Original Article

Frequency and Molecular Identification of Cryptosporidium Species among Immunocompromised Patients Referred to Hos-pitals, Central Iran, 2015-16


Background: The purpose of this study was to determine the prevalence and genotype of Cryptosporidium spp. in different groups of immunocompromised patients admitted to the referral hospitals in center of Iran during 2015–2016.

Methods: This cross-sectional study was conducted on 346 immunocompromised patients (HIV+/AIDS, Lymphoma, Leukemia and organ transplants) in referred hospitals from central parts of Iran including Isfahan, Markazi, Yazd and Chaharmahale Bakhtiari provinces. Stool samples were analyzed for Cryptosporidium species, modified Ziehl–Neelsen staining techniques followed by the semi-nested PCR and DNA sequencing methods.

Results: The total rate of Cryptosporidium spp. was 3.46% (12/346) in the patients, however, the prevalence of the parasite, was 4.6% (4/87) in HIV+/AIDS patients, 3.6% (6/168) in patients with blood malignancy and 2.1% (2/91) in organ transplant recipients. The SSU rRNA gene of Cryptosporidium spp. in all microscopic-positive samples was effectively amplified by the semi-nested PCR and DNA sequences, exposed the existence of two Cryptosporidium species, including C. hominis 91.6% (11/12) and C. parvum 8.3% (1/12).

Conclusion: The predominance of C. hominis in the present study may be certifies the importance of anthroponotic transmission of cryptosporidiosis in center of Iran.

1. Mohaghegh MA, Hejazi SH, Ghomashlooyan M, Kalani H, Mirzaei F, Azami M. Prevalence and clinical features of Cryptosporidium infection in hemodialysis patients. Gastroenterol Hepatol Bed Bench. 2017;10(2):137-42.
2. Azami M, Moghaddam DD, Salehi R, Salehi M. The identification of Cryptosporidium species (protozoa) in Ifsahan, Iran by PCR-RFLP analysis of the 18S rRNA gene. Mol Biol (Mosk). 2007;41(5):934-9.
3. Cranendonk RJ, Kodde CJ, Chipeta D, Zijlstra EE, Sluiters JF. Cryptosporidium parvum and Isospora belli infections among patients with and without diarrhoea. East Afr Med J. 2003;80(8):398-401.
4. Xiao L, Ryan UM. Cryptosporidiosis: an update in molecular epidemiology. Curr Opin Infect Dis. 2004;17(5):483-90.
5. Xiao L. Molecular epidemiology of cryptosporidiosis: an update. Exp Parasitol. 2010;124(1):80-9.
6. Fayer R, Morgan U, Upton SJ. Epidemiology of Cryptosporidium: transmission, detection and identification. Int J Parasitol. 2000;30(12-13):1305-22.
7. Ryan U, Fayer R, Xiao X. Cryptosporidium species in humans and animals: current understanding and research needs. Parasitol. 2014;141:1667–85.
8. Casemore DP, Armstrong M, Sands RL. Laboratory diagnosis of cryptosporidiosis. J Clin Pathol. 1985;38(12):1337-41.
9. Ranjbar R, Mirhendi H, Izadi M, Behrouz B, Mohammadi Manesh R. Molecular identification of Cryptosporidium spp. in Iranian dogs using semi-nested PCR; a first report. Vector-Borne Zoonotic Dis. 2018;18(2):96-100.
10. Pawlowski SW, Warren CA, Guerrant R. Diagnosis and treatment of acute or persistent diarrhea. Gastroenterol. 2009;136(6):1874-86.
11. Izadi M, Jonaidi-Jafari N, Saburi A, Eyni H, Rezaiemanesh MR, Ranjbar R. Prevalence, molecular characteristics and risk factors for cryptosporidiosis among Iranian imm-unocompromised patients. Microbiol Immunol. 2012;56(12):836-42.
12. Dehkordy AB, Rafiei A, Alavi SM, Latifi SM. Prevalence of Cryptosporidium infection in immunocompromised patients,in South-West of Iran,2009–10. Iranian J Parasitol.2010;5(4):42-7.
13. Yang Y, Zhou YB, Xiao PL, et al. Prevalence of and risk factors associated with Cryptosporidium infection in an underdevelopedrural community of southwest China. Infect Dis Poverty. 2017;9;6(1):2.
14. Rasti S, Hassanzadeh M, Hooshyar H, Momen-Heravi M, Mousavi SGA, Abdoli A. Intestinal parasitic infections in different groups of immunocompromised patients in Kashan and Qom cities, central Iran. Scand J Gastroenterol. 52(6-7):738-41.
15. Zabolinejad N, Berenji F, Eshkaftaki EB, Badeii Z, Banihashem A, Afzalaqaei M. Intestinal parasites in children with lymphohematopoietic malignancy in Iran, Mashhad. Jundishapur J Microbiol. 2013;6(6): e7765.
16. Meamar A, Rezaian M, Mohraz M, Zahabian F, Hadighi R, Kia E. A comparative analysis of intestinal parasitic infections between HIV+/AIDS patients and non-HIV infected individuals. Iranian J Parasitol. 2007;2(1):1-6.
17. Shimelis T, Tassachew Y, Lambiyo T. Cryptosporidium and other intestinal parasitic infections among HIV patients in southern Ethiopia: significance of improved HIV-related care. Parasites & Vectors. 2016;9:270.
18. Yadav P, Khalil S, Mirdha BR. Molecular appraisal of intestinal parasitic infection in transplant recipients. Indian J Med Res. 2016;144(2):258-63.
19. Abdel-Hafeez EH, Ahmad AK, Ali BA, Moslam FA. Opportunistic parasites among immunosuppressed children in Minia district, Egypt. Korean J Parasitol. 2012;50(1):57-62.
20. Nkenfou CN, Nana CT, Payne VK. Intestinal Parasitic Infections in HIV infected and non-infected patients in a low HIV prevalence region, West-Cameroon. PLoS ONE. 2013;8(2):e57914.
21. Asma I, Johari S, Sim BL, Lim YA. How common is intestinal parasitism in HIV-infected patients in Malaysia? Trop Biomed. 2011;28(2):400-10.
22. Idris NS, Dwipoerwantoro PG, Kurniawan A, Said M. Intestinal parasitic infection of immunocompromised children with diarrhoea: clinical profile and therapeutic response. J Infect Develop Count. 2010;4(05):309-17.
23. Tian LG, Chen JX, Wang TP, et al. Co-infection of HIV and intestinal parasites in rural area of China. Parasite Vectors. 2012;5:36.
24. Stark D, Fotedar R, van Hal S, et al. Prevalence of enteric protozoa in human immunodeficiency virus (HIV)-positive and HIV-negative men who have sex with men from Sydney, Australia. Am J Trop Med Hyg. 2007;76(3):549-52.
25. Aksoy U, Erbay A, Akisu C, Apa H, Ozkoc S, Ozturk S. Intestinal parasites in children with neoplasms. Turk J Pediatr. 2003;45(2):129-32.
26. Natividad FF, Buerano CC, Lago CB, et al. Prevalence rates of Giardia and Cryptosporidium among diarrheic patients in the Philippines. The Southeast Asian J Trop Med Public Health. 2008;39(6):991-9.
27. Al-alousi TI, Mahmood OI, editors. Detection of Cryptosporidium oocysts in calves and children in Mosul, Iraq. Proc 11th Vet Sci Conf. 2012.
28. Tumwine JK, Kekitiinwa A, Nabukeera N, et al. Cryptosporidium parvum in children with diarrhea in Mulago Hospital, Kampala, Uganda. Am J Trop Med Hyg. 2003;68(6):710-5.
29. Barazesh A, Fouladvand M, Tahmasebi R, Heydari A, Fallahi J. The prevalence of intestinal parasites in hemodialysis patients in Bushehr, Iran. Hemodial Int. 2015;19(3):447-51.
30. Omrani VF, Fallahi S, 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.
31. Agholi M, Hatam GR, Motazedian MH. Microsporidia and coccidia as causes of persistence diarrhea among liver transplant children: incidence rate and species/genotypes. Pediatr Infect Dis J. 2013;32(2):185-7.
32. Azami M, Sharifi M, Hejazi SH, Tazhibi M. Intestinal parasitic infections in renal transplant recipients. Braz J Infect Dis. 2010;14(1):15-8.
33. 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):1033-5.
34. Daryani A, Sharif M, Meigouni M, et al. Prevalence of intestinal parasites and profile of CD4+ counts in HIV+/AIDS people in north of Iran, 2007-2008. Pak J Biol Sci. 2009;12(18):1277-81.
35. Zavvar M, Sadraei J, Emadi H, Pirestani M. The use of a semi-nested PCR-RFLP technique, based on the parasite's 18S ribosomal RNA, to characterise Cryptosporidium isolates from HIV/AIDS patients. Ann Trop Med Parasitol. 102(7):597-601.
36. Taghipour N, Nazemalhosseini- Mojarad E, et al. molecular epidemiology of cryptosporidiosis in iranian children, Tehran, Iran. Iran J Parasitol. 2011;6(4):41-5.
37. 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.
38. Sharbatkhori M, Nazemalhosseini Mojarad E, Taghipour N, Pagheh AS, Mesgarian F. Prevalence and genetic characterization of Cryptosporidium Spp. in diarrheic children from Gonbad Kavoos city, Iran. Iran J Parasitol. 2015;10(3):441-7.
39. Luong TV. De-worming school children and hygiene intervention. Int J Environ Health Res. 2003,1:S153-9.
IssueVol 15 No 1 (2020) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijpa.v15i1.2524
Cryptosporidium Immunocompromised patients Genotype Iran

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
IZADI S, Ali MOHAGHEGH M, GHAYOUR-NAJAFABADI Z, AZAMI M, MIRZAEI F, NAMDAR F, MOHEBALI M, LESHAN WANNIGAMA D, HEJAZI SH. Frequency and Molecular Identification of Cryptosporidium Species among Immunocompromised Patients Referred to Hos-pitals, Central Iran, 2015-16. Iran J Parasitol. 2020;15(1):31-39.