A nationwide survey of the prevalence of human Gymnophalloides seoi infection on western and southern coastal islands in the Republic of Korea

Survey of Gymnophalloides seoi Metacercariae in Natural and Cultured Oysters from Several Western Coastal Areas, Korea

Gymnophalloides seoi (Digenea: Gymnophallidae) is a human intestinal trematode contracted by eating raw oysters (Crassostrea gigas) in the Republic of Korea (=Korea). It has been known to be highly endemic in Aphae Island, Shinan-gun, Jeollanam-do (Province). However, recent epidemiological status of G. seoi has not been reported since the 1990s. In this study, we investigated the prevalence of G. seoi metacercariae in natural and cultured oysters collected from 3 islands and 2 coastal areas in western parts of Korea. The oysters were examined using the artificial digestion method followed by stereomicroscopy. The overall positive rate of G. seoi metacercariae in natural oysters was 66.0% (99/150), and the oysters collected from Yubu Island showed the highest infection rate (74.0%). However, the metacercarial density per oyster was relatively low (1.5–2.4 per oyster). By contrast, no metacercaria was found in cultured oysters purchased from 2 coastal areas in Chungcheongnam-do. Thus, we could confirm that natural oysters produced from 3 western coastal islands are infected with G. seoi metacercariae, whereas cultured oysters purchased from 2 coastal areas were free from infection.

Prevalence and Density of Digenetic Trematode Metacercariae in Clams and Oysters from Western Coastal Regions of the Republic of Korea

A survey was performed to know the recent infection status of digenetic trematode metacercariae in clams and oysters from 4 sites in western coastal regions of the Republic of Korea (=Korea). Four species of clams (Mactra veneriformis, Ruditapes philippinarum, Cyclina sinensis, and Saxidomus purpuratus) were collected from Taean-gun, Chungcheongnam-do (Province), Buan-gun (County) and Gochang-gun, Jeollabuk-do, and oysters, Crassostrea gigas, from Shinan-gun, Jeollanam-do were transferred to our laboratory on ice and examined by the artificial digestion method. The metacercariae of Himasthla alincia were detected in 3 species of clams, M. veneriformis, R. philippinarum, and C. sinensis from the 3 surveyed areas. The positive rate and the mean density per clam infected were 98.9% (30.8 metacercariae) in M. veneriformis, 60.0% (5.0) in R. philippinarum, and 96.0% (28.4) in C. sinensis. The positive rate (mean density) of Acanthoparyphium tyosenense metacercariae in M. veneriformis was 50.0% (2.1) from Taean-gun and 70.0% (2.8) from Gochang-gun. The metacercariae of Parvatrema spp. were detected in M. veneriformis and R. philippinarum from Taean-gun and Gochang-gun; the positive rate (mean density) was 63.3% (4,123) and 50.0% (19) in M. veneriformis, and 6.7% (126) and 100% (238) in R. philippinarum from the 2 regions, respectively. The metacercariae of Gymnophalloides seoi were detected in all 30 oysters from Shinan-gun, and their average density per oyster was 646. From the above results, it has been confirmed that more than 3 species of metacercariae are prevalent in clams from the western coastal regions, and G. seoi metacercariae are still prevalent in oysters from Shinan-gun, Jeollanam-do, Korea

Recovery of Oswaldotrema nacinovici from Whimbrels (Aves) in Korea

Adult specimens of Oswaldotrema nacinovici (Digenea: Philophthalmidae) have been first identified in Korea from 2 migratory birds (whimbrels, Numenius phaeopus) which were found dead at a western seashore area near Gunsan. The worms were recovered in the intestine of these birds. The worms were morphologically characterized by a large ventral sucker in comparison to the oral sucker, an external seminal vesicle extending beyond the posterior margin of the ventral sucker, and conspicuous uterine seminal receptacle. It was noteworthy that metacercariae-like bodies were contained within the inflated regions of 2 ceca. Other intestinal trematode species found in whimbrels included Spelotrema pygmeum, Gynaecotyla squatarolae, Maritrema obstipum, and Himasthla megacotyle. Zoonotic potential of these trematode species should be taken into considerations.

Increased intestinal epithelial cell turnover and intestinal motility in Gymnophalloides seoi-infected C57BL/6 mice

The changing patterns of goblet cell hyperplasia, intestinal epithelial cell turnover, and intestinal motility were studied in ICR and C57BL/6 mice infected with Gymnophalloides seoi (Digenea: Gymnophallidae). Whereas ICR mice retained G. seoi worms until day 7 post-infection (PI), C57BL/6 mice showed a rapid worm expulsion within day 3 PI. Immunosuppression with Depo-Medrol significantly delayed the worm expulsion in C57BL/6 mice. Goblet cell counts were increased in both strains of mice, peaking at day 1 PI in C57BL/6 mice and slowly increasing until day 7 PI in ICR mice. In C57BL/6 mice infected with G. seoi, newly proliferating intestinal epithelial cells were remarkably increased in the crypt, and the increase was the highest at day 1 PI. However, in ICR mice, newly proliferating intestinal epithelial cells increased slowly from day 1 to day 7 PI. Intestinal motility was increased in G. seoi-infected mice, and its chronological pattern was highly correlated with the worm load in both strains of mice. Meanwhile, immunosuppression of C57BL/6 mice abrogated the goblet cell proliferation, reduced the epithelial cell proliferation, and suppressed the intestinal motility. Goblet cell hyperplasia, increased intestinal epithelial cell turnover, and increased intestinal motility should be important mucosal defense mechanisms in G. seoi-infected C57BL/6 mice.

Paleoparasitological studies on mummies of the Joseon Dynasty, Korea

Paleoparasitology is the application of conventional or molecular investigative techniques to archeological samples in order to reveal parasitic infection patterns among past populations. Although pioneering studies already have reported key paleoparasitological findings around the world, the same sorts of studies had not, until very recently, been conducted in sufficient numbers in Korea. Mummified remains of individuals dating to the Korean Joseon Dynasty actually have proved very meaningful to concerned researchers, owing particularly to their superb preservation status, which makes them ideal subjects for paleoparasitological studies. Over the past several years, our study series on Korean mummies has yielded very pertinent data on parasitic infection patterns prevailing among certain Joseon Dynasty populations. In this short review, we summarized the findings and achievements of our recent paleoparasitological examinations of Joseon mummies and discussed about the prospects for future research in this vein.

Sixteenth century Gymnophalloides seoi infection on the coast of the Korean Peninsula

Gymnophalloides seoi is a trematode species discovered as recently as 1993. Interestingly, ancient G. seoi eggs were identified in our earlier study on a 17th Century female mummy unearthed in a Korean county (HD-1) where G. seoi infection, according to a nationwide survey of 2001, was considered not to have been endemic. Although we suspected that the geographical distribution of G. seoi might have contracted over the past several hundred years from wider coastal areas on the Korean peninsula to the much more restricted region delineated by the survey, there has been only the single, above-noted report of an ancient G. seoi infection in a currently non-endemic area. As such, more evidence is needed before our contraction theory of G. seoi infection prevalence can be confirmed as fact. Our current report in this regard will perhaps help to end the controversy. In a newly discovered 17th Century male mummy found in another Korean county considered non-endemic by the 2001 survey, we identified a large number of ancient G. seoi eggs. We believe that this additional evidence for a wider distribution of G. seoi infection prior to the 20th Century is invaluable support for our earlier hypothesis.

Foodborne intestinal flukes in Southeast Asia

In Southeast Asia, a total of 59 species of foodborne intestinal flukes have been known to occur in humans. The largest group is the family Heterophyidae, which constitutes 22 species belonging to 9 genera (Centrocestus, Haplorchis, Heterophyes, Heterophyopsis, Metagonimus, Procerovum, Pygidiopsis, Stellantchasmus, and Stictodora). The next is the family Echinostomatidae, which includes 20 species in 8 genera (Artyfechinostomum, Acanthoparyphium, Echinochasmus, Echinoparyphium, Echinostoma, Episthmium, Euparyphium, and Hypoderaeum). The family Plagiorchiidae follows the next containing 5 species in 1 genus (Plagiorchis). The family Lecithodendriidae includes 3 species in 2 genera (Phaneropsolus and Prosthodendrium). In 9 other families, 1 species in 1 genus each is involved; Cathaemaciidae (Cathaemacia), Fasciolidae (Fasciolopsis), Gastrodiscidae (Gastrodiscoides), Gymnophallidae (Gymnophalloides), Microphallidae (Spelotrema), Neodiplostomidae (Neodiplostomum), Paramphistomatidae (Fischoederius), Psilostomidae (Psilorchis), and Strigeidae (Cotylurus). Various types of foods are sources of human infections. They include freshwater fish, brackish water fish, fresh water snails, brackish water snails (including the oyster), amphibians, terrestrial snakes, aquatic insects, and aquatic plants. The reservoir hosts include various species of mammals or birds.The host-parasite relationships have been studied in Metagonimus yokogawai, Echinostoma hortense, Fasciolopsis buski, Neodiplostomum seoulense, and Gymnophalloides seoi; however, the pathogenicity of each parasite species and host mucosal defense mechanisms are yet poorly understood. Clinical aspects of each parasite infection need more clarification. Differential diagnosis by fecal examination is difficult because of morphological similarity of eggs. Praziquantel is effective for most intestinal fluke infections. Continued efforts to understand epidemiological significance of intestinal fluke infections, with detection of further human cases, are required.

Gymnophalloides seoi eggs from the stool of a 17th century female mummy found in Hadong, Republic of Korea

It was previously reported that paleoparasitological clues for parasites infecting humans could be found in the feces of mummies of the Joseon Dynasty (1392-1910) in the Republic of Korea. Here, we report the presence of trematode eggs, including Clonorchis sinensis, Metagonimus yokogawai, and Gymnophalloides seoi (a human parasite known in Korea since 1993) in the feces of a recently excavated female mummy in Hadong, Republic of Korea. This is the first report of the discovery of a G. seoi infection in a human mummy. Since Hadong is currently not an endemic area for G. seoi, we speculate that the parasite might have occurred frequently along coastal areas of the Korean peninsula several hundred years ago and that the endemic areas contracted to, more or less, restricted regions since that time.

A new endemic focus of Gymnophalloides seoi infection on Aphae Island, Shinan-gun, Jeollanam-do

A new endemic focus of Gymnophalloides seoi infection has been discovered on Aphae Island (Shinangun, Jeollanam-do), Republic of Korea. This area, which is referred to as Bokyong-ri, is a small seashore village located in the northern portion of the island. Fecal samples were collected from a total of 57 residents and examined by the Kato-Katz and formalin-ether sedimentation techniques. Helminth eggs were detected in 37 samples (64.9%); 33 samples were positive for G. seoi eggs (57.9%), 4 for Pygidiopsis summa (7.0%), 13 for other heterophyids (22.8%), 1 for Clonorchis sinensis (1.7%), and 1 for Trichuris trichiura (1.7%). Women (70.4%) revealed higher rates of G. seoi infection than did men (46.7%), and individuals older than 50 years of age also evidenced higher rates of G. seoi infection than in other age groups (P < 0.05). In worm collection from 13 G. seoi egg positive cases, G. seoi (total 86,558 specimens), Heterophyes nocens (278), Stictodora sp. (10), Heterophyopsis continua (3), P. summa (3), and unidentified flukes (42) were collected. Oysters, the source of G. seoi infection, were collected from an area proximal to the village and 50 were examined for metacercariae; 47 (94%) were found infected and the observed metacercarial density was 9.5 +/- 8.9 per oyster. The results of this study indicate that Bokyong-ri is a new endemic area of G. seoi infection, with high rates of infection in humans and oysters.

Prevalence of Gymnophalloides seoi infection in coastal villages of Haenam-gun and Yeongam-gun, Republic of Korea

One coastal village in Haenam-gun and two in Yeongam-gun, Jeollanam-do were surveyed for intestinal parasite infections by fecal examination. The egg positive rates of Gymnophalloides seoi were high, 24.1% (14/58) in Haenam-gun and 9.3% (11/118) in Yeongam-gun. The egg positive rates of heterophyids, including Heterophyes nocens, and of Clonorchis sinensis were 10.3% and 6.9% in Haenam-gun, and 14.4% and 8.5% in Yeongam-gun, respectively. After praziquantel treatment and purgation, a total of 37,761 fluke specimens were recovered from 17 patients; 11 in Haenam-gun and 6 in Yeongam-gun. Gymnophalloides seoi was the most commonly recovered species, with 37,489 specimens in total (2,205 per person). Other recovered flukes included Heterophyes nocens, Stictodora fuscata, Heterophyopsis continua, Pygidiopsis summa, and undetermined species. These results indicate that the areas surveyed are new endemic foci of G. seoi.

A survey of Enterobius vermicularis infection among children on western and southern coastal islands of the Republic of Korea

To determine the status of Enterobius vermicularis infection among children living on western and southern coastal islands of the Republic of Korea, children (3-10 years) in 39 kindergartens and primary schools were examined using the cello-tape anal swab method, during July and August 2000. Of 1,661 children examined, 307 (18.5%) were found to be positive for E. vermicularis eggs. The highest infection rate (59.3%) was found in a kindergarten and a branch school of Shinyang primary school on Chujado, Jeju-do (Province). Remarkable differences in egg positive rates were observed in different localities. The egg positive rate for boys (21.3%) was significantly higher than that of girls (15.4%) (P = 0.02). However, positive rates were not significantly dependent on age. The results of the present study show that E. vermicularis infection is highly prevalent among pre-school and primary school children living on the western and southern coastal islands of the Republic of Korea, and indicate the need for efforts to control this infection.

Food-borne intestinal trematodiases in humans

Food-borne trematodiases still remain a public health problem world-wide, despite changes in eating habits, alterations in social and agricultural practices, health education, industrialization, environmental alteration, and broad-spectrum anthelmintics. Food-borne trematodiases usually occur focally, are still persistently endemic in some parts of the world, and are most prevalent in remote rural places among school-age children, low-wage earners, and women of child-bearing age. Intestinal fluke diseases are aggravated by socio-economic factors such as poverty, malnutrition, an explosively growing free-food market, a lack of sufficient food inspection and sanitation, other helminthiases, and declining economic conditions. Control programs implemented for food-borne zoonoses and sustained in endemic areas are not fully successful for intestinal food-borne trematodiases because of centuries-old traditions of eating raw or insufficiently cooked food, widespread zoonotic reservoirs, promiscuous defecation, and the use of "night soil" (human excrement collected from latrines) as fertilizer. This review examines food-borne intestinal trematodiases associated with species in families of the Digenea: Brachylaimidae, Diplostomidae, Echinostomatidae, Fasciolidae, Gastrodiscidae, Gymnophallidae, Heterophyidae, Lecithodendriidae, Microphallidae, Nanophyetidae, Paramphistomatidae, Plagiorchiidae, and Strigeidae. Because most of the implicated species are in the Echinostomatidae and Heterophyidae, emphasis in the review is placed on species in these families.

Gymnophalloides seoi: a new human intestinal trematode

A new minute intestinal fluke, recovered from a Korean woman suffering from acute pancreatitis and gastrointestinal difficulties, was described as Gymnophalloides seoi. The coastal village where the patient resided was found to be a highly endemic area for this fluke, and 24 other endemic areas have been found. This fluke infection is now recognized as an emerging parasitic disease. Its second intermediate host is the oyster, and migrating birds are a natural definitive host. This new trematode might exist in other countries.

Food-borne intestinal trematode infections in the Republic of Korea

A total of 19 species of food-borne intestinal trematodes have been reported in humans in the Republic of Korea. They include 12 species of the Heterophyidae, Metagonimus yokogawai, M. takahashii, M. miyatai, Heterophyes nocens, H. heterophyes (imported), H. dispar (imported), Heterophyopsis continua, Pygidiopsis summa, Stellantchasmus falcatus, Centrocestus armatus, Stictodora fuscata, and S. lari; four species of the Echinostomatidae, Echinostoma hortense, E. cinetorchis, Echinochasmus japonicus, and Acanthoparyphium tyosenense; and one species each of the Neodiplostomidae, Neodiplostomum seoulense, Plagiorchiidae, Plagiorchis muris, and Gymnophallidae, Gymnophalloides seoi. Fresh water fish harbor the metacercarial stage of M. yokogawai, M. takahashii, M. miyatai, C. armatus, E. hortense, E. cinetorchis, E. japonicus, or P. muris. Brackish water fish serve as the second intermediate hosts for H. nocens, H. continua, P. summa, S. falcatus, S. fuscata, and S. lari. Brackish water bivalves are the source of infection with A. tyosenense. Tadpoles and frogs are the second intermediate hosts for N. seoulense, but the major source of human infection is the grass snake Rhabdophis tigrina, a paratenic host. The metacercariae of G. seoi are observed in oysters. The natural definitive hosts are, in most cases, mammals such as rats, cats and dogs. However, several species (C. armatus, S. lari, E. japonicus, A. tyosenense, and G. seoi) have birds as natural definitive hosts. Host-parasite relationships, pathogenesis and pathology, immunity, clinical aspects, differential diagnosis, treatment, prevention and control of these intestinal trematodes are briefly discussed.

A review of Gymnophalloides seoi (Digenea: Gymnophallidae) and human infections in the Republic of Korea

Studies on Gymnophalloides seoi (Digenea: Gymnophallidae) and human infections are briefly reviewed. This minute intestinal fluke was first discovered from a Korean woman suffering from acute pancreatitis and gastrointestinal troubles. It was described as a new species by Lee, Chai and Hong in 1993. The southwestern coastal village where the patient resided was found to be a highly endemic area, and additional endemic areas have been identified. The parasite is very small, 0.33-0.50 mm long and 0.23-0.33 mm wide, and characterized by the presence of a ventral pit. The first intermediate host remains unknown, but the second intermediate host has been found to be the oyster Crassostrea gigas. Man and the Palearctic oystercatcher Haematopus ostralegus have been shown to be natural definitive hosts, and wading birds including the Kentish plover Charadrius alexandrinus are highly susceptible to experimental infection. Gerbils, hamsters, cats, and several strains of mice were also susceptible laboratory hosts. In experimentally infected mice, the parasites inhabit the small intestine, pinching and sucking the root of villi with their large oral suckers, but they did not invade beyond the mucosa in immunocompetent mice. However, they were found to invade the submucosa in immunosuppressed mice. Human G. seoi infections have been found in at least 25 localities; 23 islands on the Yellow Sea or the South Sea, and 2 western coastal villages. The highest prevalence was found in a village on Aphaedo, Shinan-gun (49% egg positive rate); other areas showed 0.8-25.3% prevalence. Infected people complained of variable degrees of gastrointestinal troubles and indigestion. The infection can be diagnosed by recovery of eggs in the feces; however, an expert is needed to identify the eggs. Praziquantel, 10 mg/kg in single dose, is effective for treatment of human infections. Eating raw oysters in endemic areas should be avoided.

Intestinal histopathology and in situ postures of Gymnophalloides seoi in experimentally infected mice

The intestinal histopathology and in situ postures of Gymnophalloides seoi (Digenea: Gymnophallidae) were studied using C3H/HeN and C57BL/6 mice as experimental hosts; the effects of immunosuppression were also observed. The metacercariae isolated from naturally infected oysters, 300 or 1,000 in number, were infected orally to each mouse, and the mice were killed at days 3-21 post-infection (PI). In immunocompetent (IC) mice, only a small number of flukes were found in the mucosa of the duodenum and jejunum during days 3-7 PI, with their large oral suckers pinching and sucking the root of villi. The intestinal mucosa showed mild villous atrophy, crypt hyperplasia, and inflammations in the villous stroma and crypt, with remarkable goblet cell hyperplasia. These mucosal changes were almost restored after days 14-21 PI. In immunosuppressed (IS) mice, displacement as well as complete loss of villi adjacent to the flukes was frequently encountered, otherwise the histopathology was generally mild, with minimal goblet cell hyperplasia. In these mice, numerous flukes were found, and it seemed that they were actively moving and rotating in situ. Several flukes were found to have invaded into the submucosa, almost facing the serosa. These results indicate that in IC mice the intestinal histopathology caused by G. seoi is generally mild, and the flukes do not penetrate beyond the mucosa, however, in IS mice, the flukes can cause severe destruction of neighboring villi, and some of them invade into the submucosa.