Inappropriate feeding practice favors the transmission of Trichinella papuae from wild pigs to saltwater crocodiles in Papua New Guinea

From wildlife to humans: The global distribution of Trichinella species and genotypes in wildlife and wildlife-associated human trichinellosis

Zoonotic nematodes of the genus Trichinella are foodborne parasites that have a global distribution in wild carnivores and omnivores, with spillover and spillback into domestic livestock and people, with concomitant trade and health consequences. Historically, most human cases were linked to domestic pigs infected with Trichinella spiralis, but under current high biosecurity swine production in many countries, wildlife have become a more important source of human trichinellosis. The aim of this review is to update the global distribution of Trichinella species and genotypes reported in wildlife, as well as reported human outbreaks from the consumption of wildlife. Using several online databases and by "snowballing" references, hundreds of reports of Trichinella spp. in wildlife published between January 1991 and December 2023 provide an important update to the host and geographic range for each of the recognized 13 species/genotypes, grouped by continent. Surveillance effort was highest in Europe and North America, while Africa, Asia, Oceania, Central and South America have had limited surveillance, in some instances with human cases serving as sentinels of transmission in a region. Dozens of human outbreaks are described, with wild boars (Sus scrofa) being the most frequently implicated wildlife species in human outbreaks globally. Bears are an important source of infection in North America, for wildlife tourism, and importation of bear meat has also been implicated in multicountry outbreaks. The largest study limitation was the dearth of molecular identification of larvae in both wildlife surveillance studies and human outbreaks, particulary in under-studied regions. We highlight the need for enhanced molecular epidemiological approaches to outbreaks of this important foodborne parasite, and emphasize the need for a One Health approach to manage Trichinella spp. which transmit among terrestrial and marine wildlife (including migratory birds), pigs, horses, and people, often across large geographic scales and borders.

The impact of globalization and climate change on Trichinella spp. epidemiology

The main reservoir hosts of nematodes of the genus Trichinella are wild carnivores, although most human infections are caused by the consumption of pork. This group of zoonotic parasites completes the entire natural life cycle within the host organism. However, there is an important phase of the cycle that has only been highlighted in recent years and which concerns the permanence of the infecting larvae in the striated muscles of the host carcasses waiting to be ingested by a new host. To survive in this unique biological niche, Trichinella spp. larvae have developed an anaerobic metabolism for their survival in rotting carcasses and, for some species, a resistance to freezing for months or years in cold regions. Climate changes with increasingly temperatures and reduction of environmental humidity lower the survival time of larvae in host carcasses. In addition, environmental changes affect the biology and ecology of the main host species, reducing their number and age composition due to natural habitat fragmentation caused by increasing human settlements, extensive monocultures, increasing number of food animals, and reduction of trophic chains and biodiversity. All of these factors lead to a reduction in biological and environmental complexity that is the key to the natural host-parasite balance. In conclusion, Trichinella nematodes can be considered as an indicator of a health natural ecosystem.

Human Outbreak of Trichinellosis Caused by Trichinella papuae Nematodes, Central Kampong Thom Province, Cambodia

In September 2017, a severe trichinellosis outbreak occurred in Cambodia after persons consumed raw wild pig meat; 33 persons were infected and 8 died. We collected and analyzed the medical records for 25 patients. Clinical signs and symptoms included myalgia, facial or peripheral edema, asthenia, and fever. We observed increased levels of creatine phosphokinase and aspartate aminotransferase-, as well as eosinophilia. Histopathologic examination of muscle biopsy specimens showed nonencapsulated Trichinella larvae. A Trichinella excretory/secretory antigen ELISA identified Trichinella IgM and IgG. Biopsy samples were digested and larvae were isolated and counted. PCR for the 5S rDNA intergenic spacer region and a multiplex PCR, followed by sequencing identified the parasite as Trichinella papuae. This species was identified in Papua New Guinea during 1999 and in several outbreaks in humans in Thailand. Thus, we identified T. papuae nematodes in humans in Cambodia.

Molecular characterization of Trichinella species from wild animals in Israel

Trichinellosis is a worldwide disease caused by nematode worms of the genus Trichinella, frequently diagnosed in Israel. However, the identity of the Israeli isolates have not been studied. Here we describe the molecular characterization of 58 isolates collected from jackals (Canis aureus), wild boar (Sus scrofa), foxes (Vulpes vulpes) and a wolf (Canis lupus) in central and northern Israel. Isolates were analyzed using the multiplex PCR analysis encompassing expansion segment V (ESV) and internal sequence 1 (ITS-1) markers, which identified 52 of the 58 samples. Out of the six unidentified samples, four were successfully identified using extended PCR assays for ESV and ITS-1, developed in this study. Our analysis identified 44 isolates as T. britovi, 8 as T. spiralis, four mixed infections, and two isolates were not identified. Clonal analysis of the ITS-1 sequences from six isolates confirmed the initial identification of four mixed infections. These results show that the prevalent species in Israel are T. britovi and T. spiralis, with nearly 7% (4 of 58) incidence of mixed infection.

Innovative molecular diagnosis of Trichinella species based on β-carbonic anhydrase genomic sequence

Trichinellosis is a helminthic infection where different species of Trichinella nematodes are the causative agents. Several molecular assays have been designed to aid diagnostics of trichinellosis. These assays are mostly complex and expensive. The genomes of Trichinella species contain certain parasite‐specific genes, which can be detected by polymerase chain reaction (PCR) methods. We selected β‐carbonic anhydrase (β‐CA) gene as a target, because it is present in many parasites genomes but absent in vertebrates. We developed a novel β‐CA gene‐based method for detection of Trichinella larvae in biological samples. We first identified a β‐CA protein sequence from Trichinella spiralis by bioinformatic tools using β‐CAs from Caenorhabditis elegans and Drosophila melanogaster. Thereafter, 16 sets of designed primers were tested to detect β‐CA genomic sequences from three species of Trichinella, including T. spiralis, Trichinella  pseudospiralis and Trichinella  nativa. Among all 16 sets of designed primers, the primer set No. 2 efficiently amplified β‐CA genomic sequences from T. spiralis, T. pseudospiralis and T. nativa without any false‐positive amplicons from other parasite samples including Toxoplasma gondii, Toxocara cati and Parascaris equorum. This robust and straightforward method could be useful for meat inspection in slaughterhouses, quality control by food authorities and medical laboratories.

Malaria endemicity and co-infection with tissue-dwelling parasites in Sub-Saharan Africa: a review

Mechanisms and outcomes of host-parasite interactions during malaria co-infections with gastrointestinal helminths are reasonably understood. In contrast, very little is known about such mechanisms in cases of malaria co-infections with tissue-dwelling parasites. This is lack of knowledge is exacerbated by misdiagnosis, lack of pathognomonic clinical signs and the chronic nature of tissue-dwelling helminthic infections. A good understanding of the implications of tissue-dwelling parasitic co-infections with malaria will contribute towards the improvement of the control and management of such co-infections in endemic areas. This review summarises and discusses current information available and gaps in research on malaria co-infection with gastro-intestinal helminths and tissue-dwelling parasites with emphasis on helminthic infections, in terms of the effects of migrating larval stages and intra and extracellular localisations of protozoan parasites and helminths in organs, tissues, and vascular and lymphatic circulations.

The probable role of cannibalism in spreading Trichinella papuae infection in a crocodile farm in Papua New Guinea

Between 2003 and 2007, 83 (50%) of 167 crocodiles (Crocodylus porosus) purchased as juveniles by a crocodile farm 3 or 4 years earlier from Kikori, Gulf Province, were found to be infected with Trichinella papuae. Between 2005 and 2007 infection was detected in a number of crocodiles at the farm obtained from six localities other than Kikori, as well as in a few animals born on the farm. Up to 2004, all juveniles at the farm, whether wild- or farm-born, were penned together; the practice was then stopped to prevent possible infection through cannibalism. The last infected animal from Kikori was seen in 2007, 4 years after the purchase of crocodiles from there ceased. The last non-Kikori infected crocodile was seen, also, in 2007. None of the 1972 crocodiles (comprising wild- and farm-born animals) tested from 2008 to 2013, using the digestion method, was infected with T. papuae. This indicates that infection of non-Kikori crocodiles was the result of cannibalism within the farm during the years up to 2004 when juvenile crocodiles were kept together, and that the farm is now free of the infection.

A review of domestic animal diseases within the Pacific Islands region

The Pacific Island countries and territories (PICTs) are reported to be free of the most serious infectious livestock diseases which are prevalent in other parts of the globe, such as Highly Pathogenic Avian Influenza, Foot and Mouth Disease or Rabies. Yet there is a lack of scientifically based evidence to confirm this animal health status. This paper reviews what has been published on diseases of domestic animals in the Pacific Islands region with a particular focus on data from the last 20 years (1992-2012). Relevant published papers were identified by a computerized literature search of two electronic databases (PubMed and Web of Knowledge). The latest reports on the animal health situation submitted by the PICTs to the World Organisation for Animal Health (OIE) were accessed on the World Animal Health Information Database (WAHID) interface and included in this review. Additionally, paper searches of resources were undertaken at the library of the Secretariat of the Pacific Community (SPC) in Fiji to retrieve any relevant grey literature for this review. The study eligibility criteria included qualitative or quantitative information on any disease (bacterial, viral, parasitic and other health disorders) affecting domestic terrestrial animals (mammals, reptiles, birds and bees) in any of the 22 PICTs members of the SPC. A total of 158 eligible references were retrieved of which only 77 (48.7%) were published since 1992 and analysed in more details. One hundred and one diseases and pathogens were reported on for bee, bird, carabao, cat, cattle, crocodile, deer, dog, donkey, goat, horse, pig, pigeon, poultry and sheep in the Oceania region and in 17 PICTs in particular. The paper gives information about known animal diseases, their reported prevalence and diseases not reported within the Pacific Islands region. The study found retrieved literature on animal diseases in PICTs was scarce and no longer up to date. There is a need to improve the published knowledge on the current animal disease status in the region.

New pieces of the Trichinella puzzle

Contrary to our understanding of just a few decades ago, the genus Trichinella now consists of a complex assemblage of no less than nine different species and three additional genotypes whose taxonomic status remains in flux. New data and methodologies have allowed advancements in detection and differentiation at the population level which in turn have demonstrably advanced epidemiological, immunological and genetic investigations. In like manner, molecular and genetic studies have permitted us to hypothesise biohistorical events leading to the worldwide dissemination of this genus, and to begin crystalising the evolution of Trichinella on a macro scale. The identification of species in countries and continents otherwise considered Trichinella-free has raised questions regarding host adaptation and associations, and advanced important findings on the biogeographical histories of its members. Using past reviews as a backdrop, we have ventured to present an up-to-date assessment of the taxonomy, phylogenetic relationships and epidemiology of the genus Trichinella with additional insights on host species, survival strategies in nature and the shortcomings of our current understanding of the epidemiology of the genus. In addition, we have begun compiling information available to date on genomics, proteomics, transcriptomics and population studies of consequence in the hope we can build on this in years to come.

Development of an ELISA to detect the humoral immune response to Trichinella zimbabwensis in Nile crocodiles (Crocodylus niloticus)

Crocodiles are known reservoir hosts of Trichinella papuae and Trichinella zimbabwensis, two zoonotic parasites that also infect mammals. Since commercial crocodile farming represents a key source of income in several countries, it is important to monitor this nematode infection in both farmed crocodiles and in breeding stocks which are frequently introduced from the wild. For this purpose, an indirect ELISA was developed to detect the anti-Trichinella immune response in crocodile sera. New Zealand rabbits were immunized with pooled sera from non-infected farmed crocodiles in the presence of Freund's complete adjuvant. The anti-crocodile serum was then conjugated with horseradish peroxidase. Serum samples from four Nile crocodiles (Crocodylus niloticus) experimentally infected with T. zimbabwensis and from four uninfected crocodiles were used to set up the ELISA. The larval burden per gram of muscle tissue was determined by muscle biopsy. The test was performed on serum samples from an additional 15 experimentally infected crocodiles as well as eight wild Nile crocodiles. Among the 19 experimentally infected crocodiles, seroconversion was observed in 11 animals. The highest antibody response was observed six weeks post infection (p.i.), but in most of these animals, antibodies were not detectable after six weeks p.i. even though live larvae were present in the muscles up to six months p.i.

Parasitic infections and myositis

Infectious myositis may be caused by a wide variety of bacterial, fungal, viral, and parasitic agents. Parasitic myositis is most commonly a result of trichinosis, cystericercosis, or toxoplasmosis, but other parasites may be involved. A parasitic cause of myositis is suggested by history of residence or travel to endemic area and presence of eosinophilia. The diagnosis of parasitic myositis is suggested by the clinical picture and radiologic imaging, and the etiologic agent is confirmed by parasitologic, serologic, and molecular methods, together with histopathologic examination of tissue biopsies. Therapy is based on the clinical presentation and the underlying pathogen. Drug resistance should be put into consideration in different geographic areas, and it can be avoided through the proper use of anti-parasitic drugs.

First report of a Trichinella papuae infection in a wild pig (Sus scrofa) from an Australian island in the Torres Strait region

Multiple Trichinella species are reported from the Australasian region although mainland Australia has never confirmed an indigenous case of Trichinella infection in humans or animals. Wildlife surveys in high-risk regions are essential to truly determine the presence or absence of Trichinella, but in mainland Australia are largely lacking. In this study, a survey was conducted in wild pigs from mainland Australia's Cape York Peninsula and Torres Strait region for the presence of Trichinella, given the proximity of a Trichinella papuae reservoir in nearby PNG. We report the detection of a Trichinella infection in a pig from an Australian island in the Torres Strait, a narrow waterway that separates the islands of New Guinea and continental Australia. The larvae were characterised as T. papuae (Kikori strain) by PCR and sequence analysis. No Trichinella parasites were found in any pigs from the Cape York Peninsula. These results highlight the link the Torres Strait may play in providing a passage for introduction of Trichinella parasites from the Australasian region to the Australian mainland.

Molecular identification of Trichinella papuae from a Thai patient with imported trichinellosis

Previously, we reported the presence of imported trichinellosis in a Thai worker returning from Malaysia, who presented with progressive generalized muscle hypertrophy and weakness after eating wild boar meat. This work analyzed a partial small subunit of a mitochondrial ribosomal RNA gene of Trichinella larvae isolated from the patient. The results showed complete identity with a mitochondrial RNA gene of Trichinella papuae (GenBank accession no. EF517130). This is the first report of imported trichinellosis in Thailand caused by T. papuae. It is possible that T. papuae is widely distributed in the wildlife of Southeast Asia.

Wild boars as sources for infectious diseases in livestock and humans

Wild boars (Sus scrofa) are indigenous in many countries in the world. These free-living swine are known reservoirs for a number of viruses, bacteria and parasites that are transmissible to domestic animals and humans. Changes of human habitation to suburban areas, increased use of lands for agricultural purposes, increased hunting activities and consumption of wild boar meat have increased the chances of exposure of wild boars to domestic animals and humans. Wild boars can act as reservoirs for many important infectious diseases in domestic animals, such as classical swine fever, brucellosis and trichinellosis, and in humans, diseases such as hepatitis E, tuberculosis, leptospirosis and trichinellosis. For examples, wild boars are reservoirs for hepatitis E virus, and cluster cases of hepatitis E have been reported in Japan of humans who consumed wild boar meat. In Canada, an outbreak of trichinellosis was linked to the consumption of wild boar meat. The incidence of tuberculosis owing to Mycobacterium bovis has increased in wild boars, thus posing a potential concern for infections in livestock and humans. It has also been documented that six hunters contracted Brucella suis infections from wild swine in Florida. This article discusses the prevalence and risk of infectious agents in wild boars and their potential transmission to livestock and humans.

Epidemiology, diagnosis, treatment, and control of trichinellosis

SUMMARY

Throughout much of the world, Trichinella spp. are found to be the causative agents of human trichinellosis, a disease that not only is a public health hazard by affecting human patients but also represents an economic problem in porcine animal production and food safety. Due to the predominantly zoonotic importance of infection, the main efforts in many countries have focused on the control of Trichinella or the elimination of Trichinella from the food chain. The most important source of human infection worldwide is the domestic pig, but, e.g., in Europe, meats of horses and wild boars have played a significant role during outbreaks within the past 3 decades. Infection of humans occurs with the ingestion of Trichinella larvae that are encysted in muscle tissue of domestic or wild animal meat. Early clinical diagnosis of trichinellosis is rather difficult because pathognomonic signs or symptoms are lacking. Subsequent chronic forms of the disease are not easy to diagnose, irrespective of parameters including clinical findings, laboratory findings (nonspecific laboratory parameters such as eosinophilia, muscle enzymes, and serology), and epidemiological investigations. New regulations laying down rules for official controls for Trichinella in meat in order to improve food safety for consumers have recently been released in Europe. The evidence that the disease can be monitored and to some extent controlled with a rigorous reporting and testing system in place should be motivation to expand appropriate programs worldwide.

Survival of Trichinella papuae muscle larvae in a pig carcass maintained under simulated natural conditions in Papua New Guinea

In Papua New Guinea, Trichinella papuae, a non-encapsulated species, is circulating among wild and domestic pigs and saltwater crocodiles. Since an important phase of the life cycle of nematodes of the genus Trichinella is the time of survival of infective larvae in decaying muscle tissues of the hosts, the carcass of a pig, experimentally infected with larvae of T. papuae, was exposed to the environmental conditions of Papua New Guinea to establish how long these larvae would survive and remain infective to a new host. Larvae retained their infectivity in the pig carcass up to 9 days after slaughtering, during which time the temperature within the carcass reached 35.0 degrees C on 2 days; the average relative humidity was 79.0%. A low number of larvae survived up to day 14 after the pig was killed, when the carcass temperature reached 38.0 degrees C, but they lost their infectivity to laboratory mice. This result suggests that the larvae of T. papuae can survive in a tropical environment for a time, favouring their transmission to a new host in spite of the lack of a collagen capsule.

World distribution of Trichinella spp. infections in animals and humans

The etiological agents of human trichinellosis show virtually worldwide distribution in domestic and/or wild animals, with the exception of Antarctica, where the presence of the parasite has not been reported. This global distribution of Trichinella and varying cultural eating habits represent the main factors favouring human infections in industrialised and non-industrialised countries. Human trichinellosis has been documented in 55 (27.8%) countries around the world. In several of these countries, however, trichinellosis affects only ethnic minorities and tourists because the native inhabitants do not consume uncooked meat or meat of some animal species. Trichinella sp. infection has been documented in domestic animals (mainly pigs) and in wildlife of 43 (21.9%) and 66 (33.3%) countries, respectively. Of the 198 countries of the world, approximately 40 (20%) are small islands far from the major continents, or city-states where Trichinella sp. cannot circulate among animals for lack of local fauna (both domestic and wild). Finally, information on the occurrence of Trichinella sp. infection in domestic and/or wildlife is still lacking for 92 countries.

Systematics and epidemiology of trichinella

In this review, we describe the current knowledge on the systematics, ecology and epidemiology of Trichinella and trichinellosis, and the impact of recent research discoveries on the understanding of this zoonosis. The epidemiology of this zoonosis has experienced important changes over the past two decades, especially with regard to the importance of the sylvatic cycle and the sylvatic species. Outbreaks of trichinellosis due to Trichinella spiralis from domestic swine, while still frequent, increasingly are caused by other Trichinella spp. infecting hosts such as horses, dogs, wild boars, bears and walruses. The latter revelations have occurred as a result of a series of discoveries on the systematics of Trichinella spp., facilitated by new molecular tools. As a consequence, the genus is now composed of two clades, an encapsulated group (five species and three genotypes) and a non-encapsulated one (three species). This has sparked renewed investigations on the host range of these parasites and their epidemiological features. Most dramatic, perhaps, is the recognition that reptiles may also serve as hosts for certain species. This new knowledge base, in addition to having an important relevance for food safety policies and protection measures, is raising important questions on the phylogeny of Trichinella spp., the ecological characteristics of the species and their geographic histories. Answers to these questions may have great value for the understanding of the evolutionary biology for other parasitic helminths, and may increase the value of this genus as models for research on parasitism in general.

Recent advances on the taxonomy, systematics and epidemiology of Trichinella

Since Owen first described Trichinella as a human pathogen in 1835, the number of organisms comprising this genus has grown dramatically. Where it was once thought to be a monospecific group, this genus is now comprised of eight species and three additional genotypic variants that have yet to be taxonomically defined. Along with the growth in the genus and description of the parasites has come a concomitant increase in our understanding of the epidemiology and geographical distribution of these organisms. Recent expansion of the non-encapsulated group to include three species biologically defined by their unique host ranges encompassing mammals, birds and reptiles, has raised substantial questions as to the term, 'Trichinella-free' as it applies to geographical localities. A true appreciation of the adaptability of this genus to host and environmental selection factors, as well as its dissemination to the far reaches of the world can best be appreciated by reviewing what we know and what we hope to know about this ancient and elusive parasite. The review herein consolidates our current understanding of the taxonomy, epidemiology, and phylogeny of the genus Trichinella, and identifies areas where data are lacking and our knowledge requires additional clarification.

Trichinella infection in a hunting population of Papua New Guinea suggests an ancient relationship between Trichinella and human beings

A new Trichinella species, Trichinella papuae, was discovered in 11.5% of wild pigs in a remote region of Papua New Guinea. A survey was conducted to determine whether the inhabitants of this region are infected with Trichinella, as wild-pig meat represents their main source of protein. The prevalence of anti-Trichinella antibodies and its determinants were assessed among the inhabitants in 51 of the villages in the Morehead District of Papua New Guinea. We tested and interviewed 1536 people (28.8% of the adult population). Anti-Trichinella IgG were detected in 10.0% (95% Cl 8.5-11.6%) of them. The prevalence of seropositivity was higher in males (12.7%) than in females (7.5%) (P<0.01), and the seroprevalence significantly increased with age. In one area, seroprevalence was highest in villages nearest the hunting area in which wild pigs are infected with Trichinella papuae (P<0.01). Seropositivity was also correlated with the consumption of raw or undercooked meat. Persons reporting pain in the muscle joints and limbs were more likely to be seropositive; no severe clinical manifestations were observed. That infection was never severe suggests that the seropositive people are reinfected relatively often, but with very few larvae. If the epidemiological pattern of Trichinella infection observed among the hunting population of this area is any indication of the pattern of infection in prehistoric hunters, we can speculate that Trichinella infection due to the consumption of meat from wild animals was possibly a common disease among prehistoric populations.

Human behaviour and the epidemiology of parasitic zoonoses

The behaviour of Homo sapiens has a pivotal role to play in the macro and microepidemiology of emerging or re-emerging parasitic zoonoses. Changing demographics and the concomitant alterations to the environment, climate, technology, land use and changes in human behavior, converge to favour the emergence and spread of parasitic zoonoses. The recent unprecedented movements of people, their animals and their parasites around the world, introduce and mix genes, cultural preferences, customs, and behavioral patterns. The increasing proclivity for eating meat, fish, crabs, shrimp, molluscs raw, undercooked, smoked, pickled or dried facilitates a number of protozoan (Toxoplasma), trematode (Fasciola sp., Paragonimus spp., Clonorchis sp., Opisthorchis spp., Heterophyes sp., Metagonimus sp., Echinostoma spp., Nanophyetus sp.) cestode (Taenia spp, Diphyllobothrum sp.) and nematode (Trichinella spp., Capillaria spp., Gnathostoma spp., Anisakis sp., Parastrongylus spp.) caused zoonoses. The increasing world population and the inability to keep pace with the provision of adequate sanitation and clean, safe drinking water, has led to an increased importance of waterborne zoonoses, such as those caused by Giardia, Cryptosporidium and Toxoplasma. Our close relationship with and the numerous uses to which we put companion animals and their ubiquitous distribution has resulted in dogs and cats unwitting participation in sharing over 60 parasite species including: Giardia, Cryptosporidium, Toxoplasma, most foodborne trematode species, Diphyllobothrum, Echinococcus spp., Ancylostoma and Toxocara. Changing human behaviour through education, to encourage the proper cooking of food, which may have cultural and social significance, will remain as challenging as controlling stray and feral pet populations, improving hygiene levels and the provision of safe drinking water and the proper use of sanctuary facilities. Long pre-patent periods and the normally insidious sub-clinical nature of most zoonoses makes advice requiring behavioural change for their control a difficult task. Our clearer understanding of the heterogeneity of susceptibility to infection, the complex genetic variations of people and parasite species and the development of molecular epidemiological tools is shedding more light on transmission routes and the spectrum of disease that is observed. Improved and new serological, molecular and imaging diagnostic tests and the development of broad spectrum chemotherapeutic agents has led to the attenuation of morbidity and mortality due to parasitic zoonoses in economically advantaged regions. Such advancements, in partnership with supportive behavioural change, has the potential for a sustainable global reduction in the burden of ill health due to parasitic zoonoses. Whether this will materialise is a challenge for us all.