Global prevalence status of avian schistosomes: A systematic review with meta-analysis

Zoonotic Threats: The (Re)emergence of Cercarial Dermatitis, Its Dynamics, and Impact in Europe

Cercarial dermatitis (CD), or "Swimmer's itch" as it is also known, is a waterborne illness caused by a blood fluke from the family Schistosomatidae. It occurs when cercariae of trematode species that do not have humans as their definitive host accidentally penetrate human skin (in an aquatic environment) and trigger allergic symptoms at the site of contact. It is an emerging zoonosis that occurs through water and is often overlooked during differential diagnosis. Some of the factors contributing to the emergence of diseases like CD are related to global warming, which brings about climate change, water eutrophication, the colonization of ponds by snails susceptible to the parasite, and sunlight exposure in the summer, associated with migratory bird routes. Therefore, with the increase in tourism, especially at fluvial beaches, it is relevant to analyze the current epidemiological scenario of CD in European countries and the potential regions at risk.

Human cercarial dermatitis (HCD) in the UK: an overlooked and under-reported nuisance?

BACKGROUND

Human cercarial dermatitis (HCD) is a clinical disease typically caused by skin-penetrative larvae of avian schistosomes. Its geographical epidemiology is firmly tied with that of infected freshwater intermediate snail hosts. To better understand the current distribution of HCD and its level of nuisance in the UK, we undertook a systematic literature review.

METHODS

Following PRIMSA guidelines, PubMed and Scopus databases were searched with keywords "human cercarial dermatitis" OR "swimmer's itch" AND "United Kingdom". Articles about imported cases of HCD, or HCD outside the UK, were not formally included.

RESULTS

A total of 30 articles were initially identified. A further two were gained by inspection of all citations. After screening, eight publications were analysed where the location, number of cases and putative avian schistosome species incriminated were tabulated. HCD is mainly found in the south of England, though gaps in evidence and reporting remain across the UK.

CONCLUSIONS

Despite its noted recent rise in open water swimmers, published literature on HCD across the UK is sparse; this condition is both overlooked and under-reported. We therefore recommend establishing a national database that raises awareness and encourages self-reporting of this nuisance disease.

Phylogenetic analysis of avian schistosome Trichobilharzia regenti (Schistosomatidae, Digenea) from naturally infected hosts in northern Iran

BACKGROUND

Trichobilharzia regenti (T. regenti) is an avian schistosomatid fluke species that causes human cercarial dermatitis (HCD) in areas of aquaculture in northern Iran. Understanding the phylogenetic relationships and genetic diversity of this thread-like fluke will deepen our thoughtful of avian schistosomiasis epidemiology and lead to more effective HCD control in the region.

OBJECTIVES

To determine the life cycle of nasal Trichobilharzia in aquatic birds as well as aquatic snails and also identify the haplotype diversity of the isolates in Mazandaran Province, northern Iran.

METHODS

In the present study, adult or egg of Trichobilharzia isolated from aquatic birds as well as schistosomes cercariae isolated from aquatic snails in Mazandaran Province, northern Iran, belonged to the authors' previous research, were examined. Molecular studies and phylogenetic analysis were carried out on these schistosomes samples.

RESULTS

The phylogenetic analysis of the ITS1 and COX1 genes in isolated schistosomes revealed that all samples belong to the T. regenti clade. Remarkably, based on phylogenetic results, these schistosomes samples from Anas platyrhynchos domesticus, A. platyrhynchos, Spatula clypeata and Lymnaea stagnalis grouped together with previously sequenced samples from Iran (Trichobilharzia cf. regenti). Unlike the phylogenetic tree and haplotype network of COX1 gene, ITS1 did not show distinct clusters.

CONCLUSION

This study completed the puzzle of the disease in Mazandaran Province by isolating and genotyping furkocercariae from L. stagnalis that was consistent with the isolated new genotype from ducks. For the first time in Iran, this confirmed the potential role of L. stagnalis snails in the transmission of the disease.

Phylogenomics and Diversification of the Schistosomatidae Based on Targeted Sequence Capture of Ultra-Conserved Elements

Schistosomatidae Stiles and Hassall 1898 is a medically significant family of digenetic trematodes (Trematoda: Digenea), members of which infect mammals or birds as definitive hosts and aquatic or amphibious gastropods as intermediate hosts. Currently, there are 17 named genera, for many of which evolutionary interrelationships remain unresolved. The lack of a resolved phylogeny has encumbered our understanding of schistosomatid evolution, specifically patterns of host-use and the role of host-switching in diversification. Here, we used targeted sequence capture of ultra-conserved elements (UCEs) from representatives of 13 of the 17 named genera and 11 undescribed lineages that are presumed to represent either novel genera or species to generate a phylogenomic dataset for the estimation of schistosomatid interrelationships. This study represents the largest phylogenetic effort within the Schistosomatidae in both the number of loci and breadth of taxon sampling. We present a near-comprehensive family-level phylogeny providing resolution to several clades of long-standing uncertainty within Schistosomatidae, including resolution for the placement of the North American mammalian schistosomes, implying a second separate capture of mammalian hosts. Additionally, we present evidence for the placement of Macrobilharzia at the base of the Schistosoma + Bivitellobilharzia radiation. Patterns of definitive and intermediate host use and a strong role for intermediate host-switching are discussed relative to schistosomatid diversification.

Cercariae of a Bird Schistosome Follow a Similar Emergence Pattern under Different Subarctic Conditions: First Experimental Study

The emergence of cercariae from infected mollusks is considered one of the most important adaptive strategies for maintaining the trematode life cycle. Short transmission opportunities of cercariae are often compensated by periodic daily rhythms in the cercarial release. However, there are virtually no data on the cercarial emergence of bird schistosomes from freshwater ecosystems in northern latitudes. We investigated the daily cercarial emergence rhythms of the bird schistosome Trichobilharzia sp. “peregra” from the snail host Radix balthica in a subarctic lake under both natural and laboratory seasonal conditions. We demonstrated a circadian rhythm with the highest emergence during the morning hours, being seasonally independent of the photo- and thermo-period regimes of subarctic summer and autumn, as well as relatively high production of cercariae at low temperatures typical of northern environments. These patterns were consistent under both field and laboratory conditions. While light intensity triggered and prolonged cercarial emergence, the temperature had little effect on cercarial rhythms but regulated seasonal output rates. This suggests an adaptive strategy of bird schistosomes to compensate for the narrow transmission window. Our results fill a gap in our knowledge of the transmission dynamics and success of bird schistosomes under high latitude conditions that may serve as a basis for elucidating future potential risks and implementing control measures related to the spread of cercarial dermatitis due to global warming.

A putative new genus of avian schistosome transmitted by Biomphalaria straminea (Gastropoda: Planorbidae) in Brazil, with a discussion on the potential involvement in human cercarial dermatitis

Human cercarial dermatitis (HCD) caused by avian schistosomes is an emerging health issue in different parts of the world. Nevertheless, parasite diversity, life cycle, and involvement in HCD remain poorly known or neglected in South America. Herein, we reported data obtained during a long-term malacological survey carried out in Pampulha Reservoir, an urban eutrophic waterbody from Brazil between 2009 and 2012. An ocellate brevifurcate cercaria emerged from 55 of 16,235 (0.34%) specimens of Biomphalaria straminea. Samples of the cercariae were subjected to morphological, experimental, and molecular study (analysis of partial sequences of nuclear 28S and mitochondrial cox1 genes). The molecular analysis revealed that the larva corresponds to an avian schistosome; however, it does not correspond to any named genus. A close related isolate was previously reported in Biomphalaria sudanica from Kenya (molecular divergences of 0.54% and 9.62% for 28S and cox1, respectively). The morphology of this cercaria was compared with other avian schistosome larvae from Biomphalaria spp. Attempts to infect experimentally ducks (Cairina moschata) and mice revealed cutaneous manifestations after exposure to cercariae, but adult parasites were not obtained in these hosts. Phylogenetic analysis suggests this parasite is a putative new genus and species of avian schistosome. The potential involvement of the larvae herein described in cases of HCD in Brazil cannot be ruled out. Surprisingly, HCD was not reported in the country so far, which can be related to difficulties in its diagnosis in areas of overlap with human schistosomes.

Crop protection practices and risks associated with infectious tropical parasitic diseases

Two recent literature reviews have shown that: i) agroecological crop protection (ACP) practices generally reduce risks of viral zoonoses, unlike conventional (agrochemical-based) practices which tend to increase them; ii) substitution-based crop protection (CP) practices (mainly biocontrol-based) could result in fewer health risks from bacterial infectious diseases. Here, we present an analysis of the scientific literature to determine to what extent the conclusions regarding viruses or bacteria can be extended to infectious diseases caused by protozoan or helminthic parasites. This analysis of cases of both vector-transmitted and water- or food-borne parasitic diseases, shows, in terms of reduction of health risks: i) an overall negative effect arising from the use of synthetic plant protection products; ii) the relevance of substitution CP practices not strictly under the ACP banner. On the other hand, the public and veterinary health issue of antiparasitic resistance is not affected by CP practices. The positive effects at the large spatio-temporal scales of ACP approaches remain valid, although to a slightly lesser extent than for bacterial diseases and viral zoonoses, in particular through biodiversity conservation which fosters natural regulations and control, preventing the undesirable effects of synthetic pesticides.

Two new genera and species of avian schistosomes from Argentina with proposed recommendations and discussion of the polyphyletic genus Gigantobilharzia (Trematoda, Schistosomatidae)

Gigantobilharzia Odhner, 1910 (Schistosomatidae) includes species that parasitize several orders of birds and families of gastropods from both freshwater and marine environments worldwide. Due to their delicate bodies, most of the species descriptions are incomplete, and lumped in the genus Gigantobilharzia, in some cases despite major morphological variability. Only three of those species have molecular sequence data but then lack a robust morphological description, making species differentiation very difficult. For this reason, several authors consider that many of the species of Gigantobilharzia should be reassigned to new genera. The aim of this paper is to describe two new genera and two new species of schistosomes using morphological and molecular characterization. We described Marinabilharzia patagonense n. g., n. sp. parasitizing Larus dominicanus from north Patagonian coast, and Riverabilharzia ensenadense n. g., n. sp. parasitizing L. dominicanus, Chroicocephalus maculipennis and Chroicocephalus cirrocephalus from freshwater Río de La Plata, in South America, Argentina. We then analysed and discussed the combinations of characters defining species of Gigantobilharzia and, based on that and on the available molecular data, we propose at least four possible new genera.

A report of Bilharziella polonica cercariae in Knowsley Safari, Prescot, United Kingdom, with notes on other trematodes implicated in human cercarial dermatitis

As part of surveillance of snail-borne trematodiasis in Knowsley Safari (KS), Prescot, United Kingdom, a collection was made in July 2021 of various planorbid (n = 173) and lymnaeid (n = 218) snails. These were taken from 15 purposely selected freshwater habitats. In the laboratory emergent trematode cercariae, often from single snails, were identified by morphology with a sub-set, of those most accessible, later characterized by cytochrome oxidase subunit 1 (cox1) DNA barcoding. Two schistosomatid cercariae were of special note in the context of human cercarial dermatitis (HCD), Bilharziella polonica emergent from Planorbarius corneus and Trichobilharzia spp. emergent from Ampullacaena balthica. The former schistosomatid was last reported in the United Kingdom over 50 years ago. From cox1 analyses, the latter likely consisted of two taxa, Trichobilharzia anseri, a first report in the United Kingdom, and a hitherto unnamed genetic lineage having some affiliation with Trichobilharzia longicauda. The chronobiology of emergent cercariae from P. corneus was assessed, with the vertical swimming rate of B. polonica measured. We provide a brief risk appraisal of HCD for public activities typically undertaken within KS educational and recreational programmes.

Association between human cercarial dermatitis (HCD) and the occurrence of Trichibilarizia in duck and snail in main wetlands from Mazandaran Province, northern Iran

Background

Avian schistosomes are considered as main causative agents of human cercarial dermatitis (HCD) in Iran. The study was conducted to determine bird schistosomes in their final and intermediate hosts, in main wetlands of Mazandaran.

Methods

A total of 255 domestic and wild ducks were collected and the infection of nasal tissues of five (Anas platyrhynchos domesticus, Aythya ferina, Cairina moschata, Anas platyrhynchos and Spatula clypeata) species were analyzed using morphological techniques. Also, 1687 freshwater snails were collected and surveyed by cercarial shedding and crushing tests. Detection of HCD was performed for the presence of clinical symptoms of itching and maculopapular rashs by physical examination.

Results

Of 255 ducks, in 41 (16%) infection with nasal Trichibilarizia spp. were recognized by observing eggs and/or adult worms. The most infected ducks were Anas clypeata and Anas platyrhynchos domesticus. Overall, 0.17% of snails were infected with avian schistosomes. Also, clinical examination of 951 rice farmers revealed that 588 (61.82%) of them were suffered from HCD.

Conclusion

Our data suggest that domestic ducks could play a prominent role as a reservoir host for establishing life cycle of Trichobilharzia in the area. Also, existence of domestic reservoir ducks and suitable snail hosts in ponds and paddy fields of this area, climate conditions of the wetlands in Mazandaran leads to a high incidence of HCD.

Descriptive Pathological Study of Avian Schistosomes Infection in Whooper Swans (Cygnus cygnus) in Japan

Simple Summary

Avian schistosomes are a group of parasites responsible for most of the reported cases of cercarial dermatitis outbreaks. Among others, Trichobilharzia is considered the largest genus of avian Schistosomatidae, and it infects more than 40 avian species. The present study involves a descriptive pathological study of avian schistosome in 54 whooper swans (Cygnus cygnus) from various rescue/rehabilitation centers in Honshu, Japan. Interestingly, adult schistosomes were detected in the lumen of mesenteric, serosal, portal, and testicular veins, in the capillaries of the intestinal lamina propria, and in the sinusoids of the adrenal gland, spleen, and liver of 23 (42.59%) swans. Schistosomes were assumed to be Allobilharzia visceralis based on the morphological characteristics of the worm and eggs found at histopathological examination of internal organs, along with suggestive pathological findings as well as the pathological findings. Collectively, the present study provides novel descriptive pathological data about schistosome infection in whooper swans with new insights on their role in the transmission and spreading of avian schistosomes in Japan.

Abstract

Cercarial dermatitis, or Swimmer’s itch, is one of the emerging diseases caused by the cercariae of water-borne schistosomes, mainly Trichobilharzia spp. Since the zoonotic potential of Allobilharzia visceralis is still unknown, studies on this schistosome would be helpful to add knowledge on its possible role in causing human infections. In the present study, 54 whooper swans (Cygnus cygnus) from rescue/rehabilitation centers in Honshu, Japan, were necropsied to identify the cause of death. Grossly, 33 (61.11%) swans were severely emaciated and 23 (42.59%) had multiple reddened areas throughout the length of the intestine with no worms detected in the internal organs. Microscopically, adult schistosomes were found in the lumen of the mesenteric, serosal, portal, and testicular veins, in the capillaries of the intestinal lamina propria, and in the sinusoids of the adrenal gland, spleen, and liver of 23 (42.59%) swans. Hypertrophy of veins containing adult worms was identified in 15 (27.77%) swans, and vascular lumen obliteration was observed in 8 (14.81%) swans. Mild to severe villous atrophy and superficial enteritis were observed in 8 birds (14.81%), whereas bile pigments and hemosiderin were detected in the livers of 14 (25.92%) and 18 (33.33%) swans, respectively. In three swans (5.55%), schistosome parasites were found in the subcapsular veins of the testes. The schistosomes in the present study were assumed to be A. visceralis based on the microscopical and histological evidence of adult schistosomes found in the lumen of veins as well as the infection pathology, which was very similar to the schistosome-induced pathology previously reported in swans infected by A. visceralis in Europe and Australia. The swans examined herein most likely died from obstructive phlebitis associated with A. visceralis, but further molecular confirmation is required for identification of this species. However, the present study does not provide new data on the zoonotic potential, but only on the pathogenic potential of this schistosome in swans. Furthermore, our study provides a novel contribution to the description of the pathological effects of avian schistosomes infection in whooper swans in Japan.

Hypertransaminasemia in the course of infection with SARS-CoV-2: Incidence and pathogenetic hypothesis

In patients infected with severe acute respiratory syndrome coronavirus 2, the respiratory symptoms, such as fever, cough and dyspnea, are the most frequent clinical manifestations. These patients may also present with less well-defined symptoms like diarrhea, nausea, vomiting and/or abdominal discomfort both at the time of diagnosis and during the clinical course. In a few cases, these symptoms may also present before the appearance of respiratory symptoms. To penetrate the body, Severe acute respiratory syndrome coronavirus 2 uses ACE2 receptors, which are present not only in respiratory epithelium but also in gastrointestinal mucosa and liver cholangiocytes. In several cases, viral RNA is detectable in the stool of patients with coronavirus disease 2019 (COVID-19). The liver damage seems to show a multifactorial origin. About 2%-11% of patients with COVID-19 have known underlying hepatic pathologies. In 14%-53% of COVID-19 cases, there is an alteration of the indices of liver cytolysis and is more frequently observed in severe forms of COVID-19, especially during hospitalization.