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Bourli P, Eslahi AV, Tzoraki O, Karanis P. Waterborne transmission of protozoan parasites: a review of worldwide outbreaks - an update 2017-2022. JOURNAL OF WATER AND HEALTH 2023; 21:1421-1447. [PMID: 37902200 PMCID: wh_2023_094 DOI: 10.2166/wh.2023.094] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
The current study presents a comprehensive review of worldwide waterborne parasitic protozoan outbreaks reported between 2017 and 2022. In total, 416 outbreaks were attributed to the waterborne transmission of parasitic protozoa. Cryptosporidium accounted for 77.4% (322) of outbreaks, while Giardia was identified as the etiological agent in 17.1% (71). Toxoplasma gondii and Naegleria fowleri were the primary causes in 1.4% (6) and 1% (4) of outbreaks, respectively. Blastocystis hominis, Cyclospora cayetanensis, and Dientamoeba fragilis were independently identified in 0.72% (3) of outbreaks. Moreover, Acanthamoeba spp., Entamoeba histolytica, Vittaforma corneae, and Enterocytozoon bieneusi were independently the causal agents in 0.24% (1) of the total outbreaks. The majority of the outbreaks (195, 47%) were reported in North America. The suspected sources for 313 (75.2%) waterborne parasitic outbreaks were recreational water and/or swimming pools, accounting for 92% of the total Cryptosporidium outbreaks. Furthermore, 25.3% of the outbreaks caused by Giardia were associated with recreational water and/or swimming pools. Developing countries are most likely to be impacted by such outbreaks due to the lack of reliable monitoring strategies and water treatment processes. There is still a need for international surveillance and reporting systems concerning both waterborne diseases and water contamination with parasitic protozoa.
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Affiliation(s)
- Pavlina Bourli
- School of the Environment, Department of Marine Sciences, University of the Aegean, University Hill, Mytilene, Lesvos 81100, Greece E-mail:
| | - Aida Vafae Eslahi
- Medical Microbiology Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Ourania Tzoraki
- School of the Environment, Department of Marine Sciences, University of the Aegean, University Hill, Mytilene, Lesvos 81100, Greece
| | - Panagiotis Karanis
- Medical Faculty and University Hospital, University of Cologne, Cologne, Germany; Medical School, Department of Basic and Clinical Sciences, Anatomy Centre, University of Nicosia, Nicosia, Cyprus
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Almeria S, Chacin-Bonilla L, Maloney JG, Santin M. Cyclospora cayetanensis: A Perspective (2020-2023) with Emphasis on Epidemiology and Detection Methods. Microorganisms 2023; 11:2171. [PMID: 37764015 PMCID: PMC10536660 DOI: 10.3390/microorganisms11092171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/11/2023] [Accepted: 08/23/2023] [Indexed: 09/29/2023] Open
Abstract
Cyclospora cayetanensis infections are prevalent worldwide, and the parasite has become a major public health and food safety concern. Although important efforts have been dedicated to advance toward preventing and reducing incidences of cyclosporiasis, there are still several knowledge gaps that hamper the implementation of effective measures to prevent the contamination of produce and water with Cyclospora oocysts. Some of these data gaps can be attributed to the fact that access to oocysts is a limiting factor in C. cayetanensis research. There are no animal models or in vivo or in vitro culture systems to propagate the oocysts needed to facilitate C. cayetanensis research. Thus, researchers must rely upon limited supplies of oocysts obtained from naturally infected human patients considerably restricting what can be learnt about this parasite. Despite the limited supply of C. cayetanensis oocysts, several important advances have happened in the past 3 years. Great progress has been made in the Cyclospora field in the areas of molecular characterization of strains and species, generation of genomes, and development of novel detection methods. This comprehensive perspective summarizes research published from 2020 to 2023 and evaluates what we have learnt and identifies those aspects in which further research is needed.
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Affiliation(s)
- Sonia Almeria
- Center for Food Safety and Nutrition (CFSAN), Department of Health and Human Services, Food and Drug Administration, Office of Applied Research and Safety Assessment (OARSA), Division of Virulence Assessment, Laurel, MD 20708, USA
| | | | - Jenny G. Maloney
- Environmental Microbial and Food Safety Laboratory, Agricultural Research Service, United States Department of Agriculture, Beltsville, MD 20705, USA;
| | - Monica Santin
- Environmental Microbial and Food Safety Laboratory, Agricultural Research Service, United States Department of Agriculture, Beltsville, MD 20705, USA;
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Li J, Xu F, Karim MR, Zhang L. Review on Cyclosporiasis Outbreaks and Potential Molecular Markers for Tracing Back Investigations. Foodborne Pathog Dis 2022; 19:796-805. [PMID: 36450125 DOI: 10.1089/fpd.2022.0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Cyclosporiasis is an emerging disease caused by Cyclospora cayetanensis, which induces protracting and relapsing gastroenteritis and has been linked to huge and complicated travel- and food-related outbreaks worldwide. Cyclosporiasis has become more common in both developing and developed countries as a result of increased global travel and the globalization of the human food supply. It is not just a burden on individual human health but also a worldwide public health problem. As a pathogen of interest, the molecular biological characteristics of C. cayetanensis have advanced significantly over the last few decades. However, only one FDA-approved molecular platform has been commercially used in the investigation of cyclosporiasis outbreaks. More potential molecular markers and genotyping of C. cayetanensis in samples based on the polymorphic region of the whole genomes might differentiate between separate case clusters and would be useful in tracing back investigations, especially during cyclosporiasis outbreak investigations. Considering that there is no effective vaccine for cyclosporosis, epidemiological investigation using effective tools is crucial for controlling cyclosporiasis by source tracking. Therefore, more and more epidemiological investigative studies for human cyclosporiasis should be promoted around the world to get a deeper understanding of its characteristics as well as management. This review focuses on major cyclosporiasis outbreaks and potential molecular markers for tracing back investigations into cyclosporiasis outbreaks.
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Affiliation(s)
- Junqiang Li
- College of Veterinary Medicine, Henan Agricultural University, Zhengzhou, China.,Key Laboratory of Quality and Safety Control of Poultry Products (Zhengzhou), Ministry of Agriculture and Rural Affairs, Zhengzhou, China.,International Joint Research Laboratory for Zoonotic Diseases of Henan, Zhengzhou, China
| | - Feifei Xu
- College of Veterinary Medicine, Henan Agricultural University, Zhengzhou, China
| | - Md Robiul Karim
- Department of Medicine, Faculty of Veterinary Medicine and Animal Science, Bangabandhu Sheikh Mujibur Rahman Agricultural University, Gazipur, Bangladesh
| | - Longxian Zhang
- College of Veterinary Medicine, Henan Agricultural University, Zhengzhou, China.,Key Laboratory of Quality and Safety Control of Poultry Products (Zhengzhou), Ministry of Agriculture and Rural Affairs, Zhengzhou, China.,International Joint Research Laboratory for Zoonotic Diseases of Henan, Zhengzhou, China
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Ma JY, Li MY, Qi ZZ, Fu M, Sun TF, Elsheikha HM, Cong W. Waterborne protozoan outbreaks: An update on the global, regional, and national prevalence from 2017 to 2020 and sources of contamination. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 806:150562. [PMID: 34852432 DOI: 10.1016/j.scitotenv.2021.150562] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/02/2021] [Accepted: 09/20/2021] [Indexed: 06/13/2023]
Abstract
The aim of this review is to identify the worldwide trend of waterborne protozoan outbreaks and how it varies between geographic regions during the period from 2017 to 2020. Data about waterborne protozoan outbreaks were gathered and stratified by continent, country, water source, and protozoan species associated with the outbreak. The highest prevalence of waterborne protozoan outbreaks was reported in developed countries. Out of 251 outbreaks reported worldwide during the studied period, 141, 51 and 24 outbreaks were recorded in the USA, UK, and New Zealand, respectively. These outbreaks were mainly associated with Cryptosporidium (192 outbreaks) and Giardia (48 outbreaks). Cyclospora cayetanensis, Dientamoebafragilis and Toxoplasma gondii were associated with 7 outbreaks. One outbreak was associated with each of Blastocystis hominis, Entamoeba histolytica, Microsporidia or Naegleria fowleri. This data suggests large discrepancies in the number of outbreaks reported between geographic regions, with most outbreaks recorded in developed countries. Differences in the prevalence of outbreaks between countries are likely attributed to the availability of diagnostic capabilities and surveillance programs to monitor water contamination with pathogenic protozoa. More attention and concerted efforts are required to improve water safety and to alleviate the impact of waterborne protozoan infections. Appropriate surveillance of water contamination with protozoa can enable public health officials to identify source of contamination and implement the necessary measures to limit transmission and prevent outbreaks.
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Affiliation(s)
- Jun-Yang Ma
- Marine College, Shandong University, Weihai, Shandong 264209, PR China
| | - Man-Yao Li
- Marine College, Shandong University, Weihai, Shandong 264209, PR China
| | - Ze-Zheng Qi
- Marine College, Shandong University, Weihai, Shandong 264209, PR China
| | - Ming Fu
- Marine College, Shandong University, Weihai, Shandong 264209, PR China
| | - Tian-Feng Sun
- School of Translation Studies, Shandong University, Weihai, Shandong 264209, PR China
| | - Hany M Elsheikha
- Faculty of Medicine and Health Sciences, School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Loughborough, United Kingdom.
| | - Wei Cong
- Marine College, Shandong University, Weihai, Shandong 264209, PR China.
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