Cryptosporidium infection in rural Gambian children: Epidemiology and risk factors.

M Jahangir Hossain,Debasish Saha,Myron M Levine,Richard A Adegbola,William C Blackwelder,Martin Antonio,Karen L Kotloff,Anna W Roose,Mitchell Adeyemi,Usman N Ikumapayi,Dilruba Nasrin,Grant A Mackenzie,Momodou Jasseh,Luther A Bartelt

doi:10.1371/journal.pntd.0007607

Abstract

BackgroundCryptosporidium is a major pathogen associated with diarrheal disease in young children. We studied Cryptosporidium diarrhea in children enrolled in the Global Enteric Multicenter Study (GEMS) in rural Gambia.MethodsWe recruited children <5 years of age with moderate-to-severe diarrhea (MSD) for 3 years (2008–2010), and children with either MSD or less severe diarrhea (LSD) for one year (November 2011-November 2012) at sentinel health centers. One or more randomly selected controls were matched to each case. Stool samples were tested to identify Cryptosporidium by immunoassay. A subset of randomly selected case-controls pairs were tested for Cryptosporidium species. We investigated the epidemiology of, and evaluated possible risk factors for, Cryptosporidium-positive diarrhea.ResultsWe enrolled 1938 cases (1381 MSD, 557 LSD) and 2969 matched controls; 231/1929 (12.0%) of diarrhea cases and 141/2962 (4.8%) of controls were positive for Cryptosporidium. Most Cryptosporidium diarrhea cases (85.7%, 198/231) were aged 6–23 months, and most (81.4%, 188/231) occurred during the rainy season. Cryptosporidium hominis (C. hominis) was the predominant (82.6%) species. We found associations between increased risk of Cryptosporidium-positive MSD or LSD, or both, with consumption of stored drinking water and certain animals living in the compound—cow, cat (MSD only) and rodents (LSD only). Larger households, fowl living in the compound, and the presence of Giardia infection were associated with decreased risk of Cryptosporidium MSD and LSD.ConclusionCryptosporidium-positive diarrhea is prevalent in this setting, especially at 6–23 months of age. The preponderance of Cryptosporidium infection in the rainy season and increased risk of Cryptosporidium-positive diarrhea with consumption of stored drinking water suggest water-borne transmission. Further investigation is needed to clarify the role of animals and contamination of stored drinking water in Cryptosporidium transmission.

Highlights

Diarrhea is the second leading cause of morbidity and mortality in children less than 5 years old, causing approximately 600,000 annual deaths, mostly in developing countries [1]
We studied Cryptosporidium diarrhea in children enrolled in the Global Enteric Multicenter Study (GEMS) in rural Gambia
We enrolled 1938 cases (1381 moderate-to-severe diarrhea (MSD), 557 less severe diarrhea (LSD)) and 2969 matched controls; 231/1929 (12.0%) of diarrhea cases and 141/2962 (4.8%) of controls were positive for Cryptosporidium

Summary

Introduction

Diarrhea is the second leading cause of morbidity and mortality in children less than 5 years old, causing approximately 600,000 annual deaths, mostly in developing countries [1]. The recent Global Enteric Multicenter Study (GEMS) found that Cryptosporidium was the third most common pathogen contributing to moderate-to-severe diarrhea (MSD) in children aged less than 5 years, irrespective of HIV prevalence [6, 7]. A multisite birth cohort community-based study (MAL-ED) detected a high burden of Cryptosporidium associated mild and severe infectious diarrhea among children aged 0–24 months [8, 9]. Cryptosporidium is associated with an estimated 48,000 global deaths per year in children aged less than five years [12]. We studied Cryptosporidium diarrhea in children enrolled in the Global Enteric Multicenter Study (GEMS) in rural Gambia

Methods

Results

Conclusion