The role of non-biting flies in the epidemiology of human infectious diseases.

The feeding and reproductive habits of non-biting synanthropic flies make them important mechanical vectors of human pathogens. Synanthropic flies are major epidemiologic factors responsible for the spread of acute gastroenteritis and trachoma among infants and young children in (predominantly) developing countries. House flies are involved in mechanical transmission of nosocomial infections with multiple antibiotic-resistant bacteria in hospital environments.

A model for the prediction of relative titres of avian malaria and Aspergillus spp. IgG in Jackass penguin (Spheniscus demersus) females based on maternal IgG in egg-yolk.

A model for the prediction of IgG titres in females of the Jackass penguin (Spheniscus demersus) was developed, based on IgG which was maternally transmitted to the yolk of unembryonated eggs produced by these females. However, prediction of the female titre based on the titre of embryonated eggs may be inadequate. Blood samples from 10 S. demersus females and their corresponding embryonated (n = 10) and unembryonated (n = 49) eggs were analysed by indirect ELISA for avian malaria (Plasmodium relictum, P. elongatum) IgG and Aspergillus spp. IgG. There was no correlation between humoral responses to avian malaria and Aspergillus spp. in females or in their eggs. Avian malaria and Aspergillus spp. titres were significantly higher (P < 0.05) in the eggs than in the corresponding females and were significantly correlated (P < 0.01) with the blood titres, r = 0.84, r = 0.89, respectively. No correlation was found between titres of embryo yolk-sac (embryonated eggs) and the blood of their female parent; however, the embryo blood and the corresponding female titres were significantly (P < 0.05) correlated (avian malaria, r = 0.74; Aspergillus spp., r = 0.69). Blood and the corresponding egg-yolk (unembryonated eggs) IgG titres regressed significantly (P < 0.01). Female IgG titre (y) is related to (unembryonated) egg-yolk IgG titre by the significant (P < 0.05) regression y = -0.61 + 1.46X for avian malaria, and y = -0.02 + 0.85X for Aspergillus spp., with +/- 95% prediction limits of +/- 0.15 and +/- 0.12, respectively. This model provides access to serological information on the remote free-ranging Jackass penguins and captive Jackass-penguin colonies without the necessity of stressful blood collection.

Intestinal Cryptosporidium sp. infection in the Egyptian tortoise, Testudo kleinmanni.

An adult Egyptian tortoise (Testudo kleinmanni) presented with clinical signs of enteritis and died 5 weeks after initiation of antibiotic therapy. Histological examination of the small intestine revealed heavy infection with Cryptosporidium sp.; over 80% of epithelial cells harboured the pathogen. No Cryptosporidium developmental stages were present in the stomach or the lungs. The intestinal lamina propria and mucosa were infiltrated by heterophils, lymphocytes and macrophages. The present study constitutes the first report of Cryptosporidium sp. infection in T. kleinmanni, and the first histological documentation of intestinal cryptosporidiosis in Chelonia.

Evaluation of commercial enzyme immunoassay (EIA) and immunofluorescent antibody (FA) test kits for detection of Cryptosporidium oocysts of species other than Cryptosporidium parvum.

A commercial enzyme immunoassay (EIA) (ProSpect Rapid Assay), a direct immunofluorescence antibody (IFA) test for stool testing (MERIFLUOR Cryptosporidium/Giardia), and an indirect IFA test for environmental testing (Hydrofluor-Combo Cryptosporidium/Giardia) were evaluated for detection of low public health risk Cryptosporidium oocyst isolates, and for C. parvum oocyst isolates from human and bovine feces that represent a high public health risk. There was no cross-reactivity of EIA with ova of eight medically important helminths, three Eimeria species oocysts, Sarcocystis cruzi sporocysts, and two Candida sp. isolates. All nine snake oocyst isolates (C. serpentis), two of seven lizard oocyst isolates, one turtle oocyst isolate, two avian oocyst isolates (turkey, C. meleagridis), one C. wrairi oocyst isolate from guinea pigs, one C. muris oocyst isolate from hyrax, one heifer C. muris isolate, and two C. muris-like oocyst isolates from a camel were positive by both IFA tests; six of these 19 oocyst isolates were EIA-positive. There was no difference in the sensitivity and specificity between direct and indirect IFA tests. The sensitivity of the EIA and both IFA tests to the C. parvum oocysts was 100%. The EIA showed less cross-reactivity with the non-C. parvum oocysts (24%) than direct or indirect IFA (76%), and was less sensitive to those isolates (20%) than both IFA tests (63%). A simulated sampling model for high and low public health risk Cryptosporidium oocysts showed that the low risk oocyst isolates may constitute up to 35% of all positive environmental samples by direct or indirect IFA determination, and up to 12% of all EIA positive samples. This study indicates a superiority of direct and indirect IFA and EIA for screening of human-or-bovine-origin fecal specimens, whereas testing of environmental samples may lead to misidentification of medically important isolates. The results demonstrated that the EIA kit can more accurately identify environmental samples containing oocytes pathogenic for humans than both IFA tests. The specificity of commercially available diagnostic kits to C. parvum should be critically examined for cross-species identification before they are recommended or adopted for use in testing environmental samples.

House flies (Musca domestica) as transport hosts of Cryptosporidium parvum.

Refuse and promiscuous-landing synanthropic filth flies, such as house flies (Musca domestica), are recognized as transport hosts for a variety of protozoan and metazoan parasites in addition to viral and bacterial pathogens of public health importance. Exposure of adult M. domestica to 20 ml of bovine diarrheal feces containing Cryptosporidium parvum oocysts (2.0 x 10(5) oocysts/ml) resulted in intense deposition of the oocysts through fly feces on the surfaces visited by the flies (mean = 108 oocysts/cm2). Cryptosporidium parvum oocysts were detected by immunofluorescent antibodies on the exoskeleton of adult flies and in their digestive tracts. An average of 267, 131, 32, 19, and 14 oocysts per adult fly were eluted from its exoskeleton on days 3, 5, 7, 9, and 11 after they emerged, respectively. Approximately 320 C. parvum oocysts per pupa were eluted from the external surface of the pupae derived from maggots that breed in a substrate contaminated with the bovine feces; the oocysts were numerous on maggots (approximately 150 oocysts/maggot). Adult and larval stages of house flies breeding or having access to C. parvum-contaminated substrate will mechanically carry the oocysts in their digestive tracts and on their external surfaces.

Diagnosis of subclinical cryptosporidiosis in captive snakes based on stomach lavage and cloacal sampling.

The applicability of stomach lavage and cloacal swab techniques for diagnosis of subclinical cryptosporidiosis were tested in eight captive snakes subclinically infected with Cryptosporidium serpentis. Two feeding regimes were employed. The snakes were first fed 7 days prior to stomach and cloaca sampling, and then 3 days prior to sampling, and the oocysts were detected by fluorescein labeled monoclonal antibody (mAb) and by acid-fast stained (AFS) direct wet smear (DWS). The overall sensitivity of AFS DWS was 95% for stomach samples and 57% for cloacal samples, with false-negativity of 5% and 43%, respectively. A significant relationship (P < 0.01) was found between stomach and cloacal samples when mAb were used for oocyst detection. Stomach sampling was diagnostically superior to cloacal sampling for identifying snake subclinical cryptosporidiosis. Based on gastric aspirates, cryptosporidial infection was diagnosed in all eight animals, and only in two or four snakes when cloacal swab material was processed by AFS or by mAb, respectively. Feeding snakes 3 days prior to sampling facilitated diagnosis based on stomach samples; however, it did not improve diagnosis when cloacal samples were used. The fraction of oocyst-positive stomach samples was significantly higher (P < 0.05) for snakes fed 3 days prior to gastric lavage when compared with the fraction of positive samples of snakes fed 7 days prior to lavage. If subclinical cryptosporidiosis is suspected in a non-eating snake patient, force-feeding and stomach lavage, 3 days after the meal, is recommended.

Oocysts of Cryptosporidium from snakes are not infectious to ducklings but retain viability after intestinal passage through a refractory host.

Six 2-week-old Cryptosporidium-free Peking ducklings (Anas platyrhynchos) each received 2.0 x 10(6) viable Cryptosporidium serpentis oocysts from 6 naturally infected captive snakes. Histological sections of digestive (stomach, jejunum, ileum, cloaca, and cecum) and respiratory tract tissues (larynx, trachea, and lungs) did not contain life-cycle stages of Cryptosporidium in any of the inoculated ducklings. Because ducklings were refractory to infection, C. serpentis transmission via a diet of Peking ducklings is improbable. Viable (per in vitro excystation assay) inoculum-derived oocysts were detected in duckling feces up to 7 days post-inoculation (PI); the number of intact oocysts excreted during the first 2 days PI was significantly higher than for the remaining 5 days PI (P < 0.01). The dynamics of oocyst shedding showed that overall the birds released a significantly higher number of intact oocysts than oocyst shells (P < 0.01). Retention of the viability of C. serpentis oocysts following intestinal passage through a refractory avian species may have epizootiological implications. Under certain circumstances such as after the ingestion of C. serpentis-infected prey, herpetivorous birds may disseminate C. serpentis oocysts in the environment.

Therapeutic efficacy of hyperimmune bovine colostrum treatment against clinical and subclinical Cryptosporidium serpentis infections in captive snakes.

Therapy based on the protective passive immunity of Hyperimmune Bovine Colostrum (HBC) (raised against Cryptosporidium parvum in dairy cows immunized during gestation) was tested for heterologous efficacy in subclinical and clinical infections of 12 captive snakes with C. serpentis. Six gastric HBC treatments of 1% snake weight at 1-week intervals each, have histologically cleared C. serpentis in three subclinically infected snakes, and regressed gastric histopathological changes in one of these snakes. In all snakes, each subsequent HBC treatment significantly decreased the number of oocysts recovered in gastric lavage eluants (P < 0.03). The treatments induced oocyst-negative gastric eluants and stools in all snakes, and improved clinical signs of infection. Clinically infected snakes displayed severe histopathological changes in the gastric region; however, the numbers of developmental stages of C. serpentis were moderate. Considering the severity of pathology, much lower than expected pathogen numbers were observed, and it is believed that clinically infected snakes did not have enough time to repair tissue damage that had occurred over the years of infection. As the HBC treatment was safe and highly efficacious, it is recommended to gastrically administer the HBC therapeutically to snakes that are clinically or subclinically infected with C. serpentis. Hyperimmune bovine colostrum can also be used in snake supportive therapy or prophylaxis.

Experimental infection of elaphid snakes with Cryptosporidium serpentis (Apicomplexa: Cryptosporidiidae).

The shedding pattern of fecal Cryptosporidium serpentis oocysts, histopathologic changes in the gastric region, and the effect of spiramycin treatment were investigated in 6 experimentally infected, captive black rat (Elaphe obsoleta obsoleta), 4 yellow rat (Elaphe obsoleta quadrivittata), and 2 corn snakes (Elaphe guttata guttata). Feces were monitored for up to 2 years postinfection (PI). No significant (P > 0.07) differences were observed between expected and observed numbers of PI oocyst-positive feces. Two of 5 control animals acquired natural infections of C. serpentis over the period of study. No morphological differences were observed between oocysts from experimental and natural infections. Clinical signs included postprandial regurgitation in 5 of 13 (38%) snakes, not coinciding with the shedding of fecal oocysts. Midbody swelling and self-cure were not observed. Spiramycin treatment of 4 of 12 experimentally infected animals resulted in negative fecal examinations in 2 snakes and reduced the percentage of oocyst-positive feces in 2 other snakes from 75.5% to 24.5% and from 83.9% to 33.6%. Biopsies and necropsies revealed stages of Cryptosporidium in the gastric mucosa of all spiramycin-treated animals. The gastric mucosa was thickened and edematous, with focal necrosis, mucosal petechiae, and brush hemorrhages. Fibroplasia of lamina propria associated with chronic mucosal inflammation were common. Examination of direct fecal smears was found not to be a reliable technique for diagnosis of cryptosporidial infections in snakes.

Cryptosporidium serpentis oocysts and microsporidian spores in feces of captive snakes.

Fecal smears of 90 snakes, 29 lizards, and 8 turtles and tortoises were tested for Cryptosporidium spp. oocysts and microsporidian spores. Microsporidian spores measured mean = 3.7 microm in length and mean = 2.3 microm in width and were present in feces of 19 snakes and 1 lizard (16%); 13 of these snakes also shed Cryptosporidium serpentis oocysts. The oocysts were numerous in all positive samples, whereas microsporidian spores were always sparse, irrespective if whether fecal samples contained the oocysts. Retrospective examination of reptile clinical records revealed that all animals shedding microsporidian spores died naturally due to diseases, pathologic conditions, and clinical problems or were killed due to severe cryptosporidiosis. The present study indicates that microsporidian infections in reptiles have the features of an opportunistic infection.

Multiple heterogenous isolates of Cryptosporidium serpentis from captive snakes are not transmissible to neonatal BALB/c mice (Mus musculus).

Oral inoculations of 9 litter-groups of 3 5-day-old suckling BALB/c mouse pups (Mus musculus) with 6.7 x 10(3) to 1.2 x 10(5) per pup of viable, Cryptosporidium serpentis oocysts from snakes resulted in no transmission. Mice showed normal development; the litter-group weight gain was not altered significantly (P > 0.05) relative to the total number of C. serpentis oocysts inoculated or to the initial group weight (P > 0.05). Histological sections of stomach, duodenum, jejunum, ileum, cecum, and colon 4 days postinoculation did not contain life-cycle stages of Cryptosporidium in any inoculated mice. Because these neonatal, C. parvum-susceptible BALB/c mice were resistant to infection it is unlikely that C. serpentis transmission to the snakes "via infected prey" results when captive snakes are maintained on a diet of BALB/c mice.

Cryptosporidium parvum is not transmissible to fish, amphibians, or reptiles.

A recent report suggested that an isolate of Cryptosporidium parvum had established infections in fish, amphibians, and reptiles and raises concern that animals other than mammals might be a potential source of waterborne Cryptosporidium oocysts. To test this possibility, viable C. parvum oocysts, infectious for neonatal BALB/c mice, were delivered by gastric intubation to bluegill sunfish, poison-dart frogs, African clawed frogs, bearded dragon lizards, and corn snakes. Histological sections of the stomach, jejunum, ileum, and cloaca prepared from tissues collected on days 7 and 14 postinoculation (PI) were negative for Cryptosporidium developmental stages. However, inoculum-derived oocysts were detectable by fluorescein-labeled monoclonal antibody in feces of inoculated animals from day 1 to day 12 PI in fish and frogs, and up to day 14 PI in lizards. Snakes did not defecate for 14 days PI. Impression smears taken at necropsy on days 7 and 14 PI revealed C. parvum oocysts in the lumen of the cloaca of 2 fish and 1 lizard on day 7 PI only. Because tissue stages of the pathogen were not found, it appears that C. parvum was not heterologously transmitted to lower vertebrates. Under certain circumstances, however, such as after the ingestion of C. parvum-infected prey, lower vertebrates may disseminate C. parvum oocysts in the environment.

ELISA method for detecting anti-Plasmodium relictum and anti-Plasmodium elongatum antibody in infected duckling sera using Plasmodium falciparum antigens.

An enzyme-linked immunosorbent assay (ELISA) with 3 Plasmodium falciparum NF-54 antigens, R32tet32, P.F.R27, and crude red blood cell extract (CRBCE), was tested for detection of anti-Plasmodium relictum and anti-Plasmodium elongatum antibodies in sera from experimentally infected ducklings. Whole blood, serum, and dried blood on filter paper gave similar results. The latter was selected for convenience. All birds infected by experimental blood challenge, but not exposed to sporozoites, had detectable antibody (up to 1.0 x 10(-3.8) dilution) reactive with R32tet32, P.F.R27, and CRBCE antigens. Ducklings infected with P. elongatum had higher antibody levels than those infected with P. relictum. In a blind trial, the described ELISA accurately distinguished sera taken from infected and uninfected ducklings. This study provides the first evidence on cross reactivity in the ELISA format between P. falciparum antigens and antibodies induced by P. relictum and P. elongatum in experimentally infected ducklings. The proposed ELISA is fast, easy to perform, reproducible, and requires a minimal amount of equipment. The assay can be used for the detection of P. relictum and P. elongatum antibodies in captive or wild ducks, along with monitoring the level of antibody in selected groups of birds or for surveys of laboratory experiments where evidence of infection is required.

Successful hyperimmune bovine colostrum treatment of Savanna monitors (Varanus exanthematicus) infected with Cryptosporidium sp.

Therapy based on the protective passive immunity of hyperimmune bovine colostrum (HBC) (raised against Cryptosporidium parvum in cows) was applied to 4 Savanna monitors (Varanus exanthematicus) with gastric Cryptosporidium sp. infections. All lizards were moderately emaciated, and their fecal and gastric lavage samples contained moderate numbers of Cryptosporidium sp. oocysts. The first 3 of 7 gastric HBC treatments at 1-wk interval each decreased the numbers of oocysts in the fecal and gastric samples to undetectable levels. Neither feces nor lavages of the HBC-treated lizards contained Cryptosporidium sp. oocysts after the HBC therapy, whereas such samples of a single control lizard remained positive for oocysts. Two of the HBC-treated lizards died spontaneously due to metastasized carcinoma and septicemia of unknown etiology, respectively, and 2 lizards treated and killed during the experiment were histologically negative for developmental stages of Cryptosporidium sp. The control lizard died spontaneously of septicemia of unknown etiology and contained developmental stages of Cryptosporidium sp. in the gastric region. The HBC therapy was efficacious in V. exanthematicus and is recommended for lizards with gastric cryptosporidiosis.

Extraction of Haemoproteus columbae (Haemosporina: Haemoproteidae) antigen from rock dove pigeons (Columba livia) and its use in an antibody ELISA.

Erythrocytic stages of Haemoproteus columbae were extracted from the cytoplasm of nucleated red blood cells (RBC) of Rock dove pigeons (Columba livia) using cationic detergent (N,N',N'-polyoxyethylene(10)-N-tallow-1,3-diaminopropane [EDTA-20]) and discontinuous Percoll gradient density. Crude RBC extract (CRBCE) antigen was prepared. Parasitized RBCs were more resistant to EDTA-20 action than unparasitized cells. An enzyme-linked immunosorbent assay (ELISA) was developed for detection of anti-H. columbae immunoglobulins in 30 wild-captured C. livia. Whole blood, serum, and dried blood on filter paper gave similar results; the latter was selected for sampling convenience. Optimal antigen concentration was 5 micrograms/ml, and anti-H. columbae immunoglobulins were detectable at a 10(-4.11) dilutions. The binding efficacy of anti-chicken IgG to the pigeon immunoglobulins was significantly higher than anti-duck IgG or anti-turkey IgG. Parasitemia by Giemsa-stained thin blood smears ranged from 20.0 to 47.5%, mean = 32.4 +/- 8.3%; 17 of 30 birds had multiply infected RBCs with a mean parasitemia of 2.4 +/- 1.1%, range 0.7-4.9%; 27 birds were positive by the ELISA. No clinical signs of infection were observed. ELISA absorbance values were not correlated with the level of parasitemia in individual birds. All pigeons were negative for anti-Plasmodium relictum and anti-P. elongatum immunoglobulins as determined by ELISA. The pigeons were not subclinically infected with Plasmodium spp. as determined by inoculation of domestic ducklings with blood from dexamethasone-immunosuppressed pigeons.

Capillaria hepatica (Nematoda) infections in human-habituated mountain gorillas (Gorilla gorilla beringei) of the Parc National de Volcans, Rwanda.

Habituation to humans of free-ranging populations of endangered mountain gorillas (Gorilla gorilla beringei) raised concern of anthropozoonotic transmission of parasitic helminths and protozoans. Examinations of liver tissue of 19 gorillas found dead in the Parc National de Volcans, Rwanda, revealed 10 cases of hepatic nematodiasis due to Capillaria hepatica. Identifiable C. hepatica eggs were present in the liver of 4 gorillas (3 juveniles, 1 adult), and nematode cross-sections were found in 1 juvenile gorilla. Six other adult gorillas had areas of periportal and subcapsular fibrosis with calcified eggs. Histologically, the lesions surrounded by the areas of mild inflammatory reaction were characterized by subcapsular, periportal foci of fibrosis in which were embedded numerous C. hepatica eggs. Control of hepatic capillariasis in the remaining populations of mountain gorillas should be focused on eradication or control of populations of rodent pests (i.e., mice and rats) that sustain the reservoir of C. hepatica in habitats shared by gorillas and humans.

Multiple Cryptosporidium serpentis oocyst isolates from captive snakes are not transmissible to amphibians.

Viable Cryptosporidium serpentis oocysts originating from 6 captive snakes were gastrically delivered to 12 Cryptosporidium-free African clawed frogs and 9 tadpoles and 3 recently metamorphosed adults of Cryptosporidium-free wood frogs. On days 7 and 14 postinoculation, no life-cycle stage of Cryptosporidium was observed in any of the histological sections of stomach, jejunum, ileum, cloaca, and cecum. However, viable inoculum-derived C. serpentis oocysts were recovered from the water in which the amphibians were kept. Amphibians may disseminate C. serpentis oocysts in the natural habitat.

Characteristics of naturally acquired Plasmodium relictum capistranoae infections in naive Hawaiian crows (Corvus hawaiiensis) in Hawaii.

Indigenous to Hawaii, the Hawaiian crow (Corvus hawaiiensis) is the world's most severely endangered species with only 3 reproductively active pairs remaining in the wild. Seven captive-reared, avian malaria-naive C. hawaiiensis were exposed in an outdoor aviary and hematologically and serologically monitored for 9 wk. Three birds showed Plasmodium relictum capistranoae parasitemia (6.35%, 2.15%, and 0.60%). All birds were seroconverted for malaria on week 7 as determined by enzyme-linked immunosorbent assay (ELISA). Malaria IgG levels of exposed parasitemic birds did not differ from those of exposed nonparasitemic C. hawaiiensis and were not significantly correlated with the level of parasitemia. Four of 9 hematological parameters, e.g., white blood cell count (WBC), relative and absolute lymphocytosis, and total solids (TS), showed significant increases related to ELISA-determined malarial infection. The sensitivity, specificity, and the positive predictive values of these 4 parameters for malarial infections in C. hawaiiensis were higher than 66%, with the WBC and TS sensitivity reaching 100%. The reference range of 9 hematological parameters was established based on uninfected, clinically healthy C. hawaiiensis. Seven birds were successfully treated and released, increasing the total wild C. hawaiiensis world population by approximately 50%.

Cryptosporidium parvum oocysts recovered from water by the membrane filter dissolution method retain their infectivity.

Cryptosporidium parvum oocysts infectious to neonatal BALB/c mice were processed by the cellulose-acetate membrane (CAM) filter dissolution method to determine if the procedure that utilizes acetone incubation and alcohol centrifugations alters their viability (determined by in vitro excystation) or infectivity (determined by infectivity bioassay). In addition, most oocysts with altered viability by desiccation, heat inactivation, and snap freezing that were processed by the CAM filter dissolution method were nonrefractile, unstained oocyst ghosts. The remaining organisms, oocyst shells, were lightly stained with the acid-fast stain. Infectious oocysts retained their infectivity and nonviable oocysts (oocyst shells) retained their morphology when processed by the CAM dissolution method. Infectious oocysts, oocyst shells, and oocyst ghosts produced positive reactions of similar intensity in direct immunofluorescence antibody staining, utilizing the MERIFLUOR Cryptosporidium/Giardia test kit. Cryptosporidium oocysts recovered from finished drinking water by the CAM dissolution method can be subjected to testing for their viability and infectivity.

Fatal cryptosporidiosis in a juvenile captive African hedgehog (Ateletrix albiventris).

Fatal intestinal cryptosporidiosis of unknown source and unexplained epizootiology is reported in a neonatal captive African hedgehog (Ateletrinx albiventris) and for the first time in a hedgehog species. The infection, confined to ileum, jejunum, and colon, was extremely severe in the lower jejunum where over 75% of the epithelial cells harbored the pathogen. The ileum and the jejunum displayed moderate and severe villus atrophy and mucosal hyperplasia. Lamina propria and mucosa were infiltrated by eosinophils, lymphocytes, and macrophages. Developmental stages of Cryptosporidium sp. produced a positive reaction with immunofluorescent antibody for detection of the human pathogen, Cryptosporidium parvum. Personnel of captive centers with hedgehogs should be alerted and undertake appropriate precautions to prevent zoonotic transmission. Commercially offered hedgehog-pets may pose a risk for Cryptosporidium infection for human immunodeficiency virus-infected people.