Food-borne intestinal trematode infections in the Republic of Korea

Global distribution of zoonotic digenetic trematodes: a scoping review

BACKGROUND

Digenetic trematodes, including blood flukes, intestinal flukes, liver flukes, lung flukes, and pancreatic flukes, are highly diverse and distributed widely. They affect at least 200 million people worldwide, so better understanding of their global distribution and prevalence are crucial for controlling and preventing human trematodiosis. Hence, this scoping review aims to conduct a comprehensive investigation on the spatio-temporal distribution and epidemiology of some important zoonotic digenetic trematodes.

METHODS

We conducted a scoping review by searching PubMed, Web of Science, Google Scholar, China National Knowledge Infrastructure, and Wanfang databases for articles, reviews, and case reports of zoonotic digenetic trematodes, without any restrictions on the year of publication. We followed the inclusion and exclusion criteria to identify relevant studies. And relevant information of the identified studies were collected and summarized.

RESULTS

We identified a total of 470 articles that met the inclusion criteria and were included in the review finally. Our analysis revealed the prevalence and global distribution of species in Schistosoma, Echinostoma, Isthmiophora, Echinochasmus, Paragonimus, Opisthorchiidae, Fasciolidae, Heterophyidae, and Eurytrema. Although some flukes are distributed worldwide, developing countries in Asia and Africa are still the most prevalent areas. Furthermore, there were some overlaps between the distribution of zoonotic digenetic trematodes from the same genus, and the prevalence of some zoonotic digenetic trematodes was not entirely consistent with their global distribution. The temporal disparities in zoonotic digenetic trematodes may attribute to the environmental changes. The gaps in our knowledge of the epidemiology and control of zoonotic digenetic trematodes indicate the need for large cohort studies in most countries.

CONCLUSIONS

This review provides important insights into the prevalence and global distribution of some zoonotic digenetic trematodes, firstly reveals spatio-temporal disparities in these digenetic trematodes. Countries with higher prevalence rate could be potential sources of transmitting diseases to other areas and are threat for possible outbreaks in the future. Therefore, continued global efforts to control and prevent human trematodiosis, and more international collaborations are necessary in the future.

Lethal effects of praziquantel and albendazole, on the cercariae of Echinochasmus sp. (Dietz, 1909) in-vitro

Echinochasmidae are considered one of the digenean intestinal parasites of carnivorous mammals and humans. Some larvicidal medications, such as praziquantel and albendazole, were employed to interrupt the life cycle of Echinochasmidae, which may cause harmful and serious effects on the domestic fish, ducks, and humans in our ecosystem. Cercariae of Echinochasmus sp. (gymnocephalus type) were harvested by exposing snails to strong artificial illumination. The emerging cercariae were exposed in vitro to different concentrations of praziquantel and albendazole at the same period of incubation 12 h. Using probit analysis in SPSS version 25, the lethal concentrations 50 and 95% were determined. They were 0.036 and 0.82 ppm, respectively, for praziquantel and 5.3 and 9.2 ppm, respectively, for albendazole. The ultrastructural changes using scanning electron microscope on the tegumental surface of the treated cercariae with the two drugs were compared to the untreated cercariae. The untreated cercariae have a pear-shaped body with a long tail. The oral sucker is armed with a spiny collar and decorated with ciliated and unciliated sensory papillae. The cardinal ventral sucker has a thick, muscular wall. The cercarial tail is decorated with parallel longitudinal tegumental processes and spherical, unciliated papillae. In comparisons, cercariae treated with both drugs lost all healthy morphological features, but in varying degrees and effects between the two drugs. Our findings suggest that the use of both drugs can be recommended during the design of control strategies to combat this type of intestinal parasite.

Assessment of the genetic diversity of lymnaeid (Gastropoda: Pulmonata) snails and their infection status with trematode cercariae in different regions of Thailand

Lymnaeid snails are some of the most widespread snails and are the first intermediate host of trematode parasites that affect human and livestock health. A full understanding of the genetic relationship of hosts and parasites is of paramount importance for effective parasite management. The present study assessed the prevalence of trematode larvae in lymnaeid snails and examined the genetic diversity of these snails collected across Thailand. We collected 672 lymnaeid snails from 39 locations in 22 provinces of six regions in Thailand. Subsequently, cercarial infection in the snails was observed by using the shedding method. Lymnaeid snails released 5 types of trematode cercariae, namely, xiphidiocercariae, echinostome cercariae I, echinostome cercariae II, furcocercous cercariae, and strigea cercariae. The phylogenetic analysis based on ITS2 and 28S rDNA sequences revealed 5 cercaria types assigned to four trematode families, of which two belong to the group of human intestinal flukes. Combination of shell morphology and sequence analysis of the mitochondrial COI and 16S rDNA genes, the lymnaeid snails were classified into two species, Radix rubiginosa and Orientogalba viridis. Moreover, the combined dataset of mtDNA genes (COI + 16S rDNA) from R. rubiginosa and O. viridis revealed 32 and 15 different haplotypes, respectively, of which only a few haplotypes were infected with cercariae. The genetic diversity and genetic structure revealed that R. rubiginosa and O. viridis experienced a bottleneck phenomenon, and showed limited gene flow between populations. Population demographic history analyses revealed that R. rubiginosa and O. viridis experienced population reductions followed by recent population expansion. These findings may improve our understanding of parasite-lymnaeid evolutionary relationships, as well as the underlying molecular genetic basis, which is information that can be used for further effective control of the spread of trematode disease.

Digenean infections in snails (cercariae stage) in Can Gio Mangrove Biosphere Reserve, Ho Chi Minh City, Vietnam

Foodborne zoonotic trematodiasis is a public health problem in many countries. A study on digenean larvae (cercariae stage) obtained from snails in all ten main small canals and two rice fields was carried out in Can Gio Mangrove Biosphere Reserve, Ho Chi Minh city, Vietnam to identify the snail composition and digenean prevalence in snails. The snails were sampled in the dry season (January 2022) and the wet season (June 2022). In the ten canals, 23 snail species belonging to 16 genera, 10 families from the samplings were found; however, there were no cercariae in these 23 snail species. In the two rice fields, 11 snail species in 11 genera and 7 families were collected. In which, Bithynia siamensis in Ly Nhon rice field and Thiara scabra in Binh Khanh rice field infected xiphidio cercariae. For Bithynia siamensis, the prevalence in the dry season (5.6%) was higher than in the wet season (4.6%) (P > 0.05). In Binh Khanh rice field, only one Thiara scabra infected cercariae in the wet season. Further research on digenean infection in different months and in other water bodies in Can Gio Mangrove Biosphere Reserve should be done to contribute to the control of digeneans and reserve the biodiversity.

Immunology and pathology of echinostomes and other intestinal trematodes

Intestinal trematodes constitute a major group of helminths that parasitize humans and animals with relevant morbidity and mortality. Despite the importance of the intestinal trematodes in medical and veterinary sciences, immunology and pathology of these helminth infections have been neglected for years. Apart from the work focused on the members of the family Echnistomatidae, there are only very isolated and sporadic studies on the representatives of other families of digeneans, which makes a compilation of all these studies necessary. In the present review, the most salient literature on the immunology and pathology of intestinal trematodes in their definitive hosts in examined. Emphasis will be placed on members of the echinostomatidae family, since it is the group in which the most work has been carried out. However, we also review the information on selected species of the families Brachylaimidae, Diplostomidae, Gymnophallidae, and Heterophyidae. For most of these families, coverage is considered under the following headings: (i) Background; (ii) Pathology of the infection; (iii) Immunology of the infection; and (iv) Human infections.

Development of the head collar and collar spines during the larval stages of Isthmiophora hortensis (Digenea: Echinostomatidae)

It is uncertain when the head collar and collar spines of Isthmiophora hortensis (Digenea: Echinostomatidae), a zoonotic echinostome species in Far Eastern Asia, develop during its larval stages. In this study, the appearance of the head collar and collar spines was studied using light and scanning electron microscopy in cercariae and metacercariae experimentally obtained from freshwater snails (Lymnaea pervia) and tadpoles (Rana nigromaculata), respectively. The cercariae were shed from the snail on day 30 after exposure to laboratory-hatched miracidia. Metacercariae were obtained from the experimental tadpoles at 3, 6, 12, 15, 20, 24, 26, and 30 h after exposure to the cercariae. The head collar was already visible in the cercarial stage, although its degree of development was weak. However, collar spines did not appear in the cercarial stage and even in the early metacercarial stage less than 24 h postinfection in tadpoles. Collar spines became visible in the metacercariae when they grew older than 24 h. It was concluded that the head collar of I. hortensis developed early in the cercarial stage, but the development of collar spines did not occur until the worms became 24-h-old metacercariae in our experimental setting. Counting the number of collar spines was concluded as an unfeasible diagnostic method for I. hortensis cercariae when they are shed from the snail host.

Molecular evidence of the absence of Metagonimus yokogawai (Katsurada, 1912) in Europe: report of Metagonimus sp. in cyprinoid fish from the River Danube in Hungary

Trematodes of the genus Metagonimus Katsurada, 1912 (Digenea: Heterophyidae) are zoonotic parasites that cause infections in humans, with most cases reported in Southeast Asia. Larvae from the second intermediate host, called metacercariae, of one of human-infecting species, M. yokogawai (Katsurada, 1912), have been reported from cyprinoid fish in Europe. In the present study, we provided DNA-based evidence that metacercariae of Metagonimus, which are commonly found in the scales of various cyprinoids in Central Europe (Danube River in Hungary) do not belong to M. yokogawai. Sequence analysis of the ITS region, 28S rDNA, and cox1 genes showed that this species is clearly distinct from all Asian species, including M. yokogawai, which probably does not occur in Europe. Metacercariae from cyprinoids might belong to Metagonimus romanicus (Ciurea, 1915), an insufficiently known species described from Romania.

General overview of the current status of human foodborne trematodiasis

Foodborne trematodes (FBT) of public health significance include liver flukes (Clonorchis sinensis, Opisthorchis viverrini, O. felineus, Fasciola hepatica and F. gigantica), lung flukes (Paragonimus westermani and several other Paragonimus spp.) and intestinal flukes, which include heterophyids (Metagonimus yokogawai, Heterophyes nocens and Haplorchis taichui), echinostomes (Echinostoma revolutum, Isthmiophora hortensis, Echinochasmus japonicus and Artyfechinostomum malayanum) and miscellaneous species, including Fasciolopsis buski and Gymnophalloides seoi. These trematode infections are distributed worldwide but occur most commonly in Asia. The global burden of FBT diseases has been estimated at about 80 million, however, this seems to be a considerable underestimate. Their life cycle involves a molluscan first intermediate host, and a second intermediate host, including freshwater fish, crustaceans, aquatic vegetables and freshwater or brackish water gastropods and bivalves. The mode of human infection is the consumption of the second intermediate host under raw or improperly cooked conditions. The major pathogenesis of C. sinensis and Opisthorchis spp. infection includes inflammation of the bile duct which leads to cholangitis and cholecystitis, and in a substantial number of patients, serious complications, such as liver cirrhosis and cholangiocarcinoma, may develop. In lung fluke infections, cough, bloody sputum and bronchiectasis are the most common clinical manifestations. However, lung flukes often migrate to extrapulmonary sites, including the brain, spinal cord, skin, subcutaneous tissues and abdominal organs. Intestinal flukes can induce inflammation in the intestinal mucosa, and they may at times undergo extraintestinal migration, in particular, in immunocompromised patients. In order to control FBT infections, eating foods after proper cooking is strongly recommended.

Morphological and molecular identification of trematode cercariae related with humans and animal health in freshwater snails from a lake and a dam in Myanmar

Freshwater snails play an essential role in the transmission of trematode parasitic flatworms that can infect wild and domestic animals, as well as humans. This study aimed to investigate the rate of cercarial infections in freshwater snails collected from two study areas, Inlay Lake and Yezin Dam, in Myanmar. A total of 4,740 snail samples were collected from Inlay Lake (n = 3,837) and Yezin Dam (n = 903), and infection rate by cercarial emergence was examined. Cercarial DNA samples were analysed by PCR. Based on morphological characteristics, eleven snail species and eight cercarial types were identified. Snails of Melanoides tuberculata in the family Thiaridae were found as the most abundant, followed by Indoplanorbis exustus of the family Planorbidae, in both study areas. The infection rate by cercarial emergence in snails in Inlay Lake and Yezin Dam was 5.8% (224/3,837) and 48.6% (439/903), respectively. Echinostome cercariae showed the highest infection rate in both study areas. Phylogenetic analysis of cercarial internal transcribed spacer 2 (ITS2) sequences revealed that at least seven cercaria types belonged to five digenean trematode families, two of which were zoonotic trematodes in the families of Opisthorchiidae/Heterophyidae and Schistosomatidae. Furthermore, cercarial 28S ribosomal RNA gene analysis showed that the furcocercous cercariae in Yezin Dam were identified as Schistosoma spindale, a causative agent of ruminant schistosomiasis. This is the first report on zoonotic trematode cercariae in snails in Myanmar. The findings indicate that various snail species act as intermediate host for trematode species that infect aquatic animals, mammals and humans in the country.

Changes in the level of oxidative stress markers in Indian catfish (Wallago attu) infected with Isoparorchis hypselobagri

Background

Helminth infection and infestation in fishes are detrimental and have a major effect on fish health and fish production. Among various factors, parasitic infections are known to modulate antioxidant defences in fish. Similar to other aerobic animals, fish are also susceptible to the effect of reactive oxygen species and thus have well established intrinsic and efficient antioxidant defences. ‘Oxidative stress markers are an important indicator of the physiological state of the parasite and its host’. Indian catfish, Wallago attu is a freshwater fish that serves as the definitive host of the adult piscine trematode Isoparorchis hypselobagri. Our two years prevalence data signifies the intensity of the problem revealing a minimum of 5.5% and a maximum of 54% I. hypselobagri infection in Indian catfish W. attu (unpublished data). The present study aimed to achieve baseline data attributed to changes in some oxidative markers due to parasitic infection.

Results

During the present study, the level of enzyme activities of Catalase (CAT), Glutathione reductase (GR), Glutathione-S-transferase (GST), Glutathione peroxidase (GPx), Superoxide dismutase (SOD) and lipid peroxidation was investigated to explore the pathogenic impact on the fish host. The level of these oxidative stress markers was monitored in the swim bladder, liver, intestine and muscle of the host. We also recorded the enzyme activities in the parasite I. hypselobagri. Analysis of data revealed an elevation in GST, SOD, GR, GPx and CAT activity in the infected host tissue as compared to the non-infected fish. Further, we observed presence of GST, SOD, GR and GPx enzymes in the parasite I. hypselobagri while CAT did not show any enzyme activity.

Conclusions

Increased level of enzyme activity in liver, muscle and intestine of infected host has been recorded which indicates increased oxidative stress in the host due to parasitic invasion. The presence of antioxidant enzymes in the parasites suggests an active antioxidant defence system to avoid immune responses to long term survival and establishment in their host.

Parasites Circulating in Wild Synanthropic Capybaras (Hydrochoerus hydrochaeris): A One Health Approach

Capybaras (Hydrochoerus hydrochaeris) are affected by a wide range of protozoan and metazoan-derived parasitic diseases. Among parasites of free-ranging capybaras are soil-, water-, food- and gastropod-borne parasitosis, today considered as opportunistic infections in semiaquatic ecosystems. The overlapping of the capybara’s natural ecological habitats with human and domestic animal activities has unfortunately increased in recent decades, thereby enhancing possible cross- or spillover events of zoonotic parasites. Due to this, three synanthropic wild capybara populations in the Orinoco Basin were studied for the occurrence of gastrointestinal parasite infections. A total of forty-six fecal samples were collected from free-ranging capybaras in close proximity to livestock farms. Macroscopical analyses, standard copromicroscopical techniques, coproELISA, PCR, and phylogenetic analysis revealed thirteen parasite taxa. In detail, the study indicates stages of five protozoans, four nematodes, one cestode, and three trematodes. Two zoonotic parasites were identified (i.e., Plagorchis muris, and Neobalantidium coli). The trematode P. muris represents the first report within South America. In addition, this report expands the geographical distribution range of echinocoelosis (Echinocoleus hydrochoeri). Overall, parasitological findings include two new host records (i.e., P. muris, and Entamoeba). The present findings collectively constitute baseline data for future monitoring of wildlife-derived anthropozoonotic parasites and call for future research on the health and the ecological impact of this largest semiaquatic rodent closely linked to humans, domestic and wild animals.

Prevalence and spatial distribution of heterophyidiasis in Southern Philippines

Heterophyidiasis is a fish-borne zoonotic disease that is considered to be an emerging public health problem in the Philippines. This study was carried out to determine the spatial distribution and risk factors of heterophyidiasis in five selected villages in New Corella, Davao del Norte in Southern Mindanao. Of the 1,101 individuals examined, 26 (2.36% overall prevalence rate, 95% CI 1.46-3.25) were positive for heterophyid eggs. Higher infection rate was observed in males (3.85%, 95% CI 2.27-5.43) than females (0.76%, 95% CI 0.02-1.5). Mapping of cases was done to show the spatial distribution of heterophyidiasis in New Corella. Multiple logistic regression analysis showed that gender, raw freshwater fish consumption, undercooked grilled fish consumption and proximity to rivers or creeks are the risk factors significantly associated with heterophyid infection. This study confirmed the presence of heterophyid infection in humans in the surveyed villages in New Corella in Southern Philippines.

The prevalence of cercarial infection and development of a duplex PCR for detection of the cercarial stage of Haplorchis taichui and H. pumilio in first intermediate hosts from Chai Nat province, Thailand

This study aimed to investigate the prevalence of cercarial infections in freshwater snails collected from the Chai Nat province of Central Thailand. Moreover, we aimed to develop a duplex PCR technique, using the ITS2 and candidate MT-ND1 gene, to determine the dissemination of H. taichui and H. pumilio, respectively. Six types of cercariae were discovered with an overall prevalence of 4.71% (59/1,252). The parapleurolophocercous cercariae were demonstrated to be the dominant type, infecting only Melanoides tuberculata snails. The duplex PCR was optimized for specific amplification of ITS2 for H. taichui (115 bp) and MT-ND1 for H. pumilio (335 bp). Both specific primers confirmed the specificity of the duplex PCR reaction, with no cross-reactivity with other heterophyids or related species. In addition, this duplex PCR could be used to detect co-infection at a concentration of 3.0 ng/µL. For the molecular identification, 9 of 22 parapleurolophocercous cercaria specimens in Chai Nat province generated the specific DNA fragment of H. pumilio. These results proved that the MT-ND1 gene is a species-specific method for heterophyid detection and provides a rapid method for identification based on larval and adult stages of H. taichui and H. pumilio in their intermediate and/or definitive hosts in the infected area.

Helminth infections in fish in Vietnam: A systematic review

In Vietnam, fisheries play a key role in the national economy. Helminth infections in fish have a major impact on public health and sustainable fish production. A comprehensive summary of the recent knowledge on fish helminths is important to understand the distribution of parasites in the country, and to design effective control measures. Therefore, a systematic review was conducted, collecting available literature published between January 2004 and October 2020. A total of 108 eligible records were retrieved reporting 268 helminth species, among which are digeneans, monogeneans, cestodes, nematodes and acanthocephalans. Some helminths were identified with zoonotic potential, such as, the heterophyids, opisthorchiids, the nematodes Gnathostoma spinigerum, Anisakis sp. and Capillaria spp. and the cestode Hysterothylacium; and with highly pathogenic potential, such as, the monogeneans of Capsalidae, Diplectanidae and Gyrodactylidae, the nematodes Philometra and Camallanidae, the tapeworm Schyzocotyle acheilognathi, the acanthocephalans Neoechinorhynchus and Acanthocephalus. Overall, these studies only covered about nine percent of the more than 2400 fish species occurring in the waters of Vietnam. Considering the expansion of the aquaculture sector as a part of the national economic development strategy, it is important to expand the research to cover the helminth fauna of all fish species, to assess their potential zoonotic and fish health impacts.

Current Knowledge of Small Flukes (Digenea: Heterophyidae) from South America

Fish-borne heterophyid trematodes are known to have a zoonotic potential, since at least 30 species are able to infect humans worldwide, with a global infection of around 7 million people. In this paper, a ‘state-of-the-art’ review of the South American heterophyid species is provided, including classical and molecular taxonomy, parasite ecology, host-parasite interaction studies and a list of species and their hosts. There is still a lack of information on human infections in South America with undetected or unreported infections probably due to the information shortage and little attention by physicians to these small intestinal flukes. Molecular tools for specific diagnoses of South American heterophyid species are still to be defined. Additional new sequences of Pygidiopsis macrostomum, Ascocotyle pindoramensis and Ascocotyle longa from Brazil are also provided.

Taxonomy of Echinostoma revolutum and 37-Collar-Spined Echinostoma spp.: A Historical Review

Echinostoma flukes armed with 37 collar spines on their head collar are called as 37-collar-spined Echinostoma spp. (group) or 'Echinostoma revolutum group'. At least 56 nominal species have been described in this group. However, many of them were morphologically close to and difficult to distinguish from the other, thus synonymized with the others. However, some of the synonymies were disagreed by other researchers, and taxonomic debates have been continued. Fortunately, recent development of molecular techniques, in particular, sequencing of the mitochondrial (nad1 and cox1) and nuclear genes (ITS region; ITS1-5.8S-ITS2), has enabled us to obtain highly useful data on phylogenetic relationships of these 37-collar-spined Echinostoma spp. Thus, 16 different species are currently acknowledged to be valid worldwide, which include E. revolutum, E. bolschewense, E. caproni, E. cinetorchis, E. deserticum, E. lindoense, E. luisreyi, E. mekongi, E. miyagawai, E. nasincovae, E. novaezealandense, E. paraensei, E. paraulum, E. robustum, E. trivolvis, and Echinostoma sp. IG of Georgieva et al., 2013. The validity of the other 10 species is retained until further evaluation, including molecular analyses; E. acuticauda, E. barbosai, E. chloephagae, E. echinatum, E. jurini, E. nudicaudatum, E. parvocirrus, E. pinnicaudatum, E. ralli, and E. rodriguesi. In this review, the history of discovery and taxonomic debates on these 26 valid or validity-retained species are briefly reviewed.

Foodborne intestinal flukes: A brief review of epidemiology and geographical distribution

Foodborne intestinal flukes are highly diverse consisting of at least 74 species with a diverse global distribution. Taxonomically they include 28 species of heterophyids, 23 species of echinostomes, and 23 species of miscellaneous groups (amphistomes, brachylaimids, cyathocotylids, diplostomes, fasciolids, gymnophallids, isoparorchiids, lecithodendriid-like group, microphallids, nanophyetids, plagiorchiids, and strigeids). The important heterophyid species (15 species) include Metagonimus yokogawai, M. takahashii, M. miyatai, Heterophyes heterophyes, H. nocens, Haplorchis taichui, H. pumilio, H. yokogawai, Heterophyopsis continua, Centrocestus formosanus, Pygidiopsis genata, P. summa, Stellantchasmus falcatus, Stictodora fuscata, and S. lari. The echinostome species of public health significance (15 species) include Echinostoma revolutum, E. cinetorchis, E. lindoense, E. ilocanum, Isthmiophora hortensis, Echinochasmus japonicus, E. perfoliatus, E. liliputanus, E. fujianensis, E. caninus, Acanthoparyphium tyosenense, Artyfechinostomum malayanum, A. sufrartyfex, A. oraoni, and Hypoderaeum conoideum. Among the other zoonotic intestinal flukes, Gastrodiscoides hominis, Brachylaima cribbi, Neodiplostomum seoulense, Fasciolopsis buski, Gymnophalloides seoi, Caprimolgorchis molenkampi, Phaneropsolus bonnei, Microphallus brevicaeca, Nanophyetus salmincola, and N. schikhobalowi (10 species) have drawn considerable medical attention causing quite a fair number of human infection cases. The principal mode of human infections include ingestion of raw or improperly cooked fish (heterophyids and echinostomes), snails including oysters (echinostomes and G. seoi), amphibians and reptiles (N. seoulense), aquatic vegetables (amphistomes and F. buski), and insect larvae or adults (C. molenkampi and P. bonnei). Epidemiological characteristics such as the prevalence, geographical distribution, and clinical and public health significance are poorly known in many of these species. Praziquantel has been proved to be highly effective against most species of intestinal fluke infections. Surveys and detection of human infection cases are urgently required for better understanding of the global status and public health significance of each species.

Infections of Two Isthmiophora Species (Digenea: Echinostomatidae) in Wild Mammals from Republic of Korea with Their Morphological Descriptions

Isthmiophora hortensis (Digenea: Echinostomatidae) is a dominant echinostome in animal reservoir hosts and humans in the Republic of Korea (Korea). We intended to investigate the infection status with this echinostome species in the several species of wild animals and describe the morphological characteristics in the faunistic view point. A total of 175 animal carcasses belonging to 3 families, i.e., Canidae, Felidae and Mustelidae, were collected from the southern regions of Korea from March 2010 to July 2017. Isthmiophora spp. worms were recovered from the small intestines of each animal under a stereomicroscope after washing of intestinal contents. Isthmiophora hortensis was recovered from 4 species of wild carnivores, i.e., Nyctereutes procyonoides (3/107: 2.8%), Mustela sibirica (11/31: 35.5%), Meles lucurus (2/3: 33.3%) and Martes flavigula (1/2: 50%). The other 3 carnivores comprising stray dogs, cat and leopard cat were negative for I. hortensis infection (0/2, 0/10 and 0/12, respectively). Specimens obtained from the Lutra lutra (6/8: 75%) were identified as a distinct species, I. inermis, by morphological comparison. Isthmiophora inermis has thinner body, elongate testes and different anterior limits of vitelline fields. Detailed morphological descriptions and comparisons with the morphological characteristics are provided. Conclusively, it was confirmed for the first time that 3 species of mustelid mammals, i.e., M. sibirica, M. lucurus, and M. flavigula, are to be the new definitive hosts of I. hortensis in Korea. Additionally, I. inermis is to be newly added in the Korean echinostome fauna.

Paraphyly of Conodiplostomum Dubois, 1937

Adult trematodes of the genera Conodiplostomum Dubois, 1937 and Neodiplostomum Railliet, 1919 (Trematoda: Diplostomidae) parasitize the intestines of birds of prey, owls and, rarely, passeriform birds. Although the family is taxonomically unsettled, molecular phylogenetics have not been applied to analyze Conodiplostomum and Neodiplostomum and the reference DNA sequences from adult Diplostomidae are scarce and limit studies of their indistinct larval forms. We analyze the Conodiplostomum and Neodiplostomum spp. found during the examination of Czech birds performed from 1962 to 2017, and we provide comparative measurements and host spectra, including prevalence and intensity; we also provide and analyze the sequences of four DNA loci from eight diplostomid species. Molecular phylogenetic analysis suggested that Conodiplostomum spathula (Creplin, 1829), the type species of this genus, is nested in Neodiplostomum. Thus, we suggest the rejection of Conodiplostomum spathula (Creplin, 1829) and the resurrection of Neodiplostomum spathula (Creplin, 1829) La Rue, 1926 and reclassification of all species of Conodiplostomum with the neodiplostomulum type of metacercariae to Neodiplostomum as well. Conodiplostomum canaliculatum (Nicoll, 1914) is reclassified as Neodiplostomum spathulaeforme (Brandes, 1888). The molecular analysis suggested that Conodiplostomum perlatum (Ciurea, 1911), the species with the neascus type of metacercariae, belongs to Crassiphialinae Sudarikov, 1960. We erect the genus Ciureatrema gen. nov. Heneberg & Sitko and reclassify Conodiplostomum perlatum (Ciurea, 1911) as Ciureatrema perlatum (Ciurea, 1911) and establish it as a type species of Ciureatrema gen. nov. Further research should focus on the evolution of the neascus and neodiplostomulum types of metacercariae, as well as the evolution of the genital cone and pseudosuckers in Diplostomidae.

Parasitic infections and medical expenses according to Health Insurance Review Assessment claims data in South Korea, 2011-2018

Introduction

In South Korea, Health Insurance Review and Assessment claims data contain comprehensive information on healthcare services for almost the entire population. The present study used claims data on parasitic diseases from 2011 to 2018, and associated medical expenses to investigate infection trends associated with endemic parasitic diseases in South Korea, including those not monitored by Korea Centers for Disease Control and Prevention.

Methods

Basic data regarding each parasitic disease were curated from the Healthcare Bigdata Hub (http://opendata.hira.or.kr). Ten endemic parasitic diseases, three pandemic protozoan diseases, and three ectoparasitic diseases were evaluated between 2011 and 2018. Data on each parasitic disease included the number of patients of each sex, age range within 5 years, province, and total medical expenses. Heatmap and principal component analysis were performed to visualize the incidence pattern of parasitic diseases by provinces.

Results

Clonorchiasis and pinworm infections decreased remarkably from 6,097 and 4,018 infections in 2011 to 3,008 and 1,988 infections in 2018, respectively. Other endemic parasitic diseases mostly declined or remained steady over the 8-year period, except for anisakiasis, which doubled from 409 in 2011 to 818 in 2018. Provinces close to North Korea had a higher frequency of claims for Plasmodium vivax infection. The highest rate of clonorchiasis was in Gyeongsangnam-do, while that of anisakiasis was in southern Korea. Jeju province had the highest number of claims for cysticercosis, anisakiasis, pinworm infection, and soil-transmitted helminth infections. The total medical expense for anisakiasis was 65 million Korean won (57,000 US$) in 2011, rising to 237 million Korean won (206,000 US$) in 2018. The medical expense for trichomoniasis was 6,063 million won and for scabies was 1,669 million won in 2018. Since the claims data include only data reported by healthcare providers, some discrepancies might have occurred.

Conclusion

Our findings provide the basis for a health policy to reduce further infections and medical expense.

Diagnosis of Human Trematode Infections

Digenetic trematodes form a major group of human parasites, affecting a large number of humans, especially in endemic foci. Over 100 species have been reported infecting humans, including blood, lung, liver, and intestinal parasites. Traditionally, trematode infections have been diagnosed by parasitological methods based on the detection and the identification of eggs in different clinical samples. However, this is complicated due to the morphological similarity between eggs of different trematode species and other factors such as lack of sensitivity or ectopic locations of the parasites. Moreover, the problem is currently aggravated by migratory flows, international travel, international trade of foods, and changes in alimentary habits. Although efforts have been made for the development of immunological and molecular techniques, the detection of eggs through parasitological techniques remains as the gold standard for the diagnosis of trematodiases. In this chapter, we review the current status of knowledge on diagnostic techniques used when examining feces, urine, and sputum and also analyze the most relevant characteristics used to identify eggs with a quick key for the identification of eggs.

Multiple food-borne trematodiases with profound systemic involvement: a case report and literature review

BACKGROUND

Food-borne trematodiases are an important group of neglected global diseases. Affected patients in regions with low prevalence usually experience delayed diagnosis, especially when presenting with atypical clinical symptoms. Here, we presented a rare case of a Chinese patient infected with three food-borne trematodiases.

CASE PRESENTATION

A 42-year-old man presented with diarrhea, lower extremity edema, and symptoms of cardiac dysfunction. He had a history of intermittent consumption of raw freshwater fishes for 6-7 years. Upon evaluation, he had eosinophilia, anemia, intrahepatic bile duct dilatation and a growing space-occupying lesion in the left atrium. The patient underwent a cardiac surgery which revealed an endocardial hematoma due to mechanical injuries. Imaging investigations also revealed intracranial and pulmonary lesions. A total of three trematodiases were diagnosed based upon microscopic stool examination, from which eggs of Clonorchis sinensis, Heterophyidae and Echinostomatidae were identified. Deposition of Clonorchis sinensis eggs was also observed from ileocecal squash slides. The patient was successfully treated with three cycles of praziquantel.

CONCLUSIONS

Food-borne trematodiases may present with systemic involvement. Patients with dietary history of high risk or atypical ingestions should be evaluated for parasitic infection, even in non-endemic areas.

Is species identification of Echinostoma revolutum using mitochondrial DNA barcoding feasible with high-resolution melting analysis?

The taxonomic evaluation of Echinostoma species is controversial. Echinostoma species are recognized as complex, leading to problems associated with accurate identification of these species. The aim of this study was to test the feasibility of using DNA barcoding of cytochrome c oxidase subunit I (COI) and NADH dehydrogenase subunit 1 (ND1) conjugated with high-resolution melting (HRM) analysis to identify Echinostoma revolutum. HRM using COI and ND1 was unable to differentiate between species in the "revolutum complex" but did distinguish between two isolates of 37-collar-spined echinostome species, including E. revolutum (Asian lineage) and Echinostoma sp. A from different genera, e.g., Hypoderaeum conoideum, Haplorchoides mehrai, Fasciola gigantica, and Thapariella anastomusa, based on the T_m values derived from HRM analysis. Through phylogenetic analysis, a new clade of the cryptic species known as Echinostoma sp. A was identified. In addition, we found that the E. revolutum clade of ND1 phylogeny obtained from the Thailand strain was from a different lineage than the Eurasian lineage. These findings reveal the complexity of the clade, which is composed of 37-collar-spined echinostome species found in Southeast Asia. Taken together, the systematic aspects of the complex revolutum group are in need of extensive investigation by integrating morphological, biological, and molecular features in order to clarify them, particularly in Southeast Asia.

Trematode Genomics and Proteomics

Trematode infections are among the most neglected tropical diseases despite their worldwide distribution and extraordinary ability to parasitise many different host species and host tissues. Furthermore, these parasites are of great socioeconomic, medical, veterinary and agricultural importance. During the last 10 years, there have been increasing efforts to overcome the lack of information on different "omic" resources such as proteomics and genomics. Herein, we focus on the recent advances in genomics and proteomics from trematodes of human importance, including liver, blood, intestinal and lung flukes. We also provide information on the latest technologies applied to study the biology of trematodes as well as on the resources available for the study of the molecular aspects of this group of helminths.

Epidemiology of Trematode Infections: An Update

Digenetic trematodes infecting humans are more than 91 species which belong to 46 genera all over the world. According to their habitat in definitive hosts, they are classified as blood flukes (Schistosoma japonicum. S. mekongi, S. mansoni, S. haematobium, and S. intercalatum), liver flukes (Clonorchis sinensis, Opisthorchis viverrini, O. felineus, Metorchis conjunctus, M. bilis, M. orientalis, Fasciola hepatica, F. gigantica, Dicrocoelium dendriticum, and D. hospes), lung flukes (Paragonimus westermani, P. heterotremus, P. skrjabini, P. miyazakii, P. kellicoti, P. mexicanus, P. africanus, and P. uterobilateralis), throat fluke (Clinostomum complanatum), pancreatic fluke (Eurytrema pancreaticum), and intestinal flukes (Metagonimus yokogawai, M. miyatai, M. takahashii, Heterophyes nocens, H. heterophyes, Haplorchis taichui, H. pumilio, H. yokogawai, Centrocestus formosanus, Echinostoma revolutum, E. ilocanum, Isthmiophora hortensis, Echinochasmus japonicus, E. lilliputanus, Artyfechinostomum malayanum, A. sufrartyfex, A. oraoni, Fasciolopsis buski, Gymnophalloides seoi, Neodiplostomum seoulense, Caprimolgorchis molenkampi, Phaneropsolus bonnei, and Plagiorchis muris). The mode of transmission to humans includes contact with cercariae contaminated in water (schistosomes) and ingestion of raw or improperly cooked fish (liver and throat flukes, heterophyids, and echinostomes), snails (echinostomes and gymnophallids), amphibia, reptiles (neodiplostomes), aquatic vegetables (amphistomes), or insect larvae or adults (plagiorchiids, lecithodendriids, and pancreatic fluke). Praziquantel has been proved to be highly effective against most species of trematode infections except fascioliasis. Epidemiological surveys and detection of human infections are required for better understanding of the geographical distribution and endemicity of each trematode species.

Infection Status with Metagonimus spp. Metacercariae in Fishes from Seomjin-gang and Tamjin-gang in Republic of Korea

To grasp the infection status of Metagonimus spp. metacercariae (MsMc), the freshwater fishes were surveyed from Seomjin-gang (river) and Tamjin-gang in the Republic of Korea. Total 1,604 fishes from 7 local sites of Seomjin-gang and 1,649 fishes from 2 sites of Tamjin-gang were examined for 6 years (2012–2017) by the artificial digestion method. MsMc were detected in fishes from 7 sites, i.e., Osucheon in Imsil-gun (36.3% fish in 6 spp.), Seomjin-gang in Sunchanggun (49.8% in 18 spp.), Songdaecheon in Namwon-si (64.5% in 8 spp.), Seomjin-gang in Gokseong-gun (72.4% in 14 spp.) and in Gurye-gun (78.8% in 17 spp.), Hoengcheon (75.9% in 11 spp.) and Namsancheon (58.9% in 7 spp.) in Hadong-gun. Their average densities were 4.2, 86.8, 39.9, 43.1, 246.5, 173.6 and 67.5 per fish infected respectively. Prevalence with MsMc in rasborinid fish from Seomjin-gang was 89.2% and their intensity was 73.6 per fish infected. Endemicities of MsMc in rasborinid fish from Seomjin-gang were significantly higher in fishes from the lower reaches (prevalence: 98.7%; density: 137) rather than in fishes from the middle (93.5%; 38) and upper (72.4%; 13) reaches. MsMc were also detected in 56.1% and 66.4% fishes from 2 surveyed areas, i.e., the middle reaches in Jangheung-gun and the lower reaches in Gangjin-gun, of Tamjin-gang, and their densities were 147 and 121 per fish infected. In susceptible fishes from Tamjin-gang, the prevalence was 84.1% and density was 227 per fish infected. By the present study, it was confirmed that MsMc is highly prevalent in the fishes from Seomjin-gang and Tamjin-gang in Korea.

Echinochasmus swabiensis n. sp. (Digenea: Echinostomatidae) from Black Kite (Milvus Migrans Migrans) in Swabi District, Pakistan

A new species of the genus Echinochasmushas been described from the small intestine of the black kite (Milvus m. migrans) collected from Swabi, Khyber Pakhtunkhwa, Pakistan and identified as E. swabiensis n. sp. The new species is different from its congeners in its body size; it has 22 collar spines which includes two corner spines on one side, four on the other side and eight marginal plus ventral spines on each side. There aretegumental-scale like spines interspersed on the anterior margin of the ventral sucker with a smaller, terminal oral sucker. The pharynx is nearly twice as large as the oral sucker, while the ventral sucker is nearly six times as large as the oral sucker. The suckers’ width ratio is 1 : 4.7 to 1 : 5.6. The vitelline follicles are compact and denser at the lateral sides masking the caeca. This species has been added to the record of trematodes circulating among avian species, especially in the study area.

Infections with Zoonotic Trematode Metacercariae in Yellowfin Goby, Acanthogobius flavimanus, from Coastal Areas of Republic of Korea

To investigate the infection status of zoonotic trematode metacercariae in yellowfin goby, Acanthogobius flavimanus, from coastal areas of the Republic of Korea (Korea), we examined total 344 gobies from 21 localities with an artificial digestion method from 2013 to 2017. The metacercariae of Stictodora lari were most frequently detected in 45.3% goby from 7 localities, i.e., Taean-gun (Chungcheongnam-do), Gochang-gun (Jeollabuk-do), Muan-gun, Shinan-gun, Haenam-gun (Jeollanam-do), Hadong-gun and Goseong-gun (Gyeongsangnam-do). Their infection rates were 90.0%, 66.7%, 46.7%, 8.0%, 3.3%, 26.7%, and 86.7% and intensities were 1,090, 6.2, 1.6 1.0, 2.0, 2.0, and 7.2 metacercariae per fish infected respectively. Heterophyopsis continua metacercariae were found in 38.2% goby from 6 localities, i.e., Gochang-gun, Muan-gun, Shinan-gun, Gangjin-gun, Boseong-gun (Jeollanam-do) and Goseong-gun, and their intensities were relatively low, 1–21 metacercariae. Stictodora fuscata metacercariae were detected in 61.3% goby from 4 localities, i.e., Taean-gun, Gochang-gun, Hadong-gun and Goseong-gun. Their infection rates were 90.0%, 53.3%, 5.9%, and 73.3% and intensities were 1,081, 3.1, 3.0, and 10.2 metacercariae per fish infected respectively. Heterophyes nocens metacercariae were found in 55.0% goby from Muan-gun and Shinan-gun. Total 3 metacercariae of Isthmiophora hortensis were detected in 2 (8.0%) gobies from Shinan-gun. Total 15 metacercariae of Centrocestus armatus were detected in 5 gobies (33.3%) from Gyeongpo-ho (ho means lake) in Gangneung-si, Gangwon-do. The present study suggests that yellowfin goby, A. flavimanus, acts as the infection sources of zoonotic intestinal flukes in western and southern coastal areas than in eastern coastal areas of Korea.

A duplex PCR for the simultaneous detection of Fasciola hepatica and Clonorchis sinensis

Both Fasciola hepatica and Clonorchis sinensis are endemic in China, South Korea, Japan and other Southeast Asian countries. Reliable and sensitive diagnostic methods are needed for detecting their infections in humans and animals. Differential simplex and duplex polymerase chain reaction (PCR) methods were developed. The PCRs targeted the second internal transcribed spacer (its2) (408 bp) of F. hepatica, and NADH dehydrogenase subunit 2 gene (nad2) (527 bp) of C. sinensis. Both simplex PCRs detected as little as 2 pg genomic DNA in one microliter in a 25 μL PCR reaction system. The duplex PCR had similar detection limit as well, and detected as low as one egg in 200 mg feces. These methods were analytical specific with no amplification being observed from the gemonic DNA of Fasciolopsis buski, Haemonchus contortus, Ascaris ovis or Eimeri ahsata. Of 158 sheep fecal samples collected from various farms, four and one samples were PCR-positive for F. hepatica and C. sinensis, respectively. The duplex PCR method described here is time-saving and convenient, and may prove to be an invaluable tool for molecular detection and epidemiological investigation of F. hepatica and C. sinensis in endemic area.

Parasite Dispersal From the Ornamental Goldfish Trade

Goldfish, Carassius auratus Linnaeus, 1758, are immensely popular ornamental cyprinid fish, traded in more than 100 countries. For more than 500 years, human translocation has facilitated the spread of goldfish globally, which has enabled numerous and repeated introductions of parasite taxa that infect them. The parasite fauna assemblage of goldfish is generally well documented, but few studies provide evidence of parasite coinvasion following the release of goldfish. This review provides a comprehensive synopsis of parasites that infect goldfish in farmed, aquarium-held, native, and invasive populations globally and summarises evidence for the cointroduction and coinvasion of goldfish parasites. More than 113 species infect goldfish in their native range, of which 26 species have probably coinvaded with the international trade of goldfish. Of these, Schyzocotyle acheilognathi (Cestoda: Bothriocephalidae), Ichthyophthirius multifiliis (Ciliophora: Ichthyophthiriidae), Argulus japonicus (Crustacea: Argulidae), Lernaea cyprinacea (Crustacea: Ergasilidae), Dactylogyrus anchoratus, Dactylogyrus vastator and Dactylogyrus formosus (Monogenea: Dactylogyridae) are common to invasive goldfish populations in more than four countries and are considered a high risk of continued spread. Coinvasive parasites include species with direct and complex life cycles, which have successfully colonised new environments through utilisation of either new native hosts or suitable invasive hosts. Specifically, I. multifiliis, A. japonicus and L. cyprinacea can cause harm to farmed freshwater fish species and are important parasites to consider for biosecurity. These species may threaten other aquatic animal industries given their low host specificity and adaptable life histories. Future attention to biosecurity, management and border detection methods could limit the continued spread of exotic parasites from the ornamental trade of goldfish.

A Bayesian analysis of the parasitic ecology in Jenynsia multidentata(Pisces: Anablepidae)

ABSTRACT Jenynsia multidentata Jenyns, 1842 (one-sided livebearers) are euryhaline viviparous fish of small size, used in the laboratory experiment, important as resource for biological control of mosquito’s larva and a key species to recover eutrophic lakes. Works have been published dealing with parasite biodiversity of this host, but little has been studied about the parasite community ecology. From early 2009 to ends of 2010 specimens of J. multidentata were collected from two places, the Salado Relief Channel (S.R.C.) on Samborombón Bay and the Sauce Chico River near to the city of Bahia Blanca (B.B.). All fish were sexed, measured and grouped into sizes/age classes. The fishes from both sites harbored 16 parasitic species: nine digenean, one monogenean, one metacestode, one acanthocephalan, two nematode and two copepods. Lecithaster confusus Odhner, 1905, the metacercariae Hemiuridae gen. sp. indet., metacercariae Thylodelphys sp. (inside the eye), Glossocercus sp. nematode L4 (intestine) and Ergasilus sieboldii Nordmann, 1832 are new records for the host. The high number of larval stages made of this fish a link between micro and macroecosystems. The size 2 had the higher biodiversity in both sites, which could be the most suitable age to store the maximal number of parasite of the environment and have a more equitability in their distribution on the host. In B.B. some parasites had higher prevalence and mean abun dance due to the small size of the waterbody compared with the S.R.C. Despite that, in S.R.C. exist a higher specific richness and biodiversity due the daily flow of saline and freshwater and proximity of the sample site to the mouth of the channel in the bay. This is the first approximation to an analysis of the parasitic ecology on this host.

Fishborne zoonotic heterophyid infections: An update

Fishborne heterophyid trematodes infecting humans are at least 29 species worldwide and belong to 13 genera. Its global burden is much more than 7 million infected people. They include Metagonimus (M. yokogawai, M. takahashii, M. miyatai, M. minutus, and M. katsuradai), Heterophyes (H. heterophyes, H. nocens, H. dispar, and H. aequalis), Haplorchis (H. taichui, H. pumilio, H. yokogawai, and H. vanissimus), Pygidiopsis (P. summa and P. genata), Heterophyopsis (H. continua), Stellantchasmus (S. falcatus), Centrocestus (C. formosanus, C. armatus, C. cuspidatus, and C. kurokawai), Stictodora (S. fuscata and S. lari), Procerovum (P. varium and P. calderoni), Acanthotrema (A. felis), Apophallus (A. donicus), Ascocotyle (A. longa), and Cryptocotyle (C. lingua). Human infections are scattered around the world but the major endemic areas are located in Southeast Asia. The source of human infection is ingestion of raw or improperly cooked fish. The pathogenicity, host-parasite relationships, and clinical manifestations in each species infection are poorly understood; these should be elucidated particularly in immunocompromised hosts. Problems exist in the differential diagnosis of these parasitic infections because of close morphological similarity of eggs in feces and unavailability of alternative methods such as serology. Molecular diagnostic techniques are promising but they are still at an infant stage. Praziquantel has been proved to be highly effective against most of the patients infected with heterophyid flukes. Epidemiological surveys and detection of human infections are required for better understanding of the geographical distribution and global burden of each heterophyid species. In this review, the most updated knowledge on the morphology, biology, epidemiology, pathogenesis and pathology, immunology, clinical manifestations, diagnosis and treatment, and prevention and control of fishborne zoonotic heterophyid infections is provided.

Prevalence and Density of Digenetic Trematode Metacercariae in Clams and Oysters from Western Coastal Regions of the Republic of Korea

A survey was performed to know the recent infection status of digenetic trematode metacercariae in clams and oysters from 4 sites in western coastal regions of the Republic of Korea (=Korea). Four species of clams (Mactra veneriformis, Ruditapes philippinarum, Cyclina sinensis, and Saxidomus purpuratus) were collected from Taean-gun, Chungcheongnam-do (Province), Buan-gun (County) and Gochang-gun, Jeollabuk-do, and oysters, Crassostrea gigas, from Shinan-gun, Jeollanam-do were transferred to our laboratory on ice and examined by the artificial digestion method. The metacercariae of Himasthla alincia were detected in 3 species of clams, M. veneriformis, R. philippinarum, and C. sinensis from the 3 surveyed areas. The positive rate and the mean density per clam infected were 98.9% (30.8 metacercariae) in M. veneriformis, 60.0% (5.0) in R. philippinarum, and 96.0% (28.4) in C. sinensis. The positive rate (mean density) of Acanthoparyphium tyosenense metacercariae in M. veneriformis was 50.0% (2.1) from Taean-gun and 70.0% (2.8) from Gochang-gun. The metacercariae of Parvatrema spp. were detected in M. veneriformis and R. philippinarum from Taean-gun and Gochang-gun; the positive rate (mean density) was 63.3% (4,123) and 50.0% (19) in M. veneriformis, and 6.7% (126) and 100% (238) in R. philippinarum from the 2 regions, respectively. The metacercariae of Gymnophalloides seoi were detected in all 30 oysters from Shinan-gun, and their average density per oyster was 646. From the above results, it has been confirmed that more than 3 species of metacercariae are prevalent in clams from the western coastal regions, and G. seoi metacercariae are still prevalent in oysters from Shinan-gun, Jeollanam-do, Korea

Multiplex Real-Time PCR Assay Targeting Eight Parasites Customized to the Korean Population: Potential Use for Detection in Diarrheal Stool Samples from Gastroenteritis Patients

Intestinal parasitic diseases occur worldwide and can cause diarrhea or gastroenteritis; however, their diagnosis is quite difficult, especially in low-endemism countries. We developed a multiplex real-time PCR assay for detection of eight intestinal parasites and prospectively evaluated it for patients with gastroenteritis. The assay targeted Cryptosporidium parvum, Giardia lamblia, Entamoeba histolytica, Blastocystis hominis, Dientamoeba fragilis, Clonorchis sinensis, Metagonimus yokogawai, and Gymnophalloides seoi. Performance characteristics were evaluated based on recovery after DNA extraction, analytical sensitivity, specificity, reproducibility, cross-reactivity, and interference characteristics. Clinical performance was validated against microscopy on 123 diarrheal samples. The assay demonstrated strong correlations between DNA concentrations and C_t values (R², 0.9924–0.9998), and had a high PCR efficiency (83.3%–109.5%). Polymerase chain reactions detected as few as 10–30 copies of genomic DNA, and coefficient of variance was 0–7%. There was no cross-reactivity to the other 54 microorganisms tested. Interference occurred only in presence of high concentrations of erythrocytes or leukocytes. This assay had a higher correct identification rate (100.0% vs. 90.2%) and lower incorrect ID rate (0.0% vs. 9.8%) when compared to microscopy. Overall, this assay showed a higher sensitivity (100.0%; 95% confidence interval [CI] of 80.5–100.0) than microscopy (29.4%; 95% CI 10.31–55.96), and the specificity levels were comparable for both methods (100.0%; 95% CI 96.58–100.0). This newly developed multiplex real-time PCR assay offers a potential use for detecting intestinal parasitic pathogens customized to the Korean population.

Malformations of the gill filaments of the ruffe Gymnocephalus cernuus (L.) (Pisces) caused by echinostomatid metacercariae

In parasite surveys of fishes from Lake Balaton and its tributaries in Hungary, infections with metacercariae of a species of the digenean genus Echinochasmus (Trematoda: Echinostomatidae) were found in seven species of fish. In ruffe, Gymnocephalus cernuus, malformations of the gill filaments apparently caused by these infections were observed. These malformations were in the form of bifurcations of the filaments at about their mid-length. At the point where the filaments bifurcate, an Echinochasmus metacercaria was always embedded in the cartilaginous ray of the gill filament. All specimens of the ruffe were found to be infected by these metacercariae, and each ruffe specimen was infected by 30-300 metacercariae. Such a bifurcation was found in all of the ruffe specimens, but, apart from these gill malformations, the metacercariae produced only local changes in the cartilage. In the other six infected fish species, only local signs were observed in the cartilage. Experimental infections of chicks with metacercariae resulted in the finding of the sexual adult (marita) of an unidentified species of Echinochasmus. ITS sequences of the adult and metacercaria corresponded with each other, and also with a cercaria isolated from a gravel snail (Lithoglyphus naticoides), with a 99.5-100% similarity.

Pygidiopsis summa (Digenea: Heterophyidae): Status of Metacercarial Infection in Mullets from Coastal Areas in the Republic of Korea

To know the infection status of zoonotic trematode metacercariae in brackish water fish, we surveyed mullets collected from 18 coastal areas in the Republic of Korea. The metacercariae of Pygidiopsis summa were detected in 236 (68.2%) out of 346 mullets examined. They were found in mullets from 15 areas except for those from Boseong-gun (Jeollanam-do), Pohang-si, and Uljin-gun (Gyeongsangbuk-do). Especially in mullets from Taean-gun (Chungcheongnam-do) and Geoje-si (Gyeongsangnam-do), their prevalences were 100% and 95.5%, and the average metacercarial density was more than 1,000 per fish. They were also detected in mullets from 3 coastal lakes, Gyeongpoho, Songjiho, and Hwajinpoho, in Gangwon-do, and their average densities were 419, 147, and 672 per infected fish, respectively. The metacercariae of 5 other heterophyid species, including Heterophyes nocens, Heterophyopsis continua, Metagonimus sp., Stictodora fuscata, and Stictodora lari, were found in the mullets examined. The metacercariae of H. nocens were detected in 66.7, 100, 28.6, 81.6, 3.9, 61.5, and 27.3% of mullets from Muan-gun, Shinan-gun, Haenam-gun, Gangjin-gun, and Boseong-gun (Jeollanam-do), Hadong-gun, and Geoje-si (Gyeongsangnam-do), and their metacercarial intensities were 64, 84, 119, 99, 1, 24, and 24 per fish infected, respectively. From the above results, it has been confirmed that P. summa metacercariae are heavily infected in mullets from coastal areas of Korea. It is suggested that residents who frequently consume raw mullet dish can be easily infected with heterophyid flukes.

Epidemiological and molecular data on heterophyid trematode metacercariae found in the muscle of grey mullets (Osteichthyes: Mugilidae) from Sardinia (western Mediterranean Sea)

This study is a contribution to the molecular taxonomy and epidemiology of heterophyid (Trematoda: Heterophyidae) metacercariae found in the muscle of Mugilidae (Osteichthyes) from Sardinia (western Mediterranean Sea). Sixty specimens of mugilids (13 Chelon labrosus, 18 Liza aurata, 6 Liza ramada, 8 Liza saliens, 15 Mugil cephalus) were examined and 17,899 metacercariae isolated in 95 % of the hosts. Four types of metacercariae were identified: Heterophyes sp. (n = 14,113), Heterophyes sp. -small (1225), Stictodora sp. (1606), and Ascocotyle (Phagicola) sp. (955). The experimental infection of a hamster with Heterophyes sp. metacercariae produced six adults identified as Heterophyes heterophyes and two as Heterophyes cf. nocens. The morphology of Heterophyes sp. -small metacercariae matched with that of Heterophyes dispar. The sequence analysis of the ITS2 and 28S portions of rDNA confirmed the morphological identification of metacercariae, showing four clusters. All adults grouped together with the Heterophyes sp. metacercariae, whereas adults of Heterophyes nocens from Korea clustered separately, showing that this species is distinguished from H. heterophyes, and suggesting caution in the exclusive use of the number of rodlets of the genital sucker to separate the two species. The presence of metacercariae was high in all hosts; the highest prevalence is of Heterophyes sp. (prevalence ≥78 %; mean intensity ≥135 metacercariae/100 g muscle), and the most heavily infected host is M. cephalus (prevalence = 100 %; mean intensity = 841 metacercariae/100 g muscle).

Molecular characterization of Stictodora tridactyla (Trematoda: Heterophyidae) from Kuwait Bay using rDNA ITS and mtCO1

Stictodora tridactyla is an intestinal fluke in the family Heterophyidae that parasitizes shorebirds and mammals, including humans. Its metacercarial cyst stage was reported in the Arabian killifish, Aphanius dispar, at Kuwait Bay. In the present study, Cerithidea cingulata was found to serve as the first intermediate host of S. tridactyla. In order to establish the snail-fish link in the life cycle of S. tridactyla, complete sequences of ribosomal DNA internal transcribed spacer region 1 and 2 (rDNA ITS1 and ITS2) and partial sequence of cytochrome oxidase subunit 1 were obtained for metacercarial cysts isolated from the fish A. dispar and rediae isolated from the snail C. cingulata. Sequence alignment demonstrated that these larval stages belong to the same heterophyid species, S. tridactyla. Phylogenetic analysis based on rDNA ITS1, ITS2, and mtCO1 confirmed the position of S. tridactyla within the Heterophyidae and found it to cluster with Haplorchis spp. The present study represents the first molecular study correlating the larval stages of S. tridactyla using rDNA ITS1, ITS2, and mtCO1 and examining the phylogenetic relationships of S. tridactyla with different heterophyid species.

Heterophyid trematodes recovered from people residing along the Boseong River, South Korea

We conducted an epidemiological survey to determine the status of heterophyid fluke infections among people residing along the Boseong River, Gokseong-gun, South Korea (= Korea) from October 2011 to February 2012. Fecal specimens were collected from 115 (male 51, female 64) people and examined for intestinal helminth eggs using the Kato-Katz thick smear technique. The eggs of Metagonimus yokogawai together with other Metagonimus spp. were detected in 28 (24.3%) cases. Eleven egg positive people were treated with 10mg/kg praziquantel followed by MgSO4 purging in order to recover the adult flukes. Whole consecutive diarrheic stools were collected individually 4-5 times. Adult flukes recovered were 66,499 specimens (6045.4/positive case) of M. yokogawai, 343 (38.1) of Metagonimus miyatai, 3293 (299.4) of Metagonimus takahashii, 81 (20.3) of Heterophyes nocens, 6 (3.0) of Heterophyopsis continua, and 1 (1.0) of Stictodora fuscata. The results indicated that the surveyed area is a highly endemic area of metagonimiasis (three Metagonimus species) with low-grade mixed infections of 3 other heterophyid flukes. The infected people experienced variable degrees of gastrointestinal discomfort and indigestion. They consumed raw freshwater and brackish water fish, including sweetfish and mullets. It is strongly recommended that people residing in the survey area avoid eating raw fish to prevent M. yokogawai and other heterophyid infections.

Potential Zoonotic Trematodes Recovered in Stray Cats from Kuwait Municipality, Kuwait

Stray cats are a common feature roaming the streets and alleys of Kuwait; they could be a source of parasites, including trematodes, that affect humans. A survey was conducted to identify feline trematodes and throw the light on their public health significance in Kuwait. Out of 240 stray cats trapped from different localities of Kuwait from June 2011 to May 2012, 59 (24.6%) were found to be infected with 14 species of trematodes. The most common were trematodes of the genus Heterophyes, particularly H. heterophyes and H. dispar that were found in respectively 15.8% and 10.8% of the cats examined. Other trematodes recorded, with lower prevalences, were Heterophyes nocens (2.9%), Haplorchis taichui (3.8%), Stictodora sawakinensis (2.1%), Stellantchasmus falcatus (1.6%), Echinochasmus japonicus (1.6%), and Mesostephanus dottrensi (1.3%). Centrocestus cuspidatus, Galactosomum fregatae, Ascocotyle sp., Mesostephanus appendiculatus, Haplorchis yokogawai, and Pygidiopsis genata showed the lowest prevalence (0.4%) and intensity. The majority of the trematodes are recorded for the first time in Kuwait and even in the Gulf region. The study reveals that stray cats are good indicators of fish-borne trematodes in the environment. As all trematodes recovered are zoonotic, their significance to public health should be considred.

Zoonotic Intestinal Trematodes in Stray Cats (Felis catus) from Riverside Areas of the Republic of Korea

The present study was performed to survey the infection status of zoonotic intestinal trematode (ZIT) in stray cats from 5 major riverside areas in the Republic of Korea. Total 400 stray cats were captured with live-traps in riverside areas of Seomjingang ('gang' means river) (203 cats) from June to October 2010, and of Yeongsangang (41), Nakdonggang (57), Geumgang (38), and Hangang (61 cats) from June to October 2011, respectively. Small intestines resected from cats were opened with a pair of scissors in a beaker with 0.85% saline and examined with naked eyes and under a stereomicroscope. More than 16 ZIT species were detected in 188 (92.6%) cats from Seomjingang areas, and the number of worms recovered was 111 per cat infected. In cats from riverside areas of Yeongsangang, Nakdonggang, Geumgang, and Hangang, more than 9, 8, 3, and 5 ZIT species were recovered, and the worm burdens were 13, 42, 11, and 56 specimens per infected cat, respectively. As the members of family Heterophyidae, more than 10 species, i.e., Metagonimus spp., Pygidiopsis summa, Heterophyes nocens, Stellantchasmus falcatus, Heterophyopsis continua, Acanthotrema felis, Centrocestus armatus, Procerovum varium, Cryptocotyle concava, and Stictodora lari, were recovered. More than 5 species of echinostomes, i.e., Echinostoma hortense, Echinochasmus japonicus, Echinochasmus sp., Echinoparyphium sp., and unidentified larval echinostomes, were collected. Plagiorchis spp. were detected in cats from areas of Seomjin-gang and Yeongsangang. From the above results, it has been confirmed that stray cats in 5 major riverside areas of Korea are highly infected with various species of ZITs.

Reprint of "An overview of freshwater snails in Asia with main focus on Vietnam"

Freshwater snails have received much attention for their role as intermediate hosts for trematodes causing disease in people and animals such as schistosomiasis and various food-borne trematodes. While effective medical treatment exists for some of these diseases there is need for preventive measures to reduce transmission, e.g. control of intermediate hosts because transmission patterns are often complicated due to presence of reservoir final hosts. In order to implement control measures against the intermediate host snails with minimal impact on the freshwater ecosystems and their biodiversity, a profound knowledge on transmission patterns of the trematodes is required and this is partly related to distribution, habitat preferences, and seasonal variation in density of the intermediate host species. Identification of snail species can be problematic on the basis of morphological and anatomical characters alone as some species show morphological plasticity and similarly morphological differentiation of cercariae found in snails may be difficult and this could lead to biased perceptions of intermediate host spectra and transmission patterns. In this paper, we give an overview of the snail families and their medical and veterinary importance in Asia but with main focus on Vietnam.

An overview of freshwater snails in Asia with main focus on Vietnam

Freshwater snails have received much attention for their role as intermediate hosts for trematodes causing disease in people and animals such as schistosomiasis and various food-borne trematodes. While effective medical treatment exists for some of these diseases there is need for preventive measures to reduce transmission, e.g. control of intermediate hosts because transmission patterns are often complicated due to presence of reservoir final hosts. In order to implement control measures against the intermediate host snails with minimal impact on the freshwater ecosystems and their biodiversity, a profound knowledge on transmission patterns of the trematodes is required and this is partly related to distribution, habitat preferences, and seasonal variation in density of the intermediate host species. Identification of snail species can be problematic on the basis of morphological and anatomical characters alone as some species show morphological plasticity and similarly morphological differentiation of cercariae found in snails may be difficult and this could lead to biased perceptions of intermediate host spectra and transmission patterns. In this paper, we give an overview of the snail families and their medical and veterinary importance in Asia but with main focus on Vietnam.

Prevalence of Haplorchis taichui among humans and fish in Luang Prabang Province, Lao PDR

This study confirmed the prevalence of the intestinal fluke Haplorchis taichui (Trematoda: Heterophyidae) among people and fish in Luang Prabang Province, Lao PDR. Fecal specimens were collected from 559 riparian people (229 males and 330 females), residing in 4 Districts (Luang Prabang, Xieng Ngeun, Pak Ou, and Nam Bak) and were examined by the Kato-Katz fecal smear technique. The overall helminth egg positive rate was 64.9%. The positive rate for small trematode eggs (STE), which may include H. taichui and other heterophyids, Opisthorchis viverrini, and lecithodendriids, was 15.2%. For recovery of adult helminths, 10 STE-positive people were treated with 40mg/kg praziquantel and 15mg/kg pyrantel pamoate, and then purged. Mixed infections with 3 Haplorchis species (H. taichui, H. pumilio, and H. yokogawai), a species of cestode (Taenia saginata), and several species of nematodes including Enterobius vermicularis and hookworms were found. The worm load for trematodes was exclusively high for H. taichui with an average of 7691 specimens per infected person, followed by H. yokogawai (8.3 specimens) and H. pumilio (4.1 specimens). Out of 207 freshwater fish (17 species) purchased in a market in Luang Prabang District, 138 (67%) harboured H. taichui metacercariae (metacercarial burden per fish; 520). Lower prevalence of fish and lower metacercarial density were observed for H. yokogawai (52% and 50 per fish, respectively) and H. pumilio (18% and 3 per fish, respectively). STE found in the surveyed population of Luang Prabang Province were verified to be those of intestinal fukes, particularly H. taichui.

Increased intestinal epithelial cell turnover and intestinal motility in Gymnophalloides seoi-infected C57BL/6 mice

The changing patterns of goblet cell hyperplasia, intestinal epithelial cell turnover, and intestinal motility were studied in ICR and C57BL/6 mice infected with Gymnophalloides seoi (Digenea: Gymnophallidae). Whereas ICR mice retained G. seoi worms until day 7 post-infection (PI), C57BL/6 mice showed a rapid worm expulsion within day 3 PI. Immunosuppression with Depo-Medrol significantly delayed the worm expulsion in C57BL/6 mice. Goblet cell counts were increased in both strains of mice, peaking at day 1 PI in C57BL/6 mice and slowly increasing until day 7 PI in ICR mice. In C57BL/6 mice infected with G. seoi, newly proliferating intestinal epithelial cells were remarkably increased in the crypt, and the increase was the highest at day 1 PI. However, in ICR mice, newly proliferating intestinal epithelial cells increased slowly from day 1 to day 7 PI. Intestinal motility was increased in G. seoi-infected mice, and its chronological pattern was highly correlated with the worm load in both strains of mice. Meanwhile, immunosuppression of C57BL/6 mice abrogated the goblet cell proliferation, reduced the epithelial cell proliferation, and suppressed the intestinal motility. Goblet cell hyperplasia, increased intestinal epithelial cell turnover, and increased intestinal motility should be important mucosal defense mechanisms in G. seoi-infected C57BL/6 mice.

Four human cases of Acanthotrema felis (Digenea: Heterophyidae) infection in Korea

Acanthotrema felis is an intestinal trematode of cats originally reported from the Republic of Korea. Only 1 human case infected with a single adult worm has been previously recorded. In the present study, we report 4 human cases infected with a total of 10 worms recovered after anthelmintic treatment and purging. All 4 patients reside in coastal areas of Jeollanam-do, Korea, and have consumed brackish water fish including the gobies, Acanthogobius flavimanus. The worms averaged 0.47 mm in length and 0.27 mm in width, and had 3 sclerites on the ventrogenital sac; 1 was short and thumb-like, another was long and blunt-ended, and the 3rd was long and broad-tipped. They were identified as A. felis Sohn, Han, & Chai, 2003. Surveys on coastal areas to detect further human cases infected with A. felis are required.