Multiple food-borne trematodiases with profound systemic involvement: a case report and literature review

A relatively high zoonotic trematode prevalence in Orientogalba ollula and the developmental characteristics of isolated trematodes by experimental infection in the animal model

Background

Food-borne parasitic diseases decrease food safety and threaten public health. The snail species is an intermediate host for numerous human parasitic trematodes. Orientogalba ollula has been reported as intermediate hosts of many zoonotic trematodes. Here, we investigated the prevalence of zoonotic trematodes within O. ollula in Guangxi, China, and assessed their zoonotic potential.

Methods

Snails were collected from 54 sites in 9 cities throughout Guangxi. The snail and trematode larvae species were determined by combining morphological characteristics and molecular markers. The trematodes prevalence and constituent ratio were calculated and compared among different habitat environments. Phylogenetic trees of the trematode species were constructed using the neighbor-joining method with nuclear internal transcribed spacer 2 (ITS2) sequences. The developmental cycles of the isolated trematodes were examined by experimental infection in ducks. The developmental characteristics of Echinostoma revolutum was recorded by dissecting infected ducklings from 1-day post infection (dpi) to 10 dpi.

Results

The overall prevalence of trematode larvae was 22.1% (1818/8238) in O. ollula from 11 sample sites. Morphological together with molecular identification, showed that E. revolutum, Australapatemon sp., Hypoderaeum conoideum, Pharyngostomum cordatum, and Echinostoma sp. parasitized O. ollula, with the highest infection rate of E. revolutum (13.0%). However, no Fasciola larvae were detected. The trematodes prevalence and constituent ratio varied in two sub-biotypes (P < 0.01). A neighbor-joining tree analysis of ITS2 sequences resulted in distinct monophyletic clades supported by sequences from isolated larvae with high bootstrap values. Ducklings exposed to O. ollula infected with Echinostoma sp., E. revolutum, and H. conoideum larvae were successfully infected. The animal model for Echinostoma revolutum was successfully established. E. revolutum matured from larvae to adult at 10 dpi in the intestine of the duck, and the developmental characteristics of E. revolutum were characterized by the maturation of the reproductive and digestive organs at 6–8 dpi.

Conclusions

This study revealed a high prevalence of zoonotic trematodes in O. ollula from Guangxi, China. Existing trematodes infection in animals and human clinical cases, coupled with the wide geographical distribution of O. ollula, necessitate further evaluations of the potential risk of spillover of zoonotic infection from animal to human and vice versa.

Graphical Abstract

Supplementary Information

The online version contains supplementary material available at 10.1186/s40249-022-01014-7.

Neglected Food-Borne Trematodiases: echinostomiasis and gastrodiscoidiasis

In the present paper, we review two of the most neglected intestinal food-borne trematodiases: echinostomiasis, caused by members of the family Echinostomatidae, and gastrodiscoidiasis produced by the amphistome Gastrodiscoides hominis. Both parasitic infections are important intestinal food-borne diseases. Humans become infected after ingestion of raw or insufficiently cooked molluscs, fish, crustaceans, amphibians or aquatic vegetables. Thus, eating habits are essential to determine the distribution of these parasitic diseases and, traditionally, they have been considered as minor diseases confined to low-income areas, mainly in Asia. However, this scenario is changing and the population at risk are currently expanding in relation to factors such as new eating habits in developed countries, growing international markets, improved transportation systems and demographic changes. These aspects determine the necessity of a better understanding of these parasitic diseases. Herein, we review the main features of human echinostomiasis and gastrodiscoidiasis in relation to their biology, epidemiology, immunology, clinical aspects, diagnosis and treatment.

Foodborne Parasites Dominate Current Parasitic Infections in Hunan Province, China

Great progress has been made in the prevention and treatment of human parasitic diseases in China over the past six decades, but parasitic diseases are still one of the most serious public health problems in the world. The specific prevalence of parasitic diseases varies in different provinces due to their geographical environment and the dietary habits of people. In this study, a total of 4,428 patients suspected to have parasitic infection by clinicians or themselves from January 1, 2016, to December 31, 2020 were recommended to our laboratory for further testing. In total, 5,246 samples including fecal, blood, and other body fluids were detected by etiological and immunological methods. Approximately 15.20% (673/4,428) of all suspected patients were infected by at least one species of parasite, and the overall positive rate of suspected patients from Hunan Province was 15.10% (594/3,933). A total of 18 species of parasites, namely, nematodes (4 species), trematodes (5 species), cestodes (4 species), protozoa (2 species), and medical arthropods (3 species), and 3 of them were imported parasites outside of Hunan Province. There are 9 species of foodborne parasites, accounting for 89.92% (464/516) of patients infected by one species of parasite. Common parasites in Hunan Province include plerocercoid, Paragonimus westermani, Clonorchis sinensis, cysticercus, Toxoplasma gondii, and Schistosoma japonicum. In this study, we found that the incidence of soilborne nematode infections has decreased significantly. However, foodborne parasites gradually become the main parasitic infections as well as multiple infections are becoming more common. Therefore, we should not only continue the prevention and control of soil-derived nematodes but also focus on the prevention and control of foodborne parasites in the future.

Diagnosing point-of-care diagnostics for neglected tropical diseases

Inadequate and nonintegrated diagnostics are the Achilles' heel of global efforts to monitor, control, and eradicate neglected tropical diseases (NTDs). While treatment is often available, NTDs are endemic among marginalized populations, due to the unavailability or inadequacy of diagnostic tests that cause empirical misdiagnoses. The need of the hour is early diagnosis at the point-of-care (PoC) of NTD patients. Here, we review the status quo of PoC diagnostic tests and practices for all of the 24 NTDs identified in the World Health Organization's (WHO) 2021-2030 roadmap, based on their different diagnostic requirements. We discuss the capabilities and shortcomings of current diagnostic tests, identify diagnostic needs, and formulate prerequisites of relevant PoC tests. Next to technical requirements, we stress the importance of availability and awareness programs for establishing PoC tests that fit endemic resource-limited settings. Better understanding of NTD diagnostics will pave the path for setting realistic goals for healthcare in areas with minimal resources, thereby alleviating the global healthcare burden.