1
|
Weitzel T, Brown A, Libman M, Perret C, Huits R, Chen L, Leung DT, Leder K, Connor BA, Menéndez MD, Asgeirsson H, Schwartz E, Salvador F, Malvy D, Saio M, Norman FF, Amatya B, Duvignaud A, Vaughan S, Glynn M, Angelo KM. Intestinal protozoa in returning travellers: a GeoSentinel analysis from 2007 to 2019. J Travel Med 2024; 31:taae010. [PMID: 38245913 DOI: 10.1093/jtm/taae010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/08/2024] [Accepted: 01/11/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND Prolonged diarrhoea is common amongst returning travellers and is often caused by intestinal protozoa. However, the epidemiology of travel-associated illness caused by protozoal pathogens is not well described. METHODS We analysed records of returning international travellers with illness caused by Giardia duodenalis, Cryptosporidium spp., Cyclospora cayetanensis or Cystoisospora belli, reported to the GeoSentinel Network during January 2007-December 2019. We excluded records of travellers migrating, with an unascertainable exposure country, or from GeoSentinel sites that were not located in high-income countries. RESULTS There were 2517 cases, 82.3% giardiasis (n = 2072), 11.4% cryptosporidiosis (n = 287), 6.0% cyclosporiasis (n = 150) and 0.3% cystoisosporiasis (n = 8). Overall, most travellers were tourists (64.4%) on long trips (median durations: 18-30 days). Cryptosporidiosis more frequently affected people < 18 years (13.9%) and cyclosporiasis affected people ≥ 40 years (59.4%). Giardiasis was most frequently acquired in South Central Asia (45.8%) and sub-Saharan Africa (22.6%), cryptosporidiosis in sub-Saharan Africa (24.7%) and South-Central Asia (19.5%), cyclosporiasis in South East Asia (31.3%) and Central America (27.3%), and cystoisosporiasis in sub-Saharan Africa (62.5%). Cyclosporiasis cases were reported from countries of uncertain endemicity (e.g. Cambodia) or in countries with no previous evidence of this parasite (e.g. French Guiana). The time from symptom onset to presentation at a GeoSentinel site was the longest amongst travellers with giardiasis (median: 30 days). Over 14% of travellers with cryptosporidiosis were hospitalized. CONCLUSIONS This analysis provides new insights into the epidemiology and clinical significance of four intestinal protozoa that can cause morbidity in international travellers. These data might help optimize pretravel advice and post-travel management of patients with travel-associated prolonged gastrointestinal illnesses. This analysis reinforces the importance of international travel-related surveillance to identify sentinel cases and areas where protozoal infections might be undetected or underreported.
Collapse
Affiliation(s)
- Thomas Weitzel
- Travel Medicine Program, Clínica Alemana, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago 7650568, Chile
- Instituto de Ciencias e Innovación en Medicina (ICIM), Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago 7590943, Chile
| | - Ashley Brown
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Michael Libman
- J.D. MacLean Centre for Tropical Diseases, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Cecilia Perret
- Department of Pediatric Infectious Diseases and Immunology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8320000, Chile
| | - Ralph Huits
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Verona 37024, Italy
| | - Lin Chen
- Division of Infectious Diseases, Mount Auburn Hospital, Cambridge, MA 02138, USA
| | - Daniel T Leung
- International Travel Clinic, University of Utah Hospital and Clinics, Salt Lake City, UT 84132, USA
| | - Karin Leder
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia
| | - Bradley A Connor
- New York Center for Travel and Tropical Medicine, New York, NY 10022, USA
| | - Marta D Menéndez
- Tropical Medicine Department, Hospital Universitario La Paz Carlos III, CIBERINFECT, Madrid 28046, Spain
| | - Hilmir Asgeirsson
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm 171 76, Sweden
- Division of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm 141 57, Sweden
| | - Eli Schwartz
- The Center of Geographical Medicine and Tropical Diseases, Sheba Medical Center, Tel HaShomer 52621, Israel
- Ramat Gan & Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Fernando Salvador
- Tropical Medicine Unit, Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS, Barcelona 08001, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid 28029, Spain
| | - Denis Malvy
- Department of Infectious Diseases and Tropical Medicine, Hôpital Pellegrin, Bordeaux 33076, France
| | - Mauro Saio
- Department of Tropical and Travel Medicine, The Nairobi Hospital, Nairobi 00100, Kenya
| | - Francesca F Norman
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, CIBERINFEC, IRYCIS, Madrid 28034, Spain
- Department of Medicine, Universidad de Alcalá, Alcalá de Henares 28801, Spain
| | - Bhawana Amatya
- CIWEC Hospital and Travel Medicine Center, Kathmandu 44600, Nepal
| | - Alexandre Duvignaud
- Department of Infectious Diseases and Tropical Medicine, Hôpital Pellegrin, Bordeaux 33076, France
| | - Stephen Vaughan
- Division of Infectious Diseases, University of Calgary, South Health Campus, Calgary, AB T3M 1M4, Canada
| | - Marielle Glynn
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Kristina M Angelo
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| |
Collapse
|
2
|
Chen Y, Qin Z, Li J, Xiao L, Zhang L. The global prevalence of Cyclospora cayetanensis infection: A systematic review, meta-analysis, and meta-regression. Acta Trop 2024; 253:107175. [PMID: 38492874 DOI: 10.1016/j.actatropica.2024.107175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 03/02/2024] [Accepted: 03/05/2024] [Indexed: 03/18/2024]
Abstract
Cyclospora cayetanensis (C. cayetanensis) is a significant pathogen that causes diarrheal illness and causes large foodborne diarrhea outbreaks in the USA and Canada. However, there is currently a lack of published meta-analysis on the prevalence of C. cayetanensis infection in the global population. A real estimation of a disease prevalence should always be done on the basis of studies designed for that purpose. We conducted a comprehensive search of various databases for articles pertaining to the prevalence of C. cayetanensis infection in humans, spanning from the inception of these databases to March 10, 2023. Utilizing a random effects model, we estimated the prevalence of C. cayetanensis infection in humans. Our analysis included a total of 150 datasets sourced from 42 different countries, which were ultimately selected for the final quantitative assessment. The prevalence of C. cayetanensis infection in humans worldwide was estimated to be 3.4 % (5636/166,611). Notably, Africa exhibited the highest prevalence rate at 5.9 % (606/11,068). Further subgroup analysis revealed a significantly higher infection rate in humans residing in low-income countries (7.6 %, 83/921) compared to those in lower-middle-income countries (4.8 %, 3280/48,852), upper-middle-income countries (2.9 %, 2194/99,419), and high-income countries (0.4 %, 79/17,419). The results indicate that the global prevalence of C. cayetanensis infection in humans is relatively low, despite its extensive geographical distribution and children were found to be more susceptible to C. cayetanensis infection compared to those adults. Sensitivity analysis revealed that one study significantly affects the prevalence of C. cayetanensis, which was adjusted to 2.9 % (4017/160,049; 95 % CI: 2.7-3.1 %) by excluding this study. The findings highlight the relatively high prevalence of C. cayetanensis infection in low-income countries and among humans with diarrhea, particularly in Africa. Consequently, routine surveillance for intestinal protozoa is crucial in these regions.
Collapse
Affiliation(s)
- Yuancai Chen
- College of Veterinary Medicine, Henan Agricultural University, Zhengzhou 450046, PR China; International Joint Research Laboratory for Zoonotic Diseases of Henan, Zhengzhou 450046, PR China; Key Laboratory of Quality and Safety Control of Poultry Products (Zhengzhou), Ministry of Agriculture and Rural Affairs, Zhengzhou 450046, PR China
| | - Ziyang Qin
- College of Veterinary Medicine, Henan Agricultural University, Zhengzhou 450046, PR China; International Joint Research Laboratory for Zoonotic Diseases of Henan, Zhengzhou 450046, PR China; Key Laboratory of Quality and Safety Control of Poultry Products (Zhengzhou), Ministry of Agriculture and Rural Affairs, Zhengzhou 450046, PR China
| | - Junqiang Li
- College of Veterinary Medicine, Henan Agricultural University, Zhengzhou 450046, PR China; International Joint Research Laboratory for Zoonotic Diseases of Henan, Zhengzhou 450046, PR China; Key Laboratory of Quality and Safety Control of Poultry Products (Zhengzhou), Ministry of Agriculture and Rural Affairs, Zhengzhou 450046, PR China
| | - Lihua Xiao
- Center for Emerging and Zoonotic Diseases, College of Veterinary Medicine, South China Agricultural University, Guangzhou 510642, PR China; Guangdong Laboratory for Lingnan Modern Agriculture, Guangzhou 510642, PR China
| | - Longxian Zhang
- College of Veterinary Medicine, Henan Agricultural University, Zhengzhou 450046, PR China; International Joint Research Laboratory for Zoonotic Diseases of Henan, Zhengzhou 450046, PR China; Key Laboratory of Quality and Safety Control of Poultry Products (Zhengzhou), Ministry of Agriculture and Rural Affairs, Zhengzhou 450046, PR China.
| |
Collapse
|
3
|
Zhao Z, Cao S, Sun M, Yang Q, Huang T, Yang X, Li J, Zhang X, Li X, Wang X, Jiang W, Gong P. Rapid visual detection of Giardia duodenalis in faecal samples using an RPA-CRISPR/Cas12a system. Parasitol Res 2024; 123:176. [PMID: 38573530 DOI: 10.1007/s00436-024-08197-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/24/2024] [Indexed: 04/05/2024]
Abstract
Giardiasis is a common intestinal infection caused by Giardia duodenalis, which is a major economic and health burden for humans and livestock. Currently, a convenient and effective detection method is urgently needed. CRISPR/Cas12a-based diagnostic methods have been widely used for nucleic acid-based detection of pathogens due to their high efficiency and sensitivity. In this study, a technique combining CRISPR/Cas12a and RPA was established that allows the detection of G. duodenalis in faecal samples by the naked eye with high sensitivity (10-1 copies/μL) and specificity (no cross-reactivity with nine common pathogens). In clinical evaluations, the RPA-CRISPR/Cas12a-based detection assay detected Giardia positivity in 2% (1/50) of human faecal samples and 47% (33/70) of cattle faecal samples, respectively, which was consistent with the results of nested PCR. Our study demonstrated that the RPA-CRISPR/Cas12a technique for G. duodenalis is stable, efficient, sensitive, specific and has low equipment requirements. This technique offers new opportunities for on-site detection in remote and poor areas.
Collapse
Affiliation(s)
- Zhiteng Zhao
- State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Key Laboratory for Zoonosis Research of the Ministry of Education, Institute of Zoonosis, and College of Veterinary Medicine, Jilin University, Changchun, 130062, People's Republic of China
| | - Songgao Cao
- Pingdu People's Hospital, Qingdao, 266700, People's Republic of China
| | - Min Sun
- State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Key Laboratory for Zoonosis Research of the Ministry of Education, Institute of Zoonosis, and College of Veterinary Medicine, Jilin University, Changchun, 130062, People's Republic of China
| | - Qiankun Yang
- State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Key Laboratory for Zoonosis Research of the Ministry of Education, Institute of Zoonosis, and College of Veterinary Medicine, Jilin University, Changchun, 130062, People's Republic of China
| | - Taojun Huang
- State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Key Laboratory for Zoonosis Research of the Ministry of Education, Institute of Zoonosis, and College of Veterinary Medicine, Jilin University, Changchun, 130062, People's Republic of China
| | - Xing Yang
- Integrated Laboratory of Pathogenic Biology, College of Preclinical Medicine, Dali University, Dali, Yunnan, 671003, People's Republic of China
| | - Jianhua Li
- State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Key Laboratory for Zoonosis Research of the Ministry of Education, Institute of Zoonosis, and College of Veterinary Medicine, Jilin University, Changchun, 130062, People's Republic of China
| | - Xichen Zhang
- State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Key Laboratory for Zoonosis Research of the Ministry of Education, Institute of Zoonosis, and College of Veterinary Medicine, Jilin University, Changchun, 130062, People's Republic of China
| | - Xin Li
- State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Key Laboratory for Zoonosis Research of the Ministry of Education, Institute of Zoonosis, and College of Veterinary Medicine, Jilin University, Changchun, 130062, People's Republic of China
| | - Xiaocen Wang
- State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Key Laboratory for Zoonosis Research of the Ministry of Education, Institute of Zoonosis, and College of Veterinary Medicine, Jilin University, Changchun, 130062, People's Republic of China
| | - Weina Jiang
- Department of Pathology, Qingdao Municipal Hospital, Qingdao, Shandong Province, 266071, People's Republic of China.
| | - Pengtao Gong
- State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Key Laboratory for Zoonosis Research of the Ministry of Education, Institute of Zoonosis, and College of Veterinary Medicine, Jilin University, Changchun, 130062, People's Republic of China.
| |
Collapse
|
4
|
Park SM, Choi C, Rhee MS. One Health approach for prioritization of potential foodborne pathogens: Risk-ranking, Delphi survey, and criteria evaluation pre- and post-COVID-19 pandemic. Compr Rev Food Sci Food Saf 2024; 23:e13258. [PMID: 38284613 DOI: 10.1111/1541-4337.13258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 10/02/2023] [Accepted: 10/04/2023] [Indexed: 01/30/2024]
Abstract
Frequent foodborne illnesses with unknown causative agents highlight the need to explore zoonotic potential foodborne pathogens (PFPs). An effective PFP prioritization tool is indispensable, especially after experiencing the recent pandemic caused by zoonotic SARS-CoV-2. Risk information on pathogens (excluding 30 known foodborne pathogens) provided by governmental and international organizations was reviewed to generate a list of PFPs. Risk-ranking of PFPs was conducted based on a literature review of food poisoning or detection cases, and the ranks were determined with a decision tree. PFPs were prioritized by infectious disease (ID), veterinary medicine (VET), and food safety (FS) experts through a pre- and postpandemic Delphi survey, and key criteria in their decisions were illuminated. Among 339 PFPs, 32 rank-1 PFPs were involved in the foodborne outbreak(s). Discrepancies in opinions on prioritization between experts in different fields deepened after the pandemic. Only VET and FS experts valued the plausibility of foodborne transmission in evaluating bacteria and viruses, and a significant correlation between their selection of PFPs was found (p < .05). The impact of the pandemic induced all fields to focus more on human transmission and severity/fatality in prioritizing viruses, and only FS experts emphasized the plausibility of foodborne transmission after the pandemic. In contrast to prioritizing bacteria or viruses, ID and VET experts are unusually focused on foodborne transmission when prioritizing parasites. Criteria of consensus deduced by interdisciplinary experts with different interests and the criteria directly related to foodborne transmission should be acknowledged for adequate PFP prioritization.
Collapse
Affiliation(s)
- Sun Min Park
- Department of Biotechnology, College of Life Sciences and Biotechnology, Korea University, Seoul, Republic of Korea
| | - Changsun Choi
- Department of Food and Nutrition, College of Biotechnology and Natural Resources, Chung-Ang University, Anseong-si, Gyeonggi, Republic of Korea
| | - Min Suk Rhee
- Department of Biotechnology, College of Life Sciences and Biotechnology, Korea University, Seoul, Republic of Korea
| |
Collapse
|
5
|
Richins T, Houghton K, Barratt J, H. Sapp SG, Peterson A, Qvarnstrom Y. Comparison of two novel one-tube nested real-time qPCR assays to detect human-infecting Cyclospora spp. Microbiol Spectr 2023; 11:e0138823. [PMID: 37819113 PMCID: PMC10715049 DOI: 10.1128/spectrum.01388-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 09/01/2023] [Indexed: 10/13/2023] Open
Abstract
IMPORTANCE Human-infecting Cyclospora spp. cause gastrointestinal distress among healthy individuals contributing to morbidity and putting stress on the economics of countries and companies in the form of produce recalls. Accessible and easy-to-use diagnostic tools available to a wide variety of laboratories would aid in the early detection of possible outbreaks of cyclosporiasis. This, in turn, will assist in the timely traceback investigation to the suspected source of an outbreak by informing the smallest possible recall and protecting consumers from contaminated produce. This manuscript describes two novel detection methods with improved performance for the causative agents of cyclosporiasis when compared to the currently used 18S assay.
Collapse
Affiliation(s)
- Travis Richins
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Parasitic Disease Branch, Atlanta, USA
- Oak Ridge Associated Universities, Oak Ridge, Tennessee, USA
| | | | - Joel Barratt
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Parasitic Disease Branch, Atlanta, USA
- Oak Ridge Associated Universities, Oak Ridge, Tennessee, USA
| | - Sarah G. H. Sapp
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Parasitic Disease Branch, Atlanta, USA
| | - Anna Peterson
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Parasitic Disease Branch, Atlanta, USA
- Oak Ridge Associated Universities, Oak Ridge, Tennessee, USA
| | - Yvonne Qvarnstrom
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Parasitic Disease Branch, Atlanta, USA
| |
Collapse
|
6
|
Hagras NAE, Makled S, Sheta E, El-hawary MA, Mogahed NMFH. Potent efficiency of the novel nitazoxanide-loaded nanostructured lipid carriers against experimental cyclosporiasis. PLoS Negl Trop Dis 2023; 17:e0011845. [PMID: 38100538 PMCID: PMC10756555 DOI: 10.1371/journal.pntd.0011845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 12/29/2023] [Accepted: 12/05/2023] [Indexed: 12/17/2023] Open
Abstract
Cyclosporiasis is a ubiquitous infection caused by an obligate intracellular protozoan parasite known as Cyclospora cayetanensis (C. cayetanensis). The disease is characterized by severe diarrhea which may be regrettably fatal in immunosuppressed patients. The commercially available treatment options have either severe side effects or low efficiency. In the present study, the novel formula of nitazoxanide (NTZ)-loaded nanostructured lipid carriers (NLCs) was assessed for the first time for C. cayetanensis treatment in both immunocompetent and immunosuppressed mice in comparison to commercially available drugs (trimethoprim-sulfamethoxazole (TMP-SMX) and NTZ). Swiss Albino mice were orally infected by 104 sporulated oocysts. The experimental groups were treated with the gold standard TMP-SMX, NTZ, blank NLCs and NTZ-loaded NLCs. The results demonstrated that NTZ-loaded NLCs represented the highest significant parasite percent reduction of (>98% reduction) in both immunocompetent and immunosuppressed mice designating successful tissue penetration and avoiding recurrence of infection at the end of the study. Oocysts treated with NTZ-loaded NLCs demonstrated the most mutilated rapturing morphology via scanning electron microscope examination as well as representing the most profound improvement of the histopathological picture. In conclusion, NTZ-loaded NLCs exhibited the uppermost efficacy in the treatment of cyclosporiasis. The safe nature and the anti-parasitic effect of the novel formulation encourage its use as a powerful treatment for human cyclosporiasis.
Collapse
Affiliation(s)
- Nancy Abd-elkader Hagras
- Department of Medical Laboratory Technology, Faculty of Applied Health Sciences Technology, Pharos University in Alexandria, Alexandria, Egypt
| | - Shaimaa Makled
- Department of Pharmaceutics, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt
| | - Eman Sheta
- Department of Pathology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | | | |
Collapse
|
7
|
Moreno-Mesonero L, Soler L, Amorós I, Moreno Y, Ferrús M, Alonso J. Protozoan parasites and free-living amoebae contamination in organic leafy green vegetables and strawberries from Spain. Food Waterborne Parasitol 2023; 32:e00200. [PMID: 37405064 PMCID: PMC10316001 DOI: 10.1016/j.fawpar.2023.e00200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/20/2023] [Accepted: 06/21/2023] [Indexed: 07/06/2023] Open
Abstract
In this study, the presence of Acanthamoeba spp., Blastocystis sp., Cryptosporidium spp., Cyclospora cayetanensis, Entamoeba histolytica, Giardia sp., Toxoplasma gondii and Vermamoeba vermiformis was assessed in organic leafy green vegetables (lettuce, spinach, cabbage) and fruits (strawberry), which are usually consumed raw. A total of 110 organic samples were collected in Valencia (Spain). Protozoa were concentrated before detection by immunofluorescence (Cryptosporidium spp. and Giardia sp.) or real-time qPCR (Acanthamoeba spp., Blastocystis sp., C. cayetanensis, E. histolytica, T. gondii and V. vermiformis). The most abundant protozoa in organic vegetables and berry fruits were Acanthamoeba (65.5%), followed by T. gondii (37.2%), V. vermiformis (17.3%), C. cayetanensis (12.7%), Cryptosporidium spp. (6.8%), Blastocystis sp. (1.8%) and Giardia sp. (1.7%). E. histolytica was not found in any of the organic samples. Thus, results showed that consumers can be exposed to protozoan parasites by consuming organic vegetables and berry fruits. This is the first report in Spain describing the presence of the protozoan pathogens Acanthamoeba spp., Blastocystis sp., C. cayetanensis, T. gondii and V. vermiformis, Cryptosporidium spp. and Giardia sp. in organic fresh produce. The results of this research will help determine the risk of foodborne protozoan parasites on organic leafy greens and strawberries that are available at local markets.
Collapse
Affiliation(s)
- L. Moreno-Mesonero
- Instituto de Ingeniería del Agua y Medio Ambiente (IIAMA), Universitat Politècnica de València, Camino de Vera s/n, 46022, Valencia, Spain
- Departamento de Biotecnología, Centro Avanzado de Microbiología de Alimentos, Universitat Politècnica de València, Camino de Vera s/n, 46022 Valencia, Spain
| | - L. Soler
- Instituto de Ingeniería del Agua y Medio Ambiente (IIAMA), Universitat Politècnica de València, Camino de Vera s/n, 46022, Valencia, Spain
| | - I. Amorós
- Instituto de Ingeniería del Agua y Medio Ambiente (IIAMA), Universitat Politècnica de València, Camino de Vera s/n, 46022, Valencia, Spain
| | - Y. Moreno
- Instituto de Ingeniería del Agua y Medio Ambiente (IIAMA), Universitat Politècnica de València, Camino de Vera s/n, 46022, Valencia, Spain
| | - M.A. Ferrús
- Departamento de Biotecnología, Centro Avanzado de Microbiología de Alimentos, Universitat Politècnica de València, Camino de Vera s/n, 46022 Valencia, Spain
| | - J.L. Alonso
- Instituto de Ingeniería del Agua y Medio Ambiente (IIAMA), Universitat Politècnica de València, Camino de Vera s/n, 46022, Valencia, Spain
| |
Collapse
|
8
|
Almeria S, Chacin-Bonilla L, Maloney JG, Santin M. Cyclospora cayetanensis: A Perspective (2020-2023) with Emphasis on Epidemiology and Detection Methods. Microorganisms 2023; 11:2171. [PMID: 37764015 PMCID: PMC10536660 DOI: 10.3390/microorganisms11092171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/11/2023] [Accepted: 08/23/2023] [Indexed: 09/29/2023] Open
Abstract
Cyclospora cayetanensis infections are prevalent worldwide, and the parasite has become a major public health and food safety concern. Although important efforts have been dedicated to advance toward preventing and reducing incidences of cyclosporiasis, there are still several knowledge gaps that hamper the implementation of effective measures to prevent the contamination of produce and water with Cyclospora oocysts. Some of these data gaps can be attributed to the fact that access to oocysts is a limiting factor in C. cayetanensis research. There are no animal models or in vivo or in vitro culture systems to propagate the oocysts needed to facilitate C. cayetanensis research. Thus, researchers must rely upon limited supplies of oocysts obtained from naturally infected human patients considerably restricting what can be learnt about this parasite. Despite the limited supply of C. cayetanensis oocysts, several important advances have happened in the past 3 years. Great progress has been made in the Cyclospora field in the areas of molecular characterization of strains and species, generation of genomes, and development of novel detection methods. This comprehensive perspective summarizes research published from 2020 to 2023 and evaluates what we have learnt and identifies those aspects in which further research is needed.
Collapse
Affiliation(s)
- Sonia Almeria
- Center for Food Safety and Nutrition (CFSAN), Department of Health and Human Services, Food and Drug Administration, Office of Applied Research and Safety Assessment (OARSA), Division of Virulence Assessment, Laurel, MD 20708, USA
| | | | - Jenny G. Maloney
- Environmental Microbial and Food Safety Laboratory, Agricultural Research Service, United States Department of Agriculture, Beltsville, MD 20705, USA;
| | - Monica Santin
- Environmental Microbial and Food Safety Laboratory, Agricultural Research Service, United States Department of Agriculture, Beltsville, MD 20705, USA;
| |
Collapse
|
9
|
Einhorn N, Lamphier I, Klinkova O, Baluch A, Pasikhova Y, Greene J. Intestinal Coccidian Infections in Cancer Patients: A Case Series. Cureus 2023; 15:e38256. [PMID: 37252590 PMCID: PMC10225162 DOI: 10.7759/cureus.38256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction Coccidian protozoa and microsporidian fungi are opportunistic pathogens increasingly implicated in infections in immunosuppressed individuals. These parasites typically infect the intestinal epithelium, resulting in secretory diarrhea and malabsorption. The disease burden and timeline are both greater and longer among immunosuppressed patients. Therapeutic options for immunocompromised individuals are limited. As a result, we wanted to better characterize the disease course and treatment efficacy of these parasitic gastrointestinal infections. Methods We performed a single-center, retrospective MedMined (BD Healthsight Analytics, Birmingham, AL, USA) chart review of patients between January 2012 and June 2022 diagnosed with coccidian or microsporidian infections. Relevant data were collected from Cerner's PowerChart (Oracle Cerner, Austin, TX, USA). Descriptive analysis was performed with IBM SPSS Statistics (IBM Corp., Armonk, NY, USA), and Microsoft Excel (Microsoft, Redmond, WA, USA) was used to generate graphs and tables. Results In these 10 years, there were 17 patients with Cryptosporidium infections, four with Cyclospora infections, and no positive cultures for Cystoisospora belli or microsporidian infections. In both infections, the majority of patients experienced diarrhea, fatigue, and nausea, with vomiting, abdominal pain, appetite loss, weight loss, and fever occurring to a lesser degree. Nitazoxanide was the most common treatment for Cryptosporidium, while trimethoprim-sulfamethoxazole or ciprofloxacin were the treatments of choice for Cyclospora. Of the Cryptosporidium infections, three received combination therapy with azithromycin, immunoreconstitution, or IV immunoglobulins. Among the four Cyclospora-infected patients, one received combination therapy of ciprofloxacin and trimethoprim-sulfamethoxazole. Treatment lasted around two weeks, and 88% of Cryptosporidium patients and 75% of Cyclospora patients had a resolution of symptoms. Conclusion The most detected coccidian infection was Cryptosporidium, followed by Cyclospora, with the lack of Cystoisospora or microsporidian infections likely due to diagnostic limitations and prevalence. Cryptosporidium and Cyclospora likely caused their associated symptoms in most cases, with other possible etiologies, including graft-versus-host disease, medications, and feeding tubes. The small number of patients receiving combination therapy prohibited a comparison with monotherapy. In our patient population, though, there was a clinical response to treatment despite immunosuppression. While promising, additional randomized control experiments are required to fully understand the efficacy of parasitic treatments.
Collapse
Affiliation(s)
- Nathan Einhorn
- Infectious Diseases, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Isis Lamphier
- Infection Control, Moffitt Cancer Center, Tampa, USA
| | - Olga Klinkova
- Infectious Diseases, Moffitt Cancer Center, Tampa, USA
| | - Aliyah Baluch
- Infectious Diseases, Moffitt Cancer Center, Tampa, USA
| | | | - John Greene
- Internal Medicine, Moffitt Cancer Center, Tampa, USA
| |
Collapse
|
10
|
Chacin-Bonilla L, Santin M. Cyclospora cayetanensis Infection in Developed Countries: Potential Endemic Foci? Microorganisms 2023; 11:microorganisms11030540. [PMID: 36985114 PMCID: PMC10058255 DOI: 10.3390/microorganisms11030540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 02/25/2023] Open
Abstract
Cyclospora cayetanensis infection has emerged as a significant public health concern worldwide. Developed countries are generally considered non-endemic for infection. However, sporadic cases and non-travel-related outbreaks of C. cayetanensis infections associated with domestically grown produce are becoming more common in developed countries. Cyclospora cayetanensis has been detected in fresh produce, surface water, wastewater, irrigation water, and soil in these countries, suggesting that the parasite may be more common in areas with advanced sanitation than previously thought and illustrating the potential risk for exposure and indigenous/autochthonous infections. The evidence suggests the possibility of foci of endemicity in developed countries, particularly in communities where sanitary conditions are compromised, and raises transmission issues that require further research to better define the risks for infection, how widespread C. cayetanensis may be in these areas, and to guide interventions against this infection. The main purpose of the present opinion was to evaluate the presence of cyclosporiasis in developed countries, which is a very important and ongoing issue in food safety.
Collapse
Affiliation(s)
- Leonor Chacin-Bonilla
- Instituto de Investigaciones Clinicas, Universidad del Zulia, Maracaibo 4001, Venezuela
- Correspondence: (L.C.-B.); (M.S.)
| | - Monica Santin
- Environmental Microbial and Food Safety Laboratory, Agricultural Research Service, United States Department of Agriculture, Beltsville, MD 20705, USA
- Correspondence: (L.C.-B.); (M.S.)
| |
Collapse
|
11
|
Liu H, Ni H, Liu S, Shen Y, Wang R, Cao J, Yin J. First report on occurrence and genotypes of Enterocytozoon bieneusi, Cryptosporidium spp. and Cyclospora cayetanensis from diarrheal outpatients in Ningbo, Southeast China. Microb Pathog 2023; 174:105952. [PMID: 36528327 DOI: 10.1016/j.micpath.2022.105952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/14/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
Enterocytozoon bieneusi, Cryptosporidium spp. and Cyclospora cayetanensis are three important zoonotic pathogens which were a major cause of foodborne or waterborne intestinal diseases in humans and animals. However, very little data about occurrence and genotypes of the three parasites in Ningbo in the south wing of the Yangtze River Delta, China, which is important for a tourist city. In the present study, molecular characterization of E. bieneusi, C. cayetanensis and Cryptosporidium spp. in fecal samples from 489 diarrheal outpatients were carried out. As a result, a total of 35 (7.16%, 35/489) and three (0.61%, 3/489) samples were positive for E. bieneusi and C. cayetanensis respectively. No Cryptosporidium-positive sample or mixed-infections were detected. Four known E. bieneusi genotypes (Type IV, D, I and CHN4) and 8 novel genotypes (NBH1-NBH8) were identified with type IV was the dominant genotype (n = 14), followed by genotypes D (n = 5), NBH8 (n = 5) and NBH7 (n = 3). The remaining genotypes were found in one sample each, and these genotypes were belonged to the previously described high-potential zoonotic group 1. One novel sequence named NBC315, and the other two sequences (NBC30 and NBC370) identical with the reported sequence were detected. Therefore, the existence and importance of zoonotic potential of E. bieneusi and C. cayetanensis in diarrheal outpatients in Ningbo indicates the public health threats, and more investigations should be carried out in human populations, animals and other environmental sources from the One Health perspective.
Collapse
Affiliation(s)
- Hua Liu
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), NHC Key Laboratory of Parasite and Vector Biology, WHO Collaborating Center for Tropical Diseases, National Center for International Research on Tropical Diseases, Shanghai, 200025, China
| | - Hongxia Ni
- Ningbo Center for Disease Control and Prevention, Ningbo, Zhejiang Province, 315010, China
| | - Shike Liu
- Ninghai County Center for Disease Control and Prevention, Ningbo, Zhejiang Province, 315699, China
| | - Yujuan Shen
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), NHC Key Laboratory of Parasite and Vector Biology, WHO Collaborating Center for Tropical Diseases, National Center for International Research on Tropical Diseases, Shanghai, 200025, China
| | - Rong Wang
- Ningbo Center for Disease Control and Prevention, Ningbo, Zhejiang Province, 315010, China
| | - Jianping Cao
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), NHC Key Laboratory of Parasite and Vector Biology, WHO Collaborating Center for Tropical Diseases, National Center for International Research on Tropical Diseases, Shanghai, 200025, China
| | - Jianhai Yin
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), NHC Key Laboratory of Parasite and Vector Biology, WHO Collaborating Center for Tropical Diseases, National Center for International Research on Tropical Diseases, Shanghai, 200025, China.
| |
Collapse
|
12
|
Li J, Xu F, Karim MR, Zhang L. Review on Cyclosporiasis Outbreaks and Potential Molecular Markers for Tracing Back Investigations. Foodborne Pathog Dis 2022; 19:796-805. [PMID: 36450125 DOI: 10.1089/fpd.2022.0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Cyclosporiasis is an emerging disease caused by Cyclospora cayetanensis, which induces protracting and relapsing gastroenteritis and has been linked to huge and complicated travel- and food-related outbreaks worldwide. Cyclosporiasis has become more common in both developing and developed countries as a result of increased global travel and the globalization of the human food supply. It is not just a burden on individual human health but also a worldwide public health problem. As a pathogen of interest, the molecular biological characteristics of C. cayetanensis have advanced significantly over the last few decades. However, only one FDA-approved molecular platform has been commercially used in the investigation of cyclosporiasis outbreaks. More potential molecular markers and genotyping of C. cayetanensis in samples based on the polymorphic region of the whole genomes might differentiate between separate case clusters and would be useful in tracing back investigations, especially during cyclosporiasis outbreak investigations. Considering that there is no effective vaccine for cyclosporosis, epidemiological investigation using effective tools is crucial for controlling cyclosporiasis by source tracking. Therefore, more and more epidemiological investigative studies for human cyclosporiasis should be promoted around the world to get a deeper understanding of its characteristics as well as management. This review focuses on major cyclosporiasis outbreaks and potential molecular markers for tracing back investigations into cyclosporiasis outbreaks.
Collapse
Affiliation(s)
- Junqiang Li
- College of Veterinary Medicine, Henan Agricultural University, Zhengzhou, China.,Key Laboratory of Quality and Safety Control of Poultry Products (Zhengzhou), Ministry of Agriculture and Rural Affairs, Zhengzhou, China.,International Joint Research Laboratory for Zoonotic Diseases of Henan, Zhengzhou, China
| | - Feifei Xu
- College of Veterinary Medicine, Henan Agricultural University, Zhengzhou, China
| | - Md Robiul Karim
- Department of Medicine, Faculty of Veterinary Medicine and Animal Science, Bangabandhu Sheikh Mujibur Rahman Agricultural University, Gazipur, Bangladesh
| | - Longxian Zhang
- College of Veterinary Medicine, Henan Agricultural University, Zhengzhou, China.,Key Laboratory of Quality and Safety Control of Poultry Products (Zhengzhou), Ministry of Agriculture and Rural Affairs, Zhengzhou, China.,International Joint Research Laboratory for Zoonotic Diseases of Henan, Zhengzhou, China
| |
Collapse
|
13
|
Dubey JP, Charlesworth JE, Pritt BS. Transmission electron microscopy on a case of Cyclospora cayetanensis infection from an immune-competent case confirms and extends prior detailed descriptions of its notably small endogenous stage. Parasitology 2022; 149:1397-1405. [PMID: 35674118 PMCID: PMC11010578 DOI: 10.1017/s0031182022000786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/12/2022] [Accepted: 05/25/2022] [Indexed: 11/07/2022]
Abstract
Although infections with Cyclospora cayetanensis are prevalent worldwide, many aspects of this parasite's life cycle remain unknown. Humans are the only known hosts, existing information on its endogenous development has been derived from histological examination of only a few biopsy specimens. In histological sections, its stages are less than 10 μm, making definitive identification difficult. Here, confirmation of cyclosporiasis in a duodenal biopsy specimen from an 80-year-old man without any recognized immunodeficiency patient is reported. Asexual forms (schizonts) and sexual forms (gamonts) were located within enterocytes, including immature and mature schizonts, an immature male gamont and a female gamont. Merozoites were small (<5 μm × 1 μm) and contained two rhoptries, subterminal nucleus and numerous micronemes and amylopectin granules. These parasite stages were like those recently reported in the gallbladder of an immunocompromised patient, suggesting that the general life-cycle stages are not altered by immunosuppression.
Collapse
Affiliation(s)
- Jitender P. Dubey
- Animal Parasitic Disease Laboratory, United States Department of Agriculture, Agricultural Research Service, Beltsville Agricultural Research Center, Building 1001, BARC-East, Beltsville, MD 20705-2350, USA
| | | | - Bobbi S. Pritt
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
| |
Collapse
|
14
|
Investigating the Potential Effects of COVID-19 Pandemic on Intestinal Coccidian Infections. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2022. [DOI: 10.22207/jpam.16.3.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
New infectious agents pose a global threat to the healthcare system, and studies are conducted to estimate their health and epidemiological outcomes in the long run. The SARS-CoV-2 virus, which has caused the COVID-19 disease, was formerly assumed to be a respiratory virus; however, it can have serious systemic effects, affecting organs such as the gastrointestinal tract (GIT). Viral RNA was reported in the stool in a subset of patients, indicating another mode of transmission and diagnosis. In COVID-19, prolonged GIT symptoms, especially diarrhea, were associated with reduced diversity and richness of gut microbiota, immunological dysregulation, and delayed viral clearance. Intestinal coccidian parasites are intracellular protozoa that are most typically transmitted to humans by oocysts found in fecally contaminated food and water. Their epidemiological relevance is coupled to opportunistic infections, which cause high morbidity and mortality among immunocompromised individuals. Among immunocompetent people, intestinal coccidia is also involved in acute diarrhea, which is usually self-limiting. Evaluating the available evidence provided an opportunity to carefully consider that; the COVID-19 virus and coccidian protozoan parasites: namely, Cryptosporidium spp., Cyclospora cayetanensis, and Isospora belli, could mutually influence each other from the microbiological, clinical, diagnostic, and elimination aspects. We further systemically highlighted the possible shared pathogenesis mechanisms, transmission routes, clinical manifestations, parasite-driven immune regulation, and intestinal microbiota alteration. Finally, we showed how this might impact developing and developed countries prevention and vaccination strategies. To the best of our knowledge, there is no review that has discussed the reciprocal effect between coccidian parasites and COVID-19 coinfection.
Collapse
|
15
|
Mozer S, Abdulwahhab IG, AL-Azaawie AF. Extraction of the DNA of Giardia lamblia isolated from vegetables and fruits in a simplified way and its diagnosis using Nested-PCR. J Parasit Dis 2022; 46:771-775. [PMID: 36091271 PMCID: PMC9458841 DOI: 10.1007/s12639-022-01484-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/11/2022] [Indexed: 10/18/2022] Open
Abstract
Giardiasis is one of the main diseases transmitted by food contaminated with infectious stages. It was usually spread through freshly eaten food. In this study, this parasite was diagnosed based on microscopic diagnosis of isolated samples of vegetables and fruits, as well as molecular diagnosis. The possibility of isolating parasites from vegetables and fruits and extract DNA to be used in most laboratories were verified in this study .The prevalence of Giardia lamblia were estimated on vegetables and fruits without the need to purchase a special extraction kit. .The prevalence of Giardia on fresh vegetables was estimated by using wet direct swab with Lugol's iodine dye in microscopic examination, at a rate of 4 positive samples out of 230 of all studied species, or 1.7%. DNA extraction was carried out for all samples, and 102 DNA samples were extracted from all samples, with a percentage of 44.3%. Moreover, the shown results of the nested PCR test for the 16 S rRNA gene on the obtained DNA the prevalence of Giardia lamblia at a rate of 5.9% from DNA samples isolated from vegetables and fruits.
Collapse
Affiliation(s)
- Sahar Mozer
- college of Education for Women Department of Biology, Tikrit University, Tikrit, Iraq
| | | | - Adnan F. AL-Azaawie
- college of Sciences Department of Biology Salah AI-dine, Tikrit University, Tikrit, Iraq
| |
Collapse
|
16
|
The Clinical Features and Immunological Signature of Cyclospora cayetanensis Co-Infection among People Living with HIV in Ghana. Microorganisms 2022; 10:microorganisms10071407. [PMID: 35889126 PMCID: PMC9316080 DOI: 10.3390/microorganisms10071407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/09/2022] [Accepted: 07/11/2022] [Indexed: 01/25/2023] Open
Abstract
Background: There is a paucity of information on the contemporary burden, disease patterns, and immunological profile of people living with HIV who are co-infected with C. cayetanensis in the post-antiretroviral therapy era. Methods: For this cross-sectional study, stool samples of 640 HIV-positive and 83 HIV-negative individuals in Ghana were tested for C. cayetanensis. Additionally, sociodemographic parameters, clinical symptoms, medical drug intake, and immunological parameters were assessed. Results: The prevalence of C. cayetanensis was 8.75% (n = 56) in HIV-positive and 1.20% (n = 1) in HIV-negative participants (p = 0.015). Within the group of HIV-positive participants, the prevalence reached 13.6% in patients with CD4+ T cell counts below 200 cells/µl. Frequencies of the clinical manifestations of weight loss and diarrheal disease were significantly higher in patients with C. cayetanensis compared to those without co-infection (36.36% vs. 22.59%, p = 0.034 and 20.00% vs. 4.90%, p < 0.001, respectively). The expression of markers of immune activation and exhaustion of T lymphocyte sub-populations was significantly elevated in patients colonized with C. cayetanensis. Conclusions: In the modern post-combined antiretroviral therapy (cART) era, the acquisition of C. cayetanensis among PLWH in Ghana is driven largely by the immunosuppression profile characterized by high expression of markers of immune activation and immune exhaustion.
Collapse
|
17
|
Comparison of Three Real-Time PCR Assays for the Detection of Cyclospora cayetanensis in Stool Samples Targeting the 18S rRNA Gene and the hsp70 Gene. Pathogens 2022; 11:pathogens11020165. [PMID: 35215106 PMCID: PMC8877086 DOI: 10.3390/pathogens11020165] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/06/2022] [Accepted: 01/25/2022] [Indexed: 12/18/2022] Open
Abstract
Diagnostic real-time PCR for the detection of Cyclospora cayetanensis in human stool samples has been applied for two decades. However, recent comparative assessments between in-house and commercial assays suggested room for improvement regarding the agreement of positive signals of the applied real-time PCRs. In order to assess the effect of the choice of the target sequence, 3 inhouse real time PCR assays targeting the 18S rRNA gene (n = 2, one of them later referred to as SSU rRNA gene assay to avoid confusion) and the hsp70 gene of C. cayetanensis were compared in a head-to-head comparison with 905 samples with high pretest probability for C. cayetanensis infections from Ghanaian HIV patients in a test comparison without a reference standard. Only slight agreement kappa of 0.095 was observed. In the assays targeting the SSU rRNA gene, the 18S rRNA gene, and hsp70, positive signals were recorded in 63, 45, and 0 instances, respectively, with latent class analysis-based estimation of sensitivity of 32.2%, 23.3%, 0% as well as of specificity of 99.7%, 99.9% and 100%, respectively. High cycle threshold values with an average of about 35 indicated low quantities of target DNA in the samples with similar Ct values in concordantly and discordantly positive samples. In conclusion, the study suggested target-gene-specific differences in the diagnostic accuracy of real-time PCR-based diagnosis of C. cayetanensis as well as an ongoing need for further standardization of this diagnostic approach.
Collapse
|
18
|
Dubey JP, Khan A, Rosenthal BM. Life Cycle and Transmission of Cyclospora cayetanensis: Knowns and Unknowns. Microorganisms 2022; 10:microorganisms10010118. [PMID: 35056567 PMCID: PMC8779055 DOI: 10.3390/microorganisms10010118] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/29/2021] [Accepted: 01/04/2022] [Indexed: 12/04/2022] Open
Abstract
Although infections with Cyclospora cayetanensis are prevalent worldwide, many aspects of this parasite’s life cycle and transmission remain unknown. Humans are the only known hosts of this parasite. Existing information on its endogenous development has been derived from histological examination of only a few biopsy specimens. Its asexual and sexual stages occur in biliary-intestinal epithelium. In histological sections, its stages are less than 10 μm, making definitive identification difficult. Asexual (schizonts) and sexual (gamonts) are located in epithelial cells. Male microgamonts have two flagella; female macrogametes contain wall-forming bodies. Oocysts are excreted in feces unsporulated. Sporulation occurs in the environment, but there are many unanswered questions concerning dissemination and survival of C. cayetanensis oocysts. Biologically and phylogenetically, C. cayetanensis closely resembles Eimeria spp. that parastize chickens; among them, E. acervulina most closely resembles C. cayetanensis in size. Here, we review known and unknown aspects of its life cycle and transmission and discuss the appropriateness of surrogates best capable of hastening progress in understanding its biology and developing mitigating strategies.
Collapse
|
19
|
Abstract
Abstract
Cyclospora cayetanensis is an emerging food- and waterborne pathogen that causes cyclosporiasis, a gastrointestinal disease in humans. The parasite is endemic in tropical and subtropical regions; however, its prevalence is largely dependent on environmental factors, such as climate and rainfall patterns. The objective of this paper was to conduct a systematic review and meta-analysis to determine the prevalence of C. cayetanensis in water and to determine if geography, water source and other variables influence this prevalence. A literature search was performed using search terms relating to water and C. cayetanensis in MEDLINE®, CAB Direct, Food Science and Technology Abstracts, Agricola databases and Environmental Science Index. Observational studies published in English after 1979 were eligible. Screening, data extraction and risk-of-bias assessment were performed independently by two reviewers. A multi-level random-effects meta-analysis was completed to determine the prevalence of C. cayetanensis in water and subgroup meta-analyses were performed to explore between-study heterogeneity. The search identified 828 unique articles, and after the screening, 33 articles were included in the review. The pooled prevalence of C. cayetanensis in water was 6.90% [95% confidence interval (CI) 2.25%–13.05%, I2 = 84.38%]. Subgroup meta-analyses revealed significant differences in the prevalence between continents. Additionally, laboratory methods between studies were highly variable and these findings highlight the need for further environmental research on C. cayetanensis in water using detection methods that include PCR and sequencing to accurately identify the organism. The results of this study can be used to help assess the risk of waterborne cyclosporiasis.
Collapse
|
20
|
Li J, Zhang K, Zhang L. Cyclospora cayetanensis. Trends Parasitol 2021; 38:419-420. [PMID: 34865971 DOI: 10.1016/j.pt.2021.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/02/2021] [Accepted: 11/10/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Junqiang Li
- College of Veterinary Medicine, Henan Agricultural University, Zhengzhou 450046, China; International Joint Research Laboratory for Zoonotic Diseases of Henan, Zhengzhou 450046, China
| | - Kaihui Zhang
- College of Veterinary Medicine, Henan Agricultural University, Zhengzhou 450046, China; International Joint Research Laboratory for Zoonotic Diseases of Henan, Zhengzhou 450046, China
| | - Longxian Zhang
- College of Veterinary Medicine, Henan Agricultural University, Zhengzhou 450046, China; International Joint Research Laboratory for Zoonotic Diseases of Henan, Zhengzhou 450046, China.
| |
Collapse
|
21
|
Totton SC, O'Connor AM, Naganathan T, Martinez BAF, Sargeant JM. A review of Cyclospora cayetanensis in animals. Zoonoses Public Health 2021; 68:861-867. [PMID: 34156154 DOI: 10.1111/zph.12872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/28/2021] [Indexed: 11/26/2022]
Abstract
Cyclosporiasis is a global, emerging disease in humans caused by Cyclospora cayetanensis. The role of animals in the epidemiology of cyclosporiasis is not fully understood. We conducted a narrative review of the published literature on C. cayetanensis in animals. MEDLINE® (Web of Science™ ), Agricola (ProQuest), CABI Global Health (1979 to December 2020) and Food Science and Technology Abstracts (EBSCOhost) (1979 to February 2020) were searched. Studies of C. cayetanensis in or on any species of animal were eligible. Thirteen relevant studies were found. C. cayetanensis was found in wild and farmed Mediterranean mussels (Mytilus galloprovincialis), wild grooved carpet shell clams (Ruditapes decussatus) and in the faeces of dogs (domestic and street), wild chickens, wild rhesus macaques (Macaca mulatta), chimpanzees (Pan troglodytes) from a wildlife research centre, and Cynomolgus monkeys (Macaca fascicularis) from an experimental primate research centre. As the small intestines of the naturally exposed animals were not biopsied, existence of a natural animal reservoir of C. cayetanensis could not be confirmed. Animals shedding oocysts in their faeces may be paratenic hosts. Investigators were able to successfully infect the following animals with C. cayetanensis: oysters, Asian freshwater clams (Corbicula fluminea), Swiss albino mice and guinea pigs. Future non-laboratory studies of animals should use PCR coupled with DNA sequencing to confirm that the species found is C. cayetanensis. The potential role of animals in the transport of oocysts and contamination of food, water, and soil could be explored through future primary research.
Collapse
Affiliation(s)
- Sarah Ceridwen Totton
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Annette Maree O'Connor
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
| | - Thivya Naganathan
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | | | - Jan Merrill Sargeant
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| |
Collapse
|
22
|
Li J, Ren Y, Chen H, Huang W, Feng X, Hu W. Risk Evaluation of Pathogenic Intestinal Protozoa Infection Among Laboratory Macaques, Animal Facility Workers, and Nearby Villagers From One Health Perspective. Front Vet Sci 2021; 8:696568. [PMID: 34660752 PMCID: PMC8511526 DOI: 10.3389/fvets.2021.696568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 08/25/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Previous epidemiological studies have confirmed non-human primates (NHPs) as reservoirs for Cryptosporidium spp. , Giardia intestinalis, and Enterocytozoon bieneusi. It highlights the possibility of interspecies transmission between humans and macaques in laboratory animal facilities. This study aimed to investigate the prevalence of pathogenic intestinal protozoan infections in macaques and humans and to determine the risk of cross-species transmission from One Health view. Materials and Methods: A total of 360 fecal samples, including 310 from the four Macaca mulatta groups, 25 from the facility workers in a laboratory animal facility, and 25 from the villagers nearby in Yongfu country, southeast China, were collected. Nested PCR assays were done for detecting protozoan pathogens from all the specimens. Furthermore, potential risk factors (gender, age, and direct contact) on the occurrence of intestinal protozoa infection among different sub-groups were evaluated. A phylogenetic and haplotype network analysis was conducted to examine the genetic structure and shared patterns of E. bieneusi and Cyclospora cayetanensis. Results: The pathogenic intestinal protozoa were detected in both human and macaque fecal samples. A total of 134 (37.2%) samples were tested positive, which included 113 (36.4%) macaques, 14 (56.0%) facility workers, and 7 (28.0%) villagers, respectively. There was no significant difference in four intestinal protozoa infections between facility workers and villagers (χ2 = 2.4, P > 0.05). However, the positive rate of pathogenic intestinal protozoa in the facility workers, who had direct contact with macaques, was significantly higher [odds ratio (OR) = 0.31, 95% confidence interval (CI): 0.09–1.00, P < 0.05).Thirty-three ITS genotypes of E. bieneusi were identified, including five known genotypes (PigEBITS7, Peru8, Henan V, D, and CM1) and six novel genotypes (MEB1–6). Seven haplotypes were identified in the network analysis from C. cayetanensis-positive samples. Meanwhile, a phylogenetic and haplotype analysis confirmed the presence of zoonotic subtypes in NHPs and humans. Conclusion: The data collected from this study confirmed a high prevalence of intestinal protozoan infection in humans and macaques. These results warrant workers of such facilities and residents to limit contact with infected animals in order to minimize related health risks. The need for comprehensive strategies to mitigate the risk of zoonotic transmission, especially from a One Health perspective, is recommended.
Collapse
Affiliation(s)
- Jian Li
- Department of Pathogen Biology, Basic Medical College, Guangxi Traditional Chinese Medical University, Nanning, China.,Department of Infectious Diseases, Huashan Hospital, State Key Laboratory of Genetic Engineering, Ministry of Education Key Laboratory for Biodiversity Science and Ecological Engineering, Ministry of Education Key Laboratory of Contemporary Anthropology, School of Life Sciences, Fudan University, Shanghai, China
| | - Yijing Ren
- Department of Veterinary Preventive Medicine, College of Animal Science and Technology, Guangxi University, Nanning, China
| | - Haiying Chen
- Department of Pathogen Biology, Basic Medical College, Guangxi Traditional Chinese Medical University, Nanning, China
| | - Weiyi Huang
- Department of Veterinary Preventive Medicine, College of Animal Science and Technology, Guangxi University, Nanning, China
| | - Xinyu Feng
- National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), Shanghai, China.,NHC Key Laboratory of Parasite and Vector Biology, Shanghai, China.,WHO Collaborating Centre for Tropical Diseases, Shanghai, China.,National Center for International Research on Tropical Diseases, Shanghai, China.,Joint Research Laboratory of Genetics and Ecology on Parasite-Host Interaction, Chinese Center for Disease Control and Prevention & Fudan University, Shanghai, China.,School of Global Health, Chinese Center for Tropical Diseases Research, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,One Health Center, Shanghai Jiao Tong University-The University of Edinburgh, Shanghai, China.,Department of Biology, College of Life Sciences, Inner Mongolia University, Hohhot, China
| | - Wei Hu
- Department of Infectious Diseases, Huashan Hospital, State Key Laboratory of Genetic Engineering, Ministry of Education Key Laboratory for Biodiversity Science and Ecological Engineering, Ministry of Education Key Laboratory of Contemporary Anthropology, School of Life Sciences, Fudan University, Shanghai, China.,National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention (Chinese Center for Tropical Diseases Research), Shanghai, China.,NHC Key Laboratory of Parasite and Vector Biology, Shanghai, China.,WHO Collaborating Centre for Tropical Diseases, Shanghai, China.,National Center for International Research on Tropical Diseases, Shanghai, China.,Joint Research Laboratory of Genetics and Ecology on Parasite-Host Interaction, Chinese Center for Disease Control and Prevention & Fudan University, Shanghai, China.,Department of Biology, College of Life Sciences, Inner Mongolia University, Hohhot, China
| |
Collapse
|
23
|
Tucker MS, O’Brien CN, Jenkins MC, Rosenthal BM. Dynamically expressed genes provide candidate viability biomarkers in a model coccidian. PLoS One 2021; 16:e0258157. [PMID: 34597342 PMCID: PMC8486141 DOI: 10.1371/journal.pone.0258157] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/18/2021] [Indexed: 11/29/2022] Open
Abstract
Eimeria parasites cause enteric disease in livestock and the closely related Cyclosporacayetanensis causes human disease. Oocysts of these coccidian parasites undergo maturation (sporulation) before becoming infectious. Here, we assessed transcription in maturing oocysts of Eimeria acervulina, a widespread chicken parasite, predicted gene functions, and determined which of these genes also occur in C. cayetanensis. RNA-Sequencing yielded ~2 billion paired-end reads, 92% of which mapped to the E. acervulina genome. The ~6,900 annotated genes underwent temporally-coordinated patterns of gene expression. Fifty-three genes each contributed >1,000 transcripts per million (TPM) throughout the study interval, including cation-transporting ATPases, an oocyst wall protein, a palmitoyltransferase, membrane proteins, and hypothetical proteins. These genes were enriched for 285 gene ontology (GO) terms and 13 genes were ascribed to 17 KEGG pathways, defining housekeeping processes and functions important throughout sporulation. Expression differed in mature and immature oocysts for 40% (2,928) of all genes; of these, nearly two-thirds (1,843) increased their expression over time. Eight genes expressed most in immature oocysts, encoding proteins promoting oocyst maturation and development, were assigned to 37 GO terms and 5 KEGG pathways. Fifty-six genes underwent significant upregulation in mature oocysts, each contributing at least 1,000 TPM. Of these, 40 were annotated by 215 GO assignments and 9 were associated with 18 KEGG pathways, encoding products involved in respiration, carbon fixation, energy utilization, invasion, motility, and stress and detoxification responses. Sporulation orchestrates coordinated changes in the expression of many genes, most especially those governing metabolic activity. Establishing the long-term fate of these transcripts in sporulated oocysts and in senescent and deceased oocysts will further elucidate the biology of coccidian development, and may provide tools to assay infectiousness of parasite cohorts. Moreover, because many of these genes have homologues in C. cayetanensis, they may prove useful as biomarkers for risk.
Collapse
Affiliation(s)
- Matthew S. Tucker
- United States Department of Agriculture, Agricultural Research Service, Beltsville Agricultural Research Center, Beltsville, MD, United States of America
| | - Celia N. O’Brien
- United States Department of Agriculture, Agricultural Research Service, Beltsville Agricultural Research Center, Beltsville, MD, United States of America
| | - Mark C. Jenkins
- United States Department of Agriculture, Agricultural Research Service, Beltsville Agricultural Research Center, Beltsville, MD, United States of America
| | - Benjamin M. Rosenthal
- United States Department of Agriculture, Agricultural Research Service, Beltsville Agricultural Research Center, Beltsville, MD, United States of America
- * E-mail:
| |
Collapse
|
24
|
Mathison BA, Pritt BS. Cyclosporiasis-Updates on Clinical Presentation, Pathology, Clinical Diagnosis, and Treatment. Microorganisms 2021; 9:microorganisms9091863. [PMID: 34576758 PMCID: PMC8471761 DOI: 10.3390/microorganisms9091863] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 08/30/2021] [Accepted: 08/30/2021] [Indexed: 11/16/2022] Open
Abstract
Cyclospora cayetanensis is an intestinal coccidian parasite transmitted to humans through the consumption of oocysts in fecally contaminated food and water. Infection is found worldwide and is highly endemic in tropical and subtropical regions with poor sanitation. Disease in developed countries is usually observed in travelers and in seasonal outbreaks associated with imported produce from endemic areas. Recently, summertime outbreaks in the United States have also been linked to locally grown produce. Cyclosporiasis causes a diarrheal illness which may be severe in infants, the elderly, and immunocompromised individuals. The increased adoption of highly sensitive molecular diagnostic tests, including commercially available multiplex panels for gastrointestinal pathogens, has facilitated the detection of infection and likely contributed to the increased reports of cases in developed countries. This manuscript reviews important aspects of the biology, epidemiology, and clinical manifestations of C. cayetanensis and provides an in-depth discussion of current laboratory diagnostic methods.
Collapse
Affiliation(s)
- Blaine A. Mathison
- ARUP Laboratories, Institute for Clinical and Experimental Pathology, Salt Lake City, UT 84108, USA;
| | - Bobbi S. Pritt
- Division of Clinical Microbiology, Mayo Clinic, Rochester, MN 55905, USA
- Correspondence:
| |
Collapse
|
25
|
Sutthikornchai C, Popruk S, Mahittikorn A, Arthan D, Soonthornworasiri N, Paratthakonkun C, Feng Y, Xiao L. Molecular detection of Cryptosporidium spp., Giardia duodenalis, and Enterocytozoon bieneusi in school children at the Thai-Myanmar border. Parasitol Res 2021; 120:2887-2895. [PMID: 34331137 DOI: 10.1007/s00436-021-07242-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 07/04/2021] [Indexed: 11/25/2022]
Abstract
Few data are available on the genetic identity of enteric protists Cryptosporidium spp., Giardia duodenalis, and Enterocytozoon bieneusi in humans in Thailand. In this study, 254 stool samples were collected from primary school children from Ratchaburi Province at the Thai-Myanmar border and examined for Cryptosporidium spp., G. duodenalis, E. bieneusi and Cyclospora cayetanensis using PCR techniques. The genotype identity of the pathogens was determined by DNA sequence analysis of the PCR products. Cryptosporidium felis was found in 1 stool sample, G. duodenalis in 19 stool samples, and E. bieneusi in 4 stool samples. For G. duodenalis, sub-assemblage AII was the dominant genotype, but one infection with assemblage F was found. The E. bieneusi genotypes found included known genotypes D and J, and one novel genotype (HPTM1). Cyclospora cayetanensis was not detected in any samples. Results of the preliminary study indicate that children at the Thai-Myanmar border from Ratchaburi Province, Thailand are infected with diverse zoonotic genotypes of Cryptosporidium spp., G. duodenalis, and E. bieneusi.
Collapse
Affiliation(s)
- Chantira Sutthikornchai
- Department of Protozoology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Supaluk Popruk
- Department of Protozoology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Aongart Mahittikorn
- Department of Protozoology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Dumrongkiet Arthan
- Department of Tropical Nutrition and Food Science, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | | | | | - Yaoyu Feng
- Center for Emerging and Zoonotic Diseases, College of Veterinary Medicine, South China Agricultural University, Guangzhou, China
| | - Lihua Xiao
- Center for Emerging and Zoonotic Diseases, College of Veterinary Medicine, South China Agricultural University, Guangzhou, China.
| |
Collapse
|
26
|
Silva JT, Fernández-Ruiz M, Grossi PA, Hernández-Jimenez P, López-Medrano F, Mularoni A, Prista-Leão B, Santos L, Aguado JM. Reactivation of latent infections in solid organ transplant recipients from sub-Saharan Africa: What should be remembered? Transplant Rev (Orlando) 2021; 35:100632. [PMID: 34130253 DOI: 10.1016/j.trre.2021.100632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 05/07/2021] [Accepted: 05/29/2021] [Indexed: 11/30/2022]
Abstract
International migration from Sub-Saharan African countries to the European Union and the United States has significantly increased over the past decades. Although the vast majority of these immigrants are young and healthy people, a minority can be affected by chronic conditions eventually leading to solid organ transplantation (SOT). Importantly, these candidates can bear geographically restricted fungal and parasitic latent infections that can reactivate after the procedure. An appropriate evaluation before transplantation followed by treatment, whenever necessary, is essential to minimize such risk, as covered in the present review. In short, infection due to helminths (Schistosoma spp. and Strongyloides stercoralis) and intestinal protozoa (Entamoeba histolytica, Giardia lamblia or Cyclospora cayetanensis) can be diagnosed by multiple direct stool examination, serological assays and stool antigen testing. Leishmaniasis can be assessed by means of serology, followed by nucleic acid amplification testing (NAAT) if the former test is positive. Submicroscopic malaria should be ruled out by NAAT. Screening for Histoplasma spp. or Cryptococcus spp. is not routinely indicated. Consultation with an Infectious Diseases specialist is recommended in order to adjust preemptive treatment among Sub-Saharan African SOT candidates and recipients.
Collapse
Affiliation(s)
- Jose Tiago Silva
- Unit of Infectious Diseases, University Hospital "12 de Octubre", Research Institute Hospital "12 de Octubre" (imas12), Madrid, Spain.
| | - Mario Fernández-Ruiz
- Unit of Infectious Diseases, University Hospital "12 de Octubre", Research Institute Hospital "12 de Octubre" (imas12), Madrid, Spain; Department of Medicine, Universidad Complutense, Madrid, Spain
| | - Paolo Antonio Grossi
- Department of Medicine and Surgery, University of Insubria and ASST Sette Laghi, Ospedale di Circolo of Varese, Varese, Italy
| | - Pilar Hernández-Jimenez
- Unit of Infectious Diseases, University Hospital "12 de Octubre", Research Institute Hospital "12 de Octubre" (imas12), Madrid, Spain
| | - Francisco López-Medrano
- Unit of Infectious Diseases, University Hospital "12 de Octubre", Research Institute Hospital "12 de Octubre" (imas12), Madrid, Spain; Department of Medicine, Universidad Complutense, Madrid, Spain
| | - Alessandra Mularoni
- Department of Infectious Diseases, Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione (IRCCS-ISMETT), Palermo, Italy
| | - Beatriz Prista-Leão
- Department of Infectious Diseases, University Hospital Center "São João", School of Medicine, University of Porto, Porto, Portugal
| | - Lurdes Santos
- Department of Infectious Diseases, University Hospital Center "São João", School of Medicine, University of Porto, Porto, Portugal
| | - José María Aguado
- Unit of Infectious Diseases, University Hospital "12 de Octubre", Research Institute Hospital "12 de Octubre" (imas12), Madrid, Spain; Department of Medicine, Universidad Complutense, Madrid, Spain
| |
Collapse
|
27
|
Frickmann H, Alker J, Hansen J, Dib JC, Aristizabal A, Concha G, Schotte U, Kann S. Seasonal Differences in Cyclospora cayetanensis Prevalence in Colombian Indigenous People. Microorganisms 2021; 9:microorganisms9030627. [PMID: 33803496 PMCID: PMC8002917 DOI: 10.3390/microorganisms9030627] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/16/2021] [Accepted: 03/16/2021] [Indexed: 12/15/2022] Open
Abstract
Fecal-orally transmitted cyclosporiasis is frequent in remote resource-limited settings in Central and South America with poor hygiene conditions. In this study, we aimed at assessing seasonal effects on the epidemiology of colonization or infection with C. cayetanensis in Colombian indigenous people living under very restricted conditions. In the rainy season between July and November and in the dry season between January and April, stool samples from indigenous people with and without gastrointestinal symptoms were collected and screened for C. cayetanensis applying in-house real-time polymerase chain reaction (PCR). In the rainy season and in the dry season, positive PCR results were observed for 11.8% (16/136) and 5.1% (15/292), respectively, with cycle threshold (Ct) values of 30.6 (±3.4) and 34.4 (±1.6), respectively. Despite higher parasite loads in the rainy season, fewer individuals (2/16, 12.5%) reported gastrointestinal symptoms compared to the dry season (6/15, 40%). In conclusion, considerable prevalence of C. cayetanensis in Colombian indigenous people persists in the dry season. Low proportions of gastrointestinal symptoms along with higher parasite loads make colonization likely rather than infection.
Collapse
Affiliation(s)
- Hagen Frickmann
- Department of Microbiology and Hospital Hygiene, Bundeswehr Hospital Hamburg, 20359 Hamburg, Germany;
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, 18057 Rostock, Germany
| | - Juliane Alker
- Central Institute of the Bundeswehr Medical Service Kiel, Department A—Veterinary Medicine, 24119 Kronshagen, Germany; (J.A.); (U.S.)
| | - Jessica Hansen
- Department for Infectious Disease Diagnostics, Bernhard-Nocht Institute for Tropical Medicine, 20359 Hamburg, Germany;
| | - Juan Carlos Dib
- Tropical Health Foundation, Santa Marta 470003, Colombia; (J.C.D.); (A.A.)
| | - Andrés Aristizabal
- Tropical Health Foundation, Santa Marta 470003, Colombia; (J.C.D.); (A.A.)
| | - Gustavo Concha
- Organization Wiwa Yugumaiun Bunkauanarrua Tayrona (OWYBT), Department Health Advocacy, Valledupar 200001, Colombia;
| | - Ulrich Schotte
- Central Institute of the Bundeswehr Medical Service Kiel, Department A—Veterinary Medicine, 24119 Kronshagen, Germany; (J.A.); (U.S.)
| | - Simone Kann
- Medical Mission Institute, 97074 Würzburg, Germany
- Correspondence: ; Tel.: +49-931-8048521; Fax: +49-931-8048525
| |
Collapse
|
28
|
Barlaam A, Temesgen TT, Tysnes KR, Rinaldi L, Ferrari N, Sannella AR, Normanno G, Cacciò SM, Robertson LJ, Giangaspero A. Contamination of fresh produce sold on the Italian market with Cyclospora cayetanensis and Echinococcus multilocularis. Food Microbiol 2021; 98:103792. [PMID: 33875219 DOI: 10.1016/j.fm.2021.103792] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/13/2021] [Accepted: 03/16/2021] [Indexed: 01/25/2023]
Abstract
To investigate the presence of Cyclospora cayetanensis, Toxoplasma gondii and Echinococcus spp. in fresh produce sold in Italy, 324 locally produced 'ready-to-eat' (RTE) mixed-salad packages belonging to three brands and 324 berries packages (blueberries and blackberries imported from Peru and Mexico, respectively, and raspberries grown in Italy) were purchased at retail. Nine individual packages from each of the six types of fresh produce were collected monthly for one year, and with the same produce pooled, this resulted in a total of 72 pools for the whole year. Using microscopy (FLOTAC), a Cyclospora-like oocyst was detected in a blueberry sample and a taeniid egg was detected in a RTE-salad sample. Molecular tools confirmed these to be C. cayetanensis and Echinococcus multilocularis, respectively. Toxoplasma gondii was not detected in any of the samples. This study shows for the first time in Europe that imported berries on the Italian market may be contaminated with C. cayetanensis and RTE salads grown in Italy with E. multilocularis. The results indicate a new epidemiological scenario and highlight that current management of fresh produce, locally produced or imported, does not ensure products are free from parasite contamination.
Collapse
Affiliation(s)
- Alessandra Barlaam
- Department of Agriculture, Food, Natural Resources and Engineering, University of Foggia, Via Napoli 25, 71121, Foggia, Italy.
| | - Tamirat T Temesgen
- Laboratory of Parasitology, Department of Paraclinical Sciences, Faculty of Veterinary Medicine, Norwegian University of Life Sciences, Adamstuen Campus, P.O. Box 369 Sentrum, 0102, Oslo, Norway
| | - Kristoffer R Tysnes
- Laboratory of Parasitology, Department of Paraclinical Sciences, Faculty of Veterinary Medicine, Norwegian University of Life Sciences, Adamstuen Campus, P.O. Box 369 Sentrum, 0102, Oslo, Norway
| | - Laura Rinaldi
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Naples, Italy
| | - Nicola Ferrari
- Department of Veterinary Medicine, University of Milan, Milan, Italy
| | - Anna R Sannella
- Department of Infectious Diseases, Istituto Superiore di Sanità, 00161, Rome, Italy
| | - Giovanni Normanno
- Department of Agriculture, Food, Natural Resources and Engineering, University of Foggia, Via Napoli 25, 71121, Foggia, Italy
| | - Simone M Cacciò
- Department of Infectious Diseases, Istituto Superiore di Sanità, 00161, Rome, Italy
| | - Lucy J Robertson
- Laboratory of Parasitology, Department of Paraclinical Sciences, Faculty of Veterinary Medicine, Norwegian University of Life Sciences, Adamstuen Campus, P.O. Box 369 Sentrum, 0102, Oslo, Norway
| | - Annunziata Giangaspero
- Department of Agriculture, Food, Natural Resources and Engineering, University of Foggia, Via Napoli 25, 71121, Foggia, Italy
| |
Collapse
|
29
|
Rozenova K, Pritt BS, Said S. Uncommon Cause of Emesis and Diarrhea in a Nonverbal Elderly Patient. Gastroenterology 2021; 160:e5-e7. [PMID: 32946898 PMCID: PMC7492160 DOI: 10.1053/j.gastro.2020.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/02/2020] [Accepted: 09/08/2020] [Indexed: 12/02/2022]
Affiliation(s)
| | | | - Samar Said
- Mayo Clinic College of Medicine, Rochester, Minnesota.
| |
Collapse
|
30
|
Temesgen TT, Robertson LJ, Stigum VM, Tysnes KR. Removal of Parasite Transmission Stages from Berries Using Washing Procedures Suitable for Consumers. Foods 2021; 10:foods10020481. [PMID: 33672362 PMCID: PMC7926854 DOI: 10.3390/foods10020481] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/15/2021] [Accepted: 02/19/2021] [Indexed: 11/24/2022] Open
Abstract
Due to the delicate nature of berries and the reduced shelf-life once washed, producers usually do not wash berries. Therefore, consumers are expected to wash the berries prior to consumption, and this might be a more effective way of infection prevention. However, the efficacy of consumer berry-washing procedures in removing the parasite contaminants from the berries surface has not been investigated. The aim of the present study was, therefore, to compare the efficacy of three different washing techniques in removing parasite contaminants. Three alternatives to washing berries before consumption were compared on berries artificially contaminated with oo/cysts of Cyclospora cayetanensis, Cryptosporidium parvum, and Giardia duodenalis. The results show that simple washing of berries under the cold tap for 1 min could remove on average at least 80% of the parasites, except for C. cayetanensis, which seems to be stickier than both G. duodenalis and C. parvum. The percent removal was slightly lower for raspberries as compared to blueberries. Although the differences are expected, a relevant result of the study is that washing contaminated berries prior to consumption by the consumer removes a considerable proportion of parasites and thereby lowers the risk of ingesting parasites’ transmission stages.
Collapse
|
31
|
Totton SC, O'Connor AM, Naganathan T, Martinez BAF, Vriezen ER, Torrence ME, Sargeant JM. A scoping review of the detection, epidemiology and control of Cyclospora cayetanensis with an emphasis on produce, water and soil. Epidemiol Infect 2021; 149:e49. [PMID: 33504406 PMCID: PMC8060822 DOI: 10.1017/s0950268821000200] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/24/2020] [Accepted: 01/25/2021] [Indexed: 01/30/2023] Open
Abstract
Cyclospora cayetanensis is a parasite causing cyclosporiasis (an illness in humans). Produce (fruits, vegetables, herbs), water and soil contaminated with C. cayetanensis have been implicated in human infection. The objective was to conduct a scoping review of primary research in English on the detection, epidemiology and control of C. cayetanensis with an emphasis on produce, water and soil. MEDLINE® (Web of ScienceTM), Agricola (ProQuest), CABI Global Health, and Food Science and Technology Abstracts (EBSCOhost) were searched from 1979 to February 2020. Of the 349 relevant primary research studies identified, there were 75 detection-method studies, 40 molecular characterisation studies, 38 studies of Cyclospora in the environment (33 prevalence studies, 10 studies of factors associated with environmental contamination), 246 human infection studies (212 prevalence/incidence studies, 32 outbreak studies, 60 studies of environmental factors associated with non-outbreak human infection) and eight control studies. There appears to be sufficient literature for a systematic review of prevalence and factors associated with human infection with C. cayetanensis. There is a dearth of publicly available detection-method studies in soil (n = 0) and water (n = 2), prevalence studies on soil (n = 1) and studies of the control of Cyclospora (particularly on produce prior to retail (n = 0)).
Collapse
Affiliation(s)
- S. C. Totton
- Department of Population Medicine, University of Guelph, Guelph, Canada
| | - A. M. O'Connor
- College of Veterinary Medicine, Michigan State University, East Lansing, USA
| | - T. Naganathan
- Department of Population Medicine, University of Guelph, Guelph, Canada
| | - B. A. F. Martinez
- College of Veterinary Medicine, Michigan State University, East Lansing, USA
| | - E. R. Vriezen
- Department of Population Medicine, University of Guelph, Guelph, Canada
| | - M. E. Torrence
- Office of Applied Research and Safety Assessment, FDA Center for Food Safety and Applied Nutrition, Laurel, USA
| | - J. M. Sargeant
- Department of Population Medicine, University of Guelph, Guelph, Canada
| |
Collapse
|
32
|
Abstract
Cyclospora is an intracellular, gastrointestinal parasite found in birds and mammals worldwide. Limited accessibility of the protozoan for experimental use, scarcity, genome heterogeneity of the isolates and narrow panel of molecular markers hamper zoonotic investigations. One of the significant limitation in zoonotic studies is the lack of precise molecular tools that would be useful in linking animal vectors as a source of human infection. Strong and convincing evidence of zoonotic features will be achieved through proper typing of Cyclospora spp. taxonomic units (e.g. species or genotypes) in animal reservoirs. The most promising method that can be employ for zoonotic surveys is next-generation sequencing.
Collapse
|
33
|
Angelici MC, Walochnik J, Calderaro A, Saxinger L, Dacks JB. Free-living amoebae and other neglected protistan pathogens: Health emergency signals? Eur J Protistol 2020; 77:125760. [PMID: 33340850 DOI: 10.1016/j.ejop.2020.125760] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 10/25/2020] [Accepted: 11/13/2020] [Indexed: 02/08/2023]
Abstract
Protistan parasites have an undisputed global health impact. However, outside of a few key exceptions, e.g. the agent of malaria, most of these infectious agents are neglected as important health threats. The Symposium entitled "Free-living amoebae and neglected pathogenic protozoa: health emergency signals?" held at the European Congress of Protistology in Rome, July 2019, brought together researchers addressing scientific and clinical questions about some of these fascinating organisms. Topics presented included the molecular basis of pathogenicity in Acanthamoeba; genomics of Naegleria fowleri; and epidemiology of poorly diagnosed enteric protistan species, including Giardia, Cryptosporidium, Blastocystis, Dientamoeba. The Symposium aim was to excite the audience about the opportunities and challenges of research in these underexplored organisms and to underline the public health implications of currently under-appreciated protistan infections. The major take home message is that any knowledge that we gain about these organisms will allow us to better address them, in terms of monitoring and treatment, as sources of future health emergencies.
Collapse
Affiliation(s)
| | - Julia Walochnik
- Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Adriana Calderaro
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Lynora Saxinger
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Alberta, Canada
| | - Joel B Dacks
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Alberta, Canada; Institute of Parasitology, Biology Centre, Czech Academy of Sciences České Budějovice, Czech Republic.
| |
Collapse
|
34
|
Ma DW, Lee MR, Ku B, Cho SH, Lee SE. Outbreak of Cyclosporiasis in Korean Travelers Returning from Nepal. THE KOREAN JOURNAL OF PARASITOLOGY 2020; 58:589-592. [PMID: 33202513 PMCID: PMC7672228 DOI: 10.3347/kjp.2020.58.5.589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 09/15/2020] [Indexed: 11/23/2022]
Abstract
Cyclospora cayetanensis is an apicomplexan protozoan and is one of the most common pathogens causing chronic diarrhea worldwide. Eight stool samples with diarrheal symptom out of 18 Korean residents who traveled to Nepal were obtained, and examined for 25 enteropathogens including 16 bacterial species, 5 viral species, and 4 protozoans in stool samples as causative agents of water-borne and food-borne disease. Only C. cayetanensis was detected by nested PCR, and 3 PCR-positive samples were sequenced to confirm species identification. However, the oocysts of C. cayetanensis in fecal samples could not be detected by direct microscopy of the stained sample. As far as we know, this is the first report of a group infection with C. cayetanensis from a traveler visiting Nepal, and the second report of a traveler’s diarrhea by C. cayetanensis imported in Korea.
Collapse
Affiliation(s)
- Da-Won Ma
- Division of Vectors & Parasitic Diseases, Korea Disease Control and Prevention Agency, Cheongju 28159, Korea
| | - Myoung-Ro Lee
- Division of Vectors & Parasitic Diseases, Korea Disease Control and Prevention Agency, Cheongju 28159, Korea
| | - Bora Ku
- Division of Vectors & Parasitic Diseases, Korea Disease Control and Prevention Agency, Cheongju 28159, Korea
| | - Shin-Hyeong Cho
- Division of Vectors & Parasitic Diseases, Korea Disease Control and Prevention Agency, Cheongju 28159, Korea
| | - Sang-Eun Lee
- Division of Vectors & Parasitic Diseases, Korea Disease Control and Prevention Agency, Cheongju 28159, Korea
| |
Collapse
|
35
|
Siwila J, Mwaba F, Chidumayo N, Mubanga C. Food and waterborne protozoan parasites: The African perspective. Food Waterborne Parasitol 2020; 20:e00088. [PMID: 32995582 PMCID: PMC7502820 DOI: 10.1016/j.fawpar.2020.e00088] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 07/24/2020] [Accepted: 07/24/2020] [Indexed: 01/22/2023] Open
Abstract
Parasitic food-borne diseases, particularly those caused by the protozoan parasites Cryptosporidium, Giardia, Cyclospora cayetanensis and Entamoeba are increasingly becoming common and have received considerable attention in the last two decades. The ability of the transmission stages of the parasites to survive in the environment for prolonged periods, globalization of the food industry and changes in eating habits have contributed to the numbers of human infections. This systematic scoping review highlights these important water- and foodborne parasites in the African context, detailing the burden in African water sources, wastewater/effluents and fresh produce. A scoping review search targeting African countries was conducted in Medline, Web of science and African journals online as well as back referencing from included studies covering the period 1990 to January 2020. Out of 1134 studies, 68 were included in the review. The articles covered 17 out of 54 African countries. There were 39/68 studies reporting on water sources while the rest reported on fresh produce. Cryptosporidium prevalence ranged from 6 to 100% in surface water, 4 to 100% in tap water and up to 100% in wastewater and sludge. In fresh produce, Cryptosporidium was reported from five countries with prevalence of 0.8-75%. Giardia was reported in 47 out of 68 articles; prevalence ranged from 2.4% in surface water; 1% to over 70% in tap water; 28-100% in wastewater and 2% - 99% in fresh produce. Prevalence of Cyclospora cayetanensis was lower. Prevalence of Entamoeba was 78% in surface water; 100% in wastewater and up to 99% in fresh produce. This study finds that Africa is no exception to the risk presented by the subject parasites from water and/or food sources. Routine screening for these parasites particularly at household level and provision of adequate and safe drinking water would help to control the parasites.
Collapse
Affiliation(s)
- Joyce Siwila
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, P.O. Box 32379, Lusaka, Zambia
| | - Florence Mwaba
- Department of Pathology and Microbiology, School of Medicine, University of Zambia, P.O. Box 50110, Lusaka, Zambia
| | - Nozyechi Chidumayo
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, P.O. Box 32379, Lusaka, Zambia
| | - Chishimba Mubanga
- Department of Clinical Studies, School of Veterinary Medicine, University of Zambia, P.O. Box 32379, Lusaka, Zambia
- Ministry of Agriculture, P.O. Box 31658, Lusaka, Zambia
| |
Collapse
|
36
|
Li J, Wang Z, Karim MR, Zhang L. Detection of human intestinal protozoan parasites in vegetables and fruits: a review. Parasit Vectors 2020; 13:380. [PMID: 32727529 PMCID: PMC7392835 DOI: 10.1186/s13071-020-04255-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 07/21/2020] [Indexed: 02/07/2023] Open
Abstract
Diarrheal diseases caused by intestinal protozoan parasites are a major food-borne public health problem across the world. Vegetables and fruits provide important nutrients and minerals, but are also common sources of some food-borne human pathogenic microorganisms. The contamination of raw vegetables and fruits with human pathogenic parasites are now a global public health threat, despite the health benefits of these foods in non-pharmacological prophylaxes against diseases. A large number of reports have documented the contamination of vegetables or fruits with human pathogenic microorganisms. In this paper, we reviewed the contamination and detection methods of human pathogenic intestinal protozoans that are frequently recovered from raw vegetables and fruits. The protozoan parasites include Cryptosporidium spp., Giardia duodenalis, Cyclospora cayetanensis, Entamoeba spp., Toxoplasma gondii, Balantioides coli, Blastocystis sp., Cystoisospora belli and Enterocytozoon bieneusi. The risk factors involved in the contamination of vegetables and fruits with parasites are also assessed.
Collapse
Affiliation(s)
- Junqiang Li
- Academy of Chinese Medical Sciences, Henan University of Chinese Medicine, Zhengzhou, 450046 China
- College of Animal Science and Veterinary Medicine, Henan Agricultural University, Zhengzhou, 450046 China
| | - Zhenzhen Wang
- Academy of Chinese Medical Sciences, Henan University of Chinese Medicine, Zhengzhou, 450046 China
| | - Md Robiul Karim
- Department of Medicine, Bangabandhu Sheikh Mujibur Rahman Agricultural University, Gazipur, 1706 Bangladesh
| | - Longxian Zhang
- College of Animal Science and Veterinary Medicine, Henan Agricultural University, Zhengzhou, 450046 China
| |
Collapse
|
37
|
Dubey JP, Almeria S, Mowery J, Fortes J. Endogenous Developmental Cycle of the Human Coccidian Cyclospora cayetanensis. J Parasitol 2020; 106:295-307. [PMID: 32316032 DOI: 10.1645/20-21] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Cyclospora cayetanensis is a coccidian parasite of humans of known and growing importance. However, we are surprisingly naïve as to our understanding of how to diagnose it and how it develops inside the human body. Here we provide details of the developmental stages of C. cayetanensis in the gallbladder of a 33-yr-old male with human immunodeficiency virus. The gallbladder was removed surgically in 2001 because of severe abdominal pain. For the present study, the archived paraffin block of gallbladder was processed for light microscopy and transmission electron microscopy (TEM). Histological sections were examined after staining with hematoxylin and eosin (HE) or using the periodic acid Schiff (PAS) reaction. Immature and mature asexual stages, gamonts, and oocysts were seen in epithelial cells, both in the superficial epithelium and in glands. The merozoites were present singly, in pairs, and 3 or more in a single parasitophorous vacuole in the host cytoplasm. Up to 6 nuclei were seen in immature schizonts without evidence of merozoite formation. Mature schizonts were 7.6 × 5.1 μm and contained up to 10, 3-4 μm long merozoites. Merozoites were 0.6 to 2.0 μm wide, and their shape varied from pear-shaped to slender. Merozoites were generally PAS-positive; however, some were intensely positive, some had only minute granules, while others were PAS-negative. The microgamonts (male) were 6.6 × 5.2 μm and contained fewer than 20 microgametes around a residual body. The microgametes were up to 2 μm long and were flagellated. Macrogamonts (female) contained distinctive eosinophilic wall-forming bodies that varied in size and were less than 1 μm in HE-stained sections. Macrogamonts were 5.8-6.5 × 5.3-6.5 μm. Oocysts in sections were unsporulated and had a diameter of 5.7-7.5 μm. The TEM examination confirmed the histologic findings. The DNA extracted from paraffin sections was confirmed as C. cayetanensis with real-time PCR. The detailed description of the life cycle stages of C. cayetanensis reported here in an immunosuppressed patient could facilitate histopathologic diagnosis of this parasite. We have shown that the parasite's development more closely resembles that of Cystoisospora than Eimeria and that the parasite has multiple nuclei per immature meront indicating schizogony, and we have undermined evidence for a Type II meront.
Collapse
Affiliation(s)
- J P Dubey
- United States Department of Agriculture, Agricultural Research Service, Beltsville Agricultural Research Service, Animal Parasitic Disease Laboratory, Building 1001, BARC-East, Beltsville, Maryland 20705-2350
| | - S Almeria
- Department of Health and Human Services, Food and Drug Administration, Center for Food Safety and Nutrition, Office of Applied Research and Safety Assessment, Division of Virulence Assessment, Laurel, Maryland 20708
| | - J Mowery
- United States Department of Agriculture, Agricultural Research Service, Beltsville Agricultural Research Center, Electron and Confocal Microscopy Unit, Building 12, Beltsville, Maryland 20705-2350
| | - J Fortes
- Departamento de Anatomía Patológica, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Spain.,Current Address: Autonomous University of Madrid, Fundacion Jimenez Diaz, Madrid 28040, Spain
| |
Collapse
|
38
|
Li J, Cui Z, Qi M, Zhang L. Advances in Cyclosporiasis Diagnosis and Therapeutic Intervention. Front Cell Infect Microbiol 2020; 10:43. [PMID: 32117814 PMCID: PMC7026454 DOI: 10.3389/fcimb.2020.00043] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 01/22/2020] [Indexed: 12/22/2022] Open
Abstract
Cyclosporiasis is caused by the coccidian parasite Cyclospora cayetanensis and is associated with large and complex food-borne outbreaks worldwide. Associated symptoms include severe watery diarrhea, particularly in infants, and immune dysfunction. With the globalization of human food supply, the occurrence of cyclosporiasis has been increasing in both food growing and importing countries. As well as being a burden on the health of individual humans, cyclosporiasis is a global public health concern. Currently, no vaccine is available but early detection and treatment could result in a favorable clinical outcome. Clinical diagnosis is based on cardinal clinical symptoms and conventional laboratory methods, which usually involve microscopic examination of wet smears, staining tests, fluorescence microscopy, serological testing, or DNA testing for oocysts in the stool. Detection in the vehicle of infection, which can be fresh produce, water, or soil is helpful for case-linkage and source-tracking during cyclosporiasis outbreaks. Treatment with trimethoprim-sulfamethoxazole (TMP-SMX) can evidently cure C. cayetanensis infection. However, TMP-SMX is not suitable for patients having sulfonamide intolerance. In such case ciprofloxacin, although less effective than TMP-SMX, is a good option. Another drug of choice is nitazoxanide that can be used in the cases of sulfonamide intolerance and ciprofloxacin resistance. More epidemiological research investigating cyclosporiasis in humans should be conducted worldwide, to achieve a better understanding of its characteristics in this regard. It is also necessary to establish in vitro and/or in vivo protocols for cultivating C. cayetanensis, to facilitate the development of rapid, convenient, precise, and economical detection methods for diagnosis, as well as more effective tracing methods. This review focuses on the advances in clinical features, diagnosis, and therapeutic intervention of cyclosporiasis.
Collapse
Affiliation(s)
- Junqiang Li
- Academy of Chinese Medical Sciences, Henan University of Chinese Medicine, Zhengzhou, China.,College of Animal Science and Veterinary Medicine, Henan Agricultural University, Zhengzhou, China
| | - Zhaohui Cui
- College of Animal Science and Veterinary Medicine, Henan Agricultural University, Zhengzhou, China
| | - Meng Qi
- College of Animal Science, Tarim University, Alar, China
| | - Longxian Zhang
- College of Animal Science and Veterinary Medicine, Henan Agricultural University, Zhengzhou, China
| |
Collapse
|
39
|
Pozio E. How globalization and climate change could affect foodborne parasites. Exp Parasitol 2019; 208:107807. [PMID: 31751558 DOI: 10.1016/j.exppara.2019.107807] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/05/2019] [Accepted: 11/18/2019] [Indexed: 12/12/2022]
Abstract
Foodborne parasites, most of which are zoonotic, represent an important human health hazard. These pathogens which include both protozoa (e.g., Cryptosporidium spp., Cyclospora cayetanensis, Toxoplasma gondii) and helminths (e.g., liver and intestinal flukes, Fasciola spp., Paragonimus spp., Echinococcus spp., Taenia spp., Angiostrongylus spp., Anisakis spp., Ascaris spp., Capillaria spp., Toxocara spp., Trichinella spp., Trichostrongylus spp.), have accompanied the human species since its origin and their spread has often increased due to their behavior. Since both domesticated and wild animals play an important role as reservoirs of these pathogens the increase/decrease of their biomasses, migration, and passive introduction by humans can change their epidemiological patterns. It follows that globalization and climate change will have a tremendous impact on these pathogens modifying their epidemiological patterns and ecosystems due to the changes of biotic and abiotic parameters. The consequences of these changes on foodborne parasites cannot be foreseen as a whole due to their complexity, but it is important that biologists, epidemiologists, physicians and veterinarians evaluate/address the problem within a one health approach. This opinion, based on the author's experience of over 40 years in the parasitology field, takes into consideration the direct and indirect effects on the transmission of foodborne parasites to humans.
Collapse
Affiliation(s)
- Edoardo Pozio
- Department of Infectious Diseases, Istituto Superiore di Sanità, viale Regina Elena 299, 00161, Rome, Italy.
| |
Collapse
|
40
|
Cyclospora cayetanensis infection in humans: biological characteristics, clinical features, epidemiology, detection method and treatment. Parasitology 2019; 147:160-170. [PMID: 31699163 DOI: 10.1017/s0031182019001471] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cyclospora cayetanensis, a coccidian parasite that causes protracted and relapsing gastroenteritis, has a short recorded history. At least 54 countries have documented C. cayetanensis infections and 13 of them have recorded cyclosporiasis outbreaks. Cyclospora cayetanensis infections are commonly reported in developing countries with low-socioeconomic levels or in endemic areas, although large outbreaks have also been documented in developed countries. The overall C. cayetanensis prevalence in humans worldwide is 3.55%. Among susceptible populations, the highest prevalence has been documented in immunocompetent individuals with diarrhea. Infections are markedly seasonal, occurring in the rainy season or summer. Cyclospora cayetanensis or Cyclospora-like organisms have also been detected in food, water, soil and some other animals. Detection methods based on oocyst morphology, staining and molecular testing have been developed. Treatment with trimethoprim-sulfamethoxazole (TMP-SMX) effectively cures C. cayetanensis infection, whereas ciprofloxacin is less effective than TMP-SMX, but is suitable for patients who cannot tolerate co-trimoxazole. Here, we review the biological characteristics, clinical features, epidemiology, detection methods and treatment of C. cayetanensis in humans, and assess some risk factors for infection with this pathogen.
Collapse
|
41
|
Almeria S, Cinar HN, Dubey JP. Cyclospora cayetanensis and Cyclosporiasis: An Update. Microorganisms 2019; 7:E317. [PMID: 31487898 PMCID: PMC6780905 DOI: 10.3390/microorganisms7090317] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 08/28/2019] [Accepted: 09/02/2019] [Indexed: 12/18/2022] Open
Abstract
Cyclospora cayetanensis is a coccidian parasite of humans, with a direct fecal-oral transmission cycle. It is globally distributed and an important cause of foodborne outbreaks of enteric disease in many developed countries, mostly associated with the consumption of contaminated fresh produce. Because oocysts are excreted unsporulated and need to sporulate in the environment, direct person-to-person transmission is unlikely. Infection by C. cayetanensis is remarkably seasonal worldwide, although it varies by geographical regions. Most susceptible populations are children, foreigners, and immunocompromised patients in endemic countries, while in industrialized countries, C. cayetanensis affects people of any age. The risk of infection in developed countries is associated with travel to endemic areas and the domestic consumption of contaminated food, mainly fresh produce imported from endemic regions. Water and soil contaminated with fecal matter may act as a vehicle of transmission for C. cayetanensis infection. The disease is self-limiting in most immunocompetent patients, but it may present as a severe, protracted or chronic diarrhea in some cases, and may colonize extra-intestinal organs in immunocompromised patients. Trimetoprim-sulfamethoxazole is the antibiotic of choice for the treatment of cyclosporiasis, but relapses may occur. Further research is needed to understand many unknown epidemiological aspects of this parasitic disease. Here, we summarize the biology, epidemiology, outbreaks, clinical symptoms, diagnosis, treatment, control and prevention of C. cayetanensis; additionally, we outline future research needs for this parasite.
Collapse
Affiliation(s)
- Sonia Almeria
- Department of Health and Human Services, Food and Drug Administration, Center for Food Safety and Nutrition (CFSAN), Office of Applied Research and Safety Assessment (OARSA), Division of Virulence Assessment, Laurel, MD 20708, USA
| | - Hediye N Cinar
- Department of Health and Human Services, Food and Drug Administration, Center for Food Safety and Nutrition (CFSAN), Office of Applied Research and Safety Assessment (OARSA), Division of Virulence Assessment, Laurel, MD 20708, USA
| | - Jitender P Dubey
- Animal Parasitic Disease Laboratory, United States Department of Agriculture, Agricultural Research Service, Beltsville Agricultural Research Center, Building 1001, BARC-East, Beltsville, MD 20705-2350, USA.
| |
Collapse
|