FLOTAC for the diagnosis of Hymenolepis spp. infection: proof-of-concept and comparing diagnostic accuracy with other methods

Human infections by the rat tapeworm Hymenolepis diminuta in China

The rat tapeworm Hymenolepis diminuta is a parasite that usually uses rats as a definitive host. It also infects humans and non-human primates. Human infections have been reported in 80 countries worldwide, including China. Nevertheless, nearly all the literature on human infections in China by the rat tapeworm is in Chinese journals, which are very difficult to access by readers outside China. The main aim of the current manuscript was to systematically review human infections by the rat tapeworm in China for readers inside and outside the country. Chinese characters for H. diminuta were used to search several databases, including Google Scholar. In total, 511 infections were reported in 24 Chinese provinces/autonomous regions, which surpassed 320 in Costa Rica as the country with the highest number of infections. Furthermore, three nationwide surveys on parasitic infections in the past 3 decades revealed detailed prevalence of this parasite along with that of roundworm, whipworm, hookworm and pinworm in Chinese populations. These data contribute to better understanding of this greatly neglected zoonosis in the world's most populated country.

High Prevalence of Hymenolepis (Rodentolepis) nana in Amateur Breeding Facilities of Chinchillas (Chinchilla lanigera) and Sugar Gliders (Petaurus breviceps) from Italy

PURPOSE

Hymenolepis (Rodentolepis) nana is an enteric tapeworm globally widespread in wild and captive rodents. The survey was carried out in three chinchilla breeding facilities and in one sugar glider breeding facility in Central and Southern Italy.

METHODS

One hundred and four chinchilla fecal pools and 40 sugar glider fecal pools were collected from cages housing breeding pairs or females with their offspring. Fecal samples were examined with a qualitative and quantitative copromicroscopical approach. Hymenolepis eggs were identified based on morphological and morphometrical features, and the average number of eggs per gram (EPG) of feces was estimated.

RESULTS

Hymenolepis nana eggs were detected in 39.42% of chinchilla samples with an average of 16.33 EPG; whereas, all of the sugar glider samples tested positive with an average of 454.18 EPG. Neither helminth eggs nor protozoan cysts/oocysts were detected in any of the breeding facilities.

CONCLUSION

The results clearly show a diffuse parasitism in both chinchillas and sugar gliders, and should be taken into consideration given the rising popularity of these two pet species combined with the zoonotic complications presented by H. nana.

Deciphering Diets and Lifestyles of Prehistoric Humans through Paleoparasitology: A Review

Parasites have affected and coevolved with humans and animals throughout history. Evidence of ancient parasitic infections, particularly, reside in archeological remains originating from different sources dating to various periods of times. The study of ancient parasites preserved in archaeological remains is known as paleoparasitology, and it initially intended to interpret migration, evolution, and dispersion patterns of ancient parasites, along with their hosts. Recently, paleoparasitology has been used to better understand dietary habits and lifestyles of ancient human societies. Paleoparasitology is increasingly being recognized as an interdisciplinary field within paleopathology that integrates areas such as palynology, archaeobotany, and zooarchaeology. Paleoparasitology also incorporates techniques such as microscopy, immunoassays, PCR, targeted sequencing, and more recently, high-throughput sequencing or shotgun metagenomics to understand ancient parasitic infections and thus interpret migration and evolution patterns, as well as dietary habits and lifestyles. The present review covers the original theories developed in the field of paleoparasitology, as well as the biology of some parasites identified in pre-Columbian cultures. Conclusions, as well as assumptions made during the discovery of the parasites in ancient samples, and how their identification may aid in better understanding part of human history, ancient diet, and lifestyles are discussed.

Improving Diagnosis of Intestinal Parasites Towards a Migrant-Friendly Health System

Purpose of Review

This study describes the results obtained by the World Health Organization (WHO) collaborating centre (CC) for the diagnosis of intestinal helminths and protozoa (WHO CC ITA-116) during the first 2 years of its activity on (i) the prevalence of intestinal parasites in migrants in southern Italy and (ii) the development and application of new diagnostic tools for intestinal helminths (e.g. FLOTAC, Mini-FLOTAC Kit 200 tests, Kubic FLOTAC microscope (KFM)).

Recent Findings

Almost 23.3% of migrants examined were positive for at least one intestinal parasite. Moreover, a significant correlation was found between the duration of stay in Italy and positivity for intestinal parasites. The results of the comparison between diagnostic techniques showed a perfect agreement between FLOTAC and Mini-FLOTAC Kit 200 tests whereas no statistically significant differences were found between the count of helminth eggs obtained by Mini-FLOTAC with optical microscope and KFM.

Summary

The results obtained by WHO CC ITA-116 during the first 2 years of its activity provide important information on innovations in parasitological diagnosis and add data to the parasitological scenario of migrants arriving in southern Italy, highlighting the importance of regular parasitological monitoring.

Morphological, Molecular, and Pathological Appraisal of Hymenolepis nana (Hymenolepididae) Infecting Laboratory Mice (Mus musculus)

Hymenolepis nana, typically a parasite found in conventionally established mouse colonies, has zoonotic potential characterized by autoinfection and direct life cycle. The objective of this study was to determine the rate of parasite infection in laboratory mice. The hymenolepidide cestode infected 40% of the 50 mice sampled. The rate of infection in males (52%) was higher than in females (28%). Morphological studies on the cestode parasite showed that worms had a globular scolex with four suckers, a retractable rostellum with 20-30 hooks, and a short unsegmented neck. In addition, the remaining strobila consisted of immature, mature, and gravid proglottids, irregularly alternating genital pores, lobulated ovaries, postovarian vitelline glands, and uteri with up to 200 eggs in their gravid proglottids. The parasite taxonomy was confirmed by using molecular characterization based on the sequence analysis of the mitochondrial cytochrome c oxidase subunit 1 (mtCOX1) gene. The parasite recovered was up to 80% identical to other species in GenBank. High blast scores and low divergence were noted between the isolated parasite and previously described H. nana (gb| AP017666.1). The phylogenetic analysis using the COX1 sequence places this hymenolepidid species of the order Cyclophyllidea.

Pre-Columbian zoonotic enteric parasites: An insight into Puerto Rican indigenous culture diets and life styles

The pre-Columbian Huecoid and Saladoid cultures were agricultural ethnic groups that supplemented their diets by fishing, hunting and scavenging. Archaeological deposits associated to these cultures contained a variety of faunal osseous remains that hinted at the cultures' diets. The present study identified zoonotic parasites that may have infected these two cultures as a result of their diets. We used metagenomic sequencing and microscopy data from 540-1,400 year old coprolites as well as the zooarchaeological data to recreate the possible interactions between zoonotic parasites and their hosts. Microscopy revealed Diphyllobothrium spp. and Dipylidium caninum eggs along with unidentified cestode and trematode eggs. DNA sequencing together with functional prediction and phylogenetic inference identified reads of Cryptosporidium spp., Giardia intestinalis and Schistosoma spp. The complimentary nature of the molecular, microscopy and zooarchaeology data provided additional insight into the detected zoonotic parasites' potential host range. Network modeling revealed that rodents and canids living in close proximity to these cultures were most likely the main source of these zoonotic parasite infections.

The dwarf tapeworm Hymenolepis nana in pet rodents in Slovakia-epidemiological survey and genetic analysis

Rodents are popular companion animals and are often kept as pets for children. However, they can be reservoirs of a variety of zoonotic pathogens. As little attention is being paid to the possibility of acquiring parasitic infections from pet rodents, the occurrence of Hymenolepis nana in rodents from pet shops and breeding clubs of Slovakia was surveyed, with parallel genetic analyses to type isolates from rodent species. In 2016-2018, pooled faecal samples from 119 boxes with 228 mice, 191 rats, 124 hamsters and 25 Mongolian gerbils were collected from 12 pet shops and 3 breeding clubs in five cities of eastern Slovakia. H. nana eggs were detected in 25 (21.0%) boxes. Animals from pet shops were infected more frequently (24.6% positive boxes) than those from breeding clubs (17.2%), without statistical significance. The highest prevalence was recorded in rats from pet shops, where 41.7% of boxes contained parasite eggs. Hamsters and mice in pet shops were also frequently infected; in 23.8% and 25% of boxes, respectively, H. nana eggs were observed. Prevalence in rats and hamsters from breeding clubs was lower, but in mice surpassed 40%. Nine samples with positive PCR products in any of the four DNA regions, mitochondrial cox1 and nuclear pmy, ITS1 and ITS2 targets, gave profiles characteristic of H. nana. The results imply the risk of zoonotic transmission of hymenolepiasis in Slovakia. Particular attention should be given to hygiene level maintained while keeping rodents. Furthermore, rodents intended for sale should be tested for parasites and then dewormed.

A survey of zoonotic pathogens carried by house mouse and black rat populations in Yucatan, Mexico

The house mouse (Mus musculus) and the black rat (Rattus rattus) are reservoir hosts for zoonotic pathogens, several of which cause neglected tropical diseases (NTDs). Studies of the prevalence of these NTD-causing zoonotic pathogens, in house mice and black rats from tropical residential areas are scarce. Three hundred and two house mice and 161 black rats were trapped in 2013 from two urban neighbourhoods and a rural village in Yucatan, Mexico, and subsequently tested for Trypanosoma cruzi, Hymenolepis diminuta and Leptospira interrogans. Using the polymerase chain reaction we detected T. cruzi DNA in the hearts of 4·9% (8/165) and 6·2% (7/113) of house mice and black rats, respectively. We applied the sedimentation technique to detect eggs of H. diminuta in 0·5% (1/182) and 14·2% (15/106) of house mice and black rats, respectively. Through the immunofluorescent imprint method, L. interrogans was identified in 0·9% (1/106) of rat kidney impressions. Our results suggest that the black rat could be an important reservoir for T. cruzi and H. diminuta in the studied sites. Further studies examining seasonal and geographical patterns could increase our knowledge on the epidemiology of these pathogens in Mexico and the risk to public health posed by rodents.

Prevalence of Hymenolepis nana and H. diminuta from Brown Rats (Rattus norvegicus) in Heilongjiang Province, China

Hymenolepis nana and Hymenolepis diminuta are globally widespread zoonotic cestodes. Rodents are the main reservoir host of these cestodes. Brown rats (Rattus norvegicus) are the best known and most common rats, and usually live wherever humans live, especially in less than desirable hygiene conditions. Due to the little information of the 2 hymenolepidid species in brown rats in China, the aim of this study was to understand the prevalence and genetic characterization of H. nana and H. diminuta in brown rats in Heilongjiang Province, China. Total 114 fecal samples were collected from brown rats in Heilongjiang Province. All the samples were subjected to morphological examinations by microscopy and genetic analysis by PCR amplification of the mitochondrial cytochrome c oxidase subunit 1 (COX1) gene and the internal transcribed spacer 2 (ITS2) region of the nuclear ribosomal RNA gene. In total, 6.1% (7/114) and 14.9% (17/114) of samples were positive for H. nana and H. diminuta, respectively. Among them, 7 and 3 H. nana isolates were successfully amplified and sequenced at the COX1 and ITS2 loci, respectively. No nucleotide variations were found among H. nana isolates at either of the 2 loci. Seventeen H. diminuta isolates produced 2 different COX1 sequences while 7 ITS2 sequences obtained were identical to each other. The present results of H. nana and H. diminuta infections in brown rats implied the risk of zoonotic transmission of hymenolepiasis in China. These molecular data will be helpful to deeply study intra-specific variations within Hymenolepis cestodes in the future.

Parasite diversity of European Myotis species with special emphasis on Myotis myotis (Microchiroptera, Vespertilionidae) from a typical nursery roost

Background

Bats belong to one of the most species-rich orders within the Mammalia. They show a worldwide distribution, a high degree of ecological diversification as well as a high diversity of associated parasites and pathogens. Despite their prominent and unique role, the knowledge of their parasite-host-relationships as well as the mechanisms of co-evolutionary processes are, partly due to strict conservation regulations, scarce.

Methods

Juvenile specimens of the greater mouse-eared bat (Myotis myotis) from a roosting colony in Gladenbach (Hesse, Germany) were examined for their metazoan endo-and ectoparasite infections and pathogens. Morphometric data were recorded and the individuals were checked for Lyssavirus-specific antigen using a direct immunofluorescence test. For unambiguous species identification, the bats were analysed by cyt-b sequence comparison.

Results

Myotis myotis were parasitized by the six insect and arachnid ectoparasite species, i.e. Ixodes ricinus, Ischnopsyllus octactenus, Ichoronyssus scutatus, Steatonyssus periblepharus, Spinturnix myoti and Cimex dissimilis. Additionally, the nematode Molinostrongylus alatus and the cestode Vampirolepis balsaci were recorded. Each bat was parasitized by at least four species. The parasites showed partially extreme rates of infection, never recorded before, with more than 1,440 parasites per single host. Ichoronyssus scutatus, Steatonyssus periblepharus, Vampirolepis balsaci and Molinostrongylus alatus are recorded for the first time in Germany. A checklist for Europe is presented containing records of 98 parasite species of 14 Myotis species.

Conclusions

The Myotis myotis from Gladenbach (Hesse, Germany) were parasitized by a diverse parasite fauna with high infestation rates. We assume that in juvenile Myotis the number of parasites is generally higher than in adults due to only later acquired immune competence and behavioural adaptations. Our results revealed new insights into parasite fauna of M. myotis and European bats in general. The finding of endoparasitic cyclophyllidean cestodes that have a two-host lifecycle is, considering the stationary behaviour of the juvenile bats, rather unusual and suggests a non-predatory transmission mechanism (e.g. via autoinfection).

A new insight gained from the collated literature was that the European wide composition of the Myotis parasite fauna is dominated by a few specific taxonomic groups in Europe.

Experimental estimation of the efficacy of the FLOTAC basic technique

The FLOTAC technique is a quantitative coproscopic method for the diagnosis of parasitic infection that is based on the centrifugation of a fecal sample to levitate helminth eggs with a flotation solution in a proprietary apparatus. Determination of the efficacy of the FLOTAC method and multiplication factors for calculation of the number of Toxocara, Trichuris, and Ascaris eggs in 1 g of feces on the basis of the number of detected eggs is presented. An investigation was conducted using feces samples enriched with a known number of parasite eggs: 3, 15, 50, or 100 parasite eggs of 3 nematode genera (Toxocara, Trichuris, and Ascaris) per 1 g (EPG) of feces. In addition, 80 samples of dog feces were prepared consisting of 20 repetitions for each level of contamination. The samples were analyzed using the FLOTAC basic technique. The limit of detection was calculated as the lowest level of egg content at which at least 50% of repetitions were positive. Multiplication factors for estimating the true number of parasite eggs in the samples were derived from regression coefficients that illustrated the linear relationship between the number of detected eggs and the number of eggs added to the sample. The percentages of recovered eggs for 1 chamber and for the whole apparatus ranged from 11.67 to 21.90% and from 21.33 to 40.10%, respectively, depending on dose enrichment and genus of parasite. The limit of detection calculated for the whole FLOTAC device was 3 EPG and was 15 EPG for 1 chamber for each of the 3 parasite genera. The limit of quantification calculated for whole FLOTAC was 15 EPG for each of 3 kinds of eggs. For 1 chamber, the limit of quantification was 15 EPG for Ascaris and Toxocara eggs and 50 EPG for Trichuris eggs. Multiplication factors for calculation of the number of eggs in 1 g of feces calculated for whole FLOTAC were 3 (for Toxocara and Ascaris eggs) and 4 (for Trichuris eggs). Experimentally calculated parameters of the method differ significantly from the theoretical assumptions of the authors of the FLOTAC technique and can significantly affect the reliability of the results. This does not alter the fact that the FLOTAC technique is the most effective parasitological quantitative method, which can be used to detect parasitic forms in feces. However, the results of our study emphasized the need for validation of the method before using it in the laboratory.

Zoonotic helminths of urban brown rats (Rattus norvegicus) in the UK: neglected public health considerations?

Urban brown rats (Rattus norvegicus) carry microbial human pathogens but their role as reservoir hosts for helminths of public health importance is less well known. In this study, 42 brown rats trapped on Merseyside were subject to thorough combined helminthological and pathohistological post-mortem examination. Eggs of the rodent-borne zoonotic nematode Calodium hepaticum were initially detected in histological sections of the livers of 9.5% of rats, but overall diagnostic sensitivity increased to 16.6% when entire liver tissue was disrupted and the resulting filtrates were examined for released eggs. In their rat host, mainly trapped inside the dockland, infections with C. hepaticum were associated with a chronic multifocal pyogranulomatous hepatitis with intralesional eggs and peripheral fibrosis. Mean intensity of hepatic C. hepaticum egg infections was 1041 eggs. This is the first report of C. hepaticum in an urban brown rat population in the UK and provides original data for liver egg burdens in this abundant commensal rodent. The zoonotic cestode Rodentolepis nana had a prevalence of infection of 14.3%. Rodent-specific, non-zoonotic helminths found were the spiruroid Mastophorus muris (16.0%) in the stomach, the trichuroid Trichosomoides crassicauda in the urinary bladder (31.0%); the ascarid Heterakis spumosa was the commonest helminth of the large intestine (76.2%). Many millions of brown rats inhabit cities and rural areas of the UK, and the infective stages of the zoonotic worm species, particularly C. hepaticum, are likely to be widely distributed in the environment presenting a threat to public health.

Comparison of the performance of two spontaneous sedimentation techniques for the diagnosis of human intestinal parasites in the absence of a gold standard

Performance evaluation of diagnostic tests is critical in the search for accurate diagnoses. A gold standard test is usually absent in parasitology, thus rendering satisfactory assessment of diagnostic accuracy difficult. Moreover, reliability (assessed by the study of repeatability) is a rarely studied characteristic of diagnostic tests. This study compared and evaluated the performance (repeatability, concordance and accuracy) of the spontaneous sedimentation technique (SST) and the Paratest for the diagnosis of Giardia lamblia, Entamoeba histolytica complex, Blastocystis spp., Ascaris lumbricoides, hookworm, Trichuris trichiura and Calodium hepaticum. Fecal samples of 143 individuals were separated into three replicates for each test. Concordance and homogeneity of the results between replicates of each test and between tests were evaluated. Proportions of positives, sensitivity and specificity were estimated using a Bayesian Latent Class Model. High repeatability of both tests was found for the detection of intestinal parasites, except for Blastocystis spp. and hookworm. Concordance between tests was generally high (concordance correlation coefficient, 0.72-0.88), except for Blastocystis spp., hookworm and T. trichiura. The Paratest detected more cases of Blastocystis spp. and fewer of hookworm than the SST. The tests were quite discordant in the detection of T. trichiura. A low sensitivity (39.4-49.2% for SST, 35.8-53.8% for Paratest) and a high specificity (93.2-97.2%) were found for both tests. The Paratest presented a slightly higher sensitivity for the diagnosis of Blastocystis spp. (53.8%), and SST did so for hookworm (49.2%). This is the first study on repeatability and accuracy (using a Bayesian approach) of two spontaneous sedimentation techniques. These results suggest underdiagnosis of little dense parasitic forms due to technical limitations in both tests. We conclude that the combined study of repeatability, concordance and accuracy is a key strategy for better evaluation of the performance of tests and is also useful for the identification of technical limitations.

Heavy Hymenolepis nana infection possibly through organic foods: report of a case

We encountered a patient with heavy Hymenolepis nana infection. The patient was a 44-year-old Korean man who had suffered from chronic hepatitis (type B) for 15 years. A large number of H. nana adult worms were found during colonoscopy that was performed as a part of routine health screening. The parasites were scattered throughout the colon, as well as in the terminal ileum, although the patient was immunocompetent. Based on this study, colonoscopy may be helpful for diagnosis of asymptomatic H. nana infections.

National intestinal helminth survey among schoolchildren in Tajikistan: prevalences, risk factors and perceptions

Solid evidence regarding the epidemiology of intestinal helminth infections in Tajikistan is currently lacking. As such information is essential for the evidence-based design, implementation and evaluation of control interventions, a national intestinal helminth survey was conducted with the following objectives: (i) to assess the prevalence of intestinal helminth infections among school-aged children nationally and stratified by region; (ii) to identify locally relevant risk factors for infection; and (iii) to better understand the children's knowledge and perception of intestinal helminth infections, and asses their haemoglobin status. Standard field and laboratory procedures including the Kato-Katz thick smear and tape test were employed. Complete data was obtained for 1642 children from 33 randomly selected primary schools from different parts of the country. Across the country, prevalences of E. vermicularis, A. lumbricoides, H. nana and T. trichiura were 26.5%, 16.9%, 15.5% and 2.7% respectively. The prevalence of common soil-transmitted helminth (A. lumbricoides and T. trichiura) infections was 19.4%. No hookworm infections were detected, and prevalences of various infections differed significantly between administrative districts (all P<0.05). Hand washing after toilet usage (OR=0.78; P=0.047) and handling animals (OR=0.66; P=0.009) were identified as significant protective factors against E. vermicularis infections. H. nana infection was associated with a 2.85g/L decrease in haemoglobin levels (P<0.001) despite already low average haemoglobin levels. The proportions of children with knowledge about intestinal helminths and protective hygiene practices varied significantly between regions (both P<0.001). Mass albendazole administration to school-aged children and women of child-bearing age against intestinal helminths has been conducted in Tajikistan in spring 2012, followed by mass albendazole and praziquantel distribution to school-aged children in autumn 2012. In the longer term, an integrated approach including chemotherapy, provision of safe water and proper sanitation as well as targeted health education will be necessary to achieve sustainable control.

Persistent digestive disorders in the tropics: causative infectious pathogens and reference diagnostic tests

BACKGROUND

Persistent digestive disorders account for considerable disease burden in the tropics. Despite advances in understanding acute gastrointestinal infections, important issues concerning epidemiology, diagnosis, treatment and control of most persistent digestive symptomatologies remain to be elucidated. Helminths and intestinal protozoa are considered to play major roles, but the full extent of the aetiologic spectrum is still unclear. We provide an overview of pathogens causing digestive disorders in the tropics and evaluate available reference tests.

METHODS

We searched the literature to identify pathogens that might give rise to persistent diarrhoea, chronic abdominal pain and/or blood in the stool. We reviewed existing laboratory diagnostic methods for each pathogen and stratified them by (i) microscopy; (ii) culture techniques; (iii) immunological tests; and (iv) molecular methods. Pathogen-specific reference tests providing highest diagnostic accuracy are described in greater detail.

RESULTS

Over 30 pathogens may cause persistent digestive disorders. Bacteria, viruses and parasites are important aetiologic agents of acute and long-lasting symptomatologies. An integrated approach, consisting of stool culture, microscopy and/or specific immunological techniques for toxin, antigen and antibody detection, is required for accurate diagnosis of bacteria and parasites. Molecular techniques are essential for sensitive diagnosis of many viruses, bacteria and intestinal protozoa, and are increasingly utilised as adjuncts for helminth identification.

CONCLUSIONS

Diagnosis of the broad spectrum of intestinal pathogens is often cumbersome. There is a need for rapid diagnostic tests that are simple and affordable for resource-constrained settings, so that the management of patients suffering from persistent digestive disorders can be improved.