Factors contributing to the public health and economic importance of waterborne zoonotic parasites

This is the first of a series of review articles in a Special Issue publication on waterborne zoonotic parasites. A brief historical overview of the occurrence and importance of waterborne parasites, dating from early civilization is presented. The article considers the diversity of parasites including protozoa, nematodes, cestodes and trematodes and the related zoonotic organism microsporidia. Many of the life cycle stages and their characteristics, which make parasites environmentally resistant and suitable for waterborne transmission are discussed. Surfaces of transmission stages consist of multiple layers of proteins, lipids, chitin or other substances capable of withstanding a variety of physical and chemical treatments. Delivery of waterborne parasites is facilitated by various mass distribution systems to consumers, and by transport and intermediate hosts such as fish and filter-feeding invertebrates which are consumed by humans. The article discusses the trends in global warming and climate change and potential for concurrent rise in waterborne disease outbreaks due to parasites. Impacts of technological modernization and globalization on the transmission of zoonotic waterborne zoonotic parasites are considered, including the effects of large-scale agricultural practices, rapid transportation of goods, and widespread movement of individuals and animals. Finally, transmission features and parasite attributes which contribute to concerns about accidental or orchestrated waterborne disease outbreaks are discussed.     

Cryptosporidium and Giardia as foodborne zoonoses

Cryptosporidium and Giardia are major causes of diarrhoeal disease in humans, worldwide and are major causes of protozoan waterborne diseases. Both Cryptosporidium and Giardia have life cycles which are suited to waterborne and foodborne transmission. There are 16 'valid'Cryptosporidium species and a further 33+ genotypes described. Parasites which infect humans belong to the Giardia duodenalis "type", and at least seven G. duodenalis assemblages are recognised. Cryptosporidium parvum is the major zoonotic Cryptosporidium species, while G. duodenalis assemblages A and B have been found in humans and most mammalian orders. In depth studies to determine the role of non-human hosts in the transmission of Cryptosporidium and Giardia to humans are required. The use of harmonised methodology and standardised and validated molecular markers, together with sampling strategies that provide sufficient information about all contributors to the environmental (oo)cyst pool that cause contamination of food and water, are recommended. Standardised methods for detecting (oo)cysts in water are available, as are optimised, validated methods for detecting Cryptosporidium in soft fruit and salad vegetables. These provide valuable data on (oo)cyst occurrence, and can be used for species and subspecies typing using appropriate molecular tools. Given the zoonotic potential of these organisms, epidemiological, source and disease tracking investigations involve multidisciplinary teams. Here, the role of the veterinarian is paramount, particularly in understanding the requirement for adopting comprehensive sampling strategies for analysing both sporadic and outbreak samples from all potential non-human contributors. Comprehensive sampling strategies increase our understanding of parasite population biology and structure and this knowledge can be used to determine what level of discrimination is required between isolates. Genetic exchange is frequent in C. parvum populations, leading to recombination between alleles at different loci, the generation of a very large number of different genotypes and a high level of resolution between isolates. In contrast, genetic exchange appears rare in Cryptosporidium hominis and populations are essentially clonal with far fewer combinations of alleles at different loci, resulting in a much lower resolution between isolates with many being of the same genotype. Clearly, more markers provide more resolution and high throughput sequencing of a variety of genes, as in multilocus sequence typing, is a way forward. Sub-genotyping tools offer increased discrimination, specificity and sensitivity, which can be exploited for investigating the epidemiology of disease, the role of asymptomatic carriers and contaminated fomites and for source and disease tracking for food and water contaminated with small numbers of (oo)cysts.     

Occurrence of Giardia duodenalis infection in chinchillas (Chincilla lanigera) from Italian breeding facilities

The present work investigated the occurrence of Giardia infection in Chinchilla lanigera reared in three Italian breeding facilities and determined their role as potential zoonotic reservoir. One hundred and four fecal samples were tested for the presence of Giardia spp. cysts using a Direct Fluorescent Assay (DFA). A high positivity rate (39.4%) was found despite all animals were asymptomatic at the time of sampling. Thirty-one positive samples were genetically characterized by sequence analysis of the ITS1-5.8S-ITS2 region of the Giardia ribosomal DNA. Assemblages B (29 isolates) and C (two isolates) were identified. These results showed that Giardia infection can be common in chinchillas, thus spurring further molecular epizootiological studies of the infection to assess the zoonotic potential or host specificity of their isolates, to determine the source of infections, to identify the routes of transmission, and to control the infection among animal populations.     

Observations on natural and experimental infections with Giardia isolated from cats.

The course of infection with Giardia was studied in (a) naturally infected cats and (b) experimentally infected Mongolian gerbils using Giardia cysts isolated from cats. Natural infection was characterized by: (a) a latent period of 11 to 13 days, (b) the pattern of cyst release which was either continuous or intermittent during the acute phase of infection and (c) elimination of the infection in four to five weeks after exposure. Mongolian gerbils were found to be susceptible to infection with Giardia isolated from cats. The course of infection in gerbils was characterized by intermittent cyst release and elimination of the infection in about three weeks. The pattern of cyst release in gerbils infected with Giardia isolated from cats was similar to the previously reported pattern of cyst release in gerbils infected with Giardia isolated from humans. The possible role of pets in the zoonotic transmission of giardiasis is discussed.     

Prevalence of dog intestinal parasites and risk perception of zoonotic infection by dog owners in São Paulo State, Brazil

Coprological examination was used to estimate the prevalence of gastrointestinal parasites in stray and domiciled dogs from Botucatu, S?o Paulo State, Brazil. Risk factors for dog infection were assessed in relation to demographic, husbandry and management data. The dog owners completed a questionnaire survey on some aspects of dog parasitism such as parasite species, mechanisms of infection, awareness of zoonotic diseases and history of anthelmintic usage. Parasites were found in the faeces of 138 dogs, with an overall prevalence of 54.3%. Dogs harbouring one parasite were more common (31.4%) than those harbouring two (18.5%), three (3.2%) or four (1.2%). The following parasites and their respective frequencies were detected: Ancylostoma (37.8%), Giardia (16.9%), Toxocara canis (8.7%), Trichuris vulpis (7.1%), Dipylidium caninum (2.4%), Isospora (3.5%), Cryptosporidium (3.1%) and Sarcocystis (2.7%). Stray dogs were found more likely to be poliparasitized (P<0.01) and presented higher prevalence of Ancylostoma, T. canis and Giardia (P<0.01) than domiciled ones. Toxocara canis was detected more frequently in dogs with <6 months of age (P<0.05) and no effect of sex or breed could be observed (P>0.05). Except for Ancylostoma, that showed a significantly higher prevalence in dogs living in a multi-dog household (P<0.01), parasite prevalences were similar in single- and multi-dog household. The answers of dog owners to the questionnaire showed that the majority does not know the species of dog intestinal parasites, the mechanisms of transmission, the risk factors for zoonotic infections, and specific prophylactic measures. The predominance of zoonotic species in dogs in the studied region, associated with the elevated degree of misinformation of the owners, indicates that the risk of zoonotic infection by canine intestinal parasite may be high, even in one of the most developed regions of Brazil.     

Prevalence of Microsporidia, Cryptosporidium spp., and Giardia spp. in beavers (Castor canadensis) in Massachusetts.

Feces from 62 beavers (Castor canadensis) in Massachusetts were examined by fluorescence microscopy (IFA) and polymerase chain reaction (PCR) for Microsporidia species, Cryptosporidium spp., and Giardia spp. between January 2002 and December 2004. PCR-positive specimens were further examined by gene sequencing. Protist parasites were detected in 6.4% of the beavers. All were subadults and kits. Microsporidia species were not detected. Giardia spp. was detected by IFA from four beavers; Cryptosporidium spp. was also detected by IFA from two of these beavers. However, gene sequence data for the ssrRNA gene from these two Cryptosporidium spp.-positive beavers were inconclusive in identifying the species. Nucleotide sequences of the TPI, ssrRNA, and beta-giardin genes for Giardia spp. (deposited in GenBank) indicated that the four beavers were excreting Giardia duodenalis Assemblage B, the zoonotic genotype representing a potential source of waterborne Giardia spp. cysts.     

The potential for zoonotic transmission of Giardia duodenalis and Cryptosporidium spp. from beef and dairy cattle in Ontario, Canada

The objective of this study was to compare the occurrence and the genotypes and species of Giardia duodenalis and Cryptosporidium spp. in beef and dairy cattle from farms in the Regional Municipality of Waterloo, Ontario, in an effort to determine the potential for zoonotic transmission from these animals. Pooled manure samples were collected from 45 dairy cattle farms and 30 beef cattle farms. The presence of Giardia cysts and Cryptosporidium oocysts was determined by immunofluorescence microscopy, while nested-PCR and DNA sequencing were used to determine genotypes and species. The overall farm prevalence was very high for both Giardia and Cryptosporidium, and was similar for dairy cattle farms (96 and 64%, respectively) and beef cattle farms (97 and 63%, respectively). However, on dairy cattle farms, G. duodenalis and Cryptosporidium spp. were detected in 44% and 6% of total pooled pen manure samples, respectively, with the occurrence of both parasites being generally higher in calves than in older animals. Most Giardia isolates were identified as either the host-adapted genotype G. duodenalis Assemblage E or the zoonotic Assemblage B. Cryptosporidium parvum and Cryptosporidium andersoni were the most frequently identified species in dairy cattle, while the non-zoonotic species Cryptosporidium ryanae and Cryptosporidium bovis were also found. On beef cattle farms, 72% and 27% of the total pooled pen manure samples were positive for Giardia and Cryptosporidium, respectively, with no obvious correlation with age. All Giardia isolates in beef cattle were identified as G. duodenalis Assemblage E, while all Cryptosporidium isolates were identified by sequence analysis as C. andersoni, although microscopic analyses, and subsequent restriction fragment length polymorphism analyses, indicated that other Cryptosporidium species were also present. The results of this study indicate that although Giardia and Cryptosporidium were identified in a higher overall percentage of the pooled beef cattle manure samples than in dairy cattle, firmly established zoonotic genotypes and species were much more common in dairy cattle than in beef cattle in this region. Dairy cattle, and especially dairy calves, may, therefore, pose a greater risk of infection to humans than beef cattle. However, these results may also provide evidence of potential zooanthroponotic transmission (human to animal).     

Evaluation of immunofluorescence microscopy and enzyme-linked immunosorbent assay in detection of Cryptosporidium and Giardia infections in asymptomatic dogs

The performance of immunofluorescence microscopy (IF) and enzyme-linked immunosorbent assay (ELISA) in canine feces was evaluated. IF and Cryptosporidium ELISA detected 10(5)oocysts/g, while the detection limit for Giardia ELISA was 10(4)cysts/g. The Cryptosporidium ELISA showed 94% specificity but only 71% sensitivity. The Giardia ELISA correlated well with IF (sensitivity 100%, specificity 96%) and was capable of detecting animal specific Giardia duodenalis genotypes. Visual interpretation appeared appropriate for assessment of ELISA results. The proportion of positive samples and possible zoonotic character of Cryptosporidium and Giardia infections in 150 asymptomatic Finnish dogs from the Helsinki area were studied. The overall proportion of dogs positive for Cryptosporidium was 5% (7/150) and that for Giardia 5% (8/150). In dogs < or =12 months old, the corresponding proportions were 17% and 19% (n=36). Sequence analyses of the 18S rDNA gene identified the isolates as Cryptosporidium canis and animal specific genotypes of G. duodenalis (assemblages C-E), indicating restricted risk of zoonotic transmission.     

Waterborne zoonotic helminthiases

This review deals with waterborne zoonotic helminths, many of which are opportunistic parasites spreading directly from animals to man or man to animals through water that is either ingested or that contains forms capable of skin penetration. Disease severity ranges from being rapidly fatal to low-grade chronic infections that may be asymptomatic for many years. The most significant zoonotic waterborne helminthic diseases are either snail-mediated, copepod-mediated or transmitted by faecal-contaminated water. Snail-mediated helminthiases described here are caused by digenetic trematodes that undergo complex life cycles involving various species of aquatic snails. These diseases include schistosomiasis, cercarial dermatitis, fascioliasis and fasciolopsiasis. The primary copepod-mediated helminthiases are sparganosis, gnathostomiasis and dracunculiasis, and the major faecal-contaminated water helminthiases are cysticercosis, hydatid disease and larva migrans. Generally, only parasites whose infective stages can be transmitted directly by water are discussed in this article. Although many do not require a water environment in which to complete their life cycle, their infective stages can certainly be distributed and acquired directly through water. Transmission via the external environment is necessary for many helminth parasites, with water and faecal contamination being important considerations. Human behaviour, particularly poor hygiene, is a major factor in the re-emergence, and spread of parasitic infections. Also important in assessing the risk of infection by water transmission are human habits and population density, the prevalence of infection in them and in alternate animal hosts, methods of treating sewage and drinking water, and climate. Disease prevention methods, including disease surveillance, education and improved drinking water treatment are described.     

Molecular epidemiology of cryptosporidium and giardia in humans on prince edward island, Canada: evidence of zoonotic transmission from cattle

To determine the zoonotic potential of Cryptosporidium and Giardia in Prince Edward Island (PEI), Canada, 658 human faecal specimens were screened that were submitted to the Queen Elizabeth Hospital diagnostic laboratory. Overall, 143 (22%) samples were Cryptosporidium positive, while three (0.5%) were positive for Giardia. Successful genotyping of 25 Cryptosporidium isolates by sequence analysis of the HSP70 gene revealed that 28 and 72% were C. hominis and C. parvum, respectively. Cryptosporidium isolates from humans and previously genotyped C. parvum from beef cattle were subtyped by sequence analysis of the GP60 gene. Subtyping identified three subtypes belonging to the family IIa. All three subtypes IIaA16G2RI (55%), IIaA16G3RI (22%) and IIaA15G2RI (22%) were found in the animal isolates, while two of the subtypes found in the animals, IIaA16G2RI (80%) and IIaA15G2RI (20%), were also identified in the human isolates. Cryptosporidium infection in humans peaked in April-June. Molecular epidemiological analysis of the human data showed a C. parvum peak in the spring and a relatively smaller peak for C. hominis in July-September. The majority (57%) of human Cryptosporidium isolates were found in children between 5 and 10 years of age. All three Giardia isolates were identified as G. duodenalis assemblage A. The overall Cryptosporidium prevalence in our human samples was high relative to other studies, but because the samples were submitted to a hospital diagnostic laboratory, the results may not be representative of the general population. Further, the presence of the same zoonotic C. parvum subtypes in cattle and human isolates implies that transmission is largely zoonotic and cattle may be a source of sporadic human infections on PEI. The presence of Giardia in people on PEI is rare, and the assemblage A found in humans might originate from humans, livestock or other domestic or wild animals.     

Prevalence and geographical distribution of Giardia spp. and Cryptosporidium spp. in dairy farms in Québec.

Giardiasis and cryptosporidiosis are parasitic infections of humans, domestic animals, and wildlife. In cattle, direct transmission through the contamination of barns and/or pasture appears to be the principal mode of infection. In Canada there is only one study reported in the literature on the prevalence of giardiasis and one study on the prevalence of cryptosporidiosis. These studies were done in Alberta and Manitoba, respectively. The purpose of this study was to determine the prevalence of Giardia spp. and Cryptosporidium spp. infections in dairy farms in Québec. Calves were sampled from 505 dairy farms. We are reporting that 45.7% of the farms were found to be positive for Giardia spp. and 88.7% were infected with Cryptosporidium spp.     

Genotype characterisation of Giardia duodenalis isolates from domestic and farm animals by SSU-rRNA gene sequencing

In order to investigate the genotypes of Giardia duodenalis from domestic and farm animals in Italy, 21 Giardia isolates, 17 from dogs, 1 from cat and 3 from dairy calves, were genetically characterised by SSU-rRNA gene sequencing. Among dogs, 76.5% of isolates showed the dog-specific genotypes (Assemblages C, D and C/D mixed Assemblage) and 23.5% exhibit potential zoonotic genotypes (Assemblage A and A/C mixed Assemblages). The cat isolate belonged to assemblage A, whereas the sequences among the isolates from calves were found to correspond to hoofed-livestock genotype, namely Assemblage E. These findings suggest that infection of humans by zoonotic genotypes from domestic animals could be of low epidemiological significance, although possible. The present study represents the first contribute to the knowledge of G. duodenalis genotypes in domestic and farm animals from Italy.     

A study of the prevalence and genotypes of Giardia duodenalis infecting kennelled dogs

Giardia duodenalis is a protozoan parasite of animals that is zoonotic. Given the capacity of this organism to spread via the faecal–oral route, animals held in overcrowded and unhygienic conditions are at high risk of infection. Faecal samples from dogs in three kennels in Rome were examined by microscopy and PCR for G. duodenalis, and the prevalence data generated were correlated with variables such as kennel identity, age of dog, length of time the dog had been kennelled and clinical signs.The overall prevalence of the parasite in the faecal samples was 20.5% and was higher in samples from the largest kennel, which had the greatest turnover of dogs, and in faecal samples from younger animals. Giardia cysts were found more frequently in diarrhoeic animals but were also found in dogs with no clinical signs. Although the finding that the majority of isolates were dog-specific rather than zoonotic genotypes suggests that the zoonotic risk from this pathogen is less than previously thought, the higher prevalence of infection in younger dogs may pose a specific public health issue as such animals are more frequently re-homed with families.     

Amebae and ciliated protozoa as causal agents of waterborne zoonotic disease

The roles free-living amebae and the parasitic protozoa Entamoeba histolytica and Balantidium coli play as agents of waterborne zoonotic diseases are examined. The free-living soil and water amebae Naegleria fowleri, Acanthamoeba spp., and Balamuthia mandrillaris are recognized etiologic agents of mostly fatal amebic encephalitides in humans and other animals, with immunocompromised and immunocompetent hosts among the victims. Acanthamoeba spp. are also agents of amebic keratitis. Infection is through the respiratory tract, breaks in the skin, or by uptake of water into the nostrils, with spread to the central nervous system. E. histolytica and B. coli are parasitic protozoa that cause amebic dysentery and balantidiasis, respectively. Both intestinal infections are spread via a fecal-oral route, with cysts as the infective stage. Although the amebic encephalitides can be acquired by contact with water, they are not, strictly speaking, waterborne diseases and are not transmitted to humans from animals. Non-human primates and swine are reservoirs for E. histolytica and B. coli, and the diseases they cause are acquired from cysts, usually in sewage-contaminated water. Amebic dysentery and balantidiasis are examples of zoonotic waterborne infections, though human-to-human transmission can occur. The epidemiology of the diseases is examined, as are diagnostic procedures, anti-microbial interventions, and the influence of globalization, climate change, and technological advances on their spread.     

Molecular characterization of Cryptosporidium and Giardia in pre-weaned calves in Western Australia and New South Wales

A total of 364 fecal specimens from randomly selected pre-weaned calves, aged up to 4 months, from 5 different farms in the south of Western Australia and 1 farm from New South Wales were screened for the presence of Cryptosporidium and Giardia using PCR. There were substantial differences in prevalence between the farms and the overall prevalence was 22.3% (81/364) and 26.9% (98/364) respectively for Cryptosporidium and Giardia. For Cryptosporidium, 70 positives were identified at the 18S locus. At a unique diagnostic locus, an additional 12 C. parvum positives were identified. Sequence analysis at the 18S ribosomal RNA locus was successful for 59 of the 70 positive isolates; of these 14 were C. parvum, 28 were C. bovis, 15 were C. ryanae, 1 was pig genotype II and 1 was a mixed C. ryanae/C. parvum infection. Sub-typing analysis at the glycoprotein 60 (gp60) locus for 24 C. parvum isolates identified all as IIa; 17 were A17G2R1, 1 was A18G3R1 and 6 were A20G3R1. For Giardia, 75 positives were identified at the 18S locus and an additional 23 positives were identified at the gdh locus. The majority of the isolates sequenced were assemblage E, however assemblage A and B and mixed A and E and A, B and E infections as well as the quenda genotype were identified. The findings of the present study indicate that pre-weaned calves are not an important source of zoonotic Giardia species in Australia but may be an important source of zoonotic Cryptosporidium.     

Occurrence of Giardia and Cryptosporidium in Norwegian red foxes (Vulpes vulpes)

Faecal samples from 269 Norwegian wild red foxes (Vulpes vulpes) shot during the hunting season (October-April) in 2002-2004 were examined for the presence of Giardia and Cryptosporidium. Cryptosporidium oocysts were detected in samples from 6 (2.2%) of the foxes, and Giardia cysts in 13 (4.8%) of the foxes. The prevalence of Giardia infection was significantly higher in juvenile male foxes than in adult male foxes, but no other significant differences between age and sex were found. No significant differences in prevalence related to geographical origin of animals were found. Insufficient nucleated Cryptosporidium oocysts were isolated for successful PCR, but genotyping of Giardia duodenalis isolates from seven foxes demonstrated a high degree of heterogeneity amongst them, with all isolates belonging to the zoonotic Assemblages A and B.     

Survey and molecular characterization of Cryptosporidium and Giardia spp. in owned companion animal, dogs and cats, in Japan

Compared with other countries, surveys of these parasites have been rarely performed in companion animals of Japan in spite of their significance for public health. Here, we investigated pet dogs and cats in Japan for the first time, and genetically analyzed the isolates to evaluate the risk of zoonotic infections. Seventy-seven fecal samples were collected from privately owned dogs and 55 samples from owned cats in Osaka city, Japan. Cryptosporidium oocysts were identified in 3/77 dogs (3.9%) and 7/55 cats (12.7%), and Giardia infection in 2/77 dogs (2.6%) and 1/55 cats (1.8%). Amplification of the target regions for genotyping was successful, Cryptosporidium isolates in dogs and cats were identified as C. canis and C. felis, respectively, and those of Giardia in dogs and cats were G. intestinalis Assemblages D and F. The discharge period of the oocysts varied within 3-16 weeks and that of the cysts was 12 weeks. To date, zoonotic types of both parasites have been identified in other animals in Japan, and further large-scale studies are needed to determine the distribution of zoonotic genotypes in these animals, especially those closely associated with humans.     

Survey on giardiosis in shelter dog populations

Faecal samples from 183 dogs living in three different shelters in the Rome metropolitan area were randomly collected and examined for the prevalence of giardiosis. Giardia infections were detected by a commercially available ELISA test (ProspecT Giardia Microplate Assay). Overall prevalence was 55.2%. Prevalence rates in single shelters were 74.3, 35.5, and 20.9%, respectively. Using multivariate analysis, no association was found between Giardia-positivity and shelter or sex, breed, or diarrhoea. Giardia-positive dogs were more likely to be younger than 5-year-old (odds ratio [OR] = 2.87; 95% confidence interval [95% CI]: 1.07-7.77; p = 0.038), living together (OR = 2.58; 95% CI: 1.12-5.93; p = 0.026), and fed commercial wet food, both alone and combined with dry food (OR = 5.67; 95% CI: 1.59-20.24; p = 0.008). Correlation between Giardia infection and type of food has not been previously reported in dogs. Possible use of the ELISA test for detection of Giardia infection in dogs and zoonotic implications are discussed.     

Blastocystis in humans and animals: new insights using modern methodologies

Among the waterborne protozoan parasites of medical and veterinary importance, Blastocystis is perhaps one of the less well-understood. However, in recent years, there has been a surge of interest in the organism, fueled in part by the possible association of Blastocystis infection with intestinal disorders, and its unusual taxonomic affiliations. Although there is information on the parasite's morphology, taxonomy and mode of transmission, its pathogenicity, life cycle, and function of certain organelles continue to baffle investigators. The clinical relevance of Blastocystis will be better answered once an animal model is found. Blastocystis infections have a worldwide distribution but prevalence is highest in areas with poor hygiene and deficient sanitation services and facilities. Application of modern molecular tools has advanced knowledge of the organism's genetic diversity, taxonomy and zoonotic potential.