A survey for Cyclospora spp. in Kenyan primates, with some notes on its biology

Hastening Progress in Cyclospora Requires Studying Eimeria Surrogates

Cyclospora cayetanensis is an enigmatic human parasite that sickens thousands of people worldwide. The scarcity of research material and lack of any animal model or cell culture system slows research, denying the produce industry, epidemiologists, and regulatory agencies of tools that might aid diagnosis, risk assessment, and risk abatement. Fortunately, related species offer a strong foundation when used as surrogates to study parasites of this type. Species of Eimeria lend themselves especially well as surrogates for C. cayetanensis. Those Eimeria that infect poultry can be produced in abundance, share many biological features with Cyclospora, pose no risk to the health of researchers, and can be studied in their natural hosts. Here, we overview the actual and potential uses of such surrogates to advance understanding of C. cayetanensis biology, diagnostics, control, and genomics, focusing on opportunities to improve prevention, surveillance, risk assessment, and risk reduction. Studying Eimeria surrogates accelerates progress, closing important research gaps and refining promising tools for producers and food safety regulators to monitor and ameliorate the food safety risks imposed by this emerging, enigmatic parasite.

Risk Evaluation of Pathogenic Intestinal Protozoa Infection Among Laboratory Macaques, Animal Facility Workers, and Nearby Villagers From One Health Perspective

Background: Previous epidemiological studies have confirmed non-human primates (NHPs) as reservoirs for Cryptosporidium spp. , Giardia intestinalis, and Enterocytozoon bieneusi. It highlights the possibility of interspecies transmission between humans and macaques in laboratory animal facilities. This study aimed to investigate the prevalence of pathogenic intestinal protozoan infections in macaques and humans and to determine the risk of cross-species transmission from One Health view.

Materials and Methods: A total of 360 fecal samples, including 310 from the four Macaca mulatta groups, 25 from the facility workers in a laboratory animal facility, and 25 from the villagers nearby in Yongfu country, southeast China, were collected. Nested PCR assays were done for detecting protozoan pathogens from all the specimens. Furthermore, potential risk factors (gender, age, and direct contact) on the occurrence of intestinal protozoa infection among different sub-groups were evaluated. A phylogenetic and haplotype network analysis was conducted to examine the genetic structure and shared patterns of E. bieneusi and Cyclospora cayetanensis.

Results: The pathogenic intestinal protozoa were detected in both human and macaque fecal samples. A total of 134 (37.2%) samples were tested positive, which included 113 (36.4%) macaques, 14 (56.0%) facility workers, and 7 (28.0%) villagers, respectively. There was no significant difference in four intestinal protozoa infections between facility workers and villagers (χ² = 2.4, P > 0.05). However, the positive rate of pathogenic intestinal protozoa in the facility workers, who had direct contact with macaques, was significantly higher [odds ratio (OR) = 0.31, 95% confidence interval (CI): 0.09–1.00, P < 0.05).Thirty-three ITS genotypes of E. bieneusi were identified, including five known genotypes (PigEBITS7, Peru8, Henan V, D, and CM1) and six novel genotypes (MEB1–6). Seven haplotypes were identified in the network analysis from C. cayetanensis-positive samples. Meanwhile, a phylogenetic and haplotype analysis confirmed the presence of zoonotic subtypes in NHPs and humans.

Conclusion: The data collected from this study confirmed a high prevalence of intestinal protozoan infection in humans and macaques. These results warrant workers of such facilities and residents to limit contact with infected animals in order to minimize related health risks. The need for comprehensive strategies to mitigate the risk of zoonotic transmission, especially from a One Health perspective, is recommended.

Frequency of enteroparasites in Cebidae and Callitrichidae primates at the Zoológico de Cali, Colombia: zoonotic implications

Introducción.

Los enteroparásitos pueden generar problemas en animales bajo cuidado humano en zoológicos y centros de acogida. Los animales silvestres presentan bajas cargas parasitarias, pero estas pueden ser mayores y llevar a manifestaciones clínicas cuando se trata de animales resguardados en recintos, lo que aumenta los gastos en tratamientos y cuidados médicos. Por otro lado, algunos enteroparásitos pueden causar infecciones zoonóticas en los cuidadores, los visitantes y otros animales del zoológico, así como afectar los programas de recuperación de especies amenazadas de extinción.

Objetivos.

Determinar la presencia y prevalencia de enteroparásitos con potencial de transmisión zoonótica en primates de las familias Cebidae y Callitrichidae del Zoológico de Cali, entre septiembre y noviembre de 2017.

Materiales y métodos.

Se hizo un estudio transversal prospectivo, para lo cual se recolectaron muestras seriadas de 50 individuos pertenecientes a siete especies de dos familias de primates y se analizaron mediante examen coprológico, flotación y coloración Kinyoun, entre septiembre y noviembre de 2017.

Resultados.

Según su prevalencia, los géneros de parásitos hallados en las siete especies de primates evaluadas, fueron Blastocystis spp., Trichomonas spp., Giardia spp., Entamoeba spp., Strongyloides spp., Cyclospora sp. y Trichuris sp.

Conclusiones.

Por lo menos, seis de los géneros de parásitos identificados tienen implicaciones zoonóticas, lo cual hace necesario establecer las posibles vías de infección de los primates del Zoológico de Cali e implementar protocolos de manejo que reduzcan el riesgo de transmisión a los humanos y a otros animales de la colección. Además, se presenta la información relevante sobre el potencial zoonótico de los enteroparásitos hallados.

Cyclospora Cayetanensis-Major Outbreaks from Ready to Eat Fresh Fruits and Vegetables

Cyclospora cayetanensis is a coccidian protozoan that causes cyclosporiasis, a severe gastroenteric disease, especially for immunocompromised patients, children, and the elderly. The parasite is considered as an emerging organism and a major contributor of gastroenteritis worldwide. Although the global prevalence of cyclosporiasis morbidity and mortality has not been assessed, global concern has arisen since diarrheal illness and gastroenteritis significantly affect both developing countries and industrialized nations. In the last two decades, an increasing number of foodborne outbreaks has been associated with the consumption of fresh produce that is difficult to clean thoroughly and is consumed without processing. Investigations of these outbreaks have revealed the necessity to increase the awareness in clinicians of this infection, since this protozoan is often ignored by surveillance systems, and to establish control measures to reduce contamination of fresh produce. In this review, the major cyclosporiasis outbreaks linked to the consumption of ready to eat fresh fruits and vegetables are presented.

Cyclospora cayetanensis infection in humans: biological characteristics, clinical features, epidemiology, detection method and treatment

Cyclospora cayetanensis, a coccidian parasite that causes protracted and relapsing gastroenteritis, has a short recorded history. At least 54 countries have documented C. cayetanensis infections and 13 of them have recorded cyclosporiasis outbreaks. Cyclospora cayetanensis infections are commonly reported in developing countries with low-socioeconomic levels or in endemic areas, although large outbreaks have also been documented in developed countries. The overall C. cayetanensis prevalence in humans worldwide is 3.55%. Among susceptible populations, the highest prevalence has been documented in immunocompetent individuals with diarrhea. Infections are markedly seasonal, occurring in the rainy season or summer. Cyclospora cayetanensis or Cyclospora-like organisms have also been detected in food, water, soil and some other animals. Detection methods based on oocyst morphology, staining and molecular testing have been developed. Treatment with trimethoprim-sulfamethoxazole (TMP-SMX) effectively cures C. cayetanensis infection, whereas ciprofloxacin is less effective than TMP-SMX, but is suitable for patients who cannot tolerate co-trimoxazole. Here, we review the biological characteristics, clinical features, epidemiology, detection methods and treatment of C. cayetanensis in humans, and assess some risk factors for infection with this pathogen.

Cyclospora cayetanensis and Cyclosporiasis: An Update

Cyclospora cayetanensis is a coccidian parasite of humans, with a direct fecal-oral transmission cycle. It is globally distributed and an important cause of foodborne outbreaks of enteric disease in many developed countries, mostly associated with the consumption of contaminated fresh produce. Because oocysts are excreted unsporulated and need to sporulate in the environment, direct person-to-person transmission is unlikely. Infection by C. cayetanensis is remarkably seasonal worldwide, although it varies by geographical regions. Most susceptible populations are children, foreigners, and immunocompromised patients in endemic countries, while in industrialized countries, C. cayetanensis affects people of any age. The risk of infection in developed countries is associated with travel to endemic areas and the domestic consumption of contaminated food, mainly fresh produce imported from endemic regions. Water and soil contaminated with fecal matter may act as a vehicle of transmission for C. cayetanensis infection. The disease is self-limiting in most immunocompetent patients, but it may present as a severe, protracted or chronic diarrhea in some cases, and may colonize extra-intestinal organs in immunocompromised patients. Trimetoprim-sulfamethoxazole is the antibiotic of choice for the treatment of cyclosporiasis, but relapses may occur. Further research is needed to understand many unknown epidemiological aspects of this parasitic disease. Here, we summarize the biology, epidemiology, outbreaks, clinical symptoms, diagnosis, treatment, control and prevention of C. cayetanensis; additionally, we outline future research needs for this parasite.

Molecular detection of Cyclospora cayetanensis in human stool specimens using UNEX-based DNA extraction and real-time PCR

Cyclospora cayetanensis is a coccidian parasite associated with diarrheal illness. In the USA, foodborne outbreaks of cyclosporiasis have been documented almost every year since the mid-1990s. The typical approach used to identify this parasite in human stools is an examination of acid-fast-stained smears under bright-field microscopy. UV fluorescence microscopy of wet mounts is more sensitive and specific than acid-fast staining but requires a fluorescence microscope with a special filter not commonly available in diagnostic laboratories. In this study, we evaluated a new DNA extraction method based on the Universal Nucleic Acid Extraction (UNEX) buffer and compared the performances of four published real-time polymerase chain reaction (PCR) assays for the specific detection of C. cayetanensis in stool. The UNEX-based method had an improved capability to recover DNA from oocysts compared with the FastDNA stool extraction method. The best-performing real-time PCR assay was a C. cayetanensis-specific TaqMan PCR that targets the 18S ribosomal RNA gene. This new testing algorithm should be useful for detection of C. cayetanensis in human stool samples.

Detection of Cyclospora in captive chimpanzees and macaques by a quantitative PCR-based mutation scanning approach

BACKGROUND

Cyclospora is a protistan parasite that causes enteritis in several species of animals including humans. The aim of this study was to investigate the presence of Cyclospora in captive non-human primates.

METHODS

A total of 119 faecal samples from Pan troglodytes, Macaca sylvanus, Cercopithecus cephus, Erythrocebus patas, Chlorocebus aethiops and Macaca fascicularis from a wildlife animal rescue center as well as from Macaca fascicularis from an experimental primate research center were tested for the presence of Cyclospora by quantitative real-time PCR (qPCR) and single-strand conformation polymorphism (SSCP) analysis.

RESULTS

Cyclospora was detected in three Pan troglodytes (13.6%) and nine (9.3%) Macaca fascicularis.

CONCLUSIONS

The present study represents the first record of Cyclospora in captive primates in Europe, suggesting the presence of Cyclospora cayetanensis, which is transmissible to humans.

Infections by Intestinal Coccidia and Giardia duodenalis

The coccidians Cryptosporidium spp, Cyclospora cayetanensis, and Cystoisospora belli and the flagellate Giardia duodenalis are pathogenic protozoa associated with gastrointestinal manifestations. Diagnosis relies heavily on microscopy, and although ova-and-parasite examinations can detect Giardia and Cystoisospora, Cryptosporidium and Cyclospora often require specific diagnostic requests. Approved non-microscopy methods are available for Giardia and Cryptosporidium, although negative results are frequently followed by microscopic assays. Polymerase chain reaction-based methods are not frequently used for diagnosis of Giardia and Cryptosporidium and have been used primarily for epidemiologic or outbreak investigations of Giardia and Cryptosporidium.

Identification and morphologic and molecular characterization of Cyclospora macacae n. sp. from rhesus monkeys in China

Cyclospora spp. in nonhuman primates are most closely related to Cyclospora cayetanensis, an emerging human pathogen causing outbreaks of cyclosporiasis in North America. Studies thus far indicate the possible existence of host specificity in Cyclospora spp. In this study, 411 fecal specimens from free-range rhesus monkeys (Macaca mulatta) were collected and examined for Cyclospora by sequence analysis of the small subunit rRNA gene. A novel Cyclospora species was identified in 28 (6.8%) specimens and named Cyclospora macacae based on morphologic and molecular characterizations. The oocyst of C. macacae is spherical and measures 8.49 ± 0.55 × 8.49 ± 0.49 μm in diameter. Phylogenetic analysis grouped this species together with the other four Cyclospora species infecting primates, including C. cayetanensis in humans, forming a monophyletic group closely related to avian Eimeria species. In addition, C. cayetanensis was detected in one specimen, although whether rhesus monkeys can serve as a natural reservoir host of C. cayetanensis needs further investigation.

Molecular characterization of Cyclospora-like organisms from golden snub-nosed monkeys in Qinling Mountain in Shaanxi province, northwestern China

Cyclospora spp. have been identified as one of the most important intestinal pathogens causing protracted diarrhea in animals and human beings. To determine the Cyclospora species in the non-human primate Rhinopithecus roxellanae, a total of 71 fecal samples from 19 endangered snub-nosed monkeys in Shaanxi province were collected and examined using Sheater's sugar flotation technique and by sequencing the fragments of 18S rDNA. Only two Cyclospora isolates from 2 golden snub-nosed monkeys (R. roxellanae) were obtained and identified between July 2011 and August of 2012. The sequences of the 18S rDNA for the two Cyclospora isolates were 477 bp, with no nucleotide variation between them. Phylogenetic analysis based on the 18S rDNA sequences revealed that the two Cyclospora isolates were posited into the clade Cyclospora spp. and sistered to C. colobi. These results first showed that Cyclospora infection occurred in R. roxellanae in hot and rainy weather, which would provide useful information for further understanding the molecular epidemiology of Cyclospora spp. and the control of Cyclospora infection in non-human primates as well as in human beings.

Cyclospora papionis, Cryptosporidium hominis, and human-pathogenic Enterocytozoon bieneusi in captive baboons in Kenya

Cyclospora papionis, Cryptosporidium hominis, and Enterocytozoon bieneusi were detected in 42 (17.9%), 6 (2.6%), and 29 (12.3%) of 235 newly captured baboons in Kenya, respectively. Most C. hominis subtypes and E. bieneusi genotypes found have been detected in humans in the area, suggesting that cross-species transmission of cryptosporidiosis and microsporidiosis is possible.

Epidemiology of Cyclospora cayetanensis: A review focusing in endemic areas

Cyclospora cayetanensis is an intestinal coccidian protozoon that has emerged as an important cause of endemic or epidemic diarrhoeal illness in children and adults worldwide. Humans appear to be the only natural hosts. However, the role of animals as natural reservoirs is uncertain but of increasing concern. Human-to-human spread of the parasite occurs indirectly via the environment through oocysts in contaminated water, food or soil. In endemic areas, risk factors associated with the infection include contaminated water or food, contact with soil or animals, type of sanitation and low socioeconomic status. Infections linked to soil contact provide reasons to believe that this route of spread may be more common than realised in disadvantaged community settings. C. cayetanensis is an important cause of traveller's diarrhoea and numerous large foodborne outbreaks associated with the globalisation of the food supply and importation of fruits and vegetables from developing countries have occurred. Waterborne outbreaks have also been reported. Implementation of measures to prevent or control the spread of Cyclospora oocysts in the environment is critical. In endemic areas, the most important steps to prevent infection are improving environmental sanitation and health education. Significant gaps remain in our understanding of the epidemiology of human cyclosporiasis that highlight the need for continued research in several aspects of C. cayetanensis.

Integrative approaches to the study of primate infectious disease: implications for biodiversity conservation and global health

The close phylogenetic relationship between humans and nonhuman primates, coupled with the exponential expansion of human populations and human activities within primate habitats, has resulted in exceptionally high potential for pathogen exchange. Emerging infectious diseases are a consequence of this process that has the capacity to threaten global health and drive primate population declines. Integration of standardized empirical data collection, state-of-the-art diagnostics, and the comparative approach offers the opportunity to create a baseline for patterns of infection in wild primate populations; to better understand the role of disease in primate ecology, behavior, and evolution; and to examine how anthropogenic effects alter the zoonotic potential of various pathogenic organisms. We review these technologies and approaches, including noninvasive sampling in field conditions, and we identify ways in which integrative research activities are likely to fuel future discoveries in primate disease ecology. In addition to considering applied aspects of disease research in primate health and conservation, we review how these approaches are shedding light on parasite biodiversity and the drivers of disease risk across primate species.

Cyclosporiasis: an emerging public health concern around the world and in Africa

BACKGROUND

Cyclosporiasis is an emerging gastro-enteric disease caused by the coccidia protozoan Cyclospora cayetanensis. It is associated with diarrhoea among children in developing countries, in the Americas where C. cayetanensis is endemic, traveller's diarrhoea and/or food and waterborne outbreaks in the developed countries.

OBJECTIVES

The aim of this review is to highlight cyclosporiasis and its relevance to public health in East Africa and Africa at large.

METHODS

All literature on Cyclospora, C. cayetanensis, cyclosporiasis in Africa, and endemic cyclosporiasis was searched from libraries, colleagues and internet but only literature on its history, clinical presentation, epidemiology in endemic settings, and occurrence in Africa were scrutinised.

RESULTS

In Sub Saharan Africa, cyclosporiasis has been reported in at least 3 countries, including Tanzania, in East Africa, occurring in both immunocompromised and immunocompetent patients. Zoonotic species of Cyclospora have also been identified in East African primates, indicating likely endemicity of this little reported disease in the region. This can be attributed to lack of awareness in the public and medical profession concerning the disease, and therefore not routinely checked at the health centres. Cyclosporiasis is characterized by intermittent diarrhoea, and secondary conditions or sequelae such as reactive arthritis syndrome (Reiter's syndrome), have been associated with progression of the disease. Its management is based on antibiotics, an unusual scenario for a protozoa.

CONCLUSIONS

Although many aspects of this disease and its transmission remain an enigma, the situation has been rapidly changing since the disease first came to medical attention in the 1970s.

The genus Cyclospora (Apicomplexa: Eimeriidae), with a description of Cyclospora schneideri n.sp. in the snake Anilius scytale scytale (Aniliidae) from Amazonian Brazil--a review

A review is made of the recorded species of the coccidian genus Cyclospora and major events leading up to the discovery of C. cayetanensis, which is responsible for serious outbreaks of diarrhoea in man and is one of the aetiological agents of "traveller's diarrhoea". Humans appear to be the specific hosts, with the entire life-cycle in the intestine: to date there is no convincing evidence that the disease is a zoonosis. A description is given of oocysts and endogenous stages of C. schneideri n.sp., in the snake Anilius scytale scytale. Sporulation is exogenous and completed after about one week at 24-26 degrees. Mature oocysts 19.8 x 16.6 (15.1 x 13.8-25.7 x 20.1), shape-index 1.2 (1.0-1.3): no oocyst residuum or polar bodies. Oocyst wall a single colourless, smooth layer with no micropyle: it is rapidly deformed or broken. Sporocysts 13.6 x 9.4 (11.3 x 8.3-15.1 x 9.9), shape-index 1.4 (1.2-1.5) with an inconspicuous Stieda body. Sporozoites 11-13 x 2.5-3. Endogenous stages are intracytoplasmic in the epithelial cells of the small intestine and with the characters of the Eimeriorina.

Cyclospora spp

PURPOSE OF REVIEW

Infection with Cyclospora cayetanensis continues to pose many questions, both in endemic populations and in travelers and food-borne outbreaks. The present review discusses existing knowledge but focuses more on what is yet to be learned about this infection.

RECENT FINDINGS

Information on the parasite in endemic settings continues to be gathered, and similarities to and differences from other intestinal coccidia, especially Cryptosporidium spp., are becoming clearer. Food-borne outbreaks in North America continue despite efforts to identify and limit importation of particular items, such as berries, at certain times of the year. Study of Cyclospora spp. found in east African primates has shed some light on human infection but raises many new questions regarding the biology of the organism.

SUMMARY

Despite new information being gathered regarding Cyclospora spp., including infection rates in various age and population groups, significant gaps remain in our knowledge of such basic issues as the factors that influence infectivity, seasonality, mode of food contamination, and geographic distribution. These gaps highlight the need for continued study on a variety of fronts, including surveillance, and clinical and basic biology.