Symptomatic and Asymptomatic Protist Infections in Hospital Inpatients in Southwestern China.

Cryptosporidium spp., Entamoeba histolytica, Giardia duodenalis, and Blastocystis sp. infections have been frequently reported as etiological agents for gastroenteritis, but also as common gut inhabitants in apparently healthy individuals. Between July 2016 and March 2017, stool samples (n = 507) were collected from randomly selected individuals (male/female ratio: 1.1, age range: 38-63 years) from two sentinel hospitals in Tengchong City Yunnan Province, China. Molecular (PCR and Sanger sequencing) methods were used to detect and genotype the investigated protist species. Carriage/infection rates were: Blastocystis sp. 9.5% (95% CI: 7.1-12.4%), G. duodenalis 2.2% (95% CI: 1.1-3.8%); and E. histolytica 2.0% (95% CI: 0.9-3.6%). Cryptosporidium spp. was not detected at all. Overall, 12.4% (95% CI: 9.7-15.6) of the participants harbored at least one enteric protist species. The most common coinfection was E. histolytica and Blastocystis sp. (1.0%; 95% CI: 0.3-2.2). Sequence analyses revealed that 90.9% (10/11) of the genotyped G. duodenalis isolates corresponded to the sub-assemblage AI. The remaining sequence (9.1%, 1/11) was identified as sub-assemblage BIV. Five different Blastocystis subtypes, including ST3 (43.7%, 21/48), ST1 (27.1%, 13/48), ST7 (18.8%, 9/48), ST4 (8.3%, 4/48), and ST2 (2.1%, 1/48) were identified. Statistical analyses confirmed that (i) the co-occurrence of protist infections was purely random, (ii) no associations were observed among the four protist species found, and (iii) neither their presence, individually or jointly, nor the patient's age was predictors for developing clinical symptoms associated with these infections. Overall, these protist mono- or coinfections are asymptomatic and do not follow any pattern.

Molecular Characterization and Immunological Evaluation of Truncated Babesia microti Rhoptry Neck Protein 2 as a Vaccine Candidate.

Babesia microti is a protozoan that infects red blood cells. Babesiosis is becoming a new global threat impacting human health. Rhoptry neck proteins (RONs) are proteins located at the neck of the rhoptry and studies indicate that these proteins play an important role in the process of red blood cell invasion. In the present study, we report on the bioinformatic analysis, cloning, and recombinant gene expression of two truncated rhoptry neck proteins 2 (BmRON2), as well as their potential for incorporation in a candidate vaccine for babesiosis. Western blot and immunofluorescence antibody (IFA) assays were performed to detect the presence of specific antibodies against BmRON2 in infected mice and the localization of N-BmRON2 in B. microti parasites. In vitro experiments were carried out to investigate the role of BmRON2 proteins during the B. microti invasion process and in vivo experiments to investigate immunoprotection. Homologous sequence alignment and molecular phylogenetic analysis indicated that BmRON2 showed similarities with RON2 proteins of other Babesia species. We expressed the truncated N-terminal (33-336 aa, designated rN-BmRON2) and C-terminal (915-1171 aa, designated rC-BmRON2) fragments of the BmRON2 protein, with molecular weights of 70 and 29 kDa, respectively. Western blot assays showed that the native BmRON2 protein is approximately 170 kDa, and that rN-BmRON2 was recognized by serum of mice experimentally infected with B. microti. Immunofluorescence analysis indicated that the BmRON2 protein was located at the apical end of merozoites, at the opposite end of the nucleus. In vitro red blood cell invasion inhibition studies with B. microti rBmRON2 proteins showed that relative invasion rate of rN-BmRON2 and rC-BmRON2 group is 45 and 56%, respectively. Analysis of the host immune response after immunization and B. microti infection showed that both rN-BmRON2 and rC-BmRON2 enhanced the immune response, but that rN-BmRON2 conferred better protection than rC-BmRON2. In conclusion, our results indicate that truncated rhoptry neck protein 2, especially its N-terminal fragment (rN-BmRON2), plays an important role in the invasion of host red blood cells, confers immune protection, and shows good potential as a candidate vaccine against babesiosis.

Prevalence and risk factors of Fascioliasis in China.

Fascioliasis has emerged as a significant public health problem among ruminants and humans. Human fascioliasis is a neglected food-borne parasitic disease, which has emerged or reemerged in more than 60 countries worldwide. In China, the first case of human fascioliasis was reported in 1921 in Fujian Province. The first major outbreak of this parasitic disease in 29 patients occurred in 2012 in Yunnan Province. Nonetheless, the prevalence of fascioliasis in China is probably underestimated due to the poor sensitivity of diagnostic tests, limited epidemiological data, and a poor understanding of the impact of subclinical illness. This study aimed to review the prevalence and risk factors of fascioliasis in China so as to improve the prevention and control of this disease.

Urgent needs in fostering neglected tropical diseases (NTDs) laboratory capacity in WHO Western Pacific Region: results from the external quality assessment on NTDs diagnosis in 2012-2015.

BACKGROUND: Neglected tropical diseases (NTDs) are a heterogeneous group of mainly chronic, debilitating and often stigmatizing diseases that largely affects low-income and politically marginalized populations, causing a large burden of public health, social and economies in the NTDs endemic countries. NTDs are caused by infections with a range of pathogen, including bacteria, parasites, protozoa and viruses. The accurate diagnosis of NTDs is important for reducing morbidity, preventing mortality and for monitoring of control programs. External Quality Assessment (EQA), a component of laboratory quality assurance, aims to assess the performance of participating laboratories in detecting parasitic infections. The aim of this paper is to report the findings and put forward the recommendations on capacity build from the EQA results of participating NTDs laboratories in selected countries in the WHO Western Pacific Region from 2012 to 2015. METHODS: Reference or public health laboratories at national level working on NTDs in 6 countries participated in EQAs organized by the National Institute of Parasitic Diseases (NIPD) of Chinese Center for Disease Control and Prevention (CDC) based in Shanghai, China. Two representatives of each participating laboratory were invited to NIPD to detect NTDs' parasitic infections using the same prepared samples for serological tests (IHA and ELISA) and helminth eggs' morphological tests (Direct smear and Kato-Katz). All of the results were scored and analyzed by using SPSS statistics 19.0 software. RESULTS: The percentage of participants who had EQA score ≥ 60 during 2012-2015 for direct smear test were 80.00% (2012), 71.43% (2013), 100% (2014) and 75.00% (2015), whereas for Kato-Katz test were 80.00% (2012), 57.14% (2013), 100% (2014) and 37.50% (2015), respectively. The detection rate of helminth eggs varied in different species, with Ascaris lumbricoides being the highest at 94.07% in average. All laboratories did very well with ELISA tests as shown by the high scores in all four years except Lab A in the first and last EQA. For the positive or negative judgments of serum samples, the total coincidence rates of ELISA between 2012 and 2015 were 90.00%, 99.29%, 94.29% and 98.75%, respectively. While the total coincidence rates of IHA were respectively 100%, 95.00%, 90.00% and 97.50%. However, detecting low levels of serum antibody remained problematic for IHA when the titres of samples were taken into consideration. CONCLUSION: This study demonstrate that EQA scheme have been beneficial to the participating laboratories. The EQA programme identifies certain deficiencies which were needed to overcome and improved the laboratories' performance in helminthiasis diagnosis. However, further optimization of accuracy and uniformity in NTDs diagnosis remains a big challenge.

[Observation on growth status of Blastocystis hominis in three media].

OBJECTIVE: To observe the growth situation of Blastocystis hominis in vitro and select the optimal method for cultivation of B. hominis in different media. METHODS: Ten positive stools with B. hominis were inoculated in three different media for cultivating, namely 1640, Jone's medium and vitro medium. And the stools with good growth status and high quantities of B. hominis were chosen to inoculate in the three media with equal amount after subcultivation, and the number of B. hominis was counted every 24 h for ten days, and the morphological changes and growth status were also observed. RESULTS: The densities of B. hominis in the 1640 and Jone's medium were higher than that in the vitro medium 48 h after the inoculation. The same stool sample was inoculated to the three different media and observed for ten days, and the results indicated that the growth of B. hominis presented regular changes in the three media, the growth peaks were on the third, sixth and ninth day post inoculation; and the density of B. hominis was the highest in the Jone's medium. The morphology of B. hominis was the clearest and most dynamic in the vitro medium, while various reproductive forms were observed in the Jone's medium. CONCLUSION: Jone's medium is suitable for the growth of B. hominis and can be the first choice for the cultivation of B. hominis in vitro, and vitro medium is the best medium for observing the growth situation of B. hominis.

[Infection of Giardia lamblia in HIV-Infected Individuals and in Kindergarden Children in Rural Area of Anhui and Genotype Analysis].

Objective: To understand the situation of Giardia lamblia infection in HIV-infected individuals and in kindergarden children in rural area of Anhui Province and analyze the genotype of the parasite. Methods: HIV-infected individuals registered in an AIDS treatment facility and children in a local kindergarden were included in this study during April 24 and May 9, 2015. The feces were collected, stained by iodine solution, and examined by microscopy. DNA was extracted from the positive feces, and nested PCR was performed to amplify the triosephosphate isomerase（tpi） gene of G. lamblia. The products were sequenced. The phylogenetic tree was constructed with BLAST, ClustalX 1.83 and MEGA6.0 softwares for analysis of homology and phylogeny. Results: One hundred and twenty-seven HIV-infected individuals and 125 kindergarden children were included. G. lamblia infection was found in three children and one HIV-infected individual. The infection detection rate in children and HIV patients was 2.40% （3/125） and 0.79% （1/127）, respectively （P>0.05）. Feces of the three infected children was soft, and no symptoms of diarrhea and stomachache were complained. Feces of the HIV-infected individual was washy, and symptoms like diarrhea, stomachache, weakness and weight loss were reported. PCR produced a specific band at 500 bp for the four persons. The sequencing results further confirmed infection in these four persons. The duplicate samples of the infected HIV patient had a 79% sequence similarity, and were 79% and 98% homologous to the Shanghai human strain of G. lamblia (GenBank accession No: KF271445), respectively. The samples of the 3 children had a 99% similarity, and all were 79% homologous to the Shanghai human strain of G. lamblia. The phylogenetic tree showed that the isolate from the HIV patient was mixed genotype of A+B, while those from the 3 children were all assemblage A. There was a high similarity between the isolates. Conclusions: There is Giardia infections in HIV patients and kindergarden children in the area. The genotype of the isolate from the HIV individual is mixed assemblage A+B while those from the children are assemblage A.

[Establishment of animal model for Pneumocystis carinii and study on etiological and molecular biological detection technology].

OBJECTIVE: To establish an animal model for Pneumocystis pneumonia (PCP) and to study the etiological and molecular biological technology for PCP detection. METHODS: SD and Wistar rats were divided into experimental and control groups randomly. The animals in the experimental group were immunosuppressed by subcutaneous injection with dexamethasone 2 mg per time per rat, twice a week, while those in the control group underwent the same way of injection with physiological saline simultaneously. After the induction for 8 weeks, all the rats were killed and their bronchoalveolar lavage fluid (BALF) and lung tissues were collected for smear making and microscopic detection. Meanwhile, the BALF samples were detected by PCR, and the products were sequenced and compared with rat source PCP in GenBank. RESULTS: A total of 34 samples of lung tissue and BALF were observed. The etiological detection showed that the infection rates of the rats in the experimental and control groups were 29.2% (7/24) and 0, respectively. In the experimental group, the infection rates of SD and Wistar rats were 25.0% (3/12) and 33.3% (4/12), respectively, and the difference between them was not statistically significant (P = 0.31). The positive detection rates of the lung smears and BALF from SD rats in the experimental group were 25.0% (3/12) and 16.7% (2/12), respectively, while those in Wistar rats in the experimental group were 33.3% (4/12) and 16.7% (2/12), respectively, and there were no statistically significant difference between them (P = 0.34, 0.24). A total of 28 samples of BALF were detected by PCR, and the positive detection rates of rats in the experimental group and control group were 91.7% (26/28) and 0, respectively. The sequence analysis of the PCR products showed that it shared 100% homology with the genes of rat source PCP in Gen Bank (JX499145, GU133622 and EF646865). CONCLUSIONS: The animal model of PCP can be established by subcutaneous injection with dexamethasone. As animal models, there are no significant difference between SD rats and Wistar rats. PCR method is suitable for PCP detection at the early stage of infection, while etiological detection with high missing rate is not a right option.

[Establishment of A1E3 and B1C4 monoclonal antibody-based ELISA for detecting circulating antigen of Schistosoma japonicum and its preliminary application].

OBJECTIVE: To establish A1E3 and B1C4 monoclonal antibody-based ELISA for detecting circulating antigen of Schistosoma japonicum and explore its application value in the field. METHODS: The characteristics of A1E3 and B1C4 monoclonal antibodies were analyzed by SDS-PAGE and Western blotting. The SEA-based ELISA was used to evaluate the titers of A1E3 and B1C4. The orthogonal test was used to determine the best concentration of coating antibody B1C4 and optimal working concentration of A1E3-HRP. Under the optimal conditions, the serum samples of 20 acute schistosomiasis cases, 46 chronic schistosomiasis cases, and 20 control sera were tested to evaluate its detection sensitivity and specificity. Seventy-two antibody positive serum samples from Jiangling County of Hubei Province were detected and compared to a commercially available ELISA kit, to evaluate the detection effects of this method. RESULTS: The results of SDS-PAGE demonstrated that the purified A1E3 and B1C4 contained a clear heavy chain with molecular weight of 88,000 and 52,000 respectively and had the same light chain with molecular weight of 20,000; while Western blotting demonstrated that A1E3 and B1C4 could be recognized by SEA and serum samples of acute schistosomiasis cases. The SEA-based ELISA demonstrated the titers of B1C4 and A1E3 were 1:10(5) and 1:30,000, respectively. The serum samples from all the acute cases and 86.9% of the chronic cases showed a positive reaction. All of the control sera from healthy persons gave a negative response. The positive rates of the double monoclonal antibody ELISA and commercial ELISA for detecting the circulating antigen were 45.8% and 43.1% respectively, and there was no significant difference between the results of the two methods. CONCLUSION: A1E3 and B1C4 monoclonal antibody-based ELISA is established successfully. It exhibits a high sensitivity and specificity in detecting circulating antigen of Schistosoma japonicum.

Field comparison of circulating antibody assays versus circulating antigen assays for the detection of schistosomiasis japonica in endemic areas of China.

BACKGROUND: Schistosomiasis remains a serious public health problem in affected countries, and routine, highly sensitive and cost-effective diagnostic methods are lacking. We evaluated two immunodiagnostic techniques for the detection of Schistosoma japonicum infections: circulating antibody and circulating antigen assays. METHODS: A total of 1864 individuals (between 6 and 72 years old) residing in five administrative villages in Hubei province were screened by serum examination with an indirect hemagglutination assay (IHA). The positive individuals (titer ≥20 in IHA) were reconfirmed by stool examination with the Kato-Katz method (three slides from a single stool specimen). Samples of good serum quality and a volume above 0.5 ml were selected for further testing with two immunodiagnostic antibody (DDIA and ELISA) and two antigen (ELISA) assays. RESULTS: The average antibody positive rate in the five villages was 12.7%, while the average parasitological prevalence was 1.50%; 25 of the 28 egg-positive samples were also circulating antigen-positive. Significant differences were observed between the prevalence according to the Kato-Katz method and all three immunodiagnostic antibody assays (P-value <0.0001). Similar differences were observed between the Kato-Katz method and the two immunodiagnostic antigen assays (P-value <0.0001) and between the antigen and antibody assays (P-value <0.0001). CONCLUSION: Both circulating antibody and circulating antigen assays had acceptable performance characteristics. Immunodiagnostic techniques to detect circulating antigens have potential to be deployed for schistosomiasis japonica screening in the endemic areas.

[Effect comparison between two ELISA kits in IgG antibody detection of Echinococcus granulosus].

OBJECTIVE: To compare the effects of two ELISA kits on IgG antibody detection of human Echinococcus granulosus. METHODS: A Total of 134 sera of patients with echinococcosis, paragonimiasis westermani, clonorchiasis sinensis, schistosomiasis japonica, and cysticercosis cellulosae, and normal persons were detected by two IgG ELISA kits produced by different companies. Furthermore, the specificity, sensitivity and cross reactivity were counted and analyzed statistically. RESULTS: The sensitivity and specificity were extremely high of the two kits as 100.00%. The cross-reactivity rates were 25.00% (paragonimiasis westermani), 26.09% (clonorchiasis sinensis), 10.00% (schistosomiasis japonica), and 87.5% (cysticercosis), respectively, by using the kit produced by the Combined Company in Shenzhen; the cross-reactivity rates were 5.00% (paragonimiasis westermani), 13.04% (clonorchiasis sinensis), 20.00% (schistosomiasis japonica), and 93.75% (cysticercosis) respectively, by using the kit produced by Haitai Company in Zhuhai. In addition, there was a significant difference of Paragonimus westermani detection (P < 0.05), but the rests had no statistically significant differences (all P > 0.05) between the two kits. CONCLUSION: Both ELISA kits on IgG antibody detection of human Echinococcus granulosus have the advantages of a high sensitivity, specificity, convenience and high-speed. However, it is also in urgent need to further solve the cross-reactivity of Echinococcus granulosus with other parasites, in order to improve the accuracy of early diagnosis.

[Effect evaluation of three ELISA kits in detection of fasciolasis].

OBJECTIVE: To evaluate the effect of 3 ELISA kits on detection of human fasciolasis. METHODS: Twenty-six serum samples from patients with fasciolasis, 180 serum samples from patients with other parasitic diseases as well as 26 serum samples from healthy people were detected by ELISA kits which using soluble antigen of Fasciola gigantica, Fasciola hepatica (Fg-ELISA and Fh-ELISA) as well as IgG antigen ELISA detection kits made by DRG company in Germany. The effects of the 3 kits were evaluated. RESULTS: The sensitivities of Fg-ELISA, Fh-ELISA, and DRG-ELISA were 100.0%, 80.8% (95% CI: 65.7%-95.9%) and 100.0%, respectively; the specificities of the three were 87.9% (95% CI: 83.5%-92.4%), 85.0%(95% CI: 80.1%-89.9%) and 83.5% (95% CI: 78.4%-88.6%), respectively, and Youden indexes of them were 0.88, 0.66 and 0.84, respectively. The detection rate of Fg-ELISA (100%) was significantly higher than that of Fh-ELISA (80.8%) (P < 0.05). The A absolute value (A/CO) of Fg-ELISA was 1.70, which was also significantly higher than the value of Fh-ELISA (1.18) (P < 0.000 1). CONCLUSION: Fg-ELISA has a good detection effect and low cost, and is more suitable than Fh-ELISA and DRG-ELISA for clinical sample tests as well as massive screening in fasciolasis endemic areas in southwest China.

[Field evaluation of IgG antibody detection kits of Schistosoma japonicum and quality control analysis].

OBJECTIVE: To evaluate the application effect of an ELISA kit for detection of IgG antibody to Schistosomajaponicum in endemic areas. METHODS: In two schistosomiasis endemic villages of Eryuan County, Yunnan Province, there were 505 permanent residents enrolled in the study. Fecal examinations were carried out by using the nylon screen bag-egg concentration method. In paralleled testing, the ELISA kit was used for the villagers to detect the IgG antibody to S. japonicum. The assay was performed daily for 20 consecutive days, and the data were analyzed by comparison with the parasitological examination and by using the L - J quality control chart method. RESULTS: In 505 examinees, 290 were positive by ELISA, with a positive rate of 57.43%. The L-J chart analysis showed that the deviation of A450 value between the quality control sera A and B was within the controllable range. The fecal examination found 20 positives with a positive rate 3.96%. Compared with the fecal examination, the positive consistency rate of the ELISA method reached to 90.00%. CONCLUSION: The ELISA kit for detection of IgG antibody to S. japonicum is stable, reliable and suitable for the screening of schistosomiasis in the field.

[Establishment of the experimental animal model of Babesia microti].

OBJECTIVE: To establish the experimental animal model for the study of Babesia microti. METHODS: BALB/c mice, immunosuppressive BALB/c mice, SCID mice and NOD-SCID mice were inoculated with B. microti-infected red blood cells (RBC) by intraperitoneal injection respectively. After inoculation, thin blood smears were prepared every day, stained with Giemsa staining and examined for the presence of parasitemia. Three mice were dissected to examine the infectivity in bone marrow, brain, spleen, heart, lung, kidney and liver tissues. The infection rate of erythrocytes in different tissues was recorded, and the relationship between the infectivity of tissues and infection rate in peripheral blood was analyzed. Blood samples infected with B. microti were preserved in liquid nitrogen with dimethyl sulfoxide (DMSO) for 2 months. The thawed parasitized blood was injected into the BALB/c mice by same route and the parasitemia was monitored. RESULTS: The four kinds of mice were all infected by B. microti with parasitemia. The percentage of parasitized red blood cells from peripheral blood were 82.4% (BALB/c mice, d7), 73.2% (immunosuppressive BALB/c mice, d5), 86.4% (SCID mice, d8) and 72.5% (NOD-SCID mice, d8) at the maximum, respectively. Parasitemia decreased rapidly in BALB/c mice, whereas decreased slowly in immunosuppressive BALB/c mice. Only the parasitemia in SCID mice and NOD-SCID mice decreased significantly and tended to picking up again. The parasites were observed in RBCs from bone marrow, brain, spleen, heart, lung, kidney and liver tissues. The infection rate of erythrocytes in tissues increased with an increase of infection in peripheral blood. After cryopreservation, the parasites proliferated in BALB/c mice. Parasitemia appeared after inoculation with frozen infected blood two days later than that of fresh infected blood. The infection rate reached its peak after inoculation with frozen infected blood one day later than that of fresh infected blood. CONCLUSION: The experimental animal model of B. microti has been established. The infection rate of erythrocytes is related to the immune status of the host mice.

[Study on the solid state transformation of PET/nano-CaCO3 composites by variable temperature FTIR spectroscopy].

Solid state transformation of crude poly (ethylene terephthalate)(PET) and PET/nano-CaCO3 (MPET) composites were studied by variable temperature FTIR spectroscopy during the heating process from 40 to 250 degrees C. The effects of nanometer calcium carbonate(nano-CaCO3) on the solid state transformation and crystal correlation bands of MPET composites were analyzed by the curves of the ratio of 1 342 and 1 410 cm(-1) absorbency(A1 342/A1 410) with temperature increasing, and together with DSC curves in the same condition. The results showed that the crystallization degrees of crude PET and MPET are obviously different in this condition by adding nano-CaCO3 particles as inhomogeneous nucleating agents.

[Study on the peaks linked to the crystalline of L-LA with variable temperature FTIR spectra method].

Variable temperature FTIR spectra method was used to study the crystalline spectra of crystal compounds. In the present paper, the sample of L-LA was synthesized and characterized by FTIR, NMR and DSC. It was found that the two peaks in therange of 800-770 cm(-1) changed sharply at 95 degrees C after being investigated by FTIR spectra between 15-120 degrees C. When the temperature increased, these peaks remained almost unchanged, but they returned to the original state after annealing. It was deduced that these two peaks are linked to the crystalline of L-LA.