The Frequency of Cryptosporidium spp. in Immunocompromised Patients by Modified Acid-Fast Staining, Cassette Kit and ELISA Methods: Comparison of the Diagnostic Techniques

Abstract

Background: Cryptosporidiosis has been reported in both immunocompetent and immunocompromised patients from over 40 countries in six continents. Objectives: This study was carried out to determine the prevalence of Cryptosporidium spp. in immunocompromised patients by methods of modified acid fast staining, ELISA and Cassette Kit, and to also compare the three methods. Methods: The patients in different age groups admitted to Bitlis state hospital between June 23, 2011 and January 13, 2015 were enrolled. The study group was composed of 300 immunocompromised volunteer patients and the control group of 100 volunteers with normal immune system. In the study group, patients with hemodialysis, chronic renal failure, diabetes mellitus, diabetes insipidus, and cancer were enrolled. Formalin-ethyl acetate, modified acid fast staining and native-lugol were used for all stool samples; they were also investigated for Cryptosporidium antigens by the ELISA and Cassette Kit. Results: The highest prevalence rate of Cryptosporidium spp. is found to be 11.3%, which is obtained by ELISA and the lowest (0.7%) by Cassette Kit in the study group. All patients with cryptosporidiosis had diarrhea. The highest prevalence rate (20%) was observed in patients with diabetes insipidus and the second highest in patients with chronic renal failure (11.5%) by ELISA. The sensitivities and specificities of Cassette Kit and modified acid fast staining were 5.9%, 100%; and 50%, 100%, respectively. Conclusions: It is concluded that Cryptosporidium spp. should be considered in immunocompromised diarrheal patients and ELISA must be chosen for detection of this parasite. Modified acid fast staining and Cassette Kit techniques could be performed if ELISA is not available. The single use of the Cassette Kit will be inadequate for the diagnosis of cryptosporidiosis.