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Kilduff S, Steinman B, Xie Y, Kiss-Farengo T, Foca M, Hayde N. Pet safety guidelines for pediatric transplant recipients. Pediatr Transplant 2024; 28:e14527. [PMID: 37550270 DOI: 10.1111/petr.14527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/06/2023] [Accepted: 03/13/2023] [Indexed: 08/09/2023]
Abstract
Approximately 70% (90.5 million) of United States (US) households own at least one pet. Dogs are the most common, making up about 38% of all household pets, followed by cats, which make up 25%. Other pets such as fish, birds, reptiles, and small animals such as hamsters, gerbils, and rabbits are less common household members. Pets are often considered a part of the family and there are significant medical and psychosocial benefits to pet ownership; however, the possibility of disease transmission exists related to the type of animal and infectious organism, and specific human risk factors. Immunocompromised individuals may be at increased risk of serious illness from zoonotic infections. During the transplant evaluation and routinely posttransplant, the multidisciplinary team should inquire about pet ownership and animal exposures to guide on potential risks. This review discusses the most common diseases seen in various household pets including dogs, cats, birds, fish, and some farm animals. We will also present guidelines for pet safety and include strategies to decrease the risk of infection while supporting the benefits of pet ownership after transplant.
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Affiliation(s)
- Stella Kilduff
- Division of Pediatric Nephrology, Children's Hospital at Montefiore, Bronx, New York, USA
| | - Benjamin Steinman
- Division of Pediatric Nephrology, Children's Hospital at Montefiore, Bronx, New York, USA
| | - Yuping Xie
- Division of Pediatric Nephrology, Children's Hospital at Montefiore, Bronx, New York, USA
| | - Tomas Kiss-Farengo
- Department of Social Work, Children's Hospital at Montefiore, Bronx, New York, USA
| | - Marc Foca
- Divison of Pediatric Infectious Diseases, Children's Hospital at Montefiore, Bronx, New York, USA
| | - Nicole Hayde
- Division of Pediatric Nephrology, Children's Hospital at Montefiore, Bronx, New York, USA
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Kuzi S, Zgairy S, Byrne BA, Suchodolski J, Turjeman SC, Park SY, Aroch I, Hong M, Koren O, Lavy E. Giardiasis and diarrhea in dogs: Does the microbiome matter? J Vet Intern Med 2024; 38:152-160. [PMID: 37890857 PMCID: PMC10800182 DOI: 10.1111/jvim.16894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 09/20/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Giardia duodenalis (Gd) causes intestinal parasitosis. The involvement of the intestinal microbiome in determining the infection's clinical phenotype is unknown. OBJECTIVE Investigate the fecal microbiome features in dogs with giardiasis. ANIMALS AND METHODS Cross-sectional study, including fecal samples of kenneled dogs with Gd diagnosed by fecal Giardia antigen dot ELISA. The fecal microbial compositional characteristics and dysbiosis index (DI) were compared between diarrheic and nondiarrheic dogs. RESULTS Fecal samples of 38 Gd-infected dogs (diarrheic, 21; nondiarrheic, 17) were included. No differences were found in Faith's phylogenic diversity and beta diversity (weighted UniFrac distances) and in specific taxa abundances at the phylum, genus, and species levels, as well as in alpha and beta diversities between diarrheic and nondiarrheic dogs, and also when divided by sex or age. Among diarrheic dogs, alpha diversity was higher in males than in females (pairwise Kruskal-Wallis, q = 0.01). Among males, fecal abundances of the genus Clostridium (W = 19) and Clostridium spiroforme species (W = 33) were higher in diarrheic compared to nondiarrheic dogs. In diarrheic dog fecal samples, Proteobacteria were more prevalent (W = 1), whereas Verrucomicrobia were less prevalent in dogs <1 year of age than in older dogs. The fecal sample DI of 19 diarrheic and 19 nondiarrheic dogs was similar (median, -0.2; range, -4.3 to 4.5 and median, -1.0; range, -4.3 to 5.8, respectively). CONCLUSIONS The fecal microbial composition of symptomatic and asymptomatic dogs with giardiasis is similar. Based on fecal DI, giardiasis is not characterized by prominent dysbiosis. Other host and parasite characteristics might determine the severity of giardiasis in dogs.
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Affiliation(s)
- Sharon Kuzi
- Hebrew University Veterinary Teaching Hospital and Koret School of Veterinary Medicine, Robert H. Smith Faculty of AgricultureFood and Environment Hebrew University of JerusalemRehovotIsrael
| | - Soha Zgairy
- Azrieli Faculty of MedicineBar‐Ilan UniversitySafedIsrael
| | - Barbara A. Byrne
- Department of Pathology, Microbiology, and ImmunologyUniversity of California—DavisDavisCaliforniaUSA
| | - Jan Suchodolski
- Gastrointestinal Laboratory, Department of Small Animal Clinical SciencesTexas A&M UniversityCollege StationTexasUSA
| | | | - So Young Park
- Gastrointestinal Laboratory, Department of Small Animal Clinical SciencesTexas A&M UniversityCollege StationTexasUSA
| | - Itamar Aroch
- Hebrew University Veterinary Teaching Hospital and Koret School of Veterinary Medicine, Robert H. Smith Faculty of AgricultureFood and Environment Hebrew University of JerusalemRehovotIsrael
| | - Mike Hong
- Gastrointestinal Laboratory, Department of Small Animal Clinical SciencesTexas A&M UniversityCollege StationTexasUSA
| | - Omry Koren
- Azrieli Faculty of MedicineBar‐Ilan UniversitySafedIsrael
| | - Eran Lavy
- Hebrew University Veterinary Teaching Hospital and Koret School of Veterinary Medicine, Robert H. Smith Faculty of AgricultureFood and Environment Hebrew University of JerusalemRehovotIsrael
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Zhou Y, Luo D, Liu K, Chen B, Chen S, Pan J, Liu Z, Jiang J. Trend of the Tuberculous Pleurisy Notification Rate in Eastern China During 2017-2021: Spatiotemporal Analysis. JMIR Public Health Surveill 2023; 9:e49859. [PMID: 37902822 PMCID: PMC10644181 DOI: 10.2196/49859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/31/2023] [Accepted: 09/19/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND Tuberculous pleurisy (TP) presents a serious allergic reaction in the pleura caused by Mycobacterium tuberculosis; however, few studies have described its spatial epidemiological characteristics in eastern China. OBJECTIVE This study aimed to determine the epidemiological distribution of TP and predict its further development in Zhejiang Province. METHODS Data on all notified cases of TP in Zhejiang Province, China, from 2017 to 2021 were collected from the existing tuberculosis information management system. Analyses, including spatial autocorrelation and spatial-temporal scan analysis, were performed to identify hot spots and clusters, respectively. The prediction of TP prevalence was performed using the seasonal autoregressive integrated moving average (SARIMA), Holt-Winters exponential smoothing, and Prophet models using R (The R Foundation) and Python (Python Software Foundation). RESULTS The average notification rate of TP in Zhejiang Province was 7.06 cases per 100,000 population, peaking in the summer. The male-to-female ratio was 2.18:1. In terms of geographical distribution, clusters of cases were observed in the western part of Zhejiang Province, including parts of Hangzhou, Quzhou, Jinhua, Lishui, Wenzhou, and Taizhou city. Spatial-temporal analysis identified 1 most likely cluster and 4 secondary clusters. The Holt-Winters model outperformed the SARIMA and Prophet models in predicting the trend in TP prevalence. CONCLUSIONS The western region of Zhejiang Province had the highest risk of TP. Comprehensive interventions, such as chest x-ray screening and symptom screening, should be reinforced to improve early identification. Additionally, a more systematic assessment of the prevalence trend of TP should include more predictors.
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Affiliation(s)
- Ying Zhou
- School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Dan Luo
- School of Public Health, Hangzhou Medical College, Hangzhou, China
| | - Kui Liu
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
- National Centre for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Bin Chen
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Songhua Chen
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Junhang Pan
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Zhengwei Liu
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Jianmin Jiang
- Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
- Key Laboratory of Vaccine, Prevention and Control of Infectious Disease of Zhejiang Province, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
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Giardia spp. promote the production of antimicrobial peptides and attenuate disease severity induced by attaching and effacing enteropathogens via the induction of the NLRP3 inflammasome. Int J Parasitol 2020; 50:263-275. [PMID: 32184085 DOI: 10.1016/j.ijpara.2019.12.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 12/12/2019] [Accepted: 12/28/2019] [Indexed: 12/14/2022]
Abstract
Polymicrobial infections of the gastro-intestinal tract are common in areas with poor sanitation. Disease outcome is the result of complex interactions between the host and pathogens. Such interactions lie at the core of future management strategies of enteric diseases. In developed countries of the world, Giardia duodenalis is a common cause of diarrheal disease. In contrast, giardiasis appears to protect children against diarrhea in countries with poor sanitation, via obscure mechanisms. We hypothesized that Giardia may protect its host from disease induced by a co-infecting pathogen such as attaching and effacing Escherichia coli. This enteropathogen is commonly implicated in pediatric diarrhea in developing countries. The findings indicate that co-infection with Giardia attenuates the severity of disease induced by Citrobacter rodentium, an equivalent of A/E E. coli in mice. Co-infection with Giardia reduced colitis, blood in stools, fecal softening, bacterial invasion, and weight loss; the protective effects were lost when co-infection occurred in Nod-like receptor pyrin-containing 3 knockout mice. In co-infected mice, elevated levels of antimicrobial peptides Murine β defensin 3 and Trefoil Factor 3, and enhanced bacterial killing, were NLRP3-dependent. Inhibition of the NLRP3 inflammasome in human enterocytes blocked the activation of AMPs and bacterial killing. The findings uncover novel NLRP3-dependent modulatory mechanisms during co-infections with Giardia spp. and A/E enteropathogens, and demonstrate how these interactions may regulate the severity of enteric disease.
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Kim HY, Lee H, Lee SH, Seo MG, Yi S, Kim JW, Kim CH, Lee YR, So B, Kwon OD, Kwak D. Multilocus genotyping and risk factor analysis of Giardia duodenalis in dogs in Korea. Acta Trop 2019; 199:105113. [PMID: 31356789 DOI: 10.1016/j.actatropica.2019.105113] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/12/2019] [Accepted: 07/25/2019] [Indexed: 11/26/2022]
Abstract
Giardia duodenalis (syn. G. intestinalis, G. lamblia), a protozoan parasite that infects most mammals (including humans), has recently been classified into eight different groups/assemblages (A to H) based on host range and genetic characteristics. Assemblages A and B have been reported in humans and in many other animals, including dogs. This study analyzed Giardia infections, implementing multilocus genotyping, including the 18S rRNA, gdh, and β-giardin genes, in sheltered, companion, and special-purpose dogs throughout Korea. Of 640 dog stool samples, 99 (15.5%) were G. duodenalis-positive; this prevalence was similar to that previously reported in Korean calves. In addition, the prevalence was significantly higher in the southern region, and lower in non-sheltered dogs, older dogs, and in the autumn season. Phylogenetic analysis revealed that all G. duodenalis-positive samples belonged to assemblages C and D. Although no G. duodenalis assemblages A and B (mainly found in humans) were identified in this study, assemblage C was detected in the main types of dogs in contact with humans. Assemblage C, thought to be dog-specific, was recently identified in humans. As Giardia (including zoonotic assemblages) is distributed throughout Korea, dog living environments and the potential for dog-human transmission should be monitored.
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Ashour DS, Saad AE, Dawood LM, Zamzam Y. Immunological interaction between Giardia cyst extract and experimental toxoplasmosis. Parasite Immunol 2017; 40. [PMID: 29130475 DOI: 10.1111/pim.12503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 11/07/2017] [Indexed: 12/16/2022]
Abstract
Toxoplasmosis is mostly associated with other intestinal parasitic infections especially Giardia due to shared mode of peroral infection. Toxoplasma and Giardia induce a strong T-helper 1- immune response. Our aim was to induce a protective immune response that results in significant impact on intestinal and extra-intestinal phases of Toxoplasma infection. This study was conducted in experimental animals and assessment of Giardia cyst extract effect on Toxoplasma infection was investigated by histopathological examination of small intestine and brain, Toxoplasma cyst count and iNOS staining of the brain, measurement of IFN-γ and TGF-β in intestinal tissues. Results showed that the brain Toxoplasma cyst number was decreased in mice infected with Toxoplasma then received Giardia cyst extract as compared to mice infected with Toxoplasma only. This effect was produced because Giardia cyst extract augmented the immune response to Toxoplasma infection as evidenced by severe inflammatory reaction in the intestinal and brain tissues, increased levels of IFN-γ and TGF-β in intestinal tissues and strong iNOS staining of the brain. In conclusion, Giardia cyst extract generated a protective response against T. gondii infection. Therefore, Giardia antigen will be a suitable candidate for further researches as an immunomodulatory agent against Toxoplasma infection.
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Affiliation(s)
- D S Ashour
- Medical Parasitology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - A E Saad
- Medical Parasitology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - L M Dawood
- Biochemistry Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Y Zamzam
- Pathology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
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Gil H, Cano L, de Lucio A, Bailo B, de Mingo MH, Cardona GA, Fernández-Basterra JA, Aramburu-Aguirre J, López-Molina N, Carmena D. Detection and molecular diversity of Giardia duodenalis and Cryptosporidium spp. in sheltered dogs and cats in Northern Spain. INFECTION GENETICS AND EVOLUTION 2017; 50:62-69. [DOI: 10.1016/j.meegid.2017.02.013] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 02/14/2017] [Accepted: 02/15/2017] [Indexed: 12/11/2022]
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Haimovich JS, Venkatesh AK, Shojaee A, Coppi A, Warner F, Li SX, Krumholz HM. Discovery of temporal and disease association patterns in condition-specific hospital utilization rates. PLoS One 2017; 12:e0172049. [PMID: 28355219 PMCID: PMC5371293 DOI: 10.1371/journal.pone.0172049] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 01/30/2017] [Indexed: 11/18/2022] Open
Abstract
Identifying temporal variation in hospitalization rates may provide insights about disease patterns and thereby inform research, policy, and clinical care. However, the majority of medical conditions have not been studied for their potential seasonal variation. The objective of this study was to apply a data-driven approach to characterize temporal variation in condition-specific hospitalizations. Using a dataset of 34 million inpatient discharges gathered from hospitals in New York State from 2008-2011, we grouped all discharges into 263 clinical conditions based on the principal discharge diagnosis using Clinical Classification Software in order to mitigate the limitation that administrative claims data reflect clinical conditions to varying specificity. After applying Seasonal-Trend Decomposition by LOESS, we estimated the periodicity of the seasonal component using spectral analysis and applied harmonic regression to calculate the amplitude and phase of the condition's seasonal utilization pattern. We also introduced four new indices of temporal variation: mean oscillation width, seasonal coefficient, trend coefficient, and linearity of the trend. Finally, K-means clustering was used to group conditions across these four indices to identify common temporal variation patterns. Of all 263 clinical conditions considered, 164 demonstrated statistically significant seasonality. Notably, we identified conditions for which seasonal variation has not been previously described such as ovarian cancer, tuberculosis, and schizophrenia. Clustering analysis yielded three distinct groups of conditions based on multiple measures of seasonal variation. Our study was limited to New York State and results may not directly apply to other regions with distinct climates and health burden. A substantial proportion of medical conditions, larger than previously described, exhibit seasonal variation in hospital utilization. Moreover, the application of clustering tools yields groups of clinically heterogeneous conditions with similar seasonal phenotypes. Further investigation is necessary to uncover common etiologies underlying these shared seasonal phenotypes.
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Affiliation(s)
- Julian S. Haimovich
- Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Arjun K. Venkatesh
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, United States of America
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Abbas Shojaee
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, United States of America
| | - Andreas Coppi
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, United States of America
| | - Frederick Warner
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, United States of America
| | - Shu-Xia Li
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, United States of America
| | - Harlan M. Krumholz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, United States of America
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
- The Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, United States of America
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Moron-Soto M, Gutierrez L, Sumano H, Tapia G, Alcala-Canto Y. Efficacy of nitazoxanide to treat natural Giardia infections in dogs. Parasit Vectors 2017; 10:52. [PMID: 28143543 PMCID: PMC5286866 DOI: 10.1186/s13071-017-1998-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 01/24/2017] [Indexed: 11/25/2022] Open
Abstract
Background Giardia parasites cause gastrointestinal disease in humans, dogs, and many other animals worldwide. The treatment of dogs for giardiasis requires further investigation to ascertain levels of drug efficacy and the possibility of adverse side effects. Nitazoxanide (NTZ) has shown good clinical anti-Giardia activity in humans, yet it has not been evaluated for the treatment of giardiasis in dogs. Methods Thirty-five dogs, naturally infected with Giardia were divided into five groups (n = 7): dogs in group NTZ1, NTZ2, and NTZ3 were treated with a single oral dose of 37.5 mg/kg, 75 mg/kg, and 150 mg/kg, respectively, of NTZ on days 0 and 14. The fourth group was treated with a commercially available regimen that includes a combination of pyrantel, praziquantel, and febantel (FEB) administered orally for three consecutive days. Additionally, an untreated control group was established. Giardia cysts from the stool of each dog were quantified on days -3, 0, 5, 7, 9, 11, 14, 18, 25, and 28. Biochemical parameters were evaluated in all dogs, before the first treatment and after concluding the experiment. Results Shedding of Giardia cysts was reduced in all treated groups when compared to untreated controls (P < 0.01). However, NTZ2, NTZ3, and FEB had a lower risk during the study. Furthermore, NTZ was also effective against another protozoan, Cryptosporidium spp. at doses of 75 mg/kg and 150 mg/kg, in contrast to the combination of febantel + pyrantel + praziquantel. Biochemical parameters of treated animals, namely, aspartate transaminase and alanine transaminase enzymes, remained within physiological ranges. Conclusions Based on these results, the implementation of NTZ as a treatment for giardiasis in dogs is proposed. The administration of a single dose is an important advantage of NTZ because it reduces workload, particularly in animals placed in shelters and kennels, where handling of large numbers of animals is required, and personnel is frequently scarce.
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Affiliation(s)
- Mario Moron-Soto
- Departamento de Parasitología, Facultad de Medicina Veterinaria y Zootecnia, Universidad Nacional Autónoma de México, Av. Universidad 3000, Delegación Coyoacán, Ciudad de México, C.P., 04510, Mexico
| | - Lilia Gutierrez
- Departamento de Fisiología y Farmacología, Facultad de Medicina Veterinaria y Zootecnia, Universidad Nacional Autónoma de México, Av. Universidad 3000, Delegación Coyoacán, Ciudad de México, C.P., 04510, Mexico
| | - Héctor Sumano
- Departamento de Fisiología y Farmacología, Facultad de Medicina Veterinaria y Zootecnia, Universidad Nacional Autónoma de México, Av. Universidad 3000, Delegación Coyoacán, Ciudad de México, C.P., 04510, Mexico
| | - Graciela Tapia
- Departamento de Genética y Bioestadística, Facultad de Medicina Veterinaria y Zootecnia, Universidad Nacional Autónoma de México, Av. Universidad 3000, Delegación Coyoacán, Ciudad de México, C.P., 04510, Mexico
| | - Yazmin Alcala-Canto
- Departamento de Parasitología, Facultad de Medicina Veterinaria y Zootecnia, Universidad Nacional Autónoma de México, Av. Universidad 3000, Delegación Coyoacán, Ciudad de México, C.P., 04510, Mexico.
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The presence of Giardia intestinalis in donkeys, Equus asinus, in China. Parasit Vectors 2017; 10:3. [PMID: 28049541 PMCID: PMC5209919 DOI: 10.1186/s13071-016-1936-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 12/13/2016] [Indexed: 11/27/2022] Open
Abstract
Background Giardia intestinalis is one of the most important zoonotic enteric parasites. As no information regarding prevalence and genotype of G. intestinalis in donkeys (Equus asinus) in China is available, 181 faecal samples from 48 donkeys from Jilin Province, from 104 from Shandong Province and from 29 from Liaoning Province were examined between May and December 2015. Findings Twenty-eight (15.47%) out of 181 donkey samples were tested G. intestinalis-positive by nested amplification of the triosephosphate isomerase (tpi) gene. The prevalence in different regional groups varied from 10.42 to 18.27%. The prevalence in adult and young donkeys was 14.29 and 22.92%, respectively. Otherwise, the prevalence was 11.69% in summer and 18.27% in winter. However, no statistically significant differences were found in relation to region or age group. Sequence analysis of the tpi, glutamate dehydrogenase (gdh) and beta giardin (bg) loci identified 4, 1 and 3 subtypes of assemblage B, respectively. Moreover, four novel multilocus genotypes (MLGs novel-1 to novel-4) were identified in assemblage B. Conclusions This first report of G. intestinalis in donkeys in China indicates that further studies of nation-wide molecular epidemiology and geographical distribution of Giardia in donkeys are warranted. Effective strategies should be implemented to control G. intestinalis infection in donkeys, other animals and humans. Electronic supplementary material The online version of this article (doi:10.1186/s13071-016-1936-0) contains supplementary material, which is available to authorized users.
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Zhang XX, Zheng WB, Ma JG, Yao QX, Zou Y, Bubu CJ, Zhao Q, Zhu XQ. Occurrence and multilocus genotyping of Giardia intestinalis assemblage C and D in farmed raccoon dogs, Nyctereutes procyonoides, in China. Parasit Vectors 2016; 9:471. [PMID: 27576343 PMCID: PMC5004317 DOI: 10.1186/s13071-016-1771-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 08/23/2016] [Indexed: 11/10/2022] Open
Abstract
Background Giardia intestinalis, the only causative agent of human giardiasis, can infect a wide range of animals. As no information concerning the prevalence and genotyping of G. intestinalis in raccoon dogs in China is available, examination of 305 faecal samples from raccoon dogs in Jilin Province (n = 110), Heilongjiang Province (n = 40), Liaoning Province (n = 72), Hebei Province (n = 54) and Shandong Province (n = 29) was conducted to estimate the prevalence of G. intestinalis in raccoon dogs in northern China and identify their genotypes using a genetic approach. Findings Of 305 faecal samples from farmed raccoon dogs, 22 (7.21 %) were detected G. intestinalis-positive by nested PCR amplification of the triosephosphate isomerase (tpi) gene. The prevalence of G. intestinalis was strongly related to the region and season of sampling. All 22 samples were analysed at the tpi, the glutamate dehydrogenase (gdh) and the beta giardin (bg) gene loci, showing 13, 3, 2 subtypes, respectively. The results also demonstrated that two raccoon dogs harboured mixed infections of assemblage C and assemblage D (or mixed C/D), whereas only assemblage C was detected in the remaining 20 samples. Moreover, five new multilocus genotypes, named as MLGs C1-C5, were observed in the assemblage C in the present study. Conclusions This is the first report of G. intestinalis infection in raccoon dogs in China. DNA sequence analysis of the tpi, gdh and bg gene indicated that 13, 3, 2 subtypes were found at these loci, respectively. Furthermore, this is also the first report of five new multilocus genotypes (MLGs C1-C5) in farmed raccoon dogs, which provides baseline data for further studies of the distribution of G. duodenalis in different hosts.
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Affiliation(s)
- Xiao-Xuan Zhang
- State Key Laboratory of Veterinary Etiological Biology, Key Laboratory of Veterinary Parasitology of Gansu Province, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, Gansu Province, 730046, People's Republic of China.,College of Animal Science and Technology, Jilin Agricultural University, Changchun, Jilin Province, 130118, People's Republic of China
| | - Wen-Bin Zheng
- State Key Laboratory of Veterinary Etiological Biology, Key Laboratory of Veterinary Parasitology of Gansu Province, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, Gansu Province, 730046, People's Republic of China.,College of Animal Science and Technology, Jilin Agricultural University, Changchun, Jilin Province, 130118, People's Republic of China
| | - Jian-Gang Ma
- State Key Laboratory of Veterinary Etiological Biology, Key Laboratory of Veterinary Parasitology of Gansu Province, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, Gansu Province, 730046, People's Republic of China.,College of Animal Science and Technology, Jilin Agricultural University, Changchun, Jilin Province, 130118, People's Republic of China
| | - Qiu-Xia Yao
- State Key Laboratory of Veterinary Etiological Biology, Key Laboratory of Veterinary Parasitology of Gansu Province, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, Gansu Province, 730046, People's Republic of China.,Jiangsu Co-innovation Center for the Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou University College of Veterinary Medicine, Yangzhou, Jiangsu Province, 225009, People's Republic of China
| | - Yang Zou
- State Key Laboratory of Veterinary Etiological Biology, Key Laboratory of Veterinary Parasitology of Gansu Province, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, Gansu Province, 730046, People's Republic of China.,College of Animal Science and Technology, Jilin Agricultural University, Changchun, Jilin Province, 130118, People's Republic of China
| | - Cai-Jia Bubu
- State Key Laboratory of Veterinary Etiological Biology, Key Laboratory of Veterinary Parasitology of Gansu Province, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, Gansu Province, 730046, People's Republic of China.,College of Animal Science and Technology, Jilin Agricultural University, Changchun, Jilin Province, 130118, People's Republic of China
| | - Quan Zhao
- College of Animal Science and Technology, Jilin Agricultural University, Changchun, Jilin Province, 130118, People's Republic of China
| | - Xing-Quan Zhu
- State Key Laboratory of Veterinary Etiological Biology, Key Laboratory of Veterinary Parasitology of Gansu Province, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, Gansu Province, 730046, People's Republic of China. .,College of Animal Science and Technology, Jilin Agricultural University, Changchun, Jilin Province, 130118, People's Republic of China. .,Jiangsu Co-innovation Center for the Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou University College of Veterinary Medicine, Yangzhou, Jiangsu Province, 225009, People's Republic of China.
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12
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Buret AG. Enteropathogen-Induced Microbiota Biofilm Disruptions and Post-Infectious Intestinal Inflammatory Disorders. CURRENT TROPICAL MEDICINE REPORTS 2016. [DOI: 10.1007/s40475-016-0079-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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13
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Valcour JE, Charron DF, Berke O, Wilson JB, Edge T, Waltner-Toews D. A descriptive analysis of the spatio-temporal distribution of enteric diseases in New Brunswick, Canada. BMC Public Health 2016; 16:204. [PMID: 26932766 PMCID: PMC4774118 DOI: 10.1186/s12889-016-2779-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 01/25/2016] [Indexed: 12/03/2022] Open
Abstract
Background Enteric diseases affect thousands of Canadians annually and several large outbreaks have occurred due to infection with enteric pathogens. The objectives of this study were to describe the spatial and temporal distributions of reportable Campylobacter, Escherichia coli, Giardia, Salmonella and Shigella from 1994 to 2002 in New Brunswick, Canada. By examining the spatial and temporal distributions of disease incidence, hypotheses as to potential disease risk factors were formulated. Methods Time series plots of monthly disease incidence were examined for seasonal and secular trends. Seasonality of disease incidence was evaluated using the temporal scan statistic and seasonal–trend loess (STL) decomposition methods. Secular trends were evaluated using negative binomial regression modeling. The spatial distribution of disease incidence was examined using maps of empirical Bayes smoothed estimates of disease incidence. Spatial clustering was examined by multiple methods, which included Moran’s I and the spatial scan statistic. Results The peak incidence of Giardia infections occurred in the spring months. Salmonella incidence exhibited two peaks, one small peak in the spring and a main peak in the summer. Campylobacter and Escherichia coli O157 disease incidence peaked in the summer months. Moran’s I indicated that there was significant positive spatial autocorrelation for the incidence of Campylobacter, Giardia and Salmonella. The spatial scan statistic identified clusters of high disease incidence in the northern areas of the province for Campylobacter, Giardia and Salmonella infections. The incidence of Escherichia coli infections clustered in the south-east and north-east areas of the province, based on the spatial scan statistic results. Shigella infections had the lowest incidence rate and no discernable spatial or temporal patterns were observed. Conclusions By using several different spatial and temporal methods a robust picture of the spatial and temporal distributions of enteric disease in New Brunswick was produced. Disease incidence for several reportable enteric pathogens displayed significant geographic clustering indicating that a spatially distributed risk factor may be contributing to disease incidence. Temporal analysis indicated peaks in disease incidence, including previously un-reported peaks.
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Affiliation(s)
- James E Valcour
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, A1B 3V6, Newfoundland and Labrador, Canada.
| | | | - Olaf Berke
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, N1G 2W1, ON, Canada.
| | - Jeff B Wilson
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, N1G 2W1, ON, Canada.
| | - Tom Edge
- Aquatic Ecosystem Protection Research Branch, National Water Research Institute, Environment Canada, Burlington, ON, Canada.
| | - David Waltner-Toews
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, N1G 2W1, ON, Canada.
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14
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Zhang XX, Tan QD, Zhao GH, Ma JG, Zheng WB, Ni XT, Zhao Q, Zhou DH, Zhu XQ. Prevalence, Risk Factors and Multilocus Genotyping of Giardia intestinalis in Dairy Cattle, Northwest China. J Eukaryot Microbiol 2016; 63:498-504. [PMID: 26729604 DOI: 10.1111/jeu.12293] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Revised: 12/22/2015] [Accepted: 12/27/2015] [Indexed: 11/28/2022]
Abstract
Giardia intestinalis is a cosmopolitan protozoan parasite that can infect a range of animals, including dairy cattle. As information regarding the prevalence and genotyping of G. intestinalis infection in dairy cattle in northwestern China is limited, 2,945 feces samples from 1,224 dairy cattle in Gansu Province and from 1,614 in Ningxia Hui Autonomous Region (NXHAR) were examined between December 2012 and March 2014. The overall prevalence of G. intestinalis was 3.63% (107/2,945), with 2.63% and 4.38% in Gansu and NXHAR, respectively. Logistic regression analysis showed region, age and season to be significant risk factors for G. intestinalis infection. Assemblage analysis identified 106 assemblage E and one assemblage A at the triose phosphate isomerase (tpi) locus in this study. Intravariations were also detected at tpi, glutamate dehydrogenase (gdh) and beta giardin (bg) loci within assemblage E, showing seven, three, and five new subtypes, respectively. Moreover, 13 new multilocus genotypes (E20-E32) were observed in assemblage E. Effective strategies and measures should be taken to prevent and control giardiasis in Gansu and NXHAR.
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Affiliation(s)
- Xiao-Xuan Zhang
- State Key Laboratory of Veterinary Etiological Biology, Key Laboratory of Veterinary Parasitology of Gansu Province, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, Gansu Province, 730046, China.,College of Animal Science and Technology, Jilin Agricultural University, Changchun, Jilin Province, 130118, China
| | - Qi-Dong Tan
- State Key Laboratory of Veterinary Etiological Biology, Key Laboratory of Veterinary Parasitology of Gansu Province, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, Gansu Province, 730046, China.,College of Animal Science and Technology, Anhui Agricultural University, Hefei, Anhui Province, 230000, China
| | - Guang-Hui Zhao
- College of Veterinary Medicine, Northwest A&F University, Yangling, Shaanxi Province, 712100, China
| | - Jian-Gang Ma
- State Key Laboratory of Veterinary Etiological Biology, Key Laboratory of Veterinary Parasitology of Gansu Province, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, Gansu Province, 730046, China
| | - Wen-Bin Zheng
- State Key Laboratory of Veterinary Etiological Biology, Key Laboratory of Veterinary Parasitology of Gansu Province, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, Gansu Province, 730046, China
| | - Xiao-Ting Ni
- College of Veterinary Medicine, Gansu Agricultural University, Lanzhou, Gansu Province, 730030, China
| | - Quan Zhao
- College of Animal Science and Technology, Jilin Agricultural University, Changchun, Jilin Province, 130118, China
| | - Dong-Hui Zhou
- State Key Laboratory of Veterinary Etiological Biology, Key Laboratory of Veterinary Parasitology of Gansu Province, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, Gansu Province, 730046, China
| | - Xing-Quan Zhu
- State Key Laboratory of Veterinary Etiological Biology, Key Laboratory of Veterinary Parasitology of Gansu Province, Lanzhou Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Lanzhou, Gansu Province, 730046, China.,College of Animal Science and Technology, Jilin Agricultural University, Changchun, Jilin Province, 130118, China.,College of Animal Science and Technology, Anhui Agricultural University, Hefei, Anhui Province, 230000, China
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Cotton JA, Amat CB, Buret AG. Disruptions of Host Immunity and Inflammation by Giardia Duodenalis: Potential Consequences for Co-Infections in the Gastro-Intestinal Tract. Pathogens 2015; 4:764-92. [PMID: 26569316 PMCID: PMC4693164 DOI: 10.3390/pathogens4040764] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 11/04/2015] [Accepted: 11/05/2015] [Indexed: 12/11/2022] Open
Abstract
Giardia duodenalis (syn. G. intestinalis, or G. lamblia) is a leading cause of waterborne diarrheal disease that infects hundreds of millions of people annually. Research on Giardia has greatly expanded within the last few years, and our understanding of the pathophysiology and immunology on this parasite is ever increasing. At peak infection, Giardia trophozoites induce pathophysiological responses that culminate in the development of diarrheal disease. However, human data has suggested that the intestinal mucosa of Giardia-infected individuals is devoid of signs of overt intestinal inflammation, an observation that is reproduced in animal models. Thus, our understanding of host inflammatory responses to the parasite remain incompletely understood and human studies and experimental data have produced conflicting results. It is now also apparent that certain Giardia infections contain mechanisms capable of modulating their host’s immune responses. As the oral route of Giardia infection is shared with many other gastrointestinal (GI) pathogens, co-infections may often occur, especially in places with poor sanitation and/or improper treatment of drinking water. Moreover, Giardia infections may modulate host immune responses and have been found to protect against the development of diarrheal disease in developing countries. The following review summarizes our current understanding of the immunomodulatory mechanisms of Giardia infections and their consequences for the host, and highlights areas for future research. Potential implications of these immunomodulatory effects during GI co-infection are also discussed.
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Affiliation(s)
- James A Cotton
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada.
| | - Christina B Amat
- Department of Biological Sciences, University of Calgary, Calgary, AB T2N 1N4, Canada.
- Inflammation Research Network, University of Calgary, Calgary, AB T2N 1N4, Canada.
- Host-Parasite Interactions, University of Calgary, Calgary, AB T2N 1N4, Canada.
| | - Andre G Buret
- Department of Biological Sciences, University of Calgary, Calgary, AB T2N 1N4, Canada.
- Inflammation Research Network, University of Calgary, Calgary, AB T2N 1N4, Canada.
- Host-Parasite Interactions, University of Calgary, Calgary, AB T2N 1N4, Canada.
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Bartelt LA, Sartor RB. Advances in understanding Giardia: determinants and mechanisms of chronic sequelae. F1000PRIME REPORTS 2015; 7:62. [PMID: 26097735 PMCID: PMC4447054 DOI: 10.12703/p7-62] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Giardia lamblia is a flagellated protozoan that is the most common cause of intestinal parasitic infection in children living in resource-limited settings. The pathogenicity of Giardia has been debated since the parasite was first identified, and clinical outcomes vary across studies. Among recent perplexing findings are diametrically opposed associations between Giardia and acute versus persistent diarrhea and a poorly understood potential for long-term sequelae, including impaired child growth and cognitive development. The mechanisms driving these protean clinical outcomes remain elusive, but recent advances suggest that variability in Giardia strains, host nutritional status, the composition of microbiota, co-infecting enteropathogens, host genetically determined mucosal immune responses, and immune modulation by Giardia are all relevant factors influencing disease manifestations after Giardia infection.
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Affiliation(s)
- Luther A. Bartelt
- Division of Infectious Diseases and International Health, University of VirginiaBox 801340, Charlottesville, VA 22908USA
| | - R. Balfour Sartor
- Division of Gastroenterology, Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel HillCampus Box 7032, Chapel Hill, NC 27599-7032USA
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Abstract
SUMMARYGiardiaspp. is a common gastrointestinal (GI) parasite of multiple host species, including dogs and humans, with the potential for zoonotic transmission. The risk of GI parasitism in dogs (includingGiardiaspp.) may increase with park use in urban areas. This study aimed to (1) determine whether park attendance is a risk factor forGiardiaspp. infection in dogs and (2) characterize the behavioural and demographic risk factors forGiardiaspp. infection in park-attending and non-park-attending dogs. From August to September 2012, a total of 1293 dog owners completed a survey and 860 corresponding dog faecal samples were collected. Dog faeces were screened forGiardiaspp. using a direct immunofluorescence assay and associations assessed among behaviours, demographics, andGiardiaspp. infection. Main results included off-leash and swimming frequencies within parks as significantly positively associated withGiardiaspp. infection in dogs. Dog-owner age was negatively associated with off-leash and swimming frequencies in parks. The results suggest some recreational behaviours in parks and certain demographics are risk factors for parasitism in pet dogs.
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Wei J, Hansen A, Liu Q, Sun Y, Weinstein P, Bi P. The effect of meteorological variables on the transmission of hand, foot and mouth disease in four major cities of shanxi province, China: a time series data analysis (2009-2013). PLoS Negl Trop Dis 2015; 9:e0003572. [PMID: 25742504 PMCID: PMC4351101 DOI: 10.1371/journal.pntd.0003572] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 01/27/2015] [Indexed: 11/18/2022] Open
Abstract
Increased incidence of hand, foot and mouth disease (HFMD) has been recognized as a critical challenge to communicable disease control and public health response. This study aimed to quantify the association between climate variation and notified cases of HFMD in selected cities of Shanxi Province, and to provide evidence for disease control and prevention. Meteorological variables and HFMD cases data in 4 major cities (Datong, Taiyuan, Changzhi and Yuncheng) of Shanxi province, China, were obtained from the China Meteorology Administration and China CDC respectively over the period 1 January 2009 to 31 December 2013. Correlations analyses and Seasonal Autoregressive Integrated Moving Average (SARIMA) models were used to identify and quantify the relationship between the meteorological variables and HFMD. HFMD incidence varied seasonally with the majority of cases in the 4 cities occurring from May to July. Temperatures could play important roles in the incidence of HFMD in these regions. The SARIMA models indicate that a 1° C rise in average, maximum and minimum temperatures may lead to a similar relative increase in the number of cases in the 4 cities. The lag times for the effects of temperatures were identified in Taiyuan, Changzhi and Yuncheng. The numbers of cases were positively associated with average and minimum temperatures at a lag of 1 week in Taiyuan, Changzhi and Yuncheng, and with maximum temperature at a lag of 2 weeks in Yuncheng. Positive association between the temperature and HFMD has been identified from the 4 cities in Shanxi Province, although the role of weather variables on the transmission of HFMD varied in the 4 cities. Relevant prevention measures and public health action are required to reduce future risks of climate change with consideration of local climatic conditions. Understanding of the impact of weather variables on HFMD transmission remains limited due to various local climatic conditions, socioeconomic status and demographic characteristics in different regions. This study provides quantitative evidence that the incidence of HFMD cases was significantly associated with temperature in Shanxi Province, North China. The delayed effects of weather variables on HFMD dictate different public health responses in 4 major cities in Shanxi Province. The results may provide a direction for local community and health authorities to perform public health actions, and the SARIMA models are helpful in the prediction of epidemics, determination of high-risk areas and susceptible populations, allocation of health resources, and the formulation of relevant prevention strategies. In order to reduce future risks of climatic variations on HFMD epidemics, similar studies in other geographical areas are needed, together with a longer study period to enable trend analysis which takes into consideration local weather conditions and demographic characteristics.
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Affiliation(s)
- Junni Wei
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
- * E-mail: (JW); (PB)
| | - Alana Hansen
- Discipline of Public Health, School of Population Health, The University of Adelaide, Adelaide, Australia
| | - Qiyong Liu
- State Key Laboratory for Infectious Diseases Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
- Shandong University Climate Change and Health Center, Jinan, Shandong, China
| | - Yehuan Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Phil Weinstein
- Division of Health Sciences, School of Pharmacy and Medical Sciences, The University of South Australia, Adelaide, Australia
| | - Peng Bi
- Discipline of Public Health, School of Population Health, The University of Adelaide, Adelaide, Australia
- * E-mail: (JW); (PB)
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Tysnes KR, Skancke E, Robertson LJ. Subclinical Giardia in dogs: a veterinary conundrum relevant to human infection. Trends Parasitol 2014; 30:520-7. [DOI: 10.1016/j.pt.2014.08.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 08/21/2014] [Accepted: 08/26/2014] [Indexed: 01/08/2023]
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