P S Craig

University of Salford, Salford, England, United Kingdom

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Publications (136)293.07 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Echinococcus multilocularis is a cestode that causes human alveolar echinococcosis, a lethal zoonosis of public health concern in central Asia and western China. In the present study, one of 42 Eastern mole voles (Ellobius tancrei) caught in Sary Mogol (Alay valley, southern Kyrgyzstan) presented liver lesions with E. multilocularis from which the EmsB target was amplified. The Asian profile obtained was almost identical to one amplified from domestic dog faeces collected in a nearby village. This observation adds additional information to the potential role of E. tancrei in the transmission of E. multilocularis, and to the known distribution range of E. multilocularis (Asian strain) in central Asia.
    Journal of Helminthology 07/2015; DOI:10.1017/S0022149X15000474 · 1.30 Impact Factor
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    ABSTRACT: SUMMARY Toxoplasma gondii is a globally distributed parasite infecting humans and warm-blooded animals. Although many surveys have been conducted for T. gondii infection in mammals, little is known about the detailed distribution in localized natural populations. In this study, host genotype and spatial location were investigated in relation to T. gondii infection. Wood mice (Apodemus sylvaticus) were collected from 4 sampling sites within a localized peri-aquatic woodland ecosystem. Mice were genotyped using standard A. sylvaticus microsatellite markers and T. gondii was detected using 4 specific PCR-based markers: SAG1, SAG2, SAG3 and GRA6 directly from infected tissue. Of 126 wood mice collected, 44 samples were positive giving an infection rate of 34·92% (95% CI: 27·14-43·59%). Juvenile, young adults and adults were infected at a similar prevalence, respectively, 7/17 (41·18%), 27/65 (41·54%) and 10/44 (22·72%) with no significant age-prevalence effect (P = 0·23). Results of genetic analysis of the mice showed that the collection consists of 4 genetically distinct populations. There was a significant difference in T. gondii prevalence in the different genotypically derived mouse populations (P = 0·035) but not between geographically defined populations (P = 0·29). These data point to either a host genetic/family influence on parasite infection or to parasite vertical transmission.
    Parasitology 12/2014; DOI:10.1017/S0031182014001760 · 2.35 Impact Factor
  • M.T. Rogan, A.J. Bodell, P.S. Craig
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    ABSTRACT: In 1982, Rickard & Williams stated that immunity to larval taeniid cestodes, could be divided into two different phases, the establishment phase, operating against oncospheres and the established phase, operating against established metacestodes in the tissues. These concepts were largely based on experimental and veterinary data. As a result of subsequent research combined with clinical data, we can consider that, for metacestodes of Echinococcus spp, a single established phase is probably too simple a concept. These parasites show developmental changes in different hosts over time, the most significant being growth, fertility and degeneration. Recent clinical cyst classifications (WHO/IWGE) have highlighted that all hydatid cysts are morphologically not the same. This is important for treatment but fails to completely address variation in the host/parasite response and the understanding of parasite survival. This review attempts to relate the immunological and developmental data obtained from experimental, veterinary and medical studies to update our understanding of established immunity against E. granulosus. It proposes that a single “Established” phase for E. granulosus could be subdivided into four additional phases: maturing; stable; unstable; and degenerative. Combining this type of information with existing cyst classification systems could significantly benefit our understanding of the parasites immunobiology.This article is protected by copyright. All rights reserved.
    Parasite Immunology 10/2014; DOI:10.1111/pim.12149 · 1.85 Impact Factor
  • A Tembo, P S Craig
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    ABSTRACT: Human taeniosis due to Taenia saginata is cosmopolitan where beef is consumed; however, there is little or no information on the symptomatology over the early time-course of human infection. Copro-antigen detection is very useful in community screening for human taeniosis, particularly for T. solium, but there are no data on copro-antigen detection in pre-patent infection. In order to provide insight into this, a voluntary self-infection with T. saginata was undertaken and monitored over a 6-month period using a copro-antigen enzyme-linked immunosorbent assay (ELISA) that we developed using anti-T. saginata antibody based reagents. Tapeworm patency, defined as first proglottid appearance, occurred on day 86 post-infection (pi) and was followed by almost daily release of proglottids (range 1-8) until termination using praziquantel on day 180 pi. The first 10 weeks post-infection (wpi) were essentially asymptomatic, followed by main symptoms of involuntary proglottid discharge throughout the infection period, and abdominal discomfort peaking around 15-19 wpi. Copro-antigens could not be reliably detected until 2 weeks before proglottid patency but then remained highly elevated over the next 15 weeks until treatment. Copro-antigen levels reverted to negative 4 days post-treatment. This time-course study suggests that although copro-antigen ELISA is an excellent diagnostic tool for established patent infections of T. saginata, it may not be reliable for faecal antigen detection in the early infection phase prior to proglottid release for T. saginata and other human taenioses.
    Journal of Helminthology 06/2014; DOI:10.1017/S0022149X14000455 · 1.30 Impact Factor
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    ABSTRACT: During the period from March 2006 to July 2009 a total of 2040 slaughtered donkeys were examined for cystic echinococcosis (CE). CE prevalence in donkeys was 8.48% and the infection pressure (0.0088 infections per year) and infection rate (0.0448 cysts per year) appeared to be lower than those previously reported for cattle, sheep, dromedaries and goats in Tunisia. However, the number of cysts per infection was relatively high (5.07 cysts per infection). Among the 901 collected hydatid cysts the majority were located in the liver (89.9%), 10.09% in the lungs and 4.77% were fertile (43/901). The amplification of a fragment within the mitochondrial gene coding for cytochrome c oxidase subunit 1 (cox1) revealed that donkeys were infected with both Echinococcus equinus (horse strain, G4 genotype) and Echinococcus granulosus (sheep strain, G1 genotype). E. granulosus G1 developed into fertile cysts (15,112 protoscoleces/ml) with a protoscoleces viability of 65.78%. This investigation is the first detailed epidemiological report on cystic echinococcosis infection in donkeys for any endemic region.
    Veterinary Parasitology 06/2014; 205(1-2). DOI:10.1016/j.vetpar.2014.06.007 · 2.55 Impact Factor
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    ABSTRACT: Echinococcus granulosus is an important zoonotic infection of dogs. The purpose of the present study assessed the performance of two laboratory diagnostic methods with arecoline purgation and necropsy in infected dogs. In total 65 dogs were successfully experimentally infected with protoscoleces of E. granulosus from ovine infection. At 14–34 days post-infection groups of dogs were purged with arecoline hydrobromide and then necropsied. Faecal samples were tested at weekly intervals by coproantigen ELISA and coproPCR. The necropsy infection rate with E. granulosus was 89.2%. Only 43% of dogs were successfully purged after one arecoline dose; this percentage increased to 76.9% for two doses of arecoline purgation. E. granulosus coproantigen was detected by coproELISA in 82.8% of faeces. The positive and negative predictive values for coproantigen ELISA were 96 and 44.4% respectively. E. granulosus DNA was detected in pre-patent faecal samples by coproPCR in 25.9% of dogs. These results indicate that coproELISA is more sensitive than arecoline purgation for the detection of pre-patent E. granulosus infection in dogs. CoproPCR detected E. granulosus DNA in dog faeces by 21 days post-infection before egg production. # 2006 Elsevier B.V. All rights reserved.
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    ABSTRACT: SUMMARY In the eastern Tibetan plateau both human cystic and alveolar echinococcosis (AE) caused by infection with Echincoccus granulosus or Echinococcus multilocularis, respectively are highly endemic. The domestic dog plays a key role in zoonotic transmission in this region. Our primary objective was to investigate the role of domestic dogs in maintaining transmission of E. multilocularis in Shiqu county, Sichuan. A cohort of 281 dogs was followed up over one year after a single treatment with praziquantel followed by re-infection surveillance at 2, 5 and 12 months post-treatment. Faecal samples were tested by an Echinococcus genus-specific coproantigen ELISA and two species-specific copro-PCR tests. Total Echinococcus coproantigen prevalence in Shiqu at baseline was 21% and 9·6% after 2 months. E. multilocularis copro-PCR was positive in 11·2% of dogs before treatment (vs 3·6% with E. granulosus copro-DNA), 2·9% at 2 months post-treatment, and 0% at 5 month and 12 months. The results suggest that dogs may have the potential to maintain E. multilocularis transmission within local pastoral communities, and thus dog dosing could be an effective strategy to reduce transmission of E. multilocularis as well as E. granulosus in these co-endemic Tibetan communities.
    Parasitology 08/2013; 140(13):1-8. DOI:10.1017/S0031182013001200 · 2.35 Impact Factor
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    ABSTRACT: A 43-year-old Tibetan woman living in northwest Sichuan, China, confirmed to be a taeniasis carrier of Taenia solium was treated with pumpkin seeds combined with Areca nut extract in October 2009. All 20 tapeworms except one without scolex were expelled under good conditions. She was free of secondary cysticercosis within one year follow up. Although the first choice for treatment of taeniasis is still praziquantel, it may often cause serious side effect on asymptomatic cysticercosis cases to suddenly become symptomatic within a half day of the treatment. Therefore, the problems in treatment of taeniasis and/or cysticercosis in Asia are briefly overviewed, since other platyhelminthic diseases including schistosomiasis, opisthorchiasis etc. are more common and praziquantel is strongly recommended for mass treatment of these trematodiases with no idea on the co-infection with eggs of T. solium which cause asymptomatic cysticercosis.
    Tropical biomedicine 06/2013; 30(2):164-73. · 0.82 Impact Factor
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    ABSTRACT: The prevalence of the digenean Plagiorchis sp. was investigated in a natural wood mouse population (Apodemus sylvaticus) in a periaquatic environment. Classical identification was complemented with the use of molecular differentiation to determine prevalence and verify species identity. Use of the complete ITS1-5.8S rDNA-ITS2 and partial 28S rDNA gene sequences have confirmed that the species reported at this location was Plagiorchis elegans and not Plagiorchis muris as reported previously. This underlines the difficulties in identification of these morphologically similar parasites. Plagiorchis elegans is typically a gastrointestinal parasite of avian species but has also been reported from small mammal populations. Although the occurrence of this digenean in A. sylvaticus in the UK is rare, in the area immediately surrounding Malham Tarn, Yorkshire, it had a high prevalence (23%) and a mean worm burden of 26.6 ± 61.5. The distribution of P. elegans followed a typically overdispersed pattern and both mouse age-group and sex were determined to be two main factors associated with prevalence. Male mice harboured the majority of worms, carrying 688 of 717 recovered during the study, and had a higher prevalence of 32.4% in comparison to only 8.7% in the small intestine of female mice. A higher prevalence of 43% was also observed in adult mice compared to 14% for young adults. No infection was observed in juvenile mice. These significant differences are likely to be due to differences in the foraging behaviour between the sexes and age cohorts of wood mice.
    Journal of Helminthology 04/2013; 88(3):1-11. DOI:10.1017/S0022149X13000199 · 1.30 Impact Factor
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    ABSTRACT: The prevalence of the digenean Plagiorchis sp. was investigated in a natural wood mouse population (Apodemus sylvaticus) in a periaquatic environment. Classical identification was complemented with the use of molecular differentiation to determine prevalence and verify species identity. Use of the complete ITS1-5.8S rDNA-ITS2 and partial 28S rDNA gene sequences have confirmed that the species reported at this location was Plagiorchis elegans and not Plagiorchis muris as reported previously. This underlines the difficulties in identification of these morphologically similar parasites. P. elegans is typically a gastrointestinal parasite of avian species but has also been reported from small mammal populations. Although, the occurrence of this digenean in A. sylvaticus in the UK is rare, in the area immediately surrounding Malham Tarn, Yorkshire, it had a high prevalence (23%) and a mean worm burden of 26.6±61.5. The distribution of P. elegans followed a typically overdispersed pattern and both mouse age group and sex were determined to be two main factors to be associated with prevalence. Male mice harboured the majority of worms carrying 688 of 717 recovered during the study and had a higher prevalence of 32.4% in comparison to only 8.7% in the small intestine of female mice. A higher prevalence of 43% was also observed in adult mice compared to 14% for young adults. No infection was observed in juvenile mice. These significant differences are likely to be due to differences in the foraging behaviour between the sexes and age cohorts of wood mice.
    Journal of Helminthology 02/2013; · 1.30 Impact Factor
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    ABSTRACT: Notocotylus malhamensis n. sp. is described from the caecum of the bank vole (Myodes glareolus) and the field vole (Microtus agrestis) from Malham Tarn Nature Reserve in North Yorkshire, UK. In total, 581 specimens were collected from rodents trapped at a wetland site (Tarn Fen) between July 2010 and October 2011 with a prevalence of 66·7% and mean intensity of 94·6 in the bank vole and 50% prevalence and a mean intensity of 4·3 in the field vole. This species appears to be most closely related to other previously described Notocotylus species infecting rodents in Europe but differs principally by the metraterm to cirrus sac ratio (1:1·5–1:1·2) in combination with a densely spinulated cirrus, simple caeca and a greater number of ventral glands in the lateral rows (14–17). The use of molecular differentiation was of limited use in this study due to a paucity of relevant information in the DNA sequence databases. However, the complete ITS1-5.8S rDNA-ITS2 and partial 28S gene sequences have been generated to provide a definitive tool for identification of this species in future studies. As far as we know this is the first report of a notocotylid infection in M. glareolus in the UK.
    Parasitology 07/2012; DOI: http://dx.doi.org/10.1017/S0031182012000911. DOI:10.1017/S0031182012000911 · 2.35 Impact Factor
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    ABSTRACT: Taeniid tapeworms which include Echinococcus and Taenia spp. are obligatory parasites of mammals with pathogenicity usually related to the larval stages of the life cycle. Two species (or genotypes) of Echinococcus, E. granulosus sensu stricto and E. equinus, as well as several Taenia spp. are endemic in the UK. Here we report on the occurrence of larval cystic stages of Echinococcus and Taenia spp. in captive mammals in the UK. Using molecular techniques we have identified E. granulosus (G1 genotype) in a guenon monkey and a Philippine spotted deer; E. equinus in a zebra and a lemur; E. ortleppi in a Philippine spotted deer; E. multilocularis in a macaque monkey and Taenia polyacantha in jumping rats. To the best of our knowledge this is the first report of E. multilocularis in a captive primate translocated to the UK. As far as we know these are the first reports of E. equinus in a primate (lemur) and in a zebra; as well as E. granulosus (G1 genotype) and E. ortleppi in a cervid translocated to the UK. These infections and implications of the potential establishment of exotic species of cestodes are discussed.
    Veterinary Parasitology 06/2012; 190(1-2):95-103. DOI:10.1016/j.vetpar.2012.05.023 · 2.55 Impact Factor
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    ABSTRACT: On the Eastern Tibetan Plateau region (Sichuan province, China) dogs are regarded as important definitive hosts of Echinococcus multilocularis. We studied dog spatial behaviour in 4 Tibetan villages in order to determine the role of dogs in environmental contamination and their potential interactions with small mammal intermediate hosts. We identified definitive host species and Echinococcus spp. infection status of feces collected in the field by PCR methods and analysed the spatial distribution of canid feces. Nocturnal space utilization of GPS collared dogs in and around villages was also undertaken. E. multilocularis DNA was amplified in 23% of dog feces (n=142) and in 15% of fox feces (n=13) but this difference was not significant. However, dog feces were more frequently observed (78% of collected feces) than fox feces and are therefore assumed to largely contribute to human environment contamination. Feces were mainly distributed around houses of dog owners (0-200 m) where collared dogs spent the majority of their time. Inside villages, the contamination was aggregated in some micro-foci where groups of dogs defecated preferentially. Finally, small mammal densities increased from the dog core areas to grasslands at the periphery of villages occasionally used by dogs; male dogs moving significantly farther than females. This study constitutes a first attempt to quantify in a spatially explicit way the role of dogs in E. multilocularis peri-domestic cycles and to identify behavioural parameters required to model E. multilocularis transmission in this region.
    Parasitology 09/2011; 138(10):1316-29. DOI:10.1017/S0031182011000874 · 2.35 Impact Factor
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    ABSTRACT: Echinococcosis/hydatidosis caused by Echinococcus granulosus has a widespread distribution in the human population of Tunisia, particularly in the north-west and centre-west of the country. In a recent study, the morphological features, fertility and viability of hydatid cysts that had been excised from patients in Tunis were explored, and the E. granulosus strain or genotype involved in each case was identified from morphology of the protoscolex hooks and the results of molecular genotyping. The hepatic cysts investigated came from 41 patients [31 women and 10 men, with a mean (S.E.) age of 43.41 (14.25) years] who were treated for cystic echinococcosis, by surgery but rarely with chemotherapy, at the La Rabta Hospital in Tunis, in the 12 months ending in June 2008. Most (56%) of these patients originated from rural areas in endemic governorates. Of the 60 hepatic cysts that were studied, 38.3% were located in the right lobe of the liver and 35.0% each involved both hepatic lobes. Almost a third (31.7%) of the excised cysts were degenerating, with the rest considered viable and either multivesicular (38.3%) or univesicular (30.0%). Almost all (93.3%) of the cysts were categorized as fertile, with a mean protoscolex viability of 21.8%. Protoscolex viability was relatively high in the viable univesicular cysts with a visible cyst wall and in the multivesicular and multiseptate cysts with daughter cysts, and lowest in the cysts that appeared to be solid calcified masses. The observed variation in protoscolex viability with cyst type, in cysts excised from patients before any chemotherapy, supports the cyst classification recommended by the World Health Organization but could also be compatible with the imaging-based 'Gharbi' classification. The results of the molecular genotyping showed that all 23 cysts investigated (which came from 20 of the patients) were caused by E. granulosus of the G1 genotype (also known as the 'sheep' or 'sheep-dog' strain).
    Annals of Tropical Medicine and Parasitology 10/2009; 103(7):593-604. DOI:10.1179/000349809X12502035776153 · 1.20 Impact Factor
  • P R Torgerson, P S Craig
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    ABSTRACT: A risk assessment was undertaken to assess the likelihood of importation of dogs infected with Echinococcus multilocularis should the requirement for treatment with praziquantel be relaxed under the Pet Travel Scheme. The analysis suggested that for every 10,000 dogs going on a short trip to Germany, the probability of at least one returning to the UK infected is approximately 98 per cent. If the dogs had been longer-term residents, this probability rises to over 99 per cent. This indicates that if praziquantel treatment of dogs on importation into the UK is abandoned, then it is almost inevitable that E multilocularis will be introduced.
    The Veterinary record 09/2009; 165(13):366-8. DOI:10.1136/vr.165.13.366 · 1.63 Impact Factor
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    ABSTRACT: Echinococcus granulosus is endemic throughout Tunisia and E. multilocularis has previously been reported as the cause of two cases of human alveolar echinococcosis in the north-west of the country. The aim of the present study was to screen wild carnivores from the north-western Jendouba governorate and semi-stray dogs from the Siliana and Sejnane regions of northern Tunisia for these two zoonotic cestodes. The results of the coproscopy, coproELISA and coproPCR that were undertaken were compared with those of necropsy, where possible. Overall, 111 faecal samples (51 from wild carnivores and 60 from stray dogs) were tested by coproELISA for Echinococcus antigen and by coproPCR for E. granulosus and E. multilocularis species-specific DNA. All 60 dogs and seven of the wild carnivores were necropsied. Eleven (18.4%) of the dogs and one golden jackal (Canis aureus) were found positive for E. granulosus at necropsy. The jackal was found to be carrying 72 E. granulosus tapeworms, which were confirmed to be of the common sheep-dog (G1) genotype. Faecal samples from 10 (19.6%) of the wild carnivores--putatively, four golden jackals, two red foxes (Vulpes vulpes atlantica), one hyaena (Hyaena hyaena) and three genets (Genetta genetta)--gave a positive result in the Echinococcus coproELISA. In the coproPCR-based follow-up, E. granulosus DNA was detected in faecal samples from five jackals, two foxes and six stray dogs. The DNA of E. multilocularis was not, however, detected in any of the faecal samples investigated. This is the first report from Tunisia of (coproPCR-)confirmed E. granulosus infections in golden jackals and red foxes. The possible role of such wild hosts in the transmission of E. granulosus in Tunisia should be investigated further. The possibility of the active transmission of E. multilocularis in Tunisia still remains an open question.
    Annals of Tropical Medicine and Parasitology 07/2009; 103(4):323-31. DOI:10.1179/136485909X440836 · 1.20 Impact Factor
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    ABSTRACT: To make an epidemiological investigation on echinococcosis in Darlag County, Guoluo Tibetan Autonomous Prefecture of Qinghai Province. Local participants were screened for echinococcosis using B ultrasound from August to September in 2007. IHA was carried out to detect antibody in human sera. Indirect ELISA using recombinant-AgB and Em18 antigen was conducted to further diagnose the human alveolar echinococcosis (AE) and cystic echinococcosis (CE) . The prevalence of echinococcosis in wild rodents, yaks, sheep and dogs was examined either by dissection or through slaughterhouses. Adult worms and hydatid cysts were detected by PCR-RFLP to discriminate 3 Echinococcus species and genotype of Eg. Dog feces were tested by double antibody sandwich ELISA method to confirm the coproantigen positive rate. 1723 people were examined by ultrasound and 236 were clinically diagnosed as hydatid diseases with an overall morbidity of 13.7%, of which 5.5% were CE and 8.2% were AE. Prevalence in males and females was 11.6% and 15.6% respectively with a statistically significant difference (chi2=7.0, P< 0.05) . Prevalence in herdsmen and monks/nuns was as high as 23.0% and 13.2%, respectively. Adult worms were found in 5 out of 9 stray dogs by necropsy. 27 of 239 pikas (Ochotona curzoniae) were infected by E. shiquicus (11.3%). CE prevalence in sheep and yaks was 26.4% and 5/16 respectively. The Eg genotype was G1 (sheep strain). Three species of Echinococcus, e.g. E. granulosus, E. multilocularis and E. shiquicus are all prevalent in Darlag County. The prevalence of both AE and CE in human population is high in the area. Domestic dogs are the primary definitive host for both E. granulosus and E. multilocularis.
    Zhongguo ji sheng chong xue yu ji sheng chong bing za zhi = Chinese journal of parasitology & parasitic diseases 03/2009; 27(1):22-6.
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    ABSTRACT: Parasite requires an understanding of complex transmission systems where individual, population and environmental factors and their interactions can hardly been considered separately. Moreover, the importance of space and time in host population and parasite transmission processes is increasingly recognised. The present review illustrates how epidemiology and transmission ecology have evolved in a multidisciplinary framework to a systems approach that includes both spatial and temporal dimensions. Focusing on population processes, three significant challenges are discussed: (i) integration of landscape ecology concepts and modelling across time-space scales, (ii) development of molecular methods that permits easy parasite/host identification and process tracking (e.g. host and parasite movements), and (iii) integration of sociology methods to estimate zoonotic risk and exposure.
    Parasite 10/2008; 15(3):469-76. DOI:10.1051/parasite/2008153469 · 0.82 Impact Factor
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    ABSTRACT: Neospora caninum is an important pathogen of cattle causing significant economic loss. There is much current interest in wild animal reservoirs for this parasite. The role of the rabbit in this is currently unknown. DNA samples from the brains of wild rabbits (Oryctolagus cuniculus) collected from the Malham area of the Yorkshire dales were investigated by species-specific PCR for the presence of N. caninum and Toxoplasma gondii. We found prevalences of N. caninum of 10.5% (6/57) and T. gondii of 68.4% (39/57) with 8.8% (5/57) co-infected. Strain typing of T. gondii positive rabbits revealed strain types I-III were present in this population. Investigation of tissue distribution determined N. caninum DNA was most often detected in the brain and heart, less often in the tongue and not in the liver. To our knowledge this is the first report of N. caninum detection in naturally infected wild rabbits.
    Experimental Parasitology 08/2008; 120(3):255-60. DOI:10.1016/j.exppara.2008.07.011 · 1.86 Impact Factor

Publication Stats

3k Citations
293.07 Total Impact Points

Institutions

  • 1992–2014
    • University of Salford
      • School of Environment and Life Sciences
      Salford, England, United Kingdom
    • Kenya Medical Research Institute
      Nairoba, Nairobi Area, Kenya
  • 2013
    • Asahikawa Medical University
      • Department of Parasitology
      Asakhigava, Hokkaidō, Japan
  • 2009
    • Ecole Nationale de Médecine Vétérinaire
      Tunis-Ville, Tūnis, Tunisia
  • 2002–2008
    • University of Franche-Comté
      Becoinson, Franche-Comté, France
  • 2003
    • Shenzhen Second People's Hospital
      Shen-ch’üan-shih, Zhejiang Sheng, China
  • 1998
    • Xinjiang Medical University
      Ouroumtchi, Xinjiang Uygur Zizhiqu, China
  • 1986–1997
    • Liverpool School of Tropical Medicine
      • Department of Parasitology
      Liverpool, England, United Kingdom
    • African Medical and Research Foundation
      Nairoba, Nairobi Area, Kenya