Clinical and epidemiological descriptions from trichinellosis outbreaks in Bulgaria

Human parasitic infections of the class Adenophorea: global epidemiology, pathogenesis, prevention and control

BACKGROUND

Human parasitic infections caused by Adenophorean nematodes encompass a range of diseases, including dioctophymiasis, trichuriasis, capillariasis, trichinellosis, and myositis. These infection can result in adverse impacts on human health and cause societal and economic concerns in tropical and subtropical regions.

METHODS

This review conducted searches in PubMed, Embase and Google Scholar for relevant studies that published in established databases up to April 26, 2024. Studies that focused on the common morphology, life cycle, disease distribution, clinical manifestations, and prevention and control strategies for Adenophorean parasitic diseases in humans were included.

RESULTS

Adenophorean nematodes exhibit shared morphological characteristics with a four-layered cuticle; uninucleate epidermal cells; pseudocoelom with six or more coelomocytes; generally three caudal glands; five esophageal glands; two testes in males with median-ventral supplementary glands in a single row; tail in males rarely possessing caudal alae; amphids always postlabial; presence of cephalic sensory organs; absence of phasmids; and a secretory-excretory system consisting of a single ventral gland cell, usually with a non-cuticularized terminal duct. Humans play two important roles in the life cycle of the nematode class, Adenophorea: 1) as a definitive host infected by ingesting undercooked paratenic hosts, embryonated eggs, infective larvae in fish tissue and meat contaminated with encysted or non-encysted larvae, and 2) as an accidental host infected by ingesting parasitic eggs in undercooked meat. Many organs are targeted by the Adenophorean nematode in humans such as the intestines, lungs, liver, kidneys, lymphatic circulation and blood vessels, resulting in gastrointestinal problems, excessive immunological responses, cell disruption, and even death. Most of these infections have significant incidence rates in the developing countries of Africa, Asia and Latin America; however, some parasitic diseases have restricted dissemination in outbreaks. To prevent these diseases, interventions together with education, sanitation, hygiene and animal control measures have been introduced in order to reduce and control parasite populations.

CONCLUSIONS

The common morphology, life cycle, global epidemiology and pathology of human Adenophorean nematode-borne parasitic diseases were highlighted, as well as their prevention and control. The findings of this review will contribute to improvement of monitoring and predicting human-parasitic infections, understanding the relationship between animals, humans and parasites, and preventing and controlling parasitic diseases.

A Large-Scale Outbreak of Trichinellosis from Infected Wild Boar Meat in Croatia and the Role of Real-Time PCR Assays in Confirming the Source of the Disease

BACKGROUND

Trichinellosis in Croatia posed a significant health concern during the 1990s, followed by a notable improvement in the epidemiological situation. However, in 2017, there was a resurgence, with 37 recorded cases in 3 outbreaks and 3 sporadic cases. The source of this epidemic was homemade meat products derived from wild boar meat, leading to 26 infections.

METHODS

At the beginning of the outbreak and during the treatment of the patients, the medical and epidemiological records prepared throughout the investigation and over the course of patient treatment were reviewed. The recovery of the first-stage (L1) larvae from suspect meat products was achieved by artificial digestion. The molecular identification of the isolated larvae was performed by multiplex PCR. The molecular identification of the meat used to prepare the meat products was performed by real-time PCR assays.

RESULTS

The epidemic started in early 2017. In total, 71 exposed persons were documented: 26 with clinical symptoms and 3 hospitalised in two cities in different counties. The L1 burden in three different meat products was from 5.25 to 7.08 larvae per gram (LPG), and T. spiralis was determined as the aetiological agent of the outbreak. The molecular and biological identification confirmed that implicated meat products were made solely from wild boar meat.

CONCLUSIONS

Although trichinellosis is no longer a frequent occurrence in Croatia, several cases are still registered nearly every year. Wild boar meat poses an important risk factor for human health if compulsory testing is not conducted before consumption, especially if the meat products are consumed without proper thermal processing.

First Identification and Molecular Characterization of Trichinella britovi (Nematoda: Trichinellidae) from the Pine Marten (Martes martes Linnaeus, 1758) in Romania

Trichinella spp. are etiological zoonotic agents spread throughout the world and affect mammals, birds, and reptiles; they evolve via two cycles: domestic and sylvatic. Martes martes is a carnivorous nocturnal mammal from the family Mustelidae. In Romania, this host is widespread in all forests of the country. Martes martes has an extremely voracious appetite, feeding on fruit and also on a variety of small animals, including rodents such as mice and rats. The aim of this study was the identification and molecular characterization of Trichinella larvae isolated from the muscle tissue of Martes martes collected in different counties of Romania. The muscle samples were examined via artificial digestion, and the larvae were identified at the species level via multiplex PCR. The presence of larvae belonging to Trichinella britovi, a species frequently identified in wild carnivores in temperate zones, was observed. Although T. britovi has been already reported in several host species in Romania, this is the first time this species has been observed in a Martes martes specimen. This finding contributes to our knowledge about the host species involved in the maintenance of the Trichinella sylvatic cycle in Romania, and it confirms that this parasite is consistently present in the wild fauna of this country.

Trichinellosis in Hospitalized Children and Adults from Western Romania: A 11-Year Retrospective Study

Trichinellosis, a serious and sometimes fatal human disease, is a consequence of consuming raw or improperly cooked meat containing the infective larvae of Trichinella spp. The aim of this observational cohort retrospective study is to compare the epidemiological, laboratory, clinical and therapeutic aspects of trichinellosis in children and adults from Western Romania. We investigated the medical records of patients who were diagnosed with trichinellosis and hospitalized between 17 January 2010 and 31 December 2020. One hundred thirty-three patients were identified according to the electronic databases of infectious disease hospitals, located in four counties from Western Romania. A total of 19 patients (14.28%) were children and 114 patients (85.71%) were adults. In children, the most frequent symptoms were digestive in 78.94%, followed by fever in 57.89%, eyelid or facial edema in 57.89% and myalgia in 52.63% of cases, while adults presented mainly myalgia in 87.71%, followed by fever in 77.19%, digestive symptoms in 68.42% and eyelid or facial edema in 66.66% of cases. The source of infection was pork meat products in the majority of patients (89.47%). Our results revealed a general declining trend in infection rates for both children and adults during the studied period. The vast majority of cases were severe and all required hospitalization. Education of the population along with public health strategies should be improved and maintained to fully prevent trichinellosis in Western Romania.

A Review on Alaria alata, Toxoplasma gondii and Sarcocystis spp. in Mammalian Game Meat Consumed in Europe: Epidemiology, Risk Management and Future Directions

Simple Summary

In many European countries, game meat consumption is related to the traditional hunting culture. Its demand and consumption are increasing, also due to the growing populations of wild ungulates. However, specific public health issues exist and should be taken into account. This review focuses on the causal agents, epidemiology, potential risk for human health and its management along the supply chain, including parasite detection at slaughtering and inactivation in meat, of three parasites (Alaria alata, Toxoplasma gondii and Sarcocystis spp.), which can be transmitted by the main mammalian game meat species in the EU: wild boar (Sus scrofa), red deer (Cervus elaphus), roe deer (Capreolus capreolus), fallow deer (Dama dama), Alpine chamois (Rupicapra rupicapra), moose (Alces alces), hare (Lepus europaeus) and wild rabbit (Oryctolagus cuniculus). By presenting the main issues and knowledge gaps, this study aims to contribute to an improved control supporting the risk analysis process.

Abstract

Game meat is increasingly appreciated and consumed in Europe, also due to the growing population of wild ungulates. In addition to interesting nutritional properties and market opportunities, game meat is characterized by some specific public health issues. This review focuses on the etiology, epidemiology, public health aspects and risk management along the supply chain, including parasite detection at slaughtering and inactivation in meat, of three selected foodborne parasitic hazards (Alaria alata, Toxoplasma gondii and Sarcocystis spp.) in the main mammalian game meat species in the EU: wild boar (Sus scrofa), red deer (Cervus elaphus), roe deer (Capreolus capreolus), fallow deer (Dama dama), Alpine chamois (Rupicapra rupicapra), moose (Alces alces), hare (Lepus europaeus) and wild rabbit (Oryctolagus cuniculus). The presented data point out the main issues, and knowledge gaps as well as the potential for improved control in order to contribute to the risk analysis process. To pursue an effective management of these parasitic zoonoses, awareness raising should involve all figures in the supply chain, including hunters, restaurateurs and consumers. Human behaviour and the lack of knowledge regarding meat borne parasitic zoonoses and the health risks they pose seem to be the most important factors responsible for human infections. However, detection methods, starting from the sampling procedure, should be further developed and standardized in order to improve the collection of accurate and up-to-date epidemiological data.

Analysis of a Trichinellosis Outbreak in Poland after Consumption of Sausage Made of Wild Boar Meat

An outbreak of trichinellosis due to the consumption of sausage made from wild boar meat unexamined for the presence of Trichinella spp. was reported in Poland in December 2020. The outbreak affected eight people. Examination of the sausages made of wild boar meat collected during epidemiological investigation indicated a high level of Trichinella spp. Larvae per gram (>30 lpg) and therefore the threat of an infection in humans after consumption of such product was significant. Over the years, the main source of trichinellosis in Poland has been wild boar meat, and the majority of trichinellosis cases were related to the consumption of traditional raw meat products such as Polish sausage. Taking this into account, there is the need for better education of consumers in the Trichinella spp. endemic regions and among cultures consuming traditional raw meat products.

Trichinella Outbreaks on Pig Farms in Poland in 2012-2020

Trichinella nematodes continue to circulate in various hosts both in the domestic and sylvatic cycles. In the majority of countries in Europe, wild boars have been noticed as a primary source of Trichinella spp. infections in humans. However, in some regions, the meat of pigs containing Trichinella spp. larvae can still be a cause of trichinellosis. Therefore, in the present study, we aimed to determine and present actual data on the occurrence of Trichinella spp. on pig farms (Sus scrofa f. domestica) in Poland. In this study, over 194 million pigs, slaughtered for commercial and personal purposes between 2012 and 2020, were tested with a digestion method according to the official rules for Trichinella control. Positive results were noticed in 172 pigs which gives an overall prevalence of 0.000088%. On seven farms, rats (Rattus norvegicus) infected with Trichinella spp. were also discovered. The species identification showed pigs were infected with Trichinella spiralis on 26 farms, and on four farms pigs with Trichinella britovi infections were found. Therefore, it is important to constantly monitor pigs for the presence of these parasites, especially in view of the growing interest in organic meat originated from ecological farms.

Differences in larval survival and IgG response patterns in long-lasting infections by Trichinella spiralis, Trichinella britovi and Trichinella pseudospiralis in pigs

BACKGROUND

Domesticated and wild swine play an important role as reservoir hosts of Trichinella spp. and a source of infection for humans. Little is known about the survival of Trichinella larvae in muscles and the duration of anti-Trichinella antibodies in pigs with long-lasting infections.

METHODS

Sixty pigs were divided into three groups of 20 animals and infected with 10,000 larvae of Trichinella spiralis, Trichinella britovi or Trichinella pseudospiralis. Four pigs from each group were sacrificed at 2, 6, 12, 18 and 24 months post-infection (p.i.) and the number of larvae per gram (LPG) of muscles was calculated. Serum samples were tested by ELISA and western blot using excretory/secretory (ES) and crude antigens.

RESULTS

Trichinella spiralis showed the highest infectivity and immunogenicity in pigs and larvae survived in pig muscles for up to 2 years p.i. In these pigs, the IgG level significantly increased at 30 days p.i. and reached a peak at about 60 days p.i., remaining stable until the end of the experiment. In T. britovi-infected pigs, LPG was about 70 times lower than for T. spiralis at 2 months p.i. and only very few infecting larvae were detected at 6 months p.i., whereas no larvae were detected at 12, 18 and 24 months p.i. At 6 months p.i., degenerated/calcified larvae and cysts were detected in the muscles by trichinoscopy and histology. The IgG pattern showed by T. britovi-infected pigs was similar to that of T. spiralis-infected pigs, although seroconversion occurred some days later. The larval burden of T. pseudospiralis was slightly greater than for T. britovi at 2 months p.i., but no larvae were detected at 6 and 12 months p.i. In T. pseudospiralis-infected pigs, seroconversion occurred slowly, as in T. britovi-infected pigs. The IgG level showed a significant drop at 6 months p.i. and declining to the cut-off value at 12 months p.i.

CONCLUSIONS

The longer survival of T. spiralis in pigs in comparison with the other two species highlights its exceptional dissemination potential. These results provide an explanation of the controversial data collected by parasitological and serological tools in the course of epidemiological investigations.

Why we need a European focus on foodborne parasites

Foodborne parasites (FBP) are recognized as being a neglected pathogen group, often associated with marginalized or disadvantaged populations, especially those living in regions where water supply or sanitation are inadequate. Nevertheless, we are also increasingly recognising that FBP are not just restricted to such places, and even those that do have a circumscribed endemic area may also travel further in our globalised world; FBP are relevant everywhere, including Europe. Against this background, COST Action Euro-FBP (FA1408) was established and ran for a period of 4 years, addressing a number of different questions related to FBP, particularly in the European setting. In this special issue (SI), some of the issues and outputs associated with Euro-FBP are considered in greater depth, as an output also of the final Euro-FBP meeting. As well as more general issues regarding, for example, globalization and climate change, use of economic models, and the value of risk-based surveillance that puts the topic in perspective, individual articles are included that address specific parasites. These include protozoan parasites, such as Cryptosporidium, Giardia, and Toxoplasma, as contaminants of water, shellfish, and fresh produce, fishborne parasites such as Anisakid nematodes, and meatborne parasites, such as Trichinella. Some of the works provide specific data on occurrence or outbreaks, whilst others are concerned with techniques. In addition, implementation of some of the educational and collaborative tools that are unique to COST Actions are described. COST Actions are not generally intended to deliver a scientific endpoint, and Euro-FBP does not do so. However, the articles in this SI, along with other articles published elsewhere during and subsequent to the course of the Action, as direct outputs of the Euro-FBP activities, indicate that FBP are indeed a relevant topic for European scientists.