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Nipa NJ, Aktar N, Hira HM, Akter F, Jahan D, Islam S, Etando A, Abdullah A, Chowdhury K, Ahmad R, Haq A, Haque M. Intestinal Parasitic Infections Among Pediatric Patients in a Metropolitan City of Bangladesh With Emphasis on Cryptosporidiosis. Cureus 2022; 14:e26927. [PMID: 35865179 PMCID: PMC9293268 DOI: 10.7759/cureus.26927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Gastrointestinal parasitic infections are one of the global health concerns in developing countries like Bangladesh. Among them, Cryptosporidium spp. plays an essential role in causing diarrhea, malnutrition, and poor cognitive function, especially in children. This study was conducted to identify the frequency of Cryptosporidium cases and other parasitic agents. Methods A cross-sectional observational study was conducted among 219 hospitalized children with diarrhea. The conventional microscopic technique was applied for parasitic detection. Particular staining (modified Ziehl-Neelsen) procedure was performed to identify oocysts of Cryptosporidium spp. A polymerase chain reaction (PCR) was performed to determine the SSU rRNA and gp60 gene of Cryptosporidium. Results Cysts of Giardia duodenalis (2.3%), ova of Ascaris lumbricoides (1.4%,), Trichuris trichiura (0.5%), and both A. lumbricoides and T. trichiura (0.9%) were identified in samples through wet mount preparation. The distribution of Cryptosporidium spp. as detected by the staining method and nested PCR was 1.4% and 4.1%, respectively. Conclusion Factors independently associated with Cryptosporidium infection are unsafe water, lack of regular hand washing, and insufficiency of exclusive breastfeeding. This study reports, presumably for the first time, the detection of Cryptosporidium oocysts in Chattogram metropolitan city of Bangladesh.
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Saray MB, Eric LG, Alba BB, Albert BS, Jesús AA, de Tudela Ivet JP, Iván PS, Mercè GG. Detection and pathological role of intestinal protozoa in children. Parasitol Int 2022; 88:102558. [PMID: 35149177 DOI: 10.1016/j.parint.2022.102558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 02/03/2022] [Accepted: 02/04/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Intestinal parasites are considered a growing public health problem, being protozoa the main cause of intestinal disease. The objective of our study is to compare the detection of intestinal protozoa by microscopy versus real-time PCR, as well as to determine the most prevalent protozoa in our environment in the paediatric population. METHOD An observational longitudinal study was carried out, both by microscopy and real time-PCR in stool samples from children (0-15 years) received from April 2019 to March 2021.Children were classified in two groups according if they had or not had clinical parasitosis. Microscopic examination was performed in all samples using the Ritchie concentration technique with the commercial Mini PARASEP system (Movaco-Grifols®). The presence of Cryptosporidium sp. was evaluated with the modified Ziehl-Neelsen acid-fast stain. The real-time PCR was performed to all samples using the Allplex ™ gastrointestinal parasite panel 4 (Seegene®). RESULTS During the study period, 500 samples were received, being positive 31 (6.2%) by microscopy and 256 (51.2%) by PCR. By microscopy, Blastocystis hominis was the most frequently observed (4.8%), followed by Giardia lamblia (1.6%), Dientamoeba fragilis (0.2%) and Cryptosporidium species (0.2%). Regarding the identification by PCR, D. fragilis (35.2%) was mainly identified, followed by B. hominis (28.1%), G. lamblia (7%) and Cryptosporidium sp. (0.8%) without finding clear differences in aetiology according to age. In the case of B. hominis and D. fragilis, there were not differences in the detection of these protozoa between the control group and children with clinical parasitosis (p = 0.11). CONCLUSIONS Real-time PCR increases the detection of intestinal protozoa, being underdiagnosed by microscopy, especially D. fragilis, in which PCR is considered the most appropriate method for its detection.
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Affiliation(s)
| | | | - Bellés Bellés Alba
- Unidad de Microbiología, Hospital Universitari Arnau de Vilanova, Spain; Universitat de Lleida, Lleida, Catalunya, Spain
| | - Bernet Sánchez Albert
- Unidad de Microbiología, Hospital Universitari Arnau de Vilanova, Spain; Universitat de Lleida, Lleida, Catalunya, Spain.
| | | | | | - Prats Sánchez Iván
- Unidad de Microbiología, Hospital Universitari Arnau de Vilanova, Spain.
| | - García González Mercè
- Unidad de Microbiología, Hospital Universitari Arnau de Vilanova, Spain; Universitat de Lleida, Lleida, Catalunya, Spain.
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Aetiology and outcome of acute diarrhoea in children with severe acute malnutrition: a comparative study. Public Health Nutr 2020; 23:1563-1568. [PMID: 31699164 DOI: 10.1017/s1368980019003069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To compare the microbiological profile, clinical course and outcome of acute diarrhoea in children aged <5 years having severe acute malnutrition (SAM) with those of children having normal nutritional status. DESIGN Cross-sectional comparative study. SETTING Tertiary-care hospital catering mainly to the urban poor of East Delhi, India. PARTICIPANTS Children aged <5 years (n 140; seventy with SAM (cases) and seventy with normal anthropometry (controls)) with acute diarrhoea (duration < 14 d). Stool samples were collected for conventional culture, microscopy, acid-fast staining, rotavirus and Cryptosporidium antigen detection, and subtyping of diarrhoeagenic Escherichia coli (DEC). We followed-up these children for persistent diarrhoea and subsequent diarrhoeal episode in the next 3 months. RESULTS Rotavirus was detected in six (9 %) cases and in fifteen (21 %) controls (P = 0·03; OR = 0·34; 95 % CI 0·12, 0·94). DEC was isolated significantly more in cases compared with controls (93 v. 64 %; P < 0·001; OR = 7·25; 95 % CI 2·57, 20·4). Cryptosporidium was detected in seven (10 %) cases and five (7 %) controls. Total duration of diarrhoea and percentage change in weight after resolution of diarrhoea were comparable between cases and controls. At 3-month follow-up, number of subsequent episodes of diarrhoea and persistent diarrhoea were comparable between the two groups. CONCLUSIONS Rotavirus was found significantly less frequently, whereas DEC was detected more frequently in children with SAM in comparison to non-malnourished children. To further reduce diarrhoea-related mortality, preventive and therapeutic interventions need to be designed against organisms causing diarrhoea in children with SAM.
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Verma S, Venkatesh V, Kumar R, Kashyap S, Kumar M, Maurya AK, Dhole TN, Singh M. Etiological agents of diarrhea in hospitalized pediatric patients with special emphasis on diarrheagenic Escherichia coli in North India. J Lab Physicians 2020; 11:68-74. [PMID: 30983806 PMCID: PMC6437815 DOI: 10.4103/jlp.jlp_123_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Infectious diarrhea is leading infectious cause of childhood morbidity, hospitalizations, and mortality particularly in children living in developing countries like India. The etiological agents differ depending on geographical area, and recent data suggest increase in drug resistance to various enteropathogens. AIMS AND OBJECTIVES The aim of the study was to investigate emerging diarrheal agents and antimicrobial resistance profile of bacterial pathogens from children (<12 years of age) hospitalized with acute diarrhea. MATERIALS AND METHODS A cross-sectional, hospital-based observational study was conducted over 1 year in which 100 children <12 years who were hospitalized due to diarrhea were recruited. Diarrhea was defined as the passage of three or more liquid stools in a 24-h period using the World Health Organization guidelines. Samples were processed for detection of various bacterial, viral, and parasitic agents by standard microbiological, serological, and molecular tests. Antimicrobial resistance testing was performed with the Kirby-Bauer disk diffusion method. ELISA was performed for Rotavirus and Escherichia coli O157. Multiplex polymerase chain reaction test was performed to detect diarrheagenic E. coli (DEC). RESULTS Pathogenic diarrheal agents were found in 63% patients. Rotavirus was identified in 52.5%, DEC in 29%, Vibrio cholerae in 4%, Shigella flexneri in 3%, Aeromonas sp. in 1%, Giardia lamblia in 4%, and Entamoeba histolytica in 1% cases. Enteropathogenic E. coli (EPEC) in 19 (65.5%) cases was the most common agent followed by Enteroaggregative E. coli (EAEC) in 5 (17.2%), Enterotoxigenic E. coli (ETEC) in 2 (6%), and Enteroinvasive E. coli (EIEC) in 3 (10.3%) cases. Resistance rates of DEC to first-line therapeutic drugs were high, 97.3% to ampicillin and 95.95% to co-trimoxazole. DEC was susceptible to chloramphenicol in 58.11%, gentamicin in 48.19%, and amikacin in 58.11% cases. Shigella sp. and V. cholerae isolates were 100% sensitive to gentamicin and ofloxacin. CONCLUSION EPEC is the most common DEC pathotype and EAEC, ETEC, and EIEC are also emerging as dominant diarrheal agents. Rotavirus was the most common causative agents of diarrhea especially in children <5 years. Most of the bacterial isolates showed high level of drug resistance to first-line empirical drugs and were multidrug resistant making them unsuitable for empiric treatment. Laboratory monitoring of drug susceptibility of stool isolates appears necessary to formulate antibiotic policy for treating diarrheal illness at the local level. There is an urgent need to strengthen diarrheal surveillance to monitor susceptibility to commonly prescribed antibiotics.
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Affiliation(s)
- Sheetal Verma
- Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Vimala Venkatesh
- Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Rashmi Kumar
- Department of Paediatrics, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Saurabh Kashyap
- Department of Community Medicine, Integral Institute of Medical Sciences and Research, Lucknow, Uttar Pradesh, India
| | - Manoj Kumar
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anand Kumar Maurya
- Department of Microbiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - T N Dhole
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Mastan Singh
- Department of Microbiology, Era's Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India
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Bauhofer AFL, Cossa-Moiane I, Marques S, Guimarães EL, Munlela B, Anapakala E, Chilaúle JJ, Cassocera M, Langa JS, Chissaque A, Sambo J, Manhique-Coutinho L, Bero DM, Kellogg TA, de Deus N. Intestinal protozoan infections among children 0-168 months with diarrhea in Mozambique: June 2014 - January 2018. PLoS Negl Trop Dis 2020; 14:e0008195. [PMID: 32320399 PMCID: PMC7176080 DOI: 10.1371/journal.pntd.0008195] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 03/03/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Intestinal parasites such as Cryptosporidium spp., Giardia lamblia and Entamoeba histolytica can cause severe diarrhea, especially among children in developing countries. This study aims to determine the frequency of Cryptosporidium spp., Giardia lamblia and Entamoeba histolytica in children with diarrhea and identify risk factors for infection. METHODOLOGY We conducted a cross-sectional study in children aged 0-168 months hospitalized with diarrhea in three regions of Mozambique, from June 2014 to January 2018. Following consent, caretakers were interviewed and a single stool specimen was collected from each child to diagnose Cryptosporidium spp., G. lamblia and E. histolytica using commercial immune-enzymatic assay (TechLab, Inc, Blacksburg, VA, USA). Anthropometric data were collected from the clinical reports. Multivariable logistic regression models were built to identify risk factors for Cryptosporidium spp. and G. lamblia infection. RESULTS Twenty-one percent of all specimens (212/1008) presented at least one parasitic infection. Cryptosporidium spp. infection was the most common 12.0% (118/985), followed by G. lamblia 9.7% (95/983) and E. histolytica 2.0% (20/1004). Risk factors for infection by Cryptosporidium spp. were: provenience (children from Nampula province showed the highest risk, OR: 8.176; CI: 1.916-34.894; p-value < 0.01); animal contact (children with animal contact had a protective effect OR: 0.627; CI: 0.398-0.986; p-value < 0.05); underweight (children severely underweight showed a risk of 2.309; CI: 1.310-4.069; p-value < 0.05). Risk factors for infection by G. lamblia were: age (group with highest risk, 60-168 months (OR: 2.322; CI: 1.000-5.393, p-value > 0.05)); and living in a household with five or more members (OR: 2.141; CI: 1.286-3.565, p-value < 0.01). CONCLUSIONS Parasitic infection is common among children with diarrhea. Routine testing, standard treatment, and assessment for risk exposure of children with diarrhea should be implemented at health facilities in Mozambique.
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Affiliation(s)
- Adilson Fernando Loforte Bauhofer
- Direcção de Formação e Comunicação em Saúde, Instituto Nacional de Saúde (INS), Marracuene, Moçambique
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Lisboa, Portugal
| | - Idalécia Cossa-Moiane
- Direcção de Laboratórios de Saúde Pública, Instituto Nacional de Saúde (INS), Marracuene, Moçambique
- Institute of Tropical Medicine (ITM), Antwerp, Belgium
| | - Selma Marques
- Direcção de Formação e Comunicação em Saúde, Instituto Nacional de Saúde (INS), Marracuene, Moçambique
- Centro de Biotecnologia, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Esperança L. Guimarães
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Lisboa, Portugal
- Direcção de Pesquisa em Saúde e Bem-Estar, Instituto Nacional de Saúde (INS), Marracuene, Moçambique
| | - Benilde Munlela
- Direcção de Formação e Comunicação em Saúde, Instituto Nacional de Saúde (INS), Marracuene, Moçambique
- Centro de Biotecnologia, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Elda Anapakala
- Direcção de Laboratórios de Saúde Pública, Instituto Nacional de Saúde (INS), Marracuene, Moçambique
| | - Jorfélia J. Chilaúle
- Direcção de Laboratórios de Saúde Pública, Instituto Nacional de Saúde (INS), Marracuene, Moçambique
| | - Marta Cassocera
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Lisboa, Portugal
- Direcção de Pesquisa em Saúde e Bem-Estar, Instituto Nacional de Saúde (INS), Marracuene, Moçambique
| | - Jerónimo S. Langa
- Direcção de Laboratórios de Saúde Pública, Instituto Nacional de Saúde (INS), Marracuene, Moçambique
| | - Assucênio Chissaque
- Direcção de Formação e Comunicação em Saúde, Instituto Nacional de Saúde (INS), Marracuene, Moçambique
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Lisboa, Portugal
| | - Júlia Sambo
- Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Lisboa, Portugal
- Direcção de Pesquisa em Saúde e Bem-Estar, Instituto Nacional de Saúde (INS), Marracuene, Moçambique
| | - Lena Manhique-Coutinho
- Direcção de Laboratórios de Saúde Pública, Instituto Nacional de Saúde (INS), Marracuene, Moçambique
| | - Diocreciano Matias Bero
- Direcção de Laboratórios de Saúde Pública, Instituto Nacional de Saúde (INS), Marracuene, Moçambique
| | - Timothy A. Kellogg
- Direcção de Inquéritos e Observação de Saúde, Instituto Nacional de Saúde (INS), Marracuene, Moçambique
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, United States of America
| | - Nilsa de Deus
- Direcção de Pesquisa em Saúde e Bem-Estar, Instituto Nacional de Saúde (INS), Marracuene, Moçambique
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Grossman T, Ken-Dror S, Pavlotzky E, Vainer J, Glazer Y, Sagi O, Peretz A, Agmon V, Marva E, Valinsky L. Molecular typing of Cryptosporidium in Israel. PLoS One 2019; 14:e0219977. [PMID: 31479457 PMCID: PMC6721021 DOI: 10.1371/journal.pone.0219977] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 07/05/2019] [Indexed: 12/28/2022] Open
Abstract
Cryptosporidium is a protozoan parasite associated with gastrointestinal illness. In immune-compromised individuals, the infection may become life-threatening. Cryptosporidiosis is a mandatory-reported disease but little was known about its prevalence and associated morbidity in Israel. Currently, laboratory diagnosis is based on microscopy or copro-antigen tests and the disease is underreported. Molecular assays, which are more sensitive and specific, are now increasingly used for identification and screening. Here, the molecular epidemiology of cryptosporidiosis is explored for the first time. Samples from 33 patients infected during an outbreak of 146 laboratory confirmed cases that occurred in Haifa and Western Galilee in 2015 were genotyped, as well as samples from 36 patients sporadically infected during 2014–2018 in different regions. The results suggest that Cryptosporidium subtypes found in Israel are more similar to those reported in the neighboring countries Jordan and Egypt than in European countries. C. hominis was the predominant species in the center and the north of Israel, implicating human-to-human transmission. C. hominis IeA11G3T3 was the most prevalent subtype contributing to morbidity.
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Affiliation(s)
- Tamar Grossman
- Public Health Central Laboratories, Jerusalem, Israel
- * E-mail:
| | - Shifra Ken-Dror
- Clalit Health Services, Haifa and Western Galilee district, Israel
| | - Elsa Pavlotzky
- Clalit Health Services, Haifa and Western Galilee district, Israel
| | - Julia Vainer
- Public Health Central Laboratories, Jerusalem, Israel
| | - Yael Glazer
- Division of Epidemiology, Ministry of Health, Jerusalem, Israel
| | - Orli Sagi
- Soroka University Medical Center, Beer-Sheva, Israel
| | - Avi Peretz
- Baruch Padeh Medical Center, Safed, Israel
- Bar-Ilan University, Ramat Gan, Israel
| | - Vered Agmon
- Public Health Central Laboratories, Jerusalem, Israel
| | - Esther Marva
- Public Health Central Laboratories, Jerusalem, Israel
| | - Lea Valinsky
- Public Health Central Laboratories, Jerusalem, Israel
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Delahoy MJ, Omore R, Ayers TL, Schilling KA, Blackstock AJ, Ochieng JB, Moke F, Jaron P, Awuor A, Okonji C, Juma J, Farag TH, Nasrin D, Panchalingam S, Nataro JP, Kotloff KL, Levine MM, Oundo J, Roellig DM, Xiao L, Parsons MB, Laserson K, Mintz ED, Breiman RF, O'Reilly CE. Clinical, environmental, and behavioral characteristics associated with Cryptosporidium infection among children with moderate-to-severe diarrhea in rural western Kenya, 2008-2012: The Global Enteric Multicenter Study (GEMS). PLoS Negl Trop Dis 2018; 12:e0006640. [PMID: 30001340 PMCID: PMC6057667 DOI: 10.1371/journal.pntd.0006640] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 07/24/2018] [Accepted: 06/27/2018] [Indexed: 01/20/2023] Open
Abstract
Background Cryptosporidium is a leading cause of moderate-to-severe diarrhea (MSD) in young children in Africa. We examined factors associated with Cryptosporidium infection in MSD cases enrolled at the rural western Kenya Global Enteric Multicenter Study (GEMS) site from 2008-2012. Methodology/Principal findings At health facility enrollment, stool samples were tested for enteric pathogens and data on clinical, environmental, and behavioral characteristics collected. Each child’s health status was recorded at 60-day follow-up. Data were analyzed using logistic regression. Of the 1,778 children with MSD enrolled as cases in the GEMS-Kenya case-control study, 11% had Cryptosporidium detected in stool by enzyme immunoassay; in a genotyped subset, 81% were C. hominis. Among MSD cases, being an infant, having mucus in stool, and having prolonged/persistent duration diarrhea were associated with being Cryptosporidium-positive. Both boiling drinking water and using rainwater as the main drinking water source were protective factors for being Cryptosporidium-positive. At follow-up, Cryptosporidium-positive cases had increased odds of being stunted (adjusted odds ratio [aOR] = 1.65, 95% CI: 1.06–2.57), underweight (aOR = 2.08, 95% CI: 1.34–3.22), or wasted (aOR = 2.04, 95% CI: 1.21–3.43), and had significantly larger negative changes in height- and weight-for-age z-scores from enrollment. Conclusions/Significance Cryptosporidium contributes significantly to diarrheal illness in young children in western Kenya. Advances in point of care detection, prevention/control approaches, effective water treatment technologies, and clinical management options for children with cryptosporidiosis are needed. Cryptosporidium is an important cause of childhood diarrhea. Research on cryptosporidiosis in countries where it is endemic remains limited; few studies have comprehensively examined risk factors for children in Kenya and similar settings. We examined characteristics associated with Cryptosporidium in children with moderate-to-severe diarrhea in rural western Kenya. We found there is little to clinically distinguish cryptosporidiosis from other childhood diarrhea in the absence of point of care diagnostics. Infants had the highest odds of Cryptosporidium infection; it has been previously established that Cryptosporidium infections in infancy can have severe consequences. Prolonged/persistent duration diarrhea and growth shortfalls were significantly more pronounced among cases with Cryptosporidium. Undernutrition and stunting in children in low- and middle-income countries have predicted decreased cognitive and school performance, thus long-term consequences could be appreciable. Using rainwater as the primary drinking water source and boiling drinking water were protective against Cryptosporidium infection, thus certain water sources may contribute to transmission. Like other studies in Kenya, we predominantly identified Cryptosporidium hominis, an anthropogenic species. Advances in point of care detection, prevention and control approaches, effective water treatment technologies, and clinical management options are needed to mitigate the potentially severe and long-term consequences of Cryptosporidium infection in children.
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Affiliation(s)
- Miranda J. Delahoy
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
- * E-mail:
| | - Richard Omore
- Kenya Medical Research Institute/CDC, Kisumu, Kenya
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Tracy L. Ayers
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Katharine A. Schilling
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Anna J. Blackstock
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - J. Benjamin Ochieng
- Kenya Medical Research Institute/CDC, Kisumu, Kenya
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Feny Moke
- Kenya Medical Research Institute/CDC, Kisumu, Kenya
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Peter Jaron
- Kenya Medical Research Institute/CDC, Kisumu, Kenya
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Alex Awuor
- Kenya Medical Research Institute/CDC, Kisumu, Kenya
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Caleb Okonji
- Kenya Medical Research Institute/CDC, Kisumu, Kenya
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Jane Juma
- Kenya Medical Research Institute/CDC, Kisumu, Kenya
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Tamer H. Farag
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America
| | - Dilruba Nasrin
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Sandra Panchalingam
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - James P. Nataro
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia, United States of America
| | - Karen L. Kotloff
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Myron M. Levine
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | | | - Dawn M. Roellig
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Lihua Xiao
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Michele B. Parsons
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kayla Laserson
- Kenya Medical Research Institute/CDC, Kisumu, Kenya
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- CDC-India, Delhi, India
| | - Eric D. Mintz
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Robert F. Breiman
- CDC-Kenya, Nairobi, Kenya
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Emory Global Health Institute, Emory University, Atlanta, Georgia, United States of America
| | - Ciara E. O'Reilly
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
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Echevarría MA, Eva ML. Cryptosporidium and Cyclospora Diarrheal Infection in Malnourished Children: a Nutritional Approach. CURRENT TROPICAL MEDICINE REPORTS 2017. [DOI: 10.1007/s40475-017-0122-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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