Cryptosporidium Infection Research Articles

Commensal Cryptosporidium colonization elicits a cDC1-dependent Th1 response that promotes intestinal homeostasis and limits other infections

Cryptosporidium can cause severe diarrhea and morbidity, but many infections are asymptomatic. Here, we studied the immune response to a commensal strain of Cryptosporidium tyzzeri (Ct-STL) serendipitously discovered when conventional type 1 dendritic cell (cDC1)-deficient mice developed cryptosporidiosis. Ct-STL was vertically transmitted without negative health effects in wild-type mice. Yet, Ct-STL provoked profound changes in the intestinal immune system, including induction of an IFN-γ-producing Th1 response. TCR sequencing coupled with invitro and invivo analysis of common Th1 TCRs revealed that Ct-STL elicited a dominant antigen-specific Th1 response. In contrast, deficiency in cDC1s skewed the Ct-STL CD4 Tcell response toward Th17 and regulatory Tcells. Although Ct-STL predominantly colonized the small intestine, colon Th1 responses were enhanced and associated with protection against Citrobacter rodentium infection and exacerbation of dextran sodium sulfate and anti-IL10R-triggered colitis. Thus, Ct-STL represents a commensal pathobiont that elicits Th1-mediated intestinal homeostasis that may reflect asymptomatic human Cryptosporidium infection.

Knowledge, Attitude and Practices Towards Cryptosporidium Among Public Swimming Pool Patrons and Staff in Western Australia.

There is a dearth of research conducted on the Knowledge, Attitude and Practices (KAP) of swimming pool patrons and staff to determine their understanding of the importance of Cryptosporidium and its transmission in swimming pools. We conducted a KAP survey of public swimming pool patrons (n = 380) and staff (n = 40) attending five public swimming pools in Western Australia (WA). Knowledge, attitudes and practices (KAP) of Cryptosporidium varied between patrons and staff but were generally limited. Only 26.1% and 25.0% of patrons and staff had heard of Cryptosporidium, while 17.4% and 10.0% knew that it causes diarrhoea, respectively. Thirty-one percent of patrons were aware of their pool policy concerning gastroenteritis and Cryptosporidium, compared to 62.5% of staff. Less than 50% of patrons demonstrated awareness of how features within the pool environment were relevant to the control of Cryptosporidium. Only about a third of patrons (35%) and staff (37.5%) were aware that showering before swimming reduced the risk of gastroenteritis. Raising awareness about hygiene-related practices through the delivery of targeted health education messages to the general public is essential to reduce the burden of Cryptosporidium infections in aquatic environments.

Prevalence and Molecular Epidemiology of Cryptosporidium Infection in Clarias gariepinus Fish in Egypt.

This study investigated the prevalence and molecular detection of Cryptosporidium spp. in catfish (Clarias gariepinus). A total of 300 Carias gariepinus fish were collected from two freshwater sources: the Nile River (180) and drainage canals (120). The stomach and intestine epithelium of each individual fish sample were screened by modified Ziehl-Neelsen (mZN) staining technique for the detection of Cryptosporidium oocysts followed by the serological survey for detection of Cryptosporidium antibodies using Enzyme-Linked Immunosorbent Assay (ELISA) and molecular characterization using complemented DNA polymerase chain reaction (cPCR). ELISA showed higher prevalence of 69.3% than that prevalence obtained by mZN, 64% for the total examined Clarias gariepinus fish. Also, higher prevalence of Cryptosporidium infection 65.5% and 75.8% obtained by ELISA than 61.1% and 68.3% by mZN, in both fish groups from Nile River and Drainage canal, respectively. PCR analysis revealed the expected positive bands at 1056bp. DNA sequencing and phylogenetic analysis proved that the positive-PCR Cryptosporidium isolate identified in the present study was Cryptosporidium molnari. Freshwater fishes (Clarias gariepinus) are subjected to a high infection rate with Cryptosporidium spp.; the drainage canals obtained fishes showed higher prevalence than that collected from Nile River which indicates an important public health problem and a potential risk of drainage canals in Egypt. ELISA showed higher prevalence of cryptosporidiosis than mZN, for the total examined Clarias gariepinus fish and phylogenetic analyses confirmed this protozoal organism to be a novel species of Cryptosporidium molnari.

Study of Cryptosporidium infection in Liver Cirrhosis and animal model.

Study of Cryptosporidium infection in Liver Cirrhosis and animal model.

Recreational water exposure and waterborne infections in a prospective salivary antibody study at a Lake Michigan beach

In a prospective observational study, seroconversion to a specific pathogen can serve as a marker of an incident infection, whether or not that infection is symptomatic or clinically diagnosed. While self-reported symptoms can be affected by reporting bias, seroconversion is likely to be free of this bias as it is based on objective measurements of antibody response. Non-invasive salivary antibody tests can be used instead of serum tests to detect seroconversions in prospective studies. In the present study, individuals and families were recruited at a Lake Michigan beach in Wisconsin in August 2011. Data on recreational water exposure and baseline saliva samples (S1) were collected at recruitment. Follow-up data on gastrointestinal symptoms were collected via a telephone interview approximately 10 days post-recruitment. Follow-up saliva samples were self-collected approximately 2 weeks (S2) and 30–40 days post-recruitment (S3) and mailed to the study laboratory. Samples were analyzed for immunoglobulin (Ig) G responses to recombinant antigens of three noroviruses and Cryptosporidium, as well as protein purification tags as internal controls, using an in-house multiplex suspension immunoassay on the Luminex platform. Responses were defined as ratios of antibody reactivities with a target protein and its purification tag. Seroconversions were defined as at least four-fold and three-fold increases in responses in S2 and S3 samples compared to S1, respectively. In addition, an S2 response had to be above the upper 90% one-sided prediction limit of a corresponding spline function of age. Among 872 study participants, there were seven (0.8%) individuals with seroconversions, including six individuals with seroconversions to noroviruses and two to Cryptosporidium (one individual seroconverted to both pathogens). Among 176 (20%) individuals who reported swallowing lake water, there were six (3.4%) seroconversions compared to one (0.14%) seroconversion among the remaining 696 individuals: the crude and age-standardized risk differences per 1000 beachgoers were 32.7 (95% confidence limits 5.7; 59.6) and 94.8 (4.6; 276), respectively. The age-adjusted odds ratio of seroconversion in those who swallowed water vs. all others was 49.5 (4.5; 549), p = 0.001. Individuals with a norovirus seroconversion were more likely to experience vomiting symptoms within 4 days of the index beach visit than non-converters with an odds ratio of 34 (3.4, 350), p = 0.003. This study contributed further evidence that recreational water exposure is associated with symptomatic and asymptomatic waterborne infections, and that salivary antibody assays can be used in epidemiological surveys of norovirus and Cryptosporidium infections.

Prevalence of Cryptosporidium in Children Under 13 Years of Age With Acute Diarrhea in Tabriz, Iran

Introduction: Cryptosporidium is a coccidian parasite that causes diarrhea in animals and humans, especially children. Although several studies have been done on Cryptosporidium infection in some parts of Iran, this parasite is not examined in routine parasitological tests. Therefore, the aim of this study was to determine the frequency of Cryptosporidium infection in children with diarrhea in Tabriz, Iran. Materials and Methods: In this study, 100 fecal samples of children under 13 years of age with acute diarrhea who referred to medical diagnostic laboratories in Tabriz during 2018 were examined for Cryptosporidium infection. The samples were first concentrated by formalin-ether method and after staining with modified acid fast method, they were examined by light microscope. Results: In this study, 3 children (3%), 2 boys, 3 years old and 5 years old, and a 3-year-old girl had cryptosporidiosis. Conclusion: The results of the present study show the presence of Cryptosporidium infection in children in Tabriz. The very low percentage of infection with this parasite indicates that this parasite is not yet considered as a health problem in this area.

Toll-Like Receptors and Mannose Binding Lectin Gene Polymorphisms Associated with Cryptosporidial Diarrhea in Children in Southern India.

ABSTRACT.In low-resource settings, Cryptosporidium spp. is a common cause of diarrheal disease in children under the age of 3 years. In addition to diarrhea, these children also experience subclinical episodes that have been shown to affect growth and cognitive function. In this study, we screened polymorphisms in the promoter and exon1 regions of the mannose binding lectin 2 (MBL2) gene, as well as single nucleotide polymorphisms (SNPs) described in toll-like receptors (TLR) TLR1, TLR2, TLR4, and TLR9 and TIR domain-containing adaptor protein (TIRAP) genes among children with cryptosporidial diarrhea (cases) and children who only experienced asymptomatic (subclinical) cryptosporidiosis (controls). Among the polymorphisms screened, the variant allele B at codon 54 (rs1800450) of the MBL2 gene was associated with susceptibility to cryptosporidial diarrhea (odds ratio [OR] = 2.2, 95% confidence interval [CI] 1.1–4.5). When plasma MBL levels were compared, 72% of cases were found to be deficient compared with 32% among controls (OR = 5.09). Among TLR polymorphisms screened, multivariate analysis showed that heterozygous genotypes of TLR4 896A/G (rs4986790, OR = 0.33, 95% CI: 0.11–0.98) and TIRAP 539 C/T (rs8177374, OR = 0.19, 95% CI: 0.06–0.64) SNPs were associated with protection from cryptosporidial diarrhea. Although not statistically significant, these findings suggest that polymorphisms of MBL2 and TLR genes influence susceptibility to symptomatic cryptosporidial diarrhea even in settings with high exposure levels. Further studies to validate these findings in a larger cohort and to understand the role of these polymorphisms in mediating innate and adaptive immune responses to cryptosporidial infection are necessary.

Prevalence and Characterization of Cryptosporidium Species in Tibetan Antelope (Pantholops hodgsonii).

Cryptosporidium is an enteric apicomplexan parasite, which can infect multiple mammals including livestock and wildlife. Tibetan Antelope (Pantholops hodgsonii) is one of the most famous wildlife species, that belongs to the first class protected wild animals in China. However, it has not been known whether Tibetan Antelope is infected with Cryptosporidium so far. The objective of the present study was to determine the prevalence and characterization of Cryptosporidium species infection in Tibetan Antelope and the corresponding species by using molecular biological method. In the current study, a total of 627 fecal samples were randomly collected from Tibetan Antelope in the Tibet Autonomous Region (2019–2020), and were examined by PCR amplification of the small subunit ribosomal RNA (SSU rRNA) gene. Among 627 samples, 19 (3.03%, 19/627) were examined as Cryptosporidium-positive, with 7 (2.33%, 7/300) in females and 12 (3.67%, 12/327) in males. The analysis of SSU rRNA gene sequence suggested that only two Cryptosporidium species, namely, C. xiaoi and C. ubiquitum, were identified in this study. This is the first evidence for an existence of Cryptosporidium in Tibetan Antelope. These findings extend the host range for Cryptosporidium spp. and also provide important data support for prevention and control of Cryptosporidium infection in Tibetan Antelope.

Prevalence of Cryptosporidium Infection in Sheep and Goat Flocks in China During 2010-2019: A Systematic Review and Meta-Analysis.

Cryptosporidiosis is an extensively contagious zoonotic waterborne disease caused by the genus Cryptosporidium and poses to be a danger to public health. Sheep and goats are an intermediate host of Cryptosporidium. Consequently, a first systematic review and meta-analysis are performed to assess the burden of the infection relative to the Cryptosporidium in sheep and goat flocks in China. Five databases were searched for relevant literature in accordance with the inclusion criteria until January 30, 2020. At last, a total of 33 qualified documents were included. We calculate the overall prevalence of Cryptosporidium (4.9%) in sheep and goats in China with the random-effects model. The prevalence after 2014 (4.6%) was higher than that before or in 2014 (2.8%). The pooled prevalence of Cryptosporidium in sheep and goats from Northern China (12.3%) was significantly higher (p < 0.05) than other regions. The infection rate of modified acid-fast staining (14.3%) was the highest among the detection methods. In age subgroups, the prevalence of Cryptosporidium in sheep and goats in 3 months or before was the highest (20.8%). Goats had a higher infection rate (5.9%) in species. The prevalence of large-scale farms (2.8%) was lower than free-ranging farms (4.4%). The medium quality level (6.4%) was the highest. Besides, geographical factors (such as latitude, longitude, height, precipitation, humidity, mean temperature, etc.) were further analyzed as potential risk factors of Cryptosporidium in sheep and goats. This meta-analysis indicates that the Cryptosporidium infection of Chinese sheep and goat flocks is general. Thus, it is necessary to further monitor the prevalence of Cryptosporidium, and the reasonable preventive strategy should be formulated on the basis of the geographical factors of different regions and the differences in sheep and goats' growth stages to reduce the prevalence of Cryptosporidium in sheep and goats.

A meta-analysis of Cryptosporidium species in humans from southern Africa (2000-2020).

The epidemiology of cryptosporidiosis in southern Africa is largely unknown. The disease is associated with diarrhea and nutritional deficiencies, leading to severe morbidity and mortality among immune-compromised patients. This study aimed to assess the pooled prevalence of Cryptosporidium spp. infection among immune-compromised humans in southern Africa over the past 20 years. Reports of Cryptosporidium spp. infection in humans published between 2000 and 2020 using Google Scholar, PubMed, Ovid Medline, African Journal Online (AJOL), and Web of Science literature databases were obtained. Inclusion criteria of sorted articles for Cryptosporidium spp. infection were standardized using preferred reporting items for systematic reviews and meta-analyses (PRISMA) checklist. A total of 22 eligible studies were sorted for meta-analysis. Overall prevalence of Cryptosporidium spp. infection in southern African countries with reports was 16.8% (95% CI 9.7–25.3). Sub-group analysis showed a pooled prevalence of 25.2, 20.5, and 17.9% among HIV/AIDS patients, children, and diarrhoeic individuals, respectively. Pooled prevalence was highest in South Africa and lowest in Zimbabwe across examined individuals. The pooled prevalence of Cryptosporidium spp. infections in diarrhoeic patients was highest in individuals from Botswana (17.6%) which is significantly different (Χ2 = 9.337; P = 0.002) from South Africans (12.7%). South African individuals with HIV/AIDS showed the highest pooled prevalence of Cryptosporidium infections than other countries. The high prevalence of Cryptosporidium spp. infections among immune-compromised patients in southern Africa showed that the pathogen is of significant importance in this region. Continuous studies on the genetic characterization of Cryptosporidium spp. isolates and associated risk factors are needed across southern Africa to identify the predominant subtypes in humans.Graphic abstract Supplementary InformationThe online version contains supplementary material available at 10.1007/s12639-021-01436-4.

Cryptosporidium and cryptosporidiosis in wild birds: A One Health perspective.

Cryptosporidium is one of the most important parasitic protozoa that can be transmitted through food and water contamination. With the increasing report of Cryptosporidium infections in wild birds, especially in herbivorous waterfowl, concerns have been raised for oocyst contamination of water and food supplies, which in turn can cause human and domestic animal infections in areas neighboring wild birds' habitats. This review discusses the epidemiology, species, and genotypes distribution of Cryptosporidium in wild birds around the world. The overall prevalence of Cryptosporidium in wild birds was calculated as 3.96% (1945/49129), with 6 Cryptosporidium species (C. andersoni, C. parvum, C. meleagridis, C. avium, C. baileyi, and C. galli) and 5 genotypes (Goose genotype I, Goose genotype II, Avian genotype I, Avian genotype III, and Avian genotype VI) reported. As wild birds mainly live in the wild, control method for the Cryptosporidium infection in wild birds is still lacking, which increases the probability of disease transmission from wild birds to humans. The main purpose of this review is to highlight the Cryptosporidium infection in wild birds and its transmission, associated risk factors, and their prevention, illustrating the necessity of multidisciplinary approaches toward screening and control of Cryptosporidium infections.

Cryptosporidiosis is predominantly an urban, anthroponotic infectious disease among Zambian children.

Cryptosporidium species are leading causes of diarrhoea in children and immunocompromised individuals. This study aimed to characterise Cryptosporidium species from children in rural and urban settings of Zambia. Stool samples collected from 490 children aged <5 y with diarrhoea were assessed for Cryptosporidium oocysts microscopically. A structured questionnaire was used to collect demographic and socioeconomic characteristics. Positive samples were subjected to PCR and gp60 sequence analysis. The overall prevalence was 10% (50/490, 95% CI 7.8 to 13.2) with a peak in March, the late rainy season. Children who came from households where boiling water was not practised (OR=2.5, 95% CI 1.29 to 5.17; p=0.007) or who had experienced recurrent episodes of diarrhoea (OR=9.31, 95% CI 3.02 to 28.73; p=0.001) were more likely to have Cryptosporidium infection. Genotyping of 16 positive samples (14 from urban and 2 from rural sources) revealed Cryptosporidium hominis (14/16) and Cryptosporidium parvum (2/16). The Cryptosporidium hominis subtypes identified were Ia, Ib and Ie with subtype families IeAIIG3 (1), IbA9G3R2 (2), IaA31R3 (3), IbA9G3 (5), IaA27R3 (1), IaA30R3 (1) and Ia (1). Subtypes IbA9G3 and Ia were identified in children from a rural area. Cryptosporidium parvum subtypes were IIcA5G3R2 (1) and IIcA5G3a (1). All isolates successfully genotyped were C. hominis or anthroponotic C. parvum, suggesting that anthroponotic transmission dominates in Lusaka and the surrounding countryside.

Sparse Evidence for Giardia intestinalis, Cryptosporidium spp. and Microsporidia Infections in Humans, Domesticated Animals and Wild Nonhuman Primates Sharing a Farm-Forest Mosaic Landscape in Western Uganda.

Zoonotic pathogen transmission is considered a leading threat to the survival of non-human primates and public health in shared landscapes. Giardia spp., Cryptosporidium spp. and Microsporidia are unicellular parasites spread by the fecal-oral route by environmentally resistant stages and can infect humans, livestock, and wildlife including non-human primates. Using immunoassay diagnostic kits and amplification/sequencing of the region of the triosephosphate isomerase, small ribosomal subunit rRNA and the internal transcribed spacer genes, we investigated Giardia, Cryptosporidium, and microsporidia infections, respectively, among humans, domesticated animals (livestock, poultry, and dogs), and wild nonhuman primates (eastern chimpanzees and black and white colobus monkeys) in Bulindi, Uganda, an area of remarkably high human–animal contact and spatial overlap. We analyzed 137 fecal samples and revealed the presence of G. intestinalis assemblage B in two human isolates, G. intestinalis assemblage E in one cow isolate, and Encephalitozoon cuniculi genotype II in two humans and one goat isolate. None of the chimpanzee and colobus monkey samples were positive for any of the screened parasites. Regular distribution of antiparasitic treatment in both humans and domestic animals in Bulindi could have reduced the occurrence of the screened parasites and decreased potential circulation of these pathogens among host species.

The global prevalence and risk factors of Cryptosporidium infection among cats during 1988–2021: A systematic review and meta-analysis

Cryptosporidiosis is an important zoonosis caused by Cryptosporidium. This disease causes a global public health problem. The cat is considered to be one of the potential hosts for transmitting Cryptosporidium to humans. In this study, a global meta-analysis for Cryptosporidium infection in cats was performed. The articles related to Cryptosporidium infection in cats were systematically searched in databases China National Knowledge Infrastructure (CNKI), Wanfang data, VIP Chinese Journal Database, PubMed, and ScienceDirect. Finally, 92 articles published from 1988 to 2021, which met the criteria of systematic review and meta-analysis, were collected. During the selected period, the overall prevalence of Cryptosporidium among cats was identified to be 6.0%. The prevalence of Cryptosporidium detected by microscopy, coproantigens, and molecular biology methods were 4.2%, 8.2%, and 5.0%, respectively. Among 9 species/genotypes (C. felis, C. parvum, C. muris, Cryptosporidium rat genotype IV, C. baileyi, C. ryanae, C. hominis, Cryptosporidium sp. rat genotype III and most closely related to Cryptosporidium sp. rat genotype III), the prevalence of C. parvum (4.2%) was significantly higher than that of other species/genotypes. Among five continents, the prevalence of Cryptosporidium in Africa (30.5%) was significantly higher than in other continents. We also analyzed the effects of different geographical factors (longitude, latitude, altitude, mean temperature, precipitation, and humidity) on Cryptosporidium infection among cats. The results showed that cryptosporidiosis was common in cats all over the world. This systematic review and meta-analysis has systematically introduced the global epidemiology of Cryptosporidium in cats and correlated risk factors. Health authorities, doctors, veterinarians and cat owners’ awareness of the prevalence, risk factors and complications of Cryptosporidium are important for the development of effective prevention strategies for cryptosporidiosis.

Cryptosporidium infection in cattle and humans in Ethiopia: A systematic review and meta-analysis

Cryptosporidium is an intracellular coccidian parasite causing gastrointestinal disturbances resulting in diarrhoea in humans and animals. It is more frequently detected in calves and early childhood, and one of the major causes of mortality in low-income countries. National estimates of Cryptosporidium infection rate in cattle and humans are lacking in Ethiopia. Therefore, this systematic review and meta-analysis estimated the prevalence and assess the risk factors of Cryptosporidium infection in cattle and humans over 20 years. Article searches were made using PubMed, HINARI, Research Gates, AJOLs and Google Scholar databases. Studies that met the inclusion criteria under the preferred reporting items for systematic reviews and meta-analyses (PRISMA) checklist were used. Random effects models and Inverse Variance Index were used to calculate the pooled prevalence of cryptosporidiosis and heterogeneity among studies, respectively. A total of 23 eligible studies published between 2000 and 2020 were selected for this study. The estimated pooled prevalence of cryptosporidiosis was found to be 16.2% and 11% in cattle and humans, respectively. Ten Cryptosporidium species were documented with cattle and human-based studies. C. andersoni, C. parvum, C. bovis and C. ryanae were the reported species in cattle. Similarly, in humans, seven types of Cryptosporidium species (such as C. parvum, C. hominis, C. viatorum, C. felis, C. meleagridis, C. canis and C. xiaoi) were recorded. C. parvum and C. hominis were the dominant and responsible species for human illness. Using gp60 gene locus analysis, various zoonotic C. parvum subgenotypes were determined in humans; but it was limited in anthroponotic C. hominis. In conclusion, the overall prevalence of Cryptosporidium infection in cattle and humans was high and linked with several risk factors. Thus, there is a need for further epidemiological and genetic diversity studies, and awareness of creations on the disease to provide strategies that mitigate the disease in cattle and humans.

M6A mRNA Methylation Regulates Epithelial Innate Antimicrobial Defense Against Cryptosporidial Infection.

Increasing evidence supports that N6-methyladenosine (m6A) mRNA modification may play an important role in regulating immune responses. Intestinal epithelial cells orchestrate gastrointestinal mucosal innate defense to microbial infection, but underlying mechanisms are still not fully understood. In this study, we present data demonstrating significant alterations in the topology of host m6A mRNA methylome in intestinal epithelial cells following infection by Cryptosporidium parvum, a coccidian parasite that infects the gastrointestinal epithelium and causes a self-limited disease in immunocompetent individuals but a life-threatening diarrheal disease in AIDS patients. Altered m6A methylation in mRNAs in intestinal epithelial cells following C. parvum infection is associated with downregulation of alpha-ketoglutarate-dependent dioxygenase alkB homolog 5 and the fat mass and obesity-associated protein with the involvement of NF-кB signaling. Functionally, m6A methylation statuses influence intestinal epithelial innate defense against C. parvum infection. Specifically, expression levels of immune-related genes, such as the immunity-related GTPase family M member 2 and interferon gamma induced GTPase, are increased in infected cells with a decreased m6A mRNA methylation. Our data support that intestinal epithelial cells display significant alterations in the topology of their m6A mRNA methylome in response to C. parvum infection with the involvement of activation of the NF-кB signaling pathway, a process that modulates expression of specific immune-related genes and contributes to fine regulation of epithelial antimicrobial defense.

Clinical and Laboratory Diagnosis of Cryptosporidiosis among Children with Acute Gastroenteritis at a Tertiary Hospital, Cairo, Egypt

Most studies on gastroenteritis have focused on viral and bacterial infections, while gastroenteritis where intestinal protozoan parasites may have played a role has not been well studied. This study was therefore, designed to assess the frequency and several potential risk factors for Cryptosporidium infection among children suffering from acute gastroenteritis and presented to a tertiary hospital in Cairo, Egypt. Effectiveness of modified Ziehl-Neelsen (MZN) and nested polymerase chain reaction (nPCR) for Cryptosporidium detection were evaluated as well. A cross-sectional study was performed during the period from July 2018 to December 2018, where 100 human diarrheic stool samples were collected from children aged 3 months up to 12 years old presented to Ain Shams University Pediatrics Hospital, Cairo, Egypt with acute gastroenteritis. Demographic and clinical data were obtained from the participants. Initial parasite screening was done using the MZN staining method, and microscopically examined for Cryptosporidium infection, while genotyping was based on molecular diagnostic assays using nPCR and sequencing for selected samples. The overall frequency of Cryptosporidium infection was 5% using light microscopy, while 19% of samples were positive by nPCR. Cryptosporidium hominis was the only detected genotype. Clinical picture among cases were not significant in comparison to patients with other causes of gastroenteritis. Cryptosporidium infection is more common below 5 years of age; however, clinical data are not enough for suspicion of infection. Nucleic acid-based methods are more sensitive and specific despite the high cost in developing countries. However, real estimation of Cryptosporidium disease burden is of an outmost importance to achieve prevention and detection of the Cryptosporidium species genetic diversity. Lay summaryCryptosporidium is a protozoan, which causes gastroenteritis in humans. It is most common below 5 years of age; however, diarrhea and vomiting characteristics are not different from other causes of gastroenteritis. General diagnostic methods are inadequate for detection of these infections. Nested polymerase chain reaction (nPCR) and sequencing are accurate methods for pathogen detection and species verification. Our study included 100 Egyptian children with acute gastroenteritis. The overall frequency of Cryptosporidium infection was 5% using light microscopy, while 19% of samples were positive by nPCR. The clinical picture of the children presenting with this disease was not significantly different from those presenting with gastroenteritis due to other causes. This emphasizes the importance of proper diagnosis to know the true burden of the disease.

Outbreaks associated with treated recreational water — United States, 2015–2019

This article describes 208 outbreaks associated with recreational water exposures in the U.S., the majority of which were due to either Cryptosporidium or Legionella infections and were primarily reported after exposure to public (i.e., nonbackyard) recreational water. These outbreaks resulted in 3646 cases of illness, 286 hospitalizations, and 13 deaths; all deaths were due to Legionella infection. Most outbreaks began between June and August each year, suggesting that solid organ transplant candidates and recipients should be mindful of the risks associated with public recreational water, particularly during the summer months.

A COMPARISON OF RAPID DIAGNOSTIC TEST AND MODIFIED ZIEHL-NEELSEN METHOD IN THE DIAGNOSIS OF CRYPTOSPORIDIOSIS.

Background: Cryptosporidium parvum as a leading cause of persistent diarrhoea in developing countries causes a more severe illness in patients infected with human immunodeficiency virus (HIV). The intermittent shedding of Cryptosporidium parvum oocysts in stool, even in patients with massive diarrhoea, makes diagnosis difficult. This study evaluated the validity of Crypto-Strip test in comparison to the modified Ziehl-Neelsen for the diagnosis of Cryptosporidium infection using polymerase chain reaction (PCR) as gold standard. Methods: This was a hospital based cross-sectional study of 100 HIV positive patients with diarrhoea at a tertiary health facility in Jos, Nigeria. We collected 15mls of stool sample and relevant information from patients who gave informed consent. The oocytes of Cryptosporidium parvum were identified in the stool samples using modified Ziehl-Neelsen stain and Rapid diagnostic test (Crypto-Strip). We also ran all samples using polymerase chain reaction (PCR). Statistical analysis was with statistical package for Social Sciences (SPSS) version 21. Result: Out of the 100 stool samples analysed, 13 (13%) were positive for cryptosporidiosis by PCR. Crypto- Strips recorded 12 (12%) positive with one (1) being false negative as compared to PCR. Conversely, eight (8%) of the 100 samples collected were positive for Cryptosporidium oocysts using modified Ziehl Neelsen (mZN) stain. Out of the eight positives by mZN stain, two were false positive as both tested negative by the PCR. The Crypto-Strip test kit had a sensitivity of 92.3% and a specificity of 100.0% and also positive and negative predictive values of 100.0% and 98.9%, respectively. Whereas, the modified Ziehl Neelsen stain had a sensitivity of 46.2% and a specificity of 97.7% with a positive and negative predictive value of 75.0% and 92.4%, respectively. Conclusion: In this study, we have shown that Crypto-Strip test was a better diagnostic method for the diagnosis of crypto

Absence of Cryptosporidium hominis and dominance of zoonotic Cryptosporidium species in patients after Covid-19 restrictions in Auckland, New Zealand.

Coronavirus disease-2019 (Covid-19) nonpharmaceutical interventions have proven effective control measures for a range of respiratory illnesses throughout the world. These measures, which include isolation, stringent border controls, physical distancing and improved hygiene also have effects on other human pathogens, including parasitic enteric diseases such as cryptosporidiosis. Cryptosporidium infections in humans are almost entirely caused by two species: C. hominis, which is primarily transmitted from human to human, and Cryptosporidium parvum, which is mainly zoonotic. By monitoring Cryptosporidium species and subtype families in human cases of cryptosporidiosis before and after the introduction of Covid-19 control measures in New Zealand, we found C. hominis was completely absent after the first months of 2020 and has remained so until the beginning of 2021. Nevertheless, C. parvum has followed its typical transmission pattern and continues to be widely reported. We conclude that ~7 weeks of isolation during level 3 and 4 lockdown period interrupted the human to human transmission of C. hominis leaving only the primarily zoonotic transmission pathway used by C. parvum. Secondary anthroponotic transmission of C. parvum remains possible among close contacts of zoonotic cases. Ongoing 14-day quarantine measures for new arrivals to New Zealand have likely suppressed new incursions of C. hominis from overseas. Our findings suggest that C. hominis may be controlled or even eradicated through nonpharmaceutical interventions.