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Applied and Environmental Microbiology, June 2004, p. 3776-3780, Vol. 70, No. 6
0099-2240/04/$08.00+0 DOI: 10.1128/AEM.70.6.3776-3780.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.
Distribution of Giardia duodenalis Genotypes and Subgenotypes in Raw Urban Wastewater in Milwaukee, Wisconsin
Irshad M. Sulaiman,1 Jianlin Jiang,1 Ajaib Singh,2 and Lihua Xiao1*
Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, U.S. Public Health Service, U.S. Department of Health and Human Services, Atlanta, Georgia 30341,1
City of Milwaukee Public Health Laboratories, Milwaukee, Wisconsin 532022
Received 30 October 2003/
Accepted 23 February 2004

ABSTRACT
Giardia cysts in 131 raw wastewater samples from Milwaukee,
Wis., were genotyped by sequence analysis of the triosephosphate
isomerase gene which showed the presence of two distinct genotypes
(assemblages A and B) of
Giardia duodenalis. Of the 131 samples,
111 belonged to assemblage A, and the remaining samples belonged
to assemblage B. A high degree of genetic polymorphism was evident
within the assemblage B cluster, with 10 distinct subgenotypes
identified, eight of which have not been reported before.

INTRODUCTION
Giardiasis is the most common parasitic disease in the United
States. A recent surveillance study of 6 years (January 1992
through December 1997) revealed occurrences of transmission
in all major geographic areas of United States, with an estimated
incidence of 2.5 million cases annually (
12). Giardiasis is
also a common cause of diarrheal disease in other mammals (
35).
Based on host origins, 41 species of
Giardia have been named
(
5,
33). However, the taxonomy of
Giardia at the species level
is unresolved because only limited morphological differences
are present between different species. Thus far, only six species
in the genus are considered valid:
Giardia duodenalis (synonym
G. lamblia or
G. intestinalis) in a wide range of mammals,
Giardia agilis in amphibians,
Giardia muris in rodents,
Giardia ardeae and
Giardia psittaci in birds, and
Giardia microti in muskrats
and voles (
7,
8,
9,
11,
32).
Waterborne outbreaks of giardiasis are a major public health problem in many industrialized nations, including the United Kingdom, Sweden, Canada, and the United States (20, 26). Human sewage has been considered a source of Giardia cyst contamination in water. In Canada and Italy, a high prevalence (73 to 100%) of Giardia cysts was reported in raw sewage samples (4, 14, 34). The public health importance and contamination sources of Giardia cysts found in water, however, are largely unclear, because very few studies have been carried out to genetically characterize the Giardia cysts in water. Nevertheless, G. duodenalis cysts of assemblage A have been identified in a few clams collected from the Rhode River, a Chesapeake Bay subestuary in Maryland (13).
Recently, we described the development of a Giardia genotyping tool based on a sequence characterization of the triosephosphate isomerase (TPI) gene of G. duodenalis from humans, domestic animals, and wild mammals (29). In this communication, we have used this molecular tool in the detection and differentiation of Giardia spp. in raw wastewater samples from Milwaukee, Wis.

Wastewater samples.
A total of 237 raw wastewater samples were obtained from the
Jones Island wastewater treatment plant in Milwaukee between
November 1999 and February 2003 (with an average of two to four
samples per week and no more than one sample per day). Each
sample was a composite from three separate siphons that delivered
influent to the treatment plant: domestic sewage, combined domestic
and industrial sewage, and diluted domestic sewage overflow.
For each siphon, a small quantity (10 to 15 ml), based on the
proportioned diurnal flow, was automatically drawn every 15
min and deposited in a 15-liter refrigerated tank on a diurnal
flow-proportioned basis. After 24 h, each tank was brought to
the laboratory and manually mixed in proportions to the volumes
delivered by the three systems. Only 50 ml of the 24-h composite
was analyzed for each sample. The 50-ml subsample was concentrated
by centrifugation at 1,000
x g for 10 min.
Giardia cysts in
pellets were isolated by immunomagnetic separation (IMS), with
magnetic beads coated with an anti-
Giardia monoclonal antibody
(Dynal, Inc., Lake Success, N.Y.). The purified
Giardia cysts
(attached to magnetic beads) were used in DNA extraction.
Some samples were also processed for microscopic detection of Giardia cysts. A portion of each sample (50 ml) was centrifuged at 1,800 x g for 15 min. The supernatant was discarded and the packed pellet volume (
0.5 ml) was resuspended. Procedures described in the U.S. Environmental Protection Agency method 1623 (30) were used to purify one-half (5 ml) of the resuspended pellet by IMS using magnetic beads (Dynal, Inc.), stained with fluorescein isothiocyanate-labeled anti-Cryptosporidium and anti-Giardia monoclonal antibodies (Merifluor; Meridian Bioscience, Inc.), and examined under a fluorescent microscope. Giardia cysts were identified by fluorescence characteristics, size, and shape and then enumerated. Any discrepancy was resolved by differential interference contrast microscopy.

DNA extraction.
To extract DNA from concentrates of wastewater, the IMS beads
with bound
Giardia cysts were subjected to five freeze-thaw
cycles, incubated at 56°C with 1 mg of proteinase K (Sigma,
St. Louis, Mo.) per ml for at least 1 h, and diluted with an
equal volume of ACS grade ethanol. DNA was extracted by passing
the cyst-ethanol suspension through QIAamp DNA Mini isolation
columns (QIAGEN, Valencia, Calif.).

PCR and sequencing analyses.
Giardia cysts in samples were identified to the species and
genotype (assemblage) level using a previously described nested
PCR protocol (
29), which amplified a 605-bp fragment of the
TPI gene in the primary PCR and a 532-bp fragment in the secondary
PCR. The secondary PCR products were purified using Microcon
PCR centrifugal filter devices (MILLIPORE, Bedford, Mass.) and
sequenced using an ABI 3100 automated sequencer (Perkin Elmer).
Sequence accuracy was confirmed by two-directional sequencing
of two separate PCR products from each sample. Multiple alignments
of the nucleotide sequences were performed using the PILEUP
program in the Wisconsin Package version 9.0 programs (Genetics
Computers Group, Madison, Wis.). To assess the extent of genetic
diversity of
Giardia species in samples and their evolutionary
relationships to other
Giardia species and assemblages, a phylogenetic
analysis was carried out. In the analysis, published
Giardia TPI nucleotide sequences (GenBank accession no.
L02116,
L02120,
U57897,
AF06957 to
AF069565, and
AY228628 to
AY228649) were
aligned with the TPI sequences from the samples obtained in
this study. A neighbor-joining tree was constructed based on
the evolutionary distances calculated by Kimura-2-parameter
analysis using the program TreeconW (
http://rrna.uia.ac.be/dcse/help/treecon.html).
Subsequently, because only assemblages A and B of
G. duodenalis were found in the samples,
G. microti (GenBank accession no.
AY228649) was used as the outgroup because of its genetic relatedness
to
G. duodenalis (Fig.
1). The reliability of these trees was
assessed using the bootstrapping method (
10) with 1,000 pseudoreplicates.

Giardia genotypes in wastewater.
In this study, a total of 237 samples were examined for
Giardia spp. by TPI-based diagnostic PCR protocols. Of these, 131 samples
(55%) were PCR positive. Fifty-two samples were also processed
by Environmental Protection Agency method 1623, all of which
were positive by immunofluorescence microscopy. The average
number of cysts per 25 ml was 95.3 (range, 13 to 223). All microscopy-positive
samples were amplified by PCR. Nucleotide sequences (532 bp)
were generated from all PCR-amplified TPI fragments. The extent
of genetic diversity was assessed by multiple alignments of
the TPI sequences with sequences of known
Giardia species and
genotypes. This analysis revealed the presence of two major
genotypes of
G. duodenalis in the samples examined (Table
1).
To confirm the existence of two of the
Giardia genotypes in
wastewater, a neighbor-joining tree was constructed with published
TPI sequences and sequences from this study, with a
G. ardeae sequence (GenBank accession no.
AF069564) as the outgroup in
an initial analysis and a
G. microti sequence (GenBank accession
no.
AY228649) in the secondary analysis. Phylogenetic analysis
revealed that all TPI sequences from wastewater were placed
in two large clusters, assemblage A and assemblage B, with 111
samples belonging to assemblage A and 20 samples belonging to
assemblage B (Fig.
1).

Intragenotypic variations.
Genetic variations in the TPI nucleotide sequences from the
samples were evident within both assemblages A and B. By using
the GenBank sequence L02120 as the reference sequence, the samples
that grouped in assemblage A had 11 single nucleotide polymorphisms
(SNPs) (Table
2). Eight of the 11 SNPs occurred at the third
position of the codons and were synonymous in nature. Altogether,
five distinct types of TPI sequences of assemblage A were evident
in the samples, of which four were new subgenotypes. These five
types of sequences were named subgenotypes WA1 to WA5, to reflect
intragenotypic variations in assemblage A. Of the 111 assemblage
A samples, the majority of them (107, subgenotype WA1) were
identical to a TPI sequence (GenBank accession no.
AY228647)
that was obtained from six human samples from Peru (
29). The
remaining four subgenotypes (WA2, WA3, WA4, and WA5) were represented
each by one sample (Table
3).
View this table:
[in this window]
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|
TABLE 3. Distribution of subgenotypes of assemblages A and B in the 131 Giardia-positive wastewater samples in Milwaukee
|
A very high degree of genetic polymorphism was seen among the
limited number of
G. duodenalis assemblage B samples. By using
the GenBank sequence L02116 as the reference sequence, 26 SNPs
were evident within the 20 samples that clustered in assemblage
B (Table
4). Twenty-one of the SNPs occurred at the third position
of the codons, but only one of the SNPs was nonsynonymous (a
change of a glutamic acid to an asparagine at nucleotide position
105). Altogether, 10 types of sequences were obtained and were
named subgenotypes WB1 to WB10 to reflect intragenotypic variations
in assemblage B. Eight of the subgenotypes were new. Five of
the subgenotypes (WB2, WB3, WB4, WB5, and WB9) were represented
each by a single sample; two subgenotypes (WB1 and WB7) were
represented by two samples each, two subgenotypes (WB6 and B10)
had three samples each, and one subgenotype (WB8) had five samples
(Table
3). Two of the subgenotypes (WB3 and WB8) were identical
to S1 and S9 subgenotypes of assemblage B recently reported
for humans (India, Peru, and the United States) and wild mammals
(beavers and muskrats) in Maryland, respectively (
29).

Public health significance.
Two major groups of
G. duodenalis have been recognized in humans,
assemblages A and B (Table
5). In addition to these two assemblages,
phylogenetic analysis of glutamate dehydrogenase, elongation
factor 1

, TPI, and small subunit (SSU) rRNA nucleotide sequences
have identified three to five other host-adapted lineages of
G. duodenalis in cattle, dogs, cats, and rodents (
23,
24,
25,
27). Only the two human-pathogenic assemblages were found in
wastewater in this study, even though rodents were expected
to be present in the wastewater distribution system, indicating
that rodents were not significant contributors to
Giardia genotypes
found in this study. The TPI gene was reported to display the
highest degree of polymorphism in
G. duodenalis, which allows
it to differentiate
G. duodenalis at both genotype and intragenotype
levels (
23,
29). It has a further advantage over the SSU rRNA
gene in being able to be easily amplified without the use of
special buffers designed for the PCR of GC-rich targets (
29).
One potential problem of the technique is its limited ability
to detect mixed genotypes in environmental samples.
The two human-pathogenic genotypes (assemblages A and B) of
G. duodenalis are distributed worldwide (Table
5). The distribution
of each genotype in humans, however, differs according to the
studies and geographic locations. For example, in a study in
Mexico, all 22 samples and derived clones from humans belonged
to the restriction fragment length polymorphism (RFLP) subtype
II of the assemblage A, with a complete lack of assemblage B.
Biological or geographic factors were attributed to the predominance
of one subtype in the study area, but the tool used divides
assemblage A only to two subtypes (
28). Another study conducted
in Mexico had also shown that all 26 homogeneous isolates from
humans belonged to assemblage A (
6). Similarly, all seven human
isolates in Korea characterized at the SSU rRNA locus were from
assemblage A (
36). However, several studies conducted in India,
Peru, and the United Kingdom showed that assemblage B was responsible
for more human infections than assemblage A (Table
5).
In recent years, several attempts have been made to detect and differentiate Giardia spp. in environmental samples by using PCR techniques (4, 31, 34). The distribution of Giardia spp. in environmental samples is likely dependent on human, agricultural, and wildlife activities. Two human-pathogenic genotypes of G. duodenalis were identified in 14 environmental samples (assemblage A in 10 and assemblage B in 4) from Canada by using a SSU rRNA-based PCR-RFLP protocol (31, 34). In Italy, 16 samples from four wastewater plants were analyzed by a beta-giardin-based PCR-RFLP method; assemblage A was found in eight of the samples, and both assemblages A and B were found in the remaining eight samples (4). The predominance of assemblage A in wastewater in Italy is in agreement with the genotype distribution in humans in the same country (3) (Table 5).
In the present study with a much larger sample size, both human-pathogenic genotypes (assemblages A and B) were found in 131 wastewater samples. The majority (84.7%) of the samples (111 samples) belonged to G. duodenalis assemblage A, which had five distinct subgenotypes (WA1 to WA5). However, one subgenotype (WA1) accounted for most of the assemblage A samples (107 of 111), indicating that humans in Milwaukee were infected with subgenotype WA1. This subgenotype was identical to a sequence previously obtained from a cultured isolate from humans (assemblage A, group II; GenBank accession no. AF069557) in Australia (23) and from six fecal samples from humans (GenBank accession no. AY228647) in Peru (29). The significance of a predominant subgenotype in Milwaukee is not clear. It is tempting to conclude a common source of human infection was responsible for the wide occurrence of subgenotype WA1. In contrast, 20 assemblage B samples had a high genetic diversity (with 10 distinct subgenotypes), indicating that it is unlikely that the transmission of Giardia infection in Milwaukee is restricted to one source. It is likely that assemblage A parasites are more conserved and evolve more slowly than assemblage B parasites. It is also possible that subgenotype WA1 of assemblage A is more infectious to humans than other Giardia parasites. Recently, it has been reported that assemblage B was seen in patients with persistent diarrhea, whereas assemblage A was seen mostly in patients with intermittent diarrhea (16).

Nucleotide sequence accession numbers.
Distinct nucleotide sequences of the TPI gene of
G. duodenalis in wastewater were deposited in the GenBank database under accession
no.
AY368157 to
AY368171.

ACKNOWLEDGMENTS
This study was supported in part by a research grant from the
AWWA Research Foundation.
We thank Birhane Dashew, Jeff MacDonald, and Sanjib Bhattacharya for their assistance in sample collection and Clem Ng for microscopic examination.

FOOTNOTES
* Corresponding author. Mailing address: Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Building 22, Mail Stop F-12, 4770 Buford Highway, Atlanta, GA 30341-3717. Phone: (770) 488-4840. Fax: (770) 488-4454. E-mail:
lxiao{at}cdc.gov.


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Applied and Environmental Microbiology, June 2004, p. 3776-3780, Vol. 70, No. 6
0099-2240/04/$08.00+0 DOI: 10.1128/AEM.70.6.3776-3780.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.
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