Less Common Parasitic Infections in Southeast Asia that can Produce Outbreaks

Human trichinellosis in Southeast Asia, 2001-2021

To present the situation of human trichinellosis in Southeast Asia in the last 20th years we analyzed outbreak data and seroprevalence studies from 2001 to 2021 for this region. We queried PubMed (https://pubmed.ncbi.nlm.nih.gov) using keywords “Trichinella”, “human” and “Southeast Asia”. In addition, we described Trichinella species circulating in this region.

In Southeast Asia, in communities eating pork, several cultural factors play important roles in the transmission of Trichinella to humans. The seroprevalences of Trichinella infection in humans are known for Laos and Vietnam to be 0–10.5% in some villages. Also, in Cambodia, Laos, Malaysia, Thailand and Vietnam relatively few human outbreaks (13) and cases (1604) have been recorded during the last 21st years. Their associated mortality rates were low (0.75%). Trichinella spiralis and T. papuae were transmitted after consumption of raw or undercooked pork from domesticated and wild pigs. T. papuae transmission was related to consumption of wild boar. In this region, trichinellosis was frequently subclinical and clinical or severe cases were sporadic and occurred more in male patients. Nevertheless, it is likely that trichinellosis is widely under-diagnosed and is an endemic disease.

•

In Southeast Asia, trichinellosis occurred mostly in rural populations eating pork or boar meat.

•

Since 2001, the majority of cases have been reported in northern Laos and Thailand.

•

Trichinella spiralis and T. papuae have been isolated as causative species.

•

There is no veterinary surveillance for Trichinella, except in Singapore.

Welfare of Native Goat Breeds in Serbia-Emphasis on Parasitological Infections

Native goat breeds in Serbia has been recognized as an important element of regional agrobiodiversity and play an important role in the safeguarding of cultural and traditional heritage. The aim of this study was to identify the main welfare issues likely to be encountered in extensive goat farming systems with an emphasis on parasitological infections. The study was conducted during the winter season on four small farms of native Balkan and Serbian white goats. For welfare assessment, animal-based indicators from AWIN protocol for goats were used. All fecal samples for parasites were qualitatively and quantitatively examined. The main welfare issues identified were poor hair coat condition (62.79%), dirty and light soiling hindquarters (31.40%), thin body condition score (26.74%), abscesses (19.78%), and udder asymmetry (18.60%). In addition, an important and prevalent welfare problem identified across all farms was parasite infection and weak significant (p < 0.001) correlation between certain parasites (Strongylidae, Moniezia spp., Buxtonella sulcate, and Protostrongylidae) and welfare indicators such as poor hair coat condition and nasal discharge. The results of this study provided the first overview and valuable insight into the impact of extensive systems on the welfare of native goats in the Balcan region.

Control of eosinopilic meningitis caused by Angiostrongylus cantonensis in China

Rat lungworm Angiostrongylus cantonensis is the major infective agent of human eosinophilic meningitis (EM) in the world. The parasite was first noted in China in 1933. However, the public health importance was not realized until several EM outbreaks occurred recent years. Such disease is considered as emerging infectious disease in the People's Republic of China (P.R. China) since the major source of infection is invasive snail species, particularly Pomacea spp. National Institute of Parasitic Diseases (NIPD) initiated a systematic implementation research on this disease since 2003. Our researchers in NIPD developed the lung-microscopy for detecting A. cantonensis larvae in Pomacea snails and further accomplished the atlas of larval morphology by this method. We studied the determinants in infection, which helped the field collection of snails and improved the infection procedure in laboratory. Our researches promoted the promulgation of diagnosis criteria of angiostrongyliasis cantonensis by the Ministry of Health. We explored the molecular diversity of rat lungworm and its major snail host for development of source-tracing technique. The transmission modelling could provide the vulnerable area for surveillance. All the studies supported the surveillance system of EM caused by A. cantonensis in P.R. China. Such implementation research will provide a case study for control of emerging infectious diseases.

A survey of gastrointestinal parasites of goats in a goat market in Kathmandu, Nepal

Gastrointestinal (GI) parasites in goats are predominant around the world. They may be the underlying cause of the pathological and immunological consequences leading to significant economic losses of the goat industry. The main aim of the current research was to reveal the prevalence of gastrointestinal parasites, including protozoa, trematodes, and nematodes in the fecal samples of goats in the goat market in Kathmandu, Nepal. A total of 400 goat fecal specimens were purposively collected from the goat market, and they were processed by direct wet mount, sedimentation, floatation techniques, and acid-fast staining, and were observed under the compound microscope. Out of a total 400 fecal samples, 349 (87.25%) were found to be infected with GI parasites among which Eimeria (80.75%), Strongyle (59.25%), Trichuris (29.75%), Strongyloides (28.75%), Moniezia (21.75%), Entamoeba (20%), Fasciola (10.25%), Balantidium (7.75%), Cryptosporidium (4%), Capillaria (1.75%), Trichomonas (1.25%), Ascaris (1.0%), Cyclospora (1%), Blastocystis (0.75%), Giardia (0.5%), and Paramphistomum (0.5%) were reported. GI parasites like protozoa and helminthes were widely distributed in the goats brought for the meat purposes in Kathmandu Valley, showing a high proportion of the goats were having higher risks of morbidity and mortality around the country.

The possible zoonotic diseases transferring from pig to human in Vietnam

Southeast Asia is considered one of worldwide hotspots consisting many distinct zoonotic infections. With optimal condition for the development of various pathogens, Vietnam is facing serious risks of zoonotic diseases. Besides, more than 50% Vietnamese people settle in rustic areas and earn their livings through small-scale animal breeding. It is possible that zoonotic diseases can be easily spread to the population by close contact with the infected animals, their infected residues, contaminated water, soil, or other possible means of transmission. In fact, zoonotic infections-transmissible infections between vertebrate animals and humans-cover a wide range of diseases with distinctive clinical and epidemiological highlights. With insufficient understanding and swift alteration in toxicity of the pathogens, these infections have gained more concerns due to sophisticated routes of transmission and harmful threats to humans. Recently emerging viral diseases exerted potential dangers to human beings, which required many countries to impose immediate actions to prevent any complications. Vietnam has recorded several cases of zoonotic diseases, especially pig-related illnesses; however, the studies on these diseases in this country remain limited. This work aims to highlight the zoonotic diseases transferring from pigs to humans and discuss risk factors of these diseases in Vietnam.

Invasive Pomacea snails as important intermediate hosts of Angiostrongylus cantonensis in Laos, Cambodia and Vietnam: Implications for outbreaks of eosinophilic meningitis

The rat lungworm Angiostrongylus cantonensis causes human eosinophilic meningitis and it is endemic in Southeast Asia, but little is known about its distribution in Laos, Cambodia and Vietnam. We conducted a multi-country survey for A. cantonensis in these countries to estimate its prevalence in snails along the Mekong River and the east coast of Vietnam. We identified Angiostrongylus species by morphological and molecular analysis. We found A. cantonensis in the invasive snail, Pomacea spp. The wide accessibility of Pomacea snails, along with their infection by A. cantonensis, indicates that this snail species could be used in surveillance for preventing outbreaks of eosinophilic meningitis.

Angiostrongylus cantonensis: a review of its distribution, molecular biology and clinical significance as a human pathogen

Angiostrongylus cantonensis is a metastrongyloid nematode found widely in the Asia-Pacific region, and the aetiological agent of angiostrongyliasis; a disease characterized by eosinophilic meningitis. Rattus rats are definitive hosts of A. cantonensis, while intermediate hosts include terrestrial and aquatic molluscs. Humans are dead-end hosts that usually become infected upon ingestion of infected molluscs. A presumptive diagnosis is often made based on clinical features, a history of mollusc consumption, eosinophilic pleocytosis in cerebral spinal fluid, and advanced imaging such as computed tomography. Serological tests are available for angiostrongyliasis, though many tests are still under development. While there is no treatment consensus, therapy often includes a combination of anthelmintics and corticosteroids. Angiostrongyliasis is relatively rare, but is often associated with morbidity and sometimes mortality. Recent reports suggest the parasites' range is increasing, leading to fatalities in regions previously considered Angiostrongylus-free, and sometimes, delayed diagnosis in newly invaded regions. Increased awareness of angiostrongyliasis would facilitate rapid diagnosis and improved clinical outcomes. This paper summarizes knowledge on the parasites' life cycle, clinical aspects and epidemiology. The molecular biology of Angiostrongylus spp. is also discussed. Attention is paid to the significance of angiostrongyliasis in Australia, given the recent severe cases reported from the Sydney region.

Prevalence of Endemic Pig-Associated Zoonoses in Southeast Asia: A Review of Findings from the Lao People's Democratic Republic

The increasing intensification of pork production in southeast Asia necessitates an urgent requirement to better understand the dual impact of pig-associated zoonotic disease on both pig production and human health in the region. Sharing porous borders with five countries and representing many regional ethnicities and agricultural practices, the Lao People's Democratic Republic (Lao PDR) appears well placed to gauge the levels of pig-associated zoonoses circulating in the wider region. Despite this, little is known about the true impact of zoonotic pathogens such as leptospirosis, Trichinella, hepatitis E virus (HEV), Japanese encephalitis (JE), and Taenia solium on human health and livestock production in the country. A comprehensive review of the published prevalences of these five pig-associated zoonoses in Lao PDR has demonstrated that although suspicion remains high of their existence in pig reservoirs across the country, epidemiological data are scarce; only 31 epidemiological studies have been undertaken on these diseases in the past 25 years. A greater understanding of the zoonoses prevalence and subsequent risks associated with pork production in the southeast Asian region could help focus public health and food safety interventions at key points along the value chain, benefiting both livestock producers and the broader animal and human health systems in the region.

Interplay between environment, agriculture and infectious diseases of poverty: case studies in China

Changes in the natural environment and agricultural systems induced by economic and industrial development, including population dynamics (growth, urbanization, migration), are major causes resulting in the persistence, emergence and re-emergence of infectious diseases in developing countries. In the face of rapid demographic, economic and social transformations, the People's Republic of China (P.R. China) is undergoing unprecedented environmental and agricultural change. We review emerging and re-emerging diseases such as schistosomiasis, dengue, avian influenza, angiostrongyliasis and soil-transmitted helminthiasis that have occurred in P.R. China due to environmental and agricultural change. This commentary highlights the research priorities and the response strategies, namely mitigation and adaptation, undertaken to eliminate the resurgence of those infectious diseases.

Patterns and risks of trichinella infection in humans and pigs in northern Laos

Several outbreaks of trichinellosis associated with the consumption of raw pork have occurred in Laos since 2004. This cross-sectional study was conducted in four provinces of northern Laos to investigate the seroepidemiology of trichinellosis in the human population and determine the prevalence and species of Trichinella infection in the domestic pig population. Serum samples and questionnaire data were obtained from 1419 individuals. Serum samples were tested for Trichinella antibodies by ELISA using larval excretory–secretory (ES) antigens and a subset of 68 positive samples were tested by western blot. The seroprevalence of Trichinella antibodies was 19.1% (95% confidence interval (CI) = 17.1–21.1%). The risk of having antibodies detected by ELISA using ES antigens increased with age, being of Lao-Tai ethnicity, living in Oudomxay province and being male. Tongue and diaphragm muscle samples were collected from 728 pigs and tested for Trichinella larvae by the artificial digestion method. Trichinella larvae were isolated from 15 pigs (2.1%) of which 13 were identified as T. spiralis by molecular typing; the species of the two remaining isolates could not be determined due to DNA degradation. Trichinella spp. are endemic in the domestic environment of northern Laos and targeted preventative health measures should be initiated to reduce the risk of further outbreaks occurring.

Trichinellosis is one of the most widely distributed parasitic zoonoses worldwide and is caused by infection with nematodes of the genus Trichinella. Infection occurs after consuming larvae in the muscle of infected animals. Several outbreaks of trichinellosis have occurred in Laos since 2004, resulting in a substantial public health problem. The principal risk factor for trichinellosis is consumption of uncooked or partially cooked meat from domestic pigs and game. We visited communities in four ethnically diverse provinces of northern Laos to determine the seroprevalence of trichinellosis in the human population and explore the population and individual level risk factors of exposure. In addition, we also examined muscle samples collected from pigs post-slaughter to determine the prevalence of Trichinella infection and identify the species of Trichinella circulating in the domestic pig population. Our findings indicate that Trichinella spp. are endemic in the domestic environment of northern Laos and consumption of uncooked pork is common for all ethnic groups. Targeted preventative health measures, taking a one health approach by bringing together medical, veterinary and health sociology professionals, should be initiated to prevent the transmission of Trichinella and other foodborne pathogens in Laos.

Rickettsiae, protozoa, and opisthokonta/metazoa

Rhizobiales (formerly named Rickettsiales) cause in rare instances meningitis and meningovasculitis, respectively. In case of history of exposure, infection by Rhizobiales needs to be considered since both diagnosis and therapy may be extremely difficult and pathogen-specific. The same applies to protozoa; in this chapter, Babesia species, free-living amoebae and Entamoeba histolytica infection, including severe meningitis and brain abscess, infection by Trypanosoma species (South American and African trypanosomiasis) are discussed with respect to history, epidemiology, clinical signs, and symptoms as well as differential diagnosis and therapy. Parasitic flatworms and roundworms, potentially able to invade the central nervous system, trematodes (flukes), cestodes (in particular, Cysticercus cellulosae), but also nematodes (in particular, Strongyloides spp. in the immunocompromised) are of worldwide importance. In contrast, filarial worms, Toxocara spp., Trichinella spp., Gnathostoma and Angiostrongylus spp. are seen only in certain geographically confined areas. Even more regionally confined are infestations of the central nervous system by metazoa, in particular, tongue worms (=arthropods) or larvae of flies (=maggots). The aim of this chapter is (1) to alert the neurologist to these infections, and (2) to enable the attending emergency neurologist to take a knowledgeable history, with an emphasis on epidemiology, clinical signs, and symptoms as well as therapeutic management possibilities.

A review of parasitic zoonoses in a changing Southeast Asia

Parasitic zoonoses are common and widely distributed in the Southeast Asian region. However, the interactions between parasites, hosts and vectors are influenced by environmental, socio-cultural and livestock production changes that impact on the distribution, prevalence and severity of disease. In this review we provide an update on new knowledge in the context of ongoing changes for the food-borne pig associated zoonoses Taenia solium and Trichinella spp., the food-borne trematodes Opisthorchis viverrini and Clonorchis sinensis, the water-borne trematodes Schistosoma spp., the vector-borne zoonotic protozoa Plasmodium knowlesi and Leishmania spp. and the soil-borne zoonotic hookworm Ancylostoma ceylanicum. These various changes need to be considered when assessing or developing regional control programs or devising new research initiatives in a changing SE Asia.

Trichinella spiralis paramyosin binds to C8 and C9 and protects the tissue-dwelling nematode from being attacked by host complement

Background

Paramyosin is a thick myofibrillar protein found exclusively in invertebrates. Evidence suggested that paramyosin from helminths serves not only as a structural protein but also as an immunomodulatory agent. We previously reported that recombinant Trichinella spiralis paramyosin (Ts-Pmy) elicited a partial protective immunity in mice. In this study, the ability of Ts-Pmy to bind host complement components and protect against host complement attack was investigated.

Methods and Findings

In this study, the transcriptional and protein expression levels of Ts-Pmy were determined in T. spiralis newborn larva (NBL), muscle larva (ML) and adult worm developmental stages by RT-PCR and western blot analysis. Expression of Ts-Pmy at the outer membrane was observed in NBL and adult worms using immunogold electron microscopy and immunofluorescence staining. Functional analysis revealed that recombinant Ts-Pmy(rTs-Pmy) strongly bound to complement components C8 and C9 and inhibited the polymerization of C9 during the formation of the membrane attack complex (MAC). rTs-Pmy also inhibited the lysis of rabbit erythrocytes (E_R) elicited by an alternative pathway-activated complement from guinea pig serum. Inhibition of native Ts-Pmy on the surface of NBL with a specific antiserum reduced larvae viability when under the attack of complement in vitro. In vivo passive transfer of anti-Ts-Pmy antiserum and complement-treated larvae into mice also significantly reduced the number of larvae that developed to ML.

Conclusion

These studies suggest that the outer membrane form of T. spiralis paramyosin plays an important role in the evasion of the host complement attack.

Trichinellosis is a serious food borne parasitic disease caused by the consumption of meat contaminated with the infective larvae of Trichinella spiralis. The ability of the tissue-dwelling parasite to evade the host complement attack is essential for its survival and for establishing infection in the host. This study describes the expression of paramyosin, a muscular protein in invertebrates, on the surface of Trichinella spiralis and its role in the defense against the host complement attack as a survival strategy. Using a specific antiserum, expression of Trichinella spiralis paramyosin was detected on the outer membrane of the adult worms and newborn larvae. Functional analysis revealed that recombinant Trichinella spiralis paramyosin protein strongly bound human complement components C8 and C9 and inhibited the formation of the complement membrane attack complex. Neutralization with a specific antiserum greatly impaired the protective effect of paramyosin on the viability and infectivity of Trichinella spiralis newborn larva when under attack by complement. These studies suggest that the outer membrane form of Trichinella spiralis paramyosin plays an important role in the evasion of the host complement attack and is therefore a good target for vaccine and pharmaceutical development.

Helminth and intestinal protozoa infections, multiparasitism and risk factors in Champasack province, Lao People's Democratic Republic

BACKGROUND

Detailed investigations of multiparasitism are scarce in the Mekong River basin. We assessed helminth (trematode, nematode, and cestode), and intestinal protozoa infections, and multiparasitism in random population samples from three different eco-epidemiological settings in Champasack province, southern Lao People's Democratic Republic (Lao PDR), and determined underlying risk factors.

METHODOLOGY

Two stool samples were collected from 669 individuals aged ≥ 6 months over consecutive days and examined for helminth infections using the Kato-Katz method. Additionally, one stool sample per person was subjected to a formalin-ethyl acetate concentration technique for diagnosis of helminth and intestinal protozoa infections. Questionnaires were administered to obtain individual and household-level data pertaining to behavior, demography and socioeconomic status. Risk factors for hepato-biliary and intestinal parasitic infections and multiparasitism were determined using multiple logistic regressions analyses.

PRINCIPAL FINDINGS

MULTIPLE SPECIES INTESTINAL PARASITE INFECTIONS WERE COMMON: 86.6% of the study participants harbored at least two and up to seven different parasites concurrently. Regarding nematode infections, hookworm was the most prevalent species (76.8%), followed by Ascaris lumbricoides (31.7%) and Trichuris trichiura (25.0%). Regarding trematodes, Opisthorchis viverrini and Schistosoma mekongi infections were found in 64.3% and 24.2% of the participants, respectively. Infections with intestinal protozoa were rare.

CONCLUSIONS/SIGNIFICANCE

There is a pressing need to intensify and sustain helminth control interventions in the southern part of Lao PDR. Given the high prevalence with nematode and trematode infections and the extent of multiparasitism, preventive chemotherapy is warranted. This intervention should be coupled with health education and improved access to clean water and adequate sanitation to consolidate morbidity control and enhance sustainability.

Important helminth infections in Southeast Asia diversity, potential for control and prospects for elimination

Besides the 'big three'-HIV/AIDS, malaria and tuberculosis-there are a host of diseases that, by comparison, are truly neglected. These so-called neglected tropical diseases (NTDs), many of which caused by helminths, are intimately linked with poverty and are rampant where housing is poor; access to clean water and adequate sanitation is lacking; hygiene and nutrition is substandard and populations are marginalized and vulnerable. More than a billion people are affected by NTDs, mainly in remote rural and deprived urban settings of the developing world. An overview of papers published in two special thematic volumes of the Advances in Parasitology is provided here under the umbrella of current status of research and control of important helminth infections. A total of 25 comprehensive reviews are presented, which summarise the latest available data pertaining to the diagnosis, epidemiology, pathogenesis, prevention, treatment, control and eventual elimination of NTDs in Southeast Asia and neighbourhood countries. The focus of the first volume provides the current regional status of schistosomiasis, lymphatic filariasis, food-borne trematodiases, echinococcosis and cysticercosis/taeniasis, less common parasitic diseases that can cause epidemic outbreaks and helminth infections affecting the central nervous system. The second volume deals with the tools and strategies for control, including diagnostics, drugs, vaccines and cutting-edge basic research (e.g. the '-omics' sciences). Moreover, cross-cutting themes such as multiparasitism, social sciences, capacity strengthening, geospatial health technologies, health metrics and modelling the potential impact of climate change on helminthic diseases are discussed. Hopefully, these two volumes will become useful for researchers and, most importantly, disease control managers for integrated and sustainable control, rigorous monitoring and eventual elimination of NTDs in Southeast Asia and elsewhere.