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Naguib D, Gantois N, Desramaut J, Dominguez RG, Arafat N, Atwa SM, Even G, Devos DP, Certad G, Chabé M, Viscogliosi E. Large-Scale Molecular Epidemiological Survey of Blastocystis sp. among Herbivores in Egypt and Assessment of Potential Zoonotic Risk. Microorganisms 2024; 12:1286. [PMID: 39065057 PMCID: PMC11278737 DOI: 10.3390/microorganisms12071286] [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: 06/03/2024] [Revised: 06/13/2024] [Accepted: 06/24/2024] [Indexed: 07/28/2024] Open
Abstract
Given the proven zoonotic potential of the intestinal protozoan Blastocystis sp., a fast-growing number of surveys are being conducted to identify potential animal reservoirs for transmission of the parasite. Nevertheless, few epidemiological studies have been conducted on farmed animals in Egypt. Therefore, a total of 1089 fecal samples were collected from herbivores (sheep, goats, camels, horses, and rabbits) in six Egyptian governorates (Dakahlia, Gharbia, Kafr El Sheikh, Giza, Aswan, and Sharqia). Samples were screened for the presence of Blastocystis sp. by real-time PCR followed by sequencing of positive PCR products and phylogenetic analysis for subtyping of the isolates. Overall, Blastocystis sp. was identified in 37.6% of the samples, with significant differences in frequency between animal groups (sheep, 65.5%; camels, 62.2%; goats, 36.0%; rabbits, 10.1%; horses, 3.3%). Mixed infections were reported in 35.7% of the Blastocystis sp.-positive samples. A wide range of subtypes (STs) with varying frequency were identified from single infections in ruminants including sheep (ST1-ST3, ST5, ST10, ST14, ST21, ST24, ST26, and ST40), goats (ST1, ST3, ST5, ST10, ST26, ST40, ST43, and ST44), and camels (ST3, ST10, ST21, ST24-ST26, ST30, and ST44). Most of them overlapped across these animal groups, highlighting their adaptation to ruminant hosts. In other herbivores, only three and two STs were evidenced in rabbits (ST1-ST3) and horses (ST3 and ST44), respectively. The greater occurrence and wider genetic diversity of parasite isolates among ruminants, in contrast to other herbivores, strongly suggested that dietary habits likely played a significant role in influencing both the colonization rates of Blastocystis sp. and ST preference. Of all the isolates subtyped herein, 66.3% were reported as potentially zoonotic, emphasizing the significant role these animal groups may play in transmitting the parasite to humans. These findings also expand our knowledge on the prevalence, genetic diversity, host specificity, and zoonotic potential of Blastocystis sp. in herbivores.
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Affiliation(s)
- Doaa Naguib
- CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019—UMR 9017—CIIL—Centre d’Infection et d’Immunité de Lille, University of Lille, F-59000 Lille, France; (D.N.); (N.G.); (J.D.); (D.P.D.); (G.C.); (M.C.)
- Department of Hygiene and Zoonoses, Faculty of Veterinary Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Nausicaa Gantois
- CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019—UMR 9017—CIIL—Centre d’Infection et d’Immunité de Lille, University of Lille, F-59000 Lille, France; (D.N.); (N.G.); (J.D.); (D.P.D.); (G.C.); (M.C.)
| | - Jeremy Desramaut
- CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019—UMR 9017—CIIL—Centre d’Infection et d’Immunité de Lille, University of Lille, F-59000 Lille, France; (D.N.); (N.G.); (J.D.); (D.P.D.); (G.C.); (M.C.)
| | - Ruben Garcia Dominguez
- Centro Andaluz de Biología del Desarrollo, CSIC, Universidad Pablo de Olavide, 41013 Sevilla, Spain;
| | - Nagah Arafat
- Department of Poultry Diseases, Faculty of Veterinary Medicine, Mansoura University, Mansoura 35516, Egypt;
| | - Samar Magdy Atwa
- Department of Internal Medicine and Infectious Diseases, Faculty of Veterinary Medicine, Mansoura University, Mansoura 35516, Egypt;
- Department of Veterinary Clinical Sciences, Faculty of Veterinary Medicine, Jordan University of Science and Technology, Irbid P.O. Box 3030, Jordan
| | - Gaël Even
- GD Biotech—Gènes Diffusion, F-59000 Lille, France;
- PEGASE-Biosciences (Plateforme d’Expertises Génomiques Appliquées aux Sciences Expérimentales), Institut Pasteur de Lille, F-59000 Lille, France
| | - Damien Paul Devos
- CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019—UMR 9017—CIIL—Centre d’Infection et d’Immunité de Lille, University of Lille, F-59000 Lille, France; (D.N.); (N.G.); (J.D.); (D.P.D.); (G.C.); (M.C.)
- Centro Andaluz de Biología del Desarrollo, CSIC, Universidad Pablo de Olavide, 41013 Sevilla, Spain;
| | - Gabriela Certad
- CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019—UMR 9017—CIIL—Centre d’Infection et d’Immunité de Lille, University of Lille, F-59000 Lille, France; (D.N.); (N.G.); (J.D.); (D.P.D.); (G.C.); (M.C.)
- Délégation à la Recherche Clinique et à l’Innovation, Groupement des Hôpitaux de l’Institut Catholique de Lille, F-59000 Lille, France
| | - Magali Chabé
- CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019—UMR 9017—CIIL—Centre d’Infection et d’Immunité de Lille, University of Lille, F-59000 Lille, France; (D.N.); (N.G.); (J.D.); (D.P.D.); (G.C.); (M.C.)
| | - Eric Viscogliosi
- CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019—UMR 9017—CIIL—Centre d’Infection et d’Immunité de Lille, University of Lille, F-59000 Lille, France; (D.N.); (N.G.); (J.D.); (D.P.D.); (G.C.); (M.C.)
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Egan S, Barbosa AD, Feng Y, Xiao L, Ryan U. Rabbits as reservoirs: An updated perspective of the zoonotic risk from Cryptosporidium and Giardia. Vet Parasitol 2024; 327:110151. [PMID: 38422710 DOI: 10.1016/j.vetpar.2024.110151] [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: 10/30/2023] [Revised: 02/14/2024] [Accepted: 02/22/2024] [Indexed: 03/02/2024]
Abstract
Rabbits are highly abundant in many countries and can serve as reservoirs of diseases for a diversity of pathogens including the enteric protozoan parasites, Cryptosporidium and Giardia. Both parasites shed environmentally robust environmental stages (oo/cysts) and have been responsible for numerous waterborne outbreaks of diseases. Cryptosporidium hominis and C. parvum are responsible for most infections in humans, while Giardia duodenalis assemblages A and B, cause most human cases of giardiasis. Cryptosporidium cuniculus, the dominant species infecting rabbits, is the only spceies other than C. hominis and C. parvum to have caused a waterborne outbreak of gastritis, which occurred in the United Kingdom in 2008. This review examines the prevalence of Cryptosporidium and Giardia species in rabbits to better understand the public health risks of contamination of water sources with Cryptosporidium and Giardia oo/cysts from rabbits. Despite the abundance of C. cuniculus in rabbits, reports in humans are relatively rare, with the exception of the United Kingdom and New Zealand, and reports of C. cuniculus in humans from the United Kingdom have declined substantially since the 2008 outbreak. Subtyping of C. cuniculus has supported the potential for zoonotic transmission. Relatively few studies have been conducted on Giardia, but assemblage B dominates. However, improved typing methods are required to better understand the transmission dynamics of Giardia assemblages in rabbits. Similarly, it is not well understood if pet rabbits or contaminated water are the main source of C. cuniculus infections in humans. Well-planned studies using high-resolution typing tools are required to understand the transmission dynamics better and quantify the public health risk of Cryptosporidium and Giardia from rabbits.
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Affiliation(s)
- Siobhon Egan
- Harry Butler Institute, Vector- and Water-Borne Pathogen Research Group, Murdoch University, Murdoch, Western Australia 6150, Australia.
| | - Amanda D Barbosa
- Harry Butler Institute, Vector- and Water-Borne Pathogen Research Group, Murdoch University, Murdoch, Western Australia 6150, Australia; CAPES Foundation, Ministry of Education of Brazil, Brasilia DF 70040-020, Brazil
| | - Yaoyu Feng
- Guangdong Laboratory for Lingnan Modern Agriculture, Center for Emerging and Zoonotic Diseases, College of Veterinary Medicine, South China Agricultural University, Guangzhou 510642, China
| | - Lihua Xiao
- Guangdong Laboratory for Lingnan Modern Agriculture, Center for Emerging and Zoonotic Diseases, College of Veterinary Medicine, South China Agricultural University, Guangzhou 510642, China
| | - Una Ryan
- Harry Butler Institute, Vector- and Water-Borne Pathogen Research Group, Murdoch University, Murdoch, Western Australia 6150, Australia
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Ávalos G, Caballero-Gómez J, Matas-Méndez P, Castro-Scholten S, Jiménez-Martín D, Köster PC, Santín M, Bailo B, Cano-Terriza D, González-Barrio D, Mateo M, García-Bocanegra I, Dashti A, Nájera F, Carmena D. Detection and genotyping of zoonotic microsporidia in the endangered Iberian lynx (Lynx pardinus). Med Mycol 2024; 62:myae027. [PMID: 38499442 DOI: 10.1093/mmy/myae027] [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: 02/12/2024] [Revised: 03/12/2024] [Accepted: 03/15/2024] [Indexed: 03/20/2024] Open
Abstract
Microsporidia is a diverse group of obligate, intracellular, and spore-forming parasites that infect a wide range of animals. Among them, Enterocytozoon bieneusi and Encephalitozoon spp. are the most frequently reported species in humans. Limited information is available about the presence and molecular diversity of microsporidian species in the endangered Iberian lynx (Lynx pardinus). Presence of Enterocytozoon bieneusi and Encephalitozoon spp. was investigated by molecular methods in wild and captive Iberian lynxes from Spain. Overall, E. bieneusi was detected in 3.2% (8/251) of the animals examined. None of the samples tested were positive for Encephalitozoon spp. Four known (D, EbfelA, PigEBITS7, and Type IV) and a novel (named as LynxSpEb1) E. bieneusi genotypes were identified. All the genotypes found belonged to the zoonotic Group 1 of E. bieneusi. This study provides the first genotyping data of E. bieneusi in Iberian lynx in Spain. Our result indicate that the Iberian lynx does not seem to play a relevant role in the epidemiology of Encephalitozoon spp., and that this endangered felid is likely acting as spillover host rather than a true reservoir of E. bieneusi. Additional studies should be conducted to assess the impact of this parasite in the health status of the endangered Iberian lynx.
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Affiliation(s)
- Gabriel Ávalos
- Parasitology Reference and Research Laboratory, Spanish National Centre for Microbiology, Health Institute Carlos III, Majadahonda, Madrid, Spain
| | - Javier Caballero-Gómez
- Department of Animal Health, Animal Health and Zoonosis Research Group (GISAZ), UIC Zoonoses and Emerging Diseases (ENZOEM), University of Córdoba, Córdoba, Spain
- Infectious Diseases Unit, Maimonides Institute for Biomedical Research (IMIBIC), University Hospital Reina Sofía, University of Córdoba, Córdoba, Spain
- CIBERINFEC, ISCIII - CIBER Infectious Diseases, Health Institute Carlos III, Madrid, Spain
| | - Pablo Matas-Méndez
- Faculty of Veterinary, Alfonso X El Sabio University (UAX), Villanueva de la Cañada, Madrid, Spain
| | - Sabrina Castro-Scholten
- Department of Animal Health, Animal Health and Zoonosis Research Group (GISAZ), UIC Zoonoses and Emerging Diseases (ENZOEM), University of Córdoba, Córdoba, Spain
| | - Débora Jiménez-Martín
- Department of Animal Health, Animal Health and Zoonosis Research Group (GISAZ), UIC Zoonoses and Emerging Diseases (ENZOEM), University of Córdoba, Córdoba, Spain
| | - Pamela C Köster
- Parasitology Reference and Research Laboratory, Spanish National Centre for Microbiology, Health Institute Carlos III, Majadahonda, Madrid, Spain
- Women for Africa Foundation, Madrid, Spain
| | - Mónica Santín
- Environmental Microbial and Food Safety Laboratory, Agricultural Research Service, United States Department of Agriculture, Beltsville, MD, USA
| | - Begoña Bailo
- Parasitology Reference and Research Laboratory, Spanish National Centre for Microbiology, Health Institute Carlos III, Majadahonda, Madrid, Spain
| | - David Cano-Terriza
- Department of Animal Health, Animal Health and Zoonosis Research Group (GISAZ), UIC Zoonoses and Emerging Diseases (ENZOEM), University of Córdoba, Córdoba, Spain
- CIBERINFEC, ISCIII - CIBER Infectious Diseases, Health Institute Carlos III, Madrid, Spain
| | - David González-Barrio
- Parasitology Reference and Research Laboratory, Spanish National Centre for Microbiology, Health Institute Carlos III, Majadahonda, Madrid, Spain
| | - Marta Mateo
- Department of Microbiology and Parasitology, Faculty of Pharmacy, Complutense University of Madrid, Madrid, Spain
| | - Ignacio García-Bocanegra
- Department of Animal Health, Animal Health and Zoonosis Research Group (GISAZ), UIC Zoonoses and Emerging Diseases (ENZOEM), University of Córdoba, Córdoba, Spain
- CIBERINFEC, ISCIII - CIBER Infectious Diseases, Health Institute Carlos III, Madrid, Spain
| | - Alejandro Dashti
- Parasitology Reference and Research Laboratory, Spanish National Centre for Microbiology, Health Institute Carlos III, Majadahonda, Madrid, Spain
| | - Fernando Nájera
- Karen C. Drayer Wildlife Health Center, School of Veterinary Medicine, University of California, Davis, CA, USA
| | - David Carmena
- Parasitology Reference and Research Laboratory, Spanish National Centre for Microbiology, Health Institute Carlos III, Majadahonda, Madrid, Spain
- CIBERINFEC, ISCIII - CIBER Infectious Diseases, Health Institute Carlos III, Madrid, Spain
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Matas-Méndez P, Ávalos G, Caballero-Gómez J, Dashti A, Castro-Scholten S, Jiménez-Martín D, González-Barrio D, Muñoz-de-Mier GJ, Bailo B, Cano-Terriza D, Mateo M, Nájera F, Xiao L, Köster PC, García-Bocanegra I, Carmena D. Detection and Molecular Diversity of Cryptosporidium spp. and Giardia duodenalis in the Endangered Iberian Lynx ( Lynx pardinus), Spain. Animals (Basel) 2024; 14:340. [PMID: 38275800 PMCID: PMC10812403 DOI: 10.3390/ani14020340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/11/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
Cryptosporidium spp. and Giardia duodenalis are the main non-viral causes of diarrhoea in humans and domestic animals globally. Comparatively, much less information is currently available in free-ranging carnivore species in general and in the endangered Iberian lynx (Lynx pardinus) in particular. Cryptosporidium spp. and G. duodenalis were investigated with molecular (PCR and Sanger sequencing) methods in individual faecal DNA samples of free-ranging and captive Iberian lynxes from the main population nuclei in Spain. Overall, Cryptosporidium spp. and G. duodenalis were detected in 2.4% (6/251) and 27.9% (70/251) of the animals examined, respectively. Positive animals to at least one of them were detected in each of the analysed population nuclei. The analysis of partial ssu rRNA gene sequences revealed the presence of rodent-adapted C. alticolis (n = 1) and C. occultus (n = 1), leporid-adapted C. cuniculus (n = 2), and zoonotic C. parvum (n = 2) within Cryptosporidium, and zoonotic assemblages A (n = 5) and B (n = 3) within G. duodenalis. Subgenotyping analyses allowed for the identification of genotype VaA19 in C. cuniculus (gp60 locus) and sub-assemblages AI and BIII/BIV in G. duodenalis (gdh, bg, and tpi loci). This study represents the first molecular description of Cryptosporidium spp. and G. duodenalis in the Iberian lynx in Spain. The presence of rodent/leporid-adapted Cryptosporidium species in the surveyed animals suggests spurious infections associated to the Iberian lynx's diet. The Iberian lynx seems a suitable host for zoonotic genetic variants of Cryptosporidium (C. parvum) and G. duodenalis (assemblages A and B), although the potential risk of human transmission is regarded as limited due to light parasite burdens and suspected low excretion of infective (oo)cysts to the environment by infected animals. More research should be conducted to ascertain the true impact of these protozoan parasites in the health status of the endangered Iberian lynx.
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Affiliation(s)
- Pablo Matas-Méndez
- Faculty of Veterinary, Alfonso X El Sabio University (UAX), 28691 Villanueva de la Cañada, Spain;
| | - Gabriel Ávalos
- Parasitology Reference and Research Laboratory, Spanish National Centre for Microbiology, Health Institute Carlos III, 28220 Majadahonda, Spain; (G.Á.); (A.D.); (D.G.-B.); (B.B.); (D.C.)
| | - Javier Caballero-Gómez
- Department of Animal Health, Animal Health and Zoonosis Research Group (GISAZ), UIC Zoonoses and Emerging Diseases (ENZOEM), University of Córdoba, 14014 Córdoba, Spain; (S.C.-S.); (D.J.-M.); (D.C.-T.); (I.G.-B.)
- Infectious Diseases Unit, Maimonides Institute for Biomedical Research (IMIBIC), University Hospital Reina Sofía, University of Córdoba, 14004 Córdoba, Spain
- CIBERINFEC, ISCIII—CIBER Infectious Diseases, Health Institute Carlos III, 28029 Madrid, Spain
| | - Alejandro Dashti
- Parasitology Reference and Research Laboratory, Spanish National Centre for Microbiology, Health Institute Carlos III, 28220 Majadahonda, Spain; (G.Á.); (A.D.); (D.G.-B.); (B.B.); (D.C.)
| | - Sabrina Castro-Scholten
- Department of Animal Health, Animal Health and Zoonosis Research Group (GISAZ), UIC Zoonoses and Emerging Diseases (ENZOEM), University of Córdoba, 14014 Córdoba, Spain; (S.C.-S.); (D.J.-M.); (D.C.-T.); (I.G.-B.)
| | - Débora Jiménez-Martín
- Department of Animal Health, Animal Health and Zoonosis Research Group (GISAZ), UIC Zoonoses and Emerging Diseases (ENZOEM), University of Córdoba, 14014 Córdoba, Spain; (S.C.-S.); (D.J.-M.); (D.C.-T.); (I.G.-B.)
| | - David González-Barrio
- Parasitology Reference and Research Laboratory, Spanish National Centre for Microbiology, Health Institute Carlos III, 28220 Majadahonda, Spain; (G.Á.); (A.D.); (D.G.-B.); (B.B.); (D.C.)
| | - Gemma J. Muñoz-de-Mier
- Faculty of Health Sciences, Alfonso X El Sabio University (UAX), 28691 Villanueva de la Cañada, Spain;
| | - Begoña Bailo
- Parasitology Reference and Research Laboratory, Spanish National Centre for Microbiology, Health Institute Carlos III, 28220 Majadahonda, Spain; (G.Á.); (A.D.); (D.G.-B.); (B.B.); (D.C.)
| | - David Cano-Terriza
- Department of Animal Health, Animal Health and Zoonosis Research Group (GISAZ), UIC Zoonoses and Emerging Diseases (ENZOEM), University of Córdoba, 14014 Córdoba, Spain; (S.C.-S.); (D.J.-M.); (D.C.-T.); (I.G.-B.)
- CIBERINFEC, ISCIII—CIBER Infectious Diseases, Health Institute Carlos III, 28029 Madrid, Spain
| | - Marta Mateo
- Department of Microbiology and Parasitology, Faculty of Pharmacy, Complutense University of Madrid, 28040 Madrid, Spain;
| | - Fernando Nájera
- Karen C. Drayer Wildlife Health Center, School of Veterinary Medicine, University of California, Davis, CA 95616, USA;
| | - Lihua Xiao
- College of Veterinary Medicine, South China Agricultural University, Guangzhou 510642, China;
| | - Pamela C. Köster
- Parasitology Reference and Research Laboratory, Spanish National Centre for Microbiology, Health Institute Carlos III, 28220 Majadahonda, Spain; (G.Á.); (A.D.); (D.G.-B.); (B.B.); (D.C.)
- Faculty of Health Sciences, Alfonso X El Sabio University (UAX), 28691 Villanueva de la Cañada, Spain;
- Faculty of Medicine, Alfonso X El Sabio University (UAX), 28691 Villanueva de la Cañada, Spain
| | - Ignacio García-Bocanegra
- Department of Animal Health, Animal Health and Zoonosis Research Group (GISAZ), UIC Zoonoses and Emerging Diseases (ENZOEM), University of Córdoba, 14014 Córdoba, Spain; (S.C.-S.); (D.J.-M.); (D.C.-T.); (I.G.-B.)
- CIBERINFEC, ISCIII—CIBER Infectious Diseases, Health Institute Carlos III, 28029 Madrid, Spain
| | - David Carmena
- Parasitology Reference and Research Laboratory, Spanish National Centre for Microbiology, Health Institute Carlos III, 28220 Majadahonda, Spain; (G.Á.); (A.D.); (D.G.-B.); (B.B.); (D.C.)
- CIBERINFEC, ISCIII—CIBER Infectious Diseases, Health Institute Carlos III, 28029 Madrid, Spain
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Baz-González E, Abreu-Acosta N, Foronda P. High Prevalence of Microsporidia in the North African Hedgehog ( Atelerix algirus) in the Canary Islands, Spain. Animals (Basel) 2023; 13:1756. [PMID: 37889680 PMCID: PMC10251962 DOI: 10.3390/ani13111756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/16/2023] [Accepted: 05/23/2023] [Indexed: 10/29/2023] Open
Abstract
Microsporidia are unicellular eukaryotic obligate intracellular parasites with a wide range of hosts reported worldwide; however, little is known about the epidemiological data on microsporidia infection in animals from the Canary Islands. Since data on microsporidia infection in hedgehog species are scarce, the aim of this study was to analyze the presence and identity of microsporidia in a group of North African hedgehogs (Atelerix algirus) using microscopic and molecular methods. From December 2020 to September 2021, a total of 36 fecal samples were collected from naturally deceased hedgehogs from Tenerife and Gran Canaria. All samples showed spore-compatible structures (100%; 36/36) under microscopic analysis, of which 61.1% (22/36) were amplified via the nested-polymerase chain reaction (PCR) targeting the partial sequence of the 16S rRNA gene, the internal transcribed spacer (ITS) region, and the partial sequence of the 5.8S rRNA gene. After Sanger sequencing and ITS analysis, Enterocytozoon bieneusi was detected in 47.2% (17/36) of the samples, identifying two novel genotypes (AAE1 and AAE2), followed by the detection of an undetermined species in 8.3% (3/36) and Encephalitozoon cuniculi genotype I in 5.6% (2/36) of the samples. This study constitutes the first report of microsporidia species in Atelerix algirus worldwide, highlighting the high prevalence of zoonotic species.
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Affiliation(s)
- Edgar Baz-González
- Department Obstetricia y Ginecología, Pediatría, Medicina Preventiva y Salud Pública, Toxicología, Medicina Legal y Forense y Parasitología, Universidad de La Laguna (ULL), Avda. Astrofísico F. Sánchez s/n, 38203 San Cristóbal de La Laguna, Tenerife, Canary Islands, Spain;
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias (IUETSPC), Universidad de La Laguna (ULL), Avda. Astrofísico F. Sánchez s/n, 38203 San Cristóbal de La Laguna, Tenerife, Canary Islands, Spain;
- Programa de Doctorado en Ciencias Médicas y Farmacéuticas, Desarrollo y Calidad de Vida, Universidad de La Laguna (ULL), Avda. Astrofísico F. Sánchez s/n, 38203 San Cristóbal de La Laguna, Tenerife, Canary Islands, Spain
| | - Néstor Abreu-Acosta
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias (IUETSPC), Universidad de La Laguna (ULL), Avda. Astrofísico F. Sánchez s/n, 38203 San Cristóbal de La Laguna, Tenerife, Canary Islands, Spain;
- Nertalab S.L.U., 38001 Santa Cruz de Tenerife, Tenerife, Canary Islands, Spain
| | - Pilar Foronda
- Department Obstetricia y Ginecología, Pediatría, Medicina Preventiva y Salud Pública, Toxicología, Medicina Legal y Forense y Parasitología, Universidad de La Laguna (ULL), Avda. Astrofísico F. Sánchez s/n, 38203 San Cristóbal de La Laguna, Tenerife, Canary Islands, Spain;
- Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias (IUETSPC), Universidad de La Laguna (ULL), Avda. Astrofísico F. Sánchez s/n, 38203 San Cristóbal de La Laguna, Tenerife, Canary Islands, Spain;
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