Respiratory symptoms and subcutaneous granuloma caused by mesocercariae: a case report

Immunology and pathology of echinostomes and other intestinal trematodes

Intestinal trematodes constitute a major group of helminths that parasitize humans and animals with relevant morbidity and mortality. Despite the importance of the intestinal trematodes in medical and veterinary sciences, immunology and pathology of these helminth infections have been neglected for years. Apart from the work focused on the members of the family Echnistomatidae, there are only very isolated and sporadic studies on the representatives of other families of digeneans, which makes a compilation of all these studies necessary. In the present review, the most salient literature on the immunology and pathology of intestinal trematodes in their definitive hosts in examined. Emphasis will be placed on members of the echinostomatidae family, since it is the group in which the most work has been carried out. However, we also review the information on selected species of the families Brachylaimidae, Diplostomidae, Gymnophallidae, and Heterophyidae. For most of these families, coverage is considered under the following headings: (i) Background; (ii) Pathology of the infection; (iii) Immunology of the infection; and (iv) Human infections.

Alaria alata (Digenea: Diplostomidae) from Korean Raccoon Dog, Nyctereutes procyonoides koreensis, in Korea

We report a species of diplostomid fluke recovered from 3 carcasses of wild Korean raccoon dog, Nyctereutes procyonoides koreensis, in Korea. A total of 107 diplostomid flukes were recovered from the small intestines of Korean raccoon dogs, which were obtained from the Gangwon Wildlife Medical Rescue Center. Worms fixed with 10% neutral formalin were subjected to microscopic observation and those fixed in 70% ethanol were used for molecular genomic analysis. The worm was divided into 2 separate parts, forebody and hindbody, with a total length of 3,020-4,090 (3,855) µm and a width of 1,210-1,770 (1,562) µm. The boat-shaped forebody has a pair of characteristic tentacular appendage, 2 suckers, holdfast organ, and vitelline follicles. The oval to cylindrical hindbody has reproductive organs. The ovary was round or elliptical and located in the anterior of the testes. Two large testes were slightly segmented and tandemly arranged, occupying almost half of hindbody. The short uterus contained a relatively small number of unembryonated eggs sized 130-140×85-96 µm. The partial sequence of 18S rRNA of this fluke was consistent with Alaria alata. Based on the morphological and molecular characteristics, the diplostomid flukes recovered from the small intestine of Korean raccoon dogs were identified as A. alata (Digenea: Diplostomidae).

Predicting the risk of Alaria alata infestation in wild boar on the basis of environmental factors

Alaria alata is an emerging parasite that poses a potential risk for those consuming game, pork, snails and frogs. One paratenic host of A. alata that is known to play an important role in its spread through its feeding habitats is the wild boar. However, no statistical analysis of the influence of aquatic environments and carnivores on the occurrence of A. alata in wild boars has yet been performed. The present study combines a small-scale analysis based on hunting districts in the Mazowieckie province with a large-scale analysis based on data for all provinces in Poland. We applied various modeling approaches, including logistic regression and a generalized linear model in order to determine the presence, intensity and prevalence of A. alata. We used the Alaria mesocercariae migration technique (AMT) to estimate the risk of A. alata among wild boar in a given hunting district or province. The small-scale analysis found that mesopredators (red fox (Vulpes vulpes)) and racoon dog (Nyctereutes procyinoides) were likely to influence A. alata infestation of wild boar; however, the effect was weak, probably as a result of the large home range size of these animals. The large-scale analysis found that wetlands influence the prevalence of A. alata in wild boar, with the estimated risk increasing in the north of the country; this finding is consistent with other studies. Our findings indicate that the occurrence of A. alata in wild boar requires analysis on many levels, and environmental factors play a key role in risk assessment.

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Alaria alata presence in wild boar was locally dependent on the red fox density.

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Intensity of Alaria alata could be predicted locally by raccoon dog density.

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Wetlands were significantly explaining the occurrence of Alaria alata in voivodeships.

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Risk of Alaria alata prevalence in wild boar in Poland increase to the north.

A Review on Alaria alata, Toxoplasma gondii and Sarcocystis spp. in Mammalian Game Meat Consumed in Europe: Epidemiology, Risk Management and Future Directions

Simple Summary

In many European countries, game meat consumption is related to the traditional hunting culture. Its demand and consumption are increasing, also due to the growing populations of wild ungulates. However, specific public health issues exist and should be taken into account. This review focuses on the causal agents, epidemiology, potential risk for human health and its management along the supply chain, including parasite detection at slaughtering and inactivation in meat, of three parasites (Alaria alata, Toxoplasma gondii and Sarcocystis spp.), which can be transmitted by the main mammalian game meat species in the EU: wild boar (Sus scrofa), red deer (Cervus elaphus), roe deer (Capreolus capreolus), fallow deer (Dama dama), Alpine chamois (Rupicapra rupicapra), moose (Alces alces), hare (Lepus europaeus) and wild rabbit (Oryctolagus cuniculus). By presenting the main issues and knowledge gaps, this study aims to contribute to an improved control supporting the risk analysis process.

Abstract

Game meat is increasingly appreciated and consumed in Europe, also due to the growing population of wild ungulates. In addition to interesting nutritional properties and market opportunities, game meat is characterized by some specific public health issues. This review focuses on the etiology, epidemiology, public health aspects and risk management along the supply chain, including parasite detection at slaughtering and inactivation in meat, of three selected foodborne parasitic hazards (Alaria alata, Toxoplasma gondii and Sarcocystis spp.) in the main mammalian game meat species in the EU: wild boar (Sus scrofa), red deer (Cervus elaphus), roe deer (Capreolus capreolus), fallow deer (Dama dama), Alpine chamois (Rupicapra rupicapra), moose (Alces alces), hare (Lepus europaeus) and wild rabbit (Oryctolagus cuniculus). The presented data point out the main issues, and knowledge gaps as well as the potential for improved control in order to contribute to the risk analysis process. To pursue an effective management of these parasitic zoonoses, awareness raising should involve all figures in the supply chain, including hunters, restaurateurs and consumers. Human behaviour and the lack of knowledge regarding meat borne parasitic zoonoses and the health risks they pose seem to be the most important factors responsible for human infections. However, detection methods, starting from the sampling procedure, should be further developed and standardized in order to improve the collection of accurate and up-to-date epidemiological data.

A comparison of detection methods of Alaria alata mesocercariae in wild boar (Sus scrofa) meat

Distomum musculorum suis (DMS), the mesocercariae of Alaria alata, is typically found accidently during examination of wild boar meat for Trichinella spp. The aim of the study was to compare DMS detection methods. Briefly, 232 wild boar meat samples were tested by mesocercariae migration technique (AMT) as a reference method; of these, 104 were found to be positive. Selected positive samples were tested again with the three other methods: compressorium method (Compressor), digestion with magnetic stirrer (Digestion) and by modified digestion with Pancreatin® bile and pancreatic enzymes (D + P). The results were analyzed by logistic regression, the non-parametric Kruskal-Wallis test and the Mann-Whitney U test. Of the 43 samples found positive by the AMT, 20 were found positive by Digestion and 25 by D + P. The Compressor identified DMS in seven of the 19 tested samples. The Digestion and D + P methods gave similar intensities (P = 0.506), i.e. 1.4 and 1.3 DMS respectively, but the AMT detected seven times higher number of parasites. The probability of detection of DMS in the meat sample by the Digestion or by D + P was higher than 0.5 when at least seven (Digestion) or five (D + P) DMS were present in the sample (AMT). The Compressor was the least sensitive method: at least 14 DMS must be present in the meat sample for detection. AMT should be considered the most accurate method of DMS detection.

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AMT appears the most sensitive method to detect Alaria alata mesocercariae.

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AMT results are seven times higher than in digestion methods in case of intensity.

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Compressor method is clearly inadequate to detect Alaria alata mesocercariae.

Alaria alata in Terms of Risks to Consumers' Health

Alaria alata flukes are cosmopolitan parasites. In Europe, the definitive hosts are red foxes (Vulpes vulpes), wolves (Canis lupus), and raccoon dogs (Nyctereutes procyonoides), as well as animals that belong to the Felidae family. Intermediate hosts, such as snails and frogs, are the sources of infection for definitive hosts. The developmental stages of A. alata mesocercariae may occur in paratenic hosts, including many species of mammals, birds, and reptiles, as well as in wild boars (Sus scrofa), which are important from the zoonotic point of view. Because there are no regulations concerning the detection of A. alata in meat, this fluke is usually detected during official obligatory Trichinella spp. inspections. However, a method dedicated to A. alata detection was developed. The growing popularity of game and organic meat has led to an increased risk of food-associated parasitic infections, including alariosis, which is caused by the mesocercarial stage of A. alata. The aim of this article is to highlight the problem of A. alata as an emerging parasite, especially in the terms of the increasing market for game and organic meats that have been processed with traditional methods, often without proper heat treatment.

Prevalence of Alaria alata mesocercariae in wild boars from Brandenburg, Germany

Since 2002, Alaria (A.) alata mesocercariae (AM) have been found during routine Trichinella inspection of wild boars in many European countries. To date, human infection with AM through consumption of undercooked or raw AM infested wild boar meat cannot be excluded. In Germany, data on the parasite’s prevalence in wild boars are scarce. To better understand temporal and spatial fluctuations of this parasite, this study investigated the prevalence of AM in wild boars in the German federal state of Brandenburg during three hunting seasons from 2017 to 2020. In total, 28.3% (100/354, 95% CI: 23.3–33.3%) of all wild boars sampled in eight counties of Brandenburg were tested positive for AM by Alaria alata mesocercariae migration technique (AMT). AM were detected in wild boars from seven different counties. Samples from one county (Havelland) tested completely negative for AM (0/16). Prevalences of the seven AM positive counties of Brandenburg ranged from 11.5 (3/26, 95% CI: 2.5–30.1%) in Märkisch-Oderland to 64.1% (25/39, 95% CI: 47.2–78.8%) in Uckermark. An association between sex and A. alata positivity could not be determined. A statistically significant increase in frequency of older AM positive wild boars was observed (p = 0.001). For a nationwide assessment of the prevalence of A. alata in wild boars and the risk for consumers of ingesting viable AM by consumption of raw or undercooked AM infested wild boar meat, further long-term studies in different regions of Germany are needed.

Occurrence of Alaria alata in wild boars (Sus scrofa) in Poland and detection of genetic variability between isolates

Alaria alata is a trematode included among several emerging zoonotic parasites. The mesocercarial larval stage of A. alata named Distomum musculorum suis (DMS) may potentially be infective for humans. In the past, DMS was often observed in wild boar meat during the official Trichinella inspection by artificial digestion before a more specific and effective detection method, the A. alata mesocercariae migration technique (AMT), was introduced. In the present study, the AMT method was used to screen 3589 tissue samples collected from wild boars hunted in Poland during the 2015–2019 period. The survey mainly focused on the southern part of Poland with the majority of samples coming from Małopolskie, Świętokrzyskie, and Dolnoślaskie provinces; samples from ten additional provinces were also included. The total prevalence was 4.2% with mean abundance of 4.7 DMS. Occurrence was dependent upon environmental conditions (i.e., wetland habitats and water reservoirs) rather than on sex of the host or season in which they were hunted. The recovered trematodes were identified as Alaria spp. according to their morphological features. Molecular analysis of 18S rDNA and COI genes confirmed the species identification to be A. alata and documented genetic variability among the isolates.

The occurrence of Alaria alata mesocercariae in wild boars (Sus scrofa) in north-eastern Poland

Various species of mammals, including humans and wild boars, can serve as paratenic hosts of Alaria alata mesocercariae – Distomum musculorum suis (DMS). Cases of DMS can be reliably detected by the recent introduction of the A. alata mesocercariae migration technique (AMT). The aim of this study is to present current data on the occurrence of DMS in wild boars in north-eastern Poland, and to compare the findings with those obtained in other European countries. A. alata was identified in 98 of 221 (44.3%) tissue samples of wild boar taken from five provinces in north-eastern Poland during the hunting seasons 2015–2016 and 2016–2017 based on AMT analysis. Positive results were found in all studied regions, but the percentage of infected individuals ranged from 26.3% in the Pomorskie province to 65.5% in the Warmińsko-Mazurskie province. The mean number of larvae exceeded seven larvae per 30 g sample for three provinces: Pomorskie, Mazowieckie and Lubelskie. In turn, lower values were found in the Warmińsko-Mazurskie province (3.3 larvae per 30 g), and the lowest in the Kujawsko-Pomorskie province (1.8 larvae per 30 g). The occurrence and intensity of A. alata infestation in wild boars was found to depend on the environment in which they live. Neither the sex or the age of the wild boar appeared to influence the occurrence nor the intensity of infestation.

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High percentage (44.3) of Alaria alata in samples of wild boars in Poland.

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High prevalence of A. alata infestation in wild boars compared to other reports.

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Sex does not affect the risk or intensity of infestation by A. alata in wild boars.

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Age does not affect the risk or intensity of A. alata infestation in wild boars.

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A. alata poses a potential risk for wild boar consumers in Poland.

Alaria alata mesocercariae in domestic pigs and wild boars in South Banat, northern Serbia

Alaria alata (Diplostomidae, Trematoda), a potentially zoonotic pathogen, is the only Alaria species in Europe. In recent years, increasing reports of mesocercariae of A. alata in wild boars have been recorded in European countries; however there have been no described cases in domestic pigs over the past decades. Out of 272 diaphragm samples from wild boars (Sus scrofa) and domestic pigs (Sus scrofa), from Serbia, included in the present investigations, mesocercariae of A. alata were found in six (3%) samples from wild boars and in two (2.77%) samples from domestic pigs. Due to the lack of sensitivity of artificial digestion with a magnetic stirrer which was applied in the study, the true prevalence is estimated to be considerably higher in the area of investigation. Confirming the infection in domestic pigs and a wide distribution in wild boars in the area of investigation, the present paper should influence the growing awareness of alariosis as a potential human disease. The meat from free-range domestic pigs and game meat as a potential source of alariosis should always be adequately thermally treated before consumption.

Helminth infections in domestic dogs from Russia

Dogs are the hosts for a wide helminth spectrum including tapeworms, flatworms, and nematodes. These parasites affect the dog health and cause morbidity and mortality, especially in young and old animals. Some species, as Toxocara canis, Ancylostoma caninum, Dipylidium caninum, and Echinococcus spp. are well-known zoonotic parasites worldwide, resulting in high public health risks. Poor data about canine helminth species and prevalence are available in Russia, mainly due to the absence of official guidelines for the control of dog parasites. Moreover, the consequent low quality of veterinary monitoring and use of preventive measures, the high rate of environmental contamination by dog feces and the increase of stray dog populations, make the control of the environmental contamination by dog helminths very difficult in this country. This paper reviews the knowledge on canine helminth fauna and prevalence in Russia. Practical aspects related to diagnosis, treatment, and control of parasitic diseases of dogs in Russia are discussed.

Effects of in vitro conditions on the survival of Alaria alata mesocercariae

The aim of this study was to determine the effect of different concentrations of table salt (NaCl) and ethanol (v/v) solutions on the viability of Alaria alata mesocercariae. Furthermore, the survival of A. alata mesocercariae during simulated human gastric digestion was evaluated. For this purpose, A. alata mesocercariae migration technique (AMT) was used for the isolation of the parasite from high-positive A. alata mesocercariae meat from wild boar, raccoon, raccoon dog, and badger meat. In total, we have studied the behavior of 582 larvae under different conditions (NaCl, ethanol, and artificial gastric juice) in three independent in vitro experiments. The larvae survived at a NaCl concentration of up to 2.0% until day 21 with a median survival time of 11 days. At 3.0% NaCl concentration, the larvae lost their vitality after less than 24 h. In addition, it was found that ethanol concentrations from 8.0 to 70.0% were effective at reducing survival of A. alata mesocercariae within a short period of time (<1 min). Finally, our studies have revealed that it required 120 min to reliably inactivate all A. alata mesocercariae within HCl-pepsin digestion solution with a pH of 1.5-2.0 at 37°C. Consequently, the results showed that 3.0% is the minimum concentration of NaCl in meat products recommended for human consumption because at lower NaCl concentration the parasite survived for a substantial period of time. Finally, the common concentrations of ethanol used for the disinfection of surfaces in household and/or laboratory, are sufficient for the inactivation of A. alata mesocercariae.

First interlaboratory test for the detection of Alaria spp. mesocercariae in meat samples using the Alaria spp. mesocercariae migration technique (AMT)

Emerging and re-emerging zoonotic diseases affect both public and animal health and require the development and contemporary implementation of suitable detection methods. A growing number of findings of the mesocercarial stage of the digenean trematode Alaria alata in game inhabiting wetlands have necessitated the development of a specific detection method. With the Alaria spp. mesocercariae migration technique (AMT), a specific and sensitive detection method is now available. To make the method accessible to the official controls, method validation is necessary. In this context, interlaboratory tests (IT) are a key factor to demonstrate both (1) the suitability of the respective method and (2) the reference materials. In the first IT performed on this issue, 15 laboratories from nine German federal states took part. Every lab received two negative and four positive standard samples each as well as a standardized examination device for AMT, and a standard operating procedure. All participating laboratories showed very good results in terms of qualitative analysis: 96.7 % of the samples were assessed correctly positive or negative. An analysis of the qualitative performance shows that 263 (58.4 %) of 450 mesocercariae that were inserted in the meatballs were identified by the participants, and 5 (33.3 %) out of 15 labs were able to count at least 70 % of the Alaria spp. mesocercariae. A direct comparison with the results of the German Trichinella IT, which were conducted since 2004, shows that the overall sensitivity of the AMT is even higher than that registered for the reference method for Trichinella detection (e.g. 93 % in 2010). Also, in terms of quantitative analysis, AMT stands up to the comparison with the results from the German Trichinella IT. The refinement of the implementation protocol of this innovative, easy-to-use and cost-effective method harbours great potential for further optimization and successful implementation in the official controls.

First detection of Alaria alata mesocercariae in wild boars (Sus scrofa Linnaeus, 1758) from Bulgaria

The trematode Alaria alata, an intestinal parasite of different carnivore species is widely distributed throughout Europe. The mesocercarial stages of Alaria spp. may infect almost all vertebrate species, including humans, and, in particular, omnivorous scavengers such as wild boars serve as paratenic hosts for the parasite. The introduction of the A. alata mesocercariae migration technique (AMT) opened the way to a reliable detection of Alaria spp. mesocercariae in different body tissues of their paratenic hosts. For the first time, it was possible to detect vital A. alata mesocercariae from two Bulgarian wild boars by means of this new method. In addition, polymerase chain reaction (PCR) examination of the respective parasitic DNA allowed the unequivocal species identification of the parasites as A. alata. Isolation and molecular biological identification of the parasite's developmental stages make significant contributions to completion of data on both the distribution of Alaria spp. in stocks of European game and the relationship between different Eurasian Alaria spp. isolates.

The prevalence and distribution of Alaria alata, a potential zoonotic parasite, in foxes in Ireland

The digenean trematode Alaria alata, an intestinal parasite of wild canids is widely distributed in Europe. The recent finding of the mesocercarial life cycle stage in the paratenic wild boar host suggests that it may potentially infect humans Mohl et al. (Parasitol Res 105:1-15, 2009). Over 500 foxes were examined during a wildlife survey for zoonotic diseases in 2009 and 2010. The prevalence of A. alata ranged from 21% to 26% in 2009 and 2010, and the intensity of infection varied, with the majority of foxes having between one and ten trematodes, but a small number of animals had parasitic burdens greater than 500. The location of foxes was geo-referenced and mapped using a geographic information system. The results of the spatial analysis suggest that A. alata may have a limited distribution being confined mainly to areas of pasture especially in the central plain and north Munster. Hot spot analysis indicated a clustering and that the level of parasitism was greatest in foxes from those areas where the prevalence of infection was highest.

Pulmonary trematodosis (Pharyngostomoides sp.) in a juvenile raccoon (Procyon lotor)

A lethargic, wild, juvenile raccoon died and was subsequently presented for necropsy. The lungs had widely disseminated, finely granular, yellow-tan foci with moderate pulmonary, as well as, thoracic lymphadenopathy. Histopathology revealed numerous cross-sections of larval trematodes morphologically consistent with diplostomid mesocercariae and metacercariae as well as moderate alveolointerstitial pneumonia with a mixed population of eosinophils, macrophages, lymphocytes, and plasma cells. The presence of larval trematodes within lymphatics in multiple organs indicates a route of fluke migration. Live specimens of mesocercariae and metacercariae recovered from refrigerated lung tissue after 7 days were identified as Pharyngostomoides sp., an intestinal diplostomid parasite (trematode) of raccoons and other mammals that is similar in appearance and life cycle to Alaria spp.

Development of a PCR approach for differentiation of Alaria spp. mesocercariae

To date classification and differentiation of Alaria spp. are based largely on external characteristics and comparative morphology of adult flukes. The accurate differentiation between various Alaria spp. mesocercariae is indeed difficult because there are only few data on morphological and morphometrical features of the parasite's developmental stages. We established a conventional polymerase chain reaction (PCR) for a molecular-based diagnosis of Alaria alata mesocercariae that can aid in their identification. Twenty Alaria spp. mesocercariae specimens were collected from three different wild boars originating from different areas of eastern Germany. DNA from the prepared isolates was extracted, and a primer pair was selected to amplify a 303-bp region of the A. alata genome. The DNA preparations extracted from the field samples as well as A. alata positive controls were successfully amplified and yielded a single sharp band of the expected size. In all samples, molecular identification was consistent with morphological identification. With our new PCR assay, we present the first approach for identification and characterization of A. alata mesocercariae specimens using molecular methods. This practicable and reproducible protocol can be used for both diagnostic and epidemiological purposes.

Biology of Alaria spp. and human exposition risk to Alaria mesocercariae-a review

Recent incidental background findings of Alaria alata mesocercariae ["Distomum muscularis suis," Duncker, 1896] in meat of wild boars during official Trichinella inspection initiated a re-assessment of the potential human health risk as posed by this parasite. The present review of the literature on Alaria biology shows that the human exposition risk should no longer be accepted to be negligible, as it demonstrates a general lack of knowledge in relevant areas of Alaria biology confounding any risk analysis. Sound risk assessment needs future studies which should concentrate on the most pressing questions of (1) the optimization and/or development of methods for reliable Alaria mesocercariae detection, (2) the distribution of the mesocercariae within their paratenic hosts, i.e., identification of potential predilection sites, particularly in wild boars, and (3) their prevalence in sylvatic populations of animals with respect to their introduction into the human food chain. Further, the degree and possibly also the species specificity of Alaria mesocercariae tenacity within the paratenic hosts and respective meat as pertaining to food technological treatments need to be elucidated. While these questions remain unanswered, it is an incontrovertible fact that Alaria mesocercariae have a potentially high human pathogenicity by both occupational and alimentary exposition.

Immunology and pathology of intestinal trematodes in their definitive hosts

This review examines the significant literature on the immunology and pathology of intestinal trematodes in their definitive hosts. We emphasize information on selected species in six families for which the literature on these topics is extensive. The families are Brachylaimidae, Diplostomidae, Echinostomatidae, Gymnophallidae, Heterophyidae, and Paramphistomidae. For most of these families, coverage is considered under the following headings: (i) background; (ii) pathology of the infection; (iii) immunology of the infection; (iv) immunodiagnosis; and (v) human infection. Some of these heading have been subdivided further, based on the literature available on a particular topic. Following this coverage, we include a final section on the important topical literature on selected trematodes in families other than the six mentioned above.