Cryptosporidium Parvum in Children With Diarrhea in Mulago Hospital, Kampala, Uganda

Abstract

A cross-sectional case-control study (ratio ‫ס‬ 3:1) was conducted over a 15-month period to determine the prevalence and consequences of cryptosporidiosis in hospitalized diarrheic children (0−5 years old) at Mulago Hospital in Kampala, Uganda. Cryptosporidium parvum was detected and genotyped among 2,446 children of whom 1,779 (72.7%) had diarrhea, and 667 (27.3%) were age-and sex-matched controls. Of the 1,779 children with diarrhea, 532 (29.9%) had persistent (> 14 days) diarrhea and 1,247 (70.1%) had acute diarrhea. Overall, 444 (25.0%) of the 1,779 children with diarrhea had C. parvum, compared with only 57 (8.5%) of the 667 children without diarrhea (2 ‫ס‬ 80.2, P Յ 0.0001). Within this group of infected children, 72.8% were infected with genotype 1, 18.4% with genotype 2, and 4.1% with a mixture of both genotypes, and 4.1% isolates were either unclassified or C. meleagridis. The prevalence was highest during the rainy months of April to June. Of the 532 children with persistent diarrhea, 166 (31.2%) had C. parvum compared with 278 (22.3%) of the 1,247 children with acute diarrhea (2 ‫ס‬ 15.8, P Յ 0.0001). There was a significant association between C. parvum and malnutrition including stunting, being underweight, and wasting. Unfavorable outcome (death or failure to resolve within 14 days) occurred in 139 (72.8%) of the 191 children with C. parvum, and in only 65.1% of the 545 without (odds ratio ‫ס‬ 1.117, 95% confidence interval ‫ס‬ 1.005−1.243, P ‫ס‬ 0.05), Of the 191 children with C. parvum, 24 (12.6%) died, compared with 34 (6.2%) of the 545 without C. parvum (P ‫ס‬ 0.005). Mortality rates were higher among children with severe dehydration and persistent diarrhea, and in stunted or underweight children infected with C. parvum. Among Ugandan children, cryptosporidiosis, which remains untreatable, is frequently associated with diarrhea and other serious and unfavorable consequences.

Symptomatic and Asymptomatic Cryptosporidium Infections in Children in a Semi-Urban Slum Community in Southern India

“…35 Low birth weight, malnutrition, stunting and lack of breastfeeding have been reported to predispose children to cryptosporidiosis. 2,4,30 In this birth cohort, the median age of weaning was three months (IQR = 1.8-4 months). In our study, multiple infections were significantly associated with a longer duration of exclusive breastfeeding.…”

“…Diarrhea caused by these parasites in early childhood has been associated with subsequent cognitive function deficits and growth faltering and stunting, and the risk of stunting increases with the number of episodes per year. [1][2][3][4][5][6] A study from Peru found that symptomatic and asymptomatic cryptosporidiosis in children were associated with growth faltering after an infection but recovery was slower in children with symptomatic infection. 7 In India, several studies have reported Cryptosporidium spp.…”

Microsporidiosis and Malnutrition in Children with Persistent Diarrhea, Uganda

“…E. bieneusi spores were detected in stool specimens by using a nested PCR with E. bieneusi-specifi c primers (7). Cryptosporidium oocysts were detected by using immunofl uorescence microscopy, with confi rmation and genotyping subsequently determined by PCR-restriction fragment length polymorphism analysis (10). HIV status was determined by using established methods, and children positive for HIV were referred to the Mulago Hospital Pediatric Infectious Disease Clinic for further care.…”

Identification of a High Diversity of Cryptosporidium Species Genotypes and Subtypes in a Pediatric Population in Nigeria

“…1 Children are a high risk group for infection, those less than five years of age are most susceptible, 2 and cryptosporidiosis may have long-term negative effects on their growth and cognitive development. 3,4 Studies indicate that prevalence varies geographically, with increased prevalence in developing countries, and temporally, with higher rates reported during the rainy season in many tropical countries. [4][5][6][7] A range of Cryptosporidium species, genotypes, and subtypes infect humans, and each may have different sources of infection, transmission routes, and pathogenicity.…”