High association of Cryptosporidium spp. infection with colon adenocarcinoma in Lebanese patients

Abstract

BackgroundThe association between Cryptosporidium and human colon cancer has been reported in different populations. However, this association has not been well studied. In order to add new strong arguments for a probable link between cryptosporidiosis and colon human cancer, the aim of this study was to determine prevalence and to identify species of Cryptosporidium among Lebanese patients.Methodology and principal findingsOverall, 218 digestive biopsies were collected in Tripoli, Lebanon, from three groups of patients: (i) patients with recently diagnosed colon intraepithelial neoplasia/adenocarcinoma before any treatment (n = 72); (ii) patients with recently diagnosed stomach intraepithelial neoplasia/adenocarcinoma before any treatment (n = 21); and (iii) patients without digestive intraepithelial neoplasia/adenocarcinoma but with persistent digestive symptoms (n = 125). DNA extraction was performed from paraffin-embedded tissue. The presence of the parasite in tissues was confirmed by PCR, microscopic observation and immunofluorescence analysis. We identified a high rate (21%) of Cryptosporidium presence in biopsies from Lebanese patients with recently diagnosed colonic neoplasia/adenocarcinoma before any treatment. This prevalence was significantly higher compared to 7% of Cryptosporidium prevalence among patients without colon neoplasia but with persistent gastrointestinal symptoms (OR: 4, CI: 1.65–9.6, P = 0.001). When the comparison was done against normal biopsies, the risk of infection increased 11-fold in the group of patients with colon adenocarcinoma (OR: 11.315, CI: 1.44–89.02, P = 0.003).ConclusionsThis is the first study performed in Lebanon reporting the prevalence of Cryptosporidium among patients with digestive cancer. These results show that Cryptosporidium is strongly associated with human colon cancer being maybe a potential etiological agent of this disease.

Prevalence and Genotyping of Cryptosporidium parvum in Gastrointestinal Cancer Patients

“…Several epidemiological studies demonstrated that colorectal cancer is highly correlated with Cryptosporidium spp. [10][11][12][13][14]. In consistence, we here found that 17.24% patients with colorectal cancer had C. parvum infections, which was significantly higher than control population.…”

“…Recently, Osman M. et al (2017) performed a systematic analysis among Lebanese patients which indicated that Cryptosporidium spp. infections were more prevalent in patients with colon adenocarcinoma (21%, 15/72) than that in patients without digestive cancers but with digestive symptoms (7%, 9/125) [13]. This study also identified C. hominis and C. parvum as the causative species of Cryptosporidium spp.…”

“…This is consistent with the previous study among Lebanese which found none of the gastric cancer patients had Cryptosporidium spp. infection [13]. Furthermore, for the first time, our study identified the high occurrences of C. parvum in patients with esophageal cancer (6.25%, 1/16) and small intestine cancer (40%, 2/5).…”

A One Health Approach to Tackle Cryptosporidiosis

“…Burden of disease studies, focussed on acute illness, estimate 4.2 million disability adjusted life years lost in children under 5 years [64], with longer term sequelae, including growth faltering and cognitive defects. Disease impact studies in high-income countries found longer term impacts following acute infection involving persistent abdominal pain, myalgia/arthralgia and fatigue [78], irritable bowel syndrome [79], and a recent study has shown a strong association between Cryptosporidium infection and human colon cancer [80].…”

Parasites in Food: From a Neglected Position to an Emerging Issue

“…For each of the parasites, improvements in diagnostics and treatment are likely to improve the clinical situation at the individual patient level, and this is particularly so for those parasites for which lack of identification may result in devastating long-term or chronic diseases, such as AE due to infection with E. multilocularis, Chagas disease for T. cruzi, various prolonged gastrointestinal problems with anisakiasis, or CCA for Opisthorchis spp. Indeed, even for cryptosporidiosis, the potential for long-term sequelae has been reported (Osman et al, 2017;Rehn et al, 2015;Stiff, Davies, Mason, Hutchings, & Chalmers, 2017); although for most people infected it is more likely to manifest as an acute, but short-lived, self-limiting episode of diarrhea. However, for most of the parasites described here, such improvements are unlikely to have a significant direct impact on transmission at the community or population level, particularly for E. multilocularis and Anisakis spp., for which humans are a dead-end host, and therefore further transmission will not occur.…”