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Krumkamp R, Conraths FJ, Caccio S, Schares G, Hogan B, Winter D, Jaeger A, Melhem S, Rakotozandrindrainy N, May J, Rakotozandrindrainy R, Eibach D. Clustering of Cryptosporidium species infections among sheep and cattle but not children in remote highland communities of Madagascar. Parasit Vectors 2022; 15:304. [PMID: 36031635 PMCID: PMC9422120 DOI: 10.1186/s13071-022-05434-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/12/2022] [Indexed: 12/02/2022] Open
Abstract
Background The aim of this study was to identify local transmission patterns of Cryptosporidium spp. infections among livestock and humans in four extremely rural and remote highland communities in Madagascar. Methods In this cross-sectional study, households were randomly sampled throughout a 1-year study period, with one feces sample collected from each child (≤ 5 years old), sheep and cattle. Cryptosporidium spp. were identified using a nested PCR assay targeting the 18S ribosomal RNA gene. All samples positive for Cryptosporidium hominis were further subtyped by sequencing the 60-kDa glycoprotein gene (gp60). Spatial clustering methods were applied to analyze potential transmission patterns. Results In total, 252 households participated in the study, and samples from 197 children, 862 cattle and 334 sheep were collected and included in the study. Of the samples collected, 11 (5.6%) from children, 30 (3.5%) from cattle and 42 (12.6%) from sheep tested positive for Cryptosporidium spp. Very little overlap in the species distribution between human and animal infections was found. Global (overall) and local (spatially defined) clustering was observed for Cryptosporidium spp. infections in sheep and for Cryptosporidium xiaoi/bovis infections among sheep and cattle. Discussion The results of this analysis do not support the occurrence of defined disease outbreaks, rather they point to a continuous series of transmission events that are spatially aggregated. Despite the close coexistence between humans, sheep and cattle in the study area, mutual transmission was not observed. Hence, the study underlines the importance of sustained sanitation and hygiene measures to prevent cryptosporidiosis transmission among infants, since asymptomatic children serve as an infection reservoir. Similarly, the study highlights the importance of improving hygiene to reduce the transmission of Cryptosporidium spp. in livestock, an infection with serious consequences, especially in newborn calves. Graphical Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s13071-022-05434-0.
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Krumkamp R, Aldrich C, Maiga-Ascofare O, Mbwana J, Rakotozandrindrainy N, Borrmann S, Caccio SM, Rakotozandrindrainy R, Adegnika AA, Lusingu JPA, Amuasi J, May J, Eibach D. Transmission of Cryptosporidium Species Among Human and Animal Local Contact Networks in Sub-Saharan Africa: A Multicountry Study. Clin Infect Dis 2021; 72:1358-1366. [PMID: 32150243 PMCID: PMC8075035 DOI: 10.1093/cid/ciaa223] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 03/03/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Cryptosporidiosis has been identified as one of the major causes of diarrhea and diarrhea-associated deaths in young children in sub-Saharan Africa. This study traces back Cryptosporidium-positive children to their human and animal contacts to identify transmission networks. METHODS Stool samples were collected from children < 5 years of age with diarrhea in Gabon, Ghana, Madagascar, and Tanzania. Cryptosporidium-positive and -negative initial cases (ICs) were followed to the community, where stool samples from households, neighbors, and animal contacts were obtained. Samples were screened for Cryptosporidium species by immunochromatographic tests and by sequencing the 18S ribosomal RNA gene and further subtyped at the 60 kDa glycoprotein gene (gp60). Transmission clusters were identified and risk ratios (RRs) calculated. RESULTS Among 1363 pediatric ICs, 184 (13%) were diagnosed with Cryptosporidium species. One hundred eight contact networks were sampled from Cryptosporidium-positive and 68 from negative ICs. Identical gp60 subtypes were detected among 2 or more contacts in 39 (36%) of the networks from positive ICs and in 1 contact (1%) from negative ICs. In comparison to Cryptosporidium-negative ICs, positive ICs had an increased risk of having Cryptosporidium-positive household members (RR, 3.6 [95% confidence interval {CI}, 1.7-7.5]) or positive neighboring children (RR, 2.9 [95% CI, 1.6-5.1]), but no increased risk of having positive animals (RR, 1.2 [95% CI, .8-1.9]) in their contact network. CONCLUSIONS Cryptosporidiosis in rural sub-Saharan Africa is characterized by infection clusters among human contacts, to which zoonotic transmission appears to contribute only marginally.
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Affiliation(s)
- Ralf Krumkamp
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.,German Center for Infection Research, Hamburg-Lübeck-Borstel-Riems, Germany
| | - Cassandra Aldrich
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.,German Center for Infection Research, Hamburg-Lübeck-Borstel-Riems, Germany.,Division of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Oumou Maiga-Ascofare
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.,German Center for Infection Research, Hamburg-Lübeck-Borstel-Riems, Germany.,Kumasi Centre for Collaborative Research in Tropical Medicine, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Joyce Mbwana
- National Institute for Medical Research, Tanga Research Centre, Tanga, United Republic of Tanzania
| | | | - Steffen Borrmann
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,Institut für Tropenmedizin and German Center for Infection Research, partner site Tübingen, Universitätsklinikum, Tübingen, Germany
| | - Simone M Caccio
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | | | - Ayola Akim Adegnika
- Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon.,Institut für Tropenmedizin and German Center for Infection Research, partner site Tübingen, Universitätsklinikum, Tübingen, Germany
| | - John P A Lusingu
- National Institute for Medical Research, Tanga Research Centre, Tanga, United Republic of Tanzania
| | - John Amuasi
- Kumasi Centre for Collaborative Research in Tropical Medicine, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Jürgen May
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.,German Center for Infection Research, Hamburg-Lübeck-Borstel-Riems, Germany
| | - Daniel Eibach
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.,German Center for Infection Research, Hamburg-Lübeck-Borstel-Riems, Germany
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Tichkule S, Jex AR, van Oosterhout C, Sannella AR, Krumkamp R, Aldrich C, Maiga-Ascofare O, Dekker D, Lamshöft M, Mbwana J, Rakotozandrindrainy N, Borrmann S, Thye T, Schuldt K, Winter D, Kremsner PG, Oppong K, Manouana P, Mbong M, Gesase S, Minja DTR, Mueller I, Bahlo M, Nader J, May J, Rakotozandrindrain R, Adegnika AA, Lusingu JPA, Amuasi J, Eibach D, Caccio SM. Comparative genomics revealed adaptive admixture in Cryptosporidium hominis in Africa. Microb Genom 2021; 7:mgen000493. [PMID: 33355530 PMCID: PMC8115899 DOI: 10.1099/mgen.0.000493] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/26/2020] [Indexed: 12/02/2022] Open
Abstract
Cryptosporidiosis is a major cause of diarrhoeal illness among African children, and is associated with childhood mortality, malnutrition, cognitive development and growth retardation. Cryptosporidium hominis is the dominant pathogen in Africa, and genotyping at the glycoprotein 60 (gp60) gene has revealed a complex distribution of different subtypes across this continent. However, a comprehensive exploration of the metapopulation structure and evolution based on whole-genome data has yet to be performed. Here, we sequenced and analysed the genomes of 26 C. hominis isolates, representing different gp60 subtypes, collected at rural sites in Gabon, Ghana, Madagascar and Tanzania. Phylogenetic and cluster analyses based on single-nucleotide polymorphisms showed that isolates predominantly clustered by their country of origin, irrespective of their gp60 subtype. We found a significant isolation-by-distance signature that shows the importance of local transmission, but we also detected evidence of hybridization between isolates of different geographical regions. We identified 37 outlier genes with exceptionally high nucleotide diversity, and this group is significantly enriched for genes encoding extracellular proteins and signal peptides. Furthermore, these genes are found more often than expected in recombinant regions, and they show a distinct signature of positive or balancing selection. We conclude that: (1) the metapopulation structure of C. hominis can only be accurately captured by whole-genome analyses; (2) local anthroponotic transmission underpins the spread of this pathogen in Africa; (3) hybridization occurs between distinct geographical lineages; and (4) genetic introgression provides novel substrate for positive or balancing selection in genes involved in host-parasite coevolution.
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Affiliation(s)
- Swapnil Tichkule
- Population Health and Immunity, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, Australia
| | - Aaron R. Jex
- Population Health and Immunity, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Cock van Oosterhout
- School of Environmental Sciences, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Anna Rosa Sannella
- Department of Infectious Disease, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Ralf Krumkamp
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine Hamburg, Bernhard-Nocht-Strasse 74, 20359 Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Germany
| | - Cassandra Aldrich
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine Hamburg, Bernhard-Nocht-Strasse 74, 20359 Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Germany
- Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich 80802, Germany
| | - Oumou Maiga-Ascofare
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine Hamburg, Bernhard-Nocht-Strasse 74, 20359 Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Germany
- Kumasi Centre for Collaborative Research in Tropical Medicine, College of Health Sciences, KNUST, Kumasi, Ghana
| | - Denise Dekker
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine Hamburg, Bernhard-Nocht-Strasse 74, 20359 Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Germany
| | - Maike Lamshöft
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine Hamburg, Bernhard-Nocht-Strasse 74, 20359 Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Germany
| | - Joyce Mbwana
- National Institute for Medical Research, Tanga Research Centre, Tanga, Tanzania
| | | | - Steffen Borrmann
- Centre de Recherches Médicales de Lambaréné, BP 242 Lambaréné, Gabon
- Institut für Tropenmedizin and German Center for Infection Research, partner site Tübingen, Universitätsklinikum, Wilhelmstraße 27, 72074 Tübingen, Germany
| | - Thorsten Thye
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine Hamburg, Bernhard-Nocht-Strasse 74, 20359 Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Germany
| | - Kathrin Schuldt
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine Hamburg, Bernhard-Nocht-Strasse 74, 20359 Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Germany
| | - Doris Winter
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine Hamburg, Bernhard-Nocht-Strasse 74, 20359 Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Germany
| | - Peter G. Kremsner
- Centre de Recherches Médicales de Lambaréné, BP 242 Lambaréné, Gabon
- Institut für Tropenmedizin and German Center for Infection Research, partner site Tübingen, Universitätsklinikum, Wilhelmstraße 27, 72074 Tübingen, Germany
| | - Kwabena Oppong
- Kumasi Centre for Collaborative Research in Tropical Medicine, College of Health Sciences, KNUST, Kumasi, Ghana
| | - Prince Manouana
- Centre de Recherches Médicales de Lambaréné, BP 242 Lambaréné, Gabon
| | - Mirabeau Mbong
- Centre de Recherches Médicales de Lambaréné, BP 242 Lambaréné, Gabon
| | - Samwel Gesase
- National Institute for Medical Research, Tanga Research Centre, Tanga, Tanzania
| | - Daniel T. R. Minja
- National Institute for Medical Research, Tanga Research Centre, Tanga, Tanzania
| | - Ivo Mueller
- Population Health and Immunity, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, Australia
| | - Melanie Bahlo
- Population Health and Immunity, Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
- Department of Medical Biology, University of Melbourne, Melbourne, Australia
| | - Johanna Nader
- Department of Genetics and Bioinformatics, Division of Health Data and Digitalisation, Norwegian Institute of Public Health, Oslo, Norway
| | - Jürgen May
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine Hamburg, Bernhard-Nocht-Strasse 74, 20359 Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Germany
| | | | - Ayola Akim Adegnika
- Centre de Recherches Médicales de Lambaréné, BP 242 Lambaréné, Gabon
- Institut für Tropenmedizin and German Center for Infection Research, partner site Tübingen, Universitätsklinikum, Wilhelmstraße 27, 72074 Tübingen, Germany
| | - John P. A. Lusingu
- National Institute for Medical Research, Tanga Research Centre, Tanga, Tanzania
| | - John Amuasi
- Kumasi Centre for Collaborative Research in Tropical Medicine, College of Health Sciences, KNUST, Kumasi, Ghana
| | - Daniel Eibach
- Department of Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine Hamburg, Bernhard-Nocht-Strasse 74, 20359 Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Lübeck-Borstel-Riems, Germany
| | - Simone Mario Caccio
- Department of Infectious Disease, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
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Manouana GP, Lorenz E, Mbong Ngwese M, Nguema Moure PA, Maiga Ascofaré O, Akenten CW, Amuasi J, Rakotozandrindrainy N, Rakotozandrindrainy R, Mbwana J, Lusingu J, Byrne N, Melhem S, Zinsou JF, Adegbite RB, Hogan B, Winter D, May J, Kremsner PG, Borrmann S, Eibach D, Adegnika AA. Performance of a rapid diagnostic test for the detection of Cryptosporidium spp. in African children admitted to hospital with diarrhea. PLoS Negl Trop Dis 2020; 14:e0008448. [PMID: 32658930 PMCID: PMC7377516 DOI: 10.1371/journal.pntd.0008448] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 07/23/2020] [Accepted: 06/02/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Cryptosporidium is a protozoan parasite that causes mild to severe diarrhoeal disease in humans. To date, several commercial companies have developed rapid immunoassays for the detection of Cryptosporidium infection. However, the challenge is to identify an accurate, simple and rapid diagnostic tool for the estimation of cryptosporidiosis burden. This study aims at evaluating the accuracy of CerTest Crypto, a commercialized rapid diagnostic test (RDT) for the detection of Cryptosporidium antigens in the stool of children presenting with diarrhoea. METHODS A cross-sectional study was conducted in four study sites in Sub-Saharan Africa (Gabon, Ghana, Madagascar, and Tanzania), from May 2017 to April 2018. Stool samples were collected from children under 5 years with diarrhoea or a history of diarrhoea within the last 24 hours. All specimens were processed and analyzed using CerTest Crypto RDT against a composite diagnostic panel involving two polymerase chain reaction (PCR) tests (qPCR and RFLP-PCR,) as the gold standard. RESULTS A total of 596 stool samples were collected. Evaluation of the RDT yielded a very low overall sensitivity of 49.6% (confidence interval (CI) 40.1-59.0), a specificity of 92.5% (CI 89.8-94.7), positive predictive value of 61.3% (CI 50.6-71.2), and negative predictive value of 88.5% (85.3-91.1) when compared to the composite reference standard of qPCR and RFLP-PCR for the detection of Cryptosporidium species. Moreover, the performance of this test varied across different sites. CONCLUSION The weak performance of the studied RDT suggests the need to carefully evaluate available commercial RDTs before their use as standard tools in clinical trials and community survey of Cryptosporidium infections in pediatric cohorts.
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Affiliation(s)
- Gédéon Prince Manouana
- Centre de Recherches Médicales de Lambaréné
- German Center for Infection Research (DZIF), African partner institution, CERMEL, Gabon
- Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
| | - Eva Lorenz
- Infectious Disease Epidemiology, Bernhard Nocht Insitute for Tropical Medicine, Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
- Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University Mainz, Germany
| | - Mirabeau Mbong Ngwese
- Centre de Recherches Médicales de Lambaréné
- German Center for Infection Research (DZIF), African partner institution, CERMEL, Gabon
| | | | - Oumou Maiga Ascofaré
- Infectious Disease Epidemiology, Bernhard Nocht Insitute for Tropical Medicine, Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana
| | | | - John Amuasi
- Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana
| | | | | | - Joyce Mbwana
- National Institute for Medical Research (NIMR) & University of Copenhagen, Denmark
| | - John Lusingu
- National Institute for Medical Research (NIMR) & University of Copenhagen, Denmark
| | - Natalie Byrne
- Centre de Recherches Médicales de Lambaréné
- German Center for Infection Research (DZIF), African partner institution, CERMEL, Gabon
| | - Sophia Melhem
- Infectious Disease Epidemiology, Bernhard Nocht Insitute for Tropical Medicine, Hamburg, Germany
| | - Jeannot Frejus Zinsou
- Centre de Recherches Médicales de Lambaréné
- German Center for Infection Research (DZIF), African partner institution, CERMEL, Gabon
| | - Roméo Bayodé Adegbite
- Centre de Recherches Médicales de Lambaréné
- German Center for Infection Research (DZIF), African partner institution, CERMEL, Gabon
| | - Benedikt Hogan
- Infectious Disease Epidemiology, Bernhard Nocht Insitute for Tropical Medicine, Hamburg, Germany
| | - Doris Winter
- Infectious Disease Epidemiology, Bernhard Nocht Insitute for Tropical Medicine, Hamburg, Germany
| | - Jurgen May
- Infectious Disease Epidemiology, Bernhard Nocht Insitute for Tropical Medicine, Hamburg, Germany
| | - Peter Gottfried Kremsner
- Centre de Recherches Médicales de Lambaréné
- German Center for Infection Research (DZIF), African partner institution, CERMEL, Gabon
- Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
- German Center for Infection Research (DZIF), partner site Tübingen, Germany
| | - Steffen Borrmann
- Centre de Recherches Médicales de Lambaréné
- German Center for Infection Research (DZIF), African partner institution, CERMEL, Gabon
| | - Daniel Eibach
- Infectious Disease Epidemiology, Bernhard Nocht Insitute for Tropical Medicine, Hamburg, Germany
- German Center for Infection Research (DZIF), Hamburg-Borstel-Lübeck-Riems, Germany
| | - Ayola Akim Adegnika
- Centre de Recherches Médicales de Lambaréné
- German Center for Infection Research (DZIF), African partner institution, CERMEL, Gabon
- Institut für Tropenmedizin, Universität Tübingen, Tübingen, Germany
- German Center for Infection Research (DZIF), partner site Tübingen, Germany
- * E-mail:
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