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Ulloque-Badaracco JR, Hernandez-Bustamante EA, Alarcón-Braga EA, Huayta-Cortez M, Carballo-Tello XL, Seminario-Amez RA, Rodríguez-Torres A, Casas-Patiño D, Herrera-Añazco P, Benites-Zapata VA. Seroprevalence of human toxocariasis in Latin America and the Caribbean: a systematic review and meta-analysis. Front Public Health 2023; 11:1181230. [PMID: 37441649 PMCID: PMC10335805 DOI: 10.3389/fpubh.2023.1181230] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/30/2023] [Indexed: 07/15/2023] Open
Abstract
Introduction The current study aimed to quantitatively synthesize available evidence regarding the seroprevalence of human toxocariasis in Latin America and the Caribbean. Methods A systematic research involving six electronic databases was conducted using a research strategy that combined MeSH terms with free terms. Article selection and information extraction were performed using a double and independent approach. The Newcastle-Ottawa tool was used to assess the risk of bias in the included articles. The meta-analysis used the random-effects approach, with subgroup analysis and sensitivity analysis for risk of bias also being performed. Results We included 101 articles with a total of 31,123 participants. The studies were conducted between 1990 and 2022, with Brazil accounting for the largest number of studies (n = 37). The overall seroprevalence of human toxocariasis was 31.0% (95% CI: 27.0-35.0%, I2 = 99%). The prevalence of the main characteristics observed in seropositive patients were as follows: ocular toxocariasis (30.0%), asymptomatic (26.0%), and presence of dogs at home (68.0%). In addition, the seroprevalence was lower in studies including only adults than in those including children or both. In contrast, no differences in seroprevalences were found between studies conducted in the community and hospital. Conclusion The overall seroprevalence of human toxocariasis in Latin America and the Caribbean was high. Notably, our findings showed that the seroprevalence was increased among populations who kept a dog at home but was decreased in populations comprising only adults. Our findings can be used to establish epidemiological surveillance strategies for the prevention and early identification of toxocariasis.
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Affiliation(s)
| | - Enrique A. Hernandez-Bustamante
- Sociedad Cientifica de Estudiantes de Medicina de la Universidad Nacional de Trujillo, Trujillo, Peru
- Grupo Peruano de Investigación Epidemiológica, Unidad Para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | | | | | | | | | - Alejandra Rodríguez-Torres
- Universidad Autónoma del Estado de México, CU Amecameca, Mexico
- Red Internacional en Salud Colectiva y Salud Intercultural, Amecameca, Mexico
| | - Donovan Casas-Patiño
- Universidad Autónoma del Estado de México, CU Amecameca, Mexico
- Red Internacional en Salud Colectiva y Salud Intercultural, Amecameca, Mexico
| | - Percy Herrera-Añazco
- Universidad Privada del Norte, Trujillo, Peru
- Red Peruana de Salud Colectiva, Lima, Peru
| | - Vicente A. Benites-Zapata
- Unidad de Investigación Para la Generación y Síntesis de Evidencias en Salud, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru
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Dos Reis LL, Lima DCDS, da Silva TRR, Braga FCDO, Nava AFD, Vicente ACP. Circulation of Giardia duodenalis in domestic and wild animals from Amazon region: a Systematic Review. Acta Trop 2022; 237:106708. [PMID: 36195184 DOI: 10.1016/j.actatropica.2022.106708] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 10/06/2022]
Abstract
Giardia is an ubiquitous protozoa that infect a broad range of vertebrate hosts, including domestic and wild animals as well as humans. Giardia duodenalis is one of the most common parasite in humans and mammals worldwide. Human giardiasis is highly prevalent in the countries that make up from Amazon. The identification of genotypes in humans and animals improves the understanding of transmission routes and the control strategies. Thus, we carried out a systematic review on Giardia in animals from Amazon region/South American, following the PRISMA guidelines. Studies up to September, 2022 were searched for in public database. A total of seven out of 432 articles were selected: four, two and one from Brazil, Colombia and Peru, respectively. Based on these articles it is seen that the G. duodenalis cosmopolitan assemblages A and B prevail within domestic and wild animals in the Amazon. Moreover, a Giardia microscopic screening in aquatic animals from this biome showed its prevalence among aquatic mammals including the endangered species Trichechus inunguis (manatee). Therefore, a yet not accessed number of susceptible hosts, new G. duodenalis assemblages and species can be occurring in this huge hotspot of biodiversity that is Amazon region.
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Affiliation(s)
- Lisiane Lappe Dos Reis
- Instituto Leônidas & Maria Deane/ILMD/Fiocruz Amazônia, Laboratório de Diversidade Microbiana da Amazônia de Importância para a Saúde, Manaus, AM, Brazil; Programa de Pós-graduação Stricto Sensu em Biologia Parasitária, Instituto Oswaldo Cruz/IOC/FIOCRUZ, Rio de Janeiro, RJ, Brazil..
| | - Dayane Costa de Souza Lima
- Instituto Leônidas & Maria Deane/ILMD/Fiocruz Amazônia, Laboratório de Diversidade Microbiana da Amazônia de Importância para a Saúde, Manaus, AM, Brazil
| | - Túllio Romão Ribeiro da Silva
- Instituto Leônidas & Maria Deane/ILMD/Fiocruz Amazônia, Laboratório de Ecologia de Doenças Transmissíveis na Amazônia, Manaus, AM, Brazil
| | - Francisco Carlos de Oliveira Braga
- Instituto Leônidas & Maria Deane/ILMD/Fiocruz Amazônia, Laboratório de Diversidade Microbiana da Amazônia de Importância para a Saúde, Manaus, AM, Brazil
| | - Alessandra Ferreira Dales Nava
- Instituto Leônidas & Maria Deane/ILMD/Fiocruz Amazônia, Laboratório de Ecologia de Doenças Transmissíveis na Amazônia, Manaus, AM, Brazil
| | - Ana Carolina Paulo Vicente
- Instituto Oswaldo Cruz/IOC/FIOCRUZ, Laboratório de Genética Molecular de Microrganismos, Rio de Janeiro, RJ, Brazil
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Elhadad H, Abdo S, Salem A, Mohamed M, El-Taweel H, El-Abd E. Comparison of gdh polymerase chain reaction-restriction fragment length polymorphism and tpi assemblage-specific primers for characterization of Giardia intestinalis in children. Trop Parasitol 2022; 12:41-47. [PMID: 35923264 PMCID: PMC9341145 DOI: 10.4103/tp.tp_28_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 09/13/2021] [Indexed: 11/04/2022] Open
Abstract
Background: Aim and objectives: Materials and Methods: Results: Conclusions:
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Malika NM, Barbagelatta G, Penny M, Reynolds KA, Sinclair R. Impact of Housing and Infrastructure on handwashing in Peru. Int Health 2021; 13:615-623. [PMID: 32239138 PMCID: PMC10553400 DOI: 10.1093/inthealth/ihaa008] [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: 07/26/2019] [Revised: 01/24/2020] [Accepted: 01/29/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The metropolitan area of Lima, Peru has a third of the nation's population living in slum dwellings that are hypothesized to contribute to inefficient household hygienic practices. The purpose of this study was to quantitatively assess which living conditions have the greatest impact on handwashing practices. METHODS A cross-sectional epidemiological design of participants ≥16 y of age from San Juan de Miraflores, a slum on the outskirts of Lima, Peru, was used. Poisson regression was applied to assess the impact of living conditions on handwashing practices. RESULTS We could not demonstrate a relationship between living conditions (home structure, overcrowding, water, grey water disposal) and reported handwashing. The reported lack of handwashing is associated with the number of children in the home (those with children <5 y of age were more likely not to report washing their hands) and length of stay in the slum in years. CONCLUSIONS Living conditions play an important role in one's health, therefore improved study designs are needed to determine which strategies are likely to be the most effective in improving outcomes for slum dwellers.
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Affiliation(s)
- Nipher M Malika
- Loma Linda University School of Public Health, 11188 Anderson Street, Loma Linda, CA 92350, USA
| | | | - Mary Penny
- Instituto de Investigacion Nutricional, Av. La Molina 1885 Peru
| | - Kelly A Reynolds
- University of Arizona, Mel and Enid Zuckerman College of Public Health, 1295 N. Martin Avenue Tucson, AZ, USA
| | - Ryan Sinclair
- Loma Linda University School of Public Health, 11188 Anderson Street, Loma Linda, CA 92350, USA
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Lompo P, Tahita MC, Sorgho H, Kaboré W, Kazienga A, Nana ACB, Natama HM, Bonkoungou IJO, Barro N, Tinto H. Pathogens associated with acute diarrhea, and comorbidity with malaria among children under five years old in rural Burkina Faso. Pan Afr Med J 2021; 38:259. [PMID: 34104307 PMCID: PMC8164431 DOI: 10.11604/pamj.2021.38.259.15864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 10/09/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION acute diarrhea in children under five years is a public health problem in developing countries and particularly in malaria-endemic areas where both diseases co-exist. The present study examined the etiology of childhood diarrhea and its comorbidity with malaria in a rural area of Burkina Faso. METHODS conventional culture techniques, direct stools examination, and viruses´ detection by rapid tests were performed on the fresh stools and microscopy was used to diagnose malaria. Some risk factors were also assessed. RESULTS on a total of 191 samples collected, at least one pathogen was identified in 89 cases (46.6%). The proportions of pathogens found on the 89 positive stool samples were parasites 51.69% (46 cases), viruses 39.33% (35 cases), and bacteria 14.61% (13 cases), respectively. The relationship between malaria and infectious diarrhea was significant in viral and parasites causes (p=0.005 and 0.043 respectively). Fever, vomiting and abdominal pain were the major symptoms associated with diarrhea, with 71.51%, 31.72% and 23.66% respectively. The highest viral diarrhea prevalence was reported during the dry season (OR=5.29, 95% CI: 1.74 - 16.07, p=0.001) while parasite diarrhea was more encountered during the rainy season (OR=0.41, 95% CI: 0.33 - 0.87, p=0.011). CONCLUSION Giardia spp and rotavirus were the leading cause of acute diarrhea in Nanoro, Burkina Faso with a predominance of rotavirus in children less than 2 years. Parasite and viral diarrhea were the most pathogens associated with malaria. However, the high rate of negative stool samples suggests the need to determine other enteric microorganisms.
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Affiliation(s)
- Palpouguini Lompo
- Institut de Recherche en Science de la Santé, Unité de Recherche Clinique de Nanoro, Ouagadougou, Burkina Faso
| | - Marc Christian Tahita
- Institut de Recherche en Science de la Santé, Unité de Recherche Clinique de Nanoro, Ouagadougou, Burkina Faso
| | - Hermann Sorgho
- Institut de Recherche en Science de la Santé, Unité de Recherche Clinique de Nanoro, Ouagadougou, Burkina Faso
| | - William Kaboré
- Institut de Recherche en Science de la Santé, Unité de Recherche Clinique de Nanoro, Ouagadougou, Burkina Faso
| | - Adama Kazienga
- Institut de Recherche en Science de la Santé, Unité de Recherche Clinique de Nanoro, Ouagadougou, Burkina Faso
| | - Ashmed Cheick Bachirou Nana
- Institut de Recherche en Science de la Santé, Unité de Recherche Clinique de Nanoro, Ouagadougou, Burkina Faso
| | - Hamtandi Magloire Natama
- Institut de Recherche en Science de la Santé, Unité de Recherche Clinique de Nanoro, Ouagadougou, Burkina Faso
| | - Isidore Juste Ouindgueta Bonkoungou
- University of Ouagadougou I, Prof. Joseph Ki Zerbo, Ouagadougou, Burkina Faso
- Laboratoire National de Santé Publique, Ouagadougou, Burkina Faso
| | - Nicolas Barro
- University of Ouagadougou I, Prof. Joseph Ki Zerbo, Ouagadougou, Burkina Faso
| | - Halidou Tinto
- Institut de Recherche en Science de la Santé, Unité de Recherche Clinique de Nanoro, Ouagadougou, Burkina Faso
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Fantinatti M, Gonçalves-Pinto M, Lopes-Oliveira LAP, Da-Cruz AM. Epidemiology of Giardia duodenalis assemblages in Brazil: there is still a long way to go. Mem Inst Oswaldo Cruz 2021; 115:e200431. [PMID: 33503146 PMCID: PMC7836984 DOI: 10.1590/0074-02760200431] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 11/25/2020] [Indexed: 12/22/2022] Open
Abstract
Giardia duodenalis infection is distributed worldwide and can achieve prevalence around 60%, especially in developing countries. This protozoan is divided into eight assemblages, in which A and B have high zoonotic potential, whereas C to H are host-specific. This scenario is changing as molecular studies progress, highlighting that knowledge on host-specificity still has a long way to go. Understanding the players involved in transmission routes enables rational designs of control strategies. Considering the high prevalence of giardiasis, this review aims to gather together the data on available studies on the distribution of G. duodenalis assemblages in Brazil until September 2020.
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Affiliation(s)
- Maria Fantinatti
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório Interdisciplinar de Pesquisas Médicas, Rio de Janeiro, RJ, Brasil
| | - Monique Gonçalves-Pinto
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório Interdisciplinar de Pesquisas Médicas, Rio de Janeiro, RJ, Brasil
| | | | - Alda Maria Da-Cruz
- Fundação Oswaldo Cruz-Fiocruz, Instituto Oswaldo Cruz, Laboratório Interdisciplinar de Pesquisas Médicas, Rio de Janeiro, RJ, Brasil.,Universidade do Estado do Rio de Janeiro, Faculdade de Ciências Médicas, Rio de Janeiro, RJ, Brasil
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Rivero MR, Feliziani C, De Angelo C, Tiranti K, Salomon OD, Touz MC. Giardia spp., the most ubiquitous protozoan parasite in Argentina: human, animal and environmental surveys reported in the last 40 years. Parasitol Res 2020; 119:3181-3201. [DOI: 10.1007/s00436-020-06853-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 08/10/2020] [Indexed: 12/13/2022]
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Higuera A, Villamizar X, Herrera G, Giraldo JC, Vasquez-A LR, Urbano P, Villalobos O, Tovar C, Ramírez JD. Molecular detection and genotyping of intestinal protozoa from different biogeographical regions of Colombia. PeerJ 2020; 8:e8554. [PMID: 32195042 PMCID: PMC7067185 DOI: 10.7717/peerj.8554] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 01/13/2020] [Indexed: 12/24/2022] Open
Abstract
Background Intestinal parasitic protozoa represent a serious problem of public health particularly in developing countries. Protozoa such as Blastocystis, Giardia intestinalis, Entamoeba histolytica and Cryptosporidium spp. are associated with diarrheal symptoms. In Colombia, there is little region-specific data on the frequency and circulating genotypes/species of these microorganisms. Therefore, the main objective of our study was to employ molecular detection and genotyping of G. intestinalis and Blastocystis, Cryptosporidium and Entamoeba spp. in samples from different biogeographical regions of Colombia. Methods We collected 649 human fecal samples from five biogeographical regions of Colombia: the Amazon, Andean, Caribbean, Orinoco and Pacific regions. Blastocystis, G. intestinalis, Cryptosporidium spp. and Entamoeba complex were detected by microscopy and conventional PCR. Molecular genotyping was conducted to identify Blastocystis subtypes (STs) (18s), G. intestinalis assemblages (triose phosphate isomerase and glutamate dehydrogenase) and Cryptosporidium species (18s). Genetic diversity indices were determined using dnasp.5. Results We detected G. intestinalis in 45.4% (n = 280) of samples, Blastocystis in 54.5% (n = 336) of samples, Cryptosporidium spp. in 7.3% (n = 45) of samples, Entamoeba dispar in 1.5% (n = 9) of samples, and Entamoeba moshkovskii in 0.32% (n = 2) of samples. Blastocystis STs 1–4, 8 and 9 and G. intestinalis assemblages AII, BIII, BIV, D and G were identified. The following Cryptosporidium species were identified: C. hominis, C. parvum, C. bovis, C. andersoni, C. muris, C. ubiquitum and C. felis. The Caribbean region had the highest frequency for each of the microorganisms evaluated (91.9% for G. duodenalis, 97.3% for Blastocystis, 10.8% for Cryptosporidium spp., 13.5% for E. dispar and 2.7% for E. moshkovskii). The Orinoco region had a high frequency of Blastocystis (97.2%) and the Andean region had a high frequency of G. intestinalis (69.4%). High and active transmission was apparent in several regions of the country, implying that mechanisms for prevention and control of intestinal parasitosis in different parts of the country must be improved.
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Affiliation(s)
- Adriana Higuera
- Grupo de Investigaciones Microbiológicas-UR (GIMUR), Departamento de Biología, Facultad de Ciencias Naturales, Universidad del Rosario, Bogota, Colombia
| | - Ximena Villamizar
- Grupo de Investigaciones Microbiológicas-UR (GIMUR), Departamento de Biología, Facultad de Ciencias Naturales, Universidad del Rosario, Bogota, Colombia
| | - Giovanny Herrera
- Grupo de Investigaciones Microbiológicas-UR (GIMUR), Departamento de Biología, Facultad de Ciencias Naturales, Universidad del Rosario, Bogota, Colombia
| | | | - Luis Reinel Vasquez-A
- Centro de Estudios en Microbiología y Parasitología (CEMPA), Departamento de Medicina Interna, Facultad de Ciencias de la Salud, Universidad del Cauca, Popayan, Colombia
| | - Plutarco Urbano
- Grupo de Investigaciones Biológicas de la Orinoquia, Unitrópico, Yopal, Colombia
| | - Oswaldo Villalobos
- Hospital Local Santa María de Mompox, Programas Especiales (Lepra y TB), Mompox, Bolivar, Colombia
| | - Catalina Tovar
- Grupo de Enfermedades Tropicales y Resistencia Bacteriana, Universidad del Sinú, Monteria, Colombia
| | - Juan David Ramírez
- Grupo de Investigaciones Microbiológicas-UR (GIMUR), Departamento de Biología, Facultad de Ciencias Naturales, Universidad del Rosario, Bogota, Colombia
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Bautista M, Bonatti TR, Fiuza VRDS, Terashima A, Canales-Ramos M, José J, Franco RMB. Occurrence and molecular characterization of Giardia duodenalis cysts and Cryptosporidium oocysts in raw water samples from the Rímac River, Peru. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2018; 25:11454-11467. [PMID: 29423699 DOI: 10.1007/s11356-018-1423-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 01/29/2018] [Indexed: 06/08/2023]
Abstract
Giardia and Cryptosporidium are potentially pathogenic protozoa which are ubiquitous in ambient surface water. The present study included 60 samples of surface water from three sampling sites from the Rímac River, Lima and Callao, Peru, to detect the occurrence of Giardia spp. and Cryptosporidium spp. and to perform molecular characterization of specimens found. Water samples were concentrated using the membrane filtration technique, and following elution, cysts and oocysts were visualized by direct immunofluorescence assay (IFA). For molecular characterization, tpi and bg gene fragments and 18S rRNA were amplified by nested PCR for Giardia and Cryptosporidium, respectively, followed by sequencing and phylogenetic analysis. Giardia cysts were found in 93.3% of the analyzed samples, whereas Cryptosporidium oocysts were detected in 15%. The positivity of the Giardia cysts was 86.6% (n = 26) in 2014, while Cryptosporidium oocysts were not detected. In 2015, both protozoa were found in raw water samples, with all 30 samples collected positive for Giardia cysts (100.0%) and 9 positive for Cryptosporidium oocysts (30.0%). Oocysts were detected in 20.0% of water samples from sites 1 (mean 5.25 oocysts/L) and 2 (mean 52.3 oocysts/L), while at site 3, oocysts were detected in 50.0% of raw water samples (mean 193.6 oocysts/L). The presence of Giardia duodenalis assemblage A was confirmed in several samples by the phylogenetic positioning of the bg and tpi genes, and the sub-assemblage AII was predominant (8/9). Sequencing for Cryptosporidium resulted in profiles compatible with Cryptosporidium hominis, Cryptosporidium meleagridis, and Cryptosporidium baileyi. This is the first time that the presence of G. duodenalis assemblage A/sub-assemblage AII and Cryptosporidium species has been reported in surface water samples in Peru. These Cryptosporidium species and the Giardia duodenalis assemblage are associated with human disease which highlights the potential risk to public health and the need to increase environmental monitoring measures to protect this water body.
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Affiliation(s)
- Meylin Bautista
- Post-Graduate Program in Animal Biology, Biology Institute, UNICAMP, Campinas, SP, Brazil
| | - Taís Rondello Bonatti
- Post-Graduate Program in Animal Biology, Biology Institute, UNICAMP, Campinas, SP, Brazil
| | - Vagner Ricardo da S Fiuza
- Oxidative Processes Laboratory, School of Civil Engineering, Architecture and Urban Design, UNICAMP, Campinas, SP, Brazil
| | - Angelica Terashima
- Parasitology Laboratory, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Marco Canales-Ramos
- Parasitology Laboratory, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Juliana José
- Laboratory of Genomics and Expression (LGE), Genetics, Evolution, Microbiology and Immunology Department, Biology Institute, UNICAMP, Campinas, SP, Brazil
| | - Regina Maura Bueno Franco
- Protozoology Laboratory, Animal Biology Department, Biology Institute, Universidade Estadual de Campinas, UNICAMP, Rua Monteiro Lobato, n° 255, Campinas, SP, Brazil.
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Daniels ME, Smith WA, Jenkins MW. Estimating Cryptosporidium and Giardia disease burdens for children drinking untreated groundwater in a rural population in India. PLoS Negl Trop Dis 2018; 12:e0006231. [PMID: 29377884 PMCID: PMC5805363 DOI: 10.1371/journal.pntd.0006231] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 02/08/2018] [Accepted: 01/10/2018] [Indexed: 01/26/2023] Open
Abstract
Background In many low-income settings, despite improvements in sanitation and hygiene, groundwater sources used for drinking may be contaminated with enteric pathogens such as Cryptosporidium and Giardia, which remain important causes of childhood morbidity. In this study, we examined the contribution of diarrhea caused by Cryptosporidium and Giardia found in groundwater sources used for drinking to the total burden of diarrheal disease among children < 5 in rural India. Methodology/Principal findings We studied a population of 3,385 children < 5 years of age in 100 communities of Puri District, Odisha, India. We developed a coupled quantitative microbial risk assessment (QMRA) and susceptible-infected-recovered (SIR) population model based on observed levels of Cryptosporidium and Giardia in improved groundwater sources used for drinking and compared the QMRA-SIR estimates with independently measured all-cause (i.e., all fecal-oral enteric pathogens and exposure pathways) child diarrhea prevalence rates observed in the study population during two monsoon seasons (2012 and 2013). We used site specific and regional studies to inform assumptions about the human pathogenicity of the Cryptosporidium and Giardia species present in local groundwater. In all three human pathogenicity scenarios evaluated, the mean daily risk of Cryptosporidium or Giardia infection (0.06–1.53%), far exceeded the tolerable daily risk of infection from drinking water in the US (< 0.0001%). Depending on which protozoa species were present, median estimates of daily child diarrhea prevalence due to either Cryptosporidium or Giardia infection from drinking water was as high as 6.5% or as low as < 1% and accounted for at least 2.9% and as much as 65.8% of the all-cause diarrhea disease burden measured in children < 5 during the study period. Cryptosporidium tended to account for a greater share of estimated waterborne protozoa infections causing diarrhea than did Giardia. Diarrhea prevalence estimates for waterborne Cryptosporidium infection appeared to be most sensitive to assumptions about the probability of infection from ingesting a single parasite (i.e. the rate parameter in dose-response model), while Giardia infection was most sensitive to assumptions about the viability of parasites detected in groundwater samples. Conclusions/Significance Protozoa in groundwater drinking sources in rural India, even at low concentrations, especially for Cryptosporidium, may account for a significant portion of child diarrhea morbidity in settings were tubewells are used for drinking water and should be more systematically monitored. Preventing diarrheal disease burdens in Puri District and similar settings will benefit from ensuring water is microbiologically safe for consumption and consistent and effective household water treatment is practiced. Water, sanitation, and hygiene (WASH) interventions aimed at reducing exposure to enteric pathogens have produced mixed health impacts, with some interventions finding no significant difference in health outcomes between intervention and control groups. While there are many explanations why individual WASH interventions may not achieve improved health outcomes, one reason is an incomplete understanding of the conditions that favor perpetuation and transmission of enteric pathogens in a given population and region. In this study, we developed a set of diarrhea-causing disease transmission models using measurements of drinking water contamination and child diarrhea over the same time period in the same study population. Using the disease transmission models, we examined how much of the observed diarrhea in children was due to waterborne transmission of enteric pathogens in a program in rural India that improved household sanitation but failed to produce improvements in child health. We focused on the role of two enteric protozoal pathogens, Cryptosporidium and Giardia, and diarrhea rates among children < 5 years of age in these communities. We found that Cryptosporidium and Giardia infections from drinking water contaminated with these enteric protozoa may have together caused as much as 65.8% (IQR 63.4–68.2%) or as little as 2.9% (IQR 2.3–3.4%) of the observed diarrhea in children depending on modeling assumptions about which protozoa species were present. These findings suggest implementing a single barrier, such as only sanitation, to disrupt the multiple pathways of fecal-oral transmission of enteric pathogens, rather than multiple barriers, such as sanitation and safe drinking water, may lead some interventions to fall short of achieving measurable health improvements. Finally, our research suggests that Cryptosporidium and Giardia may cause significant amounts of child diarrhea morbidity even at low levels of concentration when present in improved drinking water sources and their measurement should be including in community drinking water quality monitoring programs.
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Affiliation(s)
- Miles E. Daniels
- Department of Veterinary Medicine and Epidemiology, School of Veterinary Medicine, University of California at Davis, Davis, California United States of America
- Department of Institute of Marine Sciences, University of California at Santa Cruz, Santa Cruz, California, United States of America, Affiliated with: Fisheries Ecology Division, Southwest Fisheries Science Center, National Marine Fisheries Service, National Oceanic and Atmospheric Administration, Santa Cruz, California, United States of America
- * E-mail:
| | - Woutrina A. Smith
- Department of Veterinary Medicine and Epidemiology, School of Veterinary Medicine, University of California at Davis, Davis, California United States of America
| | - Marion W. Jenkins
- Department of Civil and Environmental Engineering, University of California at Davis, Davis, California, United States of America
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Cacciò SM, Lalle M, Svärd SG. Host specificity in the Giardia duodenalis species complex. INFECTION GENETICS AND EVOLUTION 2017; 66:335-345. [PMID: 29225147 DOI: 10.1016/j.meegid.2017.12.001] [Citation(s) in RCA: 122] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 12/01/2017] [Accepted: 12/02/2017] [Indexed: 12/15/2022]
Abstract
Giardia duodenalis is a unicellular flagellated parasite that infects the gastrointestinal tract of a wide range of mammalian species, including humans. Investigations of protein and DNA polymorphisms revealed that G. duodenalis should be considered as a species complex, whose members, despite being morphologically indistinguishable, can be classified into eight groups, or Assemblages, separated by large genetic distances. Assemblages display various degree of host specificity, with Assemblages A and B occurring in humans and many other hosts, Assemblage C and D in canids, Assemblage E in hoofed animals, Assemblage F in cats, Assemblage G in rodents, and Assemblage H in pinnipeds. The factors determining host specificity are only partially understood, and clearly involve both the host and the parasite. Here, we review the results of in vitro and in vivo experiments, and clinical observations to highlight relevant biological and genetic differences between Assemblages, with a focus on human infection.
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Affiliation(s)
- Simone M Cacciò
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy.
| | - Marco Lalle
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Staffan G Svärd
- Department of Cell and Molecular Biology, Uppsala University, Uppsala, Sweden
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Xiao L, Feng Y. Molecular epidemiologic tools for waterborne pathogens Cryptosporidium spp. and Giardia duodenalis. Food Waterborne Parasitol 2017; 8-9:14-32. [PMID: 32095639 PMCID: PMC7034008 DOI: 10.1016/j.fawpar.2017.09.002] [Citation(s) in RCA: 142] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/19/2017] [Accepted: 09/19/2017] [Indexed: 01/26/2023] Open
Abstract
Molecular diagnostic tools have played an important role in improving our understanding of the transmission of Cryptosporidium spp. and Giardia duodenalis, which are two of the most important waterborne parasites in industrialized nations. Genotyping tools are frequently used in the identification of host-adapted Cryptosporidium species and G. duodenalis assemblages, allowing the assessment of infection sources in humans and public health potential of parasites found in animals and the environment. In contrast, subtyping tools are more often used in case linkages, advanced tracking of infections sources, and assessment of disease burdens attributable to anthroponotic and zoonotic transmission. More recently, multilocus typing tools have been developed for population genetic characterizations of transmission dynamics and delineation of mechanisms for the emergence of virulent subtypes. With the recent development in next generation sequencing techniques, whole genome sequencing and comparative genomic analysis are increasingly used in characterizing Cryptosporidium spp. and G. duodenalis. The use of these tools in epidemiologic studies has identified significant differences in the transmission of Cryptosporidium spp. in humans between developing countries and industrialized nations, especially the role of zoonotic transmission in human infection. Geographic differences are also present in the distribution of G. duodenalis assemblages A and B in humans. In contrast, there is little evidence for widespread zoonotic transmission of giardiasis in both developing and industrialized countries. Differences in virulence have been identified among Cryptosporidium species and subtypes, and possibly between G. duodenalis assemblages A and B, and genetic recombination has been identified as one mechanism for the emergence of virulent C. hominis subtypes. These recent advances are providing insight into the epidemiology of waterborne protozoan parasites in both developing and developed countries.
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Affiliation(s)
- Lihua Xiao
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Yaoyu Feng
- College of Veterinary Medicine, South China Agricultural University, Guangzhou 510642, China
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Grothen DC, Zach SJ, Davis PH. Detection of Intestinal Pathogens in River, Shore, and Drinking Water in Lima, Peru. J Genomics 2017; 5:4-11. [PMID: 28138344 PMCID: PMC5278651 DOI: 10.7150/jgen.18378] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Water quality management is an ongoing struggle for many locations worldwide. Current testing of water supplies can be time-consuming, expensive, and lack sensitivity. This study describes an alternative, easy-to-use, and inexpensive method to water sampling and testing at remote locations. This method was employed to detect a number of intestinal pathogens in various locations of Lima, Peru. A total of 34 PCR primer pairs were tested for specificity and high-yield amplification for 12 different pathogens using known DNA templates. Select primers for each pathogen were then tested for minimum detection limits of DNA. Water samples were collected from 22 locations. PCR was used to detect the presence of a pathogen, virulence factors, or differentiate between pathogenic species. In 22 water samples, cholera toxin gene was detected in 4.5% of samples, C. perfringens DNA was detected in 50% of samples, E. histolytica DNA was detected in 54.5% of samples, Giardia intestinalis DNA was detected in 4.5% of samples, Leptospira spp. DNA was detected in 29% of samples, and T. gondii DNA was detected in 31.8% of samples. DNA from three pathogens, C. perfringens, E. histolytica, and T. gondii, were found in residential samples, which accounted for 10 out of 22 samples.
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Affiliation(s)
- David C Grothen
- Department of Biology, University of Nebraska at Omaha, Omaha NE 68182-0040
| | - Sydney J Zach
- Department of Biology, University of Nebraska at Omaha, Omaha NE 68182-0040
| | - Paul H Davis
- Department of Biology, University of Nebraska at Omaha, Omaha NE 68182-0040
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14
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Hussein EM, Ismail OA, Mokhtar AB, Mohamed SE, Saad RM. Nested PCR targeting intergenic spacer (IGS) in genotyping of Giardia duodenalis isolated from symptomatic and asymptomatic infected Egyptian school children. Parasitol Res 2016; 116:763-771. [PMID: 27975120 DOI: 10.1007/s00436-016-5347-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 12/07/2016] [Indexed: 11/30/2022]
Abstract
Distinct sequences of Giardia duodenalis assemblages raised the hypothesis that certain assemblages may contribute to its clinical outcome. However, sequences analysis is time consuming, expensive, and needs many manual operations. Nested PCR targeting intergenic spacer (IGS) region was applied successfully to genotype G. duodenalis. This study aimed to identify the prevalence of G. duodenalis assemblages among giardiasis school children and its relation to the presence of symptoms using nested IGS/PCR. Of 65 microscopically confirmed Giardia-positive samples, 65 samples were genotyped proving high sensitivity (92.3%) of IGS/PCR. Negative IGS/PCR samples were also negative for β-giardin gene. Subassemblage AI was the commonest with 66.6% (20/30) among asymptomatic children compared to 53.3% (16/30) of symptomatic, while assemblage B was found in 40% (12/30) of symptomatic compared to 20% (6/30) of asymptomatic. The difference was significant. AII was only found in asymptomatic with 13.4% (4/30), while mixed infections (AI&B) were recorded only in 6.6% (2/30) of symptomatic group. A significant relation was found between younger children susceptibility for AI and B infections as presented in 77.7 (12/16) and 83.3% (10/12) of symptomatic, respectively, and 80 (16/80) and 33.4% (2/4) of asymptomatic, respectively. Significant relations were found between AI with intermittent diarrhea and B with chronic. A significant relation was found between assemblage distributions and heavy infection intensity. In conclusion, higher incidence of assemblage B among symptomatic children compared to asymptomatic could denote its possible pathogenic potential.
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Affiliation(s)
- Eman M Hussein
- Medical Parasitology Department, Faculty of Medicine, Suez Canal University, Ismailia, 41522, Egypt.
| | - Ola A Ismail
- Medical Parasitology Department, Faculty of Medicine, Suez Canal University, Ismailia, 41522, Egypt
| | - Amira B Mokhtar
- Medical Parasitology Department, Faculty of Medicine, Suez Canal University, Ismailia, 41522, Egypt
| | - Samer E Mohamed
- Medical Parasitology Department, Faculty of Medicine, Suez Canal University, Ismailia, 41522, Egypt
| | - Rania M Saad
- Medical Parasitology Department, Faculty of Medicine, Suez Canal University, Ismailia, 41522, Egypt
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15
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Ulloa-Stanojlović FM, Aguiar B, Jara LM, Sato MIZ, Guerrero JA, Hachich E, Matté GR, Dropa M, Matté MH, de Araújo RS. Occurrence of Giardia intestinalis and Cryptosporidium sp. in wastewater samples from São Paulo State, Brazil, and Lima, Peru. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2016; 23:22197-22205. [PMID: 27638793 DOI: 10.1007/s11356-016-7537-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 08/26/2016] [Indexed: 06/06/2023]
Abstract
The objectives of the study were to detect and genotype Cryptosporidium spp. and Giardia intestinalis in wastewater samples obtained from five cities with high transit of people in the State of São Paulo, Brazil, and at the entrance of a Wastewater Treatment Plant (WWTP) in Lima, Peru. Samples were collected and concentrated by centrifugation. The genomic DNA was extracted for molecular characterization by nested PCR for Cryptosporidium and double nested PCR for Giardia, followed by sequencing and phylogenetic analysis. G. intestinalis was found in 63.6 % of the samples, and the human assemblages A and B were identified. Cryptosporidium sp. was found in 36.4 % of the samples, and the species were corresponding to Cryptosporidium hominis, Cryptosporidium cuniculus, and Cryptosporidium muris. Results revealed the presence of human pathogenic Cryptosporidium species and G. intestinalis human pathogenic assemblages. Molecular tools highlight the importance to map the genetic diversity of these parasites, as well as to detect their epidemiological circulation pathway in the environment.
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Affiliation(s)
| | - Bruna Aguiar
- School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Luis M Jara
- Facultad de Medicina Veterinaria y Zootecnia, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | | | - Elayse Hachich
- Companhia Ambiental do Estado de São Paulo-CETESB, São Paulo, Brazil
| | | | - Milena Dropa
- School of Public Health, University of São Paulo, São Paulo, Brazil
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Wegayehu T, Karim MR, Li J, Adamu H, Erko B, Zhang L, Tilahun G. Multilocus genotyping of Giardia duodenalis isolates from children in Oromia Special Zone, central Ethiopia. BMC Microbiol 2016; 16:89. [PMID: 27209324 PMCID: PMC4875739 DOI: 10.1186/s12866-016-0706-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 05/12/2016] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Giardia duodenalis is the etiologic agent of giardiasis in humans and other mammals worldwide. The burden of disease is high among children in developing countries where sanitation is inadequate. However, the epidemiology and genetic diversity of this parasite is poorly understood in Ethiopia. This study aimed to determine the prevalence and genetic diversity of G. duodenalis in asymptomatic children in Oromia Special Zone, central Ethiopia. RESULTS A total of 286 fresh fecal specimens were collected from children and screened using microscopy and PCR. The prevalence of Giardia duodenalis was 10.8 % (31/286) and 16.8 % (48/286) as detected by microscopy and nested PCR, respectively. The infection rate by the study area, sex and age group difference was not significant (P > 0.05). Genotyping results showed that 22.9 % (11/48) of the isolates belonged to assemblage A while 77.1 % (37/48) belonged to assemblage B. Although double peaks were observed at the chromatogram level, no mixed assemblage or sub-assemblage infections were demonstrated. Isolates of assemblage A mostly belonged to the sub-assemblage AII and showed similarity with previously described isolates. However, there was great genetic variability within assemblage B that showed heterogeneous nucleotide positions. Fifteen of them were new genotypes: 5 at the triose phosphate isomerase (tpi), 2 at the β-giardin (bg), and 8 at the glutamate dehydrogenase (gdh) genes. CONCLUSIONS Giardia duodenalis mainly assemblage B infection was predominant among the asymptomatic children in the study area. The high polymorphism found in isolates of assemblage B warrants a more defining tool to discriminate assemblage B at the sub-assemblage level. The findings of the present study indicate that there is a need to carry out national screening programs aiming to detect asymptomatic infections to minimize the reservoir of the disease.
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Affiliation(s)
- Teklu Wegayehu
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia. .,College of Natural Sciences, Arba Minch University, Arba Minch, Ethiopia.
| | - Md Robiul Karim
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China.,College of Animal Sciences and Veterinary Medicine, Henan Agricultural University, Zhengzhou, Henan, China
| | - Junqiang Li
- College of Animal Sciences and Veterinary Medicine, Henan Agricultural University, Zhengzhou, Henan, China
| | - Haileeyesus Adamu
- Institute of Biotechnology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Berhanu Erko
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Longxian Zhang
- College of Animal Sciences and Veterinary Medicine, Henan Agricultural University, Zhengzhou, Henan, China
| | - Getachew Tilahun
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
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Giardia duodenalis in Damascus, Syria: Identification of Giardia genotypes in a sample of human fecal isolates using polymerase chain reaction and restriction fragment length polymorphism analyzing method. Acta Trop 2016; 154:1-5. [PMID: 26524628 DOI: 10.1016/j.actatropica.2015.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 10/06/2015] [Accepted: 10/12/2015] [Indexed: 11/22/2022]
Abstract
Giardia duodenalis is a common gastrointestinal parasite that infects humans and many other mammals. It is most prevalent in many developing and industrialized countries. G. duodenalis is considered to be a complex species. While no morphological distinction among different assemblages exist, it can be genetically differentiated into eight major assemblages: A to H. The aim of this study was to determine the genetic heterogeneity of G. duodenalis in human isolates (a study conducted for the first time in Syria). 40 fecal samples were collected from three different hospitals during the hot summer season of 2014. Extraction of genomic DNA from all Giardia positive samples (based on a microscopic examination) was performed using QIAamp DNA Stool Mini Kit. β-giardin gene was used to differentiate between different Giardia assemblages. The 514 bp fragment was amplified using the Polymerase Chain Reaction method, followed by digestion in HaeIII restriction enzyme. Our result showed that genotype A was more frequent than genotype B, 27/40 (67.5%); 4/40 (10%) respectively. A mixed genotype of A+B was only detected in 9 isolates (22.5%). This is the first molecular study performed on G. duodenalis isolates in Syria in order to discriminate among the different genotypes. Further expanded studies using more genes are needed to detect and identify the Giardia parasite at the level of assemblage and sub-assemblage.
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18
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Predominance of Giardia lamblia assemblage A among iron deficiency anaemic pre-school Egyptian children. Parasitol Res 2016; 115:1537-45. [PMID: 26758448 DOI: 10.1007/s00436-015-4888-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 12/11/2015] [Indexed: 10/22/2022]
Abstract
Intestinal parasites and nutritional deficiency can coexist and influence each other. This study aimed to clarify the association between Giardia genotypes and presence of iron deficiency anaemia (IDA) among pre-school Egyptian children. Two groups (IDA and non-anaemic) of giardiasis children (44/group) were selected according to their recovery response after treatment of giardiasis. Each group included 24 and 20 gastrointestinal symptomatic and asymptomatic, respectively. Giardia human genotypes were performed by intergenic spacer (IGS) gene based polymerase chain reaction (PCR) with high-resolution melting curve (HRM). PCR/HRM proved that Tms of assemblage A and B ranged from 79.31 ± 0.29 to 84.77 ± 0.31. In IDA patients, assemblages A and B were found among 40/44 (90.9 %) and 4/44 (9.1 %), respectively, while in non-anaemic patients, assemblages A and B were found in 10/44 (22.7 %) and 32/44 (72.7 %), respectively, beside two (4.6 %) cases had mixed infection. The difference was statistically significant. No significant relation was found between symptomatic or asymptomatic assemblages and IDA as assemblage A was found in 21/24 (87.5 %) and 19/20 (95 %) of symptomatic and asymptomatic, respectively, while 3/24 (12.5 %) and 1/20 (5 %) of assemblage B were symptomatic was asymptomatic, respectively. A significant relation was found between assemblage A subtypes distribution among IDA patients as AI and AII were detected on 23 (52.3 %) and 16 (36.4 %) of patients, respectively, while one case (2.3 %) had mixed infection. In conclusion, assemblage A is predominant among IDA giardiasis children suggesting its role in enhancing the occurrence of IDA while B has a protective role.
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El Fatni C, Olmo F, El Fatni H, Romero D, Rosales MJ. First genotyping of Giardia duodenalis and prevalence of enteroparasites in children from Tetouan (Morocco). Parasite 2014; 21:48. [PMID: 25259605 PMCID: PMC4176428 DOI: 10.1051/parasite/2014049] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 09/17/2014] [Indexed: 11/21/2022] Open
Abstract
Intestinal parasites are common in the Moroccan population. Enteroparasites in children from four schools in urban and rural areas of Tetouan (Morocco) were studied to treat these children and to design prevention and control programs. A total of 673 children were examined. The prevalence of parasitized children was 51%. The average number of enteroparasites was half in urban areas than in rural areas. Multiple parasitism appeared in 30% of the samples presenting two, three, or four parasites. The most prevalent parasite was Blastocystis hominis (64%). Giardia duodenalis was the most frequent pathogen, with an overall prevalence of 20% (24% in rural areas and 16% in urban areas). Other pathogenic enteroparasites were Cyclospora cayetanensis (5% in rural and urban areas), Iodamoeba butschlii, Hymenolepis spp., Trichuris trichiura and Enterobius vermicularis, with prevalence lower than 2%. In this work, G. duodenalis genotypes were molecularly characterized by a study of the glutamate dehydrogenase (gdh) and 18S rRNA genes. This is the first study of molecular characterization of G. duodenalis in Moroccan children, and the sequence analysis revealed both Assemblage A (AII) and Assemblage B (BIII, BIV), with the predominance of Assemblage BIV (73%).
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Affiliation(s)
- Chadia El Fatni
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Département de Biologie, Faculté des Sciences, Université Abdelmalek Essaâdi Tétouan Morocco
| | - Francisco Olmo
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Departamento de Parasitología, Facultad de Ciencias, Universidad de Granada Spain
| | - Hoummad El Fatni
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Département de Biologie, Faculté des Sciences, Université Abdelmalek Essaâdi Tétouan Morocco
| | - Desiré Romero
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Departamento de Estadística, Facultad de Ciencias, Universidad de Granada Spain
| | - Maria José Rosales
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Departamento de Parasitología, Facultad de Ciencias, Universidad de Granada Spain
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Badparva E, Kheirandish F, Ebrahimzade F. Prevalence of intestinal parasites in Lorestan Province, West of Iran. ASIAN PACIFIC JOURNAL OF TROPICAL DISEASE 2014. [DOI: 10.1016/s2222-1808(14)60716-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Tak V, Mirdha BR, Yadav P, Vyas P, Makharia GK, Bhatnagar S. Molecular characterisation of Giardia intestinalis assemblages from human isolates at a tertiary care centre of India. Indian J Med Microbiol 2014; 32:19-25. [PMID: 24399382 DOI: 10.4103/0255-0857.124290] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
PURPOSE The aim of the study was to determine the genetic heterogeneity of Giardia intestinalis isolates detected in stool samples of the study population using polymerase chain reaction assay and restriction fragment length polymorphism. We also tried to correlate the association/differences between the clinical symptomatology and infection by different assemblages (genotypes) of G. intestinalis. MATERIALS AND METHODS This cross-sectional study was conducted from April 2008 to June 2010. A total of 40 adults (n = 40) and 42 children (n = 42) below the age of 12 years with the clinical suspicion of giardiasis and with the onset of one or more of the following five symptoms, i.e., loose stool, nausea, weight loss, fatigue and foul smelling faeces and confirmed laboratory diagnosis of giardiasis at least once during the current episode of diarrhoea were included in this study. RESULTS Of the 82 patients (males 66) enrolled in the study, 70 (85%) presented with diarrhoea (56 males) and 12 (15%) without diarrhoea (10 males). Out of 70 diarrheic patients, 61 (87%) had chronic diarrhoea, 8 (11.5%) had acute diarrhoea and 1 (1.5%) had persistent diarrhoea. Of the total patients, 63 (77%) were clinically assessed and were apparently immunocompetent, whereas, 19 (23%) immunocompromised patients had different underlying conditions besides giardiasis. Genotyping identified all 82 (100%) isolates as assemblage B. CONCLUSION We found that assemblage B of G. intestinalis presents with all kinds of clinical features ranging from asymptomatic carriage to acute, persistent or chronic diarrhoea.
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Affiliation(s)
| | - B R Mirdha
- Department of Microbiology, AIIMS, New Delhi, India
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Atherton R, Bhavnani D, Calvopiña M, Vicuña Y, Cevallos W, Eisenberg J. Molecular identification of Giardia duodenalis in Ecuador by polymerase chain reaction-restriction fragment length polymorphism. Mem Inst Oswaldo Cruz 2014; 108:512-5. [PMID: 23827993 DOI: 10.1590/s0074-02762013000400019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Accepted: 04/18/2013] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to determine the genetic diversity of Giardia duodenalis present in a human population living in a northern Ecuadorian rain forest. All Giardia positive samples (based on an ELISA assay) were analysed using a semi-nested polymerase chain reaction-restriction fragment length polymorphism assay that targets the glutamate dehydrogenase (gdh) gene; those amplified were subsequently genotyped using NlaIV and RsaI enzymes. The gdh gene was successfully amplified in 74 of 154 ELISA positive samples; 69 of the 74 samples were subsequently genotyped. Of these 69 samples, 42 (61%) were classified as assemblage B (26 as BIII and 16 as BIV), 22 (32%) as assemblage A (3 as AI and 19 as AII) and five (7%) as mixed AII and BIII types. In this study site we observe similar diversity in genotypes to other regions in Latin America, though in contrast to some previous studies, we found similar levels of diarrheal symptoms in those individuals infected with assemblage B compared with those infected with assemblage A.
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Affiliation(s)
- Richard Atherton
- Centro de Biomedicina, Universidad Central del Ecuador, Quito, Pichincha, Ecuador.
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23
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Bailey C, Lopez S, Camero A, Taiquiri C, Arhuay Y, Moore DAJ. Factors associated with parasitic infection amongst street children in orphanages across Lima, Peru. Pathog Glob Health 2013; 107:52-7. [PMID: 23683330 DOI: 10.1179/2047773213y.0000000073] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Infection caused by intestinal parasites has significant public health consequences amongst children in the developing world. Street children are an under-studied group of society subjected to increased health risks when compared to their peers. To estimate the prevalence of intestinal parasitic infection and ascertain risk factors for parasitosis amongst this population, stool samples were collected from 258 children across four orphanages in three districts of Lima, Peru. Surveys were used to determine associations between risk factors and infection status. The prevalence of parasitic infection within the study sample was 66·3%, with 30·6% testing positive for pathogenic species. Entamoeba coli was the most commonly detected parasite (41·9%) and Giardia lamblia was the most commonly detected pathogenic parasite (17·1%). Of the group 15·1% had helminth infection. When testing for association, age and BMI were risk factors for infection. A notable difference in prevalence (P < 0·00001) based on orphanage was observed, but the duration of residence in an orphanage was not a predictor for infection. A sub-analysis conducted amongst children who were given anti-parasitic treatment 5 months beforehand found no significant difference in parasitosis between those who had been given treatment and those who had not (P = 0·218). It is suggested that a single dose of albendazole alone may not be effective in combating long-term infection rates.
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Kuk S, Yazar S, Cetinkaya U. Stool sample storage conditions for the preservation of Giardia intestinalis DNA. Mem Inst Oswaldo Cruz 2013; 107:965-8. [PMID: 23295744 DOI: 10.1590/s0074-02762012000800001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 08/21/2012] [Indexed: 11/22/2022] Open
Abstract
Stool is chemically complex and the extraction of DNA from stool samples is extremely difficult. Haemoglobin breakdown products, such as bilirubin, bile acids and mineral ions, that are present in the stool samples, can inhibit DNA amplification and cause molecular assays to produce false-negative results. Therefore, stool storage conditions are highly important for the diagnosis of intestinal parasites and other microorganisms through molecular approaches. In the current study, stool samples that were positive for Giardia intestinalis were collected from five different patients. Each sample was stored using one out of six different storage conditions [room temperature (RT), +4ºC, -20ºC, 70% alcohol, 10% formaldehyde or 2.5% potassium dichromate] for DNA extraction procedures at one, two, three and four weeks. A modified QIAamp Stool Mini Kit procedure was used to isolate the DNA from stored samples. After DNA isolation, polymerase chain reaction (PCR) amplification was performed using primers that target the β-giardin gene. A G. intestinalis-specific 384 bp band was obtained from all of the cyst-containing stool samples that were stored at RT, +4ºC and -20ºC and in 70% alcohol and 2.5% potassium dichromate; however, this band was not produced by samples that had been stored in 10% formaldehyde. Moreover, for the stool samples containing trophozoites, the same G. intestinalis-specific band was only obtained from the samples that were stored in 2.5% potassium dichromate for up to one month. As a result, it appears evident that the most suitable storage condition for stool samples to permit the isolation of G. intestinalis DNA is in 2.5% potassium dichromate; under these conditions, stool samples may be stored for one month.
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Affiliation(s)
- Salih Kuk
- Department of Parasitology, Medical Faculty, Erciyes University, Kayseri, Turkey
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Enger KS, Nelson KL, Rose JB, Eisenberg JNS. The joint effects of efficacy and compliance: a study of household water treatment effectiveness against childhood diarrhea. WATER RESEARCH 2013; 47:1181-90. [PMID: 23290123 DOI: 10.1016/j.watres.2012.11.034] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 10/26/2012] [Accepted: 11/21/2012] [Indexed: 05/04/2023]
Abstract
The effectiveness of household water treatment (HWT) at reducing diarrheal disease is related to the efficacy of the HWT method at removing pathogens, how people comply with HWT, and the relative contributions of other pathogen exposure routes. We define compliance with HWT as the proportion of drinking water treated by a community. Although many HWT methods are efficacious at removing or inactivating pathogens, their effectiveness within actual communities is decreased by imperfect compliance. However, the quantitative relationship between compliance and effectiveness is poorly understood. To assess the effectiveness of HWT on childhood diarrhea incidence via drinking water for three pathogen types (bacterial, viral, and protozoan), we developed a quantitative microbial risk assessment (QMRA) model. We examined the relationship between log(10) removal values (LRVs) and compliance with HWT for scenarios varying by: baseline incidence of diarrhea; etiologic fraction of diarrhea by pathogen type; pattern of compliance within a community; and size of contamination spikes in source water. Benefits from increasing LRVs strongly depend on compliance. For perfect compliance, diarrheal incidence decreases as LRVs increase. However, if compliance is incomplete, there are diminishing returns from increasing LRVs in most of the scenarios we considered. Higher LRVs are more beneficial if: contamination spikes are large; contamination levels are generally high; or some people comply perfectly. The effectiveness of HWT interventions at the community level may be limited by imperfect compliance, such that the benefits of high LRVs are not realized. Compliance with HWT should be carefully measured during HWT field studies and HWT dissemination programs. Studies of pathogen concentrations in a variety of developing-country source waters are also needed. Guidelines are needed for measuring and promoting compliance with HWT.
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Affiliation(s)
- Kyle S Enger
- Department of Fisheries and Wildlife, 13 Natural Resources Building, Michigan State University, East Lansing, MI 48824, USA
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Ignatius R, Gahutu JB, Klotz C, Steininger C, Shyirambere C, Lyng M, Musemakweri A, Aebischer T, Martus P, Harms G, Mockenhaupt FP. High prevalence of Giardia duodenalis Assemblage B infection and association with underweight in Rwandan children. PLoS Negl Trop Dis 2012; 6:e1677. [PMID: 22720102 PMCID: PMC3373622 DOI: 10.1371/journal.pntd.0001677] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 04/24/2012] [Indexed: 01/25/2023] Open
Abstract
Background Giardia duodenalis is highly endemic in East Africa but its effects on child health, particularly of submicroscopic infections, i.e., those below the threshold of microscopy, and of genetic subgroups (assemblages), are not well understood. We aimed at addressing these questions and at examining epidemiological characteristics of G. duodenalis in southern highland Rwanda. Methodology/Principal Findings In 583 children <5 years of age from communities and health facilities, intestinal parasites were assessed by triplicate light microscopy and by PCR assays, and G. duodenalis assemblages were genotyped. Cluster effects of villages were taken into account in statistical analysis. The prevalence of G. duodenalis as detected by microscopy was 19.8% but 60.1% including PCR results. Prevalence differed with residence, increased with age, and was reduced by breastfeeding. In 492 community children without, with submicroscopic and with microscopic infection, underweight (weight-for-age z-score <−2 standard deviations) was observed in 19.7%, 22.1%, and 33.1%, respectively, and clinically assessed severe malnutrition in 4.5%, 9.5%, and 16.7%. Multivariate analysis identified microscopically detectable G. duodenalis infection as an independent predictor of underweight and clinically assessed severe malnutrition. Submicroscopic infection showed respective trends. Overall, G. duodenalis was not associated with gastrointestinal symptoms but assemblages A parasites (proportion, 13%) were increased among children with vomiting and abdominal pain. Conclusions/Significance The prevalence of G. duodenalis in high-endemicity areas may be greatly underestimated by light microscopy, particularly when only single stool samples are analysed. Children with submicroscopic infections show limited overt manifestation, but constitute unrecognized reservoirs of transmission. The predominance of assemblage B in Rwanda may be involved in the seemingly unimposing manifestation of G. duodenalis infection. However, the association with impaired child growth points to its actual relevance. Longitudinal studies considering abundant submicroscopic infections are needed to clarify the actual contribution of G. duodenalis to morbidity in areas of high endemicity. Giardia duodenalis is a protozoan parasite causing gastroenteritis. Although the parasite occurs worldwide, its regional prevalence varies considerably. Using PCR as a highly sensitive molecular diagnostic tool, we detected G. duodenalis in 60% of 583 children younger than five years in southern Rwanda. It was by far the most frequent intestinal parasite detected in this population. Importantly, two out of three infections would have been undetected if only the commonly used light microscopy had been applied. Genotyping revealed the presence of two distinct types of parasites, and only the infrequent subtype showed a weak association with gastrointestinal symptoms. However, G. duodenalis infection was associated with underweight and clinically assessed severe malnutrition. The data call for the establishment of more sensitive than light microscopy, yet simple diagnostic tools to identify infected children as well as for the consideration of abundant submicroscopic infections in evaluating the significance of G. duodenalis in high endemicity areas.
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Affiliation(s)
- Ralf Ignatius
- Institute of Tropical Medicine and International Health, Charité – University Medicine Berlin, Berlin, Germany
| | - Jean Bosco Gahutu
- University Teaching Hospital of Butare, Faculty of Medicine, National University of Rwanda, Butare, Rwanda
| | - Christian Klotz
- Robert Koch-Institute, Department of Mycology and Parasitology, Berlin, Germany
| | - Christian Steininger
- Institute of Tropical Medicine and International Health, Charité – University Medicine Berlin, Berlin, Germany
| | - Cyprien Shyirambere
- University Teaching Hospital of Butare, Faculty of Medicine, National University of Rwanda, Butare, Rwanda
| | - Michel Lyng
- Institute of Tropical Medicine and International Health, Charité – University Medicine Berlin, Berlin, Germany
| | - Andre Musemakweri
- University Teaching Hospital of Butare, Faculty of Medicine, National University of Rwanda, Butare, Rwanda
| | - Toni Aebischer
- Robert Koch-Institute, Department of Mycology and Parasitology, Berlin, Germany
| | - Peter Martus
- Institute of Clinical Epidemiology and Applied Biometry, Eberhard Karls University, Tübingen, Germany
| | - Gundel Harms
- Institute of Tropical Medicine and International Health, Charité – University Medicine Berlin, Berlin, Germany
| | - Frank P. Mockenhaupt
- Institute of Tropical Medicine and International Health, Charité – University Medicine Berlin, Berlin, Germany
- * E-mail:
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Ignatius R, Gahutu JB, Klotz C, Steininger C, Shyirambere C, Lyng M, Musemakweri A, Aebischer T, Martus P, Harms G, Mockenhaupt FP. High prevalence of Giardia duodenalis Assemblage B infection and association with underweight in Rwandan children. PLoS Negl Trop Dis 2012. [PMID: 22720102 DOI: 10.137/journal.pntd.0001677.epub] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Giardia duodenalis is highly endemic in East Africa but its effects on child health, particularly of submicroscopic infections, i.e., those below the threshold of microscopy, and of genetic subgroups (assemblages), are not well understood. We aimed at addressing these questions and at examining epidemiological characteristics of G. duodenalis in southern highland Rwanda. METHODOLOGY/PRINCIPAL FINDINGS In 583 children <5 years of age from communities and health facilities, intestinal parasites were assessed by triplicate light microscopy and by PCR assays, and G. duodenalis assemblages were genotyped. Cluster effects of villages were taken into account in statistical analysis. The prevalence of G. duodenalis as detected by microscopy was 19.8% but 60.1% including PCR results. Prevalence differed with residence, increased with age, and was reduced by breastfeeding. In 492 community children without, with submicroscopic and with microscopic infection, underweight (weight-for-age z-score <-2 standard deviations) was observed in 19.7%, 22.1%, and 33.1%, respectively, and clinically assessed severe malnutrition in 4.5%, 9.5%, and 16.7%. Multivariate analysis identified microscopically detectable G. duodenalis infection as an independent predictor of underweight and clinically assessed severe malnutrition. Submicroscopic infection showed respective trends. Overall, G. duodenalis was not associated with gastrointestinal symptoms but assemblages A parasites (proportion, 13%) were increased among children with vomiting and abdominal pain. CONCLUSIONS/SIGNIFICANCE The prevalence of G. duodenalis in high-endemicity areas may be greatly underestimated by light microscopy, particularly when only single stool samples are analysed. Children with submicroscopic infections show limited overt manifestation, but constitute unrecognized reservoirs of transmission. The predominance of assemblage B in Rwanda may be involved in the seemingly unimposing manifestation of G. duodenalis infection. However, the association with impaired child growth points to its actual relevance. Longitudinal studies considering abundant submicroscopic infections are needed to clarify the actual contribution of G. duodenalis to morbidity in areas of high endemicity.
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Affiliation(s)
- Ralf Ignatius
- Institute of Tropical Medicine and International Health, Charité-University Medicine Berlin, Berlin, Germany
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Enger KS, Nelson KL, Clasen T, Rose JB, Eisenberg JNS. Linking quantitative microbial risk assessment and epidemiological data: informing safe drinking water trials in developing countries. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2012; 46:5160-7. [PMID: 22486606 DOI: 10.1021/es204381e] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Intervention trials are used extensively to assess household water treatment (HWT) device efficacy against diarrheal disease in developing countries. Using these data for policy, however, requires addressing issues of generalizability (relevance of one trial in other contexts) and systematic bias associated with design and conduct of a study. To illustrate how quantitative microbial risk assessment (QMRA) can address water safety and health issues, we analyzed a published randomized controlled trial (RCT) of the LifeStraw Family Filter in the Congo. The model accounted for bias due to (1) incomplete compliance with filtration, (2) unexpected antimicrobial activity by the placebo device, and (3) incomplete recall of diarrheal disease. Effectiveness was measured using the longitudinal prevalence ratio (LPR) of reported diarrhea. The Congo RCT observed an LPR of 0.84 (95% CI: 0.61, 1.14). Our model predicted LPRs, assuming a perfect placebo, ranging from 0.50 (2.5-97.5 percentile: 0.33, 0.77) to 0.86 (2.5-97.5 percentile: 0.68, 1.09) for high (but not perfect) and low (but not zero) compliance, respectively. The calibration step provided estimates of the concentrations of three pathogen types (modeled as diarrheagenic E. coli, Giardia, and rotavirus) in drinking water, consistent with the longitudinal prevalence of reported diarrhea measured in the trial, and constrained by epidemiological data from the trial. Use of a QMRA model demonstrated the importance of compliance in HWT efficacy, the need for pathogen data from source waters, the effect of quantifying biases associated with epidemiological data, and the usefulness of generalizing the effectiveness of HWT trials to other contexts.
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Affiliation(s)
- Kyle S Enger
- Department of Fisheries and Wildlife, 13 Natural Resources Building, Michigan State University, East Lansing, Michigan 48824, USA
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Gómez-Couso H, Ortega-Mora LM, Aguado-Martínez A, Rosadio-Alcántara R, Maturrano-Hernández L, Luna-Espinoza L, Zanabria-Huisa V, Pedraza-Díaz S. Presence and molecular characterisation of Giardia and Cryptosporidium in alpacas (Vicugna pacos) from Peru. Vet Parasitol 2012; 187:414-20. [PMID: 22341616 PMCID: PMC7125553 DOI: 10.1016/j.vetpar.2012.01.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 01/13/2012] [Accepted: 01/19/2012] [Indexed: 11/30/2022]
Abstract
The presence of Giardia and Cryptosporidium was investigated in 274 faecal samples of alpacas (Vicugna pacos) from 12 herds from Peru by immunofluorescence microscopy and PCR amplification and sequencing of fragments of the ssu-rRNA and β-giardin genes from Giardia spp., as well as the ssu-rRNA gene from Cryptosporidium spp. A total of 137 samples (50.0%) were positive for Giardia spp., and 12 samples (4.4%) for Cryptosporidium spp. In ten samples (3.6%), co-infection by both pathogens was found. Herd prevalence was found to be 91.7% (11/12 herds) for Giardia and 58.3% (7/12 herds) for Cryptosporidium. Regarding the age of the animals, although Giardia was detected in animals as young as 1 week, the prevalence increased with age, reaching 80% by 8 weeks. Similarly, the highest percentage of Cryptosporidium detection (20%) was also found in the 8 week-old group. By PCR, 92 of the 274 analysed samples were positive for Giardia. Sequencing of the amplicons showed the existence of Giardia duodenalis assemblage A in 67 samples; G. duodenalis assemblage E in 24 samples; and inconsistent results between the two molecular markers used in a further sample. Cryptosporidium was only detected by PCR in 3 of the 274 samples; Cryptosporidium parvum was identified in two samples and Cryptosporidium ubiquitum in one sample. This study is the first performing molecular characterisation of both parasites in Peruvian alpacas, and the first report of C. ubiquitum in this host. The identification of G. duodenalis assemblage A, C. parvum and C. ubiquitum, suggests that zoonotic transmission of these enteropathogens between alpacas and humans is possible.
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Affiliation(s)
- Hipólito Gómez-Couso
- SALUVET, Animal Health Department, Faculty of Veterinary Sciences, Complutense University of Madrid, Ciudad Universitaria s/n, 28040 Madrid, Spain
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Giardiasis: a review on assemblage distribution and epidemiology in India. Indian J Gastroenterol 2012; 31:3-12. [PMID: 22311296 DOI: 10.1007/s12664-012-0161-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Accepted: 01/07/2012] [Indexed: 02/04/2023]
Abstract
Giardiasis is a significant cause of diarrheal disease and associated morbidity in children and adults worldwide. In addition to diarrhea, it can also lead to malnutrition and cognitive deficits in children from developing countries. Giardia duodenalis is considered to be a species complex of several assemblages, of which assemblage A and B are predominantly associated with human infections. Assemblage type has been associated with risk of occurrence of symptoms and duration of illness. Hence genotyping of giardial isolates may help understand better the epidemiology and transmission ecology of the disease in a particular setting or area. In India, prevalence rates of Giardia infection in patients with diarrhea range from 0.4% to 70%, and asymptomatic cyst passage has been found to be as high as 50% in rural southern India. In this review, the global distribution of giardial assemblage, zoonotic transmission and the association of assemblage with disease have been discussed, followed by epidemiology of giardiasis in India.
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Fish as a possible reservoir for zoonotic Giardia duodenalis assemblages. Parasitol Res 2011; 110:2193-6. [DOI: 10.1007/s00436-011-2748-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2011] [Accepted: 11/30/2011] [Indexed: 10/14/2022]
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Molina N, Minvielle M, Grenóvero S, Salomón C, Basualdo J. High prevalences of infection with Giardia intestinalis genotype B among children in urban and rural areas of Argentina. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2011; 105:299-309. [PMID: 21871166 DOI: 10.1179/136485911x12987676649665] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The protozoan parasite most frequently associated with diarrhoea worldwide is Giardia intestinalis. In 2005, a study was initiated to identify the genotypes of this parasite infecting children in the Argentinian provinces of Buenos Aires, Mendoza and Chaco, and to explore the associations between the genotype detected in a child, the characteristics of the child's household and the child's clinical presentation. Overall, 998 children (504 boys and 494 girls) aged between 2-14 years, with or without symptoms, were enrolled. The G. intestinalis in 94 of the 117 stool samples found positive for the parasite by microscopy were successfully genotyped by PCR. Seventy-seven of the children were found to be infected with genotype B only and 14 with genotype AII only, three children being found to have mixed (AII and B) infections. Only genotype B was detected in children from rural areas (P<0·05) and most Giardia detected in children from households with a piped water supply were also of this genotype (P<0·05). The other household characteristics investigated (quality of building, history of flooding, type of sanitation, level of overcrowding, and presence/absence of pet dogs) had no significant effect on the genotype distribution. Children infected with genotype AII were significantly younger than those infected with genotype B (P<0·05) and there was a significant positive association between infection with genotype B and abdominal pain (P<0·05). Diarrhoea was not, however, found to be significantly associated with genotype-AII or genotype-B infection. This is the first published report on the Giardia genotypes circulating in the provinces of Mendoza and Chaco. The results indicate the importance of asymptomatic children in the transmission of Giardia among the young.
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Affiliation(s)
- N Molina
- Cátedra de Microbiología y Parasitología, Universidad Nacionalde La Plata, Buenos Aires, Argentina.
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Zoonotic potential and molecular epidemiology of Giardia species and giardiasis. Clin Microbiol Rev 2011; 24:110-40. [PMID: 21233509 DOI: 10.1128/cmr.00033-10] [Citation(s) in RCA: 780] [Impact Index Per Article: 60.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Molecular diagnostic tools have been used recently in assessing the taxonomy, zoonotic potential, and transmission of Giardia species and giardiasis in humans and animals. The results of these studies have firmly established giardiasis as a zoonotic disease, although host adaptation at the genotype and subtype levels has reduced the likelihood of zoonotic transmission. These studies have also identified variations in the distribution of Giardia duodenalis genotypes among geographic areas and between domestic and wild ruminants and differences in clinical manifestations and outbreak potentials of assemblages A and B. Nevertheless, our efforts in characterizing the molecular epidemiology of giardiasis and the roles of various animals in the transmission of human giardiasis are compromised by the lack of case-control and longitudinal cohort studies and the sampling and testing of humans and animals living in the same community, the frequent occurrence of infections with mixed genotypes and subtypes, and the apparent heterozygosity at some genetic loci for some G. duodenalis genotypes. With the increased usage of multilocus genotyping tools, the development of next-generation subtyping tools, the integration of molecular analysis in epidemiological studies, and an improved understanding of the population genetics of G. duodenalis in humans and animals, we should soon have a better appreciation of the molecular epidemiology of giardiasis, the disease burden of zoonotic transmission, the taxonomy status and virulences of various G. duodenalis genotypes, and the ecology of environmental contamination.
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Kowalewski MM, Salzer JS, Deutsch JC, Raño M, Kuhlenschmidt MS, Gillespie TR. Black and gold howler monkeys (Alouatta caraya) as sentinels of ecosystem health: patterns of zoonotic protozoa infection relative to degree of human-primate contact. Am J Primatol 2010; 73:75-83. [DOI: 10.1002/ajp.20803] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Chacín-Bonilla L. Epidemiology of Cyclospora cayetanensis: A review focusing in endemic areas. Acta Trop 2010; 115:181-93. [PMID: 20382099 DOI: 10.1016/j.actatropica.2010.04.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Accepted: 04/01/2010] [Indexed: 01/02/2023]
Abstract
Cyclospora cayetanensis is an intestinal coccidian protozoon that has emerged as an important cause of endemic or epidemic diarrhoeal illness in children and adults worldwide. Humans appear to be the only natural hosts. However, the role of animals as natural reservoirs is uncertain but of increasing concern. Human-to-human spread of the parasite occurs indirectly via the environment through oocysts in contaminated water, food or soil. In endemic areas, risk factors associated with the infection include contaminated water or food, contact with soil or animals, type of sanitation and low socioeconomic status. Infections linked to soil contact provide reasons to believe that this route of spread may be more common than realised in disadvantaged community settings. C. cayetanensis is an important cause of traveller's diarrhoea and numerous large foodborne outbreaks associated with the globalisation of the food supply and importation of fruits and vegetables from developing countries have occurred. Waterborne outbreaks have also been reported. Implementation of measures to prevent or control the spread of Cyclospora oocysts in the environment is critical. In endemic areas, the most important steps to prevent infection are improving environmental sanitation and health education. Significant gaps remain in our understanding of the epidemiology of human cyclosporiasis that highlight the need for continued research in several aspects of C. cayetanensis.
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Johnston AR, Gillespie TR, Rwego IB, Tranby McLachlan TL, Kent AD, Goldberg TL. Molecular epidemiology of cross-species Giardia duodenalis transmission in western Uganda. PLoS Negl Trop Dis 2010; 4:e683. [PMID: 20485494 PMCID: PMC2867944 DOI: 10.1371/journal.pntd.0000683] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Accepted: 03/25/2010] [Indexed: 12/04/2022] Open
Abstract
Background Giardia duodenalis is prevalent in tropical settings where diverse opportunities exist for transmission between people and animals. We conducted a cross-sectional study of G. duodenalis in people, livestock, and wild primates near Kibale National Park, Uganda, where human-livestock-wildlife interaction is high due to habitat disturbance. Our goal was to infer the cross-species transmission potential of G. duodenalis using molecular methods and to investigate clinical consequences of infection. Methodology/Principal Findings Real-time PCR on DNA extracted from fecal samples revealed a combined prevalence of G. duodenalis in people from three villages of 44/108 (40.7%), with prevalence reaching 67.5% in one village. Prevalence rates in livestock and primates were 12.4% and 11.1%, respectively. Age was associated with G. duodenalis infection in people (higher prevalence in individuals ≤15 years) and livestock (higher prevalence in subadult versus adult animals), but other potential risk factors in people (gender, contact with domestic animals, working in fields, working in forests, source of drinking water, and medication use) were not. G. duodenalis infection was not associated with gastrointestinal symptoms in people, nor was clinical disease noted in livestock or primates. Sequence analysis of four G. duodenalis genes identified assemblage AII in humans, assemblage BIV in humans and endangered red colobus monkeys, and assemblage E in livestock and red colobus, representing the first documentation of assemblage E in a non-human primate. In addition, genetic relationships within the BIV assemblage revealed sub-clades of identical G. duodenalis sequences from humans and red colobus. Conclusions/Significance Our finding of G. duodenalis in people and primates (assemblage BIV) and livestock and primates (assemblage E) underscores that cross-species transmission of multiple G. duodenalis assemblages may occur in locations such as western Uganda where people, livestock, and primates overlap in their use of habitat. Our data also demonstrate a high but locally variable prevalence of G. duodenalis in people from western Uganda, but little evidence of associated clinical disease. Reverse zoonotic G. duodenalis transmission may be particularly frequent in tropical settings where anthropogenic habitat disturbance forces people and livestock to interact at high rates with wildlife, and this could have negative consequences for wildlife conservation. Giardia duodenalis is a common protozoan parasite that infects multiple mammalian species, including humans. We analyzed G. duodenalis from people, livestock, and wild non-human primates in forest fragments near Kibale National Park, western Uganda, where habitat disturbance and human-animal interaction are high. Molecular analyses indicated that endangered red colobus monkeys were infected with G. duodenalis assemblages BIV and E, which characteristically infect humans and livestock, respectively. G. duodenalis infected people at rates of up to 67.5% in one village, and people age 15 years or younger were especially likely to be infected. G. duodenalis infection in people was not associated with other factors related to behavior and hygiene, and infected people were no more likely to have reported gastrointestinal symptoms than were uninfected people. These results demonstrate that G. duodenalis transmission from humans and domestic animals to wildlife may occur with ease in locations such as western Uganda, where habitat disturbance causes ecological overlap among people, livestock, and primates. This conclusion has conservation implications for wildlife such as red colobus, which are already endangered by habitat loss.
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Affiliation(s)
- Amanda R. Johnston
- Center for Zoonoses and Infectious Disease Research and Department of Pathobiology, University of Illinois, Urbana, Illinois, United States of America
| | - Thomas R. Gillespie
- Department of Environmental Studies and Global Health Institute, Emory University, Atlanta, Georgia, United States of America
| | | | - Traci L. Tranby McLachlan
- Center for Zoonoses and Infectious Disease Research and Department of Pathobiology, University of Illinois, Urbana, Illinois, United States of America
| | - Angela D. Kent
- Department of Natural Resources and Environmental Sciences, University of Illinois, Urbana, Illinois, United States of America
| | - Tony L. Goldberg
- Department of Zoology, Makerere University, Kampala, Uganda
- Department of Pathobiological Sciences, Nelson Institute for Environmental Studies, University of Wisconsin, Madison, Wisconsin, United States of America
- Center for Global Health, University of Wisconsin, Madison, Wisconsin, United States of America
- * E-mail:
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Abstract
The coccidian parasite Cyclospora cayetanensis is recognized as an emerging pathogen that causes protracted diarrhea in humans. The first cases of Cyclospora infection were reported in the late 1970s and were observed among expatriates and travelers in regions where infections are endemic. Since then, Cyclospora has been considered a cause of traveler's diarrhea. Epidemiological investigations were reported and examined in areas of endemicity even before the true identity of Cyclospora was elucidated. Cyclospora was fully characterized in the early 1990s, but it was not until the 1995 Cyclospora outbreak in the United States and Canada that it caught the attention of the public and physicians. The biology, clinical presentation, epidemiology, diagnosis, treatment, and control of cyclosporiasis are reviewed, with a focus on diagnostic assays currently being used for clinical and environmental samples. Challenges and limitations in working with Cyclospora are also discussed.
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Gillespie TR, Morgan D, Deutsch JC, Kuhlenschmidt MS, Salzer JS, Cameron K, Reed T, Sanz C. A legacy of low-impact logging does not elevate prevalence of potentially pathogenic protozoa in free-ranging gorillas and chimpanzees in the Republic of Congo: logging and parasitism in African apes. ECOHEALTH 2009; 6:557-64. [PMID: 20238141 PMCID: PMC2921064 DOI: 10.1007/s10393-010-0283-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2009] [Revised: 12/02/2009] [Accepted: 01/13/2010] [Indexed: 05/28/2023]
Abstract
Many studies have examined the long-term effects of selective logging on the abundance and diversity of free-ranging primates. Logging is known to reduce the abundance of some primate species through associated hunting and the loss of food trees for frugivores; however, the potential role of pathogens in such primate population declines is largely unexplored. Selective logging results in a suite of alterations in host ecology and forest structure that may alter pathogen dynamics in resident wildlife populations. In addition, environmental pollution with human fecal material may present a risk for wildlife infections with zoonotic protozoa, such as Cryptosporidium and Giardia. To better understand this interplay, we compared patterns of infection with these potentially pathogenic protozoa in sympatric western lowland gorillas (Gorilla gorilla gorilla) and chimpanzees (Pan troglodytes troglodytes) in the undisturbed Goualougo Triangle of Nouabalé-Ndoki National Park and the adjacent previously logged Kabo Concession in northern Republic of Congo. No Cryptosporidium infections were detected in any of the apes examined and prevalence of infection with Giardia was low (3.73% overall) and did not differ between logged and undisturbed forest for chimpanzees or gorillas. These results provide a baseline for prevalence of these protozoa in forest-dwelling African apes and suggest that low-intensity logging may not result in long-term elevated prevalence of potentially pathogenic protozoa.
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Affiliation(s)
- Thomas R Gillespie
- Department of Environmental Studies and Program in Population Biology, Ecology, and Evolution, Emory University, Atlanta, GA, USA.
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Preservation of Giardia cysts in stool samples for subsequent PCR analysis. J Microbiol Methods 2009; 78:292-6. [DOI: 10.1016/j.mimet.2009.06.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2009] [Revised: 06/24/2009] [Accepted: 06/24/2009] [Indexed: 11/23/2022]
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Abstract
PURPOSE OF REVIEW To update the reader on the recent literature discussing human infections due to intestinal protozoa. RECENT FINDINGS Diarrheal diseases due to intestinal protozoa cause significant morbidity and mortality worldwide in a variety of patient populations. New literature on key pathogens Cryptosporidium, Cyclospora, Isospora, Giardia, and Entamoeba histolytica are discussed. SUMMARY The recent medical literature on these pathogens has focused on new advances in understanding human genetic markers associated with susceptibility to infection and the use of molecular diagnostic techniques for both outbreak investigations (molecular epidemiology) and to understand the variability of clinical disease within species and subspecies.
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