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Cryptosporidium and Giardia are important causes of diarrhoeal illness. Adequate knowledge of the molecular diversity and geographical distribution of these parasites and the environmental and climatic variables that influence their prevalence is important for effective control of infection in at-risk populations, yet relatively little is known about the epidemiology of these parasites in Africa. Cryptosporidium is associated with moderate to severe diarrhoea and increased mortality in African countries and both parasites negatively affect child growth and development. Malnutrition and HIV status are also important contributors to the prevalence of Cryptosporidium and Giardia in African countries. Molecular typing of both parasites in humans, domestic animals and wildlife to date indicates a complex picture of both anthroponotic, zoonotic and spill-back transmission cycles that requires further investigation. For Cryptosporidium , the only available drug (nitazoxanide) is ineffective in HIV and malnourished individuals and therefore more effective drugs are a high priority. Several classes of drugs with good efficacy exist for Giardia , but dosing regimens are suboptimal and emerging resistance threatens clinical utility. Climate change and population growth are also predicted to increase both malnutrition and the prevalence of these parasites in water sources. Dedicated and co-ordinated commitments from African governments involving “One Health” initiatives with multidisciplinary teams of veterinarians, medical workers, relevant government authorities, and public health specialists working together are essential to control and prevent the burden of disease caused by these parasites.

Background Parasitic infections, particularly those caused by protozoa, represent a considerable public health problem in developing countries. Blastocystis , Giardia duodenalis , Cryptosporidium spp. and the Entamoeba complex ( Entamoeba histolytica, Entamoeba dispar and Entamoeba moshkovskii) are the most common etiological causes of intestinal parasitic infections. Methods We carried out a descriptive cross-sectional study in school-age children attending a daycare institution in commune eight of Popayán, Cauca (Southwest Colombia). A total of 266 fecal samples were collected (258 from children and eight from pets). Blastocystis , G. duodenalis , Cryptosporidium spp. and the Entamoeba complex were identified by microscopy, quantitative real-time PCR (qPCR) and conventional PCR. The concordance of qPCR and microscopy was assessed using the Kappa index. Molecular characterization was conducted to identify Blastocystis subtypes (18S), G. duodenalis assemblages ( tpi and gdh ) and Cryptosporidium species/subtypes (18S and GP60). Potential associations between intestinal parasitism and sociodemographic factors were examined using bivariate analyses. Results A total of 258 fecal samples from children were analyzed by microscopy and 255 samples were analyzed by qPCR. The prevalence of Blastocystis was between 25.19% (microscopy) and 39.22% (qPCR), that of G. duodenalis was between 8.14% (microscopy) and 10.59% (qPCR), that of Cryptosporidium spp. was estimated at 9.8% (qPCR), and that of the Entamoeba complex was between 0.39% (conventional PCR) and 0.78% (microscopy). The concordance between microscopy and qPCR was very low. Blastocystis ST1 (alleles 4, 8, and 80), ST2 (alleles 11, 12, and 15), ST3 (alleles 31, 34, 36, 38,57, and 151), and ST4 (alleles 42 and 91), G. duodenalis assemblages AII, BIII, BIV and D, C. parvum subtype IIa and C. hominis subtype IbA9G3R2 were identified. The only identified member of the Entamoeba complex corresponded to E. histolytica . No statistically significant association was identified between parasitic infection and any sociodemographic variable. Conclusion This study revealed the usefulness of molecular methods to depict the transmission dynamics of parasitic protozoa in southwest Colombia. The presence of some of these protozoa in domestic animals may be involved in their transmission.

Techniques for sub-classifying morphologically identical Giardia duodenalis trophozoites have included comparisons of the electrophoretic mobility of enzymes and of chromosomes, and sequencing of genes encoding β-giardin, triose phosphate isomerase, the small subunit of ribosomal RNA and glutamate dehydrogenase. To date, G. duodenalis organisms have been sub-classified into eight genetic assemblages (designated A–H). Genotyping of G. duodenalis organisms isolated from various hosts has shown that assemblages A and B infect the largest range of host species, and appear to be the main (or possibly only) G. duodenalis assemblages that undeniably infect human subjects. In at least some cases of assemblage A or B infection in wild mammals, there is suggestive evidence that the infection had resulted from environmental contamination by G. duodenalis cysts of human origin. Les techniques pour sous-classer morphologiquement des trophozoïtes identiques de Giardia duodenalis ont inclus des comparaisons de la mobilité électrophorétique des enzymes et des chromosomes et le séquençage des gènes codant pour la β-giardine, la triose-phosphate isomérase, la petite sous-unité ribosomique de l’ARN et la glutamate déshydrogénase. À ce jour, G. duodenalis a été sous-classé en 8 assemblages génétiques (désignés par A-H). Le génotypage de G. duodenalis isolés à partir de divers hôtes a montré que les assemblages A et B infectent le grand plus grand nombre d’espèces d’hôtes, et semblent être les assemblages principaux (ou peut-être uniques) qui infectent les sujets humains de manière indéniable. Dans au moins certains cas d’infection chez les mammifères sauvages par les assemblages A ou B, des éléments indiquent que l’infection était due à la contamination de l’environnement par des kystes de G. duodenalis d’origine humaine.

Cryptosporidium and Giardia are globally significant protozoan parasites responsible for severe foodborne and waterborne outbreaks, posing substantial zoonotic and environmental risks. This study aimed to comprehensively assess the prevalence of cryptosporidiosis, giardiasis, and co-infections in Beni-Suef Governorate, Egypt, using an integrated diagnostic approach combining microscopy and molecular techniques. Additionally, it was sought to identify associated risk factors in cattle fecal samples. Microscopical examination of 970 cattle fecal samples revealed an overall infection rate of 67.42% (654/970), with Cryptosporidium detected in 42.68% (414/970), Giardia in 11.96% (116/970), and co-infections in 12.78% (124/970) of cases. In irrigation water, Cryptosporidium oocysts and Giardia cysts were detected in 2/24 (8.33%) and 1/24 (4.16%) of samples, respectively. Molecular and phylogenetic analyses identified Cryptosporidium hominis in cattle and, for the first time in Egypt, Cryptosporidium ubiquitum and Cryptosporidium ryanae in irrigation water, while also proving the presence of Cryptosporidium bovis and Giardia assemblage A in cattle. Risk factors, including sex, age, season, and fecal consistency, significantly influenced infection rates, with higher prevalence in females, calves under two months, spring season, and diarrheic feces. These findings underscore the urgent need for One Health-based control strategies, integrating targeted interventions to mitigate the burden of Cryptosporidium and Giardia infections and environmental contamination.

Treatment-refractory giardiasis is an emerging clinical problem. Of 4,285 giardiasis cases identified during 2008-2020 in Stockholm, Sweden, 102 (2.4%) were nitroimidazole refractory. Among cases acquired in India, the percentage was high (64/545 [12%]) and increased over time. The region of acquisition needs to be taken into consideration when managing patients.

Members of the Giardia genus are zoonotic protozoan parasites that cause giardiasis, a diarrheal disease of public and veterinary health concern, in a wide range of mammal hosts, including humans. We conducted a systematic review and meta-analysis to provide evidence-based data on the worldwide prevalence of Giardia infection in nonhuman mammals that can be used as scientific foundation for further studies. We searched public databases using specific keywords to identify relevant publications from 1980 to 2023. We computed the pooled prevalence estimates utilizing a random-effects meta-analysis model. Animals were stratified according to their taxonomic hierarchy, as well as ecological and biological factors. We investigated the influence of predetermined variables on prevalence estimates and heterogeneity through subgroup and meta-regression analyses. We conducted phylogenetic analysis to examine the evolutionary relationships among different assemblages of G. duodenalis. The study included 861 studies (1,632 datasets) involving 4,917,663 animals from 327 species, 203 genera, 67 families, and 14 orders from 89 countries. The global pooled prevalence of Giardia infection in nonhuman mammals was estimated at 13.6% (95% CI: 13.4-13.8), with the highest rates observed in Rodentia (28.0%) and Artiodactyla (17.0%). Herbivorous (17.0%), semiaquatic (29.0%), and wild (19.0%) animals showed higher prevalence rates. A decreasing prevalence trend was observed over time (β = -0.1036477, 95% CI -0.1557359 to -0.0515595, p < 0.000). Among 16,479 G. duodenalis isolates, 15,999 mono-infections belonging to eight (A-H) assemblages were identified. Assemblage E was the predominant genotype (53.7%), followed by assemblages A (18.1%), B (14.1%), D (6.4%), C (5.6%), F (1.4%), G (0.6%), and H (0.1%). The highest G. duodenalis genetic diversity was found in cattle (n = 7,651, where six assemblages including A (13.6%), B (3.1%), C (0.2%), D (0.1%), E (81.7%), and mixed infections (1.2%) were identified. Domestic mammals are significant contributors to the environmental contamination with Giardia cysts, emphasizing the importance of implementing good management practices and appropriate control measures. The widespread presence of Giardia in wildlife suggests that free-living animals can potentially act as sources of the infection to livestock and even humans through overlapping of sylvatic and domestic transmission cycles of the parasite.

Intestinal protozoan infections (IPI), including Entamoeba spp., Giardia lamblia and Cryptosporidium spp., are common in diarrhoea patients in Malaysia. These parasites are primarily transmitted through contaminated food and water sources and pose a significant public health concern. Entamoeba spp., causes amoebiasis, which is characterised by severe diarrhoea with bloody stools, while Giardia spp., causes giardiasis, which is characterised by watery diarrhoea, abdominal pain and flatulence. Cryptosporidium spp. causes cryptosporidiosis, which is particularly severe in immunocompromised individuals. Despite efforts to improve water quality, sanitation, hygiene, and surveillance, limited epidemiological data prevent a clear understanding of the prevalence of intestinal protozoa and response to treatment. This systematic review and meta-analysis aimed to estimate prevalence, identify risk factors, and evaluate detection methods. A comprehensive literature search was carried out in the following databases: Scopus, Google Scholar, Web of Science, PubMed and Cochrane Library. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidance. Based on the random effects model, results were reported as proportions with 95% confidence intervals (CI). Subgroup analyses were performed based on detection methods, target populations and regions. A total of 103 articles were found on the prevalence and risk factors of IPI in Malaysia. After removing duplicates and screening for eligibility, 49 studies were included in this meta-analysis. The overall pooled prevalence of IPI in Malaysia was 24% (95% CI: 0.17.0, 0.29). with I2 = 98.94%, (P < 0.001). Among the identified protozoa, Entamoeba spp. had the highest prevalence at 18% (95% CI: 0.12, 0.24), followed by G. lamblia at 11% (95% CI: 0.08, 0.14) and Cryptosporidium spp. at 9% (95% CI: 0.03, 0.14). A subgroup analysis revealed that Kelantan and Perak state have the highest prevalence of 39% and 29% while Selangor and Kuala Lumpur reported the lowest (13.6%). The highest prevalence was observed in the indigenous communities (27%), followed by the local communities that mainly comes from rural area (23%). According to a meta-analysis of ten risk factors, the pooled prevalence of protozoal intestinal infections was significantly higher (between 38% and 52%) in children under 15 years of age, in males, in those with low income or no formal education, and in those exposed to untreated water, poor sanitation or unhygienic practises. A high level of heterogeneity was observed (I2 > 98%), reflecting substantial variability across the included studies. This review provides valuable insights into the epidemiology of protozoal intestinal infections in Malaysia. The high pooled prevalence of 24% underscores a substantial and ongoing burden of intestinal protozoal infections in Malaysia. The pooled prevalence should be interpreted with caution due to high heterogeneity, as the findings may not be generalizable to all settings. These findings support the development of evidence-based interventions to reduce the impact of these infections. Targeted screening, improved diagnostics, better access to clean water and sanitation, and health education for vulnerable groups are essential to reduce the burden of intestinal protozoa and strengthen national control measures.

Cryptosporidiosis, giardiasis, and blastocystosis are among the most important parasitic diseases common between humans and cats. In addition, there are concerns about the possible transmission of zoonotic parasites from infected cats to humans. Hence, we investigated the molecular epidemiology of Cryptosporidium spp., Giardia duodenalis , and Blastocystis sp. in stray and household cats and cat owners. Our study was performed on 132, 33, and 33 fecal samples of stray and household cats, as well as cat owners in Tehran, Iran. Cryptosporidium spp. was identified using a nested PCR targeting the small subunit ribosomal RNA gene ( SSU rRNA) and sequencing the internal amplified fragments. Furthermore, to perform multilocus genotyping of G. duodenalis , the ß-giardin ( bg ), glutamate dehydrogenase ( gdh ), and triosephosphate isomerase ( tpi ) genes were amplified to assess the DNA of G. duodenalis in the fecal samples of cats and cat owners. In addition, Blastocystis was detected by targeting the SSU rRNA gene, and the subtypes of Blastocystis were determined via the sequencing of amplicons. Cryptosporidium felis and Cryptosporidium canis were detected in seven stray cats (5.3%) and one household cat (3%). The bg gene of G. duodenalis was amplified and successfully sequenced in two (1.5%) stray cats and revealed assemblages F and B of G. duodenalis . Sequencing and phylogenic analysis of SSU rRNA gene nucleotide sequences of Blastocystis detected ST5 and ST10 in stray cats (1.5%), ST1 in household cats (9.1%), and ST1, ST2, ST3, and ST7 in owners (30.3%). The low prevalence of Cryptosporidium, Giardia and Blastocystis in cats and the presence of species/assemblages/subtypes with limited zoonotic potential indicate that cats had a minor role in their owners' infection in the investigated population. However, the presence of zoonotic protozoa in cats suggests the necessity of special attention to high-risk individuals during close contact with cats. Therefore, it is recommended that veterinarians, physicians, and urban managers plan to prevent, control, or treat these parasites to help the urban community live healthily alongside cats.

Domestic animals can harbor a variety of enteric unicellular eukaryotic parasites (EUEP) with zoonotic potential that pose risks to human health. The aim of this study was to evaluate the occurrence and genetic diversity of EUEP of zoonotic relevance in domestic animals in Iran. Faecal samples were collected from cattle, sheep, camels, goats, donkeys, horse, and dogs. A real-time PCR was performed to detect the parasites, followed by sequence-based genotyping analyses on isolates that tested positive for Enterocytozoon bieneusi , Giardia duodenalis , and Blastocystis sp.. Overall, 53 out of 200 faecal samples (26.5%, 95% CI 20.5–33.2) were positive for one or more EUEP. Enterocytozoon bieneusi was found in 23.8%, 12.0%, 26.1%, and 13.3% of cattle, sheep, goats, and camels, respectively. Giardia duodenalis was identified in 19.3% of cattle and 6.7% of camels. Blastocystis sp. was detected in 5.7% of cattle and 16.7% of camels. Enterocytozoon bieneusi genotypes macaque1, J, BEB6, and CHG3 were identified in 3.7% (1/27), 3.7% (1/27), 44.4% (12/27), and 48.2% (13/27) of the isolates, respectively. Giardia duodenalis assemblage B and Blastocystis subtype 10 were identified in one cattle and one camel isolate, respectively. These findings suggest that domestic animals could serve as potential reservoirs for EUEP of zoonotic relevance and might play a significant role in transmitting these parasites to humans and other animals.

Giardia lamblia infections are nearly universal among children in low-income countries and are syndemic with the triumvirate of malnutrition, diarrhea, and developmental growth delays. Amidst the morass of early childhood enteropathogen exposures in these populations, G. lamblia–specific associations with persistent diarrhea, cognitive deficits, stunting, and nutrient deficiencies have demonstrated conflicting results, placing endemic pediatric giardiasis in a state of equipoise. Many infections in endemic settings appear to be asymptomatic/ subclinical, further contributing to uncertainty regarding a causal link between G. lamblia infection and developmental delay. We used G. lamblia H3 cyst infection in a weaned mouse model of malnutrition to demonstrate that persistent giardiasis leads to epithelial cell apoptosis and crypt hyperplasia. Infection was associated with a Th2-biased inflammatory response and impaired growth. Malnutrition accentuated the severity of these growth decrements. Faltering malnourished mice exhibited impaired compensatory responses following infection and demonstrated an absence of crypt hyperplasia and subsequently blunted villus architecture. Concomitantly, severe malnutrition prevented increases in B220+ cells in the lamina propria as well as mucosal Il4 and Il5 mRNA in response to infection. These findings add insight into the potential role of G. lamblia as a \"stunting\" pathogen and suggest that, similarly, malnourished children may be at increased risk of G. lamblia– potentiated growth decrements.