Abstract
The intestinal protozoan parasite Cryptosporidium is an important cause of diarrheal disease worldwide. The aim of this study was to expand the knowledge on the molecular epidemiology of human cryptosporidiosis in Sweden to better understand transmission patterns and potential zoonotic sources. Cryptosporidium-positive fecal samples were collected between January 2013 and December 2014 from 12 regional clinical microbiology laboratories in Sweden. Species and subtype determination was achieved using small subunit ribosomal RNA and 60 kDa glycoprotein gene analysis. Samples were available for 398 patients, of whom 250 (63%) and 138 (35%) had acquired the infection in Sweden and abroad, respectively. Species identification was successful for 95% (379/398) of the samples, revealing 12 species/genotypes: Cryptosporidium parvum (n = 299), C. hominis (n = 49), C. meleagridis (n = 8), C. cuniculus (n = 5), Cryptosporidium chipmunk genotype I (n = 5), C. felis (n = 4), C. erinacei (n = 2), C. ubiquitum (n = 2), and one each of C. suis, C. viatorum, C. ditrichi, and Cryptosporidium horse genotype. One patient was co-infected with C. parvum and C. hominis. Subtyping was successful for all species/genotypes, except for C. ditrichi, and revealed large diversity, with 29 subtype families (including 4 novel ones: C. parvum IIr, IIs, IIt, and Cryptosporidium horse genotype VIc) and 81 different subtypes. The most common subtype families were IIa (n = 164) and IId (n = 118) for C. parvum and Ib (n = 26) and Ia (n = 12) for C. hominis. Infections caused by the zoonotic C. parvum subtype families IIa and IId dominated both in patients infected in Sweden and abroad, while most C. hominis cases were travel-related. Infections caused by non-hominis and non-parvum species were quite common (8%) and equally represented in cases infected in Sweden and abroad.
Highlights
Cryptosporidiosis is a global parasitic disease, which usually presents with selflimiting diarrhea
There are more than 40 recognized species described, but 2 in particular (Cryptosporidium hominis and Cryptosporidium parvum) account for most cases of human cryptosporidiosis [3]
Around 20 other species/genotypes have been observed in humans, including Cryptosporidium meleagridis, Cryptosporidium cuniculus, Cryptosporidium ubiquitum, Cryptosporidium canis, Cryptosporidium felis, Cryptosporidium viatorum, and Cryptosporidium chipmunk genotype I [3,4]
Summary
Cryptosporidiosis is a global parasitic disease, which usually presents with selflimiting diarrhea. The disease can be severe, especially in immunocompromised and malnourished individuals [1]. The causative agent is the intestinal protozoan parasite. Cryptosporidium, which infects a wide range of animals, including humans [2]. There are more than 40 recognized species described, but 2 in particular (Cryptosporidium hominis and Cryptosporidium parvum) account for most cases of human cryptosporidiosis [3]. Around 20 other species/genotypes have been observed in humans, including Cryptosporidium meleagridis, Cryptosporidium cuniculus, Cryptosporidium ubiquitum, Cryptosporidium canis, Cryptosporidium felis, Cryptosporidium viatorum, and Cryptosporidium chipmunk genotype I [3,4]. Cryptosporidiosis has been a notifiable disease in Sweden since 2004, with an increasing incidence from 69 (0.8 cases/100,000 inhabitants) cases annually in 2005 to 1088
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