Opisthorchis Viverrini Infection in Bithynia Snail Habitat Courtney C
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Nawrocki et al. Parasites & Vectors (2019) 12:66 https://doi.org/10.1186/s13071-019-3313-2 SHORTREPORT Open Access Culture of fecal indicator bacteria from snail intestinal tubes as a tool for assessing the risk of Opisthorchis viverrini infection in Bithynia snail habitat Courtney C. Nawrocki1, Nadda Kiatsopit2,3, Jutamas Namsanor2,3, Paiboon Sithithaworn2,3 and Elizabeth J. Carlton1* Abstract Background: Like many trematodes of human health significance, the carcinogenic liver fluke, Opisthorchis viverrini, is spread via fecal contamination of snail habitat. Methods for assessing snail exposure to fecal waste can improve our ability to identify snail infection hotspots and potential sources of snail infections. We evaluated the feasibility of culturing fecal indicator bacteria from Bithynia snail intestinal tubes as a method for assessing snail exposure to fecal waste. Snails and water samples were collected from a site with a historically high prevalence of O. viverrini infected snails (“hotspot” site) and a site with historically no infected snails (“non-hotspot” site) on two sampling days. Snails were tested for O. viverrini and a stratified random sample of snails from each site was selected for intestinal tube removal and culture of gut contents for the fecal indicator bacteria, Escherichia coli. Water samples were tested for E. coli and nearby households were surveyed to assess sources of fecal contamination. Results: At the hotspot site, 26 of 2833 Bithynia siamensis goniomphalos snails were infected with O. viverrini compared to 0 of 1421 snails at the non-hotspot site. A total of 186 snails were dissected and cultured. Escherichia coli were detected in the guts of 20% of uninfected snails, 4% of O. viverrini-positive snails and 8% of snails not examined for cercarial infection at the hotspot site. Only one of 75 snails from the non-hotspot site was positive for E. coli. Accounting for sampling weights, snails at the hotspot site were more likely to have gut E. coli than snails from the non-hotspot site. The concentration of fecal indicator bacteria in surface water was higher at the hotspot vs non-hotspot site on only the first sampling day. Conclusions: Fecal indicator bacteria can be detected in the intestinal tubes of Bithynia snails. The presence of fecal indicator bacteria in Bithynia snail guts may indicate risk of O. viverrini infection in snail populations. This method has the potential to aid in identifying locations and time windows of peak snail infection risk and may be applicable to other trematodes of human-health significance. Keywords: Opisthorchis viverrini, Liver fluke, Bithynia, E. coli, Fecal indicator bacteria, Dissection * Correspondence: [email protected] 1Department of Environmental and Occupational Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA Full list of author information is available at the end of the article © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Nawrocki et al. Parasites & Vectors (2019) 12:66 Page 2 of 8 Background in and around snail habitat. Fecal indicator bacteria such Opisthorchis viverrini is a food-borne, trematode parasite as Escherichia coli are appropriate indicators of fecal that is endemic in Southeast Asia including parts of contamination due to their presence in the typical gut Thailand, Cambodia, Vietnam and Lao PDR. Approxi- microflora of humans and other animals. Kaewkes et al. mately 10 million people are infected, primarily rural [15] found that concentrations of fecal indicator bacteria farmers who consume raw or undercooked cyprinid fish, in water collected from snail habitat can be linked to which harbor the parasite [1]. Opisthorchis viverrini causes temporal and spatial patterns of snail infections. Recent cholangiocarcinoma (CCA), a highly fatal cancer in studies have used this approach to define pathways by endemic regions, and heavy infection is associated with a which poor sanitation [16, 17], landscape characteristics range of hepatobiliary complications [2, 3]. Due to its [17] and snail habitat type [18] impact fecal contamin- public health impact, opisthorchiasis and CCA have re- ation of Bithynia snail habitat. However, these recent ceived considerable attention from the scientific commu- studies have found few or no infected snails at their nity [4–6]. Recent progress has been made, particularly in sampling sites [16–18], which makes it challenging to the areas of the epidemiology of human infection and link these potential infection pathways to actual snail pathogenesis [7]. It is also known that O. viverrini is a spe- infections. cies complex consisting of at least two cryptic species in Another potential method for assessing snail exposure Thailand and Lao PDR which are related to biological is through examination of snail gut flora. Snail gut dis- characteristics of the parasites [8–10]. Recently O. viver- section has been used to study microflora in terrestrial rini from Sakon Nakhon, in northeast Thailand, were dis- edible snails Cornu aspersum and Helix pomatia and the covered as another cryptic species distinct from other aquatic snail Pomacea canaliculata [19–22]. Dissection isolates in Thailand and Lao PDR [11]. The snail inter- and culture of gut contents proves an effective way of mediate host, Bithynia siamensis goniomphalos, has been characterizing gut bacteria when done aseptically. This shown to contain distinct cryptic species [12]. However, method has the potential to be used to measure fecal in- less is known about the risk factors for O. viverrini infec- dicator bacteria in the guts of Bithynia snails. Bithynia tions in these snails, and this information may be crucial snails become infected with O. viverrini when they eat to the long-term control and elimination of this disease. the parasite egg, which is shed in the stool of definitive We are interested in methods for assessing snail ex- hosts. Thus, culture of gut contents has the potential to posure to fecal waste as a means of identifying snail provide a direct measure of snail exposure to fecal habitat that is likely playing a key role in disease trans- waste. mission. Like many trematode parasites of human health The purpose of this study was to evaluate the feasibil- significance including schistosomes, Fasciola spp., Para- ity of snail gut dissection and culture of fecal indicator gonimus spp. and Clonorchis sinensis, eggs of O. viverrini bacteria as a tool for assessing the risk of O. viverrini in- are shed in the stool of humans and other competent fections in Bithynia snail habitat. We field-tested the mammalian hosts and the parasite requires a snail host method in two locations: a suspected snail infection hot- to complete part of the developmental process before spot and an area where snail infection risk was expected reaching a stage infectious to humans (O. viverrini must to be low, and validated these classifications through additionally infect cyprinid fish). Fecal contamination of snail infection testing. We tested water samples for fecal snail habitat is a necessary condition for transmission of indicator bacteria in parallel, allowing us to compare the these parasites. Snail infection prevalence is often below methods. To our knowledge, this is the first reported ap- 1% in endemic areas [13], although members of our plication of culture of snail gut fecal indicator bacteria in group have reported on snail infection hotspots where the context of O. viverrini surveillance. the prevalence of O. viverrini infection in Bithynia snails was as high as 8% [14]. This spatial heterogeneity in Methods snail infections raises interesting questions about the This study was conducted in Sakon Nakhon Province in causes of such patterns and underscores the need for northeastern Thailand, where O. viverrini is endemic. tools to distinguish high and low risk areas for snail Two distinct study locations were selected, one where the infection. Methods for assessing snail exposure to fecal research team had consistently found infected snails in the waste can improve our ability to identify likely snail in- past (the “hotspot site”) and another where they had not fection hotspots, and better define the conditions under (the “non-hotspot site”), in order to allow comparison of which humans and other mammals contribute to snail snail exposure methods in sites with high vs low risk of O. infections and thus propagate the O. viverrini transmis- viverrini infection. Both sites are rice paddies, located ap- sion cycle. proximately 39 km apart. The low risk site is located in One method for assessing snail exposure is through Phanna Nikhom District, Na Nai sub-district. This site is measurement of fecal indicator bacteria in surface water relatively isolated: there are no major villages nearby, the Nawrocki et al. Parasites & Vectors (2019) 12:66 Page 3 of 8 road to the site had little traffic and no bovines were ob- contamination from other snail tissues. Each intestinal served during sampling. The hotspot site was located in tube sample was then diluted with 1 ml of physiological Phang Khon District, an area where snail infection hot- solution in an Eppendorf tube and vortexed for several spots had previously been documented [14]. This site is in seconds to release the contents of the tube. A 1 ml ali- the Hai Yong sub-district. In contrast to the first site, the quot of solution was then plated onto E.coli/Coliform hotspot site is adjacent to a nearby village, with the closest Count Petrifilms (3M, St.