The impact of the waterborne transmission of Toxoplasma gondii and analysis efforts for water detection: an overview and update

Toxoplasma gondii exposure in wildlife in Spain: Is there any predictable threat for humans and domestic animals?

Toxoplasmosis is a parasitic zoonosis of key importance in veterinary and public health. This article summarizes the available data (from 2000 to 2023) of exposition to Toxoplasma gondii in wildlife species in Spain based on a systematic bibliographic search, as well as further analysis of its potential relationship with environmental variables, biodiversity, anthropogenic impact on the habitat, and the reported human cases of toxoplasmosis. The overall seroprevalence of T. gondii in carnivorous mammals, birds, ungulate and lagomorph species in Spain was estimated at 69.3 %, 36.4 %, 18.4 %, and 16.2 %, respectively. Among the studies considered, great heterogeneity was observed both between and within taxonomic groups [Cohen's d > 0.8; X2 = 1039.10, df = 4 (p < 0.01) I2 = 97 %, r2 = 1.88, (p < 0.001)] and between and within bioregions [Cohen's d > 0.5; X2 = 368.59, df = 4 (p < 0.01)]. The results of a generalized linear model explaining T. gondii seroprevalence in wild animals suggest the influence of abiotic variables [wetland (p < 0.001), unvegetated (p < 0.001), isothermality (p < 0.001), and mean temperature during wettest quarter (p < 0.05)] and number of intermediate host species as positively associated with increased exposure of wildlife to T. gondii (p < 0.01). Toxoplasma gondii DNA was detected in both wild birds and wild mammals (range: 0.0-51.2 %) mainly from north-centre, northeast, and central-west of Spain. Regarding hospitalisation rates due to toxoplasmosis in humans, some abiotic variables [permanent crops (p < 0.05) and mean temperature during wettest quarter (p < 0.05)] showed a positive association. Despite certain limitations, this research evidences a substantial gap of knowledge on the implication of wildlife in the life cycle of T. gondii in Spain. This lack of knowledge is particularly evident in areas where the human-livestock-wildlife interface overlaps, preventing us from accurately determining its true distribution in different habitats, as well as its potential direct or indirect implications on public and veterinary health.

Investigation of the presence of Toxoplasma gondii, Giardia duodenalis and Cryptosporidium spp. in drinking waters in the region of Marrakech, Morocco

The association between the parasitic illnesses and the consumption of contaminated water has been largely reported. However, there is still a lack of studies investigating the extent of parasitic contamination in water in Morocco. This is the first study in Morocco that aimed at assessing the presence of protozoan parasites, namely Cryptosporidium spp., Giardia duodenalis and Toxoplasma gondii, in drinking water consumed in the region of Marrakech. Samples processing was performed by membrane filtration and qPCR detection. A total of 104 drinking water samples (tap water, well and spring waters) was collected between 2016 and 2020. The analysis revealed an overall protozoa contamination rate of 67.3% (70/104), of which 35 samples were positive for Giardia duodenalis, 18 for Toxoplasma gondii and 17 for both parasites. Whereas no sample was positive for Cryptosporidium spp. This first study showed that drinking water in the region of Marrakech contained parasites which could represent a risk for consumers. For better understanding and estimation of the risk encountered by local inhabitants, further studies concerned with (oo)cyst viability, infectivity and genotype identification need to be performed.

Toxoplasma gondii exposure in Brazilian indigenous populations, their dogs, environment, and healthcare professionals

Although Toxoplasma gondii exposure has been reported in indigenous populations worldwide, a One Health approach has not been applied to date. This study concurrently assessed T. gondii exposure in indigenous populations, and their dogs, environment, and indigenous or non-indigenous healthcare professionals (HPs). Human and dog serum samples from 9 indigenous communities in Brazil were assessed by indirect immunofluorescence antibody test for anti-T. gondii antibodies. Soil samples (30 per community) were processed with PCR to amplify T. gondii DNA. Associated risk factors and seroprevalence were analyzed using logistic regression models. Human seropositivity and type of water source were assessed by generalized linear mixed model (GLMM) with binomial error distribution, and game meat consumption with chi-squared test. Overall, 225/463 (49%) indigenous persons were seropositive for anti-T. gondii antibodies. Of all the HPs, 67/168 (40%) were positive, and included 54/147 (37%) positive non-indigenous HPs. Indigenous persons more likely to be seropositive compared with non-indigenous HPs (OR: 1.63; 95% CI: 1.11-2.39). A total of 97/253 (38%) dogs were seropositive and highly associated with seropositive owners (p < 0.001). Based on univariate analysis for indigenous individuals, state location of community (p < 0.001), ethnicity (p < 0.001), consumption of game meat (p < 0.001), type of water source (p < 0.001), and educational level (p = 0.026) were associated with seropositivity. Logistic regression showed that indigenous seropositivity was associated with eating game meat (p = 0.002), drinking water from rivers (p < 0.001), and inversely proportional to the educational level. According to univariate analysis for non-indigenous HP, age (p = 0.005), frequency of visits to the indigenous populations (p < 0.001), consumption of water at the indigenous communities (p < 0.001), and ingestion of raw meat (p = 0.023) were associated with T. gondii seropositivity. Logistic regression revealed living outdoors (p = 0.042), habit of hunting (p = 0.008), and drinking river water (p = 0.007) as risk factors associated to seropositivity in dogs. In addition, indigenous communities lacking water treatment had higher seroprevalence for all groups including indigenous persons (GLMM; z = -7.153; p < 0.001), their dogs (GLMM; z = -2.405; p = 0.0162), and all HPs (GLMM; z = -2.420; p = 0.0155). Human seropositivity was associated with that of their dogs (p < 0.001). A single soil sample, out of 270 (0.37%), was positive for T. gondii by PCR. Our results indicate water source is a risk for human and dog toxoplasmosis in indigenous communities; both share similar exposure. Moreover, quality water access was shown to be crucial to prevent toxoplasmosis in both total and non-indigenous HPs who work in these indigenous communities.

Toward waterborne protozoa detection using sensing technologies

Drought and limited sufficient water resources will be the main challenges for humankind during the coming years. The lack of water resources for washing, bathing, and drinking increases the use of contaminated water and the risk of waterborne diseases. A considerable number of waterborne outbreaks are due to protozoan parasites that may remain active/alive in harsh environmental conditions. Therefore, a regular monitoring program of water resources using sensitive techniques is needed to decrease the risk of waterborne outbreaks. Wellorganized point-of-care (POC) systems with enough sensitivity and specificity is the holy grail of research for monitoring platforms. In this review, we comprehensively gathered and discussed rapid, selective, and easy-to-use biosensor and nanobiosensor technologies, developed for the early detection of common waterborne protozoa.

Terrestrial runoff influences the transport and contamination levels of Toxoplasma gondii in marine organisms

There is a growing concern regarding the potential adverse impact of Toxoplasma gondii contamination of the marine environment on marine wildlife and public health. Terrestrial runoff is a significant route for dissemination of T. gondii oocysts from land to sea. Yet, the influence of terrestrial runoff on T. gondii prevalence in marine animals in China is largely unknown. To address this concern, we examined the presence of T. gondii in marine oysters Crassostrea spp., rockfish Sebastes schlegelii (S. schlegelii), fat greenling fish Hexagrammos otakii (H. otakii), and Asian paddle crab Charybdis japonica (C. japonica) using a PCR assay targeting T. gondii B1 gene. A total of 1920 samples were randomly collected, in Jan-Dec 2020, from terrestrial runoff areas (TRA, TRB, and TRC) and non-terrestrial runoff area (Grape bay) in Weihai, China. T. gondii prevalence in TRB and TRC was 6.04 % and 5.83 %, respectively, which was higher than 2.29 % detected in the non-terrestrial runoff area. The highest prevalence was detected in Crassostrea spp., and a correlation was observed between T. gondii prevalence and weight of Crassostrea spp. The temperature, but not precipitation, significantly correlated with T. gondii prevalence. Understanding the fate of T. gondii delivered to oceans by terrestrial runoff is critical for predicting future disease risks for marine wildlife and humans.

Investigation of Toxoplasma gondii in wastewater and surface water in the Qinghai-Tibet Plateau, China using real-time PCR and multilocus genotyping

Toxoplasma gondii is a protozoan parasite, causing one of the most prevalent parasitic infections in the world. In the present study water sources of the Qinghai-Tibet Plateau (QTP), China, where the hygienic infrastructure is still developing, were investigated. A total of 214 water samples of 10 L volume, were collected from wastewater treatment plants (WWTPs), a slaughterhouse and rivers. The samples were filtered and then analysed using real-time PCR and multilocus genotyping. T. gondii DNA was found in four (1.9%) samples representing T. gondii type I; in one of them T. gondii-like oocysts were also confirmed microscopically. The approximate level of contamination of positive samples ranged between 30 and 2300 T. gondii sporozoites. The results of this study confirmed that T. gondii is present in wastewater in the greater metropolitan area of Xining and a neighbouring county. Contamination of wastewater at this level constitutes rather a moderate source of Toxoplasma infections in humans and animals. It suggests, however, a link between environmental exposure of animals, meat processing facilities and WWTPs. To our knowledge, this is the first investigation describing T. gondii detection in wastewater and environmental water samples collected from the territory of P.R. China using sensitive molecular tools.

Comparative Evaluation of Re 529-Bp Sequence and B1 Gene in the Detection of Toxoplasma gondii Through PCR in Water Samples of Denizli, Turkey

Purpose

While Toxoplasma gondii (T. gondii) infection is asymptomatic in immunocompetent individuals, it is a life-threatening protozoan in immunocompromised individuals. Its water-borne transmission to humans poses a serious public health concern. Polymerase Chain Reaction (PCR) has a considerable potential for the sensitive and specific detection of T. gondii oocysts in waters.

Methods

Comparative evaluation of RE 529-bp sequence and B1 gene to detect T. gondii tachyzoites and oocysts via PCR in agricultural irrigation water taken from downtown Denizli, Turkey and water samples collected from neighborhood fountains was performed for the first time in Turkish context.

Results

Based on real-time PCR targeting the B1 genetic markers and RE 529-bp sequence, T. gondii DNA was identified in 6 (16.7%) out of 48 samples collected from agricultural irrigation water. Besides, our PCR analysis did not establish any presence of T. gondii in drinking water samples.

Conclusion

T. gondii showed lower sensitivity in B1-based PCR than in PCR targeting RE 529-bp sequence.

Toxoplasma gondii infection in pet cats and their owners in northeastern China:an important public health concern

Background

Limited information about Toxoplasma gondii infection in pet cats and their owners is available in China.

Methods

In this study, blood samples were randomly collected from 306 pet cats and 397 corresponding pet owners in Jilin province, northeastern China. Sera from the pet cats and the pet owners were tested for anti-T. gondii antibodies using an modified agglutination test (MAT) and an enzyme-linked immunosorbent assay (ELISA), respectively. Moreover, the risk factors for T. gondii infection in pet cats and corresponding pet owners were explored.

Result

In total, 62 sera out of 306 examined pet cats (20.3%) and 18.1% (72/397) pet cat owners were seropositive for T. gondii, respectively. The results of statistical analysis showed that both pet cats and their owners from rural area had significantly higher T. gondii seroprevalence than those from urban area (p < 0.001). Moreover, owners of pet cas who have the knowledge of zoonotic protozoan diseases had a significantly lower T. gondii seroprevalence than those without the knowledge of zoonotic protozoan diseases (p < 0.001).

Conclusions

The present results revealed that the seroprevalence of T. gondii infection are widespread in pet cats and their owners in Jilin province, northeastern China. Residence area and understanding knowledge of zoonotic protozoan diseases are considered to be raleted to the T. gondii infection. Hence, it is necessary to highlight the dangers and protection methods of zoonotic protozoan diseases caused by pet cats, especially in rural area.

Seroprevalence of Toxoplasma gondii infection from water buffaloes (Bubalus bubalis) in northeastern and southern Thailand

Toxoplasmosis is a parasitic disease resulting from infection with the apicomplexan Toxoplasma gondii (Nicolle et Manceaux, 1908), one of the world's most common parasites in warm-blooded animals, including humans. Sources of infection can be exposed to infected cat faeces, mother-to-child transmission during pregnancy, and notably, the consumption of undercooked contaminated meat of intermediate hosts. In Thailand, water buffaloes are highly valued for rice cultivation, traditional culture and meat production. Like several other mammalian species, these animals play a role as reservoirs of T. gondii, thus representing a threat to human health. The seroprevalence of T. gondii infection in swamp buffaloes was examined in southern and northeastern Thailand. In total, serum samples of 721 water buffaloes were collected from seven provinces (Ubon Ratchathani, Roi Et, Si Sa Ket, Surin, Buri Ram, Sakon Nakhon, and Songkhla) and examined for the presence of T. gondii infection using commercial latex agglutination test kits (TOXOCHECK-MT, Eiken Chemical Co., Tokyo, Japan). Of the 721 animals analysed, 49 (6.8%) were positive for T. gondii. Songkhla province had the highest seroprevalence (14.7%) among the seven provinces covered in this survey. There was a potential risk to local citizens of T. gondii infection identified by the present study, notably in northeastern Thailand, where despite lower seroprevalence consuming raw buffalo meat salad should be restricted to avoid the risk of zoonotic infections.

Prevalence, genotypes and risk factors for Toxoplasma gondii contamination in marine bivalve shellfish in offshore waters in eastern China

We conducted a large-scale epidemiological investigation to detect the prevalence of Toxoplasma gondii in four marine bivalve shellfish species collected from six representative coastal regions of Weihai, eastern China. Between January 2018 and December 2018, 14,535 marine bivalve shellfish pooled into 2907 samples were randomly collected and examined for T. gondii DNA by a nested PCR assay targeting B1 gene. The results showed that 2.8% (82) of the 2907 pooled samples were tested positive for T. gondii DNA. Two T. gondii genotype (ToxoDB Genotype #9 and ToxoDB Genotype #1) were identified PCR-restriction fragment length polymorphism analysis. Factors that were found significantly associated with the presence of T. gondii DNA in marine bivalve shellfish included the source of samples (being wild) (odds ratio [OR], 3.34; 95% confidence interval [CI], 2.00-5.84; p < 0.01), surface runoff near the sampling site (OR, 2.64; 95% CI, 1.47-4.72; p < 0.01), and presence of cats near the sampling site (OR, 1.77; 95% CI, 1.02-3.07; p = 0.04). Moreover, the prevalence of T. gondii DNA in marine bivalve shellfish correlated with temperature (Pearson's correlation: R = 0.75, p = 0.0049) and precipitation (R = 0.87, p = 0.00021). These findings provide new insights into the presence of T. gondii DNA in marine bivalve shellfish and highlight the impact of human activity on marine pollution by such an important terrestrial pathogen pollutant.

Molecular and serological study on congenital toxoplasmosis in newborn of Shiraz, Southern Iran

Toxoplasmosis is a zoonotic disease caused by an obligatory intracellular parasite, Toxoplasma gondii. The congenital form of the disease is a significant health problem around the world. This study aimed to determine the incidence of congenital toxoplasmosis in the newborn of Shiraz, Southern Iran, between 2013 and 2018. A total of 2498 blood samples of neonates were randomly collected by a standard heel puncture technique and dried on Guthrie cards from Shiraz newborn screening center. We provided questionnaire forms for mothers according to their demographic characteristics, such as age, place of residence, history of having cats as pet, and literacy level. ELISA immunocapture and PCR assays were applied to detect anti-Toxoplasma IgM and the parasite DNA in dried blood spot samples. The anti-Toxoplasma IgM antibody was detected in two out of the 2498 infants. Moreover, borderline titers were observed in 3 samples, which were considered suspicious, so these were retested after 18 months to detect IgG against Toxoplasma. Positive IgG titer was observed in two infants who had a positive IgM level. The genome of Toxoplasma was detected in one sample out of 2498. No significant differences were seen between the epidemiological factors with congenital infection. The incidence of congenital toxoplasmosis is estimated at 0.08% of studied samples. It seems that this incidence could present to the health ministry as a logical research achievement for the national screening program of newborns in Iran.

Seroepidemiology and Associated Risk Factors of Toxoplasma gondii in Hemodialysis Patients

PURPOSE

Immunocompromised patients may be at risk for reactivation of the toxoplasmosis infection, because of defection in cell-mediated immunity. Therefore, early diagnosis would be highly desirable in these individuals. This case-control study was designed to increase information about toxoplasmosis in hemodialysis (HD) patients in Guilan province, Iran.

METHODS

The study was performed among 150 patients and 150 controls referred to hospitals of Guilan University of Medical Sciences during 2018-2019. Questionnaire forms, including demographic and epidemiological information, were completed. Peripheral blood samples were taken for serum separation and were collected into tubes and then kept at - 20 °C until use. IgG and IgM antibodies to Toxoplasma gondii were detected by a commercial ELISA kit. Accordingly, IgG absorbance levels < 9 were considered negative, 9-11 was considered borderline, and > 11 was positive; IgM absorbance levels < 0.9 were considered negative, 0.9-1.1 was assumed to be borderline, and > 1.1 was positive.

RESULTS

Throughout the study, 72.0% of HD patients and 64.7% of the control group were positive for anti-Toxoplasma IgG antibody subsequently. 2% of HD patients and 0.7% of the control group were positive for anti-Toxoplasma IgM antibody and these difference weren't significant between control and ones with HD (P > 0.05). There was no significant difference between dialysis duration factor and the seropositivity rate. Seroprevalence of T. gondii infection did not vary significantly with age, educational level, residence and presence of a cat at home. On the contrary, seroprevalence varied significantly with gender and consumption of raw vegetables.

CONCLUSION

Because of the high percentage of positivity for Toxoplasma IgG antibodies in hemodialysis patients, we suggest a periodically screening program to carry out for monitoring and evaluating the possible dissemination of toxoplasmosis during hemodialysis.

Epidemiological survey of Toxoplasma gondii and Neospora caninum infections in dairy goats in Central-Southern Taiwan

Toxoplasma gondii and Neospora caninum are intracellular protozoan parasites that cause reproductive disorders in ruminants and humans. Information on the risk factors of T. gondii and N. caninum infections in goats is very limited in Taiwan. The aim of the study was to investigate the epidemiology and identify the risk factors of these two infections in goats. A total of 630 caprine sera were collected from 42 dairy goat farms and the owners were interviewed by a structured questionnaire. The apparent seroprevalences of T. gondii in farm- and individual- levels were respectively 88.1% and 32.22%, while those of N. caninum were 19.05% and 2.54%, respectively. Toxoplasma gondii B1 gene was identified in 7 feed samples and 8 from the water samples whereas N. caninum was not found. Wooden flooring was the main risk factor for T. gondii infection while the frequency of visits by staff to other farms and the breed of goat were risk factors for N. caninum. The improvement of flooring materials or thorough cleaning, periodic disinfection and maintenance of dryness on the floor are highly recommended for the prevention of T. gondii infection in farmed goats. In addition, unnecessary visits to other farms should be limited to prevent the spread of N. caninum. These factors should be highlighted for the prevention of T. gondii and N. caninum in goats, particularly when raised in intensive housing system with flooring on height.

Contaminated water confirmed as source of infection by bioassay in an outbreak of toxoplasmosis in South Brazil

The protozoan Toxoplasma gondii is a causative agent of toxoplasmosis, an important and widespread zoonotic disease. The transmission of this disease in humans includes ingestion of sporulated oocysts present in contaminated water or food. T. gondii oocysts are widely distributed and toxoplasmosis is considered a major food- and waterborne pathogen worldwide, making drinking water containing sporulated T. gondii oocysts a major source of contamination for people. In the first half of 2018, an unprecedented outbreak of toxoplasmosis was reported in the city of Santa Maria, southern Brazil. The temporal and spatial distribution of the cases strongly suggested a waterborne infection. Thus, the aim of this study was to investigate a possible involvement of treated water as a source of the outbreak. For this, piglets received potentially contaminated water ad libitum for 21 days and the infection was monitored by serology through IFAT and investigation of T. gondii DNA in tissues by PCR amplification of a 529 bp followed by mouse bioassays. All piglets receiving test water ad libitum for 21 days as well as positive controls seroconverted to T. gondii. T. gondii DNA was detected in 62.5% of the piglets that received test water. All mice inoculated with tissues from each positive piglet were PCR-positive. These results strongly indicated the presence of viable oocysts in the test water administered to the animals during the study.

First report of detection of Toxoplasma gondii DNA in oysters (Crassostrea sp.) in the state of Maranhão

Abstract The aim of this study was to report on detection of Toxoplasma gondii DNA in oysters (Crassostrea sp.) in the state of Maranhão. To conduct this study, 200 farmed oysters were acquired in the municipality of Raposa and 100 in Paço do Lumiar; and a further 100 oysters were taken from the natural stock in the municipality of Primeira Cruz. This total of 400 specimens sampled was divided into 80 pools composed of five animals each. The gills and visceral mass of each oyster were removed for DNA extraction (per pool of oysters), using a commercial kit. The nested PCR technique (with the primer SAG-1) was then used to investigate any presence of protozoa. This molecular technique demonstrated the presence of DNA of T. gondii in 2.5% of the pools of oysters (n = 2/80): these oysters were exclusively from farms. The results from this study allow the conclusion that oysters of the genus Crassostrea that are farmed in the state of Maranhão are capable of filtering oocysts of T. gondii and maintaining them in their tissues. They are therefore potential sources of contamination for humans and other animals.

Toxoplasma gondii Oocyst Infectivity Assessed Using a Sporocyst-Based Cell Culture Assay Combined with Quantitative PCR for Environmental Applications

Toxoplasma gondii is a ubiquitous foodborne protozoan that can infect humans at low dose and displays different prevalences among countries in the world. Ingestion of food or water contaminated with small amounts of T. gondii oocysts may result in human infection. However, there are no regulations for monitoring oocysts in food, mainly because of a lack of standardized methods to detect them. The objectives of this study were (i) to develop a reliable method, applicable in biomonitoring, for the rapid detection of infectious oocysts by cell culture of their sporocysts combined with quantitative PCR (sporocyst-CC-qPCR) and (ii) to adapt this method to blue and zebra mussels experimentally contaminated by oocysts with the objective to use these organisms as sentinels of aquatic environments. Combining mechanical treatment and bead beating leads to the release of 84% ± 14% of free sporocysts. The sporocyst-CC-qPCR detected fewer than ten infectious oocysts in water within 4 days (1 day of contact and 3 days of cell culture) compared to detection after 4 weeks by mouse bioassay. For both mussel matrices, oocysts were prepurified using a 30% Percoll gradient and treated with sodium hypochlorite before cell culture of their sporocysts. This assay was able to detect as few as ten infective oocysts. This sporocyst-based CC-qPCR appears to be a good alternative to mouse bioassay for monitoring infectious T. gondii oocysts directly in water and also using biological sentinel mussel species. This method offers a new perspective to assess the environmental risk for human health associated with this parasite.IMPORTANCE The ubiquitous protozoan Toxoplasma gondii is the subject of renewed interest due to the spread of oocysts in water and food causing endemic and epidemic outbreaks of toxoplasmosis in humans and animals worldwide. Displaying a sensitivity close to animal models, cell culture represents a real alternative to assess the infectivity of oocysts in water and in biological sentinel mussels. This method opens interesting perspectives for evaluating human exposure to infectious T. gondii oocysts in the environment, where oocyst amounts are considered to be very small.

Virulence of atypical Toxoplasma gondii strains isolated in French Guiana in a murine model

Background. Toxoplasma gondii is an obligate intracellular protozoan parasite of warm-blooded vertebrates. Most infections in immunocompetent patients are asymptomatic. However, since 2000s, strains with particular genetic profiles that differ from the known clonal type (type I, II, III), have been described. In French Guiana, these strains are highly pathogenic in immunocompetent patients. They have defined a new clinical entity called Amazonian Toxoplasmosis. The present study aims to further improve our knowledge on the pathogenicity of these Amazonian T. gondii strains in comparison with three reference strains using Swiss strain mice. With these data, we tried to establish a predictive virulence score to classify these strains, but also to correlate this virulence with the severity of the disease in infected patients. Results. All the virulence indicators revealed that the Amazonian strains isolated in French Guiana presented a high virulence profile, but lower than the highly virulent type I reference RH strain. The findings reveal differences in virulence between human and animal strains, but also between anthropized and wild strains. Conclusion. In addition to being a clinically relevant animal model of Amazonian Toxoplasmosis, this model could also provide a solid experimental basis for future studies aiming to investigate the underlying mechanisms of Amazonian Toxoplasmosis disease.

Human cyclosporiasis

Cyclospora species are socioeconomically important protistan pathogens. Cyclospora cayetanensis is usually transmitted via food or water to a human host via the faecal-oral route and can cause the gastrointestinal disease cyclosporiasis, which can be complicated by extra-intestinal disorders, particularly in immune-compromised people. Although more than 2 million children die each year from diarrhoeal diseases worldwide, it is not known to what extent cyclosporiasis is involved. Few epidemiological data are available on Cyclospora as a water-borne and food-borne pathogen in both underprivileged communities and developed countries. To gain an improved understanding of human cyclosporiasis, this Review describes the background of Cyclospora, summarises salient aspects of the pathogenesis, epidemiology, diagnosis, treatment, and control of cyclosporiasis, and explores what is known about its prevalence and geographical distribution. The findings show that the effect on human health of cyclosporiasis is likely underestimated, and recommendations are made about areas of future research and the prevention and control of this disease within an international collaborative context.

Toxoplasma gondii and Other Zoonotic Protozoans in Mediterranean Mussel ( Mytilus galloprovincialis) and Blue Mussel ( Mytilus edulis): A Food Safety Concern?

Mediterranean mussels ( Mytilus galloprovincialis) and blue mussels ( Mytilus edulis) are among the most consumed fishery products, but they are frequent vehicles of foodborne infection worldwide. In this study, we investigated the occurrence and seasonality of zoonotic protozoans in mussels farmed or sold at retail outlets in Italy. We collected and tested 1,440 M. galloprovincialis and 180 M. edulis. Pooled samples were molecularly tested for Giardia duodenalis, Cryptosporidium spp., and Toxoplasma gondii and then sequenced. Sixty-two (45.9%; 95% confidence interval, 37.5 to 54.3%) mussel pools tested positive for one or more of the investigated pathogens. Both Mytilus species and samples from all the investigated areas harbored pathogens. Mussels were statistically more contaminated by Cryptosporidium spp., followed by T. gondii and G. duodenalis assemblage A, and M. galloprovincialis was more contaminated than M. edulis ( P < 0.01). Contamination was more likely in mussels at retail outlets ( P < 0.05) than in those from farms and in mussels collected in spring ( P < 0.01) than in other seasons. This is the first report of T. gondii found in M. galloprovincialis in Italy and in M. edulis in Europe. The detection of zoonotic protozoans in a widely consumed food source indicates the need for a more detailed microbiological risk analysis, especially considering that bivalve mollusks are often consumed raw worldwide.

Global initiative for congenital toxoplasmosis: an observational and international comparative clinical analysis

Globally, congenital toxoplasmosis remains a significant cause of morbidity and mortality, and outbreaks of infection with T. gondii represent a significant, emerging public health burden, especially in the developing world. This parasite is a threat to public health. Disease often is not recognized and is inadequately managed. Herein, we analyze the status of congenital toxoplasmosis in Morocco, Colombia, the United States, and France. We identify the unique challenges faced by each nation in the implementation of optimal approaches to congenital toxoplasmosis as a public health problem. We suggest that developed and developing countries use a multipronged approach, modeling their public health management protocols after those in France. We conclude that education, screening, appropriate treatment, and the development of novel modalities will be required to intervene successfully in caring for individuals with this infection. Gestational screening has been demonstrated to be cost-effective, morbidity-sparing, and life-saving. Recognition of the value and promise of public health interventions to prevent human suffering from this emerging infection will facilitate better patient and societal outcomes.

Prevalence of antibodies against Toxoplasma gondii in pets and their owners in Shandong province, Eastern China

Background

Pet ownership in China has been steadily increasing over recent years. However, the risk of pet-associated zoonotic infection with the protozoan parasite Toxoplasma gondii remains poorly defined.

Methods

In a cross-sectional survey, we have determined the seroprevalence of T. gondii infection in pet dogs and cats, and pet owners. Serum samples were collected from 360 pets and 460 corresponding pet owners between March 2016 to June 2017, from Shandong province, eastern China. Sera from the animals were tested for anti-T. gondii antibodies using an indirect haemagglutination assay (IHA) and from the pet owners using an enzyme-linked immunosorbent assay (ELISA).

Results

Antibodies against T. gondii were detected in 67 of 360 (18.61%) pets. Seroprevalence of T. gondii in pet cats and dogs was 21.67% and 15.56%, respectively. IgG and IgM antibodies were detected in 79 (17.17%) and 4 (0.87%) of pet owners, respectively; with a total of 83 of 460 (18.04%) pet owners testing seropositive for T. gondii. Our seroprevalence data also suggest that cat owners in general and female pet owners in particular could face a higher risk of acquiring T. gondii infection.

Conclusions

Significant levels of anti-T. gondii antibodies were detected in the pets and their owners in Shandong province, eastern China, indicating a potential zoonotic risk. Prophylactic measures should be implemented to reduce the risk of pet owner’s exposure to T. gondii infection.

Toxoplasma gondii Lineages Circulating in Slaughtered Industrial Pigs and Potential Risk for Consumers

Toxoplasma gondii is a cosmopolitan zoonotic protozoan parasite, and the consumption of raw or undercooked pig meat is one of the most important sources of T. gondii infection. Three predominant lineages, types I, II, and III, are widespread in Europe. Although still poorly understood, a relationship between each type and the severity of illness represents a public health issue. To gain further knowledge of the genotypes in circulation and of the potential risk for consumers, one heart sample and one diaphragm sample (206 total) were taken from each of 103 pig carcasses at an abattoir in Italy. Then, we used 529-bp repetitive element PCR and a B1 real-time PCR high-resolution melting assay coupled with sequencing to detect and genotype T. gondii isolates. T. gondii DNA was detected in 14 pigs (13.6%, 95% confidence interval = 7 to 20.2%), and types I (3.9%), II (5.8%), and III (3.9%) were identified. We found that heart tissue had a significantly higher PCR positivity rate for T. gondii than did diaphragm tissue. This is Europe's largest study on genotyping of T. gondii from pigs, and it demonstrates that all three main lineages are present in carcasses of industrially reared pigs in Italy. There is a potential risk to consumers of infection with any or all of the three lineages, and the related clinical consequences should be taken into account. This study suggests that monitoring of T. gondii types in meat is essential, especially in meat that is traditionally eaten raw or that is minimally processed.

The first detection of Toxoplasma gondii DNA in environmental air samples using gelatine filters, real-time PCR and loop-mediated isothermal (LAMP) assays: qualitative and quantitative analysis

Toxoplasma gondii infections are acquired through the ingestion of oocysts present in the environment. However, there is no data about their occurrence in the air or about airborne transmission of these infections. In the present paper, we report on the identification of T. gondii using rapid molecular detection methods, supported by microscopic analysis, in environmental air samples. A total of 71 samples were collected, using gelatine filters, from kitchen gardens, recreational areas and sandpits located in northern and north-eastern Poland. Material recovered from the filters was analysed using real-time PCR and loop-mediated isothermal assays targeting the T. gondii B1 gene. Toxoplasma gondii DNA was found in two samples, as confirmed by both molecular assays. Genotyping at the SAG2 locus showed Toxoplasma SAG2 type I. Moreover, the presence of T. gondii oocysts was confirmed in one of the positive samples with the use of microscopy. The results showed that T. gondii may be present in environmental air samples and that respiratory tract infections may play a role in the high prevalence of toxoplasmosis in humans and animals. To the best of our knowledge, this is the first epidemiological evidence that oro-fecal and foodborne toxoplasmosis may be traceable to an airborne respiratory origin and that this may represent a new, previously unknown transmission route for this disease.

Water-borne protozoa parasites: The Latin American perspective

Health systems, sanitation and water access have certain limitations in nations of Latin America (LA): typical matters of developing countries. Water is often contaminated and therefore unhealthy for the consumers and users. Information on prevalence and detection of waterborne parasitic protozoa are limited or not available in LA. Only few reports have documented in this field during the last forty years and Brazil leads the list, including countries in South America and Mexico within Central America region and Caribbean islands. From 1979 to 2015, 16 outbreaks of waterborne-protozoa, were reported in Latin American countries. T. gondii and C. cayetanensis were the protozoa, which caused more outbreaks and Giardia spp. and Cryptosporidium spp. were the most frequently found protozoa in water samples. On the other hand, Latin America countries have not got a coherent methodology for detection of protozoa in water samples despite whole LA is highly vulnerable to extreme weather events related to waterborne-infections; although Brazil and Colombia have some implemented laws in their surveillance systems. It would be important to coordinate all surveillance systems in between all countries for early detection and measures against waterborne-protozoan and to establish effective and suitable diagnosis tools according to the country's economic strength and particular needs.

Neglected waterborne parasitic protozoa and their detection in water

Outbreak incidents raise the question of whether the less frequent aetiological agents of outbreaks are really less frequent in water. Alternatively, waterborne transmission could be relevant, but the lack of attention and rapid, sensitive methods to recover and detect the exogenous stages in water may keep them under-recognized. High quality information on the prevalence and detection of less frequent waterborne protozoa, such as Cyclospora cayetanensis, Toxoplasma gondii, Isospora belli, Balantidium coli, Blastocystis hominis, Entamoeba histolytica and other free-living amoebae (FLA), are not available. This present paper discusses the detection tools applied for the water surveillance of the neglected waterborne protozoa mentioned above and provides future perspectives.

Detection of protozoa in water samples by formalin/ether concentration method

Methods to detect protozoa in water samples are expensive and laborious. We evaluated the formalin/ether concentration method to detect Giardia sp., Cryptosporidium sp. and Toxoplasma in water. In order to test the properties of the method, we spiked water samples with different amounts of each protozoa (0, 10 and 50 cysts or oocysts) in a volume of 10 L of water. Immunofluorescence assay was used for detection of Giardia and Cryptosporidium. Toxoplasma oocysts were identified by morphology. The mean percent of recovery in 10 repetitions of the entire method, in 10 samples spiked with ten parasites and read by three different observers, were for Cryptosporidium 71.3 ± 12, for Giardia 63 ± 10 and for Toxoplasma 91.6 ± 9 and the relative standard deviation of the method was of 17.5, 17.2 and 9.8, respectively. Intraobserver variation as measured by intraclass correlation coefficient, was fair for Toxoplasma, moderate for Cryptosporidium and almost perfect for Giardia. The method was then applied in 77 samples of raw and drinkable water in three different plant of water treatment. Cryptosporidium was found in 28 of 77 samples (36%) and Giardia in 31 of 77 samples (40%). Theses results identified significant differences in treatment process to reduce the presence of Giardia and Cryptosporidium. In conclusion, the formalin ether method to concentrate protozoa in water is a new alternative for low resources countries, where is urgently need to monitor and follow the presence of theses protozoa in drinkable water.

Waterborne toxoplasmosis investigated and analysed under hydrogeological assessment: new data and perspectives for further research

We present a set of data on human and chicken Toxoplasma gondii seroprevalence that was investigated and analysed in light of groundwater vulnerability information in an area endemic for waterborne toxoplasmosis in Brazil. Hydrogeological assessment was undertaken to select sites for water collection from wells for T. gondii oocyst testing and for collecting blood from free-range chickens and humans for anti-T. gondii serologic testing. Serologic testing of human specimens was done using conventional commercial tests and a sporozoite-specific embryogenesis-related protein (TgERP), which is able to differentiate whether infection resulted from tissue cysts or oocysts. Water specimens were negative for the presence of viable T. gondii oocysts. However, seroprevalence in free-range chickens was significantly associated with vulnerability of groundwater to surface contamination (p < 0.0001; odds ratio: 4.73, 95% confidence interval: 2.18-10.2). Surprisingly, a high prevalence of antibodies against TgERP was detected in human specimens, suggesting the possibility of a continuous contamination of drinking water with T. gondii oocysts in this endemic setting. These findings and the new proposed approach to investigate and analyse endemic toxoplasmosis in light of groundwater vulnerability information associated with prevalence in humans estimated by oocyst antigens recognition have implications for the potential role of hydrogeological assessment in researching waterborne toxoplasmosis at a global scale.

Impact of environmental factors on the emergence, transmission and distribution of Toxoplasma gondii

Toxoplasma gondii is an obligate intracellular protozoan that poses a great threat to human health and economic well-being worldwide. The effects of environmental factors such as changing climate and human activities on the ecology of this protozoan are being discovered. Accumulated evidence shows that changes of these environmental factors can exert influence on the occurrence, transmission and distribution of T. gondii. This article reviews studies from different geographical regions with varying climates, social cultures and animal welfare standards. It aims to illustrate how these environmental factors work, highlighting their importance in influencing the ecology of T. gondii, as well as providing clues which may contribute to preventing transmission of this important zoonotic pathogen.

Molecular detection of Toxoplasma gondii in water samples from Scotland and a comparison between the 529bp real-time PCR and ITS1 nested PCR

Waterborne transmission of Toxoplasma gondii is a potential public health risk and there are currently no agreed optimised methods for the recovery, processing and detection of T. gondii oocysts in water samples. In this study modified methods of T. gondii oocyst recovery and DNA extraction were applied to 1427 samples collected from 147 public water supplies throughout Scotland. T. gondii DNA was detected, using real time PCR (qPCR) targeting the 529bp repeat element, in 8.79% of interpretable samples (124 out of 1411 samples). The samples which were positive for T. gondii DNA originated from a third of the sampled water sources. The samples which were positive by qPCR and some of the negative samples were reanalysed using ITS1 nested PCR (nPCR) and results compared. The 529bp qPCR was the more sensitive technique and a full analysis of assay performance, by Bayesian analysis using a Markov Chain Monte Carlo method, was completed which demonstrated the efficacy of this method for the detection of T. gondii in water samples.

Environmentally Transmitted Pathogens

This chapter describes a variety of pathogens found in the environment that are capable of infecting humans and causing disease. Different classes of pathogens are discussed including bacteria, parasites and viruses. For each pathogen, data are provided on the incidence of the organism in a particular environmental matrix such as water, food or municipal waste. In addition, we discuss: the disease caused by the particular microbe; the mode of transmission; the incubation time needed within the host prior to the onset of disease; and the duration of illness. Fate and transport of pathogens in the environment are also described. A variety of bacterial pathogens are discussed including waterborne and waterbased bacteria. Parasites discussed include protozoa, nematodes, cestodes and trematodes. For viruses, both enteric and respiratory viruses are included.

Comparative study on Toxoplasma infection between Malaysian and Myanmar pregnant women

Background

Toxoplasma gondii, an obligate intracellular protozoan parasite, causes a disease called toxoplasmosis which can sometimes be acquired congenitally by a newborn from an infected mother. This study aimed to determine the seroprevalence of Toxoplasma infection and its associated risks among 219 and 215 pregnant women from Malaysia and Myanmar, respectively.

Methods

Anti-Toxoplasma IgG and IgM antibodies were screened by using standard commercial ELISA kits. The socio-demographic, obstetrics and risk factors associated with Toxoplasma infection data were compared between the two countries.

Results

The overall prevalence of Toxoplasma infection in Malaysian pregnant women (42.47%; 95% CI = 36.11-49.09) was significantly higher (p < 0.05) than Myanmar pregnant women (30.70%; 95% CI = 27.92-37.16). By univariate analysis, this study identified that age group, education, parity, awareness on toxoplasmosis and consumption of undercooked meat were significantly associated (p < 0.05) with Toxoplasma seropositive Malaysian pregnant women but none of these factors associated with Toxoplasma seropositive Myanmar pregnant women. In comparison using univariate analysis between the two countries, it was found that Toxoplasma seropositive Malaysian pregnant women was associated with aged 30 years and above, secondary or lower-secondary level of education, the third trimester of pregnancy, having one child or more, lacking awareness of toxoplasmosis, absence of bad obstetrics history, having no history of close contact with cats or soil, living on a farm and also consumption of undercooked meat, unpasterized milk or untreated water. Avidity measurement was used to confirm the stages of Toxoplasma infection in pregnant women who were positive for both IgG and IgM antibodies and found all were infected in the past.

Conclusion

From our study, Toxoplasma screening and its risk measurement in pregnant women is firmly recommended for monitoring purposes and assisting proper management, including diagnosis and treatment during antenatal period. Also, it is necessary to initiate preventive measures for Toxoplasma infection among reproductive-age women in general and seronegative pregnant women in particular. Avidity measurement should be incorporated in Toxoplasma routine screening, especially with the availability of a single serum sample to assist in the diagnosis.

Electronic supplementary material

The online version of this article (doi:10.1186/s13071-014-0564-9) contains supplementary material, which is available to authorized users.

Attempted detection of Toxoplasma gondii oocysts in environmental waters using a simple approach to evaluate the potential for waterborne transmission in the Galápagos Islands, Ecuador

Toxoplasmosis is a health concern for wildlife and humans, particularly in island ecosystems. In the Galápagos Islands, exposure to Toxoplasma gondii has been found in marine avifauna on islands with and without domestic cats. To evaluate potential waterborne transmission of T. gondii, we attempted to use filtration and epifluorescent microscopy to detect autofluorescent T. gondii oocysts in fresh and estuarine surface water samples. T. gondii oocyst-like structures were microscopically visualized but were not confirmed by polymerase chain reaction and sequence analyses. Further research is needed to refine environmental pathogen screening techniques and to evaluate disease risk of waterborne zoonoses such as T. gondii for wildlife and humans, particularly in the Galápagos and other naive island ecosystems.

Antibodies to Toxoplasma gondii in individuals with mania

OBJECTIVES

Increased rates of infection with Toxoplasma gondii have been found in individuals with schizophrenia as compared to control groups but this issue has not been studied in mania.

METHODS

We measured immunoglobulin G (IgG) and IgM class antibodies to T. gondii in 57 individuals with mania who were assessed at up to three time-points. We also measured these antibodies in 743 individuals in other psychiatric groups and in 314 non-psychiatric controls. T. gondii antibody levels were compared among groups by multivariate analyses. IgG class and IgM class antibodies to cytomegalovirus were also measured in the same samples. T. gondii antibody levels were also compared over time in the mania group.

RESULTS

The mania group had a significantly elevated level of IgM antibodies to T. gondii as compared to the control individuals without a psychiatric diagnosis [odds ratio (OR) = 2.33, p < 0.04 at hospital admission; and OR = 2.32, p < 0.02 at study entry during the hospital stay]. Elevated IgM class antibodies to T. gondii were not found in individuals with the other psychiatric diagnoses. We also did not find an increased level of IgG class antibodies to T. gondii or IgG or IgM class antibodies to CMV in the individuals with mania. Within the mania group, there was a significant difference between the prevalences of increased levels of T. gondii IgM at the baseline and the follow-up time-point (t = 2.97, p < 0.003).

CONCLUSIONS

Infection with T. gondii may confer risk for mania.

Bioaccumulation of human waterborne protozoa by zebra mussel (Dreissena polymorpha): interest for water biomonitoring

Cryptosporidium parvum, Giardia duodenalis and Toxoplasma gondii are ubiquitous pathogens, which waterborne transmission has been largely demonstrated. Since they can be found in various watercourses, interactions with aquatic organisms are possible. Protozoan detection for watercourses biomonitoring is currently based on large water filtration. The zebra mussel, Dreissena polymorpha, is a choice biological model in ecotoxicological studies which are already in use to detect chemical contaminations in watercourses. In the present study, the zebra mussel was tested as a new tool for detecting water contamination by protozoa. In vivo exposures were conducted in laboratory experiments. Zebra mussel was exposed to various protozoan concentrations for one week. Detection of protozoa was realized by Taqman real time qPCR. Our experiments evidenced C. parvum, G. duodenalis and T. gondii oocyst bioaccumulation by mussels proportionally to ambient contamination, and significant T. gondii prevalence was observed in muscle tissue. To our knowledge, this is the first study that demonstrates T. gondii oocyst accumulation by zebra mussel. The results from this study highlight the capacity of zebra mussels to reveal ambient biological contamination, and thus to be used as a new effective tool in sanitary biomonitoring of water bodies.

Epidemiology, pathophysiology, and the future of ocular toxoplasmosis

Despite large advances in the field of ocular toxoplasmosis, large gaps still exist in our knowledge concerning the epidemiology and pathophysiology of this potentially blinding infectious disease. Although ocular toxoplasmosis is considered to have a high health burden, still little is known about its exact prevalence and how it affects the quality of life. The epidemiology of toxoplasmosis depends on local habits throughout the globe, and changes are likely in view of increased meat consumption in developing countries and demands for higher animal welfare in the Western world. Water is increasingly seen as an important risk factor and more studies are needed to quantitate and control the role of water exposure (drinking, swimming). Tools are now becoming available to study both the human host as well as parasite genetic factors in the development of ocular toxoplasmosis. Further research on the role of Toxoplasma strains as well as basic studies on parasite virulence is needed to explain why Toxoplasma associated eye disease is so severe in some countries, such as Brazil. Although genetic analysis of the parasite represents the gold standard, further developments in serotyping using peptide arrays may offer practical solutions to study the role of parasite strains in the pathogenesis of Toxoplasma retinochoroiditis. More research is needed concerning the pathways whereby the parasite can infect the retina. Once in the retina further tissue damage may be due to parasite virulence factors or could be caused by an aberrant host immune response. Local intraocular immune responses are nowadays used for diagnostic procedures. Future developments may include the use of Raman technology or the direct visualization of a Toxoplasma cyst by optical coherence tomography (OCT). With the availability of ocular fluid specimens obtained for diagnostic purposes and the development of advanced proteomic techniques, a biomarker fingerprint that is unique for an eye with toxoplasmosis may become available. It is hoped that such a biomarker analysis may also be able to distinguish between acquired versus congenital disease. Recently developed mouse models of congenital ocular toxoplasmosis are extremely promising with regard to disease pathogenesis, diagnosis, and treatment.

Fate and transport of Toxoplasma gondii oocysts in seasonally snow covered watersheds: a conceptual framework from a melting snowpack to the Canadian arctic coasts

Toxoplasma gondii is a zoonotic protozoan that causes serious illness in humans and infects animals worldwide, including the Canadian Arctic. Indeed, high prevalence of infection amongst Inuit has been recorded, possibly due to consumption of raw infected seal meat. Here we explore the hypothesis that T. gondii oocysts contaminate the coastal marine environment via surface runoff from across the boreal watershed, particularly during the snowmelt period. We propose a conceptual framework of the different processes governing the fate and transport of T. gondii oocysts from the melting snowpack to the Canadian arctic coast via the freshwater runoff. This framework identifies the feasibility of a transmission pathway of oocysts from contaminated soil to the marine environment, but also the complexity and multiplicity of mechanisms involved. In addition, the framework identifies knowledge gaps for guiding future studies on T. gondii oocysts. Furthermore, this work could be used as a tool to investigate the possible estuarine contamination by other faeces-borne pathogens transported via the spring freshet in seasonally snow covered watersheds.