Atypical outbreak of caprine cryptosporidiosis in the Sultanate of Oman

Cryptosporidium Infections in Africa-How Important Is Zoonotic Transmission? A Review of the Evidence

Cryptosporidium, a protozoan parasite in the phylum Apicomplexa, is the etiological agent of cryptosporidiosis, an intestinal infection characterized by profuse watery diarrhea. Over 30 species of Cryptosporidium are recognized, some host specific whereas others infect a broader host range. Cryptosporidium hominis and Cryptosporidium parvum are the species most commonly associated with human infection; C. hominis is largely associated only with human infections, but C. parvum is also associated with infection in animals, especially young ruminants. In some regions, cryptosporidiosis is a serious veterinary problem, particularly for calves, and lambs. Many outbreaks of human cryptosporidiosis have been associated with zoonotic transmission following contact with infected animals. In Africa, where cryptosporidiosis is a major contributor to pediatric morbidity and mortality, evidence suggests transmission is principally anthroponotic. Given the frequent close contact between humans and animals in Africa, the apparent predominance of human-to-human transmission is both interesting and puzzling. In this article, after a brief “text book” introduction to the parasite, we consider in separate sections the different aspects of relevance to Cryptosporidium transmission in African countries, describing different aspects of the various species and subtypes in human and animal infections, considering livestock management practices in different African countries, and looking for any characteristic “hot spots” where zoonotic transmission has apparently occurred. Studies where transmission networks have been investigated are particularly relevant. Finally, in a separate section, we try to gather these different strands of evidence together in order to assess the reasons behind the apparent predominance of anthroponotic transmission in Africa. Reviewing the available evidence provides an opportunity to re-think transmission pathways, not only in Africa but also elsewhere, and also to pose questions. Does the predominance of human-to-human transmission in Africa reflect a relative absence of zoonotic C. parvum in African livestock? Are Africans less susceptible to zoonotic Cryptosporidium infection, perhaps resulting from early immunostimulation by C. hominis or due to inherent genetic traits? Is the African environment—in all its variety—simply more detrimental to oocyst survival? Will the so-called hypertransmissible subtypes, currently relatively rare in Africa, be introduced from Europe or elsewhere, and, if so, will they fade out or establish and spread? Our intention with this manuscript is not only to summarize and consolidate diverse data, thereby providing an overview of data gaps, but also to provide food for thought regarding transmission of a parasite that continues to have a considerable impact on both human and animal health.

Cryptosporidium and Cryptosporidiosis: The Perspective from the Gulf Countries

The present review discusses the burden of cryptosporidiosis in the Gulf Cooperation Council (GCC), which is underreported and underestimated. It emphasizes that the Cryptosporidium parasite is infecting inhabitants and expatriates in the Gulf countries. Children under 5 years are a vulnerable group that is particularly affected by this parasitic disease and can act as carriers, who contribute to the epidemiology of the disease most probably via recreational swimming pools. Various risk factors for cryptosporidiosis in the GCC countries are present, including expatriates, predisposing populations to the infection. Water contamination, imported food, animal contact, and air transmission are also discussed in detail, to address their significant role as a source of infection and, thus, their impact on disease epidemiology in the Gulf countries' populations.

Periparturient rise in the Cryptosporidium oocyst count in Beetal goats and evaluation of infection in new born kids

In cryptosporidial infection, very scarce literature is available about periparturient pattern of oocyst excretion in goats and its implications in the epidemiology of disease in kids; thus the present investigation was done. Faecal samples (160) were examined from 20 pregnant goats, collected at weekly interval, commencing from 4 weeks before kidding up to 3 weeks after kidding. Faecal sample examination by Sheather’s floatation sedimentation technique followed by modified Ziehl-Neelsen staining technique revealed an overall positivity of 26.25% for Cryptosporidium oocysts. Prevalence of oocysts excretion was high around parturition and the number of oocysts shed oscillated between 20–400 oocysts/g (OPG) of faeces. Examination of 60 faecal samples of 20 kids born to studied goats from 1 to 3 weeks of age revealed 40% samples positive for Cryptosporidium oocysts and 65% kids became infected by the end of the 3 weeks. The OPG of kids ranged from 100 to 1,560. Molecular characterization by PCR-RFLP of 18S small subunit (SSU) rRNA gene showed that 73.80% and 26.19% goat samples, and 87.5% and 12.5% kids samples were positive for C. parvum and C. ubiquitum, respectively. The study indicated periparturient transmission of Cryptosporidium spp. from pregnant goats to their new born kids.

Cryptosporidiosis caused by Cryptosporidium parvum subtype IIdA15G1 at a dairy farm in Northwestern China

Background

Cryptosporidium spp. are zoonotic parasites responsible for diarrhoeal diseases in animals and humans worldwide. Cattle are the most common mammalian species in which Cryptosporidium is detected, with pre-weaned calves considered to be reservoirs for zoonotic C. parvum. In October 2013, severe diarrhoea was observed in 396 pre-weaned calves at a farm in the Ningxia Autonomous Region of Northwestern China. 356 of the infected calves died despite antibiotic therapy.

Findings

252 faecal samples were collected from the investigated farm. The identity of Cryptosporidium species was determined by polymerase chain reaction (PCR) restriction fragment length polymorphism (RFLP) analysis, and by DNA sequence analysis of the small subunit (SSU) rRNA gene. C. parvum was subtyped using sequence analysis of the 60 kDa glycoprotein (gp60) gene. The highest infection rate of 83.3% (40/48) was seen in 2–3-week-old calves with diarrhoea, corresponding to the age at which animals died. Three Cryptosporidium species were identified, including C. parvum (n = 51), C. bovis (n = 1), and C. ryanae (n = 1). All C. parvum isolates were further identified as subtype IIdA15G1.

Conclusions

Cryptosporidium parvum was likely to be most responsible for diarrhoea and death. This is the first report of a cryptosporidiosis outbreak caused by C. parvum IIdA15G1 in Chinese dairy cattle.

High excretion of Cryptosporidium ubiquitum by peri-parturient goats in one flock in western France

Cryptosporidium spp. is an important agent of neonatal diarrhoea in goat kids. Little is known about its molecular characterization in adult goats. A longitudinal study was set up to identify the species excreted by adult goats around parturition. Individual faecal samples were collected from 20 pregnant adult goats between 1 and 5 years old in one flock. Samplings began 3 weeks before the estimated kidding date and were done weekly until kidding and for 2 weeks after kidding. Cryptosporidium oocysts were concentrated from 15 g of faeces using a caesium chloride (CsCl) method. Oocyst output was determined using a direct immunofluorescent antibody test (IFAT). Genomic DNA was extracted from each CsCl-concentrated faecal sample positive by IFAT and submitted to a nested PCR-RFLP on the SSU rDNA gene followed by sequencing to identify the isolates at species level. According to their kidding date, goats were sampled between 4 and 8 times. Sixteen goats, out of the eighteen which kidded, were found positive at least at one sampling date. Infection was asymptomatic. Prevalence of excretion was maximal 14 days before kidding with half of the goats excreting oocysts at this date. Excretion was higher before kidding than after kidding. Unexpected levels of excretion were observed with individual oocyst excretion ranging from 6 to 2.5 × 10(5) oocysts per gram of faeces. All isolates were identified as Cryptosporidium ubiquitum.

Cryptosporidiosis in Farmed Animals

Cryptosporidiosis was first identified as a disease of veterinary, rather than human medical, importance, and infection of farmed animals with different species of Cryptosporidium continues to be of veterinary clinical concern. This chapter provides insights into Cryptosporidium infection in a range of farmed animals – cattle, sheep, goats, pigs, cervids, camelids, rabbits, water buffalo and poultry – presenting not only an updated overview of the infection in these animals, but also information on clinical disease, infection dynamics and zoonotic potential. Although extensive data have been accrued on, for example, Cryptosporidium parvum infection in calves, and calf cryptosporidiosis continues to be a major veterinary concern especially in temperate regions, there remains a paucity of data for other farmed animals, despite Cryptosporidium infection causing significant clinical disease and also, for some species, with the potential for transmission of infection to people, either directly or indirectly.

GiardiaandCryptosporidiuminfections in sheep and goats: a review of the potential for transmission to humans via environmental contamination

The public health significance of giardiasis and cryptosporidiosis in sheep is currently unclear. Some research suggests that they are probably not an important zoonotic reservoir, whilst other research indicates this potential exists, and some outbreaks have also been associated with infections in sheep. Actions to limit water supply contamination by sheep have sometimes been severe, occasionally creating problems between farming and public health communities. Here our knowledge on these parasites in both sheep and goats is reviewed; although direct evidence of transmission to humans via water supply contamination is limited, the data accrued indicate that this is a real possibility. As cryptosporidiosis in sheep is generally more prevalent than giardiasis, and species/genotypes ofCryptosporidiuminfections in sheep are likely to be infectious to humans, this parasite may be considered the greater threat. Nevertheless, geographical variation in prevalence and genotypic distribution is extensive and as measures to limit sheep grazing can have a highly negative impact, it is important that cases are judged individually. If water contamination from a particular population of sheep/goats is suspected, then suitable investigations should be instigated, investigating both prevalence and species/genotype, before precautionary measures are imposed.

Cryptosporidiosis in Saudi Arabia and neighboring countries

Cryptosporidium is a coccidian protozoan parasite of the intestinal tract that causes severe and sometimes fatal watery diarrhea in immunocompromised patients, and self-limiting but prolonged diarrheal disease in immunocompetent individuals. It exists naturally in animals and can be zoonotic. Although cryptosporidiosis is a significant cause of diarrheal diseases in both developing and developed countries, it is more prevalent in developing countries and in tropical environments. We examined the epidemiology and disease burden of Cryptosporidium in Saudi Arabia and neighboring countries by reviewing 23 published studies of Cryptosporidium and the etiology of diarrhea between 1986 and 2006. The prevalence of Cryptosporidium infection in humans ranged from 1% to 37% with a median of 4%, while in animals it was different for different species of animals and geographic locations of the studies. Most cases of cryptosporidiosis occurred among children less than 7 years of age, and particularly in the first two years of life. The seasonality of Cryptosporidium varied depending on the geographic locations of the studies, but it was generally most prevalent in the rainy season. The most commonly identified species was Cryptosporidium parvum while C. hominis was detected in only one study from Kuwait. The cumulative experience from Saudi Arabia and four neighboring countries (Kuwait, Oman, Jordan and Iraq) suggest that Cryptosporidium is an important cause of diarrhea in humans and cattle. However, the findings of this review also demonstrate the limitations of the available data regarding Cryptosporidium species and strains in circulation in these countries.

Herd-level risk factors for Cryptosporidium infection in dairy-goat kids in western France

We conducted a cross-sectional study of risk factors for herd-level kid positivity for Cryptosporidium parvum oocysts in dairy-goat farms (Deux-Sèvres, western France). From January to March 2003, faeces from a convenient sample of 879 5- to 30-day-old goat kids from 60 herds were examined microscopically after staining with carbol fuschin. Oocyst shedding was scored semi-quantitatively (0 to 4+) allowing us to obtain a cumulative score per herd. Standardized questionnaires with information about management practices were collected in each farm. We found positive kids in 32 of 60 herds (53.3%) and in 142 animals out of 879 (16.2%). We used logistic regression for two risk-factor model: (1) simple positive (case: herd score > or = 1+, at least one positive kid in the herd, versus control: herd score=0), (2) strongly positive (case: overall herd score > or = 3+ versus control: herd score <3+). Risk factors associated with simple positive herds were period of sampling compared to the peak of births (After versus Before, OR=4.2, 95% CI 1.2, 15.3) and practice of kid grouping by age or weight (Yes versus No, OR=4.4, 95% CI 1.0, 19.1). Risk factors associated with strongly positive herds were period of investigation (February/March versus January, OR=12.7, 95% CI 2.1, 76.6), exposure to graminaceous plants in forage (OR=11.6, 95% CI 1.7, 81.0) and type of ventilation in the goat premises (Vertical versus Wind effect, OR=14.7, 95% CI 2.1, 106.1). No important association was found between kid-management practices and herd positivity. These results suggest a major role of the environment of kids during their first hours of life in the adult-goat premises regarding the transmission of C. parvum infection.

Influence of colostrum deprivation and concurrent Cryptosporidium parvum infection on the colonization and persistence of Escherichia coli O157 : H7 in young lambs

Escherichia coliO157 : H7 andCryptosporidium parvuminfections of man have been associated with direct contact with small ruminants. Colostrum protects neonates against gastrointestinal pathogens, and orphan lambs, which are common on petting farms, may be deprived of this protection. In a recent study, it was demonstrated that high shedding ofE. coliO157 : H7 by an 8-week-old goat kid was associated with coincidentalC. parvuminfection. Furthermore, both pathogens were co-located in the distal gastrointestinal tract. It was hypothesized that colostrum deprivation and pre-infection withC. parvumpredisposed young ruminants to colonization and increased shedding ofE. coliO157 : H7. To test this, 21 lambs 5 weeks of age were divided into four groups as follows: (A) colostrum-deprived and inoculated withE. coliO157 : H7, (B) colostrum-deprived and inoculated withC. parvumand thenE. coliO157 : H7, (C) conventionally reared and inoculated withE. coliO157 : H7, (D) conventionally reared and inoculated withC. parvumand thenE. coliO157 : H7.C. parvumwas detected between 8 and 12 days post-inoculation in most of the infected lambs. At 24 h post-inoculation withE. coliO157 : H7, all lambs were shedding between 5×104and 5×107 c.f.u.E. coliO157 : H7 per gram of faeces.E. coliO157 : H7 was shed in higher numbers in the groups pre-inoculated withC. parvum, whether conventionally reared or colostrum-deprived. Interestingly, for the colostrum-deprived lambs on day 3, a significant difference in shedding ofE. coliO157 : H7 was observed (P=0.038), with the lambs inoculated withE. colialone yielding higher counts than those pre-inoculated withC. parvum. From day 15 onwards, shedding ofE. coliO157 : H7 was highest from the colostrum-deprivedC. parvum-infected lambs, then (in descending order of shedding) the colostrum-deprived lambs, the conventionally reared lambs infected withC. parvum, and the conventionally reared animals. In total, four animals were euthanized, two at 24 h and two at 96 h post inoculation withE. coliO157 : H7 (two conventionally reared and two colostrum-deprived). All animals euthanized were from groups pre-inoculated withC. parvumprior to challenge withE. coliO157 : H7. On examination of tissues, in three of the four animals examined, multifocal attaching and effacing lesions were observed in the caecum, colon, rectum and at the recto-anal junction, and were confirmed by immunohistochemistry to be associated withE. coliO157 : H7.

Colonization of 8-week-old conventionally reared goats by Escherichia coli O157 : H7 after oral inoculation

Enterohaemorrhagic Escherichia coli O157 : H7 infections of man have been associated with consumption of unpasteurized goat's milk and direct contact with kid goats on petting farms, yet little is known about colonization of goats with this organism. To assess the contribution of flagella and intimin of E. coli O157 : H7 in colonization of the goat, 8-week-old conventionally reared goats were inoculated orally in separate experiments with 1×1010 c.f.u. of a non-verotoxigenic strain of E. coli O157 : H7 (strain NCTC 12900 Nalr), an aflagellate derivative (DMB1) and an intimin-deficient derivative (DMB2). At 24 h after inoculation, the three E. coli O157 : H7 strains were shed at approximately 5×104 c.f.u. (g faeces)−1 from all animals. Significantly fewer intimin-deficient bacteria were shed only on days 2 (P = 0.003) and 4 (P = 0.014), whereas from day 7 to 29 there were no differences. Tissues from three animals inoculated with wild-type E. coli O157 : H7 strain NCTC 12900 Nalr were sampled at 24, 48 and 96 h after inoculation and the organism was cultured from the large intestine of all three animals and from the duodenum and ileum of the animal examined at 96 h. Tissues were examined histologically but attaching-effacing (AE) lesions were not observed at any intestinal site of the animals examined at 24 or 48 h. However, the animal examined at 96 h, which had uniquely shed approximately 1×107 E. coli O157 : H7 (g faeces)−1 for the preceding 3 days, showed a heavy, diffuse infection with cryptosporidia and abundant, multifocal AE lesions in the distal colon, rectum and at the recto-anal junction. These AE lesions were confirmed by immunohistochemistry to be associated with E. coli O157 : H7.

Biology of Cryptosporidium parvum in pigs: from weaning to market

Cryptosporidium parvum is commonly identified as infecting domestic livestock and humans. Prevalence of C. parvum in pigs has been reported, however, the duration and infection pattern of naturally acquired Cryptosporidium infections in pigs has not been reported. This study was undertaken to investigate the age of oocyst shedding and duration of natural Cryptosporidium parvum infections in pigs from weaning to market weight. Fecal samples were collected from weaned Yorkshire-Landrace piglets (n=33) twice per week until Cryptosporidium oocysts were detected. Upon oocyst detection, fecal samples were collected three times per week and pigs were monitored throughout the study for diarrhea and examined after concentration and immunofluroescent staining. Cryptosporidium isolates were genotyped by polymerase chain reaction to amplify the HSP70 gene which was subsequently sequence analyzed. All 33 pigs shed oocysts some time during the study. The mean age of initial oocyst detection was 45.2 days post-weaning with the mean duration of infection 28.7 days. Mean number of Cryptosporidium oocysts was low and declined to zero prior to study completion. Episodes of diarrhea were not associated with oocyst excretion. Genetic sequences were obtained for 10 of the pigs. All of the 10 isolates aligned as the Cryptosporidium parvum 'pig' genotype. This study demonstrates that the age and duration of oocyst shedding in pigs infected with C. parvum porcine genotype is different from other livestock species.

Prevalence of Cryptosporidium infection in goats in selected locations in three agroclimatic zones of Sri Lanka

The prevalence of Cryptosporidium oocysts in the faeces of 1020 goats in three age categories was examined during 1999 in selected locations of three agroclimatic zones of Sri Lanka. The oocysts were demonstrated using the Sheather's sucrose flotation method followed by staining with the modified Ziehl Neelsen technique. Cryptosporidium oocysts were detected in animals from all agroclimatic zones with the highest prevalence of infection in the dry zone (33.6%) compared with 24.7 and 21.7% in the intermediate zones and wet, respectively (P<0.001). Overall, Cryptosporidium oocyst counts were significantly higher in goats of <6 months and 7-12 months of age groups compared with goats of >12 months of age (P<0.001). Cryptosporidium oocysts were detected in 291/1020 (28.5%) animals, while 194/1020 animals (19%), 84/1020 animals (8.2%) and 13/1020 animals (1.3%) excreted low (1-1000 oocysts per gram of faeces), moderate (1000-5000 oocysts per gram of faeces) and high (>5000 oocysts per gram of faeces) counts, respectively. The mean Cryptosporidium count was 383 oocysts per gram of faeces. The majority of the infected goats were asymptomatic. These animals are likely to play an important role in the epidemiology of cryptosporidiosis in goat kids and humans.