Outbreak of trichinellosis due to wild boar meat and evaluation of the effectiveness of post exposure prophylaxis, Germany, 2013

Hepatitis E and Potential Public Health Implications from a One-Health Perspective: Special Focus on the European Wild Boar (Sus scrofa)

The hepatitis E virus (HEV) has become increasingly important in recent years in terms of risk for public health, as the main causative agent of acute viral hepatitis. It is a foodborne disease transmitted to humans through the consumption of contaminated water or contaminated food. Human-to-human transmission is sporadic and is linked to transfusions or transplants. The main reservoirs of the hepatitis E virus are domestic pigs and wild boars, although, compared to pigs, wild boars represent a lesser source of risk since their population is smaller and the consumption of derived products is more limited. These peculiarities often make the role of the wild boar reservoir in the spread of the disease underestimated. As a public health problem that involves several animal species and humans, the management of the disease requires an interdisciplinary approach, and the concept of "One Health" must be addressed. In this direction, the present review intends to analyze viral hepatitis E, with a particular focus on wild boar. For this purpose, literature data have been collected from different scientific search engines: PubMed, MEDLINE, and Google scholar, and several keywords such as "HEV epidemiology", "Extrahepatic manifestations of Hepatitis E", and "HEV infection control measures", among others, have been used. In the first part, the manuscript provides general information on the disease, such as epidemiology, transmission methods, clinical manifestations and implications on public health. In the second part, it addresses in more detail the role of wild boar as a reservoir and the implications related to the virus epidemiology. The document will be useful to all those who intend to analyze this infectious disease from a "One-Health" perspective.

Trichinella findings in Germany from 2013 to 2023 indicate an increased prevalence in wild boar (Sus scrofa) population

In Germany, Trichinella spp. are mainly detected in the sylvatic cycle. Here, the affected animal species are wild boar, fox, badger, raccoon dog, wolf, raccoon and golden jackal. The predominantly detected species are T. spiralis, followed by T. pseudospiralis and T. britovi. Due to legal requirements in Germany, all hunted wild boars and other susceptible animals must be examined for Trichinella spp. if their meat is intended for human consumption. In recent years, an increase in the number of Trichinella-positive wild boar shot in Germany has been registered and the prevalence of positive wild boar scaled up from 0.002 % to 0.005 % between 2013 and 2023. Regarding regional distribution, most Trichinella findings in wild boar have been registered in the North-Eastern part of Germany. Here, the federal states Western-Pomerania, Brandenburg and Saxony that are bordering to Poland are particularly affected. The increase in positive wild boar may be associated with the spread of raccoon dogs and wolves in these regions. Thus, measures are required to prevent the spread of Trichinella among wild animals and to follow the systematic meat inspection in susceptible wild animals intended for food especially wild boar.

From wildlife to humans: The global distribution of Trichinella species and genotypes in wildlife and wildlife-associated human trichinellosis

Zoonotic nematodes of the genus Trichinella are foodborne parasites that have a global distribution in wild carnivores and omnivores, with spillover and spillback into domestic livestock and people, with concomitant trade and health consequences. Historically, most human cases were linked to domestic pigs infected with Trichinella spiralis, but under current high biosecurity swine production in many countries, wildlife have become a more important source of human trichinellosis. The aim of this review is to update the global distribution of Trichinella species and genotypes reported in wildlife, as well as reported human outbreaks from the consumption of wildlife. Using several online databases and by "snowballing" references, hundreds of reports of Trichinella spp. in wildlife published between January 1991 and December 2023 provide an important update to the host and geographic range for each of the recognized 13 species/genotypes, grouped by continent. Surveillance effort was highest in Europe and North America, while Africa, Asia, Oceania, Central and South America have had limited surveillance, in some instances with human cases serving as sentinels of transmission in a region. Dozens of human outbreaks are described, with wild boars (Sus scrofa) being the most frequently implicated wildlife species in human outbreaks globally. Bears are an important source of infection in North America, for wildlife tourism, and importation of bear meat has also been implicated in multicountry outbreaks. The largest study limitation was the dearth of molecular identification of larvae in both wildlife surveillance studies and human outbreaks, particulary in under-studied regions. We highlight the need for enhanced molecular epidemiological approaches to outbreaks of this important foodborne parasite, and emphasize the need for a One Health approach to manage Trichinella spp. which transmit among terrestrial and marine wildlife (including migratory birds), pigs, horses, and people, often across large geographic scales and borders.

Trichinella Infection in Culled Wild Boar (Sus scrofa) from El Palmar National Park, Argentina, and Exposure Risk in Humans and Dogs Consuming Wild Boar Meat

Trichinellosis is a foodborne disease caused by ingestion of raw or undercooked meat containing Trichinella spp. larvae. Consumption of wild boar (Sus scrofa) meat represents an important source of human trichinellosis worldwide. In El Palmar National Park (EPNP), Argentina, invasive alien wild boars are controlled and meat from culled animals is released for public consumption following on-site artificial digestion (AD) testing. Meat trimmings and offal from the control program are often used as food for dogs (Canis familiaris). We evaluated infection and exposure to Trichinella spp. in wild boars from EPNP, as well as exposure to Trichinella spp. and associated risk factors in dogs and human consumers of wild boar meat. Trichinella spp. larvae were detected in muscle samples from 5/49 wild boars by AD (10.2%; 95% confidence interval [CI], 3.8%-23%), with a mean burden of 0.24 larvae per gram (lpg; range, 0.06-0.95 lpg). Anti-Trichinella antibodies were not detected in wild boar serum samples (n=42). In dogs, 12/34 were seropositive to Trichinella spp. (35.29%; 95%, CI, 20.3%-53.5%). Immunoglobulin (Ig) G antibodies were not detected in human serum samples (n=63). Our results reveal the presence, albeit at low prevalence, of Trichinella spp. in wild boars and exposure in dogs fed game offal. These findings suggest that the low prevalence and parasitic load in wild boars, together with the best practices applied by EPNP culling program personnel, contribute to keeping the risk of infection in people low. The dog results highlight that the parasite is circulating in the area, and therefore the risk of infection is not negligible. We recommend the implementation of an animal surveillance strategy in order to monitor the evolution of this zoonosis in the study area.

A Large-Scale Outbreak of Trichinellosis from Infected Wild Boar Meat in Croatia and the Role of Real-Time PCR Assays in Confirming the Source of the Disease

BACKGROUND

Trichinellosis in Croatia posed a significant health concern during the 1990s, followed by a notable improvement in the epidemiological situation. However, in 2017, there was a resurgence, with 37 recorded cases in 3 outbreaks and 3 sporadic cases. The source of this epidemic was homemade meat products derived from wild boar meat, leading to 26 infections.

METHODS

At the beginning of the outbreak and during the treatment of the patients, the medical and epidemiological records prepared throughout the investigation and over the course of patient treatment were reviewed. The recovery of the first-stage (L1) larvae from suspect meat products was achieved by artificial digestion. The molecular identification of the isolated larvae was performed by multiplex PCR. The molecular identification of the meat used to prepare the meat products was performed by real-time PCR assays.

RESULTS

The epidemic started in early 2017. In total, 71 exposed persons were documented: 26 with clinical symptoms and 3 hospitalised in two cities in different counties. The L1 burden in three different meat products was from 5.25 to 7.08 larvae per gram (LPG), and T. spiralis was determined as the aetiological agent of the outbreak. The molecular and biological identification confirmed that implicated meat products were made solely from wild boar meat.

CONCLUSIONS

Although trichinellosis is no longer a frequent occurrence in Croatia, several cases are still registered nearly every year. Wild boar meat poses an important risk factor for human health if compulsory testing is not conducted before consumption, especially if the meat products are consumed without proper thermal processing.

The impact of MIF deficiency on alterations of fecal microbiota in C57BL/6 mice induced by Trichinella spiralis infection

Trichinellosis caused by Trichinella spiralis (T. spiralis) is a major food-borne parasitic zoonosis worldwide. Prevention of trichinellosis is an effective strategy to improve patient quality of life. Macrophage migration inhibitory factor (MIF) is closely related to the occurrence and development of several parasitic diseases. Studying the impact of MIF deficiency (Mif-/- ) on the alterations in host fecal microbiota due to T. spiralis infection may contribute to proposing a novel dual therapeutic approach for trichinellosis. To reveal the diversity and differences in fecal microbial composition, feces were collected from T. spiralis-uninfected and T. spiralis-infected wild-type (WT) and MIF knockout (KO) C57BL/6 mice at 0, 7, 14, and 35 days post-infection (dpi), and the samples were sent for 16S rRNA amplicon sequencing on the Illumina NovaSeq platform. Flow cytometry was used to determine the expression levels of IFN-γ and IL-4 in the CD4+ /CD8+  T-cell sets of mouse spleens. The results showed that operational taxonomic unit (OTU) clustering, relative abundance of microbial composition, alpha diversity, and beta diversity exhibited significant changes among the eight groups. The LEfSe analysis selected several potential biomarkers at the genus or species level, including Akkermansia muciniphila, Lactobacillus murinus, Coprococcus catus, Firmicutes bacterium M10_2, Parabacteroides sp. CT06, and Bacteroides between the KTs and WTs groups. The predicted bacterial functions of the fecal microbiota were mainly involved in metabolism, such as the metabolism of carbohydrates, amino acids, energy, cofactors, vitamins, nucleotides, glycans, and lipids. Flow cytometry revealed an increased CD3+ CD8- /CD3+ CD8+  T-cell ratio and increased IFN-γ and IL-4 levels in CD3+ CD8- T-cell sets from WT and MIF KO mice at 7 dpi. The results indicated that both MIF KO and infection time have a significant influence on the CD3+ CD8- IFN-γ+ and CD3+ CD8- IL-4+ response in mice after T. spiralis. In conclusion, this research showed alterations of the fecal microbiota and immune response in both WT and MIF KO mice before and after T. spiralis infection. These results revealed a potential role of MIF in regulating the pathogenesis of trichinellosis related to the intestinal microbiota. Importantly, the selected potential biomarkers combined with MIF will also offer a novel therapeutic approach to treat trichinellosis in the future.

Food safety incidents in the red meat industry: A review of foodborne disease outbreaks linked to the consumption of red meat and its products, 1991 to 2021

Red meat is a significant source of human nutrition, and the red meat industry contributes to the economy of nations. Nonetheless, there is a widespread global concern about public health issues posed by severe food safety incidents within the red meat industry. Most of these incidents are associated with foodborne disease outbreaks that impact individual consumers, food businesses and society. This study adopts a systematic search and review approach to identify three decades of published investigation reports of global foodborne disease outbreaks linked with the consumption of red meat and products made from them. The review aims to evaluate the critical features of these outbreak incidents to get insight into their contributing factors and root causes. In particular, this review discusses the transmission setting (origin of pathogenic agents), the food vehicles mostly incriminated, the causative pathogens (bacteria, viruses, and parasites) causing the most illnesses, and the most commonly reported contributing factors to the outbreaks. This information can help researchers and food business operators (FBOs) inform future risk assessment studies and support risk management activities in developing risk-mitigating strategies for the industry. Findings from this study suggest that implementing food safety management strategies which include adequate control measures at all stages of the food chain, from farm to fork, is imperative in preventing outbreak incidents. Of equal importance is the need for enhanced and sustained public education about the risk of foodborne illnesses associated with meat and its products whilst discouraging the consumption of raw meat products, especially by high-risk groups.

Trichinellosis in Hospitalized Children and Adults from Western Romania: A 11-Year Retrospective Study

Trichinellosis, a serious and sometimes fatal human disease, is a consequence of consuming raw or improperly cooked meat containing the infective larvae of Trichinella spp. The aim of this observational cohort retrospective study is to compare the epidemiological, laboratory, clinical and therapeutic aspects of trichinellosis in children and adults from Western Romania. We investigated the medical records of patients who were diagnosed with trichinellosis and hospitalized between 17 January 2010 and 31 December 2020. One hundred thirty-three patients were identified according to the electronic databases of infectious disease hospitals, located in four counties from Western Romania. A total of 19 patients (14.28%) were children and 114 patients (85.71%) were adults. In children, the most frequent symptoms were digestive in 78.94%, followed by fever in 57.89%, eyelid or facial edema in 57.89% and myalgia in 52.63% of cases, while adults presented mainly myalgia in 87.71%, followed by fever in 77.19%, digestive symptoms in 68.42% and eyelid or facial edema in 66.66% of cases. The source of infection was pork meat products in the majority of patients (89.47%). Our results revealed a general declining trend in infection rates for both children and adults during the studied period. The vast majority of cases were severe and all required hospitalization. Education of the population along with public health strategies should be improved and maintained to fully prevent trichinellosis in Western Romania.

Laboratory Features of Trichinellosis and Eosinophilia Threshold for Testing, Nunavik, Quebec, Canada, 2009-2019

Prolonged eosinophilia is characteristic of trichinellosis. To determine the optimal eosinophil threshold for reflex Trichinella testing, we examined all 43 cases in Nunavik, Quebec, Canada, during 2009-2019. Using receiver operating characteristic analysis, we determined that eosinophil counts >0.8 × 10⁹ cells/L should prompt consideration of trichinellosis and testing to rapidly identify potential outbreaks.

The genus Trichinella and its presence in wildlife worldwide: A review

The genus Trichinella has a worldwide distribution, infecting people, domestic animals, and wildlife. It includes 13 genotypes, which are geographically delimited; Trichinella is transmitted to people through the ingestion of undercooked meat. Historically, it has been associated with pigs, but most Trichinella species affect wildlife, and cases of trichinellosis due to the consumption of game meat have been emerging. Therefore, it is important to monitor the sources of transmission to domestic animals and humans. The objective of this work was to analyse reports of Trichinella spp. in wild/feral animals around the world to identify the needs of future research in the epidemiology of the sylvatic cycle. A search of studies published until 2021 was conducted using Web of Science and SciELO. In the Palearctic, the most commonly studied hosts were wild boars and red foxes, and hosts with the highest prevalence rates were polar bears and martens. In the Nearctic, red foxes and black bears were the most frequently studied hosts, and the highest prevalence was found for wolverines and brown bears. In the Neotropics, positive reports were only identified in two countries, with wild boars being the most commonly studied species, and armadillos featuring the highest prevalence. In the Afrotropics, Trichinella limits its presence to Sub-Saharan Africa, where lions are the most studied hosts, and spotted hyenas have the highest prevalence. In the Indo-Malaya and Australasia ecozones, information on wildlife is scarce; the Norwegian rat is the most frequently studied host, and the Tasmanian devil has the highest prevalence of infection. In the last decade, research on world wildlife has increased which is associated with more frequent trichinellosis outbreaks caused by the consumption of wild meat. The results suggest the need to increase research in developing countries, particularly where more diverse sources of meat are available for human consumption.

Vaccines as a Strategy to Control Trichinellosis

Trichinellosis caused by Trichinella spiralis is a worldwide food-borne parasitic zoonosis. Several approaches have been performed to control T. spiralis infection, including veterinary vaccines, which contribute to improving animal health and increasing public health by preventing the transmission of trichinellosis from animals to humans. In the past several decades, many vaccine studies have been performed in effort to control T. spiralis infection by reducing the muscle larvae and adult worms burden. Various candidate antigens, selected from excretory-secretory (ES) products and different functional proteins involved in the process of establishing infection have been investigated in rodent or swine models to explore their protective effect against T. spiralis infection. Moreover, different types of vaccines have been developed to improve the protective effect against T. spiralis infection in rodent or swine models, such as live attenuated vaccines, natural antigen vaccines, recombinant protein vaccines, DNA vaccines, and synthesized epitope vaccines. However, few studies of T. spiralis vaccines have been performed in pigs, and future research should focus on exploring the protective effect of different types of vaccines in swine models. Here, we present an overview of the strategies for the development of effective T. spiralis vaccines and summarize the factors of influencing the effectiveness of vaccines. We also discuss several propositions in improving the effectiveness of vaccines and may provide a route map for future T. spiralis vaccines development.

Analysis of a Trichinellosis Outbreak in Poland after Consumption of Sausage Made of Wild Boar Meat

An outbreak of trichinellosis due to the consumption of sausage made from wild boar meat unexamined for the presence of Trichinella spp. was reported in Poland in December 2020. The outbreak affected eight people. Examination of the sausages made of wild boar meat collected during epidemiological investigation indicated a high level of Trichinella spp. Larvae per gram (>30 lpg) and therefore the threat of an infection in humans after consumption of such product was significant. Over the years, the main source of trichinellosis in Poland has been wild boar meat, and the majority of trichinellosis cases were related to the consumption of traditional raw meat products such as Polish sausage. Taking this into account, there is the need for better education of consumers in the Trichinella spp. endemic regions and among cultures consuming traditional raw meat products.

Seroprevalence and Risk Factors of Trichinella spiralis Infection in Blood Donors from Western Romania

Background and Objectives: Trichinellosis, a serious and sometimes fatal human disease, is a foodborne zoonotic disease with worldwide distribution caused by parasitic nematodes of the genus Trichinella. Humans are infected with Trichinella larvae through the ingestion of meat that has not been properly cooked. Romania reported most of the confirmed cases of trichinellosis among the EU countries. The aim of this cross-sectional study was to evaluate, for the first time, the seroprevalence and risk factors of Trichinella infection in blood donors from Western Romania. Materials and Methods: Serum samples of 1347 consecutive blood donors were investigated using an immunoenzymaticassay (ELISA) for the determination of specific IgG class antibodies against T.spiralis. A questionnaire interview was used to obtain information regarding the potential risk factors associated with T. spiralis infection. Mantel–Haenszel chi-squared test or the Fisher exact two-tailed test, as appropriate, were used for comparison between T. spiralis positive and T. spiralis negative blood donors. Student’s t-test was used to evaluate differences between means in studied groups and body mass index was calculated by dividing weight in kilograms by height in meters squared. Statistical analysis was performed using Epi Info Version 7.2 and Stata 16.1. Results: T. spiralis IgG antibodies were detected in 2.00% (27) of 1347 consecutive blood donors. Eating raw and/or undercooked meat, from pigs or wild boars, was found to be the main risk factor (p < 0.001). Strong alcoholic drink consumption was highly associated with T. spiralis infection (p = 0.009). Trichinella seroprevalence was higher among rural residents and males. Subjects identified as Trichinella seropositive were not previously diagnosed and have not been treated for Trichinella infection with any specific therapy. Conclusions: The demonstration of T. spiralis antibodies in healthy blood donors suggests that Trichinella infection may be detected in asymptomatic individuals that were not previously diagnosed with this zoonosis.

Selected Livestock-Associated Zoonoses as a Growing Challenge for Public Health

The aim of this paper is to review the most significant livestock-associated zoonoses. Human and animal health are intimately connected. This idea has been known for more than a century but now it has gained special importance because of the increasing threat from zoonoses. Zoonosis is defined as any infection naturally transmissible from vertebrate animals to humans. As the frequency and prevalence of zoonotic diseases increase worldwide, they become a real threat to public health. In addition, many of the newly discovered diseases have a zoonotic origin. Due to globalization and urbanization, some of these diseases have already spread all over the world, caused by the international flow of goods, people, and animals. However, special attention should be paid to farm animals since, apart from the direct contact, humans consume their products, such as meat, eggs, and milk. Therefore, zoonoses such as salmonellosis, campylobacteriosis, tuberculosis, swine and avian influenza, Q fever, brucellosis, STEC infections, and listeriosis are crucial for both veterinary and human medicine. Consequently, in the suspicion of any zoonoses outbreak, the medical and veterinary services should closely cooperate to protect the public health.

Serological Detection of Trichinellosis among Suspected Wild Boar Meat Consumers in North and Northeast of Iran

Background

Trichinellosis is a foodborne zoonosis disease worldwide. Humans acquire infection by ingesting raw or uncooked animal flesh containing viable Trichinella larvae. The most common reservoirs of this helminth are pigs and wild boars. In northern Iran, hunting and consuming wild boars meat by some communities, including ethnic Armenians, may expose them to trichinellosis. Here, we investigated anti-Trichinella IgG antibodies in high-risk individuals in northeastern Iran.

Methods

From Mar to Aug 2020, we collected 189 blood samples from individuals with a history of wild boar meat consumption and examined the sera for anti-Trichinella IgG antibodies using a commercial ELISA kit (NovaTec Immunodiagnostica GmbH, Germany). Sera from 30 individuals with no history of eating wild boar meat was used to determine the range of actual negative values and possible cross-reactivity with other similar antigens.

Results

Of the 189 participants, 5 (2.6%) had anti-Trichinella IgG antibodies (OD, 1.176 ±0.154). None of the 30 negative controls became positive (OD, 0.198 ± 0.044). The age, gender, occupation, and education showed no significant association with Trichinella seropositivity rate (P>0.05). All five seropositive cases were among 112 individuals (4.46% seropositivity) that resided in the western part of the study area, stretching from Behshar to Gorgan.

Conclusion

Eating wild boar meat might expose individuals to trichinellosis in the north and northeast of Iran. Further studies with more individuals from different parts of the country and confirmation of the ELISA by additional tests like Western blot will give a more in-depth insight into human trichinellosis epidemiology in Iran.

Reprint of: Survival of Trichinella spiralis in cured meat products

Processing of meat is one possible approach to control meat-borne parasites. Processing methods such as freezing, cooking and irradiation are recommended for the control of Trichinella in pork, horse or game meat if specific technical conditions are fulfilled. Curing is a widely used preservation process influencing product characteristics such as shelf life, food safety, and taste. As curing methods are characterized by high parameter variability and predictions about inactivation of parasitic stages in raw meat products are difficult, curing and smoking are not recommended for Trichinella control. The objective of this study was to investigate the survival of T. spiralis in cured raw sausages taking into account water activity (a_w-value), pH value, temperature, and time. For this purpose, four different types of sausage (Knackwurst, vacuum packed Knackwurst, short ripened salami, long ripened salami) were produced using T. spiralis infested batter. After production, the sausages were stored at product specific conditions for up to 35 days. During storage, pH value and a_w-value of the sausages were monitored over time. Further, sausages of each type were digested using the magnetic stirrer method and the viability of the isolated larvae was assessed using a previously published larval motility test as a proxy for viability and infectivity of Trichinella larvae. In this context, we also introduce a three-level rated infectivity score (RIS) with a clear categorization scheme allowing the assessment of the infectivity of larvae. Based on the RIS, larvae isolated from the salamis were regarded as potentially infective until day 2 (short ripened salami) or day 3 (long ripened salami) post ripening, whereas in Knackwurst, potentially infective larvae were still found by day 8 post ripening. In contrast potentially infective larvae were detected in vacuum-packed Knackwurst until day 24 post ripening. Finally, using the RIS approach, data from previously published studies were collected and subjected to a correlation analysis to identify matrix factors linked to short Trichinella inactivation times.

Oral immunization with recombinant Lactobacillus plantarum expressing Nudix hydrolase and 43 kDa proteins confers protection against Trichinella spiralis in BALB/c mice

Trichinellosis is a significant food-borne zoonotic parasitic disease caused by parasite Trichinella. Given the side effects of anti-Trichinella drugs (e.g., Mebendazole) aroused in the course of treatments, an effective vaccine against the parasite is called for. The therapies available to date are in most instances targeting a single stage of Trichinella, resulting in an incomplete protective immunity against the parasite in terms of the complexity of its developmental stages. In this study, a recombinant dual-expression double anchor vector NC8-pLp-TsNd-S-pgsA'-gp43 was constructed carrying two antigen genes from Trichinella spiralis (T. spiralis), encoding the gp43 and T. spiralis Nudix hydrolase (TsNd) proteins which were mainly expressed in muscle larva (ML) and intestinal infective larva stages of the parasite respectively. These two proteins were to be expressed by Lactobacillus plantarum NC8 (L. plantarum NC8) which was designed to express the two anchored peptides, a truncated poly-γ-glutamic acid synthetase A (pgsA') and the surface layer protein of Lactobacillus acidophilus (SlpA), on its surface for attaching expressed foreign proteins. Oral immunization with the above recombinant vaccine induced higher levels of specific serum IgG and mucosal secretory IgA (SIgA) in BALB/c mice. In addition, cytokines, interferon-γ (IFN- γ), interleukin-4 (IL-4) and IL-17 released by lymphocytes, and CD4+ levels displayed on the surfaces of splenic and mesenteric lymph cells were significantly enhanced by the vaccination. Moreover, after larval challenges, a 75.67 % reduction of adult worms (AW) at 7 days post-infection (dpi) and 57.14 % reduction of ML at 42 dpi were observed in mice immunized with the recombinant vaccine. Furthermore, this oral vaccination reduced the counts of encysted larvae presented in tongue and masseter muscles after infected with T. spiralis in mice. The overall results demonstrated that the recombinant vaccine developed in this study could induce specific humoral, mucosal, and cellular immune responses, and provides protections against different stages (adult worms and muscle larva) of T. spiralis infections in BALB/c mice, which could make it a promising oral vaccine candidate against trichinellosis.

Trichinellosis in hospitalized patients from Western Romania: A retrospective study

Trichinellosis is a public health problem and an economic issue in porcine animal production and food safety. The aim of this retrospective study was to evaluate the current epidemiologic, laboratory, clinical and therapeutic aspects of human trichinellosis in Western Romania. We retrospectively investigated the medical records of patients hospitalized in infectious diseases hospitals from three counties in Western Romania, between January 1st, 2012 and December 31st, 2016. A total of 83 patients diagnosed with trichinellosis were included in the study. Pork meat was the food source of infection in 76 (91.6%) patients and wild boar meat in 4 (4.8%). Patients were aged between 2 and 78 years; 48 (57.8%) were males and 27 (32.5%) came from an urban area. The most frequent symptoms included myalgia in 66 (79.5%) patients, fever in 55 (66.3%), eyelid edema in 40 (48.2%) and asthenia in 35 (42.2%). Two patients died and the others had favorable outcome. Although the number of reported cases has decreased in the past years, trichinellosis remains an important public health problem in Western Romania. Educational programs for both swine breeders and consumers are imperative, and implementation of strict hygienic measures aimed to control infection transmission are strongly recommended.

Foodborne Zoonoses Common in Hunted Wild Boars

The northern European wild boar population has increased during the last decade. Highest wild boar numbers in Finland have been reported in the southeastern part near the Russian border. Wild boars may be infected with several human and animal pathogens. In this study, we investigated the presence of important foodborne pathogens in wild boars hunted in 2016 in Finland using serology, PCR and culturing. Seroprevalence of Salmonella (38%) and Yersinia (56%) infections was high in wild boars. Antibodies to hepatitis E virus, Toxoplasma gondii and Brucella were found in 18%, 9% and 9% of the wild boars, respectively. Trichinella antibodies were detected in 1% of the animals. We recorded no differences in the seroprevalence between males and females. However, Yersinia and T. gondii antibodies were detected significantly more often in adults than in young individuals. Listeria monocytogenes (48%) and stx-positive Escherichia coli (33%) determinants were frequently detected in the visceral organs (spleen and kidneys) by PCR. Yersinia pseudotuberculosis O:1 and L. monocytogenes 2a and 4b were identified by culturing from the PCR-positive samples. Brucella suis biovar 2 was isolated from visceral organs. No African swine fever, classical swine fever or Aujeszky's disease were detected in the wild boars. Our study shows that wild boars are important reservoirs of foodborne pathogens.

Survival of Trichinella spiralis in cured meat products

Processing of meat is one possible approach to control meat-borne parasites. Processing methods such as freezing, cooking and irradiation are recommended for the control of Trichinella in pork, horse or game meat if specific technical conditions are fulfilled. Curing is a widely used preservation process influencing product characteristics such as shelf life, food safety, and taste. As curing methods are characterized by high parameter variability and predictions about inactivation of parasitic stages in raw meat products are difficult, curing and smoking are not recommended for Trichinella control. The objective of this study was to investigate the survival of T. spiralis in cured raw sausages taking into account water activity (aw-value), pH value, temperature, and time. For this purpose, four different types of sausage (Knackwurst, vacuum packed Knackwurst, short ripened salami, long ripened salami) were produced using T. spiralis infested batter. After production, the sausages were stored at product specific conditions for up to 35 days. During storage, pH value and aw-value of the sausages were monitored over time. Further, sausages of each type were digested using the magnetic stirrer method and the viability of the isolated larvae was assessed using a previously published larval motility test as a proxy for viability and infectivity of Trichinella larvae. In this context, we also introduce a three-level rated infectivity score (RIS) with a clear categorization scheme allowing the assessment of the infectivity of larvae. Based on the RIS, larvae isolated from the salamis were regarded as potentially infective until day 2 (short ripened salami) or day 3 (long ripened salami) post ripening, whereas in Knackwurst, potentially infective larvae were still found by day 8 post ripening. In contrast potentially infective larvae were detected in vacuum-packed Knackwurst until day 24 post ripening. Finally, using the RIS approach, data from previously published studies were collected and subjected to a correlation analysis to identify matrix factors linked to short Trichinella inactivation times.

[Trichinella induced polymyositis with unilateral lameness in a dog]

A 9-year-old Cairn Terrier was presented for a right thoracic limb lameness of 3-month duration resistant to anti-inflammatory pain treatment. Blood chemistry revealed a highly elevated creatine kinase activity. An orthopedic or vascular etiology of the lameness was excluded by radiographs, computed tomography, and magnetic resonance imaging. Further workup for a neurologic or muscular etiology by electromyography, nerve conduction velocity measurement, and histology of muscle as well as nerve biopsies identified the cause of the lameness. Histology revealed a pyogranulomatous, necrotizing myositis with parasites of the species Trichinella. Furthermore different developmental stages of fungi were detected which were identified as Mucor sp. Treatment with albendazole and itraconazole significantly improved the patient's clinical signs.

Diversity of Trichinella species in relation to the host species and geographical location

Trichinella nematodes still circulate in various hosts in both domestic and sylvatic environments. Recently, in Europe, the transmission of Trichinella spp. to humans has been attributed more to wild animals than to domestic animals. However, domestic animals could still be a source of human infections in some regions. Therefore, our aim was to determine the species composition of Trichinella and the prevalence and intensity of infections in animal populations from the domestic cycle, namely pigs (Sus scrofa f. domestica); the synantropic cycle, in the form of rats (Rattus norvegicus); and the sylvatic cycle, namely wild boars (Sus scrofa) and red foxes (Vulpes vulpes), in Poland. The findings showed that the nematode prevalence in pigs (0.0002 %) and wild boars (0.3 %) was lower than it was in red foxes (4 %). A very high prevalence was found in rats (23.3 %), but it must be emphasized that the investigated rat samples were collected from farms where pigs were infected with Trichinella spp. The mean larval burden was found to be higher in wild boars and pigs (11.48 lpg and 10.19 lpg) than in red foxes and rats (4.09 and 2.30). Trichinella spiralis was the predominant species in pigs (98.6 %), wild boars (77.3 %) and rats (100 %), while in red foxes, this species occurred less frequently (15.5 %). The most frequently occurring species in red foxes was Trichinella britovi (73.2 %). Moreover, in wild boar and red fox coinfections, T. spiralis/T. britovi were detected (3.1 and 9.9 %, respectively). In addition, Trichinella pseudospiralis was detected in a few wild boars (0.5 %) and Trichinella nativa was found in one red fox and one wild boar. Furthermore, different T. spiralis and T. britovi prevalence ratios in various geographical regions were found. In the wild boar population, a higher frequency of T. spiralis (70-85 % of infected animals) was observed in the western and central parts of Poland, while in the eastern part, this dominance was not as evident (46-59 %). In the red fox population, T. britovi was abundant throughout the entire territory; however, its highest prevalence was in the east (90-100 %).

Toxoplasma gondii and Trichinella infections in wild boars (Sus scrofa) from Northeastern Patagonia, Argentina

Wild boar (Sus scrofa) was introduced in many countries of the world and is recognized as carrier of many infectious diseases. Wild game meat consumption is recognized as a source of transmission of Toxoplasma gondii and Trichinella spp. The aim of the present study was to evaluate the prevalence of antibodies to T. gondii and Trichinella spp. in free-range wild boars in Northeastern Argentine Patagonia. Between 2014 and 2018, 144 blood samples and 423 muscle samples from 423 carcasses were collected. To detect T. gondii IgG, 144 sera were processed by an immunofluorescent antibody test, and to detect anti-Trichinella IgG, 125 sera and 304 muscle juice samples were processed by ELISA. Detection of first stage larvae in muscle was performed by artificial digestion. A total of 423 wild boars muscle samples were negative to Trichinella spp. by artificial digestion. Antibodies to Trichinella spp. were detected in 2.4% (3/125) of serum samples and in 1.64% (5/304) of meat juice samples. Antibodies to T. gondii infection were detected in 12.5% (18/144) of the serum samples. This is the first study to reveal the presence of antibodies to T. gondii in wild boars from Argentina. The present results suggest that consumption of raw or undercooked wild boar meat could represent a potential source risk for toxoplasmosis in humans and that Trichinella spp. is infrequent and/or that it circulates in low burdens among wild boars in Northeastern Patagonia.

Epidemiology of taeniosis, cysticercosis and trichinellosis in Iran: A systematic review

BACKGROUND

The aim of this review was to establish the current epidemiology of taeniosis, cysticercosis and trichinellosis among humans and animals in Iran by carrying out a comprehensive assessment of published articles reporting on these foodborne zoonotic diseases across the country.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was used in the search for relevant published articles reporting on cysticercosis, taeniosis and trichinellosis in Iran using a number of appropriate key words. The search was conducted through PubMed, Web of Science, Google Scholar, SpringerLink, SCOPUS, WHOLIS, FAO and CDC. Published scientific articles including journals, books and book chapters reporting on cysticercosis, taeniosis and trichinellosis in Iran for the period between 1967 and 2018 were selected.

RESULTS

A total of 37 articles met the search criteria and were incorporated in this review. Of these, 10 (27%) reported on human taeniosis, 15 (40.5%) on cysticercosis (10 on Taenia saginata and five on Taenia spp. cysticercosis) and 12 (32.5%) on trichinellosis. T. saginata was implicated in all human taeniosis cases. All Taenia spp. cysticercosis cases were reported among domesticated pigs and wild animals. A case of neurocysticercosis was reported in a male patient at Shohada Hospital in Tehran. Eleven (91.7%) of the 12 studies reported on trichinellosis among wild animals, while one (8.3%) study detected anti-Trichinella IgG in 8 (2.2%) of the 364 at-risk human beings tested. Nevertheless, most of these studies were carried out in northern Iran.

CONCLUSION

This review found T. saginata to be the most prevalent and of greater economic and public health significance in Iran. However, T. solium and Trichinella spp. were of little significance to human health. More studies should focus on other regions besides northern Iran.

Wild Boar: A Reservoir of Foodborne Zoonoses

Wild boar populations around the world have increased dramatically over past decades. Climate change, generating milder winters with less snow, may affect their spread into northern regions. Wild boars can serve as reservoirs for a number of bacteria, viruses, and parasites, which are transmissible to humans and domestic animals through direct interaction with wild boars, through contaminated food or indirectly through contaminated environment. Disease transmission between wild boars, domestic animals, and humans is an increasing threat to human and animal health, especially in areas with high wild boar densities. This article reviews important foodborne zoonoses, including bacterial diseases (brucellosis, salmonellosis, tuberculosis, and yersiniosis), parasitic diseases (toxoplasmosis and trichinellosis), and the viral hepatitis E. The focus is on the prevalence of these diseases and the causative microbes in wild boars. The role of wild boars in transmitting these pathogens to humans and livestock is also briefly discussed.

Multiplex TaqMan qPCR assay for specific identification of encapsulated Trichinella species prevalent in North America

BACKGROUND Human trichinellosis is a foodborne parasitic zoonotic disease caused by ingestion of raw or undercooked meat infected with nematode larvae of the genus Trichinella. In the USA, sporadic cases and outbreaks caused by the consumption of wild game meat infected with Trichinella have been reported. The current methods for diagnosis such as serology and microscopy are not specific, may result in false negative results, and cannot differentiate encapsulated Trichinella larvae to species level. The molecular protocols currently available for the differentiation of all encapsulate Trichinella species prevalent in North America have some limitations such as the inability to identify and resolve the presence of several Trichinella species in a single test. OBJECTIVES/METHODS In this study we developed and evaluated a multiplex TaqMan quantitative real-time polymerase chain reaction (qPCR) assay, which can simultaneously detect, identify and differentiate all species of encapsulated Trichinella occurring in North America i.e., T. nativa, T. spiralis, T. murrelli and Trichinella T6, even in cases of multiple infection in a single sample. We investigated two human biopsies and 35 wild animal meat samples considered as having a high likelihood of harboring Trichinella larvae obtained from the United States during 2009-2017. FINDINGS Using the multiplex assay describe here, 22 (59%) samples that tested positive contained Trichinella spp., were identified as: T. nativa (n = 7, including a human biopsy), T. spiralis (n = 9, including a human biopsy), T. murrelli (n = 3), Trichinella T6 (n = 1). Results also included two rare mixed infection cases in bears, a T. nativa/T. spiralis from Alaska and a T. spiralis/Trichinella T6 from California. The species identifications were confirmed using a conventional PCR targeting the rRNA ITS1-ITS2 region, followed by DNA sequencing analysis. The estimated limit of detection (LOD) was approximately seven larvae per gram of meat. MAIN CONCLUSIONS Differentiation of Trichinella spp. is needed to improve efforts on identification of case, optimize food safety control and better understand the geographic distribution of Trichinella species. The Trichinella qPCR multiplex proved to be a robust, easy to perform assay and is presented as an improved technique for identification of all known encapsulated species occurring in North America continent.

Trichinella Nativa Outbreak With Rare Thrombotic Complications Associated With Meat From a Black Bear Hunted in Northern Ontario

Background

Although trichinellosis is known to cause thrombotic disease, serious thrombotic events are rare and have not been previously associated with Trichinella nativa infection.

Methods

Patient interviews and medical chart reviews were conducted on 10 men who became ill following consumption of a common source of black bear meat. Trichinella serology on patient sera as well as polymerase chain reaction (PCR) and larval identification of the meat samples was conducted.

Results

All 10 exposed individuals developed an acute illness clinically compatible with trichinellosis, characterized by fever, abdominal pain, and diarrhea, along with eosinophilia ranging from 0.9 × 109/L to 6.1 × 109/L. Within 2 weeks of the diarrheal illness, systemic symptoms developed in all exposed individuals characterized by fever, myalgia, periorbital edema, and fatigue. ST-elevation myocardial infarction and sinus venous tract thrombosis occurred as a complication of trichinellosis in 2 patients. Acute serology was nonreactive in all patients, though convalescent serology was reactive in 6 of 8 (75%) patients for whom sera was available. Multiplex PCR identified T. nativa from the bear meat, and was corroborated by microscopic larval identification.

Conclusions

We report a 100% attack rate of T. nativa from bear meat among those who were exposed, and demonstrate that this species can cause serious thrombotic complications of trichinellosis in humans. Education of hunters and the public regarding the importance of proper preparation of wild game prior to ingestion is warranted.

Outbreak of trichinellosis related to eating imported wild boar meat, Belgium, 2014

Trichinellosis is a rare parasitic zoonosis caused by Trichinella following ingestion of raw or undercooked meat containing Trichinella larvae. In the past five years, there has been a sharp decrease in human trichinellosis incidence rates in the European Union due to better practices in rearing domestic animals and control measures in slaughterhouses. In November 2014, a large outbreak of trichinellosis occurred in Belgium, related to the consumption of imported wild boar meat. After a swift local public health response, 16 cases were identified and diagnosed with trichinellosis. Of the 16 cases, six were female. The diagnosis was confirmed by serology or the presence of larvae in the patients' muscle biopsies by histology and/or PCR. The ensuing investigation traced the wild boar meat back to Spain. Several batches of imported wild boar meat were recalled but tested negative. The public health investigation allowed us to identify clustered undiagnosed cases. Early warning alerts and a coordinated response remain indispensable at a European level.

Validation studies of the latex agglutination test for the detection of Trichinella larvae in meat products

Human trichinellosis is a foodborne disease caused by ingestion of meat infected with Trichinella muscle larvae. To control Trichinella spp. infection in the European Union, all slaughtered pigs from holdings that are not officially recognized as applying controlled housing conditions and other animals susceptible to Trichinella infection and intended for human consumption should be examined by one of the approved digestion methods described in Regulation (EU) No. 2015/1375. In the past, Trichinella outbreaks due to the consumption of cured wild boar or pork products have been described in several European countries, making the identification of the larvae from these products relevant for Trichinella control. Therefore, this study aimed to validate the newly approved latex agglutination test (Trichin-L) for routine testing of cured meat products. The test was validated based on the OIE Guidelines using pork products spiked with Trichinella larvae. The sensitivity of the method varied greatly depending on the investigated meat product and was usually lower than for the gold standard, the magnetic stirrer method. The detection rate reached 80% for three larvae and 60% for one larva in cured pork sausages. A detection rate of 100% for three larvae and 50% for one larva was found in bacon. For frozen samples (-20°C) the Trichin-L kit is similarly sensitive as for cured samples. Further, to determine the performance of the test under field conditions, pork products from regions with known high Trichinella prevalences confiscated by customs authorities at two German international airports were analyzed. Problems associated with the Trichin-L test were incomplete digestion due to fatty ingredients, spices and very dry meat products, resulting in data which could not be evaluated. Therefore, the test is currently not suitable for the detection of Trichinella larvae in cured meat products and needs further adaptation steps to increase both usability and sensitivity.

Parasitic Zoonoses in Humans and Their Dogs from a Rural Community of Tropical Mexico

A cross-sectional study was made on 89 inhabitants and their dogs from a rural community of Yucatan, Mexico, to determine the serological prevalence of some zoonotic parasitic agents. Samples were taken to monitor the presence and intensity of infection with gastrointestinal parasites in dogs. In humans, the serological prevalence of T. canis, T. gondii, and T. spiralis was 29.2%, 91.0%, and 6.7%, respectively. No associations were found between positive cases and studied variables. From the total of blood samples taken from dogs, 87 (97.6%) were seropositive to T. gondii; only 52 viable fecal samples were collected from dogs of which 46.2% had the presence of gastrointestinal parasites with low to moderate intensity; from those, 12% had the presence of T. canis. This study demonstrates the presence of the studied zoonotic agents in the area particularly T. gondii which suggest a common source of infection in dogs and humans and a high number of oocyts present in the environment. Preventive measures must be designed towards good prophylactic practices in domestic and backyard animals (T. canis and T. spiralis). Contaminated sources with T. gondii (food and water) should be further investigated in order to design effective control measures.