DOI QR코드

DOI QR Code

Prevalence of Cryptosporidium-Associated Diarrhea in a High Altitude-Community of Saudi Arabia Detected by Conventional and Molecular Methods

  • Hawash, Yousry (Department of Medical Parasitology, NLI, Menoufia University) ;
  • Dorgham, Laila Sh. (Department of Nursing, College of Applied Medical Sciences, Taif University) ;
  • Al-Hazmi, Ayman S. (Department of Medical Laboratory Science, College of Applied Medical Sciences, Taif University) ;
  • Al-Ghamdi, Mohammed S. (Department of Medical Laboratory Science, College of Applied Medical Sciences, Taif University)
  • Received : 2014.04.28
  • Accepted : 2014.07.15
  • Published : 2014.10.31

Abstract

Cryptosporidium diarrhea represents a relevant clinical problem in developing countries. In Al-Taif, a city of Saudi Arabia that lies at an altitude of an around 2 km above the sea level, Cryptosporidium infection seems to be undiagnosed in nearly all clinical laboratories. Furthermore, nothing was published regarding Cryptosporidium-associated diarrhea in this area. The objectives of this research were to (1) determine the Cryptosporidium prevalence among patients with diarrhea and (2) to estimate the performances of 3 different diagnostic methods. Total 180 diarrheal fecal samples, 1 sample per patient, were collected between January and August 2013. Samples were screened for Cryptosporidium with modified Zeihl Neelsen (ZN) microscopy, $RIDA^{(R)}$ Quick lateral flow (LF) immunotest, and a previously published PCR. The Cryptosporidium prevalence rate was 9.4% (17/180), 10% (18/180), and 11.6% (21/180) by microscopy, LF, and PCR test, respectively. Infection was significantly (P=0.004) predominant among children <5 years (22%) followed by children 5-9 years (11.1%). Although infection was higher in males than in females (16.2% males and 8.5% females), the difference was not statistically significant (P=0.11). Compared to PCR, the sensitivity of microscopy and the LF test were 80.9%, 85.7%, respectively. To conclude, high Cryptosporidium-associated diarrhea was found in this area especially in children ${\leq}9$ years. The PCR test showed the best performance followed by the LF test and ZN staining microscopy. The primary health care providers in Al-Taif need to be aware of and do testing for this protozoon, particularly for children seen with diarrhea.

Keywords

References

  1. Nime FA, Burek JD, Page DL, Holscher MA, Yardley JH. Acute enterocolitis in a human being infected with the protozoan Cryptosporidium. Gastroenterology 1976; 70: 592-598.
  2. Huang DB, White AC. An updated review on Cryptosporidium and Giardia. Gastroenterol Clin North Am 2006; 35: 291-314. https://doi.org/10.1016/j.gtc.2006.03.006
  3. Xiao L, Morgan UM, Fayer R, Thompson RC, Lal AA. Cryptosporidium systematics and implications for public health. Parasitol Today 2000; 16: 287-292. https://doi.org/10.1016/S0169-4758(00)01699-9
  4. Surl CG, Jung BD, Park BK, Kim HC. Resistance of Cryptosporidium parvum oocysts following commercial bleach treatment. Korean J Vet Res 2011; 51: 101-105.
  5. Elwin K, Chalmers RM, Hadfield SJ, Hughes S, Hesketh LM, Rothburn MM, Muller T, Hunter PR. Serological responses to Cryptosporidium in human populations living in areas reporting high and low incidences of symptomatic cryptosporidiosis. Clin Microbiol Infect 2007; 13: 1179-1185. https://doi.org/10.1111/j.1469-0691.2007.01823.x
  6. Arora DR, Arora B. AIDS-associated parasitic diarrhoea. Indian J Med Microbiol 2009; 27: 185-190. https://doi.org/10.4103/0255-0857.53199
  7. Desai NT, Sarkar R, Kang G. Cryptosporidiosis: an under-recognized public health problem. Trop Parasitol 2012; 2: 91-98. https://doi.org/10.4103/2229-5070.105173
  8. McHardy IH, Wu M, Cohen RS, Couturier MR. Humphries RM. Clinical laboratory diagnosis of intestinal protozoa. J Clin Microbiol 2013 (doi: 10.1128/JCM 02877-13).
  9. van Lieshout L, Verweij JJ. Newer diagnostic approaches to intestinal protozoa. Curr Opin Infect Dis 2010; 23: 488-493. https://doi.org/10.1097/QCO.0b013e32833de0eb
  10. Jex AR, Smith HV, Monis PT, Campbell BE, Gasser RB. Cryptosporidium-biotechnological advances in the detection, diagnosis and analysis of genetic variation. Biotechnol Adv 2008; 26: 304-317. https://doi.org/10.1016/j.biotechadv.2008.02.003
  11. Khan ZH, Namnyak SS, Al Jama AA, Madan I. Prevalence of cryptosporidiosis in Dammam and Alkhobar, Saudi Arabia. Ann Trop Paediatr 1988; 8: 170-172.
  12. El-Sheikh SM, El-Assouli SM. Prevalence of viral, bacterial and parasitic enteropathogens among young children with acute diarrhoea in Jeddah, Saudi Arabia. J Health Popul Nutr 2001; 19: 25-30.
  13. Al-Harthi SA, Jamjoom MB. Enteroparasitic occurrence in stools from residents in Southwestern region of Saudi Arabia before and during Umrah season. Saudi Med J 2007; 28: 386-389.
  14. Hawash Y. DNA extraction from protozoan oocysts/cysts in feces for diagnostic PCR. Korean J Parasitol 2014; 52: 263-271. https://doi.org/10.3347/kjp.2014.52.3.263
  15. Casemore DP, Armstrong M, Sands RL. Laboratory diagnosis of cryptosporidiosis. J Clin Pathol 1985; 38: 1337-1341. https://doi.org/10.1136/jcp.38.12.1337
  16. Spano F, Putignani L, McLauchlin J, Casemore DP, Crisanti A. PCR-RFLP analysis of the Cryptosporidium oocyst wall protein (COWP) gene discriminates between C. wrairi and C. parvum, and between C. parvum isolates of human and animal origin. FEMS Microbiol Lett 1997; 150: 209-217. https://doi.org/10.1016/S0378-1097(97)00115-8
  17. Milaat WA, Elassouli SM. Epidemiology of diarrhoea in two major cities in Saudi Arabia. J Commun Dis 1995; 27: 84-91.
  18. Paralikar SJ, Paralikar JH. High-altitude medicine. Indian J Occup Environ Med 2010; 14: 6-12. https://doi.org/10.4103/0019-5278.64608
  19. Al-Megrin WAI. Intestinal parasites infection among immunocompromised patients in Riyadh, Saudi Arabia. Pak J Biol Sci 2010; 13: 390-394. https://doi.org/10.3923/pjbs.2010.390.394
  20. Abdel-Messih IA, Wierzba TF, Abu-Elyazeed R, Ibrahim AF, Ahmed SF, Kamal K, Sanders J, Frenck R. Diarrhea associated with Cryptosporidium parvum among young children of the Nile River Delta in Egypt. J Trop Pediatr 2005; 51: 154-159. https://doi.org/10.1093/tropej/fmh105
  21. Moyo SJ, Gro N, Matee MI, Kitundu J, Myrmel H, Mylvaganam H, Maselle SY, Langeland N. Age specific aetiological agents of diarrhoea in hospitalized children aged less than five years in Dar es Salaam, Tanzania. BMC Pediatr 2011; 11: 19 (p. 1-6). https://doi.org/10.1186/1471-2431-11-19
  22. Gatei W, Wamae CN, Mbae C, Waruru A, Mulinge E, Waithera T, Gatika SM, Kamwati SK, Revathi G, Hart CA. Cryptosporidiosis: prevalence, genotype analysis, and symptoms associated with infections in children in Kenya. Am J Trop Med Hyg 2006; 75: 78-82.
  23. Laubach HE, Bentley CZ, Ginter EL, Spalter JS, Jensen LA. A study of risk factors associated with the prevalence of Cryptosporidium in villages around Lake Atitlan, Guatemala. Braz J Infect Dis 2004; 8: 319-323.
  24. Yoder JS, Beach MJ. Cryptosporidium surveillance and risk factors in the United States. Exp Parasitol 2010; 124: 31-39. https://doi.org/10.1016/j.exppara.2009.09.020
  25. Hawash Y. Evaluation of an immunoassay-based algorithm for screening and identification of Giardia and Cryptosporidium antigens in human faecal specimens from Saudi Arabia. J Parasitol Res 2014 (doi: 10.1155/2014/213745).
  26. Agnamey P, Sarfati C, Pinel C, Rabodoniriina M, Kapel N, Dutoit E, Garnaud C, Diouf M, Garin JF, Totet A, Derouin F, ANOFEL Cryptosporidium National Network. Evaluation of four commercial rapid immunochromatographic assays for detection of Cryptosporidium antigens in stool samples: a blind multicenter trial. J Clin Microbiol 2011; 49: 1605-1607. https://doi.org/10.1128/JCM.02074-10
  27. De A. Current laboratory diagnosis of opportunistic enteric parasites in human immunodeficiency virus-infected patients. Trop Parasitol 2013; 3: 7-16. https://doi.org/10.4103/2229-5070.113888
  28. Elsafi SH, Al-Maqati TN, Hussein MI, Adam AA, Hassan MM, Al Zahrani EM. Comparison of microscopy, rapid immunoassay, and molecular techniques for the detection of Giardia lamblia and Cryptosporidium parvum. Parasitol Res 2013; 112: 1641-1646. https://doi.org/10.1007/s00436-013-3319-1
  29. Stark D, Al-Qassab SE, Barratt JL, Stanley K, Roberts T, Marriott D, Harkness J, Ellis JT. Evaluation of multiplex tandem real-time PCR for detection of Cryptosporidium spp., Dientamoeba fragilis, Entamoeba histolytica, and Giardia intestinalis in clinical stool samples. J Clin Microbiol 2011; 49: 257-262. https://doi.org/10.1128/JCM.01796-10

Cited by

  1. Internal Amplification Control for a Cryptosporidium Diagnostic PCR: Construction and Clinical Evaluation vol.53, pp.2, 2014, https://doi.org/10.3347/kjp.2015.53.2.147
  2. Assessment of microscopic and molecular tools for the diagnosis and follow-up of cryptosporidiosis in patients at risk vol.35, pp.1, 2016, https://doi.org/10.1007/s10096-015-2519-2
  3. Human cryptosporidiosis in Iran: a systematic review and meta-analysis vol.116, pp.4, 2014, https://doi.org/10.1007/s00436-017-5376-3
  4. High Frequency of Enteric Protozoan, Viral, and Bacterial Potential Pathogens in Community-Acquired Acute Diarrheal Episodes: Evidence Based on Results of Luminex Gastrointestinal Pathogen Panel Assay vol.55, pp.5, 2014, https://doi.org/10.3347/kjp.2017.55.5.513
  5. Foodborne intestinal protozoan infection and associated factors among patients with watery diarrhea in Northern Ethiopia; a cross-sectional study vol.37, pp.1, 2014, https://doi.org/10.1186/s41043-018-0137-1
  6. Cryptosporidium and Cryptosporidiosis: The Perspective from the Gulf Countries vol.17, pp.18, 2020, https://doi.org/10.3390/ijerph17186824