities for intervention to prevent and control cryptosporidiosis in high risk populations.

The parasite Cryptosporidium is a common cause of gastroenteritis worldwide. Ineffectively focused interventions are partly why the disease remains a challenge to control. In this study, we describe the geographical, seasonal and demographic characteristics of reported cryptosporidiosis in Australia from 2001–2012. We combine this analysis of illnesses with evidence published in peer review articles and state health bulletins to identify high disease risk areas and populations. We find that rates of reported cryptosporidiosis are highest in warm, remote areas and in Aboriginal and Torres Strait Islander populations’ dominated regions. Our review of the published literature and health reports highlights a focus on short term outbreaks in metropolitan areas. This negligible overlap between areas with high disease rates and areas of public health focus is of concern. Public health interventions and promotion programs to prevent and control diarrhoea need to focus on remote and Indigenous dominated Australia to reduce the currently high rates in these regions and populations.

Multiplex polymerase chain reaction tests for detection of pathogens associated with gastroenteritis

A wide range of enteric pathogens can cause infectious gastroenteritis. Conventional diagnostic algorithms are time-consuming and often lack sensitivity and specificity. Advances in molecular technology have provided new clinical diagnostic tools. Multiplex polymerase chain reaction (PCR)-based testing has been used in gastroenterology diagnostics in recent years. This article presents a review of recent laboratory-developed multiplex PCR tests and current commercial multiplex gastrointestinal pathogen tests. It focuses on two commercial syndromic multiplex tests: Luminex xTAG Gastrointestinal Pathogen Panel and BioFire FilmArray gastrointestinal test. Multiplex PCR tests have shown superior sensitivity to conventional methods for detection of most pathogens.

Parasitic gastroenteritis in lambs widespread

Parasitic gastroenteritis diagnosed in lambs by all veterinary investigation centres, Clostridium perfringens epsilon enterotoxaemia suspected in two cows, Comparative quarterly porcine reproductive and respiratory syndrome diagnoses reach a 10-year peak, Failure of an entire colony of gulls in Cumbria, Endoparasitism the predominant feature in exotic farmed animals, These are among matters discussed in the Animal and Plant Health Agency's (APHA's) disease surveillance report for September 2014.