Correlation between markers of strain variation in Cryptosporidium parvum: Evidence of clonality

Multi-locus analysis of human infective Cryptosporidium species and subtypes using ten novel genetic loci

Background

Cryptosporidium is a protozoan parasite that causes diarrheal illness in a wide range of hosts including humans. Two species, C. parvum and C. hominis are of primary public health relevance. Genome sequences of these two species are available and show only 3-5% sequence divergence. We investigated this sequence variability, which could correspond either to sequence gaps in the published genome sequences or to the presence of species-specific genes. Comparative genomic tools were used to identify putative species-specific genes and a subset of these genes was tested by PCR in a collection of Cryptosporidium clinical isolates and reference strains.

Results

The majority of the putative species-specific genes examined were in fact common to C. parvum and C. hominis. PCR product sequence analysis revealed interesting SNPs, the majority of which were species-specific. These genetic loci allowed us to construct a robust and multi-locus analysis. The Neighbour-Joining phylogenetic tree constructed clearly discriminated the previously described lineages of Cryptosporidium species and subtypes.

Conclusions

Most of the genes identified as being species specific during bioinformatics in Cryptosporidium sp. are in fact present in multiple species and only appear species specific because of gaps in published genome sequences. Nevertheless SNPs may offer a promising approach to studying the taxonomy of closely related species of Cryptosporidia.

Molecular analysis of Cryptosporidium parvum HNJ-1 isolated in Japan

Cryptosporidium parvum HNJ-1 is widely used as a reference strain in Japan. In the present study, the parasite was subjected for further molecular analysis including transcribed ribosomal region (ITS rRNA), dihydrofolate reductase (DHFR) and surface glycoprotein (GP60) genes. Partial sequence analysis of these genes indicated extensive polymorphism in ITS region compared with relevant sequences of other Cryptosporidium parvum isolates. In addition, this strain was identified as C. parvum IIaA15G2R1 subtype, based on the sequence results of GP60 gene locus.

Multilocus genetic analysis of Cryptosporidium parvum from Egypt

Cryptosporidium parvum is a ubiquitous zonootic parasite causing enteritis in man and animals. Cryptosporidium infection was confirmed microscopically in neonatal calves (less than 6 weeks of age) at Kafr El Sheikh Province, Egypt. Multilocus analysis using a wide array of genetic markers was carried out to assess genetic diversity of C. parvum isolates. PCR amplification and partial sequence analysis of 70 kDa heat shock protein, dihydrofolate reductase, alpha-tubulin, elongation factor 1 alpha as well as thrombospondin-related anonymous protein of Cryptosporidium-1, and thrombospondin-related anonymous protein of Cryptosporidium-2 gene markers were achieved. Data indicated that the analyzed isolates belong to C. parvum genotype II with obvious sequence heterogeneity compared with counterparts deposited in Genebank.

Mixed Cryptosporidium infections and HIV

Mixed Cryptosporidium infections were detected in 7 of 21 patients with a diagnosis of rare Cryptosporidium canis or C. felis infections; 6 patients were infected with 2 Cryptosporidium spp. and 1 patient with 3 species. Mixed infections may occur more frequently than previously believed and should be considered when assessing cryptosporidiosis.

Cryptosporidium taxonomy: recent advances and implications for public health

There has been an explosion of descriptions of new species of Cryptosporidium during the last two decades. This has been accompanied by confusion regarding the criteria for species designation, largely because of the lack of distinct morphologic differences and strict host specificity among Cryptosporidium spp. A review of the biologic species concept, the International Code of Zoological Nomenclature (ICZN), and current practices for Cryptosporidium species designation calls for the establishment of guidelines for naming Cryptosporidium species. All reports of new Cryptosporidium species should include at least four basic components: oocyst morphology, natural host specificity, genetic characterizations, and compliance with the ICZN. Altogether, 13 Cryptosporidium spp. are currently recognized: C. muris, C. andersoni, C. parvum, C. hominis, C. wrairi, C. felis, and C. cannis in mammals; C. baïleyi, C. meleagridis, and C. galli in birds; C. serpentis and C. saurophilum in reptiles; and C. molnari in fish. With the establishment of a framework for naming Cryptosporidium species and the availability of new taxonomic tools, there should be less confusion associated with the taxonomy of the genus Cryptosporidium. The clarification of Cryptosporidium taxonomy is also useful for understanding the biology of Cryptosporidium spp., assessing the public health significance of Cryptosporidium spp. in animals and the environment, characterizing transmission dynamics, and tracking infection and contamination sources.

An evaluation of molecular diagnostic tools for the detection and differentiation of human-pathogenic Cryptosporidium spp

The performance of 10 commonly used genotyping tools in the detection and differentiation of 7 human-pathogenic Cryptosporidium spp. (C. hominis, C. parvum, C. meleagridis, C. felis, C. canis, C. muris and Cryptosporidium pig genotype 1) was evaluated. All 3 SU rRNA gene-based tools could amplify the DNA of 7 Cryptosporidium spp. efficiently. However, the tools based on the antigens TRAP-C1, TRAP-C2 and COWP genes, the housekeeping genes HSP70 and DHFR, or a genomic sequence, failed to detect the DNA of C. felis, C. canis, Cryptosporidium pig genotype I, and C. muris. With the exception of 1 tool based on the TRAP-C2 gene, the PCR-RFLP or the PCR sequencing tools evaluated in this study could differentiate C. hominis, C. parvum and C. meleagridis from each other, and 2 SSU rRNA gene-based tools could differentiate all 7 Cryptosporidium spp. Thus, a thorough understanding of the strength and weakness of each technique is needed when using molecular diagnostic tool in epidemiological investigations of human cryptosporidiosis.

Cryptosporidium spp. no ambiente aquático: aspectos relevantes da disseminação e diagnóstico

A criptosporidiose é uma doença de importância para a saúde pública. A via de transmissão do Cryptosporidium parvum é associada freqüentemente à contaminação de água. Porém, estudos epidemiológicos revelam que sua incidência no ambiente aquático é subestimada. A falta de método apropriado de detecção para a pesquisa dos oocistos em amostras de água contribui para isso. O artigo discute vários aspectos do tema, dentre eles, a ocorrência desse patógeno no ambiente aquático e os avanços nos métodos de detecção. Apesar da existência de técnicas de biologia molecular para a identificação do agente, métodos parasitológicos ainda apresentam resultados satisfatórios. A reação em cadeia de polimerase (PCR) é um método de detecção promissor. A identificação dos oocistos de Cryptosporidium spp. na amostra de água é influenciada pelo número de oocistos presentes, pela sensibilidade do método e pelo método de concentração dos oocistos na amostra, cujo aperfeiçoamento é fundamental para a precisão da análise e pesquisa do parasito.

Cryptosporidium hominis n. sp. (Apicomplexa: Cryptosporidiidae) from Homo sapiens

The structure and infectivity of the oocysts of a new species of Cryptosporidium from the feces of humans are described. Oocysts are structurally indistinguishable from those of Cryptosporidium parvum. Oocysts of the new species are passed fully sporulated, lack sporocysts. and measure 4.4-5.4 microm (mean = 4.86) x 4.4-5.9 microm (mean = 5.2 microm) with a length to width ratio 1.0-1.09 (mean 1.07) (n = 100). Oocysts were not infectious for ARC Swiss mice, nude mice. Wistar rat pups, puppies, kittens or calves, but were infectious to neonatal gnotobiotic pigs. Pathogenicity studies in the gnotobiotic pig model revealed significant differences in parasite-associated lesion distribution (P = 0.005 to P = 0.02) and intensity of infection (P = 0.04) between C. parvum and this newly described species from humans. In vitro cultivation studies have also revealed growth differences between the two species. Multi-locus analysis of numerous unlinked loci, including a preliminary sequence scan of the entire genome demonstrated this species to be distinct from C. parvum and also demonstrated a lack of recombination, providing further support for its species status. Based on biological and molecular data, this Cryptosporidium infecting the intestine of humans is proposed to be a new species Cryptosporidium hominis n. sp.

Detection and differentiation of Cryptosporidium parasites that are pathogenic for humans by real-time PCR

Cryptosporidiosis is a significant cause of food-borne and waterborne outbreaks of diarrheal diseases. To better understand the route of transmission of Cryptosporidium parasites, a number of genotyping techniques have been developed, based on PCR-restriction fragment length polymorphism or sequencing analysis of antigen, structural, and housekeeping genes. In this study, a real-time assay for the detection of Cryptosporidium oocysts is described. This technique had a detection limit of five oocysts. By melting curve analysis of PCR products with fluorescence-labeled hybridization probes, this technique was able to differentiate five common Cryptosporidium parasites that are pathogenic for humans in a single PCR. We evaluated and validated the test using samples from presently known Cryptosporidium parasites that are pathogenic for humans. This technique provides an alternative molecular tool in epidemiologic studies of human cryptosporidiosis.

Modification of a rapid method for the identification of gene-specific polymorphisms in Cryptosporidium parvum and its application to clinical and epidemiological investigations

The application of genotyping to clinical isolates of Cryptosporidium has increased significantly our knowledge and understanding of the distribution and epidemiology of this parasite. However, some methods can be laborious and demand specialist technical expertise. PCR-restriction fragment length polymorphism (RFLP) techniques represent a more rapid and simple method of genotyping to support epidemiological and clinical investigations than conventional DNA analytical techniques. We describe a nested PCR-RFLP technique that identifies polymorphisms in the C. parvum thrombospondin-related adhesive protein gene locus; this method offers a sensitive and specific tool for the confirmation and investigation of disease associated with C. parvum. The potential of this enhanced method is demonstrated by its application to the confirmation and epidemiological investigation of an outbreak of cryptosporidiosis associated with a school visit to an open farm.

Eradication of cryptosporidia and microsporidia following successful antiretroviral therapy

OBJECTIVES

Incidence of opportunistic protozoal infections causing diarrheal illnesses in patients with HIV has decreased since the introduction of highly active antiretroviral therapy (HAART). The objective of this study was to determine whether the parasites, cryptosporidia, and microsporidia were effectively eradicated or only suppressed following treatment.

DESIGN

Six HIV-positive patients with diarrheal symptoms caused by cryptosporidia or microsporidia were prospectively followed up with stool samples and duodenal biopsies. Samples were taken before HAART, between 1 to 3 months, and 6 months post-HAART.

METHODS

Duodenal samples were analyzed using routine histology and transmission electron microscopy. Stool samples were analyzed by both light microscopy and polymerase chain reaction (PCR) techniques.

RESULTS

Patients who responded successfully to HAART eradicated both cryptosporidial and microsporidial organisms. Symptoms improved within 1 month of therapy but complete eradication of the organisms was only observed after 6 months of treatment.

CONCLUSIONS

AIDs-related cryptosporidiosis and microsporidiosis can be cured following successful antiretroviral therapy.

Identification of species and sources of Cryptosporidium oocysts in storm waters with a small-subunit rRNA-based diagnostic and genotyping tool

The identification of Cryptosporidium oocysts in environmental samples is largely made by the use of an immunofluorescent assay. In this study, we have used a small-subunit rRNA-based PCR-restriction fragment length polymorphism technique to identify species and sources of Cryptosporidium oocysts present in 29 storm water samples collected from a stream in New York. A total of 12 genotypes were found in 27 positive samples; for 4 the species and probable origins were identified by sequence analysis, whereas the rest represent new genotypes from wildlife. Thus, this technique provides an alternative method for the detection and differentiation of Cryptosporidium parasites in environmental samples.

Eradication of cryptosporidia and microsporidia following successful antiretroviral therapy

OBJECTIVES

Incidence of opportunistic protozoal infections causing diarrheal illnesses in patients with HIV has decreased since the introduction of highly active antiretroviral therapy (HAART). The objective of this study was to determine whether the parasites, cryptosporidia, and microsporidia were effectively eradicated or only suppressed following treatment.

DESIGN

Six HIV-positive patients with diarrheal symptoms caused by cryptosporidia or microsporidia were prospectively followed up with stool samples and duodenal biopsies. Samples were taken before HAART, between 1 to 3 months, and 6 months post-HAART.

METHODS

Duodenal samples were analyzed using routine histology and transmission electron microscopy. Stool samples were analyzed by both light microscopy and polymerase chain reaction (PCR) techniques.

RESULTS

Patients who responded successfully to HAART eradicated both cryptosporidial and microsporidial organisms. Symptoms improved within 1 month of therapy but complete eradication of the organisms was only observed after 6 months of treatment.

CONCLUSIONS

AIDs-related cryptosporidiosis and microsporidiosis can be cured following successful antiretroviral therapy.

Does Cryptosporidium parvum have a clonal population structure?

Cryptosporidiosis, the disease caused in humans by the opportunistic parasite Cryptosporidium parvum, is the result of zoonotic or anthroponotic transmission. Molecular characterization of different isolates from humans and other mammalian species has recently shown this species to be heterogeneous; this heterogeneity has been linked to the host of isolation, suggesting that the parasites causing zoonotic cryptosporidiosis and those propagated by anthroponotic transmission are genetically distinct. Here, Fatih Awad-El-Kariem provides an update on the taxonomic and epidemiological significance of these observations, and discusses evidence for and against the clonality hypothesis as a model to explain strain variation in this species.

Variation in Cryptosporidium: towards a taxonomic revision of the genus

Cryptosporidium is an important cause of enteric disease in humans and other animals. Limitations associated with conventional diagnostic methods for cryptosporidiosis based on morphological features, coupled with the difficulty of characterising parasites isolated in the laboratory, have restricted our ability to clearly identify species. The application of sensitive molecular approaches has obviated the necessity for laboratory amplification. Such studies have found considerable evidence of genetic heterogeneity among isolates of Cryptosporidium from different species of vertebrate, and there is now mounting evidence suggesting that a series of host-adapted genotypes/strains/species of the parasite exist. In this article, studies on the molecular characterisation of Cryptosporidium during the last 5 years are reviewed and put into perspective with the past and present taxonomy of the genus. The predictive value of achieving a sound taxonomy for the genus Cryptosporidium with respect to understanding its epidemiology and transmission and controlling outbreaks of the disease is also discussed.

Evaluation of Cryptosporidium parvum genotyping techniques

We evaluated the specificity and sensitivity of 11 previously described species differentiation and genotyping PCR protocols for detection of Cryptosporidium parasites. Genomic DNA from three species of Cryptosporidium parasites (genotype 1 and genotype 2 of C. parvum, C. muris, and C. serpentis), two Eimeria species (E. neischulzi and E. papillata), and Giardia duodenalis were used to evaluate the specificity of primers. Furthermore, the sensitivity of the genotyping primers was tested by using genomic DNA isolated from known numbers of oocysts obtained from a genotype 2 C. parvum isolate. PCR amplification was repeated at least three times with all of the primer pairs. Of the 11 protocols studied, 10 amplified C. parvum genotypes 1 and 2, and the expected fragment sizes were obtained. Our results indicate that two species-differentiating protocols are not Cryptosporidium specific, as the primers used in these protocols also amplified the DNA of Eimeria species. The sensitivity studies revealed that two nested PCR-restriction fragment length polymorphism (RFLP) protocols based on the small-subunit rRNA and dihydrofolate reductase genes are more sensitive than single-round PCR or PCR-RFLP protocols.

Isolation, propagation and characterisation of Cryptosporidium

This review consists of 11 papers presented at the Consensus Conference on Cryptosporidium in Water (Parasitology Stream), held in Melbourne, Australia, from 5 to 6th October 1998. The conference was sponsored by the Water Services Association of Australia, the Australian Water and Wastewater Association, and the Collaborative Research Centre for Water Quality and Treatment. The papers summarise the advantages and disadvantages of various contemporary technologies applicable to parasite propagation and biochemical/molecular characterisation. Studies have detected distinct genetic differences between clinical isolates from humans and animals, and it is hoped that comprehensive documentation studies will facilitate the identification of environmental isolates in the not too distant future.