Effect of Glycosaminoglycans on Cryptosporidium Oocyst Attachment and Excystation

Cryptosporidium causes severe gastrointestinal disease resulting from the ingestion of oocysts, followed by oocyst excystation in the small intestine and the release of infective sporozoites. An understudied strategy for Cryptosporidium inactivation is purposeful oocyst excystation, as sporozoites do not survive long in the environment. This study showed that C. parvum oocyst excystation was induced by direct contact with various glycosaminoglycans (GAGs), including heparin (Hep), chondroitin sulfate A (CSA), and hyaluronan (HA), assembled on polydopamine (PD)-functionalized surfaces. PD surfaces elicited 97.9 ± 3.6% oocyst attachment, with some of the attached oocysts partially (7.3 ± 1.3%) or fully (4.0 ± 0.6%) excysted after 4 days. The PD-GAG surfaces (GAG concentration = 2 mg/mL) elicited similarly high attachment (>97%) and higher oocyst excystation efficiencies after 4 days. The PD-Hep surfaces elicited the highest number of attached excysted oocysts (11.8 ± 0.63% partially excysted; 11.9 ± 0.49% fully excysted), and the PD-HA surfaces elicited the lowest (8.8 ± 2.1% partially excysted; 7.8 ± 1.2% fully excysted). Surface characterization revealed that the addition of GAGs to the PD surface changed both the surface roughness as well as the surface wettability. Treatment of oocysts with an enzyme that degraded the surface glycocalyx markedly reduced excystation (to <2%) of the oocysts attached to the PD and PD-GAG surfaces. These findings suggest that GAGs provide an important local signal for the excystation of C. parvum oocysts and that certain surface-expressed oocyst receptors are necessary for efficient excystation. These oocyst-receptor relationships may be useful in the design of functionalized surfaces for the purposeful inactivation of oocysts in the environment or in water treatment systems. IMPORTANCE Polydopamine surfaces functionalized with glycosaminoglycans were shown to facilitate the attachment and excystation of Cryptosporidium parvum oocysts. Our findings suggest that a surface-expressed receptor on the oocyst wall plays a key role in excystation, with glycosaminoglycans serving as ligands that trigger the initiation of the process. Future technologies and treatment strategies designed to promote premature excystation of oocysts will minimize the ingestion of sporozoites that initiate infection. Therefore, the results from this study have important implications for the protection of public health from waterborne cryptosporidiosis and may serve as a foundation for engineered surfaces designed to remove oocysts from surface waters or inactivate oocysts in water treatment systems.

Molecular characterization of Cryptosporidium spp. in dogs and cats in the city of Rio de Janeiro, Brazil, reveals potentially zoonotic species and genotype

Intestinal cryptosporidiosis is a diarrheal disease caused by protists of genus Cryptosporidium that infect a wide variety of hosts, primarily vertebrates. Due to the close contact between humans and their companion animals, especially dogs and cats, there is concern about the potential for zoonotic transmission of this enteric protozoan parasite by infected animals. This study aimed to perform a microscopic and molecular diagnosis of Cryptosporidium spp. in fecal samples from domiciled dogs and cats. One hundred and nineteen fecal samples were processed using sugar centrifugal flotation followed by molecular detection of Cryptosporidium spp. DNA using nested PCR. Subtyping of isolates positive for C. parvum was performed by sequence analysis of the 60 kDa glycoprotein gene (GP60). Cryptosporidium oocysts were detected in 7.8% (5/64) and 5.4% (3/55) of the fecal samples from dogs and cats, respectively. Cryptosporidium canis (n = 3) and C. parvum (n = 2) were the main species found in dogs, whereas C. felis (n = 3) was prevalent in cats. Subtype IIaA17G2R2 (potentially zoonotic) was identified in samples positive for C. parvum. Despite the low prevalence of Cryptosporidium observed in the domiciled dogs and cats, the presence of potentially zoonotic C. parvum in dogs evidences a public health concern. Further research is needed to better understand the epidemiology, source, and potential impacts of Cryptosporidium infection in cats and dogs.

Intestinal organoid/enteroid-based models for Cryptosporidium

Cryptosporidium is a leading cause of diarrhea and death in young children and untreated AIDS patients in resource-poor settings, and of waterborne outbreaks of disease in developed countries. However, there is no consistently effective treatment for vulnerable populations. Progress towards development of therapeutics for cryptosporidiosis has been hampered by lack of optimal culture systems to study it. New advances in organoid/enteroid technology have contributed to improved platforms to culture and propagate Cryptosporidium. Here we discuss recent breakthroughs in the field and highlight different models for functional ex vivo organoid or enteroidderived culture systems. These systems will lead to a better understanding of the mechanisms of host-parasite interactions in vivo.

Selected Emerging Infectious Diseases of Squamata: An Update

This article details emerging infectious diseases that have devastating impacts on captive and wild squamates. Treatment advances have been attempted for Cryptosporidium infections in squamates. Gram-positive bacteria, Devriesea agamarum and Austwickia chelonae, are contributing to severe disease in captive and now in wild reptiles, some critically endangered. Nannizziposis, Paranannizziopsis, and Ophidiomyces continue to cause fatal disease as primary pathogens in wild and captive populations of squamates and sphenodontids. Nidovirus, bornavirus, paramyxovirus, sunshine virus, and arenavirus have emerged to be significant causes of neurorespiratory disease in snakes. Controlled studies evaluating environmental stability, disinfection, transmission control, and treatment are lacking.

Global prevalence of Cryptosporidium infection in rodents: A systematic review and meta-analysis

The One-Health approach implies that the health of people is connected to the health of animals and the environment. Rodents, which are abundant and widespread, have been considered the major reservoirs of Cryptosporidium infection in humans and other animals. However, there is a paucity of information about global patterns of occurrence of Cryptosporidium in rodents. This systematic review and meta-analysis aimed to estimate the pooled global prevalence of Cryptosporidium infection and associated risk factors in rodents. International databases (PubMed, Web of Science, Scopus, and Google scholar) were systematically searched to identify relevant studies. A random-effects meta-analysis model was used to estimate the overall and the subgroup-pooled prevalence of Cryptosporidium across studies, and the variance between studies (heterogeneity) were quantified by I2 index. The data were classified according to WHO-region, type of diagnostic methods, different kinds of rodents, and specific risk factors, including geographical and climate parameters. Eighty-four articles (including 92 datasets), from 29 countries met eligibility criteria for analysis. The pooled global prevalence (95% CI) of Cryptosporidium infection in rodents was 17% (13-20%), being highest in North American and Caribbean regions 27% (16-40%) and lowest in South American 5% (0-16%) countries. Considering the detection methods, the pooled prevalence was estimated to be 25% (13-39%) using coproantigen detection methods, 17% (13-23%) using molecular detection methods, and 14% (9-20%) using microscopic detection methods. The highest prevalence of Cryptosporidium was found in muskrats 47% (27-68%), while Meriones persicus 1% (0-3%) had the lowest prevalence. These results emphasize the role of rodents as reservoir hosts for human-infecting Cryptosporidium. This highlights the need for an increased focus on implementing affordable, appropriate control programs to reduce the public health threat of cryptosporidiosis as a zoonosis of global importance.

Waterborne protozoan pathogens in environmental aquatic biofilms: Implications for water quality assessment strategies

Biofilms containing pathogenic organisms from the water supply are a potential source of protozoan parasite outbreaks and a significant public health concern. The aim of the present study was to demonstrate the simultaneous and multi-spatial occurrence of waterborne protozoan pathogens (WBPP) in substrate-associated biofilms (SAB) and compare it to surface water (SW) and sediments with bottom water (BW) counterparts using manual filtration and elution from low-volume samples. For scenario purposes, simulated environmental biofilm contamination was created from in-situ grown one-month-old SAB (OM-SAB) that were spiked with Cryptosporidium parvum oocysts. Samples were collected from the largest freshwater reservoirs in Luzon, Philippines and a University Lake in Thailand. A total of 69 samples (23 SAB, 23 SW, and 23 BW) were evaluated using traditional staining techniques for Cryptosporidium, and Immunofluorescence staining for the simultaneous detection of Cryptosporidium and Giardia. WBPP were found in 43% SAB, 39% SW, and 39% BW of the samples tested in the present study with SAB results reflecting SW and BW results. Further highlights were demonstrated in the potential of using low-volume samples for the detection of parasites in source water. Scanning electron microscopy of OM-SAB samples revealed a naturally-associated testate amoeba shell, while Cryptosporidium oocysts spiked samples provided a visual profile of what can be expected from naturally contaminated biofilms. This study provides the first evidence for the simultaneous and multi-spatial occurrence of waterborne protozoan pathogens in low-volume aquatic matrices and further warrants SAB testing along with SW and BW matrices for improved water quality assessment strategies (iWQAS).

A One Health Approach to Tackle Cryptosporidiosis

Cryptosporidiosis is a significant diarrhoeal disease in both people and animals across the world and is caused by several species of the protozoan parasite Cryptosporidium. Recent research has highlighted the longer-term consequences of the disease for malnourished children, involving growth stunting and cognitive deficits, and significant growth and production losses for livestock. There are no vaccines currently available to prevent the disease and few treatment options in either humans or animals, which has been a significant limiting factor in disease control to date. A One Health approach to tackle zoonotic cryptosporidiosis looking at new advances in veterinary, public, and environmental health research may offer several advantages and new options to help control the disease.

Deprivation of dietary fiber enhances susceptibility of mice to cryptosporidiosis

Based on our initial observations showing that mice consuming a probiotic product develop more severe cryptosporidiosis, we investigated the impact of other dietary interventions on the intracellular proliferation of Cryptosporidium parvum and C. tyzzeri in the mouse. Mice were orally infected with oocysts and parasite multiplication measured by quantifying fecal oocyst output. High-throughput sequencing of 16S ribosomal RNA amplicons was used to correlate oocyst output with diet and with the composition of the intestinal microbiota. On average, mice fed a diet without fiber (cellulose, pectin and inulin) developed more severe infections. As expected, a diet without fibers also significantly altered the fecal microbiota. Consistent with these observations, mice fed a prebiotic product sold for human consumption excreted significantly fewer oocysts. The fecal microbiota of mice consuming no plant polysaccharides was characterized by a lower relative abundance of Bacteroidetes bacteria. Since bacterial metabolites play an important role in the physiology of intestinal enterocytes, we hypothesize based on these observations that the impact of diet on parasite proliferation is mediated primarily by the metabolic activity of the anaerobic microbiota, specifically by the effect of certain metabolites on the host. This model is consistent with the metabolic dependence of intracellular stages of the parasite on the host cell. These observations underscore the potential of dietary interventions to alleviate the impact of cryptosporidiosis, particularly in infants at risk of recurrent enteric infections.

The infection with Cryptosporidium parasite, a condition known as cryptosporidiosis, is a common cause of infant diarrhea in developing countries. We have previously shown that mice infected with C. parvum, one of the main cause of human cryptosporidiosis, develop a more severe infection if given probiotics. To investigate the mechanism of this effect, we fed mice prebiotics and diet lacking plant fiber. We found that fermentable fiber, whether administered as a prebiotic supplement or as part of the diet, has a protective effect against cryptosporidiosis in mice. We also observed a significant association between the severity of infection and the composition of the gut microbiota. A significant inverse correlation was found between severity of cryptosporidiosis and the ratio between the abundance of bacteria belonging to the phylum Bacteroidetes and the abundance of Firmicutes bacteria. This ratio is frequently viewed as a marker of a healthy microbiota. These results raise the possibility that dietary interventions could be used to alleviate the impact of cryptosporidiosis.

Climate-driven QMRA model for selected water supply systems in Norway accounting for raw water sources and treatment processes

Formulating effective management intervention measures for water supply systems requires investigation of potential long-term impacts. This study applies an integrated multiple regression, random forest regression, and quantitative microbial risk assessment (QMRA) modelling approach to assess the effect of climate-driven precipitation on pathogen infection risks in three drinking water treatment plants (WTPs) in Norway. Pathogen removal efficacies of treatment steps were calculated using process models. The results indicate that while the WTPs investigated generally meet the current water safety guidelines, risks of Norovirus and Cryptosporidium infection may be of concern in the future. The pathogen infections attributable to current projections of average precipitation in the study locations may be low. However, the pathogen increases in the drinking water sources due to the occurrence of extreme precipitation events in the catchments could substantially increase the risks of pathogen infections. In addition, without optimal operation of the UV disinfection steps in the WTPs, both the present and potential future infection risks could be high. Therefore, the QMRA models demonstrated the need for improved optimization of key treatment steps in the WTPs, as well as implementation of stringent regulations in protecting raw water sources in the country. The variety of models applied and the pathogen: E. coli used in the study introduce some uncertainties in the results, thus, management decisions that will be based on the results should consider these limitations. Nevertheless, the integration of predictive models with QMRA as applied in this study could be a useful method for climate impact assessment in the water supply industry.

Quantitative microbial risk assessment of Cryptosporidium in bivalve samples from Manila Bay, Philippines

In the Philippines, consumption of bivalves is very common due to its year-round availability and cheap price. However, many consume bivalves as lightly-cooked or raw. This might pose health hazards because bivalves are filter-feeders which act as vehicles for transmission of several pathogens such as the protozoan parasite Cryptosporidium, the causative agent of cryptosporidiosis. Cryptosporidiosis in humans is manifested by profuse diarrhea and abdominal pain. To determine the risk of acquiring cryptosporidiosis from consumption of bivalves, quantitative microbial risk assessment (QMRA) should be done. This study aimed to determine the risk associated with the consumption of bivalves which are contaminated with Cryptosporidium oocysts. The results indicate that consumption of at least 21 grams of cooked bivalves contaminated with at least 0.1% viable oocysts might pose a risk to consumers, especially to immunocompromised individuals. This estimated risk of infection exceeded the United States Environmental Protection Agency (US EPA) standards (1.0×10-4). Results call for drive of decision-makers to establish an educational or treatment program to reduce the incidence of gastrointestinal infections of the consumers. Improvement of sanitation techniques and hygienic practices will contribute to the decrease of occurrence of the disease.

Study on Giardia duodenalis and Cryptosporidium spp. infection in veterinarians in Poland

The risk of exposure to zoonotic factors among veterinarians comprises still underestimated problem. Many etiological factors of infectious diseases are so far poorly known, including the way of their transmission from environment to humans and their impact for health. The main aim of the study was to determine the risk of two selected zoonosis infections caused by Giardia duodenalis and Cryptosporidium spp. among occupational group of veterinarians in Poland. Two hundred ninety seven samples of stool were tested for the presence of Giardia cysts and Cryptosporidium oocysts using Direct Fluorescent Assay (DFA). There were no positive results for Cryptosporidium. The presence of Giardia cysts was found in two samples of faeces (0.67%), confirmed by polymerase chain reaction and sequencing. The risk with regard to the parasites Giardia duodenalis and Cryptosporidium spp. seems to be low among the group of veterinarians.

Sheep as a Potential Source of Zoonotic Cryptosporidiosis in China

In this study, we assessed the prevalence and genetic characteristics of Cryptosporidium in sheep from 10 provinces in China. Fecal samples from 1,035 sheep originating from 16 farms were collected, and 295 (28.5%) were found to be Cryptosporidium positive by nested PCR. Cryptosporidium was detected at all farms, with infection rates between 5.7% and 50.0%. Three Cryptosporidium species were identified, including Cryptosporidium xiaoi (73.2%, 216/295), Cryptosporidium ubiquitum (21.7%, 64/295), and Cryptosporidium parvum (5.1%, 15/295). The distribution of Cryptosporidium species differed by province and by farm. All three species were detected in lambs and adult sheep but the highest infection rate was found in postweaned lambs. All three species were detected in all four seasons, with the highest prevalence found in autumn. Four C. parvum subtypes (IIaA15G2R1, IIaA17G2R1, IIdA18G1, and IIdA19G1) and one C. ubiquitum subtype (XIIa) were identified. For most provinces in this study, we are not aware of a previously published description or molecular characterization of Cryptosporidium infections in sheep. This information will improve our knowledge and understanding of the epidemiology of cryptosporidiosis in China.IMPORTANCECryptosporidium is an important zoonotic parasite that causes diarrhea in humans and animals worldwide. Previous studies suggested geographic differences in the distribution of Cryptosporidium species in sheep. However, molecular characterization studies of Cryptosporidium species in sheep have been carried out in only a few provinces in China, and the limited data available do not reflect the real situation. In this study, five districts, covering most areas where sheep are bred in China, were selected for examination of Cryptosporidium species, and Cryptosporidium infections were detected at all farms assessed, suggesting that Cryptosporidium is widespread in sheep in China. We also found geographic differences in the distribution of Cryptosporidium species but did not detect any differences between sheep age groups or seasons. Subtyping analyses showed that all of the subtypes identified in this study have been reported in humans, suggesting that sheep may be a potential source of zoonotic cryptosporidiosis.

Clinical, environmental, and behavioral characteristics associated with Cryptosporidium infection among children with moderate-to-severe diarrhea in rural western Kenya, 2008-2012: The Global Enteric Multicenter Study (GEMS)

Background

Cryptosporidium is a leading cause of moderate-to-severe diarrhea (MSD) in young children in Africa. We examined factors associated with Cryptosporidium infection in MSD cases enrolled at the rural western Kenya Global Enteric Multicenter Study (GEMS) site from 2008-2012.

Methodology/Principal findings

At health facility enrollment, stool samples were tested for enteric pathogens and data on clinical, environmental, and behavioral characteristics collected. Each child’s health status was recorded at 60-day follow-up. Data were analyzed using logistic regression. Of the 1,778 children with MSD enrolled as cases in the GEMS-Kenya case-control study, 11% had Cryptosporidium detected in stool by enzyme immunoassay; in a genotyped subset, 81% were C. hominis. Among MSD cases, being an infant, having mucus in stool, and having prolonged/persistent duration diarrhea were associated with being Cryptosporidium-positive. Both boiling drinking water and using rainwater as the main drinking water source were protective factors for being Cryptosporidium-positive. At follow-up, Cryptosporidium-positive cases had increased odds of being stunted (adjusted odds ratio [aOR] = 1.65, 95% CI: 1.06–2.57), underweight (aOR = 2.08, 95% CI: 1.34–3.22), or wasted (aOR = 2.04, 95% CI: 1.21–3.43), and had significantly larger negative changes in height- and weight-for-age z-scores from enrollment.

Conclusions/Significance

Cryptosporidium contributes significantly to diarrheal illness in young children in western Kenya. Advances in point of care detection, prevention/control approaches, effective water treatment technologies, and clinical management options for children with cryptosporidiosis are needed.

Cryptosporidium is an important cause of childhood diarrhea. Research on cryptosporidiosis in countries where it is endemic remains limited; few studies have comprehensively examined risk factors for children in Kenya and similar settings. We examined characteristics associated with Cryptosporidium in children with moderate-to-severe diarrhea in rural western Kenya. We found there is little to clinically distinguish cryptosporidiosis from other childhood diarrhea in the absence of point of care diagnostics. Infants had the highest odds of Cryptosporidium infection; it has been previously established that Cryptosporidium infections in infancy can have severe consequences. Prolonged/persistent duration diarrhea and growth shortfalls were significantly more pronounced among cases with Cryptosporidium. Undernutrition and stunting in children in low- and middle-income countries have predicted decreased cognitive and school performance, thus long-term consequences could be appreciable. Using rainwater as the primary drinking water source and boiling drinking water were protective against Cryptosporidium infection, thus certain water sources may contribute to transmission. Like other studies in Kenya, we predominantly identified Cryptosporidium hominis, an anthropogenic species. Advances in point of care detection, prevention and control approaches, effective water treatment technologies, and clinical management options are needed to mitigate the potentially severe and long-term consequences of Cryptosporidium infection in children.

Risk factors for Cryptosporidium infection in low and middle income countries: A systematic review and meta-analysis

BACKGROUND

Cryptosporidium infection causes gastrointestinal disease and has a worldwide distribution. The highest burden is in developing countries.

OBJECTIVES

We sought to conduct a systematic review and meta-analysis to identify Cryptosporidium risk factors in Low and Middle Income countries (LMICs).

METHODS

Medline Ovid and Scopus databases were searched with no restriction on year or language of publication. All references were screened independently in duplicate and were included if they presented data on at least 3 risk factors. Meta-analyses using random effects models were used to calculate overall estimates for each exposure.

RESULTS

The most frequently reported risk factors in the 15 included studies were overcrowding, household diarrhoea, poor quality drinking water, animal contact, open defecation/ lack of toilet and breastfeeding. The combined odds ratio for animal contact was 1.98 (95%CI: 1.11-3.54) based on 11 studies and for diarrhoea in the household 1.98 (95%CI: 1.13-3.49) based on 4 studies. Open defecation was associated with a pooled odds ratio of 1.82 (95%CI: 1.19-2.8) based on 5 studies. Poor drinking water quality was not associated with a significant Cryptosporidium risk, odds ratio 1.06 (95%CI: 0.77-1.47). Breastfeeding was protective with pooled odds ratio 0.4 (95%CI: 0.13-1.22), which was not statistically significant.

CONCLUSIONS

Based on the included studies, crowded living conditions, animal contact and open defecation are responsible for the majority of Cryptosporidium cases in LMICs. Future studies investigating Cryptosporidium risk factors should have a good study design and duration, include appropriate number of cases, select suitable controls, investigate multiple relevant risk factors, fully report data and perform multivariate analysis.

Common occurrence of Cryptosporidium hominis in asymptomatic and symptomatic calves in France

BACKGROUND

Cryptosporidium spp. infections are the most frequent parasitic cause of diarrhea in humans and cattle. However, asymptomatic cases are less often documented than symptomatic cases or cases with experimentally infected animals. Cryptosporidium (C.) hominis infection accounts for the majority of pediatric cases in several countries, while C. parvum is a major cause of diarrhea in neonatal calves. In cattle Cryptosporidium spp. infection can be caused by C. parvum, C. bovis, C.andersoni and C. ryanae, and recently, reports of cattle cases of C. hominis cryptosporidiosis cases suggest that the presence of C. hominis in calves was previously underestimated.

METHODOLOGY/PRINCIPAL FINDINGS

From February to November 2015, Cryptosporidium spp. infected calves were detected in 29/44 randomly included farms from 5 geographic regions of France. C. hominis and C. parvum were found in 12/44 and 26/44 farms, respectively with higher C. hominis prevalence in the western region. In 9 farms, both C. parvum and C. hominis were detected. Eighty-six of 412 (73/342 asymptomatic and 13/70 symptomatic) one to nine-week-old calves shed C. hominis or C. parvum oocysts (15 and 71 calves, respectively), with no mixed infection detected. The predominant C. hominis IbA9G3 genotype was present in all regions, and more frequent in the western region. An incompletely characterized Ib, and the IbA13G3, IbA9G2 and IbA14G2 genotypes were present only in the western region. For C. parvum, the most frequent genotype was IIaA16G3R1 with no geographic clustering. Most C. hominis infected calves were asymptomatic, with some exceptions of IbA9G2 and IbA9G3 isolates, while C. parvum IIaA16G3R1 was associated with symptoms.

CONCLUSIONS/SIGNIFICANCE

Present results indicate for the first time that in several geographic regions of France, C. hominis was present in about one fifth of both asymptomatic and symptomatic infected calves, with isolated genotypes likely associated with human infection. Further investigations are aimed at documenting direct or indirect transmissions between livestock and humans.

Epidemiology, determinants, and management of AIDS cholangiopathy: A review

Diseases of the liver and biliary tree have been described with significant frequency among patients with human immunodeficiency virus (HIV), and its advanced state, acquired immunodeficiency syndrome (AIDS). Through a variety of mechanisms, HIV/AIDS has been shown to affect the hepatic parenchyma and biliary tree, leading to liver inflammation and biliary strictures. One of the potential hepatobiliary complications of this viral infection is AIDS cholangiopathy, a syndrome of biliary obstruction and liver damage due to infection-related strictures of the biliary tract. AIDS cholangiopathy is highly associated with opportunistic infections and advanced immunosuppression in AIDS patients, and due to the increased availability of highly active antiretroviral therapy, is now primarily seen in instances of poor access to anti-retroviral therapy and medication non-compliance. While current published literature describes well the clinical, biochemical, and endoscopic management of AIDS-related cholangiopathy, information on its epidemiology, natural history, and pathology are not as well defined. The objective of this review is to summarize the available literature on AIDS cholangiopathy, emphasizing its epidemiology, course of disease, and determinants, while also revealing an updated approach for its evaluation and management.

Cryptosporidium spp. Contamination in Perna perna Mussels Destined for Human Consumption in Southeastern Rio de Janeiro, Brazil

Cryptosporidium spp. has been recognized as an important pathogen. As bivalve mollusks are noted as potential sources of several pathogens due to their consumption as foodstuffs, the aim of this study was to investigate the occurrence of Cryptosporidium spp. oocysts in Perna perna mussels and in seawater samples from a mussel farm in Southeastern Brazil, where mussels are grown directly in the sea, attached to ropes. Oocysts were observed by microscopy and confirmed by an enzyme-linked immunosorbent assay. Oocysts were present in mussel gills and GI tracts, as well as in the seawater. Of the 100 females, 10% and 11% showed contaminated GI tracts and gills, respectively, while this rate was lower in males, at 5% and 8.9%. Oocysts were present in higher amounts in the GI tract compared to gills and water. Contamination of the study area is apparent, leading to public health risks. More in-depth studies are needed, including molecular investigations, to identify Cryptosporidium species in mussels, as well as the implementation of monitoring actions in animals destined for human consumption.

High association of Cryptosporidium spp. infection with colon adenocarcinoma in Lebanese patients

Background

The association between Cryptosporidium and human colon cancer has been reported in different populations. However, this association has not been well studied. In order to add new strong arguments for a probable link between cryptosporidiosis and colon human cancer, the aim of this study was to determine prevalence and to identify species of Cryptosporidium among Lebanese patients.

Methodology and principal findings

Overall, 218 digestive biopsies were collected in Tripoli, Lebanon, from three groups of patients: (i) patients with recently diagnosed colon intraepithelial neoplasia/adenocarcinoma before any treatment (n = 72); (ii) patients with recently diagnosed stomach intraepithelial neoplasia/adenocarcinoma before any treatment (n = 21); and (iii) patients without digestive intraepithelial neoplasia/adenocarcinoma but with persistent digestive symptoms (n = 125). DNA extraction was performed from paraffin-embedded tissue. The presence of the parasite in tissues was confirmed by PCR, microscopic observation and immunofluorescence analysis. We identified a high rate (21%) of Cryptosporidium presence in biopsies from Lebanese patients with recently diagnosed colonic neoplasia/adenocarcinoma before any treatment. This prevalence was significantly higher compared to 7% of Cryptosporidium prevalence among patients without colon neoplasia but with persistent gastrointestinal symptoms (OR: 4, CI: 1.65–9.6, P = 0.001). When the comparison was done against normal biopsies, the risk of infection increased 11-fold in the group of patients with colon adenocarcinoma (OR: 11.315, CI: 1.44–89.02, P = 0.003).

Conclusions

This is the first study performed in Lebanon reporting the prevalence of Cryptosporidium among patients with digestive cancer. These results show that Cryptosporidium is strongly associated with human colon cancer being maybe a potential etiological agent of this disease.

Keeping it cool: Survival of Giardia cysts and Cryptosporidium oocysts on lettuce leaves

Fresh produce has been recognized as a vehicle for transmission of protozoan parasites for many years, and there are numerous publications regarding their occurrence on such foodstuffs, indicating their potential importance as foodborne parasites. Nevertheless, few studies have been published regarding the effectiveness of this transmission route, and whether contamination is likely to result in transmission. The purpose of this study was to assess the viability of Cryptosporidium oocysts and Giardia cysts, two protozoa associated with both waterborne and foodborne transmission, by spiking fresh produce (lettuce leaves) with viable transmission stages and determining changes in viability. These investigations were performed under different conditions and over time spans that may be used in a regular household; a fridge at 4°C, under ambient temperatures exposed to natural cycles of light during night and day, and inside a cupboard to ensure no light exposure, for a duration of up to two weeks, or as long as the produce remained visually palatable. The major finding from this study is that whereas both Cryptosporidium oocysts and Giardia cysts survive well when kept moist and refrigerated, survival of Giardia cysts was abrogated on lettuce at room temperature. Indeed, almost 50% die-off of Giardia cysts was recorded within the first 24h. Cryptosporidium oocysts had a stable viability throughout the experiment under all the conditions investigated, indicating that fresh produce is a suitable transmission vehicle for Cryptosporidium, even if contamination occurs on-farm and the parasites are exposed to non-favourable storage conditions, as may be common in developing countries. Giardia cysts were not as robust as Cryptosporidium oocysts, and would be probably unlikely to survive under ambient storage conditions on-farm, during sale, or at home. However, if kept refrigerated, then some contaminating Giardia cysts may remain viable and therefore may pose a threat to the consumer. Thus, as the cold chain for transport and storage of fresh produce improves, it is important that similar improvements are implemented to reduce the contamination of fresh produce with parasite transmission stages.

Waterparks are high risk for cryptosporidiosis: A case-control study in Victoria, 2015

BACKGROUND

An increase in notifications of cryptosporidiosis was observed in Victoria between March and April 2015. Cases mostly resided in one metropolitan region and hypothesis-generating interviews identified common exposures to aquatic facilities. We conducted a case-control study to determine exposure source(s) and facilitate control measures.

METHODS

Laboratory-confirmed cases of cryptosporidiosis from the region of interest notified between 1 March and 23 April 2015 were included. Controls residing in the same region were recruited from participants in a population health survey and frequency matched (2 per case) by age group. Details of exposure to potential risk factors were collected using a standardised telephone questionnaire for the 14-days prior to illness for cases, and an analogous exposure period for controls. Univariable and multivariable logistic regression were used to determine risk factors associated with illness using STATA SE 13.1.

RESULTS

Thirty cases and 66 controls were included in the study. Half the cases were less than 12 years of age and 62% were female. Illness was most strongly associated with recreational water exposure at any waterpark (adjusted odds ratio (aOR)=73.5; 95% confidence interval (CI):6.74-802), and specifically at Victorian waterparks (aOR=45.6; 95% CI:5.20-399). Cases were linked with attendance at either a waterpark in the region or an adjacent region. As a result of this investigation, hyperchlorination was completed at identified facilities and swim hygiene information distributed.

CONCLUSION

This study reinforces the potential for recreational water facilities, particularly waterparks, to act as a transmission source of Cryptosporidium infections. Continued communication to patrons is required to ensure healthy swimming practice in Victorian aquatic facilities.

Limiting swimming pool outbreaks of cryptosporidiosis - the roles of regulations, staff, patrons and research

Cryptosporidium is the leading cause of swimming pool outbreaks of gastroenteritis. Transmission occurs through the ingestion of oocysts that are passed in the faeces of an infected person or animal when an accidental faecal release event occurs. Cryptosporidium parasites present specific challenges for infection control as oocysts are highly resistant to chlorine levels used for pool disinfection, infected individuals can shed large numbers of oocysts, there is a long incubation period and shedding of oocysts occurs even after symptom resolution. The purposes of this review are to identify key barriers to limiting swimming pool-associated outbreaks of cryptosporidiosis and to outline needs for research and collaboration to advance co-ordinated management practices. We reviewed swimming pool-associated cryptosporidiosis outbreaks, disinfection teachniques, current regulations and the role of staff and patrons. Key barriers to limiting swimming pool-associated outbreaks of cryptosporidiosis are a lack of uniform national and international standards, poor adherence and understanding of regulations governing staff and patron behaviour, and low levels of public knowledge and awareness.

Characteristics of child daycare centres associated with clustering of major enteropathogens

Insights into transmission dynamics of enteropathogens in children attending daycare are limited. Here we aimed at identifying daycare centre (DCC) characteristics associated with time-clustered occurrence of enteropathogens in DCC-attending children. For this purpose, we used the KIzSS network, which comprises 43 DCCs that participated in infectious disease surveillance in The Netherlands during February 2010-February 2013. Space-time scan statistics were used to identify clusters of rotavirus, norovirus, astrovirus, Giardia lamblia and Cryptosporidium spp. in a two-dimensional DCC characteristic space constructed using canonical correlation analysis. Logistic regression models were then used to further identify DCC characteristics associated with increased or decreased odds for clustering of enteropathogens. Factors associated with increased odds for enteropathogen clustering in DCCs were having indoor/outdoor paddling pools or sandpits, owning animals, high numbers of attending children, and reporting outbreaks to local health authorities. Factors associated with decreased odds for enteropathogen clustering in DCCs were cleaning child potties in designated waste disposal stations, cleaning vomit with chlorine-based products, daily cleaning of toys, extra cleaning of toys during a suspected outbreak, and excluding children with gastroenteritis. These factors provide targets for reducing the burden of gastrointestinal morbidity associated with time-clustered occurrence of major enteropathogens in DCC attendees.

Enteric Parasites in Arctic Communities: Tip of the Iceberg?

Human enteric parasitoses, particularly from Cryptosporidium, were recently recognized as being highly prevalent in parts of the Arctic. This is important because cryptosporidiosis has been repeatedly associated with impaired growth and development and may synergize with other challenges faced by children in remote Arctic communities, such as overcrowding and food insecurity.

Use of aerobic spores as a surrogate for cryptosporidium oocysts in drinking water supplies

Waterborne illnesses are a growing concern among health and regulatory agencies worldwide. The United States Environmental Protection Agency has established several rules to combat the contamination of water supplies by cryptosporidium oocysts, however, the detection and study of cryptosporidium oocysts is hampered by methodological and financial constraints. As a result, numerous surrogates for cryptosporidium oocysts have been proposed by the scientific community and efforts are underway to evaluate many of the proposed surrogates. The purpose of this review is to evaluate the suitability of aerobic bacterial spores to serve as a surrogate for cryptosporidium oocysts in identifying contaminated drinking waters. To accomplish this we present a comparison of the biology and life cycles of aerobic spores and oocysts and compare their physical properties. An analysis of their surface properties is presented along with a review of the literature in regards to the transport, survival, and prevalence of aerobic spores and oocysts in the saturated subsurface environment. Aerobic spores and oocysts share many commonalities with regard to biology and survivability, and the environmental prevalence and ease of detection make aerobic spores a promising surrogate for cryptosporidium oocysts in surface and groundwater. However, the long-term transport and release of aerobic spores still needs to be further studied, and compared with available oocyst information. In addition, the surface properties and environmental interactions of spores are known to be highly dependent on the spore taxa and purification procedures, and additional research is needed to address these issues in the context of transport.

A hydrodynamics-based approach to evaluating the risk of waterborne pathogens entering drinking water intakes in a large, stratified lake

Pathogen contamination of drinking water lakes and reservoirs is a severe threat to human health worldwide. A major source of pathogens in surface sources of drinking waters is from body-contact recreation in the water body. However, dispersion pathways of human waterborne pathogens from recreational beaches, where body-contact recreation is known to occur to drinking water intakes, and the associated risk of pathogens entering the drinking water supply remain largely undocumented. A high spatial resolution, three-dimensional hydrodynamic and particle tracking modeling approach has been developed to analyze the risk and mechanisms presented by pathogen dispersion. The pathogen model represents the processes of particle release, transport and survival. Here survival is a function of both water temperature and cumulative exposure to ultraviolet (UV) radiation. Pathogen transport is simulated using a novel and computationally efficient technique of tracking particle trajectories backwards, from a drinking water intake toward their source areas. The model has been applied to a large, alpine lake - Lake Tahoe, CA-NV (USA). The dispersion model results reveal that for this particular lake (1) the risk of human waterborne pathogens to enter drinking water intakes is low, but significant; (2) this risk is strongly related to the depth of the thermocline in relation to the depth of the intake; (3) the risk increases with the seasonal deepening of the surface mixed layer; and (4) the risk increases at night when the surface mixed layer deepens through convective mixing and inactivation by UV radiation is eliminated. While these risk factors will quantitatively vary in different lakes, these same mechanisms will govern the process of transport of pathogens.

A perspective on Cryptosporidium and Giardia, with an emphasis on bovines and recent epidemiological findings

Cryptosporidium and Giardia are two common aetiological agents of infectious enteritis in humans and animals worldwide. These parasitic protists are usually transmitted by the faecal-oral route, following the ingestion of infective stages (oocysts or cysts). An essential component of the control of these parasitic infections, from a public health perspective, is an understanding of the sources and routes of transmission in different geographical regions. Bovines are considered potential sources of infection for humans, because species and genotypes of Cryptosporidium and Giardia infecting humans have also been isolated from cattle in molecular parasitological studies. However, species and genotypes of Cryptosporidium and Giardia of bovids, and the extent of zoonotic transmission in different geographical regions in the world, are still relatively poorly understood. The purpose of this article is to (1) provide a brief background on Cryptosporidium and Giardia, (2) review some key aspects of the molecular epidemiology of cryptosporidiosis and giardiasis in animals, with an emphasis on bovines, (3) summarize research of Cryptosporidium and Giardia from cattle and water buffaloes in parts of Australasia and Sri Lanka, considering public health aspects and (4) provide a perspective on future avenues of study. Recent studies reinforce that bovines harbour Cryptosporidium and Giardia that likely pose a human health risk and highlight the need for future investigations of the biology, population genetics and transmission dynamics of Cryptosporidium and Giardia in cattle, water buffaloes and other ruminants in different geographical regions, the fate and transport of infective stages following their release into the environment, as well as for improved strategies for the control and prevention of cryptosporidiosis and giardiasis, guided by molecular epidemiological studies.

Investigating source water Cryptosporidium concentration, species and infectivity rates during rainfall-runoff in a multi-use catchment

Protozoan pathogens present a significant human health concern, and prevention of contamination into potable networks remains a key focus for drinking water providers. Here, we monitored the change in Cryptosporidium concentration in source water during high flow events in a multi-use catchment. Furthermore, we investigated the diversity of Cryptosporidium species/genotypes present in the source water, and delivered an oocyst infectivity fraction. There was a positive and significant correlation between Cryptosporidium concentration and flow (ρ = 0.756) and turbidity (ρ = 0.631) for all rainfall-runoff events, despite variable source water pathogen concentrations. Cell culture assays measured oocyst infectivity and suggested an overall source water infectious fraction of 3.1%. No infectious Cryptosporidium parvum or Cryptosporidium hominis were detected, although molecular testing detected C. parvum in 7% of the samples analysed using PCR-based molecular techniques. Twelve Cryptosporidium species/genotypes were identified using molecular techniques, and were reflective of the host animals typically found in remnant vegetation and agricultural areas. The inclusion of molecular approaches to identify Cryptosporidium species and genotypes highlighted the diversity of pathogens in water, which originated from various sources across the catchment. We suggest this mixing of runoff water from a range of landuses containing diverse Cryptosporidium hosts is a key explanation for the often-cited difficulty forming strong pathogen-indicator relationships.

Prevalence and molecular characterization of Cryptosporidium in goats across four provincial level areas in China

This study assessed the prevalence, species and subtypes of Cryptosporidium in goats from Guangdong Province, Hubei Province, Shandong Province, and Shanghai City of China. Six hundred and four fecal samples were collected from twelve goat farms, and the overall infection rate was 11.4% (69/604). Goats infected with Cryptosporidium were found in eleven farms across four provincial areas, and the infection rate ranged from 2.9% (1/35) to 25.0% (9/36). Three Cryptosporidium species were identified. Cryptosporidium xiaoi (45/69, 65.2%) was the dominant species, followed by C. parvum (14/69, 20.3%) and C.ubiquitum (10/69, 14.5%). The infection rate of Cryptosporidium spp. was varied with host age and goat kids were more susceptible to be infected than adult goats. Subtyping C.parvum and C.ubiquitum positive samples revealed C. parvum subtype IIdA19G1 and C. ubiquitum subtype XIIa were the most common subtypes. Other C. parvum subtypes were detected as well, such as IIaA14G2R1, IIaA15G1R1, IIaA15G2R1 and IIaA17G2R1. All of these subtypes have also been detected in humans, suggesting goats may be a potential source of zoonotic cryptosporidiosis. This was the first report of C. parvum subtypes IIaA14G2R1, IIaA15G1R1 and IIaA17G2R1 infecting in goats and the first molecular identification of C.parvum and its subtypes in Chinese goats.

Effects of different inoculation routes on the parasitic sites of Cryptosporidium baileyi infection in chickens

Cryptosporidiosis is prevalent in domesticated, caged, and wild birds. Cryptosporidium baileyi, an ascendant species of avian Cryptosporidium, is an important pathogen. It causes respiratory disease in chickens, especially chickens younger than 50 days. In this study, SEM, histological, semi-quantitative PCR, and nested PCR techniques were used to explore the impact of different inoculation routes on sites of C. baileyi infection in chickens. Results showed that inoculation with sporozoites or oocysts via the rectum was an effective means of causing infection. This may provide an important reference for the development of the transfection system of C. baileyi in chickens. Numerous endogenous stages of C. baileyi were observed in the bursas of Fabricius (BF) and cloacas of chickens inoculated with sporozoites or oocysts via the rectum, but no parasite was seen in the tracheas of any of these chickens. In chickens infected with oocysts via the crop, the number of parasites in the BF was approximately 23-fold more than in the trachea. All blood samples collected after inoculation were negative for C. baileyi. These data show that C. baileyi was not transferred by blood circulation between the BF and respiratory tract. Different routes of inoculation were here found to distinctly affect sites of parasitism in chickens. These findings may facilitate further understanding of the biology of C. baileyi and efforts to control avian cryptosporidiosis.

Variance decomposition: a tool enabling strategic improvement of the precision of analytical recovery and concentration estimates associated with microorganism enumeration methods

Concentrations of particular types of microorganisms are commonly measured in various waters, yet the accuracy and precision of reported microorganism concentration values are often questioned due to the imperfect analytical recovery of quantitative microbiological methods and the considerable variation among fully replicated measurements. The random error in analytical recovery estimates and unbiased concentration estimates may be attributable to several sources, and knowing the relative contribution from each source can facilitate strategic design of experiments to yield more precise data or provide an acceptable level of information with fewer data. Herein, variance decomposition using the law of total variance is applied to previously published probabilistic models to explore the relative contributions of various sources of random error and to develop tools to aid experimental design. This work focuses upon enumeration-based methods with imperfect analytical recovery (such as enumeration of Cryptosporidium oocysts), but the results also yield insights about plating methods and microbial methods in general. Using two hypothetical analytical recovery profiles, the variance decomposition method is used to explore 1) the design of an experiment to quantify variation in analytical recovery (including the size and precision of seeding suspensions and the number of samples), and 2) the design of an experiment to estimate a single microorganism concentration (including sample volume, effects of improving analytical recovery, and replication). In one illustrative example, a strategically designed analytical recovery experiment with 6 seeded samples would provide as much information as an alternative experiment with 15 seeded samples. Several examples of diminishing returns are illustrated to show that efforts to reduce error in analytical recovery and concentration estimates can have negligible effect if they are directed at trivial error sources.

Aquatic biomonitoring of Giardia cysts and Cryptosporidium oocysts in peninsular Malaysia

An aquatic biomonitoring of Giardia cysts and Cryptosporidium oocysts in river water corresponding to five villages situated in three states in peninsular Malaysia was determined. There were 51.3% (20/39) and 23.1% (9/39) samples positive for Giardia and Cryptosporidium (oo)cysts, respectively. Overall mean concentration between villages for Giardia cysts ranged from 0.10 to 25.80 cysts/l whilst Cryptosporidium oocysts ranged from 0.10 to 0.90 oocysts/l. Detailed results of the river samples from five villages indicated that Kuala Pangsun 100% (9/9), Kemensah 77.8% (7/9), Pos Piah 33.3% (3/9) and Paya Lebar 33.3% (1/3) were contaminated with Giardia cysts whilst Cryptosporidium (oo)cysts were only detected in Kemensah (100 %; 9/9) and Kuala Pangsun (66.6%; 6/9). However, the water samples from Bentong were all negative for these waterborne parasites. Samples were collected from lower point, midpoint and upper point. Midpoint refers to the section of the river where the studied communities are highly populated. Meanwhile, the position of the lower point is at least 2 km southward of the midpoint and upper point is at least 2 km northward of the midpoint. The highest mean concentration for (oo)cysts was found at the lower points [3.15 ± 6.09 (oo)cysts/l], followed by midpoints [0.66 ± 1.10 (oo)cysts/l] and upper points [0.66 ± 0.92 (oo)cysts/l]. The mean concentration of Giardia cysts was highest at Kuala Pangsun (i.e. 5.97 ± 7.0 cysts/l), followed by Kemensah (0.83 ± 0.81 cysts/l), Pos Piah (0.20 ± 0.35 cysts/l) and Paya Lebar (0.10 ± 0.19 cysts/l). On the other hand, the mean concentration of Cryptosporidium oocysts was higher at Kemensah (0.31 ± 0.19 cysts/l) compared to Kuala Pangsun (0.03 ± 0.03cysts/l). All the physical and chemical parameters did not show significant correlation with both protozoa. In future, viability status and molecular characterisation of Giardia and Cryptosporidium should be applied to identify species and genotypes/subgenotypes for better understanding of the epidemiology of these waterborne parasites.

Recent insights into apicomplexan parasite egress provide new views to a kill

A hallmark of apicomplexan pathogens such as Plasmodium, Toxoplasma and Cryptosporidium is that they invade, replicate within, and then egress from their host cells. Egress usually results in lysis of the host cell, with deleterious consequences for the host. In the case of malaria, for example, much of the disease pathology is associated with cyclical waves of host erythrocyte destruction. This review highlights recent advances in mapping the signaling pathways that lead to egress and the parasite molecules involved in responding to and transmitting those signals. The review also discusses new findings for effector molecules that mediate disruption of the bounding membranes that enclose the intracellular parasite and the manner in which membrane rupture occurs to finally release invasive forms of the parasite.

[Effect of radix sophorae flavescentis (RSF) mixture on mast cells in jejunal mucosa of mice infected by Cryptosporidium]

OBJECTIVE

To elucidate the role of mast cells (MC) activation in the jejunal mucous membrane in the pathogenesis of cryptosporidiosis (CPS) and explore the mechanism of prevention and treatment of radix sophorae flavescetis(RSF) mixture on CPS.

METHODS

A total of 30 healthy male BALB/c mice were randomly divided into a normal control group, CPS model control group and RSF mixture experimental group. The mice of CPS model were inoculated intragastrically with 1 x 10(5) Cryptosporidium oocyst (CSO). The mice in the RSF mixture experimental group were treated with inoculation of RSF mixture (0.2 ml doses) twice one week for three weeks continuously after CPS models were established. Pathological changes of the jejunal mucosa membrane were observed by a light microscope. The MCs were stained by toluidine blue, the number of mast cells was recorded and the changes of degranulation were observed.

RESULTS

The HE staining showed inflammatory pathological changes in the jejunal mucosa membrane of the CPS model control group. After three-week treatment of RSF mixture, the small intestine epithelium was integrated on the whole. The toluidine blue stain showed the number of mast cell in submucosa and muscular layer of the jejunal mucous membrane increased significantly in the model control group (12.80 +/- 0.84) compared with those of the normal control group (1.60 +/- 0.89) (P < 0.01) and an obvious degranulation was seen in the CPS model control group. The number of mast cells of the mice in the RSF mixture experimental group decreased significantly (P < 0.01) and the number (2.00 +/- 0.71) and morphous were closed to the normal after administration for three weeks.

CONCLUSIONS

MC activation is involved in the intestinal inflammatory response caused by Cryptosporidium. RSF mixture could decline the number of MC, inhibit the activation and degranulation of MC in the jejunal mucosa membrane of CPS mice to reduce inflammation and repair the damaged intestinal mucosa, which may realize the purpose of treatment of CPS.

Occurrence and potential health risk of Cryptosporidium and Giardia in the Three Gorges Reservoir, China

The Three Gorges Reservoir (TGR) is the biggest lake in the world and a major water source in China. There is no information about occurrence and impact of Cryptosporidium and Giardia on the aquatic ecosystem. 61 surface water samples from 23 monitoring sites and 5 treated effluent samples were collected and analyzed. Cryptosporidium oocysts and Giardia cysts were found, respectively, in 86.4% and 65.2% of a total of 66 water samples, with high concentrations in treated effluent. The mean percent recovery was 29.14% for oocysts and 34.86% for cysts. A seasonal pattern was observed, with positive samples for Cryptosporidium more frequent in flood period and positive samples for Giardia more frequent in impounding period. Counts of enterococci, fecal coliforms and total coliforms, and turbidity were significantly associated with Cryptosporidium concentration in backwater (water in a main river which is backed up by the Three Gorges Dam) areas of tributaries but not Giardia. High associations were also found between oocyst and cyst in backwater areas of tributaries and cities. The risks of infection and illness due to water consumption in four different exposure routes were estimated. The results showed that swimming in the TGR has the highest infection risk with 1.39 × 10(-3) per time (95% confidence interval (CI): 0.05-600.3 × 10(-5)) for Cryptosporidium and 2.08 × 10(-4) per time (95% CI: 0.05-878.87 × 10(-6)) for Giardia, while directly drinking unboiled tap water treated with the conventional process has the highest morbidity with 524.98 per 100,000 population per year (95% CI: 10.35-2040.26) for Cryptosporidium and 5.89 per 100,000 population per year (95% CI: 0.08-22.67) for Giardia. This study provides new useful information for drinking water plants, health care workers and managers to improve the safety of tap water and deduce the risk of surface water contamination in China.

Protozoa interaction with aquatic invertebrate: interest for watercourses biomonitoring

Toxoplasma gondii, Cryptosporidium parvum, and Giardia duodenalis are human waterborne protozoa. These worldwide parasites had been detected in various watercourses as recreational, surface, drinking, river, and seawater. As of today, water protozoa detection was based on large water filtration and on sample concentration. Another tool like aquatic invertebrate parasitism could be used for sanitary and environmental biomonitoring. In fact, organisms like filter feeders could already filtrate and concentrate protozoa directly in their tissues in proportion to ambient concentration. So molluscan shellfish can be used as a bioindicator of protozoa contamination level in a site since they were sedentary. Nevertheless, only a few researches had focused on nonspecific parasitism like protozoa infection on aquatic invertebrates. Objectives of this review are twofold: Firstly, an overview of protozoa in worldwide water was presented. Secondly, current knowledge of protozoa parasitism on aquatic invertebrates was detailed and the lack of data of their biological impact was pointed out.

Outbreak of cryptosporidiosis associated with a man-made chlorinated lake--Tarrant County, Texas, 2008

In July 2008, clusters of laboratory-confirmed cryptosporidiosis cases and reports of gastrointestinal illness in persons who visited a lake were reported to Tarrant County Public Health. In response, epidemiologic, laboratory, and environmental health investigations were initiated. A matched case-control study determined that swallowing the lake water was associated with illness (adjusted odds ratio = 16.3; 95% confidence interval: 2.5-infinity). The environmental health investigation narrowed down the potential sources of contamination. Laboratory testing detected Cryptosporidium hominis in case-patient stool specimens and Cryptosporidium species in lake water. It was only through the joint effort that epidemiologic, laboratory, and environmental health investigators could determine that >1 human diarrheal fecal incidents in the lake likely led to contamination of the water. This same collaborative effort will be needed to develop and maintain an effective national Model Aquatic Health Code.

The burden of drinking water-associated cryptosporidiosis in China: the large contribution of the immunodeficient population identified by quantitative microbial risk assessment

A comprehensive quantitative microbial risk assessment (QMRA) of Cryptosporidium infection, considering pathogen removal efficiency, different exposure pathways and different susceptible subpopulations, was performed based on the result of a survey of source water from 66 waterworks in 33 major cities across China. The Cryptosporidium concentrations in source water were 0-6 oocysts/10 L, with a mean value of 0.7 oocysts/10 L. The annual diarrhea morbidity caused by Cryptosporidium in drinking water was estimated to be 2701 (95% confidence interval (CI): 138-9381) cases per 100,000 immunodeficient persons and 148 (95% CI: 1-603) cases per 100,000 immunocompetent persons, giving an overall rate of 149.0 (95% CI: 1.3-606.4) cases per 100,000 population. The cryptosporidiosis burden associated with drinking water treated with the conventional process was calculated to be 8.31 × 10(-6) (95% CI: 0.34-30.93 × 10(-6)) disability-adjusted life years (DALYs) per person per year, which was higher than the reference risk level suggested by the World Health Organization (WHO), but lower than that suggested by the United States Environmental Protection Agency (USEPA). Sixty-six percent of the total health burden due to cryptosporidiosis that occurred in the immunodeficient subpopulation, and 90% of the total DALYs was attributed to adults aged 15-59 years. The sensitivity analysis highlighted the great importance of stability of the treatment process and the importance of watershed protection. The results of this study will be useful in better evaluating and reducing the burden of Cryptosporidium infection.

Assessment of waterborne protozoan passage through conventional drinking water treatment process in Venezuela

Three drinking water treatment plants (DWTPs) differing in source water and treatment capacity were investigated for the potential passage of waterborne protozoan (oo)cysts through conventional processing. DWTP I (15,000 L/s), DWTP II (7,500 L/s) and DWTP III (4,300 L/s) provide drinking water for approximately 2.7 million inhabitants of the Metropolitan District of Caracas (Venezuela). The US Environmental Protection Agency Method 1623 for detection of Cryptosporidium and Giardia was used to analyze raw water and finished drinking water samples collected from the three plants. (Oo)cyst recovery efficiencies varied between 23 and 84%. The concentration of confirmed (oo)cysts detected in raw water samples ranged between 1 and 100 per 100 L. (Oo)cyst levels in finished water samples ranged from 2 to 25 per 100 L. These data indicated that the conventional treatment process to produce finished water at two filtration plants was not effective in preventing the passage of protozoan (oo)cysts. Monitoring strategies that include multiple microbial indicators and waterborne pathogens are strongly recommended for accurate source water characterization and for verification of the effectiveness of treatment process barriers to microbial breakthrough in the finished water.

Identification and characterization of a novel calcium-activated apyrase from Cryptosporidium parasites and its potential role in pathogenesis

Herein, we report the biochemical and functional characterization of a novel Ca²⁺-activated nucleoside diphosphatase (apyrase), CApy, of the intracellular gut pathogen Cryptosporidium. The purified recombinant CApy protein displayed activity, substrate specificity and calcium dependency strikingly similar to the previously described human apyrase, SCAN-1 (soluble calcium-activated nucleotidase 1). CApy was found to be expressed in both Cryptosporidium parvum oocysts and sporozoites, and displayed a polar localization in the latter, suggesting a possible co-localization with the apical complex of the parasite. In vitro binding experiments revealed that CApy interacts with the host cell in a dose-dependent fashion, implying the presence of an interacting partner on the surface of the host cell. Antibodies directed against CApy block Cryptosporidium parvum sporozoite invasion of HCT-8 cells, suggesting that CApy may play an active role during the early stages of parasite invasion. Sequence analyses revealed that the capy gene shares a high degree of homology with apyrases identified in other organisms, including parasites, insects and humans. Phylogenetic analysis argues that the capy gene is most likely an ancestral feature that has been lost from most apicomplexan genomes except Cryptosporidium, Neospora and Toxoplasma.

Water reclamation redesign for reducing Cryptosporidium risks at a recreational spray park using stochastic models

Recreational outbreaks associated with sprayparks are well recognized, and may be partly due to the engineering designs used for their water reclamation systems are problematic to control. This work is based on an outbreak of cryptosporidiosis linked to a spraypark in New York State, where it was determined, specifically that the spraypad (the main attraction) was the primary exposure point. We first determined the likely dose the spraypad users were exposed to, then modeled the efficacy of the treatment system and used this to inform a Monte Carlo method to estimate the probability of infection and illness for the users of the spraypad. The current treatment system which consists of; two holding tanks, a dual media filter and chlorine injection as well as two design change recommendations were modeled using three independent Markov chain models. Within the current treatment system design the receiving tank for the treatment train is also connected with a second pipe to the spraypad used to deliver the return (treated) water, this return pipe is acting potentially as a bypass for the treatment train. Based on the risk assessments performed it is recommended that the bypass pipe be removed from the treatment system since in doing so the probability of infection and illness were reduced appreciably. Secondarily including an ozone contactor was shown to slightly reduce the risk further and provide a multiple barrier.

Disposable swim diaper retention of Cryptosporidium-sized particles on human subjects in a recreational water setting

Cryptosporidium is a chlorine-resistant protozoan parasite responsible for the majority of waterborne disease outbreaks in recreational water venues in the USA. Swim diapers are commonly used by diaper-aged children participating in aquatic activities. This research was intended to evaluate disposable swim diapers for retaining 5-μm diameter polystyrene microspheres, which were used as non-infectious surrogates for Cryptosporidium oocysts. A hot tub recirculating water without a filter was used for this research. The microsphere concentration in the water was monitored at regular intervals following introduction of microspheres inside of a swim diaper while a human subject undertook normal swim/play activities. Microsphere concentrations in the bulk water showed that the majority (50-97%) of Cryptosporidium-sized particles were released from the swim diaper within 1 to 5 min regardless of the swim diaper type or configuration. After only 10 min of play, 77-100% of the microspheres had been released from all swim diapers tested. This research suggests that the swim diapers commonly used by diaper-aged children in swimming pools and other aquatic activities are of limited value in retaining Cryptosporidium-sized particles. Improved swim diaper solutions are necessary to efficiently retain pathogens and effectively safeguard public health in recreational water venues.

Evolution of Cryptosporidium in vitro culture

This overview discusses findings from culturing Cryptosporidium spp. in cell and axenic cultures as well as factors limiting the development of this parasite in cultivation systems during recent years. A systematic review is undertaken of findings regarding the life cycle of the parasite, taking into account physiological, biochemical and genetic aspects, in the hope that this attempt will facilitate future approaches to research and developments in the understanding of Cryptosporidium biology.

Modelling Cryptosporidium oocysts transport in small ungauged agricultural catchments

Cryptosporidium is an environmentally robust pathogen that has caused severe waterborne disease outbreaks worldwide. The main source of zoonotic Cryptosporidium parvum oocysts in human drinking water is likely to be from farm animals via catchment pathways with water as the main transport vector. The vast majority of small agricultural catchments are ungauged therefore it is difficult to use a process model to predict and understand the mechanisms and activities that regulate the risk of surface water contamination from agricultural areas. For this study, two ungauged agricultural catchments in Ireland were used to model Cryptosporidium oocyst transport using SWAT2005 on a daily basis with reference data from adjacent catchment gauging stations. The results indicated that SWAT2005 could simulate stream flow with good agreement between prediction and observation on a monthly basis (R(2) from 0.94 to 0.83 and E (efficiency) from 0.92 to 0.66), but Cryptosporidium oocyst concentration results were less reliable (R(2) from 0.20 to 0.37, P < 0.05; with poor E -0.37 to -2.57). A sensitivity analysis using independent parameter perturbation indicated that temperature was the most important parameter regulating oocyst transport in the study catchments and that the timing of manure application relative to the occurrence of water runoff event was critical. The results also showed that grazing management had little influence on predicted oocyst transport while fields fertilized with manure were the key critical source areas for microbial contaminations in the study catchments. It was concluded that the approach presented could be used to assist with understanding the epidemiology of waterborne cryptosporidiosis outbreaks and to improve catchment management for the safety of the general public health.

Environmental and demographic risk factors associated with the prevalence of Cryptosporidium infection in the Alice rural settlements of the Eastern Cape Province of South Africa: a pilot study

We undertook this study to identify the risk factors and prevalence of Cryptosporidium spp. in HIV-positive and HIV-negative diarrhea patients in the Alice rural settlement in the Eastern Cape Province of South Africa. A total of 180 stool specimens (35 HIV-positive diarrhea, 125 HIV-negative diarrhea patients, and 20 apparently healthy subjects) were screened for cryptosporidiosis using an ELISA-based approach. Sociodemographic information, water supply, and animal contact were recorded for diarrhea-positive patients. The data were analyzed using Pearson's chi2-test and Fisher's exact test. Cryptosporidium antigen was detected in 122 of 180 specimens (overall prevalence=67.8%). In HIV-positive diarrhea patients, the age groups 31-43 years (mean age 36.5 years) and 70-82 years (mean age 75.8 years) had a higher prevalence (100%) of the antigen than age groups 18-30 years (mean age 23.2 years) and 83-95 years (mean age 88.8 years) (50.0%). In HIV-negative diarrhea patients, the prevalence was highest (87.5%) at ages 18-30 years (mean age 23.2 years) and lowest (35.7%) at ages 83-95 years (mean age 88.8 years). Cryptosporidium antigenemia was slightly higher in females (78.2%, mean age 46.7 years) than in males (71.1%, mean age 42.6 years), but the difference was not significant (p>0.05). No apparently healthy control subject was infected with Cryptosporidium. HIV-negative patients had a significantly higher prevalence of antigen than HIV-positive patients, with farm animals considered a possible risk factor. In HIV-positive diarrhea patients, the prevalence peak was detected in more low income patients (85.7%) than in high income patients (32%). The high infection rate of specific groups was associated with exposure to a contaminated water supply. The results indicate that Cryptosporidium infection is highly prevalent in adult fecal specimens from the Nkonkobe Municipality, an indication of active infection that is likely to emerge as a major human pathogen in this locality owing to socioeconomic changes that favor transmission.

[Research progress on nutrient transport and metabolism of Cryptosporidium]

Cryptosporidiosis is a worldwide zoonotic disease, and Cryptosporidium is coccidia-like parasite that develops in epithelial cells in digestive and respiratory tracts of human and animals. This review summarizes the specific function structure of Cryptosporidium, nutrient uptake, transport, metabolism, and the impact of Cryptosporidium on host nutrient absorption.

Quantitative risk assessment of Cryptosporidium in tap water in Ireland

Cryptosporidium species are protozoan parasites associated with gastro-intestinal illness. Following a number of high profile outbreaks worldwide, it has emerged as a parasite of major public health concern. A quantitative Monte Carlo simulation model was developed to evaluate the annual risk of infection from Cryptosporidium in tap water in Ireland. The assessment considers the potential initial contamination levels in raw water, oocyst removal and decontamination events following various process stages, including coagulation/flocculation, sedimentation, filtration and disinfection. A number of scenarios were analysed to represent potential risks from public water supplies, group water schemes and private wells. Where surface water is used additional physical and chemical water treatment is important in terms of reducing the risk to consumers. The simulated annual risk of illness for immunocompetent individuals was below 1 x 10(-4) per year (as set by the US EPA) except under extreme contamination events. The risk for immunocompromised individuals was 2-3 orders of magnitude greater for the scenarios analysed. The model indicates a reduced risk of infection from tap water that has undergone microfiltration, as this treatment is more robust in the event of high contamination loads. The sensitivity analysis highlighted the importance of watershed protection and the importance of adequate coagulation/flocculation in conventional treatment. The frequency of failure of the treatment process is the most important parameter influencing human risk in conventional treatment. The model developed in this study may be useful for local authorities, government agencies and other stakeholders to evaluate the likely risk of infection given some basic input data on source water and treatment processes used.