Zoonotic Threats: The (Re)emergence of Cercarial Dermatitis, Its Dynamics, and Impact in Europe

Cercarial dermatitis (CD), or "Swimmer's itch" as it is also known, is a waterborne illness caused by a blood fluke from the family Schistosomatidae. It occurs when cercariae of trematode species that do not have humans as their definitive host accidentally penetrate human skin (in an aquatic environment) and trigger allergic symptoms at the site of contact. It is an emerging zoonosis that occurs through water and is often overlooked during differential diagnosis. Some of the factors contributing to the emergence of diseases like CD are related to global warming, which brings about climate change, water eutrophication, the colonization of ponds by snails susceptible to the parasite, and sunlight exposure in the summer, associated with migratory bird routes. Therefore, with the increase in tourism, especially at fluvial beaches, it is relevant to analyze the current epidemiological scenario of CD in European countries and the potential regions at risk.

High prevalence of natural infection by the ruminant blood fluke Schistosoma spindale in the intermediate snail host Indoplanorbis exustus in Uttaradit, Northern Thailand

Background and Aim

Freshwater snails belonging to the family Planorbidae serve as the first intermediate hosts of many species of important parasitic flukes of animals and humans. Information regarding the occurrence of planorbid snail larval trematode infection is limited in Northern Thailand. Thus, this study aimed to estimate the prevalence of larval trematode infection of the freshwater snail Indoplanorbis exustus in Uttaradit, Thailand, and to identify trematode species based on their morphological and molecular characteristics.

Materials and Methods

Planorbid snail specimens were collected from a water reservoir in Uttaradit, Thailand, from June to August 2023. Snails were assessed for larval trematode infection through cercarial shedding and crushing methods. The released cercariae were preliminarily identified on the basis of their morphological characteristics. In addition, species identification of the detected cercariae was conducted using 28S ribosomal RNA and cytochrome c oxidase subunit 1 gene sequence analyses.

Results

The overall prevalence of cercarial infection was 61.5% (107/174) in planorbid snails in Uttaradit province. Two species of cercarial trematodes, Schistosoma spindale (106/174, 60.9%) and Artyfechinostomum malayanum (1/174, 0.6%), were identified using morphological and molecular analyses, of which S. spindale was the most abundant species. Our studied snails did not have mixed infection with more than two cercarial species.

Conclusion

Our findings reveal a remarkably high prevalence of S. spindale cercariae infecting planorbid snails in Uttaradit, indicating that humans and animals across the study area are at risk of infection. Our data may contribute to the development of effective strategies to control this zoonotic infectious disease.

Scratching the Itch: Updated Perspectives on the Schistosomes Responsible for Swimmer's Itch around the World

Although most studies of digenetic trematodes of the family Schistosomatidae dwell on representatives causing human schistosomiasis, the majority of the 130 identified species of schistosomes infect birds or non-human mammals. The cercariae of many of these species can cause swimmer's itch when they penetrate human skin. Recent years have witnessed a dramatic increase in our understanding of schistosome diversity, now encompassing 17 genera with eight more lineages awaiting description. Collectively, schistosomes exploit 16 families of caenogastropod or heterobranch gastropod intermediate hosts. Basal lineages today are found in marine gastropods and birds, but subsequent diversification has largely taken place in freshwater, with some reversions to marine habitats. It seems increasingly likely that schistosomes have on two separate occasions colonized mammals. Swimmer's itch is a complex zoonotic disease manifested through several different routes of transmission involving a diversity of different host species. Swimmer's itch also exemplifies the value of adopting the One Health perspective in understanding disease transmission and abundance because the schistosomes involved have complex life cycles that interface with numerous species and abiotic components of their aquatic environments. Given the progress made in revealing their diversity and biology, and the wealth of questions posed by itch-causing schistosomes, they provide excellent models for implementation of long-term interdisciplinary studies focused on issues pertinent to disease ecology, the One Health paradigm, and the impacts of climate change, biological invasions and other environmental perturbations.

Diversity of Trichobilharzia in New Zealand with a new species and a redescription, and their likely contribution to cercarial dermatitis

In response to annual outbreaks of human cercarial dermatitis (HCD) in Lake Wanaka, New Zealand, ducks and snails were collected and screened for avian schistosomes. During the survey from 2009 to 2017, four species of Trichobilharzia were recovered. Specimens were examined both morphologically and genetically. Trichobilharzia querquedulae, a species known from four continents, was found in the visceral veins of the duck Spatula rhynchotis but the snail host remains unknown. Cercaria longicauda [i.e. Trichobilharzia longicauda (Macfarlane, 1944) Davis, 2006], considered the major aetiological agent of HCD in Lake Wanaka, was discovered, and redescribed from adults in the visceral veins of the duck Aythya novaeseelandiae and cercariae from the snail Austropeplea tomentosa. Recovered from the nasal mucosa of Ay. novaeseelandiae is a new species of Trichobilharzia that was also found to cycle naturally through Au. tomentosa. Cercariae of a fourth species of Trichobilharzia were found in Au. tomentosa but the species remains unidentified.

Parasitological and molecular characterization of the avian schistosomatid cercariae infecting lymnaeidae snails in Phayao, Northern Thailand

Background and Aim:

Cercarial dermatitis or swimmer’s itch is an allergic skin reaction caused by penetrating cercaria of animal blood flukes. It is considered as a zoonotic water-borne skin condition that is found globally. Among the schistosomatid trematodes, avian schistosomes are the most responsible for cercarial dermatitis. Very little is known regarding the occurrence of dermatitis-causing cercariae in Thailand. Therefore, the objective of this study was to preliminarily investigate the presence of larval blood fluke infection among local lymnaeidae snails in Phayao by the incorporation of morphological and molecular methods.

Materials and Methods:

Overall 500 Radix (Lymnaea) rubiginosa (Michelin, 1831) were collected from freshwater reservoirs near Phayao Lake in San Kwan village in Phayao, Thailand, from October to December 2020. The snails were examined for avian blood fluke infection by the cercarial shedding technique followed by morphological and molecular characterization.

Results:

Only one type of furcocercous cercaria was observed to emerge from six infected snails (1.2%). Our molecular analyses demonstrated that the emerging cercariae showed most similarity to either the 28S ribosomal RNA gene (28S rDNA) or cytochrome oxidase C subunit 1 gene (cox1 or COI) sequences to those of Trichobilharzia species. In addition, phylogenetic tree analyses of both loci revealed similar results; the emerging cercariae were consistently clustered together with Trichobilharzia regenti.

Conclusion:

Our results clearly confirmed that the detected furcocercous cercariae belonged to the genus Trichobilharzia and displayed the highest homology to T. regenti. This study provides important data on the occurrence of dermatitis causing cercariae infection among local lymnaeidae snails, encouraging effective management, and control measures for this zoonotic infectious disease.

Clinical Spectrum of Schistosomiasis: An Update

Schistosomiasis is a helminthic infection and one of the neglected tropical diseases (NTDs). It is caused by blood flukes of the genus Schistosoma. It is an important public health problem, particularly in poverty-stricken areas, especially those within the tropics and subtropics. It is estimated that at least 236 million people worldwide are infected, 90% of them in sub-Saharan Africa, and that this disease causes approximately 300,000 deaths annually. The clinical manifestations are varied and affect practically all organs. There are substantial differences in the clinical presentation, depending on the phase and clinical form of schistosomiasis in which it occurs. Schistosomiasis can remain undiagnosed for a long period of time, with secondary clinical lesion. Here, we review the clinical profile of schistosomiasis. This information may aid in the development of more efficacious treatments and improved disease prognosis.

Avian schistosome species in Danish freshwater lakes: relation to biotic and abiotic factors

Due to the increased prevalence of human infections with bird schistosome larvae (cercarial dermatitis) associated with bathing in Danish lakes, a nationwide survey of infected intermediate host snails was conducted in 2018-2020. Pulmonate snails (10,225 specimens) were collected from 39 freshwater lakes (in the four major geographic regions in Denmark) and subjected to shedding. Released schistosome cercariae were isolated and identified by polymerase chain reaction and sequencing whereby Trichobilharzia regenti, Trichobilharzia franki, Trichobilharzia szidati and Trichobilharzia anseri were recorded. Infections were primarily determined by biotic factors such as the presence of final host birds and intermediate host snails and water temperature was noted as an important abiotic parameter associated with the infection. No clear connection with other abiotic factors (conductivity, alkalinity, pH, nitrogen, phosphorous) was seen. The widespread occurrence of infected snails, when compared to previous investigations, suggests that climate changes at northern latitudes could be responsible for the increased risk of contracting cercarial dermatitis.

The complete mitochondrial genome of the causative agent of the human cercarial dermatitis, the visceral bird schistosome species Trichobilharzia szidati (platyhelminthes: Trematoda: Schistosomatidae)

We report the first complete mitochondrial genome of visceral bird schistosome Trichobilharzia szidati(Platyhelminthes, Trematoda: Schistosomatidae). The circular genome is 14293 bp in length and contains 12 protein-coding genes, 12S and 16S rRNAs genes, 22 tRNAs and one non-coding region (202 bp) (accession number MF136777). Phylogenetic relationships based on 12 protein-coding gene sequences (PCG) of mitogenomes of a number of trematode and cestode species have shown that T. szidati is the closest genetic relative to nasal bird schistosome T. regenti. The complete mitogenome sequence of T. szidati may serve as a resource for comparative mitogenomics and trematode evolution studies.

[Cercarial dermatitis of bathers in northern Argentine Patagonia]

The cercarial dermatitis is a zoonotic, summer, skin-disease, caused by a swimming larva (cercaria) of a schistosomatid trematode. This larva accidentally penetrates the skin of people in the water, causing an allergic reaction, which is not always reported in health centers, so it is difficult to determine its incidence. Cases have been registered worldwide, including Argentina, although the epidemiological studies were performed only in the Northern Hemisphere. In this survey the epidemiology of cercarial dermatitis was studied in three Patagonian lakes watering places, Pellegrini, Mari Menuco, and Puelo, where surveys were conducted during summers of 2012-2013 and 2013-2014. The risk factors were analyzed and grouped in "personal characteristics", "use of the recreational resource", and "prevention measures". At the Pellegrini Lake, the people's sensitivity included in "personal characteristics" was the only determining factor for the occurrence of this zoonosis, mean while in Mari Menuco Lake, the bathing time and distance from the coast, and the use of lotions would affect the occurrence of swimmer's itch. In Puelo Lake, no cases were recorded during the study period.