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Hommes F, Dörre A, Behnke SC, Stark K, Faber M. Autochthonous and imported giardiasis cases: An analysis of two decades of national surveillance data, Germany, 2002 to 2021. Euro Surveill 2024; 29:2300509. [PMID: 38757286 PMCID: PMC11100295 DOI: 10.2807/1560-7917.es.2024.29.20.2300509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 02/18/2024] [Indexed: 05/18/2024] Open
Abstract
BackgroundGiardia duodenalis is a major cause of gastroenteritis globally, and is the most common food- and waterborne parasitic infection in Europe.AimTo describe the epidemiology of reported acute giardiasis cases in Germany and compare demographic and clinical characteristics between imported and autochthonous cases.MethodsWe conducted a descriptive analysis of giardiasis cases that fulfilled the national case definition and were reported between January 2002 and December 2021. We defined an imported case as having at least one place of exposure abroad in the 3-25 days before symptom onset. We analysed case numbers and incidence by age, sex, month reported and geographic region, both overall and stratified by autochthonous and imported cases.ResultsFrom 2002 to 2021, 72,318 giardiasis cases were reported in Germany, corresponding to a mean annual incidence of 4.4 per 100,000 population. Annual incidence gradually decreased since 2013, declining sharply during the COVID-19 pandemic in 2020-21. Of 69,345 cases reported between 2002 and 2019, 35% were imported. Incidence of autochthonous cases (overall yearly mean: 3.1/100,000) was highest in males and young children (< 5 years); imported cases were predominantly adults aged 20-39 years. We identified seasonal patterns for imported and autochthonous cases.ConclusionsGiardiasis in Germany is typically assumed to be imported. Our data, however, underline the importance of autochthonous giardiasis. Travel advice might reduce imported infections, but prevention strategies for autochthonous infections are less clear. Dietary, behavioural and environmental risk factors need to be further investigated to enhance infection prevention measures for autochthonous giardiasis.
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Affiliation(s)
- Franziska Hommes
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
- Postgraduate Training for Applied Epidemiology (PAE), Robert Koch Institute, Berlin, Germany
- ECDC Fellowship Programme, Field Epidemiology path (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Achim Dörre
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
- Postgraduate Training for Applied Epidemiology (PAE), Robert Koch Institute, Berlin, Germany
| | - Susanne C Behnke
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Klaus Stark
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Mirko Faber
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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Kanski S, Weber K, Busch K. [Feline and canine giardiosis: An Update]. TIERARZTLICHE PRAXIS. AUSGABE K, KLEINTIERE/HEIMTIERE 2023; 51:411-421. [PMID: 38056479 DOI: 10.1055/a-2191-1723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
Giardia duodenalis is a facultative pathogenic intestinal parasite. Giardiosis in dogs and cats may appear with or without clinical signs. Typical signs include diarrhea with or without vomiting. The prevalence in young animals is high and may amount to up to 50%. There are 8 different genotypes (A - H), which are called assemblages. Assemblages C and D are most common in dogs and assemblage F most frequent in cats. However, animals may also be infected with the zoonotically effective assemblages A and B or exhibit mixed infections. The immunofluorescence test (IFA), the enzyme-linked immunosorbent assay (ELISA) and fecal centrifugation using zinc sulphate solution are currently recommended as diagnostic methods. Polymerase chain reaction (PCR) may be used to determine the corresponding assemblage. Approved treatments for giardiosis include fenbendazole and metronidazole. In addition, undertaking specific hygiene measures is warranted. Only animals showing clinical signs or those living in the same household with high-risk patients (e. g. immunosuppressed humans) are recommended to receive medication. The aim of treatment is clinical improvement of the diseased dogs and cats. Frequently, complete elimination of Giardia is not attained.
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Affiliation(s)
- Sabrina Kanski
- Medizinische Kleintierklinik, Ludwig-Maximilians-Universität München
| | - Karin Weber
- Medizinische Kleintierklinik, Ludwig-Maximilians-Universität München
| | - Kathrin Busch
- Medizinische Kleintierklinik, Ludwig-Maximilians-Universität München
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Richardson D, Pakianathan M, Ewens M, Mitchell H, Mohammed H, Wiseman E, Tweed M, Nichols K, Rawdah W, Cooper R, Macrowan R, Irish M, Evans A, Godbole G. British Association of Sexual Health and HIV (BASHH) United Kingdom national guideline for the management of sexually transmitted enteric infections 2023. Int J STD AIDS 2023:9564624231168217. [PMID: 37247427 DOI: 10.1177/09564624231168217] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This is the first British Association of Sexual Health and HIV (BASHH) national guideline for the management of sexually transmitted enteric infections (STEI). This guideline is primarily aimed for level 3 sexual health clinics; however, it may also be applicable to other settings such as primary care or other hospital departments where individuals with STEI may present. This guideline makes recommendations on testing, management, partner notification and public health control of STEI.
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Affiliation(s)
- Daniel Richardson
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
- Brighton & Sussex Medical School, Brighton, UK
| | | | | | | | | | | | | | | | - Waseem Rawdah
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Richard Cooper
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | | | | | - Amy Evans
- University Hospitals Sussex NHS Foundation Trust, Brighton, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Anisuzzaman, Hossain MS, Hatta T, Labony SS, Kwofie KD, Kawada H, Tsuji N, Alim MA. Food- and vector-borne parasitic zoonoses: Global burden and impacts. ADVANCES IN PARASITOLOGY 2023; 120:87-136. [PMID: 36948728 DOI: 10.1016/bs.apar.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Around 25% of the global population suffer from one or more parasitic infections, of which food- and vector-borne parasitic zoonotic diseases are a major concern. Additionally, zoonoses and communicable diseases, common to man and animals, are drawing increased attention worldwide. Significant changes in climatic conditions, cropping pattern, demography, food habits, increasing international travel, marketing and trade, deforestation, and urbanization play vital roles in the emergence and re-emergence of parasitic zoonoses. Although it is likely to be underestimated, the collective burden of food- and vector-borne parasitic diseases accounts for ∼60 million disability-adjusted life years (DALYs). Out of 20 neglected tropical diseases (NTDs) listed by the World Health Organization (WHO) and the Centres for Disease Control and Prevention (CDC), 13 diseases are of parasitic origin. There are about 200 zoonotic diseases of which the WHO listed eight as neglected zoonotic diseases (NZDs) in the year 2013. Out of these eight NZDs, four diseases, namely cysticercosis, hydatidosis, leishmaniasis, and trypanosomiasis, are caused by parasites. In this review, we discuss the global burden and impacts of food- and vector-borne zoonotic parasitic diseases.
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Affiliation(s)
- Anisuzzaman
- Department of Parasitology, Faculty of Veterinary Science, Bangladesh Agricultural University, Mymensingh, Bangladesh.
| | - Md Shahadat Hossain
- Department of Parasitology, Faculty of Veterinary Science, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Takeshi Hatta
- Department of Parasitology and Tropical Medicine, Kitasato University School of Medicine, Minami, Sagamihara, Kanagawa, Japan
| | - Sharmin Shahid Labony
- Department of Parasitology, Faculty of Veterinary Science, Bangladesh Agricultural University, Mymensingh, Bangladesh
| | - Kofi Dadzie Kwofie
- Department of Parasitology and Tropical Medicine, Kitasato University School of Medicine, Minami, Sagamihara, Kanagawa, Japan; Department of Parasitology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Hayato Kawada
- Department of Parasitology and Tropical Medicine, Kitasato University School of Medicine, Minami, Sagamihara, Kanagawa, Japan
| | - Naotoshi Tsuji
- Department of Parasitology and Tropical Medicine, Kitasato University School of Medicine, Minami, Sagamihara, Kanagawa, Japan.
| | - Md Abdul Alim
- Department of Parasitology, Faculty of Veterinary Science, Bangladesh Agricultural University, Mymensingh, Bangladesh
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Popruk S, Abu A, Ampawong S, Thiangtrongjit T, Tipthara P, Tarning J, Sreesai S, Reamtong O. Mass Spectrometry-Based Metabolomics Revealed Effects of Metronidazole on Giardia duodenalis. Pharmaceuticals (Basel) 2023; 16:ph16030408. [PMID: 36986506 PMCID: PMC10052756 DOI: 10.3390/ph16030408] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/22/2023] [Accepted: 03/02/2023] [Indexed: 03/30/2023] Open
Abstract
Giardia duodenalis is a significant protozoan that affects humans and animals. An estimated 280 million G. duodenalis diarrheal cases are recorded annually. Pharmacological therapy is crucial for controlling giardiasis. Metronidazole is the first-line therapy for treating giardiasis. Several metronidazole targets have been proposed. However, the downstream signaling pathways of these targets with respect to their antigiardial action are unclear. In addition, several giardiasis cases have demonstrated treatment failures and drug resistance. Therefore, the development of novel drugs is an urgent need. In this study, we performed a mass spectrometry-based metabolomics study to understand the systemic effects of metronidazole in G. duodenalis. A thorough analysis of metronidazole processes helps identify potential molecular pathways essential for parasite survival. The results demonstrated 350 altered metabolites after exposure to metronidazole. Squamosinin A and N-(2-hydroxyethyl)hexacosanamide were the most up-regulated and down-regulated metabolites, respectively. Proteasome and glycerophospholipid metabolisms demonstrated significant differential pathways. Comparing glycerophospholipid metabolisms of G. duodenalis and humans, the parasite glycerophosphodiester phosphodiesterase was distinct from humans. This protein is considered a potential drug target for treating giardiasis. This study improved our understanding of the effects of metronidazole and identified new potential therapeutic targets for future drug development.
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Affiliation(s)
- Supaluk Popruk
- Department of Protozoology, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Amanee Abu
- Department of Protozoology, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Sumate Ampawong
- Department of Tropical Pathology, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Tipparat Thiangtrongjit
- Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Phornpimon Tipthara
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Joel Tarning
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford OX1 4BH, UK
| | - Suthasinee Sreesai
- Central Equipment Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Onrapak Reamtong
- Department of Molecular Tropical Medicine and Genetics, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
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Asiimwe D, Bangi I, Esanyu J, Ojok D, Okot B, Olong C, Wagubi R, Kisembo G, Sempijja F, Muwanguzi E, Okongo B. Association Between Helicobacter pylori Infection and Anemia Among Adult Dyspeptic Patients Attending Kiryandongo General Hospital, Uganda. J Blood Med 2023; 14:57-66. [PMID: 36718427 PMCID: PMC9883989 DOI: 10.2147/jbm.s392146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/06/2023] [Indexed: 01/25/2023] Open
Abstract
Purpose To determine the prevalence of anemia and its association with Helicobacter pylori infection among adult dyspeptic patients. Patients and Methods A cross-sectional study was conducted among 283 dyspeptic patients at Kiryandongo General Hospital, in Uganda. A structured questionnaire was administered to capture demographic and clinical characteristics of study participants. Four milliliters of blood were then collected into an EDTA vacutainer for Complete Blood Count (CBC) and analyzed using HUMA COUNT 30TS, and peripheral blood smears were made and stained using Giemsa stain. Anemia was defined as hemoglobin levels <12g/dl in females and <13g/dl in men according to the World Health Organization (WHO). Helicobacter pylori (H. pylori) stool antigen test was performed using Whole power H. pylori Ag rapid test device, and saline stool preparation was examined for intestinal parasites. Chi-squared test and Logistic regression were performed to determine association, and a p-value of ≤0.05 was considered statistically significant. Results The overall prevalence of Helicobacter pylori infection was 42.4% (120/283). The prevalence of anemia among H. pylori-infected patients was 25.8% (31/120) and 15.3% (25/163) among H. pylori-negative counterparts. H. pylori infection was significantly associated with anemia (p-value 0.042), age (p-value 0.02, 0.009), water sources (p-value 0.0049,) and intestinal parasitic infestation (p-value 0.02), respectively. Conclusion This study has shown that the prevalence of H. pylori infection and anemia is high among dyspeptic patients at Kiryandongo General Hospital. H. pylori infection was found associated with anemia, age, water sources, and intestinal parasitic infestation. Routine screening of anemia in H. pylori-infected individuals and further studies to explore the relationship between anemia and H. pylori disease is highly recommended.
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Affiliation(s)
- Daisy Asiimwe
- Department of Medical Laboratory Science, Mbarara University of Science and Technology, Mbarara City, Uganda
| | - Isaac Bangi
- Department of Medical Laboratory Science, Mbarara University of Science and Technology, Mbarara City, Uganda
| | - Jospeh Esanyu
- Department of Medical Laboratory Science, Mbarara University of Science and Technology, Mbarara City, Uganda
| | - Daniel Ojok
- Department of Medical Laboratory Science, Mbarara University of Science and Technology, Mbarara City, Uganda
| | - Benedict Okot
- Department of Medical Laboratory Science, Mbarara University of Science and Technology, Mbarara City, Uganda
| | - Clinton Olong
- Department of Medical Laboratory Science, Mbarara University of Science and Technology, Mbarara City, Uganda
| | - Robert Wagubi
- Department of Medical Laboratory Science, Mbarara University of Science and Technology, Mbarara City, Uganda
| | - Godfrey Kisembo
- Department of Hospital Administration, Kiryandongo General Hospital, Kiryandongo, Uganda
| | - Fred Sempijja
- Department of Medical Laboratory Technology, Uganda Institute of Allied Health and Management Sciences - Mulago, Kampala City, Uganda
| | - Enoch Muwanguzi
- Department of Medical Laboratory Science, Mbarara University of Science and Technology, Mbarara City, Uganda
| | - Benson Okongo
- Department of Medical Laboratory Science, Mbarara University of Science and Technology, Mbarara City, Uganda,Correspondence: Benson Okongo, Department of Medical Laboratory Science, Mbarara University of Science and Technology, P.O. BOX 1410, Mbarara City, Uganda, Tel +256 778 557 867, Fax +256-485-20782, Email
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7
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Zajaczkowski P, Lee R, Fletcher-Lartey SM, Alexander K, Mahimbo A, Stark D, Ellis JT. The controversies surrounding Giardia intestinalis assemblages A and B. CURRENT RESEARCH IN PARASITOLOGY & VECTOR-BORNE DISEASES 2022; 1:100055. [PMID: 35284870 PMCID: PMC8906113 DOI: 10.1016/j.crpvbd.2021.100055] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 10/09/2021] [Indexed: 11/27/2022]
Abstract
Giardia intestinalis continues to be one of the most encountered parasitic diseases around the world. Although more frequently detected in developing countries, Giardia infections nonetheless pose significant public health problems in developed countries as well. Molecular characterisation of Giardia isolates from humans and animals reveals that there are two genetically different assemblages (known as assemblage A and B) that cause human infections. However, the current molecular assays used to genotype G. intestinalis isolates are quite controversial. This is in part due to a complex phenomenon where assemblages are incorrectly typed and underreported depending on which targeted locus is sequenced. In this review, we outline current knowledge based on molecular epidemiological studies and raise questions as to the reliability of current genotyping assays and a lack of a globally accepted method. Additionally, we discuss the clinical symptoms caused by G. intestinalis infection and how these symptoms vary depending on the assemblage infecting an individual. We also introduce the host-parasite factors that play a role in the subsequent clinical presentation of an infected person, and explore which assemblages are most seen globally.
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Affiliation(s)
- Patricia Zajaczkowski
- Faculty of Science, School of Life Sciences, University of Technology Sydney, Australia
| | - Rogan Lee
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, Westmead Hospital, Westmead, New South Wales, Australia.,Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead Hospital, Westmead, NSW, Australia
| | | | - Kate Alexander
- Public Health Unit, South Western Sydney Local Health District, Liverpool, Australia
| | - Abela Mahimbo
- Faculty of Health, School of Public Health, University of Technology Sydney, Australia
| | - Damien Stark
- Department of Microbiology, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia
| | - John T Ellis
- Faculty of Science, School of Life Sciences, University of Technology Sydney, Australia
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Krumrie S, Capewell P, Smith-Palmer A, Mellor D, Weir W, Alexander CL. A scoping review of risk factors and transmission routes associated with human giardiasis outbreaks in high-income settings. CURRENT RESEARCH IN PARASITOLOGY & VECTOR-BORNE DISEASES 2022; 2:100084. [PMID: 36589877 PMCID: PMC9795371 DOI: 10.1016/j.crpvbd.2022.100084] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/04/2022] [Accepted: 02/16/2022] [Indexed: 01/04/2023]
Abstract
The flagellated pathogen Giardia duodenalis is one of the leading causes of parasitic gastrointestinal illness worldwide. In many higher income countries, such as the United Kingdom, the disease is often perceived as being travel-related, likely leading to the under-reporting of sporadic cases and outbreaks. A summary of the literature describing outbreaks and risk factors in higher income countries is necessary to improve our understanding of this pathogen and identify existing knowledge gaps. Initial literature searches were carried out in September 2016 and updated at regular intervals until November 2021, using appropriate search terms in Medline, Embase and PubMed databases. A total of 75 papers met the inclusion criteria, revealing that the consumption of contaminated water and contact with young children of diaper-wearing age were the most common transmission routes leading to outbreaks of giardiasis. Of the ten studies where food was primarily associated with outbreaks, food handlers accounted for eight of these. Another reported transmission route was direct contact with fecal material, which was reported in six studies as the primary transmission route. Travel-associated giardiasis was considered the sole transmission route in two studies, whereas multiple transmission routes contributed to giardiasis outbreaks in eleven studies. The evidence around zoonotic transmission was less clear and hampered by the lack of robust and regularly applied parasite molecular typing techniques. This literature review summarizes the findings of Giardia outbreak investigations and epidemiological studies in high-income countries. Transmission routes are identified and discussed to highlight the associated risk factors. These data also indicate gaps in our current knowledge that include the need for robust, in-depth molecular studies and have underscored the importance of water as a transmission route for Giardia cysts. These future molecular studies will improve our understanding of Giardia epidemiology and transmission pathways in higher income countries to prevent spread of this significantly under-reported pathogen.
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Affiliation(s)
- Sarah Krumrie
- University of Glasgow School of Veterinary Medicine, 464 Bearsden Road, Glasgow, G61 1QH, UK
- Corresponding author. University of Glasgow School of Veterinary Medicine, 464 Bearsden Road, Glasgow, G61 1QH, UK.
| | - Paul Capewell
- University of Glasgow School of Veterinary Medicine, 464 Bearsden Road, Glasgow, G61 1QH, UK
- BioClavis Ltd, Queen Elizabeth Teaching and Learning Centre, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - Alison Smith-Palmer
- Gastrointestinal and Zoonoses Team, Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, UK
| | - Dominic Mellor
- University of Glasgow School of Veterinary Medicine, 464 Bearsden Road, Glasgow, G61 1QH, UK
- Gastrointestinal and Zoonoses Team, Public Health Scotland, Meridian Court, 5 Cadogan Street, Glasgow, G2 6QE, UK
| | - Willie Weir
- University of Glasgow School of Veterinary Medicine, 464 Bearsden Road, Glasgow, G61 1QH, UK
| | - Claire L. Alexander
- Scottish Microbiology Reference Laboratories, New Lister Building, 10-16 Alexandria Parade, Glasgow Royal Infirmary, Glasgow, G31 2ER, UK
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Rahal A, Sharma DK, Kumar A, Sharma N, Dayal D. In silico to In vivo development of a polyherbal against Haemonchus contortus. Heliyon 2022; 8:e08789. [PMID: 35106389 PMCID: PMC8789534 DOI: 10.1016/j.heliyon.2022.e08789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/09/2021] [Accepted: 01/13/2022] [Indexed: 10/25/2022] Open
Abstract
Haemonchus contortus is a major constraint in the development of small ruminant subsector due to significant production losses incurred by it. The present study explores the antiparasitic potential of three anthelmintic plants (Butea monosperma, Vitex negundo and Catharanthus roseus (L.) G.Don) against H. contortus taking albendazole as the standard. In silico molecular docking and pharmacokinetic prediction studies were conducted with known bioactive molecules of these plants (palasonin, vinblastine, vincristine, betulinic acid and ursolic acid) against Glutamate Dehydrogenase (GDH) and tubulin molecules of the parasite. Methanolic extracts of these herbs were fractionated (hexane, ethyl acetate, chloroform and methanol) and used in in vitro larvicidal studies. Based on the in vitro data, two herbal prototypes were developed and clinically tested. All the 5 ligand molecules showed better binding affnity for GDH and tubulin protein as compared with albendazole and shared similar binding site in the core of the GDH hexamer with slight variations. Albendazole approximately stacked against GLY190A residue, showing hydrophobic interactions with PRO157A and a Pi-cation electrostatic interaction with ARG390 along with four hydrogen bonds. Vincristine formed 2 pi-anionic electrostatic bonds with ASP158 of B and C subunits alongwith hydrogen bonding and hydrophobic interaction and an additional pi-anion electrostatic interaction at ASP158A for vinblastine. Albendazole bound to α-tubulin next to colchicine site whereas vinblastine is bound at the nearby laulimalide/peloruside site of the dimer. Betulinic acid showed lateral interaction between the H2-H3 loop of one alpha subunit and H10 of the adjacent alpha subunit of two tubulin dimers. Ursolic acid and palasonin bound at the intradimer N site of microtubulin involving the H1-H7 and H1-H2 zone, respectively. The in vitro studies demonstrated good dose dependent anthelmintic potential. Both the prototypes were quite efficacious in clearing the infection, keeping it to a minimal for more than 5 months, probably, through direct anthelmintic effect through GDH, tubulin depolymerization and uncoupling as well as indirectly through immunomodulation along with antioxidant and anti-inflammatory properties.
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Affiliation(s)
- Anu Rahal
- Division of Animal Health, ICAR-Central Institute for Research on Goats, Makhdoom, Farah, Mathura, 281122, UP, India
| | - D K Sharma
- Division of Animal Health, ICAR-Central Institute for Research on Goats, Makhdoom, Farah, Mathura, 281122, UP, India
| | - Ashok Kumar
- Division of Animal Health, ICAR-Central Institute for Research on Goats, Makhdoom, Farah, Mathura, 281122, UP, India
| | - Nitika Sharma
- Division of Animal Health, ICAR-Central Institute for Research on Goats, Makhdoom, Farah, Mathura, 281122, UP, India
| | - Deen Dayal
- Division of Animal Health, ICAR-Central Institute for Research on Goats, Makhdoom, Farah, Mathura, 281122, UP, India
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Dual intestinal parasitosis unmasked by treatment for gastrointestinal sarcoidosis. IDCases 2021; 26:e01334. [PMID: 34815939 PMCID: PMC8592863 DOI: 10.1016/j.idcr.2021.e01334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/06/2021] [Accepted: 11/07/2021] [Indexed: 02/07/2023] Open
Abstract
The symptoms and complications of intestinal parasitosis can occur with long-term corticosteroid therapy. We highlight the case of a young man who developed chronic gastrointestinal (GI) symptoms of diarrhea, crampy abdominal pain, and vomiting while on treatment for multisystemic sarcoidosis with corticosteroids. His symptoms were initially thought to be related to the gastrointestinal manifestations of sarcoidosis, but further evaluation revealed a combined case of intestinal strongyloidiasis and giardiasis as well as previously undiagnosed human T-cell lymphotropic virus (HTLV -1) infection. This distinctive case of dual intestinal parasitosis highlights the need for clinicians to maintain a high level of awareness to screen for intestinal parasites, particularly Strongyloides when prescribing corticosteroids in the long term given the potential risk of hyperinfection in the setting of immunosuppression..
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Prevalence and Associated Risk Factors of Intestinal Parasitic Infections among Pregnant Women Attending Antenatal Care in Yifag Health Center, Northwest Ethiopia. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2021; 2021:7291199. [PMID: 34721748 PMCID: PMC8553486 DOI: 10.1155/2021/7291199] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/12/2021] [Indexed: 01/20/2023]
Abstract
Background A cross-sectional study was conducted from November 2019 to March 2020 to determine the prevalence and associated risk factors of intestinal parasitic infections (IPIs) among pregnant women attending antenatal care (ANC) at Yifag Health Center. Methods The data were collected by a questionnaire interview technique and collecting the stool samples from each pregnant woman. Wet-mount and formol-ether concentration techniques were applied to identify the IPIs. Data were analyzed using SPSS, version 25, and P-values < 0.05 were considered statistically significant. Results Out of the total 280 pregnant women who were selected using a simple random sampling technique, 277 participated in the questionnaire survey and gave stool samples (a response rate of 98.9%). The prevalence of IPIs among pregnant women was 53.4% (95% CI: 47.37, 59.42). Taenia species (18.1%) was the predominant parasite followed by Giardia lamblia (12.6%), Entamoeba histolytica/dispar (9.4%), hookworms (9%), Ascaris lumbricoides (4%), Schistosoma mansoni (3.2%), Hymenolepis nana (0.7%), Strongyloides stercoralis (0.4%), and Enterobius vermicularis (0.4%). Eating raw vegetables (AOR = 2.721; 95% CI: 1.266, 5.849; P=0.010) and poor personal hygiene (AOR = 4.015; 95% CI: 1.456, 11.07; P=0.007) were associated risk factors for G. lamblia, while eating raw meat (AOR = 2.477; 95% CI: 1.252, 4.902; P=0.009) for Taenia species infections. The prevalence of intestinal parasites was high and still a health burden to the pregnant women in the study area. We recommend avoiding eating raw meat, strengthening sanitation and hygiene programs, and routine deworming of pregnant mothers to reduce the burden of IPIs among pregnant women.
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Risk factors for and management of metronidazole-refractory giardiasis in international travellers: A retrospective analysis. Travel Med Infect Dis 2021; 43:102090. [PMID: 34082086 DOI: 10.1016/j.tmaid.2021.102090] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 04/14/2021] [Accepted: 05/25/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Giardia lamblia is a common cause of diarrhoea in returning travellers. Failure of the recommended first-line treatment, metronidazole, has frequently been observed. Recommendations for treatment of metronidazole-refractory giardiasis lack clarity and evidence. METHODS We conducted a retrospective data analysis of returned travellers with confirmed giardiasis at the Bernhard-Nocht-Clinic in Hamburg, Germany, between 2007 and 2016. RESULTS We identified 339 cases of giardiasis, mostly acquired in South Asia (n = 157). 308 patients received metronidazole as first-line treatment, leading to treatment failure in 93 cases. Statistical analysis suggested by far the highest risk of metronidazole treatment failure for travellers returning from South Asia (Odds Ratio 8.73). Second-line therapy consisted of various different therapy regimens. Combination therapy as second-line treatment seemed to be more effective than monotherapy. A repeat course of metronidazole proved to be futile. CONCLUSION This study reveals a strikingly low effectiveness of metronidazole, especially in patients returning from South Asia. Second-line treatment showed inconsistency of regimens and yielded unsatisfactory results. These findings require reconsideration of treatment strategies for giardiasis. Large prospective trials are urgently needed to assess new first-line treatment options and to help implement advice for effective, agreed second-line treatment strategies. Translational projects should be created to link the understanding of resistance mechanisms with epidemiological data and clinical outcome.
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Woschke A, Faber M, Stark K, Holtfreter M, Mockenhaupt F, Richter J, Regnath T, Sobottka I, Reiter-Owona I, Diefenbach A, Gosten-Heinrich P, Friesen J, Ignatius R, Aebischer T, Klotz C. Suitability of current typing procedures to identify epidemiologically linked human Giardia duodenalis isolates. PLoS Negl Trop Dis 2021; 15:e0009277. [PMID: 33764999 PMCID: PMC8023459 DOI: 10.1371/journal.pntd.0009277] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 04/06/2021] [Accepted: 02/26/2021] [Indexed: 12/26/2022] Open
Abstract
Background Giardia duodenalis is a leading cause of gastroenteritis worldwide. Humans are mainly infected by two different subtypes, i.e., assemblage A and B. Genotyping is hampered by allelic sequence heterozygosity (ASH) mainly in assemblage B, and by occurrence of mixed infections. Here we assessed the suitability of current genotyping protocols of G. duodenalis for epidemiological applications such as molecular tracing of transmission chains. Methodology/Principal findings Two G. duodenalis isolate collections, from an outpatient tropical medicine clinic and from several primary care laboratories, were characterized by assemblage-specific qPCR (TIF, CATH gene loci) and a common multi locus sequence typing (MLST; TPI, BG, GDH gene loci). Assemblage A isolates were further typed at additional loci (HCMP22547, CID1, RHP26, HCMP6372, DIS3, NEK15411). Of 175/202 (86.6%) patients the G. duodenalis assemblage could be identified: Assemblages A 25/175 (14.3%), B 115/175 (65.7%) and A+B mixed 35/175 (20.0%). By incorporating allelic sequence heterozygosity in the analysis, the three marker MLST correctly identified 6/9 (66,7%) and 4/5 (80.0%) consecutive samples from chronic assemblage B infections in the two collections, respectively, and identified a cluster of five independent patients carrying assemblage B parasites of identical MLST type. Extended MLST for assemblage A altogether identified 5/6 (83,3%) consecutive samples from chronic assemblage A infections and 15 novel genotypes. Based on the observed A+B mixed infections it is estimated that only 75% and 50% of assemblage A or B only cases represent single strain infections, respectively. We demonstrate that typing results are consistent with this prediction. Conclusions/Significance Typing of assemblage A and B isolates with resolution for epidemiological applications is possible but requires separate genotyping protocols. The high frequency of multiple infections and their impact on typing results are findings with immediate consequences for result interpretation in this field. Giardia duodenalis is a leading cause of gastroenteritis worldwide. Humans are mainly infected by the two different genetic subtypes, assemblage A and B. Molecular typing tools for epidemiological applications such as tracking transmission, attribution to a source and outbreak investigations have been developed and are highly desirable. However, to what degree the tetraploid genome with allelic sequence heterogeneity (ASH), and the frequent occurrence of mixed, assemblage A and B infections hamper performance is unclear. Here, we assessed the suitability of current genotyping protocols for deciphering the molecular epidemiology of G. duodenalis. Against a common reporting bias, we incorporated ASH in the analysis and we show that typing with resolution for epidemiological applications is possible for both, assemblage A and B isolates, but requires separate protocols. We also demonstrate how the high frequency of multiple infections overall impacts on typing results, which has immediate consequences for result interpretation in this field.
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Affiliation(s)
- Andreas Woschke
- Department of Infectious Diseases, Unit for Mycotic and Parasitic Agents and Mycobacteria, Robert Koch Institute, Berlin, Germany
- Laboratory of Innate Immunity, Institute of Microbiology, Infectious Diseases and Immunology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | - Mirko Faber
- Department for Infectious Disease Epidemiology, Gastrointestinal Infections, Zoonoses and Tropical Infections Unit, Robert Koch Institute, Berlin, Germany
| | - Klaus Stark
- Department for Infectious Disease Epidemiology, Gastrointestinal Infections, Zoonoses and Tropical Infections Unit, Robert Koch Institute, Berlin, Germany
| | - Martha Holtfreter
- Department of Gastroenterology, Hepatology and Infectiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Frank Mockenhaupt
- Institute of Tropical Medicine and International Health, Charité University Medicine and Berlin Institute of Health, Corporate member of Free University Berlin and Humboldt University Berlin, Berlin, Germany
| | - Joachim Richter
- Department of Gastroenterology, Hepatology and Infectiology, University Hospital Düsseldorf, Düsseldorf, Germany
- Institute of Tropical Medicine and International Health, Charité University Medicine and Berlin Institute of Health, Corporate member of Free University Berlin and Humboldt University Berlin, Berlin, Germany
| | | | - Ingo Sobottka
- LADR GmbH, Medizinisches Versorgungszentrum, Geesthacht, Germany
| | - Ingrid Reiter-Owona
- Institute of Medical Microbiology, Immunology and Parasitology (IMMIP), University Clinic Bonn, Germany
| | - Andreas Diefenbach
- Laboratory of Innate Immunity, Institute of Microbiology, Infectious Diseases and Immunology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
- Department of Microbiology and Hygiene, Labor Berlin, Charité - Vivantes GmbH, Berlin, Germany
| | - Petra Gosten-Heinrich
- Department of Infectious Diseases, Unit for Mycotic and Parasitic Agents and Mycobacteria, Robert Koch Institute, Berlin, Germany
| | | | - Ralf Ignatius
- Laboratory of Innate Immunity, Institute of Microbiology, Infectious Diseases and Immunology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
- MVZ Labor 28, Berlin, Germany
| | - Toni Aebischer
- Department of Infectious Diseases, Unit for Mycotic and Parasitic Agents and Mycobacteria, Robert Koch Institute, Berlin, Germany
| | - Christian Klotz
- Department of Infectious Diseases, Unit for Mycotic and Parasitic Agents and Mycobacteria, Robert Koch Institute, Berlin, Germany
- * E-mail:
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Rare infectious complication following simultaneous pancreas-kidney transplantation: A case report. CLINICAL INFECTION IN PRACTICE 2020. [DOI: 10.1016/j.clinpr.2020.100027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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15
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Han M, Xiao S, An W, Sang C, Li H, Ma J, Yang M. Co-infection risk assessment of Giardia and Cryptosporidium with HIV considering synergistic effects and age sensitivity using disability-adjusted life years. WATER RESEARCH 2020; 175:115698. [PMID: 32220670 DOI: 10.1016/j.watres.2020.115698] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 02/29/2020] [Accepted: 03/06/2020] [Indexed: 06/10/2023]
Abstract
Co-infection with multiple pathogens, especially the spread of Giardia and Cryptosporidium in source water among those with immunodeficiency, is common worldwide, which will result in an increase in overall risk. In this study, the quantitative microbial risk assessment model was used to estimate the cumulative risk of co-infection with Giardia and Cryptosporidium promoted by HIV, considering age sensitivity. The sensitivity of population segments with different ages was estimated by the optimization method, based on clinical data of cryptosporidiosis and giardiasis with age structure. The factors of co-infection enhancement were used to quantify HIV synergism with the action of other pathogens. The removal rates of Giardia and Cryptosporidium through water treatment were estimated by a model involving turbidity and particles. The results showed that children (0-4 years) were 17.911-fold more sensitive to infection with Giardia than adults (15-64 years), and that with Cryptosporidium was 10.592-fold. Removal rates of these parasites in water treatment plants in major cities in China were estimated to be 2.03 log10. Considering the HIV-synergistic and age-susceptibility effects, the cumulative risk of exposure to Giardia or Cryptosporidium was about 38.781 × 10-6DALYs (Disability-adjusted life years) per person per year, which was much higher than the reference risk level recommended by the World Health Organization (10-6DALYs). The methodology and results of this study will be useful in better evaluating and reducing the burden due to infection of Giardia and/or Cryptosporidium in China and other countries.
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Affiliation(s)
- Mingyi Han
- Key Laboratory of Drinking Water Science and Technology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing, China; University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Shumin Xiao
- School of Environmental and Municipal Engineering, Tianjin Chengjian University, Tianjin, 300384, China
| | - Wei An
- Key Laboratory of Drinking Water Science and Technology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing, China; University of Chinese Academy of Sciences, Beijing, 100049, China; Department of Mathematical Sciences, Tsinghua University, 100084, China.
| | - Chenhui Sang
- Key Laboratory of Drinking Water Science and Technology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing, China; Sino-Danish College, University of Chinese Academy of Sciences, Beijing, 100190, China
| | - Hongyan Li
- Key Laboratory of Drinking Water Science and Technology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing, China
| | - Jinfeng Ma
- Key Laboratory of Drinking Water Science and Technology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing, China
| | - Min Yang
- Key Laboratory of Drinking Water Science and Technology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing, China; University of Chinese Academy of Sciences, Beijing, 100049, China.
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Kostopoulou D, Claerebout E, Arvanitis D, Ligda P, Casaert S, Sotiraki S. Identifying human enteric parasitic infections in Greece, with focus on Giardia and Cryptosporidium. Exp Parasitol 2020; 211:107864. [PMID: 32088147 DOI: 10.1016/j.exppara.2020.107864] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 01/15/2020] [Accepted: 02/19/2020] [Indexed: 12/29/2022]
Abstract
A study was conducted in two different areas in Greece to investigate the presence of intestinal human parasitic infections (targeting healthy and individuals with diarrhoea). In total, 876 stool samples were collected from 822 adults and 54 children. Both sedimentation (acid/ether) and concentration/flotation techniques were performed in all samples to detect intestinal parasites. Additionally, a quantitative direct immunofluorescence assay was used specifically for the detection of Giardia and Cryptosporidium. PCR followed by sequencing was applied to genotype Giardia and Cryptosporidium positive samples. Thirty-five (4%) of the individuals examined harboured at least one species of intestinal parasite, the majority of which were protozoa (3.8%). The species found were Blastocystis hominis (1.8%), Giardia duodenalis (1.3%), Cryptosporidium spp. (0.6%), Entamoeba coli (0.2%) and E. histolytica/E. dispar (0.1%). Two persons were positive for Enterobius vermicularis. Genotyping results revealed the presence of G. duodenalis sub-assemblage AII, whereas sequencing was not successful for Cryptosporidium positive samples. A novel multi-locus genotype of G. duodenalis was identified, which has not been described in humans or animals previously. Overall, in the studied population, infection rates with intestinal parasites were low and similar to previous published data. As infection levels were low, no associations could be made between infection status and clinical relevance, risk factors or indication of potential sources of infection, apart from the fact that infections with Giardia were positively correlated to diarrhoea. Based on the parasite species and genotypes detected, there was no indication that animals were an important source of infection. Thus, it is suggested that Giardia infections were more likely to be acquired via human-to-human transmission, either involving indirect pathways such as contaminated food or water, or via direct contact.
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Affiliation(s)
- D Kostopoulou
- Laboratory of Parasitology, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, Merelbeke, B-9820, Belgium; Veterinary Research Institute - Hellenic Agricultural Organization Demeter, 57001, Thermi, Thessaloniki, Greece.
| | - E Claerebout
- Laboratory of Parasitology, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, Merelbeke, B-9820, Belgium.
| | - D Arvanitis
- Veterinary Research Institute - Hellenic Agricultural Organization Demeter, 57001, Thermi, Thessaloniki, Greece.
| | - P Ligda
- Laboratory of Parasitology, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, Merelbeke, B-9820, Belgium; Veterinary Research Institute - Hellenic Agricultural Organization Demeter, 57001, Thermi, Thessaloniki, Greece.
| | - S Casaert
- Laboratory of Parasitology, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, Merelbeke, B-9820, Belgium.
| | - S Sotiraki
- Veterinary Research Institute - Hellenic Agricultural Organization Demeter, 57001, Thermi, Thessaloniki, Greece.
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17
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Giardia and Cryptosporidium in children with diarrhea, Kufra, Libya, a North African migration route city. Int J Hyg Environ Health 2019; 222:840-846. [DOI: 10.1016/j.ijheh.2019.04.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 04/15/2019] [Accepted: 04/16/2019] [Indexed: 11/23/2022]
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18
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Rehbein S, Klotz C, Ignatius R, Müller E, Aebischer A, Kohn B. Giardia duodenalisin small animals and their owners in Germany: A pilot study. Zoonoses Public Health 2018; 66:117-124. [DOI: 10.1111/zph.12541] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 10/23/2018] [Accepted: 10/28/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Sina Rehbein
- Small Animal Clinic, Faculty of Veterinary Medicine; Freie Universität Berlin; Berlin Germany
| | - Christian Klotz
- Unit for Mycotic and Parasitic Agents and Mycobacteria (FG16); Robert Koch-Institute; Berlin Germany
| | - Ralf Ignatius
- MVZ Labor 28; Berlin Germany
- Department of Microbiology and Hygiene; Charité-Universitätsmedizin Berlin; Berlin Germany
| | | | - Anton Aebischer
- Unit for Mycotic and Parasitic Agents and Mycobacteria (FG16); Robert Koch-Institute; Berlin Germany
| | - Barbara Kohn
- Small Animal Clinic, Faculty of Veterinary Medicine; Freie Universität Berlin; Berlin Germany
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19
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Giardia duodenalis in the UK: current knowledge of risk factors and public health implications. Parasitology 2018; 146:413-424. [PMID: 30318029 DOI: 10.1017/s0031182018001683] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Giardia duodenalis is a ubiquitous flagellated protozoan parasite known to cause giardiasis throughout the world. Potential transmission vehicles for this zoonotic parasite are both water and food sources. As such consumption of water contaminated by feces, or food sources washed in contaminated water containing parasite cysts, may result in outbreaks. This creates local public health risks which can potentially cause widespread infection and long-term post-infection sequelae. This paper provides an up-to-date overview of G. duodenalis assemblages, sub-assemblages, hosts and locations identified. It also summarizes knowledge of potential infection/transmission routes covering water, food, person-to-person infection and zoonotic transmission from livestock and companion animals. Public health implications focused within the UK, based on epidemiological data, are discussed and recommendations for essential Giardia developments are highlighted.
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20
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Zajaczkowski P, Mazumdar S, Conaty S, Ellis JT, Fletcher-Lartey SM. Epidemiology and associated risk factors of giardiasis in a peri-urban setting in New South Wales Australia. Epidemiol Infect 2018; 147:e15. [PMID: 30264685 PMCID: PMC6520257 DOI: 10.1017/s0950268818002637] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 08/29/2018] [Accepted: 08/30/2018] [Indexed: 12/26/2022] Open
Abstract
Giardiasis is one of the most important non-viral causes of human diarrhoea. Yet, little is known about the epidemiology of giardiasis in the context of developed countries such as Australia and there is a limited information about local sources of exposure to inform prevention strategies in New South Wales. This study aimed to (1) describe the epidemiology of giardiasis and (2) identify potential modifiable risk factors associated with giardiasis that are unique to south-western Sydney, Australia. A 1:2 matched case-control study of 190 confirmed giardiasis cases notified to the South-Western Local Health District Public Health Unit from January to December 2016 was employed to investigate the risk factors for giardiasis. Two groups of controls were selected to increase response rate; Pertussis cases and neighbourhood (NBH) controls. A matched analysis was carried out for both control groups separately. Variables with a significant odds ratio (OR) in the univariate analysis were placed into a multivariable regression for each matched group, respectively. In the regression model with the NBH controls, age and sex were controlled as potential confounders. Identified risk factors included being under 5 years of age (aOR = 7.08; 95% confidence intervals (CI) 1.02-49.36), having a household member diagnosed with a gastrointestinal illness (aOR = 15.89; 95% CI 1.53-164.60) and having contact with farm animals, domestic animals or wildlife (aOR = 3.03; 95% CI 1.08-8.54). Cases that travelled overseas were at increased risk of infection (aOR = 19.89; 95% CI 2.00-197.37) when compared with Pertussis cases. This study provides an update on the epidemiology and associated risk factors of a neglected tropical disease, which can inform enhanced surveillance and prevention strategies in the developed metropolitan areas.
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Affiliation(s)
- P. Zajaczkowski
- Faculty of Science, School of Life Sciences, University of Technology Sydney, Australia
| | - S. Mazumdar
- Healthy People and Places Unit, South Western Sydney Local Health District, Liverpool, Australia
| | - S. Conaty
- Public Health Unit, South Western Sydney Local Health District, Liverpool, Australia
| | - J. T. Ellis
- Faculty of Science, School of Life Sciences, University of Technology Sydney, Australia
| | - S. M. Fletcher-Lartey
- Public Health Unit, South Western Sydney Local Health District, Liverpool, Australia
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Li M, Baker CA, Danyluk MD, Belanger P, Boelaert F, Cressey P, Gheorghe M, Polkinghorne B, Toyofuku H, Havelaar AH. Identification of Biological Hazards in Produce Consumed in Industrialized Countries: A Review. J Food Prot 2018; 81:1171-1186. [PMID: 29939791 DOI: 10.4315/0362-028x.jfp-17-465] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Microbial contamination of fresh produce (fresh fruits and vegetables) poses serious public health concerns worldwide. This study was conducted as a comprehensive analysis of biological hazards in the global fresh produce chain. Data about produce-related outbreaks and illness were collected from the annual reports and databases of foodborne outbreak surveillance systems in different regions and countries from 2010 to 2015. The global patterns of and regional differences in documented outbreaks and cases were analyzed, and produce commodities and pathogens of greatest concern were identified. Data on sporadic illnesses were also collected through a comprehensive literature review of case-control studies. We found 988 produce-related outbreaks (with known agents) and 45,723 cases in all regions and countries. The numbers of produce-related outbreaks per million person-years were approximately 0.76, 0.26, 0.25, 0.13, 0.12, and 0.05 in New Zealand, Australia, the United States, the European Union, Canada, and Japan, respectively. The top three food categories and pathogens contributing to produce-related outbreaks were vegetables and nonfruits (i.e., food other than fruits; 27.0%), unspecified vegetables (12.2%), and vegetable row crops (11.7%) and norovirus (42.4%), Salmonella enterica (19.9%), and Staphylococcus aureus (7.9%), respectively. Produce consumption was identified as a protective factor, a risk factor, and either a protective or risk factor for sporadic illnesses in 11, 5, and 5 studies, respectively, among 21 case-control studies. Risks associated with produce consumption in the United States and the European Union have been linked to various factors such as irrigation water, cross-contamination, storage time and temperature abuse, infected food handlers, and unprocessed contaminated ingredients. The results of the current study indicate the complexity of produce products consumed across the globe and the difficulty in tracing illnesses back to specific food ingredients.
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Affiliation(s)
- Min Li
- 1 Emerging Pathogens Institute, Institute for Sustainable Food Systems, Department of Animal Sciences, University of Florida, Gainesville, Florida 32610, USA (ORCID: http://orcid.org/0000-0002-6456-5460 [A.H.H.])
| | - Christopher A Baker
- 2 Department of Food Science and Human Nutrition, University of Florida, Gainesville, Florida 32611, USA
| | - Michelle D Danyluk
- 2 Department of Food Science and Human Nutrition, University of Florida, Gainesville, Florida 32611, USA.,3 Citrus Research and Education Center, University of Florida, Lake Alfred, Florida 33850, USA
| | | | | | - Peter Cressey
- 6 Institute of Environmental Science and Research, Christchurch 8041, New Zealand
| | - Mihaela Gheorghe
- 7 Public Health Agency of Canada, Ottawa, Ontario, Canada K2E 7L9
| | - Ben Polkinghorne
- 8 Department of Health, Canberra, Australian Capital Territory 2601, Australia
| | - Hajime Toyofuku
- 9 Joint Faculty of Veterinary Medicine, Yamaguchi University, Yamaguchi 753-8515, Japan
| | - Arie H Havelaar
- 1 Emerging Pathogens Institute, Institute for Sustainable Food Systems, Department of Animal Sciences, University of Florida, Gainesville, Florida 32610, USA (ORCID: http://orcid.org/0000-0002-6456-5460 [A.H.H.])
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Abstract
Although Giardia, the aetiological agent of giardiasis, is one of the most prevalent intestinal parasitic infections world-wide, for industrialised countries, it is mainly appreciated as an imported disease with the minimal local transmission. However, the current evidence challenges this perception; Giardia has relevance beyond the high prevalence areas. This infection may be asymptomatic or cause gastrointestinal complains and long-term sequelae, including irritable bowel syndrome, chronic fatigue and impaired child growth and cognitive development. Its detection and diagnosis present a challenge to physicians who may not be familiar with this infection. To improve interventions to control this parasitosis, it is necessary to maintain a high index of suspicion and remain vigilant in finding cases at risk for infection. A better understanding of the characteristics of populations importing infections alongside improved methods to reliably classify infections as imported or acquired locally will help to ensure early and accurate diagnosis. The evidence shows that public health problems like giardiasis are global issues that need to be addressed collectively by both high and low prevalence countries.
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Gutiérrez-Gutiérrez F, Palomo-Ligas L, Hernández-Hernández JM, Pérez-Rangel A, Aguayo-Ortiz R, Hernández-Campos A, Castillo R, González-Pozos S, Cortés-Zárate R, Ramírez-Herrera MA, Mendoza-Magaña ML, Castillo-Romero A. Curcumin alters the cytoskeleton and microtubule organization on trophozoites of Giardia lamblia. Acta Trop 2017; 172:113-121. [PMID: 28465123 DOI: 10.1016/j.actatropica.2017.04.027] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 04/06/2017] [Accepted: 04/17/2017] [Indexed: 11/30/2022]
Abstract
Giardia lamblia is a worldwide protozoan responsible for a significant number of intestinal infections. There are several drugs for the treatment of giardiasis, but they often cause side effects. Curcumin, a component of turmeric, has antigiardial activity; however, the molecular target and mechanism of antiproliferative activity are not clear. The effects of curcumin on cellular microtubules have been widely investigated. Since tubulin is the most abundant protein in the cytoskeleton of Giardia, to elucidate whether curcumin has activity against the microtubules of this parasite, we treated trophozoites with curcumin and the cells were analyzed by scanning electron microscopy and confocal microscopy. Curcumin inhibited Giardia proliferation and adhesion in a time-concentration-dependent mode. The higher inhibitory concentrations of curcumin (3 and 15μM) disrupted the cytoskeletal structures of trophozoites; the damage was evident on the ventral disk, flagella and in the caudal region, also the membrane was affected. The immunofluorescence images showed altered distribution of tubulin staining on ventral disk and flagella. Additionally, we found that curcumin caused a clear reduction of tubulin expression. By docking analysis and molecular dynamics we showed that curcumin has a high probability to bind at the interface of the tubulin dimer close to the vinblastine binding site. All the data presented indicate that curcumin may inhibit Giardia proliferation by perturbing microtubules.
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Affiliation(s)
- Filiberto Gutiérrez-Gutiérrez
- Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - Lissethe Palomo-Ligas
- Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - José Manuel Hernández-Hernández
- Departamento de Biología Celular, Centro De Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, México City, Mexico
| | - Armando Pérez-Rangel
- Departamento de Biología Celular, Centro De Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, México City, Mexico
| | - Rodrigo Aguayo-Ortiz
- Facultad de Química, Departamento de Farmacia, Universidad Nacional Autónoma de México, México City, Mexico
| | - Alicia Hernández-Campos
- Facultad de Química, Departamento de Farmacia, Universidad Nacional Autónoma de México, México City, Mexico
| | - Rafael Castillo
- Facultad de Química, Departamento de Farmacia, Universidad Nacional Autónoma de México, México City, Mexico
| | - Sirenia González-Pozos
- Unidad de microscopia electrónica, Centro De Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, México City, Mexico
| | - Rafael Cortés-Zárate
- Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - Mario Alberto Ramírez-Herrera
- Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - María Luisa Mendoza-Magaña
- Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | - Araceli Castillo-Romero
- Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, Mexico.
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Gutiérrez-Gutiérrez F, Puebla-Pérez AM, González-Pozos S, Hernández-Hernández JM, Pérez-Rangel A, Alvarez LP, Tapia-Pastrana G, Castillo-Romero A. Antigiardial Activity of Podophyllotoxin-Type Lignans from Bursera fagaroides var. fagaroides. Molecules 2017; 22:E799. [PMID: 28505094 PMCID: PMC6154107 DOI: 10.3390/molecules22050799] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 05/08/2017] [Accepted: 05/09/2017] [Indexed: 01/08/2023] Open
Abstract
Giardiasis, a diarrheal disease, is highly prevalent in developing countries. Several drugs are available for the treatment of this parasitosis; unfortunately, all of them have variable efficacies and adverse effects. Bursera fagaroides has been known for its anti-inflammatory and antidiarrheal properties in Mexican traditional medicine. We investigated the in vitro anti-giardial activities of four podophyllotoxin-type lignans from Bursera fagaroides var. fagaroides, namely, 5'-desmethoxy-β-peltatin-A-methylether (5-DES), acetylpodophyllotoxin (APOD), burseranin (BUR), and podophyllotoxin (POD). All lignans affected the Giardia adhesion and electron microscopy images revealed morphological alterations in the caudal region, ventral disk, membrane, and flagella, to different extents. Only 5-DES, APOD, and POD caused growth inhibition. Using the Caco-2 human cell line as a model of the intestinal epithelium, we demonstrated that APOD displayed direct antigiardial killing activity and low toxicity on Caco-2 cells. This finding makes it an attractive potential starting point for new antigiardial drugs.
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Affiliation(s)
| | - Ana María Puebla-Pérez
- Departamento de Química y Farmacobiología, Universidad de Guadalajara, Guadalajara 44430, Jalisco, Mexico.
| | - Sirenia González-Pozos
- Unidad de Microscopía Electrónica LaNSE, Centro de Investigación y Estudios Avanzados del Instituto Politécnico Nacional, Ciudad de México 07360, Mexico.
| | - José Manuel Hernández-Hernández
- Departamento de Biología Celular, Centro de Investigación y Estudios Avanzados del Instituto Politécnico Nacional, Ciudad de México 07360, Mexico.
| | - Armando Pérez-Rangel
- Departamento de Biología Celular, Centro de Investigación y Estudios Avanzados del Instituto Politécnico Nacional, Ciudad de México 07360, Mexico.
| | - Laura Patricia Alvarez
- Centro de Investigaciones Químicas, Universidad Autónoma del Estado de Morelos, Morelos 62209, Mexico.
| | - Gabriela Tapia-Pastrana
- Laboratorio de Investigación Biomédica, Hospital Regional de Alta Especialidad de Oaxaca, Oaxaca 71256, Mexico.
| | - Araceli Castillo-Romero
- Departamento de Microbiología y Patología, Universidad de Guadalajara, Guadalajara 44340, Jalisco, Mexico.
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Abstract
BACKGROUND Infection with Giardia lamblia is a common cause of diarrheal disease in the developing and industrialized world. AIMS We aimed to assess the prevalence of giardiasis in the United States (US) among patients with duodenal biopsies, investigating demographic and clinical factors associated with this condition. METHODS We conducted a cross-sectional study of patients with duodenal biopsies submitted to a national pathology laboratory between January 2, 2008, and December 31, 2015. The prevalence of giardiasis was calculated and categorized by the following patient sociodemographic and clinical data: age, sex, ethnicity, endoscopy indication, season, year, urban-rural setting, region, and presence of H. pylori and atrophic gastritis. RESULTS Among all patients (n = 432,813), the mean age was 52.2 years. The prevalence of giardiasis was 0.11%. Patients with giardiasis were more likely to be male (57.8 vs. 34.1%, p < 0.0001). Among patients who had a gastric biopsy (n = 363,788), those with giardiasis were more likely to be colonized with H. pylori (25.7 vs. 9.4%, p < 0.0001). There was no statistically significant association with age, endoscopy indication, urban-rural setting, ethnicity, season, or the presence of atrophic gastritis. On multivariate analysis, male sex, Southern region, and the presence of H. pylori were independently associated with giardiasis. CONCLUSIONS To our knowledge, this is the largest study to date to assess predictors of giardiasis in the US. We found that male sex, being colonized with H. pylori, and residing in the Southern US are independently associated with giardiasis infection.
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Skhal D, Aboualchamat G, Al Mariri A, Al Nahhas S. Prevalence of Giardia duodenalis assemblages and sub-assemblages in symptomatic patients from Damascus city and its suburbs. INFECTION GENETICS AND EVOLUTION 2016; 47:155-160. [PMID: 27919804 DOI: 10.1016/j.meegid.2016.11.030] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 11/29/2016] [Accepted: 11/30/2016] [Indexed: 11/27/2022]
Abstract
Giardia duodenalis is one of the most important human enteric parasites worldwide and is endemic throughout the world with a vast range of mammalian hosts. However, there is limited information on the prevalent genetic variability of G. duodenalis in Syria. This study aimed to evaluate the predominance of G. duodenalis assemblages/sub-assemblages causing humans infection in the city of Damascus and its suburbs. 40 symptomatic giardiasis patients were recruited in this study. Fecal samples were genotyped using PCR/RFLP assay targeting the β-giardin and glutamate dehydrogenase (gdh) genes. HaeIII, BspL1 and RsaI restriction enzymes were used to differentiate between G. duodenalis assemblages/sub-assemblages. Our data showed that 65% of isolates were of assemblage A; 45% belonged to sub-assemblage AII and 20% to sub-assemblage AI. Assemblage B was detected in 27.5% of isolates; 12.5% fit in sub-assemblage BIV, 5% fit in sub-assemblage BIII and 10.5% fit in Discordant genotype BIII/BIV. Mixed genotypes (AII+BIII and AI+BIV) were identified in 3 isolates (7.5%). Significant correlation was found between Giardia AII sub-assemblage and weight loss symptom (P-value=0.05) as well as between contact with domestic animals (cats, P-value=0.027). Moreover, a significant correlation was found between sub-assemblage AI and livestock breeding (P-value=0.000). In conclusion genotyping of human Giardia duodenalis isolates suggests anthroponotic transmission for the route of infection in Damascus and its suburbs. Further studies are needed to screen a wide geographic areas in Syria and to estimate the prevalence of G. duodenalis infection in our population.
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Affiliation(s)
- Dania Skhal
- Department of Animal Biology, Faculty of Science, Damascus University, Damascus, Syria
| | - Ghalia Aboualchamat
- Department of Animal Biology, Faculty of Science, Damascus University, Damascus, Syria
| | - Ayman Al Mariri
- Atomic Energy Commission of Syria, Department of Molecular Biology and Biotechnology, Microbiology and Immunology Division, Syria
| | - Samar Al Nahhas
- Department of Animal Biology, Faculty of Science, Damascus University, Damascus, Syria.
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Lee MF, Auer H, Lindo JF, Walochnik J. Multilocus sequence analysis of Giardia spp. isolated from patients with diarrhea in Austria. Parasitol Res 2016; 116:477-481. [PMID: 27885465 DOI: 10.1007/s00436-016-5306-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 10/20/2016] [Indexed: 11/30/2022]
Abstract
Giardia duodenalis is a protozoan parasite causing intestinal infections in a wide range of mammals. Two distinct assemblages, A and B, infect humans predominantly; however, both are believed to be generally zoonotic. Giardia strains associated with infections in Austria have not been investigated at the molecular level. In this study, 65 human stool samples microscopically positive for Giardia spp. were subjected to DNA isolation and nested PCR targeting fragments of the glutamate dehydrogenase (gdh), triose phosphate isomerase (tpi), and beta-gardin (bg) genes. A total of 52 samples were successfully analyzed using PCR and DNA sequencing. Assemblage B was detected most frequently and accounted for 65.4% (34/52) of infections, while Assemblage A accounted for 34.6% (18/52). There was a high level of genetic diversity among the isolates with 46.2% designated as sub-assemblage BIV (24/52), 25% sub-assemblage AII (13/52), 19.2% sub-assemblage BIII (10/52), and 9.6% sub-assemblage AI (5/52). No mixed infections were detected. The results suggest that the majority of infections were imported and that endemic anthroponotic transmission plays a minor role in Austria.
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Affiliation(s)
- Mellesia F Lee
- Institute of Specific Prophylaxis and Tropical Medicine, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria.,Department of Microbiology, The University of the West Indies, Kingston 7, Mona, Jamaica
| | - Herbert Auer
- Institute of Specific Prophylaxis and Tropical Medicine, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - John F Lindo
- Department of Microbiology, The University of the West Indies, Kingston 7, Mona, Jamaica.
| | - Julia Walochnik
- Institute of Specific Prophylaxis and Tropical Medicine, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
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ADAM EA, YODER JS, GOULD LH, HLAVSA MC, GARGANO JW. Giardiasis outbreaks in the United States, 1971-2011. Epidemiol Infect 2016; 144:2790-801. [PMID: 26750152 PMCID: PMC5150856 DOI: 10.1017/s0950268815003040] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 10/14/2015] [Accepted: 11/11/2015] [Indexed: 11/05/2022] Open
Abstract
Giardia intestinalis is the leading parasitic aetiology of human enteric infections in the United States, with an estimated 1·2 million cases occurring annually. To better understand transmission, we analysed data on all giardiasis outbreaks reported to the Centers for Disease Control and Prevention for 1971-2011. The 242 outbreaks, affecting ~41 000 persons, resulted from waterborne (74·8%), foodborne (15·7%), person-to-person (2·5%), and animal contact (1·2%) transmission. Most (74·6%) waterborne outbreaks were associated with drinking water, followed by recreational water (18·2%). Problems with water treatment, untreated groundwater, and distribution systems were identified most often during drinking water-associated outbreak investigations; problems with water treatment declined after the 1980s. Most recreational water-associated outbreaks were linked to treated swimming venues, with pools and wading pools implicated most often. Produce was implicated most often in foodborne outbreaks. Additionally, foods were most commonly prepared in a restaurant and contaminated by a food handler. Lessons learned from examining patterns in outbreaks over time can help prevent future disease. Groundwater and distribution system vulnerabilities, inadequate pool disinfection, fruit and vegetable contamination, and poor food handler hygiene are promising targets for giardiasis prevention measures.
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Affiliation(s)
- E. A. ADAM
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, USA
| | - J. S. YODER
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - L. H. GOULD
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - M. C. HLAVSA
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - J. W. GARGANO
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Ismail MAM, El-Akkad DMH, Rizk EMA, El-Askary HM, El-Badry AA. Molecular seasonality of Giardia lamblia in a cohort of Egyptian children: a circannual pattern. Parasitol Res 2016; 115:4221-4227. [PMID: 27449642 DOI: 10.1007/s00436-016-5199-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 07/13/2016] [Indexed: 11/25/2022]
Abstract
Giardia lamblia (G. lamblia) is the most worldwide prevailing intestinal parasite, notorious for its broad range of seasonal and age-related prevalence. The potentially lethal nature of giardiasis makes it essential that the seasonality, the groups at risk, and other potential risk factors are identified. The present molecular epidemiological study was designed to determine the genetic diversity of G. lamblia infection, taking into account seasonal peaks, age distribution, and associated symptoms in a cohort of Egyptian diarrheic patients. Stool samples were collected from 1187 diarrheic patients attending outpatient clinics of Cairo University hospitals, of all age groups over a 12-month period. The patients were examined microscopically for fecal G. lamblia cysts, and/or trophozoites, and for copro-DNA detection using nested polymerase chain reaction (nPCR) assays targeting beta giardin gene. PCR-positive samples were characterized molecularly by nPCR restriction fragment length polymorphism (RFLP) to determine Giardia assemblages. The findings revealed circannual prevalence of Giardia, with a seasonal pattern peaking in mid-summer and late winter, with the summer peak preceded by a peak in temperature. Infection was prevailing in 224 (18.9 %) cases, mainly assemblage B (81.2 %) followed by assemblage A (18.8 %). There were statistically significant associations between the detection of Giardia and flatulence, persistent diarrhea, vomiting, and abdominal pain, while gender and intermittent diarrhea showed no association. The pre-school age group was the most vulnerable. This is the first study of molecular characterization of Giardia to determine its circannual prevalence in Egypt, a finding which carries promising potential for the diagnosis, treatment, and elimination of the disease.
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Affiliation(s)
- Mousa A M Ismail
- Medical Parasitology Department, Kasr Al-Ainy Faculty of Medicine, Cairo University, El-Manial, Cairo, Egypt
| | - Dina M H El-Akkad
- Medical Parasitology Department, Kasr Al-Ainy Faculty of Medicine, Cairo University, El-Manial, Cairo, Egypt
| | - Enas M A Rizk
- Medical Parasitology Department, Kasr Al-Ainy Faculty of Medicine, Cairo University, El-Manial, Cairo, Egypt
| | - Hala M El-Askary
- Medical Parasitology Department, Faculty of Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Ayman A El-Badry
- Medical Parasitology Department, Kasr Al-Ainy Faculty of Medicine, Cairo University, El-Manial, Cairo, Egypt.
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Estimating and mapping the incidence of giardiasis in Colombia, 2009-2013. Int J Infect Dis 2016; 49:204-9. [PMID: 27312583 DOI: 10.1016/j.ijid.2016.06.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 06/04/2016] [Accepted: 06/07/2016] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Giardiasis is one of the most common intestinal infections in the world. There have been no national studies on the morbidity of giardiasis in Colombia. In this study, incidence rates of giardiasis were estimated for the years 2009-2013. METHODS An observational, retrospective study of the giardiasis incidence in Colombia, 2009-2013, was performed using data extracted from the personal health records system (Registro Individual de Prestación de Servicios, RIPS). Official population estimates from the National Department of Statistics (DANE) were used for the estimation of crude and adjusted incidence rates (cases/100 000 population). RESULTS During the period studied, 15 851 cases were reported (median 3233/year; 5-year cumulated crude national rate of 33.97 cases/100 000 population). Of these, 50.3% were female; 58.4% were <10 years old and 14.8% were 10-19 years old. By region, 17.7% were from Bogotá (10.07 cases/100 000 population, 2009), 10.9% from Antioquia (9.42, 2009), 8.6% from Atlántico (15.67, 2009), and 6.5% from Risaralda (33.38, 2009). Cases were reported in all departments (even insular areas). CONCLUSIONS As giardiasis is neglected in many countries, surveillance is not regularly undertaken. Despite its limitations, this study is the first attempt to provide estimates of national giardiasis incidence with consistent findings regarding affected age groups and geographical distribution.
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Narayan S, Galanis E. Are enteric infections sexually transmitted in British Columbia? CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2016; 42:24-29. [PMID: 29770000 PMCID: PMC5864255 DOI: 10.14745/ccdr.v42i02a01] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Enteric infections may on occasion be sexually transmitted, particularly among people who engage in oral-anal sexual contact. Although outbreaks of enteric infections have been reported among men who have sex with men (MSM) in British Columbia (BC), the epidemiology of sexually transmitted enteric infections has never been assessed. OBJECTIVE To describe the epidemiology of enteric infections in BC to determine if sexual transmission may be occurring. METHODS A descriptive analysis was conducted of all reported cases of shigellosis, amebiasis and giardiasis in BC for the period 2003-2012. RESULTS For shigellosis and amebiasis, there was a high male-to-female ratio and a higher rate of infection in males aged 20-59 years as compared to all other age-sex groups. Additionally, for shigellosis, adult males were significantly more likely than females to acquire disease locally (RR 1.9; CI 1.7--.4). CONCLUSION Analysis suggests that sexual transmission of enteric infections, particularly shigellosis and amebiasis, may be occurring in MSM in BC. Further studies are indicated.
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Affiliation(s)
- S Narayan
- Simon Fraser University, Burnaby, BC
| | - E Galanis
- BC Centre for Disease Control, Vancouver, BC
| | - BC STEI Group
- BC STEI group membership: Forsting S, Hoang L, Jeyes J, Nowakowski C6, Ritson M4, Stone J, Tone G
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A comparison of exposure to risk factors for giardiasis in non-travellers, domestic travellers and international travellers in a Canadian community, 2006-2012. Epidemiol Infect 2015; 144:980-99. [PMID: 26419277 DOI: 10.1017/s0950268815002186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The purpose of this study is to determine how demographic and exposure factors related to giardiasis vary between travel and endemic cases. Exposure and demographic data were gathered by public health inspectors from giardiasis cases reported from the Region of Waterloo from 2006 to 2012. Logistic regression models were fit to assess differences in exposure to risk factors for giardiasis between international travel-related cases and Canadian acquired cases while controlling for age and sex. Multinomial regression models were also fit to assess the differences in risk profiles between international and domestic travel-related cases and endemic cases. Travel-related cases (both international and domestic) were more likely to go camping or kayaking, and consume untreated water compared to endemic cases. Domestic travel-related cases were more likely to visit a petting zoo or farm compared to endemic cases, and were more likely to swim in freshwater compared to endemic cases and international travel-related cases. International travellers were more likely to swim in an ocean compared to both domestic travel-related and endemic cases. These findings demonstrate that travel-related and endemic cases have different risk exposure profiles which should be considered for appropriately targeting health promotion campaigns.
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Case-Control Study of Risk Factors for Sporadic Giardiasis and Parasite Assemblages in North West England. J Clin Microbiol 2015; 53:3133-40. [PMID: 26157151 PMCID: PMC4572545 DOI: 10.1128/jcm.00715-15] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 07/01/2015] [Indexed: 11/20/2022] Open
Abstract
Giardia duodenalis is a major cause of infectious gastroenteritis worldwide, and it is diversified into eight genetic assemblages (A to H), which are distinguishable only by molecular typing. There is some evidence that the assemblages infecting humans (assemblages A and B) may have different transmission routes, but systematically acquired data, combining epidemiological and molecular findings, are required. We undertook a case-control study with Giardia genotyping in North West England, to determine general and parasite assemblage-specific risk factors. For people without a history of foreign travel, swimming in swimming pools and changing diapers were the most important risk factors for the disease. People infected with assemblage B reported a greater number of symptoms and higher frequencies of vomiting, abdominal pain, swollen stomach, and loss of appetite, compared with people infected with assemblage A. More importantly, keeping a dog was associated only with assemblage A infections, suggesting the presence of a potential zoonotic reservoir for this assemblage. This is the first case-control study to combine epidemiological data with Giardia genotyping, and it shows the importance of integrating these two levels of information for better understanding of the epidemiology of this pathogen.
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Triage and protocol recommendations for the parasitology laboratory based on an epidemiological investigation of parasite diagnostics in Ontario laboratories. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2015; 25:305-10. [PMID: 25587292 PMCID: PMC4277158 DOI: 10.1155/2014/452815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES A study was performed using a subset of Ontario laboratory parasitology data, with three objectives: to describe parasitic infections in Ontario; to identify risk factors for acquiring a parasitic infection using routinely collected information; and to use this information to assess current protocols for parasite testing in laboratories and, in turn, to propose alternatives to optimize the allocation of laboratory resources. METHODS All parasitology records from January 4, 2010 to September 14, 2010 were reviewed descriptively and risk factor analyses were performed using information collected from requisitions. These results were used to develop preliminary alternative protocols, which considered high-throughput screening tests and inclusion/exclusion criteria for ova and parasite testing; these were then retrospectively analyzed with the dataset to determine appropriateness. RESULTS Of the 29,260 records analyzed, 10% were multiple samples from single patients submitted on the same day, of which 98% had the same result. Three percent of all parasite tests were positive, with the most prevalent parasites being (in ascending order) Dientamoeba fragilis, Giardia lamblia, Cryptosporidium species and Entamoeba histolytica/dispar. Age and sex were found to be weak risk factors, while rural living was found to be a moderate risk factor for D fragilis, G lamblia and Cryptosporidium infections. The strongest risk factor was travel history, especially for nonendemic parasites. The retrospective analysis of six alternative protocols identified four that may be more efficient than current procedures. CONCLUSIONS The present study demonstrated that current protocols may be redundant and can be optimized to target prevalent parasites and populations with high risk factors.
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Lal A, Baker MG, Hales S, French NP. Potential effects of global environmental changes on cryptosporidiosis and giardiasis transmission. Trends Parasitol 2013; 29:83-90. [DOI: 10.1016/j.pt.2012.10.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 10/31/2012] [Accepted: 10/31/2012] [Indexed: 10/27/2022]
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Ajonina C, Buzie C, Otterpohl R. The detection of Giardia cysts in a large-scale wastewater treatment plant in Hamburg, Germany. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2013; 76:509-514. [PMID: 23721585 DOI: 10.1080/15287394.2013.785208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Giardia is one of the most common human enteric parasites that continue to be a major cause of diarrheal disease globally. Wastewater is an important source of Giardia transmission, and control of the pathogen by appropriate treatment of wastewater would limit its transmission. In this study the occurrence of Giardia cysts at various stages of the wastewater treatment plants was monitored for a period of 18 mo. Using immunomagnetic separation and immunofluorescence with monoclonal antibodies, cysts were detected in all samples throughout the sampling period at a concentration ranging from 50 to 7548 cysts/L. The overall removal efficiency of the cysts in the treatment plants was 78%. Seasonal analyses of results revealed that the pathogens (cysts) were most prevalent in influents and effluents during autumn and winter.
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Affiliation(s)
- Caroline Ajonina
- Institute of Wastewater Management and Water Protection, Hamburg University of Technology, Hamburg, Germany.
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Pardhan-Ali A, Wilson J, Edge VL, Furgal C, Reid-Smith R, Santos M, McEwen SA. A descriptive analysis of notifiable gastrointestinal illness in the Northwest Territories, Canada, 1991-2008. BMJ Open 2012; 2:e000732. [PMID: 22761280 PMCID: PMC3391378 DOI: 10.1136/bmjopen-2011-000732] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 05/29/2012] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To describe the major characteristics of reported notifiable gastrointestinal illness (NGI) data in the Northwest Territories (NWT) from January 1991 through December 2008. DESIGN Descriptive analysis of 708 reported cases of NGI extracted from the Northwest Territories Communicable Disease Registry (NWT CDR). SETTING Primary, secondary and tertiary health care centres across all 33 communities of the NWT. POPULATION NWT residents of all ages with confirmed NGI reported to the NWT CDR from January 1991 through December 2008. MAIN OUTCOME MEASURE Laboratory-confirmed NGI, with a particular emphasis on campylobacteriosis, giardiasis and salmonellosis. RESULTS Campylobacteriosis, giardiasis and salmonellosis were the most commonly identified types of NGI in the territory. Seasonal peaks for all three diseases were observed in late summer to autumn (p<0.01). Higher rates of NGI (all 15 diseases/infections) were found in the 0-9-year age group and in men (p<0.01). Similarly, rates of giardiasis were higher in the 0-9-year age group and in men (p<0.02). A disproportionate burden of salmonellosis was found in people aged 60 years and older and in women (p<0.02). Although not significant, the incidence of campylobacteriosis was greater in the 20-29-years age group and in men (p<0.07). The health authority with the highest incidence of NGI was Yellowknife (p<0.01), while for salmonellosis and campylobacteriosis, it was Tlicho (p<0.01) and for giardiasis, the Sahtu region (p<0.01). Overall, disease rates were higher in urban areas (p<0.01). Contaminated eggs, poultry and untreated water were believed by health practitioners to be important sources of infection in cases of salmonellosis, campylobacteriosis and giardiasis, respectively. CONCLUSIONS The general patterns of these findings suggest that environmental and behavioural risk factors played key roles in infection. Further research into potential individual and community-level risk factors is warranted.
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Affiliation(s)
- Aliya Pardhan-Ali
- Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada
| | - Jeff Wilson
- Novometrix Research Inc., Moffat, Ontario, Canada
| | - Victoria L Edge
- Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada
| | - Chris Furgal
- Department of Indigenous Environmental Studies, Trent University, Peterborough, Ontario, Canada
| | - Richard Reid-Smith
- Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada
| | - Maria Santos
- Department of Health and Social Services, Government of the Northwest Territories, Yellowknife, Northwest Territories, Canada
| | - Scott A McEwen
- Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada
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Epidemiological and clinical description of the top three reportable parasitic diseases in a Canadian community. Epidemiol Infect 2012; 141:431-42. [PMID: 22631610 PMCID: PMC3539240 DOI: 10.1017/s095026881200057x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
This study provides a comprehensive epidemio-clinical picture of sporadic, domestically acquired cases of amoebiasis, cryptosporidiosis and giardiasis in one Canadian community based on patient symptom, outcome and exposure data from an enhanced surveillance system. It yields valuable data for estimating the burden of those diseases including the proportion of bloody diarrhoea, hospitalization, and disease duration. Age differences were observed by incidence rate and for some clinical information and exposures to risk factors. For each of the three diseases, the animal/environment-to-person route was the most common possible main transmission route according to the exposure reported, whereas the person-to-person route was the least common. Exposure was higher for the 10–24 years age group of giardiasis cases for swimming in recreational waters (79%) and attending a barbeque (50%). Therefore, comparisons between groups of cases or extrapolation of results when estimating the burden of illness should be adjusted for age.
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Seasonality in human zoonotic enteric diseases: a systematic review. PLoS One 2012; 7:e31883. [PMID: 22485127 PMCID: PMC3317665 DOI: 10.1371/journal.pone.0031883] [Citation(s) in RCA: 116] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Accepted: 01/19/2012] [Indexed: 12/26/2022] Open
Abstract
Background Although seasonality is a defining characteristic of many infectious diseases, few studies have described and compared seasonal patterns across diseases globally, impeding our understanding of putative mechanisms. Here, we review seasonal patterns across five enteric zoonotic diseases: campylobacteriosis, salmonellosis, vero-cytotoxigenic Escherichia coli (VTEC), cryptosporidiosis and giardiasis in the context of two primary drivers of seasonality: (i) environmental effects on pathogen occurrence and pathogen-host associations and (ii) population characteristics/behaviour. Methodology/Principal Findings We systematically reviewed published literature from 1960–2010, resulting in the review of 86 studies across the five diseases. The Gini coefficient compared temporal variations in incidence across diseases and the monthly seasonality index characterised timing of seasonal peaks. Consistent seasonal patterns across transnational boundaries, albeit with regional variations was observed. The bacterial diseases all had a distinct summer peak, with identical Gini values for campylobacteriosis and salmonellosis (0.22) and a higher index for VTEC (Gini = 0.36). Cryptosporidiosis displayed a bi-modal peak with spring and summer highs and the most marked temporal variation (Gini = 0.39). Giardiasis showed a relatively small summer increase and was the least variable (Gini = 0.18). Conclusions/Significance Seasonal variation in enteric zoonotic diseases is ubiquitous, with regional variations highlighting complex environment-pathogen-host interactions. Results suggest that proximal environmental influences and host population dynamics, together with distal, longer-term climatic variability could have important direct and indirect consequences for future enteric disease risk. Additional understanding of the concerted influence of these factors on disease patterns may improve assessment and prediction of enteric disease burden in temperate, developed countries.
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Bello J, Núñez FA, González OM, Fernández R, Almirall P, Escobedo AA. Risk factors for Giardia infection among hospitalized children in Cuba. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2011; 105:57-64. [PMID: 21294949 DOI: 10.1179/136485911x12899838413385] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The risk factors associated with Giardia infection, in children hospitalized in Havana, Cuba, were recently explored. Children aged ≥5 years were more likely to be positive for Giardia infection than the younger children, with an odds ratio (OR) of 3·41 [95% confidence interval (CI) = 1·36-9·69]. The risk factors found to be associated with Giardia infection in univariate analyses were rural residence (OR = 3·01; CI = 1·23-7·35), belonging to a household that did not receive water from an aqueduct (OR = 3·27; CI = 1·21-8·91), drinking unboiled water (OR = 3·64; CI = 2·14-6·26), nail biting (OR = 3·47; CI = 1·97-6·08), eating unwashed vegetables raw (OR = 4·84; CI = 2·33-10·14), and a personal (OR = 3·23; CI = 1·58-6·59) or family history (OR = 3·96; CI = 1·53-10·47) of previous parasitic infection. In multivariate analyses, however, only two (modifiable) risk factors were found to be independently and significantly associated with Giardia infection: nail biting and eating unwashed vegetables raw. It therefore seems that, at least at the individual level, giardiasis-prevention activities in Havana should be focussed on health education to improve personal hygiene and food-related practices. If appropriately managed, the surveillance of drinking water and foodstuffs, for Giardia and other parasites, might also help to reduce the hospitalization of Cuban children.
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Affiliation(s)
- J Bello
- Academic Paediatric Hospital of Cerro, Calzada del Cerro No. 2002, Cerro, Ciudad de La Habana, Cuba
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Sejdini A, Mahmud R, Lim YAL, Mahdy M, Sejdini F, Gjoni V, Xhaferraj K, Kasmi G. Intestinal parasitic infections among children in central Albania. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2011; 105:241-50. [PMID: 21801503 DOI: 10.1179/136485911x12987676649584] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Although intestinal parasitic infections (IPI) among children remain a global issue, the current information on such infections in Albanian children is very limited. A cross-sectional study of the IPI in 321 children living in the Albanian counties of Tirana (152) and Elbasan (169) was therefore conducted in 2008, with a pre-tested standard questionnaire employed to gather the relevant personal and clinical data. Using formalin-ether concentration and permanent stains, stool samples were examined microscopically for the ova, cysts and oocysts of any parasites. The overall prevalence of IPI was 19% (61 of 321), with protozoan infections (11·5%) apparently more common than infections with soil-transmitted helminths (STH; 8·1%). Giardia duodenalis was the parasite most frequently detected (10·9%), followed by hookworm (5·6%), Ascaris lumbricoides (1·9%), Trichuris trichiura (0·6%), Cryptosporidium (0·3%) and Entamoeba histolytica/dispar (0·3%). The results of a univariate analysis indicated that the children from Tirana county were significantly more likely to be found infected with STH compared with the children from Elbasan county (12·5% v. 4·1%; P=0·006). Children sampled in the community were also more likely to be found STH-positive than the children sampled as they attended hospitals and health clinics (10·5% v. 6·0%) but this difference did not reach statistical significance. The children found STH-positive were five times more likely to be suffering from diarrhoea than the other children checked in clinical settings (P=0·004) and were also more likely to be suffering from abdominal pain (P=0·054) and/or diminished appetite (P=0·016).
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Affiliation(s)
- A Sejdini
- University of Malaya, 50603 Kuala Lumpur, Malaysia
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Baaten GG, Geskus RB, Kint JA, Roukens AHE, Sonder GJ, van den Hoek A. Symptoms of infectious diseases in immunocompromised travelers: a prospective study with matched controls. J Travel Med 2011; 18:318-26. [PMID: 21896095 DOI: 10.1111/j.1708-8305.2011.00543.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Immunocompromised travelers to developing countries are thought to have symptomatic infectious diseases more often and longer than non-immunocompromised travelers. Evidence for this is lacking. This study evaluates whether immunocompromised short-term travelers are at increased risk of diseases. METHODS A prospective study was performed between October 2003 and May 2010 among adult travelers using immunosuppressive agents (ISA) and travelers with inflammatory bowel disease (IBD), with their non-immunocompromised travel companions serving as matched controls with comparable exposure to infection. Data on symptoms of infectious diseases were recorded by using a structured diary. RESULTS Among 75 ISA, the incidence of travel-related diarrhea was 0.76 per person-month, and the number of symptomatic days 1.32 per month. For their 75 controls, figures were 0.66 and 1.50, respectively (p > 0.05). Among 71 IBD, the incidence was 1.19, and the number of symptomatic days was 2.48. For their 71 controls, figures were 0.73 and 1.31, respectively (p > 0.05). These differences also existed before travel. ISA had significantly more and longer travel-related signs of skin infection and IBD suffered more and longer from vomiting. As for other symptoms, no significant travel-related differences were found. Only 21% of immunocompromised travelers suffering from diarrhea used their stand-by antibiotics. CONCLUSIONS ISA and IBD did not have symptomatic infectious diseases more often or longer than non-immunocompromised travelers, except for signs of travel-related skin infection among ISA. Routine prescription of stand-by antibiotics for these immunocompromised travelers to areas with good health facilities is probably not more useful than for healthy travelers.
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Affiliation(s)
- Gijs G Baaten
- Department of Infectious Diseases, Public Health Service, GGD, Amsterdam, Amsterdam, The Netherlands.
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Nikolić A, Klun I, Bobić B, Ivović V, Vujanić M, Zivković T, Djurković-Djaković O. Human giardiasis in Serbia: asymptomatic vs symptomatic infection. Parasite 2011; 18:197-201. [PMID: 21678797 PMCID: PMC3671421 DOI: 10.1051/parasite/2011182197] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Accepted: 10/08/2010] [Indexed: 11/16/2022] Open
Abstract
Despite the public health importance of giardiasis in all of Europe, reliable data on the incidence and prevalence in Western Balkan Countries (Serbia, Bosnia and Herzegovina, Croatia, Montenegro and FYR Macedonia) are scarce, and the relative contribution of waterborne and food-borne, or person-to-person and/or animal-to-person, transmission of human giardiasis is not yet clear. To provide baseline data for the estimation of the public health risk caused by Giardia, we here review the information available on the epidemiological characteristics of asymptomatic and symptomatic human infection in Serbia. Although asymptomatic cases of Giardia represent a major proportion of the total cases of infection, high rates of Giardia infection were found in both asymptomatic and symptomatic populations. No waterborne outbreaks of giardiasis have been reported, and it thus seems that giardiasis mostly occurs sporadically in our milieu. Under such circumstances, control measures to reduce the high prevalence of giardiasis in Serbia have focused on person-to-person transmission, encouraging proper hygiene, but for more targeted intervention measures, studies to identify other risk factors for asymptomatic and symptomatic infections are needed.
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Affiliation(s)
- A Nikolić
- Serbian Centre for Parasitic Zoonoses, Institute for Medical Research, University of Belgrade, Serbia.
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Zoonotic potential and molecular epidemiology of Giardia species and giardiasis. Clin Microbiol Rev 2011; 24:110-40. [PMID: 21233509 DOI: 10.1128/cmr.00033-10] [Citation(s) in RCA: 804] [Impact Index Per Article: 61.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Molecular diagnostic tools have been used recently in assessing the taxonomy, zoonotic potential, and transmission of Giardia species and giardiasis in humans and animals. The results of these studies have firmly established giardiasis as a zoonotic disease, although host adaptation at the genotype and subtype levels has reduced the likelihood of zoonotic transmission. These studies have also identified variations in the distribution of Giardia duodenalis genotypes among geographic areas and between domestic and wild ruminants and differences in clinical manifestations and outbreak potentials of assemblages A and B. Nevertheless, our efforts in characterizing the molecular epidemiology of giardiasis and the roles of various animals in the transmission of human giardiasis are compromised by the lack of case-control and longitudinal cohort studies and the sampling and testing of humans and animals living in the same community, the frequent occurrence of infections with mixed genotypes and subtypes, and the apparent heterozygosity at some genetic loci for some G. duodenalis genotypes. With the increased usage of multilocus genotyping tools, the development of next-generation subtyping tools, the integration of molecular analysis in epidemiological studies, and an improved understanding of the population genetics of G. duodenalis in humans and animals, we should soon have a better appreciation of the molecular epidemiology of giardiasis, the disease burden of zoonotic transmission, the taxonomy status and virulences of various G. duodenalis genotypes, and the ecology of environmental contamination.
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