Outbreak of Amazonian Toxoplasmosis: A One Health Investigation in a Remote Amerindian Community
Open Access
- 11 September 2020
- journal article
- research article
- Published by Frontiers Media SA in Frontiers in Cellular and Infection Microbiology
Abstract
Background: Toxoplasma gondii is a parasite of worldwide importance but its burden in indigenous communities remains unclear. In French Guiana, atypical strains of T. gondii originating from a complex rainforest cycle involving wild felids have been linked to severe infections in humans. These cases of Amazonian toxoplasmosis are sporadic and outbreaks are rarely described. We report on the investigation of an outbreak of acute toxoplasmosis in a remote Amerindian village. We discuss the causes and consequences of this emergence. Methods: In May 2017, during the rainy season and following an episode of flooding, four simultaneous cases of acute toxoplasmosis were serologically confirmed in two families living the village. Other non-diagnosed cases were then actively screened by a medical team along with epidemiological investigations. Inhabitants from nine households were tested for T. gondii antibodies and parasite DNA by PCR when appropriate. Samples of water, cat feces and cat rectal swabs, soil, and meat were tested for T. gondii DNA by PCR. Positive PCR samples with sufficient DNA amounts were genotyped using 15 microsatellite markers. Results: Between early May and early July 2017, out of 54 tested inhabitants, 20 cases were serologically confirmed. A fetus infected at gestational week 10 died but other cases were mild. Four patients tested positive for parasite DNA and two identical strains belonging to an atypical genotype could be isolated from unrelated patients. While domestic cats had recently appeared in the vicinity, most families drank water from unsafe sources. Parasite DNA was recovered from one water sample and nine soil samples. Three meat samples tested positive, including wild and industrial meat. Conclusions: The emergence of toxoplasmosis in such a community living in close contact with the Amazon rainforest is probably multifactorial. Sedentary settlements have been built in the last few decades without providing safe water sources, increasing the risk of parasite circulation in cases of dangerous new habits such as cat domestication. Public health actions should be implemented in these communities such as safe water supply, health recommendations, and epidemiological surveillance of acute toxoplasmosis. A “One Health” strategy of research involving medical anthropology, veterinary medicine, and public health needs to be pursued for a better understanding of the transmission routes and the emergence of this zoonosis.This publication has 55 references indexed in Scilit:
- Epidemiology of and Diagnostic Strategies for ToxoplasmosisClinical Microbiology Reviews, 2012
- Seroprevalence and Sources of Toxoplasmosis among Orang Asli (Indigenous) Communities in Peninsular MalaysiaThe American Journal of Tropical Medicine and Hygiene, 2011
- Disseminated toxoplasmosis: an atypical presentation in an immunocompetent patientTropical Doctor, 2011
- Genotyping of Toxoplasma gondii Isolates with 15 Microsatellite Markers in a Single Multiplex PCR AssayJournal of Clinical Microbiology, 2010
- Neglected Infections of Poverty among the Indigenous Peoples of the ArcticPLoS Neglected Tropical Diseases, 2010
- Severe Acquired Toxoplasmosis Caused by Wild Cycle ofToxoplasma gondii, French GuianaEmerging Infectious Diseases, 2009
- The Neglected Tropical Diseases of Latin America and the Caribbean: A Review of Disease Burden and Distribution and a Roadmap for Control and EliminationPLoS Neglected Tropical Diseases, 2008
- Toxoplasma gondii Pneumonia in Immunocompetent Subjects: Case Report and ReviewClinical Infectious Diseases, 2007
- Waterborne Toxoplasmosis, Northeastern BrazilEmerging Infectious Diseases, 2007
- Oocyst-Transmitted Toxoplasmosis Associated with Ingestion of Contaminated WaterThe New England Journal of Medicine, 1982