[An Epidemiological Study On Zoonoses In Korea]

Current status of Clonorchis sinensis and clonorchiasis in Korea: epidemiological perspectives integrating the data from human and intermediate hosts

Clonorchis sinensis is a carcinogenic liver fluke that causes clonorchiasis in humans. Clonorchiasis is prevalent in East Asian countries, and approximately 15–20 million individuals are estimated to be infected with this fluke globally. This review highlights the current status of C. sinensis and clonorchiasis in Korea from the epidemiological perspective involving the analysis of humans and intermediate hosts. Despite the recent decline in C. sinensis infection rate in Korea, C. sinensis infections remain endemic in 5 major river basins (Han-gang, Geum-gang, Seomjin-gang, Yeongsan-gang and Nakdong-gang; gang means river) with a high incidence of cholangiocarcinoma. A noticeable pattern involves increasing mild infections among patients diagnosed positive for C. sinensis eggs. The infection rate of C. sinensis metacercariae in the second intermediate host, freshwater fish, is also maintained at a substantial level. Thus, the One Health approach integrating different sectors and disciplines is recommended to accelerate and sustain control of C. sinensis, thereby leading to successful eradication. Health promotion via information dissemination and health education should be extended to prevent the consumption of raw freshwater fish by residents living in high-risk areas.

Human sparganosis, a neglected food borne zoonosis

Human sparganosis is a food borne zoonosis caused by the plerocercoid larvae (spargana) of various diphyllobothroid tapeworms of the genus Spirometra. Human infections are acquired by ingesting the raw or undercooked meat of snakes or frogs, drinking untreated water, or using raw flesh in traditional poultices. More than 1600 cases of sparganosis have been documented worldwide, mostly in east and southeast Asia. Sporadic cases have been reported in South America, Europe, and Africa, and several cases have been described in travellers returning from endemic regions. Epidemiological data suggest that the increased effect of sparganosis on human health is because of greater consumption of raw meat of freshwater frogs and snakes. This Review provides information about the Spirometra parasites and their lifecycles, summarises clinical features, diagnosis, and treatment of human sparganosis, and describes geographical distribution and infection characteristics of Spirometra parasites in host animals.

Evaluation of the MGL method to detect Paragonimus eggs and its improvement

Dog feces containing 500 Paragonimus westermani eggs per gram were examined by the Medical General Laboratory (MGL), the simple sedimentation (SS), and the Army Medical School III (AMS III) methods. The number of eggs per gram of feces (EPG) obtained by the MGL method was 17.2 and was significantly lower than those obtained by the SS method (324.0) and the AMS III method (505.6). When isolated P. westermani eggs were processed by the MGL method and four layers (ether, ether-fecal, formalin layers, and sediment) of the final centrifugation product were separately examined, almost 100% of eggs were found at the ether-fecal layer. Similarly, when fecal samples containing P. westermani, Paragonimus skrjabini miyazakii, Paragonimus ohirai, or Paragonimus harinasutai eggs were processed by the MGL method, more than 95% of the eggs were found in the supernatant layers. The formalin-ethyl acetate (FEA) method showed a similar tendency as the MGL method and over 90% of eggs remained in the supernatant layers. Contrary to Paragonimus eggs, 63 and 96% of Clonorchis and Metagonimus eggs were found in the sediment in the MGL method, respectively. When surfactant (Tween 80) was added to fecal solution, most of Paragonimus eggs spun down in the sediment in the MGL and FEA methods, suggesting that Paragonimus eggs have hydrophobic components on their surface. It is suggested that surfactant addition to the fecal solution should be considered when the MGL method is used for detection of Paragonimus eggs.

Cross-reactivity of Toxocariasis with Crude Antigen of Toxascaris leonina Larvae by ELISA

Roundworms of Toxocara canis and Toxascaris leonina are common gastrointestinal helminths of canids over the world. Humans are infected with T. canis larvae through ingestion of infective eggs in contaminated environments or larvae by consumption of raw or uncooked meat or livers. Recently, patients of clinically diagnosed toxocariasis are increasing and require correct diagnosis in Korea. The present study investigated serological cross-reactivity between crude antigens of T. canis (TCLA) and T. leonina (TLLA) larvae. We collected serum specimens from 177 toxocariasis patients who were clinically suspected in the Seoul National University Hospital and 115 healthy controls. An ELISA method for toxocariasis was used to evaluate diagnostic efficacy of TLLA for serodiagnosis of human toxocariasis. The IgG ELISA using TLLA gave 14 (14.3%) positives of 98 TCLA positive specimens among 177 suspected toxocariasis patients. Most of them showed high absorbances with TCLA. In conclusion, there is a partial cross reaction between serum specimens of toxocariasis and TLLA.

Review of zoonotic parasites in medical and veterinary fields in the Republic of Korea

Zoonotic parasites are animal parasites that can infect humans. The major zoonotic protozoa in the Republic of Korea are Babesia bovis, Chilomastix mesnili, Cryptosporidium parvum, Endolimax nana, Entamoeba coli, Entamoeba hitolytica, Giardia lamblia, Iodamoeba bütschlii, Pneumocystis carinii, Sarcocystis cruzi, and Toxoplasma gondii. The major zoonotic helminths in Korea include trematodes, cestodes, and nematodes. Trematodes are Clonorchis sinensis, Echinostoma hortense, Echinostoma spp., Fasciola hepatica, Heterophyes nocens, Metagonimus yokogawai, and Paragonimus westermani. Cestodes are Diphyllobothrium latum, Dipylidium caninum, Echinococcus granulosus, Hymenolepis nana, Raillietina tetragona, sparganum (Spirometra spp.), Taenia saginata, T. solium, and T. asiatica. Nematodes are Ancylostoma caninum, Brugia malayi, Capillaria hepatica, Dirofilaria immitis, Gnathostoma dololesi, Gnathostoma spinigerum, Loa loa, Onchocerca gibsoni, Strongyloides stercoralis, Thelazia callipaeda, Trichinella spiralis, Trichostrongylus orientalis, Trichuris trichiura, and Trichuris vulpis. The one arthropod is Sarcoptes scabiei. Many of these parasites have disappeared or were in decline after the 1990's. Since the late 1990's, the important zoonotic protozoa have been C. parvum, E. nana, E. coli, E. hitolytica, G. lamblia, I. buetschlii, P. carinii and T. gondii. The important zoonotic helminths have been C. sinensis, H. nocens, M. yokogawai, P. westermani, D. latum, T. asiatica, sparganum, B. malayi, T. orientalis, T. callipaeda and T. spiralis. However, outbreaks of these parasites are only in a few endemic areas. The outbreaks of Enterobius vermicularis and head lice, human parasites, have recently increased in the kindergartens and primary schools in the Republic of Korea.

Toxocariasis and ingestion of raw cow liver in patients with eosinophilia

Ingestion of raw animal liver has been suggested as a possible mode of infection of human toxocariasis. We evaluated the relationship between toxocariasis and the ingestion of raw meat in patients with eosinophilia of unknown etiology. The study population consisted of 120 patients presenting with peripheral blood eosinophilia (>500 cells/microliter or >10% of the white blood cell count). They were divided into 2 groups: 104 seropositive patients based on a Toxocara excretory-secretory IgG ELISA and 16 seronegative patients. While 25.0% of seronegative patients had a recent history of eating raw cow liver, 87.5% of seropositive patients had this history. Multivariate statistical analysis showed that a recent history of eating raw cow liver was related to an increased risk of toxocariasis. Collectively, it is proposed that raw cow liver is a significant infection source of toxocariasis in the patients with eosinophilia of unknown etiology.

Molecular identification of Trichuris vulpis and Trichuris suis isolated from different hosts

Trichuris suis was isolated from the cecum of two different hosts (Sus scrofa domestica -- swine and Sus scrofa scrofa -- wild boar) and Trichuris vulpis from dogs in Sevilla, Spain. Genomic DNA was isolated and internal transcribed spacers (ITS)1-5.8S-ITS2 segment from the ribosomal DNA (rDNA) was amplified and sequenced using polymerase chain reaction techniques. The sequence of T. suis from both hosts was 1,396 bp in length while that of T. vulpis was 1,044 bp. ITS1 of both populations isolated of T. suis was 661 nucleotides in length, while the ITS2 was 534 nucleotides in length. Furthermore, the ITS1 of T. vulpis was 410 nucleotides in length, while the ITS2 was 433 nucleotides in length. One hundred fifty-four nucleotides were observed along the 5.8S gene of T. suis and T. vulpis. Intraindividual and intraspecific variations were detected in the rDNA of both species. The presence of microsatellites was observed in all the individuals assayed. Sequence analysis of the ITSs and the 5.8S gene has demonstrated no sequence differences between T. suis isolated from both hosts (S. scrofa domestica -- swine and S. scrofa scrofa -- wild boar). Nevertheless, clear differences were detected between the ITS1 and ITS2 of T. suis and T. vulpis. Furthermore, a comparative molecular analysis between both species and the previously published ITS1-5.8S-ITS2 sequence data of Trichuris ovis, Trichuris leporis, Trichuris muris, Trichuris arvicolae, and Trichuris skrjabini was carried out. A common homology zone was detected in the ITS1 sequence of all species of trichurids.

Infection status with helminthes in feral cats purchased from a market in Busan, Republic of Korea

The present study was performed to investigate the infection status with helminth in a group of feral cats in Korea. More than 29 helminth species including adults or eggs were detected in visceral and fecal samples of the examined cats. Among these were a host of nematodes, including toxocarids, Ancylostoma sp. and the larva of Anisakis simplex; trematodes, including Clonorchis sinensis, Paragonimus westermani, Eurytrema pancreaticum, Pharyngostomum cordatum, Metagonimus spp., Heterophyes nocens, Pygidiopsis summa, Heterophyopsis continua, Stictodora fuscata, Stictodora lari, Acanthotrema felis, Stellantchasmus falcatus, Centrocestus armatus, Procerovum varium, Cryptocotyle sp., Echinostoma revolutum, Echinostoma hortense, Echinochasmus japonicus, Stephanoprora sp., Plagiorchis muris, Neodiplostomum sp. and diplostomulum. We also detected a variety of cestodes, including Spirometra erinacei, Taenia taeniaeformis and unidentified species of tapeworm. We also found examples of the acanthocephalan, Bolbosoma sp. In our assessment of the stools, we detected at least 12 species of helminth eggs. These findings confirmed that feral cats in Korea are infected with a variety of helminth parasite species. Furthermore, among the helminths detected, E. pancreaticum, S. fuscata, S. lari, A. felis, S. falcatus, C. armatus, P. varium, Cryptocotyle sp., E. revolutum, E. japonicus, Stephanoprora sp., P. muris, Neodiplostomum sp. and Bolbosoma sp. represent helminth fauna which have not been reported previously in feral cats in the Republic of Korea.

Prevalence of Toxocara canis, Toxascaris leonina and Dirofilaria immitis in dogs in Chuncheon, Korea (2004)

The intestines and hearts of dogs were examined for Toxocara canis, Toxascaris leonina, and Dirofilaria immitis, after necropsy between June 26 and September 29, 2004 in Chuncheon, Korea. Of the 662 dogs examined, 6 were infected with T. canis (0.9%), 86 with T. leonina (13.0%). Fifty dogs were infected with D. immitis among 500 dogs examined (10.0%). Five were co-infected with T. canis and T. leonina, and three were co-infected with T. leonina and D. immitis. The cumulative positive infection rate for three species was 134/662 (20.2%). Considering previously reported seropositive rates of T. canis excretory-secretory antigen, i.e., 5% in the adult population in Korea, the possibility of toxocariasis caused by T. leonina should be reevaluated.

Acanthotrema felis n. sp. (Digenea: Heterophyidae) from the small intestine of stray cats in the Republic of Korea

Acanthotrema felis n. sp. (Digenea: Heterophyidae) is described from adult flukes recovered in the small intestine of stray cats caught in the southwestern part of the Republic of Korea. The worms were characterized by minute body size, the presence of a bipartite seminal vesicle, and a ventral sucker associated with a ventrogenital sac, which enclosed 3 sclerites (2 long and pointed, and I short and thumblike), and an unarmed gonotyl. They were assigned to Acanthotrema Travassos, 1928, which currently contains 4 species. The new species resembles A. acanthotrema, the type species, because both have 3 sclerites on the ventrogenital sac. However, all 3 sclerites in the new species are armed with minute spines on their base, whereas only 2 sclerites in A. acanthotrema have minute spines near their tips. Three species of Stictodora Looss, 1899, namely,Stictodora tridactyla Martin and Kuntz, 1955, S. cursitans Kinsella and Heard, 1974, and S. tanayensis Velasquez, 1973, are transferred to Acanthotrema, and the new species is distinguished from them particularly in terms of the number and shape of its sclerites. The generic diagnosis of Acanthotrema is emended.

Intestinal parasites of cats purchased in Seoul

Fecal samples of cats purchased in Seoul were examined for helminth ova or protozoan oocysts from December 1987 to March 1988. Out of the 41 samples, 31 (75.6%) were positive and 60 (146.3%) were cumulative positive for parasites. The followings were identified in the samples: Eggs of Toxocara cati, Clonorchis sinensis, Metagonimus sp., Pharyngostomum cordatum, Spirometra erinacei, Taenia taeniaeformis and oocysts of Isospora sp. From nine autopsied cats, larvae of Anisakis simplex, adults of C. sinensis, M. yokogawai, P. cordatum, S. erinacei and T. taeniaeformis were identified. This is the first report on the detection of Anisakis larvae from cats in Korea. The possible role of cats as a source of human infection with each parasite was discussed.

Paragonimus and paragonimiasis in Korea

The lung fluke, Paragonimus, and lung fluke disease, were reviewed, especially on the works performed in Korea. Among 43 species of Paragonimus recorded in the world literature, P. westermani, P. pulmonalis, and P. iloktsuenensis are known to distribute in Korea. Biological studies on P. westermani have revealed that its snail intermediate host is Semisulcospira spp. and major second intermediate hosts are crabs such as Eriocheir japonicus and E. sinensis or crayfish such as Cambaroides similis and C. dauricus. The final hosts other than man are dogs, cats, pigs, and wild animals. Paragonimiasis has been known to distribute widely over the south Korea, however, the prevalence among people and intermediate hosts is gradually decreasing in recent years. In Korean people, the lung fluke have caused pulmonary infections in a great many of cases but as well extrapulmonary ones including cerebral, spinal, subcutaneous, hepatic, splenic, abdominal, urinary, gynecologic, and other types. The definite diagnosis of paragonimiasis can be executed by the recovery of eggs from sputum or feces of patients, however, immunological methods such as intradermal test, complement-fixation test, precipitin reactions, immunofluorescent techniques, enzyme-linked immunosorbent assay (ELISA) are greatly helpful for egg-negative or extrapulmonary cases. Various drugs have been introduced for the treatment of paragonimiasis, and among them, bithionol, niclofolan and praziquantel have shown high therapeutic efficacy. The most recommendable one is considered praziquantel. For control of this disease, mass chemotherapy of patients seems to be the most efficient and feasible measure.

A human case of gallbladder fascioliasis in Korea

The authors would record the fifth case of human fascioliasis in Korea, occurring in a 48 year old Korean man who lived in Munkyong, Kyongsangbuk-do. The diagnosis was based on the morphology and measurements of the eggs which were collected in necrotic debris from the tunnel-like ulcerations of the gallbladder wall which was surgically removed for a gall stone. Although we failed to find out the fluke in the specimen, there found an evidence of once presence of Fasciola in the inflamed wall of the gallbladder in this patient.

Heterophyid trematodes (Heterophyopsis continua, Pygidiopsis summa and Heterophyes heterophyes nocens) from domestic cats in Korea

During 8 april 1983 to 9 April 1985, a total of 181 domestic cats (Felis catus domestica Linnaeus) of unknown localities in Korea were purchased at Seoul Chung-ang market, and the internal organs were dissected for helminth infections. In the results, three kinds of trematodes of family Heterophyidae (Ohdner, 1914) were obtained from small intesine of domestic cats and identified as follows: five adult worms of Heterophyopsis continua (Onji et Nishio, 1916) from three hosts, two hundreds and twenty three adult worms of Pygidiopsis summa Onji et Nishio, 1916 from seven hosts and twenty six adult worms of Heterophyes heterophyes nocens (Onji et Nishio, 1916) from three hosts. Among them, Heterophyopsis continua and Pygidiopsis summa had not been proved as natural infectios of cats in Korea.

Pharyngostomum cordatum (Trematoda: Alariidae) collected from a cat in Korea

Ten adult worms of Pharynogostomum cordatum were recovered from a cat instesine purchased in August 1980 at the Namdaemun Market, Seoul, Korea. It is the first case report of cat pharyngostomiasis in Korea.