Intestinal Trematode Infections

Anthelmintic potential of sulphonamides and Cucurbita pepo seeds extract on Heterophyes heterophyes experimentally infected mice

Since 1980s, no new drugs were described for treatment of heterophyiasis with many side effects of the currently used drug; praziquantel. This work aimed to study the therapeutic effect of clorsulon (sulphoamide) and aqueous extract of Cucurbita pepo in the treatment of experimental heterophyiasis. Mice were infected with encysted metacercaiae of Heterophyes heterophyes obtained from infected fish flesh. Mice were divided into five groups according to the drug used. The treatment started two weeks post-infection. Our results showed reduction of the recovered worm count with high efficacy of clorsulon and a moderate effect of C. pepo which was increased in the second week with much improvement of the intestinal histopathological changes. Scanning electron microscopy of adult H. heterophyes obtained from the intestine of mice treated with praziquantel appeared contracted with multiple small vesicles over the dorsal surface. Clorsulon produced loss of the spines on the lateral sides of the parasite with few vesicles whereas C. pepo seeds showed complete loss of the spines. In conclusion, clorsulon has high efficacy against H. heterophyes infection. Although the extract of C. pepo showed moderate curative effect against this parasite, it can be used in combination with other agents for a better synergistic effect.

Research Note: Genetic analysis, pathology, and vectors of echinostomiasis, a zoonotic helminth infection in chickens in Bangladesh

Echinostomes (Trematoda: Echinostomatidae) are food-borne zoonotic flatworms that affect birds, animals and humans, and has been classified as neglected tropical diseases (NTDs) by the World Health Organization (WHO), which cause severe enteritis in poultry and hamper production. Here, we confirmed the species of echinostomes affecting chickens in Bangladesh along with their genetic analyses, pathology and vectors. We isolated and identified adult worms from chickens, cercariae from fresh water snails and metacerariae (MC) from some wild fishes. We recovered Echinostoma revolutum (10.3%) and Hypoderaeum conoideum (6.0%) from chickens. Zoonotic E. revolutum was confirmed by amplifying nad1 gene and subsequent sequencing. Several mutations were detected in nad1 gene and our isolates belonged to the Euro-Asian clade. We observed thickening of mucosal layer, hyperplasia of goblet cells, infiltration of eosinophils, lymphocytes and must cells in the infected intestine. About 5.3% snails were infected and the highest percentage of infection was found in Lymnaea luteola (12.1%). Echinostome infection in snails was the highest in November (9.6%) and lowest in February (3.1%) in Bangladesh. MC of echinostomes were identified from blue panchax (Aplocheilus panchax) and tank goby (Glossogobius giuris). In conclusion, echinostomiasis is a notable big problem in indigenous chickens in Bangladesh and people, especially, villagers are at risk.

Alterations in Lipids and Minerals in Relation To Larval Trematode Infections of Nerita Polita Marine Snails

Marine snails provide an important source of vitamins, proteins, minerals, and essential fatty acids, and their mucus has a therapeutic significance. Parasitic infection of larval trematodes in these snails affects their nutritional value. The present study aimed to screen Nerita polita marine snails for the prevalence of cercarial infections and to evaluate the changes in lipids and some minerals in the infected as well as non-infected ones. Snails were collected randomly from February 2018 to January 2019 from the Red Sea Obhor bay, Jeddah city, Saudi Arabia. The amount of triglycerides, cholesterol, and phospholipids in the Digestive Gland Gonad Complex (DGG), hemolymph, and Snail Conditioned Water (SCW) of non-infected and infected Nerita polita snail was estimated using a spectrophotometer. Minerals content such as Ca, Zn, Pb, Na, Mn, Mg, K, Fe, Cu, and Cd, in the DGG and shell in the infected and non-infected snails were analyzed using an Inductively Coupled Plasma Optical Emission Spectrometer (ICP-OES). Two types of cercariae were detected, ocellate furcocercus cercaria (Trichobilharzia regent) and xiphidiocercaria (Litorina saxatilis VII). The study showed that there is a fl uctuation in the concentration of lipids and minerals between increase and decrease in DGG, hemolymph, shell, and SCW in infected snails. The nutritive value of the snails is affected with infection through the decrease of some lipids and minerals in infected snails. Further qualitative studies are needed.

Taxonomy of Echinostoma revolutum and 37-Collar-Spined Echinostoma spp.: A Historical Review

Echinostoma flukes armed with 37 collar spines on their head collar are called as 37-collar-spined Echinostoma spp. (group) or 'Echinostoma revolutum group'. At least 56 nominal species have been described in this group. However, many of them were morphologically close to and difficult to distinguish from the other, thus synonymized with the others. However, some of the synonymies were disagreed by other researchers, and taxonomic debates have been continued. Fortunately, recent development of molecular techniques, in particular, sequencing of the mitochondrial (nad1 and cox1) and nuclear genes (ITS region; ITS1-5.8S-ITS2), has enabled us to obtain highly useful data on phylogenetic relationships of these 37-collar-spined Echinostoma spp. Thus, 16 different species are currently acknowledged to be valid worldwide, which include E. revolutum, E. bolschewense, E. caproni, E. cinetorchis, E. deserticum, E. lindoense, E. luisreyi, E. mekongi, E. miyagawai, E. nasincovae, E. novaezealandense, E. paraensei, E. paraulum, E. robustum, E. trivolvis, and Echinostoma sp. IG of Georgieva et al., 2013. The validity of the other 10 species is retained until further evaluation, including molecular analyses; E. acuticauda, E. barbosai, E. chloephagae, E. echinatum, E. jurini, E. nudicaudatum, E. parvocirrus, E. pinnicaudatum, E. ralli, and E. rodriguesi. In this review, the history of discovery and taxonomic debates on these 26 valid or validity-retained species are briefly reviewed.

Mini-FLOTAC as an alternative, non-invasive diagnostic tool for Schistosoma mansoni and other trematode infections in wildlife reservoirs

BACKGROUND

Schistosomiasis and food-borne trematodiases are not only of major public health concern, but can also have profound implications for livestock production and wildlife conservation. The zoonotic, multi-host nature of many digenean trematodes is a significant challenge for disease control programmes in endemic areas. However, our understanding of the epidemiological role that animal reservoirs, particularly wild hosts, may play in the transmission of zoonotic trematodiases suffers a dearth of information, with few, if any, standardised, reliable diagnostic tests available. We combined qualitative and quantitative data derived from post-mortem examinations, coprological analyses using the Mini-FLOTAC technique, and molecular tools to assess parasite community composition and the validity of non-invasive methods to detect trematode infections in 89 wild Hubert's multimammate mice (Mastomys huberti) from northern Senegal.

RESULTS

Parasites isolated at post-mortem examination were identified as Plagiorchis sp., Anchitrema sp., Echinostoma caproni, Schistosoma mansoni, and a hybrid between Schistosoma haematobium and Schistosoma bovis. The reports of E. caproni and Anchitrema sp. represent the first molecularly confirmed identifications for these trematodes in definitive hosts of sub-Saharan Africa. Comparison of prevalence estimates derived from parasitological analysis at post-mortem examination and Mini-FLOTAC analysis showed non-significant differences indicating comparable results between the two techniques (P = 1.00 for S. mansoni; P = 0.85 for E. caproni; P = 0.83 for Plagiorchis sp.). A Bayesian model, applied to estimate the sensitivities of the two tests for the diagnosis of Schistosoma infections, indicated similar median posterior probabilities of 83.1% for Mini-FLOTAC technique and 82.9% for post-mortem examination (95% Bayesian credible intervals of 64.0-94.6% and 63.7-94.7%, respectively).

CONCLUSIONS

Our results showed that the Mini-FLOTAC could be applied as an alternative diagnostic technique for the detection of the zoonotic S. mansoni and other trematodes in rodent reservoirs. The implementation of non-invasive diagnostics in wildlife would offer numerous advantages over lethal sampling methodologies, with potential impact on control strategies of zoonotic helminthiases in endemic areas of sub-Saharan Africa and on fostering a framework of animal use reduction in scientific practice.

Diagnosis of Human Trematode Infections

Digenetic trematodes form a major group of human parasites, affecting a large number of humans, especially in endemic foci. Over 100 species have been reported infecting humans, including blood, lung, liver, and intestinal parasites. Traditionally, trematode infections have been diagnosed by parasitological methods based on the detection and the identification of eggs in different clinical samples. However, this is complicated due to the morphological similarity between eggs of different trematode species and other factors such as lack of sensitivity or ectopic locations of the parasites. Moreover, the problem is currently aggravated by migratory flows, international travel, international trade of foods, and changes in alimentary habits. Although efforts have been made for the development of immunological and molecular techniques, the detection of eggs through parasitological techniques remains as the gold standard for the diagnosis of trematodiases. In this chapter, we review the current status of knowledge on diagnostic techniques used when examining feces, urine, and sputum and also analyze the most relevant characteristics used to identify eggs with a quick key for the identification of eggs.

A case report of human gastrodiscoidiasis in Nepal

Gastrodiscoidiasis is a snail-transmitted zoonotic infection caused by the digenean trematode Gastrodiscoides hominis, which is the only species in the genus Gastrodiscoides infecting humans. We report a case of human gastrodiscoidiasis in a 66 years-old Nepali man without history of travels outside of Nepal who was admitted in the hospital with pain in upper abdomen for 4 months with history of passage of black-tarry stools, anemia and eosinophilia. During upper endoscopy a living trematode worm was seen in the antrum of the stomach. After isolation, the worm was identified morphologically as Gastrodiscoides hominis. Stool analysis of the patient revealed eggs of this parasite. The cause of the infection appeared to be related to the habit of the patient to eat raw watercress. This is the first report of human infection with Gastrodiscoides hominis in Nepal. However, the burden of this foodborne trematode infection in Nepal might be underestimated.

The study of Cytochrome B (CYTB): species-specific detection and phylogenetic relationship of Echinostoma revolutum, (Froelich, 1802)

Echinostoma revolutum is known as a significant intestinal trematode in various species of animals and humans. It presents complexities in terms of both the morphological and molecular biological data. This is the first study of the application of Cytochrome B gene (CYTB) as a target for studying the phylogeny and designing species-specific primer of E. revolutum. Adult trematodes were harvested from experimentally infected hamsters at 18 days of post-infection. Each worm was identified based on their morphological appearance. The novel CYTB primers were designed from other Echinostoma species to initially amplify CYTB region in E. revolutum. All sequence data of E. revolutum in five provinces of Central Thailand were used as the target for designing the species-specific primer for E. revolutum. The results revealed that CYTB gene can separate E. revolutum into two sister groups by geographical distribution, comprising the eastern and western area groups. Moreover, it also separates E. revolutum from other Echinostoma species, including two sibling species; E. caproni and E. paraensei. In addition, we developed the high performance species-specific primer of E. revolutum. It can detect DNA from a single egg, as well as cercaria, metacercaria and adult stages of this trematode with no cross-reactions to other trematodes and their hosts. Therefore, this research is a positive initial step for the future study of E. revolutum CYTB. The future studies based on this gene should be continued with all species in revolutum complex to overcome the problems of systemic classification that arise in this complex group.

Human echinostomiasis: a case report

Background

Echinostomiasis is a food-borne infection caused by an intestinal trematodes belonging to the family Echinostomatidae. They infect the gastrointestinal tract of humans. Patients are usually asymptomatic. However, with heavy infections, the worms can produce catarrhal inflammation with mild ulceration and the patient may experience abdominal pain, anorexia, nausea, vomiting, diarrhea and weight loss. Infection are associated with common sociocultural practices of eating raw or insufficiently cooked mollusks and fish.

Case presentation

We report a first case of echinostomiasis from Nepal in a 62 years old, hindu male who presented to Tribhuvan University Teaching Hospital, Kathmandu with a complaint of abdominal pain and distension with vomiting on and off for 3–4 months. He had history of consumption of insufficiently cooked fish and snail with alcohol. During endoscopy, an adult flat worm was seen with mild portal hypertensive gastropathy (McCormack’s classification) and erosive duodenopathy. The adult worm was identified as Echinostoma species based on its morphology and characteristic ova found on stool routine microscopic examination of the patient. Patient was treated with praziquantel 40 mg/kg (single dose) which is the drug of choice for Echinostoma species infection by which he got improved and on follow up stool examination after 2 weeks revealed no ova of Echinostoma species.

Conclusions

The patients having history of consumption of insufficiently cooked snail and fish with suggestive clinical features of echinostomiasis should be suspected by physicians and ova of Echinostoma species should be searched by trained microscopists. An epidemiological survey is required to know the exact burden of Echinostoma species infection in the place where people have habit of eating insufficiently cooked fish and snails, as it can be endemic in that community or geographical area.

Trematoda (flukes)

The class Trematoda is the largest group of Platyhelminths and includes two subclasses: Aspidogastrea and Digenea. Trematodes, and particularly Digeneans, is a large group of organisms with significant medical and veterinary interest. Over 100 species of digenetic trematodes have been reported infecting humans. Although the significant mortality and morbidity that some of these infections cause, they are among the most neglected tropical diseases. Apart from their impact in public and animal health, the Digenea constitutes an intriguing group of organisms that has a vast interest in experimental biology. Systematics and taxonomy of this group constitute a challenge for biologists in relation to the difficulty entailed in the establishment of phylogenetic relationships between trematodes and the determination of valid diagnostic features. Moreover, their complex life cycles, using at least two hosts and alternating free-living and parasitic stages or sexual and asexual multiplication, constitute a paradigm of how organisms can evolve to become adapted to different biotic and abiotic environments to enhance survival. In this review, we briefly summarize the major features of trematodes in relation to both biological and medical areas.

Interleukin-25 Induces Resistance Against Intestinal Trematodes

Echinostoma caproni is an intestinal trematode that has been extensively used as an experimental model to investigate the factors determining the resistance to intestinal helminths or the development of chronic infections. ICR mice are permissive hosts for E. caproni in which chronic infections are developed, concomitantly with local Th1 responses, elevated levels of local IFN-γ, inflammation and antibody responses. However, mice develop partial resistance to homologous challenge infections after cure of a primary infection, which converts this subject into an adequate model for the study of the mechanisms generating resistance against intestinal helminths. The purpose of the present study was to compare the immune response induced in primary and secondary infections to elucidate the factors determining the different outcome of the infection in each type of infection. The results obtained indicate that susceptibility is determined by the lack of IL-25 expression in response to primary infection. In contrast, infection in an environment with elevated levels of IL-25, as occurs in challenge infection, results in a Th2 phenotype impairing parasite survival. This was confirmed by treatment of naïve mice with exogenous IL-25 and subsequent infection. Changes induced in goblet cell populations and mucin glycosylation could be implicated in resistance to infection.