Evaluation of the optimal number of faecal specimens in the diagnosis of cryptosporidiosis in AIDS and immunocompetent patients

Clavel, Antonio; Arnal, Ana Cristina Murillo; Sánchez, Elena Curto; Varea, Marzo; Castillo, Francisco; Ocáriz, Inmaculada Ramírez de; Quílez, Joaquín; Cuesta, Jorge

doi:10.1007/bf02112618

Cited by 21 publications

(10 citation statements)

References 14 publications

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“…In particular, in UK, peaks of incidence in the spring and late autumn or early winter appear to be associated with farming activity and peak rainfall (Casemore 1990;Fayer et al 2000). In Spain, the prevalence of cryptosporidiosis is significantly higher in the autumnwinter period (October to March) with a mean of 100 cases than in the spring-summer period (April to September) with a mean of 60 cases (Clavel et al 1995). In addition, in Mediterranean area, two peaks in rainfall have been documented to occur during spring (mean value of 50 ± 6AE98 mm) and mainly in autumn (mean value of 78 ± 14 mm).…”

Section: Discussionmentioning

confidence: 99%

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Occurrence of Cryptosporidium spp. oocysts in raw and treated sewage and river water in north-eastern Spain

Montemayor

Valero²,

Jofre

et al. 2005

J Appl Microbiol

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Aims: To determine the occurrence and levels of Cryptosporidium parvum oocysts in wastewater and surface waters in north-eastern Spain. Methods and Results: Samples from five sewage treatment plants were taken monthly and quarterly during 2003. In addition, water was collected monthly from the River Llobregat (NE Spain) during the period from 2001 to 2003. All samples were analysed by filtration on cellulose acetate filters or through Envirocheck TM using EPA method 1623, followed by immunomagnetic separation and examination by laser scanning cytometry. All raw sewage, secondary effluent and river water samples tested were positive for Cryptosporidium oocysts. Of the tertiary sewage effluents tested, 71% were positive for Cryptosporidium oocysts. The proportion of viable oocysts varied according to the sample. Conclusions: Two clear maxima were observed during spring and autumn in raw sewage, showing a seasonal distribution and a correlation with the number of cryptosporidiosis cases and rainfall events. Significance and Impact of the Study: This study provides the first data on the occurrence of Cryptosporidium oocysts in natural waters in north-eastern Spain.

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Section: Discussionmentioning

confidence: 99%

“…2000). In Spain, the prevalence of cryptosporidiosis is significantly higher in the autumn–winter period (October to March) with a mean of 100 cases than in the spring–summer period (April to September) with a mean of 60 cases (Clavel et al. 1995).…”

Section: Discussionmentioning

confidence: 99%

Occurrence of Cryptosporidium spp. oocysts in raw and treated sewage and river water in north-eastern Spain

Montemayor

Valero²,

Jofre

et al. 2005

J Appl Microbiol

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“…The use of random diarrhea samples to measure oocyst excretion by grade, while acceptable as a diagnostic test [32,33], was not strongly predictive of clinical response. It has been suggested that quantitation for oocysts in a 24-h stool collection may be a more accurate indicator of organism load [34].…”

Section: Discussionmentioning

confidence: 99%

Paromomycin: No More Effective than Placebo for Treatment of Cryptosporidiosis in Patients with Advanced Human Immunodeficiency Virus Infection

et al. 2000

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To evaluate the efficacy of paromomycin for the treatment of symptomatic cryptosporidial enteritis in human immunodeficiency virus-infected adults, we conducted a prospective, randomized, double-blind, placebo-controlled trial before the widespread introduction of highly active antiretroviral therapy (HAART). Seven units under the auspices of the AIDS Clinical Trials Group enrolled 35 adults with CD4 cell counts of < or = 150/mm(3). Initially, 17 patients received paromomycin (500 mg 4 times daily) and 18 received matching placebo for 21 days. Then all patients received paromomycin (500 mg q.i.d.) for an additional 21 days. Clinical definitions of response were measured by an average number of bowel movements per day in association with concurrent need for antidiarrheal agents that was lower than that before study entry. There was no treatment response during the placebo-controlled phase of the study according to protocol-defined criteria (P=.88). Three paromomycin recipients (17.6%) versus 2 placebo recipients (14.3%) responded completely. Rates of combined partial and complete responses in the paromomycin arm (8 out of 17, 47.1%) and the placebo arm (5 out of 14, 35.7%) of the study were also similar (P=.72). The clinical course of cryptosporidiosis was quite variable. Paromomycin was not shown to be more effective than placebo for the treatment of symptomatic cryptosporidial enteritis. However, inadequate statistical power prevents definitive rejection of the usefulness of paromomycin as therapy for this infection.

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“…But some major pitfalls have been identified in the routine diagnosis of intestinal cryptosporidiosis [21]. Firstly, the direct microscopic examination after modified ZN staining relies on the morphologic recognition of small-sized oocysts which may be scant in number, intermittently shed, or inconsistently stained [13, 22]. This method is therefore impractical to standardize as it is influenced by the individual skills of the microscopist involved.…”

Section: Discussionmentioning

confidence: 99%

“…Cryptosporidiosis is most commonly diagnosed by identifying oocysts in the stool specimens of infected persons. The diagnostic difficulties arise from the fact that shedding of C. parvum oocysts is intermittent even in patients with massive diarrhea [13]. The number of oocysts present in the stool sample may not be adequate for detection and it is usually seen that oocysts are better recovered from watery stools than the formed samples [14].…”

Section: Introductionmentioning

confidence: 99%

A Comparison of Nested PCR Assay with Conventional Techniques for Diagnosis of Intestinal Cryptosporidiosis in AIDS Cases from Northern India

Uppal

Singh

Chadha

et al. 2014

Journal of Parasitology Research

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Cryptosporidiosis is a very important opportunistic infection and is responsible for significant morbidity and mortality in HIV/AIDS patients. Although current laboratory methods are generally considered adequate to detect high concentrations of oocysts, they fail to detect cases of cryptosporidiosis in many immunocompromised patients. The present study was done to determine the diagnostic efficacy of modified Ziehl-Neelsen (ZN), antigen detection ELISA, and a nested PCR assay for detection of Cryptosporidium in 58 adult AIDS cases with diarrhea from the ART clinic of Lok Nayak Hospital, New Delhi. Cryptosporidium was detected in 17 (29.4%), 39 (67.3%), and 45 (77.5%) cases by modified ZN staining, antigen ELISA, and nested PCR assay, respectively. Taking nested PCR as the gold standard, specificity of both modified ZN staining and Cryptosporidium antigen detection ELISA was 100% while the sensitivity of the tests was 37.8% and 86.6%, respectively. PCR was more sensitive than the other two diagnostic modalities but required a more hands-on time per sample and was more expensive than microscopy. PCR, however, was very adaptable to batch analysis, reducing the costs considerably. This assay can therefore have considerable advantages in the treatment of immunosuppressed individuals like AIDS patients, allowing their early diagnosis and decreasing the morbidity and the mortality.

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Evaluation of the optimal number of faecal specimens in the diagnosis of cryptosporidiosis in AIDS and immunocompetent patients

Cited by 21 publications

References 14 publications

Occurrence of Cryptosporidium spp. oocysts in raw and treated sewage and river water in north-eastern Spain

Occurrence of Cryptosporidium spp. oocysts in raw and treated sewage and river water in north-eastern Spain

Paromomycin: No More Effective than Placebo for Treatment of Cryptosporidiosis in Patients with Advanced Human Immunodeficiency Virus Infection

A Comparison of Nested PCR Assay with Conventional Techniques for Diagnosis of Intestinal Cryptosporidiosis in AIDS Cases from Northern India

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