Pierre Dorny

Emerging food-borne parasites

Parasitic food-borne diseases are generally underrecognised, however they are becoming more common. Globalization of the food supply, increased international travel, increase of the population of highly susceptible persons, change in culinary habits, but also improved diagnostic tools and communication are some factors associated with the increased diagnosis of food-borne parasitic diseases worldwide. This paper reviews the most important emerging food-borne parasites, with emphasis on transmission routes. In a first part, waterborne parasites transmitted by contaminated food such as Cyclospora cayetanensis, Cryptosporidium and Giardia are discussed. Also human fasciolosis, of which the importance has only been recognised in the last decades, with total numbers of reported cases increasing from less than 3000 to 17 million, is looked at. Furthermore, fasciolopsiosis, an intestinal trematode of humans and pigs belongs to the waterborne parasites as well. A few parasites that may be transmitted through faecal contamination of foods and that have received renewed attention, such as Toxoplasma gondii, or that are (re-)emerging, such as Trypanosoma cruzi and Echinococcus spp., are briefly reviewed. In a second part, meat-borne parasite infections are reviewed. Humans get infected by eating raw or undercooked meat infected with cyst stages of these parasites. Meat inspection is the principal method applied in the control of Taenia spp. and Trichinella spp. However, it is often not very sensitive, frequently not practised, and not done for T. gondii and Sarcocystis spp. Meat of reptiles, amphibians and fish can be infected with a variety of parasites, including trematodes (Opisthorchis spp., Clonorchis sinensis, minute intestinal flukes), cestodes (Diphyllobothrium spp., Spirometra), nematodes (Gnathostoma, spp., anisakine parasites), and pentastomids that can cause zoonotic infections in humans when consumed raw or not properly cooked. Another important zoonotic food-borne trematode is the lungfluke (Paragonimus spp.). Traditionally, these parasitic zoonoses are most common in Asia because of the particular food practices and the importance of aquaculture. However, some of these parasites may emerge in other continents through aquaculture and improved transportation and distribution systems. Because of inadequate systems for routine diagnosis and monitoring or reporting for many of the zoonotic parasites, the incidence of human disease and parasite occurrence in food is underestimated. Of particular concern in industrialised countries are the highly resistant waterborne protozoal infections as well as the increased travel and immigration, which increase the exposure to exotic diseases. The increased demand for animal proteins in developing countries will lead to an intensification of the production systems in which the risk of zoonotic infections needs to be assessed. Overall, there is an urgent need for better monitoring and control of food-borne parasites using new technologies.

The emergence of Taenia solium cysticercosis in Eastern and Southern Africa as a serious agricultural problem and public health risk

Pig production has increased significantly in the Eastern and Southern Africa (ESA) region during the past decade, especially in rural, resource-poor, smallholder communities. Concurrent with the increase in smallholder pig keeping and pork consumption, there have been increasing reports of porcine cysticercosis in the ESA region. This article reviews the findings concerning the presence and impact of porcine cysticercosis in seven of the ESA countries. Most of the reported findings are based on surveys utilising lingual palpation and post-mortem examination, however, some also used serological assays. In Tanzania, community-based studies on porcine cysticercosis indicate a prevalence of 17.4% in the northern highlands district of Mbulu and a prevalence range of 5.1-16.9% in the southern highlands. In Kenya recent surveys in the southwestern part of the country where smallholder pig keeping is popular indicate that 10-14% of pigs are positive for cysticercosis by lingual examination. Uganda has the most pigs in Eastern Africa, most of which are kept under smallholder conditions. Preliminary surveys in 1998 and 1999 at slaughterhouses in Kampala indicated a prevalence of porcine cysticercosis between 0.12 and 1.2%, however, a rural survey in northern Uganda in 1999 indicated 34-45% of pigs slaughtered in selected villages were infected. Additionally, a new survey of 297 pigs slaughtered in Kampala in 2002 indicated that pigs from the central region of the country were negative for cysticercosis while 33.7% of the pigs coming from the rural Lira district in the north were positive. Interestingly 8 piglet foetuses removed from an infected slaughtered sow coming from Lira district were all found to harbour cysts of T. solium providing evidence of congenital transmission of porcine cysticercosis. In Mozambique, abattoir records indicate that porcine cysticercosis is present in all provinces of the country. A serological survey on pigs in rural Tete Province found 15% of pigs positive. In Zimbabwe, a retrospective study in official abattoirs around the country from 1994 to 2001 reported a mean prevalence of 0.34% which is in contrast to a post-mortem survey in 1999, which showed that the prevalence of porcine cysticercosis in rural west Zimbabwe where smallholder pig keeping is popular was 28.6%. In Zambia, abattoir records reported porcine cysticercosis in six of the nine provinces. Routine meat inspection of 1316 pigs at a slaughter slab in Lusaka showed that 20.6% of the pigs had cysticercosis whereas serological testing of 874 pigs at the same abattoir indicated that 56.6% were found to have circulating antigens of Taenia solium. Field surveys based on lingual palpation in Southern and Eastern Provinces of Zambia revealed prevalences of 8.2-28.4 and 5.2%, respectively. South Africa has the largest number of pigs in Southern Africa and cysticercosis has been recognised as a problem in the country for many decades. There is strong evidence supporting the high prevalence of neurocysticercosis infecting humans from resource-poor areas of the country where pigs are being raised under smallholder conditions. In spite of this community-based surveys on porcine cysticercosis have never been conducted in South Africa and the last slaughterhouse survey was conducted nearly 40 years ago. The prevalences of porcine cysticercosis found in these ESA countries rank among the highest in the world and the disease is emerging as an important constraint for the nutritional and economic well being of resource-poor smallholder farming communities. The current findings suggest the widespread presence of human tapeworm carriers and thus a high risk of human cysticercosis in both rural areas and urban centres in the ESA region. More research is required in the region to assess the extent and public health and economic impact of T. solium infection in order to determine whether and what prevention and control efforts are needed.

Sero-epidemiological study of Taenia saginata cysticercosis in Belgian cattle.

A sero-epidemiological survey of Taenia saginata cysticercosis was carried out to determine the prevalence of the infection in cattle presented for slaughter in Belgium. Between November 1997 and June 1998, a total of 1164 serum samples were collected in 20 export abattoirs. Meat inspection was routinely carried out by veterinary inspectors. Serum samples were examined for circulating parasite antigen using a monoclonal antibody-based sandwich enzyme-linked-immunosorbent assay (Ag-ELISA). Thirty six serum samples (3.09%) were found positive in the Ag-ELISA, while by meat inspection on the same animals cysticerci were detected in only three carcasses (0.26%). Sero-prevalence was positively correlated with the age of the animals. The sero-prevalence found in this study was more than 10 times higher than the annual prevalence (0.26%) reported by the Institute for Veterinary Inspection. This study clearly indicates that the classical meat inspection techniques detect only a minor fraction of the carcasses infected with cysticerci.

REGIONAL STATUS, EPIDEMIOLOGY AND IMPACT OF TAENIA SOLIUM CYSTICERCOSIS IN WESTERN AND CENTRAL AFRICA.

In West Africa, Taenia solium cysticercosis in both pigs and man has been reported in Benin, Burkina-Faso, Ghana, Ivory Coast, Senegal and Togo, and although official data are lacking, T. solium is anticipated to be present in most of the pig-raising regions of other West African countries as well. In some regions of Nigeria, the prevalence of porcine cysticercosis and human taeniosis is quite high (20.5 and 8.6%, respectively). Surprisingly, however, no cases of human cysticercosis have been reported, although epilepsy is very common. Large epidemiological surveys have only been carried out in Togo and Benin, where the prevalence of human cysticercosis was 2.4 and 1.3%, respectively. In Central Africa, porcine and human cysticercosis are (hyper)-endemic in Rwanda, Burundi, the Democratic Republic of Congo and Cameroon. The parasite also has been reported in pigs in Chad and Angola. Cysticercosis has been shown to be one of the major causes of epilepsy in Cameroon with figures as high as 44.6%. Cameroon is one of the few countries where the taeniosis-cysticercosis complex has been examined more in detail. In the Western province of Cameroon large scale surveys have shown that active cysticercosis is present in 0.4-3% of the local population and in 11% of the village pigs. However, the prevalence of adult T. solium was only 0.1%, which underscores the frequency of the T. solium paradox. Based on the available information, a very conservative economic estimate indicates that the annual losses due to porcine cysticercosis in 10 West and Central African countries amount to about 25 million Euro. The financial losses due to human cysticercosis are very difficult to estimate, but are certainly exceeded by the social impact of the disease, especially because of the particular perception of epilepsy in many African communities. It is concluded that the true prevalence of T. solium cysticercosis in pigs and humans in Central and West Africa remains underestimated because of unreliable slaughterhouse data and the lack of awareness and diagnostic facilities in the public health sector.

Gastrointestinal nematode infections in adult dairy cattle: impact on production, diagnosis and control.

Due to the intensification of dairy herds and the recognition of subclinical infections with a negative impact on production as disease, control of gastrointestinal (GI) nematodes in adult cows is becoming established in an increasing number of dairy herds. The objectives of this paper are to review the aspects related to the impact on production, diagnosis and control of GI nematodes in adult dairy cattle. During the last decade substantial evidence has been generated that GI nematodes can have a negative impact on the performance of adult animals. The milk-yield response to anthelmintic treatment in recent studies in pastured dairy herds was observed to be around 1kg/cow per day, whereas effects on reproductive performance remain equivocal. GI-nematode infections can be monitored based on Ostertagia ostertagi-specific antibody measurement, which provides information on the level of larval exposure and an indication of the associated production losses. Other diagnostic parameters are considered of limited use in adult cattle. Control relies on anthelmintic treatment and grazing management, which can be used complementary to each other. There are three critical points that need to be considered when developing anthelmintic control recommendations in adult cows: the unpredictability of the treatment response, the timing of treatment and the risk for developing anthelmintic resistance. As a consequence, monitoring of GI-nematode infections is desirable in order to focus anthelmintic treatments on those herds with a high larval challenge and associated production losses. For the future, more studies are needed to evaluate the effects of different control approaches in terms of financial benefits for the farmer and sustainability on the long term.

Immunodiagnosis of Taenia solium taeniosis/cysticercosis

Neurocysticercosis, the infection of the central nervous system by larvae of Taenia solium, is a major cause of epilepsy in developing countries. This cestode is a public health problem in most developing countries where pigs are raised and its occurrence is strongly associated with poverty. The development of immunodiagnostic tools has contributed to our knowledge on the importance of this parasite by enabling seroepidemiological surveys and community-based studies to be conducted. Here, we present a comprehensive overview of the various proteins used in antibody detection techniques, as well as the latest developments in antigen detection techniques and serodiagnosis of taeniosis. A critical view on the use of serology in epidemiological studies and clinical control programs is given and future research needs are presented.

Elimination of Taenia solium transmission to pigs in a field trial of the TSOL18 vaccine in Cameroon.

Graphical abstract

Detection of Taenia solium Antigens and Anti–T. solium Antibodies in Paired Serum and Cerebrospinal Fluid Samples from Patients with Intraparenchymal or Extraparenchymal Neurocysticercosis

BACKGROUND Neurocysticercosis (NCC) is a frequent cause of epilepsy worldwide. Compared with the more common parenchymal brain cysts, extraparenchymal infections are difficult to manage and have a poor prognosis. Serological assays are used to detect circulating Taenia solium antigens or anti-T. solium antibodies in serum or cerebrospinal fluid (CSF) samples. There are no guidelines on whether to use serum or CSF specimens for a particular assay. METHODS We obtained paired serum and CSF samples from 91 patients with NCC (48 had intraparenchymal NCC, and 43 had extraparenchymal NCC) for detection of antibodies, using an enzyme-linked immunotransfer blot (EITB) assay, and antigens, using a monoclonal antibody-based enzyme-linked immunosorbent assay (ELISA). RESULTS For the intraparenchymal NCC group, the EITB assay yielded more true-positive results for serum samples, and the ELISA yielded slightly more true-positive results for CSF samples than for serum samples, but none of these differences were statistically significant. Most patients with calcified NCC were antibody positive but antigen negative. For extraparenchymal disease, all samples were antibody positive, and all but 2 were antigen positive, with most samples containing high antigen levels. CONCLUSIONS The sensitivity of antibody-detecting EITB assays is not increased through the use of CSF samples rather than serum samples. The antigen-detecting ELISA performed better for CSF samples than for serum samples, but for both specimen types it was less sensitive than the EITB assay. Active and inactive NCC are better differentiated from each other by the antigen-detecting ELISA, for both serum and CSF samples. High antigen levels suggest the presence of subarachnoid NCC.

Nematode parasitism in adult dairy cows in Belgium.

Over a period of 1 year, from November 1997 to October 1998, the abomasa, blood and faecal samples of 121 dairy cows in Belgium were collected and examined for nematode infections. Nematodes were present in the abomasa of 110 animals. Ostertagia was found in all 110, Trichostrongylus was seen in 65 and Haemonchus in 14 abomasa. Overall, 91% of all trichostrongyles recovered were Ostertagia. The geometric mean total number of Ostertagia was 2750, with an average of 74% inhibited early fourth stage larvae (EL4). Between November and February >90% of the Ostertagia worm burden were EL4 stages. The majority of the animals (56%) harboured a low Ostertagia burden (100-5000) and 15% had a high burden (>10,000). Sixty-four percent of the coprocultures were positive and the genera recovered were Ostertagia sp. (100%), Trichostrongylus sp. (42%), Oesophagostomum (32%), Haemonchus sp. (29%) and Cooperia sp. (16%). A seasonal pattern was evident for serum Ostertagia-specific antibodies and for serum pepsinogen concentration, with the highest levels during the summer, and low values during the winter. Dictyocaulus viviparus specific antibodies were detected in the serum of eight (7%) animals.

Evaluation of pepsinogen, gastrin and antibody response in diagnosing ostertagiasis

Ostertagia ostertagi is widely distributed and is one of the most important parasites affecting young bovine livestock. There is, therefore, a substantial need for sensitive and specific parameters in support of diagnosis of ostertagiasis, especially for subclinical disease related to production losses. In this review, the value and application of pepsinogen, gastrin and antibody response as diagnostic tools are discussed. These three parameters are useful and comparable for confirming clinical disease in calves during their first grazing season. However, their value for detecting subclinical parasitism is questionable. Differences in the course of gastrin and pepsinogen late in the grazing season can be correlated with larval inhibition and the possibility of ostertagiasis Type II. Relatively few serological methods have been developed for the immunodiagnosis of Ostertagia and until now the indirect antibody-detecting enzyme-linked immunosorbent assay (ELISA) has been the method of choice. Antibody measuring methods have several disadvantages, most notably a lack of sensitivity and specificity, which limits their use in longitudinal epidemiological studies. Considering the necessity of cost effectiveness and ease of use, it is anticipated that additional work will result in the enhancement and quality of current immunodiagnostic methods.