Molluscan and vertebrate immune responses to bird schistosomes

Zoonotic Threats: The (Re)emergence of Cercarial Dermatitis, Its Dynamics, and Impact in Europe

Cercarial dermatitis (CD), or "Swimmer's itch" as it is also known, is a waterborne illness caused by a blood fluke from the family Schistosomatidae. It occurs when cercariae of trematode species that do not have humans as their definitive host accidentally penetrate human skin (in an aquatic environment) and trigger allergic symptoms at the site of contact. It is an emerging zoonosis that occurs through water and is often overlooked during differential diagnosis. Some of the factors contributing to the emergence of diseases like CD are related to global warming, which brings about climate change, water eutrophication, the colonization of ponds by snails susceptible to the parasite, and sunlight exposure in the summer, associated with migratory bird routes. Therefore, with the increase in tourism, especially at fluvial beaches, it is relevant to analyze the current epidemiological scenario of CD in European countries and the potential regions at risk.

Other Schistosomatoidea and Diplostomoidea

Trematodes of the order Diplostomida are well known as serious pathogens of man, and both farm and wild animals; members of the genus Schistosoma (Schistosomatidae) are responsible for human schistosomosis (schistosomiasis) affecting more than 200 million people in tropical and subtropical countries, and infections of mammals and birds by animal schistosomes are of great veterinary importance. The order Diplostomida is also rich in species parasitizing other major taxa of vertebrates. The "Aporocotylidae" sensu lato are pathogenic in fish, "Spirorchiidae" sensu lato in reptiles. All these flukes have two-host life cycles, with asexually reproducing larvae usually in mollusks and occasionally in annelids, and adults usually live in the blood vessels of their vertebrate hosts. Pathology is frequently associated with inflammatory reactions to eggs trapped in various tissues/organs. On the other hand, the representatives of Diplostomidae and Strigeidae have three- or four-host life cycles in which vertebrates often serve not only as definitive but also as intermediate or paratenic hosts. Pathology is usually associated with migration of metacercariae and mesocercariae within the host tissues. The impact of these trematode infections on both farm and wild animals may be significant.

Schistosomatoidea and Diplostomoidea

Trematodes of the order Diplostomida are well known as serious pathogens of man, and both farm and wild animals; members of the genus Schistosoma (Schistosomatidae) are responsible for human schistosomosis affecting more than 200 million people in tropical and subtropical countries, infections of mammals and birds by animal schistosomes are of great veterinary importance. The order Diplostomida is also rich in species parasitizing other major taxa of vertebrates. The Aporocotylidae are pathogenic in fish, Spirorchiidae in reptiles. All these flukes have two-host life cycles, with asexually reproducing larvae usually in molluscs and occasionally in annelids, and adults usually live in the blood vessels of their vertebrate hosts. Pathology is frequently associated with inflammatory reactions to eggs trapped in various tissues/organs. On the other hand, the representatives of Diplostomidae and Strigeidae have three- or four-host life cycles in which vertebrates often serve not only as definitive, but also as intermediate or paratenic hosts. Pathology is usually associated with migration of metacercariae and mesocercariae within the host tissues. The impact of these trematode infections on both farm and wild animals may be significant.

Swimmer's Itch in Belgium: First Recorded Outbreaks, Molecular Identification of the Parasite Species and Intermediate Hosts

BACKGROUND

Cercarial dermatitis or swimmer's itch is a skin condition in humans due to the larval forms of bird schistosomes of some species of the genus Trichobilharzia. The life cycle of these schistosomes requires freshwater snails (intermediate host) and waterfowl (definitive host). Repeated exposures to cercariae can lead to skin sensitization with the induction of pruritic skin lesions.

METHODS

We describe, in this study, two outbreaks of human cercarial dermatitis at the Eau d'Heure Lakes, Belgium. In July and August 2012, a total of, respectively, 78 and 10 people reported a sudden skin rash accompanied by pruritus following recreational activities in the Plate Taille Lake. However, no ocellate furcocercariae were detected following light exposure of the snails collected between September 2012 and September 2013 (n = 402). No outbreaks were recorded in 2013 and 2014. In August 2015, about 30 new cases were recorded. Snails were collected (n = 270) in different locations around the lake. PCR was used to identify accurately the intermediate hosts and the parasite species involved.

RESULTS

After light exposure, seven Radix spp. (2.6%) shed ocellate furcocercariae. Molecular identification based on the rDNA internal transcribed spacer 2 sequence ascribed the infected snails to R. balthica ( = R. peregra = R. ovata) (6/7) and R. auricularia (1/7). Based on the amplification of the D2 domain of the 28S rDNA, the cercariae were shown to belong to two different haplotypes of Trichobilharzia franki.

CONCLUSIONS

This is the first record in Belgium of T. franki and associated skin condition.

The Early Worm Catches the Bird? Productivity and Patterns of Trichobilharzia szidati Cercarial Emission from Lymnaea stagnalis

Digenean trematodes are common and abundant in aquatic habitats and their free-living larvae, the cercariae, have recently been recognized as important components of ecosystems in terms of comprising a significant proportion of biomass and in having a potentially strong influence on food web dynamics. One strategy to enhance their transmission success is to produce high numbers of cercariae which are available during the activity peak of the next host. In laboratory experiments with 13 Lymnaea stagnalis snails infected with Trichobilharzia szidati the average daily emergence rate per snail was determined as 2,621 cercariae, with a maximum of 29,560. During a snail’s lifetime this summed up to a mass equivalent of or even exceeding the snail’s own body mass. Extrapolated for the eutrophic pond where the snails were collected, annual T. szidati biomass may reach 4.65 tons, a value equivalent to a large Asian elephant. Emission peaks were observed after the onset of illumination, indicating emission synchronizing with the high morning activities of the definitive hosts, ducks. However, high cercarial emission is possible throughout the day under favorable lightning conditions. Therefore, although bird schistosomes, such as T. szidati constitute only a fraction of the diverse trematode communities in the studied aquatic ecosystem, their cercariae can still pose a considerable risk for humans of getting cercarial dermatitis (swimmer's itch) due to the high number of cercariae emitted from infected snails.

Swimmer's itch: etiology, impact, and risk factors in Europe

This review summarizes current knowledge about the occurrence and distribution of swimmer's itch, with a focus on Europe. Although recent publications have reviewed the biology and systematics of bird schistosomes and their complex host-parasite interactions, the underlying ecological factors that create favorable conditions for the parasites and the way humans interact with infested water bodies require further attention. Relevant studies from the past decade were analyzed to reveal an almost complete set of ecological factors as a prerequisite for establishing the life cycle of bird schistosomes. Based on both records of the occurrence of the parasite infective agents, and epidemiological studies that investigate outbreaks of swimmer's itch, this review concentrates on the risk factors for humans engaged in recreational water activities.

Macroevolutionary Immunology: A Role for Immunity in the Diversification of Animal life

An emerging picture of the nature of immune systems across animal phyla reveals both conservatism of some features and the appearance among and within phyla of novel, lineage-specific defense solutions. The latter collectively represent a major and underappreciated form of animal diversity. Factors influencing this macroevolutionary (above the species level) pattern of novelty are considered and include adoption of different life styles, life histories, and body plans; a general advantage of being distinctive with respect to immune defenses; and the responses required to cope with parasites, many of which afflict hosts in a lineage-specific manner. This large-scale pattern of novelty implies that immunological phenomena can affect microevolutionary processes (at the population level within species) that can eventually lead to macroevolutionary events such as speciation, radiations, or extinctions. Immunologically based phenomena play a role in favoring intraspecific diversification, specialization and host specificity of parasites, and mechanisms are discussed whereby this could lead to parasite speciation. Host switching - the acquisition of new host species by parasites - is a major mechanism that drives parasite diversity and is frequently involved in disease emergence. It is also one that can be favored by reductions in immune competence of new hosts. Mechanisms involving immune phenomena favoring intraspecific diversification and speciation of host species are also discussed. A macroevolutionary perspective on immunology is invaluable in today's world, including the need to study a broader range of species with distinctive immune systems. Many of these species are faced with extinction, another macroevolutionary process influenced by immune phenomena.

Final hosts and variability of Trichobilharzia regenti under natural conditions

In Europe, despite of intensive work on avian schistosomes in the past, only one representative of nasal schistosomes has been detected so far, Trichobilharzia regenti, a species that remained undescribed to the scientific community until 1998. Since then, however, T. regenti has gained a considerable attention, not only due to the induction of serious lesions concomitant with the migration of the schistosomulae through the central nervous system of their natural hosts (birds) but also due to their implication in cercarial dermatitis and their neurotrophic behaviour in mammals (mice, experimental) where the parasite migrate to the CNS. From 2001 to 2010, by a parasitic control of various potential final hosts (aquatic birds) living in natural condition in France and in Iceland, we detected T. regenti in six species: Anas platyrhynchos, Cygnus olor, Aythya fuligula, Aythya ferina, Mergus merganser and Anser anser. Although morphological features, mainly of eggs, showed some variations with the original description of the parasite, molecular analysis confirmed their membership to the T. regenti species. Nevertheless, specific molecular and morphological variations were especially observed for nasal parasite isolated from Anas clypeata. For this species, we discuss the possibility for this nasal schistosome to belong to a nasal Trichobilharzia species already described in Africa or even an undescribed nasal species.

A review on swimmer's itch and the occurrence of bird schistosomes in Iceland

In the past decade, swimmer's itch (SI) has repeatedly occurred in people who have been wading or bathing in ponds or lakes in Iceland where water birds and snails are abundant. Some of the affected sites were warmed by geothermal activity, and others were not. A search for the causative agent of SI, ocellate furcocercariae that have been found in Iceland only in Radix peregra snails, revealed an average infection prevalence of 1.4% (n = 12,432). Locally, infection rates commonly exceeded 6%, the highest value observed being 24.5%. A search for adult schistosomes in visceral organs and the nasal cavities of 110 water birds belonging to the orders Gaviiformes, Podicipediformes and Anseriformes revealed eggs, miracidia or adult stages of at least seven previously identifiable schistosome species in four anseriform bird species. A previously unknown species of schistosome, Allobilharzia visceralis, was detected in whooper swans (Cygnus cygnus), and classified in a new genus. In mallards (Anas platyrhynchos) a nasal Trichobilharzia sp. and the visceral schistosome T. franki were identified. In red-breasted merganser (Mergus serrator), distinct egg types belonging to two species of the genus Trichobilharzia have been found. In grey-lag goose (Anser anser) two different egg types were also found - a large Trichobilharzia sp. and small eggs of a Dendritobilharzia sp. Additionally, unidentified cercariae, probably belonging to a previously undescribed genus were detected in R. peregra in Oslandsstjörn. Taken together, the data obtained by morphological examination of eggs and recent DNA sequencing results, indicate that at least eight species of bird schistosomes occur in Iceland.

Antibody responses induced by Trichobilharzia regenti antigens in murine and human hosts exhibiting cercarial dermatitis

Cercariae of bird schistosomes (genus Trichobilharzia) are able to penetrate the skin of mammals (noncompatible hosts), including humans, and cause a Th2-associated inflammatory cutaneous reaction termed cercarial dermatitis. The present study measured the antibody reactivity and antigen specificity of sera obtained after experimental infection of mice and natural infection of humans. Sera from mice re-infected with T. regenti showed a bias towards the development of antigen-specific IgM and IgG1 antibodies and elevated levels of total serum IgE, indicative of a Th2 polarized immune response. We also demonstrate that cercariae are a source of antigens triggering IL-4 release from basophils collected from healthy human volunteers. Analysis of sera from patients with a history of cercarial dermatitis revealed elevated levels of cercarial-specific IgG, particularly for samples collected from adults (> 14 years old) compared with children (8-14 years old), although elevated levels of antigen-specific IgE were not detected. In terms of antigen recognition, IgG and IgE antibodies in the sera of both mice and humans preferentially bound an antigen of 34 kDa. The 34 kDa molecule was present in both homogenate of cercariae, as well as cercarial excretory/secretory products, and we speculate it may represent a major immunogen initiating the Th2-immune response associated with cercarial dermatitis.

The complete mitochondrial genome of the bird schistosome Trichobilharzia regenti (Platyhelminthes: Digenea), causative agent of cercarial dermatitis

The complete mitochondrial (mt) genome of the neuropathogenic bird schistosome Trichobilharzia regenti was fully sequenced in order to develop molecular markers for future diagnostic, molecular ecological, population, and phylogenetic studies. The genome was 14,838 bp in length, with a 68.4% AT bias in protein coding regions. A repeat element (3 x 184 bp) between trnV and trnW distinguished a single short noncoding region. As 9 of 14 genera of schistosomes parasitize birds, future characterization of their mt genomes is desirable for species-specific and strain- or population-specific diagnostic markers; this concerns not only the nasal representatives, e.g., T. regenti characterized in this study, but also numerous species within the predominant group of visceral (blood dwelling) bird schistosomes.

Comparison of cysteine peptidase activities inTrichobilharzia regentiandSchistosoma mansonicercariae

Cercariae of the bird schistosomeTrichobilharzia regentiand of the human schistosomeSchistosoma mansoniemploy proteases to invade the skin of their definitive hosts. To investigate whether a similar proteolytic mechanism is used by both species, cercarial extracts ofT. regentiandS. mansoniwere biochemically characterized, with the primary focus on cysteine peptidases. A similar pattern of cysteine peptidase activities was detected by zymography of cercarial extracts and their chromatographic fractions fromT. regentiandS. mansoni.The greatest peptidase activity was recorded in both species against the fluorogenic peptide substrate Z-Phe-Arg-AMC, commonly used to detect cathepsins B and L, and was markedly inhibited (>96%) by Z-Phe-Ala-CHN2at pH 4·5. Cysteine peptidases of 33 kDa and 33–34 kDa were identified in extracts ofT. regentiandS. mansonicercariae employing a biotinylated Clan CA cysteine peptidase-specific inhibitor (DCG-04). Finally, cercarial extracts from bothT. regentiandS. mansoniwere able to degrade native substrates present in skin (collagen II and IV, keratin) at physiological pH suggesting that cysteine peptidases are important in the pentration of host skin.

Human schistosomiasis

Schistosomiasis or bilharzia is a tropical disease caused by worms of the genus Schistosoma. The transmission cycle requires contamination of surface water by excreta, specific freshwater snails as intermediate hosts, and human water contact. The main disease-causing species are S haematobium, S mansoni, and S japonicum. According to WHO, 200 million people are infected worldwide, leading to the loss of 1.53 million disability-adjusted life years, although these figures need revision. Schistosomiasis is characterised by focal epidemiology and overdispersed population distribution, with higher infection rates in children than in adults. Complex immune mechanisms lead to the slow acquisition of immune resistance, though innate factors also play a part. Acute schistosomiasis, a feverish syndrome, is mostly seen in travellers after primary infection. Chronic schistosomal disease affects mainly individuals with long-standing infections in poor rural areas. Immunopathological reactions against schistosome eggs trapped in the tissues lead to inflammatory and obstructive disease in the urinary system (S haematobium) or intestinal disease, hepatosplenic inflammation, and liver fibrosis (S mansoni, S japonicum). The diagnostic standard is microscopic demonstration of eggs in the excreta. Praziquantel is the drug treatment of choice. Vaccines are not yet available. Great advances have been made in the control of the disease through population-based chemotherapy but these required political commitment and strong health systems.