Developing strategies for the control of Ichthyophthirius multifiliis Fouquet, 1876 (Ciliophora)

The intensification of freshwater aquaculture worldwide has facilitated the propagation of the parasitic ciliate protozoan Ichthyophthirius multifiliis Fouquet, 1876 commonly known as “fish white spot” or “Ich”. Ichthyophthirius multifiliis infections lead to high mortalities, generating significant economic losses in most cultured freshwater fish species worldwide. Until recently, malachite green was the chemical treatment traditionally used to control I. multifiliis infections. Its reclassification as carcinogenic to humans and its subsequent ban for use in food fish has left the industry without any suitable treatments. Currently, in-bath formaldehyde and sodium chloride treatments are the most common option used in farm systems to control I. multifliis infections. Given their low efficacy, however, they are not considered as sustainable long–term options. There is, therefore, an urgent necessity to find efficacious alternatives for controlling I. multifliis infections. The general aim of this research project was to improve the management of I. multifiliis infections in order to develop more comprehensive, environmentally friendly and sustainable therapeutic strategies for use in freshwater food fish aquaculture. The present PhD-thesis present first a literature review chapter providing an overview and critical assessment of chemotherapeutants and physical interventions tested within the last 30 years against I. multifiliis infections. The experimental worked consisted of a number of in vitro and in vivo trials were conducted using experimental scale flow-through, static tank systems and commercial scale raceways within a rainbow trout hatchery, in addition to molecular work on different isolates of the parasite. The results of this research are organised into three experimental chapters which describe the testing of chemical and non-chemical treatments against I. multifiliis infections and work undertaken to determine the most suitable molecular markers to identify I. multifiliis isolates. In the first experimental chapters, the possibility of efficiently controlling I. multifliis infections through the administration of novel environmentally-friendly chemical treatments (e.g. bronopol and peracetic acid-based products) was investigated. The results clearly showed that bronopol and peractic acid-based products have a strong biocidal/cytotoxic effect against all free-living stages of I. multifiliis (e.g. tomonts, cysts and theronts). The administration of high concentrations of bronopol (e.g. 20, 50 and 100 mg L-1) over short periods of exposure (e.g. 30 min) significantly reduced the survival of tomonts, cysts and theronts and delayed the development of I. multifiliis tomonts and cysts. Prolonged low concentrations of bronopol (e.g. 1 mg L-1) greatly reduced the survival of infective theronts, although such treatment did not affect the ability of surviving theronts to subsequently infect a host. When tested in vivo, the continuous prolonged exposure (e.g. 27 days) of low concentrations of bronopol (e.g. 2 and 5 mg L-1) had an impact on the population dynamics of I. multifiliis, this being demonstrated by a significant reduction in the number of trophonts developing within the fish. Low concentrations of bronopol (e.g. 2 mg L-1) administrated as a preventive treatment prior to infection also proved to be very successful at reducing the colonisation success of I. multifiliis. Peracetic acid administrated at low concentrations (e.g. 8, 12 and 15 mg L-1) over a short window of exposure (e.g. 1 h) displayed a strong biocidal effect against all the free-living stages of I. multifiliis (e.g. tomonts, cysts and theronts). The bronopol and peracetic acid-based products tested here both appear to be capable of disrupting the development of the cyst stage of I. multifiliis which is seldom reported for chemotherapeutants currently used against this parasite. These results suggest that bronopol and peracetic acid-based products have a place in the arsenal of treatment options for controlling I. multifiliis infections in commercial aquaculture systems. The use of a mechanical device or a biological control agent to remove the cyst stage of I. multifiliis and the impact of such control on the population dynamics and the levels of infection of fish were also investigated. The results revealed that tomonts preferentially settle and encyst on the base of culture systems and on biofilm–covered substrates. The survival of the tomont stage is greatly affected by the composition of the substrate upon which it settles and is significantly lower on polypropylene-based plastic. The lining of raceways in a commercial rainbow trout hatchery with a low-adhesion polymer created a smooth surface facilitating the dislodgement and elimination of the cyst stage of I. multifilis by natural flushing or brushing. The physical removal of the cyst stage alone, through the use of a mechanical device or substrate detrivorous/algae feeder as a biological control agent, significantly reduced the propagation of I. multifiliis to a low level of infection without the need to deploy an additional chemical treatment. These studies demonstrate that the cyst is a key stage in the dynamics of I. multifiliis infection and its removal from the fish culture systems could constitute an effective and simple mean of managing I. multifiliis infections. The third experimental chapter explores the utilisation of molecular marker to characterise different isolates of I. multifiliis. The results highlight the unsuitability of the rDNA region (ITS-1 and ITS-2) and the strong potential of the mtDNA (COI) as molecular markers to discriminate isolates of I. multifiliis from distant geographical locations. It is suggested that genetic “barcoding” using mtDNA is the most effective method to identify I. multifiliis isolates. Importantly, genetic “barcoding” could allow associating I. multifiliis strains or geographical isolates with particular properties as regards their ecophysiology, pathogenicity and sensitivity to treatment, in order to improve the management of I. multifiliis infections according to the specific genetic isolate encountered. This research project demonstrates the efficacy of a range of new approaches against the propagation of I. multifiliis. Together, our findings contribute towards the development of a more effective and integrated system for managing I. multifliis infections in farm systems. The utilisation of physical methods and of environmentally friendly chemotherapeutants holds great potential for the control of I. multifiliis infections in organic fish production and in a broader context to any freshwater food fish farms affected by I. multifiliis

An assessment of the use of drug and non-drug interventions in the treatment of Ichthyophthirius multifiliis Fouquet, 1876, a protozoan parasite of freshwater fish

Infection by the ciliate protozoan Ichthyophthirius multifiliis Fouquet, 1876 causes significant economic losses in freshwater aquaculture worldwide. Following the ban on the use of malachite green for treating food fish, there has been extensive research aimed at identifying suitable replacements. In this paper we critically assess drug and non-drug interventions, which have been tested for use or have been employed against this parasite and evaluate possibilities for their application in farm systems. Current treatments include the administration of formaldehyde, sodium chloride (salt), copper sulphate and potassium permanganate. However, purportedly more environmentally friendly drugs such as humic acid, potassium ferrate (VI), bronopol and the peracetic acid-based products have recently been tested and represent promising alternatives. Further investigation, is required to optimize the treatments and to establish precise protocols in order to minimize the quantity of drug employed whilst ensuring the most efficacious performance. At the same time, there needs to be a greater emphasis placed on the non-drug aspects of management strategies, including the use of non-chemical interventions focusing on the removal of free-swimming stages and tomocysts of I. multifiliis from farm culture systems. Use of such strategies provides the hope of more environmentally friendly alternatives for the control of I. multifiliis infections

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

In vitro assessment of the chemotherapeutic action of a specific hydrogen peroxide, peracetic, acetic, and peroctanoic acid-based formulation against the free-living stages of Ichthyophthirius multifiliis (Ciliophora)

Traditionally, malachite green administrated as in-bath treatment was the most effective and common strategy used in freshwater aquaculture systems to control infections of the ciliate protozoan parasite Ichthyophthirius multifiliis Fouquet, 1876. After the ban of malachite green in the USA and Europe to be used in fish for human consumption, there has been extensive research destined to find efficacious replacements. Recently, peracetic acid-based compounds have demonstrated a strong cytotoxic effect in vitro and in vivo against I. multifiliis. In the present study, we tested the efficacy of a hydrogen peroxide, peracetic, acetic and peroctanoic acid-based formulation (HPPAPA) to eliminate the free-living stages of I. multifiliis (tomonts, cysts and theronts). The results obtained showed that the administration of low doses (8, 12 or 15 mg/l) of a specific HPPAPA-based product during a short window of exposure (60 min) kills nearly all free-living stages of I. multifiliis (theronts, tomonts and cysts) within the window of treatment (&sim;100% mortality for all the stages; one-way ANOVA, P&thinsp;&le;&thinsp;0.001). Of note, even the lowest concentration of HPPAPA tested (8 mg/l) was able to disrupt normal cyst development and therefore theront release. The demonstrated in vitro efficacy of the peracetic acid-based product tested on the present study suggests its great potential to control I. multifiliis infections in commercial aquacultural systems

Effects of long duration, low dose bronopol exposure on the control of Ichthyophthirius multifiliis (Ciliophora), parasitising rainbow trout (Oncorhynchus mykiss Walbaum)

Ichthyophthirius multifiliis Fouquet, 1876 infections on intensively reared fish stocks can increase rapidly, which if left unmanaged, can result in the heavy loss of stock. The present study explores the efficacy of long duration, low dose (1, 2 and 5 mg L-1) treatments of bronopol (marketed as PycezeTM, Novartis Ltd.) in reducing the number of trophonts establishing on juvenile Oncorhynchus mykiss held under small scale culture conditions. The effect of bronopol on the colonisation success of infective theronts was also investigated by adding 2 mg L-1 bronopol to the water prior and during the infection process. The number of parasites surviving on fish treated this way was compared to groups of fish that only received treatment after infection had occurred. The effect of bronopol on exiting trophonts throughout their external development to the point of theront release was also assessed through the delivery of 1 mg L-1, 2 mg L-1 and 5 mg L-1 bronopol for up to 27 days consecutively (days 9-36 post-infection). The trial showed that a nominal dose of 2 mg L-1 bronopol administered prior to infection significantly reduced the number of theronts surviving in the water column at the time of the initial challenge by 35-40% (P&nbsp;less than&nbsp;0.05). Similarly, doses of 2 and 5 mg L-1 bronopol administered as the first wave of mature I. multifiliis trophonts exited fish (i.e. day 11 onwards) to develop externally, reduced the number of trophonts establishing on fish as the second cycle of infection by 52-83%. Continuous application of 2 and 5 mg L-1 bronopol throughout the second and third cycles of I. multifiliis infection gave further reductions of between 90 and 98%. The number of trophonts on the fish in the control tanks and those treated with 1 mg L-1 and the 2 mg L-1 dose at the time of initial infection, by comparison, were observed to increase with successive cycles of infection. From these small scale tank trials, this study demonstrates that the strategic, long duration, low dose delivery of drugs like bronopol can significantly reduce the number of trophonts establishing on fish suggesting the potential of this drug at managing I. multifiliis infections

The anti-protozoal activity of bronopol on the key life-stages of Ichthyophthirius multifiliis Fouquet, 1876 (Ciliophora)

PycezeTM (Novartis Animal Vaccines Ltd.) is licensed as a veterinary medicine to treat fungal infections in salmon, trout and their eggs. The active ingredient is bronopol, which due to its broad-spectrum activity has the potential to be an effective treatment against other important aquatic pathogens. In this study the efficacy of bronopol against Ichthyophthirius multifiliis was tested both in vitro and in vivo. In vitro trials demonstrated a 30 min exposure to 100 mg L-1 bronopol killed 51.7% of the infective theronts. In vitro exposure of the protomonts to bronopol (0, 20, 50 and 100 mg L-1) for 30 min was observed to kill 0%, 76.2%, 97.2% and 100% respectively. Protomonts surviving treatment, demonstrated delayed development with the time taken from protomont until the release of theronts ranging from 28.3 h for 0 mg L-1 exposure, to 70 h for parasites in 20 and 50 mg L-1 exposure groups. These concentrations also caused asymmetric cell division of the encysted tomonts. Exposure of encysted tomonts (min. 8 cell stage) to 100 mg L-1 bronopol for 30 min, killed 50% within this period, with the remainder dying within the subsequent 42 h post exposure. Lower doses of bronopol were less effective in killing encysted tomonts than the higher doses (3.3% of parasites were killed in 20 mg L-1; 10% in 50 mg L-1), but they still delayed theront release significantly (25.7 h for 0 mg L-1 to 46.2 h for parasites exposed to 20-50 mg L-1). Long, low dose (1 mg L-1) exposure to bronopol was also efficacious against theronts. Survival after 12 h was 29% (c.f. 100% in control parasites), and less than 1% after 24 h exposure (c.f. 74% in control parasites). Theronts surviving these exposures demonstrated reduced infection success compared to control theronts. The findings of this study demonstrate that bronopol (PycezeTM) affects the survival of all free-living stages of I. multifiliis (protomonts, tomont and theronts), thus suggesting that bronopol may serve a useful role in the control of I. multifiliis infections

Multi-centre testing and validation of current protocols for the identification of Gyrodactylus salaris (Monogenea)

Despite routine screening requirements for the notifiable fish pathogen Gyrodactylus salaris, no standard operating procedure exists for its rapid identification and discrimination from other species of Gyrodactylus. This study assessed screening and identification efficiencies under real-world conditions for the most commonly employed identification methodologies: visual, morphometric and molecular analyses. Obtained data were used to design a best-practice processing and decision-making protocol allowing rapid specimen throughput and maximal classification accuracy. True specimen identities were established using a consensus from all three identification methods, coupled with the use of host and location information. The most experienced salmonid gyrodactylid expert correctly identified 95.1% of G. salaris specimens. Statistical methods of classification identified 66.7% of the G. salaris, demonstrating the need for much wider training. Molecular techniques (internal transcribed spacer region-restriction fragment length polymorphism (ITS-RFLP)/cytochrome c oxidase I (COI) sequencing) conducted in the diagnostic laboratory most experienced in the analysis of gyrodactylid material, identified 100% of the true G. salaris specimens. Taking into account causes of potential specimen loss, the probabilities of a specimen being accurately identified were 95%, 87% and 92% for visual, morphometric and molecular techniques, respectively, and the probabilities of correctly identifying a specimen of G. salaris by each method were 81%, 58% and 92%. Inter-analyst agreement for 189 gyrodactylids assessed by all three methods using Fleiss' Kappa suggested substantial agreement in identification between the methods. During routine surveillance periods when low numbers of specimens are analysed, we recommend that specimens be analysed using the ITS-RFLP approach followed by sequencing of specimens with a "G. salaris-like" (i.e. G. salaris, Gyrodactylus thymalli) banding pattern. During periods of suspected outbreaks, where a high volume of specimens is expected, we recommended that specimens be identified using visual identification, as the fastest processing method, to select "G. salaris-like" specimens, which are subsequently identified by molecular-based techniques