Comparison of in vitro growth characteristics of Cryptosporidium hominis (IdA15G1) and Cryptosporidium parvum (Iowa-IIaA17G2R1 and IIaA18G3R1)

Cryptosporidium is a major cause of diarrhoeal disease and mortality in young children in resource-poor countries, for which no vaccines or adequate therapeutic options are available. Infection in humans is primarily caused by two species: C. hominis and C. parvum. Despite C. hominis being the dominant species infecting humans in most countries, very little is known about its growth characteristics and life cycle in vitro, given that the majority of our knowledge of the in vitro development of Cryptosporidium has been based on C. parvum. In the present study, the growth and development of two C. parvum isolates (subtypes Iowa-IIaA17G2R1 and IIaA18G3R1) and one C. hominis isolate (subtype IdA15G1) in HCT-8 cells were examined and compared at 24 h and 48 h using morphological data acquired with scanning electron microscopy. Our data indicated no significant differences in the proportion of meronts or merozoites between species or subtypes at either time-point. Sexual development was observed at the 48-h time-point across both species through observations of both microgamonts and macrogamonts, with a higher frequency of macrogamont observations in C. hominis (IdA15G1) cultures at 48-h post-infection compared to both C. parvum subtypes. This corresponded to differences in the proportion of trophozoites observed at the same time point. No differences in proportion of microgamonts were observed between the three subtypes, which were rarely observed across all cultures. In summary, our data indicate that asexual development of C. hominis is similar to that of C. parvum, while sexual development is accelerated in C. hominis. This study provides new insights into differences in the in vitro growth characteristics of C. hominis when compared to C. parvum, which will facilitate our understanding of the sexual development of both species.

Association of Lung CT Findings in Coronavirus Disease 2019 (COVID-19) With Patients' Age, Body Weight, Vital Signs, and Medical Regimen

Objective

This study aimed to detect possible associations between lung computed tomography (CT) findings in COVID-19 and patients' age, body weight, vital signs, and medical regimen in Jordan.

Methods

The present cross-sectional study enrolled 230 patients who tested positive for COVID-19 in Prince Hamza Hospital in Jordan. Demographic data, as well as major lung CT scan findings, were obtained from the hospital records of the COVID-19 patients.

Results

The main observed major lung changes among the enrolled COVID-19 patients included ground-glass opacification in 47 (20.4%) patients and consolidation in 22 (9.6%) patients. A higher percentage of patients with major lung changes (24%) was observed among patients above 60 years old, while (50%) of patients with no changes in their lung findings were in the age group of 18–29 years old. Results obtained from the present study showed that only patients with major CT lung changes (9.7%) were prescribed more than three antibiotics. Additionally, 41.6 % of patients with major lung CT scan changes had either dry (31.0%) or productive (10.6%) cough at admission.

Conclusion

Several factors have been identified by this study for their ability to predict lung changes. Early assessment of these predictors could help provide a prompt intervention that may enhance health outcomes and reduce the risk for further lung changes.

Vitamin B12 binding to mutated human transcobalamin, in-silico study of TCN2 alanine scanning and ClinVar missense mutations/SNPs

Many missense mutations/SNPs of the TCN2 gene (which yield Transcobalamin (TC)) were reported in the literature but no study is available about their effect on binding to vitamin B12(B12) at the structural level experimentally nor computationally. Predict the effect of TC missense mutations/SNPs on binding affinity to B12 and characterize their contacts to B12 at the structural level. TC-B12 binding energy difference from the wildtype (ΔΔGmut) was calculated for 378 alanine scanning mutations and 76 ClinVar missense mutations, repeated on two distinct X-ray structures of holoTC namely 2BB5 and 4ZRP. Destabilizing mutations then went through 100 ns molecular dynamics simulation to study their effect on TC-B12 binding at the structural level employing 2BB5 structure. Out of the studied 454 mutations (378 alanine mutations + 76 ClinVar mutations), 19 were destabilizing representing 17 amino acid locations. Mutation energy results show a neutral effect on B12 binding of several missense SNPs reported in the literature including I23V, G94S, R215W, P259R, S348F, L376S, and R399Q. Compared to the wildtype, all the destabilizing mutations have higher average RMSD-Ligand in the last 25% of the MD simulation trajectories and lower average hydrogen bond count while the other parameters vary. Previously reported TCN2 SNPs with an unknown effect on TC-B12 binding were found to have a neutral effect in the current study based on mutation energy calculations. Also, we reported 17 possible amino acids that destabilize TC-B12 binding upon mutation (four listed in ClinVar) and studied their structural effect computationally. Communicated by Ramaswamy H. Sarma.

A review of the molecular epidemiology of Cryptosporidium spp. and Giardia duodenalis in the Middle East and North Africa (MENA) region

Cryptosporidium spp. and Giardia duodenalis are important protozoan parasites which are associated with diarrheal diseases in humans and animals worldwide. Relatively little is known about the molecular epidemiology of Cryptosporidium spp. and Giardia duodenalis in the Middle East Countries and North Africa (MENA region). Therefore, this review aimed to inspect published genotyping and subtyping studies on Cryptosporidium spp. and Giardia duodenalis in the MENA region. These studies indicate that both anthroponotic and zoonotic transmission of Cryptosporidium occurs with the predominance of zoonotic transmission in most countries. Seven Cryptosporidium species were identified in humans (C. parvum, C. hominis, Cryptosporidium meleagridis, C. felis, Cryptosporidium muris, C. canis and C. bovis), with C. parvum by far being the most prevalent species (reported in 95.4% of the retrieved studies). Among C. parvum gp60 subtype families, IIa and IId predominated, suggesting potential zoonotic transmission. However, in four MENA countries (Lebanon, Israel, Egypt and Tunisia), C. hominis was the predominant species with five subtype families reported including Ia, Ib, Id, If and Ie, all of which are usually anthroponotically transmitted between humans. In animals, the majority of studies were conducted mainly on livestock and poultry, 15 species were identified (C. parvum, C. hominis, C. muris, Cryptosporidium cuniculus, C. andersoni, C. bovis, C. meleagridis, C. baileyi, C. erinacei, C. ryanae, C. felis, C. suis, Cryptosporidium galli, C. xiaoi and C. ubiquitum) with C. parvum (IIa and IId subtypes) the dominant species in livestock and C. meleagridis and C. baileyi the dominant species in poultry. With G. duodenalis, five assemblages (A, B, C, E and F) were identified in humans and six (A, B, C, E, D and F) in animals in MENA countries with assemblages A and B commonly reported in humans, and assemblages A and E dominant in livestock. This review also identified a major knowledge gap in the lack of Cryptosporidium spp. and Giardia duodenalis typing studies in water and food sources in the MENA region. Of the few studies conducted on water sources (including drinking and tap water), ten Cryptosporidium species and four genotypes were identified, highlighting the potential role of water as the major route of Cryptosporidium spp. transmission in the region. In addition, three G. duodenalis assemblages (A, B and E) were detected in different water sources with AI, AII and BIV being the main sub-assemblages reported. More research is required in order to better understand the molecular diversity and transmission dynamics of Cryptsporidum spp. and Giardia duodenalis in humans, animals, water and food sources in MENA region.

Molecular characterization of Entamoeba, Blastocystis and Cryptosporidium species in stool samples collected from Jordanian patients suffering from gastroenteritis

Little is known about the prevalence of intestinal protozoa in patients suffering from diarrhea in Jordan. The present study aimed to detect and speciate Entamoeba, Blastocystis, and Cryptosporidium species in a total of 159 human patients with diarrhea from November 2014 to October 2016. The overall prevalence for the three parasites was 19.5% (31/159). Entamoeba spp. (Entamoeba. dispar and/or Entamoeba histolytica), Blastocystis hominis, and Cryptosporidium parvum subtype IIaA15G2R1 were detected in 12.6%, 6%, and 0.6 of samples, respectively. This is the first molecular study in Jordan to confirm the diagnosis of Entamoeba species and to discriminate between E. histolytica and E. dispar.

Cryptosporidium infection in humans and animals from Iraq: A review

The apicomplexan parasite Cryptosporidium causes serious diarrheal disease in humans and animals worldwide. The present review summarizes epidemiological and molecular studies as well as the clinical disease burden of natural Cryptosporidium infections in humans and animals from Iraq. Retrieved reports regarding cryptosporidiosis in Iraq indicated that the disease is highly prevalent in humans and animals, but the results extracted from these reports are confusing and mostly employed traditional methodologies for the detection of Cryptosporidium infective stage, the oocysts, in clinical samples. Many screened surveys represent point prevalence studies, which described diarrhea in infants and children due to cryptosporidiosis; however, other pathogens causing diarrhea were not excluded. High prevalence of Cryptosporidium oocysts was recovered from many studies from different environmental matrices in different parts of Iraq including drinking tap water, which facilitates its transmission to humans and animals. Reports on molecular characterization of different Cryptosporidium species which exist in Iraq are few but both Cryptosporidium hominis and Cryptosporidium parvum were detected in humans and the latter was more prevalent in isolates from cattle, sheep, goats and birds. A national study on adequate numbers of samples from different hosts and environmental matrices, and employing advanced diagnostic methodologies is required to precisely detect the epidemiological situation of cryptosporidiosis in Iraq. Furthermore, molecular genotyping studies are required to be conducted in Iraq to characterize the species and subtypes of Cryptosporidium infecting humans and animals especially during outbreaks. Therefore, Cryptosporidium parasite should be included in the routine diagnosis and surveillance system of infectious diseases in Iraq and should be regarded as an important public health problem of concern.

Iron deposition and atrophy in cerebral grey matter and their possible association with serum iron in relapsing-remitting multiple sclerosis

PURPOSE

The present study was carried out to investigate any possible linkage between cerebral grey matter volumetric, iron changes, white matter's lesions load and serum iron levels in a group of relapsing-remitting multiple sclerosis (RRMS) patients.

MATERIALS AND METHODS

Sixty-five RRMS patients along with thirty-four age-matched healthy controls (HCs) were recruited. Serum samples were isolated from blood samples which were collected in vacutainer plain tubes individually from both groups. Both groups were scanned at 1.5 T magnetic resonance imaging (MRI) using the following 3D sequences; T1-weighted gradient echo (MPRAGE), T2*-weighted gradient echo and T2-weighted fluid-attenuated inversion recovery (FLAIR).

RESULTS

Significant differences were observed between the RRMS patients and HCs for cortical and deep grey matter (dGM) volumes where cortical and dGM volumes in RRMS patient were significantly smaller than those in HCs. While iron deposition in the cortex, putamen (PT) and globus pallidus (GP) of RRMS patients were significantly higher than those of HCs, iron levels in thalamus (TH) and serum were significantly lower in RRMS compared to those in HCs. Except for T2 lesion load, none of volumetric measures showed any association with patients' disability status. Cerebral grey matter's iron changes did not show any association with those of serum.

CONCLUSION

Smaller cortical and subcortical grey matter volumes in RRMS patients compared to HCs were detected. None of the volumetric measures showed any association with patients' disability status. RRMS patients showed increased iron levels in the PT, GP and cortex and decreased levels in the TH and serum.

Seroprevalence of cystic echinococcosis in a high-risk area (Al-Mafraq Governorate) in Jordan, using indirect hemagglutination test

Hydatid disease (HD) is a zoonotic disease of humans and animals which is caused by infection with the larval stages of the taeniid cestodes of the genus Echinococcus. HD is endemic in many countries of the Middle East, including Jordan. The seroprevalence rate of HD in areas of elevated risk in Jordan has not previously been investigated using indirect haemagglutination (IHA) testing. In the present study, 512 blood samples were collected from recruited outpatients from an internal medicine clinic in Al-Mafraq Governmental Hospital in Jordan. Each participant signed a consent form and completed a questionnaire. The presence of antibodies specific for E. granulosus antigens was detected using an IHA test. Statistical analysis was performed by SPSS software using the Chi-square test. In all, 4.1% of the study participants were seropositive for E. granulosus IgG antibodies. There was a significant correlation between unexplained weight loss among seropositive patients (P = 0.018). Seropositivity was significantly higher in patients who slaughtered sheep inside their houses (P = 0.023). HD seroprevalence did not correlate with gender (P = 0.433), age (P = 0.880), residency status (P = 0.938), or educational level (P = 0.808). The vast majority (75.2%) of participants reported no prior knowledge about HD, and 99.8% were not aware about the etiology of the disease.

The association of hepatic fat percentage with selected anthropometric and biochemical parameters at 3-Tesla magnetic resonance imaging

BACKGROUND AND AIM

This relatively comprehensive and multi-parametric study was conducted to investigate an association between hepatic fat percentage (HFP) values measured using high-field magnetic resonance imaging (MRI), anthropometric and biochemical measurements in healthy adults.

METHODS

Abdominal MRI, anthropometric and biochemical measurements were determined in 156 healthy subjects. HFP values were derived from the MRI, whilst routine lipids, leptin, resistin, IL6 and adiponectin were measured by routine methods.

RESULTS

Eighty per cent of the calculated HFP values were in the normal range of hepatic fat accumulation. Significant sex-adjusted correlations were found between HFP and waist circumference (WC) (measured by tape), BMI, leptin, resistin, WC (measured by MRI) and hip circumference (all p<0.001) and triglycerides (p=0.01). A significant inverse correlation was detected between HFP and adiponectin (p<0.001).

CONCLUSIONS

A multi-parametric approach of MRI, biochemical and anthropometric measurements could be adopted to identify subjects at risk of developing non-alcoholic fatty liver disease.

Giardia: an under-reported foodborne parasite

Foodborne zoonotic pathogens are a serious public health issue and result in significant global economic losses. Despite their importance to public health, epidemiological data on foodborne diseases including giardiasis caused by the enteric parasite, Giardia duodenalis, are lacking. This parasite is estimated to cause ∼28.2 million cases of diarrhoea each year due to contamination of food, but very few foodborne outbreaks have been documented due to the limitations of current detection as well as surveillance methods. The current method for the recovery of Giardia cysts from food matrices using immunomagnetic separation requires further standardisation and cost reduction before it can be widely used. It also should incorporate downstream molecular procedures for genotyping, and traceback and viability analyses. Foodborne giardiasis can be potentially controlled through improvements in national disease surveillance systems and the establishment of Hazard Analysis and Critical Control Point interventions across the food chain. Studies are needed to assess the true prevalence and public health impact of foodborne giardiasis.

Nasal colonization by methicillin-sensitive and methicillin-resistant Staphylococcus aureus among medical students

INTRODUCTION

Nasal carriers of methicillin-resistant Staphylococcus aureus (MRSA) are common and play an important role in nosocomial infections. The prevalence rate and characterization of nasal carriers of MRSA among medical students in Jordan has not been investigated before.

METHODOLOGY

The resistance of S. aureus to several antibiotics was tested using disc diffusion method, automatic Vitek 2, and penicillin binding protein (PBP) 2 slide test. Bacterial species and resistance genes were confirmed using molecular analysis of three relevant genes by real-time PCR. Two hundred ninety nasal swabs were collected from medical students at Hashemite University from June 2015 to August 2016. All participants signed a voluntary consent form and filled a predesigned questionnaire.

RESULTS

The mean age of participants was 19.7 ± 2 years and 61.7% of them were males. 63 out of the 290 (21.7%) samples were identified to have S. aureus, 56 (19.3%) were methicillin-sensitive S. aureus (MSSA) and 7 (2.4%) were MRSA. S. aureus nasal colonization significantly associates with male gender (OR = 1.7, CI = 0.94-3.18, P = 0.049) and chronic illnesses (OR = 4.0, CI = 1.52-10.65, P = 0.006). Consistency between disc diffusion, Vitek 2, and PBP 2 methods for MRSA screening were satisfactory compared to molecular analysis. All MRSA samples were positive for SCCmec:orfx junction gene (MRSA-specific), nuc gene (S. aureus- specific), mecA gene (PBP-mediated resistant), and PBP2 production. All MRSA isolates were multi-drug resistant and were sensitive to Linezolid, Vancomycin, and Tigecycline.

CONCLUSIONS

This study confirms that nasal colonization by MRSA among medical students necessitates further attention to prevent nosocomial infections.

Foodborne cryptosporidiosis

Foodborne illness, the majority of which is caused by enteric infectious agents, costs global economies billions of dollars each year. The protozoan parasite Cryptosporidium is particularly suited to foodborne transmission and is responsible for >8 million cases of foodborne illness annually. Procedures have been developed for sensitive detection of Cryptosporidium oocysts on fresh produce and molecular diagnostic assays have been widely used in case linkages and infection source tracking, especially during outbreak investigations. The integrated use of advanced diagnostic techniques with conventional epidemiological studies is essential to improve our understanding of the occurrence, source and epidemiology of foodborne cryptosporidiosis. The implementation of food safety management tools such as Good Hygienic Practices (GHP), Hazard Analysis and Critical Control Points (HACCP), and Quantitative Microbial Risk Assessment (QMRA) in industrialised nations and Water, Sanitation, and Hygiene (WASH) in developing countries is central for prevention and control and foodborne cryptosporidiosis in the future.

Prevalence of Cryptosporidium species and subtypes in paediatric oncology and non-oncology patients with diarrhoea in Jordan

Cryptosporidiosis is a protozoan parasitic disease which affects human and animals worldwide. In adult immunocompetent individuals, cryptosporidiosis usually results in acute and self-limited diarrhoea; however, it can cause life threatening diarrhoea in children and immunocompromised individuals. In the present study, we compared the prevalence of Cryptosporidium species and gp60 subtypes amongst paediatric oncology patients with diarrhoea (n=160) from King Hussein Medical Centre for Cancer in Jordan, and non-oncology paediatric patients with diarrhoea (n=137) from Al-Mafraq paediatric hospital. Microscopy results using modified acid fast staining identified a significantly (p≤0.05) higher prevalence of Cryptosporidium in paediatric oncology patients with diarrhoea (14.4% - 23/160), compared to non-oncology paediatric patients with diarrhoea only (5.1% - 7/137). With the exception of one sample, all microscopy-positive samples (n=29) and an additional 3/30 microscopy-negative controls were typed to species and subtype level at the 18S and gp60 loci, respectively. All Cryptosporidium positives were typed as C. parvum. Of the 22 typed Cryptosporidium positives from the paediatric oncology patients, 21 were subtyped as IIaA17G2R1 and one as IIaA16G2R1 C. parvum subtypes. The 7 typed positives from the paediatric patients from Al-Mafraq hospital were subtyped as IIaA17G2R1 (n=5) and IIaA16G2R1 (n=2). The 3 additional positives from the 30 microscopy negative control samples were subtyped as IIaA17G2R1. The high prevalence of the IIaA17G2R1 subtype, particularly amongst oncology patients, suggests that an outbreak of cryptosporidiosis may have been occurring in oncology patients during the collection period (April to December, 2016). New therapies for cryptosporidiosis in immunocompromised patients are urgently required.

It's official - Cryptosporidium is a gregarine: What are the implications for the water industry?

Parasites of the genus Cryptosporidium are a major cause of diarrhoea and ill-health in humans and animals and are frequent causes of waterborne outbreaks. Until recently, it was thought that Cryptosporidium was an obligate intracellular parasite that only replicated within a suitable host, and that faecally shed oocysts could survive in the environment but could not multiply. In light of extensive biological and molecular data, including the ability of Cryptosporidium to complete its life cycle in the absence of a host and the production of novel extracellular stages, Cryptosporidium has been formally transferred from the Coccidia, to a new subclass, Cryptogregaria, with gregarine parasites. In this review, we discuss the close relationship between Cryptosporidium and gregarines and discuss the implications for the water industry.

Specific and quantitative detection and identification of Cryptosporidium hominis and C. parvum in clinical and environmental samples

Cryptosporidium is an enteric protozoan parasite that is resistant to inactivation by commonly used drinking water disinfectants. Between 2004 and 2010, it was responsible for 60% of all waterborne protozoan parasitic outbreaks reported worldwide. Most sporadic infections in humans and almost all outbreaks are caused by Cryptosporidium parvum and Cryptosporidium hominis. We report the development and validation of a quantitative qPCR assay using minor groove binder (MGB)-probes targeting a unique Cryptosporidium specific protein-coding gene, that directly detects, quantitates and identifies C. hominis and C. parvum in environmental and faecal samples. An internal amplification control (IAC) was also developed and included in this assay. The qPCR assay was compared with an 18S nested PCR assay for sensitivity and specificity. The analytical sensitivity for the qPCR assay was 1 oocyst and 1-10 oocysts for the 18S assay. Evaluation of analytical specificity of the qPCR assay revealed no cross-reactions with other genera and detected all C. parvum and C. hominis isolates correctly. The diagnostic sensitivity and specificity of the qPCR was 100% compared to 96.9% and 98.4%, respectively for the 18S assay. The qPCR assay was also highly reproducible with RSD (relative standard deviation) values of 1.4-9.4%, when the assay was performed by four different technicians. When tested on water samples, the qPCR assay was more sensitive than the 18S assay, detecting positives in 37 of 138 water samples compared to 35 for the 18S locus. This qPCR assay should be a valuable tool for the detection and differentiation of C. hominis and C. parvum in both clinical and environmental samples.

Effectiveness of dietary intervention for obese women in Jordan

OBJECTIVE

The aim was to evaluate the outcome of body weight loss consulting in an outpatient nutrition clinic.

METHODS

Forty-five adult females attended 10 individualized treatment one-to-one sessions. Weight and height were measured and the body mass index was calculated. Triceps, biceps, subscapular and suprailiac skinfold thickness were measured and the fat percentage was calculated. A hypocaloric diet was given to the women; the percentages of carbohydrate, protein and fat in the diet were kept between 50 and 55% for carbohydrates, between 15 and 20% for protein, and < or =30% of fat.

RESULTS

Average weight loss was 7.4 kg, which was 8.4% of initial. Class III obese subjects achieved the highest weight loss (-9.4 kg). Weight loss was statistically significant after week 1, week 2, week 3, and week 4 (P < 0.001). The body mass index was significantly decreased (P < 0.001). The mean fat percentage was not significantly different.

CONCLUSIONS

The results indicate the increasing importance of nutrition counselling in Jordan.

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.

Prevalence of hydatid cysts in livestock from five regions of Jordan

When the prevalences of cystic echinococcosis in indigenous sheep, goats, cattle and camels from five regions of Jordan were investigated, from March to December 1992, they were found to be 12.9%, 12.7%, 0.9% and 11%, respectively. They were substantially higher in sheep from Karak (27.6%) and in cattle from central Jordan (18.0% in Amman and 14.3% in Sahab) than in the same animals in other regions. Age-intensity data indicated that the parasite population is endemic in sheep and cattle and hyperendemic in goats. Infection rate increased steadily with age in sheep, but became constant in goats and cattle when they were about 2 years of age. The most common locations of cysts were the liver in sheep and goats and the lungs in cattle. Co-infection of the liver and lungs was common in sheep and cattle. Although the majority of the sheep, cattle and goats had 1-10 cysts, 20.4% of the sheep and 22.2% of the cattle had 11-50 and 11-30 cysts, respectively. Although 38.1% of the cysts in sheep were fertile, only 8.7% of the cattle cysts and 4.5% of the goat cysts were in this condition. The overall mean number of protoscolices/sheep cyst was 2.7 x 10(3); although the liver cysts had more protoscolices than the lung cysts (3.2 x 10(3) v. 1.9 x 10(3)/cyst), more of the lung cysts were viable (71.1% v. 62.3%). Some 0.2% of 13,436 sheep and 6.1% of 786 cattle imported live into Jordan were infected with hydatid cysts; 16.3% of the sheep cysts (61.4% viable) and 9.6% of the cattle cysts (76.1% viable) were fertile.