Detection of Cryptosporidium oocysts from out-patients of the Severance Hospital, Korea

Multilocus typing of Cryptosporidium spp. in young calves with diarrhea in Korea

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Cryptosporidium spp. were detected using PCR and ELISA in diarrheal feces from calves.

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PCR and ELISA data showed good agreement in detecting C. parvum.

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Multilocus typing with 18S rRNA, gp60, and hsp70 genes of C. parvum was performed.

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Subtyping of C. parvum gp60 gene first revealed IIaA18G3R1 and IIaA16G3R1 in Asia.

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PCR and sequencing of hsp70 gene clearly differentiated C. bovis and C. ryanae.

We assessed the prevalence and performed molecular analysis of Cryptosporidium spp. in diarrheal feces of calves in Korea. Diarrheal fecal samples were collected from 951 young calves (<3 months) on 425 farms. Cryptosporidium prevalence was assessed by PCR and ELISA, and molecular characterization was performed by targeting the 18S rRNA, heat-shock protein 70 (hsp70), and glycoprotein 60 (gp60) genes. Data were analyzed according to the sex, type of cattle, region, season, and type of diarrhea. PCR analysis revealed Cryptosporidium spp. in 9.9% (94/951) of diarrheal fecal samples. C. parvum and C. bovis/ryanae were present in 6.1% (58/951) and 4.1% (39/951) of diarrheal fecal samples, respectively. In addition, ELISA showed positive results for C. parvum in 9.7% (92/951) samples. Statistical analysis of the PCR and ELISA results revealed a lower prevalence of C. parvum in the hemorrhagic diarrheal samples (P < 0.05). For C. bovis/ryanae, seasonality and high prevalence in hemorrhagic diarrhea were observed (P < 0.05). Of the 951 samples tested for C. parvum, 903 samples showed agreement with a κ value of 0.65, indicating good agreement between the two tests. Although C. bovis and C. ryanae share highly similar 18S rRNA sequences, PCR based on hsp70 successfully distinguished C. bovis from C. ryanae. Sequence analysis of gp60 revealed that C. parvum belonged to the IIa families and was further subtyped as IIaA18G3R1 and IIaA16G3R1, which have not been previously reported in Asia. These findings indicate that Cryptosporidium spp. play an important role in diarrhea in young calves in Korea. Considering the zoonotic significance of C. parvum IIa subtype and dense rearing system of cattle in Korea, prevention and continuous monitoring of Cryptosporidium are required.

A waterborne outbreak and detection of cryptosporidium oocysts in drinking water of an older high-rise apartment complex in seoul

From May to June 2012, a waterborne outbreak of 124 cases of cryptosporidiosis occurred in the plumbing systems of an older high-rise apartment complex in Seoul, Republic of Korea. The residents of this apartment complex had symptoms of watery diarrhea and vomiting. Tap water samples in the apartment complex and its adjacent buildings were collected and tested for 57 parameters under the Korean Drinking Water Standards and for additional 11 microbiological parameters. The microbiological parameters included total colony counts, Clostridium perfringens, Enterococcus, fecal streptococcus, Salmonella, Shigella, Pseudomonas aeruginosa, Cryptosporidium oocysts, Giardia cysts, total culturable viruses, and Norovirus. While the tap water samples of the adjacent buildings complied with the Korean Drinking Water Standards for all parameters, fecal bacteria and Cryptosporidium oocysts were detected in the tap water samples of the outbreak apartment complex. It turned out that the agent of the disease was Cryptosporidium parvum. The drinking water was polluted with sewage from a septic tank in the apartment complex. To remove C. parvum oocysts, we conducted physical processes of cleaning the water storage tanks, flushing the indoor pipes, and replacing old pipes with new ones. Finally we restored the clean drinking water to the apartment complex after identification of no oocysts.

A hospital-based serological survey of cryptosporidiosis in the Republic of Korea

The seroprevalence of cryptosporidiosis was examined using patients' sera collected from hospitals located in 4 different areas of the Republic of Korea. ELISA was used to measure antibody titers against Cryptosporidium parvum antigens from a total of 2,394 serum samples, which were collected randomly from patients in local hospitals; 1) Chungbuk National University Hospital, 2) Konkuk University Hospital, 3) local hospitals in Chuncheon, Gangwon-do (province), 4) Jeonnam National University Hospital, from 2002 through 2003. Of the 2,394 samples assayed, 34%, 26%, and 56% were positive for C. parvum-specific IgG, IgM, and IgA antibodies, respectively. Positive IgG titers were most common in sera from Jeonnam National University Hospital, Gwangju, Jeollanam-do, and positive IgM titers were most common in sera from Chungbuk National University Hospital, Cheongju, Chuncheongbuk-do. The seropositivity was positively correlated with age for both the IgG and IgA antibodies but was negatively correlated with age for the IgM antibodies. Western blotting revealed that 92%, 83%, and 77% of sera positive for IgG, IgM, and IgA ELISA reacted with 27-kDa antigens, respectively. These results suggested that infection with Cryptosporidium in hospital patients occurs more commonly than previously reported in the Republic of Korea.

Ultrastructural localization of Cryptosporidium parvum antigen using human patients sera

The antigen location of Cryptosporidium parvum, which stimulates antibody formation in humans and animals, was investigated using infected human sera. Immuno-electron microscopy revealed that antigenicity-inducing humoral immunity was located at various developmental stages of parasites, including asexual, sexual stages, and oocysts. The amount of antigen-stimulating IgG antibodies was particularly high on the oocyst wall. The sporozoite surface was shown to give stimulation on IgG and IgM antibody formation. Trophozoites implicated the lowest antigenicity to humoral immunity, both IgG and IgM, by showing the least amount of gold labeling. Immunogold labeling also provided clues that antigens were presented to the host-cell cytoplasm via feeder organelles and host-parasite junctions.

A survey of cryptosporidiosis among 2,541 residents of 25 coastal islands in Jeollanam-Do (Province), Republic of Korea

In order to determine the distribution and prevalence of human cryptosporidiosis on western and southern coastal islands of Jeollanam-do (Province), fecal samples were collected from 2,541 people residing on 25 islands, 13 in the western coasts and 12 in the southern coasts, during July and August 2000. Fecal smears were prepared following formalin-ether sedimentation of the samples and stained by a modified acid-fast procedure. The presence of Cryptosporidium oocysts was determined by light microscopy. Cryptosporidium oocysts were detected in 38 specimens (1.5%). The oocyst positive rate varied (0-6.0%) according to island; the highest was detected on Oenarodo (6.0%), followed by Naenarodo (5.6%) and Nakwoldo (5.4%). The majority (35 persons, 94.6%) of Cryptosporidium-infected individuals were older than 50 years of age. Men (22/1,159; 1.9%) were infected at a higher rate than women (16/1,382; 1.2%). The results of the present survey indicate that human Cryptosporidium infections (due to Cryptosporidium hominis and/or C. parvum) are maintained at a relatively low prevalence on coastal islands of Jeollanam-do, Republic of Korea.

Prevalence of cryptosporidiosis among the villagers and domestic animals in several rural areas of Korea

The present study was undertaken to investigate the infection status of Cryptosporidium parvum in the villagers and the reservoir hosts in several rural areas in Korea. A total 5,262 fecal samples were collected from the inhabitants residing at Gangwon-do, Chungcheongbuk-do, Jeollanam-do, and Gyeongsangnam-do between the dates of September, 2001 to June, 2002. In addition, 1,453 fecal samples were collected from livestock reared in Gokseong-gun, Jeollanam-do and Chungju-si, Chungcheongbuk-do. All the fecal smears were prepared by formalin-ether sedimentation, and examined by light microscopy after modified acid-fast staining. The overall positive rate of human cryptosporidiosis was 3.3%. Gokseong-gun, Jeollanam-do showed a 8.2% positive rate and appeared as the highest endemic area among the surveyed areas. Haman-gun, Gyeongsangnam-do showed a 0.4% positive rate and was the lowest endemic area. The positive rate of livestock infection in Gokseong-gun, Jeollanam-do was 94%, which was more than ten times higher than that of Chungju-si, Chungcheongbuk-do (9.3%). From these results, it was revealed that cryptosporidiosis was an endemic disease in some rural areas of Korea, and the livestock could be an important source of human infection.

Infection status of pigs with Cryptosporidium parvum

To investigate the infection status of pigs with Cryptosporidium parvum, 589 fecal samples were collected from pigs raised at farm in Chungcheongbuk-do and Chungcheongnam-do. Of the 589 pig fecal samples, 62 (10.5%) were positive for C. parvum. The area showing the highest positive rate was Dangjin-gun, Chungcheongnam-do (14.0%), and the lowest (0%) Salmi-myon, Chungcheongbuk-do. The positive rate of C. parvum in Judok-eup increased from 12.7% in the winter to 22.1% in the summer. The results of this study suggest that the pigs may be a source of human C. parvum infection.

Detection of Cryptosporidium oocysts in canine fecal samples by immunofluorescence assay

Fecal samples were collected from 257 dogs in four areas in Korea during the period of January 1996 to November 1997 and examined by immunofluorescence assay for Cryptosporidium oocysts using a commercial diagnostic kit (Meridian Diagnostics, Cincinnati, Ohio). Of the 257 samples, 25 (9.7%) were positive for Cryptosporidium. Differences were noted in the prevalence of canine cryptosporidiosis in both areas and dog types. The results provide a further evidence of environmental contamination and widespread distribution of the parasite in Korea.

Localization of cytoskeletal proteins in Cryptosporidium parvum using double immunogold labeling

Actin and some actin binding proteins such as tropomyosin, alpha-actinin and troponin T were localized by simultaneous double immunogold labeling in several developmental stages of Cryptosporidium parvum. All of the observed developmental stages have many particles of tropomyosin and actin around pellicle and cytoplasm. Tropomyosin was labeled much more than the actin when these two proteins were labeled simultaneously. And alpha actinin was labeled mostly in the pellicle, but troponin T labeling was very rarely observed. From this study, it was suggested that tropomyosin seemed to be one of the major proteins of C. parvum, so it must be playing important roles in C. parvum.

An epidemiological survey of Cryptosporidium parvum infection in randomly selected inhabitants of Seoul and Chollanam-do

An epidemiological survey was performed to know the status of Cryptosporidium sp. infection among the people in Seoul and Chollanam-do in 1992. One village of Chollanam-do (Hwasun-gun) which showed the highest oocyst positive rate was re-surveyed in 1995 for human infection and for cattle also. The subjected areas consisted of 8 urban villages ( = dongs) of Seoul and 4 urban ( = dongs) and 7 rural ( = myons) villages of Chollanam-do. A total of 3,146 fecal samples was collected randomly, and smears were made from formalin-ether sediments. They were examined for Cryptosporidium oocysts by modified acid fast staining. The overall oocyst positive rate was 7.9% (248/3,146), but the rate was remarkably different between Seoul and Chollanam-do, 0.5% (4/853) and 10.6% (244/2,293), respectively. The average size of oocysts was 4.8 +/- 0.5 by 4.2 +/- 0.5 microns, compatible with C. parvum. In Chollanam-do, rural villages showed significantly higher rate (14.0%) than urban villages (3.7%). Especially the people in Iyang-myon. Hwasun-gun, a typical rural village, revealed a very high rate of 40.0% (74/185). Adults aged 51-70 years revealed the highest positive rate among all age groups. At the re-survey of the same village of Hwasun-gun in 1995, 44 (35.2%) of 125 villagers and 14 (93.3%) of 15 cattle examined were positive for C. parvum oocysts. The results suggest that C. parvum is highly prevalent in rural areas of Chollanam-do, and an important source or mode of infection seems to be contaminated water or contact with the feces of infected cattle.

Evaluation for detection of Cryptosporidium oocysts in diarrheal feces of calves

For the detection of Cryptosporidium oocysts, fecal samples were collected from 201 calves which showed diarrhea. Among the 201 samples, 29 samples (14.4%) were positive for Cryptosporidium spp. by the DMSO-modified acid-fast stain (MAFS), 23 samples (11.4%) were positive by commercial kit (Meridian Diagnostics, Cincinnati, Ohio) and 23 by the indirect immunofluorescence antibody (IFA) assay employing the monoclonal antibody (mAb C6). When tested by both IFA and MAFS, 20 fecal samples were positive for Cryptosporidium oocysts whereas 169 fecal samples were negative. If the MAFS is considered a standard method for oocyst detection, the IFA showed 69% of sensitivity and 98% of specificity. When tested by both IFA and commercial kit, 22 fecal samples were positive for Cryptosporidium oocysts while 177 samples were negative. One sample tested by IFA was found to be false negative, when compared with the results by commercial kit. The sensitivity of IFA was calculated as high as 96%; the specificity as 99% and the predictive value was also 99%. In the present study, IFA employing the mAb C6 revealed that 23 samples (11.4%) were positive among the 201 calves showing diarrhea. Of 23 IFA positive samples, 4 samples (5%) showed cryptosporidial oocysts more than 10(5) OPG. Therefore, it is concluded that the calves showing cryptosporidial oocysts more than 10(5) OPG in the feces were highly associated with clinical cryptosporidiosis.