Human waterborne trematode and protozoan infections

Waterborne trematode and protozoan infections inflict considerable morbidity on healthy, i.e., immunocompetent people, and may cause life-threatening diseases among immunocompromised and immunosuppressed populations. These infections are common, easily transmissible, and maintain a worldwide distribution, although waterborne trematode infections remain predominantly confined to the developing countries. Waterborne transmission of trematodes is enhanced by cultural practices of eating raw or inadequately cooked food, socio-economical factors, and wide zoonotic and sylvatic reservoirs of these helminths. Waterborne protozoan infections remain common in both developed and developing countries (although better statistics exist for developed countries), and their transmission is facilitated via contacts with recreational and surface waters, or via consumption of contaminated drinking water. The transmissive stages of human protozoan parasites are small, shed in large numbers in feces of infected people or animals, resistant to environmental stressors while in the environment, and few are (e.g., Cryptosporidium oocysts) able to resist standard disinfection applied to drinking water.