Validation of multiple diagnostic techniques to detect Cryptosporidium sp. and Giardia sp. in free-ranging western lowland gorillas (Gorilla gorilla gorilla) and observations on the prevalence of these protozoan infections in two populations in Gabon

Prevalence of Cryptosporidium spp. infection in rodents and chickens in Franceville, Gabon

Background and Aim

Cryptosporidium spp. members of the phylum Apicomplexa are obligate protozoan parasites capable of infecting various vertebrate hosts, including rodents and chickens. Infection caused by these parasites may lead to zoonotic diseases in humans. The aim of this study was to estimate the prevalence of Cryptosporidium spp. in rodents and domestic chickens sampled in Franceville, Gabon.

Materials and Methods

Two hundred and eighty-five samples were collected, of which 185 samples were from rodents and 100 from domestic chickens. Microscopy after modified Ziehl-Neelsen staining and nested polymerase chain reaction targeting the small subunit (SSU) rRNA gene were used to examine Cryptosporidium spp.

Results

The overall prevalence of Cryptosporidium oocysts was 55.8%, with a prevalence of 72.4% in rodents and 25.0% in domestic chickens. Molecular analysis showed that Cryptosporidium spp. were present in 4.0% of the samples. No significant correlation was observed between Cryptosporidium spp. carriage and sex or location in this study. These results indicate that Cryptosporidium spp. persist and circulate in the studied animal species in Franceville, Gabon.

Conclusion

Infection with Cryptosporidium is very common in rodents and chickens in Franceville. The potential risk of human contamination cannot be ruled out. More research should be conducted to characterize Cryptosporidium species circulating in rodents and chickens in Gabon. Such studies are essential to better understand the epidemiology of this protozoan and its potential impact on public health.

A review of Gabonese gorillas and their pathogens: Diversity, transfer and One Health approach to avoid future outbreaks?

In Africa, great apes, among which gorillas, are the reservoir of several infectious agents, some of which have zoonotic potential. However, scientific reports summarizing data on the pathogens harbored by some primate species still need to be published for the scientific community, conservation, and public health actors. In the case of Gabon, despite its outstanding biodiversity, particularly in great apes, and the history of outbreaks involving wildlife, there is a lack of reports on pathogens found in some ape species living in the vicinity of the human being. Thus, it is becoming urgent for us to synthesize the available data on pathogens (parasites, bacteria, and viruses) identified in gorillas living in different ecosystems of Gabon to assess the risks for the human population. Therefore, this review article presents the diversity of pathogens identified in gorillas in Gabon, their impact on primates' health, the cases of transfer between gorillas and humans, and the interest in a One Health approach for prevention and a better understanding of the ecology of gorilla's diseases infection in Gabon.

After Theranos: Using point-of-care testing to advance measures of health biomarkers in human biology research

OBJECTIVES

The rise and fall of the health technology startup Theranos is emblematic of the promise and peril of point-of-care testing (POCT). Instruments that deliver immediate results from minimally invasive samples at the location of collection can provide powerful tools to deliver health data in clinical and public health contexts. Yet, POCT availability is driven largely by market interests, which limits the development of inexpensive tests for diverse health conditions that can be used in resource-limited settings. These constraints, combined with complex regulatory hurdles and substantial ethical challenges, have contributed to the underutilization of POCT in human biology research.

METHODS

We evaluate current POCT capabilities and limitations, discuss promising applications for POCT devices in resource-limited settings, and discuss the future of POCT.

RESULTS

As evidenced by publication trends, POCT platforms have rapidly advanced in recent years, gaining traction among clinicians and health researchers. We highlight POCT devices of potential interest to population-based researchers and present specific examples of POCT applications in human biology research.

CONCLUSIONS

Several barriers can limit POCT applications, including cost, lack of regulatory approval for non-clinical use, requirements for expensive equipment, and the dearth of validation in remote field conditions. Despite these issues, we see immense potential for emerging POCT technology capable of analyzing new sample types and used in conjunction with increasingly common technology (e.g., smart phones). We argue that the fallout from Theranos may ultimately provide an opportunity to advance POCT, leading to more ethical data collection and novel opportunities in human biology research.

Giardia duodenalis in a clinically healthy population of captive zoo chimpanzees: Rapid antigen testing, diagnostic real-time PCR and faecal microbiota profiling

Giardia duodenalis is one of the most common intestinal parasites of humans, with a worldwide distribution. Giardia duodenalis has been reported in both wild and captive populations of non-human primates, namely chimpanzees. In this study we investigated an entire troop of clinically healthy chimpanzees (n = 21) for the presence of G. duodenalis and its association with faecal microbiota profile. Faecal samples (n = 26) were collected from the chimpanzee exhibit from a zoo in Sydney, Australia. Diagnosis of G. duodenalis was made using a Rapid Antigen Test (RAT) as a point-of-care-test and compared to a reference standard real-time PCR test. Approximately half of the chimpanzee faecal samples tested positive for G. duodenalis by both RAT (13/26, 50%) and real-time PCR (14/26, 53.85%). The RAT sensitivity was 85.7% (95% CI: 63.8%–96%) and specificity was 91.7% (95% CI: 68.3%–99%) when compared to the in-house real-time PCR. Genotyping of the samples revealed the presence of zoonotic assemblage B. Microscopic analysis revealed the presence of Troglodytella spp. (14/26), Balantioides sp. (syn. Balantidium sp.) (8/26) as well as Entamoeba spp. (3/26). Microbiota profile based on 16S rRNA gene sequencing revealed that the community was significantly different between G. duodenalis positive and negative samples if RAT results were taken into an account, but not real-time PCR diagnostics results. Proteobacteria and Chloroflexi were the significant features in the dataset that separated G. duodenalis positive and negative samples using LEfSe analysis. Being able to rapidly test for G. duodenalis in captive populations of primates assists in point-of-care diagnostics and may better identify animals with subclinical disease. Under the investigated conditions of the zoo setting, however, presence of G. duodenalis either detected by RAT or real-time PCR was not associated with clinically apparent disease in captive chimpanzees.

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Whole troop investigation of healthy captive chimpanzees for Giardia duodenalis.

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Whole chimpanzee troop faecal microbiota profiled.

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Diagnosing G. duodenalis with Rapid Antigen Test (RAT) as a point-of-care-test.

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Comparison of RAT and reference real-time PCR test.

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Presence of G. duodenalis assemblage B.

Diversity of gastrointestinal parasites in sympatric mammals in Moukalaba-Doudou National Park, Gabon

Background and Aim: Gastrointestinal parasites identified in the wild can negatively affect host fitness, lower performance, and growth. On the other side, sympatric mammals that share habitat and resources may also cross-transmit parasites, which are often zoonotic and can contribute to morbidity and mortality. This study aimed to characterize the diversity of gastrointestinal parasites circulating in mammalian hosts in Moukalaba-Doudou National Park. Materials and Methods: We screened a total of 25 fecal samples collected from nine wild mammalian species, namely, western gorilla (Gorilla gorilla gorilla), chimpanzee (Pan troglodytes), putty-nosed monkey (Cercopithecus nictitans), African forest elephant (Loxodonta cyclotis), African buffalo (Syncerus caffer), blue duiker (Philantomba monticola), bay duiker (Cephalophus dorsalis), and red river hog (Potamochoerus porcus) as well as people working as trackers (Homo sapiens) using direct microscopic observations following a sedimentation technique to concentrate the fecal material. Results: Of the total 25 fecal samples screened, 15 (60%) were positive for parasitic gastrointestinal infection. Based on the morphology of parasite eggs and cysts, we identified a rich diversity of nematodes, protozoans, trematodes, and cestodes, including unidentified strongyles (73%), Oesophagostomum spp. (53%), Ancylostoma spp. (27%), Trichuris spp. (13%), Ascaris spp. (13%), Mammomonogamus spp. (13%), Strongyloides spp. (47%), Balantidium coli (20%), Entamoeba coli (20%), Endolimax nana (6%), Fasciola hepatica (6%), Paramphistomum spp. (13%), and Taenia spp. (6%). Conclusion: All parasites were found at least once in one of the hosts, and most were potentially zoonotic and responsible for several diseases of public health concern. Because of the small sample size, our findings should not be considered conclusive. Nevertheless, they highlight the diversity of gastrointestinal parasites in this area.

Cryptosporidium hominis infections in non-human animal species: revisiting the concept of host specificity

Parasites in the genus Cryptosporidium, phylum Apicomplexa, are found worldwide in the intestinal tract of many vertebrate species and in the environment. Driven by sensitive PCR methods, and the availability of abundant sequence data and reference genomes, the taxonomic complexity of the genus has steadily increased; 38 species have been named to date. Due to its public health importance, Cryptosporidium hominis has long attracted the interest of the research community. This species was initially described as infectious to humans only. This perception has persisted in spite of an increasing number of observations of natural and experimental infections of animals with this species. Here we summarize and discuss this literature published since 2000 and conclude that the host range of C. hominis is broader than originally described. The evolving definition of the C. hominis host range raises interesting questions about host specificity and the evolution of Cryptosporidium parasites.

A review of wildlife tourism and meta-analysis of parasitism in Africa's national parks and game reserves

The recent increase of parasitic diseases associated with wildlife tourism can be traced to human contact with wildlife and intense modification of wildlife habitat. The continental estimates of parasitic diseases among visited wildlife-tourists and mammalian wildlife present in conservation areas are lacking; therefore, a general review was necessary to provide insights into Africa's parasitic disease burden and transmission between humans and wildlife. A two-step analysis was conducted with searches in Ovid MEDLINE, EMBASE, PubMed, Web of Science and Global Health. All diseases reported without prevalence were grouped and analysed as categorical data while meta-analysis of prevalence rates of parasitic diseases in wildlife from national parks and reserves in Africa was conducted. Only 4.7% of the tourist centres reported routine wildlife diagnosis for parasitic diseases. Disease intensity shows that cryptosporidiosis and seven other parasitic diseases were observed in both human and wildlife; however, no significant difference in intensity between human and wildlife hosts was observed. Schistosomiasis intensity reports showed a significant increase (P < 0.05) while entamoebiasis showed a significant decrease (P < 0.05) in humans as compared to wildlife. Visiting tourists were more infected with malaria, while wildlife was more infected with parasitic gastroenteritis (PGE). The meta-analysis of wildlife revealed the highest prevalence of PGE with mixed parasites and lowest prevalence of Giardia spp. at 99.9 and 5.7%, respectively. The zoonotic and socioeconomic impact of some of these parasites could pose a severe public threat to tourism. Pre- and post-travel clinical examinations are important for tourists while routine examination, treatment and rational surveillance are important for these animals to improve wildlife tourism.

Cryptosporidium and Giardia in Africa: current and future challenges

Cryptosporidium and Giardia are important causes of diarrhoeal illness. Adequate knowledge of the molecular diversity and geographical distribution of these parasites and the environmental and climatic variables that influence their prevalence is important for effective control of infection in at-risk populations, yet relatively little is known about the epidemiology of these parasites in Africa. Cryptosporidium is associated with moderate to severe diarrhoea and increased mortality in African countries and both parasites negatively affect child growth and development. Malnutrition and HIV status are also important contributors to the prevalence of Cryptosporidium and Giardia in African countries. Molecular typing of both parasites in humans, domestic animals and wildlife to date indicates a complex picture of both anthroponotic, zoonotic and spill-back transmission cycles that requires further investigation. For Cryptosporidium, the only available drug (nitazoxanide) is ineffective in HIV and malnourished individuals and therefore more effective drugs are a high priority. Several classes of drugs with good efficacy exist for Giardia, but dosing regimens are suboptimal and emerging resistance threatens clinical utility. Climate change and population growth are also predicted to increase both malnutrition and the prevalence of these parasites in water sources. Dedicated and co-ordinated commitments from African governments involving "One Health" initiatives with multidisciplinary teams of veterinarians, medical workers, relevant government authorities, and public health specialists working together are essential to control and prevent the burden of disease caused by these parasites.

Prevalence of Cryptosporidium spp., Enterocytozoon bieneusi, Encephalitozoon spp. and Giardia intestinalis in Wild, Semi-Wild and Captive Orangutans (Pongo abelii and Pongo pygmaeus) on Sumatra and Borneo, Indonesia

Background

Orangutans are critically endangered primarily due to loss and fragmentation of their natural habitat. This could bring them into closer contact with humans and increase the risk of zoonotic pathogen transmission.

Aims

To describe the prevalence and diversity of Cryptosporidium spp., microsporidia and Giardia intestinalis in orangutans at seven sites on Sumatra and Kalimantan, and to evaluate the impact of orangutans’ habituation and location on the occurrence of these zoonotic protists.

Result

The overall prevalence of parasites in 298 examined animals was 11.1%. The most prevalent microsporidia was Encephalitozoon cuniculi genotype II, found in 21 animals (7.0%). Enterocytozoon bieneusi genotype D (n = 5) and novel genotype Pongo 2 were detected only in six individuals (2.0%). To the best of our knowledge, this is the first report of these parasites in orangutans. Eight animals were positive for Cryptosporidium spp. (2.7%), including C. parvum (n = 2) and C. muris (n = 6). Giardia intestinalis assemblage B, subtype MB6, was identified in a single individual. While no significant differences between the different human contact level groups (p = 0.479–0.670) or between the different islands (p = 0.992) were reported in case of E. bieneusi or E. cuniculi, Cryptosporidium spp. was significantly less frequently detected in wild individuals (p < 2×10⁻¹⁶) and was significantly more prevalent in orangutans on Kalimantan than on Sumatra (p < 2×10⁻¹⁶).

Conclusion

Our results revealed that wild orangutans are significantly less frequently infected by Cryptosporidium spp. than captive and semi-wild animals. In addition, this parasite was more frequently detected at localities on Kalimantan. In contrast, we did not detect any significant difference in the prevalence of microsporidia between the studied groups of animals. The sources and transmission modes of infections were not determined, as this would require repeated sampling of individuals, examination of water sources, and sampling of humans and animals sharing the habitat with orangutans.

Low sensitivity of the ImmunocardSTAT® Crypto/Giardia Rapid Assay test for the detection of Giardia and Cryptosporidium in fecal samples from children living in Libreville, Central Africa

Giardiasis and cryptosporidiosis are now recognized as neglected tropical parasitic diseases. The risk of their dissemination  in developing countries, such as Gabon, is increasing, due to urban crowding and poor sanitation. Accurate, simple and rapid diagnosis tools are thus necessary for the estimation of their real burden. The aim of this study was to evaluate the performances of the ImmunocardSTAT^®Crypto/Giardia Rapid Assay test for the detection of Cryptosporidium (C.) spp. and Giardia (G.) duodenalis in children living in Libreville, Gabon. Stool samples of 173 healthy children were screened by routine microscopic using the merthiolate iodine formol concentration technique for Giardia, the modified Ziehl Neelsen (ZN) staining for Cryptosporidium and the ImmunocardSTAT^® Crypto/Giardia RDT for the detection of Giardia and Cryptosporidium parasite forms and antigens respectively. G. duodenalis was detected with microscopy and the ImmunocardSTAT^® Crypto/Giardia in 27 (15.6 %) and 22 (13.3 %) fecal samples respectively. C. spp. oocysts were found in 18 (10.4 %) ones, whereas only one sample was positive with the immunochromatographic assay. When microscopic examination was considered as the reference method, sensitivity and specificity of the ImmunocardSTAT^® Crypto/Giardia Rapid Assay were found to be 63.0 %, 96.6 and 5.5 %, 99.3 % for G. duodenalis and C. spp. respectively. The prevalence of G. duodenalis and C. spp. carriage is high in children from Libreville. A low sensitivity of the ImmunocardSTAT^® Crypto/Giardia for the detection of both parasites is observed. It is thus inappropriate as a diagnostic tool for detecting asymptomatic carriers.

Long-term monitoring of microsporidia, Cryptosporidium and Giardia infections in western Lowland Gorillas (Gorilla gorilla gorilla) at different stages of habituation in Dzanga Sangha Protected Areas, Central African Republic

BACKGROUND

Infectious diseases pose one of the greatest threats to endangered species, and a risk of gastrointestinal parasite transmission from humans to wildlife has always been considered as a major concern of tourism. Increased anthropogenic impact on primate populations may result in general changes in communities of their parasites, and also in a direct exchange of parasites between humans and primates.

AIMS

To evaluate the impact of close contact with humans on the occurrence of potentially zoonotic protists in great apes, we conducted a long-term monitoring of microsporidia, Cryptosporidium and Giardia infections in western lowland gorillas at different stages of the habituation process, humans, and other wildlife in Dzanga-Sangha Protected Areas in the Central African Republic.

RESULTS

We detected Encephalitozoon cuniculi genotypes I and II (7.5%), Enterocytozoon bieneusi genotype D and three novel genotypes (gorilla 1-3) (4.0%), Giardia intestinalis subgroup A II (2.0%) and Cryptosporidium bovis (0.5%) in gorillas, whereas in humans we found only G. intestinalis subgroup A II (2.1%). In other wild and domestic animals we recorded E. cuniculi genotypes I and II (2.1%), G. intestinalis assemblage E (0.5%) and C. muris TS03 (0.5%).

CONCLUSION

Due to the non-specificity of E. cuniculi genotypes we conclude that detection of the exact source of E. cuniculi infection is problematic. As Giardia intestinalis was recorded primarily in gorilla groups with closer human contact, we suggest that human-gorilla transmission has occurred. We call attention to a potentially negative impact of habituation on selected pathogens which might occur as a result of the more frequent presence of humans in the vicinity of both gorillas under habituation and habituated gorillas, rather than as a consequence of the close contact with humans, which might be a more traditional assumption. We encourage to observe the sections concerning hygiene from the IUCN best practice guidelines for all sites where increased human-gorilla contact occurs.