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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 references22

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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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            Molecular diagnostics of intestinal parasites in returning travellers

            A new diagnostic strategy was assessed for the routine diagnosis of intestinal parasites in returning travellers and immigrants. Over a period of 13 months, unpreserved stool samples, patient characteristics and clinical data were collected from those attending a travel clinic. Stool samples were analysed on a daily basis by microscopic examination and antigen detection (i.e. care as usual), and compared with a weekly performed multiplex real-time polymerase chain reaction (PCR) analysis on Entamoeba histolytica, Giardia lamblia, Cryptosporidium and Strongyloides stercoralis. Microscopy and antigen assays of 2,591 stool samples showed E. histolytica, G. lamblia, Cryptosporidium and S. stercoralis in 0.3, 4.7, 0.5 and 0.1% of the cases, respectively. These detection rates were increased using real-time PCR to 0.5, 6.0, 1.3 and 0.8%, respectively. The prevalence of ten additional pathogenic parasite species identified with microscopy was, at most, 0.5%. A pre-selective decision tree based on travel history or gastro-intestinal complaints could not be made. With increased detection rates at a lower workload and the potential to extend with additional parasite targets combined with fully automated DNA isolation, molecular high-throughput screening could eventually replace microscopy to a large extent.
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              Bacteriological and parasitological assessment of food handlers in the Omdurman area of Sudan.

              Pathogenic organisms are thought to be widely distributed among food handlers. This study was designed to assess the prevalence of carriers of some pathogenic bacteria and intestinal parasites among food handlers in the city of Omdurman, Sudan. A total of 518 nasal swabs and stool specimens were collected. Nasal swabs were cultured on bacteriological culture media. Stool specimens were examined microscopically for intestinal parasites. Of the total subjects examined, 30.1% were found to be carriers of pathogenic organisms. The pathogens isolated and identified were the bacteria Staphylococcus aureus, Salmonella typhi, and Shigella boydii, and the intestinal parasites, Giardia lamblia and Entamoeba histolytica/dispar. Bacteria and intestinal parasites were most prevalent among storekeepers (41%), followed by restaurant workers (24.4%), bakers (24.4%), butchers (5.1%), milk distributors (2.6%), and fruits/vegetables sellers (2.6%). S. aureus, the most abundant pathogen, was most prevalent in storekeepers (44.6%), followed by restaurant workers (25%), bakers (17.9%), butchers (5.4%), milk distributors (3.6%), and fruit/vegetable sellers (3.6%). The findings from this study indicate a key role for food handlers in the spread and transmission of food communicable diseases and reveal the need for protective measures.
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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
                a0a21d6d-8f68-411a-acc5-c262e3085fab
                History
                : 5 October 2012
                : 23 October 2012

                Medicine,Immunology,Health & Social care,Microbiology & Virology,Infectious disease & Microbiology
                deployment,field camp,food hygiene,water hygiene,parasite,real-time PCR

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