Prevalence, Clinical Manifestations and Genotyping of Cryptosporidium Spp. in Patients with Gastrointestinal Illnesses in Western Iran
AbstractBackground: Cryptosporidium species are recognized as important gastrointestinal pathogens. This study was conducted to identify the prevalence, clinical manifestations and genotyping of Cryptosporidium spp. in patients with gastrointestinal illnesses (GIs) in western Iran. Methods: Overall, 1301 fecal samples were collected from patients with GIs referred to the 12 clinical laboratories in Nahavand County, west of Iran. Modified Ziehl-Neelsen staining method was used to identify the oocysts. DNA was extracted from positive samples and Cryptosporidium spp. were characterized by Nested PCR and sequence analysis of the 60-kDa glycoprotein (gp60) gene. Data analysis was performed using SPSS ver. 16. Results: Prevalence of cryptosporidiosis was 1.3% (17/1301). Cryptosporidium infection was significantly associated with vomiting and nausea (P=0.001, OR=0.013; CI 95%=0.004- 0.044), abdominal pain (P=0.018, OR=0.073; CI 95%=0.008- 0.633) and diarrhea (P=0.001, OR=0.092; CI 95%=0.023- 0.362). Of the 17 isolates typed, 11 belonged to the C. parvum IId subtype family (subtypes IIdA26G1 and IIdA20G1) and six belonged to the C. parvum IIa subtype family (subtypes IIaA15G2R1 and IIaA16G3R1). There was no significant difference between subtype families IIa and IId in occurrence of clinical symptoms (P= 0.75). Conclusion: Improved hygiene and avoidance of contact with animals and contaminated soil should be advocated to reduce the occurrence of Cryptosporidium infections, especially in children.
Sang X-L, Liang X-C, Li JD et al. Estimating the burden of acute gastrointestinal illness in the community in Gansu Province, northwest China, 2012-2013. BMC Public Health. 2014;14:787.
Kim HP, Crockett SD, Shaheen NJ. The Burden of Gastrointestinal and Liver Disease Around the World. In: GI Epidemiology: Diseases and Clinical Methodology. John Wiley & Sons, Second Edition. 2014:1–13.
Rostami A, Ebrahimi M, Mehravar S et al. Contamination of commonly consumed raw vegetables with soil transmitted helminth eggs in Mazandaran province, northern Iran. Int J Food Microbiol. 2016;225:54–8.
Omrani VF, Fallahi Sh, Rostami A et al. Prevalence of intestinal parasite infections and associated clinical symptoms among patients with end-stage renal disease undergoing hemodialysis. Infection. 2015:43(5):537–44.
Smith HV, Caccio SM, Cook N et al. Cryptosporidium and Giardia as foodborne zoonoses. Vet Parasitol. 2007;149(1-2):29–40.
O'Connor RM, Shaffie R, Kang G et al. Cryptosporidiosis in patients with HIV/AIDS. AIDS. 2011;25(5):549–60.
Xiao L, Feng Y. Zoonotic cryptosporidiosis. FEMS Immunol Med Microbiol. 2008;52(3):309–23.
Na Li, Lihua Xiao, Keri Alderisio et al. Subtyping Cryptosporidium ubiquitum, a zoonotic pathogen emerging in humans. Emerg Infect Dis. 2014;20:217–24.
Xiao L. Molecular epidemiology of cryptosporidiosis: an update. Exp Parasitol. 2010;124(1):80–9.
Ryan U, Fayer R, Xiao L. Cryptosporidium species in humans and animals: current understanding and research needs. Parasitology. 2014;141(13):1667–85.
Keshavarz A, Athari A, Haghighi A et al. Genetic characterization of Cryptosporidium spp. among children with diarrhea in Tehran and Qazvin provinces, Iran. Iran J Parasitol. 2008;3(3):30–36.
Kiani H, Haghighi A, Rostami A et al. Prevalence, risk factors and symptoms associated to intestinal parasite infections among patients with gastrointestinal disorders in nahavand, western Iran. Rev Inst Med Trop Sao Paulo. 2016; 58: 42.
Nazemalhosseini-Mojarad E, Haghighi A, Taghipour N et al. Subtype analysis of Cryptosporidium parvum and Cryptosporidium hominis isolates from humans and cattle in Iran. Vet Parasitol. 2011;179(1-3):250–2.
Fayer R, Morgan U, Upton SJ. Epidemiology of Cryptosporidium: transmission, detection and identification. Intl J Parasitol. 2000;30(12-13):1305–22.
Gholami Sh, Khanmohammadi M, Ahmadpour E et al. Cryptosporidium infection in patients with gastroenteritis in Sari, Iran. Iran J Parasitol. 2014;9(2):226–232.
Sharbatkhori M, Nazemalhosseini Mojarad E, Taghipour N et al. Prevalence and Genetic Characterization of Cryptosporidium Spp. In Diarrheic Children from Gonbad Kavoos City, Iran. Iran J Parasitol. 2015;10(3):441–7.
Abdel-Messih IA, Wierzba TF, Abu-Elyazeed R et al. Diarrhea associated with Cryptosporidium parvum among young children of the Nile River Delta in Egypt. J Trop Pediatr. 2005;51(5):154–9.
Endeshaw T, Mohammed H, Woldemichael T. Cryptosporidium parvum and other instestinal parasites among diarrhoeal patients referred to EHNRI in Ethiopia. Ethiop Med J. 2004;42(3):195–8.
Hijjawi N, Ng J, Yang R, et al. Identification of rare and novel Cryptosporidium GP60 subtypes in human isolates from Jordan. Exp Parasitol. 2010;125(2):161–4.
Natividad FF, Buerano CC, Lago CB et al. Prevalence rates of Giardia and Cryptosporidium among diarrheic patients in the Philippines. Southeast Asian J Trop Med Public Health. 2008;39(6):991–9.
Ng J, MacKenzie B, Ryan U. Longitudinal multi-locus molecular characterisation of sporadic Australian human clinical cases of cryptosporidiosis from 2005 to 2008. Exp Parasitol. 2010;125(4):348–56.
Meamar AR, Guyot K, Certad G et al. Molecular characterization of Cryptosporidium isolates from humans and animals in Iran. Appl Environ Microbiol. 2007;73(3):1033–1035.
Taghipour N, Nazemalhosseini- Mojarad E, Haghighi A et al. Molecular epidemiology of cryptosporidiosis in Iranian children, Tehran, Iran. Iran J Parasitol. 2011;6(4):41–45.
Zavvar M, Sadraei J, Emadi H et al. The use of a nested PCR–RFLP technique, based on the parasite's 18S ribosomal RNA, to characterise Cryptosporidium isolates from HIV/AIDS patients. Ann Trop Med Parasitol. 2008;102(7):597–601.
Al-Brikan FA, Salem HS, Beeching N et al. Multilocus genetic analysis of Cryptosporidium isolates from Saudi Arabia. J Egypt Soc Parasitol. 2008;38(2):645–58.
Sulaiman IM, Hira PR, Zhou L et al. Unique endemicity of cryptosporidiosis in children in Kuwait. J Clin Microbiol. 2005;43:2805–2809.
Tamer GS, Turk M, Dagci H et al. The prevalence of cryptosporidiosis in Turkish children, and genotyping of isolates by nested polymerase chain reaction-restriction fragment length polymorphism. Saudi Med J. 2007;28:1243–6.
Adamu H, Petros B, Zhang G et al. Distribution and clinical manifestations of Cryptosporidium species and subtypes in HIV/AIDS patients in Ethiopia. PLoS Negl Trop Dis. 2014;8(4):e2831.
Waldron LS, Ferrari BC, Power ML. Glycoprotein 60 diversity in C. hominis and C. parvum causing human cryptosporidiosis in NSW, Australia. Exp Parasitol. 2009;122(2):124–7.
Chalmers RM, Smith RP, Hadfield SJ et al. Zoonotic linkage and variation in Cryptosporidium parvum from patients in the United Kingdom. Parasitol Res. 2011;108(5):1321–5.
Quílez J, Torres E, Chalmers RM et al. Cryptosporidium genotypes and subtypes in lambs and goat kids in Spain. Appl Environ Microbiol. 2008;74(19):6026–31.
Wang R, Zhang L, Axén C et al. Cryptosporidium parvum IId family: clonal population and dispersal from Western Asia to other geographical regions. Sci Rep. 2014;4:4208.
Amer S, Zidan S, Feng Y et al. Identity and public health potential of Cryptosporidium spp. in water buffalo calves in Egypt. Vet Parasitol. 2013;191(1-2):123–7.
Silverlås C, Bosaeus-Reineck H, Näslund K et al. Is there a need for improved Cryptosporidium diagnostics in Swedish calves?. Int J Parasitol. 2013;43(2):155–61.
Trotz-Williams LA, Martin DS, Gatei W et al. Genotype and subtype analyses of Cryptosporidium isolates from dairy calves and humans in Ontario. Parasitol Res. 2006;99(4):346–52.
Peng MM, Wilson ML, Holland RE et al. Genetic diversity of Cryptosporidium spp. in cattle in Michigan: implications for understanding the transmission dynamics. Parasitol Res. 2003;90(3):175–80.
Thompson HP, Dooley JS, Kenny J et al. Genotypes and subtypes of Cryptosporidium spp. in neonatal calves in Northern Ireland. Parasitol Res. 2007;100(3):619–24.
Stensvold CR, Ethelberg S, Hansen L et al. Cryptosporidium infections in Denmark, 2010-2014. Dan Med J. 2015; 62(5):Pii:A50862015.
Cama VA, Ross JM, Crawford S et al. Differences in clinical manifestations among Cryptosporidium species and subtypes in HIV-infected persons. J Infect Dis. 2007,196(5):684–91.
Cama VA, Bern C, Roberts J et al. Cryptosporidium species and subtypes and clinical manifestations in children, Peru. Emerg Infect Dis. 2088;14:1567–74.
Alves M, Xiao L, Antunes F et al. Distribution of Cryptosporidium subtypes in humans and domestic and wild ruminants in Portugal. Parasitol Res. 2006;99(3):287–92.