Portal de Periódicos da CAPES

Zoonotic Parasites of Reptiles: A Crawling Threat

2020; Elsevier BV; Volume: 36; Issue: 8 Linguagem: Inglês

10.1016/j.pt.2020.04.014

1471-5007

Jairo Alfonso Mendoza‐Roldan, David Modrý, Domenico Otranto,

Vector-borne infectious diseases

Species of protozoa, helminths, pentastomids, and arthropod vectors exploit reptiles as definitive or paratenic hosts, which may represent a public health concern.The zoonotic risk is associated with human–reptile interactions and includes environmental contamination, reptile consumption, or keeping reptiles as pets.Exotic reptile species may introduce new zoonotic parasites in a previously nonendemic region.Pentastomiasis and sparganosis are life-threatening food-borne parasitoses.In our households, if precautions are not taken, reptiles may transmit zoonotic parasites by direct contact or fecal contamination.Trained veterinarians, physicians, and public health officials are important to advocate for proper diagnostics, parasite identification and treatment, as well as for surveillance strategies and food inspection in areas where reptiles are consumed. Reptiles are reservoirs of a wide range of pathogens, including many protozoa, helminths, pentastomids, and arthropod parasitic species, some of which may be of public health concern. In this review we discuss the zoonotic risks associated with human–reptile interactions. Increased urbanization and introduction of exotic species of reptile may act as drivers for the transmission of zoonotic parasites through the environment. In addition, being a part of human diet, reptiles can be a source of life-threatening parasitoses, such as pentastomiasis or sparganosis. Finally, reptiles kept as pets may represent a risk to owners given the possibility of parasites transmitted by direct contact or fecal contamination. Awareness of reptile-borne zoonotic parasitoses is important to advocate control, prevention, and surveillance of these neglected diseases. Reptiles are reservoirs of a wide range of pathogens, including many protozoa, helminths, pentastomids, and arthropod parasitic species, some of which may be of public health concern. In this review we discuss the zoonotic risks associated with human–reptile interactions. Increased urbanization and introduction of exotic species of reptile may act as drivers for the transmission of zoonotic parasites through the environment. In addition, being a part of human diet, reptiles can be a source of life-threatening parasitoses, such as pentastomiasis or sparganosis. Finally, reptiles kept as pets may represent a risk to owners given the possibility of parasites transmitted by direct contact or fecal contamination. Awareness of reptile-borne zoonotic parasitoses is important to advocate control, prevention, and surveillance of these neglected diseases. Crawling creatures, identified as reptiles (from the Latin repere 'to crawl'), include a polyphyletic (see Glossary) group of animals belonging to different orders and a large number of species (Box 1) [1.Pincheira-Donoso D. et al.Global taxonomic diversity of living reptiles.PLoS One. 2013; 8: 3Crossref Scopus (128) Google Scholar]. In many aspects, reptiles represent enigmatic creatures and arouse an incredible range of feelings in humans as they are perceived, according to different cultures, as fascinating and even worshipped in some African and Asian societies, such as the ball pythons (Python regius) and black cobra (Naja melanoleuca) in Africa, or scary and disgusting wild creatures crawling on earth, mainly in the western world [2.Alves R. Albuquerque U. Ethnozoology: Animals in Our Lives. Academic Press, 2018Google Scholar]. Accordingly, the symbolic usage of reptiles varied through history in many cultures. The range of attitudes of humans toward reptiles commonly affects their conservation, being often persecuted as dangerous creatures (P. Luís Ceríaco, Master's Thesis, Évora University, 2010). Nowadays, reptiles have become popular exotic pets and account for an estimated 21% of the value of the live animal trade [3.Engler M. Parry-Jones R. Opportunity or Threat: The Role of the European Union in Global Wildlife Trade. TRAFFIC Europe, 2007Google Scholar]. In addition, in some parts of the world, the reptiles are used as important source of food, medicines, and materials (e.g., the leather industry) (Box 2).Box 1Evolution, Biodiversity, and Ecological RelevanceReptiles are among the most diverse group of animals that inhabit almost all continents and environments and, as a matter of fact, one of the most ancient groups of animals alive, having their ancestors in dinosaurs (i.e., reptiliomorph tetrapods) that colonized the earth during the Carboniferous period, around 300 million years ago [91.Shaw G. End of Cretaceous extinction: the end of the dinosaurs.in: Shaw G. Great Moments in the History of Life. Springer, 2018: 65-68Crossref Google Scholar]. However, a relatively low number of species survived the mass extinction events during the Cretaceous–Paleogene period (i.e., around 65 million years ago), spreading through almost all the biotopes on earth and becoming increasingly adapted to life on dry land [92.Mohabey D. Samant B. Cretaceous–paleogene transition of reptilian tetrapods across deccan volcanism in India.Open J. Geol. 2019; 9: 639Crossref Google Scholar]. This class of animals includes about 1200 genera, and more than 10 000 species have been described, mainly within the group Squamata (i.e., 10 417 species of lizards, snakes, and worm-like amphisbaenians), Testudines (i.e., 351 species of turtles and tortoises), Crocodylia (i.e., 24 species), and Rhynchocephalia (i.e., 1 species of tuataras) [93.Uetz P. et al.A global catalogue of primary reptile type specimens.Zootaxa. 2019; 4695: 438-450Crossref Scopus (61) Google Scholar]. Some reptiles are of great ecological significance as they represent in nature either the first (e.g., lizards, geckos) or the higher level (e.g., crocodiles) of the food chain. In the latter case, given their aquatic habits and longevity (generally >50 years), crocodilians have also been suggested as potential indicators for environmental pollution as they reflect changes in an area over longer periods.Box 2Reptiles as Food and MedicamentsReptiles have represented an important source of protein in the diet of humans in many parts of the world and are still important in tropical countries and as gourmet specialties in Europe and North America (i.e., crocodilian meat) [94.European Food Safety Authority (EFSA) Public health risks involved in the human consumption of reptile meat – Scientific Opinion of the Panel on Biological Hazards.EFSA J. 2007; 5: 578Crossref Google Scholar]. Infection by the food-borne pathogens closely depends on the way in which the reptile meat is prepared and eaten. In many areas of the world reptiles are eaten as any other protein source; however, it is also broadly believed that reptile meat and organs have medicinal properties [95.da Nóbrega A. et al.Reptiles used in traditional folk medicine: conservation implications.Biodivers. Conserv. 2008; 17: 2037-2049Crossref Scopus (154) Google Scholar]. While the usage of dry or alcohol-based remedies is rather safe, most of the clinical reports of reptile-associated helminthiases of humans are connected with the consumption of raw meat, organs, blood, or bile of snakes or lizards. In some part of Asia, applying snake meat as a poultice to a wound represents an alternative route of human infection by Spirometra [52.Liu Q. et al.Human sparganosis, a neglected food borne zoonosis.Lancet Infect. Dis. 2015; 15: 1226-1235Abstract Full Text Full Text PDF PubMed Scopus (140) Google Scholar]. Usually, when reptiles are cooked as a dish, the risk of parasite transmission relates mainly to the way in which the animal was kept at home prior its slaughtering, evisceration, and food preparation, rather than to consumption of the resulting meal.To illustrate, here is the traditional finger-licking recipe from Gabon made with African rock python: 'Take medium to large size African rock python. Skin the snake, chop to small pieces and place into a large pot. Sprinkle with salt, add cold water and lemongrass (to reduce snake smell), bring to boil and simmer shortly. Remove snake pieces from water, put into larger pan with hot vegetable oil and gently fry the meat with curry and black pepper. Add little water, bring to the boil, cover with lid and boil for another 20 minutes. Serve with tomato sauce and steamed rice.'Interestingly, similar recipes are popping up in the USA as a reaction to the growing presence of invasive Burmese pythons, for example, in the Everglades. Reptiles are among the most diverse group of animals that inhabit almost all continents and environments and, as a matter of fact, one of the most ancient groups of animals alive, having their ancestors in dinosaurs (i.e., reptiliomorph tetrapods) that colonized the earth during the Carboniferous period, around 300 million years ago [91.Shaw G. End of Cretaceous extinction: the end of the dinosaurs.in: Shaw G. Great Moments in the History of Life. Springer, 2018: 65-68Crossref Google Scholar]. However, a relatively low number of species survived the mass extinction events during the Cretaceous–Paleogene period (i.e., around 65 million years ago), spreading through almost all the biotopes on earth and becoming increasingly adapted to life on dry land [92.Mohabey D. Samant B. Cretaceous–paleogene transition of reptilian tetrapods across deccan volcanism in India.Open J. Geol. 2019; 9: 639Crossref Google Scholar]. This class of animals includes about 1200 genera, and more than 10 000 species have been described, mainly within the group Squamata (i.e., 10 417 species of lizards, snakes, and worm-like amphisbaenians), Testudines (i.e., 351 species of turtles and tortoises), Crocodylia (i.e., 24 species), and Rhynchocephalia (i.e., 1 species of tuataras) [93.Uetz P. et al.A global catalogue of primary reptile type specimens.Zootaxa. 2019; 4695: 438-450Crossref Scopus (61) Google Scholar]. Some reptiles are of great ecological significance as they represent in nature either the first (e.g., lizards, geckos) or the higher level (e.g., crocodiles) of the food chain. In the latter case, given their aquatic habits and longevity (generally >50 years), crocodilians have also been suggested as potential indicators for environmental pollution as they reflect changes in an area over longer periods. Reptiles have represented an important source of protein in the diet of humans in many parts of the world and are still important in tropical countries and as gourmet specialties in Europe and North America (i.e., crocodilian meat) [94.European Food Safety Authority (EFSA) Public health risks involved in the human consumption of reptile meat – Scientific Opinion of the Panel on Biological Hazards.EFSA J. 2007; 5: 578Crossref Google Scholar]. Infection by the food-borne pathogens closely depends on the way in which the reptile meat is prepared and eaten. In many areas of the world reptiles are eaten as any other protein source; however, it is also broadly believed that reptile meat and organs have medicinal properties [95.da Nóbrega A. et al.Reptiles used in traditional folk medicine: conservation implications.Biodivers. Conserv. 2008; 17: 2037-2049Crossref Scopus (154) Google Scholar]. While the usage of dry or alcohol-based remedies is rather safe, most of the clinical reports of reptile-associated helminthiases of humans are connected with the consumption of raw meat, organs, blood, or bile of snakes or lizards. In some part of Asia, applying snake meat as a poultice to a wound represents an alternative route of human infection by Spirometra [52.Liu Q. et al.Human sparganosis, a neglected food borne zoonosis.Lancet Infect. Dis. 2015; 15: 1226-1235Abstract Full Text Full Text PDF PubMed Scopus (140) Google Scholar]. Usually, when reptiles are cooked as a dish, the risk of parasite transmission relates mainly to the way in which the animal was kept at home prior its slaughtering, evisceration, and food preparation, rather than to consumption of the resulting meal. To illustrate, here is the traditional finger-licking recipe from Gabon made with African rock python: 'Take medium to large size African rock python. Skin the snake, chop to small pieces and place into a large pot. Sprinkle with salt, add cold water and lemongrass (to reduce snake smell), bring to boil and simmer shortly. Remove snake pieces from water, put into larger pan with hot vegetable oil and gently fry the meat with curry and black pepper. Add little water, bring to the boil, cover with lid and boil for another 20 minutes. Serve with tomato sauce and steamed rice.' Interestingly, similar recipes are popping up in the USA as a reaction to the growing presence of invasive Burmese pythons, for example, in the Everglades. As other animals, reptiles are hosts of viral, bacterial, and parasitic pathogens, some of which are of zoonotic concern [4.Mitchell M. Zoonotic diseases associated with reptiles and amphibians: an update.Vet. Clin. North. Am. Exot. Anim. Pract. 2011; 14: 439-456Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar]. In particular, Salmonella bacteria are the most common causative agents of zoonotic disease due to their biological characteristics (e.g., fast logarithmic growth rate, tolerance to a wide variety of environmental temperatures and humidity, and potential to colonize artificial environments created by humans), as well as their natural affinity with this group of hosts [5.Corrente M. et al.Risk for zoonotic Salmonella transmission from pet reptiles: a survey on knowledge, attitudes and practices of reptile-owners related to reptile husbandry.Prev. Vet. Med. 2017; 146: 73-78Crossref PubMed Scopus (28) Google Scholar]. Most of the available studies on parasites of reptiles have dealt with ecological investigations of hosts and have focused on the conservational aspects rather than on the zoonotic potential [6.Bower D. et al.A review of the role of parasites in the ecology of reptiles and amphibians.Austral. Ecol. 2019; 44: 433-448Crossref Scopus (52) Google Scholar]. As a result, zoonotic parasites have been less studied, and information on the biology, ecology, and zoonotic potential of most of them is scarce, being historically neglected even in endemic areas. The transmission of reptile-borne parasitic zoonoses is mainly related to organisms for which these animals are intermediate or paratenic, rather than definitive hosts [4.Mitchell M. Zoonotic diseases associated with reptiles and amphibians: an update.Vet. Clin. North. Am. Exot. Anim. Pract. 2011; 14: 439-456Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar]. In the first case, humans are infected usually through consumption of reptiles, whereas in the latter, the parasite stages are shed into the environment, where humans are exposed to them (Figure 1). Moreover, reptiles are a source of blood meal for arthropods, acting as reservoirs of several zoonotic vector-borne diseases (VBDs) (Table 1). Overall, zoonotic parasites may be transmitted through different modalities (e.g., environmental contamination, food, or by direct contact with captive animals), and also according to the geographical area and human level of interaction with reptiles (Table 1). In this article we discuss the risks of transmission of reptile-associated parasitic zoonotic diseases in different contexts, answering practical questions from a veterinary and medical perspective.Table 1Zoonotic Parasites of Reptiles Grouped According to the Modality of TransmissionPathogens (zoonosis)Geographic origin of reportsReptile hostsCategories of zoonotic importanceaZoonotic importance categorized as follows: high importance (HI): causing severe or lethal cases in humans clearly associated with reptiles; low importance (LI): causing human cases that are likely linked to reptiles, even though rare or accidental; unknown importance (UI): possibly zoonotic parasites that were isolated from reptiles (including spurious parasites) but causative link of reptiles to a human disease was not proved.Main clinical signs in humansRefsProtozoaGiardia duodenalis(giardiasis)SpainLizardsUIDiarrhea[10.Reboredo-Fernández A. et al.Detection of zoonotic and livestock-specific assemblages of Giardia duodenalis in free-living wild lizards.Rev. Bras. Parasitol. Vet. 2017; 26: 395-399Crossref PubMed Google Scholar]Cryptosporidium parvum subtype: IIaA15G2R1(cryptosporidiosis)ItalySnakes, lizards and turtlesUIAcute to persistent diarrhea[75.Traversa D. et al.Cryptosporidium from tortoises: genetic characterisation, phylogeny and zoonotic implications.Mol. Cell. Probe. 2008; 22: 122-128Crossref PubMed Scopus (48) Google Scholar,76.Rinaldi L. et al.Prevalence and molecular identification of Cryptosporidium isolates from pet lizards and snakes in Italy.Parasite. 2012; 19: 437Crossref PubMed Scopus (21) Google Scholar,78.Díaz P. et al.Cryptosporidium in pet snakes from Italy: molecular characterization and zoonotic implications.Vet. Parasitol. 2013; 197: 68-73Crossref PubMed Scopus (17) Google Scholar]Sarcocystis nesbitti(sarcocystosis)Mainly Southeast AsiaSnakesLIMuscular sarcocystosis[17.Fayer R. et al.Human infections with Sarcocystis species.Clin. Microbiol. Rev. 2015; 28: 295-311Crossref PubMed Scopus (164) Google Scholar]Leishmania tropica, Leishmania. donovani, Leishmania turanica(cutaneous and visceral leishmaniasis)AsiaLizards, snakesUIUnknown[40.Zhang J. et al.Molecular detection, identification and phylogenetic inference of Leishmania spp. in some desert lizards from Northwest China by using internal transcribed spacer 1 (ITS1) sequences.Acta Trop. 2016; 162: 83-94Crossref PubMed Scopus (16) Google Scholar]Trypanosoma brucei(sleeping sickness)AfricaMonitor lizardsUIUnknownsee Box S1bFor a full reference list see Box S1 in the supplemental information online.CestodaSpirometra erinaceieuropaei, Spirometra mansonoides(sparganosis)Americas, Europe, Asia, AustraliaSnakesHIBlindness, paralysis, death[51.Anantaphruti M. et al.Human sparganosis in Thailand: an overview.Acta Trop. 2011; 118: 171-176Crossref PubMed Scopus (84) Google Scholar]PentastomidaArmillifer armillatus, Armillifer moniliformis, Armillifer grandis, Armillifer agkistrodontis(pentastomiasis)Asia, AfricaSnakesHIOrgan damage by larvae[83.Tappe D. Warrell D. Pentastomiasis.in: Ryan E.T. Hunter's Tropical Medicine and Emerging Infectious Diseases. Elsevier, 2019: 1030-1032Google Scholar]Raillietiella hemidactyli(creeping disease)SE AsiaLizardsLISubcutaneous pentastomiasis[59.Paré J. An overview of pentastomiasis in reptiles and other vertebrates.J. Exot. Pet Med. 2008; 17: 285-294Crossref Scopus (60) Google Scholar]NematodaTrichinella zimbabwensis, Trichinella papuae(trichinosis)WorldwideCrocodiles,snakes,Monitor lizards,turtlesLIFever, myalgia, gastrointestinal symptoms[47.Magnino S. et al.Biological risks associated with consumption of reptile products.Int. J. Food Microbiol. 2009; 134: 163-175Crossref PubMed Scopus (125) Google Scholar]Contracaecum spp., Anisakis spp., Pseudoterranova spp.(anisakiasis)WorldwideCrocodilesUIEosinophilic granulomas[47.Magnino S. et al.Biological risks associated with consumption of reptile products.Int. J. Food Microbiol. 2009; 134: 163-175Crossref PubMed Scopus (125) Google Scholar]Eustrongylides spp.(eustrongylidosis)WorldwideCrocodilesUINo specific symptoms recorded so far[84.Boomker J. et al.Eustrongylides sp. (Nematoda: Dioctophymatoidea) from the stomach of a Nile crocodile, Crocodylus niloticus Laurenti, 1768, in Botswana: research communication.Onderstepoort J. Vet. Res. 2006; 73: 315-317PubMed Google Scholar]Gnathostoma binucleatum,Gnathostoma doloresi,Gnathostoma hispidum,Gnathostoma nipponicum,Gnathostoma spingerum(gnathostomosis)Africa, Asia, Central AmericaSnakes (but mainly fish)LICutaneous or visceral larvae migrans symptoms[85.Nawa Y. et al.Ocular gnathostomiasis – update of earlier survey.Am. J. Trop. Med. Hyg. 2017; 97: 1232-1234Crossref PubMed Scopus (11) Google Scholar]Angiostrongylus cantonensis(neuroangiostrongyliasis)SubtropicsMonitor lizardsHIEosinophilic meningitis[86.Eamsobhana P. Review paper eosinophilic meningitis caused by Angiostrongylus cantonensis – a neglected disease with escalating importance.Trop. Biomed. 2014; 31: 569-578PubMed Google Scholar]TrematodaAlaria and Echinostoma(echinostomiasis)AsiaTurtles and crocodilesLICatarrhal inflammationPeripheral eosinophilia[87.Pauwels O. Pantchev N. Risks for human health related to invasive alien reptiles and amphibians.in: Mazza G. Tricarico E. Invasive Species and Human Health. CABI International, 2018: 108-119Crossref Google Scholar]IxodidaAmblyomma spp.Africa, AsiaMonitor lizards, tortoises, snakesLIDermatitis and VBDs[44.Patro S. Padhi S. Saltwater crocodile and human conflict around Bhitarkanika National Park, India: a raising concern for determining conservation limits.Ocean Coast. Manag. 2019; 182: 104923Crossref Scopus (7) Google Scholar,88.Sánchez-Montes S. et al.Rickettsia species in ticks that parasitize amphibians and reptiles: novel report from Mexico and review of the worldwide record.Ticks Tick Borne Dis. 2019; 10: 987-994Crossref PubMed Scopus (29) Google Scholar]Bothriocroton hydrosauriAustraliaSnakes, lizardsHIVector of Flinders Island spotted fever[33.Whiley H. et al.Rickettsia detected in the reptile tick Bothriocroton hydrosauri from the lizard Tiliqua rugosa in South Australia.Pathogens. 2016; 5: 41Crossref Scopus (19) Google Scholar]Haemaphysalis spp.Europe, Africa, AsiaLizards, viperid snakesLIDermatitis and VBDs[88.Sánchez-Montes S. et al.Rickettsia species in ticks that parasitize amphibians and reptiles: novel report from Mexico and review of the worldwide record.Ticks Tick Borne Dis. 2019; 10: 987-994Crossref PubMed Scopus (29) Google Scholar]Hyalomma aegyptiumAfricaTortoisesLIDermatitis and VBDs[88.Sánchez-Montes S. et al.Rickettsia species in ticks that parasitize amphibians and reptiles: novel report from Mexico and review of the worldwide record.Ticks Tick Borne Dis. 2019; 10: 987-994Crossref PubMed Scopus (29) Google Scholar]Ixodes spp.Europe, North AmericaSnakes, lizardsHIDermatitis and VBDs[35.Mendoza-Roldan J. et al.Borrelia burgdorferi (sensu lato) in ectoparasites and reptiles in southern Italy.Parasit. Vectors. 2019; 12: 35Crossref PubMed Scopus (41) Google Scholar]Ornithodoros spp.Africa, North AmericaTortoises and viperid snakesLIDermatitis and VBDs[88.Sánchez-Montes S. et al.Rickettsia species in ticks that parasitize amphibians and reptiles: novel report from Mexico and review of the worldwide record.Ticks Tick Borne Dis. 2019; 10: 987-994Crossref PubMed Scopus (29) Google Scholar]MesostigmataOphionyssus natricisWorldwideSnakes, lizardsLIDermatitis[89.Amanatfard E. et al.Human dermatitis caused by Ophionyssus natricis, a snake mite.Iran. J. Parasitol. 2014; 9: 594PubMed Google Scholar,90.Mendoza-Roldan J. et al.Mites and ticks of reptiles and amphibians in Brazil.Acta Trop. 2020; (Published online May 11, 2020. https://doi.org/10.1016/j.actatropica.2020.105515)Crossref PubMed Scopus (31) Google Scholar]ProstigmataEutrombicula spp.AmericasSnakes, lizards, turtlesLIDermatitis[35.Mendoza-Roldan J. et al.Borrelia burgdorferi (sensu lato) in ectoparasites and reptiles in southern Italy.Parasit. Vectors. 2019; 12: 35Crossref PubMed Scopus (41) Google Scholar,90.Mendoza-Roldan J. et al.Mites and ticks of reptiles and amphibians in Brazil.Acta Trop. 2020; (Published online May 11, 2020. https://doi.org/10.1016/j.actatropica.2020.105515)Crossref PubMed Scopus (31) Google Scholar]Neotrombicula autumnalisEuropeLizards, snakesHIDermatitis[35.Mendoza-Roldan J. et al.Borrelia burgdorferi (sensu lato) in ectoparasites and reptiles in southern Italy.Parasit. Vectors. 2019; 12: 35Crossref PubMed Scopus (41) Google Scholar,90.Mendoza-Roldan J. et al.Mites and ticks of reptiles and amphibians in Brazil.Acta Trop. 2020; (Published online May 11, 2020. https://doi.org/10.1016/j.actatropica.2020.105515)Crossref PubMed Scopus (31) Google Scholar]a Zoonotic importance categorized as follows: high importance (HI): causing severe or lethal cases in humans clearly associated with reptiles; low importance (LI): causing human cases that are likely linked to reptiles, even though rare or accidental; unknown importance (UI): possibly zoonotic parasites that were isolated from reptiles (including spurious parasites) but causative link of reptiles to a human disease was not proved.b For a full reference list see Box S1 in the supplemental information online. Open table in a new tab Reptiles live in our houses, backyards, or any place where they can find shelter, food, and heat. Thus, it is not surprising that increasing urbanization and habitat loss have facilitated the encounters with humans and enabled numerous reptile species to adapt to peridomestic environments [7.Wolfe K. et al.Does urbanization influence the diet of a large snake?.Curr. Zool. 2017; 64: 311-318Crossref PubMed Scopus (34) Google Scholar]. As a matter of fact, parasite transmission from reptiles to humans depends not only on their biology and abundance in a host population but also on environmental conditions. Thus, the transmission of some parasites could be trigged, but also limited, by urbanization [8.French S. et al.Town and country reptiles: a review of reptilian responses to urbanization.Integr. Comp. Biol. 2018; 58: 948-966PubMed Google Scholar]. Undoubtedly, in peridomestic areas, the synanthropic species (i.e., geckos and lizards) may transmit zoonotic protozoa and pentastomids through contamination of the environment (Table 1) [9.Kelehear C. et al.Invasive parasites in multiple invasive hosts: the arrival of a new host revives a stalled prior parasite invasion.Oikos. 2013; 122: 1317-1324Crossref Scopus (28) Google Scholar,10.Reboredo-Fernández A. et al.Detection of zoonotic and livestock-specific assemblages of Giardia duodenalis in free-living wild lizards.Rev. Bras. Parasitol. Vet. 2017; 26: 395-399Crossref PubMed Google Scholar]. Meanwhile, invasive/exotic reptile species may be a source of spill-over of parasites to native species, eventually representing a further threat for public health [11.Hoyer J. et al.Mammal decline, linked to invasive Burmese python, shifts host use of vector mosquito towards reservoir hosts of a zoonotic disease.Biology. 2017; 13: 10Google Scholar,12.Miller A. et al.Parasite spillover: indirect effects of invasive Burmese pythons.Ecol. Evol. 2018; 8: 830-840Crossref PubMed Scopus (46) Google Scholar]. It was an invasive Burmese python (Python bivittatus), introduced into Florida and bringing Asiatic pentastomids (i.e., Raillietiella orientalis), which eventually infected native species of snake [12.Miller A. et al.Parasite spillover: indirect effects of invasive Burmese pythons.Ecol. Evol. 2018; 8: 830-840Crossref PubMed Scopus (46) Google Scholar]. Although the majority of human infections by pentastomids occur through the ingestion of snake meat (which is typical in Asian and African countries), clinicians should be aware that alternative routes of infection exist, for example, through exposure to snake nasal secretions, saliva, and feces [13.Dakubo J. et al.Totemism and the transmission of human pentastomiasis.Ghana Med. J. 2008; 42: 165PubMed Google Scholar], suggesting the potential risk for humans. Such transmission routes may explain some of the human cases recorded in the USA, where this infection is unexpected or considered to be of travel-medicine concern. In addition, when the same species of python was transported back to Asia it carried American pentastomids (i.e., Raillietiella bicaudata) into local populations [14.Westfall A. et al.Host-specific phenotypic variation of a parasite co-introduced with invasive Burmese pythons.PLoS One. 2019; 14: 1Crossref Scopus (6) Google Scholar]. In tropical Asia, muscular sarcocystosis of humans has been associated with ingestion of sporocysts of Sarcocystis nesbitti (Figure 2A ), probably originating from snake feces [15.Italiano C. et al.Sarcocystis nesbitti causes acute, relapsing febrile myositis with a high attack rate: description of a large outbreak of muscular sarcocystosis in Pangkor Island, Malaysia, 2012.PLoS Negl. Trop. Dis. 2014; 8: 5Crossref Scopus (48) Google Scholar, 16.Lau Y. et al.Sarcocystis nesbitti infection in human skeletal muscle: possible transmission from snakes.Am. J. Trop. Med. Hyg. 2014; 90: 361-364Crossref PubMed Scopus (53) Google Scholar, 17.Fayer R. et al.Human infections with Sarcocystis species.Clin. Microbiol. Rev. 2015; 28: 295-311Crossref PubMed Scopus (164) Google Scholar]. Overall, veterinarians play a pivotal role in avoiding zoonotic infections through coprological screening of captive snakes. Reptiles serve also as a blood source for many species of hematophagous arthropods (e.g., mites, ticks, sand flies, mosquitoes) and then as possible reservoirs for bacterial, viral, and protozoan pathogens (Table 1) [18.Yared S. et al.A molecular analysis of sand fly blood meals in a visceral leishmaniasis endemic region of northwestern Ethiopia reveals a complex host–vector system.Heliyon. 2019; 5: 7Abstract Full Text Full Text PDF Scopus (16) Google Scholar,19.Bosco-Lauth A. et al.Reptiles and amphibians as potential reservoir hosts of Chikungunya virus.Am. J. Trop. Med. Hyg. 2018; 98: 841-844Crossref PubMed Scopus (19) Google Scholar]. For example, some species of tick (Ixodidae and Argasidae) and mites (Macronyssidae, Trombiculidae) often feed on reptiles as well as on humans (Table 1). The macronyssid mite Ophionyssus natricis, one of the most widely distributed mite species of snakes, is a mechanical vector of Aeromonas hydrophila, the causative agent of hemorrhagic disease in reptiles as well as of gastroenteritis, and in rare cases, of necrotizing fasciitis in humans [20.Tsujimoto Y. et al.Necrotizing fasciitis and sepsis caused by Aeromonas hy