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      Food and drinking water hygiene and intestinal protozoa in deployed German soldiers

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          Abstract

          This report analyzes the occurrence of Cryptosporidium spp., E. histolytica, and G. intestinalis in stool of returnees from military deployments and the impact of hygiene precautions. Between 2007 and 2010, stool samples of 830 returnees that were obtained 8–12 weeks after military deployments in Afghanistan, Uzbekistan, the Balkans, Democratic Republic of the Congo/Gabonese Republic, and Sudan and 292 control samples from non-deployed soldiers were analyzed by PCR for Cryptosporidium spp., E. histolytica, G. intestinalis, and the commensal indicator of fecal contamination E. dispar. Data on hygiene precautions were available. The soldiers were questioned regarding gastrointestinal and general symptoms. Among 1122 stool samples, 18 were positive for G. intestinalis, 10 for E. dispar, and no-one for Cryptosporidium spp. and E. histolytica. An increased risk of acquiring chronic parasitic infections in comparison with non-deployed controls was demonstrated only for G. intestinalis in Sudan, where standardized food and drinking water hygiene precautions could not be implemented. Standard food and drinking water hygiene precautions in the context of screened military field camps proved to be highly reliable in preventing food-borne and water-borne chronic infections and colonization by intestinal protozoa, leading to detection proportions similar to those in non-deployed controls.

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          Most cited references 22

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          Waterborne transmission of protozoan parasites: a worldwide review of outbreaks and lessons learnt.

          At least 325 water-associated outbreaks of parasitic protozoan disease have been reported. North American and European outbreaks accounted for 93% of all reports and nearly two-thirds of outbreaks occurred in North America. Over 30% of all outbreaks were documented from Europe, with the UK accounting for 24% of outbreaks, worldwide. Giardia duodenalis and Cryptosporidium parvum account for the majority of outbreaks (132; 40.6% and 165; 50.8%, respectively), Entamoeba histolytica and Cyclospora cayetanensis have been the aetiological agents in nine (2.8%) and six (1.8%) outbreaks, respectively, while Toxoplasma gondii and Isospora belli have been responsible for three outbreaks each (0.9%) and Blastocystis hominis for two outbreaks (0.6%). Balantidium coli, the microsporidia, Acanthamoeba and Naegleria fowleri were responsible for one outbreak, each (0.3%). Their presence in aquatic ecosystems makes it imperative to develop prevention strategies for water and food safety. Human incidence and prevalence-based studies provide baseline data against which risk factors associated with waterborne and foodborne transmission can be identified. Standardized methods are required to maximize public health surveillance, while reporting lessons learned from outbreaks will provide better insight into the public health impact of waterborne pathogenic protozoa.
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            Traveler's diarrhea due to intestinal protozoa.

            Intestinal protozoa account for a minority of cases of acute traveler's diarrhea, but they are common pathogens in travelers who experience protracted diarrhea during or after travel. Evaluation of the traveler with chronic diarrhea should include a careful examination for typical infecting organisms, such as Giardia and Entamoeba species, as well as for emerging parasites, such as Cryptosporidium species, Cyclospora species, and microsporidia. The microbiology, epidemiology, clinical presentation, and treatment of the most common intestinal parasites found in travelers are presented in this minireview.
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              • Record: found
              • Abstract: not found
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              Epidemiological aspects of human cryptosporidiosis.

               D Casemore (1990)
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                Author and article information

                Journal
                1886
                122234
                European Journal of Microbiology and Immunology
                EuJMI
                Akadémiai Kiadó, co-published with Springer Science+Business Media B.V., Formerly Kluwer Academic Publishers B.V.
                2062-509X
                2062-8633
                1 March 2013
                : 3
                : 1
                : 53-60
                Affiliations
                [ 1 ] Department of Tropical Medicine at the Bernhard Nocht Institute, German Armed Forces Hospital of Hamburg, Hamburg, Germany
                [ 2 ] Institute for Microbiology, Virology and Hygiene, University Hospital Rostock, Rostock, Germany
                [ 3 ] Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
                [ 4 ] Medical Parasitology Laboratory, Central Institute of the German Armed Forces Medical Services, Koblenz, Germany
                [ 5 ] Laboratory Department 1, Central Institute of the German Armed Forces Medical Services Kiel, External site Berlin, Germany
                [ 6 ] Laboratory Department 2, Central Institute of the German Armed Forces Medical Services Kiel, Kronshagen, Germany
                [ 7 ] Laboratory Department 1, Central Institute of the German Armed Forces Medical Services Munich-Garching, Garching, Germany
                [ 8 ] Department of Tropical Medicine at the Bernhard Nocht Institute, German Armed Forces Hospital of Hamburg, Bernhard Nocht Street 74, D-20359, Hamburg, Germany
                Author notes

                These authors contributed equally to this study.

                [* ] +49(0)40/6947-2862, +49(0)40/6947-2859, Frickmann@ 123456bni-hamburg.de
                Article
                8
                10.1556/EuJMI.3.2013.1.8
                3832084
                24265919

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