Possible factors influencing distribution and prevalence of Echinococcus granulosus in Utah

A systematic review of zoonotic enteric parasitic diseases among nomadic and pastoral people

Introduction

Zoonotic enteric parasites are ubiquitous and remain a public health threat to humans due to our close relationship with domestic animals and wildlife, inadequate water, sanitation, and hygiene practices and diet. While most communities are now sedentary, nomadic and pastoral populations still exist and experience unique exposure risks for acquiring zoonotic enteric parasites. Through this systematic review we sought to summarize published research regarding pathogens present in nomadic populations and to identify the risk factors for their infection.

Methods

Using systematic review guidelines set forth by PRISMA, research articles were identified, screened and summarized based on exclusion criteria for the documented presence of zoonotic enteric parasites within nomadic or pastoral human populations. A total of 54 articles published between 1956 and 2016 were reviewed to determine the pathogens and exposure risks associated with the global transhumance lifestyle.

Results

The included articles reported more than twenty different zoonotic enteric parasite species and illustrated several risk factors for nomadic and pastoralist populations to acquire infection including; a) animal contact, b) food preparation and diet, and c) household characteristics. The most common parasite studied was Echinococcosis spp. and contact with dogs was recognized as a leading risk factor for zoonotic enteric parasites followed by contact with livestock and/or wildlife, water, sanitation, and hygiene barriers, home slaughter of animals, environmental water exposures, household member age and sex, and consumption of unwashed produce or raw, unprocessed, or undercooked milk or meat.

Conclusion

Nomadic and pastoral communities are at risk of infection with a variety of zoonotic enteric parasites due to their living environment, cultural and dietary traditions, and close relationship to animals. Global health efforts aimed at reducing the transmission of these animal-to-human pathogens must incorporate a One Health approach to support water, sanitation, and hygiene development, provide education on safe food handling and preparation, and improve the health of domestic animals associated with these groups, particularly dogs.

Global Distribution of Alveolar and Cystic Echinococcosis

Alveolar echinococcosis (AE) and cystic echinococcosis (CE) are severe helminthic zoonoses. Echinococcus multilocularis (causative agent of AE) is widely distributed in the northern hemisphere where it is typically maintained in a wild animal cycle including canids as definitive hosts and rodents as intermediate hosts. The species Echinococcus granulosus, Echinococcus ortleppi, Echinococcus canadensis and Echinococcus intermedius are the causative agents of CE with a worldwide distribution and a highly variable human disease burden in the different endemic areas depending upon human behavioural risk factors, the diversity and ecology of animal host assemblages and the genetic diversity within Echinococcus species which differ in their zoonotic potential and pathogenicity. Both AE and CE are regarded as neglected zoonoses, with a higher overall burden of disease for CE due to its global distribution and high regional prevalence, but a higher pathogenicity and case fatality rate for AE, especially in Asia. Over the past two decades, numerous studies have addressed the epidemiology and distribution of these Echinococcus species worldwide, resulting in better-defined boundaries of the endemic areas. This chapter presents the global distribution of Echinococcus species and human AE and CE in maps and summarizes the global data on host assemblages, transmission, prevalence in animal definitive hosts, incidence in people and molecular epidemiology.

Sero-epidemiology of cystic echinococcosis (Echinococcus granulosus) in the livestock of Oman

A cross-sectional serological survey of cystic echinocossis was carried out on 2802 randomly collected sera of camels (n=706), cattle (n=687), goats (n=701) and sheep (n=708) from all governorates of Oman. The samples were analysed by in house indirect ELISA (iELISA) using Echinococcus granulosus antigen B (EgAgB) of naturally infected camels. The overall percentage of antibodies against EgAgB was found to be 14.6%. The highest percentage of positive was observed in sera from camels (22.4%) followed by cattle (12.9%), sheep (12.2%) and goats (10.9%). The highest percentage of seropositivity was observed in females (15.4%) as compared to male animals (10.6%). The imported livestock were found more seropositive (15.2%) as compared to local (14.7%) and crossbred livestock (14.1%). The highest exposure was observed in animals with the age group of above 5years (18.3%) followed by the age group of up to 2years (15.1%,) and those between 2 and 5years (12.4%). The univariate analysis has indicated that camels (OR:2.33, CI 1.74, 3.14), cattle (OR:1.21, CI 0.87, 1.67), sheep (OR:1.12, CI 0.81, 1.55) were more likely to test positive than goats. Furthermore, females (OR: 1.53, CI 1.11, 2.11) were more likely to test seropositive. Sera from animals above 5years of age (OR:1.58, CI 1.25, 2.01) and between 2 and 5years old (OR:1.30, CI 0.98, 1.71) were found more likely to test seropositive than those up to 2years of age. The multivariable analysis at individual level indicated that camels (OR: 2.07, CI 1.66, 2.56, p<0.001) and female (OR: 1.43, CI 1.04, 1.98, p=0.030) were more likely to acquire CE. At herd level, the final multivariable model indicated that herds located in Dofar and Musandam (OR: 4.48, CI 2.69, 7.45, p<0.001), in areas receiving seasonal rains (OR: 2.54, CI 1.09, 5.90, p<0.001) and practicing transhumance (OR: 4.22, CI 1.84, 9.65, p<0.001) and sedentary (OR: 2.07, CI 1.38, 3.12, p=0.001) farming system were more likely to acquire CE in Oman. The study documents the serological evidence of CE in livestock of Oman and a carefully planned control program should be devised after further epidemiological and molecular investigations in the intermediate and final hosts.

Worldwide epidemiology of liver hydatidosis including the Mediterranean area

The worldwide incidence and prevalence of cystic echinococcosis have fallen dramatically over the past several decades. Nonetheless, infection with Echinococcus granulosus (E. granulosus) remains a major public health issue in several countries and regions, even in places where it was previously at low levels, as a result of a reduction of control programmes due to economic problems and lack of resources. Geographic distribution differs by country and region depending on the presence in that country of large numbers of nomadic or semi-nomadic sheep and goat flocks that represent the intermediate host of the parasite, and their close contact with the final host, the dog, which mostly provides the transmission of infection to humans. The greatest prevalence of cystic echinococcosis in human and animal hosts is found in countries of the temperate zones, including several parts of Eurasia (the Mediterranean regions, southern and central parts of Russia, central Asia, China), Australia, some parts of America (especially South America) and north and east Africa. Echinococcosis is currently considered an endemic zoonotic disease in the Mediterranean region. The most frequent strain associated with human cystic echinococcosis appears to be the common sheep strain (G1). This strain appears to be widely distributed in all continents. The purpose of this review is to examine the distribution of E. granulosus and the epidemiology of a re-emerging disease such as cystic echinococcosis.

Molecular and immunological diagnosis of echinococcosis

Echinococcosis is an infectious disease of humans caused by the larval (metacestode) stage of the cestode species Echinococcus granulosus (cystic echinococcosis or hydatid disease) or Echinococcus multilocularis (alveolar echinococcosis or alveolar hydatid disease). Clinical manifestations depend primarily on localization and size of hepatic lesions and may include hepatomegaly, obstructive jaundice, or cholangitis. Prognostically, alveolar echinococcosis is considered similar to liver malignancies, including a lethality rate of 90% for untreated cases. Diagnosis is based on imaging techniques coupled with immunodiagnostic procedures. Antibody detection tests for E. multilocularis have markedly improved with the use of affinity-purified Em2 antigen and recombinant antigen II/3-10 in enzyme immunoassays. Antigens of corresponding quality for E. granulosus are still unavailable. The detection of circulating antigens and immune complexes in the sera of patients with cystic echinococcosis, the demonstration of in vitro lymphocyte proliferation in response to stimulation with Echinococcus antigens, and the discrimination of serum immunoglobulin isotype activity to various Echinococcus antigens in both cystic and alveolar echinococcosis have been suggested for diagnostic purposes as well as for monitoring patients after treatment. New diagnostic molecular tools include DNA probes for Southern hybridization tests and polymerase chain reaction for the amplification of E. multilocularis and E. granulosus species-specific DNA fragments.