Cryptosporidiosis: Prevalence, Genotype Analysis, and Symptoms Associated With Infections in Children in Kenya

Abstract

Cryptosporidium parasites are leading causes of enteric disease, especially in children. A prospective survey on the prevalence of cryptosporidiosis in children less than five years of age was undertaken at six microbiology laboratories in Kenya on fecal samples submitted for routine parasite and ova investigations. Analysis of 4,899 samples over a two-year study period showed an overall prevalence of cryptosporidiosis of 4% that was highest between November to February. Investigations on the nature of enteric diseases prompting ova and cyst examination requests showed 66.4% had acute diarrhea, 9% had persistent diarrhea, and 21% had recurrent diarrhea. The main symptoms were abdominal pain (51.1%), vomiting (51.6%), and abdominal swelling (11%). The prevalence of cryptosporidiosis was highest among children 13-24 months of age (5.2%) and least among those 48-60 months of age (2%). No significant differences were observed by sex but vomiting was slightly higher in males than in females (65% males and 52% females; P = 0.07). Cryptosporidiosis was significantly associated with persistent diarrhea (P = 0.0001, odds ratio [OR] = 2.193, 95% confidence interval [CI] = 1.463-3.29), vomiting (P = 0.0273, OR = 1.401, 95% CI = 1.04-1.893), and abdominal swelling (P = 0.0311, OR = 1.56, 95% CI = 1.04-2.34). Genotype analysis based on polymerase chain reaction-restriction fragment length polymorphism of the 18S rRNA gene fragment showed that 87% (153 of 175) of the Cryptosporidium isolates were C. hominis, 9% (15 of 175) were C. parvum, and remaining 4% were C. canis, C. felis, C. meleagridis, and C. muris. The most common protozoa in coinfected patients were Entamoeba histolytica/E. dispar, E. coli, and Giardia intestinalis (6%, 5%, and 2%, respectively). Our results show that Cryptosporidium is among the most common protozoan parasites in children with enteric diseases and that anthroponotic species are the leading cause of human cryptosporidiosis in Kenya, which suggests that human-to-human transmission is the main mode of spread.

Low sensitivity of the ImmunocardSTAT® Crypto/Giardia Rapid Assay test for the detection of Giardia and Cryptosporidium in fecal samples from children living in Libreville, Central Africa

“…oocysts in their stools was found to be 11.0 %, a surprisingly high rate given the lack of symptoms in these individuals. This rate is comparable to the prevalence observed in diarrheic individuals which vary from 3 to 10 % according to HIV prevalence (Wumba et al 2012;Gatei et al 2006;Morse et al 2007). The existence of this reservoir therefore constitutes a potential risk for the infection of malnourished and immunocompromised individuals.…”

“…This species is a strictly human parasite and PlaineOrety is a district of Libreville in which the human population rarely comes into contact with the C. parvum parasite non human reservoir. Moreover, in tropical areas, most surveys on the general population, and even on patients with diarrhea, have shown that C. hominis predominates (Wumba et al 2012;Gatei et al 2006;Morse et al 2007;Walker al. 2010).…”

“…However, it has been shown that C. spp. is not restricted to immunocompromised hosts, it is also found in immunocompetent individuals (Nchito et al 1998;Gatei et al 2006;Salyer et al 2012). This parasite frequently infects children, in which it may have adverse effects on nutritional outcomes, affecting intestinal absorption, nutrition, and childhood development (Checkley et al 1997;Mondal et al 2009;Mølbak et al 1997).…”

Sporadic Cryptosporidium infection in Nigerian children: risk factors with species identification

“…6%, and 31 . 2%, respectively [7,11,25,26]. Our study identified a number of risk factors for sporadic Cryptosporidium infection that varied by species.…”

Cryptosporidiumspecies in Australian wildlife and domestic animals

“…Genotyping studies of Cryptosporidium oocysts in feces of dogs and cats, have demonstrated that most infections in these animals are caused by C. canis and C. felis, respectively. Cryptosporidium felis has a restricted host range and has been identified in cats, immunocompetent and immunocompromised humans and a cow Cryptosporidium muris has a wide host range and has also been identified in a few humans in developing countries (Palmer et al 2003;Gatei et al 2006;Muthusamy et al 2006). However, most human cases of cryptosporidiosis, worldwide, are associated with C. hominis and C. parvum (Xiao, 2010) and therefore C. muris, C. canis and C. felis are likely to be of low zoonotic risk to humans.…”