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Chique C, Hynds PD, Andrade L, Burke L, Morris D, Ryan MP, O'Dwyer J. Cryptosporidium spp. in groundwater supplies intended for human consumption - A descriptive review of global prevalence, risk factors and knowledge gaps. WATER RESEARCH 2020; 176:115726. [PMID: 32247994 DOI: 10.1016/j.watres.2020.115726] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/05/2020] [Accepted: 03/15/2020] [Indexed: 06/11/2023]
Abstract
Cryptosporidiosis is one of the leading causes of diarrhoeal illness and mortality induced by protozoan pathogens worldwide. As a largely waterborne disease, emphasis has been given to the study of Cryptosporidium spp. in surface waters, readily susceptible to pathogenic contamination. Conversely, the status of Cryptosporidium in potable groundwater sources, generally regarded as a pristine and "safe" drinking-water supply owing to (sub)-soil protection, remains largely unknown. As such, this investigation presents the first literature review aimed to ascertain the global prevalence of Cryptosporidium in groundwater supply sources intended for human consumption. Thirty-seven peer-reviewed studies were identified and included in the review. Groundwater sample and supply detection rates (estimated 10-20%) indicate Cryptosporidium is frequently present in domestic groundwater sources, representing a latent health concern for groundwater consumers. Specifically, sample (10.4%) and source (19.1%) detection rates deriving from comprehensive "temporal" investigations are put forward as representative of a contamination 'baseline' for Cryptosporidium in 'domestic' groundwater supplies. Proposed 'baseline' prevalence figures are largely applicable in preventive risk-based catchment and groundwater quality management including the formulation of Quantitative Microbial Risk Assessment (QMRA). Notwithstanding, a large geographical disparity in available investigations and lack of standardized reporting restrict the transferability of research findings. Overall, the mechanisms responsible for Cryptosporidium transport and ingress into groundwater supplies remain ambiguous, representing a critical knowledge gap, and denoting a distinctive lack of integration between groundwater and public-health sub-disciplines among investigations. Key recommendations and guidelines are provided for prospective studies directed at more integrative and multi-disciplinary research.
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Affiliation(s)
- C Chique
- School of Biological, Earth and Environmental Science (BEES), University College Cork, Cork, Ireland; Environmental Research Institute, University College Cork, Cork, Ireland
| | - P D Hynds
- Irish Centre for Research in Applied Geosciences, University College Dublin, Dublin, Ireland; Environmental Sustainability and Health Institute (ESIH), Technological University Dublin, Ireland.
| | - L Andrade
- School of Biological, Earth and Environmental Science (BEES), University College Cork, Cork, Ireland; Environmental Research Institute, University College Cork, Cork, Ireland; Irish Centre for Research in Applied Geosciences, University College Dublin, Dublin, Ireland
| | - L Burke
- Antimicrobial Resistance and Microbial Ecology Group, School of Medicine and Centre for Health from Environment, Ryan Institute, National University of Ireland, Galway, Ireland
| | - D Morris
- Antimicrobial Resistance and Microbial Ecology Group, School of Medicine and Centre for Health from Environment, Ryan Institute, National University of Ireland, Galway, Ireland
| | - M P Ryan
- Department of Chemical Sciences, University of Limerick, Limerick, Ireland
| | - J O'Dwyer
- School of Biological, Earth and Environmental Science (BEES), University College Cork, Cork, Ireland; Environmental Research Institute, University College Cork, Cork, Ireland; Irish Centre for Research in Applied Geosciences, University College Dublin, Dublin, Ireland.
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Roelfsema JH, Sprong H, Cacciò SM, Takumi K, Kroes M, van Pelt W, Kortbeek LM, van der Giessen JWB. Molecular characterization of human Cryptosporidium spp. isolates after an unusual increase in late summer 2012. Parasit Vectors 2016; 9:138. [PMID: 26965442 PMCID: PMC4785642 DOI: 10.1186/s13071-016-1397-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 02/20/2016] [Indexed: 11/12/2022] Open
Abstract
Background During the late summer 2012, a number of medical microbiological laboratories (MMLs) reported an unusual increase in cases of cryptosporidiosis, a gastrointestinal infection caused by the protozoan parasites Cryptosporidium spp. Prompted by this signal, the National Institute of Public Health and the Environment (RIVM) started an epidemiological investigation into possible causes. Simultaneously, samples diagnosed at MMLs were sent to RIVM for genotyping, aiming to further identify the possible source of the increase. Methods Genotyping was performed by sequencing a fragment of the GP60 gene. Additional genotyping was performed on a subset of samples using six microsatellite markers. Population genetic analysis was performed using BEAST. Results The majority of the samples were typed as C. hominis, and a single GP60 genotype (IbA10G2) largely predominated. Genotyping microsatellite markers further supported the circulation of a single genetic type. Population genetic analysis with genotypes found in previous years is inconsistent with a decrease in effective population size. Conclusions The conclusion of this finding is that the rise reflects more an overall increase and not a common source outbreak.
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Affiliation(s)
- Jeroen H Roelfsema
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
| | - Hein Sprong
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Simone M Cacciò
- Department of Infectious, Parasitic and Immunomediated Diseases Istituto Superiore di Sanità, Rome, Italy
| | - Katsuhisa Takumi
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Michiel Kroes
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Wilfrid van Pelt
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Laetitia M Kortbeek
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Joke W B van der Giessen
- Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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Pavli P, Venkateswaran S, Bradley M, Bridle H. Enhancing Cryptosporidium parvum recovery rates for improved water monitoring. CHEMOSPHERE 2016; 143:57-63. [PMID: 26009471 DOI: 10.1016/j.chemosphere.2015.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 05/04/2015] [Accepted: 05/07/2015] [Indexed: 06/04/2023]
Abstract
Water monitoring is essential to ensure safe drinking water for consumers. However existing methods have several drawbacks, particularly with regard to the poor recovery of Cryptosporidium due to the inability to efficiently elute Cryptosporidium oocysts during the established detection process used by water utilities. Thus the development of new inexpensive materials that could be incorporated into the concentration and release stage that would control Cryptosporidium oocysts adhesion would be beneficial. Here we describe improved filter performance following dip-coating of the filters with a "bioactive" polyacrylate. Specifically 69% more oocysts were eluted from the filter which had been coated with a polymer than on the naked filter alone.
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Affiliation(s)
- Pagona Pavli
- Institute of Biological Chemistry, BioPhysics & BioEngineering, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh Campus, EH14 1AS Edinburgh, United Kingdom
| | - Sesha Venkateswaran
- School of Chemistry, Joseph Black Building, University of Edinburgh, West Mains Road, EH9 3JJ Edinburgh, United Kingdom
| | - Mark Bradley
- School of Chemistry, Joseph Black Building, University of Edinburgh, West Mains Road, EH9 3JJ Edinburgh, United Kingdom
| | - Helen Bridle
- Institute of Biological Chemistry, BioPhysics & BioEngineering, School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh Campus, EH14 1AS Edinburgh, United Kingdom.
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4
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Siberry GK, Abzug MJ, Nachman S, Brady MT, Dominguez KL, Handelsman E, Mofenson LM, Nesheim S, National Institutes of Health, Centers for Disease Control and Prevention, HIV Medicine Association of the Infectious Diseases Society of America, Pediatric Infectious Diseases Society, American Academy of Pediatrics. Guidelines for the prevention and treatment of opportunistic infections in HIV-exposed and HIV-infected children: recommendations from the National Institutes of Health, Centers for Disease Control and Prevention, the HIV Medicine Association of the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the American Academy of Pediatrics. Pediatr Infect Dis J 2013; 32 Suppl 2:i-KK4. [PMID: 24569199 PMCID: PMC4169043 DOI: 10.1097/01.inf.0000437856.09540.11] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- George K Siberry
- 1National Institutes of Health, Bethesda, Maryland 2University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado 3State University of New York at Stony Brook, Stony Brook, New York 4Nationwide Children's Hospital, Columbus, Ohio 5Centers for Disease Control and Prevention, Atlanta, Georgia
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Agholi M, Hatam GR, Motazedian MH. HIV/AIDS-associated opportunistic protozoal diarrhea. AIDS Res Hum Retroviruses 2013; 29:35-41. [PMID: 22873400 DOI: 10.1089/aid.2012.0119] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Human immunodeficiency virus (HIV) infection has altered both the epidemiology and outcome of enteric opportunistic parasitic infections. This study was done to determine the prevalence and species/genotypes of intestinal coccidian and microsporidial infections among HIV/AIDS patients with diarrhea and/or a history of diarrhea alternately with an asymptomatic interval, and their association with CD4 T cell count. This cross-sectional study was done from May 2010 to May 2011 in Shiraz University of Medical Sciences, South of Iran. A blood sample was obtained from HIV-positive patients for a CD4 T cell count upon enrollment. Sociodemographic data and a history of diarrhea were collected by interviewing 356 consecutive participants (273 males and 83 females). Whenever possible more than a fecal sample was collected from all the participants and examined for parasites using direct, physiological saline solution ethyl acetate, an acid-fast trichrome stain, nested polymerase chain reaction, and sequencing techniques for the detection, confirmation, and genotyping of Cryptosporidium spp., Cyclospora cayetanensis, Isospora belli, and intestinal microsporidia (Enterocytozoon bieneusi). The most common opportunistic and nonopportunistic pathogens were Cryptosporidium spp. (C. parvum and C. andersoni), E. bieneusi, Giardia lamblia, Sarcocystis spp., and Blastocystis homonis affecting 34, 8, 23, 1, and 14 patients, respectively. C. cayetanensis, I. belli, Enterobius vermicularis, and Hymenolepis nana were observed in few patients. A CD4 count <200 cells/μl was significantly associated with the presence of opportunistic parasites and diarrhea (p<0.05). Opportunistic intestinal parasites should be suspected in any HIV/AIDS patient with chronic diarrhea. Tropical epidemic nonopportunistic enteric parasitic infections among such patients should not be neglected in Iran.
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Affiliation(s)
- Mahmoud Agholi
- Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Gholam Reza Hatam
- Basic Sciences in Infectious Diseases Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hossein Motazedian
- Basic Sciences in Infectious Diseases Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Izadi M, Jonaidi-Jafari N, Saburi A, Eyni H, Rezaiemanesh MR, Ranjbar R. Prevalence, molecular characteristics and risk factors for cryptosporidiosis among Iranian immunocompromised patients. Microbiol Immunol 2012; 56:836-42. [DOI: 10.1111/j.1348-0421.2012.00513.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Seasonality in human zoonotic enteric diseases: a systematic review. PLoS One 2012; 7:e31883. [PMID: 22485127 PMCID: PMC3317665 DOI: 10.1371/journal.pone.0031883] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Accepted: 01/19/2012] [Indexed: 12/26/2022] Open
Abstract
Background Although seasonality is a defining characteristic of many infectious diseases, few studies have described and compared seasonal patterns across diseases globally, impeding our understanding of putative mechanisms. Here, we review seasonal patterns across five enteric zoonotic diseases: campylobacteriosis, salmonellosis, vero-cytotoxigenic Escherichia coli (VTEC), cryptosporidiosis and giardiasis in the context of two primary drivers of seasonality: (i) environmental effects on pathogen occurrence and pathogen-host associations and (ii) population characteristics/behaviour. Methodology/Principal Findings We systematically reviewed published literature from 1960–2010, resulting in the review of 86 studies across the five diseases. The Gini coefficient compared temporal variations in incidence across diseases and the monthly seasonality index characterised timing of seasonal peaks. Consistent seasonal patterns across transnational boundaries, albeit with regional variations was observed. The bacterial diseases all had a distinct summer peak, with identical Gini values for campylobacteriosis and salmonellosis (0.22) and a higher index for VTEC (Gini = 0.36). Cryptosporidiosis displayed a bi-modal peak with spring and summer highs and the most marked temporal variation (Gini = 0.39). Giardiasis showed a relatively small summer increase and was the least variable (Gini = 0.18). Conclusions/Significance Seasonal variation in enteric zoonotic diseases is ubiquitous, with regional variations highlighting complex environment-pathogen-host interactions. Results suggest that proximal environmental influences and host population dynamics, together with distal, longer-term climatic variability could have important direct and indirect consequences for future enteric disease risk. Additional understanding of the concerted influence of these factors on disease patterns may improve assessment and prediction of enteric disease burden in temperate, developed countries.
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Abdolrasouli A, McMillan A, Ackers JP. Sexual transmission of intestinal parasites in men who have sex with men. Sex Health 2009; 6:185-94. [PMID: 19653954 DOI: 10.1071/sh08084] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2008] [Accepted: 04/24/2009] [Indexed: 11/23/2022]
Abstract
Direct oral-anal sexual contact is a common practice among men who have sex with men (MSM) and is implicated in the transmission of various enteric pathogens including intestinal parasites. The present study reviewed data on the sexual transmission of intestinal parasites among MSM, and highlighted advances in the diagnosis of such infections. The emergence and spread of intestinal parasites is of public health concern particularly in the homosexual community. Intestinal parasitic infection should be considered in the differential diagnosis of gastrointestinal disease in this population. Combination of traditional diagnostic procedures with implementation of testing based on novel molecular methods in the accurate identification of intestinal parasites is important so that early intervention and control of infection is facilitated.
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Affiliation(s)
- Alireza Abdolrasouli
- Department of Clinical Microbiology, Pathology Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London W12 0HS, UK.
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Guk SM, Chai JY, Shin YO, Seo M. Antibody responses to Cryptosporidium antigen in HIV-positive patients in the Republic of Korea. THE KOREAN JOURNAL OF PARASITOLOGY 2008; 46:71-5. [PMID: 18552541 DOI: 10.3347/kjp.2008.46.2.71] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The diagnosis of cryptosporidiosis has been carried out using coprologic techniques in the Republic of Korea. However, antibody responses to Cryptosporidium have rarely been studied. Serum antibodies from HIV-positive/oocyst-positive Korean patients recognized significantly 31 and 27 kDa antigens, and HIV-negative/oocyst-positive individuals clearly reacted to 15/17 kDa antigens. Compared with oocyst-positive cases, 18.7% and 75.8% of sera from HIV-positive patients reacted to 31 and 27 kDa antigens. Only 11.1% of HIV-negative individuals reacted to 15/17 kDa. Based on these findings, serum antibody responses were different between HIV-positive and HIV-negative individuals infected with Cryptosporidium, and it is suggested that HIV-positive patients are more frequently exposed to C. parvum compared to HIV-negative individuals.
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Affiliation(s)
- Sang-Mee Guk
- Department of Parasitology and Tropical Medicine, Seoul National University College of Medicine, Seoul, Korea
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Rao Ajjampur SS, Asirvatham JR, Muthusamy D, Gladstone BP, Abraham OCM, Mathai D, Ward H, Wanke C, Kang G. Clinical features & risk factors associated with cryptosporidiosis in HIV infected adults in India. Indian J Med Res 2007; 126:553-557. [PMID: 18219083 PMCID: PMC2673507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND & OBJECTIVE Cryptosporidiosis is a leading cause of protracted, life threatening diarrhoea in HIV infected patients. Although data on prevalence are available for Indian patients, no information on risk factors for transmission exists. We therefore undertook this study to identify risk factors for transmission of cryptosporidiosis in HIV infected adults. METHODS Both symptomatic (diarrhoeal) and asymptomatic HIV infected patients were screened for cryptosporidiosis. All Cryptosporidium spp. positive cases were enrolled in the study and interviewed to record socio-demographic information, water supply and animal contact. Data were analysed to study clinical features and potential association with species and genotype. RESULTS Of the 28 cryptosporidial infections identified on screening 111 HIV positive patients with diarrhoea, 10 (35.7%) had chronic diarrhoea, 14 (50%) had associated fever and 8 (28.6%) had nausea. Symptomatic patients had a significantly higher number of co-infections with other enteric parasites (P=0.04) than 20 asymptomatics of 423 HIV positive individuals screened. Eleven of 17 (64%) patients with potentially zoonotic infections had diarrhoea. Patients with zoonotic species (64%) also tended to have fever more frequently than those infected with C. hominis (58%). Association between area of residence, rural or urban, water source and contact with animals and acquisition of cryptosporidiosis was not statistically significant. INTERPRETATION & CONCLUSION Cryptosporidiosis is an important cause of morbidity in HIV infected individuals in India, resulting in chronic diarrhoea. Risk factors for potentially zoonotic transmission of cryptosporidiosis were described in this study, but larger studies need to be done for a clearer understanding of the transmission dynamics of different cryptosporidial species in developing countries.
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Affiliation(s)
- S S Rao Ajjampur
- Department of Gastrointestinal Sciences, Christian Medical College Vellore,India
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Teixeira MCA, Barreto ML, Melo C, Silva LR, Moraes LRS, Alcântara-Neves NM. A serological study of Cryptosporidium transmission in a periurban area of a Brazilian Northeastern city. Trop Med Int Health 2007; 12:1096-104. [PMID: 17714433 DOI: 10.1111/j.1365-3156.2007.01892.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To study the prevalence of Cryptosporidium infection by measuring the levels of anti-Cryptosporidium IgG antibodies among people inhabiting three neighbourhoods of a periurban area of Salvador, Northeast of Brazil; and to investigate the effects of environmental sanitation measures, hygienic habits and household water supply, storage and handling on the frequency of these antibodies in sera of the studied population. METHODS Cryptosporidium inter-household transmission was studied by comparing the frequency of anti-Cryptosporidium IgG antibodies among people inhabiting areas with or without different environmental sanitation measures and intra-household transmission by comparing the presence of these antibodies in families with or without cases of diarrhoea, associated with the presence of Cryptosporidium oocysts in their stools. Children or family members with diarrhoeal episodes were evaluated parasitologically for Cryptosporidium infection by testing stool specimens with the Ritchie-modified formol-ether concentration and the acid-fast staining methods. All groups were serologically evaluated for parasite exposure by an indirect enzyme-linked immunosorbent assay. RESULTS A statistically significant difference was detected in the prevalence of Cryptosporidium infection between area 1 which had no environmental sanitation measures and area 3 which had improved environmental sanitation measures (P = 0.044). Most of the hygienic habits investigated did not correlate with the presence of anti-Cryptosporidium antibody in sera of the population studied. However, positive associations were found between both poor household water supply (OD = 0.17; 90% CI = 0.09-0.32; P = 0.0001) and drinking unboiled/unfiltered water (OD = 0.40; 90% CI = 0.24-0.67; P = 0.0002) with high levels of anti-Cryptosporidium antibodies in sera. CONCLUSIONS These data suggest that although uncorrected household water supply, storage and handling play an important role on Cryptosporidium transmission in periurban areas of developing country cities, like Salvador, Brazil, inadequate environmental conditions may also contribute to the spread of this parasite.
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Affiliation(s)
- M C A Teixeira
- Faculdade de Farmácia, Universidade Federal da Bahia, Bahia, Brazil.
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Denkinger CM, Harigopal P, Ruiz P, Dowdy LM. Cryptosporidium parvum-associated sclerosing cholangitis in a liver transplant patient. Transpl Infect Dis 2007; 10:133-6. [PMID: 17605744 DOI: 10.1111/j.1399-3062.2007.00245.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Cryptosporidium parvum causes severe long-standing diarrhea in immunocompromised patients. Sclerosing cholangitis caused by C. parvum is a rare complication in transplant recipients. We report herein the presentation of Cryptosporidium-associated cholangitis in an adult liver transplant patient diagnosed by liver biopsy. The patient improved on treatment with azithromycin and paromomycin.
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Affiliation(s)
- C M Denkinger
- Beth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts 02215, USA.
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14
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Xiao L, Fayer R, Ryan U, Upton SJ. Cryptosporidium taxonomy: recent advances and implications for public health. Clin Microbiol Rev 2004; 17:72-97. [PMID: 14726456 PMCID: PMC321466 DOI: 10.1128/cmr.17.1.72-97.2004] [Citation(s) in RCA: 544] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
There has been an explosion of descriptions of new species of Cryptosporidium during the last two decades. This has been accompanied by confusion regarding the criteria for species designation, largely because of the lack of distinct morphologic differences and strict host specificity among Cryptosporidium spp. A review of the biologic species concept, the International Code of Zoological Nomenclature (ICZN), and current practices for Cryptosporidium species designation calls for the establishment of guidelines for naming Cryptosporidium species. All reports of new Cryptosporidium species should include at least four basic components: oocyst morphology, natural host specificity, genetic characterizations, and compliance with the ICZN. Altogether, 13 Cryptosporidium spp. are currently recognized: C. muris, C. andersoni, C. parvum, C. hominis, C. wrairi, C. felis, and C. cannis in mammals; C. baïleyi, C. meleagridis, and C. galli in birds; C. serpentis and C. saurophilum in reptiles; and C. molnari in fish. With the establishment of a framework for naming Cryptosporidium species and the availability of new taxonomic tools, there should be less confusion associated with the taxonomy of the genus Cryptosporidium. The clarification of Cryptosporidium taxonomy is also useful for understanding the biology of Cryptosporidium spp., assessing the public health significance of Cryptosporidium spp. in animals and the environment, characterizing transmission dynamics, and tracking infection and contamination sources.
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Affiliation(s)
- Lihua Xiao
- Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Chamblee, Georgia 30341, USA.
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15
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Khalakdina A, Vugia DJ, Nadle J, Rothrock GA, Colford JM. Is drinking water a risk factor for endemic cryptosporidiosis? A case-control study in the immunocompetent general population of the San Francisco Bay Area. BMC Public Health 2003; 3:11. [PMID: 12689343 PMCID: PMC153519 DOI: 10.1186/1471-2458-3-11] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2002] [Accepted: 03/07/2003] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Cryptosporidiosis, caused by Cryptosporidium, is an enteric illness that has received much attention as an infection of immunocompromised persons as well as in community outbreaks (frequently waterborne). There are, however, no studies of the risk factors for sporadic community-acquired cryptosporidiosis in the immunocompetent US population. We undertook a case-control study in the San Francisco Bay Area as part of a national study sponsored by the Centers for Disease Control and Prevention to ascertain the major routes of transmission for endemic cryptosporidiosis, with an emphasis on evaluating risk from drinking water. METHODS Cases were recruited from a population-based, active surveillance system and age-matched controls were recruited using sequential random-digit dialing. Cases (n = 26) and controls (n = 62) were interviewed by telephone using a standardized questionnaire that included information about the following exposures: drinking water, recreational water, food items, travel, animal contact, and person-to-person fecal contact, and (for adults) sexual practices. RESULTS In multivariate conditional logistic regression analyses no significant association with drinking water was detected. The major risk factor for cryptosporidiosis in the San Francisco Bay Area was travel to another country (matched odds ratio [95% confidence interval]: 24.1 [2.6, 220]). CONCLUSION The results of this study do not support the hypothesis that drinking water is an independent risk factor for cryptosporidiosis among the immunocompetent population. These findings should be used to design larger studies of endemic cryptosporidiosis to elucidate the precise mechanisms of transmission, whether waterborne or other.
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Affiliation(s)
- Asheena Khalakdina
- Division of Public Health Biology and Epidemiology, Centers for Family & Community Health and Occupational & Environmental Health, School of Public Health, University of California, Berkeley, California, USA
| | - Duc J Vugia
- California Emerging Infections Program, Oakland, California, USA
- Division of Communicable Disease Control, California Department of Health Services, Berkeley, California, USA
| | - Joelle Nadle
- California Emerging Infections Program, Oakland, California, USA
| | | | - John M Colford
- Division of Public Health Biology and Epidemiology, Centers for Family & Community Health and Occupational & Environmental Health, School of Public Health, University of California, Berkeley, California, USA
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Aragón TJ, Novotny S, Enanoria W, Vugia DJ, Khalakdina A, Katz MH. Endemic cryptosporidiosis and exposure to municipal tap water in persons with acquired immunodeficiency syndrome (AIDS): a case-control study. BMC Public Health 2003; 3:2. [PMID: 12515584 PMCID: PMC149226 DOI: 10.1186/1471-2458-3-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2002] [Accepted: 01/06/2003] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND In persons with acquired immunodeficiency syndrome (AIDS), Cryptosporidium parvum causes a prolonged, severe diarrheal illness to which there is no effective treatment, and the risk of developing cryptosporidiosis from drinking tap water in non-outbreak settings remains uncertain. To test the hypothesis that drinking tap water was associated with developing cryptosporidiosis, we conducted a matched case-control study among persons with AIDS in San Francisco. METHODS Among patients reported to the San Francisco AIDS Registry from May 1996 through September 1998, we compared patients who developed cryptosporidiosis to those who did not. Cases were individually matched to controls based on age, sex, race/ethnicity, CD4+ T lymphocyte count, date of CD4+ count, and date of case diagnosis. Population attributable fractions (PAFs) were calculated. RESULTS The study consisted of 49 cases and 99 matched controls. In the multivariable analysis with adjustments for confounders, tap water consumption inside and outside the home at the highest exposure categories was associated with the occurrence of cryptosporidiosis (inside the home: odds ratio (OR), 6.76; 95% CI 1.37-33.5, and outside the home: OR 3.16; 95% CI 1.23-8.13). The PAF was 85%; that is, the proportion of cases of cryptosporidiosis in San Francisco AIDS patients attributable to tap water consumption could have been as high as 85%. CONCLUSIONS Although the results from this observational study cannot be considered definitive, until there is more data, we recommend persons with AIDS, especially those with compromised immune systems, consider avoiding tap water.
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Affiliation(s)
- Tomás J Aragón
- Department of Epidemiology and Biostatistics, and of Medicine, University of California, San Francisco, USA
- San Francisco Department of Public Health, City and County of San Francisco, USA
| | - Suzanne Novotny
- San Francisco Department of Public Health, City and County of San Francisco, USA
| | - Wayne Enanoria
- Division of Public Health Biology and Epidemiology, School of Public Health, University of California, Berkeley, California, USA
- San Francisco Department of Public Health, City and County of San Francisco, USA
| | - Duc J Vugia
- California Emerging Infections Program, Oakland, California, USA
- Division of Communicable Disease Control, California Department of Health Services, Berkeley, California, USA
| | - Asheena Khalakdina
- Division of Public Health Biology and Epidemiology, School of Public Health, University of California, Berkeley, California, USA
- San Francisco Department of Public Health, City and County of San Francisco, USA
| | - Mitchell H Katz
- Department of Epidemiology and Biostatistics, and of Medicine, University of California, San Francisco, USA
- San Francisco Department of Public Health, City and County of San Francisco, USA
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17
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Ferreira MS, Borges AS. Some aspects of protozoan infections in immunocompromised patients- a review. Mem Inst Oswaldo Cruz 2002; 97:443-57. [PMID: 12118272 DOI: 10.1590/s0074-02762002000400001] [Citation(s) in RCA: 117] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Protozoa are among the most important pathogens that can cause infections in immunocompromised hosts. These microorganisms particularly infect individuals with impaired cellular immunity, such as those with hematological neoplasias, renal or heart transplant patients, patients using high doses of corticosteroids, and patients with acquired immunodeficiency syndrome. The protozoa that most frequently cause disease in immunocompromised patients are Toxoplasma gondii, Trypanosoma cruzi, different Leishmania species, and Cryptosporidium parvum; the first two species cause severe acute meningoencephalitis and acute myocarditis, Leishmania sp. causes mucocutaneous or visceral disease, and Cryptosporidium can lead to chronic diarrhea with hepatobiliary involvement. Various serological, parasitological, histological and molecular methods for the diagnosis of these infections are currently available and early institution of specific therapy for each of these organisms is a basic measure to reduce the morbidity and mortality associated with these infections.
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Affiliation(s)
- Marcelo Simão Ferreira
- Faculdade de Medicina, Universidade Federal de Uberlândia, Uberlândia, MG, 38400-027, Brasil.
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18
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Hunter PR, Nichols G. Epidemiology and clinical features of Cryptosporidium infection in immunocompromised patients. Clin Microbiol Rev 2002; 15:145-54. [PMID: 11781272 PMCID: PMC118064 DOI: 10.1128/cmr.15.1.145-154.2002] [Citation(s) in RCA: 292] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Cryptosporidium spp. are a major cause of diarrheal disease in both immunocompetent and immunodeficient individuals. They also cause waterborne disease in both the United States and United Kingdom. Studies on the mechanisms of immunity to cryptosporidiosis indicate the importance of the T-cell response. The spectrum and severity of disease in immunocompromised individuals with cryptosporidiosis reflect this importance since the most severe disease is seen in individuals with defects in the T-cell response. The most commonly studied group is that of patients with AIDS. These patients suffer from more severe and prolonged gastrointestinal disease that can be fatal; in addition, body systems other than the gastrointestinal tract may be affected. The widespread use of antiretroviral therapy does appear to be having a beneficial effect on recovery from cryptosporidiosis and on the frequency of infection in human immunodeficiency virus-positive patients. Other diseases that are associated with increased risk of severe cryptosporidiosis, such as primary immunodeficiencies, most notably severe combined immunodeficiency syndrome, are also predominantly associated with T-cell defects. Of the remaining groups, children with acute leukemia seem to be most at risk from cryptosporidiosis. There is less evidence of severe complications in patients with other malignant diseases or in those receiving immunosuppressive chemotherapy.
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Affiliation(s)
- Paul R Hunter
- School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, United Kingdom.
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19
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Hassl A, Benyr G, Sommer R. Occurrence of Cryptosporidium sp. oocysts in fecal and water samples in Austria. Acta Trop 2001; 80:145-9. [PMID: 11600093 DOI: 10.1016/s0001-706x(01)00169-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Oocysts of Cryptosporidium spp. were detected and differentiated by a modular arranged gene amplification procedure in various samples, mostly human stool, feces of herpetotaxa, and water, in different locations of South and Eastern Austria. Cryptosporidium parvum was found in stool samples of immunocompromised persons, in reptile feces, and in water samples. The presence of Cryptosporidium in an area is probably associated with high human population densities since water from protected sources in sparsely inhabited areas is rarely contaminated.
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Affiliation(s)
- A Hassl
- Micro-Biology Consult Andreas Hassl, Ameisgasse 63/4/12, A-1140 Vienna, Austria.
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20
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Eisenberg JN, Priest JW, Lammie PJ, Colford JM. The Serologic response to Cryptosporidium in HIV-infected persons: implications for epidemiologic research. Emerg Infect Dis 2001; 7:1004-9. [PMID: 11747729 PMCID: PMC2631897 DOI: 10.3201/eid0706.010614] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Advances in serologic assays for Cryptosporidium parvum have made serology an attractive surveillance tool. The sensitivity, specificity, and predictive value of these new assays for surveillance of immunocompromised populations, however, have not been reported. Using stored serum specimens collected for the San Francisco Men's Health Study, we conducted a case-control study with 11 clinically confirmed cases of cryptosporidiosis. Based on assays using a 27-kDa antigen (CP23), the serum specimens from cases had a median response immunoglobulin (Ig) G level following clinical diagnosis (1,334) and a net response (433, change in IgG level from baseline) that were significantly higher than their respective control values (329 and -32, Wilcoxon p value = 0.01). Receiver operator curves estimated a cutoff of 625 U as the optimal sensitivity (0.86 [0.37, 1.0]) and specificity (0.86 [0.37, 1.0]) for predicting Cryptosporidium infection. These data suggest that the enzyme-linked immunosorbent assay technique can be an effective epidemiologic tool to monitor Cryptosporidium infection in immunocompromised populations.
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Affiliation(s)
- J N Eisenberg
- School of Public Health, University of California, Berkeley, 94720-7360, USA.
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21
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Morgan U, Weber R, Xiao L, Sulaiman I, Thompson RC, Ndiritu W, Lal A, Moore A, Deplazes P. Molecular characterization of Cryptosporidium isolates obtained from human immunodeficiency virus-infected individuals living in Switzerland, Kenya, and the United States. J Clin Microbiol 2000; 38:1180-3. [PMID: 10699017 PMCID: PMC86369 DOI: 10.1128/jcm.38.3.1180-1183.2000] [Citation(s) in RCA: 173] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A total of 22 Cryptosporidium isolates from human immunodeficiency virus-infected patients from Kenya, Switzerland, and the United States were examined at three genetic loci: the 18S ribosomal DNA, HSP-70, and acetyl coenzyme A synthetase genes. Four distinct Cryptosporidium genotypes were identified: (i) the Cryptosporidium parvum "human" genotype, (ii) the C. parvum "cattle" genotype, (iii) Cryptosporidium felis, and (iv) Cryptosporidium meleagridis. This is the first report of C. meleagridis in a human host. These results and those of others indicate that immunocompromised individuals are susceptible to a wide range of Cryptosporidium species and genotypes. Future studies are required to understand the full public health significance of Cryptosporidium genotypes and species in immunocompromised hosts.
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Affiliation(s)
- U Morgan
- World Health Organisation Collaborating Centre for the Molecular Epidemiology of Parasitic Infections and State Agricultural Biotechnology Centre, Murdoch University, Murdoch, WA 6150, Australia.
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Abstract
Infectious diseases of the gastrointestinal tract continue to be an important source of morbidity and mortality. Viruses, bacteria, fungi, and protozoa that infect normal hosts also infect the gastrointestinal tract in immunocompromised hosts. Disease caused by these pathogens may be more severe and more difficult to treat in immunocompromised hosts. In addition, pathogens that rarely cause disease in normal hosts cause significant disease in immunosuppressed hosts. Diagnostic decisions need to take into account expected pathogens and response to therapy. Treatment decisions must be based on the findings of diagnostic procedures; expected pathogens; and recent data suggesting that highly active antiretroviral therapy, with its ability to reconstitute immune function, is an essential component of treatment. This review summarizes the most important developments made in the pathogenesis, clinical presentation, diagnosis, and treatment of gastrointestinal infections in immunocompromised hosts in the past year.
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Affiliation(s)
- L Fantry
- University of Maryland School of Medicine, Baltimore, Maryland 21201, USA
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