Cryptosporidium in water and food Prof. Panagiotis Karanis Medical - PowerPoint PPT Presentation

6 th International Conference on Sustainable Solid Waste Management 13 – 16 June 2018 Cryptosporidium in water and food Prof. Panagiotis Karanis Medical School, University of Cologne, Germany 22-25 November 2017, Sousse, Tunisia

1 Contents of this presentation Short self – introduction Cryptosporidium ‐ What are the facts: Importance of Crypto Prevalence & outbreaks What is Cryptosporidium? Transmission & life cycle Crypto in food Diagnosis Treatment & prevention Water treatment & pathogen removal What are the problems ? Inter alia tourism in danger What are the solutions ? Take home message

PANAGIOTIS KARANIS Professor & Director of The Centre of Biomedicine and Infectious Diseases, Qinghai University in Xining, China PANAGIOTIS KARANIS Professor at The Medical School, University of Cologne, Germany

CHINA Qinghai Province XINING

1000 Talent Plan of the Chinese Government

Upgraded to Key State Laboratory for Plateau Ecology and Agriculture 1000 TP of the Chinese Government

7 Prof. Dr. Panagiotis Karanis – Short CV 1959: 1959: Born in Chrysso / Evritania / Greece 1979: 1979: Germany / Studies of Biology & Medicine 1992: 1992: PhD in Parasitology / Bonn University / Germany 1999: 1999: Habilit Habilitation tion ( Venia legendi ) in Parasitology, Medical School / Bonn University / Germany 2000 ‐ to 2000 toda day: y: Professor at Cologne Medical School / Germany 1999, 1999, 2003, 2003, 2004: 2004: Visiting Professor at the National Research Center for Protozoan Diseases (NRCPD) / Japan 2005 2005 ‐ 2009: 2009: Professor, NRCPD / Japan 2014 2014 ‐ 2017: 2017: Professor, Center for Biomedicine and Infectious Diseases, Qinghai University / China

Dormant / transmissive stage: Oocyst Oocysts with infectious sporozoites:  Size: 5 μ m  2 y survival in the environment by 4 ˚ C What is Cryptosporidium ? • Parasite (Protozoon), cause disease called Cryptosporidiosis in humans • Most common species Cryptosporidium hominis & C. parvum , other species • There are 34 different Cryptosporidium – species and 62 genotypes

THE IMPORTANCE OF CRYPTOSPORIDIUM

Clinical importance of Cryptosporidium Food- and waterborne gastroenteritis Cryptosporidium is responsible for: 1 Mio children’s deaths / year • Human colon cancer • Transplant rejection •

Occurrence & worldwide outbreaks of Cryptosporidium WORLDWIDE & UBIQUITOUS

Cryptosporidium Prevalence  Immunosuppressed, HIV-infected and organ transplants.  Children, in particular 0-2; 2-4 years.  In industrialized countries: ‘ Crypto .’- detection in 2-4% patients with diarrhea. ‘Crypto’ .- detection by 1-4% healthy, asymptomatic humans.  In developing countries the prevalence is higher compared to industrialized countries.  In Germany: since 2001 registered by RKI: 800 - 1.500 cases with increasing number from July to the end of November. www.rki.de

Global burden of food-borne / water-borne (diarrheal) diseases currently unknown • 1.8 million people died from diarrheal diseases (WHO 2005) due to contaminated food and drinking water. • This is not just a problem of the underdeveloped world. • About 76 million cases of food-borne diseases, resulting in 325.000 hospitalizations and 5.000 deaths, are estimated to occur each year only in the U.S.A. (Mead et al., 1999). • Over 200 known microbial, chemical or physical agents can cause illness when ingested. • Over the last 20 years, at least in the industrialized world, water- and food-borne diseases caused by bacteria, parasites, viruses and prions have significantly moved up the political agenda and generated substantial media attention.

15 Cryptosporidium : diarrhea Cryptosporidium is the number 2 cause (after Rota ‐ virus) of diarrhea ‐ associated mortality in children under 5 years of age, worldwide Kotlof et al. (2013)

Cryptosporidium : waterborne 16 transmission and worldwide outbreaks From the begin of the last century until 2016, Cryptosporidium was responsible for ̴ 60% (524/913) of all reported waterborne outbreaks caused by protozoan parasites Karanis et al (2007); Baldursson & Karanis (2011); Efstratiou et al (2017)

17 Cryptosporidium : outbreaks Lar Largest wa waterborne Cryp yptosp sporid idiu ium outbr outbreak: ak: • Milwaukee, USA USA in 1993 1993 (1) • ̴ 403,000 individuals with cryptosporidiosis • via contaminated drinking water • ̴ illness ‐ associated cost of US $96.2 million ̴ 100 deaths (2) • Second Sec nd lar largest wa waterborne outbr outbreak ak occurr occurred ed in in: • Östersund, Sw Sweden eden in 2010 2010 • ̴ 27,000 individuals infected (3) Another Another wa waterborne outbr outbreak: ak: • Skellefteå, Sw Sweden eden in 2011 2011 • ̴ 18,500 individuals (4) (1) MacKenzie et al (1995); (2) Corso et al (2003); (3) Widerström et al (2014); (4) Bjelkmar et al (2017)

INCREASE OF:  Waterborne diseases  Foodborne diseases  Vectorborne diseases

Unlimited Mobility

MIGRANTS & REFUGEES

Transmission of Cryptosporidium • Human - to - Human • Animal - Human - Animal • Water • Food • Air

22 Cryptosporidium Life Cycle Gas Gastroen enteri riti tis Food ood

Identify the contamination sources!

CRYPTOSPORIDIUM IN WATER & FOOD

25 Cryptosporidium : foodborne transmission Main causes uses of of foodborne oodborne Cryptosporidium outbr outbreak aks usual sually as associa sociated ed wi with food od service and nd cateri tering ng indus dustries: s: • Col Cold pr pressed essed non non ‐ alcoholic lic appl apple cider cider • Ozona onated ed appl apple cider cider Highl Hi ghly ex expected • Milk ilk of of bei being ve vehicles • Béarnaise Béarnaise sauce sauce fo for tr transm ansmission ission of of • Ra Raw me meat at, ra raw liv liver Cryptosporidium: • Chi Chicken salad salad freshly fr eshly pr produced, oduced, and and • Pre Pre ‐ cut cut mi mixed salad salad le leaves (bag (bagged salad) salad) when consumed when nsumed wi with • Frisé isée sa sala lad mi mini nima mal pr prepar eparation. n. • Frui Fruit ju juice ice • Mollu lluscs scs • Spr Sprout uted ed seeds seeds Ahmed & Karanis (2017). An overview of methods / techniques for the detection of Cryptosporidium in food samples. Parasitol Res 117, 629 ‐ 653.

33 years review (Ahmed & Karanis, 2017, in press): 26 Cryptosporidium detection in food material

Cryptosporidium : foodborne 27 transmission and worldwide outbreaks Cryptosporidium was ranked 5 th out of 24 potentially foodborne parasites in terms of importance as a foodborne pathogen FAO/WHO 2014

28 Cryptosporidium : foodborne transmission Cryptosporidium is among the 10 foodborne pathogens monitored by the FoodNet surveillance system in the United States Crim et al. (2014)

Cryptosporidium : foodborne 29 transmission and worldwide outbreaks Cryptosporidium is particularly suited to foodborne transmission and is responsible for > 8 million cases of foodborne illness annually